Minimally invasive direct decompression for lumbar spinal stenosis: impact of multiple prior epidural steroid injections.

A modified algorithm for the treatment of lumbar spinal stenosis with hypertrophic ligamentum flavum using minimally-invasive lumbar decompression ()was assessed, with a focus on earlier intervention. Records of 145 patients treated with after receiving 0-1 epidural steroid injections (ESIs) or 2+ ESIs were retrospectively reviewed. Pain assessments as measured by visual analog scale (VAS) scores were recorded at baseline and 1-week and 3-month follow-ups. Improvements in VAS scores at follow-ups compared with baseline were significant in both groups. No statistically significant differences were found between the two groups. Multiple ESIs prior to showed no benefit. A modified algorithm to perform immediately upon diagnosis or after the failure of the first ESI is recommended.