Annals of rheumatic Diseases & American College of Rheumatology (2003)

 “Steroid injections, though widely used in clinical practice for sciatic/HNP for over 50 years provide no additional benefit vs. saline solution. The natural history of sciatica is such that most patients improve over time, which may hide the treatment effect”.

The prevalence of prolapsed disc is 1%-3%. Sciatic due to herniation resolves within one month in up to 70% of patients and within one year in 90% according to these studies. Surgery should be reserved for the very small minority who do not show response within the expected parameters.

The widespread use and reliance on steroid injections shouldn’t be confused with the effectiveness of such injections. Cochrane reviews suggest a small-to-modest effect but as is noted the natural history vs. treatment effect is always difficulty to factor out (the so-called regressive analysis).

We all have sent patients to the pain management centers for fluoroscope injections and at times they clearly “appear” to work…and at other times the patient continues with our treatment.

Recent studies cast doubt on Medrol dose packs and these studies cast doubt on injections.

Laser, decompression, spinal adjusting and core-control are still the best, most advantageous approach for most patients.