Efficacy of Steroid and Nonsteroid Caudal Epidural Injections for Low Back Pain and Sciatica

Sayegh, Fares E.; Kenanidis, Eustathios; Papavasiliou, Kyriakos A.; Potoupnis, Michael; Kirkos, John M.; Kapetanos, G.

doi:10.1097/brs.0b013e3181a4804a

Cited by 70 publications

(75 citation statements)

References 35 publications

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“…The ODI scores are reported in 9 studies [12, 17, 19-23, 25-26], RMDQ in 2 studies [2, 16], International Classification of Impairments, Disabilities, and Handicaps (ICIDH) by WHO Grade score in 1 study [27], and JOA score in 1 study [30]. In all of these studies, a significant improvement after EI was observed.…”

Section: Resultsmentioning

confidence: 99%

Role of Epidural Injections to Prevent Surgical Intervention in Patients with Chronic Sciatica: A Systematic Review and Meta-Analysis

Bhatti¹,

Kim²

2016

Cureus

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Objective: The aim of this study is to evaluate the efficacy of the different types of epidural injections (EI) to prevent surgical intervention in patients suffering from chronic sciatica due to lumbar disc herniation (LDH).Material and Methods: Studies were identified by searching PubMed, MEDLINE, and Google Scholar to retrieve all available relevant articles. Lists of references of several systematic reviews were also used for scanning further references. Publications from the past ten years (2006-2016) were considered, and all studies selected were in the English language only. The studies employed specified the use of EI to treat sciatica caused by LDH. A total of 19 papers meeting the eligibility criteria (mentioned below) were included in this study. The pain scores, functional disability scores, and surgical rates from these studies were considered, and meta-analysis was performed.Outcome measures: Pain scores, functional disability scores, and surgical rates were assessed from the included studies. The Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS) have been the most commonly used baseline scales for pain evaluation followed by the Verbal Numerical Rating Scale (VNRS) and Japanese Orthopedic Association (JOA). The Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) scales were used for the functional disability scoring system in the literature.Results: Significant improvement in the pain scores and functional disability scores were observed. Additionally, greater than 80% of the patients suffering from chronic sciatica caused by LDH could successfully prevent surgical intervention after EI treatment with or without steroids.Conclusion: The management of sciatica with EI treatment results in significant improvements in the pain score, functional disability score, and surgical rate. We concluded that EI provides new hope to prevent surgical intervention in patients suffering from sciatica caused by LDH.

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Section: Resultsmentioning

confidence: 99%

Role of Epidural Injections to Prevent Surgical Intervention in Patients with Chronic Sciatica: A Systematic Review and Meta-Analysis

Bhatti¹,

Kim²

2016

Cureus

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“…Several studies do support the shorttenn effieaey of epidural steroid injections (7,9), including several systematic reviews (1,2,10,27,32). Recently, two studies reported that epidural injections containing local anesthetic and a steroid demonstrated better and faster efficacy than loeal anesthetic and saline alone (24,30). In a 2007 report by the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology, it was concluded that epidural steroid injections may ameliorate radicular leg pain between 2 and 6 wk after the injeetion, compared with control treatment (6).…”

Section: Discussionmentioning

confidence: 95%

Epidural Steroid Injection for Lumbar Disc Herniation in NFL Athletes

Krych

Richman

Drakos

et al. 2012

Medicine &Amp; Science in Sports &Amp; Exercise

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“…164,165 In contrast, the large majority of randomized controlled studies evaluating surgery rates as a secondary outcome measure failed to find a difference in operative rates between ESI and placebo treatment, 99, 137,145,146,166Y178 compared with the few that did. 179,180 The difficulty in evaluating surgery rates as a secondary outcome is that nearly all studies are underpowered to detect a difference and incorporate some degree of bias through patient selection. Many patients who receive ESI are either poor surgical candidates or do not want surgery, so that even an effective treatment may not be able to demonstrate a decrease in surgery rates.…”

Section: Prevention Of Surgerymentioning

confidence: 99%

Epidural Steroids

Cohen¹,

Bicket

Jamison

et al. 2013

Regional Anesthesia and Pain Medicine

282

107

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Epidural steroid injections (ESIs) 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. Despite the extensive literature on the subject, there continues to be considerable controversy surrounding their safety and efficacy. The results of clinical trials and review articles are heavily influenced by specialty, with those done by interventional pain physicians more likely to yield positive findings. Overall, more than half of controlled studies have demonstrated positive findings, suggesting a modest effect size lasting less than 3 months in well-selected individuals. Transforaminal injections are more likely to yield positive results than interlaminar or caudal injections, and subgroup analyses indicate a slightly greater likelihood for a positive response for lumbar herniated disk, compared with spinal stenosis or axial spinal pain. Other factors that may increase the likelihood of a positive outcome in clinical trials include the use of a nonepidural (eg, intramuscular) control group, higher volumes in the treatment group, and the use of depo-steroid. Serious complications are rare following ESIs, provided proper precautions are taken. Although there are no clinical trials comparing different numbers of injections, guidelines suggest that the number of injections should be tailored to individual response, rather than a set series. Most subgroup analyses of controlled studies show no difference in surgical rates between ESI and control patients; however, randomized studies conducted by spine surgeons, in surgically amenable patients with standardized operative criteria, indicate that in some patients the strategic use of ESI may prevent surgery.

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Efficacy of Steroid and Nonsteroid Caudal Epidural Injections for Low Back Pain and Sciatica

Abstract: CEI containing local anesthetic and steroids or WFI seems to be effective when treating patients with LBP and sciatica. CEI containing steroid preparations demonstrated better and faster efficacy.

Cited by 70 publications

References 35 publications

Role of Epidural Injections to Prevent Surgical Intervention in Patients with Chronic Sciatica: A Systematic Review and Meta-Analysis

Role of Epidural Injections to Prevent Surgical Intervention in Patients with Chronic Sciatica: A Systematic Review and Meta-Analysis

Epidural Steroid Injection for Lumbar Disc Herniation in NFL Athletes

Epidural Steroids

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