Article

Corticosteroids* Administered Intradurally for Relief of Sciatica

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Abstract

IT has been shown that 58 per cent of patients with sciatica due to extradural adhesions may be benefited by hydrocortisone in one per cent procaine hydrochloride solution injected into the epidural space via the sacral hiatus.1 This injection is accompanied by straight-leg raising exercises designed to mobilize the nerve roots. When this extradural treatment fails, or in cases where the causative lesion is known or presumed to be in the subarachnoid space, we have injected corticosteroids intradurally by lumbar puncture. The early results have been encouraging.

Material

Thirty-six patients with sciatica have received intradural (subarachnoid) injections of corticosteroids. The average duration of sciatica was three and one-half years, and all required analgesics for pain. Twenty-nine patients had one or more myelograms prior to the treatment, and in five a second myelogram was followed by an immediate and continuing increase of pain. Twenty-eight patients had undergone one or more laminectomies, twenty-five had received extradural injections of hydrocortisone in procaine, two had received corticotropin (ACTH) intravenously, and five had received corticosteroids orally—all with little or no benefit. In eight patients, arachnoiditis was confirmed at operation before the intradural injections were given.

After a preliminary trial of corticosteroids in other forms, methylprednisolone acetate was selected as the least irritating and longest acting preparation for subarachnoid administration.

Method

With the patient lying on his side, lumbar puncture is performed, and from 40 to 80 mg. of methylprednisolone acetate is injected (Fig. 1). If the patient’s pain is aggravated by straight-leg raising, 50 . . .


 

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