Caudal Epidural Steroid Injection in adults with Chronic Lower Backache: Comparison of Landmark-Guided Technique and Ultrasonography-Guided Technique.

INTRODUCTION

Caudal epidural steroid injection (CESI) is a commonly performed interventional procedure for the management of chronic lower backache. The conventional landmark-guided (LG) technique is widely practiced, particularly in resource-limited settings, while ultrasound guidance is increasingly used to improve procedural accuracy and safety.

OBJECTIVES

The objective of the study was to compare the clinical efficacy, safety, and need for repeat intervention between LG and ultrasound-guided (USG) CESI in adults with chronic low backache.

MATERIALS AND

METHODS

A prospective randomized controlled study was conducted on 200 patients with chronic low backache, equally divided into two groups: Group L (LG CESI) and Group U (USG CESI). Pain intensity, functional disability, and straight leg raise test (SLRT) were assessed at baseline, 1 week, 1 month, and 2 months after injection using the visual analog scale (VAS), Oswestry disability index (ODI), and SLRT. The requirement for repeat injections and procedure-related complications was also recorded.

RESULTS

Both groups demonstrated significant improvement in VAS and ODI scores following CESI. The USG group showed better improvement in right-sided SLRT at 1 week (P = 0.003) and required fewer repeat injections compared to the LG group (8% vs. 11%, P = 0.029). No complications were observed in either group.

CONCLUSION

Both LG and USG CESI are safe and effective techniques for the management of chronic low backache. Ultrasound guidance provides early functional benefits and reduces the need for repeat injections, while the LG technique remains a practical alternative in resource-constrained settings.