Comparison of epidural steroid injections with conservative management in patients with lumbar radiculopathy

ABSTRACT

To determine the difference in short- and long-term pain improvement between lumbar Epidural Steroid Injections [ESIs] and conservative management in patients with lumbar radiculopathy. Quasi-experimental study. The Postgraduate Medical Institute of Hayatabad Medical Complex, Peshawar, from April 2005 to March 2007. Fifty elective patients fulfilling the inclusion criteria were randomly divided into two groups. Patients in the steroid group were treated with 80 mg of methylprednisolone injected in combination with 3 ml of 2% plain xylocaine and 3 ml of normal saline in the lumbar epidural space, while patients in the conservative group were treated with bed rest, non-steroidal anti-inflammatory agents, muscle relaxants, and opioids. All the 50 patients in the two groups were regularly assessed at 2 weeks, 1 month, 3 months and 6 months of periods for pain score by the Visual Analogue Scale [VAS], patients satisfaction score and any unwanted side effects. A marked improvement of the pain score and patients satisfaction score were noticed in the steroid group. Less significant improvement was seen in the conservative group during the initial period i.e 2 weeks and 1 month [p <0.05]. The difference in Visual Analogue Scale [VAS] and patients satisfaction score was non-significant in chronic stages of treatment in both groups [p > 0.05]. Epidural steroid injections in acute symptoms of sciatica are considered to be a better option compared to conservative treatment