OUTPATIENT LUMBAR EPIDURAL CORTICOSTEROID INJECTION IN THE MANAGEMENT OF SCIATICA

The value of epidural injections of corticosteroid as an outpatienttreatment of sciatica has been hitherto uncertain. An epiduralinjection of 80 mg methylprednisolone in 10 ml physiologicalsaline was compared with an interspinous injection of 2 ml physiologicalsaline in a double blind fashion amongst 39 outpatients. Significantdifferences of pain relief were seen between the two groupswithin 2 weeks. This benefit disappeared for six (35%) patientswithin 6 months of treatment although 11 (65%) successfullytreated subjects had sustained improvement up to this time.Outpatient epidural injections of corticosteroid are thus auseful short-term means of relieving pain in sciatica but probablyhave little effect on the long-term natural history of symptoms.Factors associated with a failure to respond to epidural steroidinjections are discussed. KEY WORDS: Nerve root, Disc prolapse, Methylprednisolone, Pain relief ^* Present address: Department of Rheumatology, St Thomas' Hospital,London, SE1.