| 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 | S Carette, R Leclaire, S Marcoux, F Morin, G A Blaise, A St-Pierre, R Truchon, F Parent, J Levésque, V Bergeron, P Montminy, C Blanchette
(Affiliation: Department of Medicine, Laval University, Quebec City, Canada.)
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| Journal | The New England journal of medicine
(N Engl J Med)
Vol. 336
Issue 23
Pg. 1634-40
(Jun 5 1997)
ISSN: 0028-4793 UNITED STATES |
| PMID | 9171065
(Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
|
| Chemical References |
- Anti-Inflammatory Agents
- methylprednisolone acetate
- Methylprednisolone
|
| Topics |
- Adult
- Anti-Inflammatory Agents
(therapeutic use)
- Double-Blind Method
- Female
- Humans
- Injections, Epidural
(adverse effects)
- Intervertebral Disk Displacement
(complications, surgery)
- Male
- Methylprednisolone
(analogs & derivatives, therapeutic use)
- Sciatica
(drug therapy, etiology, physiopathology)
- Treatment Outcome
|
