Caudal Epidural Injection

The epidural cavity is the space surrounding the spinal cord, which extends from the skull to the tailbone, and consists of fat, nerves and blood vessels. Nerves in this space can be blocked by injecting an anesthetic, or a constricted nerve can be relieved of pain and inflammation by injecting steroid medication into the epidural space. Caudal epidural injections are administered at the spinal segments of the lower back and tail bone. The injection can also be used as a diagnostic tool to ascertain the location of pain caused by a nerve pinched by vertebral bone herniation or bone spurs.

Indications

Caudal epidural injections are recommended to treat conditions such as:

  • Sciatica: weakness or pain caused by irritation of the nerve root originating from the lower back
  • Herniated/bulging disc: vertebral discs extend beyond the vertebrae, pinching the neighboring nerve
  • Degenerative lumbar spinal stenosis: nerve impingement caused due to narrowing of the spinal canal

Caudal epidural injection is contraindicated in those allergic to anesthetic or steroid medication.

Procedure

You will lie on your abdomen on an X-ray table. Your doctor will administer intravenous medication to help you relax. Your lower back area will be numbed using local anesthesia. Your doctor then inserts a needle into your back just above your tail bone, guided by X-ray imagery. A contrast dye is injected to confirm the epidural space. Following this, your doctor injects a mixture of anesthesia and steroid medication which spreads throughout the epidural space to treat and relieve the inflammation and pain. The procedure takes about 15 minutes and you will be discharged on the same day.

Recovery

After your procedure, you will be advised to rest and not drive for the next 24 hours. You can commence your normal activities after 24 hours. The effect of the medication starts working after a week, however, if you do not experience improvement within 10-14 days, please consult your doctor.

Risks and complications

Complications from caudal epidural injections are very rare. There is a risk of bleeding or infection at the site of the injections and sometimes headache in case of a puncture of the dura (outer membrane of the spinal cord). You may also have allergic reactions to the medication administered.

aaPN&R North American Neuromodulation Society NASS American Society of Interventional Pain Physicians