DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20181799

Correlation of functional results of caudal epidural steroid injections with duration of symptoms in PIVD

Harpreet Singh, Ankit Singh, Parth B. Bhavsar, Kirti Dhavaj Merawat

Abstract


Background: Low backache and sciatica is a common complaint signifying some underlying pathology; it may be a soft tissue strain or disc protrusion, or conditions such as neoplasm or ankylosing spondylitis besides others. We aim to assess the functional outcome of epidural steroid injection in patients with low backache and sciatica as well as the effect of pre operative duration of symptoms in Indian population presenting to our centre, on the post procedure outcome, if any.

Methods: 50 patients were evaluated with complaints of low backache and radiculopathy. They were subjected to following questionnaires including the ODI and VAS, and the scores were evaluated before and after the intervention, and at every follow up.

Results: Patients commonly affected were from 4th and 5th decade. The commonest intervertebral disc involved was L4-5 (44%) followed by L5-S1 (30%). Significant Functional status improvement according to ODI scoring was observed in all follow up visits. Similarly significant reduction in pain intensity according to VAS scoring was observed in all follow up visits. On comparing the improvement in functional status (ODI) and pain (VAS) between the 3 groups, it is seen that patients in group A had the highest rate of improvement, while patients in group C had the least improvement.

Conclusions: Caudal epidural injections are safe, effective and less expensive modality of treatment without any significant complications. The lesser the duration of symptoms i.e. earlier the patient presents, better are the results with caudal epidural injection.

 


Keywords


Low backache, Sciatica, Radiculopathy, Epidural steroid injection

Full Text:

PDF

References


Keith DW, Ashley LP. Low back pain and disorders of intervertebral discs. S. Terry Canale, editor, Campbell's Operative Orthopaedics. Vol-III. 9th ed. Mosby; 2003: 3014-3080.

Becker A, Held H, Redaelli M, Strauch K, Chenot JF, Leonhardt C, et al. Low back pain in primary care: costs of care and prediction of future health care utilization. Spine. 2010;35(18):1714-20.

Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10:185-212.

Cuckler JM, Bernini PA, Wiesel SW, Booth RE, Rothman RH, Pickens GT. The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double- blind study. J Bone Joint SurgAmer 1985;67:63-6.

Benzon HT. Epidural steroid injections for low back pain and lumbosacral radiculopathy. Pain. 1986;24:277-95.

Glenn R. Buttermann. Treatment of lumbar disc herniation: epidural steroid injection Compared with discectomy: a prospective, randomized study. J Bone Joint Surg. 2004;86: 670-9.

Fairbank JC, Pynsent PB. The Oswestry disability index. Spine. 2000 Nov 15; 25(22): 2940-53.

Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983; 17(1): 45-56.

Bogduk N. Epidural steroids for low back pain and sciatica. Pain Digest 1999; 9: 226-7.

Koes BW, Scholten RJPM, Mens JMA, Bouter LM. Efficacy of epidural steroid injections for low-back pain and sciatica:asystematic review of randomized clinical trials. Pain 1995;63:279-88.

Helliwell M, Robertson JC, Ellis RM. Outpatient treatment of low back pain and sciatica by a single extradural corticosteroid injection. Brit J Clin Pract 1985; 39: 228-31.

Singh H, Kaur M, Nagpal S, Gupta S. Role of caudal epidural steroid injections in lumbar disc prolapse. Journal of the Indian Medical Association. 2010; 108(5):287-8.

Dilke TF, Burry HC, Grahame R. Extradural corticosteroid injection in management of lumbar nerve root compression. Brit Med. J 197 3;2:635-7.

Yates DW. A comparison of the types of epidural injection commonly used in the treatment of low back pain and sciatica. Rheumatol Rehabil. 1978;17: 181-6.

Mathews JA, Mills SB, Jenkins VM et al. Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. Brit J Rheumatol. 1987;26:416-23.

Ridley MG, Kingsley GH, Gibson T, Grahame R. Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Brit J Rheumatol. 1988;27:295-9.

Raj PP. Intervertebral disc: anatomy-physiology- pathophysiology-treatment. Pain Pract. 2008;8:18-44.

Burke JG. Intervertebral discs causing LBP secrete high levels of pro inflammatory mediators. J Bone Joint Surg. 2002;84:196-201.

Sharma PK. Indications, technique and results of caudal epidural injection for lumbar disc retropulsion. Postgraduate Med J. 1977 ;53(615):1-6.

Cicala RS, Thoni K, Angel JJ. Long term results of cervical epidural steroid injections. Clin J Pain. 1989;5(2):143-5.

Roy C, Chatterjee N, Patro SN, Chakraborty A, Vijay Kumar GR, Sengupta R. The efficiency of transforaminal epidural steroid injections in lumbosacral radiculopathy. Neurology India. 2011;59(5).

Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy: a prospective, randomized study. JBJS. 2004;86(4):670-9.