Comparison of interlaminar epidural steroid versus caudal steroid injection for low back pain with radiculopathy due to disc prolapse

Sunil Nikose, Gurminder Singh, Pradeep K Singh, Sohael Khan, Devashree Nikose, Mahendra Gudhe


Background: Low back pain is a common entity with a lifetime prevalence of 65 to 80 percent in general population, and   usually disrupts work, social activity and activity of daily living. The purpose of our study was to evaluate the results of interlaminar epidural steroid injection versus caudal steroid injection for patients of lower back pain with radiculopathy, due to disc prolapse or disc degeneration in terms of pain relief and complications.

Methods: A total of 272 subjects having low back pain with radicular leg pain and MRI evidence of single or double level disc prolapse were chosen. Out of 272, patients were randomly assigned to two group; the first group having 131 patients and second group having 141 patients. The first group received caudal steroid injection, and second group received interlaminar epidural steroid under fluoroscopy control. Follow up for both groups was at 1 week, 6 weeks, and 12 weeks.

Results: The change in pain scores were rated as mild, moderate and excellent. The interlaminar epidural steroid injection fared excellent in earlier follow up, getting to moderate at 12 weeks’ time. The caudal steroid injection produced moderate relief in early phase at 12 weeks’ time.

Conclusions: The caudal steroid injection is cost effective, easy to administer and is having much less complications as compared to interlaminar steroid injection. Both these procedures are safe, well tolerated procedures, and can be performed as outpatient procedures



Caudal injection, Epidural injection, Interlaminar, Low back pain, Radiculopath, Lumbar disc prolapse, Steroid injection

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Bush K, Cowan N, Katz DE, Gishen P. The natural history of sciatica associated with disc pathology: a prospective study with clinical and independent radiologic follow-up. Spine.1992;17:1205-12.

Bogduk N, Brazenor G, Christophides N et al. Epidural Steroids in the Management of Low Back Pain and Sciatica of Spinal Origin: Report of the Working Party. Sydney: National Health and Medical Research Council. 1993:102–6.

Runu R, Sinba NK, Pai R, Shankar PR, Vijayabhaskar P. Our experience with epidural steroid injections in management of low backpain aod sciatica. Kathmaodu University Medical Journa1.2005;12:349-54.

Verhaak PF, Kerssens JJ, Dekker J, Sorbi MJ, Bensing JM. Prevalence of chronic benign pain disorder among adults: a review of the literature. Pain .1998;77:231-9.

Lawrence RC, Helmick CG, Arnett FC. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778-99.

Côté P, Cassidy JD, Carroll L. The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine. 1998;23:1689-98.

Manchikanti L. The role of neural blockade in the management of chronic low back pain. Pain Digest.1999;9:166-81.

Lofstrom B. Caudal anesthesia. In Erickson E (ed).Illustrated Handbook of Local Anesthesia .Copenhagan, Sorrenson and Cohn.1969:120-9.

Stone JA, Bartynski WS. Treatment of facet and sacroiliac joint a rthropathy: steroid injections and radiofrequency ablation. Tech Vasc Interv Radiol. 2009;12:22–32

Gro¨nblad M, Virri J, Tolonen J et al. A controlled immunohistochemical study of inflammatory cells in disc herniation tissue. Spine .1994;19:2744–51.

Saal JS. The role of inflammation in lumbar pain. Spine. 1995;20:1821-7.

Burke JG, Watson RW, McCormack D et al. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br. 2002;84:196-201.

Chen C, Cavanaugh JM, Ozaktay AC et al. Effects of phospholipase A2 on lumbar nerve root structure and function. Spine .1997;22:1057–64.

Rydevik B, Brown MD, Lundborg G. Pathoanatomy and pathophysiology of nerve root compression. Spine.1984;9:7–15.

Yoshizawa H, Kobayashi S, Morita T. Chronic nerve root compression. Pathophysiologic mechanism of nerve root dysfunction. Spine.1995;20:397–407.

Takahashi N, Yabuki S, Aoki Y, et al. Pathomechanisms of nerve root injury caused by disc herniation: An experimental study of mechanical compression and chemical irritation.Spine. 2003;28:435–41.

Melzack R, Coderre TJ, Katz J, et al. Central neuroplasticity and pathological pain. Ann N Y Acad Sci. 2001;933:157–74.

Cuellar JM, Golish SR, Reuter MW et al. Cytokine evaluation in individuals with low back pain using discographic lavage. Spine J. 2010;10:212–8.

Vad VB, Bhat AL, Lutz GE, et al. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine. 2002;27:11–6.

McGregor AH, Anjarwalla NK, Stambach T. Does the method of injection alter the outcome of epidural injections? J Spinal Disord. 2001;14:507-10.