Caudal Epidural Steroid Injection

What Is a Caudal Epidural Steroid Injection?

A caudal epidural steroid injection is a minimally invasive procedure that delivers anti-inflammatory medication into the epidural space of the lower spine through the sacral hiatus, an opening near the tailbone (sacrum).

The epidural space surrounds the spinal nerves. When those nerves become irritated from disc herniation, spinal stenosis, inflammation, or post-surgical scarring, they can produce lower back pain, buttock pain, or pain radiating down the legs.

A caudal epidural injection works by reducing inflammation around those nerves and calming the pain signaling process.

Why Is It Called “Caudal”?

“Caudal” simply means “toward the tail.” Instead of entering the epidural space from higher lumbar levels, this approach accesses it from the base of the spine.

This technique can be particularly useful when:

• Multiple lumbar levels are involved

• Prior lumbar surgery has altered anatomy

• There is epidural scarring

• A broader spread of medication is desired

It allows medication to flow upward within the epidural space to reach inflamed nerve roots.

What Conditions Can It Treat?

Caudal epidural steroid injections are commonly used for:

• Lumbar radiculopathy (sciatica)

• Lumbar disc herniation

• Spinal stenosis

• Degenerative disc disease with nerve irritation

• Post-laminectomy or failed back surgery syndrome

• Epidural fibrosis (scar tissue after surgery)

The goal is to decrease nerve inflammation, reduce leg pain, and improve function.

How the Procedure Is Performed

The procedure is performed under fluoroscopic (x-ray) guidance to ensure safe and accurate placement.

1. You lie comfortably on your stomach.

2. The skin near the tailbone is cleaned and numbed with local anesthetic.

3. A thin needle is guided into the sacral hiatus.

4. Contrast dye confirms proper placement in the epidural space.

5. A mixture of steroid and anesthetic is injected.

The procedure typically takes 10–20 minutes and is performed on an outpatient basis.

What Does It Feel Like?

You may feel:

• Mild pressure during injection

• Temporary warmth or heaviness in the legs

• Brief numbness from the anesthetic

Most patients tolerate the procedure well.

When Will I Feel Relief?

Relief timeline varies:

• Immediate numbness may occur from the anesthetic

• Steroid effect typically begins within 2–5 days

• Improvement may continue over 1–2 weeks

Some patients experience significant relief. Others may require a series of injections depending on severity and diagnosis.

How Long Does Relief Last?

Duration depends on:

• Underlying condition

• Degree of nerve inflammation

• Activity level

• Individual response

Relief may last weeks to months. In some cases, the injection provides enough symptom reduction to allow physical therapy and strengthening to become more effective.

Benefits of a Caudal Epidural Injection

• Minimally invasive

• Outpatient procedure

• Useful in post-surgical patients

• Allows medication to spread across multiple lumbar levels

• Can reduce leg pain and improve mobility

• May delay or prevent surgery in selected patients

Risks and Considerations

Caudal epidural injections are generally safe but may include:

• Temporary increase in pain

• Headache (rare)

• Bleeding

• Infection (rare)

• Temporary leg weakness or numbness

• Transient elevation in blood sugar

Imaging guidance significantly improves safety and accuracy.

Who Is a Good Candidate?

You may be a candidate if you:

• Have persistent leg pain (sciatica)

• Have lumbar spinal stenosis

• Have disc-related nerve irritation

• Have post-surgical lumbar pain

• Have not improved with conservative care

A thorough clinical evaluation ensures the epidural space is the appropriate target.

Frequently Asked Questions

Is this the same as a lumbar epidural injection?
Both are epidural injections, but the caudal approach enters from the tailbone. It allows broader medication spread and is often preferred in post-surgical anatomy.

Will I be sedated?
Most procedures are performed with local anesthetic. Light sedation may be used depending on patient preference and medical history.

How many injections can I receive?
Frequency depends on clinical response and overall treatment strategy. Long-term spine health is always considered.

Reference

North American Spine Society (NASS). “Lumbar Epidural Steroid Injections.” Available at: https://www.spine.org