The preliminary results of a comparative effectiveness evaluation of adhesiolysis and caudal epidural injections in managing chronic low back pain secondary to spinal stenosis: a randomized, equivalence controlled trial.

Pain Physician. 2009 Nov-Dec;12(6):E341-54

Authors: Manchikanti L, Cash KA, McManus CD, Pampati V, Singh V, Benyamin R

Lumbar surgery and epidural injections for spinal stenosis are the most commonly performed interventions in the United States. However, there is only moderate evidence to the effectiveness of surgery and caudal epidural injections. The next sequential step is adhesiolysis and hypertonic neurolysis with targeted delivery. There have not been any randomized trials evaluating the effectiveness of percutaneous adhesiolysis and targeted delivery of local anesthetic, steroid and hypertonic sodium chloride solution in lumbar spinal stenosis.

PMID: 19935991 [PubMed – indexed for MEDLINE]

The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations.

Anesth Analg. 2007 May;104(5):1217-22, tables of contents

Authors: Ackerman WE, Ahmad M

Lumbar epidural steroid injection can be accomplished by one of three methods: caudal (C), interlaminar (IL), or transforaminal (TF). In this study we sought to determine the efficacy of these techniques for the management of radicular pain associated with lumbar disk herniations.

PMID: 17456677 [PubMed – indexed for MEDLINE]

Fluoroscopically guided caudal epidural steroid injections for lumbar spinal stenosis: a restrospective evaluation of long term efficacy.

Pain Physician. 2004 Apr;7(2):187-93

Authors: Barre L, Lutz GE, Southern D, Cooper G

Degenerative lumbar spinal stenosis is a frequent cause of disability in the elderly population. Epidural steroid injections are a commonly used conservative modality in the treatment of patients with degenerative lumbar spinal stenosis. Relatively few studies have specifically addressed the efficacy of epidural steroid injections for spinal stenosis, with success rates varying from 20% to 100%.

PMID: 16868591 [PubMed]

Injections and surgical therapy in chronic pain.

Clin J Pain. 2001 Dec;17(4 Suppl):S94-104

Authors: Bernstein RM

The purpose of this review was to determine how effective surgery and injection therapy are in the management of chronic pain.

PMID: 11783838 [PubMed – indexed for MEDLINE]

Sacral nerve stimulation as a treatment modality for intractable neuropathic testicular pain.

Pain Physician. 2009 Nov-Dec;12(6):991-5

Authors: McJunkin TL, Wuollet AL, Lynch PJ

BACKGROUND: Chronic testicular pain, or “chronic orchalgia,” is defined as testicular pain 3 months or longer in duration that significantly interferes with the daily activities of the patient. For patients failing to respond to conservative treatment, microsurgical denervation of the spermatic cord, epididymectomy, and vasovasostomy have all shown a degree of relief. However, these are all invasive procedures and no treatment has proven efficacy when these options fail. We present a case of a male who presented with over a decade of chronic right-sided testicular pain secondary to recurrent epididymitis. Before arriving at our clinic the patient had an epididymectomy performed with no appreciable improvement in pain. Initially ilioinguinal, iliohypogastric, and genetofemoral nerve blocks; right-sided S1, S2, and S3 transforaminal epidural steroid injections (TFESIs) with inferior hypogastric blocks; and right-sided T12-L1, L1-L2, and L2-L3 TFESIs all failed to provide pain relief. After conservative therapies had failed, a sacral nerve stimulation trial was done via a caudal epidural approach. The permanent implant has provided the patient with sustained 80% decrease in pain at 4 months status post permanent sacral nerve stimulation implant. The above case demonstrates the potential benefit of sacral nerve stimulation with neuropathic intractable testicular pain in a patient that failed conservative treatment. In this case, the patient had exhausted medical and surgical management, including advanced interventional pain options. We were unable to find any previous published cases of neurostimulation used as a modality of treatment for testicular pain, and further studies are needed to gain a better understanding of the efficacy in this setting.

PMID: 19935985 [PubMed – indexed for MEDLINE]

Caudal epidural injection for L4-5 versus L5-S1 disc prolapse: is there any difference in the outcome?

