Suresh Bora, Hari Krishnan S. V
BACKGROUND Epidural Steroid Injection for radicular pain is an Effective method of treatment. No conclusive evidence exists to compare the efficacy of Epidural steroid injections (ESI) and conservative Management in Acute Flare up of Discogenic Pain in Degenerative Disc Disease (DDD). The aim and objective of the study is to determine the efficacy of Epidural Steroid injections and to compare the outcome with conservative mode of treatment in patients with acute flare up of DDD and to determine whether patients with inflammatory end plate changes are a unique subgroup in terms of treatment response. MATERIALS AND METHODS Pain and function in patients with DDD were prospectively assessed in 89 patients for a period of 1year by an outcomes questionnaire (VAS pain score, Oswestry Disability index [ODI]), Use of pain medication and Opinion of treatment success before and after ESI and a course of conservative management. Further correlation was made with end-plate inflammatory (Modic Type 1) changes identified on Magnetic Resonance Imaging (MRI) and compared. RESULTS ESI was effective in improving pain and function, as assessed by outcomes scores at short-term follow-up .Patients had significant improvement in the 6 months follow up when compared to conservative group (p<0.05). Patients with inflammatory end-plate changes seem to represent a subgroup of DDD patients who respond better to steroid injections. CONCLUSION Spinal Epidural steroid injections are low risk and rapid treatment option for acute flare up of Discogenic Pain in DDD. It is beneficial and more effective in patients with Modic type 1 adjacent inflammatory end plate MRI findings when compared to conservative management.
