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Meta-Analysis of Epidural Corticosteroid Injections for Sciatica

Summary and Comment |
December 13, 2012

Meta-Analysis of Epidural Corticosteroid Injections for Sciatica

  1. Jamaluddin Moloo, MD, MPH

No long-term benefit was found for leg pain, disability, or back pain.

  1. Jamaluddin Moloo, MD, MPH

Published data and guidelines are mixed about whether epidural steroid injections benefit patients with sciatica. Researchers performed a meta-analysis of 23 randomized trials (>2000 patients) in which steroid injections were compared with placebo injections. The placebo arms included injection of inert substances (such as saline) or short-acting anesthetics. Both acute and chronic cases were included in the trials; patients with histories of surgery or potential spinal canal stenosis were excluded. Short- (>2 weeks but ≤3 months) and long-term (>12 months) efficacy was measured on a scale from 0 to 100 points (difference of 10–30 points is clinically significant).

Epidural steroid injections were associated with less short-term leg pain (mean difference, –6.2 points) and disability (mean difference, –3.1 points) but not with less back pain relative to placebo. In the long term, no significant differences were found in leg pain, disability, or back pain.

Comment

This meta-analysis of trials of epidural steroid injections for sciatica showed a small, clinically insignificant benefit in the short term (leg pain and disability) but failed to identify benefit beyond 12 months. The finding supports using conservative measures and avoiding epidural steroid injections in patients with sciatica.

Citation(s):

Reader Comments (3)

Thomas M. Ewald, M.D. Physician, Family Medicine/General Practice, clinic

I doubt if the studies included epidurals via the caudal route, as most docs are only trained in the lumbar route,which only covers one spinal level. I have had reasonably good success with them over 25 years. By using more volume, along with steroid and anesthetic, the injection covers 3 spinal levels instead of just one. They are very useful for the old folks who can't tolerate surgery. They usually give 3-12 months relief. I believe the caudal route has not been studied, and is superior to the routes that have been studied. We should not give up on helping the elderly with stenosis.

Carl Wyne Physician, Internal Medicine, medical director insurance company

The requirement for epidural steroid injections before approving surgery does provide a three month window for the patient to improve without surgery.

MV Anderson

I have been preaching this for five years. I had one patient come in that had 36 injections in 36 months. This has become a plight on medicine.

Competing interests: None declared

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