Efficacy of epidural steroids in low back pain and sciatica - A critical appraisal by a French task force of randomized trials

Objective. Several 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 rele vant randomized trials published up to 1997. Attention was directed to meth odological quality. results, and clinical implications. Method. A Medline s earch identified 13 trials published between 1966 and 1997. Trial methodolo gy was evaluated using a 100-point grid based on four groups of items, name ly study population, therapeutic intervention, evaluation method, and data presentation and analysis. Results. Methodology quality scores ranged from 12 to 84 and were unrelated to the results of epidural steroid therapy. Fiv e trials demonstrated greater pain relief within the first month in the ste roid group as compared to the control group. Fight trials found no measurab le benefits. Obstacles to meaningful comparisons across studies included di fferences in the patient populations, steroid used, volume injected. and nu mber of injections. None of the published studies used the injection modali ties that are standard practice in France. Conclusion. Whether epidural ste roids are effective in common low back pain and sciatica cannot be determin ed based on our review.