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Steroid Injections or Discectomy for Large Disc Herniations?

Dr. Glenn Buttermann at the Midwest Spine Institute looked at the results of two treatments for large disc herniations. All disc problems were in the lumbar spine. When a disc protrudes or herniates, the center of the disc (the nucleus) pushes through its own outer covering (the annulus). It can push into the canal where the spinal cord is located or press on the nearby spinal nerves. A large herniation was defined as one taking up more than 25 percent of the spinal canal.

One hundred patients were either treated with a steroid injection or discectomy (disc removal). Everyone had tried at least six weeks of other treatment first, with little success.

Here are the results:

  • Patients who had the discectomy got better faster.
  • Only about half the injection group got relief from pain.
  • Injections worked for up to three years in the successful injection group.
  • Injection first then discectomy works for some patients; having the injection first doesn't seem to affect the result of a later discectomy.
  • Patients used less pain medication in both groups.
  • Discectomy patients used less pain medicine than the injection group.

    The author concludes that steroid injections can sometimes be used instead of surgery. Noninvasive treatment should be tried first. But steroid injections certainly have a role to play in patients with large disc herniations.

    Glenn R. Buttermann, MD. Treatment of Lumbar Disc Herniation: Epidural Steroid Injection Compared with Discectomy. In The Journal of Bone and Joint Surgery. April 2004. Vol. 86-A. No. 4. Pp. 670-679.

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