Is Caudal Epidural Steroid Injection Effective In Chronic Low Back Pain Due To Multiple Lumbar Disc Prolapse? A Prospective Study

Abstract

ABSTRACT Background : Chronic low back pain has multiple etiologies, and multiple bulged or prolapsed lumbar intervertebral discs are a frequent finding on MRI. Epidural steroid injections are an established mode of conservative management, working by spreading up and down the epidural space and reducing inflammation. We prospectively investigated the caudal method of epidural steroid injections for such patients with MR proven multiple disc bulges. Material and Methods : A cohort of 38 patients was enrolled in the study from May 2014 to April 2015. We included patients older than 18 years with history of chronic low back pain with or without neurological claudication, with MRI findings of multiple prolapsed lumbar intervertebral discs not responding to conservative management. Patients were evaluated at baseline, three weeks, three months and six months using Objective Parameters of Straight Leg Raise test (SLRT) and Claudication distance and subjective parameters of pain using Numeric Pain Rating Scale (NPRS) and Disability using Oswestry Disability Index (ODI). Results : The 38 patients (27 male and 11 females) had a mean age of 48.34 years, and their mean duration of back pain was 18.2 months. Mean NPRS and ODI improved from 7.21 and 41.8 at baseline to 4.6 and 26.8 respectively at 6 m. Similarly Mean SLRT and Claudication distance improved from 40.8 degrees and 350 m at baseline to 62.9 degrees and 500 m at 6 months. Change in NPRS, ODI and SLRT were statistically significant. Conclusion : Caudal epidural injections are an effective modality of treatment in managing chronic low back pain due to multiple lumbar disc bulges. They provide significant pain relief, improvement in functional status and facilitate return to work.