Oral Steroids for Acute Radiculopathy Due to a Herniated Lumbar Disk – A Randomized Clinical Trial. Goldberg H, Firtch W, Tyburski M, et al. JAMA. 2015; 313(19): 1915-1923.
Submitted by Kenten P. Wang, DO, News Science Editorial Board
This randomized, double-blind, placebo-controlled clinical enrolled 269 adults with radicular pain below knee for 3 months or less and MRI evidence of herniated intervertebral disk. Participants were randomized in a 2:1 ratio to receive a 15-day course of oral prednisone (5 days each of 60 mg, 40 mg, and 20 mg) or matching placebo. Outcome measures included Oswestry Disability Index (ODI), change in lower extremity pain, SF-36, Physical Component Summary (PCS), Mental Component Summary (MCS), and spine surgery rate at 3 weeks and 1 year. Greater improvement was noted in ODI scores at 3 weeks and at 1 year in prednisone-treated compared to placebo-treated patients. Pain reduction at 3 weeks and 1 year also favored the prednisone group, but was much less robust. There were no differences in the surgery rates at 1 year follow up. Adverse events, none major, were more common in the prednisone group compared to the placebo group (49.2% vs 23.9%).
Comment: Acute lumbar radiculopathy due to intervertebral disk herniation is a common disorder that causes substantial pain and disability. Though spontaneous recovery occurs in most patients, epidural steroid injections and lumbar discectomy are commonly performed in patients with a chronic relapsing remitting course or in those who do not respond to conservative treatment. Despite conflicting evidence, ESI is performed frequently. Over the past 35 years, six trials have evaluated the use of non-epidural steroid in patients with sciatica and most of these studies did not find evidence of efficacy of the steroid treatment. In this trial, the authors found a small, statistically significant improvement in function at both 3 weeks and at 1 year. The use of prednisone did not decrease the likelihood of undergoing surgery and did not lead to significant pain improvement.
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