Caudal Epidural Steroid Injection Research Articles

Long-term outcomes of caudal epidural steroid injection in failed back surgery syndrome patients with loss of resistance technique

Background: Failed back surgery syndrome (FBSS) is a complicated issue with various treatment approaches. This retrospective study assesses the success and safety of caudal epidural steroid injection (CESI) in FBSS patients utilizing the loss of resistance (LOR) strategy, focusing on long-term outcomes lasting up to two years. Methods: The 75 FBSS patients had CESI with triamcinolone and normal saline under local anesthesia. The visual analog score (VAS), Oswestry disability index (ODI), and patient satisfaction score (PSS) were measured at pre-intervention and 3, 6, 12, 18, and 24 months following the procedure. Result: Majority of patients (57.33%) reported bilateral sciatica, with recurrent disc herniation (54.67%) being the most prevalent MRI finding. Significant improvements (p<0.001) in VAS, ODI, and PSS scores were seen in all subsequent periods. Furthermore, no significant issues reported, demonstrating the safety and effectiveness of CESI with LOR. Conclusions: CESI with the LOR technique is helpful treatment in FBSS at three, six, twelve, eighteen, and twenty-four months. It is easy to perform, less technically demanding, has low complications, and lower costs than surgery. A CESI may offer an alternative approach to managing FBSS for short-term and long-term outcomes.

Effectiveness of Ultrasonography- and Fluoroscopy-Guided Caudal Epidural Injections in the Management of Chronic Lumbar Disc Disease: A Retrospective Comparative Study.

Lumbar disc disease is one of the common causes of lower back pain caused by a change in the structure of the normal disc. Most of the time, disc disease happens as a result of aging and the normal breakdown that occurs within the disc.Caudal epidural steroid injections are the popular treatment for patients with chronic low back pain that does not respond to conservative management. A retrospective survey was administered to 160 patients whohad received caudal epidural injections forchronic low back pain in the past, but only 74 patients who completed the scheduled follow-ups were included in the study. They were divided into two groups based on the imaging modality used for guiding the caudal epiduralsteroid injections, either ultrasonography or fluoroscopy, and thenassessed for improvement in pain on the Numeric Rating Scale (NRS), forfunctional improvement on theOswestry Disability Index (ODI), and for satisfaction on the North American Spine Society Patient Satisfaction Scale (SSPSS). Mean NRS pain scores improved significantly from baseline at 6.78 and 7.00 in the fluoroscopy and ultrasound groups, respectively, to 2.03 and 2.16 at 12 weeks post-procedure. The difference between the groups was not statistically significant (p > 0.05). The Oswestry Disability Index was completed at baseline and after 12 weeks of follow-up for both groups, and there was no significant difference between the two groups; the fluoroscopy group's mean Oswestry Disability Index scores were 52.4 at baseline and 35.6 at 12 weeks, whereas the scores for the ultrasound group were 50.3 at baseline and 37.9 at 12 weeks. Conversely, patient satisfaction as assessed using the SSPSS rose in both groups up to 12 weeks (p > 0.05). The ultrasound- and fluoroscopy-guided caudal epidural steroid injections proved equally effective in easing the pain, disability, and satisfaction levels of patients with chronic lower back pain.

Combined Ultrasound and Fluoroscopy versus Ultrasound versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain: A Retrospective Comparative Study.

Background and Objectives: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. Materials and Methods: A total of 154 patients who underwent CESI between 2018 and 2022 were included. Patients were categorized into three groups based on the guidance method: combined US and FL (n = 51), US-guided (n = 51), and FL-guided (n = 52). The study design was retrospective case-controlled, utilizing patient charts and standardized forms to assess clinical outcomes, adverse events, complications during the procedures. Results: In all groups, Oswestry Disability Index and Verbal Numeric Scale scores improved at 1, 3, and 6 months after the last injection, with no significant differences between groups (p < 0.05). The treatment success rate at all time points was also similar among the groups. Logistic regression analysis showed that injection method, cause, sex, age, number of injections, and pain duration did not independently predict treatment success. Blood was aspirated before injection in 2% (n = 1), 13.5% (n = 7), and 4% (n = 2) of patients in the combined US and FL groups, FL-guided groups, and US-guided groups, respectively. Intravascular contrast spread was detected in one patient in the combined method groups and seven in the FL-guided groups. Conclusions: When comparing pain reduction and functional improvement, there was no significant difference between the three methods. The combined method took less time compared to using FL alone. The combined approach also showed a lower occurrence of intravascular injection compared to using FL alone. Moreover, blood vessels at the injection site can be identified with an ultrasound using the combined method. Given these advantages, it might be advisable to prioritize the combined US- and FL-guided therapy when administering CESI for patients with unilateral lumbar radicular pain.

