Quality of Life and Functional Outcomes after Caudal Epidural Steroid Injection Versus Selective Nerve Root Block in Chronic Low Back Pain: A Single-Center Retrospective Cohort Study

Quality of Life and Functional Outcomes after Caudal Epidural Steroid Injection Versus Selective Nerve Root Block in Chronic Low Back Pain: A Single-Center Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Quality of Life and Functional Outcomes after Caudal Epidural Steroid Injection Versus Selective Nerve Root Block in Chronic Low Back Pain: A Single-Center Retrospective Cohort Study Muhammad Iqbal, Sutan Agung L. Tobing, Andreas M. H. Siagian, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7213922/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To compare the quality of life and functional outcomes of Caudal Epidural Steroid Injection (CESI) versus Selective Nerve Root Block (SNRB) in chronic low back pain patients, including those who refuse or not eligible for spine surgery. Methods A retrospective cohort study was conducted in Ulin General Hospital for patients who suffered from chronic low back pain and underwent CESI and/or SNRB between January 2020 to December 2024. 90 patients were included in this study. The patient’s pain intensity using VAS, and health-related quality of life after intervention using the SF-36 questionnaire were analyzed. Results 33 male and 57 female patients with mean age 51.38 years ± 11.27 SD were included in this study. The patients were classified into 3 groups: 42 patients (46.67%) received CESI, 6 patients (6,67%) received SNRB only, and 42 patients (46.67%) received both CESI and SNRB. The mean VAS before & after intervention was 8.26 ± 1.4 SD and 3.50 ± 1.64 SD. There was a statistically significant difference in VAS scores before and after intervention (p-value < 0.001). However, there was no significant difference among each group of intervention (p = 0.169). For quality of life and functional outcome, there was significant difference in physical functioning (p = 0.01), energy/fatigue (p < 0.001), emotional well-being (p = 0.001) and pain (p = 0.002) between each group. Conclusion There was significant reduction in pain intensity across all groups, but the specific intervention types (CESI, SNRB, or both) did not significantly differ. Differences in quality-of-life measurement, particularly in physical functioning, energy/fatigue, emotional well-being and pain were noted between each group. Therefore, CESI and SNRB remain valuable treatment modalities for LBP patients who refuse or not eligible for spine surgery. Caudal Epidural Steroid Injection Selective Nerve Root Block Chronic Low Back Pain Introduction Chronic low back pain (cLBP) is a prevalent condition that significantly impacting quality of life and functional capacity worldwide. About 84% of the adult population complains of LBP at some time. Although 80–90% of LBP has a benign course and can be recovered within six weeks regardless of the treatment modality, 5–15% develop chronicity. 1 It is estimated that up to 30% of individuals with chronic low back pain continue to experience pronounced symptoms beyond one year, despite the tendency for spontaneous resolution in many cases. 2 The socioeconomic burden of cLBP is substantial, with direct healthcare costs and indirect costs from lost productivity posing major challenges to health systems globally. Among the interventional approaches for managing cLBP, caudal epidural steroid injections (CESIs) and selective nerve root blocks (SNRBs) are two commonly utilized procedures. 3 CESIs involve the administration of corticosteroids into the epidural space via the caudal canal, aiming to reduce inflammation and alleviate pain. Recent systematic reviews and clinical studies have demonstrated that CESIs can provide significant pain relief and functional improvement, with up to 50% of patients achieving meaningful reduction in pain intensity and improved disability scores. Short-term benefits in pain and function have been consistently reported, although long-term efficacy remains a subject of ongoing investigation. 4 , 5 SNRBs, on the other hand, are targeted injections delivered adjacent to the affected nerve root, often under imaging guidance. This technique is particularly useful for both diagnostic and therapeutic purposes in patients with radicular symptoms. Evidence suggests that SNRBs can offer substantial short-term pain relief and may predict postoperative outcomes in certain patient populations. 6 However, the technical demands of SNRBs are higher, requiring skilled practitioners to ensure safety and efficacy. 2 Comparative studies have sought to elucidate the relative effectiveness of CESIs versus SNRBs. Recent evidence indicates that CESIs may provide superior short-term pain relief and functional improvement compared to SNRBs, especially within the first month post-intervention; however, both interventions tend to demonstrate similar efficacy at three months. 