title: Analysis of efficacy differences between caudal and lumbar interlaminar epidural injections in chronic lumbar axial discogenic pain: local anesthetic alone vs. local combined with steroids.
abstract: METHODS
  Comparative assessment of randomized controlled trials of caudal and lumbar interlaminar epidural injections in chronic lumbar discogenic pain.
  
  
  OBJECTIVE
  To assess the comparative efficacy of caudal and lumbar interlaminar approaches of epidural injections in managing axial or discogenic low back pain.
  
  
  BACKGROUND
  Epidural injections are commonly performed utilizing either a caudal or lumbar interlaminar approach to treat chronic lumbar axial or discogenic pain, which is pain exclusive of that associated with a herniated intervertebral disc, or that is due to degeneration of the zygapophyseal joints, or due to dysfunction of the sacroiliac joints, respectively. The literature on the efficacy of epidural injections in managing chronic axial lumbar pain of presumed discogenic origin is limited.
  
  
  METHODS
  The present analysis is based on 2 randomized controlled trials of chronic axial low back pain not caused by disc herniation, radiculitis, or facet joint pain, utilizing either a caudal or lumbar interlaminar approach, with a total of 240 patients studied, and a 24-month follow-up. Patients were assigned to receive either local anesthetic only or local anesthetic with a steroid in each 60 patient group.
  
  
  RESULTS
  The primary outcome measure was significant improvement, defined as pain relief and functional status improvement of at least 50% from baseline, which was reported at 24-month follow-ups in 72% who received local anesthetic only with a lumbar interlaminar approach and 54% who received local anesthetic only with a caudal approach. In patients receiving local anesthetic with a steroid, the response rate was 67% for those who had a lumbar interlaminar approach and 68% for those who had a caudal approach at 12 months. The response was significantly better in the lumbar interlaminar group who received local anesthetic only, 77% versus 56% at 12 months and 72% versus 54% at 24 months.
  
  
  CONCLUSIONS
  This assessment shows that in patients with axial or discogenic pain in the lumbar spine after excluding facet joint and SI Joint pain, epidural injections of local anesthetic by the caudal or lumbar interlaminar approach may be effective in managing chronic low back pain with a potential superiority for a lumbar interlaminar approach over a caudal approach.
authors: 1. The Pain Management Center of Paducah, Paducah, KY, USA.
authors: Laxmaiah
authors: L
authors: Manchikanti
authors: 1. The Pain Management Center of Paducah, Paducah, KY, USA.
authors: Vidyasagar
authors: V
authors: Pampati
authors: 2. Millennium Pain Center, Bloomington, College of Medicine, University of Illinois, Urbana-Champaign, IL, USA.
authors: Ramsin M
authors: RM
authors: Benyamin
authors: 1. The Pain Management Center of Paducah, Paducah, KY, USA. ; 3. Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA.
authors: Mark V
authors: MV
authors: Boswell
mesh_terms: D000328:Adult; D000763:Anesthesia, Caudal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000188:drug therapy / Q000473:pathology; D017116:Low Back Pain / Q000188:drug therapy* / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D016032:Randomized Controlled Trials as Topic; D013256:Steroids / Q000008:administration & dosage
chemical_list: D000779:Anesthetics, Local; D013256:Steroids
keywords: Chronic low back pain; axial low back pain; caudal epidural injections; lumbar discogenic pain; lumbar interlaminar epidural injections.