Ultrasound-guided caudal epidural injection to treat symptoms of lumbar spinal stenosis: a retrospective study.

Lumbar spinal stenosis (LSS) occurs when bony, ligamentous, and synovial elements of the lower axial spine degenerate and overgrow, compressing neural and vascular elements in the spinal canal. Compression can cause static back pain, radicular lower extremity pain, or neurogenic claudication. Radiological and clinical findings are needed to diagnose lumbar stenosis. In this framework, caudal epidural steroid injection (ESI) is a standard treatment. The volume injected and needle positioning are the main issues that could compromise the effectiveness of the epidural injection. However, ultrasound-guided caudal epidural injections have become more common in recent years. Since Klocke and colleagues described the ultra-sound-guided caudal block in 2003, it has grown in popularity. Multiple ethnic studies have reported ultrasound-guided caudal injection success rates of 96.9-100%. Color Doppler ultrasonography can also determine if a drug solution reaches the lumbosacral region. We enrolled 42 patients with lumbar spinal stenosis, persistent lumbosciatalgia, and neurogenic claudicatio unresponsive to painkillers who were not surgical candidates. Each patient receives four weekly injections for four weeks. If the patient responds to treatment but still has pain, monthly injections are needed to reach and maintain the benefit. Treatment will be changed if the patient does not respond after 4 caudal injections. Sterile caudal epidural injections are performed with ultrasound guidance and a spinal needle 21G. Triamcinolone 40 mg, levobupivacaine 10 mg, and physiological solution 10 ml are delivered. Each patient received an average of 4 injective treatments (4±2, Means 4, SD 2). Data analysis shows that the treatment reduced pain significantly before and after therapy, which persisted after 3 months. Caudal epidural injection is one of the most common conservative treatments for chronic low back pain with radiculopathy, and lidocaine alone or with steroids is effective. In this framework, the two main literature issues about caudal epidural injection effectiveness on lumbar pain are correct. Therefore, 10 ml is suitable and effective for treating symptoms without side effects. Pain reduction of over 50% from start to finish and three-month follow-up have shown significant results in pain control and disability improvement. Finally, caudal epidural injection for lumbar spinal stenosis symptoms is effective, safe, and provides long-term pain relief.

Evaluation of the effectiveness of caudal epidural steroid injection as an adjuvant to ganglion impar pulsed radiofrequency therapy in chronic coccygodynia

BackgroundThis study aimed to evaluate the effectiveness of adding caudal epidural steroid injection (CESI) to ganglion impar pulsed radiofrequency (GI-PRF) therapy in patients with refractory chronic coccygodynia, and to determine the effect of pain duration and trauma on treatment success. Materials and methodsForty patients who underwent GI-PRF (n = 20) or GI-PRF + CESI (n = 20) were retrospectively assessed for age, gender, pain duration, history of trauma to the coccyx, Numerical Rating Scale (NRS) pain scores pre-procedure and 1, 3, and 6 months post-procedure and satisfaction rates at 6 months post-procedure. Satisfaction was categorized as excellent, high, moderate, and low. ResultsIn both groups, NRS scores were significantly decreased at 6 months (pre-vs. 6 mo. post-procedure: GI-PRF [8 vs. 5], GI-PRF + CESI [8.5 vs. 3.5]; p < 0.001). The proportion of patients reporting excellent satisfaction was significantly higher in the GI PRF + CESI group (50 % vs. 15 %; p < 0.05). Patients with trauma history in the GI-PRF + CESI group had significantly lower median NRS values at 6 months compared to patients in both groups with negative trauma history (p < 0.02). Within the GI-PRF only group, patients with trauma history had significantly lower NRS scores at 6 months than those without a history of trauma (p = 0.012). Pain duration did not significantly impact satisfaction levels (p = 0.055). ConclusionGI-PRF therapy was effective in coccygodynia, especially in patients with positive trauma history, and adjuvant CESI increased patient satisfaction by providing better pain control.

