***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: BACKGROUND Degenerative lumbar spinal stenosis is one of the most common causes of chronic lower back pain and radiculopathy . Spinal stenosis is anatomically classified as central and lateral spinal canal stenosis . Many treatment modalities and techniques , including surgery and epidural injection , have been used to manage the pain . However , the effect of hypertonic saline injection via the transforaminal approach has not yet been studied . OBJECTIVES The aim of this study is to determine the effect of adding hypertonic saline to conventional transforaminal epidural steroid injections ( TFEI ) to provide pain relief for chronic radiculopathy patients secondary to lateral canal spinal stenosis . STUDY DESIGN A double-blind , r and omized , active-control trial . SETTING An interventional pain management practice in a hospital , Republic of Korea . METHODS Two groups : the hypertonic group received hypertonic saline combined with triamcinolone and the control group received normal saline combined with triamcinolone . A total of 68 patients were r and omly allocated into either 2 groups by a computer-generated r and omization program . Twenty-seven patients in the hypertonic group and 26 patients in the control group were assessed . A total of 53 patients were included in this analysis . Outcome measures were taken at baseline , one , 2 , 3 , 4 , and 6 months post-procedure . The primary outcome measures included the numerical rating scale ( NRS ) and the proportion of substantial responders . The secondary outcome measures included the Oswestry disability index ( ODI ) , the proportion of substantial and moderate responders , and patient satisfaction . RESULTS Transforaminal epidural injection of steroids , with or without the addition of 10 % hypertonic saline , was effective and provided significant pain relief with the improvement of functional outcome within 4 months . The addition of hypertonic saline was superior in efficacy compared with conventional TFEI at 3 months follow-up . The differences in the absolute pain scores did not demonstrate statistical significance between the 2 groups . The reduction in pain intensity from the baseline was greater in the hypertonic group and demonstrated higher rates of satisfaction . The use of hypertonic saline also extended the duration of significant pain relief to 6 months compared with baseline . LIMITATIONS The lack of placebo group and small sample size . CONCLUSION Superior short-term pain relieving efficacy , but limited long-term effects of hypertonic saline , when added to TFEIs 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 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 The management of sciatica due to lumbar nerve root compromise remains controversial , probably because few well-controlled studies of conservative management have been performed . This preliminary study assesses the efficacy of epidural injections of 80 mg triamcinolone acetonide plus 0.5 % procaine hydrochloride in saline , administered via the caudal route , in a double-blind , placebo controlled trial with 1 year follow-up . Twenty-three patients were entered into the study : 12 received treatment and 11 placebo .  The active group showed significant pain relief ( P=0.02 ) and a significant increase in mobility ( P=0.01 ) at 4 weeks , which result ed in improved quality of life ( P=0.02 ) . At 1 year , subjective and objective measures improved in both groups . The improvement was greater in the actively treated group , but only the objective assessment ( straight leg raise ) was statistically significant Objective The objectives of this study were to clarify the short-term effects of transforaminal epidural steroid injection ( TFESI ) for degenerative lumbar scoliosis combined with spinal stenosis ( DLSS ) , and to extrapolate factors relating to the prognosis of treatment . Method Thirty-six patients with lumbar radicular pain from DLSS were enrolled . Subjects were r and omly assigned to one of two groups ( steroid or lidocaine group ) . We compared the effect of pain suppression at 2 , 4 and 12 weeks after the procedure between the two groups . Radiographic analysis included measurement of the Cobb 's angle , the upper endplate obliquities of L3 and L4 , and maximal lateral olisthy between two adjacent lumbar vertebrae . Sagittal plane measurement included lumbar lordosis , and thoracolumbar kyphosis . Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two . Results There were no significant differences in the demographic data , initial visual analogue scale ( VAS ) or Oswestry disability index ( ODI ) between the steroid group ( n=17 ) and the lidocaine group ( n=19 ) . Two , 4 , and 12 weeks after injection VAS , ODI showed a significantly greater improvement in the steroid group compared to 
    Output:
    
Epidural corticosteroid injections for radiculopathy or spinal stenosis with sodium chloride solution or bupivacaine were shown to be ineffective .
Lidocaine alone or lidocaine in conjunction with steroids were significantly effective