Lumbosacral radicular pain (LRP) is a condition characterized by debilitating pain and functional impairment. Epidural steroid injections (ESIs) are frequently used to relieve symptoms of LRP; there are currently no FDA-approved corticosteroid products specifically indicated for this condition. Moreover, existing products carry safety warnings against epidural administration, which have been linked to the off-label use of formulations. SP-102 (10 mg dexamethasone in a 2 ml viscous gel) is a proposed product that is formulated to provide rapid onset of action while prolonging the duration of effect, potentially resulting in extended pain relief and an improved safety profile for dexamethasone. Phase I and phase II studies have demonstrated SP-102 to be safe and well-tolerated. In phase III, SP-102 demonstrated greater pain relief compared to placebo; SP-102 reduced leg pain scores by an average of 1.1 points more than placebo over four weeks (p < 0.001) and extended the median time before repeat injection to 84 days compared with 58 days for placebo. SP-102 also produced an average 8.9-point reduction in the Oswestry Disability Index (ODI) from baseline versus 5.5 points with placebo (p = 0.015). Importantly, no serious adverse events related to the injection of SP-102 were reported.

Epidural steroid injections (ESIs) are commonly used to manage chronic spinal pain. However, variations in ESI practices remain prevalent among interventional pain physicians. This study evaluates current practice patterns and perceptions of ESI efficacy to identify areas for potential standardization in clinical application. A structured survey was distributed to interventional pain physicians via email and social media outlets, collecting data on several aspects of ESI practice: (1) the importance of precise injectate placement, (2) perceived effectiveness for axial versus limb pain, and (3) preference for fixed versus variable injectate volume based on contrast pattern spread. Responses were collected and analyzed to understand prevailing practice trends. The survey included a diverse group of pain management physicians representing different primary specialties and practice settings. Of the 94 respondents, 77.7% (73/94) selected that precise injectate placement is crucial for optimal outcomes, while 22.3% (21/94) did not view it as essential. Regarding pain type, 61.7% (58/94) selected that ESIs help with axial and limb pain, while 36.2% (34/94) found ESIs primarily effective for limb pain. Only 1.1% (1/94) selected that ESIs were beneficial solely for axial back pain, with one respondent selecting ineffectiveness for either pain type. For injectate volume, 69.2% (65/94) selected that they use a fixed volume for injection, while 30.9% (29/94) adjusted injectate volume based on contrast spread. This survey highlights practice patterns among interventional pain physicians regarding ESIs, underscoring the value placed on targeted injectate placement and the perceived broad efficacy of ESIs for axial and limb pain. However, the variability in volume administration suggests a need for further research to explore the impact of fixed versus variable injectate volumes on clinical outcomes. These findings may influence future standardization efforts in ESI practice.

Lumbar transforaminal epidural steroid injections (TFESIs) are a widely used interventional procedure for managing lumbosacral radicular pain and other spinal conditions. TFESIs help reduce inflammation and enhance function by delivering corticosteroids into the nerve root and epidural space. The transforaminal approach is commonly utilized for its precise targeting, offering both diagnostic and therapeutic benefits. Furthermore, this technique can be performed in patients with a history of laminectomy or contraindications to performing an interlaminar approach at the targeted levels. This study reviews current practice patterns, technical preferences, and procedural experiences of interventional pain physicians performing lumbar TFESIs. A survey was distributed to interventional pain physicians via email, web links, and social media platforms. Respondents included academic physicians in ACGME-accredited fellowship programs, as well as hospital-based and private practice physicians. The survey contained questions focusing on fluoroscopic views used for TFESIs, frequency of one-level versus two-level injections, and the occurrence of paresthesias during lumbar TFESIs. Data were collected anonymously, and descriptive statistics were used to analyze responses. A total of 87 respondents completed the survey. For fluoroscopic guidance, 60.9% (53/87) preferred using a combination of AP, oblique, and lateral views. Regarding injection levels, 63.2% (55/87) reported sometimes performing two-level injections, while 27.6% (24/87) always performed two levels, and 9.2% (8/87) exclusively performed one-level injections. The frequency of paresthesia during TFESIs varied, with 73.6% (64/87) reporting paresthesia occurring sometimes, 18.4% (16/87) reporting it most of the time, and 6.9% (6/87) stating it never occurred. This study highlights diverse practice patterns among interventional pain physicians performing lumbar TFESIs. Most physicians prefer multi-view fluoroscopic guidance and adapt the number of injection levels based on clinical need. Paresthesia during TFESIs is commonly reported but varies in frequency. These findings provide preliminary insights into procedural techniques and decision-making in lumbar TFESIs, offering a foundation for future research to refine best practices and improve patient outcomes.

