• Antje Spijker-Huiges, Karin Vermeulen, Jan C Winters, Marten van Wijhe, and Klaas van der Meer.
• Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: a.spijker-huiges@umcg.nl.
• Arch Phys Med Rehabil. 2015 Mar 1;96(3):381-7.

ObjectiveTo investigate the effect of adding segmental epidural steroid injections (SESIs) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome (LRS) in general practice.DesignA pragmatic randomized controlled trial. Results were analyzed using mixed models.SettingPrimary care.ParticipantsPatients (N=50) in the acute phase of LRS.InterventionsOne epidural injection containing 80mg of triamcinolone in normal saline.Main Outcome MeasureBack pain at 4 weeks after the start of the treatment.ResultsBoth groups experienced a significant increase in quality of life in (especially) the physical domains of the Medical Outcomes Study 36-Item Short-Form Health Survey. The intervention group scored significantly better than the control group at certain time points in the physical domain. The differences were small. The cost-utility analysis showed that with a negligible loss of utility (3d in perfect health), societal costs (193,354 euros per quality-adjusted life year lost) would be saved because of more productivity in the intervention group.ConclusionsAlthough the beneficial effects of SESIs are small and the natural course of LRS is predominantly favorable, we think decision makers can consider implementing SESIs in daily practice with the purpose of saving resources. Caution must be taken, and further research should be directed at identifying patient subgroups who might benefit from SESIs, with additional focus on (costs of) complications and adverse effects.Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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