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Logo of brjgenpracThe British Journal of General Practice
Br J Gen Pract. 1999 January; 49(438): 57–61.
PMCID: PMC1313321

Conflicting conclusions from two systematic reviews of epidural steroid injections for sciatica: which evidence should general practitioners heed?


Systematic reviews and meta-analyses are becoming increasingly important in informing clinical practice and commissioning. Two systematic reviews of a treatment for low back pain and sciatica using epidural steroid injections, published in the same year, arrived at conflicting conclusions. Only one was reported in a digest for evidence-based medicine. This paper aims to find the reasons for the discordance between the reviews, and draw conclusions for users of reviews. Using comparative analysis of two published systematic reviews and their source material, it was found that the two reviews had the same overall aims and met the criteria for review methods. They differed in their choice of methods, including the judgement of quality of studies for inclusion and for summing-up evidence. Estimation of summary odds ratios in one review led to stronger conclusions about effectiveness. In conclusion, the choice of methods for systematic review may alter views about the current state of evidence. Users should be aware that systematic reviews include an element of judgement, whatever method is used.

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Selected References

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  • Thompson SG, Pocock SJ. Can meta-analyses be trusted? Lancet. 1991 Nov 2;338(8775):1127–1130. [PubMed]
  • Oxman AD, Cook DJ, Guyatt GH. Users' guides to the medical literature. VI. How to use an overview. Evidence-Based Medicine Working Group. JAMA. 1994 Nov 2;272(17):1367–1371. [PubMed]
  • Petticrew M, Kennedy SC. Detecting the effects of thromboprophylaxis: the case of the rogue reviews. BMJ. 1997 Sep 13;315(7109):665–668. [PMC free article] [PubMed]
  • Naylor CD. Meta-analysis and the meta-epidemiology of clinical research. BMJ. 1997 Sep 13;315(7109):617–619. [PMC free article] [PubMed]
  • Watts RW, Silagy CA. A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth Intensive Care. 1995 Oct;23(5):564–569. [PubMed]
  • McQuay HJ, Moore A. Epidural steroids for sciatica. Anaesth Intensive Care. 1996 Apr;24(2):284–285. [PubMed]
  • Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low-back pain and sciatica: a systematic review of randomized clinical trials. Pain. 1995 Dec;63(3):279–288. [PubMed]
  • Popiołek A, Domanik A, Mazurkiewicz G. Leczenie sterydowymi ostrzyknieciami nadoponowymi chorych z przewlekła rwa kulszowa w przebiegu dyskopatii. Neurol Neurochir Pol. 1991 Sep-Oct;25(5):640–646. [PubMed]
  • Czarski Z. Leczenie rwy kulszowej wstrzykiwaniem hydrokortyzonu i nowokainy do rozworu krzyzowego. Przegl Lek. 1965;21(7):511–513. [PubMed]
  • Rocco AG, Frank E, Kaul AF, Lipson SJ, Gallo JP. Epidural steroids, epidural morphine and epidural steroids combined with morphine in the treatment of post-laminectomy syndrome. Pain. 1989 Mar;36(3):297–303. [PubMed]
  • Serrao JM, Marks RL, Morley SJ, Goodchild CS. Intrathecal midazolam for the treatment of chronic mechanical low back pain: a controlled comparison with epidural steroid in a pilot study. Pain. 1992 Jan;48(1):5–12. [PubMed]
  • Yates DW. A comparison of the types of epidural injection commonly used in the treatment of low back pain and sciatica. Rheumatol Rehabil. 1978 Aug;17(3):181–186. [PubMed]
  • Cuckler JM, Bernini PA, Wiesel SW, Booth RE, Jr, Rothman RH, Pickens GT. The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. J Bone Joint Surg Am. 1985 Jan;67(1):63–66. [PubMed]
  • Mathews JA, Mills SB, Jenkins VM, Grimes SM, Morkel MJ, Mathews W, Scott CM, Sittampalam Y. Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. Br J Rheumatol. 1987 Dec;26(6):416–423. [PubMed]
  • Snoek W, Weber H, Jørgensen B. Double blind evaluation of extradural methyl prednisolone for herniated lumbar discs. Acta Orthop Scand. 1977;48(6):635–641. [PubMed]
  • Bush K, Hillier S. A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine (Phila Pa 1976) 1991 May;16(5):572–575. [PubMed]
  • Dilke TF, Burry HC, Grahame R. Extradural corticosteroid injection in management of lumbar nerve root compression. Br Med J. 1973 Jun 16;2(5867):635–637. [PMC free article] [PubMed]
  • Klenerman L, Greenwood R, Davenport HT, White DC, Peskett S. Lumbar epidural injections in the treatment of sciatica. Br J Rheumatol. 1984 Feb;23(1):35–38. [PubMed]
  • Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975 Sep;1(3):277–299. [PubMed]
  • Huskisson EC. Measurement of pain. Lancet. 1974 Nov 9;2(7889):1127–1131. [PubMed]
  • Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997 Sep 13;315(7109):629–634. [PMC free article] [PubMed]
  • Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, Truchon R, Parent F, Levésque J, Bergeron V, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med. 1997 Jun 5;336(23):1634–1640. [PubMed]
  • Ridley MG, Kingsley GH, Gibson T, Grahame R. Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Br J Rheumatol. 1988 Aug;27(4):295–299. [PubMed]
  • Béliveau P. A comparison between epidural anaesthesia with and without corticosteroid in the treatment of sciatica. Rheumatol Phys Med. 1971 Feb;11(1):40–43. [PubMed]

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