Brotis Alexandros G, Spiliotopoulos Theodosios, Kalogeras Adamantios, Fountas Kostas N, Demetriades Andreas K
University Hospital of Larissa, Larissa, Thessaly, Greece.
School of Health Sciences, University of Thessaly Volos, Thessaly, Greece.
Brain Spine. 2025 Mar 13;5:104216. doi: 10.1016/j.bas.2025.104216. eCollection 2025.
The role of epidural steroid injection in treating sciatica still remains debatable.
To compare epidural steroid injection with other manipulations in terms of pain control, quality of life and other parameters (Q1), compare the various available ESI alternatives regarding the approach (Q2), compare ESI to analgesia (Q3), identify the ideal ESI protocol (Q4), compare different guiding techniques (Q5) and determine the role of ESI as e predictive factor for the outcome.
This systematic review searched three databases from inception to February 2024. Independent reviewers assessed and gathered the data and also the quality of evidence was critically appreciated.
The systematic review included 72 randomized controlled trials 7701 patients. There was a big variation among the aim of the studies. ESI proved to surpass other conservative methods for treating sciatica, however it does not provide long-term results. US- guided as well asFL-guided ESI was proved to have superior results. On the other hand, the role of ESIs in predicting the requirement for surgery is understudied. Comparing the different approaches in ESI the TFESI proved mostly to have better results.Surgery still remains the method with the most instant results providing also long-term treatment.
ESI has superior results to other conservative treatment modalities for sciatica; However surgery seems to have more immediate effect and better long term outcome. Apart from different approaches, additional agents such as amitriptyline proved to have effect when administered additionally to ESI. More studies need to be conducted for ESI as a predictive factor for the outcome or need of surgery.
硬膜外类固醇注射治疗坐骨神经痛的作用仍存在争议。
比较硬膜外类固醇注射与其他治疗方法在疼痛控制、生活质量和其他参数方面的差异（问题1），比较各种可用的硬膜外类固醇注射替代方法在操作途径上的差异（问题2），比较硬膜外类固醇注射与镇痛治疗的差异（问题3），确定理想的硬膜外类固醇注射方案（问题4），比较不同的引导技术（问题5），并确定硬膜外类固醇注射作为手术结果预测因素的作用。
本系统评价检索了从起始到2024年2月的三个数据库。独立评审员评估并收集数据，同时严格评估证据质量。
该系统评价纳入了72项随机对照试验，共7701例患者。各研究的目的差异很大。硬膜外类固醇注射被证明优于其他治疗坐骨神经痛的保守方法，但不能提供长期效果。超声引导和荧光透视引导的硬膜外类固醇注射被证明效果更佳。另一方面，硬膜外类固醇注射在预测手术需求方面的作用研究不足。比较硬膜外类固醇注射的不同操作途径，经椎间孔硬膜外类固醇注射大多显示出更好的效果。手术仍然是见效最快且能提供长期治疗的方法。
硬膜外类固醇注射治疗坐骨神经痛的效果优于其他保守治疗方式；然而，手术似乎起效更快且长期效果更好。除了不同的操作途径外，如阿米替林等其他药物在与硬膜外类固醇注射联合使用时也被证明有效果。关于硬膜外类固醇注射作为手术结果或手术需求预测因素，还需要进行更多研究。
