***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: OBJECTIVE This study was carried out to evaluate the therapeutic effect of epidural steroid injection on pseudoclaudication in patients with lumbar degenerative spinal canal stenosis . DESIGN Fifty-three patients who complained of pseudoclaudication of less than 20 m in walking distance were r and omly divided into three groups . Group 1 ( n = 16 ) underwent epidural injection with 8 ml of saline . Group 2 ( n = 18 ) underwent epidural block with 8 ml of 1 % mepivacaine . Group 3 ( n = 19 ) underwent epidural block with a combination of 8 ml of 1 % mepivacaine and 40 mg of methylprednisolone . The criteria of evaluation were as follows : excellent effect , > 100 m in walking distance ; good effect , 20 - 100 m in walking distance ; poor effect , < 20 m in walking distance . RESULTS In group 1 , the numbers of patients who showed a good effect were two ( 12.5 % ) after 1 week , one ( 6.5 % ) after 1 month , and one ( 6.5 % ) after 3 months . In group 2 , the numbers of patients who showed a good or excellent result were 10 ( 55.5 % ) after 1 week , three ( 16.7 % ) after 1 month , and one ( 5.6 % ) after 3 months . In group 3 , the numbers of patients who showed a good or excellent result were 12 ( 63.2 % ) after 1 week , three ( 15.8 % ) after 1 month , and one ( 5.3 % ) after 3 months . There was no significant difference in the effectiveness of treatment between group 2 and group 3 throughout the time course . CONCLUSION The results suggest that epidural steroid injection has no beneficial effect on the pseudoclaudication associated with spinal canal stenosis as compared with epidural block with a local anesthetic alone Study Design . A r and omized , controlled , double-blind trial . Objective . To assess the effectiveness of fluoroscopically directed caudal epidural injections in managing chronic low back and lower extremity pain in patients with disc herniation and radiculitis with local anesthetic with or without steroids .  Summary of Background Data . The available literature on the effectiveness of epidural injections in managing chronic low back pain secondary to disc herniation is highly variable . Methods . One hundred twenty patients suffering with low back and lower extremity pain with disc herniation and radiculitis were r and omized to one of the two groups : group I received caudal epidural injections with an injection of local anesthetic , lidocaine 0.5 % , 10 mL ; group II patients received caudal epidural injections with 0.5 % lidocaine , 9 mL , mixed with 1 mL of steroid . The Numeric Rating Scale ( NRS ) , the Oswestry Disability Index 2.0 ( ODI ) , employment status , and opioid intake were utilized with assessment at 3 , 6 , and 12 months posttreatment . Results . The percentage of patients with significant pain relief of 50 % or greater and /or improvement in functional status with 50 % or more reduction in ODI scores was seen in 70 % and 67 % in group I and 77 % and 75 % in group II with average procedures per year of 3.8 ± 1.4 in group I and 3.6 + 1.1 in group II . However , the relief with first and second procedures was significantly higher in the steroid group . The number of injections performed was also higher in local anesthetic group even though overall relief was without any significant difference among the groups . There was no difference among the patients receiving steroids . Conclusion . Caudal epidural injection with local anesthetic with or without steroids might be effective in patients with disc herniation or radiculitis . The present evidence illustrates potential superiority of steroids compared with local anesthetic at 1-year follow-up Objective : To determine the efficacy of epidural corticosteroid injections for sciatica . Methods : Three epidural injections ( two day intervals ) of 2 ml prednisolone acetate ( 50 mg ) or 2 ml isotonic saline were administered to patients with sciatica presumably due to a disk herniation lasting 15–180 days .  