73 Characteristics of sciatica patients listed for an ultrasound guided epidural spinal injection and clinical outcomes

Stynes, S.; Daud, N.; Nagington, A.; Bourne, C.; Dennison, C.; Huckfield, L.; Morley-Williams, K.; Konstantinou, K.

Abstract

Purpose: Clinical guidelines recommend consideration of epidural steroid injection (ESI) for severe sciatica but there is uncertainty of effectiveness. ESI is any type of spinal injection (including local anaesthetic and corticosteroid) for disc-related sciatica and can be delivered via ultrasound, CT or fluoroscopic guidance. Here we describe characteristics and early clinical outcomes of patients from Midlands Partnership University NHS Foundation Trust who received an ultrasound-guided caudal ESI delivered by a spinal advanced practice physiotherapist in a Day Case Unit in a community hospital setting. The average waiting times from referral to injection is 4 weeks. This treatment is embedded in the Spinal Interface Service which is the ‘gatekeeper’ for referrals to secondary care, delivered by consultant and advanced practice physiotherapists, assessing over 7,000 patients per year.
Methods: Patients with sciatica listed for a caudal ESI were invited to take part. Participant baseline characteristics at time of referral for the ES and 6 weeks post ESI follow-up outcomes are presented. Outcomes include pain intensity (0-10 NRS), disability (Oswestry Disability index 0-100) and global change in symptoms.
Results: 98 patients were invited to participate, over 20 months, and 55 (56%) completed baseline questionnaires. Mean (SD) age 45.0 years (14.4), 60% female, and 46% (n=17) of those in work had certified time off for sciatica. Mean pain intensity was 7.8 (1.6) and 6.4 (2.6) for leg and back pain respectively, mean disability (ODI) 44.1 (17.4). 56% (n=31) had leg pain for >6 months. Average confidence at baseline (0 to 10) that the ESI would help their symptoms was 5.5 (1.9).
Outcomes analysis for 36 patients reaching 6-week follow-up shows mean leg and back pain intensity of 4.7 (2.9) and 4.5 (2.7) respectively and ODI of 33.3 (19.1), with 67% reporting improvement (completely recovered/much better/better).
Conclusion(s): This analysis shows that at 6 weeks post ultrasound-guided caudal ESI there is considerable reduction in leg pain and two-thirds of patients report recovery. These results support the use of ultrasound-guided caudal ESI, delivered by a spinal advanced practice physiotherapist in a well-supported setting outside secondary care, for the management of patients with severe sciatica who fit the criteria for a caudal ESI.
Impact: The patients described here are taking part in a larger multicentre POiSE prospective cohort study which is investigating predictors of outcome for sciatica patients following ESI at 6, 12 and 24 weeks.

Citation

Stynes, S., Daud, N., Nagington, A., Bourne, C., Dennison, C., Huckfield, L., Morley-Williams, K., & Konstantinou, K. (2024, October). 73 Characteristics of sciatica patients listed for an ultrasound guided epidural spinal injection and clinical outcomes. Poster presented at CSP Annual Conference 2024, Manchester, UK

• Presentation Conference Type: Poster
• Conference Name: CSP Annual Conference 2024
• Start Date: Oct 10, 2024
• End Date: Oct 12, 2024
• Acceptance Date: Mar 27, 2025
• Online Publication Date: Mar 27, 2025
• Deposit Date: Apr 9, 2025
• Journal: Physiotherapy
• Print ISSN: 0031-9406
• Electronic ISSN: 1873-1465
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 126
• Issue: S1
• Article Number: 101487
• Pages: 17-18
• DOI: https://doi.org/10.1016/j.physio.2025.101487
• Keywords: Epidural steroid injection, Sciatica, Clinical outcomes
• Public URL: https://keele-repository.worktribe.com/output/1192822
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0031940625000252?via%3Dihub
• Related Public URLs: https://www.sciencedirect.com/science/article/pii/S0031940625000252/pdfft?md5=db7472f9e7e76ae0ab3e59575ceae3f0&pid=1-s2.0-S0031940625000252-main.pdf