Abstract
Study Design: A randomised, double-blind controlled trial.
Objectives: To determine the efficacy of corticosteroids in periradicular infiltration for radicular pain. We also examined prognostic factors in relation to the outcome of the procedure.
Summary of background data: Various studies have examined the therapeutic value of periradicular infiltration using treatment agents consisting of local anaesthetic and corticosteroids for radicular pain, secondary to lumbar disc herniation and spinal stenosis. There is currently no randomised trial to determine the efficacy of single injection of corticosteroids.
Methods: Eligible patients with radicular pain who had unilateral symptoms who failed conservative management were randomised for single double-blind injection with bupivicaine and methylprednisolone (b+s) or bupivicaine (b) only. Outcome measures include change in Oswestry Disability Index (ODI), change in Visual Analogue Score for back pain and leg pain (VAS), change in walking distance and patient’s subjective level of satisfaction of the outcome. Objective successful clinical outcome is defined as a change in 10% of ODI.
Results: We recruited 37 patients in the b+s group and 38 patients in the b only group. The follow up rate is 100%. 4 patients had early termination of the trial for discectomy and further rootblock. There is no statistically significant difference in the outcome measure between the groups at 3 months (change of the ODI [p=0.6], change in VAS [back pain, p=0.28, leg pain, p=0.95], change in walking distance [p=0.9]). 35% of patients in the b+s group and 55% in the b only group had a successful clinical outcome. Duration of symptoms has a statistically significant negative association with the change in ODI (p=0.03). No prognostic value is found in age, gender, pre-operative Modified Somatic Perception and Modified Zung Depression score.
Conclusion: Clinical improvement occurs in both groups of patients. However, corticosteroids do not provide additional benefit.
The abstracts were prepared by Editorial Secretary, Dr Charles Pither. Correspondence should be addressed to SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
