Caudal epidural steroid injection for chronic low back pain: A prospective analysis of 107 patients

Article type: Research Article

Authors: Dernek, Bahar^a | Aydoğmuş, Suavi^b | Ulusoy, İbrahim^d | Duymuş, Tahir Mutlu^c | Ersoy, Sedef^{a; *} | Kesiktaş, Fatma Nur^a | Dıracoğlu, Demirhan^e | Aksoy, Cihan^e

Affiliations: [a] Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey | [b] Department of Orthopaedic Surgery, Klinikum Esslingen, Esslingen am Neckar, Germany | [c] Özel Saygı Hospital, Istanbul, Turkey | [d] Diyarbakır Selahaddin Eyyübi State Hospital, Turkey | [e] Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey

Correspondence: [*] Corresponding author: Sedef Ersoy, Kocasinan Merkez, Mahallesi, Karadeniz Cd. 48, 34186 Bahçelievler, Istanbul, Turkey. E-mail: sedef_ersoy@yahoo.com.

Abstract: BACKGROUND: Low back pain affects 80% of people worldwide at least once in a lifetime and reduces the quality of life and causes absence from work. OBJECTIVE: To evaluate the pain and functional status of patients with lumbar disc disease who received blind caudal epidural injections (CEI) for pain relief. METHODS: The records of 107 patients who had been given CEI between September 2017 and January 2018 were retrospectively analyzed. The inclusion criteria were age > 18 years, > 3-month history of low back pain, and diagnosis of lumbar disc disease by magnetic resonance imaging. The epidural injection solution consisted of 2 mL of betamethasone sodium and 8 mL saline. Follow-up examinations were conducted 3 and 6 months post-injection and the patients were evaluated using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: The most common disc pathology was at the L4–L5 level. The VAS and ODI scores indicated significantly reduced pain at 3 and 6 months compared with the pre-injection baseline. Two patients experienced total anesthesia and paresis of the lower limbs, but recovered fully after 2 weeks. Blood was aspirated during the injection in two patients, but second-attempt injections were successful in both cases. No other complications were observed. CONCLUSION: Our results suggest that the blind method is safe for administering CEI to patients with chronic low back pain in the absence of radiological screening and results in significant pain relief with improved functional capacity.

Keywords: Low back pain, caudal injection, steroid, conservative treatment, lumbar injection, chronic back pain

DOI: 10.3233/BMR-200262

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 1, pp. 135-139, 2022