Epidural steroid injection returns most professional football players to the field

SAN FRANCISCO – Researchers found an 89% success rate of epidural steroid injection treatment for acute lumbar disk herniation in professional football players, according to Aaron J. Krych, MD at the American Orthopaedic Society for Sports Medicine 2012 Specialty Day Meeting, here.

“Acute lumbar disc herniation is relatively common in athletes, especially those playing contact sports,” Krych said. “Currently, nonoperative treatment demonstrates a 79% successful return to play at an average of almost 5 months. Surgical treatment shows a similar 74% to 90% success rate of return to play for elite college athletes and professional football players. Epidural steroid injections have been shown to be a pain relief modality; however, currently there are conflicting reports of potential efficacy or pain improvement as well as improvement in function.”

Krych and colleagues assessed the efficacy of epidural injection with the goal of return to play, identified the adverse events associated with the injection and pinpointed potential risk factors for failure of the approach. They retrospectively reviewed all records of professional American football players examined at their institution between 2003 and 2010 who had acute lumbar disc herniation confirmed on MRI. Exclusions included preexisting hip pathology or prior back surgery. They found 27 episodes of disc herniations and performed 37 injections. Average age was 25 years, and the most affected players were offensive and defensive linemen. The investigators performed detailed musculoskeletal and neurology examinations, took radiographs and MRIs and referred players to spine surgeons or pain specialists as needed. The most commonly affected areas of disk herniation were the L4 to L5 regions. The researchers injected patients with 80 mg to160 mg of triamcinolone.

Krych and his team considered the injections successful if athletes returned to play within game conditions with no overtime and no additional surgical procedures. They found 89% of patients were fit to return to play, and the players continued an average of 3 seasons with 10 of the players still on the field. Four players required repeat injection with inability to return to play following a second injection, and three players needed surgery.

“In our hands, epidural steroid injections were an effective therapeutic option for treatment of acute lumbar disk herniation in professional athletes,” Krych said. “They appear to be safe and well-tolerated with minimal side effects. In this small study, risk factors for failure included sequestered disk on MRI as well as presentation of lower extremity weakness. We continue to recommend an individualized treatment approach for our athletes.”

Reference:

Krych AJ, Drakos M, Birmingham P, et al. Return to play after epidural steroid injection for lumbar disc herniation in professional American football athletes. Paper #19. Presented at the American Orthopaedic Society for Sports Medicine Specialty Day at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 11. San Francisco.

Disclosure: Krych has no relevant financial disclosures.

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