Differences of therapeutic responses to epidural steroid injection in elderly patients with radiculopathy

Abstract

Background: Lumbar epidural steroid injections (ESI) administered in patients with radicular symptoms produce variable effects. Further, factors associated with improved outcomes are unclear. We investigated the effect of lumbar ESI not only on pain but also on depression and insomnia. Previous studies have only investigated the relationship between pain and magnetic resonance imaging (MRI) findings. Therefore, we aimed to determine the relationships between pain, MRI findings, sleep, and depression scores. Methods: Thirty-five patients with lumbar radiculopathy were recruited in the study. After excluding 15 patients, 20 were evaluated both before and after ESI. These patients were categorized into 3 groups according to lumbar MRI findings as disk herniation I (bulging and protrusion) and disk herniation II (extrusion and sequestration) and central canal stenosis group. We evaluated treatment outcomes using changes in the visual analogue scale. Additionally, patients completed the Beck Depression Inventory and the Insomnia Severity Index (ISI) before and after ESI. Results: After ESI, patients with disk herniation I showed improvement in pain, depression, and sleep; however, there were no significant differences between disk herniation I and the other 2 groups. Conclusion: We believe that active treatment with ESI may alleviate pain, depression, and insomnia in patients with disk herniation I showing bulging and protrusion.