Lumbar disc herniation complicated by lumbar spinal stenosis is a common degenerative condition in spinal surgery, particularly among middle-aged and elderly individuals. Conservative treatments or open surgery are commonly used but often have limited efficacy or significant risks, especially in older patients. Oxygen-ozone therapy, known for its mechanical decompression, anti-inflammatory, analgesic, and neuroprotective effects, is gaining attention as a minimally invasive treatment for lumbar disc herniation, offering an alternative to traditional treatments. Therefore, this study aimed to evaluate the clinical therapeutic effect of computed tomography-guided percutaneous oxygen-ozone injection on lumbar disc herniation complicated by lumbar spinal stenosis. This retrospective study analyzed the clinical outcomes of 47 patients with lumbar disc herniation complicated by lumbar spinal stenosis who were treated between September 2023 and February 2024. Patients were divided into two groups: the ozone group received computed tomography-guided percutaneous oxygen-ozone injection (n = 25), and the caudal epidural steroid injection group underwent ultrasound-guided (n = 22). Pain relief and functional outcomes were assessed preoperatively and at 1 day, 1 month, 3 months, and 6 months postoperatively using the visual analog scale, and Oswestry Disability Index and modified MacNab criteria. Both groups showed significant reduction in visual analog scale and Oswestry Disability Index at 1 day and 1 month postoperatively compared with preoperatively (P < 0.05), with the ozone group demonstrating more pronounced improvements than the caudal epidural steroid injection group. At 3 months, although further improvement was observed in both groups, the differences in visual analog scale and Oswestry Disability Index between the two groups were not statistically significant (P > 0.05). By 6 months, the ozone group showed significantly greater improvements than the caudal epidural steroid injection group (P < 0.05). The total effective rate based on modified MacNab criteria increased over time in both groups. Although the ozone group exhibited a slightly higher rate, the difference was not statistically significant (P > 0.05). Computed tomography-guided oxygen-ozone injection provides sustained pain relief and functional recovery in lumbar disc herniation with lumbar spinal stenosis, demonstrating superior long-term efficacy to epidural steroids.

Randomized, double-blind, placebo-controlled trial. To evaluate the efficacy and safety of inhaled methoxyflurane for pain relief during transforaminal epidural steroid injection (TFESI) in patients with lumbar radiculopathy. TFESI is a common intervention for lumbar radiculopathy, but procedural pain remains a concern. Methoxyflurane is a rapid-onset, inhaled analgesic with a favorable safety profile. While its effectiveness in procedural pain relief has been demonstrated in other medical settings, its role in TFESI remains underexplored. Sixty patients undergoing TFESI were randomized to receive inhaled methoxyflurane or placebo before the procedure. Pain intensity was assessed using the Visual Analog Scale (VAS) at multiple time points during and after TFESI. Secondary outcomes included patient and physician satisfaction, as well as the incidence of adverse events. Renal and hepatic function parameters were evaluated pre- and post-procedure to assess safety. The methoxyflurane group reported significantly lower worst pain scores during TFESI compared to placebo (3.33±0.70 vs. 5.71±1.23, p <0.01), with sustained pain relief for up to 60 minutes post-procedure. Adverse events in the methoxyflurane group were mild and self-limiting (dizziness, nausea/vomiting, and dry mouth), occurring in 10% of patients. No significant between-group differences were observed in renal or hepatic function indices. Patient satisfaction was significantly higher with methoxyflurane (96.67%) than with placebo. Inhaled methoxyflurane is a safe and effective analgesic for TFESI, offering significant procedural pain reduction and high patient satisfaction, while maintaining a favorable safety profile.

