Epidural Corticosteroid Injections in the Management of Sciatica

  title={Epidural Corticosteroid Injections in the Management of Sciatica},
  author={Rafael Zambelli Pinto and Christopher G. Maher and Manuela Loureiro Ferreira and Mark Jonathan Hancock and Vin{\'i}cius Cunha Oliveira and Andrew J. McLachlan and Bart W. Koes and Paulo Henrique Ferreira},
  journal={Annals of Internal Medicine},
  pages={865 - 877}
BACKGROUND Existing guidelines and systematic reviews provide inconsistent recommendations on epidural corticosteroid injections for sciatica. Key limitations of existing reviews are the inclusion of trials with active controls of unknown efficacy and failure to provide an estimate of the size of the treatment effect. PURPOSE To determine the efficacy of epidural corticosteroid injections for sciatica compared with placebo. DATA SOURCES International Pharmaceutical Abstracts, PsycINFO… 

Epidural corticosteroid injections for sciatica: An Abridged Cochrane Systematic Review and Meta-Analysis.

A review of 25 placebo-controlled randomized trials provides moderate quality evidence that epidural corticosteroid injections are effective, though the effects are small and short term.

Efficacy of Epidural Injections in Managing Chronic Spinal Pain: A Best Evidence Synthesis.

The efficacy of epidural injections in managing a multitude of chronic spinal conditions is shown, with an assessment of the quality of manuscripts and outcome parameters, shows.

Epidural Steroids: A Comprehensive, Evidence-Based Review

Epidural steroid injections are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews, but there continues to be considerable controversy surrounding their safety and efficacy.

Epidural corticosteroid injections for lumbosacral radicular pain.

BACKGROUND Lumbosacral radicular pain (commonly called sciatica) is a syndrome involving patients who report radiating leg pain. Epidural corticosteroid injections deliver a corticosteroid dose into

Epidural Injections for Lumbar Radiculopathy and Spinal Stenosis: A Comparative Systematic Review and Meta-Analysis.

Epidural corticosteroid injections for radiculopathy or spinal stenosis with sodium chloride solution or bupivacaine were shown to be ineffective, and meta-analysis showed a similar effectiveness for pain and function without non-inferiority of lidocaine compared to lidocane with steroid at 3 months and 12 months.

Safety of Epidural Corticosteroid Injections

Overall, the available literature supports the view that serious complications following injections of corticosteroid suspensions into the cervical and lumbar epidural space are uncommon, but if they occur they can be devastating.

Epidural injections in prevention of surgery for spinal pain: systematic review and meta-analysis of randomized controlled trials.

Treatment of acute sciatica with transforaminal epidural corticosteroids and local anesthetic: design of a randomized controlled trial

A clinically relevant outcome in favor of TESI-plus implies that future patients with acute sciatica should be recommended TESi-plus within the first few weeks rather than being treated with pain medication alone in order to relieve pain and improve their functioning.

Epidural Injections for Spinal Pain: A Systematic Review and Meta-analysis Evaluating the “Control” Injections in Randomized Controlled Trials

Epidural nonsteroid injections may provide improved benefit compared with nonepidural injections on some measures, though few, low-quality studies directly compared controlled treatments, and only short-term outcomes were examined.



Epidural steroids in the management of chronic spinal pain: a systematic review.

There is moderate evidence for interlaminar epidurals in the cervical spine and limited evidence in the lumbar spine for long-term relief in managing chronic pain of lumbr radiculopathy and postlumbar laminectomy syndrome.

Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial

The efficacy of isotonic saline administered epidurally for sciatica cannot be excluded, but epidural steroid injections provide no additional improvement.

Cost-effectiveness and safety of epidural steroids in the management of sciatica.

It was found that ESIs confer only transient benefit in symptoms and self-reported function in a small group of patients with sciatica at substantial costs, and ESIs do not provide good value for money if NICE recommendations are followed.

A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study.

In this pragmatic study, ESIs offered transient benefit in symptoms at 3 weeks in patients with sciatica, but no sustained benefits in terms of pain, function or need for surgery.

Periradicular Infiltration for Sciatica: A Randomized Controlled Trial

The combination of methylprednisolone and bupivacaine seems to have a short-term effect, but at 3 and 6 months, the steroid group seems to experience a “rebound” phenomenon.

Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review

A large low-risk-of-bias trial demonstrated that early surgery in patients with 6–12 weeks of radicular pain leads to faster pain relief when compared with prolonged conservative treatment, but there were no differences after 1 and 2 years.

Assessment: Use of epidural steroid injections to treat radicular lumbosacral pain

It is concluded that epidural steroid injections may result in some improvement in radicular lumbosacral pain when assessed between 2 and 6 weeks following the injection, compared to control treatments.

Systematic review of therapeutic lumbar transforaminal epidural steroid injections.

The indicated evidence for transforaminal lumbar epidural steroid injections is level II-1 for short-term relief and Level II-2 for long-term improvement in the management of lumbr nerve root and low back pain.

A Controlled Study of Caudal Epidural Injections of Triamcinolone Plus Procaine for the Management of Intractable Sciatica

The efficacy of epidural injections of 80 mg triamcinolone acetonide plus 0.5% procaine hydrochloride in saline, administered via the caudal route in a double-blind, placebo controlled trial with 1 year follow-up is assessed.

Outpatient lumbar epidural corticosteroid injection in the management of sciatica.

Outpatient epidural injections of corticosteroid are thus a useful short-term means of relieving pain in sciatica but probably have little effect on the long-term natural history of symptoms.