Abstract

ROLE OF EPIDURAL STEROID INJECTION IN MANAGEMENT OF HERNIATED INTERVERTEBRAL DISC WITH RADICULOPATHY

*Dr. Abdulwadood Yousif Ghafoori (FICMS) and Dr. Fwaz Hazim Ahmed (FICMS).

ABSTRACT

Backgroung: Epidural steroid injection is an important modality in the conservative management of herniated intervertebral disc with radiculopathy. Epidural steroid injections (ESI) have been used since the 1950s for treatment of back pain[1,2], and it was considered from that time till now as a low-risk alternative to surgical intervention in the treatment of intervertebral disc herniation in some patients for whom non-invasive treatment has failed. It has been advocated because it modulates the body‘s response to inflammatory stimuli such as those related to a disc herniation. However, controversy still persists regarding their effectiveness in reducing the pain and improving the function with literature both supporting and opposing them are available. Objective: The aim of the study is to assess the efficacy of Epidural Steroid Injection (ESI) in managing radicular pain due to herniated intervertebral disc. Patients and Methods: This follow up prospective study was planned to know the results of epidural injections with corticosteroids in managing of symptomatic patients with intervertebral disc herniation, a total of one hundred sixty-six (166) patients aged from 25 years to 80 years were enrolled in the study of both sexes, of two affected spine regions : lumbar and cervical with different levels of disc herniation associated with radiculopathy. After failure of conservative treatment for at least 6 weeks, those patients were managed in Baquba's Pain Management Center by epidural steroid injection (ESI) at the same affected disc level and entrapped nerve root. All the patients were evaluated before and after the ESI using Visual Analogue Score (VAS) and the Oswestry Disability Index (ODI). Results: Patients sample was 166 cases included 92 (55%) male and 74 (44%) female, a total of 227 ESI were given for those patients in lumbar and cervical regions by caudal, interlaminar and transforaminal techniques. Pre-procedural VAS scores for lumbar and cervical patients were 7.93, 8.18 respectively. 137 (82.5%) cases responded very well to ESI (patients developed ≥ 50% pain relief within 2 weeks after first injection) from those lumbar cases were 120 (72.2%) and cervical were 17(10.2%). The number of unresponded cases was 29 (17.4%): 24(14.4%) lumbar and cervical were 5 (3%). Conclosion: Epidural Steroid Injection (ESI) is an effective, simple, minimally invasive and safe method in treating symptomatic herniated intervertebral disc and it could avoid the patient surgical interventional option.

Keywords: epidural steroid injection, herniated intervertebral disc, radiculopathy.