Primary studies included in this systematic review

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Primary study

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Epidural steroid injection for nerve root compression. A randomised, controlled trial.

Journal The Journal of bone and joint surgery. British volume
Year 2005
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This article is included in 10 Systematic reviews Systematic reviews (10 references) 1 Broad synthesis Broad syntheses (1 reference)

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We have assessed whether an epidural steroid injection is effective in the treatment of symptoms due to compression of a nerve root in the lumbar spine by carrying out a prospective, randomised, controlled trial in which patients received either an epidural steroid injection or an intramuscular injection of local anaesthetic and steroid. We assessed a total of 93 patients according to the Oxford pain chart and the Oswestry disability index and followed up for a minimum of two years. All the patients had been categorised as potential candidates for surgery. There was a significant reduction in pain early on in those having an epidural steroid injection but no difference in the long term between the two groups. The rate of subsequent operation in the groups was similar.

Primary study

Unclassified

Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study.

Authors Vad VB , Bhat AL , Lutz GE , Cammisa F
Journal Spine
Year 2002
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This article is included in 11 Systematic reviews Systematic reviews (11 references)

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STUDY DESIGN: A prospective study randomized by patient choice from the private practice of a single physician affiliated with a major teaching hospital was conducted. OBJECTIVES: To compare transforaminal epidural steroid injections with saline trigger-point injections used in the treatment of lumbosacral radiculopathy secondary to a herniated nucleus pulposus. SUMMARY OF BACKGROUND DATA: Epidural steroid injections have been used for more than half a century in the management of lumbosacral radicular pain. At this writing, however, there have been no controlled prospective trials of transforaminal epidural steroid injections in the treatment of lumbar radiculopathy secondary to a herniated nucleus pulposus. METHODS: Randomized by patient choice, patients received either a transforaminal epidural steroid injection or a saline trigger-point injection. Treatment outcome was measured using a patient satisfaction scale with choice options of 0 (poor), 1 (fair), 2 (good), 3 (very good), and 4 (excellent); a Roland-Morris low back pain questionnaire that showed improvement by an increase in score; a measurement of finger-to-floor distance with the patient in fully tolerated hip flexion; and a visual numeric pain scale ranging from 0 to 10. A successful outcome required a patient satisfaction score of 2 (good) or 3 (very good), improvement on the Roland-Morris score of 5 or more, and pain reduction greater than 50% at least 1 year after treatment. The final analysis included 48 patients with an average follow-up period of 16 months (range, 12-21 months). RESULTS: After an average follow-up period of 1.4 years, the group receiving transforaminal epidural steroid injections had a success rate of 84%, as compared with 48% for the group receiving trigger-point injections (P < 0.005). CONCLUSION: Fluoroscopically guided transforaminal injections serve as an important tool in the nonsurgical management of lumbosacral radiculopathy secondary to a herniated nucleus pulposus.

Primary study

Unclassified

Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus.

Journal The New England journal of medicine
Year 1997
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This article is included in 12 Systematic reviews Systematic reviews (12 references)

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BACKGROUND: Although epidural corticosteroid injections are commonly used for sciatica, their efficacy has not been established. METHODS: In a randomized, double-blind trial, we administered up to three epidural injections of methylprednisolone acetate (80 mg in 8 ml of isotonic saline) or isotonic saline (1 ml) to 158 patients with sciatica due to a herniated nucleus pulposus. All patients had Oswestry disability scores higher than 20 (on a scale of 1 to 100, with scores of 20 or less indicating minimal disability, and higher scores greater disability). RESULTS: At three weeks, the Oswestry score had improved by a mean of -8.0 in the methylprednisolone group and -5.5 in the placebo group (95 percent confidence interval for the difference, -7.1 to 2.2). Differences in improvements between the groups were not significant, except for improvements in the finger-to-floor distance (P=0.006) and sensory deficits (P=0.03), which were greater in the methylprednisolone group. After six weeks, the only significant difference was the improvement in leg pain, which was greater in the methylprednisolone group (P=0.03). After three months, there were no significant differences between the groups. The Oswestry score had improved by a mean of -17.3 in the methylprednisolone group and -15.4 in the placebo group (95 percent confidence interval for the difference, -9.3 to 5.4). At 12 months, the cumulative probability of back surgery was 25.8 percent in the methylprednisolone group and 24.8 percent in the placebo group (P=0.90). CONCLUSIONS: Although epidural injections of methylprednisolone may afford short-term improvement in leg pain and sensory deficits in patients with sciatica due to a herniated nucleus pulposus, this treatment offers no significant functional benefit, nor does it reduce the need for surgery.

Primary study

Unclassified

Intrathecal midazolam for the treatment of chronic mechanical low back pain: a controlled comparison with epidural steroid in a pilot study.

Journal Pain
Year 1992
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This article is included in 7 Systematic reviews Systematic reviews (7 references)

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This paper describes a prospective, double blind, randomised and dummy-controlled trial in 28 patients with chronic mechanical low back pain presenting to the York Pain Clinic. The therapeutic effects of epidural methyl prednisolone (80 mg) were compared with intrathecal midazolam (2 mg). All the patients had pain for a considerable length of time (range: 1-35 years) and all had received previous treatments which had failed. The two groups of patients were comparable in terms of pain duration, demography, extent of disability, anxiety and depression and pain locus of control. The pain was assessed before and for 2 months after treatment using the short form McGill Pain Questionnaire as well as visual analogue and verbal rating scales for sensory and affective components of their pain experience; patients also completed a pain diary. Both treatments caused a similar improvement in one-half to three-quarters of the patients for 2 months in patterns of activity and sleep as well as in the sensory and affective components of the pain. However, although the improvement in the two groups was similar, all the patients treated with steroid were either taking more or the same amount of self-administered analgesic medication after their treatment, whereas between one-third and one-half of the midazolam-treated patients took less medication during the 2 month follow-up period. We conclude that intrathecal midazolam is an effective treatment for chronic mechanical low back pain. The mechanism responsible for this effect is discussed.