Rates of cervical spine surgery and repeat epidural injections after cervical transforaminal epidural steroid injections for patients with cervical radiculopathy utilizing a large national database

This study primarily aims to evaluate the effectiveness of thoracic interlaminar epidural injections in alleviating pain and enhancing function in patients with chronic mid and/or upper back pain. One hundred patients were randomly divided into 2 groups, 50 patients in each. Group I received only a local anesthetic, whereas Group II received a combination of local anesthetic and steroids. The random assignment to either Group I or Group II was determined using a simple computer-generated sequence. The results were evaluated using the numeric rating scale and the revised Oswestry Disability Index. Patients who showed significant improvement for >4 weeks after the first 2 procedures were considered successful. Those who did not were classified as failed participants. Significant improvement was defined as a reduction by >50% in both numeric rating scale and revised Oswestry Disability Index scores, and assessments were conducted at the beginning and 3rd, 6th, and 12th months after the intervention. This study included 100 participants divided into 2 groups. At the 12th month, significant pain relief (≥50%) and a reduction of at least 50% in ODI scores from baseline were observed in 86% of patients in Group I and 90% of patients in Group II. The results achieved in this study suggest that chronic thoracic pain of non-facet joint origin can be managed conservatively using thoracic interlaminar epidural injections, either with or without steroids.

Acute pancreatitis is a complex condition characterized by severe abdominal pain due to inflammation of the pancreas. In addition to pain, patients may present with symptoms such as nausea, vomiting, diarrhea, fever, and elevated pancreatic enzymes, including amylase and lipase. We report a case of recurrent acute pancreatitis precipitated by the administration of epidural steroid injections (ESIs), in the setting of a subsequent diagnosis of intraductal papillary mucinous neoplasm of the pancreas (IPMN).

Objectives: This study aims to assess the clinical effectiveness and safety of transforaminal epidural injections of steroid and ozone mixture versus steroid alone in patients with low back and radicular pain. Patients and methods: This retrospective study reviewed the files of 120 patients (60 males, 60 females; mean age: 48.5±12.0 years; range, 18 to 75 years) who underwent fluoroscopy-guided transforaminal epidural steroid or steroid plus ozone injection between June and December 2020. The patients’ clinical and demographic information were noted. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were recorded at baseline and one, three, six, and 12 months after the procedure. MacNab scores were evaluated at baseline and 12 months. Postprocedure outcomes were compared with baseline and between the two groups. Results: Patient characteristics were similar, and both treatment groups showed significant differences in mean VAS and ODI scores compared to baseline (p&lt;0.001). However, the results showed a greater decrease in the combination therapy group (p&lt;0.001). The mean ODI scores were comparable at one, three, and six months but differed at 12 months, with more favorable outcomes in patients who received additional ozone. After a prolonged observation, 61.6% of patients received steroid injections and 78.3% of those who underwent combined treatment were satisfied. The long-term follow-up revealed the absence of significant complications in both treatment groups. Conclusion: Transforaminal injection of steroid alone and its combination with ozone were both effective in short- and long-term pain and disability. Additionally, ozone had a moderate effect on the results. Therefore, combining steroids and ozone could be a complementary treatment for better outcomes.

Background: The prevalence of lumbar radiculopathy was reported to be 3-5 % among male and female. Conservative treatment is the first remedy to treat chronic lower back pain. If symptoms not improved then epidural steroid injection (ESI) is the non-surgical technique to alleviate patient symptoms. Information regarding influence of ESI on rate of SSI is limited in developing nation like Pakistan. Therefore, we aim to determine influence of ESI on SSI following lumbar decompression surgery with or without arthrodesis. Materials and Methods: This was a single center retrospective study conducted in Bolan Medical Complex Hospital, Quetta Pakistan. Patients included were those who underwent for decompressive laminectomy or lumbar fusion surgery for degenerative lumbar spine conditions following ESI. Spinal tumor, infection or decompression surgery performed for fracture was excluded. Timing of ESI was categorized into 30 days, 30-60 days and 61-90 days before surgery. Continuous variables were presented as mean± standard deviation whereas categorical variables were presented in frequencies and percentages. Categorical variables were analyzed through Chi square test, whereas student-t test was used to analyzed continuous variables. Multivariable regression analysis was performed to determine independent risk factors associated with SSI following lumbar spinal surgery. Results: Total 756 patients underwent for lumbar spinal operation during the study period. Out of 756 patients, 374 patients underwent for lumbar decompression surgery with or without arthrodesis.33 patients were lost to follow-up so were not included. Therefore 341 patients were enrolled in our study. Decompression was performed in 157 (46%) cases whereas decompression with arthrodesis performed in 184 (53.9%) cases. The SSI rate following lumbar decompression surgery in our study was found to be 14%. The SSI rate following lumbar decompression and arthrodesis surgery was found to be 10.3%. Conclusion: We conclude that ESI had positive effect on occurrence of SSI following lumbar decompression surgery with or without arthrodesis. Multivariable regression analysis revealed that age, duration of surgery, modified CCI and timing of ESI were the most common factors associated with SSI following lumbar spinal surgery. Keywords: Lumbar Radiculopathy, ESI, Surgical decompression, Spinal Fusion, SSI.

