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

@entity1 @entity890 @entity479
BACKGROUND: The purpose of this study was to determine the use of Central Epidural @entity479 Injections (ESI) and Selective Nerve Root Blocks (SNRB) along with the crossover rate to lumbar discectomy in @entity1 with a @entity890 using retrospective records database search. Butterman et al found a crossover rate for @entity1 with symptomatic disc herniations treated with ESI of 54% (27/50), while Riew similarly found a 53% (29/55) crossover @entity1 receiving SNRB. METHODS: The database was searched in a sequential Boolean style for @entity1 with the diagnosis of a @entity890 (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 @entity1 with the diagnosis of a disc herniation, 27,799(5.76%) underwent a lumbar discectomy. The 29,941 @entity1 who received at least one SNRB for a disc herniation, 10.80% later underwent a lumbar discectomy. The 41,420 @entity1 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 @entity1 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.
