Management of Lumbosacral Pain With Radiculopathy by Epidural Steroid Injection in Tertiary Care Hospital in Dar Es Salaam, Tanzania

Introduction:- The aim of this retrospective observational study was to compare the potential efcacy of epidural steroid injection along with other conservative measures for relieving pain and improving function in patients with lumbosacral pain with radiculopathy caused by lumbar disc herniation. The route of administration (transforaminal, caudal or translaminar) were chosen on basis of pattern of radiculopathy and mri ndings of disc herniation. Methods:- This study included 131 patients who presented with low back pain and radiculopathy due to lumbar disc herniation(at levels of L4–L5 or L5–S1) diagnosed clinically and conrmed by means of MRI. 4 patients were lost to follow up remainig 127 patients at nal follow up.(127 patients)All patients were given fair trial of conservative treatment with drugs and physiotherapy. All patients were assessed at presentation and after starting the treatment at the second week and then third and sixth month using the visual analogue scale (VAS) for pain and the Oswestry Disability Index (ODI) for function status. Results:- In the transforaminal group (45 patients), there was a statistically signicant improvement in the ODI scores from before the injection (ODI mean 62.4) to 2 weeks after the injection (ODI mean 24.4, P < 0.01), and upon follow-up at 3 months. (ODI mean 20.8, P < 0.01). 21 patients (16.5%) required 1 or 2 repeated injections, 4 (3.1%) patients underwent surgery. In the interlaminar group (19 patients), there was a statistically signicant improvement in the ODI scores from before the injection (ODI mean 60.7) to 2 weeks after the injection (ODI mean 30.1, P < 0.01), but not upon follow-up (ODI mean 43.2, P = 0.09).5 (26.3%) patients required 1 or 2 repeated injection, 2 (10.5%) patients underwent surgery and 4(21%) patients developed transient paraparesis.In caudal group(63 patients) there was statistically signicant improvement in ODI SCROES from before the injection (ODI mean 39.6) to 2 weeks after the injection (ODI mean 29.6) which deteriorate at 3 months( ODI mean 31.8).There was an insignicant difference (P > 0.05) between the transformainal and caudal groups in the VAS, except at the third month (P < 0.05). Epidural steroid injection could be a preferable choice in chronic lowback and radicular Conclusion:- pain due to LDH. It has shown good short term outcomes and can be safe, cost effective and minimally invasive treatment and alternative to surgery.