Retrospective study assessing the efficacy of i.v. dexamethasone, SNRB, and nonsteroidal treatment for radiculopathy

Abstract

Retrospective study.The purpose of this study was to investigate the clinical symptomatology of discopathies before and 7 days after treatment with one of the following: intravenous dexamethasone, selective nerve root block (SNRB), and systemic treatment with different nonsteroidal antiinflammatory drugs (NSAIDs).Radiculopathy is a clinical condition in which dysfunction of one or more nerves occurs due to mechanical compression and/ or chemical irritation of the nerve roots. Most often located in the lumbar spine, radiculopathy remains one of the most common complaints in primary health. Some patients responded well to conservative treatment. However, those who show no improvement may benefit from more invasive treatment options, such as intravenous corticosteroids, spinal injections, and surgical procedures.We conducted a retrospective study of 81 male and female patients aged 18 years and above who had radicular pain and were referred to our facility over a 7-year period. Of the 100 patients assessed for eligibility, 19 patients were not included in the study due to malignancy or surgical intervention, 32 patients received intravenous dexamethasone, 24 patients received SNRB, and 25 received various NSAIDs as the control group. The visual analog scale, straight leg raise test and neurological deficits were assessed to evaluate the patients before and after receiving treatment. All patients underwent spinal computed tomography to confirm the diagnosis of disc herniation. Pearson chi-squared test, Kruskal-Wallis test, and Mann-Whitney test were used to evaluate the results.Visual analog scale scores and the ability to perform straight leg raise test significantly improved after treatment with dexamethasone, SNRB, and NSAIDs. However, clinical improvement was significantly better in both the dexamethasone and SNRB groups than in the control group. Motor deficits improved significantly after dexamethasone treatment alone.Dexamethasone and SNRB are useful and safe treatment options for treating patients with acute radicular pain. Randomized, double-blinded, control studies are warranted.

Intravenous Corticosteroid Therapy for Acute Lumbar Radicular Pain

“…Some have shown a short-term advantage [ 23 , 24 ], while others have not shown any value [ 4 ]. The rationale for intravenous (IV) glucocorticoid administration in acute sciatica is rapid delivery of high-level glucocorticoids that reduce the inflammatory cascade caused by the HNP without the discomfort and dangers of epidural injection and allow an easy and accessible treatment as SNRB availability varies between countries and health systems [ 25 , 26 , 27 ]. Previous studies suggested that IV administration has a better risk–benefit ratio than other methods of treatment [ 28 , 29 ]; still, recent publications showed limited effect [ 12 , 30 ].…”

“…Previous studies suggested that IV administration has a better risk–benefit ratio than other methods of treatment [ 28 , 29 ]; still, recent publications showed limited effect [ 12 , 30 ]. Despite numerous publications regarding IV glucocorticoid administration in ALRP, the role and efficacy of this treatment remain undetermined without an agreed single treatment protocol or dosage showing superiority [ 25 ].…”