Epidural corticosteroid injections have a small, short-term benefit for leg pain and disability in people with sciatica

Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012;157:865-77.

Review questions

How effective are epidural corticosteroid injections in the management of sciatica?

Background

Sciatica refers to symptoms from general compression or irritation of 1 of 5 spinal nerve roots of each sciatic nerve (which runs from the lower back down to the leg).

Symptoms include lower back pain, buttock pain, pain and numbness in various parts of the leg and foot, a pins-and-needles sensation or tingling, and difficulty controlling the leg. They usually occur on one side of the body.

Corticosteroids are medications that closely resemble cortisol (a hormone involved in stress response and regulation of inflammation).

Epidural injections deliver drugs through a tube (catheter) placed into the lower spine area (known as the epidural space).

How the review was done

The source of this summary is a systematic review of 25 studies (23 randomized controlled trials) that were published between 1970 and 2012 and included 2133 people (age 18 to 75 years).

The corticosteroids assessed were methylprednisolone, prednisone, triamcinolone, and betamethasone.

The review evaluated the effects of injections at specific epidural sites: opening just above the tailbone, back of the epidural space, and opening at the side of the spine where a nerve root exits.

What the researchers found

The overall quality of this evidence is high for benefits. No information was available about safety or harms.

Compared with placebo, epidural corticosteroid injections resulted in a small reduction in leg pain in the short term. Average reduction was 6.2 points on a 100-point scale (where 0 = no pain or disability and 100 = worst possible pain or disability).

Compared with placebo, epidural corticosteroid injections resulted in a small reduction in disability in the short term. Average reduction was 3.1 points on a 100-point scale.

Epidural corticosteroid injections do not differ from placebo for long-term relief of leg pain or disability.

Conclusions

Epidural corticosteroid injections offer small, short-term reductions in leg pain and disability in people with sciatica.

Effects of corticosteroids compared with placebo for sciatica

Symptoms	Short-term effects	Long-term effects
Leg pain	Small reduction with corticosteroids	No difference between corticosteroids and placebo
Disability	Small reduction with corticosteroids	No difference between corticosteroids and placebo

This Evidence Summary was originally prepared for the McMaster Optimal Aging Portal.

Published: Monday, August 14, 2017

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