Epidural Steroids, Etanercept, or Saline in Subacute Sciatica

Abstract

Agency for Healthcare Research and Quality.

A systematic review and meta-analysis of biological treatments targeting tumour necrosis factor α for sciatica

“…We identified seven RCTs [19][20][21][22][23][24][25][26] one non-RCT [27,28] and one historical cohort study [29]. Two studies were reported in two separate publications each [23,24,27,28].…”

“…One RCT compared subcutaneous injection of etanercept with a placebo injection of saline [25], and another RCT compared three different doses of an epidural injection of etanercept with each other and with an epidural saline injection [20]. One three-armed RCT compared epidural injections of etanercept with epidural injections of corticosteroid and with epidural injection of saline [26].…”

“…The nine studies included 412 participants with mean ages between 39 and 54 years, with 40-80 % men, five with acute [21][22][23][24][27][28][29], one with chronic [25] and three with acute and chronic symptom duration [19,20,26] (Tables 1, 2). Three RCTs included patients with recurrent symptoms [21,23,24,29], but symptom recurrence was not reported in six studies [19,20,22,25,26,29]. Sciatica was confirmed by imaging in all studies and previous back surgery was excluded in five trials [22][23][24][25][26][27][28].…”

“…Three RCTs included patients with recurrent symptoms [21,23,24,29], but symptom recurrence was not reported in six studies [19,20,22,25,26,29]. Sciatica was confirmed by imaging in all studies and previous back surgery was excluded in five trials [22][23][24][25][26][27][28]. Participants were selected from consecutive outpatient [19] or inpatient attendances [29], after failure to respond to conservative therapy such as physiotherapy and oral analgesia [20,25] or were candidates for disc surgery [22][23][24].…”

“…Five reported an adequate method of random number generation [19,[21][22][23][24], but only three documented a secure method of allocation concealment [21,25,26]. Three studies had moderately good external validity [21,26,29] (Table 3). Two RCTs reported medians rather than means [22][23][24].…”