A rational approach to the use of epidural medication in the treatment of sciatic pain.

The results of a series of 120 epidural injections given as treatment for backache and sciatica using Methylprednisolone and local anaesthetic, performed in the Gloucestershire area, are presented and compared with other published results. Wide variations in the results of this treatment are found and these may in part be explained on the basis of the variable severity of the histological changes known to occur in and around nerve roots in cases of sciatica. The pathogenesis of sciatica in lumbar disc disease is discussed in relation to its treatment by epidural injections of a long-acting steroid. It is shown that the treatment is more successful in acute onset cases and cases that have epidurals within 6 months of the onset of symptoms and it is suggested that earlier epidurals are given in cases that do not respond to the usual conservative measures. Manipulation of the spine and sciatic stretch should not be carried out at the same time as the epidural, as these procedures may adversely affect the results in some cases and certainly tend to make them more difficult to assess.