3 Despite the widespread use of both CESIs and SNRBs, there is ongoing debate regarding their comparative impact on long-term quality of life and functional outcomes in patients with chronic low back pain. This study aims to compare the quality of life and functional outcomes of Caudal Epidural Steroid Injection (CESI) versus Selective Nerve Root Block (SNRB) in chronic low back pain patients. The comparison includes individuals who have either declined spine surgery or are not considered suitable candidates due to medical or personal reasons. Method A retrospective cohort study was conducted in Ulin General Hospital for patients who suffered from chronic low back pain and underwent Caudal Epidural Steroid Injection (CESI) and/or Selective Nerve Root Block (SNRB) between January 2020 to December 2024. Patients were identified through the institutional medical records system. Data collected included demographic information, clinical presentation, imaging findings, intervention details, and outcomes related to pain intensity, quality of life, and functional status. Inclusion Criteria include adults aged 18 years or older, diagnosed with chronic low back pain with or without radicular symptoms, imaging confirmation (MRI or CT) correlating with clinical symptoms and received at least CESI or/and SNRB. Exclusion criteria of this study were patients with incomplete medical records or loss to follow-up before outcome assessment. The primary outcomes measured were pain intensity and health-related quality of life following the interventions. Pain intensity was assessed using the Visual Analog Scale (VAS), a widely used tool for quantifying pain levels on a scale from 0 (no pain) to 10 (worst imaginable pain). In addition, the health-related quality of life of the patients was evaluated using the SF-36 questionnaire, which is a comprehensive instrument that measures various aspects of physical and mental health, including physical functioning, bodily pain, vitality, social functioning, and mental health. By analyzing these metrics, the study aimed to evaluate not only the immediate pain relief provided by CESI and SNRB but also the broader impact of these interventions on the patients' overall quality of life and functional outcomes. This study received ethical clearance from the Health Research Ethics Committee of the Faculty of Medicine, Universitas Lambung Mangkurat, with approval number 050/KEPK-FKIK ULM/EC/VI/2025. Given the retrospective nature of the study, the requirement for informed consent was waived by the ethics committee. However, all data were handled confidentially and anonymized prior to analysis to ensure the privacy and rights of the participants were protected in accordance with the Declaration of Helsinki. Data collected were analyzed statistically using SPSS software. Continuous variables were expressed as mean ± standard deviation or median as appropriate. Results A total of 90 patients suffering from chronic low back pain, who underwent either Caudal Epidural Steroid Injection (CESI) and/or Selective Nerve Root Block (SNRB) at Ulin General Hospital between January 2020 and December 2024, were included in this study. The cohort consisted of 33 male (36.67%) and 57 female (63.33%) patients, with a mean age of 51.38 years (± 11.27 SD). The patients were categorized into three distinct intervention groups: 42 patients (46.67%) received CESI alone, 6 patients (6.67%) underwent only SNRB, and 42 patients (46.67%) received both CESI and SNRB. Pain Intensity At baseline, the mean pain intensity, as measured by the Visual Analog Scale (VAS), was 8.26 (± 1.4 SD), indicating that the patients experienced severe pain before intervention. This score represents a substantial burden of pain, consistent with the chronic low back pain condition that the patients were suffering from. Following the intervention, there was a significant reduction in pain intensity, with the post-intervention mean VAS score decreasing to 3.50 (± 1.64 SD). The reduction in pain was consistent across all treatment groups, demonstrating the overall effectiveness of both Caudal Epidural Steroid Injection (CESI) and Selective Nerve Root Block (SNRB) in alleviating pain. A statistically significant difference was observed in pain intensity scores measured by the Visual Analog Scale (VAS) when comparing pre- and post-intervention values (p < 0.001). This indicates that the interventional treatments —CESI, SNRB, or a combination of both— resulted in a clinically meaningful reduction in pain among patients with chronic low back pain. The significant change in VAS scores reflects the overall efficacy of these procedures in alleviating pain symptoms and improving patients’ perceived pain levels following treatment. However, no significant difference in post-treatment VAS scores was observed when comparing the three intervention groups (CESI alone, SNRB alone, and combined CESI + SNRB), with a p-value of 0.169. This suggests that the type of intervention—whether CESI, SNRB, or a combination of both—did not produce differential outcomes in terms of pain reduction. In other words, although these treatments were effective in reducing pain, no one intervention proved to be superior in comparison to the others. Quality of Life and Functional Outcome The impact of the interventions on patients’ quality of life and functional capacity was evaluated using the Short Form-36 (SF-36) questionnaire, a validated tool