Epidural Steroids; Does the level of injection make any difference in pain releif and outcome?

Abstract

Aim of the study: To know whether level of injection of epidural steroid in lumbar disc prolapse makes any difference in pain relief and function. Materials and Methods: Consecutive 22 patients from June 2008 to Jan 2011, who were diagnosed as having Lumbar disc prolapse clinically with confirmation of level by MRI were included in the study. Epidural steroid (120 mg of Tricort) was given along with Bupivacaine in these patients at the same level of disc prolapse(Group A) or one level higher(Group B) alternatively. Post-injection numbness in legs was considered as confirmatory evidence of placing steroid in epidural space correctly. Outcome was assessed using Visual analog score and Oswestry disability index at 6 months.
Results: There were 12 patients in Group A and 10 in Group B. 18 patients showed numbness following injection. Mean VAS improved from 8.4 to 4.3 in Group A, 8.3 to 4.5 in Group B. Mean ODI improved from 42.8 to 13.6 in Group A and 43.6 to 16.6 in Group B. Two way Anova test did not show any statistical difference (P - 0.482). However patients who noticed numbness following injection showed better result compared to those who did not(P- 0.001)
Conclusion: There is no necessity to exactly detect Disc prolapse level while injecting epidural steroid as clinical level assessment may be sufficient and erring one space higher does not decrease the benefit. However, injecting epidural steroid at L3-4 level or higher may be technically difficult and experience or image guidance may be beneficial. Also, in all patients L4-5 space can be targeted as most of patients have either L4-5 or L5-S1 disc.