Background & Aims
The global increase in the elderly population has led to a higher prevalence of degenerative lumbar spinal diseases. Epidural steroid injection is a widely used procedure for managing lower back pain. This study investigated the association of pre-procedural frailty status with the efficacy of epidural steroid injection in elderly patients diagnosed with degenerative lumbar spinal diseases.
Methods
This retrospective observational study included patients aged 65 and older who underwent lumbar epidural steroid injection. Frailty status (robust, pre-frail, and frail) assessed via the frailty phenotype questionnaire was collected along with demographic and clinical parameters. Good analgesia was defined as a ?50% reduction in pain score at 4-week follow-up evaluation. Multivariable logistic regression analyses were performed to identify factors associated with poor analgesia.
Results
We included 289 patients in this study. Frailty status correlated with analgesic outcomes, with worsening frailty status correlating with increasingly poor analgesia after the injection (robust=34.5%, pre-frail=40.8%, and frail=60.0%, P=0.003), predominantly in female patients. After adjusting for demographic and clinical factors, frail patients demonstrated much higher odds of poor analgesia than robust individuals (aOR=2.673, 95% CI=1.338–5.342, P=0.005). Conversely, pre-frail patients did not show a significant association with analgesic outcome (aOR = 1.293, 95% CI = 0.736–2.272, p = 0.372).
Conclusions
Frailty, but not pre-frailty, appeared to be an independent factor associated with poor analgesic efficacy of epidural steroid injection in elderly patients with symptomatic degenerative lumbar spinal disease receiving conservative care.
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