Caudal Epidural Steroid Injection

What is a caudal epidural steroid injection?

A caudal epidural steroid injection (CESI) is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into your lower back to manage pain. More specifically, the injection goes into the space around your spinal nerves known as the epidural space. A CESI is a specific type of epidural steroid injection (ESI).

The injection can help treat pain caused by irritation and inflammation of your spinal nerve roots. Healthcare providers use CESIs as a chronic pain management tool for lower back pain.

“Caudal” means “toward the tail.” For a CESI, the path of the needle is through your sacral hiatus. This is toward the bottom of your sacrum and just above your tailbone (coccyx). It’s the path to reach the lowest spinal nerves. Your sacrum is the triangular bone in your lower back that’s situated between your hip bones.

The thought of getting an injection near your spinal cord may be nerve-wracking. But caudal epidural steroid injections are generally safe procedures and may be a minimally invasive way to get pain relief. To ensure your safety, make sure you get the injection from a healthcare provider who performs this procedure often.

When would I need a caudal epidural steroid injection?

A caudal epidural steroid injection helps manage sciatica or radiculopathy (pain from a pinched nerve) and inflammation in your lower back, which may extend into your leg. Causes of nerve pain and inflammation in your lower back may include:

• Degenerative disk disease.
• Facet joint syndrome.
• Failed back surgery syndrome or post-laminectomy syndrome.
• Herniated disks.
• Lumbar spinal stenosis.
• Lumbar spondylosis.
• Spondylolisthesis.

Each of these conditions has several options for pain management. Ask your healthcare provider if a CESI is right for you.

What happens before a caudal epidural steroid injection?

During an appointment in the days or weeks before a caudal epidural steroid injection, your healthcare provider will make sure the injection is safe for you. They’ll ask for a complete health history and medication list.

It’s important to share all of your current medications and supplements. Some medications or supplements thin your blood, which increases bleeding risks. Your provider may ask you to stop taking certain medications a few days before the injection.

It’s also important to tell your provider if you’re pregnant or might be pregnant. The imaging guidance providers typically use for CESIs may be harmful to fetal development.

You’ll also need to arrange for someone to take you home after your injection appointment. You shouldn’t drive for at least 24 hours after a CESI.

What happens during a caudal epidural steroid injection procedure?

In most cases, a caudal epidural steroid injection involves the following steps:

1. You change into a medical gown and lie face-down on an X-ray table. You may use a pillow under your abdomen for increased comfort.
2. A healthcare provider cleans (disinfects) the area of your back where the injection will go.
3. A provider injects a local anesthetic (numbing medication) into the skin of your lower back. This is so you won’t experience pain from the epidural steroid injection.
4. A provider uses a needle to inject contrast dye into the epidural space around your spinal cord in your lower back. This dye helps your tissues show up better in imaging.
5. A provider uses several pulses (brief bursts) of an X-ray beam to see the tissues in your lower back. This is called fluoroscopy. This imaging guidance helps your provider see exactly where the medicine should go.
6. Using a needle, your provider injects steroid medication into your epidural space. You may feel some pressure during the injection. It’s important not to move during the procedure.
7. Once your provider removes the needle, they’ll place a sterile dressing over the site.

The entire process usually takes only 15 to 30 minutes. After the procedure, a provider will monitor you for 15 to 20 minutes before you can go home.

What happens after a caudal epidural steroid injection?

A caudal epidural steroid injection is an outpatient procedure, which means you go home the same day.

Typically, you need to avoid strenuous activity and driving for the first 24 hours after the injection. You may notice some soreness near the injection site. Many people experience back pain relief within two to three days.

What are the side effects and risks of a caudal epidural steroid injection?

Side effects are somewhat expected outcomes of a procedure or medication. Side effects of caudal epidural steroid injections may include:

• A temporary increase in pain before the steroid medication starts working.
• Tenderness and/or bruising at the site of the injection.
• If you have diabetes, an epidural steroid injection (ESI) will likely cause high blood sugar (hyperglycemia). This could last for hours or even days.
• If you have glaucoma, an ESI may temporarily increase your blood pressure and eye pressure.

Caudal epidural steroid injections are usually safe, but they come with certain risks and complications. Although rare, risks and complications may include:

• Low blood pressure, which can make you feel lightheaded.
• Infection.
• Bleeding around your spinal column. This could cause a hematoma or a blood clot to form.
• Allergic reaction to the medication.
• Spinal headache due to spinal fluid leakage. Less than 1% of people experience this complication.
• Nerve damage.
• Temporarily losing the ability to regulate your bladder and bowels (incontinence). You might need a catheter (a small tube) to help you pee.

Getting epidural steroid injections too often or receiving higher doses of steroid medication may weaken your spinal bones or nearby muscles. Because of this, most healthcare providers limit people to two to three ESIs per year.

What are the benefits of a caudal epidural steroid injection?

The benefits of a caudal epidural steroid injection may include:

• Temporary or long-term pain relief.
• Better quality of life and an improved ability to do daily activities.
• Providing diagnostic information on the origin of your pain. This is often helpful if you have more than one possible cause of pain.
• Potentially reducing the need for more invasive procedures for pain management.

While many people experience symptom improvement with a caudal steroid epidural injection, it’s not a guarantee. Talk to your healthcare provider about other pain management options if you don’t notice a change in your symptoms after getting an injection.

What is the recovery time for a caudal epidural steroid injection?

You can resume your usual activities 24 hours after a caudal epidural steroid injection. Many people experience pain relief after only a few days. But it may take up to 10 days for you to notice a difference.

How long does a caudal epidural steroid injection last?

While evidence shows that epidural steroid injections are effective in providing pain relief, the length of time the pain relief lasts may vary. This is especially dependent on the underlying cause of the pain. The pain relief may last for weeks to months but rarely up to a year.

For some people, a CESI provides permanent pain relief. Others may need steroid injections a few times a year. Your provider will let you know if periodic steroid injections fit into your pain management plan.

How often do I need a caudal epidural steroid injection?

Some people experience significant pain relief after only one steroid injection. If you still have pain, your healthcare provider may recommend up to two more injections to increase the effects. These injections may occur two to four weeks apart. Most providers limit people to two to three ESIs per year.

When should I see my healthcare provider?

If you experience any of the following symptoms after you’ve returned home from your CESI, be sure to contact your healthcare provider or go to the nearest hospital as soon as possible:

• Severe headache while you’re standing up or sitting that feels better after lying down.
• Fever, which could be a sign of an infection.
• Reduced or complete loss of bladder or bowel control.
• Numbness and/or weakness in your legs, which could be a sign of nerve injury.