CLINICAL OUTCOME AND FLOUROSCOPIC COMPARISON OF TWO DIFFERENT APPROACHES OF EPIDURAL STEROID IN LOW BACKACHE PATIENTS

Epidural steroid injections have a long history of efficacy and safety in treating low back pain and radiculitis still their use remains controversial. OBJECTIVES: To compare and correlate clinical outcome with flouroscopic findings of interlaminar midline with caudal approaches for epidural steroid injections in low backache patients. METHODS: In a randomised manner, 40 patients with chronic low backache with or without leg radiation, either received midline interlaminar (Group A; n=20) or caudal epidural block (Group B; n=20) under fluoroscopic guidance and epidurography was noted. A two weekly follow up till 3 month done, recording VAS (Visual Analogue Scale) and Modified NASS patient satisfaction index score (NASSPSI). RESULTS: Demographic and preinjection clinical data was comparable between groups (p>0.05). Improvement in VAS score was seen in both groups compared to baseline (p 0.05). Dorsal spread was seen in all patients, ventral spread was seen in 30% patients in group A and 20% patients in group B. Nerve root spread was seen in 70% patients in Group A and 60% patients in Group B. All findings were statistically comparable between groups. Clinical outcome in terms of percentage improvement in VAS at 3 months did not correlate with ventral spread (p 0.05). More than 70% patients in both groups were satisfied (NASSPSI 1 & 2) with their results on last follow up. CONCLUSION: Presence of ventral spread of contrast did not correlate well with VAS improvement. Both approaches were comparable for improving pain and providing patient satisfaction.