Aims

Cervical radiculopathy is a significant cause of pain and morbidity. For patients with severe and poorly controlled symptoms who may not be candidates for surgical management, treatment with transforaminal epidural steroid injections (CTFESI) has gained widespread acceptance. However, a paucity of high-quality evidence supporting their use balanced against perceived high risks of the procedure potentially undermines the confidence of clinicians who use the technique. We undertook a systematic review of the available literature regarding CTFESI to assess the clinical efficacy and complication rates of the procedure.

A rat model of lumbar root constriction with an additional sympathectomy in some animals was used to assess whether the sympathetic nerves influenced radicular pain. Behavioural tests were undertaken before and after the operation. On the 28th post-operative day, both dorsal root ganglia and the spinal roots of L4 and L5 were removed, frozen and sectioned on a cryostat (8 μm to 10 μm). Immunostaining was then performed with antibodies to tyrosine hydroxylase (TH) according to the Avidin Biotin Complex method. In order to quantify the presence of sympathetic nerve fibres, we counted TH-immunoreactive fibres in the dorsal root ganglia using a light microscope equipped with a micrometer graticule (10 x 10 squares, 500 mm x 500 mm). We counted the squares of the graticule which contained TH-immunoreactive fibres for each of five randomly-selected sections of the dorsal root ganglia. The root constriction group showed mechanical allodynia and thermal hyperalgesia. In this group, TH-immunoreactive fibres were abundant in the ipsilateral dorsal root ganglia at L5 and L4 compared with the opposite side. In the sympathectomy group, mechanical hypersensitivity was attenuated significantly. We consider that the sympathetic nervous system plays an important role in the generation of radicular pain

Study Purpose. To examine the presence of radicular pain and its relationship to the degree of lumbar nerve root compression in patients with a degenerative lumbar spine condition about to undergo surgery for either lumbar disc prolapse or lumbar canal stenosis. Background. The pathophysiology underlying radicular pain is not completely understood but it is thought that nerve root compression is a key factor and from a surgical perspective, decompressing the nerve root is considered to be the key therapeutic step. However, despite often severe root compression in patients with lumbar stenosis, radicular pain is not a typical feature. Methods. Thirty-nine pre-surgical patients with either lumbar disc prolapse or lumbar canal stenosis were studied using the Standardised Evaluation of Pain (StEP), a clinical assessment tool known to predict with a high degree of sensitivity and specificity the presence or absence of lumbar radicular pain. A nerve root compression score was given from lumbar MRI for each patient by a neuroradiologist blinded to the patients history. Results. The StEP assessment tool was able to distinguish the presence or absence of radicular pain with high sensitivity and specificity. This correlated well with the pre-operative diagnosis of disc prolapse or canal stenosis. The relationship between radicular pain and nerve root compression was less clear and will be discussed. Conclusion. This study confirms StEP as a useful bedside tool for identifying the presence of radicular pain in patients with a degenerative lumbar spine condition. Nerve root compression per se does not necessarily produce radicular pain. Conflicts of Interest. None. Source of Funding. None. This study has not been published or presented at a previous meeting

Background and Objective. In industrialized societies, the prevalence of radicular low back pain has exploded in recent years. Lumbar disc prolaps, protrusion, or extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The primary rationale for any form of surgery for disc prolaps is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of surgical treatment continues to be either open or microdiscectomy, but several alternative techniques including. Nucleoplasty. It provokes ablation of the nucleus of the disk by a controlled thermal effect produced by radiofrequency. Nucleoplasty is minimally invasive treatment aimed at removing nuclear material and lowering intradiscal pressure and decompressing through coblation needle inserted percutaneously into the nucleus of intervertebral discs. This paper will show a 3 years experience with 110 cases with lumbar radicular pain secondary to a disc protrusion that underwent Nucleoplasty as their secondary therapy. Methods. Included in this series were 110 patients with significant lumbar radicular pain, resistant to interventional therapy done before hand like fluoroscopically guided spinal transforaminal epidural injections or sacral injections with steroids. These cases were done under local anaesthesia with short analgesia and stand by monitoring. Results. In the overall cohort, the average Visual Analogue Scale (VAS) pain score decreased. Conclusions. We conclude that with use of the present selection criteria, Nucleoplasty is very effective long-term treatment for lumbar radicular pain. We recommend modifying the criteria to include only those cases with lumbar radicular pain due to protrusion whose annular integrity is confirmed via MRI and by either selective nerve root blocks and to exclude cases with axial pain