Experience with Gore’s Block in Patients with Lower Lumbar Radiculopathy

Abstract Lower lumbar radiculopathy is one of the most common presentations in the pain clinic outpatient department (OPD). A thorough history, physical examination, neurological assessment, and imaging help in the diagnosis and management. The inability to identify the correct pain generator often causes a failure of treatment. Dr. Satishchandra Gore has proposed a new method for the diagnosis of affected lower lumbar nerve root (L5 and S1) at a peripheral level. His hypothesis is that in an inflamed nerve root, sodium channels are upregulated at both proximal and distal ends (central and peripheral). This results in tenderness at the distal peripheral end of the nerve on palpation. We can block the sodium channels at the distal portion of the same inflamed nerve, which may be able to abolish pain. This procedure is called “Gore’s Block” and the result is called “Gore’s sign.” We used this technique in 10 patients with suspected L5-S1 radiculopathy. Out of 10 patients, seven patients had pain relief after Gore’s block. These seven patients also responded well to a Caudal epidural steroid injection. Two patients did not have significant pain relief with Gore’s block and had poor responses to epidural steroid injections. One patient got therapeutic pain relief after Gore’s block, probably due to the natural resolution of the disease. Gore’s block is a simple, OPD procedure, helpful in diagnosing the level of nerve affection in lower lumbar radiculopathy. It is diagnostic and has a good correlation with epidural blocks. Whether it is therapeutic in nature needs to be further investigated.

Hybrid Technique for Caudal Epidural Steroid Injection in Morbid Obese Patient

Incidence of back pain related to disc prolapse is higher in morbid obesepatients. Treatment options including epidural injections and surgery is difficult in such patients. Here we are discussing a case of successful Hybrid technique for caudal epidural steroid injection in a morbidly obese patient.

Practice Patterns of Physicians who Perform Caudal Epidural Steroid Injections.

Caudal epidural steroid injections (ESIs) are commonly employed in the management of low back pain and radiculopathy. Despite their widespread use, practice patterns among physicians performing caudal ESIs can vary significantly. This study aims to identify variability in injection techniques utilized by physicians during caudal ESIs, focusing on steroid use, needle selection, and catheter use. This study also looks at major permanent neurological injuries related to caudal ESIs. A survey was distributed to a cohort of physicians who regularly perform ESIs. The survey comprised questions regarding the type of needle primarily used, steroid selection, the use of catheters, and major neurological injuries from caudal ESIs. The respondents included a diverse group of pain management physicians from various specialties and practice settings. The results revealed a predominant preference for the use of particulate steroids (72.41%) when performing caudal ESIs. Additionally, physicians primarily prefer to use spinal needles (72.41%) compared to other needle types. A majority of physicians (65.12%) reported that they never use a catheter when performing caudal ESIs to access higher pathology. Finally, all physician responders (100%) reported that they have never caused a permanent neurological injury when performing a caudal ESI. This survey provides initial data among physicians who perform caudal ESIs. Our results demonstrate the majority of physicians favor using particulate steroids and a spinal needle, with fewer opting to use a catheter during these procedures. There were no reported major permanent neurological injuries, demonstrating that caudal ESIs are a safe interventional option for managing lumbosacral pain complaints.

Efficacy of caudal epidural steroid injection in the Management of low backache with radiculopathy

Efficacy of caudal epidural steroid injection in the Management of low backache with radiculopathy

Comparative Evaluation of Caudal Epidural Method to Ultrasound-Guided S1 Transforamen Block in Patient's Lumbar Discectomy with Failed Back Syndrome Symptoms: A Double-Blind Clinical Trial.

