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Efficacy of Epidural Steroid Injection in Management of Lumbar Prolapsed
Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar
Routes
#MMPMID27630917
Pandey RA
J Clin Diagn Res
2016[Jul]; 10
(7
): RC05-11
PMID27630917
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INTRODUCTION: Epidural steroid is an important modality in the conservative
management of prolapsed lumbar disc and is being used for over 50 years. However,
controversy still persists regarding their effectiveness in reducing the pain and
improving the function with literature both supporting and opposing them are
available. AIM: To study the efficacy of epidural steroid injection in the
management of pain due to prolapsed lumbar intervertebral disc and to compare the
effectiveness between caudal, transforaminal and interlaminar routes of
injection. MATERIALS AND METHODS: A total of 152 patients with back pain with or
without radiculopathy with a lumbar disc prolapse confirmed on MRI, were included
in the study and their pre injection Japanese Orthopaedic Association (JOA) Score
was calculated. By simple randomization method (picking a card), patients were
enrolled into one of the three groups and then injected methyl prednisone in the
epidural space by one of the techniques of injection i.e. caudal, transforaminal
and interlaminar. Twelve patients didn't turn up for the treatment and hence were
excluded from the study. Remaining 140 patients were treated and were included
for the analysis of the results. Eighty two patients received injection by caudal
route, 40 by transforaminal route and 18 by interlaminar route. Post injection
JOA Score was calculated at six month and one year and effectiveness of the
medication was calculated for each route. The data was compared by LSD and ANOVA
method to prove the significance. Average follow-up was one year. RESULTS: At one
year after injecting the steroid, all three routes were found to be effective in
improving the JOA Score (Caudal route in 74.3%, transforaminal in 90% and
interlaminar in 77.7%). Transforaminal route was significantly more effective
than caudal (p=0.00) and interlaminar route (p=0.03) at both 6 months and one
year after injection. No significant difference was seen between the caudal and
interlaminar route (p=0.36). CONCLUSION: The management of low back pain and
radicular pain due to a prolapsed lumbar intervertebral disc by injecting methyl
prednisone in epidural space is satisfactory in the current study. All three
injection techniques are effective with the best result obtained by
transforaminal route.
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