Forceful sacrococcygeal injections in the treatment of postdiscectomy sciatica. A controlled study versus glucocorticoid injections

The role of epidural fibrosis in postoperative sciatica is unclear. Few the rapeutic trials have been published. We evaluated the mechanical effects of forceful saline injections through the sacrococcygeal hiatus comparatively with glucocorticoid injections. Patients and mehods. Forty-seven patients with postdiscectomy sciatica but no evidence of compression by computed tom ography or magnetic resonance imaging were included in a multicenter, rando mized, controlled, parallel-group study comparing forceful injections of sa line (20 ml) with or without prednisolone acetate (125 mg) to epidural pred nisolone acetate (125 mg) alone. Each of the three treatments was given onc e a month for three consecutive months. Outcome measures were pain severity on a Visual analog scale (VAS) and the scores on the Dallas algofunctional self-questionnaire on day 0, day 60, and day 120. Analysis of variance for repeated measures and Student's t test for paired series were used to eval uate the data. Results. Forty-seven patients were evaluated. The VAS scare improved significantly between day 0 and day 30 in the glucocorticoid group as compared to the forceful injection group (P = 0.01). No other significa nt differences were found across the groups. The VAS score improved steadil y in the forceful injection group, producing a nearly significant differenc e on day 120 as compared to baseline (P = 0.08). Conclusion. Forceful epidu ral injections produced a non-significant improvement in postdiscectomy sci atica four months after surgery. Epidural glucocorticoids used alone induce d short-lived pain relief. (C) 2001 Editions scientifiques et medicales Els evier SAS.