COMPARATIVE EFFICACY OF ULTRASOUND (US) VERSUS (FL) FLUOROSCOPY-GUIDED CAUDAL EPIDURAL STEROID INJECTION (CESI) FOR THE MANAGEMENT OF CHRONIC LOWER RADICULAR BACK PAIN (LBP); A TRANSITION FROM CHRISTMAS TREE TO FROG’S EYES

Background: Chronic lower back pain (LBP) with associated radiculopathy presents a significant healthcare burden, often resulting in physical disability and reduced quality of life. Caudal epidural steroid injection (CESI) is a commonly employed interventional approach for symptom relief in these patients. While fluoroscopic (FL) guidance has been the gold standard for CESI, ultrasound (US) guidance is gaining traction as a radiation-free, cost-effective alternative. This study compared both techniques to assess their procedural efficiency and clinical outcomes. Objective: To evaluate and compare the efficacy, procedural time, and clinical outcomes of ultrasound-guided versus fluoroscopy-guided CESI in patients with chronic LBP and bilateral radiculopathy. Methods: A randomized trial was conducted involving 110 patients aged 30–60 years with chronic LBP and radicular symptoms unresponsive to conservative treatment. Patients were randomly assigned to two equal groups: Group US (n = 55) received CESI under ultrasound guidance, and Group FL (n = 55) under fluoroscopic guidance. All patients were administered 40 mg of depot methylprednisolone diluted in 3 ml bupivacaine and 10 ml normal saline. Pain intensity and functional disability were assessed using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at baseline, 2 weeks, 1 month, and 2 months post-procedure. Procedural time and adverse events were recorded. Results: Needle placement was significantly faster in the ultrasound group (119 ± 7.66 seconds) compared to the fluoroscopy group (222.28 ± 29.65 seconds; p < 0.001). Both groups demonstrated significant intragroup improvements in VAS and ODI scores over the follow-up period with no significant differences between them at any timepoint (p > 0.05). No major adverse events were reported. Conclusion: Ultrasound guidance offers a faster and radiation-free alternative to fluoroscopy for CESI without compromising clinical outcomes. Both modalities are effective in managing chronic LBP, but ultrasound significantly reduces procedural time, supporting its broader application in pain clinics.