Researchers at Sapienza University of Rome explored a minimally invasive approach for sciatica that combines radiotherapy with epidural steroid injections, reporting notable reductions in pain among study participants. The findings, published in Radiology, suggest that this combination could offer meaningful relief for patients whose symptoms persist despite conventional treatments. The study provides a careful look at how precision radiotherapy and targeted corticosteroid delivery might work together to modulate nerve irritation and pain signaling in the lumbar region.
Sciatica occurs when the sciatic nerve is compressed or irritated, typically by a herniated lumbar disc or, in some cases, by irritation from nearby muscular structures such as the piriformis. This compression or inflammation creates pain that travels from the lower back and buttock down the leg, often accompanied by numbness, tingling, or weakness. The condition can be intermittent or persistent, and traditional treatments range from physical therapy and anti-inflammatory medications to more invasive interventions. Yet a substantial subset of patients does not achieve lasting relief with standard therapies, underscoring the need for additional, effective options.
In this study, epidural steroid injections are a common therapeutic choice for those who do not respond adequately to initial measures. While these injections often provide relief, the duration of benefit can be limited. The investigators proposed that adding pulsed radiofrequency therapy could amplify and prolong the analgesic effect of steroids. Pulsed RF therapy delivers short bursts of radiofrequency energy to the nerve roots near the spine, aiming to modulate pain signals without causing permanent tissue damage. This approach is characterized as minimally invasive and can be performed with imaging guidance to target the affected nerve segments precisely.
Participants were drawn from a total pool of 351 individuals diagnosed with sciatica and lumbar disc herniation. They were randomly assigned to receive CT-guided pulsed RF therapy, epidural steroid injections, or a combination of both treatments. The randomization design allowed for direct comparisons across several clinically relevant outcomes, including leg pain intensity, functional impairment, and disability scores, across multiple time points. By structuring follow-ups at four, twelve, and fifty-two weeks, the researchers could assess both short-term and longer-term effects of each intervention and their combination.
At the four-week, twelve-week, and one-year milestones, the group receiving the combined pulsed RF therapy and injections demonstrated greater reductions in leg pain and disability than the group receiving injections alone. The magnitude of improvement was most pronounced for leg pain, with participants reporting meaningful gains in daily activities and mobility. These results suggest that the synergistic effect of the two modalities may yield more robust and sustained relief for certain patients compared with steroid injections alone, especially in those who do not respond adequately to conventional care.
Beyond the immediate outcomes, the study highlights practical considerations for clinical practice. The authors emphasize that the procedures are minimally invasive and feasible in many settings equipped for image-guided interventions. The practical implications point toward a potential shift in treatment algorithms for sciatica when standard methods fail to deliver lasting benefits. While the data are encouraging, the researchers acknowledge the need for longer follow-up, additional replication in diverse patient populations, and careful monitoring of safety and tolerability across extended periods. These considerations help frame the results as a meaningful step forward rather than a definitive replacement for existing therapies, illustrating how combination strategies can fill gaps in care for patients with persistent symptoms. [1]