Use of Epidural Steroid Injections in the Management of Sciatica

Epidural steroid injection was first used for the
treatment of sciatica as far back as 1953. The
technique rapidly gained popularity and is still
frequently used for the managment of this form of
neuropathic pain. Despite the longevity and
widespread acceptance of this technique, there
remains a lack of solid evidence for efficacy.
Numerous clinical trials have been performed over
the years, but results have been inconsistant.
Indeed, even reviews of these trials have led to
differences in conclusions.
The object of this thesis was to review the evidence
available and ask three fundamental questions
relating to the use of epidural steroid injections
in the management of sciatica ie
1 - Is the effect of epidural steroid injections
dose related?
2 - Is the effect of epidural steroid due to direct
placement around epidual nerve roots or simply due
to systemic uptake from the vascular epidural space?
3 - Is the effect of epidural injections due to the
injectate simply washing intradiscal pro-
inflammatory cytokines away from nerve roots?
Conclusive answers to these questions could throw
further light on the efficacy of this technique.

Autorentext

Michael Stafford, a graduate of the Queen's University, Belfast is a consultant in anaesthesia and pain management at the Ulster Hospital, Belfast. After a fellowship in pain management in Toronto, he was awarded a Medical Doctorate in 2004 and a fellowship of the Faculty of Pain Management (College of Anaesthetists, Ireland) in 2008.

Klappentext

Epidural steroid injection was first used for the treatment of sciatica as far back as 1953. The technique rapidly gained popularity and is still frequently used for the managment of this form of neuropathic pain. Despite the longevity and widespread acceptance of this technique, there remains a lack of solid evidence for efficacy. Numerous clinical trials have been performed over the years, but results have been inconsistant. Indeed, even reviews of these trials have led to differences in conclusions.The object of this thesis was to review the evidence available and ask three fundamental questions relating to the use of epidural steroid injections in the management of sciatica ie1 - Is the effect of epidural steroid injections dose related?2 - Is the effect of epidural steroid due to direct placement around epidual nerve roots or simply due to systemic uptake from the vascular epidural space?3 - Is the effect of epidural injections due to the injectate simply washing intradiscal pro-inflammatory cytokines away from nerve roots?Conclusive answers to these questions could throw further light on the efficacy of this technique.