Background: Non-surgical methods are the first choice in the management of degenerative spondylolisthesis. However, limited data is available which gives a comparison between the outcomes of operative and non-operative management. Thus, the present study evaluates the outcomes of operative versus non-operative management of degenerative lumbar spondylolisthesis. Materials and Methods: The selected patients (n = 197), were diagnosed with degenerative spondylolisthesis and received non-surgical treatment. The outcome variable was based on the choice of the patients to go for surgery or not. Various radiological and clinical assessments were made to evaluate the outcomes. Also, the data were analyzed by using statistical approaches. Results: The non-operative group (65.2%, p-value=0.03) had more number of women than the operative group (34.8%, p-value=0.03). The non-operative group described improvement from pain (74.7% vs 54.7%, p-value = 0.002) for a prolong period of time than the operative group (148.7 vs 44.8 days, p-value = 0.00). Patients who informed relief in pain of more than 70% after the administration of epidural steroid injection had undergone surgery at a low rate as compared to those who described relief in pain less than 70% after the administration of epidural steroid injection (15.7% vs 42.6%, p-value = 0.000). Conclusion: Nonsurgical interventions were more effective in the management of degenerative spondylolisthesis in comparison to that of surgical treatment. Keywords: Degenerative spondylolisthesis; Surgical; Non-surgical treatment; Epidural Injection; Exercises.

Epidural steroid injections (ESIs) are widely employed for managing low back pain (LBP), particularly when conservative treatment fails. The Racz catheter technique offers targeted drug delivery and mechanical adhesiolysis, potentially enhancing outcomes in chronic LBP. The present study aimed to compare the Racz catheter technique and the conventional technique in lumbar epidural steroid injection for the management of LBP. This randomized, controlled, double-blind study was conducted on a sample of 60 patients, aged 18 - 65, comprising both sexes, who had persistent lumbar pain, grade 1 spondylolisthesis, and facet osteoarthropathy with small disc findings on radiological examination. Participants were randomized equally into two groups. The Racz catheter group received lumbar epidural steroids using a Racz catheter, while the conventional lumbar group received conventional lumbar steroid injections. The Visual Analog Scale (VAS) and Oswestry Low Back Disability Questionnaire (OSW) scores were insignificantly different at baseline, immediately post-procedure, and at 1 month between both groups. However, they were significantly lower at 2 months, 4 months, and 6 months in the Racz catheter group compared to the conventional lumbar group (P < 0.05). Incidences of hypotension, paraesthesia, bleeding, and headache were insignificantly different between both groups. Patient satisfaction levels were significantly higher in the Racz catheter group than in the conventional lumbar group (P < 0.05). The Racz catheter technique is a superior interventional option for lumbar epidural steroid delivery in patients with persistent LBP, providing enhanced pain relief, improved functional outcomes, greater patient satisfaction, and equivalent procedural safety compared to the conventional technique.

