The use of steroid injections is on the rise for lumbar disc herniation. But there’s no evidence to support this treatment. Success rates vary from 18 to 90 per cent for lumbosacral injections. More study is needed to find out why results vary so much and determine ways to improve results for all patients.
Studies do support the use of injections for sciatica more than any other diagnosis. But there’s been a big increase in the use of injections for many other problems in the Medicare population. There is some concern that injections are being over used in this age group because Medicare pays more for procedures than for other kinds of treatment.
Younger patients may be treated with lumbar disc chemonucleolysis. This is the dissolving of the disc using an injection of an enzyme such as chymopapain. It is used most effectively when the disc has protruded but is still contained within its outer covering. Chemonucleolysis works well to bridge the gap between conservative (nonoperative) care and surgery. And having this procedure doesn’t prevent the patient from having surgery if it is needed later.