Introduction: The treatment with epidural steroids and local anaesthetic for radicular pain arising from nerve root compression is a commonly utilised and recognised treatment. The aim of this study is to determine the efficacy of CT-guided injection of epidural steroids without anaesthetic for radicular pain but without clinical neurology in the presence of a degenerative of lytic spondylolisthesis and concomitant foraminal narrowing. Method: The study subjects, 21 in total, were selected over a 1-year period by the surgeon. All patients had either degenerative or lytic spondylolisthesis as determined by CT, MRI and plain film and were suffering from radicular pain – sharp, shooting and burning in the L5 or S1 dermatome. For inclusion, there had to be no associated evidence of nerve root compression. All patients completed, prior to epidural therapy, a pain diagram, visual analogue scale (VAS) of pain severity on a scale of 1 to 10 and Oswestry Disability Index (ODI). The MRI and clinical pain picture were correlated. The level of the spondylolithesis was determined. Highly selective CT-guided epidural steroid injection was then carried out at the level of spondylolithesis by an experienced interventional radiologist. The pain diagram, VAS of pain severity and ODI were all completed again by the subjects themselves or by telephone at 1 and 3 months after injection in the presence of an independent assessor (nurse) and then reviewed and discussed with the treating doctor. All subjects were also asked to complete a functional questionnaire. Results: One month after injection 86% of those treated had greater than 50% radicular pain relief and from this group 72% had radicular pain reduction of greater than 80%. All had improvement in function. All of the above, confirmed that their quality of life had certainly improved. Three months after injection 76% of those treated still had a reduction in their radicular pain of greater than 50% (92% of these still had pain reduction of over 80%). Again all reported continued functional improvement. Discussion: Despite the small sample size, this study highlights the short-term Benefit of CT-guided steroid epidural injections with symptomatic lumbosacral spondylolisthesis and spondylolysis with radicular pain. Pain can be relieved without anaesthesia. The mechanisms of pain relief are speculative

Aims. The aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation. Patients and Methods. A cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12). Results. A second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days . (sd. 46.5) and 47 days . (sd. 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm . (sd. 10.3) and a mean VAS for arm pain of 6.3 mm . (. sd. 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (. sd. 12.4; p < 0.001); mean NPAD, 19.3 (. sd. 24.3; p = 0.041); mean SF-12 physical component summary (PCS) in lumbar herniation, 46.8 (. sd. 7.7; p < 0.001); mean SF-12 PCS in cervical herniation, 43 (. sd. 6.8; p = 0.103). Conclusion. Repeat steroid injections are a justifiable form of treatment in symptomatic patients with lumbar or cervical disc herniation whose symptoms are not satisfactorily relieved after the first injection. Cite this article: Bone Joint J 2018;100-B:1364–71

