Data collection
Oswestry Disability, pain
STERILE, INFILTRATION
A physical medicine and rehabilitation specialist with more than 10 years of experience in spinal procedures performed caudal injection. After reviewing the inclusion criteria, the first group was injected with 80 mg of triamcinolone hexavalent with 4 mL of marcaine 0.5% and 6 mL of distilled water during the intervention. The second group received an injection similar to the first group with the addition of 10 mL of ozone (O2-O3) gas at a concentration of 10 µg/cc. The dose of consumed O2-O3 gas was selected by reviewing previous studies in the field of transforaminal and intradiscal injections and the absence of a similar study on the use of O2 -O3 gas in caudal epidural steroid injection to ensure safety and efficacy of treatment. Patients were followed up one and six months after injection. During this period, clinical outcomes were collected using Visual Analog Scale (VAS) for pain intensity, Oswestry Disability Index (ODI), and Walking Distance (WD) [A curvilinear transducer at 5 to 12 MHz was used as the US instrument (Mindray M7, Shenzhen Mindray Bio-Medical Electronics Co., Ltd). The patient was in the prone position. First, sacral area was prepped and the legs were rotated internally to open up injection site. The transducer was covered with a sterile sheet. Then the probe was placed in the long axis position to scan for sacral hiatus. Following local anesthetic infiltration, a 3.5-inch 22G spinal needle was inserted with an in-plane technique. After passing the sacrococcygeal ligament to confirm the location of the needle, the probe was rotated to observe the needle in sacral hiatus in short axis. Then we turned on the color Doppler. After negative blood aspiration and observing turbulence of injectate drug was completely injected.