International Orthopaedics

, Volume 43, Issue 8, pp 1883–1889 | Cite as

Fluoroscopically guided caudal epidural steroid injections for axial low back pain associated with central disc protrusions: a prospective outcome study

  • James J. Lee
  • Elizabeth T. Nguyen
  • Julian R. Harrison
  • Caitlin K. Gribbin
  • Nicole R. Hurwitz
  • Jennifer Cheng
  • Kwadwo Boachie-Adjei
  • Eric A. Bogner
  • Peter J. Moley
  • James F. Wyss
  • Gregory E. LutzEmail author
Original Paper



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.


Low 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.


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Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • James J. Lee
    • 1
  • Elizabeth T. Nguyen
    • 1
  • Julian R. Harrison
    • 1
  • Caitlin K. Gribbin
    • 1
  • Nicole R. Hurwitz
    • 1
  • Jennifer Cheng
    • 1
  • Kwadwo Boachie-Adjei
    • 1
  • Eric A. Bogner
    • 2
  • Peter J. Moley
    • 1
  • James F. Wyss
    • 1
  • Gregory E. Lutz
    • 1
    Email author
  1. 1.Department of PhysiatryHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Radiology and ImagingHospital for Special SurgeryNew YorkUSA

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