Study Design: A consecutive retrospective cohort including all patients treated by a single consultant spinal surgeon (BJCF) with targeted foraminal epidural steroid injection (FESI) for radicular pain. Objective: To assess the efficacy of targeted foraminal epidural steroid injection (FESI) for radicular pain in preventing surgical intervention. Summary of Background Data: 90% of sciatica resolves within 90 days. Beyond this period, decompresssive surgery for pain relief maybe considered. Open surgery however carries attendant risk including nerve root injury, dural laceration, cauda equina syndrome, deep infection, recurrent disc prolapse, epidural fibrosis and post-discectomy lumbar instability. Peri-radicular infiltration of local anaesthetic and steroid has been shown to reduce pain, at least in the short term. We were interested in whether FESI could obviate the need for surgery in refractory cases of nerve root pain. Methods: 83 consecutive patients (45 female, 38 male) with a mean age of 51 years (range 24 to 87) presenting between November 2000 and February 2003 with radicular pain were treated with targeted FESI. 55 patients had a principal diagnosis of disc prolapse, 20 had lateral canal stenosis and 8 had degenerative spondylolisthesis. Fourteen had previous surgery and 38 had previous caudal or lumbar epidural injections. Outcome Measures: Pain was assessed using the Visual Analogue Score and disability by the Oswestry Disability Index. The product-limit method of Kaplan Meier was used to assess the time to further procedure or the date of last review. Results: 21 of 83 patients (25.3%) underwent an open procedure (discectomy/decompression) within the designated time period (median 20 months). Median time to open procedure was 6.5 months (mean 8.2 months). Repeat FESI was required in 16 patients (19.2%). The remaining 46 (55.4%) patients avoided any further procedure at a median of 20 months (range 13 to 36). No complications resulted from these procedures. Conclusions: Targeted foraminal epidural steroid injection can resolve radicular pain caused by varying pathologies. Surgical procedures (decompression/discectomy) can be avoided in 74.7% of cases up to a median of 20 months thereby avoiding unnecessary surgical risk

Abstract: Objective of this study was to assess the adequacy of relief provided by Nerve Root Block for Lumbar Radicular pain. If successful, this treatment can obviate the need for surgery considering the favourable natural history of this pathology. We studied 64 patients who had this injection, from February 2000 to July 2001. These patients had clinical and radiographic confirmation of nerve root compression and were followed up at 2 and 6 weeks post injection and then at an average of 10 months by a questionnaire, which addressed patient satisfaction with injection treatment and pre-injection and present Low Back Outcome Score and Pain intensity on Visual Analogue Scale. Overall, out of 64 patients injected, at 10 months follow-up, 50% (n=32) were satisfied with the treatment, 42% (n=27) injections failed and 8% (n=5) had incomplete follow-up. Pain intensity as measured on Visual Analogue Scale decreased from pre-injection mean value of 9.1 to post injection value of 4.9 the difference being statistically significant (p< 0.01). The Low Back Outcome Score increased from mean of 43 to 61, again the difference being statistically significant (p< 0.01). Nerve Root Block is an effective therapeutic tool for Lumbar Radicular pain and should be recommended as the initial treatment of choice for this condition since it can provide persistent relief to the point that the patient does not require surgery

Study Design: A randomized, double blind controlled trial. Objectives: Various studies have examined the therapeutic value of peri-radicular infiltration using treatment agents consisting of local anaesthetic and corticosteroids for radicular pain. The main objective is to determine the treatment effect of corticosteroids in peri-radicular infiltration for radicular pain. We also examined prognostic factors in relation to the outcome of the procedure. Subjects: Eligible patients with radicular pain who had unilateral symptoms who failed conservative management were randomised for a single injection with bupivicaine and methylprednisolone (b+s) or bupivicaine (b) only. Outcome measures: Oswestry Disability Index (ODI), Visual Analogue Score (VAS) for back pain and leg pain, claudication walking distance and patient’s subjective level of satisfaction of the outcome. Results: We recruited 43 patients in the b+s group and 43 patients in the b only group. The follow up rate is 100%. There is no statistically significant difference in the outcome measures between the groups at 3 months (change of the ODI [p=0.7], change in VAS [back pain, p=0.68; leg pain, p=0.94], change in walking distance [p=0.7]). No statistical difference in the change in VAS score between stenotic group and disc herniation group at 3 months. Further subgroup analysis also showed no difference in the outcome between contained and non-contained herniation group. Conclusion: Clinical improvement occurs in both groups of patients. Corticosteroid did not provide additional benefit

