Evaluation of Fluoroscopic Caudal Epidural Steroid Injections

In contrast to this statement by Southern et al (1), Manchikanti et al (2-4) evaluated the role of caudal epidural injections in chronic low back pain in two prospective and one retrospective evaluation. Particularly in one study (3), they evaluated the role of caudal epidural injections in discogram positive and negative chronic low back pain, utilizing the International Association for the Study of Pain (IASP) criteria (5). Both the studies were performed in patients without radicular pain. Thus, they would be considered as chronic low back pain. It is quite possible that these patients may have had somatic lower extremity pain, however, not radicular pain. Further, all the patients were excluded for low back pain of facet joint origin with controlled comparative local anesthetic blocks prior to including them in the study for effectiveness of caudal epidural injections. This study showed that patients equally responded with fluoroscopically directed caudal epidural steroid injections in patients with or without positive concordant discogenic pain. Manchikanti et al (4) also retrospectively evaluated fluoroscopically directed caudal epidural injections and compared them with interlaminar and transforaminal epidural injections, the results of which have been quoted by Southern et al (1).