J Korean Soc Spine Surg.  2020 Dec;27(4):138-146. 10.4184/jkss.2020.27.4.138.

Predictive Factors for the Short-Term Efficacy of Epidural Injections in Lumbar Disc Herniation Treatment

Affiliations
  • 1Department of Orthopedic Surgery, College of Medicine, Wonkwang University Hospital, Iksan, South Korea

Abstract

Study Design: Retrospective study.
Objectives
The purpose of this study was to analyze several factors affecting the efficacy of epidural steroid injections as a nonoperative treatment modality in lumbar disc herniation patients. Summary of Literature Review: Despite several studies, the normal course of intervertebral disc herniation is not fully understood, and the optimal timing of surgery is unclear.
Methods
From January 2017 to April 2019, among outpatients in our hospital, 64 patients diagnosed with 3-4 or 4-5 single-level lumbar disc herniation and followed up for at least 6 weeks were included. Epidural steroid injection was performed in all patients during their 1-week admission. Symptoms improved in 36 patients (group 1) and persisted or recurred in 28 patients (group 2), who were finally treated surgically. Demographic factors, magnetic resonance imaging findings, and clinical assessments were analyzed.
Results
The only demographic factor with a significant difference between groups was symptom duration. In magnetic resonance imaging, significant differences were found in disc sequestration and the degree of the herniated disc. At 6 weeks after the injection, significant differences were found between the 2 groups in visual analog scale scores and the Korean version of the Oswestry Disability Index.
Conclusions
Several factors must be considered when treating patients with lumbar disc herniation. Of note, longer symptom duration was found to be associated with a lower effectiveness of conservative treatment. The effects of treatment could also be influenced by the disc form and the degree of disc herniation.

Keyword

Epidural steroid injection; Intervertebral disc herniation; Sciatica
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