Ultrasound-guided selective nerve root blocks and caudal epidural injection in the management of lumbar radicular syndrome: a case series with one-year follow-up.

INTRODUCTION: Lumbar radicular syndrome (LRS), a prevalent spinal disorder, is frequently characterized by radiating pain in the lower limbs, which significantly impairs daily functioning. Ultrasound-guided selective nerve root blocks (SNRB) and caudal epidural steroid injections (CESI) have demonstrated clinical value in alleviating the inflammatory aspects of LRS. To achieve better clinical therapeutic effects, the combination of the two blocking methods were applied to such patients as the combined approach.

METHODS: This study sought to evaluate the clinical efficacy of ultrasound-guided combined SNRB and CESI in patients with LRS and refractory sciatica who did not respond to conservative therapy, such as oral analgesics and traditional Chinese medicine. The therapeutic effect of the combined approach was assessed using the numerical rating scale (NRS) and the Oswestry Disability Index (ODI) scores during telephone follow-ups at 1, 3, 6, and 12 months.

RESULTS: We present a case series involving six individuals diagnosed with LRS and severe sciatic pain. All patients underwent combined ultrasound-guided selective nerve root and caudal epidural blocks while positioned prone. Notably, none of the cases experienced any complications associated with the combined approach. Subsequent follow-up assessments revealed a significant improvement in the numeric rating scale (NRS) and the Oswestry Disability Index (ODI) scores for LRS and refractory sciatica in all patients.

CONCLUSION: The combined approach may potentially relieve the radiating pain in patients with debilitating sciatica, and then enhance the recovery for patients with lumbar radicular syndrome.