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Epidural corticosteroid injections for
sciatica due to herniated nucleus pulposus [see comments] |
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AUTHORS: |
Carette S; Leclaire R; Marcoux S;
Morin F; Blaise GA; St.-Pierre A; Truchon R; Parent F; Levesque J; Bergeron V; Montminy P;
Blanchette C |
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AUTHOR AFFILIATION: |
Department of Medicine, Laval
University, Quebec City, Canada. |
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SOURCE: |
N Engl J Med 1997 Jun
5;336(23):1634-40 |
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CITATION IDS: |
PMID: 9171065 UI: 97301685 |
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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. |
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MAIN MESH HEADINGS: |
Anti-Inflammatory Agents,
Steroidal/*therapeutic use
Intervertebral Disk Displacement/*complications
Methylprednisolone/*analogs & derivatives
Sciatica/*drug therapy |
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ADDITIONAL MESH HEADINGS: |
Adult
Double-Blind Method
Female
Human
Injections, Epidural/adverse effects
Intervertebral Disk Displacement/surgery
Male
Methylprednisolone/therapeutic use
Sciatica/etiology
Sciatica/physiopathology
Support, Non-U.S. Gov't
Treatment Outcome |
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CAS REGISTRY NUMBERS: |
0 (Anti-Inflammatory Agents,
Steroidal)
53-36-1 (Depo-Medrol)
83-43-2 (Methylprednisolone) |
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PUBLICATION TYPES: |
CLINICAL TRIAL
JOURNAL ARTICLE
MULTICENTER STUDY
RANDOMIZED CONTROLLED TRIAL |
