Transforaminal Epidural Injection in Acute Sciatica

NCT ID: NCT03924791

Last Updated: 2023-10-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

142 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-06-01

Study Completion Date

2026-07-31

Brief Summary

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Patients suffering from sciatica are treated conservatively for the first 8 weeks due to the favourable prognosis. This period is preferably extended up to 14-16 weeks after which patients may opt for surgery. However, patients may experience severe discomfort due to pain in the leg which can lead to decreased physical activity and socio-economic problems. An adequate therapy to alleviate symptoms during this period of 'wait-and-see' is lacking. In this study, patients will be randomized to treatment with transforaminal epidural injections or standard oral pain medication.

Detailed Description

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Sciatica is a condition of radicular pain in the leg and is usually caused by herniation of a lumbar intervertebral disc. The herniated disc compresses a lumbar nerve root that continues its route into the sciatic nerve. About 13% to 40% of all people will suffer from sciatica at least once during their lifetime. Sciatica can have severe socio-economic effects; patients are immobilised by the pain they experience and therefore cannot go to work or participate in social events. Most cases resolve spontaneously with conservative therapy using only standard analgesics and/or physiotherapy. In a large RCT it was demonstrated that outcome of conservative and surgical therapy was comparable after 26 weeks. With this knowledge the guidelines for surgical treatment of sciatica were adjusted and it is nowadays usual care to offer surgery only after at least 8 weeks of conservative care and preferably after 14-16 weeks of conservative care. This decision is made together with the patient in a process of Shared Decision making. Although this treatment regimen has been demonstrated to be efficacious and cost effective, the burden for a patient during these weeks of conservative care is usually high. The investigators seek to find a type of conservative care to reduce the discomfort due to the pain and to enable the patient to remain physically active. Not only will this add to the quality of life of the patient, but it will also prevent the patient from taking a sick-leave. In this study, patients will be randomized to either treatment with transforaminal epidural injections or to standard care consisting of oral pain medication.

Conditions

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Sciatica Sciatica Due to Intervertebral Disc Disorder Sciatic Radiculopathy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomized to either treatment with transforaminal epidural injection or standard oral pain medication.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Since masking is not possible for treatment with injections and oral pain medication, this is an open-label study. Outcomes are assessed by patients through online questionnaires and therefore the outcome assessor is not masked as well.

Study Groups

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Transforaminal Epidural Injection

Transforaminal Epidural Injection containing 1,5 mL lidocaine 2% and 40mg methylprednisolone acetate for injections L3 or below Transforaminal Epidural Injection containing 1,5 mL lidocaine 1% and 10mg dexamethasone for injections above L3

Group Type EXPERIMENTAL

Lidocaine

Intervention Type DRUG

In combination with dexamethasone or methylprednisolone acetate

Methylprednisolone Acetate

Intervention Type DRUG

In combination with lidocaine

Dexamethasone

Intervention Type DRUG

In combination with lidocaine

Oral pain medication

Patients will receive oral pain medication according to general practitioner guidelines.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Lidocaine

In combination with dexamethasone or methylprednisolone acetate

Intervention Type DRUG

Methylprednisolone Acetate

In combination with lidocaine

Intervention Type DRUG

Dexamethasone

In combination with lidocaine

Intervention Type DRUG

Other Intervention Names

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Depo-Medrol

Eligibility Criteria

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Inclusion Criteria

* Diagnosed with sciatica by GP
* NRS leg pain of 6 or more on a 10-point NRS scale
* Minimum duration of symptoms of 3 weeks and maximum duration of 8 weeks

Exclusion Criteria

* Age under 18 years
* Condition preventing to receive transforaminal epidural injection
* Severe scoliosis
* Transforaminal epidural injection received in 6 months before randomization date
* Surgery for sciatica at the same level
* Surgery for sciatica at another level within one year before inclusion
* Pregnancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Spaarne Gasthuis

