To study the efficacy of epidural steroid injection in the treatment of lumbar disc herniation

Abstract

Introduction: Low back pain is a problem that is common and its effective management remains a challenge [1]. Major cause of morbidity due to low back pain is prolapsed intervertebral disc which mostly affects young adults in their fourth decade of life. The treatment of lumbar disc herniation remains contro-versial. Lumbar epidural steroid injection is a reasonable non-surgical option available in lumbar disc disease.Methods: 50 patients attending orthopaedic OPD in HIMS for the treatment of low back ache in the age group 20 – 70 years and who meet the inclusion criteria were selected for the study. Back pain for atleast six weeks in an adult male/female aged between 20-70 years with evidence of lumbar disc herniation at single level protrusion were included.Results: The patients were followed up for a period of 6 months and were evaluated according VAS scores (visual analogue score) and SLRT (straight leg raising test) taken pre procedure and on follow up visits.Beyond doubt steroid definitely helps control the chemical inflammation causing nerve root irritation which is believed to play a critical role in the genesis of radicular pain with and without the presence of mechanical compression of the nerve roots or cord. VAS score improved [pain relief] in 40 (80%) patients and worsened in 10(20%) patients.Improvement in vas score [pain relief] by 2-4 in around 40 patients (80%) in the initial 2- 16 weeks after ESI, at the end of 6 months it showed improvement in 20(40%) patients, remained almost same score 20(40%) patients and worsened in another 10 patients (20%). SLRT was positive in 27(54%) patients, at the end of 6 months SLRT showed improvement in 13 (26%) patients, remained same in 12(24%) patients and worsened in 2 (4%) patients.Conclusion: Epidural steroid injection probably accelerates pain relief in patients who eventually have natural resolution of radicular pain in a gradual delayed fashion. Epidural steroid could allow faster return to function during the natural history of sciatica.