Abstract
The aim of this work was to compare the potential efficacy of epidural steroid injection versus other conservative measures for relieving pain and improving function in patients with lumbar disc herniation (LDH). This study included 45 patients who presented with low back pain and sciatica due to LDH (at levels of L4–L5 or L5–S1) diagnosed clinically and confirmed by means of MRI. Patients were classified into two groups: group I (15 patients) was treated with drugs and physiotherapy, and group II (30 patients) was subclassified into two subgroups of 15 patients each (group IIL received lumbar epidural injection, whereas group IIC received caudal epidural injection). All patients were assessed at presentation and after starting the treatment at the first week and first, second, and third month using the visual analogue scale (VAS) for pain and the Oswestry Disability Index (ODI) for function status. Groups I, IIL, and IIC showed improvement in pain and function, confirmed by a decrease in the mean VAS and ODI scores. Both groups of injection showed a significant difference (P 0.05) between the lumbar and caudal groups in the VAS, except at the second month (P < 0.05), and in the ODI, except at first week and first month (P < 0.05). Epidural injection could be a preferable choice in managing low back and radicular pain due to LDH. It was a clinically useful mode of treatment that is cost-effective and could offset the need for surgery.
Highlights
The aim of this work was to compare the potential efficacy of epidural steroid injection versus other conservative measures for relieving pain and improving function in patients with lumbar disc herniation (LDH)
Patients and methods This study was carried out on 45 patients with LDH who presented with Low back pain (LBP) and sciatica for more than 6 weeks, diagnosed clinically and confirmed by means of recent MRI
We found that there was a significant difference (P < 0.05) between groups І and ІІ in the mean visual analogue scale (VAS) and the mean Oswestry Disability Index (ODI) score
Summary
The aim of this work was to compare the potential efficacy of epidural steroid injection versus other conservative measures for relieving pain and improving function in patients with lumbar disc herniation (LDH). Results Groups І, ІІL, and IIC showed improvement in pain and function, confirmed by a decrease in the mean VAS and ODI scores. It was a clinically useful mode of treatment that is cost-effective and could offset the need for surgery. The vast majority of patients with LBP suffer from some mechanical disorder of the disc, ligaments, facet, or nerve root complex The majority of these problems resolve with conservative treatment [2]. Radicular pain has been attributed to both mechanical deformation as well as to the effect of inflammatory cytokines on the dorsal root ganglion For this reason, the local delivery of steroids through epidural injection seems to be a rational option [3,4]
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