A Prospective Analysis of Ultrasonography-guided Caudal Epidural Steroid in the Management of Chronic Low Back Pain and Radicular Leg Pain
R Kanthimathy, Ganesh Annamalai, Ashok K Durairaj
Citation Information :
Kanthimathy R, Annamalai G, Durairaj AK. A Prospective Analysis of Ultrasonography-guided Caudal Epidural Steroid in the Management of Chronic Low Back Pain and Radicular Leg Pain. J Recent Adv Pain 2017; 3 (3):119-124.
Low back pain and sciatica (LBPS) is a major health and socioeconomic problem in modern India. Inadequate treatment of pain leads to loss of valuable man-hours for the country.
Aim
The study aims to validate the effect of ultrasonography (USG)-guided caudal epidural steroid (CES) injection in the management of pain due to LBPS.
Materials and methods
This is a noncomparative clinical study in patients with LBPS due to lower lumbar and sacral nerve root involvement. Under USG guidance caudal epidural space was identified; mixture of local anesthetic and methyl prednisolone is injected as bolus dose; and visual analog scale (VAS) score and straight leg raising test (SLRT) were recorded pre- and postprocedure. Patients are followed up to 6 months for assessing the pain relief.
Results
The mean VAS score before the procedure is 7.78, postprocedure is 2.95. The SLRT before the procedure is 28.58, and the postprocedure is 71.83. Our study showed statistically significant improvement in pain relief and SLRT.
Conclusion
The USG guidance enables us to perform the procedure in real time and helps us to avoid inadvertent vascular deposition of drug. Caudal approach minimizes the possibility of dural puncture. The USG-CES injection is effective in managing the chronic LBPS of lower lumbar and sacral nerve root involvement.
How to cite this article
Kanthimathy R, Durairaj AK, Annamalai G. A Prospective Analysis of Ultrasonography-guided Caudal Epidural Steroid in the Management of Chronic Low Back Pain and Radicular Leg Pain. J Recent Adv Pain 2017;3(3):119-124.
Epidemiology of low back pain in Indian population: a review. Int J Basic Appl Med Sci 2015 Jan-Apr;5(1):166-179.
Prevalence of low back pain and its relation to quality of life and disability among women in rural area of Puducherry, India. Indian J Pain 2016 Jul;30(2):111-115.
Caudal epidural injections in the management of chronic low back pain: a systematic appraisal of the literature. Pain Physician 2016 Sep-Oct;19(7):E917-E934.
Ultrasonography for neuraxial blocks: a review of the evidence. Minerva Anestesiol 2017 May;83(5):512-523.
Evidence for the use of ultrasound in neuraxial blocks. Reg Anesth Pain Med 2010 Mar-Apr;35(2 Suppl):S43-S46.
A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth Intensive Care 1995 Oct;23(5):564-569.
Caudal epidural steroid injection: a randomized controlled trial. Evid Based Spine Care J 2011 Nov;2(4):19-26.
; Christophidis, N.; Cherry, D. et al. Epidural use of steroids in the management of back pain. Report of working party on epidural use of steroids in the management of back pain. National Health and Medical Research Council. Canberra: Commonwealth of Australia; 1994. pp. 1-76
Comparison of the efficacy of caudal, interlaminar, and transforaminal epidural injections in managing lumbar disc herniation: is one method superior to the other? Korean J Pain 2015 Jan;28(1):11-21.
Outcome of caudal epidural steroid injection in chronic low back pain. 2013. Available from: http://applications.emro.who.int/imemrf/Med.../Med_Forum_Mon_2013_24_7_78_81.
Comparison of caudal steroid epidural with targeted steroid placement during spinal endoscopy for chronic sciatica: a prospective, randomized, double-blind trial. British J of Anesth 2005 April;94(4):514-519.
Efficacy of steroid and nonsteroid caudal epidural injections for low back pain and sciatica: a prospective, randomized, double-blind clinical trial. Spine (Phila Pa 1976) 2009 Jun;34(14):1441-1447.
Epidural steroids: a comprehensive, evidence-based review. Reg Anesth Pain Med 2013 May-Jun;38(3):175-200.
A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine (Phila Pa 1976) 1991 May;16(5):572-575.
NASS comments on draft AHRQ technology assessment on pain management injection therapies for low back pain. Burr Ridge (IL): NASS; 2014. Available from: http://www.spine.org/documents/researchclinicalcare/comments/scientificpolicy121514.pdf.
Our experience with epidural steroid injections in management of low back pain and sciatica. Kathmandu Univ Med J (KUMJ) 2005 Oct-Dec;3(4):349-354.
Comparison of the caudal and lumbar approaches to the epidural space. Ann Rheum Dis 2000 Nov;59(11):879-882.
