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Epidural corticosteroid injection is a common treatment for leg and lower back pain when more conservative treatments are not effective. In light of the recent outbreak of fungal meningitis associated with contaminated steroid preparations, DynaMed editors decided to highlight a recent systematic review assessing the efficacy of epidural steroids for sciatica.
The systematic review compiled data from 23 randomized trials with 2,334 patients who had sciatica for at least 6 weeks to compare epidural corticosteroid injections to placebo. Corticosteroids included methylprednisolone, prednisone, prednisolone, triamcinolone, and betamethasone, and were administered by caudal, interlaminar, or transforaminal approaches. Because different scales were used across trials to assess pain and disability, all scores were converted to a 0-100 scale for analysis. The authors considered a reduction of at least 10 points in pain or disability to be clinically relevant, a threshold suggested by multiple sources.
At follow-up of up to 3 months, epidural steroids were associated with statistically significant reductions in mean leg pain (weighted mean reduction 6.2 points, 95% CI 3-9.4 in analysis of 14 trials with 1,316 patients) and mean disability score (weight mean reduction 3.1 points, 95% CI 1.2-5 in analysis of 10 trials with 1,154 patients) (level 2 [mid-level] evidence). Neither of these short-term improvements reached the threshold for clinical significance. Due to the nature of the data available from the original trials, the review did not analyze any dichotomous outcomes (e.g. proportion of patients with at least 30% pain reduction), so these analyses may not exclude the possibility of significant benefit in some subpopulations.
There were no significant differences in either leg pain or disability at 12 months follow-up. Low back pain was not significantly reduced in the steroid group at either 3 months or 12 months follow-up (Ann Intern Med 2012 Nov 13 early online).
For more information, see the Sciatica topic in DynaMed.