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Epidural Steroid Injection for Lumbar Disc Herniation in NFL Athletes

KRYCH, AARON J.1; RICHMAN, DANIEL2; DRAKOS, MARK3; WEISS, LEIGH4; BARNES, RONNIE4; CAMMISA, FRANK1; WARREN, RUSSELL F.1

Medicine & Science in Sports & Exercise: February 2012 - Volume 44 - Issue 2 - p 193–198
doi: 10.1249/MSS.0b013e31822d7599
Clinical Sciences

Purpose: To our knowledge, there is no published information on the efficacy of epidural steroid injections for the treatment of lumbar disc herniation in an athletic population. The purpose of this study was to evaluate the efficacy of epidural corticosteroid injection for treatment of lumbar disc herniation in a group of National Football League (NFL) players.

Methods: We retrospectively reviewed the records of all NFL players who underwent an epidural steroid injection at our institution for incapacitating pain secondary to an acute lumbar disc herniation (confirmed on magnetic resonance imaging) from 2003 to 2010. Our primary outcome was success of the injection, defined as return to play. The secondary outcome of the study was to evaluate risk factors for failure of this treatment approach.

Results: Seventeen players had a total of 37 injections for 27 distinct lumbar disc herniation episodes from 2003 to 2010. The success rate of returning an athlete to play for a given episode of disc herniation was 89% (24 of 27 episodes) with an average loss of 2.8 practices (range = 0–12) and 0.6 games (range = 0–2) after the injection. Four players required a repeat injection for the same episode. Three of these four players ultimately failed conservative management and required surgical intervention. Risk factors for failing injection therapy included sequestration of the disc herniation on magnetic resonance imaging (P = 0.01) and weakness on physical examination (P = 0.002). There were no complications reported.

Conclusions: In this highly selective group of professional athletes, our results suggest that epidural steroid injections are a safe and effective therapeutic option in the treatment of symptomatic lumbar disc herniation.

1Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY; 2Department of Anesthesiology, Hospital for Special Surgery, New York, NY; 3Department of Orthopaedic Surgery, North Shore-Long Island Jewish Health System, Great Neck, NY; and 4New York Football Giants, TIMEX Performance Center, East Rutherford, NJ

Address for correspondence: Aaron J. Krych, M.D., Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021; E-mail: krycha@hss.edu.

Submitted for publication April 2011.

Accepted for publication July 2011.

©2012The American College of Sports Medicine