Long-term outcomes of caudal epidural steroid injections in managing chronic low back pain and radiculopathy in patients with previous lumbar surgery

Persistent pain following lumbar spinal surgery can be a significant problem for both patients and their treating physicians. The caudal epidural approach is commonly utilized with patients who are on anticoagulation or who have had prior lumbar surgery to treat radicular pain originating from the lumbar 5 (L5) or sacral 1 (S1) levels. Objective: To evaluate and determine the efficacy of caudal epidural steroid injections (ESI) in managing pain in patients with previous lumbar surgery (PLS) and radiculopathy. Study group: Retrospective clinical outcome analysis. Methods: Retrospective review of patients undergoing caudal ESIs for radiculopathy from January 1, 2006 to August 30, 2013, a total of 288 injections were analyzed. Results: The percentage improvement and relief duration for the PLS patients was compared to a cohort group of non-surgical patients undergoing caudal ESIs. The percentage improvement for the two groups was compared using the two-sample t-test for injections number 1 to 3. There was no significant difference between the two groups. For analysis of relief duration, the distribution is skewed and the medians for the two groups were compared using the Mann-Whitney test. There was no significant difference of the medians between the two groups. Conclusions: Efficacy following a caudal ESI for treating radicular pain in patients with a previous history of back surgery is not significantly different from patients without a previous history of back surgery. Fluroscopically guided caudal epidural steroid injection is an effective short to intermediate treatment for radicular pain in post lumbar surgical patients with chronic radiculopathy.