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

Abstract

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.

Treatment Options for Sciatica: Surgery, Epidural Injections, and Osteopathic Manipulative Treatment

“…Another 7 studies used the VAS scale, with one showing 83% improvement and another with 50% improvement in pain level. In one study, 68% of patients reported pain relief, though the results were not statistically significant [5].…”

“…The argument for epidural injections is that sciatic pain is predominantly due to inflammation rather than mechanical compression [5]. Bhatti et al conducted a meta-analysis of different epidural injection approaches including lumbar transforaminal epidural injection (TEI), lumbar interlaminar epidural injection (IEI), and caudal epidural injections (CEI) and their effects on chronic sciatica.…”

Kronik bel-boyun ağrılı hastada adjuvan analjezikler

“…[57][58][59] Kronik bel-boyun ağrılarında, epidural kortikosteroid enjeksiyonunun etkinliği gös-terilmiştir. [60][61][62] …”

Lumbar Radicular Pain Response to First Injection with Non-particulate Steroid

“…Fortunately, the natural history of these cases is often benign and without resultant long-term disability [1]. When more conservative treatment measures fail to provide adequate relief, transforaminal epidural steroid injection (TFESI) may be an effective means of providing both pain relief and avoiding surgical intervention [2,3]. Most of the prior literature examining the use of TFESI has typically employed the use of particulate corticosteroids [4,5].…”