OTHER

Sponsor Role collaborator

Stichting Achmea Gezondheidszor

OTHER

Sponsor Role collaborator

Posthumus Meyjes Fonds

UNKNOWN

Sponsor Role collaborator

C.L.A.Vleggeert-Lankamp

OTHER

Sponsor Role lead

Responsible Party

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C.L.A.Vleggeert-Lankamp

Dr. C.L.A. Vleggeert-Lankamp

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Carmen LA Vleggeert-Lankamp, MD Msc Ph.D

Role: PRINCIPAL_INVESTIGATOR

Leiden University Medical Center

Locations

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Spaarne Gasthuis

Haarlem, , Netherlands

Site Status RECRUITING

Spaarne Gasthuis

Hoofddorp, , Netherlands

Site Status RECRUITING

Countries

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Netherlands

Central Contacts

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Carmen LA Vleggeert-Lankamp, MD Msc Ph.D

Role: CONTACT

+31715262109

Eduard JA Verheijen, Bsc

Role: CONTACT

+31715262109

Facility Contacts

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Carmen Vleggeert-Lankamp, M.D. Ph.D

Role: primary

Carmen Vleggeert-Lankamp, M.D. Ph.D

Role: primary

References

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Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW; Leiden-The Hague Spine Intervention Prognostic Study Group. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007 May 31;356(22):2245-56. doi: 10.1056/NEJMoa064039.

Reference Type BACKGROUND
PMID: 17538084 (View on PubMed)

Hofstede SN, van Bodegom-Vos L, Wentink MM, Vleggeert-Lankamp CL, Vliet Vlieland TP, Marang-van de Mheen PJ; DISC study group. Most important factors for the implementation of shared decision making in sciatica care: ranking among professionals and patients. PLoS One. 2014 Apr 7;9(4):e94176. doi: 10.1371/journal.pone.0094176. eCollection 2014.

Reference Type BACKGROUND
PMID: 24710328 (View on PubMed)

Joswig H, Neff A, Ruppert C, Hildebrandt G, Stienen MN. The Value of Short-Term Pain Relief in Predicting the Long-Term Outcome of Lumbar Transforaminal Epidural Steroid Injections. World Neurosurg. 2017 Nov;107:764-771. doi: 10.1016/j.wneu.2017.08.055. Epub 2017 Aug 23.

Reference Type BACKGROUND
PMID: 28838872 (View on PubMed)

Spijker-Huiges A, Vermeulen K, Winters JC, van Wijhe M, van der Meer K. Epidural steroids for lumbosacral radicular syndrome compared to usual care: quality of life and cost utility in general practice. Arch Phys Med Rehabil. 2015 Mar;96(3):381-7. doi: 10.1016/j.apmr.2014.10.017. Epub 2014 Nov 8.

Reference Type BACKGROUND
PMID: 25448243 (View on PubMed)

Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am. 1991 Apr;22(2):181-7.

Reference Type BACKGROUND
PMID: 1826546 (View on PubMed)

Takahashi H, Suguro T, Okazima Y, Motegi M, Okada Y, Kakiuchi T. Inflammatory cytokines in the herniated disc of the lumbar spine. Spine (Phila Pa 1976). 1996 Jan 15;21(2):218-24. doi: 10.1097/00007632-199601150-00011.

Reference Type BACKGROUND
PMID: 8720407 (View on PubMed)

El Barzouhi A, Vleggeert-Lankamp CL, Lycklama A Nijeholt GJ, Van der Kallen BF, van den Hout WB, Verwoerd AJ, Koes BW, Peul WC; Leiden-The Hague Spine Intervention Prognostic Study Group. Magnetic resonance imaging interpretation in patients with sciatica who are potential candidates for lumbar disc surgery. PLoS One. 2013 Jul 10;8(7):e68411. doi: 10.1371/journal.pone.0068411. Print 2013.