Study Design: A randomised, double-blind controlled trial. Objectives: To determine the efficacy of corticosteroids in periradicular infiltration for radicular pain. We also examined prognostic factors in relation to the outcome of the procedure. Summary of background data: Various studies have examined the therapeutic value of periradicular infiltration using treatment agents consisting of local anaesthetic and corticosteroids for radicular pain, secondary to lumbar disc herniation and spinal stenosis. There is currently no randomised trial to determine the efficacy of single injection of corticosteroids. Methods: Eligible patients with radicular pain who had unilateral symptoms who failed conservative management were randomised for single double-blind injection with bupivicaine and methylprednisolone (b+s) or bupivicaine (b) only. Outcome measures include change in Oswestry Disability Index (ODI), change in Visual Analogue Score for back pain and leg pain (VAS), change in walking distance and patient’s subjective level of satisfaction of the outcome. Objective successful clinical outcome is defined as a change in 10% of ODI. Results: We recruited 37 patients in the b+s group and 38 patients in the b only group. The follow up rate is 100%. 4 patients had early termination of the trial for discectomy and further rootblock. There is no statistically significant difference in the outcome measure between the groups at 3 months (change of the ODI [p=0.6], change in VAS [back pain, p=0.28, leg pain, p=0.95], change in walking distance [p=0.9]). 35% of patients in the b+s group and 55% in the b only group had a successful clinical outcome. Duration of symptoms has a statistically significant negative association with the change in ODI (p=0.03). No prognostic value is found in age, gender, pre-operative Modified Somatic Perception and Modified Zung Depression score. Conclusion: Clinical improvement occurs in both groups of patients. However, corticosteroids do not provide additional benefit

Radiofrequency (RF) lesions have been used for over 25 years in the treatment of intractable pain of spinal origin. The conventional understanding of this technique is that the heat which is produced in the tissue surrounding the electrode tip causes destruction of nervous tissue, which in turn reduces the input of noxious nerve stimuli and alleviates pain. Neuropathic pain is usually a contra-indication to the use of RF nerve lesioning. For treatment of patients with severe radicular pain we use pulsed radiofrequency who has been recently described as a technique to apply a relatively high voltage near a nerve but without the usual effects of rise in temperature or subsequent nerve injury. This study reports the effect of pulsed RF in 21 patients with severe radicular pain who had previously failed to respond to conventional therapy. Patients and Methods: From December 2000 to August 2001, 18 patients underwent pulsed RF Rhizotomy of Dorsal Root Ganglion (DRG) of segmental N. Root of the painful dermatome. Out of them, 16 passed treatment in the lumbar area and 2 in the neck. The age of the patients ranged from 20 to 75 years (m=55.7 years). Male/female ratio was 1.4/1. 50% was previously operated (discectomy, laminectomy). No complications were seen either in the procedure or in the follow-up. Results: Out of 21 patients, 3 (14.3%) did not respond to treatment. In the remaining 18 patients Rhizotomy was successful at 3 months follow-up. Mean VAS score before procedures was 8.85 (range 7–10), after treatment 3.8 (range 0–10). Conclusion: Pulsed RF treatment is a safe, simple procedure to control radicular, neuropathic pain in the cervical, thoracic and lumbar regions. Advantages of this method:. It is non-destructive procedure and it can therefore be used for different indication which were not suitable for conventional RF. Post-procedure discomfort does occur but it is less pronounced than following conventional RF. Although permanent sensory loss is a rare complication of RF it does occur. Pulsed RF does not have this complication

Objectives. The main objective of our study was to determine the treatment effect of corticosteroids in peri-radicular infiltration for radicular pain. We also examined whether there was any effect on the need for subsequent interventions such as additional root blocks and/or surgery. Subjects and Method. In a randomised, double blind controlled trial, 150 eligible patients with radicular pain and unilateral symptoms who failed conservative management were randomised for a single injection with bupivacaine and methylprednisolone (b+s) or bupivacaine (b) alone. The outcome measures used included the Oswestry Disability Index (ODI), Low Back Outcome Score (LBOS), Visual Analogue Score (VAS) for leg pain and back pain and patient's subjective level of satisfaction of the outcome. Results. We recruited 76 patients in the b only group and 74 patients in the b+s group. There was no statistically significant difference in the outcome measures between the groups at 3 months (change in ODI [p=0.2], change in VAS [back pain, p=0.28; leg pain, p=0.67]. Subgroup analysis revealed that there was no statistically significant difference in the change in scores between the stenotic group and disc herniation group at 3 months. At 1 year follow-up data was available for 86% of the patients. There was no statistically significant difference in the rate of further interventions in either group. Conclusion. Clinical improvement occurs in both groups of patients. Corticosteroids did not provide additional benefit. There is no difference in the need for further root blocks or surgery

