***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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    Input: 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 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 Study Design . We r and omized 200 patients after lumbar discectomy to receive  epidural steroid or none with a 2-year follow-up . Objective . To evaluate the outcome , neurologic impairment and safety of epidural steroid following lumbar discectomy for herniated disc disease . Summary of Background Data . Convalescence after discectomy for herniated disc disease is dependent on pain and the inflammatory response . Previous studies in arthroscopic and abdominal surgery demonstrate steroids , which reduce the inflammatory response and enhance recovery . Here we report a 2-year follow-up of a r and omized trial of epidural steroid following lumbar discectomy . Methods . Through 2001 and 2003 200 patients undergoing discectomy for herniated disc disease were r and omly allocated to receive epidural methylprednisolone 40 mg or none . In the control group ( 62 males and 38 females , median age 41 years , 18–66 ) 48 L5 , 50 L4 , and 6 L3 discectomies were performed and in the intervention group ( 60 males and 40 females , median age 45 years , 15–53 ) 56 L5 , 46 L4 , and 3 L3 discectomies . Contemporary with r and omization to epidural steroid or none both groups received preoperative prophylactic antibiotics and the same multimodal pain treatment . Results . Hospital stay was reduced from 8 to 6 days ( P = 0.0001 ) and the number of patients with neurologic signs were reduced more ( 70 % vs. 44 % , P = 0.0004 ) by epidural steroid . Incidence of reoperation at 1 year was 6 % in both groups and 8 % in the control group and 7 % in the intervention group after 2 years . No infections were registered . Conclusion . Epidural methylprednisolone enhances recovery after discectomy for herniated disc disease without apparent side effects 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 A BSTRACT Background Although epidural corticosteroid injections are commonly used for sciatica , their efficacy has not been established . Methods In a r and omized , double-blind trial , we administered up to three epidural injections of methylprednisolone acetate ( 80 mg in 8 ml of isotonic saline ) or isotonic saline ( 1 ml ) to 158 patients with sciatica due to a herniated nucleus pulposus . All patients had Oswestry disability scores higher than 20 ( on a scale of 1 to 100 , with scores of 20 or less indicating minimal disability , and higher scores greater disability ) . Results At three weeks , the Oswestry score had improved by a mean of 8.0 in the methylprednisolone group and 5.5 in the placebo group ( 95 percent confidence interval for the difference , 7.1 to 2.2 ) . Differences in improvements between the groups were not significant , except for improvements in the finger-to-floor distance ( P 0.006 ) and sensory deficits ( P 0.03 ) , which were greater in the methylprednisolone group . After six weeks , the only significant difference was the improvement in leg pain , which was greater in the methylprednisolone group ( P 0.03 ) . After three months , there were no significant differences between the groups . The Oswestry score had improved by a mean of 17.3 in the methylprednisolone group and 15.4 in the placebo group ( 95 percent confidence interval for the difference , 9.3 to 5.4 ) . At 12 months , the cumulative probability of back surgery was 25.8 percent in the methylprednisolone group and 24.8 percent in the placebo group ( P 0.90 ) . Conclusions Although epidural injections of methylprednisolone may afford short-term improvement in leg pain and sensory deficits in patients with sciatica due to a herniated nucleus pulposus , this treatment offers no significant functional benefit , nor does it reduce the need for surgery . ( N Engl J Med 1997 ; 336:1634 - 40 . Study Design . Subgroup analysis of prospect i ve , r and omized data base from the Spine Patient Outcomes Research Trial ( SPORT ) Objective . The hypothesis of this study was that patients who received ESI during initial treatment as part of SPORT ( The Spine Patient Outcomes Research Trial ) would have improved clinical outcome and a lower rate of crossover to surgery than patients who did not receive ESI . Summary of Background Data . The use of epidural steroid injection ( ESI ) in patients with lumbar spinal stenosis is common , although there is little evidence in the literature to demonstrate its long-term benefi t in the treatment of lumbar stenosis . Methods . Patients with lumbar spinal stenosis who received ESI within the first 