Bottom line:
- TFESI (Transforaminal steroid injections) should be considered as a first invasive treatment option
- Surgery is unlikely to be a cost-effective alternative to TFESI
Analysis
- Number of Patients
- 163 patients enrolled
- Number of Centres Participating
- 11 spinal units across the UK
- Treatment Arms
- Transforaminal epidural steroid injection (TFESI)
- Surgical microdiscectomy
- Inclusion Criteria
- Aged 16–65 years
- MRI-confirmed sciatica secondary to herniated lumbar disc
- Symptoms duration between 6 weeks and 12 months
- Leg pain not responsive to non-invasive management
- Exclusion Criteria
- Emergency cases like significant ankle weakness or cauda equina syndrome
- Far lateral disc prolapses
- Primary Outcome
- Oswestry Disability Questionnaire (ODQ) score at 18 weeks
- Results: No significant difference between TFESI and surgery
- Secondary Outcomes
- ODQ score at weeks 30, 42, and 54
- Numerical rating scores for leg and back pain
- Likert Scale for patient treatment satisfaction
- Modified Roland-Morris outcome score for sciatica
- Core Outcome Measures Index (COMI) score
- Results: Similar improvements in both groups
- Surgery was associated with more serious adverse events and higher costs than TFESI.
- Conclusions
- TFESI should be considered as a first invasive treatment option
- Surgery is unlikely to be a cost-effective alternative to TFESI
Pros and Cons
- Pros: High-quality evidence supporting a stepwise treatment framework
- Cons: Limited by the number of participants and potential for missing data
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