Caudal Injection

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Caudal Injection

What is a caudal injection?

A caudal injection is actually an injection into the lowest portion of the epidural space. A caudal steroid injection can help reduce lower back and leg pain caused by sciatica, herniated discs, bone spurs or other back problems.

You have nerves that run from your spinal cord out to your back and legs. When one of those nerve “roots” (the end closest to your spinal cord) gets irritated and inflamed due to a damaged disc or other condition, it can cause back or leg pain.

A steroid medication can help reduce the inflammation and alleviate the pain. It’s injected into your back, into the area between the membrane that contains the spinal fluid (the dura) and the thickest ligament between your vertebra. The caudal canal is below the lower end of the spinal cord.

How is a caudal injection performed?

First, you will lie on your abdomen on an x-ray table. Then, an intravenous medication to help you relax will be administered.

The doctor will numb an area of skin on your lower back, just above your buttocks, 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
  • Inject dye to confirm that medication is administered into the caudal space
  • Inject a mixture of anesthetic (for temporary pain relief) and steroid (for longer term relief)

The medicines then spread in the epidural and caudal spaces, thereby hopefully reducing nerve inflammation and pain.

Usually, the procedure 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.

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.

What are the risks?

The risk of a complication from an interlaminar epidural steroid injection is very low. Rarely, complications include bleeding or infection at the injection site or possibly a headache if the dura is punctured, which is unusual in a caudal injection.

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

These effects resolve within a few hours.

What happens after the procedure?

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.

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.

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.

Talk to your physician about it. Or schedule an evaluation at Cleveland Clinic’s Department of Pain Management by calling 216.444.PAIN (7246) or 800.392.3353.

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