Steroid vs saline injections for chronic radiculopathy

January 01, 0001

Steroid vs saline injections for chronic radiculopathy

This group of Norwegian, Danish, and Dutch researchers tested caudal epidural steroid or saline injections in chronic lumbar radiculopathy. They performed a multicentre, blinded, randomized controlled trial. Enrollees were randomized to two subcutaneous sham injections of 2 mL 0.9% saline, two caudal epidural injections of 30 mL 0.9% saline, or two caudal epidural injections of 40 mg triamcinolone acetonide in 0.9% saline. The patients’ pain and disability were measured with Oswestry disability index scores.

The researchers found: "All groups improved after the interventions, but we found no statistical or clinical differences between the groups over time. For the sham group (n=40), estimated change in the Oswestry disability index from the adjusted baseline value was -4.7 at 6 weeks, -11.4 at 12 weeks, and -14.3 at 52 weeks. For the epidural saline intervention group (n=39) compared with the sham group, differences in primary outcome were -0.5 at 6 weeks, 1.4 at 12 weeks, and -1.9 at 52 weeks. For the epidural steroid group (n=37), corresponding differences were -2.9, 4.0, and 1.9. Analysis adjusted for duration of leg pain, back pain, and sick leave did not change this trend."

The researchers concluded: "Caudal epidural steroid or saline injections are not recommended for chronic lumbar radiculopathy."

Neither steroid nor saline injections were significantly different from sham injections in chronic radiculopathy.

For the full abstract, click here.

BMJ 343:d5278, 8 September 2011 © 2011 BMJ Publishing Group Ltd.
Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial. Trond Iversen, consultant, Tore K Solberg, consultant, Bertil Romner, et al. Correspondence to T Iversen: [email protected]

Category: N. Neurological. Keywords: steroid, saline, triamcinolone, injections, radiculopathy, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 4 October 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

COVID-19 Resources

WONCA webinars, journal links and more

WONCA position statements

WONCA statements on a variety of issues

PEARLS

577 Individual behavioural counselling helps people to quit smoking 575 Antioxidant vitamin and mineral supplements may be beneficial in age-related macular degeneration 574 Oral antifungals effective for toenail onychomycosis 570 Decision aids beneficial for people facing health treatment or screening decisions 569 Computer-generated reminders on paper benefit quality of care