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The Incidence of Lumbar Discectomy after Epidural Steroid Injections or Selective Nerve Root Blocks

William F. Lavelle, MD,1 Thomas Mroz, MD,2 Isador Lieberman, MD3

1Department of Orthopedic Surgery, SUNY Upstate Medical University, East Syracuse, NY, 2 Center for Spine Health, The Cleveland Clinic, Cleveland, OH, 3 Scoliosis & Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital, Plano, TX

Abstract

Background

The purpose of this study was to determine the use of Central Epidural Steroid Injections (ESI) and Selective Nerve Root Blocks (SNRB) along with the crossover rate to lumbar discectomy in patients with a lumbar disc herniation using retrospective records database search. Butterman et al found a crossover rate for patients with symptomatic disc herniations treated with ESI of 54% (27/50), while Riew similarly found a 53% (29/55) crossover patients receiving SNRB.

Methods

The database was searched in a sequential Boolean style for patients with the diagnosis of a lumbar disc herniation (Displaced Lumbar Disc - 722.1) and a SNRB (64483) or ESI (62311) who subsequently underwent a Lumbar Discectomy (63030) over a three year time period from January 2004 through December 2006. Statistical analysis was preformed examining the impact of injection type, age, location, gender, and year.

Results

Of 482,893 patients with the diagnosis of a disc herniation, 27,799(5.76%) underwent a lumbar discectomy. The 29,941 patients who received at least one SNRB for a disc herniation, 10.80% later underwent a lumbar discectomy. The 41,420 patients who received at least one ESI for a disc herniation 9.34% later underwent a lumbar discectomy. There was a noted increase in injection procedures, particularly SNRB during the study with a greater than 50% increase.

Conclusions

Our examination found a much smaller, but similar crossover rate to surgery between both injection methods, which argues against one method being more effective than another in avoiding surgery. It is likely that patients are receiving these procedures more frequently during the course of conservative treatment for a disc herniation.

Level of Evidence

This was a Level III study.

keywords: 
Central Epidural Steroid Injections (ESI), lumbar discectomy, lumbar disc herniation, Selective Nerve Root Blocks (SNRB)
Volume 9 Article 12
doi: 
10.14444/2012