title: The impact of epidural steroid injections on the outcomes of patients treated for lumbar disc herniation: a subgroup analysis of the SPORT trial.
abstract: BACKGROUND
  The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of operative versus nonoperative treatment of lumbar intervertebral disc herniation. It has been suggested that epidural steroid injections may help improve patient outcomes and lower the rate of crossover to surgical treatment.
  
  
  METHODS
  One hundred and fifty-four patients included in the intervertebral disc herniation arm of the SPORT who had received an epidural steroid injection during the first three months of the study and no injection prior to the study (the ESI group) were compared with 453 patients who had not received an injection during the first three months of the study or prior to the study (the No-ESI group).
  
  
  RESULTS
  There was a significant difference in the preference for surgery between groups (19% in the ESI group compared with 56% in the No-ESI group, p < 0.001). There was no difference in primary or secondary outcome measures at four years between the groups. A higher percentage of patients changed from surgical to nonsurgical treatment in the ESI group (41% versus 12% in the No-ESI, p < 0.001).
  
  
  CONCLUSIONS
  Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection. There was a higher prevalence of crossover to nonsurgical treatment among surgically assigned ESI-group patients, although this was confounded by the increased baseline desire to avoid surgery among patients in the ESI group. Given these data, we concluded that more studies are necessary to establish the value of epidural steroid injection for symptomatic lumbar intervertebral disc herniation.
authors: Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, Philadelphia, PA 19107, USA. Radcliffk@gmail.com
authors: Kristen
authors: K
authors: Radcliff
authors: Alan
authors: A
authors: Hilibrand
authors: Jon D
authors: JD
authors: Lurie
authors: Tor D
authors: TD
authors: Tosteson
authors: Lawrence
authors: L
authors: Delasotta
authors: Jeffrey
authors: J
authors: Rihn
authors: Wenyan
authors: W
authors: Zhao
authors: Alexander
authors: A
authors: Vaccaro
authors: Todd J
authors: TJ
authors: Albert
authors: James N
authors: JN
authors: Weinstein
mesh_terms: D019540:Area Under Curve; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000188:drug therapy* / Q000628:therapy; D008159:Lumbar Vertebrae; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D013256:Steroids / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States
chemical_list: D013256:Steroids