Caudal Epidural Steroid Injection

Access to the irritated nerves and herniated discs of the lumbar spine is via several approaches. Amongst the most straightforward, more easily accessible approach is the caudal approach, hence the caudal epidural steroid injection.

This approach delivers steroid and local anesthetic to the lower portions, notably the L5/S1 disc herniation, via an injection through the tailbone.

After IV access, the patient is positioned facedown and made comfortable.
The tailbone is visualized using x-ray guidance or fluoroscopy, and a slight depression in the upper part of the coccyx is noted. This is called the sacral hiatus.
Local anesthetic is infiltrated at this location, and the epidural needle is guided under x-ray visualization into the epidural space.
Confirmation of location is via administration of a small amount of x-ray Inc. or contrast material.
When this is viewed from the side, it appears as a thin dark line between the bones of the outer part of the sacrum.
When this is viewed from top to bottom, it assumes a Christmas tree appearance, with the branches being the sacral nerves.

Once satisfactory location confirmation is obtained, steroid mixed in a local anesthetic/saline solution is administered in slow doses.
The needle is removed area is cleaned, and Band-Aid is applied.
The patient is given some time to recover and discharged home.)

Risks and complications are the same as for lumbar epidural.

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Before and After the Procedure and the Risks

Before the Procedure

Since you will be receiving medication, it is recommended that you do not eat within four or five hours before the procedure. If you are a diabetic, be sure to discuss your eating and medication schedule with your doctor. You may need to stop taking certain medications several days before the procedure. Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements. The doctor will tell you if and when you need to discontinue the medications. It is very important to tell the doctor if you have asthma, had an allergic reaction (i.e. hives, itchiness, difficulty breathing, any treatment which required hospitalization) to the injected dye for a previous radiology exam (CT scan, angiogram, etc) or if you have had an allergic reaction to shellfish (shrimp, scallops, lobster, crab). The doctor may prescribe some medications for you to take before having the procedure. Tell the doctor if you develop a cold, fever, or flu symptoms before your scheduled appointment.

After the Procedure

You may experience some weakness and/or numbness in your legs (lumbar injection), arms (cervical injection), or chest wall (thoracic injection) for a few hours after the procedure. If so, do not engage in any activities that require lifting, balance and coordination. Drink plenty of clear liquids after the procedure to help remove the dye from the kidneys. Do not drive for the remainder of the day. Please have an adult drive you home or accompany you in a taxi or other public transportation. Depending on how you feel, you may resume normal activities and return to work the following day. If the doctor prescribes physical therapy, it is very important that you continue with the physical therapy program. Although you may feel much better immediately after the injection (due to the numbing medicine), there is a possibility your pain may return within a few hours. It sometimes takes a few days for the steroid medication to start working.

Procedure Risks

The risks, although infrequent, include: Allergic reaction to the medication; Nerve damage; Bruising at the injection site; Infection at the injection site; Puncture of dura resulting in a headache. If you experience severe back pain, new numbness, or weakness of your legs, a headache that will not go away or signs of infection in the area of the injection, you should call the doctor right away.