Role of caudal epidural steroid injections in lumbar disc prolapse

Lumbar disc prolapse as a cause of back and leg pain is quite common and results in significant disability. This is a prospective uncontrolled study done on 40 patients with signs and symptoms of lumbar disc prolapse, in whom conservative treatment of at least 6 weeks had failed. The aim of the present study was to study the effect of caudally administered epidural steroids in the treatment of such patients. Back pain and leg pain was quantitatively assessed separately using the visual analogue scale and the functional disability was measured using Oswestry disability index (ODI) version 2.0, before the procedure and at regular intervals after the procedure for a period of 6 months. All the patients had an ODI more than 40% before the procedure. Through the sacral hiatus, methylprednisolone, lignocaine 2% and normal saline were injected into the epidural space. After 24 hours, pain relief was seen in all the patients except one. After 3 weeks, symptomatic improvement was seen in 97.5% of the cases, with good results in 65% and fair results in 32.5%. After 6 months, symptomatic improvement was seen in 67.5% of the cases with good results in 47.5% and fair results in 20% of the patients. No major complications were observed. It is concluded that caudally administered epidural steroid injections are a safe and effective modality of treatment in lumbar disc prolapse with good results in short term and possibly long term in some patients.