Study Design. A randomized, double-blind trial was conducted.
Objectives. To test the efficacy of periradicular corti costeroid injection
Summary of Background Data. The efficacy of epidural corticosteroids for sc
iatica is controversial. Periradicular infiltration is a targeted technique
, but there are no randomized controlled trials of its efficacy.
Methods. In this study 160 consecutive, eligible patients with sciatica who
had unilateral symptoms of 1 to 6 months duration, and who never underwent
surgery were randomized for double-blind injection with methylprednisolone
bupivacaine combination or saline. Objective and self-reported outcome par
ameters and costs were recorded at baseline, at 2 and 4 weeks, at 3 and 6 m
onths, and at 1 year.
Results. Recovery was better in the steroid group at 2 weeks for leg pain (
P = 0.02), straight leg raising (P = 0.03), lumbar flexion (P = 0.05), and
patient satisfaction (P = 0.03). Back pain was significantly lower in the s
aline group at 3 and 6 months (P = 0.03 and 0.002, respectively), and leg p
ain at 6 months (13.5, P = 0.02). Sick leaves and medical costs were simila
r for both treatments, except for cost of therapy visits and drugs at 4 wee
ks, which were in favor of the steroid injection (P = 0.05 and 0.005, respe
ctively). By 1 year, 18 patients in the steroid group and 15 in the saline
group underwent surgery.
Conclusions. improvement during the follow-up period was found in both the
methylprednisolone and saline groups. The combination of methylprednisolone
and bupivacaine seems to have a short-term effect, but at 3 and 6 months,
the steroid group seems to experience a "rebound" phenomenon.