Advertisement

European Spine Journal

, Volume 18, Issue 8, pp 1220–1225 | Cite as

Corticosteroids in peri-radicular infiltration for radicular pain: a randomised double blind controlled trial. One year results and subgroup analysis

  • Suhayl TafazalEmail author
  • Leslie Ng
  • Neeraj Chaudhary
  • Philip Sell
Original Article

Abstract

The objective of this study is to evaluate the efficacy of corticosteroids in patients with radicular pain due to lumbar disc herniation or lumbar spinal stenosis through a prospective randomised, double blind controlled trial, and whether there was an effect on subsequent interventions such as additional root blocks or surgery. Peri-radicular infiltration of corticosteroids has previously been shown to offer no additional benefit in patients with sciatica compared to local anaesthetic alone. It is not known if the response to peri-radicular infiltration is less marked in certain subgroups of patients such as those with radicular pain due to lumbar spinal stenosis. Previous studies have suggested that peri-radicular infiltration of corticosteroids may obviate the need for subsequent interventions and we therefore further investigated this in the current study. We randomised 150 patients to receive a single injection with either bupivacaine alone or bupivacaine and methylprednisolone. Patients were assessed at 6 weeks and 3 months after the injection using standard outcome measures including Oswestry Disability Index (ODI), visual analogue score for leg pain and patient’s subjective assessment of outcome. At 1-year follow-up, we looked at the outcome in terms of the need for subsequent interventions such as additional root blocks or surgery. At 3-month follow-up, there was no statistically significant difference in the standard outcome measures between the two injection groups. At a minimum 1-year post injection, there was no difference in the need for subsequent interventions in either group. Patients with lumbar spinal stenosis had a less marked reduction in the ODI at 3 months with a mean change of 3.3 points when compared with 15 points for patients with lumbar disc herniation. In conclusion, peri-radicular infiltration of corticosteroids for sciatica does not provide any additional benefit when compared to local anaesthetic injection alone. Corticosteroids do not obviate the need for subsequent interventions such as additional root blocks or surgery.

Keywords

Corticosteroids Peri-radicular infiltration Lumbar disc herniation Lumbar spinal stenosis Surgery 

