THE EFFECTIVENESS OF CAUDAL EXTRADURAL STEROID INJECTION IN PATIENTS WITH LOW BACK PAIN AND SCIATICA-A CASE CONTROL STUDY

Abstract

Background: Caudal extradural steroid injection is an alternative method of treating patients with chronic low back pain and sciatica.

Aim: The purpose of our study is determining the effectiveness of the caudal extradural steroid injection in patients with severe chronic low back pain and sciatica.

Patients – Methods: A total of 158 patients with severe and chronic low back pain and sciatica participated in the study, aged 23–78 years old. 86 patients were men and 72 women.

Patients were divided into two groups according to the injected drug. Group 1 or the injected group (n=91) received a caudal extradural injection (CEI) that consists of 12 to 15 ml of 2% xylocaine together with 1 ml of Betamethasone Dipropionate and Betamethasone phosphate. Group 2 or the placebo group (n=52), received a caudal extradural injection that consists of 6–8 ml of 2% xylocaine mixed with 6–8 ml of water for injection. The mean duration of symptoms was comparable between the two groups.

In order to estimate the degree of recovery from symptoms, all patients answered a specific questionnaire. The Oswestry Disability Index Questionnaire (ODI) was answered by all patients on the first day of clinical examination, and on different follow-up periods after caudal injection.

The straight leg-raising test was evaluated in all patients at the same follow – up periods.

Results: Recovery from symptoms and a decrease in the O.D.I score after the CEI was observed in both groups. However the mean ODI score of the injected group was statistically significant lower than this of control group for a period until one month after the injection (p < 0,001, Wilkoxon Signed Ranks test). Also the mean improvement time of positive SLR test in the injected group was statistically significant lower than this of control group (log rank test, p = 0,019)

Conclusions: The caudal extradural steroid injection is a reasonable non-surgical therapeutic option among patients with severe chronic low back pain and sciatica. It offers pain relief to patients who do not respond to prolonged conservative therapy, or who refuse surgery. It can easily be performed in the outpatient clinic.