Periradicular infiltration for sciatica: a randomized controlled trial.
METHODS
A randomized, double-blind trial was conducted.


OBJECTIVE
To test the efficacy of periradicular corticosteroid injection for sciatica.


BACKGROUND
The efficacy of epidural corticosteroids for sciatica 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 parameters and costs were recorded at baseline, at 2 and 4 weeks, at 3 and 6 months, 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 saline group at 3 and 6 months (P = 0.03 and 0.002, respectively), and leg pain at 6 months (13.5, P = 0.02). Sick leaves and medical costs were similar for both treatments, except for cost of therapy visits and drugs at 4 weeks, which were in favor of the steroid injection (P = 0.05 and 0.005, respectively). 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.
Karppinen
J
J
Department of Physical Medicine and Rehabilitation, University Hospital of Oulu, Finland. jaro.karppinen@ppshp.fi
Malmivaara
A
A
Kurunlahti
M
M
Kyllönen
E
E
Pienimäki
T
T
Nieminen
P
P
Ohinmaa
A
A
Tervonen
O
O
Vanharanta
H
H
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D018450:Disease Progression; D004338:Drug Combinations; D016527:Drug Costs; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D007267:Injections; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D012585:Sciatica / Q000188:drug therapy* / Q000503:physiopathology; D012965:Sodium Chloride / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D013126:Spinal Nerve Roots / Q000187:drug effects; D016896:Treatment Outcome
D000779:Anesthetics, Local; D004338:Drug Combinations; D005938:Glucocorticoids; D012965:Sodium Chloride; D008775:Methylprednisolone; D002045:Bupivacaine