encompassing multiple domains of health-related quality of life. Analysis of the SF-36 results revealed statistically significant improvements in several key dimensions following treatment with CESI, SNRB, or a combination of both. The assessment of quality of life and functional outcomes encompassed several key domains, including physical functioning, physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain, and general health. In terms of quality of life and functional outcome, there was significant statistical difference in physical functioning (p = 0.01), energy/fatigue (p < 0.001), emotional well-being (p = 0.001) and pain (p = 0.002) between each group. In contrast, there was no significant statistical difference in physical health (p = 0.589), emotional problems (p = 0.055), social functioning (p = 0.540), and general health (p = 0.130) between the groups. Discussion This retrospective cohort study evaluated and compared the effects of CESI and/or SNRB on pain intensity, quality of life, and functional outcomes in patients with chronic Low Back Pain (cLBP) who were not eligible for or declined spine surgery. Our findings demonstrate a significant reduction in pain intensity across all intervention groups, with no statistically significant difference in pain relief among CESI, SNRB, or their combination. Pain Intensity The significant decrease in mean VAS scores post-intervention, from 8.26 to 3.50, corroborates the effectiveness of both CESI and SNRB in managing chronic low back pain. These results are consistent with recent studies that have demonstrated both interventions provide substantial short-term pain relief in patients with lumbar radiculopathy and cLBP. The lack of statistically significant difference in pain reduction among the three groups aligns with the conclusions of other recent randomized trials and meta-analyses, which suggest that while both CESI and SNRB are effective, neither is consistently superior in terms of pain control at intermediate follow-up. Kale et al. (2024) reported similar findings in a comparative study, showing significant pain reduction following both procedures, with no clear superiority of one over the other in terms of VAS improvement. 3 Likewise, Nagpal et al. (2022) found that CESI is associated with significant pain relief and functional gains, especially in the first few months following intervention. 4 Quality of Life and Functional Outcomes A key strength of this study is the use of the SF-36 (Short Form-36 Health Survey) questionnaire to capture multidimensional aspects of patient well-being. Unlike a unidimensional pain scale (e.g., VAS) which quantifies a single symptom, the SF-36 provides a comprehensive profile of health-related quality of life (HRQoL) by assessing eight distinct domains: physical functioning, role limitations due to physical health, bodily pain, general health, vitality (energy/fatigue), social functioning, role limitations due to emotional problems, and mental health (emotional well-being). This holistic approach is paramount in chronic pain management, where the impact of pain extends far beyond mere physical discomfort, permeating various facets of a patient's life, including their ability to perform daily activities, engage socially, maintain employment, and experience emotional stability. Our results show significant differences between intervention groups in physical functioning, energy/fatigue, emotional well-being, and pain domains. This finding highlights that, beyond pain relief, these interventions may differentially impact broader aspects of health-related quality of life. Recent literature supports the importance of evaluating such outcomes. Dernek et al. (2022) demonstrated that CESI not only reduces pain but also improves physical functioning and vitality in cLBP patients. 5 Their findings, which similar to our own, suggest that CESI's therapeutic effect extends beyond analgesia, positively influencing a patient's ability to engage with their physical environment and experience increased energy levels, which are critical for resuming daily activities and improving overall life satisfaction. Similarly, Ko et al. (2022) found that patients receiving SNRB reported improvements in physical and mental health domains, although the extent varied depending on baseline characteristics and comorbidities. 6 Our findings strongly reinforce the notion that while pain reduction remains a primary and undeniable goal in managing chronic low back pain, healthcare providers must also diligently assess interventions for patients’ broader impact on Health-Related Quality of Life (HRQoL) and daily functioning. Relying solely on pain intensity scores risks overlooking significant improvements, or indeed, differential impacts, on a patient's capacity to live a full and productive life. The use of robust, multidimensional HRQoL instruments like the SF-36 provides a more complete and clinically relevant picture of treatment efficacy, enabling more informed decision-making and patient-centered care. Conclusion There was significant reduction in pain intensity across all groups, but the specific intervention types (CESI, SNRB, or both) did not significantly differ. Differences