Therapeutics and Drug Brief

Corticosteroid Injections for Sciatica

Source: Carette S. N Engl J Med 1997;336:1634-1640.

Epidural steroids (es) have been used since the early 1950s to treat sciatica, but controlled trials have been mixed in their findings on effectiveness of this method. About half of trials report ES to be superior to a comparator treatment, and the other half indicate equal efficacy. Unfortunately, most studies had sufficient methodologic deficits that a conclusive answer has been elusive. The safety of ES has not been in doubt, based upon literally thousands of patients who have received the treatment.

Over a four-year period, 156 patients were enrolled in a trial comparing methylprednisolone with saline by epidural injection. Patients received up to three injections. No serious complications occurred.

At three weeks, six weeks, and three months, there was no clinically relevant difference between the two groups in most aspects. Though the methylprednisolone group had improved flexibility and afforded lesser sensory deficit than the placebo group, the clinical relevance of these aspects of improvement appears small. On the other hand, there was a statistically significant improvement in leg pain (requiring less analgesia) in those who received ES, corroborated by the observation that almost three times as many patients withdrew due to lack of efficacy from the placebo group than from the ES group. Twelve-month risk of undergoing surgery for the sciatica was the same in both groups.

Although ES may not prevent likelihood of need for surgery, it nonetheless provides significant reductions in leg pain, sensory deficits, and requirements for analgesics.