Effectiveness of Epidural Methylprednisolone Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes.

INTRODUCTION

Lumbar prolapsed intervertebral disc (PIVD) is a prevalent cause of radicular pain and functional impairment. Epidural steroid injections are an established non-surgical treatment option. This study compares the efficacy of caudal, transforaminal, and interlaminar routes for methylprednisolone delivery.

OBJECTIVES

To evaluate and compare the analgesic and functional outcomes of different ESI routes in managing lumbar PIVD.

MATERIALS AND

METHODS

In this prospective, randomized study, 75 patients aged 25-75 years with magnetic resonance imaging -confirmed single-level PIVD and refractory symptoms were allocated to one of three intervention groups: Caudal, transforaminal, or interlaminar ESI (n = 25 each). All patients received methylprednisolone acetate injections under fluoroscopic guidance. Pain and function were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline, 1, 2, and 4 weeks, and at 3 months post-intervention.

RESULTS

All groups showed significant reductions in VAS and ODI scores over time (P < 0.001). At 3 months, the transforaminal group had the greatest improvement (VAS: 0.72 ± 1.1;ODI: 2.92 ± 4.61), followed by caudal and interlaminar routes. Analysis of variance and post hoc analysis confirmed the superiority of the transforaminal approach (P < 0.001).

CONCLUSION

Transforaminal ESI with methylprednisolone provides superior pain relief and functional recovery compared to caudal and interlaminar routes. Route selection should consider anatomical precision and patient-specific factors.