How surgeons view epidural steroid injections

[Agast]

I'm sitting through this mandatory worker's compensation certifying exam course and the ortho presenter dropped this tidbit:

"Epidural steroid injections don't change the natural course of the herniated disc, they only give temporary relief. I use the epidural steroid injection to show the patient how much better they will feel after their surgery."

I should send him all my engineer patients 🙄

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[powermd]

I'm sitting through this mandatory worker's compensation certifying exam course and the ortho presenter dropped this tidbit:

"Epidural steroid injections don't change the natural course of the herniated disc, they only give temporary relief. I use the epidural steroid injection to show the patient how much better they will feel after their surgery."

I should send him all my engineer patients 🙄

Except temporary can be a year or more and allow the patient to keep their OEM parts. I guess all medications used to treat chronic disease should be abandoned because they only provide 'temporary' relief of the problem. Let's throw in vaccinations too, since they often need boosters. Oh, and spine surgery too, because that's just as temporary as an epidural injection when you account for the new and truly unfixable problems that arise. Maybe we should abandon life all together, since it's only temporary. F'king idiot.

 

[SommeRiver]

Probably 10x a week I'm referred pts from a surgeon with whiplash for CESI.

"Pt with neck pain refractory to PT after MVC - Cervical epidural."

 

[Agast]

Unless the patient is obese. Then they are told surgery won't help, they need an epidural steroid injection instead.

 

[bedrock]

Unless the patient is obese. Then they are told surgery won't help, they need an epidural steroid injection instead.

Agree. Or they have bad insurance or history of surgical infections.....then suddenly an epidural is just what they need!

 

[BobBarker]

Probably 10x a week I'm referred pts from a surgeon with whiplash for CESI.

"Pt with neck pain refractory to PT after MVC - Cervical epidural."

10x/week???
That is a lot of MVC patients and a ton of money after the case is settled.

 

[SommeRiver]

10x/week???
That is a lot of MVC patients and a ton of money after the case is settled.

Mmm...I say MVC but you can swap that with falls or any other trauma resulting in axial neck pain without referral into the arm or scapula.

Let's call it axial neck pain - I get a lot of that...A LOT.

Edit - Maybe not 10 every week, but there are two spine surgeons in my group and they're not going to listen to me or read my notes.

 

[jsaul]

Agree. Or they have bad insurance or history of surgical infections.....then suddenly an epidural is just what they need!

Or if they don't have the good insurance plans

 

[bedrock]

Or if they don't have the good insurance plans

correct. That would make a complete list. If the patient is medicaid, or medi-medi, then suddenly they are not a surgical candidate......

 

[Laryngospasm]

Nevermind the number of patients that get better over time even without interventions. But surgery is definitely the answer. I’m always shocked when surgeons don’t tell patients they have a good chance of getting better even without doing anything. To the man with a hammer the whole world looks like a PLIF

 

[Crybaby]

However, surgeons are quick to refer their friends and spouses for ESI to avoid surgery🙂

 

[Baron Samedi]

The probability of spontaneous regression of lumbar herniated disc: a systematic review - PubMed

Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc...

pubmed.ncbi.nlm.nih.gov

 

[DrSpine]

The probability of spontaneous regression of lumbar herniated disc: a systematic review - PubMed

Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc...

pubmed.ncbi.nlm.nih.gov

Thanks for sharing this!

 

[gaseous_clay]

10x/week???
That is a lot of MVC patients and a ton of money after the case is settled.

Which may take years...that’s a lot of money sitting on AR.

 

[xvaderx]

Probably 10x a week I'm referred pts from a surgeon with whiplash for CESI.

"Pt with neck pain refractory to PT after MVC - Cervical epidural."

I'll take them.

 

[SommeRiver]

I'll take them.

I RFA them.