DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20194812

Study of role of caudal epidural steroid in management of low back pain in Malayalam patients

Jayakrishnan Rajasekharan

Abstract


Background: 85 patients of different age groups were treated with caudal epidural steroid injection for the management of low back pain. As low back pain is quite common in adults.

Methods: X-ray, MRI of the lumbar region was studied. Degree of the pain was assessed by VAS (visual analogue scale) scale, study of Lumbo-sacral joint was studied to know the causes of low back pain (LBP).

Results: As per the MRI study classification LBP was classified as, 16 (16.3%) had Acute back pain without any cause, 14 (14.2%) had spondylolithesis having symptoms of claudication with low back pain. 26 (26.5%) had stenosis of Lumbar canal with symptoms of claudication 42 (42.8%) had disc degeneration with or without root radiation having complaint of back pain and leg pain. The improvement as per VAS scale was from 1 week to 3 months in the management of LBP.

Conclusions: This pragmatic approach to various causes of low back pain managed with epidural steroid injection will be useful to orthopedic surgeon to treat such pain efficiently because back pain becomes common factor as age advances due to resorption or degenerative factors andcurvatures of vertebral column becomes less pronounceds. 


Keywords


Visual analogue scale, Lumbar canal stenosis, Caudal epidural steroid injection, Low back pain

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Data citation

Material and Methods 98 patients often visiting to Azeezia medical college hospital meeyannor P O. Kollam 37 kerala. X-ray AP andLat view of lumbar region was taken and symptomatic treatment was given to them for 4 to 6 weeks and assessed with VAS scale and patients who did not show any improvement on VAS scale MRI of lumbo-sacral spine was done to study cause of low back pain, who did not respond to conservative treatment. Inclusive criteria:- Patients aged between 30 to 65 years having low back pain radicular symptoms and neurogenic claudication not responding to symptomatic treatment for 4 to 6 week were selected for study Exclusive criteria:- The patients having osteoporotic fracture lumbar spine, patients younger that 30 years, older than 65 year, patients having cardio- vascular and neurogenic disease were excluded from study. Method:-After routine investigation. Caudal epidural injection was given under monitorial aesthetic care. The patients were asked to lay down in prone position Ona radiolucent table. The Gluteal region was cleared and draped. 4 cm above the proximal and of natal cleft. Needle was inserted straight through sacral hiatus, also there was C-Arm image intensifier to confirm the site of needle insertion. 20 G spinal needle was inserted into sacral hiatus Aspiration was done to confirm that that the needle did not pierce epidural blood vessels or inside the dura 2cc air was injected through the syringe to confirm the needle was in the epidural space.Position of the needle in the sacralhiatus was also confirmed under C- Arm 50 cc syringe containing 25cc normal saline 5cc lignocaine 2% and 80 mg Depomedrol acetate was slowly injected. It was stop and go procedure. After the injection patient was put in supine position and vitals were monitored for 5-10 minutes. Then patients was asked to move toes and legs actively to check the muscle power. The patients in whom bloody tap was encountered, the procedure was abandoned and post ponded for a week. The patients was discharged on the same day and instructed to like in supine position for next 6 hours to prevent headache,nausea and vomiting. He was called after 24 hours to know about the pain and any adverse effects. He was again started with conservative treatment simultaneously, subsequent follow up in OPD was done one week, three weeks and three months intervals and assessed on VAS (Visual Analogue scale) The visual Analogue scale (VAS) score givin from 0-10. The intensity of pain was divided as under. 1 None 0-2 I 2 Un- comfortable 2-4 II 3 Annoying 4-6 III 4 Dreadful 6-8 IV 5 Excruciating 8-10 V Adverse effect observed in the patients was vertigo (47%) immediately and injection site pain (68%) And headache (9%) Statastically:-Types of LBP was classified as per MRI vision with percentage, study of duration of improvement as per VAS score was noted. The ratio of male and female was 2:1. The duration of study was about three years(2016 to 2018)