Post-lumbar surgery syndrome (PLSS) refers to persistent or recurrent pain following spinal surgery with an unknown cause. It is commonly associated with epidural fibrosis (EF). Some studies suggest that epidural steroid injection (ESI) can effectively alleviate pain in PLSS, particularly when targeting the S1 nerve root using S1 transforaminal epidural steroid injection (S1-TFESI). A key factor in a successful block is accurately visualizing the first dorsal sacral foramen, and the needle's destination is the dorsal S1 foramen. Although S1-TFESI is often performed under fluoroscopy through the transforaminal route, an alternative to reduce radiation exposure is ultrasound guidance. This study aimed to compare the efficacy of ultrasound-guided caudal epidural steroid injection (CESI) and S1-TFESI in PLSS patients. A randomized double-blinded clinical trial was conducted involving 52 PLSS patients who were randomly assigned to either the CESI group or the S1-TFESI group. The patients were positioned prone. A linear transducer with a curve at a low frequency (2 - 5 MHz) was used to visualize the area. An aseptically prepared puncture site was used to insert a 2- to 5-MHz curved ultrasound probe with an ultrasound gel to identify the articular processes of the lower lumbar vertebrae and the posterior sacral surface. The probe was then positioned longitudinally to the para-sacral area, about 2 cm lateral to the midline. The articular process represented the L5/S1 level at the farthest caudal side, and the S1 posterior sacral foramen was represented by the concavity at the posterior sacral surface that was somewhat caudal. The probe was angled caudally to provide enough room for the needle to enter the S1 foramen. The injection site for the needle tip was the S1 foramen. A combination of triamcinolone (40 mg, 1 mL), normal saline (2 mL), and ropivacaine (0.2%) was administered. For TFS1 ESI, 5 mL of the combination was used. For CESI, the sacral hiatus was palpated in the prone position, and a linear high-frequency transducer was placed transversely to obtain a transverse view of the sacral hiatus. A combination of triamcinolone 40 mg and ropivacaine (0.2%) totaling 10 mL was employed. The Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) were used to assess patients' preoperative and postoperative conditions, and adverse events were recorded. Follow-up was conducted one week and one month after the procedures. In both groups, NRS and ODI scores decreased at different time points after treatment, compared to baseline (P < 0.001). The CESI group had lower median ODI scores after one week and one month, although this difference did not reach statistical significance (P = 0.334). Despite similar baseline NRS ratings, the CESI group had statistically significantly lower mean NRS scores at one week and one month (P < 0.001). The current study demonstrated that both CESI and TFESI treatments for PLSS following lumbar discectomy are effective and safe. These procedures can alleviate pain and reduce disability. Although the success rates of the two procedures are comparable, CESI appears to be more successful in reducing pain at the one-week and one-month follow-up.

Effect of caudal epidural adhesiolysis plus steroid injections on pain and daily activities among chronic lumbar disc herniation patients; an observational study

Effect of caudal epidural adhesiolysis plus steroid injections on pain and daily activities among chronic lumbar disc herniation patients; an observational study

Efficacy of Caudal Epidural Steroid Injections in Chronic Low Backache Patients.

Caudal epidural steroid injections are the popular treatment for patients with chronic low back aches (LBA) and radiculopathy, pain that radiates down the legs. These injections are typically given in the lower back, and their purpose is to reduce inflammation and pain caused by a herniated disc or other issues in the lumbosacral spine. Studies have generally found that caudal epidural steroid injections effectively manage chronic LBP, although they may not provide long-term relief in all cases. It is essential to remember that these injections should be combined with other forms of conservative management, such as physical therapy, before considering more invasive interventions. A prospective analysis is performed at the Orthopedics Department At The Hind Institute Of Medical Sciences In Sitapur, Uttar Pradesh, India, over two years. In the study, 80 patients with chronic low back pain and symptoms that did not improve with conservative therapies. The patients are clinically examined before and after receiving a cervical epidural steroid injection (CESI) based on their ability to perform daily activities and work using the Oswestry disability index (ODI) and visual analog scale (VAS). The experiment was conducted with 165 CESI administered to 120 patients. A single injection is given to 85 patients; two injections are given to 25 patients, and 10 patients receive three injections. Of the 120 patients, 50 were male, and 70 were female, all of whom had chronic LBA. Of the 120 cases of LBA, 37 were diagnosed with lumbar disc herniation, 11 with lumbar canal stenosis, and 22 with degenerative disc disease. The remaining 50 cases were classified as non-specific LBA. Follow-up evaluations were conducted 1 week, 1 month, and 3 months after that, till 12 months of treatment. The mean pre-CESI VAS score was 7.11, and the mean post-CESI VAS score was 4.82 after one year of treatment. The mean ODI score before CESI treatment was 59.12; after CESI treatment for a full year, it was 44.64. We observed excellent outcomes in 27.5% of patients, good outcomes in 38.33%, fair outcomes in 21.67%, and bad outcomes in 12.5% of patients. Patients who experience chronic function aches can dramatically reduce their discomfort with the help of CESIs.

