Epidural Steroid Injection for Low Back Pain and Lumbosacral Radiculopathy; Experience from a Neurosurgery Center in a Developing Country
Low back pain (LBP), with or without radiculopathy, is a leading cause of disability worldwide, and one of the commonest reasons for visit to neurosurgery clinic. LBP has a lifetime prevalence ranging between 40% and 70%. Degenerative changes in the spine involving disc herniation, and facet joint arthropathy, spondylolisthesis or spinal canal stenosis by bone or surrounding soft tissue have been attributed to be the foremost cause of these symptoms. Diagnosing the cause and treating LBP and lumbar radiculopathy can be a difficult task particularly in young patients. Various treatment modalities including conservative approaches with analgesics and physiotherapy, interventions such as epidural steroid injections (ESI) and surgical treatment options have been used for this condition. ESI are the only treatment option for patients who do not respond to conservative measures or develop side effects of prolonged oral antiinflammatory drugs, and are not fit for surgery, or those with mild to moderate stenosis. Sixty three patients were included in the study. Median age was 55 years and number of female patients was slightly higher than males (n=37; 58.7%). Around one-third of the patients were morbidly obese (n=23; 36.5%). All patients had complain of low back pain, while 49 patients (77.8%) complained of radicular symptoms as well. Radicular pain was most common in L5 dermatome (n=42; 85.7%), so L4-L5 inter-laminar epidural space was most commonly negotiated for injection.