Epidural Steroid Injections for Patients with Acute and Severe Sciatica

Threshold

Norfolk and Waveney ICB will fund epidural steroid injections for acute and severe sciatica with or without the presence of low back pain on a restricted basis for patients who meet ALL the following criteria:

• Patients to undergo an appropriate assessment in MDT clinic.
• Patients should demonstrate moderate to severe disability due to pain, measured by ODI > 40 despite physiotherapy and analgesia.
• Patients have had appropriate spinal imaging within 12 months of referral to define spinal pathology to enable appropriate targeting of injection.
• If there is documented evidence of functional improvement lasting > 3 months following the initial procedure, further epidurals can be undertaken at consultant discretion and at intervals of no less than 6 months. NB: if efficacy of epidurals decline, then this management strategy should be curtailed.
• If the patient develops new spinal pathology, a revaluation of the role of epidural steroid injection can be considered following pain specialist review.

NICE have provided a link to United Kingdom Spine Society Board website for further detailed information on pathways that can be assessed by relevant groups for local implementation – https://www.ukssb.com/improving-spinal-care-project

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.