Objective: To investigate the clinical outcomes, and the requirement of surgery following selective nerve root block performed for cervical radicular pain in patients with MRI proven disc pathology. Methods: Thirty consecutive patients with cervical radiculopathy and correlating MRI pathology were studied. Mean age of patient was 46yrs (range 28–64yrs). Twenty nine of the thirty patients also complained of associated neck pain. All underwent fluoroscopically guided, selective cervical nerve root block with steroid (20mg Depomedrone) and local anaesthetic (0.5ml Bupivo-caine 0.25%). Radiographic contrast was used to confirm needle position. All procedures were conducted by the same clinician. Pre and post procedure pain and physical function scores were noted using the standard SF 36 questionnaire, as well as whether subsequent surgery was required. Mean follow up time was seven months (range 2–13 months). Results: 81% of patients reported an improvement in arm pain, and 66% in neck pain following the procedure. 77% of patients had an improvement in pain score (mean improvement 16 points). 68% of patients had an improvement in physical function score (mean improvement 20 points). At the time of follow up only one patient had undergone surgery for cervical radicular pain. Conclusion: This study suggests that fluoroscopically guided selective nerve root block is a clinically effective interventional procedure in the management of cervical radicular pain, and may prevent the need for open surgery

Northumbria Healthcare NHS Trust, Ashington, UK. To assess if a pain diary is useful in assessment and management of patients who undergo diagnostic nerve root block (NRB) for lumbar radicular pain. Prospective study. 23 patients who underwent diagnostic NRB for lumbar radicular pain were given a pain diary. They recorded their response to one of four options from Day 0 to Day 14 (good relief, partial satisfactory, partial unsatisfactory, and no relief of leg pain) and could also add additional comments. A Consultant Spinal Surgeon reviewed the diary with the patient at 6-week follow up appointment to formulate a management plan. Patient response, completion of the pain diary and final clinical outcome (surgical or non surgical treatment). The response rate was 91% (21/23). The pain diary was very useful in 43% (9/21), useful in 33% (7/21) and not useful in 24% (5/21) of patients in formulating further management. There was a tendency for patients with complex problems and poor response to add descriptive notes and comments (9/ 23). Patient compliance with pain diary was good and it has been valuable in making further management decisions. We found the pain diary to be a useful and inexpensive adjunct in the assessment of patients who underwent diagnostic NRB

Background: The management of radicular pain due to lumbar or sacral nerve root compromise remains controversial. Caudal epidural steroid injections are widely employed although there is little hard evidence to confirm their efficacy. This empirical treatment still remains a matter of personal choice and experience. Objectives: To investigate the clinical effectiveness of caudal epidural steroid injections (CESIs) in the treatment of sciatica and to identify potential predictors (clinical subgroups) of response to CESIs. Main outcome measures: The primary outcome measure was the Oswestry Disability Questionnaire (ODQ). The Visual analogue score (VAS) and the Hospital Anxiety and Depression Scores (HADS) were also employed in all cases to measure pain relief, physical and psychological function. Method: Prospective study. All patients with corresponding radicular pain received a course of three caudal epidural steroid injections, two weeks apart. A standard mixture of 80 mgs of triamcinalone plus 7 mls of 1% lignocaine plus 5 mls of 0.9% saline used for all patients. All patients reviewed at 3 months interval in a dedicated epidural follow up clinic. The epidural database included age, BMI, duration of symptoms, smoking, employment status and source of referral, any pending litigation, i.e., work or accident related, MRI results, diagnosis and complications. VAS scores documented both axial and limb pain for actual and comparative analysis. ODI and HADS were recorded prior to treatment and at three months follow up. Overall patient satisfaction was recorded on a scale of 0–10 and complications noted. Results: In the largest single series to date, we report on 628 consecutive patients, with 3 months follow up. 58 % were females, 24% smoked and 4.1% had ongoing litigation due to their pain. The mean age was 56yrs with BMI ranging from 17 to 50 (mean=28). 7 (1%) patients required subsequent surgical intervention due to disc herniation. BMI did not affect the outcome. Mean VAS for axial pain reduced from 5.859 to 2.59 at three months. Mean VAS for limb pain similarily reduced from 6.23 to 2.53. Mean ODI reduced from 45.49 at first visit to 21.98 at 3 months. Mean HADS also improved from 17 to 7. Following treatment, overall Patient satisfaction ranged from 0–10 with mean of 5.4. Conclusion: Significant improvement in both axial and limb pain in the short and intermediate terms was achieved facilitating onward referral for physical therapy, which is fundamental in optimising outcomes. Long term follow-up is underway. Subgroups predicting poor outcome are identified. Positive primary care feedback encourages further recruitment

