Efficacy of nerve root versus interspinous injections of glucocorticoids in the treatment of disk-related sciatica - A pilot, prospective, randomized, double-blind study

Study objectives. Pilot study comparing the short-term efficacy on pain and functional impairment of nerve root sheath versus interspinous glucocortic oid injections in patients admitted to a French rheumatology department for disk-related sciatica or femoral neuralgia. Patients and methods. Thirty p atients with refractory nerve root pain (sciatica, n = 29; femoral neuralgi a, n = Ij for a mean of four months were randomized to nerve root injection (n = 17) or interspinous injection (n = 13) of the same mixture of 0.10 g of lidocaine hydrochloride and 3.75 mg of cortivazol. Both injection method s were performed under analgesia and benzodiazepine sedation to maintain do uble blinding. Each patient was evaluated daily during the first seven days of bed rest in the hospital, then after discharge on postinjection day 28. Results. Prompt pain relief was obtained in both groups. On day 1,the mean pain scale scare (0-100) fell from 70 +/- 3.9 to 26+/-5.6 in the nerve roo t group and from 63 +/- 4 to 23 +/- 4.7 in the interspinous group. These re sults were sustained on D7 and D28. Conclusions. The unusually high level o f efficacy of glucocorticoid injection in our study may be ascribable in pa rt to strong placebo and Hawthorne effects and in part to the intrinsic eff ects of the injections. Whether nerve root injection is superior over inter spinous injection remains unproven. (C) Edition scientifiques et medicales Elsevier SAS.