Self evaluation was the main judgment criterion at day 20 . Patients who recovered or showed marked improvement were considered as success . Pain measured by VAS , the SLR test , Schober ’s test , Dallas pain question naire , and the Rol and -Morris index were evaluated at days 0 , 5 , 20 , and 35 . Only analgesics were authorised , patients requiring non-steroidal anti-inflammatory drugs ( NSAIDs ) before day 20 were considered as failure . Results : 42 patients were included in the control group ( CG ) , 43 in the steroid group ( SG ) . On an intention to treat analysis 15/42 ( 36 % ) in the CG and 22/43 ( 51 % ) in the SG ( p=0.15 ) were considered as success ( difference 15.5 % , 95 % CI ( −5.4 to 36.3 ) ) . Among the 48 failures , 14 patients ( 6 CG , 8 SG ) required NSAIDs , 3 ( 2 CG , 1 SG ) required surgery , and 7 ( 3 CG , 4 SG ) other treatments . On analysis according to protocol , in 74 remaining patients 12/35 ( 34 % ) in the CG and 22/39 ( 56 % ) in the SG ( p=0.057 ) were considered as success ( difference 22.1 % , 95 % CI ( 0.0 to 44.2 ) ) . For all secondary end points intragroup improvement with time was significant , but intergroup differences were not . Conclusion : The efficacy of isotonic saline administered epidurally for sciatica can not be excluded , but epidural steroid injections provide no additional improvement BACKGROUND Epidural injections ( EI ) are the most commonly performed minimally invasive intervention to manage chronic low back pain ( CLBP ) with lumbosacral radicular pain ( LRP ) .  Local anesthetic ( LA ) and /or steroids are frequently used injectates for EI and are reported with variable effectiveness . The majority of earlier studies have used either caudal , transforaminal ( TF ) , or undefined interlaminar approaches for EI . The parasaggital interlaminar ( PIL ) approach route is reported to have good ventral epidural spread and comparable effectiveness to the TF route . However , there is a lack of head-to-head comparative effectiveness research of LA with or without steroid for managing CLBP with LRP using a PIL approach . OBJECTIVE To compare the effectiveness of EI of LA alone and LA with steroid using a PIL approach for managing CLBP with LRP . STUDY DESIGN R and omized , double blind , active control one year follow-up study . SETTING Interventional pain management clinic in a tertiary care center in India . METHODS Sixty-nine patients were r and omized to receive fluoroscopic guided EI of either 8 mL of 0.5 % lidocaine ( group L , n = 34 ) or 6 mL of 0.5 % lidocaine mixed with 80 mg ( 2 mL ) of methylprednisolone acetate ( group LS , n = 35 ) . Patients were evaluated for pain intensity using 0 - 10 numerical rating scale ( NRS ) and functional disability using Modified Oswestry Disability Question naire ( MODQ ) at baseline ; and 2 weeks , one , 2 , 3 , 6 , 9 , and 12 months after injection . Patients with inefficacy with the initial injection or response deterioration received an additional injection of the same injectate and dose . Patients were evaluated for achieving effective pain relief ( EPR , i.e. , ≥ 50 % from baseline ) , overall NRS and MODQ , number of injections , and presence of ventral and perineural spread over one year follow-up . Primary outcome was proportion of patients achieving EPR at 3 months . RESULTS A significantly higher proportion of patients achieved EPR at 3 months in group LS [ 30 ( 86 % , 90 % CI 73 % - 93 % ) ] as compared to group L [ 17 ( 50 % , 90 % CI 36 % - 64 % ) ] ( P = 0.02 ) . Similar results were obtained at 6 , 9 , and 12 months , respectively . The probability of achieving EPR was significantly higher in group LS at various time-points during the one year follow-up as compared to group L ( P = 0.01 ) A significant reduction in NRS and improvement in MODQ were observed at all time-points post-intervention compared to baseline ( P < 0.001 ) in both groups . NRS and MODQ scores were significantly lower in group LS as compared to group L at all time intervals post baseline . On average patients in group L received 2.0 ( 0.85 ) and group LS received 1.7 ( 0.71 ) injections annually ( P = 0.07 ) . Ventral epidural spread was comparable in both groups ( 97 % ) . No major complications were encountered in either group ; however , intravascular spread of contrast was noted during 2 injections ( one in each group ) requiring relocation . LIMITATIONS A single center study , lack of documentation of adjuvant therapies like individual analgesic medication , and lack of placebo group . CONCLUSIONS Using a PIL approach and the addition of steroid to LA for EI may provide superior effectiveness in terms of extent and duration of pain relief for managing CLBP with unilateral LRP , even though , local anesthetic alone also was effective . TRIAL REGISTRATION Two controlled studies for a new epidural , perineural , singleshot , selective nerve root injection with a double-needle approach to the anterior epidural space