Functional Outcome of Ultrasound-Guided Caudal Epidural Triamcinolone Acetonide Injection in Patients With Prolapsed...

Introduction Prolapsed lumbar intervertebral disc (PLID) with radiculopathy is a prevalent cause of low back pain, often treated conservatively or with invasive interventions such as epidural steroid injections (ESIs). Ultrasound-guided caudal ESIs have gained attention due to their accuracy and reduced complication rates compared to traditional methods. This study aimed to assess the efficacy of ultrasound-guided caudal epidural triamcinolone acetonide injection in managing PLID with radiculopathy, in comparison to physical therapy (PT). Methods This quasi-experimental study was conducted at Dhaka Medical College Hospital between May 1, 2022 and March 31, 2023. Seventy-one patients with clinically diagnosed and MRI-confirmed PLID were non-randomly allocated into two groups: Group A (n=35) received ultrasound-guided caudal epidural triamcinolone acetonide injections, while Group B (n=36) underwent PT. Pain and functional disability were assessed at baseline and after four, six, and 12 weeks, using the visual analogue scale (VAS) and the Oswestry disability index (ODI). During follow-up, one patient from each group was lost at weeks 1 and 4, respectively. Additionally, three patients from each group dropped out by week 12, resulting in 64 patients (30 from Group A and 34 from Group B) for analysis. The missing data from these dropouts were excluded from the final statistical analysis. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 26 (Released 2018; IBM Corp., Armonk, New York, United States). Means and standard deviations were used for continuous variables, while categorical variables were analyzed with chi-square tests, and group differences were assessed using independent and paired t-tests, with p<0.05 considered significant. Results At baseline, the mean VAS scores were comparable between Group A and Group B (7.8 vs. 7.4; p = 0.071). By the fourth week, VAS scores had significantly decreased in both groups, with a greater reduction observed in Group A compared to Group B (2.6 vs. 3.6; p = 0.004). At the sixth and 12th weeks, Group A continued to demonstrate significantly lower VAS scores than Group B (p < 0.001). Similarly, baseline ODI scores did not differ significantly between Group A and Group B (43.1 vs. 41.7; p = 0.092). At the fourth week, the ODI score was significantly lower in Group A compared to Group B (p < 0.001), and this difference remained statistically significant at both the sixth and 12th weeks (p < 0.001). Both the VAS scores and ODI significantly reduced after treatment in Group A and Group B (p<0.001). Conclusion Ultrasound-guided caudal epidural triamcinolone acetonide injection is more effective than PT for reducing pain and improving functional disability in patients with PLID and radiculopathy. Ultrasound guidance offers a more accurate approach than PT. Further multi-center studies with larger sample sizes and long-term follow-up are needed to validate these findings.