The Correlation between Caudal Epidurogram and Low Back Pain

Area of Science:

• Pain Management
• Diagnostic Imaging
• Spinal Procedures

Background:

• Lower back pain, with or without leg pain, often stems from disk disease or spinal stenosis.
• Magnetic resonance imaging (MRI) is standard for diagnosis, but symptom-MRI finding discrepancies complicate treatment.
• This study investigates epidurography's utility in correlating imaging findings with patient-reported pain.

Purpose of the Study:

• To assess the correlation between caudal epidurography contrast patterns and the location/severity of lower back pain.
• To determine if epidurography can provide more consistent diagnostic information than MRI in certain cases.
• To evaluate the relationship between pain laterality and contrast flow in patients with unilateral lower back pain.

Main Methods:

• Sixty-nine outpatients with unilateral lower back pain underwent caudal epidurography using an image intensifier.
• Contrast agent flow patterns were analyzed for consistency with reported pain laterality (left vs. right side).
• Pain severity was assessed using the Visual Analog Scale (VAS), with groups divided into VAS ≤7 and VAS ≥8 for correlation analysis.

Main Results:

• Thirty of 69 patients (43.5%) showed consistent pain laterality and contrast flow; 39 (56.5%) showed inconsistency (P=0.137).
• Patients with lower pain severity (VAS ≤7, n=46) had a significantly greater mean number of contrasted cells (9.0 ± 2.2) compared to those with higher severity (VAS ≥8, n=23; 6.5 ± 2.0; P < 0.001).
• A significant correlation was found between contrast flow patterns and pain severity, but not pain laterality.

Conclusions:

• Caudal epidurography contrast flow patterns correlate significantly with lower back pain severity.
• The laterality of pain in patients was not found to correlate with the contrast agent's flow pattern.
• Epidurography may offer valuable insights into pain mechanisms, particularly regarding pain intensity.