• S Rozenberg, G Dubourg, P Khalifa, L Paolozzi, E Maheu, and P Ravaud.
• Department of Rheumatology, Pitié Teaching Hospital, Paris, France.
• Rev Rhum Engl Ed. 1999 Feb 1; 66 (2): 79-85.

ObjectiveSeveral randomized trials have suggested recently that epidural steroid injections may not be a valid treatment in common low back pain and sciatica. To clarify this issue, we conducted a critical appraisal of relevant randomized trials published up to 1997. Attention was directed to methodological quality, results, and clinical implications.MethodA Medline search identified 13 trials published between 1966 and 1997. Trial methodology was evaluated using a 100-point grid based on four groups of items, namely study population, therapeutic intervention, evaluation method, and data presentation and analysis.ResultsMethodology quality scores ranged from 12 to 84 and were unrelated to the results of epidural steroid therapy. Five trials demonstrated greater pain relief within the first month in the steroid group as compared to the control group. Eight trials found no measurable benefits. Obstacles to meaningful comparisons across studies included differences in the patient populations, steroid used, volume injected, and number of injections. None of the published studies used the injection modalities that are standard practice in France.ConclusionWhether epidural steroids are effective in common low back pain and sciatica cannot be determined based on our review.

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