Use of Epidural Steroid Injections in the Management of Sciatica

Epidural steroid injection was first used for the §treatment of sciatica as far back as 1953. The §technique rapidly gained popularity and is still §frequently used for the managment of this form of §neuropathic pain. Despite the longevity and §widespread acceptance of this technique, there §remains a lack of solid evidence for efficacy. §Numerous clinical trials have been performed over §the years, but results have been inconsistant. §Indeed, even reviews of these trials have led to §differences in conclusions.§The object of this thesis was to review the evidence §available and ask three fundamental questions §relating to the use of epidural steroid injections §in the management of sciatica ie§1 - Is the effect of epidural steroid injections §dose related?§2 - Is the effect of epidural steroid due to direct §placement around epidual nerve roots or simply due §to systemic uptake from the vascular epidural space?§3 - Is the effect of epidural injections due to the §injectate simply washing intradiscal pro-§inflammatory cytokines away from nerve roots?§Conclusive answers to these questions could throw §further light on the efficacy of this technique.