3 months of enrollment in SPORT ( ESI ) were  compared with patients who did not receive epidural injections during the first 3 months of the study ( no-ESI ) . Results . There were 69 ESI patients and 207 no-ESI patients . There were no significant differences in demographic factors , baseline clinical outcome scores , or operative details between the groups , although there was a significant increase in baseline preference for nonsurgical treatment among ESI patients ( ESI 62 % vs. no-ESI 33 % , P < 0.001 ) . There was an average 26-minute increase in operative time and an increased length of stay by 0.9 days among the ESI patients who ultimately underwent surgical treatment . Averaged over 4 years , there was significantly less improvement in 36-Item Short Form Health Survey ( SF-36 ) Physical Function among surgically treated ESI patients ( ESI 14.8 vs. no-ESI 22.5 , P = 0.025 ) . In addition , there was significantly less improvement among the nonsurgically treated patients in SF-36 Body Pain ( ESI 7.3 vs. no-ESI 16.7 , P = 0.007 ) and SF-36 Physical Function ( ESI 5.5 vs. no-ESI 15.2 , P = 0.009 ) . Of the patients assigned to the surgical treatment group , there was a significantly increased crossover to nonsurgical treatment among patients who received an ESI ( ESI 33 % vs. no-ESI 11 % , P = 0.012 ) . Of the patients assigned to the nonoperative treatment group , there was a significantly increased crossover to surgical treatment in the ESI patients ( ESI 58 % vs. no-ESI 32 % , P = 0.003 ) . Conclusion . Despite equivalent baseline status , ESIs were associated with significantly less improvement at 4 years among all patients with spinal stenosis in SPORT . Furthermore , ESIs were associated with longer duration of surgery and longer hospital stay . There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically BACKGROUND Epidural steroid injections ( ESIs ) are commonly used to treat low back pain , including symptomatic lumbar spinal stenosis ( LSS ) . Reports on LSS treatment with ESIs have not differentiated between neurogenic claudication , which is believed to result from nerve root compression , and lumbar radicular pain , thought to be caused by inflammation . While there is overlap between these groups , the clinical relevance of ESI treatment can not be generalized between these 2 distinct diseases with completely different pathophysiological causes . METHODS This was a double-blind , r and omized , prospect i ve study of ESI vs. the mild procedure in patients with symptomatic LSS , conducted at a single pain management center . Patient reported outcome measures included Visual Analog Scale , Oswestry Disability Index , and Zurich Claudication Question naire ( ZCQ ) patient satisfaction . RESULTS Thirty-eight patients were r and omized into 2 treatment groups , 21 in mild and 17 in ESI . At 6- and 12-week follow-up , patients treated with mild reported significantly greater pain decrease over time ( P < 0.0001 ) , and significantly greater functional mobility improvement over time ( P < 0.0018 ) than ESI patients . At week 6 , mild ZCQ patient satisfaction score of 2.2 indicated a higher level of satisfaction than for ESI with a score of 2.8 . In addition , 12-week ZCQ satisfaction score was 1.8 , demonstrating sustained near-term satisfaction in the mild group . No major mild or ESI  device or procedure-related complications were reported . CONCLUSIONS This study demonstrated that in LSS patients suffering with neurogenic claudication , mild provides statistically significantly better pain reduction and improved functional mobility vs. treatment with ESI The effect of extradural corticosteroid injection in patients with nerve root compression syndromes associated with degenerative disease of the lumbar intervertebral discs was assessed in a double-blind controlled trial on 100 consecutive in patients assigned by r and om allocation to treatment and control groups . Assessment during admission and at three months revealed statistically highly significant differences in respect of relief of pain and resumption of normal occupation in favour of the group treated by extradural injection . This treatment seems to be a valuable adjunct to the management of lumbar nerve root compression syndromes associated with degenerative disc disease OBJECTIVE To determine the effectiveness and predictors of response to lumbar epidural corticosteroid injections ( ESI ) in 
    Output:
    
CONCLUSIONS Epidural steroid injections may provide a small surgery-sparing effect in the short term compared with control injections and reduce the need for surgery in some patients who would otherwise proceed to surgery