Epidurography in the management of sciatica

Fifty consecutive patients starting treatment for sciatica with epidural injections of steroid and local anaesthetic underwent concomitant epidurography. The prognostic potential of this combination was investigated. Epidurography was confirmed as a safe out-patient procedure. Incorrect needle siting accounted for five total and two partial failures. The procedure was found to be a sensitive investigation, 36 showing definite abnormalities. It was of particular value in the diagnosis of lateral canal stenosis. However, it was found to have no prognostic value. For 12 of 16 patients requiring invasive therapy, it was considered that epidurography would have obviated later radiculography had the results been known. It is suggested that the combination of this out-patient investigation with the last of three epidural anaesthetic injections in patients whose symptoms persist, represents an improvement in management both financially and in terms of patient convenience.