Orthopedics-Online

Cortisone in a herniated disc

introduction

In order to avoid an operation in the case of a herniated disc, it is also possible to treat it conservatively.
This means that the symptoms of a herniated disc, such as pain in the back, tingling and numbness, can also be treated well with medication.
A very important drug in conservative therapy for herniated discs is cortisone, a glucocorticoid that has anti-inflammatory and immunosuppressive effects.
Cortisone ensures that the patient does not experience pain, does not develop inflammation in the affected area of the spine and also does not permanently impair their nerve cords.
It is possible to administer cortisone in the form of tablets, infusions or also in the form of injections.

Therapy options with cortisone

Cortisone in the form of tablets

Treatment of the symptoms, which can include pain, tingling and numbness in a herniated disc, can be improved within a few hours by taking cortisone.
In some cases they are given as tablets. The patient can simply take them depending on the arrangement.
Since a herniated disc often involves severe pain in the back area, the tablets are arranged in high doses.

The most common drug is prednisolone, which is offered by various pharmaceutical suppliers. It is a synthetically produced glucocorticoid whose active ingredient prednisone has anti-inflammatory (anti-inflammatory) and immunosuppressive effects.

You can find out more about this topic here:

Cortisone in tablet form
Prednisolone

Cortisone as an infusion therapy

It is also possible to perform cortisone therapy with infusions in the event of a herniated disc.
The drug is administered directly into the bloodstream through a vein access.
Prednisolone is available to dissolve so that it can be used as an infusion. For this, however, a longer inpatient stay in the hospital is necessary.

The infusions are often given for up to 10 days. How often the patient receives the drug via the vein during the day depends on the individual dose and, of course, on the extent of his symptoms, which are due to the severity of the herniated disc.
One advantage of this form of administration is that the active ingredient of the drug gets into the blood very quickly and can develop its effect.
An initial improvement in symptoms can often be seen within the first two hours after the first infusion, if the drug works very well and is well tolerated by the patient.

Appointment with a specialist for a herniated disc?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

A herniated disc is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

Therefore, treating a herniated disc requires a lot of experience.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert

Cortisone injections

There is also the option of injecting cortisone directly locally into the painful area on the spine.

This method is particularly popular when the patient is in acute acute pain, but it does not correct the prolapse (protrusion) of the intervertebral disc. The advantage of this method is the quick and longer-lasting effect directly on the spot.

The pain and the threat of inflammation can be quickly prevented. The injection is usually given once a week and can be repeated several times, depending on the severity of the symptoms and the further treatment options.

Periradicular Therapy

PRT - periradicular therapy - is a diagnostic and treatment method for so-called radicular pain, such as can occur after a herniated disc, for example.

Under the control of a CT, a syringe with cortisone is guided past the spinal cord to the nerve root, which is thought to be responsible for the symptoms. If you can then see in the CT that the needle tip has reached the nerve root, the cortisone is applied from the syringe. It is supposed to work locally and thereby treat swelling or inflammation of the nerve root, which should also reduce the existing pain. Ideally, this therapy is even sufficient to achieve complete freedom from pain.

In this therapy, the patient is placed on his stomach and receives a local anesthetic so that the pain from the injection is not too severe. It is important that the skin area is well disinfected beforehand. The doctor can now insert the syringe under visual inspection. This will ensure that the syringe is in both the correct depth and the correct direction. At the same time, the risk of injuring other important structures such as the spinal cord is minimized. This periradicular therapy takes about 5-10 minutes.

After the injection, the patient should avoid sports, heavy lifting and driving a car, as the local anesthesia can temporarily lead to sensory disorders and symptoms of paralysis. However, these regress after about two hours.

More information on this topic: Periradicular Therapy

Complications and contraindications to cortisone therapy

As with many interventions, complications can arise in the treatment of a herniated disc with cortisone, especially with cortisone injections.
It is therefore important to inform the patient about the possible risks in a preliminary discussion before the procedure. First, the patient should be made aware that cortisone can cause side effects.

Furthermore, an unexpected allergic reaction can occur, which can lead to a drop in blood pressure and various skin rashes.

The injections can also trigger other complaints. There is a risk of damaging nerves, which can lead to reversible and, in the worst case, irreversible loss of sensitivity or muscles.
There is also the risk that the introduction of the syringe will also carry germs into the vicinity of the spinal cord and cause inflammation there.

Such treatment should not be carried out in pregnant women. Treatment with cortisone injections is also contraindicated for patients who take blood-thinning drugs such as heparin or Marcumar, because this can lead to increased bleeding in the area of the puncture site, which can lead to uncomfortable swelling in the back area.

