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Assessment of the implication of epidural steroid injection versus other conservative measures in the management of lumbar disc herniation



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) when compared with group I with regard to VAS and ODI. There was an insignificant 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.


  1. Dincer U, Kiralp MZ, Cakar E, Yasar E, Dursan H. Caudal epidural injection versus nonsteroidal anti-inflammatory drugs in the treatment of low back pain accompanied with radicular pain. Joint Bone Spine 2007; 74:467–471.

    Article  CAS  Google Scholar 

  2. Singh H, Kaur M, Nagpal S, Gupta S. Role of caudal epidural steroid injections in lumbar disc prolapse. J Indian Med Assoc 2010; 108:287–288.

    PubMed  Google Scholar 

  3. Ahn SH, Cho YW, Ahn MW, Jang SH, Sohn YK, Kim HS. mRNA expression of cytokines and chemokines in herniated lumbar intervertebral discs. Spine (Phila Pa 1976). 2002; 27:911–917.

    Article  Google Scholar 

  4. Harrington JF, Messier AA, Bereiter D, Barnes B, Epstein MH. Herniated lumbar disc material as a source of free glutamate available to affect pain signals through the dorsal root ganglion. Spine (Phila Pa 1976) 2000; 25:929– 936.

    Article  CAS  Google Scholar 

  5. Manchikanti L, Singh V, Falco FJ, Cash KA, Pampati V. Evaluation of the effectiveness of lumbar interlaminar epidural injections in managing chronic pain of lumbar disc herniation or radiculitis: a randomized, double-blind, controlled trial. Pain Physician 2010; 13:343–355.

    PubMed  Google Scholar 

  6. Pincus T, Swearingen C, Wolfe F. Toward a multidimensional health assessment questionnaire (MDHAQ): assessment of advanced activity of daily living and psychological status in the patient-friendly health assessment questionnaire formate. Arthritis Rheum 1999; 42:2220– 2230.

    Article  CAS  Google Scholar 

  7. Fairbank JC, Pynsent PB. The Oswestry Disability Index Spine (Phila Pa 1976) 2000; 25:2940–2952(discussion 2952).

    Article  CAS  Google Scholar 

  8. Byström MG, Rasmussen-Barr E, Grooten WJ. Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. Spine (Phila Pa 1976) 2013; 38:E350–E358.

    Article  Google Scholar 

  9. Owlia MB, Salimzadeh A, Alishiri G, Haghighi A. Comparison of two doses of corticosteroid in epidural steroid injection for lumbar radicular pain. Singapore Med J 2007; 48:241–245.

    CAS  PubMed  Google Scholar 

  10. Cohen SP, Bicket MC, Jamison D, Wilkinson I, Rathmell JP Epidural steroids: a comprehensive, evidence-based review. Reg Anesth Pain Med 2013; 38:175–200.

    Article  CAS  Google Scholar 

  11. Cherkin DC, Wheeler KJ, Barlow W, Deyo RA. Medications used for low back pain in primary care. Spine (Phila Pa 1976) 1998; 23:607–614.

    Article  CAS  Google Scholar 

  12. Van Duijvenbode ICD, Jellema P, van Poppel MNM, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database Syst Rev 2008; 16:CD001823.

    Google Scholar 

  13. Ye C, Ren J, Zhang J, Wang C, Liu Z, Li F, Sun T. Comparison of lumbar spine stabilization exercise versus general exercise in young male patients with lumbar disc herniation after 1 year of follow-up Int J Clin Exp Med 2015; 8:9869–9875.

    Google Scholar 

  14. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database Syst Rev 2006; 1:CD004750.

    Google Scholar 

  15. Y Hayashi. Physical therapy for low back pain. Japan Med Assoc J 2004; 47:234–239.

    Google Scholar 

  16. Norris C, Matthews M. The role of an integrated back stability program in patients with chronic low back pain. Complement Ther Clin Pract. 2008; 14:255–263.

    Article  Google Scholar 

  17. Kennedy DJ, Noh MY. The role of core stabilization in lumbosacral radiculopathy. Phys Med Rehabil Clin N Am. 2011; 22:91–103.

    Article  Google Scholar 

  18. Barr KP, Griggs M, Cadby T. Lumbar stabilization: core concepts and current literature, part 1. Am J Phys Med Rehabil. 2005; 84:473–480.

    Article  Google Scholar 

  19. Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Curr Sports Med Rep 2008; 7:39–44.

    Article  Google Scholar 

  20. Wang XQ, Zheng JJ, Yu ZW, Bi X, Lou SJ, Liu J et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One 2012; 7:e52082.

    Article  CAS  Google Scholar 

  21. Benyamin RM, Manchikanti L, Parr AT, Diwan S, Singh V, Falco FJ, et al. The effectiveness of lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain. Pain Physician 2012; 15:E363–E404.

    PubMed  Google Scholar 

  22. Laiq N, Khan MN, Iqbal MJ, Khan S. Comparison of epidural steroid injections with conservative management in patients with lumbar radiculopathy. J Coll Physicians Surg Pak 2009; 19:539–543.

    PubMed  Google Scholar 

  23. Shah RV, Encksen JI, Lacerte M. Interventions in chronic pain management. 2. New froatiers: invasive nonsurgical interventions. Arch Phys Med Rehabil 2003; 54:539–544.

    Google Scholar 

  24. Manchikanti L, Singh V, Pampati V, Falco FJ, Hirsch JA. Comparison of the efficacy of caudal, interlaminar, and transforaminal epidural injections in managing lumbar disc herniation: is one method superior to the other?. Korean J Pain 2015; 28:11–21.

    Article  Google Scholar 

  25. Mendoza-Lattes S, Weiss A, Found E, Zimmerman B, Gao Y. Comparable effectiveness of caudal vs. trans-foraminal epidural steroid injections. Iowa Orthop J 2009; 29:91–96.

    PubMed  PubMed Central  Google Scholar 

  26. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, et al.. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997; 336:1634–1640.

    Article  CAS  Google Scholar 

  27. Wilson-MacDonald J, Burt G, Griffin D, Glynn C. Epidural steroid injection for neve root compression: a randomised, controlled trial. J Bone Johnt Surg Br 2005; 87:352–355.

    Article  CAS  Google Scholar 

  28. Bush K, Hillier S. A controlled study of caudal epidural injections of tnamcinolone plus procaine for the management of intractable sciatica. Spine 2007; 16:572–575.

    Article  Google Scholar 

  29. Cohen SP, Hayek S, Semenov Y, Pasquina PF, White RL, Veizi E, et al. Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: a multicenter, randomized, comparative-effectiveness study. Anesthesiology 2014; 121:1045–1055.

    Article  Google Scholar 

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Correspondence to Amal F. Soliman MD.

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Soliman, A.F., Hammad, G.A., El-gamal, R.I. et al. Assessment of the implication of epidural steroid injection versus other conservative measures in the management of lumbar disc herniation. Egypt Rheumatol Rehabil 43, 53–58 (2016).

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