Effect of Transforaminal Epidural Corticosteroid Injections in Acute Sciatica: A Randomized Controlled Trial

OBJECTIVE: Transforaminal epidural steroid injections (TESIs) are widely administered for sciatica. The aim of this trial was to evaluate the effectiveness of TESIs in patients with acute sciatica (<8 wk).

METHODS: This study was conducted in two Dutch hospitals. Participants (n=141) were randomly assigned to: 1) usual care and TESI of 1ml of 40mg/ml Methylprednisolone plus 1ml of 0.5% Levobupivacaine (intervention 1); 2) usual care and transforaminal epidural injection with 1 ml of 0.5% Levobupivacaine and 1ml NaCl 0.9% (intervention 2); 3) usual care consisting of oral pain medication with or without physiotherapy (control). Co-primary outcomes were back- and leg pain intensity, physical functioning and recovery measured during 6-month follow-up.

RESULTS: There were no significant mean differences in co-primary outcomes between groups during follow-up, except for leg pain when comparing intervention group 1 with control (-0.96 95%CI:-1.83 to -0.09). For secondary outcomes, some significant between group differences were found for treatment satisfaction and surgery, but only when comparing intervention group 2 to control. Post-hoc analyses showed a significant difference in response (50% improvement of leg pain [yes/no]) between intervention 1 and the control group at 3 months and that both intervention groups used less opioids.

DISCUSSION: Except for a statistically significanteffect of TESI on leg pain for patients with acute sciatica compared to usual care, there were no differences in co-primary outcomes. Nonetheless, transforaminal epidural injections seem to be associated with less opioid use, which warrants further exploration.