Original ArticleSelective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc – A prospective randomized study
Introduction
Chronic lumbar radiculopathy is defined as a clinical syndrome of back and leg pain accompanied by sensory, reflex, or motor deficits in a nerve root distribution lasting for more than 12 weeks.1, 2, 3, 4 The lifetime prevalence of lumbar radiculopathy has been reported to be 5.3% in men and 3.7% in women.5, 6 Lumbar radiculopathy due to a prolapsed disc resolves spontaneously in 23–48% of patients, but up to 30% will still have pronounced symptoms after one year, 20% will be out of work, and 5–15% will undergo surgery.7, 8, 9, 10
Section snippets
Aims
A prospective randomized single-blind study was conducted to compare the efficacy of caudal epidural steroid injection and lumbar steroid injection (selective nerve root block) in management of pain associated with prolapsed lumbar intervertebral disc in patients who were not relieved by nonsurgical treatment modalities.
Materials and methods
The study was conducted in tertiary care hospital from December 2013 to December 2014. Patients of lumbar disc herniation at one level with backache and radiculopathy, who failed to respond to conservative therapy for duration of 6 weeks, were included in the study. The diagnosis of lumbar disc herniation was confirmed clinically and radiologically by MRI. The exclusion criteria included patients with prior back surgery, cauda equina syndrome, back pain or radiculopathy due to other causes
Results
There were a total of 80 patients (49 men and 31 women). Each group had 40 patients. The average age was 36.48 ± 10.5 (range: 18–62) years in SNRB group while it was 36.98 ± 11.3 in caudal group. The average height was 173.7 ± 8.1 cm (range: 152–187 cm) in SNRB group and 170.17 ± 9.02 in caudal group. The average weight was 79.93 ± 8.7 (range: 68–99) kg in SNRB group and 80.12 ± 9.6 kg in caudal group. The average duration of pain was 15.07 ± 3.3 months in SNRB group and 11.08 ± 3.8 in caudal group (Table 1). The
Discussion
Epidural steroid injections for lumbar radiculopathy have been used since 1953.11 Along with mechanical compression of nerve roots, lumbar radiculopathy can be triggered by different proinflammatory chemical agents, causing ectopic neuron firing.12, 13, 14, 15, 16 Steroids injected into the epidural space or around the affected nerve root are thought to inhibit these inflammatory mediators. It is believed that epidural steroid injection reduces inflammatory edema of the injured nerve roots,
Conclusions
Our study has shown that caudal epidural block is an easy and safe method with better short-term, midterm, and long-term pain relief and improvement in functional disability than selective nerve root block in cases of lumbar intervertebral disc herniation and can be given by an orthopedic surgeon. Selective nerve root block injection is technically more demanding and has to be given by a trained physician.
Conflicts of interest
The authors have none to declare.
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Comments on the article “Selective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc – A prospective randomized study”
2019, Journal of Clinical Orthopaedics and TraumaNonsurgical medical treatment in the management of pain due to lumbar disc prolapse: A network meta-analysis
2019, Seminars in Arthritis and RheumatismComparison of clinical efficacy of transforaminal and caudal epidural steroid injection in lumbar and lumbosacral disc herniation: A systematic review and meta-analysis
2018, Spine JournalCitation Excerpt :This property seriously lowered clinical efficacy and duration of effectiveness [18]. Among the four selected RCTs in our study, the report by Singh et al. indicated that CESI was superior to TFESI [23], although the other three studies favored TFESI over CESI [18,19,22]. Singh et al.’s study injected 32 mL of medication.