References

  1. 1.
    Autio RA, Karpinnen J, Kurunlahti M (2004) Effect of periradicular methylprednisolone on spontaneous resorption of intervertebral disc herniations. Spine 29(15):1601–1607. doi: 10.1097/01.BRS.0000132511.46818.67 PubMedCrossRefGoogle Scholar
  2. 2.
    Carette S, Leclaire R, Marcoux S et al (1997) Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 336(23):1634–1640. doi: 10.1056/NEJM199706053362303 PubMedCrossRefGoogle Scholar
  3. 3.
    Cuckler JM, Bernini PA, Wiesel SW et al (1985) The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomised, double-blind study. J Bone Joint Surg Am 67-A(1):63–66Google Scholar
  4. 4.
    Fairbank J, Couper J, Davies JB et al (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMedGoogle Scholar
  5. 5.
    Greenough CG, Fraser RD (1992) Assessment of outcome in patients with low back pain. Spine 17:36–41. doi: 10.1097/00007632-199201000-00006 PubMedCrossRefGoogle Scholar
  6. 6.
    Holt AE, Shaw NJ, Shetty A, Greenough CG (2002) The reliability of the low back outcome score for back pain. Spine 27(2):206–210PubMedCrossRefGoogle Scholar
  7. 7.
    Karpinnen J, Malmivaara A, Kurunlahti M (2001) Periradicular infiltration for sciatica. A randomised controlled trial. Spine 26(9):1059–1067. doi: 10.1097/00007632-200105010-00015 CrossRefGoogle Scholar
  8. 8.
    Luijsterburg PAJ, Verhagen AP, Ostelo RWJG et al (2007) Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J 16:881–899. doi: 10.1007/s00586-007-0367-1 PubMedCrossRefGoogle Scholar
  9. 9.
    Lutz GE, Vad VB, Wisneski RJ (1998) Fluoroscopic transforaminal epidural steroids, an outcome study. Arch Phys Med Rehabil 79:1362–1366. doi: 10.1016/S0003-9993(98)90228-3 PubMedCrossRefGoogle Scholar
  10. 10.
    Muramoto T, Atsuta Y, Iwahara T (1997) The action of prostaglandin E2 and triamcinolone acetonide on the firing activity of lumbar nerve roots. Int Orthop 21(3):172–175. doi: 10.1007/s002640050144 PubMedCrossRefGoogle Scholar
  11. 11.
    Ng L, Chaudhary N, Sell P (2005) The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain. A randomised, double-blind, controlled trial. Spine 30(8):857–862. doi: 10.1097/01.brs.0000158878.93445.a0 PubMedCrossRefGoogle Scholar
  12. 12.
    Ng L, Sell P (2004) Predictive value of the duration of sciatica for lumbar discectomy, a prospective cohort study. J Bone Joint Surg Br 86-B(4):546–549Google Scholar
  13. 13.
    Olmarker K, Blomquist J, Stromberg J et al (1995) Inflammatogenic properties of nucleus pulposus. Spine 20:665–669. doi: 10.1097/00007632-199503150-00006 PubMedCrossRefGoogle Scholar
  14. 14.
    Olmarker K, Byrod G, Cornefjord M et al (1994) Effects of methylprednisolone on nucleus pulposus-induced nerve root injury. Spine 19:1803–1808. doi: 10.1097/00007632-199408150-00003 PubMedCrossRefGoogle Scholar
  15. 15.
    Olmarker K, Rydevik B, Nordborg C (1993) Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equine nerve roots. Spine 18:1425–1432PubMedCrossRefGoogle Scholar
  16. 16.
    Riew DK, Yin Y, Gilula L et al (2000) The effect of nerve root injections on the need for operative treatment of lumbar radicular pain: a prospective, randomised, controlled, double-blind study. J Bone Joint Surg Am 82-A(11):1589–1593PubMedGoogle Scholar
  17. 17.
    Roland M, Fairbank J (2000) The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine 25(24):3115–3124. doi: 10.1097/00007632-200012150-00006 PubMedCrossRefGoogle Scholar
  18. 18.
    Slipman CW, Chow DW (2002) Therapeutic spinal corticosteroid injections for the management of radiculopathies. Phys Med Rehabil Clin N Am 13(3):697–711PubMedGoogle Scholar
  19. 19.
    Tajima T, Fuukawa K, Kuramochi E (1980) Selective lumbosacral radiculopathy and block. Spine 5:68–77. doi: 10.1097/00007632-198001000-00013 PubMedCrossRefGoogle Scholar
  20. 20.
    Thomas E, Cyteval C, Abiad L et al (2003) Efficacy of transforaminal versus interspinous corticosteroid injection in discal radiuculagia—a prospective, randomised, double-blind study. Clin Rheumatol 22:299–304. doi: 10.1007/s10067-003-0736-z PubMedCrossRefGoogle Scholar
  21. 21.
    Vad VB, Bhat AL, Lutz GE et al (2002) Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomised study. Spine 27:11–16. doi: 10.1097/00007632-200201010-00005 PubMedCrossRefGoogle Scholar
  22. 22.
    Wang R, Lagakos SW, Ware JH (2007) Statistics in medicine—reporting of subgroup analyses in clinical trials. N Engl J Med 357(21):2189–2194. doi: 10.1056/NEJMsr077003 PubMedCrossRefGoogle Scholar
  23. 23.
    Weber H (1994) The natural history of disc herniation and the influence of intervention. Spine 19:2234–2238PubMedCrossRefGoogle Scholar
  24. 24.
    Weber H, Holme I, Amlie E (1993) The natural cause of acute sciatica with nerve root symptoms in a double-blind placebo controlled trial evaluating the effect of piroxicam. Spine 18:1433–1438. doi: 10.1097/00007632-199312000-00021 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Suhayl Tafazal
    • 1
    • 2
    Email author
  • Leslie Ng
    • 1
  • Neeraj Chaudhary
    • 1
  • Philip Sell
    • 1
  1. 1.University Hospitals of LeicesterLeicesterUK
  2. 2.Department of OrthopaedicsLeicester General HospitalLeicesterUK

Personalised recommendations