Epidural application of cortico-steroids in low-back pain and sciatica

Abstract

Seven women and nine men, aged 27-59 years (mean 45), with lumbar pain and sciatica had epidural blocks once with 80 mg of depo-medrol and lidocaine in individual doses. All had static and kinetic lumbar pain up to 16 years and all but four also pain radiating to the lower limbs. Radiculography was "negative" in all patients, but three exhibited minor neurological abnormalities. Five patients had had a lumbar hemilaminectomy previously. In case of segmental pain in the lower limbs the appropriate level was used, in all other patients injection was done in L3-4 interspace. By means of a visual analogous scale 10 patients (62%) stated relief of half the pain the following day. One month later only 7 patients (43%) stated relief of one third of the pain. Only one patient benefited ultimately (after 6 months). In the remainder complaints were unaffected by the epidural injection. These discouraging results are not compatible with other reports, and a planned double-blind randomized investigation was abandoned. For the present category of patients (long-lasting complaints, previous "disc" operations) we found the epidural steroid injection useless.