title: Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus.
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.
authors.affiliation: Department of Medicine, Laval University, Quebec City, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Carette
authors.forename: R
authors.initials: R
authors.lastname: Leclaire
authors.forename: S
authors.initials: S
authors.lastname: Marcoux
authors.forename: F
authors.initials: F
authors.lastname: Morin
authors.forename: G A
authors.initials: GA
authors.lastname: Blaise
authors.forename: A
authors.initials: A
authors.lastname: St-Pierre
authors.forename: R
authors.initials: R
authors.lastname: Truchon
authors.forename: F
authors.initials: F
authors.lastname: Parent
authors.forename: J
authors.initials: J
authors.lastname: Levésque
authors.forename: V
authors.initials: V
authors.lastname: Bergeron
authors.forename: P
authors.initials: P
authors.lastname: Montminy
authors.forename: C
authors.initials: C
authors.lastname: Blanchette
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000601:surgery; D008297:Male; D008775:Methylprednisolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077555:Methylprednisolone Acetate; D012585:Sciatica / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone