Clinical Effectiveness of Lumbar Epidural Injection for Spinal Disc Herniation: A Randomised Control Trial.

Abstract

Purpose: Lumbar epidural is an established procedure, which is commonly used to control pain in cases of disc herniation secondary to lumbar disc disease. We conducted the present study to evaluate the clinical effectiveness of lumbar epidural injection using image intensifier comparing to injection using loss of resistance technique with no fluoroscopy. We also evaluated the outcome of these patients with patients treated conservatively with opioid or other analgesia as a control group. Setting: Epsom General Hospital, an elective part of Epsom & St Helier’s University Hospital spine services. Study Design: Prospective randomized controlled trial. Period: April 2013 and October 2013. Material and Methods: Single center, after seeking appropriate ethical approval in our institution. Group allocation for loss of resistance and II was done by list schedulers independent to the knowledge of trial, operating list become available to research team on the day of procedure. Fifty-five patients were included in each group. A single clinician performed all procedures and the same combination of local anaesthetic and steroid were injected in all patients. Preoperative and postoperative visual analogue score (VAS) and Oswestry Disability Index (ODI) were obtained for each patient. Conclusions: There is a better outcome demonstrated in both injection groups when compared with control. The post-operative scores did not statistically differ significantly between fluoroscopic and loss of resistance groups. The final results of this trial question the efficacy and cost effectiveness of epidural injections using image intensifier and may be used as a reference to change the current practice within several hospitals as cost saving measure. Level of Evidence: 1.