Selective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc - A...

Area of Science:

• Pain Management
• Neurosurgery
• Anesthesiology

Background:

• Chronic lumbar radiculopathy affects a significant portion of the population, with persistent symptoms in up to 30% of cases after one year.
• Lumbar disc herniation is a common cause of radiculopathy, necessitating effective treatment strategies.

Purpose of the Study:

• To compare the efficacy of caudal epidural steroid injection versus selective nerve root block for pain and disability in lumbar disc herniation.
• To evaluate long-term outcomes of these minimally invasive procedures.

Main Methods:

• A prospective, randomized, single-blind study involving 80 patients with single-level lumbar disc herniation.
• Patients were randomized into two groups: caudal epidural steroid injection (three injections) and selective nerve root block (single injection).
• Pain and disability (using Oswestry Disability Index - ODI) were assessed at multiple follow-up intervals.

Main Results:

• The caudal epidural group demonstrated sustained pain reduction (>50%) up to one year, while the selective nerve root block group showed this effect for up to six months.
• Functional disability (ODI) showed significantly better improvement in the caudal epidural group (maintained >64% improvement) compared to the selective nerve root block group (46.7% improvement at one year).

Conclusions:

• Caudal epidural block is a safe and effective method for managing pain and functional disability in lumbar disc herniation.
• Selective nerve root block is technically more demanding and may be less effective for long-term pain relief and functional recovery.