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Nerve-Root Injections for Lumbar Radicular Pain

Results from a recent randomized trial showed that epidural steroid injections did not change 1-year outcomes in patients with sciatica (JW Jul 1 1997, accession number 970613005, and N Engl J Med 1997; 336:1634). An alternative is selective nerve-root steroid injections, with placement of the injecting needle adjacent to the affected nerve-root under fluoroscopic guidance.

Researchers at Washington University in St. Louis enrolled 55 patients with lumbar radicular pain and radiographically confirmed nerve-root compression (by a herniated disc or foraminal stenosis). All participants had undergone at least 6 weeks of conservative therapy without benefit and had requested conventional surgical intervention; at this time, they were offered the alternative of enrolling in this double-blind study. Patients were randomized to receive a selective nerve-root injection with either bupivicaine alone or bupivicaine plus betamethasone; at the patients' request, up to 3 additional injections could be given. During an average follow-up of about 2 years, the proportion of patients opting to proceed with surgery was significantly lower in the steroid group than in the control group (29 percent vs. 67 percent).

Comment: Some key information is missing from this article, including the average duration of symptoms before enrollment and whether any demographic subgroups seemed more likely to respond. Nevertheless, the results suggest that nerve-root injection might be worthwhile before patients with lumbar radicular pain proceed to surgery. This interventional trial deserves to be repeated at other centers.

— AS Brett

Published in Journal Watch General Medicine December 26, 2000

Citation(s):

Riew KD et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. J Bone Joint Surg Am 2000 Nov 82-A 1589-1593.

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