Efficacy of ultrasound-guided caudal epidural steroid injection in prolapsed intervertebral disc and canal stenosis in lower lumbar region

Abstract

Introduction: Lower back pain is mainly accounted by neurological back pain and disc herniation, which results in physical limitations. This study aimed to evaluate efficacy of Caudal epidural steroid injection (CESI) under ultrasound guidance in patients with lumbar disc herniation (LDH) and lumbar canal stenosis. Methodology: This prospective observational interventional study was conducted at Kathmandu Medical College Teaching Hospital. All patients 20 years and above diagnosed with low back pain with radiculopathy and/or neurological claudication were included in the study. Each patient was injected with a mixture of 2ml (80 mg) of Depomedrol, 2ml of 2% lignocaine, and 6ml of normal saline under ultrasound guidance. Patients were observed for 30 minutes after injection and then discharged. Severity of pain and disability were assessed using visual analog scale (VAS), Numeric Pin Rating Scale (NRS) and Oswestry Disability Index (ODI) before the injection; and at 3 and 12 weeks post injection. Results: Out of 56 patients, 3 patients were lost to follow up and remaining 53 (29 males and 24 females) who completed their follow-up were included. Mean age was 45.9±16.1 years. L4-L5 and L5-S1 levels were involved in 25 (47.2%) and 9 (17%) respectively. 19 (17%) patients had involvement of both levels. 62.3% (n=33) had LDH and 37.7% (n=20) had spinal canal stenosis. Mean pre-injection ODI and at 3 weeks and 12weeks follow-up were 50.5±14.2, 30.30±12.52 and 29.64±12.12 respectively. Mean VAS pre-injection and at follow-up of 3 weeks and 12 weeks were 2.9±0.7, 1.30±0.54 and 1.25±0.51 respectively (p-value