Caudal Epidural Injections

What is a caudal epidural injection?

Caudal injection is an injection into the lowest portion of the epidural space, located near the tailbone (coccyx), where a small area of access to the epidural space is possible. A caudal steroid injection can help reduce lower back and leg pain caused by sciatica, herniated discs, bone spurs or other back problems. A steroid medication can help reduce the inflammation of irritated nerve roots and alleviate the pain.

How is a caudal injection performed?

First, you will lie on your abdomen on an x-ray table. The doctor will numb an area of skin on your lower back, just above your tailbone, with a local anesthetic. Then, guided by an x-ray, he or she will:

  • Insert a thin needle into your back, just above your tailbone
  • May inject dye to confirm that medication is administered into the caudal space
  • Inject a steroid (for longer term relief)

The medicines then spread in the epidural and caudal spaces, thereby reducing nerve irritation and pain. The entire procedure usually takes less than 15 minutes and you can go home the same day.

How effective is a caudal injection?

Some patients report pain relief within 30 minutes after the injection, but pain may return a few hours later as the local anesthetic wears off. Longer-term relief usually begins in two to three days, once the steroid begins to work. Some individuals may have increased pain for a day or two after the procedure. The most important and greatest success achieved with the use of epidural steroid injections is the rapid relief of symptoms. This often allows patients to experience enough relief to become active and resume their normal daily activities. How long the pain relief lasts is different for each patient. For some, the relief lasts several months or longer. If the treatment works for you, you can have periodic injections to stay pain-free. Many of the patients who receive these injections for management of their chronic back pain enjoy improved function and diminished pain for years and can benefit from additional procedures for prolonged relief (Barre 2004).

What are the risks?

The risk of a complication from a caudal epidural steroid injection is very low. Rarely, complications include bleeding or infection at the injection site, nerve damage, or possibly a headache if the dura is punctured. The medications used can also cause pharmacological complications. These risks include allergic reaction, high blood sugars, decreased immune response, and the potential for weight gain.

Your doctor will discuss with you further the risks and benefits associated with this procedure, as well as other treatment options.

What happens afterwards?

Do not drive or do any rigorous activity for 24 hours after your caudal injection. Take it easy. You can return to your normal activities the next day. You can continue your regular diet and medications immediately. Please let the staff know if you take blood thinners, as there are special instructions for you. It may take up to a week for the steroid to begin working. If you don’t feel better within 10-14 days, see your doctor for additional evaluation and to discuss different treatment options.

Who should not have a caudal injection?

Patients who have an allergy to any anesthetic, are on blood thinning medications, are diabetic, have an active infection, or are pregnant should consult with the pain physician before receiving the procedure. There may be special instructions or lab testing or the procedure might need to be rescheduled.

Is caudal injection right for you?

Caudal injection may be right for you if your back pain has lasted longer than four weeks, is severe, or has not improved with other treatments, such as physical therapy. Early intervention may decrease the chances of developing a worsening chronic pain syndrome. Talk to your physician about it. Or schedule an evaluation at PrairieShore Pain Center to see one of our pain specialists about the most appropriate treatment options.

At PrairieShore™ Pain Center, our goal is to relieve your pain and improve your quality of life. If your primary physician has advised you to see a specialist for your pain, turn to us for help. To schedule your appointment, please contact us here or give us a call at (847) 883-0077.

Fluoroscopically Guided Caudal Epidural Steroid Injections for Lumbar Spinal Stenosis: A Retrospective Evaluation of Long Term Efficacy. Barre, Lisha. Pain Physician 2004; 7:187-193. Cleveland Clinic Pain Management