Combined Transforaminal and Caudal Epidural Injection for Lumbar Radicular Pain: A Retrospective Comparative Study

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Baymurat A. C., Gök H.

Kazakh Journal of Clinical Neuroscience, cilt.79, ss.1-10, 2026 (Hakemli Dergi)

Özet

Epidural and periradicular injections are commonly used in the nonoperative management of lumbar radicular pain. However, the clinical durability of a combined transforaminal nerve root injection and caudal epidural injection strategy may vary according to the underlying pathology. This study evaluated the outcomes of this combined approach in patients with isolated lumbar disc herniation and in patients with degenerative disc disease accompanied by additional degenerative spinal pathologies. Methods. This retrospective comparative study included 48 patients with lumbar radicular pain who underwent combined transforaminal nerve root injection and caudal epidural injection under sedation. Patients were divided into a disc herniation group (H group, n=21) and a degenerative group (D group, n=27). Pain and disability were assessed using the visual analog scale (VAS) and Oswestry Disability Index (ODI) at baseline, postoperative day 1, week 1, month 1, month 3, month 6, and month 12. Results. Both groups showed significant early improvement in VAS and ODI scores after the procedure. Baseline VAS and ODI scores were comparable between groups, whereas the D group was significantly older. In the H group, the early clinical improvement was largely maintained through 12 months. In contrast, the D group demonstrated attenuation of treatment effect, particularly after month 6, with significantly worse ODI and VAS scores than the H group at later follow-up. Nevertheless, both groups remained significantly improved compared with baseline throughout follow-up. Conclusions. Combined transforaminal nerve root and caudal epidural injection appears to provide meaningful early pain relief and functional improvement in lumbar radicular pain. The benefit seems more durable in younger patients with isolated disc herniation, whereas in older patients with greater degenerative burden, the effect may diminish over time but still remain clinically meaningful. This approach may represent a valuable nonoperative option in selected patients without a definite surgical indication.