in quality-of-life measurement, particularly in physical functioning, energy/fatigue, emotional well-being and pain were noted between each group. Therefore, CESI and SNRB remain valuable treatment modalities for LBP patients who refuse or not eligible for spine surgery. Declarations Funding Statement This research was self-funded by the authors. No external financial support, grant, or sponsorship was received from any individual, institution, or organization during the planning, execution, or publication of this study. Author Contribution tasks during the research and writing of the research manuscript.Muhammad Iqbal, Sutan Agung L. Tobing, Andreas M.H. Siagian, Izaak Z. Akbar, Husna D. Putera, Essy D. Damayanthi, Wongso Kesuma, and M. Rifqi F. Akbar wrote the research proposal and served as the research team.Eric R. Lovin and Ridma I. Septadi served as enumerators.Zairin Noor, Candra Kusuma Negara, and Ricky Prawira wrote the manuscript and analyzed the research data. Acknowledgement N/A References Alfalogy E, Mahfouz S, Elmedany S, Hariri N, Fallatah S (2023) Chronic Low Back Pain: Prevalence, Impact on Quality of Life, and Predictors of Future Disability. Cureus 15(9):e45760. 10.7759/cureus.45760 . PMID: 37872924; PMCID: PMC10590648 https://pmc.ncbi.nlm.nih.gov/articles/PMC10590648/ Singh S, Kumar S, Chahal G, Verma R (2017 Apr-Jun) Selective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc - A prospective randomized study. J Clin Orthop Trauma 8(2):142–147. 10.1016/j.jcot.2016.02.001 . Epub 2016 Feb 22. PMID: 28720990; PMCID: PMC5498739 https://pubmed.ncbi.nlm.nih.gov/28720990/ Kale A, Taneja A, Sharma PA, Comparative Study (2024) Between Selective Nerve Root Blocks Versus Caudal Epidural Steroid Injection in the Management of Lumbar Radiculopathy. Cureus. ;16(10):e72224. doi: 10.7759/cureus.72224. PMID: 39583438; PMCID: PMC11584173. https://pmc.ncbi.nlm.nih.gov/articles/PMC11584173/ Nagpal AS, Vu TN, Gill B, Conger A, McCormick ZL, Duszynski B, Boies BT (2022) Systematic review of the effectiveness of caudal epidural steroid injections in the treatment of chronic low back or radicular pain. Interv Pain Med. ;1(4):100149. 10.1016/j.inpm.2022.100149 . PMID: 39238877; PMCID: PMC11373049. https://pubmed.ncbi.nlm.nih.gov/39238877/ Dernek B, Aydoğmuş S, Ulusoy İ et al (2022) Caudal epidural steroid injection for chronic low back pain: A prospective analysis of 107 patients. J Back Musculoskelet Rehabil 35(1):135–139. 10.3233/BMR-200262 Ko S, Jun C, Min WK, Son E, Lee S, Lee GW, Yoo H, Daegu Spine Study Group (DGSSG) (2022) Pain Relief After Selective Nerve Root Block as a Predictor of Postoperative Functional Outcome in Patients with Degenerative Lumbar Spinal Stenosis Patients Undergoing Decompressive Surgery. Spine (Phila Pa 1976) 47(9):666–671 Epub 2021 Aug 30. PMID: 34468438. https://pubmed.ncbi.nlm.nih.gov/34468438/ Tables Tables 1 to 10 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7213922","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":497155940,"identity":"82d57d37-32ae-4edb-ba6d-e2ad257cb47f","order_by":0,"name":"Muhammad Iqbal","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuUlEQVRIiWNgGAWjYFACxgZmBgYLOQZ2CJeH4QBxWiSMGZiJ18IAUiyR2MAM4xLSotvA3Hi7oEYifcNh7gSGHzUMMnyEtJgdYGy2nnFMInfDYd4NjD3HGHgkidDSJs3DBtHCwNvAwGNAnJZ/EukGIFv+Eq2Ft00iAaSFmThbDgP9MrNPwnAmUMthmWMSRPjlePvD2wXfbOT5jvdufPimxsaeYIiBIwXGPoDExg+IVDYKRsEoGAUjFgAAorw7ZPfmJGwAAAAASUVORK5CYII=","orcid":"","institution":"Ulin General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Muhammad","middleName":"","lastName":"Iqbal","suffix":""},{"id":497155941,"identity":"e1b80d21-13f9-4648-8b67-0626ef5e1d72","order_by":1,"name":"Sutan Agung L. 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About 84% of the adult population complains of LBP at some time. Although 80–90% of LBP has a benign course and can be recovered within six weeks regardless of the treatment modality, 5–15% develop chronicity.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e It is estimated that up to 30% of individuals with chronic low back pain continue to experience pronounced symptoms beyond one year, despite the tendency for spontaneous resolution in many cases.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The socioeconomic burden of cLBP is substantial, with direct healthcare costs and indirect costs from lost productivity posing major challenges to health systems globally.\u003c/p\u003e\u003cp\u003eAmong the interventional approaches for managing cLBP, caudal epidural steroid injections (CESIs) and selective nerve root blocks (SNRBs) are two commonly utilized procedures.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e CESIs involve the administration of corticosteroids into the epidural space via the caudal canal, aiming to reduce inflammation and alleviate pain. Recent systematic reviews and clinical studies have demonstrated that CESIs can provide significant pain relief and functional improvement, with up to 50% of patients achieving meaningful reduction in pain intensity and improved disability scores. Short-term benefits in pain and function have been consistently reported, although long-term efficacy remains a subject of ongoing investigation.