Objectives: To determine the treatment effect of corticosteroids in peri-radicular infiltration for radicular pain. Secondary investigations were on the requirement for subsequent interventions such as root blocks and/or surgery. A sub group analysis between sciatica and stenosis was undertaken. Study Design: A randomised, double blind controlled trial. Subjects: 150 eligible patients with radicular pain and unilateral chronic symptoms were randomised for a single injection with bupivacaine and methylprednisolone (b+s) or bupivacaine (b) alone. Outcome measures: The outcome measures included the Oswestry Disability Index (ODI), Low Back Outcome Score (LBOS), Visual Analogue Score (VAS) for leg pain and back pain and patient’s subjective level of satisfaction of the outcome. Results: 76 patients in the b only group and 74 patients in the b+s group. Clinically useful improvements of greater than 10 points on the ODI occurred in 54%, deterioration of 10 points or more occurred in 17%. Visual analogue for leg improved by 2 or more in 63%. There was no statistically significant difference between the groups at 3 months (change in ODI [p=0.2], change in VAS [back pain, p=0.28; leg pain, p=0.67]. Subgroup analysis revealed no statistically significant difference in the change in scores between the stenotic group and disc herniation group at 3 months. At 1 year follow-up data was available for 86% of the patients. There was no statistically significant difference in the rate of further interventions. Conclusion: Clinical improvement occurs in both groups of patients. Corticosteroids did not provide additional benefit. There is no difference in the need for further root blocks or surgery

Background. Doubt has been cast over the accuracy of dermatome charts. This study investigated a large group of patients with known lumbar nerve root compression (NRC), and identified whether their radicular pain corresponded with the predicted distribution on a dermatome chart. Methods. The study included 209 patients that presented with lumbar radiculopathy. 106 were confirmed as L5 NRC and 103 as S1 NRC, by MRI. Each patient used an interactive computer assessment program to record their pain on a body map image. The coordinates were then used to compare the sensory distribution to a standard dermatome chart. Results. Of those patients with L5 NRC, 56 recorded pain on the front aspect of the body map image, with 36 patients (64%) registering pain within the L5 dermatome. 94 recorded pain on the posterior aspect of the body, of which 31 (33%) registered pain within the L5 dermatome. Of those patients with S1 NRC, 40 recorded pain on the front aspect of the body map image, with 18 patients (45%) registering pain within the S1 dermatome. 80 recorded pain on the posterior aspect of the body, of which 45 (56%) registered pain within the S1 dermatome. Conclusion. Although the study found that patients did experience pain within the corresponding boundary on the dermatome chart, it was not exclusive to that zone. With the exception of the front aspect of L5, pain was experienced more in other lumbar dermatomes. This would illustrate the necessity of developing a revision of sensory innervation patterns. Conflicts of Interest. None. Source of Funding. None

