Rapid Resolution of Chronic Sciatica With Intravenous Infliximab After Failed Epidural Steroid Injections
Bibliographic record
Abstract
In Brief 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. A man with chronic sciatica who had failed epidural steroids was given a single infusion of the anti-tumor necrosis factor alpha agent infliximab and evaluated according to a previously published protocol. He had immediate and sustained improvement throughout a 6-month follow-up period, with disappearance of nerve root compression on magnetic resonance imaging 3 months posttreatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".