SLURP: Steroidinjections in LUmbosacral Radicular Syndrome.

INTRODUCTION:
Lumbosacral radicular syndrome (LRS) is defined according to the Guidelines of the Dutch College of General Practitioners (GPs) as pain, radiating from the back into the leg to below the knee, in combination with either Las�gue�s sign, or with segmental disorder characterized by paresis, sensory disorders and/or changes in reflexes reducible to a single nerve root. It is most commonly caused by protrusion of a low lumbar intevertebral disc. The average Dutch GP encounters ten to twelve patients with LRS per year. Because of the pain and inability to work, LRS is troublesome for the patient and places a great financial burden on our healthcare system. Many patients with LRS do not respond satisfactory to the usual conservative treatment, which consists of pain medication and bedrest, followed by mobilisation with avoidance of painful movements. Although segmental epidural steroid injections (SESIs) are not considered an evidence-based therapeutic option in the treatment of LRS, evidence exists that SESI may be a helpful intervention, especially when administered in the acute phase. The question remains whether this is a cost-effective and general practice applicable strategy.

RESEARCH QUESTION:
Is administration of one or two SESIs on top of standard treatment a cost-effective, general practice applicable intervention in the acute phase of LRS when patients do not satisfactory respond to conservative treatment?

METHODOLOGY:
A randomized controlled general practice trial comparing additional segmental epidural steroid injections to care as usual in patients suffering from acute lumbosacral radicular syndrome. Patients who respond unsatisfactory to conservative treatment for LRS are referred by their GPs to the anesthesiology outpatient clinic of the University Medical Centre Groningen and will be randomly assigned to either the control group or the intervention group. Intervention treatment consists of care as usual and an additional segmental epidural corticosteroid injections containing 80 mgs of triamcinolone-acetonide, once repeated if necessary. The control group receives care as usual. The treatment according to the Dutch College of General Practitioners� Guideline on LRS consists of analgesics, mobilisation with avoidance of painful movements and/or referral to a neurologist. Follow-up will be at 2, 4 and 6 weeks, 3 months, 6 months and 1 year after the intervention. Primary outcome measures are: pain in back and/or leg while walking, standing and lying down, severity of main complaint, perceived recovery and satisfaction with treatment. Secondary outcome measures are: primary and secondary healthcare costs, mobility and quality of life. To demonstrate a clinically significant difference of 35 points with a standard deviation of 17 on a numerical rating scale, given a statistical power of 80% and an alpha of 5%, we will need to include 30 patients in each group. Our aim is to include a total number of 80 patients to take lost-to-follow-up into account.

Adding segmental steroid injections to usual care in the treatment of acute lumbosacral radicular syndrome will reduce pain and fasten recovery in general practice.

Intervention group: Care as usual, combined with one or two segmental epidural corticosteroid injections (80 mg kenacort);
Control group: Care as usual.