Epidural steroid injection as a predictor of surgical outcome

The value of patient response to epidural steroid injection as a predictor of surgical outcome was studied. One hundred and eighty-seven patients with clinical signs of root compression underwent lumbar epidural steroid injection. Eighty-five of these patients had been told that an operation on the lumbar spine would be necessary. Over the ensuing one to three years, only 34 of these patients eventually required an operation upon the lumbar spine or an injection of chymopapain. Fifty-four per cent of the patients who were unimproved after epidural steroid injection were also unimproved after chymopapain whereas all patients who were improved, even transiently, after epidural steroid injection were improved after chymopapain injection. A statistical comparison of these two groups revealed the probability of these occurrences of 0.088. There was no correlation between outcome of open surgical procedures and response to epidural steroids. Epidural steroid injection may be a valuable aid to predicting the outcome of chemonucleolysis.