Purpose: 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. 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.

Method: Prospective study. All patients with corresponding radicular pain received a course of three caudal epidural steroid injections, two weeks apart. All patients reviewed at three months interval in a dedicated epidural follow up clinic and one-year postal and telephonic follow-up. Exhaustive epidural database maintained. VAS scores documented both axial and limb pain for actual and comparative analysis. ODI and HADS were recorded prior to treatment, at three months follow-up and one year. 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.

Results: In the largest single series to date, we report on 928 consecutive patients, with three months follow-up and 354 patients with 12 months follow-up. Fifty-eight percent were females, 24% smoked and 4.1% had ongoing litigation due to their pain. The mean age was 56 years with BMI ranging from 17 to 50 (mean=28). Ten (0.6%) patients required subsequent surgical intervention due to disc herniation. The mean VAS, ODI and HADS improved significantly at three months and one-year results were encouraging.

Conclusion: Significant improvement in both axial and limb pain in the short and intermediate terms achieved facilitating onward referral for physical therapy. Subgroups predicting poor outcome are identified. Positive primary care feedback encourages further recruitment.