Epidural steroid compared to placebo injection in sciatica: a systematic review and meta-analysis

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 tr...

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Veröffentlicht in:European spine journal 2021-11, Vol.30 (11), p.3255-3264
Hauptverfasser: Verheijen, E. J. A., Bonke, C. A., Amorij, E. M. J., Vleggeert-Lankamp, C. L. A.
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container_end_page 3264
container_issue 11
container_start_page 3255
container_title European spine journal
container_volume 30
creator Verheijen, E. J. A.
Bonke, C. A.
Amorij, E. M. J.
Vleggeert-Lankamp, C. L. A.
description 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.
doi_str_mv 10.1007/s00586-021-06854-9
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J. A. ; Bonke, C. A. ; Amorij, E. M. J. ; Vleggeert-Lankamp, C. L. A.</creator><creatorcontrib>Verheijen, E. J. A. ; Bonke, C. A. ; Amorij, E. M. J. ; Vleggeert-Lankamp, C. L. A.</creatorcontrib><description>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.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-021-06854-9</identifier><identifier>PMID: 33974132</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Analgesics ; Clinical trials ; Epidural ; Medicine ; Medicine &amp; Public Health ; Meta-analysis ; Neurosurgery ; Pain ; Placebos ; Review Article ; Steroids ; Surgical Orthopedics ; Systematic review</subject><ispartof>European spine journal, 2021-11, Vol.30 (11), p.3255-3264</ispartof><rights>The Author(s) 2021</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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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. 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J. A.</au><au>Bonke, C. A.</au><au>Amorij, E. M. J.</au><au>Vleggeert-Lankamp, C. L. A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidural steroid compared to placebo injection in sciatica: a systematic review and meta-analysis</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2021-11-01</date><risdate>2021</risdate><volume>30</volume><issue>11</issue><spage>3255</spage><epage>3264</epage><pages>3255-3264</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33974132</pmid><doi>10.1007/s00586-021-06854-9</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-9202-4496</orcidid><oa>free_for_read</oa></addata></record>
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subjects Analgesics
Clinical trials
Epidural
Medicine
Medicine & Public Health
Meta-analysis
Neurosurgery
Pain
Placebos
Review Article
Steroids
Surgical Orthopedics
Systematic review
title Epidural steroid compared to placebo injection in sciatica: a systematic review and meta-analysis
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