Epidural Injections for Lumbar Discs?

 The Facts:

a. The authors evaluated the effectiveness of the procedure of fluoroscopically directed caudal epidural injections for chronic low back/lower extremity pain. This was done for patients who suffered from disc herniation and radiculitis.

b. The authors looked at using local anesthetic (lidocaine) in the injections and also by using lidocaine combined with a steroid.

c. The authors called epidural injections a minimally invasive and common procedure for the treatment of chronic low back and/or lower extremity pain.

d. There were 120 patients in this study.

e. They looked at patients who experienced a 50 percent or greater reduction of their pain. They also looked at those who improved 50 percent or more on the Oswestry Disability Index (ODI).

f. Of patients who received the lidocaine only injections, 70 percent experienced 50 percent or greater reduction in pain and 67 percent got a 50 percent or greater improvement in ODI.

h. In the lidocain plus steroid injection group 77 percent got a 50 percent or greater reduction in pain and 75 percent reported a 50 percent or greater improvement in ODI.

ij. Patients who received lidocain only reported relief for about 3.8 weeks with the first injection.

j. Patients receiving the lidocain/steroid combinations reported relief for about 6.3 weeks with the first injection.

k. The number of injections that the lidocain only group needed each year was about 3.8. For the lidocain/steroid group it was about 3.6.

l. The patients reported about 40 weeks of relief annually if the procedures were repeated.

Lidocain plus steroid appears to work better than lidocain alone, but the procedure still needs to be repeated multiple times during the year.

It seems you might have to repeat these procedures a number of times over the course of a year. 

I have to wonder what an insurance company would inform me if I told them my patient needed 4 periods of treatment annually (let’s say 3 weeks of 3 sessions of care per week) a year to give the patient 40 weeks of relief. 

The chiropractic care would likely cost less and is certainly less invasive, but would the chiropractor be called an overutilizer?  I leave it to you to wonder which would be better for you: a chiropractor who helps your body heal (successfully) on its own with minimal intervention  or  injections which subject your body to chemical/medications with side-effects.

Reference: Manchikanti L, Singh V, Cash KA, Pampati V, Damron KS, Boswell MV. A randomized, controlled, double-blind trial of fluoroscopic caudal epidural injections in the treatment of lumbar disc herniation and radiculitis. Spine 2011;36:1897-905.

Link to Abstract: