Rapid Resolution of Chronic Sciatica With Intravenous Infliximab After Failed Epidural Steroid Injections

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Abstract

Study Design.

A case study of the use of infliximab to treat sciatica associated with disc herniation in a man who had failed extensive treatment, including 3 epidural injections, for several months.

Objective.

To compare and contrast the clinical and imaging data before and after treatment with infliximab and to compare these results to those of a previously published case series.

Summary of Background Data.

One prior case series had reported good results in patients with sciatica and disc herniation of up to 3 months’ duration. However, patients had not had previous epidural steroid injections, and no comparative imaging data were reported.

Methods.

After 8 months of unrelenting sciatica, the patient received a single infusion of infliximab. He was evaluated using the same measures used in the previously published case series. Pain scales, functional assessments, physical examinations, and imaging studies were performed immediately before infusion and for several months after treatment, with a final evaluation 6 months following infliximab treatment.

Results.

One week after treatment, he reported >50% reduction in back and leg pain. Six months posttreatment, his back and leg pains were reduced by 89% and 86%, respectively. Strength and reflexes were restored to normal. Magnetic resonance imaging performed 3 months postinfliximab showed a 50% reduction in the herniation and disappearance of previously noted S1 root compression. There were no side effects from the treatment.

Conclusion.

This report extends the potential use of infliximab to patients with more chronic sciatica and to those who have had prior epidural steroids. Larger, randomized trials are warranted.

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