Efficacy of ultrasound guided caudal epidural steroid injection with or without ozone in patients with lumbosacral canal stenosis; a randomized clinical controlled trial

BackgroundLumbosacral canal stenosis is known as the most common cause of back surgery with several complications. Selecting a minimally invasive treatment with high efficacy in such patients is necessary. This study was designed to evaluate the effectiveness of ozone therapy in combination with caudal epidural steroid in patients with lumbar spinal stenosis.MethodsA double-blind randomized clinical trial was conducted on 50 patients with lumbar spinal stenosis allocated into two study groups. Under ultrasound guidance, the first group received 80 mg of triamcinolone hexavalent with 4 mL of Marcaine 0.5% and 6 mL of distilled water to the caudal epidural space. The second group received an injection similar to the first group, combined with 10 mL of ozone (O2-O3) gas at a concentration of 10 µg/cc. The patients were followed at baseline, one, and six months after injection with clinical outcomes measures using Visual Analog Scale (VAS), Walking Distance (WD) and Oswestry Disability Index (ODI).ResultsThe mean age of subjects, 30 males (60%) and 20 females (40%), was reported as 64.51 ± 7.19 years old. Reduction of pain intensity based on VAS score was statistically significant in both groups at follow-up periods (P < 0.001). The VAS changes in the first month and sixth months showed no significant difference between the two groups (P = 0.28 and P = 0.33, respectively). The improvement in disability index (ODI) in both types of treatment during follow-up was significant (P < 0.0001), and there was no difference between the two treatment groups in one month and six months (P = 0.48 and P = 0.88, respectively). As for walking distance, the improvement process with both types of treatment during follow-up periods was significant (P < 0.001). However, after one and six months of treatment, the rate of improvement in patients’ walking distance in the caudal epidural steroid injection plus ozone group was significantly higher than in the epidural steroid group (p = 0.026 and p = 0.017, respectively).ConclusionsIn this study, the results of VAS and ODI outcomes showed that caudal epidural steroid injection combined with ozone has no advantage over caudal epidural steroid injection alone. Interestingly, our results demonstrated that the group receiving caudal epidural steroid injection plus ozone scored significantly higher on the walking distance index than the group receiving caudal epidural steroid alone.Trial RegistrationIRCT IRCT20090704002117N2 (registration date: 07/08/2019).

Caudal epidural steroid injection versus transforaminal ESI for unilateral S1 radiculopathy: a prospective, randomized trial.

Epidural steroid injections are frequently performed to manage radicular symptoms. Most research investigating the effectiveness of different routes of epidural injections were conducted with non-homogeneous groups. In this study our aim was to investigate the efficacy of caudal versus transforaminal approaches in patients with unilateral S1 radiculopathy secondary to a paracentral L5-S1 disc herniation. Prospective, randomized clinical trial. A university hospital pain management center. The study was conducted between January 2022 and February 2023. Patients with unilateral S1 radiculopathy were randomly divided into two groups: the caudal epidural steroid injection (CESI) and the transforaminal epidural steroid injection (TFESI) group. Severity of pain and disability were assessed with Numeric Rating Scale (NRS-11) and Oswestry Disability Index (ODI) at baseline, 3 weeks, and 3 months after treatment. Fifty percent or more improvement in NRS-11 was defined as treatment success. Fluoroscopy time and doses of exposed radiation were also recorded. A total of 60 patients were included in the final analysis (n = 30 for each group). Significant improvement in pain and disability scores was observed at 3rd week and 3rd month compared to baseline (P < .001). Treatment success rate at 3rd month was 77% for the CESI group and 73% for the TFESI group without any significant difference between the groups (P = .766). CESI is equally effective as TFESI in the management of S1 radiculopathy due to a paracentral L5-S1 disc herniation. Both approaches can reduce pain and disability, while CESI requires shorter fluoroscopy time and less radiation exposure.