Primary study

Unclassified

A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica.

Authors Bush K , Hillier S
Journal Spine
Year 1991
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This article is included in 11 Systematic reviews Systematic reviews (11 references)

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The management of sciatica due to lumbar nerve root compromise remains controversial, probably because few well-controlled studies of conservative management have been performed. This preliminary study assesses 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. Twenty-three patients were entered into the study: 12 received treatment and 11 placebo. The active group showed significant pain relief (P = 0.02) and a significant increase in mobility (P = 0.01) at 4 weeks, which resulted in improved quality of life (P = 0.02). At 1 year, subjective and objective measures improved in both groups. The improvement was greater in the actively treated group, but only the objective assessment (straight leg raise) was statistically significant.

Primary study

Unclassified

Epidural steroids, epidural morphine and epidural steroids combined with morphine in the treatment of post-laminectomy syndrome.

Journal Pain
Year 1989
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This article is included in 6 Systematic reviews Systematic reviews (6 references)

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Epidural morphine injection followed by a steroid has been reported to be effective for the post-laminectomy pain ('failed back') syndrome. This double-blind, parallel study was undertaken to evaluate that mode of therapy. Twenty-two patients who had undergone at least one prior laminectomy, who were still symptomatic, were randomized to receive 50 mg of lidocaine epidurally with: (a) 75 mg triamcinolone diacetate (TR); or (b) 8 mg of preservative-free morphine (MP); or (c) both (TR and MP), at 1 month intervals for 3 consecutive months. The spinal interspace identified with the patients' pain complaint was the site of injection. For each treatment, patients were admitted to the Clinical Research Center for 24 h and their condition continuously monitored with a pulse oximeter and apnea monitor. Five to 7 patients in each group had pain relief for less than 1 month. No patient given morphine had pain relief for more than 1 month. Life-threatening ventilatory depression occurred in the group given triamcinolone and morphine. The use of morphine alone or combined with slow release triamcinolone does not appear to be appropriate for the treatment of the post-laminectomy pain syndrome.

Primary study

Unclassified

Outpatient lumbar epidural corticosteroid injection in the management of sciatica.

Journal British journal of rheumatology
Year 1988
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This article is included in 11 Systematic reviews Systematic reviews (11 references)

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The value of epidural injections of corticosteroid as an outpatient treatment of sciatica has been hitherto uncertain. An epidural injection of 80 mg methylprednisolone in 10 ml physiological saline was compared with an interspinous injection of 2 ml physiological saline in a double blind fashion amongst 39 outpatients. Significant differences of pain relief were seen between the two groups within 2 weeks. This benefit disappeared for six (35%) patients within 6 months of treatment although 11 (65%) successfully treated subjects had sustained improvement up to this time. 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. Factors associated with a failure to respond to epidural steroid injections are discussed.

Primary study

Unclassified

Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections.

Journal British journal of rheumatology
Year 1987
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This article is included in 15 Systematic reviews Systematic reviews (15 references)

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Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated. The largest group studied had low back pain with limited straight-leg raising (SLR) and in them the beneficial effect of manipulation in hastening pain relief was highly significant. In similar patients without limitation of SLR, the effect was of borderline significance. In all the other groups, treated patients also recovered more quickly than their controls. Traction, for patients with low back pain and sciatica, and epidural injections when a root palsy was present also produced some significant pain relief. The effect of sclerosants for back pain was less clear.

Primary study

Unclassified

The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study.

Journal The Journal of bone and joint surgery. American volume
Year 1985
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This article is included in 13 Systematic reviews Systematic reviews (13 references) 1 Broad synthesis Broad syntheses (1 reference)

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Seventy-three patients with lumbar radicular pain syndromes were treated in a prospective, randomized, double-blind fashion with either seven milliliters of methylprednisolone acetate and procaine or seven milliliters of physiological saline solution and procaine. All patients had radiographic confirmation of lumbar nerve-root compression, consistent with the clinical diagnosis of either an acute herniated nucleus pulposus or spinal stenosis. No statistically significant difference was observed between the control and experimental patients with either acute disc herniation or spinal stenosis. Long-term follow-up, averaging twenty months, failed to demonstrate the efficacy of a second injection of epidural steroids administered to the patients whose pain did not respond within twenty-four hours to an injection of either eighty milligrams of methylprednisolone acetate combined with five milliliters of 1 per cent procaine or two milliliters of sterile saline combined with five milliliters of 1 per cent procaine. Therefore, a decision to use epidural steroids must be made with the realization that we failed to demonstrate its clinical efficacy in this study and that reports of serious complications of this procedure have been published.

Primary study

Unclassified

Lumbar epidural injections in the treatment of sciatica.

Journal British journal of rheumatology
Year 1984
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This article is included in 5 Systematic reviews Systematic reviews (5 references)

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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.