From the FDA Drug Label
The lowest possible dose of corticosteroids should be used to control the condition under treatment. When reduction in dosage is possible, the reduction should be gradual Since complications of treatment with glucocorticoids are dependent on the size of the dose and the duration of treatment, a risk/benefit decision must be made in each individual case as to dose and duration of treatment and as to whether daily or intermittent therapy should be used
The recommended steroid treatment for severe cervical spinal stenosis is not explicitly stated in the provided drug labels. However, corticosteroids such as prednisone may be used to control the condition under treatment.
- The lowest possible dose of corticosteroids should be used.
- The reduction in dosage should be gradual.
- A risk/benefit decision must be made in each individual case as to dose and duration of treatment 1 1.
From the Research
Epidural steroid injections are recommended for severe cervical spinal stenosis when conservative treatments fail but before considering surgery, as they can provide temporary relief by reducing inflammation and pain. The primary steroid treatment typically involves using methylprednisolone (40-80mg), triamcinolone (40-80mg), or dexamethasone (4-10mg) mixed with a local anesthetic like lidocaine, administered via interlaminar, transforaminal, or caudal approaches, with the interlaminar approach often preferred for cervical stenosis due to safety considerations 2. Some key points to consider include:
- A typical regimen includes 1-3 injections spaced 2-4 weeks apart, with effects lasting from weeks to months.
- Oral steroids like prednisone (starting at 60mg daily with a 10-14 day taper) may be used for acute flare-ups but aren't recommended for long-term use due to side effects.
- Patients should be aware of potential side effects including temporary pain at the injection site, facial flushing, elevated blood sugar, and rare but serious complications like spinal cord injury or infection.
- These treatments aim to provide temporary relief while addressing underlying causes through physical therapy and lifestyle modifications. It's worth noting that the evidence for the effectiveness of epidural steroid injections in cervical spinal stenosis is limited, and more research is needed to fully understand their benefits and risks 2. However, based on the available evidence, epidural steroid injections can be a useful treatment option for patients with severe cervical spinal stenosis who have not responded to conservative treatments and are not yet candidates for surgery.