Effectiveness of ultrasonography-guided caudal epidural steroid injection compared to the fluoroscopic application

Authors: EMRULLAH CEM KESİLMEZ, KASIM ZAFER YÜKSEL, AYŞE AZAK BOZAN, CENGİZHAN YAVUZ

Abstract: Background/aim: Caudal epidural steroid injection (CESI) has been increasingly used for treating lower back pain. However, there is still significant controversy about the efficacy and safety of different imaging techniques used to guide CESI. In this context, the objective of this study is to compare the efficacies of fluoroscopy- and ultrasonography-guided CESI in patients with chronic lower back pain. Materials and methods: The population of this retrospective, observational study consisted of all consecutive patients who underwent CESI for lower back pain between 2018 and 2020. Of the 371 patients included in the study sample, 192 had undergone fluoroscopy- guided CESI (Group F) and 179 ultrasonography-guided CESI (Group U). Patients' pain and functional statuses were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) immediately before (baseline) and after the procedure (postintervention day 0-D0), during the second week (D15), the first month (D30), and the third month (D90) after the procedure. Results: The mean age of Group F was significantly higher than that of Group U (p < 0.001). The number of patients with lumbar disc hernia was significantly higher in Group U, whereas the number of patients with spinal stenosis and lumbar disc hernia + spinal/lumbar stenosis was significantly higher in Group F (p = 0.001). The baseline and D0 ODI scores were significantly lower in Group U than in Group F (p = 0.006 and p = 0.017, respectively). There was no significant difference between the groups in other VAS and ODI scores (p > 0.05). Intragroup analyses revealed significant reductions in VAS and ODI scores over the follow-up period till D30 compared to the baseline scores in each group (p < 0.001). The decrease recorded in the ODI score between the D15 and baseline measurements was significantly higher in Group F than in Group U (p = 0.006). Conclusion: The CESI was as effective as fluoroscopy-guided CESI in treating chronic lower back pain.

Keywords: Caudal epidural steroid injection, lower back pain, ultrasonography, fluoroscopy

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