CAUDAL EPIDURAL INJECTIONS FOR LUMBAR PROLAPSED INTER VERTEBRAL DISC: ASSESSMENT WITH URDU VERSION OF OSWESTRY DISABILITY INDEX

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Background/Aims: Oswestry Disability index is an established tool for assessment of Spinal Disability. It has been translated into many languages and but observational study was translation, application and validation of Urdu version of the Oswestry Disability Index (Urdu ODI) for our specific cultural background. Methods: Urdu version of ODI was developed and applied for outcome assessment in 50 patients, suffering from lumbar prolapsed inter vertebral discs and treated with caudal epidural steroid injection. All patients having mechanical low backache with radiculopathy and single level disc prolapse at L-4-5 or L5-S1 on Magnetic Resonance Imaging (MRI) were included in the study. Single Steroid Injection with local anesthetic was injected into sacral caudal epidural space through sacral hiatus. A Performa was made for each patient and records were kept in a custom built Microsoft access database. Outcome was assessed using Urdu ODI and validation by comparing with Numeric rating Scale 0-10 at each visit. Results: Fifty patients received caudal epidural injections, 23 (46%) were male and 27 (54%) were female. The mean age was 34 years, with the range being 21-55. Low mechanical backache with right sided radiculopathy was in 29 (58%) and left sided in 21 (42%) patients. The commonest involved disc was L4-5 in 28 (56%) and L5-S1 in 22 (44%) patients Pain was assessed with Numeric Rating Scale (NRS) of ten points. This was mean 7.35, range 9-6 at presentation and mean improvement was 4.15 with range 5-3 at fist week, 3.80 with range 5-2 at first month and 3.05 with range 4-1 after six months. Functional disability assessment was done using Urdu ODI. The mean Urdu ODI at the time of presentation was 66.23% with range 81%-48%. The mean functional status was found to be 38.64% with range 26%-45% at the end of the first week, 43.65% with range 31%-48% after one month and 44.85% with range 28%-48% after six months. So there was mean improvement in score of Urdu ODI: 41.65% at the end of the first week, 34.09% after the first month and 32.28% after the end of six months. Pain at injection site was the only complication in 4 (8%) patients. Conclusion: Urdu ODI is useful tool for assessment of spinal disability in Pakistani population. This will meet the local cultural and literacy requirement. Caudal epidural injection can be injected in Out Patient Clinics safely with good outcome avoiding surgery in majority of the cases. To our knowledge this is the first Urdu translation and validation of ODI. Key Words: Oswestry Disability Index, ODI, Urdu Oswestry Disability Index, Urdu ODI, Caudal Epidural Injection