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e SNRBs, on the other hand, are targeted injections delivered adjacent to the affected nerve root, often under imaging guidance. This technique is particularly useful for both diagnostic and therapeutic purposes in patients with radicular symptoms. Evidence suggests that SNRBs can offer substantial short-term pain relief and may predict postoperative outcomes in certain patient populations.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e However, the technical demands of SNRBs are higher, requiring skilled practitioners to ensure safety and efficacy.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eComparative studies have sought to elucidate the relative effectiveness of CESIs versus SNRBs. Recent evidence indicates that CESIs may provide superior short-term pain relief and functional improvement compared to SNRBs, especially within the first month post-intervention; however, both interventions tend to demonstrate similar efficacy at three months.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Despite the widespread use of both CESIs and SNRBs, there is ongoing debate regarding their comparative impact on long-term quality of life and functional outcomes in patients with chronic low back pain. This study aims to compare the quality of life and functional outcomes of Caudal Epidural Steroid Injection (CESI) versus Selective Nerve Root Block (SNRB) in chronic low back pain patients. The comparison includes individuals who have either declined spine surgery or are not considered suitable candidates due to medical or personal reasons.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eA retrospective cohort study was conducted in Ulin General Hospital for patients who suffered from chronic low back pain and underwent Caudal Epidural Steroid Injection (CESI) and/or Selective Nerve Root Block (SNRB) between January 2020 to December 2024.\u003c/p\u003e\u003cp\u003ePatients were identified through the institutional medical records system. Data collected included demographic information, clinical presentation, imaging findings, intervention details, and outcomes related to pain intensity, quality of life, and functional status.\u003c/p\u003e\u003cp\u003eInclusion Criteria include adults aged 18 years or older, diagnosed with chronic low back pain with or without radicular symptoms, imaging confirmation (MRI or CT) correlating with clinical symptoms and received at least CESI or/and SNRB. Exclusion criteria of this study were patients with incomplete medical records or loss to follow-up before outcome assessment.\u003c/p\u003e\u003cp\u003eThe primary outcomes measured were pain intensity and health-related quality of life following the interventions. Pain intensity was assessed using the Visual Analog Scale (VAS), a widely used tool for quantifying pain levels on a scale from 0 (no pain) to 10 (worst imaginable pain). In addition, the health-related quality of life of the patients was evaluated using the SF-36 questionnaire, which is a comprehensive instrument that measures various aspects of physical and mental health, including physical functioning, bodily pain, vitality, social functioning, and mental health. By analyzing these metrics, the study aimed to evaluate not only the immediate pain relief provided by CESI and SNRB but also the broader impact of these interventions on the patients' overall quality of life and functional outcomes.\u003c/p\u003e\u003cp\u003eThis study received ethical clearance from the Health Research Ethics Committee of the Faculty of Medicine, Universitas Lambung Mangkurat, with approval number 050/KEPK-FKIK ULM/EC/VI/2025. Given the retrospective nature of the study, the requirement for informed consent was waived by the ethics committee. However, all data were handled confidentially and anonymized prior to analysis to ensure the privacy and rights of the participants were protected in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003eData collected were analyzed statistically using SPSS software. Continuous variables were expressed as mean \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e±\u003c/span\u003e standard deviation or median as appropriate.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 90 patients suffering from chronic low back pain, who underwent either Caudal Epidural Steroid Injection (CESI) and/or Selective Nerve Root Block (SNRB) at Ulin General Hospital between January 2020 and December 2024, were included in this study. The cohort consisted of 33 male (36.67%) and 57 female (63.33%) patients, with a mean age of 51.38 years (\u0026plusmn;\u0026thinsp;11.27 SD).\u003c/p\u003e\n\u003cp\u003eThe patients were categorized into three distinct intervention groups: 42 patients (46.67%) received CESI alone, 6 patients (6.67%) underwent only SNRB, and 42 patients (46.67%) received both CESI and SNRB.\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePain Intensity\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eAt baseline, the mean pain intensity, as measured by the Visual Analog Scale (VAS), was 8.26 (\u0026plusmn;\u0026thinsp;1.4 SD), indicating that the patients experienced severe pain before intervention. This score represents a substantial burden of pain, consistent with the chronic low back pain condition that the patients were suffering from.