PMID- 33974132
OWN - NLM
STAT- MEDLINE
DCOM- 20211126
LR  - 20211126
IS  - 1432-0932 (Electronic)
IS  - 0940-6719 (Linking)
VI  - 30
IP  - 11
DP  - 2021 Nov
TI  - Epidural steroid compared to placebo injection in sciatica: a systematic review 
      and meta-analysis.
PG  - 3255-3264
LID - 10.1007/s00586-021-06854-9 [doi]
AB  - PURPOSE: The purpose of this systematic review and meta-analysis was to determine 
      whether epidural steroid injections (ESI) are superior to epidural or 
      non-epidural placebo injections in sciatica patients. METHODS: The PubMed, 
      Embase, Cochrane Library, and Web of science databases were searched for trials 
      comparing ESI to epidural or non-epidural placebo. Risk of bias was assessed 
      using the Cochrane RoB 2 tool. The primary outcome measures were pooled using a 
      random-effects model for 6-week, 3-month, and 6-month follow-up. Secondary 
      outcomes were described qualitatively. Quality of evidence was graded using GRADE 
      classification. RESULTS: Seventeen out of 732 articles were included. ESI was 
      superior compared to epidural placebo at 6 weeks (- 8.6 [- 13.4; - 3.9]) and 
      3 months (- 5.2 [- 10.1; - 0.2]) for leg pain and at 6 weeks for functional 
      status (- 4.1 [- 6.5; - 1.6]), though the minimally clinical important difference 
      (MCID) was not met. There was no difference in ESI and placebo for back pain, 
      except for non-epidural placebo at 3 months (6.9 [1.3; 12.5]). Proportions of 
      treatment success were not different. ESI reduced analgesic intake in some 
      studies and complication rates are low. CONCLUSION: The literature indicates that 
      ESI induces larger improvements in pain and disability on the short term compared 
      to epidural placebo, though evidence is of low to moderate quality and MCID is 
      not met. Strong conclusions for longer follow-up or for comparisons with 
      non-epidural placebo cannot be drawn due to general low quality of evidence and 
      limited number of studies. Epidural injections can be considered a safe therapy.
CI  - (c) 2021. The Author(s).
FAU - Verheijen, E J A
AU  - Verheijen EJA
AUID- ORCID: 0000-0001-9202-4496
AD  - Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 
      2300 RC, Leiden, The Netherlands. e.j.a.verheijen@lumc.nl.
AD  - Department of Neurosurgery, Spaarne Gasthuis Hospital, Haarlem/Hoofddorp, The 
      Netherlands. e.j.a.verheijen@lumc.nl.
FAU - Bonke, C A
AU  - Bonke CA
AD  - Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 
      2300 RC, Leiden, The Netherlands.
FAU - Amorij, E M J
AU  - Amorij EMJ
AD  - Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 
      2300 RC, Leiden, The Netherlands.
FAU - Vleggeert-Lankamp, C L A
AU  - Vleggeert-Lankamp CLA
AD  - Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 
      2300 RC, Leiden, The Netherlands.
AD  - Department of Neurosurgery, Spaarne Gasthuis Hospital, Haarlem/Hoofddorp, The 
      Netherlands.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20210511
PL  - Germany
TA  - Eur Spine J
JT  - European spine journal : official publication of the European Spine Society, the 
      European Spinal Deformity Society, and the European Section of the Cervical Spine 
      Research Society
JID - 9301980
RN  - 0 (Analgesics)
RN  - 0 (Steroids)
SB  - IM
MH  - Analgesics/therapeutic use
MH  - Humans
MH  - Injections, Epidural
MH  - Pain
MH  - *Sciatica/drug therapy
MH  - Steroids/therapeutic use
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Epidural steroid injection
OT  - Lumbar disc herniation
OT  - Lumbar radiculopathy
OT  - Placebo
EDAT- 2021/05/12 06:00
MHDA- 2021/11/27 06:00
CRDT- 2021/05/11 12:22
PHST- 2021/02/03 00:00 [received]
PHST- 2021/04/18 00:00 [accepted]
PHST- 2021/05/12 06:00 [pubmed]
PHST- 2021/11/27 06:00 [medline]
PHST- 2021/05/11 12:22 [entrez]
AID - 10.1007/s00586-021-06854-9 [pii]
AID - 10.1007/s00586-021-06854-9 [doi]
PST - ppublish
SO  - Eur Spine J. 2021 Nov;30(11):3255-3264. doi: 10.1007/s00586-021-06854-9. Epub 
      2021 May 11.