Intended for healthcare professionals

Rapid response to:


Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial

BMJ 2008; 336 doi: (Published 12 June 2008) Cite this as: BMJ 2008;336:1355

Rapid Response:

Steroid injections provide a middle way

Peul et al. have added useful detail to the debate on how to manage lumbar disc prolapses. Unfortunately, the two arms of their randomised control trial do not reflect current practice in specialist spinal centres in the UK. It would be more usual for patients with lower limb pain to be offered epidural steroids, either through a classical epidural injection, or via an X-ray guided nerve root block. These interventions can be markedly successful and result in patients becoming virtually pain free in the acute phase of the prolapse, making it more likely that the patient will progress to longer-term conservative care. It is public knowledge that Tony Blair underwent a steroid nerve root block whilst he was Prime Minister, without having to progress to surgery.[1] Clearly a treatment worthy of consideration at the highest level.


Competing interests: None declared

Competing interests: No competing interests

28 May 2008
Gareth L Greenslade
Consultant in pain medicine
Pain Clinic, Macmillan Centre, Frenchay Hospital, Bristol, BS16 1LE