\u003c/p\u003e\n\u003cp\u003eFollowing the intervention, there was a significant reduction in pain intensity, with the post-intervention mean VAS score decreasing to 3.50 (\u0026plusmn;\u0026thinsp;1.64 SD). The reduction in pain was consistent across all treatment groups, demonstrating the overall effectiveness of both Caudal Epidural Steroid Injection (CESI) and Selective Nerve Root Block (SNRB) in alleviating pain.\u003c/p\u003e\n\u003cp\u003eA statistically significant difference was observed in pain intensity scores measured by the Visual Analog Scale (VAS) when comparing pre- and post-intervention values (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This indicates that the interventional treatments \u0026mdash;CESI, SNRB, or a combination of both\u0026mdash; resulted in a clinically meaningful reduction in pain among patients with chronic low back pain. The significant change in VAS scores reflects the overall efficacy of these procedures in alleviating pain symptoms and improving patients\u0026rsquo; perceived pain levels following treatment.\u003c/p\u003e\n\u003cp\u003eHowever, no significant difference in post-treatment VAS scores was observed when comparing the three intervention groups (CESI alone, SNRB alone, and combined CESI\u0026thinsp;+\u0026thinsp;SNRB), with a p-value of 0.169. This suggests that the type of intervention\u0026mdash;whether CESI, SNRB, or a combination of both\u0026mdash;did not produce differential outcomes in terms of pain reduction. In other words, although these treatments were effective in reducing pain, no one intervention proved to be superior in comparison to the others.\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eQuality of Life and Functional Outcome\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe impact of the interventions on patients\u0026rsquo; quality of life and functional capacity was evaluated using the Short Form-36 (SF-36) questionnaire, a validated tool encompassing multiple domains of health-related quality of life. Analysis of the SF-36 results revealed statistically significant improvements in several key dimensions following treatment with CESI, SNRB, or a combination of both. The assessment of quality of life and functional outcomes encompassed several key domains, including physical functioning, physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain, and general health.\u003c/p\u003e\n\u003cp\u003eIn terms of quality of life and functional outcome, there was significant statistical difference in physical functioning (p\u0026thinsp;=\u0026thinsp;0.01), energy/fatigue (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), emotional well-being (p\u0026thinsp;=\u0026thinsp;0.001) and pain (p\u0026thinsp;=\u0026thinsp;0.002) between each group. In contrast, there was no significant statistical difference in physical health (p\u0026thinsp;=\u0026thinsp;0.589), emotional problems (p\u0026thinsp;=\u0026thinsp;0.055), social functioning (p\u0026thinsp;=\u0026thinsp;0.540), and general health (p\u0026thinsp;=\u0026thinsp;0.130) between the groups.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis retrospective cohort study evaluated and compared the effects of CESI and/or SNRB on pain intensity, quality of life, and functional outcomes in patients with chronic Low Back Pain (cLBP) who were not eligible for or declined spine surgery. Our findings demonstrate a significant reduction in pain intensity across all intervention groups, with no statistically significant difference in pain relief among CESI, SNRB, or their combination.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePain Intensity\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThe significant decrease in mean VAS scores post-intervention, from 8.26 to 3.50, corroborates the effectiveness of both CESI and SNRB in managing chronic low back pain. These results are consistent with recent studies that have demonstrated both interventions provide substantial short-term pain relief in patients with lumbar radiculopathy and cLBP. The lack of statistically significant difference in pain reduction among the three groups aligns with the conclusions of other recent randomized trials and meta-analyses, which suggest that while both CESI and SNRB are effective, neither is consistently superior in terms of pain control at intermediate follow-up. Kale et al. (2024) reported similar findings in a comparative study, showing significant pain reduction following both procedures, with no clear superiority of one over the other in terms of VAS improvement.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Likewise, Nagpal et al. (2022) found that CESI is associated with significant pain relief and functional gains, especially in the first few months following intervention.