Introduction. Chronic discogenic low back pain represents a major medical and social issue, affecting a significant portion of the working-age population and severely impacting quality of life. This condition is frequently triggered by degenerative-dystrophic changes in intervertebral discs, resulting in inflammation, structural damage, and compression of nerve roots. Conservative treatments, such as pharmacotherapy or physiotherapy, often fail to provide lasting relief, while surgical interventions carry substantial risks of complications and require prolonged recovery periods. Consequently, minimally invasive techniques are gaining prominence as a less invasive alternative for managing this condition effectively. Aim. To compare the effectiveness of intradiscal platelet-rich plasma (PRP) injections and caudal epidural steroid injections (CESI) in treating discogenic low back pain. Materials and methods. A retrospective study involved 81 patients aged 22–57 years with chronic pain lasting over 3 months, confirmed by MRI (Modic I or II). Patients were divided into two groups based on the treatment method: 45 received PRP, and 36 received ESI. Platelet-rich plasma (PRP) was prepared from 50 ml of blood and administered at 1–1.5 ml per disc under fluoroscopic guidance. Epidural steroid injections (ESI) were performed via the hiatus sacralis using a 20 ml solution (19 ml of 1% lidocaine + 1 ml of betamethasone). Assessments were conducted using the VAS and ODI at 1 and 6 months. Results. At 1 month, ESI reduced VAS from 5.8±1.1 to 1.9±0.4 and ODI from 39.8±6.32% to 7.3±4.1%, while PRP reduced VAS from 5.18±0.9 to 3.67±0.8 and ODI from 37.1±4.9% to 20.6±3.7% (p&lt;0.05). At 6 months, ESI showed an increase in VAS to 3.52±0.3 and ODI to 19.2±2.1%, whereas PRP showed a decrease in VAS to 2.06±0.4 and ODI to 4.4±2.9% (p&lt;0.05). Conclusions. Epidural steroid injections (ESI) are effective for rapid pain relief, but their effect is short-lived. Platelet-rich plasma (PRP) provides sustained improvement and is promising for long-term pain control.

Disclosure: A. Lee: None. J. Gilman: None. J. Saunders: None. K. Slinchenkova: None. Y. Chen: None. N. Shaparin: None. A. Vydyanathan: None. N. Suda: None.Background: Glucocorticoid injections are frequently used to manage pain. Possible metabolic side effects such as hyperglycemia raise concerns for providers when considering administration to patients with pre-existing dysglycemia.1 Currently, there is insufficient data identifying the specific metabolic factors that predispose certain patients to experiencing greater glycemic excursions following glucocorticoid administration.2 The aim of this study is to evaluate the impact of epidural glucocorticoid injections on glycemia in patients with Type 2 Diabetes (T2DM) utilizing changes in plasma fructosamine levels. Additionally, it seeks to identify metabolic variables associated with greater glycemic excursions after glucocorticoid therapy. Methods: This prospective observational cohort study protocol was reviewed and approved by the Institutional Review Board on 2/13/20. All patients participating provided written informed consent. Adult patients with T2DM who were steroid naïve for ≥ 6 months and scheduled to receive an epidural steroid injection were enrolled at an academic medical center. Patients with a diagnosis of insulin-deficient diabetes (autoimmune or pancreatogenic), recent (< 6 months) steroid use, current pregnancy, or on dialysis were excluded. Once enrolled, pre-glucocorticoid injection serum blood samples were collected for baseline fructosamine levels, hemoglobin A1c (HbA1c), estimated glomerular filtration rate (eGFR), hepatic and lipid levels. Serum fructosamine levels were collected again 2 weeks post-glucocorticoid injection. Non-parametric analyses of these continuous variables with a p-value of 0.05 were utilized. Results: Study participants (n=34) were 34% male with an average age of 67 years and BMI of 32.87 kg/m2. The average baseline HbA1c was 7.3%, corresponding to a fructosamine level of 332 µmol/L. At baseline, the average eGFR was 73mL/min/BSA with an average total cholesterol of 170 mg/dL, HDL of 46 mg/dL, LDL of 98 mg/dL and triglycerides of 134 mg/dL. Prior to enrollment, 69% of patients were on metformin, 29% were on insulin, and 26% were on a glucagon-like peptide 1 receptor agonist. There was no significant change in fructosamine levels between the pre- and post-glucocorticoid injection period. Conclusions: Consistent with our previous findings, analysis of this larger data set again demonstrates statistically insignificant glycemic variability following glucocorticoid administration. These results reaffirm that many patients with T2DM can safely receive glucocorticoid injections without experiencing significant glycemic excursions. Moving forward, the study population can be expanded to include patients with higher baseline glucose levels and greater metabolic dysfunction.Presentation: Monday, July 14, 2025

