Targeted indwelling caudal epidural steroid injection (ESI) in combination with a 4-step manipulative therapy may be a safe and effective method for reducing pain intensity and functional disability in patients with symptomatic lumbar disc hernia, according to a study published in World Neurosurgery.
This prospective single-blind controlled trial was conducted to assess the efficacy of caudal ESI with targeted indwelling catheter for patients experiencing lumbar disc herniation.
Researchers randomly assigned 85 patients (mean age, 55.2 years) to receive targeted indwelling catheter ESI or traditional ESI.
Back and leg pain, assessed with the Visual Analog Scale (VAS), disability, evaluated with the Oswestry Disability Index, and clinical symptom scores of the Japanese Orthopaedic Association (JOA) were measured at baseline and at 1, 3, 7, and 28 days after injection.
Short-term impacts on pain intensity and functional disability were comparable in both groups. However, compared with participants receiving traditional ESI, those in the catheter group reported greater decreases in VAS scores at day 1 (P =.001 for back pain and P =.008 for leg pain) and day 3 (P =.005 for back pain and P =.232 for leg pain) and greater JOA scores (P =.013) and Oswestry Disability Index scores (P =.025) at day 1 of follow-up.
The study’s limitations included small sample size, lack of documentation of adjuvant therapies, and short follow-up period.
Researchers believe the targeted indwelling catheter was responsible for the observed improvements. In terms of efficacy, they stated that serious complications with ESI are rare, adding, “In our clinical work and the study, there are no adverse events and complications. [Therefore] we generally consider this technology [to be] a safe and effective treatment for [lumbar disc hernia] with radiculopathy.”
Yin M, Mo W, Wu H, et al. The efficacy of caudal epidural steroid injections with targeted indwelling catheter and manipulation in managing patients with lumbar disc herniation with radiculopathy: a prospective, randomized, single-blind controlled trial [published online February 3, 2018] World Neurosurg. doi: 10.1016/j.wneu.2018.01.162