Are Fluoroscopic Caudal Epidural Steroid Injections Effective for Managing Chronic Low Back Pain? An Original Contribution

Objective: This study sought to deter-mine the efficacy of fluoroscopic caudal epi-dural steroid injections as a conservative treatment in patients with presumably chron-ic lumbar discogenic pain. Summary of Background Data: Epidu-ral steroid injections have been used in the treatment of lumbar radicular pain with suc-cess. However, despite their widespread use, there are few, if any, reports of the effi-cacy of Epidural steroid injections in patients with predominantly axial lumbar pain. Prior studies have been limited by the use of non-fluoroscopically guided injections and failing to apply a specific injection approach (i.e. transforaminal, interlaminar, or caudal) to a specific patient population. Methods: Ninety-seven patients with chronic axial low back pain and Magnetic Res-onance Imaging evidence of disc pathology without stenosis were selected from chart re-view. All patients received at least one fluoro-scopically guided caudal epidural injection with 12mg of betamethasone and 8cc of 0.5% lido-caine. Collected follow-up information includ-ed Roland-Morris Disability, Visual Numeric Pain Scale, and patient satisfaction scores.Results: Only nineteen patients (23%) were determined to have a successful long- term (> 1 year) outcome and 65 (77%) were deemed failures. Average follow-up was 28.6 ± 15.6 months. Successes were found to differ significantly from failures in pre-in-jection pain scores and patient satisfaction. Overall patient satisfaction was 45%.Conclusion: At greater than two year fol-low-up, the efficacy of fluoroscopically guided caudal epidural steroid injections in patients with chronic lumbar discogenic pain is poor. Pa-tient satisfaction exceeds the reported rate of ef-ficacy. Patients responding to injection have sig-nificantly lower pre-injection pain scores.Key Words: low back pain, epidural ste-roid injections, caudal, inter laminar, transfo-raminal