Clinical Evaluation of Caudal Epidural Steroid Injections in Managing Lumbar Disc Prolapse

Abstract

Lumber disc prolapse as a cause of back and leg pain is quite a common presentation at a pain clinic which results in significant disability & overall loss of productive work. This study is an uncontrolled, prospective study that included 25 patients (15 males and 10 females) during the period 2013-2014 with signs and symptoms of back pain associated with lumber disc prolapsed with lumbar radiculopathy, in whom conservative treatment of least 6 weeks had failed. The present study was undertaken with the aim to observe the effectiveness of caudal epidural injection of a combination of depomedrol (Methyl prednisolone acetate) along with a local anesthetic (0.5% bupivacaine) in relieving symptoms of lumbar disc prolapse with radiculopathy. Quantitative assessment was done for back pain & leg pain separately using the visual analogue scale and the functional disability was measured using oswestry disability index (ODI) before the procedure and at regular intervals after the procedure for a period of 6 months. All the patients had an ODI more than 40% before the procedure. At 24 hours, significant pain relief was seen in all the patients. After 3 weeks, symptomatic improvement was seen in 100.0% (25/25 patients) of the cases, with good results in 68.0% (17/25, ODI 0-20%) and fair result (ODI 20-40%) in 32.0% (8/25 patients). At 6 months follow up, 60.0% (15 patients/25) of patients showed functional improvement of which with good results were seen in 52.0% (13/25) and fair result in 8.0% (2/25) and poor results in 40.0% (10/25). None of the patients had any major complications. Thus, it can be concluded that caudal epidural steroid injections are one of the safe and effective modality of treatment in back pain associated with lumbar disc prolapse with good short term results and possibly long term in some patients.