This study was a prospective, randomized, single-blind controlled trial, which aimed to detect the safety and clinical efficacy of cauda epidural steroid injection with targeted indwelling catheter combined with four-step manipulative therapy (stretch, oblique pull, pull hip flexion knees, shaking the waist) in patients with lumbar disk herniation with radiculopathy. Patient visits were performed at baseline and on days one, three, seven and twenty-eight after treatment. Clinical outcomes were measured using the visual analog scale for back and leg pain (VAS), which measured pain intensity, and Oswestry Disability Index (ODI) and clinical symptom scores of the Japanese Orthopedic Association (JAO), which measured functional disability. The study included 85 participants which were randomly categorized into the catheter group and the no-catheter group. All procedures were performed under the guidance of C-arm fluoroscopy in the operating room and a combination of 10 mg triamcinolone acetate, 40 ml of normal saline, and 5 ml of lidocaine were injected.
The study concluded that the caudal approach can effectively relieve pain in patients with lumbar disk herniation with lumbosacral radicular pain, compared with the traditional approach. Catheter group showed a more significant decrease in VAS (back and leg) at days 1 and 3 of follow-up and greater JOA and ODI scores at day 1 of follow-up, compared with the no-catheter group. There was no significant difference in pain intensity and functional disability at days 7 and 28 of follow-up.
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