Fluoroscopically guided caudal epidural steroid injections for axial low back pain associated with central disc protrusions: a prospective outcome study
- 136 Downloads
To determine if axial low back pain (LBP) associated with central disc protrusions can be improved by caudal epidural steroid injections (ESIs).
Adults with chronic (> 3 months) moderate-to-severe axial LBP with L4–5 and/or L5-S1 central disc protrusions were enrolled in this prospective study. Participants underwent caudal ESIs under standard-of-care practice. The numerical rating scale (NRS) pain score, modified North American Spine Society satisfaction, and Roland Morris Disability Questionnaire (RMDQ) were collected at one week, one month, three months, six months, and one year post-injection. Pre-injection magnetic resonance images were assessed by a musculoskeletal radiologist.
Sixty-eight participants (42 males, 26 females) were analyzed. There were statistically significant improvements in all outcome measures at all follow-up time points, with the exception of NRS best pain at six months. Clinically significant improvements in outcomes were observed at various time points: at three months and one year for current pain; at one week, one month, three months, six months, and one year for worst pain; and at one month and one year for RMDQ. The proportion of satisfied participants ranged from 57 to 69% throughout the study. No adverse events were observed.
This study demonstrated significant improvements in pain and function following caudal ESIs in a cohort of axial LBP with associated central disc protrusions. Further studies, including the use of randomized controlled trials, are needed to determine the ideal subset of candidates for this treatment and to explore additional applications that caudal ESIs may have for chronic LBP.
KeywordsLow back pain Caudal epidural steroid injection Axial Central disc protrusion Outcomes
We thank Dr. Paul Cooke, Dr. Jennifer Solomon, Dr. Vincenzo Castellano, Dr. Matthew Diamond, Elizabeth LaSalle, and Kristen Santiago for their contributions to this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- 1.Frank JW, Kerr MS, Brooker AS, DeMaio SE, Maetzel A, Shannon HS, Sullivan TJ, Norman RW, Wells RP (1996) Disability resulting from occupational low back pain. Part I: what do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine (Phila Pa 1976) 21(24):2908–2917. https://doi.org/10.1097/00007632-199612150-00024 CrossRefGoogle Scholar
- 2.Frymoyer JW, Cats-Baril WL (1991) An overview of the incidences and costs of low back pain. Orthop Clin N Am 22(2):263–271Google Scholar
- 3.Cassidy JD, Cote P, Carroll LJ, Kristman V (2005) Incidence and course of low back pain episodes in the general population. Spine (Phila Pa 1976) 30(24):2817–2823. https://doi.org/10.1097/01.brs.0000190448.69091.53 CrossRefGoogle Scholar
- 7.Suseki K, Takahashi Y, Takahashi K, Chiba T, Yamagata M, Moriya H (1998) Sensory nerve fibres from lumbar intervertebral discs pass through rami communicantes. A possible pathway for discogenic low back pain. J Bone Joint Surg (Br) 80(4):737–742. https://doi.org/10.1302/0301-620X.80B4.0800737 CrossRefGoogle Scholar
- 8.Jensen TS, Albert HB, Soerensen JS, Manniche C, Leboeuf-Yde C (2006) Natural course of disc morphology in patients with sciatica: an MRI study using a standardized qualitative classification system. Spine (Phila Pa 1976) 31(14):1605–1612; discussion 1613. https://doi.org/10.1097/01.brs.0000221992.77779.37 CrossRefGoogle Scholar
- 10.Lee JH, Shin KH, Bahk SJ, Lee GJ, Kim DH, Lee CH, Kim DH, Yang HS, Lee SH (2018) Comparison of clinical efficacy of transforaminal and caudal epidural steroid injection in lumbar and lumbosacral disc herniation: a systematic review and meta-analysis. Spine J. https://doi.org/10.1016/j.spinee.2018.06.720
- 14.Cha SO, Jang CH, Hong JO, Park JS, Park JH (2014) Use of magnetic resonance imaging to identify outcome predictors of caudal epidural steroid injections for lower lumbar radicular pain caused by a herniated disc. Ann Rehabil Med 38(6):791–798. https://doi.org/10.5535/arm.2014.38.6.791 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Childs JD, Piva SR, Fritz JM (2005) Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976) 30(11):1331–1334. https://doi.org/10.1097/01.brs.0000164099.92112.29 CrossRefGoogle Scholar
- 21.Ajiboye LO, Alimi M, Gbadegesin SA, Oboirien M (2019) Treatment outcome of quality of life and clinical symptoms in patients with symptomatic lumbar degenerative disc diseases: which treatment modality is superior? Int Orthop 43(4):875–881. https://doi.org/10.1007/s00264-018-4248-5 CrossRefPubMedGoogle Scholar
- 23.Nie HY, Qi YB, Li N, Wang SL, Cao YX (2018) Comprehensive comparison of therapeutic efficacy of radiofrequency target disc decompression and nucleoplasty for lumbar disc herniation: a five year follow-up. Int Orthop 42(4):843–849. https://doi.org/10.1007/s00264-017-3661-5 CrossRefPubMedGoogle Scholar
- 26.Liu J, Zhou H, Lu L, Li X, Jia J, Shi Z, Yao X, Wu Q, Feng S (2016) The effectiveness of transforaminal versus caudal routes for epidural steroid injections in managing lumbosacral radicular pain: a systematic review and meta-analysis. Medicine (Baltimore) 95(18):e3373. https://doi.org/10.1097/md.0000000000003373 CrossRefGoogle Scholar