# A Comparative Study of Transforaminal Epidural Steroid Injection (TFESI) Versus Caudal Epidural Steroid Injections (CESI) in the Management of Lumbar Radiculopathy

## TL;DR

This study compares two types of epidural steroid injections for lower back pain, finding that one offers faster short-term relief while the other provides better long-term results.

## Contribution

The study provides a 6-month comparative analysis of transforaminal and caudal ESIs for lumbar radiculopathy, revealing distinct short- and long-term efficacy patterns.

## Key findings

- Transforaminal injections provided better short-term pain and disability reduction at 1 month.
- Caudal injections showed superior long-term outcomes at 6 months across all measured parameters.
- Caudal ESIs were technically simpler and safer, making them favorable for long-term management.

## Abstract

Background

Lumbar radiculopathy is a common orthopedic condition often managed non-surgically with epidural steroid injections (ESIs). Among the three commonly used approaches - caudal, interlaminar, and transforaminal - the ideal route for maximum efficacy remains under debate. This study compares the effectiveness of caudal versus transforaminal ESI in terms of pain relief, functional improvement, and disability reduction over a 6-month follow-up period.

Methodology

A retrospective cross-sectional study was conducted at R.L. Jalappa Hospital and Research Center and Sri Devraj Urs Medical College, Karnataka, India, from June 2021 to June 2024. Sixty patients with confirmed lumbar radiculopathy and radiological evidence of disc prolapse were divided into two groups: transforaminal (n=30) and caudal (n=30). All participants had failed six weeks of conservative management prior to intervention. Outcomes were assessed at baseline and 1, 3, and 6 months post-intervention using the Visual Analog Scale (VAS), Modified Oswestry Disability Index (MODI), Clinical Outcome Rating Index (CORI), and Modified Roland-Morris (MRM) scores. Statistical analysis included independent t-tests, repeated measures ANOVA, and descriptive statistics with significance set at p < 0.05.

Results

The mean age of participants was 43.5 ± 8.33 years in the transforaminal (TF) group and 40.2 ± 8.96 years in the caudal group (p = 0.143). The sex distribution exhibited slight variation, with a predominance of males in the TF group (n = 17, 56.7%) compared to a predominance of females in the caudal group (n = 16, 53.3%); however, this difference was not statistically significant (p = 0.432). Both groups demonstrated significant improvements in all outcome measures over time (p < 0.001). The transforaminal group (n = 30) exhibited superior short-term outcomes for 1 month, with lower VAS scores (3.87 vs 5.13) and MODI scores (35.47% (n = 30) vs 43.4% (n = 30)). At 3 months, the caudal group began showing better improvement. By 6 months, the caudal group demonstrated significantly better outcomes across all parameters: lower VAS scores (1.47 vs 2.13, p < 0.001), reduced MODI scores (11.5% (n = 30) vs 18.13% (n = 30), p < 0.001), improved CORI scores (1.23 vs 3.88), and higher MRM percentages (86.6% (n = 30) vs 67.95% (n = 30), p < 0.001). Repeated measures ANOVA confirmed significant time × group interactions for VAS (F = 49.2, p < 0.001), MODI (F = 59.2, p < 0.001), CORI (F = 2.7, p < 0.001), and MRM scores (F = 173.8, p < 0.001), indicating different recovery trajectories between the two groups. These findings suggest that while transforaminal injections provide more immediate relief, caudal injections offer superior long-term efficacy for managing lumbar radiculopathy.

Conclusions

While transforaminal ESIs offer faster short-term relief, caudal ESIs demonstrated superior long-term outcomes in terms of both pain reduction and functional recovery. Caudal ESIs, being technically simpler and safer, may be a favorable alternative for long-term management in lumbar radiculopathy.