EFFICACY OF EPIDURAL STEROID INJECTIONS FOR LOW-BACK-PAIN AND SCIATICA - A SYSTEMATIC REVIEW OF RANDOMIZED CLINICAL-TRIALS

The purpose of the study was to assess the efficacy of epidural steroi d injections for low-back pain. Data was obtained using computer-aided search of published randomized clinical trials and assessment of the methods of the studies. Twelve randomized clinical trials evaluating e pidural steroid injections were identified. Data was extracted based o n scores for quality of the methods, using 4 categories (study populat ion, interventions, effect measurement, and data presentation and anal ysis) and the conclusion of the author(s) with regard to the efficacy of epidural steroid injections. Method scores of the trials ranged fro m 17 to 72 points (maximum 100 points). Eight trials showed method sco res of 50 points or more. Of the 4 best studies (> 60 points), 2 repor ted positive outcomes and 2 reported negative results. Overall, 6 stud ies indicated that the epidural steroid injection was more effective t han the reference treatment and 6 reported it to be no better or worse than the reference treatment. There appeared to be no relationship be tween the methodological quality of the trials and the reported outcom es. In conclusion, there are flaws in the design of most studies. The best studies showed inconsistent results of epidural steroid injection s. The efficacy of epidural steroid injections has not yet been establ ished. The benefits of epidural steroid injections, if any, seem to be of short duration only. Future research efforts are warranted, but mo re attention should be paid to the methods of the trials.