Nedra El Fani, N/A, MD
Assistant Doctor
IBN AL Jazzar University Hospital Kairouan
sousse, Sousse, Tunisia
dhouha khalifa, n/a
assistant
rhumatology departement, farhat hached university hospital
sousse, Sousse, Tunisia
soumaya el arem, n/a
assistant
PRM departement , taher sfar university hospital
MAHDIA, Al Mahdia, Tunisia
mariam gadour, dr
assistant
university hospital of sahloul PRM department
sousse, Sousse, Tunisia
rihab moncer, n/a
professor
PRM department sahloul university hospital
sousse, Sousse, Tunisia
sahbi mtaoua, dr
professor
university hospital of kairouan PRM department
sousse, Sousse, Tunisia
to study the short-term and mid-term efficacy of caudal epidural steroid injections in patients suffering from sciatica and to determinate the factors of its efficacy.
Design:
A retroscpective, descriptive and monocentric study . Medical records of patients who suffered from sciatica due to disc herniation or spinal stenosis were analysed. Only patients who benefited from at least one caudal epidural steroid injection were included. Other etiologies were ruled out by CT-scan or MRI and laboratory tests. Efficacy of the injection was evaluated by the visual analog scale of pain (VAS) at the first week post infiltration, 3 months and 6 months later. The presence of anxiety and depression was also tracked down with the hospital anxiety and depression scale.
Results:
Twenty-five patients were included The mean age was 51.88± 15.28 .Median duration was 30 months. Sciatica was bilateral in 41.7%. The median VAS score at baseline was 7 out of 10 (min=4; max=9). The median number of epidural caudal injections was 3 injections. The caudal epidural steroid injections were effective in 60% of the patients at the first week, 56% in the cases at 3 months and 56% of the cases at 6 months. Factors associated with efficacy of the injection at the first week were greater total volume injected (p=0.001), and greater saline solution volumes (p=0.016). At 3 months, factors significantly associated with efficacy were having unilateral pain (p=0.05), a positive straight leg (p=0.028), a lower anxiety and depression score (0.014), (0.000). At 6 months, factors associated were unilateral pain (p=0.05), low anxiety (p=0.014) and low depression (p=0.001) scores and a higher number of steroid injections (p=0.05).
Conclusions:
Caudal epidural steroid injections seem effective on the short-term and this efficacy is maintained till the mid-term. Greater volumes may help with pain by possible adhesiolyse-like mechanisms makes the infiltration more effective.
