309 patients treated with fluoroscopy-guided caudal epidural injection for lumbar disc herniation

OBJECTIVE: To present our experience, discuss the complications, and assess early vs long-term outcomes of fluoroscopy-guided caudal epidural injection for lumbar disc herniation (LDH). METHODS: This was a prospective study of 309 patients who underwent fluoroscopy-guided caudal epidural injection from 2014 to 2020. The inclusion criteria were LDH diagnosis by magnetic resonance imaging, surgical treatment not required, age >18 years, and history of low back or leg pain despite >6 weeks of treatment comprising a combination of analgesics, anti-inflammatories, and physical therapy. The epidural injection solution comprised 8 mL of 0.5% bupivacaine hydrochloride (HCL), 2 mL dexamethasone, and 10 mL saline. Each patient completed a questionnaire comprising a visual analog scale (VAS) and the Back Pain Functional Scale (BPFS) at baseline, and 1 month and 1 year after injection. RESULTS: The VAS and BPFS scores indicated significantly less pain at 1 month and 1 year compared with the pre-procedure baseline values. Complications developed in 11 patients (reversible paresis in 7 patients, arrhythmia in 1 patient, headache in 1 patient, seizure in 1 patient, spondylodiscitis in 1 patient). CONCLUSIONS: Fluoroscopy-guided caudal epidural injection for LDH is safe, and the procedure reduced pain and improved functional capacity compared with baseline.