Assessing the effectiveness of fluoroscopy-guided transforaminal and caudal epidural steroid injections in alleviating chronic pain post-spinal surgery

Assessing the effectiveness of fluoroscopy-guided transforaminal and caudal epidural steroid injections in alleviating chronic pain post-spinal surgery

Effectiveness of ultrasonography-guided caudal epidural steroid injection in improving pain and functional status of geriatric patients with spinal pain

Introduction: Treatment of lumbar spinal pain in geriatric patients is challenging. This study retrospectively investigated the effects of an ultrasonography-guided caudal epidural steroid injection on pain and functional recovery in geriatric patients (age ≥65 years). Materials and Methods: Fifty-eight patients who received ultrasonography-guided caudal epidural steroid injection between December 2019 and March 2023 were retrospectively evaluated. Pain levels were evaluated using the Visual Analog Scale, and functional recovery was assessed using Oswestry Disability Index. The time points for evaluation were preoperative, immediately post-procedure, and at three weeks and three months post-procedure. Results: The main underlying conditions in this cohort were lumbar spondylosis, lumbar disc herniation, and lumbar spondylolisthesis. Thirty patients had multiple-level lumbar canal narrowing, 13 had L4-5 and L5-S1 disc herniation, and five had lumbar spondylolisthesis. Ten patients had a history of lumbar spinal surgery. Fourteen patients had at least three comorbid conditions (cardiovascular disease, morbid obesity, renal disease, etc.), and six had four comorbid conditions. Pain Visual Analog Scale scores in the immediate postoperative period and at three weeks and three months were significantly lower than the preoperative score (p &lt; 0.001). Oswestry Disability Index scores at three weeks and three months postoperatively were significantly better than the pre-procedure scores (p &lt; 0.001). Conclusions: Ultrasonography-guided caudal epidural steroid injection is an excellent pain management modality in the treatment of spinal pain, especially in the geriatric age group. Keywords: Pain; Steroid; Ultrasonography; Comorbidity.

The Role of Caudal Epidural Steroid Injections in Diabetic Lumbosacral Radiculoplexus Neuropathy: A Case Report

BACKGROUND: Diabetic lumbosacral radiculoplexus neuropathy (DLSRPN) or diabetic amyotrophy, although relatively uncommon and typically self-resolving, often leads to a period of severe compromise in quality of life. CASE REPORT: We present the case of a 46-year-old woman with 6 months of bilateral lower extremity weakness and neuropathic pain, diagnosed with diabetic lumbosacral plexopathy. Her recovery course was significantly improved by receiving a caudal epidural steroid injection (ESI) to address her pain and decreased function that was not sufficiently controlled by neuropathic agents and oral opioids. CONCLUSIONS: Caudal ESI may have a beneficial role treatment of DLSRPN to facilitate participation in a functional rehabilitation program. KEY WORDS: Diabetic lumbosacral plexopathy, diabetic lumbosacral radiculoplexus neuropathy, diabetic amyotrophy, Bruns-Garland syndrome, proximal diabetic neuropathy, caudal epidural steroid injection, epidural steroid injection, chronic pain

Effect of caudal epidural adhesiolysis plus steroid injections on pain and daily activities among chronic lumbar disc herniation patients; an observational study

