A new review evaluated the efficacy of epidural corticoste-roid injections in treating sciatica. Researchers analyzed 25 reports of 23 randomized controlled trials comparing these injections with placebo. The corticosteroids studied were methylprednisolone, prednisone-prednisolone, triamcin-olone, and betamethasone, administered through the transforaminal, caudal, or-most often-interlaminar route. Study populations included patients with acute, subacute, and chronic symptoms.

To determine the short-term efficacy of epidural corticosteroid injections on leg pain, the authors analyzed data on 1,316 patients from 14 studies and found that corticosteroids were significantly more effective than placebo. Similarly, data from 10 studies involving 1,154 patients showed a significant short-term benefit of corticosteroids on disability. In contrast, analysis of six studies involving 723 patients showed no short-term benefit on back pain.

The authors also examined long-term effects and found corticosteroids not to be beneficial over the long term for leg pain, back pain, or disability. They drew this conclusion from seven studies of patients with leg pain (n = 714), three studies of patients with back pain (n = 453), and six trials of patients with disability (n = 691).

Based on the data from the chosen high-quality studies, the authors concluded that epidural corticosteroid injections offer only small, short-term benefits for leg pain and disability. These limited benefits were below the thresholds for clinically significant change in pain or disability. Also, the route of epidural administration had no effect on short-term pain reduction.

The authors conclude that the limited short-term benefit provided by epidural corticosteroid injections for leg pain and disability may not be substantial enough to warrant use of this treatment.

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