• Muhammad Saqib medical officer khyber teaching hospital orthopaedic department
  • Sajid Nazir Bhatti
  • Muhammad Ayaz Khan
  • Muhammad Mukhtar Khan
  • Ehtisham Ahmed Khan Afridi
  • Rubaiqa Khan
  • Muhammad Imran Khan


Background: Backache is a significant source of disability and suffering in our society. The treatment modalities need continued enhancement in order to achieve the desired goals of lowering morbidity and financial losses while improving the response of the patient. Methods: This prospective comparative study was conducted at the department of Orthopaedics and Spine Surgery, Khyber Teaching Hospital Peshawar from July 2013 to June 2015. Two interventional groups were designated; Group 1 was comprised of 54 patients who were injected with epidural bupivacaine plus methylprednisolone while Group 2 included 55 patients who were injected with bupivacaine only. Outcome was assessed using the visual analogue scale and Oswestry disability index (ODI). Results: Fifty-five female and 54 male patients with mean age 49.37 years±10.46 SD, Mean symptoms duration was 15.01 months±9.32 SD. Common presenting symptoms were backache (77.1%), lower limbs pain (66.1%), dermatomal paresthesias (54.1%) and neurogenic claudication in 57.8% patients. The mean visual analogue score (VAS) after injection was 3.18±1.29 while mean ODI after injection was 23.615. There was a statistically significant reduction in VAS scores (2-sided p=0.003, OR =4.03, 95% CI: 1.535–10.60) following the injection. Conclusion: An epidural spinal injection is a viable option for achieving relief of pain & improves functioning in individuals with radicular backache. However, further research is advised in order to clarify the role of ESI for long-term relief.Keywords: Backache, Outcome; Epidural steroid injection; Local anaesthetic

Author Biography

Muhammad Saqib, medical officer khyber teaching hospital orthopaedic department

Department of Orthopaedic and Spine SurgeryKhyber Teaching Hospital Peshawar


Simeone FA. Lumbar disk disease. In: Wilkins RH, Rengachary SS, editors. Neurosurgery. 2nd ed. New York: McGraw-Hill, 1996:3805–16.

Doo AR, Kim JW, Lee JH, Han YJ, Son JS. A Comparison of Two Techniques for Ultrasound-guided Caudal Injection: The Influence of the Depth of the Inserted Needle on Caudal Block. Korean J Pain 2015;28(2):122–8.

Mostofi K. Total disc arthroplasty for treating lumbar degenerative disc disease. Asian Spine J 2015;9(1):59–64.

Steinberger J, Skovrlj B, Caridi JM, Cho SK. The top 100 classic papers in lumbar spine surgery. Spine (Phila Pa 1976) 2015;40(10):740–7.

Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician 2007;10(1):185–212.

Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol 2015;36(4):811–6.

Leonardi M, Pfirrmann CW. Spinal Injetions. In: Boos N, Aebi M, editors. Spinal Disorders: Fundamentals of Diagnosis and Treatment. New York: Springer-Verlag Berlin Heidelberg; 2008. p. 261–90.

Cansever T, Kabatas S, Civelek E, Kircelli A, Yilmaz C, Musluman M, et al. Transforaminal epidural steroid injection via a preganglionic approach for the treatment of lumbar radicular pain. Turk Neurosurg 2012;22(2):183–8.

Choi HJ, Hahn S, Kim CH, Jang BH, Park S, Lee SM, et al. Epidural steroid injection therapy for low back pain: a meta-analysis. Int J Technol Assess Health Care 2013;29(3):244–53.

Fanciullo GJ, Hanscom B, Seville J, Ball PA, Rose RJ. An observational study of the frequency and pattern of use of epidural steroid injection in 25,479 patients with spinal and radicular pain. Reg Anesth Pain Med 2001;26(1):5–11.

Leem JG. Epidural steroid injection: a need for a new clinical practice guideline. Korean J Pain 2014;27(3):197–9.

Ghai B, Kumar K, Bansal D, Dhatt SS, Kanukula R, Batra YK. Effectiveness of Parasagittal Interlaminar Epidural Local Anesthetic with or without Steroid in Chronic Lumbosacral Pain: A Randomized, Double-Blind Clinical Trial. Pain Physician 2015;18(3):237–48.

Cote P, Cassidy JD, Carroll L. The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976). 1998;23(15):1689–98.

Pai S, Sundaram LJ. Low back pain: an economic assessment in the United States. Orthop Clin North Am 2004;35(1):1–5.

Gaskin Dj. The Economic Costs of Pain in the United States. In: Institute of Medicine (U.S.), editor. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, D.C: National Academies Press; 2011.

Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, et al. Expenditures and health status among adults with back and neck problems. JAMA 2008;299(6):656–64.

Karamouzian S, Ebrahimi-Nejad A, Shahsavarani S, Keikhosravi E, Shahba M, Ebrahimi F. Comparison of two methods of epidural steroid injection in the treatment of recurrent lumbar disc herniation. Asian Spine J 2014;8(5):646–52.

Manchikanti L, Nampiaparampil DE, Manchikanti KN, Falco FJ, Singh V, Benyamin RM, et al. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials. Surg Neurol Int 2015;6(Suppl 4):S194–235.

Miller T, Burns J, Gilligan J, Baffour F, Brook A. Patients with refractory back pain treated in the emergency department: is immediate interlaminar epidural steroid injection superior to hospital admission and standard medical pain management? Pain Physician 2015;18(2):E171–6.

Epstein NE. The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature. Surg Neurol Int. 2013;4(Suppl 2):S74–93.



Most read articles by the same author(s)

1 2 3 > >>