Lumbar Epidural Injections in the Treatment of Sciatica

Abstract

A randomized trial of lumbar epidural injections for the treatment of acute sciatic pain was carried out. All the patients had unilateral sciatica for less than six months and had never previously been treated in hospital for their backs. The treatments used were 20 ml normal saline, 80 mg Depomedrone in normal saline made up to 20 ml, 20 ml, 20 ml 0.25% bupivacaine solution and needling with a standard Touhy injection needle into the interspinous ligament but with no injection. The patients improved at about the same rate for all four treatments. Overall, 75% of the patients improved or were cured. As some of these were in the group treated by needling of the interspinous ligament, it seems likely that the epidural injections administered achieved effects partially as a placebo and partially by virtue of the natural history of the acute sciatic syndrome.

Epidural Injections for Spinal Pain

“…67,81,83 Both injections were examined in one study of high methodological and technical quality with 130 patients using four "control" groups. In this study 81 the proportion of patients with 50% or more pain relief was not significantly different among all comparison groups: 7% for transforaminal local anesthetic, 19% for transforaminal saline, 21% for intramuscular steroids, and 13% for intramuscular saline.…”

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

“…Description of epidural/intradiscal injection studies Summary of interventions Sixty-three studies evaluated the use of epidural/intradiscal injection for sciatica 95, (eight studies had more than two treatment arms 146,149,161,163,167,169,183,197 181,[183][184][185]187,193,194,197,200,202 (two studies had more than two treatment arms 183,197 ) compared different modes of administering epidural/intradiscal injections and 20 studies 149,167,[177][178][179][180]182,186,[188][189][190][191][192]195,196,198,199,203,204,207 compared the use of different epidural/intradiscal injections. Details of the interventions are summarised in Table 17b, but the findings of these studies are not considered any further here.…”

“…Most included epidural studies were RCTs (24/29, 83%); however, the proportion that were deemed good quality was very low (4/29, 14%), all of which compared epidural with inactive control. Although 10 studies 149,152,153,156,160,163,165,168,171,173 used and adequate method for generating a random number sequence, eight of these used sealed envelopes to conceal allocation, which is a partially adequate method. Only one study had good external validity.…”

The Incidence of Lumbar Discectomy after Epidural Steroid Injections or Selective Nerve Root Blocks

“…Numerous authors have reported on their value in treating patients with radicular pain with the possibility of delaying or even obviating the need for lumbar discectomy in well-selected patients. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] There are two well-performed clinical studies in the peer reviewed literature that examined the crossover rates to surgery for patients who received either ESI or SNRB. In a prospective study, Buttermann et al found a crossover rate to surgery for patients with symptomatic disc herniations treated with ESI of 54% (27/50).…”