Identification of epidural space in the sacral spine by means of a thermolesion needle and an radiofrequency (RF) generator - a preliminary report

Abstract

Caudal epidural injections are one of the commonly used interventions in managing chronic low back pain. The caudal approach to epidural space was first reported by Sicard in 1901. Injection of steroids to treat low back pain was introduced in 1952. Corticosteroids delivered into epidural space demonstrate higher local concentrations over an inflamed nerve root and will be more effective than a steroid administered either orally or by intramuscular injection. The clinical effectiveness evaluations fill the literature with various types of reports including randomised clinical trials, prospective trials, retrospective studies, case reports, and meta-analyses. Evidence from all types of evaluations with regard to clinical outcomes and cost-effectiveness of caudal epidural injections is encouraging. Reports of the effectiveness of all types of epidural steroids vary from 18% to 90%. One of the reasons for this discrepancy is the difficulty in accurate identification of caudal epidural space and inaccurate needle placement when performed without imaging guidance in a substantial number of patients. Caudal epidural injection is a safe, effective technique when performed with due care. In many centres this procedure is performed under fluoroscopic or ultrasound guidance. In our study we used stimulation with a radiofreqency needle to identify caudal epidural space for low back pain treatment (30 patients).Caudal epidural injections are one of the commonly used interventions in managing chronic low back pain. The caudal approach to epidural space was first reported by Sicard in 1901. Injection of steroids to treat low back pain was introduced in 1952. Corticosteroids delivered into epidural space demonstrate higher local concentrations over an inflamed nerve root and will be more effective than a steroid administered either orally or by intramuscular injection. The clinical effectiveness evaluations fill the literature with various types of reports including randomised clinical trials, prospective trials, retrospective studies, case reports, and meta-analyses. Evidence from all types of evaluations with regard to clinical outcomes and cost-effectiveness of caudal epidural injections is encouraging. Reports of the effectiveness of all types of epidural steroids vary from 18% to 90%. One of the reasons for this discrepancy is the difficulty in accurate identification of caudal epidural space and inaccurate needle placement when performed without imaging guidance in a substantial number of patients. Caudal epidural injection is a safe, effective technique when performed with due care. In many centres this procedure is performed under fluoroscopic or ultrasound guidance. In our study we used stimulation with a radiofreqency needle to identify caudal epidural space for low back pain treatment (30 patients)