From the Guidelines
Prednisone is the most commonly used corticosteroid for spinal inflammation, but its effectiveness is not well-established.
Key Points
- The evidence from multiple trials, including a good-quality trial with 269 patients 1, suggests that systemic corticosteroids, such as prednisone, have no significant benefit for acute nonradicular low back pain, spinal stenosis, or radicular low back pain.
- A trial with 269 patients found that oral prednisone (initial dose, 60 mg/d) was associated with small effects on function, but also increased the risk of adverse events, such as insomnia, nervousness, and increased appetite 1.
- Another trial found that a tapering course of intramuscular dexamethasone was associated with an increased risk of adverse effects, but no withdrawals due to adverse events were reported 1.
- The evidence for methylprednisolone is limited, but one trial found no difference in pain relief between a single intramuscular injection of methylprednisolone (160 mg) and placebo for patients with acute low back pain and a negative result on a straight-leg-raise test 1.
Corticosteroid Options
- Prednisone: commonly used, but effectiveness not well-established
- Dexamethasone: may be associated with increased risk of adverse effects
- Methylprednisolone: limited evidence, but may not be effective for acute low back pain
From the Research
Corticosteroids for Spinal Inflammation
- The use of corticosteroids for spinal inflammation has been studied in various trials, with some showing positive effects on pain and function 2, 3, 4, 5, 6.
- Methylprednisolone is a commonly used corticosteroid for spinal inflammation, with studies showing it can improve neurologic outcome up to one year post-injury if administered within eight hours of injury 3, 4, 6.
- The optimal dose and duration of methylprednisolone therapy are still debated, with some studies suggesting a bolus dose of 30mg/kg followed by a maintenance infusion of 5.4 mg/kg per hour for 23 hours 3, 4, 6.
- Other studies have investigated the use of epidural steroid injections (ESIs) and intradiscal steroid injections (ISIs) for degenerative disc disease, with some showing improvement in pain and function 5.
Specific Conditions
- For radicular low back pain, systemic corticosteroids may slightly decrease pain and improve function at short-term follow-up 2.
- For non-radicular low back pain, the effects of systemic corticosteroids are unclear 2.
- For spinal stenosis, systemic corticosteroids are probably ineffective 2.
- For acute spinal cord injury, high-dose methylprednisolone steroid therapy has been shown to improve neurologic outcome up to one year post-injury if administered within eight hours of injury 3, 4, 6.
Safety and Efficacy
- The safety and efficacy of corticosteroids for spinal inflammation have been evaluated in several studies, with some showing no significant increase in complications or mortality 2, 3, 4, 6.
- However, the evidence is not always consistent, and more randomized trials are needed to fully understand the benefits and risks of corticosteroids for spinal inflammation 2, 3, 4, 6.