Role of Caudal Epidural Corticosteroid Injection in the Management of Sciatica

Objective: To determine the effectiveness of caudal epidural corticosteroid injection in patients with sciatica. Study Design: Descriptive Case series Place and Duration: Orthopaedic Surgery Unit Mardan Medical Complex Teaching hospital Bacha Khan Medical College Mardan KPK from May 2010 to June 2011, Materials and Methods: 42 patients of sciatica were injected with caudal epidural injection 80 mg of methylprednisolone in combination with 3 ml of 2% plain xylocaine and 3 ml of normal saline. Efficacy of the injection was determined by improvement in the Oswestry Disability Index (Version 2) and Visual Analogue Scale (VAS) measured preinjection and at follow-up visit at 3, 6, 10 and 12 weeks. Patient with post-injection Oswestry Disability Index ≥ 40% or pain score ≥ 5 at 3 weeks were injected a second injection. No more than two injections were given to any patient presented. Results: All the patients enrolled in our study had pre-injection mean Oswestry Disability Index 58.4% and pain score 4.5 on Visual Analogue Scale. Twenty four (57.1%) patients responded well to one injection and resulted in maximum improvement of Oswestry Disability Index(mean 10.4%) and pain score(mean 1) at 12th week.18(42.8%) patients however received another injection at 3rd week and resulted in improvement of Oswestry Disability Index(mean10.8%) and pain score(mean1.5) in 13(30.9%) patients while 5(11.9%) patients showed no improvement of Oswestry Disability Index (mean 59%) and pain score (mean 4.8) at all. Conclusion: Caudally administered epidural steroid injection is an effective modality of treatment in sciatica with good results.