Outcome of C-arm Guided Epidural Steroid Injections in Patients with Prolapsed Lumbar Intervertebral Disc with Radiculopathy

Author(s): Tamjid Ali MD, Moshiur Rahman Khasru, Salek AKM, Alauddin Sikdar, Quazi Tamanna Haque

Background: Prolapsed Lumbar Intervertebral Disc (PLID) is one of the most common health problems worldwide, as well as in our country, and is one of the potential causes of temporary disability, morbidity, and reasoning of absence at workplaces.

Objective: To find out the outcome of C-arm guided transforaminal and caudal epidural steroid injection for low back pain with radiculopathy due to PLID.

Methodology: This was a randomized clinical trial conducted among purposively selected 54 patients with PLID with radiculopathy as per selection criteria, attending the Department of Physical Medicine & Rehabilitation in BSMMU, Dhaka, from March 2020 to February 2021. Patients (N=54) were randomly allocated into two groups; patients in group A (n=26) were treated with C-arm guided transforaminal and caudal epidural steroid injection with conservative treatment, and patients in group B (n=28) were treated with conservative treatment only. All patients were followed up in 1st week, 1st month, and 3rd month.

Results: The mean age of the participants in group A and group B were 40.88 (± 8.70) and 43.00 (± 11.54) years, respectively. In group A, 9 (34.6%) were housewives, 4 (15.4%) were manual workers, while in group B, 10 (35.7%) were housewives, and 8 (28.6%) were manual workers. In group A, 21 (80.8%) had three disc involvement, while in group B, 19 (67.9%) had three discs involvement, where L4-5-disc involvement was most common in both groups. There was no significant statistical difference between the groups regarding VAS scores at baseline (p=0.235), 1st week (p=0.164), and 1st month (p=0.125). The VAS score was significantly reduced in group A compared to group B at 3rd month (p=0.001). The ODI score was significantly reduced in group A compared to group B at 1st week (p=0.034), 1st month (p=0.016), and at 3rd month (p=0.001).

Conclusion: C-arm guided transforaminal and caudal Epidural Steroid Injection significantly improves pain and functional outcomes of patients with radiculopathy due to PLID. Long-term, large scale and multicenter research studies are required to establish the outcome and effectiveness of this procedure.