Do Oral Steroid Dose Packs Predict How Well Epidural Steroid Injections Will Work?

Inclusion Criteria:

- 18 years and older

- Diagnosed by participating physicians during the study enrollment period as having
intervertebral disk herniation and persistent symptoms with or without some
nonoperative treatment for at least 4 weeks

- Radicular pain (below the knee for lower lumbar herniations, into the anterior thigh
for upper lumbar herniations)

- Evidence of nerve-root irritation with a positive nerve-root tension sign (straight
leg raise-positive between 30° and 70°) or a corresponding neurologic deficit
(asymmetrical depressed reflex, decreased sensation in a dermatomal distribution)

- Undergone either MRI or CT scan showing disc herniation (protrusion, extrusion, or
sequestered fragment) at a level and side corresponding to the clinical symptoms

- Patients with multiple herniations can be included if only one of the herniations is
considered symptomatic

- Preenrollment nonprocedural care can include: education/counseling, physical therapy,
chiropractic therapy, anti-inflammatory medications, opioid analgesics, adjuvant
analgesics such as anticonvulsants and antidepressants

Exclusion Criteria:

- Prior lumbar surgery

- Cauda equina syndrome

- Vertebral fractures

- Spine infection or tumor

- Severe motor deficit

- Inflammatory spondyloarthropathy

- Pregnancy

- Cardiac or pulmonary comorbid conditions contraindicating interventional procedures

- Diabetes

- Inability/unwillingness to have spinal injections