Epidural steroid injections in lumbar disc herniation- Evidence synthesis from 72 randomised controlled trials (RCTs) and a total of 7701 patients

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine Pub Date : 2025-01-01 DOI:10.1016/j.bas.2025.104216

Alexandros G. Brotis , Theodosios Spiliotopoulos , Adamantios Kalogeras , Kostas N. Fountas , Andreas K. Demetriades

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引用次数: 0

Abstract

Introduction

The role of epidural steroid injection in treating sciatica still remains debatable.

Research question

To compare epidural steroid injection with other manipulations in terms of pain control, quality of life and other parameters (Q1), compare the various available ESI alternatives regarding the approach (Q2), compare ESI to analgesia (Q3), identify the ideal ESI protocol (Q4), compare different guiding techniques (Q5) and determine the role of ESI as e predictive factor for the outcome.

Material and methods

This systematic review searched three databases from inception to February 2024. Independent reviewers assessed and gathered the data and also the quality of evidence was critically appreciated.

Results

The systematic review included 72 randomized controlled trials 7701 patients. There was a big variation among the aim of the studies. ESI proved to surpass other conservative methods for treating sciatica, however it does not provide long-term results. US- guided as well asFL-guided ESI was proved to have superior results. On the other hand, the role of ESIs in predicting the requirement for surgery is understudied. Comparing the different approaches in ESI the TFESI proved mostly to have better results.Surgery still remains the method with the most instant results providing also long-term treatment.

Discussion and conclusions

ESI has superior results to other conservative treatment modalities for sciatica; However surgery seems to have more immediate effect and better long term outcome. Apart from different approaches, additional agents such as amitriptyline proved to have effect when administered additionally to ESI. More studies need to be conducted for ESI as a predictive factor for the outcome or need of surgery.

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硬膜外类固醇注射治疗腰椎间盘突出症——来自72项随机对照试验（RCTs）和7701例患者的证据综合

硬膜外类固醇注射在治疗坐骨神经痛中的作用仍有争议。研究问题：比较硬膜外类固醇注射与其他方法在疼痛控制、生活质量和其他参数方面的差异（Q1），比较各种可用的ESI替代方法（Q2），比较ESI与镇痛（Q3），确定理想的ESI方案（Q4），比较不同的指导技术（Q5），并确定ESI作为预后预测因素的作用。材料和方法本系统综述检索了从成立到2024年2月的三个数据库。独立的审稿人评估和收集了数据，证据的质量也得到了严格的评价。结果系统评价纳入72项随机对照试验7701例患者。这些研究的目的有很大的差异。事实证明，ESI治疗坐骨神经痛优于其他保守方法，但不能提供长期效果。超声引导下的ESI和荧光引导下的ESI均有较好的效果。另一方面，ESIs在预测手术需求方面的作用尚未得到充分研究。比较不同的ESI方法，以TFESI效果较好。手术仍然是最能立竿见影并提供长期治疗的方法。讨论与结论sesi治疗坐骨神经痛的效果优于其他保守治疗方式；然而，手术似乎有更直接的效果和更好的长期结果。除了不同的方法外，其他药物如阿米替林被证明对ESI额外使用有效果。ESI作为预后或手术需要的预测因素，需要进行更多的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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