EFFECTIVENESS OF EPIDURAL INJECTION UNDER FLOUROSCOPIC GUIDANCE IN CHRONIC LOW BACK PAIN WITH BILATERAL LOWER LIMB RADICULOPATHY

Abstract

Introduction: Chronic Low back pain with lumbosacral radiculopathy is one of the most common complain amongst patient in any orthopaedic out patient department . Therapeutic management of this problem is still a big task. Lumbar intervertebral disc herniation stands out to be most common cause , others include spinal stenosis , disc degeneration, post lumbar surgery syndrome. Epidural injections are used in patients with chronic low back pain with radiculopathy not relieved by conservative management. The aim of the study was to check the efcacy of uoroscopy guided epidural Injection of local anaesthetic and steroid in chronic low back pain with bilateral lower limb radiculopathy and compare the results with existing data of blind epidural injection without uoroscopic control. Materials And Method: The study was conducted among 52 patients visiting our out patient department at SMIMER hospital with complain of chronic low back pain bilateral lower limb radiculopathy not responding to conservative treatment. Outcomes were evaluated on the basis of pain relief (VAS score was used pre and post procedure), improvement in Oswestry low back disability score ,short term relief -6 months and long term relief > 6 months. Secondary outcome measure was functional status , psychological status and return to work. Results: In our study of 52 patients with chronic low back pain with bilateral lower limb radiculopathy not responding to medications, epidural injection was given under uoroscopic guidance after which 90.3%(47 patients) reported signicant improvement with mean VAS score improvement to 1.89 post procedure from mean score of 8.89 post procedure. Oswestry low back disability score decreased post procedure to 9% from pre-procedure score of 56.8%. No complications were reported in our study group. Conclusion: Epidural steroid injection is an effective treatment for the patients with chronic low back pain with bilateral lower limb radiculopathy not responding to therapeutic treatment. It is cost effective, safe and minimizes use of analgesics, allows early return to work and prevents or postpones surgical intervention needed for the same. Fluoroscopy adds on the benet of precision and accuracy of the epidural space for injection leading to increased efcacy and no requirement of sequential dosage as in epidural injection without uoroscopy due to lack of accuracy in that.