Is ultrasound-guided caudal steroid injection effective in the management of lower lumbar radicular pain? A two-center prospective observational study on 150 patients

François Robin (1, 2) , Guillaume Coiffier (1, 2) , Jean-David Albert (1, 2) , Christelle Darrieutort-Laffite (3) , Simon Rio (1) , Benoit Le Goff (3) , Pascal Guggenbuhl (1, 2)

1 CHU Pontchaillou [Rennes]
2 NuMeCan - Nutrition, Métabolismes et Cancer
3 CHU Nantes - Centre hospitalier universitaire de Nantes

Lower lumbar radicular pain is a benign and frequent condition, mostly induced by disk herniation or osteoarthritis. The management of lower lumbar radicular pain is a public health problem, with multimodal management. Lumbar epidural steroid injections are considered as a treatment but their effectiveness remains controversial, with conflicting results. Injection via the caudal hiatus route (CH) under ultrasound (US) guidance has gained popularity because of accessibility or US equipment, absence of irradiation, feasibility and very few complications reported.A pragmatic prospective observational two-center (Rennes and Nantes University Hospitals) study was performed to evaluate the effectiveness of a single steroid (cortivazol) epidural injection delivered under US guidance via the CH on lower lumbar radicular pain. The primary outcome for success was achieving a numerical pain rating scale score (NPRS ≤ 3/10 at day 30 (D30) after epidural injection. The secondary endpoints were achieving a NPRS ≤ 3/10 at D30 without opiates and NSAIDs, level of analgesic and NSAIDs consumption, absence from work and occurrence of adverse events. Factors related to efficacy were not well established.

Keywords: ultrasound-guided; caudal hiatus epidural injection; Lower lumbar radicular pain

Domains: Life Sciences [q-bio]; Human health and pathology; Rhumatology and musculoskeletal system; Life Sciences [q-bio]; Pharmaceutical sciences; Pharmacology

François Robin, Guillaume Coiffier, Jean-David Albert, Christelle Darrieutort-Laffite, Simon Rio, et al.. Is ultrasound-guided caudal steroid injection effective in the management of lower lumbar radicular pain? A two-center prospective observational study on 150 patients. Joint Bone Spine, 2020, 87 (4), pp.364-365. ⟨10.1016/j.jbspin.2019.11.006⟩. ⟨hal-02442527⟩