Background &amp; Objective: The management of lumbar disc herniation (LDH) remains a big challenge as it may involve the surrounding tissues, and attract neovascularization facilitated macrophage aggregates. Epidural triamcinolone might have a half-life action ranging from 10 to 31 days, whereas 80 mg methylprednisolone might improve the pain up to 1 week. The higher doses of steroids will lead to adrenal cortex suppression and osteopenia. We evaluated the effect of treatment with 1500 international unit (IU) hyaluronidase followed by 20 mg triamcinolone at 2 weeks, and 3 and 6 months follow-up.&#x0D; Methodology: We enrolled seven males (38.9%) and 11 females (61.1%) with mean age 44 ± 23 y in the study. Eight (44.44%) subjects were younger than 51 y old, whereas the 10 (55.56%) subjects were ≥ 51 y old. Twelve (66.7%) subjects had had a bulged disc, and 6 (33.3%) subjects had disc protrusion. We injected 1500 international unit (IU) hyaluronidase followed by 20 mg triamcinolone at the site of disc lesion. Pain scores were measured with NRS scale and Oswestry Disability Index (ODI) scores at 2 weeks, and 3- and 6-months follow-up.&#x0D; Results: The NRS score improved at 2 weeks, 40% to 71.43%, at 3 months 60% to 100%, and 6 months 80% to 100%. And the Oswestry Disability Index (ODI) score was improved at 2 weeks from 23.5% to 68.18%), at 3 months from 39.13% to 100%, and at 6 months 82.35% to 100%. A significant association was observed between age older than 50 y old and ODI scores at 2 weeks followed up.&#x0D; Conclusions: The intra-epidural 1500 IU hyaluronidase before triamcinolone brings better results even though using a lower dose of triamcinolone. This approach showed the lower-cost better pain scores as compared to the routine use of heavy doses of triamcinolone for managing bulged and protruding LDH.

Comparison of treatment outcome of transforaminal and caudal epidural steroid injections for radiating low back pain

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Low back pain is a common disorder. Nearly everyone is affected by it at some time during one’s life time. Corticosteroid injections showed early and moderate but unsustained improvements versus placebo in certain outcomes for lumbar radiculitis. Hence; the present study was undertaken for assessing and comparing the efficacy of transforaminal and caudal epidural steroid injections outcome for the treatment of lumbar radiculitis.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study was conducted prospectively on 60 patients (30 each) from 20-75 years of age. All the patients were divided into two groups; Group A included patients in which Transforaminal route was used while Group B included patients in which caudal route was used. Pain relief was assessed after the epidural steroid injection using visual analogue scale (VAS) and Oswestry disability index (ODI).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean VAS and mean ODI score for the patients of Group A was significantly lower in comparison to the patients of group B at post-last injection, 15 days post-last injection, 1-month post-last injection and 3 months post-last injection time interval.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Transforaminal approach exhibited superior efficacy and should be performed with increasing frequency. Transforaminal epidural steroid injection also gave better quality of life.&lt;/p&gt;

Efficacy and safety of ultrasound-guided caudal epidural steroid injection in patients with low back pain and sciatica.

Fluoroscopy-guided caudal epidural steroid injection (EDSI) is an option for conservative treatment of low back pain and sciatica; however, repeated exposure to radiation is a concern. With the blind technique, the needle misplacement rate is 30%; hence, ultrasound-guided caudal EDSI is a favored option. To determine the efficacy of ultrasound-guided EDSI for low back pain and sciatica. One hundred and ten patients with low back pain and sciatica who were unresponsive to conservative treatment, were prospectively recruited. Ultrasound-guided caudal EDSI was administered at 0, 3, and 6 weeks. Visual Analog Scale (VAS) score was recorded at 0, 2, 4, 12, and 24 weeks. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) at pre-injection and 24 weeks post-injection. VAS was significantly reduced at 2, 4, 12, and 24 weeks (p< 0.01). At 2, 4, 12, and 24 weeks after injection, 20%, 26%, 74%, and 83% of patients displayed > 50% VAS reduction, respectively. The mean pre-injection RMDQ score was 15 and that post-injection at 24 weeks was 7 (p< 0.01). The majority of patients had > 50% reduction in the RMDQ score. Ultrasound-guided EDSI was safe and efficacious for low back pain and sciatica treatment at the intermediate follow-up.