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eQuality of Life and Functional Outcomes\u003c/span\u003e\u003c/p\u003e\u003cp\u003eA key strength of this study is the use of the SF-36 (Short Form-36 Health Survey) questionnaire to capture multidimensional aspects of patient well-being. Unlike a unidimensional pain scale (e.g., VAS) which quantifies a single symptom, the SF-36 provides a comprehensive profile of health-related quality of life (HRQoL) by assessing eight distinct domains: physical functioning, role limitations due to physical health, bodily pain, general health, vitality (energy/fatigue), social functioning, role limitations due to emotional problems, and mental health (emotional well-being). This holistic approach is paramount in chronic pain management, where the impact of pain extends far beyond mere physical discomfort, permeating various facets of a patient's life, including their ability to perform daily activities, engage socially, maintain employment, and experience emotional stability.\u003c/p\u003e\u003cp\u003eOur results show significant differences between intervention groups in physical functioning, energy/fatigue, emotional well-being, and pain domains. This finding highlights that, beyond pain relief, these interventions may differentially impact broader aspects of health-related quality of life. Recent literature supports the importance of evaluating such outcomes. Dernek et al. (2022) demonstrated that CESI not only reduces pain but also improves physical functioning and vitality in cLBP patients.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Their findings, which similar to our own, suggest that CESI's therapeutic effect extends beyond analgesia, positively influencing a patient's ability to engage with their physical environment and experience increased energy levels, which are critical for resuming daily activities and improving overall life satisfaction. Similarly, Ko et al. (2022) found that patients receiving SNRB reported improvements in physical and mental health domains, although the extent varied depending on baseline characteristics and comorbidities.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eOur findings strongly reinforce the notion that while pain reduction remains a primary and undeniable goal in managing chronic low back pain, healthcare providers must also diligently assess interventions for patients\u0026rsquo; broader impact on Health-Related Quality of Life (HRQoL) and daily functioning. Relying solely on pain intensity scores risks overlooking significant improvements, or indeed, differential impacts, on a patient's capacity to live a full and productive life. The use of robust, multidimensional HRQoL instruments like the SF-36 provides a more complete and clinically relevant picture of treatment efficacy, enabling more informed decision-making and patient-centered care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere was significant reduction in pain intensity across all groups, but the specific intervention types (CESI, SNRB, or both) did not significantly differ. Differences in quality-of-life measurement, particularly in physical functioning, energy/fatigue, emotional well-being and pain were noted between each group. Therefore, CESI and SNRB remain valuable treatment modalities for LBP patients who refuse or not eligible for spine surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding Statement\u003c/h2\u003e\u003cp\u003eThis research was self-funded by the authors. No external financial support, grant, or sponsorship was received from any individual, institution, or organization during the planning, execution, or publication of this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003etasks during the research and writing of the research manuscript.Muhammad Iqbal, Sutan Agung L. Tobing, Andreas M.H. Siagian, Izaak Z. Akbar, Husna D. Putera, Essy D. Damayanthi, Wongso Kesuma, and M. Rifqi F. Akbar wrote the research proposal and served as the research team.Eric R. Lovin and Ridma I. Septadi served as enumerators.Zairin Noor, Candra Kusuma Negara, and Ricky Prawira wrote the manuscript and analyzed the research data.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eN/A\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlfalogy E, Mahfouz S, Elmedany S, Hariri N, Fallatah S (2023) Chronic Low Back Pain: Prevalence, Impact on Quality of Life, and Predictors of Future Disability. Cureus 15(9):e45760. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.45760\u003c/span\u003e\u003cspan address=\"10.7759/cureus.45760\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 37872924; PMCID: PMC10590648 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC10590648/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC10590648/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh S, Kumar S, Chahal G, Verma R (2017 Apr-Jun) Selective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc - A prospective randomized study. J Clin Orthop Trauma 8(2):142\u0026ndash;147. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcot.2016.02.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jcot.2016.02.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2016 Feb 22. PMID: 28720990; PMCID: PMC5498739 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/28720990/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/28720990/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKale A, Taneja A, Sharma PA, Comparative Study (2024) Between Selective Nerve Root Blocks Versus Caudal Epidural Steroid Injection in the Management of Lumbar Radiculopathy. Cureus. ;16(10):e72224. doi: 10.7759/cureus.72224. PMID: 39583438; PMCID: PMC11584173. