Comparative Effectiveness of Transforaminal and Caudal Epidural Steroid Injections for Lumbosacral Radicular Pain Management

Abstract

Background: Lumbosacral radicular pain is a common and debilitating condition that significantly impacts patients' quality of life. Epidural steroid injections (ESIs) are widely used to alleviate symptoms, with transforaminal epidural steroid injection (TFESI) and caudal epidural steroid injection (CESI) being the two primary approaches. However, their comparative effectiveness remains a subject of debate.
Objective: This study aims to compare the effectiveness of TFESI and CESI in managing lumbosacral radicular pain in terms of pain relief, functional improvement, and adverse effects.
Methods: A prospective comparative study was conducted at the Department of Orthopedics, Government Medical College Baramulla, from January 2022 to December 2022. Patients diagnosed with lumbosacral radicular pain were randomly assigned to receive either TFESI or CESI. Methylprednisolone (40 mg) with 2 ml of 0.5% bupivacaine was administered under fluoroscopic guidance. Pain relief was assessed using the Visual Analog Scale (VAS), functional improvement was evaluated using the Oswestry Disability Index (ODI), and adverse effects were recorded at baseline, one month, and three months post-injection.
Results: The TFESI group demonstrated a greater reduction in VAS scores at one month (mean reduction 4.2 ± 1.1) and three months (mean reduction 3.8 ± 1.3) compared to the CESI group (3.6 ± 1.2 and 3.2 ± 1.4, respectively) (p < 0.05). Similarly, ODI scores showed greater improvement in the TFESI group (p < 0.05). Adverse effects were minimal in both groups, with no significant difference observed.
Conclusion: TFESI was more effective than CESI in providing pain relief and functional improvement in patients with lumbosacral radicular pain. However, CESI remains a viable alternative for patients requiring a less technically demanding and more broadly diffused steroid administration. Further studies with larger sample sizes and extended follow-up durations are recommended to validate these findings.