You can find alternative therapy suggestions on our website:

Treatment of a herniated disc

Side effects of cortisone

Cortisone is the body's own hormone, but it can also be used to treat certain inflammatory diseases.
In order for it to develop its effect, it is often administered in very high doses, which of course can also cause undesirable side effects.

The most common side effects of cortisone include an increase in blood pressure (hypertension) and increase in blood sugar.
For many patients, the possibility of weight gain in particular is a major concern. Cortisone therapy can also lead to increased storage of water, which makes the patient feel swollen and gain weight.

Since cortisone has an immune-inhibiting effect, it is often used in autoimmune diseases to curb the body's own defense system. However, this also increases the susceptibility to bacterial or viral infections.

Another side effect, which is particularly caused by prolonged therapy with glucocorticoids such as cortisone, is Cushing's syndrome.
In addition to a shrinkage (atrhophia) of the adrenal cortex due to the supplied cortisone, there is a formation of a full moon face, bull neck, trunk obesity with thinner extremities, increased acne, depression and high blood pressure.

In addition, cortisone has a negative effect on the bone metabolism and promotes the development of osteoporosis.

Find out more here:

Side effects of cortisone

Dosage of cortisone

To treat the herniated disc, 50 mg cortisone is used and a high-dose therapy with a maximum of 250 mg per day is aimed for.
The maximum dose is divided into three to four individual doses a day, so that a consistently high blood level of the active ingredient is achieved.
This ensures that the patient does not experience any pain or inflammation in the damaged area of the spine. How long the patient should take the tablets depends on the one hand on the success of the treatment but also on whether the patient tolerates the prednisolone well.
Treatment can usually last up to two weeks.

Duration of intake

The duration of the cortisone intake depends on the improvement in the symptoms during the therapy. Since cortisone is taken to improve the symptoms of the herniated disc, the symptom reduction should also be the manipulated variable that decides whether it is taken.

Basically, taking a glucocorticoid for a few weeks is rather safe. The longer cortisone is taken, the more likely systemic side effects become. However, if taking cortisone helps the patient so well and the side effects are acceptable for the patient or less severe than the symptoms of the herniated disc, the cortisone can also be taken for several years. However, regular blood counts should be carried out.

Alternatives to cortisone

Since cortisone already represents a significant increase within conservative therapy, oral cortisone intake is followed by periradicular therapy.

In addition to the application of cortisone to the nerve root, the use of a local anesthetic can also be considered. This should specifically block the transmission of pain to the brain.

If this is unsuccessful either, an operation usually represents the next stage of therapy. Here one tries to create enough space for the nerve root so that it is not restricted by other structures. For this, the bulging intervertebral disc is usually removed. Whether it is sufficient to remove the intervertebral disc or remove the intervertebral disc completely and stiffen the intervertebral space varies from patient to patient. Furthermore, the canal through which the nerve is directed past the spinal column into the periphery can also be widened if there is a narrowing that causes the nerve to become trapped.

Additional information on cortisone

Cortisone is a steroid hormone and belongs to the group of glucocorticoids.
It is produced by the body in the adrenal cortex and takes on important functions in the mineral and water balance, in the immune system and also has effects on the bones, muscles, the central nervous system and the eyes.

It is also used for therapeutic purposes in many diseases of an inflammatory nature, such as skin diseases, asthma and rheumatism.
Cortisone has a strong anti-inflammatory effect as it prevents the production of certain pro-inflammatory mediators. This curbs the body's own immune system and can also prevent an excessive reaction in the case of allergies or asthma.

Here you can find detailed information about the drug:

Cortisone

Summary of cortisone therapy for a herniated disc

In the case of a herniated disc, muscle and sensitivity failures can occur.
The reason for this is the narrowing of certain nerve fibers in the spinal canal due to the slipped gelatinous nucleus, which is part of the intervertebral disc.

So that the symptoms do not progress and nerve cords are permanently damaged, attempts are made to alleviate the symptoms with cortisone treatment as part of a conservative treatment.
Cortisone has anti-inflammatory and decongestant effects.
It is hoped that the treatment will reduce the swelling in the area of the herniated disc. Symptoms often improve as the swelling recedes.

The constriction of the nerves and the surrounding tissue can also trigger an inflammatory reaction that would further damage the spine, but this can be avoided by administering cortisone.

Cortisone can be administered in the form of tablets, as an infusion or locally as injections. Which method is used depends primarily on the severity of the symptoms, which in turn depend on the extent of the damaged nerve fibers.

A good diagnosis should therefore be preceded by treatment with cortisone. In addition to the cortisone, other drugs are often administered. The patient receives a pain reliever and, if necessary, a local anesthetic at the same time.

Cortisone therapy is used specifically to improve symptoms for a short time. In most cases, long-term causal therapy is recommended.