Reference Type BACKGROUND
PMID: 23874616 (View on PubMed)

Verwoerd AJ, Peul WC, Willemsen SP, Koes BW, Vleggeert-Lankamp CL, el Barzouhi A, Luijsterburg PA, Verhagen AP. Diagnostic accuracy of history taking to assess lumbosacral nerve root compression. Spine J. 2014 Sep 1;14(9):2028-37. doi: 10.1016/j.spinee.2013.11.049. Epub 2013 Dec 8.

Reference Type BACKGROUND
PMID: 24325881 (View on PubMed)

el Barzouhi A, Vleggeert-Lankamp CL, Lycklama a Nijeholt GJ, Van der Kallen BF, van den Hout WB, Koes BW, Peul WC; Leiden-The Hague Spine Intervention Prognostic Study Group. Reliability of gadolinium-enhanced magnetic resonance imaging findings and their correlation with clinical outcome in patients with sciatica. Spine J. 2014 Nov 1;14(11):2598-607. doi: 10.1016/j.spinee.2014.02.028. Epub 2014 Feb 21.

Reference Type BACKGROUND
PMID: 24561397 (View on PubMed)

el Barzouhi A, Vleggeert-Lankamp CL, Lycklama a Nijeholt GJ, Van der Kallen BF, van den Hout WB, Koes BW, Peul WC; Leiden-The Hague Spine Intervention Prognostic Study Group. Influence of low back pain and prognostic value of MRI in sciatica patients in relation to back pain. PLoS One. 2014 Mar 17;9(3):e90800. doi: 10.1371/journal.pone.0090800. eCollection 2014.

Reference Type BACKGROUND
PMID: 24637890 (View on PubMed)

Verwoerd AJH, Mens J, El Barzouhi A, Peul WC, Koes BW, Verhagen AP. A diagnostic study in patients with sciatica establishing the importance of localization of worsening of pain during coughing, sneezing and straining to assess nerve root compression on MRI. Eur Spine J. 2016 May;25(5):1389-1392. doi: 10.1007/s00586-016-4393-8. Epub 2016 Feb 2.

Reference Type BACKGROUND
PMID: 26842881 (View on PubMed)

El Barzouhi A, Verwoerd AJ, Peul WC, Verhagen AP, Lycklama A Nijeholt GJ, Van der Kallen BF, Koes BW, Vleggeert-Lankamp CL; Leiden-The Hague Spine Intervention Prognostic Study Group. Prognostic value of magnetic resonance imaging findings in patients with sciatica. J Neurosurg Spine. 2016 Jun;24(6):978-85. doi: 10.3171/2015.10.SPINE15858. Epub 2016 Feb 12.

Reference Type BACKGROUND
PMID: 26871651 (View on PubMed)

Katz NP, Paillard FC, Ekman E. Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions. J Orthop Surg Res. 2015 Feb 3;10:24. doi: 10.1186/s13018-014-0144-x.

Reference Type BACKGROUND
PMID: 25645576 (View on PubMed)

Joswig H, Neff A, Ruppert C, Hildebrandt G, Stienen MN. The Value of Short-Term Pain Relief in Predicting the One-Month Outcome of Lumbar Transforaminal Epidural Steroid Injections. World Neurosurg. 2016 Dec;96:323-333. doi: 10.1016/j.wneu.2016.09.016. Epub 2016 Sep 15.

Reference Type BACKGROUND
PMID: 27641258 (View on PubMed)

Verheijen E, Munts AG, van Haagen O, de Vries D, Dekkers O, van den Hout W, Vleggeert-Lankamp C. Transforaminal epidural injection versus continued conservative care in acute sciatica (TEIAS trial): study protocol for a randomized controlled trial. BMC Neurol. 2019 Sep 3;19(1):216. doi: 10.1186/s12883-019-1445-9.

Reference Type DERIVED
PMID: 31481010 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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TEIAS

Identifier Type: -

Identifier Source: org_study_id

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