Effect of Caudal Epidural Injection for management of Lumbar Spinal Stenosis: A randomized controlled Trial
Abstract
Chronic low back pain (LBP) is a common cause of morbidity and work absenteeism worldwide. This hospital based randomized, controlled, interventional study is conducted to assess the effectiveness of caudal epidural steroid injection in lumbar spinal stenosis. Study subjects were chronic low back pain patients attending at department of Physical Medicine and Rehabilitation (PMR), Sawai Man Singh Hospital, Jaipur (Rajasthan) India. For study purpose, 60 LBP cases were taken in Study group and 60 cases were taken for control group. To compare the effect between conservative treatment alone and added with caudal epidural injection of steroid plus saline in lumbar spinal stenosis, in study group, a mixture of MPA (3mg/kg body wt.) plus 16 ml of normal saline was injected in epidural space along with conservative treatment and in control group only conservative treatment was given. It was observed in this study that patient had more significant improvement in low back pain, leg pain, walking distance and functional activity after caudal epidural block in the study group than control group for a period of 3-6 months. So it was concluded that when conservative treatments were combined with interventional methods in form of caudal epidural steroid injection the amount of relief gets augmented as compared to the conservative treatment alone resulting in the patient benefiting in terms of much better symptom control and pain relief, improvement in anxiety, depression and activity limitations and quality of life.
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Introduction
Chronic low back pain (LBP) is a common cause of morbidity and work absenteeism worldwide and a very common presenting complaint in out-patient departments dealing with geriatric patients. The prevalence of LBP is 5-20% in USA, 25-45% in Europe and 23.09 % in India, 1 Among various causes lumber spinal stenosis (LSS) is a common cause in elderly for spinal surgery. LSS is a growing concern with the aging of the population. 2
Spinal stenosis can be primary (congenital) or secondary (acquired stenosis). The natural history of spinal stenosis remains poorly understood. Prevalence of congenital LSS is 4.7% for relative and 2.6% for absolute. Acquired LSS is 22.5% and 7.3% for relative and absolute respectively. Acquired LSS showed increasing prevalence with age ≥ 40 years, the prevalence of relative and absolute LSS found 20.0% and 4.0%, respectively; in those 60–69 years the prevalence found 47.2% and 19.4%, respectively. 3
Degenerative LSS involve central canal, lateral recess, foramina or combination. Central canal stenosis results from decrease in antero-posterior, transversal or combined. Entrapment of cauda equina roots by hypertrophy of the osseous and soft tissue structure surrounding the lumber spinal canal.
Conclusion
It was concluded that when conservative treatments for lumbar canal stenosis were combined with caudal epidural steroid injection the amount of relief gets augmented as compared to the conservative treatment alone resulting in the patient benefiting in terms of much better symptom control and pain relief, improvement in anxiety, depression and activity limitations, and quality of life. So This caudal epidural may be opted for treatment of lumbar canal stenosis as it is cost effective and reasonably accurate and hence appropriate for the Indian scenario.