Epidural steroid injection for nerve root compression

Abstract

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.

The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model

“…Two studies included patients who had previously received an epidural for their current episode, but this information was not reported for most studies. Three studies 94,156,169 included patients who had had previous disc surgery, one of which 169 did not report data on global effect, pain or CSOMs. (One study 95 compared the use of epidural with disc surgery.)…”

“…(One study 95 compared the use of epidural with disc surgery.) Two studies 156,166 (comparator included non-opioids) included some patients with spinal stenosis and one study 94 (epidural vs disc surgery) included patients with sequestered discs. Summary of study design and quality for epidural/intradiscal injection studies Summary information on study details is presented in Table 19, excluding studies 146,161,164,169,172 that did not report outcome data for global effect, pain intensity or CSOMs.…”

“…Most included epidural studies were RCTs (24/29, 83%); however, the proportion that were deemed good quality was very low (4/29, 14%), all of which compared epidural with inactive control. Although 10 studies 149,152,153,156,160,163,165,168,171,173 used and adequate method for generating a random number sequence, eight of these used sealed envelopes to conceal allocation, which is a partially adequate method. Only one study had good external validity.…”

Effect of Low Level Laser versus McKenzie Technique in Treatment of Chronic Low Back Pain

“…Moreover, it was found that there is a requirement of more randomized controlled studies for the evaluation of the impact of the associated factors such as lengths of treatment, wavelengths and dosage [13,14].…”

Interlaminar Lumbar Epidural Steroid Injections in Degenerative Lumbar Spinal Stenosis Patients

“…Similarly, another study was conducted on 92 patients with a 16 gauge tuohy needle. The injection was administered at the specific interval near the affected nerve root [11]. When the needle touched lamina, it was pulled back a little and one group of patients received a steroid injectate into muscle tissue whereas the other group received a steroid into the epidural space.…”