J Spinal Disord Tech. 2007 Feb;20(1):49-52

Authors: Mohamed MM, Ahmed M, Chaudary M

One hundred seventy-seven patients with radicular pain due to disc prolapse treated with caudal epidural injection were included in our study. All the injections were carried out between January 2000 and December 2004. Inclusion criteria include symptomatic disc prolapse diagnosed with magnetic resonance imaging scan, disc prolapse of 1 level only either L4-5 or L5-S1, leg pain for more than 4 wk and age more than 18. Exclusion criteria include multiple disc levels, spondylolithesis, spinal stenosis, cauda equina, and progressive neurologic deficits. Outcome Measures include Oswestry score and patient satisfaction and final outcome patient satisfaction either excellent (complete pain relief), good (minimal symptoms), moderate (some symptoms), no relief (symptoms unchanged), and worse (symptoms deteriorated). The final outcome is excellent (more than 6 mo pain relief), very good (3 to 6 mo pain relief), good (6 wk to 3 mo pain relief), fair (4 to 6 wk pain relief), brief (less than 4 wk pain relief), and no relief postal questionnaire sent and telephone interview done with the nonresponders. Ninety-six answered the postal questionnaire and this number increased to 136 after telephone interview. Forty-nine percent females and 51% males. Eighty-nine with L5-S1 disc prolapse and 47 with L4-5 disc prolapse. Caudal epidural not only relieve leg pain but also relieve back pain. There is no significant difference in the Oswestry disability index nor in the patient satisfaction nor the final outcome after caudal epidural injections for patients with disc prolapse L5-S1 and L4-5 ones. The number of patients who required surgery were much less than the literature figures 3.05%. There is no significant difference in the response after caudal epidural injection considering the sex only. The longest the back pain before injection is associated with the worst Oswestry disability index.

PMID: 17285052 [PubMed – indexed for MEDLINE]

Mini-surgical approach for spinal endoscopy in the presence of stenosis of the sacral hiatus.

Pain Physician. 2004 Jul;7(3):323-5

Authors: Helm S, Gross JD, Varley KG

Spinal endoscopy is a useful tool for the management of intractable low back or radicular pain originating from post lumbar laminectomy syndrome, epidural scarring, or disc protrusions, and non-responsive to conservative modalities and other interventional techniques including fluoroscopically directed epidural steroid injections and percutaneous adhesiolysis. Spinal endoscopy requires that the caudal canal be entered via the sacral hiatus. However, in a very small proportion of patients, access to the caudal canal is restricted because of stenosis or cartilaginous overgrowth of the hiatus. In such cases, the procedure is stopped because of the absence of an alternative approach to enter the epidural space with the spinal endoscope, resulting in non-availability of this treatment. This report describes a novel method of dealing with the problem of cartilaginous obstruction of the sacral hiatus, using a mini-surgical approach to decompress the hiatus, allowing access into the caudal canal.

PMID: 16858469 [PubMed]

Does the method of injection alter the outcome of epidural injections?

J Spinal Disord. 2001 Dec;14(6):507-10

Authors: McGregor AH, Anjarwalla NK, Stambach T

A pilot study involving 44 patients with low back and leg pain was performed to compare the relative efficacy of epidural caudal and lumbar injections.

PMID: 11723401 [PubMed – indexed for MEDLINE]

Comparable effectiveness of caudal vs. trans-foraminal epidural steroid injections.

Iowa Orthop J. 2009;29:91-6

Authors: Mendoza-Lattes S, Weiss A, Found E, Zimmerman B, Gao Y

Retrospective case-control study.

PMID: 19742093 [PubMed – indexed for MEDLINE]

Accuracy of caudal epidural injection: the importance of real-time imaging.

Pain Pract. 2005 Sep;5(3):251-4

Authors: Ergin A, Yanarates O, Sizlan A, Orhan ME, Kurt E, Guzeldemir ME

Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure. In this preliminary report, we demonstrate that fluoroscopic guidance for caudal epidural Tuohy needle placement without real-time imaging may result in inadvertent intravenous injection of the drug. We detected intravenous leakage of the drug in 4 cases of 10 when real-time fluoroscopic imaging was used. Thus, real-time imaging may be recommended in addition to routine fluoroscopic guidance for caudal epidural procedures, as it may improve efficacy and safety by assuring accurate drug deposition.

PMID: 17147588 [PubMed]

© 2017 - London Spine unit

For emergency cases        (+44) 0844 589 2020