Ann Rehabil Med.  2014 Dec;38(6):791-798. 10.5535/arm.2014.38.6.791.

Use of Magnetic Resonance Imaging to Identify Outcome Predictors of Caudal Epidural Steroid Injections for Lower Lumbar Radicular Pain Caused by a Herniated Disc

• Cha SO
• Jang CH
• Hong JO
• Park JS
• Park JH

• KMID: 2267089
• DOI: http://doi.org/10.5535/arm.2014.38.6.791

Abstract

OBJECTIVE
We used lumbar magnetic resonance image (MRI) findings to determine possible outcome predictors of a caudal epidural steroid injection (CESI) for radicular pain caused by a herniated lumbar disc (HLD).
METHODS
Ninety-one patients with radicular pain whose MRI indicated a HLD were enrolled between September 2010 and July 2013. The CESIs were performed using ultrasound (US). A responder was defined as having complete relief or at least a 50% reduction of pain as assessed by the visual analog scale (VAS) and functional status on the Roland Morris Disability Questionnaire (RMDQ); responder (VAS n=61, RMDQ n=51), and non-responder (VAS n=30, RMDQ n=40). MRI findings were analyzed and compared between the two groups with regard to HLD level, HLD type (protrusion or exclusion), HLD zone (central, subarticular, foraminal, and extraforaminal), HLD volume (mild, moderate, or severe), relationship between HLD and nerve root (no contact, contact, displaced, or compressed), disc height loss (none, less than half, or more than half ), and disc degeneration grade (homogeneous disc structure or inhomogeneous disc structure-clear nucleus and height of intervertebral disc).
RESULTS
A centrally located herniated disc was more common in the responder group than that in the non-responder group. Treatment of centrally located herniated discs showed satisfactory results. (VAS p=0.025, RMDQ p=0.040). Other factors, such as HLD level, HLD type, HLD volume, relationship to nerve root, disc height loss, and disc degeneration grade, were not critical.
CONCLUSION
The HLD zone was significant for pain reduction after CESI. A centrally located herniated disc was a predictor of a good clinical outcome.

Keyword

Radicular pain; Epidural injections; Caudal; Ultrasound; Magnetic resonance image

MeSH Terms

Humans
Injections, Epidural
Intervertebral Disc Degeneration
Intervertebral Disc Displacement*
Magnetic Resonance Imaging*
Ultrasonography
Visual Analog Scale
Surveys and Questionnaires

Figure

• 

  Fig. 1 A 51-year-old woman in the responder group after a caudal epidural injection. Central disc herniation was noted at the L5/S1 level on magnetic resonance imaging, with right L5 nerve root contact (white arrow). Rt., right side; Lt., left side.

• 

  Fig. 2 A 49-year-old woman in the non-responder group after a caudal epidural injection. Left foraminal disc herniation was noted at the L5/S1 level on magnetic resonance imaging, with left L5 nerve root compression (white arrow). Rt., right side; Lt., left side.

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