Publication: Our experience with epidural steroid injections in management of low backpain and sciatica
Date
2005
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Background: Low back pain and sciatica is a common clinical condition. It is a most common orthopaedic
complaint in the Kaski region of Nepal. The reason for its increased incidence may be hilly terrain, difficult working
and living environment of the region.
The initial treatment of Low back pain is conservative. Epidural steroid injection is being slowly established as a
reliable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of
on-going study of the use of epidural steroid in the management of low back pain cases coming to the orthopaedic
department of Manipal Teaching Hospital.
Methods: Prospective clinical trial was carried out on the patients reporting with low back pain and sciatica not
responding to other modes of conservative treatment. Pre and post injection evaluation was done clinically. The
level of pain, improvement in physical signs and ability to do activities of daily living were noted.
Results: Fifty two patients were observed for the average duration of 2.87 months. Average duration of symptoms
was for 10 months. After first epidural steroid injection 83% of patients reported relief on day one. In some cases
the onset of analgesia was delayed. Four patients reported no relief after first injection. Fifteen patients were given
two injections and four received three injections. The average duration between two injections was three weeks.
Average duration of pain relief was 20days. At the end of 3 months, good results were seen in 39%, fair in 33% and
bad results in 27%. Overall 59% of patients were able to do activities of daily living. Three patients (5.76%)
required operation for disc prolapse. Postoperatively two patients reported back with back pain. Most common
complaint of patients after injection was pain at the injection site. No major complications were encountered.
Conclusion: Epidural Steroid Injection is a safe and effective mode of treatment of Low Back Pain. It provides pain
free period to enable the patient for physiotherapy which helps in early recovery.
Keywords: Epidural steroid Injection, Low Back Pain, Sciatica.