Abstract
Background: Nerve Root pain is a problem caused by mechanical compression from disc herniation or foraminal stenosis, which stimulates an inflammatory response. We present a review of the evidence for corticosteroid infiltration in nerve root infiltration (NRI).
Methods: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised controlled trials of the use of NRI in the treatment of radicular pain. For the purpose of this meta-analysis, the control group “no steroid” was chosen to encompass various subtypes. The primary outcomes were Oswestry Disability Scores (ODI) and Visual Analogue Scores (VAS) for pain. Outcomes were compared at 3 and 6 months from injection. For the purpose of the meta-analysis, repeat injection and progression to surgery are grouped as a composite endpoint.
Results: We identified 96 papers; but only 5 RCT’s which included 402 patients receiving NRI; 202 were randomised to receiving steroids. No trials reported significant intergroup differences in baseline VAS or ODI.
At 3 months there was no significant difference in VAS or ODI between the groups. Only two trials reported ODI data at 6 months but a significant effect in favour of the control arm was noted (P = 0.040). Four of the five trials reported the need for further injection or surgery due to failure but no significant difference between the groups was found (P = 0.038).
Conclusion: Our analysis suggests that the addition of steroids to local anaesthetic agents or placebo solutions confers no additional benefit, but the theoretical risk of infection. Further information is needed on hospital stay, economic and long term responses, and is required to counter confounding with small trials and study numbers, and any methodological heterogeneity.
Correspondence should be addressed to BASS/BCSS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
