Spinal decompression vs. epidural steroid injections

How do they compare side by side?

One is a needle and medicine; the other is a series of mechanical stretching sessions. Here are the main differences.

Sources: MedlinePlus, Cochrane 2020, Cochrane 2013.

What does an epidural steroid injection do?

It delivers anti-inflammatory medicine directly around irritated nerve roots to reduce swelling and pain.

According to MedlinePlus, an epidural steroid injection (ESI) is usually recommended for pain spreading from the low back into the hip or leg, most often from a bulging disc pressing on a nerve, and only after medicines, physical therapy or other non-surgical care haven't helped. The steroid usually takes 3 to 5 days to work. Relief often lasts weeks to months. It doesn't fix the underlying cause, so exercise and other treatment continue.

Possible risks include headache, dizziness, nausea, infection, bleeding and, rarely, nerve damage. Frequent injections may weaken bone and nearby muscle.

What does spinal decompression do?

It gently stretches the spine in slow cycles, aiming to ease pressure on a disc and the nerve next to it, without drugs or needles.

You lie on a padded table with a harness. The table pulls and relaxes in slow, controlled cycles for about 30 to 45 minutes. Most people describe a gentle stretch. See how decompression works and does it hurt?

What does the research say?

Injections have more research, showing small short-term benefit. Decompression has little high-quality research.

A 2020 Cochrane review of 25 trials found epidural steroid injections probably slightly reduce leg pain and disability in the short term (up to 3 months) compared with placebo, and called the support limited. For traction, a 2013 Cochrane review found it was no more effective than sham treatment or other treatments for low back pain, with or without sciatica. Decompression tables are a form of motorized traction, and there isn't strong independent research showing they work better. Some people still report relief. Read more: does spinal decompression work?

Who might lean toward each?

It depends on your diagnosis, how severe the pain is, your health history and how you feel about needles, medicine and time.

• An injection may make sense if leg pain is severe, you need faster short-term relief to stay active or work, and conservative care hasn't helped.
• Decompression may be worth asking about if you prefer to avoid medication or needles, can commit to several weeks of visits, and have disc-related pain without conditions that rule it out.
• Neither replaces exercise and staying active, which have the strongest evidence for long-lasting back pain.

Some people try one, then the other. Your physician and Dr. Gordon Stapel, DC can talk through the order that makes sense for you.

What about cost?

Costs depend on your plan and how many visits or injections you need. This site doesn't list prices.

Injections are a single procedure that's often billed to health insurance. Decompression is a series of visits, and coverage varies widely. Ask both offices for your expected out-of-pocket cost before you start. See cost and insurance.

Questions? Call Springville Disc Center at Stapel Family Chiropractic at (801) 491-8688.

This website is operated for Stapel Family Chiropractic (Springville Disc Center) in Springville, Utah. Care is provided by Dr. Gordon Stapel, DC, a licensed chiropractic physician. About this site.