Clinical outcome of caudal epidural steroid injection in lumbosacral radiculopathy

Abstract

This is a prospective, non-randomized, single-blind study conducted in twenty-three patients of both sexes, with either L5 or S1 or both L5 and S1 radiculopathy, secondary to disc pathology at L4L5 and L5S1 suffering from chronic leg pain for three months or more. The objective of this study was to analyze the difference in the efficacy of administering caudal epidural corticosteroid in the patients with single and double level disc pathology, in terms of improvement of walking distance and relief of leg pain-decrease in Visual Analog Score (VAS). All the patients were evaluated clinically and radiologically, including magnetic resonance imaging of the spine. The patients were divided into two groups i.e., Group I – with single level pathology at either L4L5 or L5S1 and Group II – with double level pathology. Injection Dexamethasone 8mg mixed with injection Bupivacaine 0.5% and distilled water was injected by the caudal route to all patients under fluoroscopy. The pre-injection, 3 weeks, 3 months and 6 months post-injection Visual Analogue Score (VAS) and walking distance were analysed. There was significant reduction of VAS & improvement of walking distance at 3 weeks, 3 months and 6 months post Caudal Epidural Steroid Injection (CESI) in both the groups. There is no statistical correlation in both the groups in terms of clinical efficacy of the corticosteroid with respect to the number of levels of disc pathology. No major adverse event was reported in this series. Caudal Epidural Steroid Injection is a safe and reproducible modality for the treatment of lumbosacral radiculopathy. We would recommend CESI in L5 and S1 radiculopathy, secondary to disc pathology and maybe repeated after 3 months.