Disclosures: Naglaa A. Hussein, MD, PhD: No financial relationships or conflicts of interest

Objective : evaluate factors affecting outcome of ultrasound guided caudal epidural injection in sciatica patients

Design: prospective study

Setting : outpatient

Participants : 320 patients with chronic back pain with sciatica more than 3 month, exclusion; severe motor weakness, cauda equina syndrome , previous back surgery, infection at the site of injection

Interventions: Detailed history taking, body mass index( BMI), neurological & musckeloskeletal examination, MRI lumbosacral spine, Nerve conduction-electromyography. Followed by ultrasound guided caudal epidural injection.

Main Outcome Measures: BMI, back pain by visual analog scale(VAS) , Oswestry Disability Index ; both before and 3 weeks after injection. number of injection and duration between of injection recorded.

Results: : mean age 56.2 12.74, male(36.3%), female (63.7%). Mean BMI 34.38.01, obese 45.3%, history of diabetes 24.1%..side of sciatica ; Right 60.9%, left 29.4%, bilateral 9.7%. Objective sensory exam 65.3%, objective motor exam 21.9%.
MRI findings; L3-4 disc 20%, L4-5 disc 25.1%, L5-S1 23.4%, facet arthropathy 7.8%, spinal stenosis 16.3%. MRI with one disc 64.1%, two disc 27.7% , three or more 11.3%. EMG findings; Chronic radiculopathy ; L4 ; 10.3%, L5 ; 45.9%, S1 ; 48.4%, bilateral radiculopathy 17.2%, axonal polyneuropathy 4.7%. Mean VAS before injection 8.751.36 , after injection 4.22.34 (p 0.001). Mean Oswestry disability index before injection 77.48.9, after injection 40.112.2 (p 0.001).Degree of VAS improvement ;>75% ;20.3%, 50-75% ; 38.1%, 75% ; 26.6%, 50-75% ; 38.8%, < 50% ;22.5%, no change 12.2%. Number of injections : one (78.8%), two 14.4%, three 1.3%, four 5%, six 0.6%. Mean duration between injection ;2.82 2.01months. factors significantly affect VAS improvement; Age p=0.013, BMI p=0.022, diabetes p=0.003, objective sensory & motor exam p=0.046,0.04 respectively, presence of more than one disc p=0.0021, spinal stenosis p=0.003

Conclusions: Ultrasound guided epidural injection is a significantly effective in sciatica patients and is Significantly influenced by age, BMI, Diabetes, neurologic deficit, and multiple disc and spinal stenosis.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/prognostic-factors-affecting-ultrasound-guided-caudal-epidural-injection-in-sciatica-patients/