IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 5 Ver. 15 (May. 2018), PP 38-41 www.iosrjournals.org DOI: 10.9790/0853-1705153841 www.iosrjournals.org 38 | Page The adjuvant effect of Hyaluronidase to Lumbar Interlaminar Epidural Steroid injection in Central Spinal Stenosis: A Randomized Controlled Trial. Shalini Bajpai 1 , Y. Raghu 2 1 Assistant Professor, Department of Anaesthesiology, GIMSR, Visakhapatnam, India. 2 Senior Resident, Department of Orthopaedics, GIMSR, Visakhapatnam, India. Corresponding author- Shalini Bajpai Abstract: Introduction: Lumbar spinal canal stenosis is a common cause of lower extremity and low back pain. Interlaminar epidural steroid injection is commonly used for pain relief in spinal stenosis. In this study we evaluated the adjuvant effect of hyaluronidase to epidural steroid in increasing duration of pain relief and functional outcome in patients with central spinal stenosis. Material and methods: In this study 80 patients were randomly allocated to two groups. Group D received lumbar interlaminar epidural injection with 5ml Bupivacaine (0.25%), 2ml methylprednisolone (40mg/ml), 1 ml normal saline. Group DH received 5ml Bupivacaine (0.25% ), 2ml methylprednisolone (40mg/ml), 1 ml hyaluronidase 1500 IU. The effects were evaluated by Numeric pain rating scale (NPS) and Oswestry disability index (ODI) at 2, 6 and 12 weeks after intervention. Results: Result of 30 patients in each group was assessed. Pain relief and improvement in ODI was observed in both groups 2 weeks after injection. Group DH had significantly better pain relief and ODI improvement as compared to group D 12 weeks after intervention. 40 % patients in group DH had more than 50% pain relief after 12 weeks as compared to 3% patients in group D. Conclusion: Addition of hyaluronidase to lumbar interlaminar epidural injection of methylprednisolone improves its efficacy by increasing the duration of pain relief and functional improvement. Keywords: Hyaluronidase, Interlaminar Epidural Injection, Steroid, Central spinal stenosis. --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 14-05-2018 Date of acceptance: 30-05-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Low backache is common cause of disability in India. Lumbar canal stenosis is a common cause of lower extremity and low back pain leading to neuropathy and disability. Canal stenosis is defined as narrowing of spinal canal leading to encroachment of neural structures by surrounding tissues 1 . Multiple modalities of treatment including decompressive surgery with or without fusion and conservative treatments as analgesics, nonsteroidal anti-inflammatory drugs, orthosis, rehabilitation, physical therapy, exercise, heat and cold, transcutaneous electrical nerve stimulation, ultrasound and epidural steroids have been recommended in the treatment of symptomatic central spinal stenosis. 2 Lumbar interlaminar epidural injection of local anesthetic with steroid is beneficial in patients with lumbar central spinal stenosis 3 . It is a commonly performed nonsurgical intervention that can bring symptomatic and functional improvement in patients of central spinal stenosis. . Primary symptoms can be relieved by epidural steroids thus reducing the need of surgery. It is the only option in patients who are not candidates for surgery or after failure of conservative treatments and surgery. Steroids relieves the radiculopathy and pain by its anti inflammatory effect through reduction of prostaglandins and phospholipases, increases micro - circulation and also reduces of edema surrounding nerve roots. 4 But the duration of analgesia provided by epidural steroid injection differs among patients and is short lived. Hyaluronidase has been used as adjuvant to epidural steroid to increase its efficacy and duration of action by reducing the fibrosis and edema in tissues and lysing the adhesions thus facilitating the spread of injected steroid. 5 Studies have been done to determine additional effect of hyaluronidase in interlaminar epidural steroid injection for failed back surgery syndrome 6 and low back pain and sciatica 7 but there is paucity of literature regarding its adjuvant effect in central canal stenosis. In this context this study was done to evaluate adjuvant effect of hyaluronidase to interlaminar lumbar epidural steroid injections in increasing the pain relief duration and functional improvement in patients with lumbar central canal stenosis.