Introduction and Aims: Caudal and lumbar epidural steroid injections have had a contentious history in the treatment of lumbar radiculopathy. We set out to assess the efficacy of these injections with relation to key discriminators and to assess the safety of these injections.

Method: After a literature search highlighted several possible discriminators regarding outcomes for lumbar radiculopathy and surgery we undertook a pilot study to assess the above aims. This took the form of a retrospective telephone interview. When our pilot study reached statistical significance after only 25 patients, we undertook a retrospective study of all 138 patients who had received a caudal or epidural steroid injection for radiculopathy in the last eight years. This took the form of a postal questionnaire, with telephone interview follow-up. Appropriate statistical analysis was performed for the paired and non-paired data collected.

Results: Of the 138 patients, 105 could be traced and of these it was possible to compare caudal vs. lumbar epidural in 75. All other comparisons were made on the full available population (105). We showed a statistically significant difference in the following: (i) an overall reduction in pain scores from 7.78 to 5.16 (mean values, difference –2.62, p< 0.0001); (ii) an overall increase in march tolerance from 804m to 1788m (mean values, difference 984m, p,0.0001); (iii) smokers had a higher level of pain overall before, immediately after and longer term than non(N)smokers (mean values smokers vs. non are; before 8.25:7.4, immediately 5.75:4.269, long-term 6.708:5.173, p< 0.01). We found no significant difference between sexes, activity-provoked pain, cough/impulse pain, unemployment due to pain or number of injections received. We had only one serious complication (anaphylactoid reaction) and 10 minor complications including headaches (five), pain at injection site (two), dizziness (one), hot flushes (one) and one diabetic patient had different insulin requirements for two days.

Conclusion: Although more research, ideally in the form of a randomised, controlled, double-blind trial is indicated, we have concluded that by either route these injections are a safe and effective measure of temporary pain relief for lumbar radiculopathy and that smoking is associated with higher levels of pain.