Management of lumbar nerve-root pain by intrathecal and epidural injections of depot methylprednisolone acetate.

Sciatica is one of the most incapacitating and difficult to treat of all benign pains. This is a report of the results of using epidural and intrathecal corticosteroids in depot form, methylprednisolone acetate (Depo-Medrol), in 108 patients who presented with a clinical diagnosis of acute lumbar disc prolapse and nerve-root pain. There was a 75% response rate in patients with less than four weeks of symptoms, whereas in patients with more than six weeks of symptoms the rate dropped to 43%. Patients with a high level of protein in their cerebrospinal fluid appeared to have a higher response rate. The treatment is most likely to be effective when the patient is male, the duration of symptoms is less than four weeks, and the patient has irritant rather than compressive neuropathy.