Biomarker may signal whether common back pain treatment will work, doctor finds

Roughly a quarter of all people with back pain have a herniated disc, and approximately 90 percent of herniated discs occur in the lower back. Steroid injections generally cost a few thousand dollars each, and patients often receive a series of three or more of them, said Gaetano Scuderi, MD, a clinical assistant professor of orthopaedic surgery who is the senior author of the study to be published in the Aug. 15 edition of Spine. The lead author, S. Raymond Golish, MD, PhD, was recently a fellow in spine surgery at Stanford.

“There’s about a 50-50 chance that the epidural steroid will work, so most people figure, ‘Hey, I have nothing to lose,’” Scuderi said. “However, there is a significant expense, not to mention the procedural risks and lost productivity.”

Scuderi cited a 2008 study showing that Americans spend $90 billion every year on treatments for lower-back pain, and said the findings in his new study provide the basis for a test that might someday lead to substantial savings for the health-care system.

A herniated disc is a problem with one of the small, spongy cushions that sit between the vertebrae of the spine. The hernia occurs when the inside portion of the disc ruptures and bulges out from between the vertebrae. If it’s in the lumbar, or lower spine, region, it may lead to pain, numbness and tingling in the legs and buttocks, not to mention a backache.

Most people with herniated discs get better within one to six months, but the symptoms can be hard to live with, so physicians often prescribe muscle relaxants, painkillers or a series of steroid injections, which have been shown to provide moderate, short-term relief. Many patients also undergo a physical-therapy regimen. In a small number of cases, surgery is needed.

But if patients with lower-back pain could be screened to determine whether they would respond to the injections, they could be spared the discomfort and cost of a futile procedure, Scuderi said, as well as its potential complications, such as bleeding, infection and thinning and even death of bone tissue.