Friedly 2014 — epidural glucocorticoid injections

One-paragraph summary

This double-blind multisite trial randomized 400 people with lumbar central stenosis and moderate-to-severe leg pain and disability to epidural glucocorticoid plus lidocaine or lidocaine alone. At six weeks, the adjusted between-group difference was −1.0 RMDQ points (95% CI −2.1 to 0.1; P=0.07) and −0.2 points on a 0–10 leg-pain scale (95% CI −0.8 to 0.4; P=0.48). Prespecified interlaminar-versus-transforaminal subgrouping did not identify an added steroid benefit (Friedly 2014, PMID 24988555).

Key findings

• Sample: 400; one or two injections before the six-week endpoint.
• Disability: −1.0 RMDQ points versus lidocaine alone (95% CI −2.1 to 0.1).
• Leg pain: −0.2/10 (95% CI −0.8 to 0.4).
• The trial estimates the incremental effect of glucocorticoid over anesthetic, not injection versus no injection.

Limitations

• The primary horizon was six weeks.
• Lidocaine was an active comparator and both groups could improve.
• The result does not cover every radicular-pain phenotype or every injection indication.

Why it matters

It changed the interpretation of a widely used procedure by separating within-group improvement from the added value of steroid.

Cited by wiki pages

• Overview
• Injections and minimally invasive procedures
• Clinical trials landscape