FORCEFUL EPIDURAL INJECTIONS FOR THE TREATMENT OF LUMBOSCIATIC PAIN WITH POSTOPERATIVE LUMBAR SPINAL FIBROSIS

Objective, To evaluate the efficacy of forceful epidural corticosteroi d injections in lumbosciatic pain ascribed to post-operative lumbar sp inal fibrosis. Method. Randomized controlled study comparing forceful injections via the sacral hiatus of 125 mg prednisolone acetate + 40 m l saline (treatment group) and injections via the same route of 125 mg prednisolone acetate alone (control group), Results were compared aft er six and 18 months, The main evaluation criterion was a subjective a ssessment of overall efficacy done by the patient using a seven-level scale, Results, After six months, the proportion of patients who were relieved of their sciatica was significantly higher in the forceful in jection group (n=29; 45%) than in the control group (n=31; 19%) (p=0.0 3), Success rates for low back pain were 29% and 6% in the forceful in jection and control groups, respectively, Among secondary efficacy cri teria, nerve root pain evaluated on a visual analog scale and by Schob er's index showed significantly greater improvement in the forceful in jection group than in the control group, After 18 months, results were still in favor of the forceful injection group, with success rates of 39% for the sciatica and 31% for the low back pain, The proportion of patients who returned to work was similar in the two groups. Conclusi on. Although mediocre overall, the results of forceful epidural cortic osteroid injections are better than those of simple epidural injection s of a corticosteroid alone. Given the paucity of effective treatments for lumbosciatic pain apparently due to postoperative fibrosis, force ful injections should be given a place in the treatment of this condit ion.