title: Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial.
abstract: OBJECTIVE
  Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP). Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultrasound guidance for caudal epidural steroid injection with respect to the time needed for correct placement of the needle and clinical effectiveness in patients with chronic LBP.
  
  
  METHODS
  Fifty patients with chronic LBP with radiculopathy, not responding to conventional medical management, were randomly allocated to receive injection depot methyl prednisolone (40 mg) through caudal route either using ultrasound guidance (Group U, n = 25) or fluoroscopy guidance (Group F, n = 25). Pre-procedural visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were noted. During the procedure, the time needed for correct placement of needle was observed. Adverse events, if any, were also noted. All patients were followed up for next 2 months to evaluate Visual Analogue Scale (VAS) score and ODI at the 2(nd) week and again at the end of 1(st) and 2(nd) month.
  
  
  RESULTS
  The needle-placement time was less using ultrasound guidance as compared to fluoroscopy guidance (119 ± 7.66 vs. 222.28 ± 29.65 s, respectively, P < 0.001). Significant reduction in VAS score and ODI (clinical improvement) was noted in the follow-up time points and comparable between the groups at all time points.
  
  
  CONCLUSIONS
  Ultrasound guidance can be a safe alternative tool for achieving faster needle placement in caudal epidural space. Clinical effectiveness (reduction of VAS and ODI scores) remains comparable between both the techniques.
authors.affiliation: Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, India.
authors.forename: Arindam Kumar
authors.initials: AK
authors.lastname: Hazra
authors.affiliation: Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, India.
authors.forename: Dipasri
authors.initials: D
authors.lastname: Bhattacharya
authors.affiliation: Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, India.
authors.forename: Sayantan
authors.initials: S
authors.lastname: Mukherjee
authors.affiliation: Department of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India.
authors.forename: Santanu
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Department of Anaesthesiology, MGM Medical College, Kishanganj, Bihar, India.
authors.forename: Manasij
authors.initials: M
authors.lastname: Mitra
authors.affiliation: Department of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India.
authors.forename: Mohanchandra
authors.initials: M
authors.lastname: Mandal
keywords: Disability evaluation; epidural steroids; fluoroscopy; low back pain; radiculopathy; ultrasonography