Intrathecal Triamcinolone for Lumbar Degenerative Disease: A Single-Center Retrospective Cohort of 499 Patients

Abstract

Background/Objectives: While epidural and periradicular corticosteroid injections are well-established treatments for degenerative spinal conditions, intrathecal administration of glucocorticoids remains uncommon and under-researched. To our knowledge, this is the first large contemporary dataset on intrathecal triamcinolone in degenerative lumbar disorders. This study retrospectively analyzes clinical outcomes and complication rates associated with this treatment. Methods: We reviewed patients who received intrathecal injections of triamcinolone for lumbar degenerative spinal diseases between May 2023 and June 2024. Data were extracted from electronic records and included demographics, indication, application method (freehand or CT-guided), dosage, symptom relief, and complications. Results: A total of 722 intrathecal injections were performed (499 patients). The most common indication was lumbar spinal canal stenosis (94.0%). Punctures were performed freehand in 68.4% of the injections; 80 mg of triamcinolone was administered in 71.2%. Follow-up data were available for 528 injections. After 87.3% of these, symptom improvement (binary yes/no) after injection was reported. Duration of benefit was documented after 144 injections: 39.6% reported a relief lasting up to six months, and 25% up to one month. Four complications (0.6%) occurred: one post-puncture headache, one pain aggravation, one case of shortness of breath, and one intracranial subdural hygroma. All were managed conservatively. Conclusions: Despite limited data quality, including missing/non-standardized follow-up and the lack of standardized pain scales for follow-up, this large retrospective cohort provides preliminary evidence that intrathecal triamcinolone may be a safe and effective treatment option for lumbar degenerative spinal disorders, with pain relief observed in the majority of cases. Given the inherent limitations of retrospective Level IV evidence, prospective controlled studies are warranted to further evaluate its role compared to other interventional pain therapies.

Keywords: corticosteroid therapy; degenerative spine disease; intrathecal triamcinolone; lumbar spinal stenosis; pain management.

Figure 1

STROBE-style flow diagram, describing the retrospective cohort of patients receiving intrathecal triamcinolone between May 2023 and June 2024 with inclusion and exclusion criteria.

Figure 2

Axial T2 MRI, showing subdural hygroma on the right side. The image was acquired 1 month after intrathecal injection due to persistent headache.

Figure 3

Axial T2-weighted MRI at L1, showing epidural cerebrospinal fluid accumulation both ventral and dorsal to the thecal sac.

Figure 4

Axial T2 weighted MRI at L1, 6 weeks after blood patch. No epidural cerebrospinal fluid collections can be distinguished anymore.