الفهرس 
Acknowledgement
Chapter I : AnatomyOnly 14 pages are availabe for public view
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Abstract
Caudal epidural steroid injection is effective in treatment of radicular pain due to LDP. CESI causes improvement in all functional parameters of the patients. Patient with predominant radicular pain due to lumbar disc herniation at one or two levels can be considered for treatment with CESI prior to being considered for operative intervention. It offer a cost effective and low risk alternative to surgery. Injection with imaging guidance is mandatory due to the high failure rate of blind injection. Generally, FL is considered the gold standard procedure of guiding CESI. In both groups, there were significant improvement of VAS, Modified Schober test, SLRT and ODI at 1 month and 3 months after injection versus pre-injection. This indicate improvement in pain and function after injection for 3 months in the two groups and persistence of improvement.As regards age, patients > 40 years were more susceptible to failure in either groups in our study. Shorter duration of disease (˂6 months) had a favorable outcome than longer duration (≥6 months). Concerning target root level, higher levels were associated with higher failure rates. US is excellent in guiding caudal epidural injection with similar treatment outcome as compared with FL-guided caudal epidural injection and ultrasound should be the preferred alternative when FL is not available. Caudal epidural steroid injection offer alternative effective approach in management of LDP of duration < 6 months, target level not L2-3/L3-4, -ve FST, LDP other than foraminal type and age < 40 years and sufficient diameter of SH.