From the Guidelines
Systemic steroids, such as prednisone, are not recommended for the management of lumbar disk stenosis due to their limited effectiveness and potential for significant adverse effects. The use of systemic corticosteroids in lumbar disk stenosis has been evaluated in several trials, but the evidence does not support their effectiveness in improving pain or function 1. For example, a trial of 61 patients with spinal stenosis found no differences between a 3-week course of prednisone and placebo in pain intensity or functional outcomes 1.
When considering treatment options for lumbar disk stenosis, it is essential to prioritize conservative approaches, such as:
- Physical therapy to improve mobility and strength
- NSAIDs to reduce pain and inflammation
- Activity modification to avoid exacerbating the condition These approaches should be tried before considering any pharmacologic interventions, including systemic steroids.
If systemic steroids are considered, they should be used with caution and under close monitoring by a healthcare provider, due to the potential risks of:
- Bone density loss
- Weight gain
- Elevated blood glucose
- Mood changes
- Increased susceptibility to infections As noted in the study, oral prednisone was associated with an increased risk of adverse events, including insomnia, nervousness, and increased appetite 1.
In cases of chronic stenosis symptoms, other interventions such as epidural steroid injections or surgical decompression may be more appropriate than oral steroids. Ultimately, the decision to use systemic steroids should be made on a case-by-case basis, taking into account the patient's overall health status, comorbidities, and the potential benefits and risks of treatment.
From the Research
Systemic Steroids in Disk Stenosis
- Systemic corticosteroids, such as prednisone, have been used to treat various types of low back pain, including radicular back pain and spinal stenosis 2.
- The evidence suggests that systemic corticosteroids may be slightly effective at improving short-term pain and function in people with radicular low back pain not due to spinal stenosis, but are probably ineffective for spinal stenosis 2.
- A study found that oral steroids, such as prednisone, resulted in modestly improved function, but no improvement in pain, among patients with acute radiculopathy due to a herniated lumbar disk 3.
Role of Systemic Steroids in Lumbar Disk Stenosis
- The use of systemic steroids in lumbar disk stenosis is not well established, and the evidence is limited 2, 4, 5, 6.
- A study found that epidural steroid injections, not systemic steroids, were effective in improving pain and function in patients with lumbar spinal stenosis, especially those with degenerative spondylolisthesis 6.
- Another study found that transforaminal epidural steroid injection was effective in patients with foraminal stenosis, but not in patients with central spinal stenosis or lumbar disc herniations 5.
Adverse Effects of Systemic Steroids
- The evidence suggests that a single dose or short course of systemic corticosteroids for low back pain does not appear to cause serious harms, but may be associated with adverse events such as hyperglycemia and increased risk of infection 2, 3.
- A study found that patients who received oral steroids had a higher rate of adverse events, such as insomnia, mood changes, and increased appetite, compared to those who received placebo 3.