Epidural steroids, etanercept, or saline in subacute sciatica: a multicenter, randomized trial.

Area of Science:

• Pain Management
• Spinal Injections
• Neurology

Background:

• Lumbosacral radiculopathy treatment is evolving, with interest in alternatives to epidural steroid injections.
• Perineural inhibitors of tumor necrosis factor (TNF) are being explored for managing radicular pain.
• Epidural steroid injections (ESIs) are a common treatment for lumbosacral radiculopathy.

Purpose of the Study:

• To compare the efficacy of epidural steroids, etanercept, and saline in improving pain and function for adults with lumbosacral radiculopathy.
• To evaluate pain reduction and functional capacity changes following two weeks apart epidural injections.
• To assess patient-reported outcomes including leg pain, back pain, and global perceived effect.

Main Methods:

• A multicenter, randomized, placebo-controlled trial involving 84 adults with lumbosacral radiculopathy.
• Participants received two epidural injections of steroids, etanercept, or saline, separated by two weeks.
• Blinding of patients, physicians, and outcome assessors was maintained throughout the study.

Main Results:

• Epidural steroids showed a trend towards greater leg pain reduction compared to saline and etanercept, though not statistically significant.
• Etanercept was associated with significantly worse functional capacity outcomes compared to both epidural steroids and saline.
• At one month, a higher percentage of patients receiving epidural steroids reported significant leg pain relief and positive global perceived effect.

Conclusions:

• Epidural steroid injections may offer modest short-term pain relief for lumbosacral radiculopathy.
• The study suggests potential limitations including short follow-up, small sample size, and possibly subtherapeutic etanercept dosage.
• Larger studies with longer follow-up are required to definitively establish the benefits of epidural steroid injections for this condition.