Abstract
Objective: The aim of this study is to evaluate the efficacy of the different types of epidural injections (EI) to prevent surgical intervention in patients suffering from chronic sciatica due to lumbar disc herniation (LDH).Material and Methods: Studies were identified by searching PubMed, MEDLINE, and Google Scholar to retrieve all available relevant articles. Lists of references of several systematic reviews were also used for scanning further references. Publications from the past ten years (2006-2016) were considered, and all studies selected were in the English language only. The studies employed specified the use of EI to treat sciatica caused by LDH. A total of 19 papers meeting the eligibility criteria (mentioned below) were included in this study. The pain scores, functional disability scores, and surgical rates from these studies were considered, and meta-analysis was performed.Outcome measures: Pain scores, functional disability scores, and surgical rates were assessed from the included studies. The Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS) have been the most commonly used baseline scales for pain evaluation followed by the Verbal Numerical Rating Scale (VNRS) and Japanese Orthopedic Association (JOA). The Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) scales were used for the functional disability scoring system in the literature.Results: Significant improvement in the pain scores and functional disability scores were observed. Additionally, greater than 80% of the patients suffering from chronic sciatica caused by LDH could successfully prevent surgical intervention after EI treatment with or without steroids.Conclusion: The management of sciatica with EI treatment results in significant improvements in the pain score, functional disability score, and surgical rate. We concluded that EI provides new hope to prevent surgical intervention in patients suffering from sciatica caused by LDH.
Highlights
Medical literature refers to sciatica as a lumbosacral radicular syndrome, lumbar radiculopathy, nerve root pain, and nerve root entrapment/irritation
Greater than 80% of the patients suffering from chronic sciatica caused by lumbar disc herniation (LDH) could successfully prevent surgical intervention after epidural injections (EI) treatment with or without steroids
We aimed to update the literature on the potential role of EI in preventing surgical intervention based on outcome measures assessment after treatment with EI for sciatica or radiculitis caused by LDH
Summary
Medical literature refers to sciatica as a lumbosacral radicular syndrome, lumbar radiculopathy, nerve root pain, and nerve root entrapment/irritation. It is characterized by pain radiating from the back into the leg [1,2,3]. It is a common and debilitating symptom rather than a specific diagnosis. It may be caused by lumbar disc herniation (LDH), lumbar canal or foraminal stenosis, and or inflammatory processes around the nerve root [4]. The sciatica is reported in 1-2% of these cases; LDH has been reported to occur in 90% [7]
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