COMPARATIVE STUDY OF TREATMENT WITH TRANSFORAMINAL EPIDURAL STEROID INJECTION VERSUS CAUDAL EPIDURAL INJECTION IN RADIATING LOWER BACK PAIN
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Keywords
Lumbar radiculopathy, radiating lower back pain, epidural steroid injection, transforaminal, Visual Analog Scale, Oswestry Disability Index
Abstract
Radiating lower back pain secondary to lumbar radiculopathy is one of the most common causes of disability and functional limitation worldwide. Epidural steroid injection (ESI) is a recognized non-surgical treatment modality aimed at reducing inflammation around irritated nerve roots. Among the available routes, transforaminal and caudal approaches are most frequently used, but the relative efficacy of these two techniques remains debated. Aim: To compare the clinical effectiveness of transforaminal epidural steroid injection versus caudal epidural steroid injection in patients presenting with radiating lower back pain at Government Medical College, Srinagar. Methods: This prospective comparative study was conducted over an 18-month period (January 2022 – June 2024) in the Department of Orthopaedics , Government Medical College, Srinagar. A total of 40 patients with radiating lower back pain consistent with lumbar radiculopathy were included and divided into two groups of 20 each: Group A (Transforaminal ESI) and Group B (Caudal ESI). All injections were performed under fluoroscopic guidance using a combination of corticosteroid and local anesthetic. Pain relief and functional improvement were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline, 1 month, 3 months, 6 months, and 12 months post-procedure. Duration of analgesic effect and occurrence of adverse events were also recorded. Statistical analysis employed paired and unpaired t-tests, chi-square tests, and repeated-measures ANOVA, with p < 0.05 considered statistically significant. Results: Both groups demonstrated significant reduction in pain scores and disability indices after treatment (p < 0.001). The transforaminal group showed a faster onset of pain relief (mean VAS reduction at 1 month = 4.0 ± 1.2 vs 3.0 ± 1.4 in the caudal group, p = 0.02), whereas the caudal group exhibited more sustained improvement at 12 months (ODI reduction = 22.5 % vs 18.0 %, p = 0.04). The median duration of analgesic effect was longer in the caudal group (9.2 ± 2.1 months) compared with the transforaminal group (7.8 ± 1.9 months, p = 0.03). No major complications were observed in either group. Conclusion: Transforaminal epidural steroid injection provides quicker initial pain relief, while the caudal approach yields longer-lasting functional improvement and analgesic duration. Both methods are safe and effective for managing radiating lower back pain, though route selection may be tailored to patient-specific anatomy, symptom duration, and response profile.
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Dr. Vishesh Amrit
Postgraduate Scholar, Department of orthopaedics , Government Medical College Srinagar, India
Dr. Vasu
Postgraduate Scholar, Department of orthopaedics , Government Medical College Srinagar, India
Dr. Nitish Sharma
Senior resident, Department of orthopaedics , Government Medical College Kathua, India
Dr. Muhammad Mussa
Associate professor, Department of orthopaedics , Government Medical College Srinagar, India
Dr. Sumedha Ghai
Postgraduate Scholar, Department of Ophthalmology , Government Medical College Srinagar, India
Dr. Pariksha
6Postgraduate Scholar, Department of Gynaecology & Obstetrics , Government Medical College Srinagar, India