Landmark Loss-of-Resistance Versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for Sciatica: A Prospective Comparative Study
DOI:
https://doi.org/10.56929/jseaortho-2026-0285Keywords:
caudal epidural steroid injection, fluoroscopy, loss-of-resistance, sciatica, lumbar disc herniationAbstract
Purpose: To compare clinical outcomes, procedure time, and adverse events between landmark loss-of-resistance (LOR) and fluoroscopy-guided (FL) caudal epidural steroid injection (CESI) for sciatica due to magnetic resonance imaging (MRI)-confirmed lumbar disc protrusion or extrusion.
Methods: In a prospective, randomized, 1:1-allocation trial, patients received LOR or FL CESI using an identical injectate. Pain (Visual Analog Scale [VAS]), disability (Oswestry Disability Index [ODI]), and patient satisfaction (Patient Satisfaction Score [PSS]) were assessed at baseline and at 1, 3, 6, and 12 months. Procedure time and adverse events were recorded. The primary between-group inference at 12 months used baseline-adjusted analysis of covariance (ANCOVA), reported as adjusted mean differences (AMD; LOR−FL) with 95% confidence intervals (CIs).
Results: Seventy patients were randomized equally (LOR n = 35; FL n = 35). Both groups showed improvement in VAS, ODI, and PSS over 12 months. At 12 months, adjusted between-group differences were small and not statistically significant: VAS 0.41 (95% CI -0.54 to 1.36), ODI 1.96 (95% CI -2.96 to 6.87), and PSS 0.37 (95% CI -0.45 to 1.20). Procedure time was significantly shorter with LOR (6.37 ± 1.99 vs 14.09 ± 2.20 minutes; p < 0.001). Adverse events were rare, with no dural puncture or bleeding in either group.
Conclusions: In this single-center randomized study, LOR and FL CESI showed comparable 12-month outcomes for pain, disability, and satisfaction. LOR required much less procedure time and may be a practical alternative when fluoroscopy is unavailable or resources are limited.
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