An Overview of Caudal Epidural Steroid Injections
Out of all the methods of administering epidural steroid injections, the caudal variety is widely regarded as the easiest to perform. There are actually quite a few advantages with the caudal variety of epidural steroid injections, in addition to its ease of administration.
Epidural injections in pain management have been performed for over 60 years with predominately good results. There have been multiple studies criticizing whether or not the benefits outweigh the risks associated, but the majority of them show they can be very helpful for pain relief and helping patients avoid the need for surgery.
Benefits of Caudal Epidurals
Benefits of the caudal epidural injections are that injections are target specific for lower lumbar levels and are able to reach multiple sites of nerve root compression. In addition, these epidurals can reach around the epidural space to the front, which is very different than the other two types. Also, caudal epidurals can be safely performed in post-surgical situations even when hardware has been placed.
Caudal epidural injections are performed on an outpatient basis in either a procedure room or an outpatient surgery center. Patients are placed in a well padded prone position table that allows x-rays to go through it. Modern pain management doctors utilize fluoroscopy for these procedures, which is a real-time form of x-ray guidance.
Caudal injections are placed through the bottom most portion of the spine, through an opening known as the sacral hiatus. The other types of epidural steroid injections involve placement of the steroid medication much closer to the actual area of nerve root compression.
However, caudal epidurals represent an indirect method of steroid placement, where the medication moves after placement to cover a broader area. This allows the steroid to reach multiple areas of nerve root compression, which makes it beneficial for the problems such as spinal stenosis where multiple nerve roots are being compressed.
Because caudal epidural injections are an indirect method of pain relief, a larger amount of steroid medication is used during these injections. Therefore, enough medicine needs to be placed to gravitate towards the areas of compression in a broad fashion.
Results of Caudal Epidural Injections
The results of caudal injections have been very promising for a broad range of pain management conditions. A 2012 review in Pain Physician evaluated over 100 studies looking at the effectiveness of caudal epidurals.
The results showed very good short and long-term results of caudal epidural injections for disc herniations with sciatica.
For degenerative disc disease pain and chronic axial low back pain, there also are some beneficial results with caudal epidural injections, but the results were not as strong as for the sciatica variety. In addition, there was also a fair amount of good outcomes from caudal injections performed for post surgical pain such as with failed back surgery syndrome, along with spinal stenosis.
Here are a few examples of some of the studies available. One study showed over 80% good to excellent results for caudal epidurals in managing back pain with or without disc herniation. These amazing results lasted for upwards of a year.
One study looking at caudal epidurals for spinal stenosis showed over 60% pain relief for spinal stenosis at the three month timeframe, with almost half continuing to achieve excellent pain relief at the one-year point. Most studies looking at caudal epidurals for disc herniations and sciatica show between 40 and 80% pain relief with a series of injections over 3 to 12 months.
Risks of Caudal Injections
The risks involved with caudal epidural injections are very low. There is a small risk of infection, nerve injury, bleeding or allergic reaction to the medications used.
There may also be a transient reaction to the cortisone including weight gain, water retention, elevated blood sugars or some facial flushing.
The Bottom Line
Overall, caudal epidural steroid injections represent an excellent procedure for those suffering from disc herniations, sciatica, chronic low back pain, spinal stenosis, and failed back surgery syndrome even if hardware is present.
One of the best reasons to opt for a caudal injection is when multiple levels appear to be the pain generator, as the injections allow the steroid medication to gravitate towards numerous areas including the front of the epidural space.