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The question of using epidural steroid injections (ESIs) for patients with sciatica is still a hotly debated topic. Studies report results on both sides: the injection helps or the injection doesn't help. Patients are saved from surgery. Or patients still have the surgery anyway.
The reason there are such differences in opinions may have to do with the quality of the studies. Experts who take a step back and review all the research report that the design of many studies is poor. The results can't really be trusted without better research methods.
Looking at the big picture, patients who need surgery are going to need it with or without the injection. But it isn't always easy to tell who's going to need an operation. So sometimes patients opt to try the injections first. They do provide fast relief from the pain. And the pain relief can last up to three months.
The injections don't necessarily change your ability to function. That's when surgery is needed. Removing the disc that's pressing on the nerve may be the only way to calm down the painful symptoms and restore full function.
It looks like mild disc protrusion responds well to ESI without the need for surgery. With a disc protrusion, the disc is bulging but still intact. The inner core or nucleus of the disc has not pushed through the outer covering around the disc.
With a herniated disc, the outer covering has a crack or hole in it and the disc material is oozing out. If you have a herniated disc, then surgery is recommended sooner than later.
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