Efficacy of caudal epidural steroid injection for lumbar disc-related sciatica: Influence of symptom duration in a prospective study

Abstract

Objective: To evaluate the effectiveness of caudal epidural steroid injections (ESI) for sciatica from lumbar disc prolapse and determine if symptom duration affects outcomes.

Methods: 98 patients with MRI-confirmed lumbar disc prolapse and sciatica were recruited. They were divided by symptom duration: Group A (acute/subacute, <4 months, n=50) and Group B (chronic, >4 months, n=48). Each received one caudal injection of 80 mg triamcinolone acetonide with normal saline. Pain was measured using the Visual Analogue Scale (VAS) at baseline, one, three, and six months post-injection. Data were analysed using repeated measures ANOVA and independent t-tests, with significance set at p<0.05.

Results: Both groups showed significant VAS reduction at one month (Group A: 7.56±1.31 to 3.86±1.82, p=0.001; Group B: 7.52±1.41 to 4.52±2.19, p=0.001). At three months, only Group A maintained significant improvement (4.87±1.64, p<0.001 vs. baseline), while Group B’s pain returned toward baseline (5.54±1.47, p=0.08). At six months, neither group showed significant improvement from baseline. However, 24% of Group A reported ≥30% pain reduction at six months versus 6% in Group B (p=0.01).

Conclusions: Caudal ESI effectively provides short- and medium-term pain relief for sciatica from lumbar disc prolapse. Treatment within the first four months yields better and more durable outcomes. Symptom duration is a key predictor of treatment response.