1. 2020;23;365-374Long-Term Outcomes of Epidurals with Lidocaine With or Without Steroids for Lumbar Disc Herniation and Spinal Stenosis: A Meta-Analysis
   Systematic Review
   Jianxiong An, MD, PhD, Xuezhen Lai, MD, Quanfeng Wei, MD, Xinyou Gao, MD, Jianping Wu, MD, PhD, Yong Wang, MD, and Wenxing Zhao, MD, PhD.

BACKGROUND: Previous meta-analyses examined only the short-term differences between lidocaine and steroids vs lidocaine alone in treating lumbar degenerative diseases. Long-term outcomes (1-2 years) in patients with lumbar disc herniation (LDH) and lumbar central spinal stenosis (LCSS) have not yet been systematically evaluated.

OBJECTIVE: The objective of our study was to assess quantitatively the difference in efficacy at 1 to 2 years between lidocaine alone vs lidocaine and steroids for the management of LDH or LCSS.

STUDY DESIGN: We conducted a meta-analysis.

METHODS: PubMed, EMBASE, and the Cochrane library were electronically searched up to July 22, 2016, for randomized controlled trials comparing lidocaine alone vs in combination with steroids for the treatment of LDH and LCSS. Effective pain relief (EPR), Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), opioid intake (OI), and total employed increased rate (TEIR) were the endpoints. Risk ratios (RRs) or weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated, and the pooled analysis was conducted using RevMan 5.2.

RESULTS: Seven trials were included. EPR was not significantly different at 1 and 2 years, with RR = 1.08 (95% CI, 0.90-1.30; P = .39) and RR = 1.04 (95% CI, 0.92-1.18; P = .51), respectively, in patients treated with lidocaine alone vs in combination with steroids. The NRS-11 was also similar at 1 and 2 years. ODI and OI were not significantly different at 1 and 2 years. A similar TEIR effect was also observed for the 2 treatments.

LIMITATIONS: This meta-analysis relied on a small sample size of trials. Significant heterogeneity among studies was observed. Several significant differences in terms of age of the patients were reported in one included trial.

CONCLUSION: This meta-analysis confirmed the similar effects associated with lidocaine alone vs in combination with steroids for the management of LDH and LCSS. Studies with longer follow-up periods are still recommended.

KEY WORDS: Effective pain relief, lidocaine, long-term, lumbar central spinal stenosis, lumbar disc herniation, Numeric Rating Scale, opioid intake, Oswestry Disability Index, steroids, total employed increased rate.