To investigate the clinical effectiveness and complications of caudal epidural steroid injections in the treatment of sciatica in patients with an MRI proven sacral tarlov cyst. A Prospective case control study. All patients with corresponding radicular pain received a course of three caudal epidural steroid injections, two weeks apart and patients were reviewed at 3 months, 6 months and 1 year interval in a dedicated epidural follow up clinic. Data including demographics, MRI results, diagnosis and complications were documented. Outcome measures included the Oswestry Disability Questionnaire (ODQ), the visual analogue score (VAS) and the hospital anxiety and depression (HADS) score. Overall patient satisfaction was recorded on a scale of 0-10. 38 patients with a sacral tarlov cyst were compared to a matched control group. In the sacral cyst group, mean VAS for axial pain reduced from 5.859 to 2.59 at three months (p<0.001). VAS for limb pain reduced from 6.23 to 2.53(<0.005). Mean ODI reduced from 45.49 at first visit to 21.98 at 3 months. Mean HADS also improved from 17 to 7. There was no statistical difference between the two groups. BMI did not affect the outcome in either group. Based on our study, we conclude that presence of a sacral tarlov cyst is not a contraindication to caudal epidural steroid injection, as comparable significant improvement in both axial and limb pain in the short and intermediate periods was achieved without any major complications

Lumbar steroid injection can be endorsed as a treatment component for lumbrosacral radicular pain syndrome resulting from disc herniation. The facet joint steroid injection seems to be beneficial for patients with chronic backache due to the facet joint arthritis and in the lumbar Spondylosis. We did a retrospective review of 31 patients whom we treated between 2004 and 2005 with follow up of 6 months to 24 months. There were 19 females and 12 males, aged between 29–81 years. Five patients had previous surgery for simple discectomy to posterior spinal fusion. Four patients had multiple disc prolapse at 3–4 levels, 2 patients had a severe lumbar spondylosis and spinal stenosis. The remaining 20 patients had a single level disc prolapse. All these patients were given caudal and facet joint blocks. The pre and post steroid injection Oswestry score was done. After steroid injection the Oswestry score improved by 30%. Majority of the patients had pain relief for 2–18 months. The pain relief was much better in the non operative group with single level disc pro-lapse and those patients with lumbar spondylosis. In patients with chronic back pain there is an inflammatory basis for pain generation. Lumbar steroid injection seems to be beneficial in patients with disc prolapse and lumbar spondylosis. In the literature various randomized trials have been done and their results are controversial. Our study showed definitive improvement in terms of pain and function of our patient

Aims. To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability. Methods. This was a cross-sectional study of 2,206 subjects along with L1-S1 axial and sagittal MRI. Clinical and radiological information regarding their demographics, workload, smoking habits, anteroposterior (AP) vertebral canal diameter, spondylolisthesis, and MRI changes were evaluated. Mann-Whitney U tests and chi-squared tests were conducted to search for differences between subjects with and without DSS. Associations of LBP and radicular pain reported within one month (30 days) and one year (365 days) of the MRI, with clinical and radiological information, were also investigated by utilizing univariate and multivariate logistic regressions. Results. Subjects with DSS had higher prevalence of radicular leg pain, more pain-related disability, and lower quality of life (all p < 0.05). Subjects with DSS had 1.5 (95% confidence interval (CI) 1.0 to 2.1; p = 0.027) and 1.8 (95% CI 1.3 to 2.6; p = 0.001) times higher odds of having radicular leg pain in the past month and the past year, respectively. However, DSS was not associated with LBP. Although, subjects with a spondylolisthesis had 1.7 (95% CI 1.1 to 2.5; p = 0.011) and 2.0 (95% CI 1.2 to 3.2; p = 0.008) times greater odds to experience LBP in the past month and the past year, respectively. Conclusion. This large-scale study identified DSS as a risk factor of acute and chronic radicular leg pain. DSS was seen in 6.9% of the study cohort and these patients had narrower spinal canals. Subjects with DSS had earlier onset of symptoms, more severe radicular leg pain, which lasted for longer and were more likely to have worse disability and poorer quality of life. In these patients there is an increased likelihood of nerve root compression due to a pre-existing narrowed canal, which is important when planning surgery as patients are likely to require multi-level decompression surgery. Cite this article: Bone Joint J 2021;103-B(1):131–140