Corticosteroids for a herniated disc

Examples

Generic Name	Brand Name
dexamethasone
methylprednisolone acetate	Depo-Medrol, Medrol
prednisone

How It Works

Corticosteroids may be given orally or injected into the spinal canal (epidural) or near a spinal nerve to treat herniated disc symptoms. These medicines may help reduce swelling and inflammation in the area surrounding the herniated disc and may help relieve pressure on the nerve roots.

Why It Is Used

Epidural and spinal nerve corticosteroids can be used for people with symptoms of nerve root compression and inflammation if their symptoms have not improved after several weeks of nonsurgical treatment. Occasionally corticosteroid injections are used sooner to treat acute disc herniations that are causing severe symptoms.

Corticosteroids may successfully relieve symptoms caused by a herniated disc on a short-term basis (a few weeks to a few months). They also may be used to delay or even eliminate the need for surgery for some people who have severe pain caused by a herniated disc.

How Well It Works

There is evidence that corticosteroid injections can help you feel better. There is also evidence that the injections do not help any more than a placebo.¹ Research continues on both oral and injected corticosteroids. Oral corticosteroids have not been shown to help relieve symptoms of herniated discs, but some doctors use them because they are safe and simple for short-term use and they seem to help some people.

Corticosteroid treatment does not provide long-term pain relief by itself. But if corticosteroids can help calm down the acute inflammation, the body's normal healing process may lead to long-term improvement.

Side Effects

Mild side effects may include:

• Headache, sometimes severe. This usually lasts no more than 1 to 2 days.
• Dizziness.
• Increased back or leg pain.

Rare but serious side effects may include:

• Infectious and noninfectious inflammation of spinal nerves or other tissues.
• Degeneration or damage to soft tissue from multiple injections.
• Damage to nerve roots.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

An imaging test, such as magnetic resonance imaging (MRI), computerized tomography (CT scan), or myelogram may be done before a corticosteroid injection to find the exact location of the herniated disc.

Although some doctors prefer to use two to three epidural corticosteroid injections, others will prescribe only one, repeating the treatment only if symptoms recur and if the first injection was effective.

Repeated use of corticosteroid injections or pills may cause serious side effects.

Despite a lack of solid research supporting the practice, corticosteroid injections are commonly prescribed to treat herniated disc symptoms that haven't responded to a few weeks of treatment with other methods.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: July 21, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Robert B. Keller, MD - Orthopedics
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