Background: Chronic spinal pain can be managed through various approaches, including surgical options and interventional techniques like epidural injections and trigger point injections. However, there is a notable lack of comparative research addressing the effectiveness of these two specific methods in alleviating chronic low back pain. This study aimed to evaluate and compare the pain relief outcomes associated with caudal epidural steroid injections and trigger point steroid injections in patients suffering from chronic low back pain. Methods: Sixty patients aged between 20 and 75 years, who had been dealing with chronic low back pain for more than 12 weeks and had a Visual Analog Scale (VAS) score exceeding three, were randomly assigned into two groups of thirty. One group received caudal epidural injections, while the other group was treated with trigger point injections. In the caudal epidural group, a mixture of corticosteroid and 2 mg of ropivacaine was administered under ultrasound guidance at the caudal epidural site. Similarly, the trigger point injection group received the same dosage of corticosteroid and local anesthetic, injected into the identified trigger points under ultrasound guidance. Participants were monitored for six weeks after the injections, with pain levels evaluated at weeks 2, 4, and 6 using the VAS. A two-way ANOVA analysis was conducted to identify differences in pain relief between the two groups. Results: The findings showed significant differences in pain levels between the two groups. Patients who received caudal epidural injections reported a more substantial reduction in pain compared to those who received trigger point injections. Additionally, the caudal epidural group exhibited a continuous decrease in pain levels at the follow-up assessments from weeks 2 to 6. Conclusion: This study indicates that caudal epidural steroid injections are a safe and effective method for managing and reducing chronic low back pain. Given these results, caudal epidural injections should be considered a viable treatment option for patients experiencing chronic low back pain.

Background: Lumbosacral radiculopathy due to disc herniation is a leading cause of chronic pain and disability worldwide. While fluoroscopic-guided epidural steroid injections (ESIs) are widely used for symptom relief, their efficacy is variable, and the long-term benefits remain controversial. Ozone therapy has emerged as a promising adjunct to steroid injections due to its anti-inflammatory, analgesic, and oxygenating effects. This study aimed to compare the efficacy and safety of fluoroscopic-guided caudal epidural steroid injections with and without ozone therapy in patients with lumbosacral radiculopathy. Methods: A randomized, single-blind clinical trial was carried out with 40 adults diagnosed with radicular pain from lumbar disc protrusion at L4-L5 or L5-S1. They were randomly placed into two equal-sized groups. The first group (n=20) received a caudal injection containing dexamethasone (8 mg), lidocaine (5 mL, 1%), and saline (3 mL). The second group (n=20) received the same injection along with 5 mL of ozone (10 µg/cc). Fluoroscopy was used to guide all procedures. Pain and physical function were tracked using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), both before treatment and again after one, three, and six months. Results: Improvements were seen in both groups over time. Still, the ozone group reported stronger pain relief and better functional scores at every follow-up. At one month, VAS and ODI scores were significantly lower in the ozone group (VAS: 1.85 ± 0.75 vs. 2.40 ± 0.90, p = 0.029; ODI: 22.3 ± 4.5 vs. 26.7 ± 5.1, p = 0.025). The difference held steady at three months (VAS: p = 0.022; ODI: p = 0.021) and at six months (VAS: p = 0.017; ODI: p = 0.015). No major side effects occurred, and mild ones cleared up on their own. Conclusion: The addition of ozone therapy to fluoroscopic-guided caudal epidural steroid injections significantly enhances pain relief and functional recovery in patients with lumbosacral radiculopathy compared to steroid injections alone. This combination therapy represents a safe, minimally invasive, and effective treatment option for individuals with refractory radicular pain. Further large-scale, multicenter trials with long-term follow-up are warranted to validate these findings and optimize treatment protocols.

