Caudal epidural steroid injection in the treatment of chronic discogenic low back pain. Comparative, prospective and randomized study

Abstract

ObjectiveThere is no consensus on the treatment of chronic low back pain of disk origin in the medical literature. The few prospective, randomized, controlled studies evaluating the effectiveness of caudal epidural steroid injections (CESI) have obtained contradictory results. The aim of this study is to evaluate the efficacy of CEI in reducing pain and improving the associated disability. Material and methodThis is a prospective, randomized, case-control study of a group of 46 patients with chronic low back disk pain. Patients were randomly allocated into 2 groups to either receive fluoroscopy guided CESI (CESI-group), or oral non-steroidal anti-inflammatory drugs (NSAID-group). All patients were clinically evaluated at 4, 12, and 24 weeks, and according to the indications of the Spanish Society for Study of Diseases of the Spine (GEER). ResultsLumbar pain, measured by the visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ), did not improve significantly during follow-up in any of the two study groups (p>0.05). Younger patients, women, patients with shorter duration of symptoms, low physical job demand, without leg pain, and sport-active, included in CESI-group showed a trend toward better results, but none reached statistical significance (p>0.05). ConclusionsThe present study has not demonstrated the superiority of CESI over NSAIDs in treating chronic low back pain of disk origin. While CESI could show some improvement in patients with degenerative lumbar disk disease, we consider it should be used with caution, informing patients about realistic expectations on the success of treatment.