of the lumbar spinal canal are presented . The results were analysed to determine the effectiveness of the new epidural perineural injection technique . The trial comprised two controlled studies on 182 patients . One study compared prospect ively r and omized results of patients with lumbar radicular syndromes who received epidural perineural injections  ( n = 47 ) , conventional posterior epidural injections ( n = 40 ) and , as a control group , paravertebral local anaesthetic ( n = 46 ) . A second , prospect i ve , double-blind study compared the effect of epidural perineural injections with triamcinolone ( n = 24 ) and pure saline ( n = 25 ) . Epidural perineural injections were more effective than conventional posterior epidural injections . Both epidural groups had better results than the paravertebral local injection group . Epidural perineural injections with steroids ( 10 mg triamcinolone ) were more effective than saline alone . A systemic steroid effect was excluded by additional intramuscular steroid injections in the saline group . There were no severe complications or side effects in any of the three groups . The studies concluded that single-shot epidural perineural injection is effective in the treatment of lumbar radicular pain . It is a “ one drop only ” therapy to the source of pain Abstract This analysis of the lumbar epidural steroid injections for spinal stenosis multicenter r and omized controlled trial data identifies the degree of and risk factors for cortisol suppression after epidural steroid injections in older adults with spinal stenosis . Four hundred patients aged 50 years and older with back or leg pain and central lumbar spinal stenosis completed baseline demographic and psychosocial measures . Morning serum cortisol levels were measured at baseline and 3 weeks after initial injection . Patients were r and omized to receive epidural injections of either local anesthetic with corticosteroid ( n = 200 ) or local anesthetic only ( n = 200 ) . The specific corticosteroid was chosen at the treating physician 's discretion ( methylprednisolone , betamethasone , triamcinolone , or dexamethasone ) . Thirty-two patients ( 20.3 % ) treated with corticosteroid experienced cortisol reduction at 3 weeks of > 50 % compared with 10 patients ( 6.7 % ) treated with lidocaine only ( adjusted treatment effect = 3.5 , 95 % confidence interval : 1.6 - 7.9 , P = 0.002 ) . The effect on 3-week cortisol changes did not differ by demographic or patient-level characteristics . Those treated with methylprednisolone or triamcinolone had an average 3-week cortisol reduction of 41.0 % ( P = 0.005 ) and 41.6 % ( P < 0.001 ) from baseline , respectively , whereas patients treated with betamethasone or dexamethasone were not significantly different than comparable patients in the lidocaine arm . The higher rates of cortisol suppression at 3 weeks in those receiving epidural corticosteroid injections , particularly with longer-acting insoluble corticosteroid formulations , are consistent with sustained systemic absorption of corticosteroid Background Transforaminal epidural injections with steroids ( TESI ) are used increasingly for patients with sciatica . However there is much debate about their safety and effectiveness . It is important to identify patients that benefit most from TESI and only few trials have yet evaluated the effects in patients with acute sciatica . Methods We describe a prospect i ve , r and omized controlled trial ( RCT ) , with the aim to evaluate the hypothesis that TESI plus Levobupivacaine ( TESI-plus ) added to oral pain medication is more effective compared to pain medication alone or compared to transforaminal injection with a local 
    Output:
    
AUTHORS ' CONCLUSIONS This study found that epidural corticosteroid injections probably slightly reduced leg pain and disability at short-term follow-up in people with lumbosacral radicular pain .
In addition , no minor or major adverse events were reported at short-term follow-up after epidural corticosteroid injections or placebo injection .
Although the current review identified additional clinical trials , the available evidence still provides only limited support for the use of epidural corticosteroid injections in people with lumbosacral radicular pain as the treatment effects are small , mainly evident at short-term follow-up and may not be considered clinical ly important by patients and clinicians ( i.e. mean difference lower than 10 % ) .