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Epidural steroids...no long term benefits..metaanalysis said


Published data and guidelines are mixed about whether epidural steroid injections benefit patients with sciatica. Researchers performed a meta-analysis of 23 randomized trials (>2000 patients) in which steroid injections were compared with placebo injections. The placebo arms included injection of inert substances (such as saline) or short-acting anesthetics. Both acute and chronic cases were included in the trials; patients with histories of surgery or potential spinal canal stenosis were excluded. Short- (>2 weeks but ≤3 months) and long-term (>12 months) efficacy was measured on a scale from 0 to 100 points (difference of 10–30 points is clinically significant).
Epidural steroid injections were associated with less short-term leg pain (mean difference, –6.2 points) and disability (mean difference, –3.1 points) but not with less back pain relative to placebo. In the long term, no significant differences were found in leg pain, disability, or back pain.
Comment: This meta-analysis of trials of epidural steroid injections for sciatica showed a small, clinically insignificant benefit in the short term (leg pain and disability) but failed to identify benefit beyond 12 months. The finding supports using conservative measures and avoiding epidural steroid injections in patients with sciatica.

Pinto RZ et al. Epidural corticosteroid injections in the management of sciatica: A systematic review and meta-analysis.Ann Intern Med 2012 Nov 13; [e-pub ahead of print]. 


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