Epidural injections for lumbosciatica syndrome–medications and routes

It was a prospective study involving 103 patients, suffering from lumbosciatic syndrome due to various causes. Purpose of this study was to study the efficacy of two steroids methylprednisolone and triamcinolone used epidurally via lumbar and caudal route and to highlight value of this simple procedure in lumbosciatic syndrome. About 80% people suffer from back pain at some point of life. Majority of the patients can be managed effectively with conservative treatment like bed rest, analgesics, lumbar traction and transcutaneous electrical nerve stimulation (TENS), etc. The epidural steroid injection has an important role in the patients of lumbosciatic syndrome due to various causes. Its judicious use can avoid the surgery in many patients.Between September 2003 and August 2004, 103 patients received 309 injections (156 lumbar route and 153 caudal). Pain was assessed by visual analog scale, SLR, and Lasègue test. Three epidural injections were given at a monthly interval and patients followed up for minimum period of 4 months. Patients were randomly divided into 2 groups, on the basis of whether they received methylprednisolone or triamcinolone and further into 2 subgroups for either lumbar/caudal route.78.43% in caudal group and 82.6% had excellent to good results. Complications were minimal and that to in the lumbar route only. Data was analyzed using t-test. Significant difference (p < 0.01) was seen in improvement of low backache (LBA) by both routes and both drugs but the difference was statistically insignificant (p > 0.05) among 2 steroid groups and 2 routes.Epidural steroid injection (triamcinolone/methylprednisolone) through either caudal or lumbar route is an excellent conservative method for treatment of LBA with sciatica. Caudal route is relatively safer than lumbar, so lumbar route should be used by experienced persons and in setups where resuscitation equipments are available.