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Previous Volume 336:1634-1640 June 5, 1997 Number 23 Next

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ABSTRACT

Background Although epidural corticosteroid injections are commonly used for sciatica, their efficacy has not been established.

Methods In a randomized, double-blind trial, we administered up to three epidural injections of methylprednisolone acetate (80 mg in 8 ml of isotonic saline) or isotonic saline (1 ml) to 158 patients with sciatica due to a herniated nucleus pulposus. All patients had Oswestry disability scores higher than 20 (on a scale of 1 to 100, with scores of 20 or less indicating minimal disability, and higher scores greater disability).

Results At three weeks, the Oswestry score had improved by a mean of -8.0 in the methylprednisolone group and -5.5 in the placebo group (95 percent confidence interval for the difference, -7.1 to 2.2). Differences in improvements between the groups were not significant, except for improvements in the finger-to-floor distance (P = 0.006) and sensory deficits (P = 0.03), which were greater in the methylprednisolone group. After six weeks, the only significant difference was the improvement in leg pain, which was greater in the methylprednisolone group (P = 0.03). After three months, there were no significant differences between the groups. The Oswestry score had improved by a mean of -17.3 in the methylprednisolone group and -15.4 in the placebo group (95 percent confidence interval for the difference, -9.3 to 5.4). At 12 months, the cumulative probability of back surgery was 25.8 percent in the methylprednisolone group and 24.8 percent in the placebo group (P = 0.90).

Conclusions Although epidural injections of methylprednisolone may afford short-term improvement in leg pain and sensory deficits in patients with sciatica due to a herniated nucleus pulposus, this treatment offers no significant functional benefit, nor does it reduce the need for surgery.

Source Information

From the Departments of Medicine (S.C., F.M.), Social and Preventive Medicine (S.M., C.B.), Anesthesiology (A.S., R.T., F.P.), Radiology (J.L., V.B.), and Orthopedic Surgery (P.M.), Laval University, Quebec City, Canada; and the Departments of Medicine (R.L.) and Anesthesiology (G.A.B.), University of Montreal, Montreal.

Address reprint requests to Dr. Carette at the Centre Hospitalier Universitaire de Québec, Pavillon CHUL, 2705 Blvd. Laurier, Sainte-Foy, QC G1V 4G2, Canada.

Full Text of this Article

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Corticosteroid Injections for Sciatica
Raza K., Orlando M. P., Sherman M. O., Manning D. C., Hopwood M. B., Gillies J. H., Ward J. H., Griesdale D. E., Carette S., Marcoux S., Leclaire R.
Extract | Full Text  
N Engl J Med 1997; 337:1241-1243, Oct 23, 1997. Correspondence

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