Caudal Steroid Injections

A low back (caudal) steroid injection can help reduce lower back and leg pain caused by sciatica, spondylosis, facet joint pain, spinal stenosis, herniated discs, and other back problems. The injection occurs in your back, into the area between the membrane that contains the spinal fluid and the thickest ligament between your vertebrae. Learn more about this procedure, its risks, and how it may help you manage your chronic pain.

A low back (caudal) steroid injection is an injection into the lowest portion of the epidural space (a fat-filled area that covers the spinal cord to protect it and the surrounding nerves from damage). The injection can help reduce chronic lower back and leg pain caused by sciatica, spondylosis, facet joint pain, spinal stenosis, herniated discs, and other back problems.

Once injected, the steroid medication moves up and down the spinal canal to coat the nerve roots near the injection area. Sometimes pain relief is short term; other times, the benefits continue for some time.

The procedure itself takes a few minutes and there are minimal risks associated. Caudal steroid injections are often recommended before attempting surgery.

With any procedure, there are different types of risks. Your doctor will explain the specific risks of your procedure. These potential risks are common to many spinal injections:

• Nerve problems that cause arm and leg weakness
• Increasing feelings of numbness
• Increased pain (may be brief or long term)
• Incontinence
• Post-injection headache (also known as “spinal headache”)
• Bleeding
• Infection
• Stroke
• Spinal cord injury
• Sleeping problems

The following are potential benefits to caudal steroid injections:

• May relieve or diagnose pain
• Caudal injections are less invasive than surgery, fewer risks
• Allows fast recovery
• Does not require a hospital stay

There are a few things you can do to make your procedure go smoothly:

• Bring any x-ray films, MRIs, CT scans, or any other test results with you to your appointment.
• Bring a list of all your current medications. This includes over-the-counter medicines and vitamins. Be sure to tell your healthcare providers if you have any allergies to medications.
• If the purpose of your injections is to diagnose, do not take pain medications. Arrive at your appointment feeling your usual amount of pain. This will help your healthcare provider determine if the injection relieved your pain.
• Ask your healthcare providers about eating and drinking before the procedure. You may be asked to not eat or drink anything for 4 to 8 hours before the procedure.
• Tell your healthcare providers if you are ill or pregnant. If you have a cold, flu, or other illness the day or the procedure, be sure to tell your healthcare providers. And be sure to tell your providers if there is a chance you may be pregnant.
• Wear comfortable clothing. Wear clothing that won’t rub against, or aggravate the site of the injection.

The injection takes only a few minutes, but plan on 30 to 60 minutes for the whole procedure. You will remain awake during the entire procedure. During the process of administering the injection:

• Your health care team will monitor your heart rate and breathing
• You will receive mild sedation to help you relax
• You may lie face down, face up, or on your side
• You will be given a local anesthetic near the injection site to numb the skin
• The doctor may inject a contrast dye that helps identify specific parts of your spine and confirm the correct needle placement
• Numbing medications, or steroids, will then be injected into your spine

You should feel results immediately following the injection.

If the spinal injection does not help, your physician may recommend physical therapy or surgery.

Call your doctor if you experience the following:

• Severe pain or headache
• Fever or chills
• Loss of bladder or bowel control
• Redness or swelling around the injection site
• Weakness or numbness

North American Spine Society:
https://www.spine.org/KnowYourBack/Treatments/InjectionTreatmentsforSpinalPain/EpiduralSteroidInjections.aspx

American Academy of Orthopedic Surgeons:
http://orthoinfo.aaos.org/topic.cfm?topic=A00560