Caudal epidural injection

What is a caudal epidural injection?

A caudal epidural injection is a common treatment for lower back and leg pain. It involves injecting an anti-inflammatory medication into a specific area of your spine called the “epidural space” to help treat the pain and other symptoms you are experiencing.

Caudal epidurals are sometimes confused with lumbar epidurals. They're essentially the same, but the difference is where the injection is performed. In a caudal epidural, it’s injected into the tailbone area of the spine, while with the lumbar variety, it goes into an epidural space in your lower back.

What are the benefits of a caudal epidural injection?

There are a number of benefits of a caudal epidural injection, including:

• Fast, effective relief from pain that can last up to a few months at a time
• Improved mobility by reducing stiffness in your lower body
• Reduced reliance on pain medication
• Delays the need for more invasive treatments, such as surgery
• Improved quality of life

What else is a caudal epidural injection known as?

You may also hear of a caudal epidural injection referred to as a caudal steroid injection, caudal block, caudal epidural steroid injection CESI) or a spinal block.

How does a caudal epidural injection work?

A caudal epidural injection contains a combination of local anaesthetic and anti-inflammatory medications, sometimes called steroids. When these are injected into the epidural space in your spine, they have several effects.

First, the local anaesthetic numbs the nerves in the space for several hours, providing fast, short-term pain relief. Second, the steroid medication gets to work reducing inflammation around the nerves, ensuring longer-term relief.

What conditions can a caudal epidural injection treat?

A caudal epidural injection can be used to treat a wide range of conditions, including:

• Sciatica – a condition characterised by pain that runs from the lower back, into the buttocks and down the legs, sometimes as far as into the feet. It’s caused by compression or irritation of the sciatic nerve.
• Spinal stenosis – this is where the spaces within your spine narrow, causing pressure on your spinal cord and nerves that triggers pain and other symptoms. It’s usually caused by age-related wear and tear.
• Degenerative disc disease – not an actual disease, but a term used to describe the natural deterioration of the soft discs in your spine. It too is usually a result of wear and tear as you get older.
• Herniated discs – this is a term used to describe a disc that bulges out of place, irritating the surrounding nerves. It can be caused by wear and tear, or by a traumatic injury.

Caudal epidural injections for chronic lower back pain

Chronic lower back pain is pain and stiffness in the lower part of your back that lasts 12 weeks or longer. It can be caused by many things, including those we have listed above. Other causes include things like muscle or ligament strains caused by repeated heavy lifting or bending in an unsafe way, or bone conditions like osteoporosis. It can also be unexplained, such as in the case of conditions like fibromyalgia.

Caudal epidural injections can be used to treat some types of chronic lower back pain, but not all. Always listen to the recommendations of your doctor.

How do I know if I need a caudal epidural injection?

You may be a good candidate for a caudal epidural injection if you are experiencing chronic lower back, buttock or leg pain that is believed to be caused by sciatica, herniated disc, degenerative disc disease or spinal stenosis. Usually, an epidural injection will only be recommended when other non-invasive treatments and therapies, such as rest, pain medication and physiotherapy, have been unsuccessful.

Who is not suitable for a caudal epidural injection?

You may not be suitable for a caudal epidural injection if you:

• are pregnant
• have an allergy to any of the ingredients in the medications being injected
• have a skin infection in the area to be injected

Every treatment decision is made on a case-by-case basis, and your doctor needs to believe the benefits of treatment will outweigh any perceived risks.

What are the alternatives to a caudal epidural injection?

There are several alternatives to a caudal epidural injection, including other types of spinal injection, oral or topical pain medications, physiotherapy and surgery.

Caudal epidural injection vs other spinal injections - what is the difference?

A caudal epidural injection goes in through the very bottom of the spine. Other spinal injections are usually put in higher up or aimed at a more specific nerve, so they can be more targeted. In simple terms, the caudal injection is a broader approach, and the others are significantly more targeted.

How can I prepare for a caudal epidural injection?

As an outpatient appointment, preparing for a caudal epidural injection is straightforward. However, it’s important that you follow all preparatory steps as recommended by your doctor. These will include:

• arranging for someone to drive you home after your treatment
• not eating solid food for at least six hours before your procedure
• drinking only clear liquids until up to two hours before your procedure
• arriving in comfortable clothing, with good access to your lower back/tailbone
• stopping any medications in advance if advised by your medical team.

What should I expect during a caudal epidural injection?

You’ll be asked to lie down on a table with your lower back/tailbone area exposed. You may be given an intravenous sedative to help you relax, and this is delivered via a cannula into the back of your hand.

Once you’re comfortable, the skin across your lower back/tailbone will be sterilised. Your doctor will inject a local anaesthetic into your skin at the base of your spine, which will numb the area. You may feel a slight scratch when this happens, but the anaesthetic will quickly take effect.

Your doctor will then use an X-ray to help them guide the injection into the right area of your spine. Sometimes a small amount of contrast dye is injected first, which helps them to ensure that the medication will be delivered exactly where it’s needed. After this, the medication will be administered via injection into your spine. It shouldn’t hurt, but you may feel some pressure or a heavy sensation.

Once the injection is over, the needle will be removed and a small dressing placed over the site. You’ll then be taken to a recovery area for the sedation to wear off, before you are allowed to go home.

How long does a caudal epidural injection take?

The entire procedure usually takes less than 30 minutes, including preparation time.

What type of anaesthetic is used for a caudal epidural injection?

In most cases, your injection will use a combination of a fast-acting local anaesthetic like lidocaine with a longer-acting one such as bupivacaine. This is in addition to the anti-inflammatory medication (corticosteroid).

How long does it take to recover after a caudal epidural injection?

Getting back to your usual activities after a caudal epidural injection is usually fast, with most people able to return to their daily routine within 48 hours. However, it will probably take longer for you to feel the full benefit of your treatment – anywhere from two days to two weeks.

Can I drive home after a caudal epidural injection?

No. If you’ve had sedation, you won’t be able to drive for at least 24 hours, to allow the sedative time to process out of your body. Driving before this time is unsafe and could invalidate your insurance. Even if you’ve not had sedation, your legs will be weaker and less responsive than usual, making it unsafe to drive.

What are the side effects and complications of a caudal epidural injection?

As with any procedure, there are some side effects and complications associated with a caudal epidural injection that you should be aware of. Your doctor will explain these to you in full, but they could include:

• Bruising or a small hematoma at the injection site
• A temporary increase in pain for a few days after the injection
• Bleeding
• Infection, which is rare but can be serious
• Headache
• Feeling faint or a drop in blood pressure
• Temporary numbness or weakness in the buttocks or legs
• Temporary trouble passing urine or bladder control changes
• Flushing, nausea, or insomnia
• Raised blood sugar for a short time, especially in people with diabetes
• Rare but serious nerve injury, cauda equina syndrome, or permanent nerve damage.

If you’ve got any concerns after your caudal epidural, speak to your medical team right away.

How much does a caudal epidural injection cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.