Epidural steroid injections work. For many patients with acute disc herniations and severe radiculopathy, an ESI can provide dramatic, rapid relief — enough to get through the acute phase, start physical therapy, and in some cases avoid surgery altogether.
The problem is that they stop working. Either the relief never materializes the way it did the first time, or it wears off faster with each subsequent injection, or the pain comes back as severe as before. What then?
This is one of the most common clinical situations I see at West Hills Chiropractic Pain Center — patients who’ve had two, three, or four rounds of injections over the past year or two, with diminishing returns, who are now being told they’re “out of options” short of surgery.
They’re usually not out of options.
Why Epidural Steroids Work (and Why They Stop)
An epidural steroid injection delivers corticosteroid medication — a powerful anti-inflammatory — directly into the epidural space surrounding the nerve root. The goal is to reduce the local inflammatory response around a compressed or irritated nerve, which can dramatically reduce pain even before the underlying disc pathology changes.
Here’s the critical distinction: ESIs treat inflammation. They don’t treat the mechanical cause of that inflammation — the herniated or bulging disc that is physically pressing on the nerve.
This is why ESIs work initially: the inflammation around the nerve decreases, the nerve calms down, and pain improves. And it’s why they stop working: the disc is still there, still pressing on the nerve. The inflammation returns. Sometimes the disc condition progresses. And eventually, corticosteroid injections in the same region begin to have diminishing biological effect — the tissue becomes less responsive, and there are practical limits to how many injections are safe in a given period (typically 3 per year in the same region, due to steroid-related tissue effects).
What a patient often experiences as “the injections stopped working” is actually “we’ve been treating the downstream symptom without addressing the upstream cause.”
The Mechanical Problem That Injections Can’t Solve
If your pain is generated by a disc that is physically compressing a nerve root, reducing inflammation around that nerve buys time — but the compression is still there. The nerve is still being mechanically irritated. The inflammatory cascade continues to be driven by that compression.
For some patients with acute herniations, the disc material resorbs naturally over 6-18 months. This is a real phenomenon — the body does sometimes reabsorb herniated disc fragments — and when it happens, the combination of time and symptom management (including ESIs) can produce resolution without intervention.
But for patients with chronic disc compression, significant degenerative changes, or herniations that haven’t resorbed, the mechanical load on the nerve persists. No amount of anti-inflammatory medication permanently resolves mechanical compression.
What VAX-D Does Differently
VAX-D addresses the mechanical problem directly. By creating negative intradiscal pressure — measured in landmark research at -100 to -160 mmHg — decompression creates a retraction force on herniated disc material, physically pulling it away from the nerve root.
This is a fundamentally different mechanism than steroid injection. Rather than reducing the inflammatory response to compression, it attempts to reduce the compression itself. When successful, it addresses the upstream cause rather than the downstream symptom.
Patients who’ve been on the injection merry-go-round for 12-24 months are often excellent candidates for decompression, precisely because we know the inflammatory approach alone isn’t solving the problem. The disc is still there. The nerve is still compressed. What those patients need isn’t more injections — it’s a treatment that targets the mechanical load.
Can You Do Both?
Yes — and in many cases, a strategic combination is the right approach. An ESI can quiet down an acutely inflamed nerve root enough to make decompression more tolerable and more effective. Trying to decompress a nerve that is severely inflamed and hypersensitive can be difficult because the patient’s guarding and pain limit how well we can execute the protocol.
The sequencing I often use for patients in this situation: a final ESI to reduce acute inflammation, followed by a course of VAX-D beginning 2-3 weeks later once the acute phase has settled. We’re using the injection for what it’s good at (acute inflammation control) and then following with decompression to address the mechanical cause.
What doesn’t make sense is continuing to stack injections indefinitely when they’re producing less and less benefit. That’s symptom management without a strategy.
What to Bring to Your Evaluation
If you’ve had ESIs and are evaluating your next steps, here’s what helps us give you the most accurate recommendation:
- Your MRI — specifically the most recent one, even if it’s a year old. We want to see the current disc morphology and any changes over time.
- Your injection history — how many, at what levels, what kind (interlaminar vs. transforaminal), and how you responded to each one.
- Your current symptom pattern — axial (back) pain vs. radicular (leg) pain vs. both, and how they’ve changed over the course of your injections.
The specific disc level, the type of herniation, the severity of nerve compression, and your response pattern to ESIs all inform whether decompression is likely to help. Some patients are clear candidates. Some need a surgical consultation first. And some have mixed pathology where the right answer is a staged approach.
What I can promise is an honest assessment based on your actual clinical picture — not a protocol you’ll be plugged into regardless of whether it fits your condition.
You May Have More Options Than You Think
If you’ve been through the injection cycle and are being told your choices are “keep injecting” or “have surgery,” come in for an evaluation. We’ve been treating disc patients since 1997. We’ve seen this clinical pattern hundreds of times. There’s usually more road to travel before surgery becomes the right answer.
Call 631-659-2980 or schedule your evaluation online. West Hills Chiropractic Pain Center, 400 W Jericho Turnpike, Huntington, NY 11743.
— Dr. Tom Oddo, DC CSCS CEAS, West Hills Chiropractic Pain Center