Transforaminal epidural steroid injection for discectomy candidates: an outcome study with a minimum of two-year follow-up.

BACKGROUND The efficacy of epidural steroid injection for sciatica due to herniated disc is controversial. This study evaluates the therapeutic effect of an alternative technique that uses a modified approach of epidural steroid injection for the above mentioned disease. The aim was to determine whether this procedure can reduce the need of surgery among discectomy candidates. METHODS Twenty-one eligible patients who had suffered from sciatica with unilateral symptoms for 2 to 24 months received injections of betamethasone in combination with xylocaine. The treatment outcome was evaluated by direct questioning and examination using the JOA score (the criteria for low back pain syndrome of Japanese Orthopaedic Association) before the procedure and at the final follow-up visit. The final analysis comprised 19 patients with a minimum of 24-month follow-up. RESULTS The overall JOA score increased significantly from 14.26 +/- 3.25 before injection to 23.38 +/- 4.46 after injection showing improvement. In terms of subcategories, the JOA score for sciatica increased significantly from 0.69 +/- 0.48 before infection to 2.13 +/- 0.72 after injection and the JOA score for daily activity increased significantly from 7.44 +/- 2.16 before injection to 12.19 +/- 2.23 after injection). In the end, three treated patients received surgical decompression for intractable recurrent pain. CONCLUSIONS Transforaminal epidural steroid injection is a relatively simple, effective and low-risk alternative to surgical decompression for the treatment of lumbar disc herniation in selected cases. The procedure significantly alleviates the severity of sciatica due to a herniated disc and improves the patient's daily activity; this reduces the need for surgical decompression.