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11584173/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC11584173/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNagpal AS, Vu TN, Gill B, Conger A, McCormick ZL, Duszynski B, Boies BT (2022) Systematic review of the effectiveness of caudal epidural steroid injections in the treatment of chronic low back or radicular pain. Interv Pain Med. ;1(4):100149. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.inpm.2022.100149\u003c/span\u003e\u003cspan address=\"10.1016/j.inpm.2022.100149\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 39238877; PMCID: PMC11373049. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/39238877/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/39238877/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDernek B, Aydoğmuş S, Ulusoy İ et al (2022) Caudal epidural steroid injection for chronic low back pain: A prospective analysis of 107 patients. J Back Musculoskelet Rehabil 35(1):135\u0026ndash;139. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3233/BMR-200262\u003c/span\u003e\u003cspan address=\"10.3233/BMR-200262\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKo S, Jun C, Min WK, Son E, Lee S, Lee GW, Yoo H, Daegu Spine Study Group (DGSSG) (2022) Pain Relief After Selective Nerve Root Block as a Predictor of Postoperative Functional Outcome in Patients with Degenerative Lumbar Spinal Stenosis Patients Undergoing Decompressive Surgery. Spine (Phila Pa 1976) 47(9):666\u0026ndash;671 Epub 2021 Aug 30. PMID: 34468438. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/34468438/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/34468438/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 10 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Caudal Epidural Steroid Injection, Selective Nerve Root Block, Chronic Low Back Pain","lastPublishedDoi":"10.21203/rs.3.rs-7213922/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7213922/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo compare the quality of life and functional outcomes of Caudal Epidural Steroid Injection (CESI) versus Selective Nerve Root Block (SNRB) in chronic low back pain patients, including those who refuse or not eligible for spine surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective cohort study was conducted in Ulin General Hospital for patients who suffered from chronic low back pain and underwent CESI and/or SNRB between January 2020 to December 2024. 90 patients were included in this study. The patient\u0026rsquo;s pain intensity using VAS, and health-related quality of life after intervention using the SF-36 questionnaire were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e33 male and 57 female patients with mean age 51.38 years\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;11.27 SD were included in this study. The patients were classified into 3 groups: 42 patients (46.67%) received CESI, 6 patients (6,67%) received SNRB only, and 42 patients (46.67%) received both CESI and SNRB. The mean VAS before \u0026amp; after intervention was 8.26\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.4 SD and 3.50\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.64 SD. There was a statistically significant difference in VAS scores before and after intervention (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, there was no significant difference among each group of intervention (p\u0026thinsp;=\u0026thinsp;0.169). For quality of life and functional outcome, there was significant difference in physical functioning (p\u0026thinsp;=\u0026thinsp;0.01), energy/fatigue (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), emotional well-being (p\u0026thinsp;=\u0026thinsp;0.001) and pain (p\u0026thinsp;=\u0026thinsp;0.002) between each group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThere was significant reduction in pain intensity across all groups, but the specific intervention types (CESI, SNRB, or both) did not significantly differ. Differences in quality-of-life measurement, particularly in physical functioning, energy/fatigue, emotional well-being and pain were noted between each group. Therefore, CESI and SNRB remain valuable treatment modalities for LBP patients who refuse or not eligible for spine surgery.\u003c/p\u003e","manuscriptTitle":"Quality of Life and Functional Outcomes after Caudal Epidural Steroid Injection Versus Selective Nerve Root Block in Chronic Low Back Pain: A Single-Center Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-11 15:36:52","doi":"10.21203/rs.3.rs-7213922/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1dfb346a-5f5a-4ce4-98e8-78e6b730e9fd","owner":[],"postedDate":"August 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-19T11:09:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-11 15:36:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7213922","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7213922","identity":"rs-7213922","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}