Pos1286 short-Term and Mid-Term Efficacy of Caudal Epidural Steroid Injections in the Management of Degenerative Sciatica

Abstract

Background:Epidural steroid injections are largely used in the management of osteoarthritis-related sciatica. Three possible sites of injection are possible: the caudal through the sacral hiatus, the interlaminar and the transforaminal site. The caudal technique is known to be the most simple one. However, doubts still persist about this infiltration’s efficacy.Objectives:The aim of this work was to study the short-term and mid-term efficacy of caudal epidural steroid injections in patients suffering from sciatica related to a degenerative etiology and to study the determining factors of its efficacy.Methods:A retroscpective, descriptive and monocentric study was conducted in Sahloul university hospital of Tunisia. Medical records of patients who suffered from sciatica due to disc herniation or spinal stenosis were analysed. Only patients who benefited from at least one caudal epidural steroid injection were included. Other etiologies were ruled out by CT-scan or MRI and laboratory tests. Efficacy of the injection was evaluated by the visual analog scale of pain (VAS) at the first week post infiltration, 3 months and 6 months later. The infiltration was considered effective if the difference of pain scoe by VAS was ≥50% compared to baseline‘s score. The presence of anxiety and depression was also tracked down with the hospital anxiety and depression scale. Data was collected and analysed using the statistical tool SPSS.20.Results:Twenty-five patients were included. They were 7 males and 18 females. The mean age at diagnosis was 51.88± 15.28 years. Eleven patients had another osteoarthritis site. Five patients had previous back surgery: 2 dissectomies, 1 arthrodesis, and 2 laminectomies. Median duration of sciatica was 30 months. Sciatica was bilateral in 41.7% of the cases, impulsive during efforts in 52% of the cases and with claudication in 92% of the cases. The median VAS score at baseline was 7 out of 10 (min=4; max=9). All patients had tried medical treatment using NSAIDS and painkillers, and physical therapy before prescribing the infiltration. The technique was similar in all patients: Lidocaine 1% was first injected at a median volume of 5ml, followed by corticosteroids and finally a saline solution (median volume of 20ml). The median number of epidural caudal injections was 3 injections (min=1; max=3). The caudal epidural steroid injections were effective in 60% of the patients at the first week, 56% in the cases at 3 months and 56% of the cases at 6 months. Factors associated with efficacy of the injection at the first week were greater total volume injected (p=0.001), and greater saline solution volumes (p=0.016). At 3 months, factors significantly associated with efficacy of the infiltration were having unilateral pain (p=0.05), a positive straight leg raise test sign (p=0.028), a lower anxiety score (0.014) and a lower depression (0.000) score. At 6 months, factors associated with efficacy were not having cervical osteoarthritis (p=0.03), unilateral pain (p=0.05), low anxiety (p=0.014) and low depression (p=0.001) scores and a higher number of steroid injections (p=0.05).Conclusion:Caudal epidural steroid injections seem effective on the short-term and this efficacy is maintained till the mid-term. Greater volumes may help with pain by possible adhesiolyse-like mechanisms and having unilateral pain, positive straight leg raise sign, a higher number of injections, no anxiety or depression and no other osteoarthritis sites makes the infiltration more effective.References:[1]Dincer U, Kiralp MZ, Cakar E, Yasar E, Dursan H. Caudal epidural injection versus non-steroidal anti-inflammatory drugs in the treatment of low back pain accompanied with radicular pain. Joint Bone Spine. 2007;5.Disclosure of Interests:None declared