Patients with borderline surgical lumbar spinal stenosis (LSS), defined by significant canal narrowing without absolute surgical indications, present a therapeutic challenge. While caudal epidural steroid injections (ESI) are widely used, direct comparisons with pharmacological therapy remain limited. This study compared ultrasound-guided caudal ESI and tramadol-based therapy on pain, disability, walking capacity, and analgesic use. This single-center retrospective cohort included adults with LSS and dural cross-sectional area 50 to 75 mm². Two contemporaneous cohorts were analyzed: one treated with ultrasound-guided caudal ESI (dexamethasone 12 mg + 0.25% bupivacaine, 8 mL), the other with standardized tramadol/paracetamol (37.5/325 mg TID). Outcomes were Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline, 1, 3, and 6 months, and 6-minute walk test (6MWT) and daily nonsteroidal anti-inflammatory drug use at baseline and 6 months. Analyses used nonparametric tests and analysis of covariance adjusted for baseline clinical and radiological variables. Fifty-five patients received ESI and 60 tramadol-based therapy. Both cohorts improved significantly (all P < .001). In the ESI group, VAS decreased from 8.85 ± 1.03 to 4.09 ± 0.89 (1M), 3.71 ± 0.83 (3M), and 5.76 ± 0.77 (6M). ODI improved from 56.18 ± 3.04% to 23.80 ± 3.08%, 27.80 ± 2.86%, and 37.78 ± 2.88%. 6MWT rose by ~83 m and nonsteroidal anti-inflammatory drug use decreased (P < .001). In controls, VAS declined to 5.52 ± 1.30, 5.78 ± 1.22, and 5.92 ± 1.28 at 1, 3, and 6M; ODI to 38.54 ± 11.18%, 40.14 ± 10.44%, and 42.70 ± 7.74%; 6MWT rose by ~50 m (all P < .001). Between-group comparisons showed greater improvement with ESI at 1 to 3M for VAS (P < .001) and at all time points for ODI (P < .001), but no difference in VAS at 6M (P = .568). Analysis of covariance confirmed these results. Higher baseline symptom burden predicted greater 6M improvement. In borderline surgical LSS, ultrasound-guided caudal ESI provides faster and greater pain and functional improvement than tramadol-based therapy. Pain benefit attenuates by 6 months, but functional gains persist. ESI may serve as an effective interim option to enhance mobility and quality of life in carefully selected patients.

Epidural Steroid Facet Joint Injections Augment the Outcomes of Percutaneous Lumbar Spinal Fixation for Post-discectomy Failed Surgery through Local Immunomodulation

Introduction:Lower back pain, a leading cause of global disability, is commonly attributed to lumbar disc herniation (LDH) and lumbar degenerative disc disease (LDDD). These conditions result in nerve inflammation and compression, causing significant pain and mobility limitations. Epidural steroid injections (ESIs) are a minimally invasive treatment targeting inflammation to provide pain relief and improve functionality.Objective:This study aimed to evaluate the short-term efficacy of ESIs in patients with LDH and LDDD, analyze Visual Analog Scale (VAS) pain scores over time, and assess factors influencing treatment outcomes.Materials and Methods:A prospective study of 50 patients with lumbar radiculopathy due to LDH or LDDD was conducted between November 2022 and November 2024. Inclusion criteria comprised adults (>18 years) with radicular pain unresponsive to conservative treatments. Demographics, medical history, radiculopathy levels, and VAS scores were recorded at baseline and during follow-ups at 3 and 6 months. Statistical analyses evaluated differences based on diagnosis, gender, body mass index (BMI), and radiculopathy levels.Results:The cohort (mean age 47 years) included 66% males and 34% females. LDH accounted for 76% of cases, and LDDD for 24%. Significant pain reduction was observed post-injection (VAS scores from ~7 to ~4 at 3 months). However, symptoms partially recurred by 6 months (VAS ~5.5). No significant differences in outcomes were noted across gender, BMI, or radiculopathy levels (P > 0.05).Conclusion:ESIs effectively reduce pain in LDH and LDDD patients during short-term follow-ups. However, symptom recurrence indicates the need for sustained management strategies. While ESIs offer temporary relief, their integration into a comprehensive treatment plan is essential for optimizing long-term outcomes.

Minimal Clinically Important Difference in the Self-Measured 6-Minute Walking Test in Patients with Sciatica Undergoing Epidural Steroid Injection.