Effectiveness of Epidural Methylprednisolone Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes

Introduction: Lumbar prolapsed intervertebral disc (PIVD) is a prevalent cause of radicular pain and functional impairment. Epidural steroid injections are an established non-surgical treatment option. This study compares the efficacy of caudal, transforaminal, and interlaminar routes for methylprednisolone delivery. Objectives: To evaluate and compare the analgesic and functional outcomes of different ESI routes in managing lumbar PIVD. Materials and Methods: In this prospective, randomized study, 75 patients aged 25–75 years with magnetic resonance imaging -confirmed single-level PIVD and refractory symptoms were allocated to one of three intervention groups: Caudal, transforaminal, or interlaminar ESI (n = 25 each). All patients received methylprednisolone acetate injections under fluoroscopic guidance. Pain and function were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline, 1, 2, and 4 weeks, and at 3 months post-intervention. Results: All groups showed significant reductions in VAS and ODI scores over time (P < 0.001). At 3 months, the transforaminal group had the greatest improvement (VAS: 0.72 ± 1.1; ODI: 2.92 ± 4.61), followed by caudal and interlaminar routes. Analysis of variance and post hoc analysis confirmed the superiority of the transforaminal approach (P < 0.001). Conclusion: Transforaminal ESI with methylprednisolone provides superior pain relief and functional recovery compared to caudal and interlaminar routes. Route selection should consider anatomical precision and patient-specific factors.