Efficacy and safety of epidural steroid injection following discectomy for patients with lumbar disc herniation: A protocol

Comprehensive Analysis of Treatment Approaches for Lumbar Disc Herniation: A Systematic Review

Lumbar disc herniation is a common disorder that has an important impact on the quality of life and daily activities of those affected. It is defined as the displacement of the nucleus pulposus beyond the intervertebral space. This systematic review aims to evaluate and compare the efficacy of several treatment modalities, including conservative, pharmaceutical, and surgical interventions. The data sources utilized were PubMed, Google Scholar, Embase, and Cochrane. We conducted a systematic review of English-language articles published between 2019 and 2024, using the PRISMA guidelines. A total of 720 studies were identified during the search. Following the evaluation of the title, abstract, and full text, and the application of exclusion criteria, a total of 15 studies met the requirements for inclusion in the analysis. The results indicate that although conservative treatment is frequently successful in providing immediate relief of symptoms, surgical interventions may be required for patients experiencing neurological deficits or those who do not respond to conservative treatments. One limitation of this systematic review is the inclusion of a limited number of studies, which may affect the generalizability of the findings. Additionally, the review was restricted to English-language publications from 2019 to 2024, potentially excluding relevant research published in other languages or outside this timeframe.

Comparing Quality of Life: Discectomy Surgery versus Epidural Corticosteroid Injection for Lumbar Disc Herniation

BACKGROUND

Selecting an efficient treatment for patients with radiculopathy caused by lumbar disc herniation (LDH) unresponsive to conservative management remains a challenging task under investigation, yielding varying results. This study aims to compare the outcomes of the 2 most prevalent invasive treatments.

METHODS

In this retrospective longitudinal study, we enrolled patients with confirmed refractory symptomatic LDH who sought treatment at Valiasr Hospital and underwent either discectomy surgery or epidural steroid injection (ESI) between 2019 and 2022. The outcome measures included pain intensity using the Visual Analog Scale (VAS) and quality of life (QoL) using the SF-36 questionnaire.

RESULTS

A total of 202 individuals (112 in the discectomy group and 90 in the ESI group) consisting of 90 males and 112 females, with a mean age of 50.9 ± 13.5 years, underwent analysis. In the univariate analysis, QoL scores were significantly higher in the discectomy group (57.4 ± 2.4) compared to the ESI group (44.2 ± 2.4) (P < 0.01). Furthermore, the surgery group exhibited a significantly greater reduction in the Leg VAS score after treatment compared to the ESI group (mean difference: -2.59, 95% confidence interval (CI): -3.45 to -1.70, P < 0.01). After adjusting for the most important confounding variables using multiple linear regression analysis, the association between surgery and higher QoL scores remained statistically significant (Unstandardized Coefficients B = 7.65, 95% CI: 0.55, 14.76, P = 0.03).

CONCLUSIONS

Our findings indicate that discectomy surgery has a more pronounced effect on patient outcomes and is a preferable treatment option for LDH patients.

Epidural Steroid Injections Acutely Suppress Bone Formation Markers in Postmenopausal Women

CONTEXT

Over 9 million epidural steroid injections (ESIs) are performed annually in the United States. Although these injections effectively treat lumbar radicular pain, they may have adverse consequences, including bone loss.

OBJECTIVE

To investigate acute changes in bone turnover following ESI. We focused on postmenopausal women, who may be at greatest risk for adverse skeletal consequences due to the combined effects of ESIs with aging and estrogen deficiency.

METHODS

Single-center prospective observational study. Postmenopausal women undergoing lumbar ESIs and controls with no steroid exposure were included. Outcomes were serum cortisol, markers of bone formation, osteocalcin, and procollagen type-1 N-terminal propeptide (P1NP), and bone resorption by C-telopeptide (CTX) measured at baseline, 1, 4, 12, 26, and 52 weeks after ESIs.

RESULTS

Among ESI-treated women, serum cortisol declined by ~50% 1 week after injection. Bone formation markers significantly decreased 1 week following ESIs: osteocalcin by 21% and P1NP by 22%. Both markers remained suppressed at 4 and 12 weeks, but returned to baseline levels by 26 weeks. There was no significant change in bone resorption measured by CTX. Among controls, there were no significant changes in cortisol or bone turnover markers.

CONCLUSION

These results provide evidence of an early and substantial reduction in bone formation markers following ESIs. This effect persisted for over 12 weeks, suggesting that ESIs may have lasting skeletal consequences. Given the large population of older adults who receive ESIs, further investigation into the long-term skeletal sequelae of these injections is warranted.

The skeletal consequences of epidural steroid injections: a literature review

This literature review summarized studies that evaluated the effects of epidural steroid injections (ESIs) on skeletal health. While evidence is limited, studies suggest that ESIs may cause bone loss. Better understanding of these skeletal consequences will help foster strategies to prevent bone loss in the growing population of patients receiving ESIs.

PURPOSE

Approximately nine million epidural steroid injections (ESIs) are administered annually in the United States to treat radicular back pain. ESIs often provide pain relief and functional improvement. While the overall incidence of adverse events resulting from ESIs is low, their effects on the skeleton are poorly understood. This is an important consideration given the profound skeletal impact of other forms of glucocorticoids.

METHODS

Ovid MEDLINE and PubMed search results since 2010, including older, frequently referenced publications were reviewed.

RESULTS

Systemic absorption of glucocorticoids occurs after ESI, which can cause hyperglycemia and endogenous cortisol suppression. The majority of studies investigating the skeletal effects of ESIs are retrospective. Several have found a relationship between low areal bone mineral density (BMD) by dual-energy x-ray absorptiometry and ESI exposure, but this finding is not uniform. Recently a dose-response relationship between ESI exposure and low spine volumetric BMD by computed tomography has been reported. Few studies have investigated the relationship between ESI exposure and fracture risk. Results of these studies are conflicting, and most have not been adequately powered to detect fracture outcomes.

CONCLUSIONS

While evidence is limited, studies suggest that ESIs may cause bone loss, particularly those investigating volumetric BMD. Larger doses appear to confer greater risk. Further prospective studies are needed to investigate the relationship between ESI and fracture risk. Better understanding of the skeletal consequences of ESIs will help foster strategies to prevent bone loss in the growing population of patients receiving this treatment.

Chinese Association for the Study of Pain: Expert consensus on diagnosis and treatment for lumbar disc herniation

Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease. Many guidelines and consensus for the diagnosis and treatment of lumbar disc herniation have been published domestically and internationally. According to the expert consensus, clinicians could adopt tailored and personalized diagnosis and treatment management strategies for lumbar disc herniation patients.