Lumbar Versus Caudal Epidural Injection Of Steroid In Chronic Low Back Ache & Sciatica A Randomized Controlled Trial

Abstract

Purpose: To compare the efficacy of epidural steroid injection, using either the lumbar or the caudal route in patients suffering from low back pain & sciatica. Methods: 133 cases of severe low back pain with sciatica > 3 months attending the orthopaedic outpatient clinic at our tertiary care hospital were selected after screening for inclusion criteria. All cases answered Oswestry Disability Index questionnaire, Becks Depression Inventory Questionnaire, Numerical Pain Intensity Score, Visual Analogue Score & underwent physical examination, before & immediately after intervention & then at 3 weeks, 3 months & 6 months. Pain relief, disability, & activity levels were assessed & statistically evaluated. The patients of Group A underwent lumbar epidural injection while Group B underwent caudal epidural injection both Xylocaine (2 ml) & Steroid (2 mL). Results: Symptoms improved in both the groups, with group A having a statistical significance. The mean ODIS, the mean BDIS, the mean NPIS, as well as the VAS score were statistically significant lower than at prior to time of enrolment. Seven patients underwent a second caudal injection with six of them reporting improvement while one did not respond well & underwent decompression (n=1). Twelve patients underwent a second lumbar injection with eight of them reporting improvement while four did not respond well & underwent decompression (n=4). Conclusion: Caudal epidural steroid injections seem to be effective when treating patients with low back pain & sciatica. They are easy to perform, less technically demanding, with lower complications compared to other routes of epidural injection placement & less expensive way of treating chronic low back pain.