A Prospective, Randomized Study
Glenn R. Buttermann, MD
Epidural steroid injection is a low-risk alternative to surgical intervention in the treatment of lumbar disc herniation.
Patients who had undergone discectomy had the most rapid decrease in symptoms, with 92% to 98% of the patients reporting that the treatment had been successful over the various follow-up periods. Only 42% to 56% of the fifty patients who had undergone the epidural steroid injection reported that the treatment had been effective. Those who did not obtain relief from the injection had a subsequent discectomy, and their outcomes did not appear to have been adversely affected by the delay in surgery resulting from the trial of epidural steroid injection.
Epidural steroid injection was not as effective as discectomy with regard to reducing symptoms and disability associated with a large herniation of the lumbar disc. However, epidural steroid injection did have a role: it was found to be effective for up to three years by nearly one-half of the patients who had not had improvement with six or more weeks of noninvasive care.
However, it does support the notion that a minimum of six weeks of noninvasive treatment is reasonable prior to invasive treatment. Thus, the rate of failure of nonoperative treatment during the course of the present study was 31%, which is similar to the 26% rate predicted in a previous report.1
In other words, this study failed to show, with the number of patients available, that a delay in decompression due to an initial trial of epidural steroid injection was detrimental to neurological recovery at the time of follow-up.
- Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, Truchon R, Parent F, Levesque J, Bergeron V, Montminy P, Blanchette C. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med. 1997;336:1634-40.