Caudal Epidural Steroid Injection
Low back pain is a common condition; it has been estimated that approximately 40-70% of adults will suffer from some type of low back pain at some point during their lifetime. A preferred treatment option for patients suffering with chronic low back pain has been caudal steroid injections. These injections usually include a mixture of a steroid and an anesthetic, which is injected into the lower back region, to help reduce nerve pain.
Epidural steroid injections are the most frequently used technique for treating episodes of acute and chronic back pain. This is possibly due to the fact that the procedure is relatively simple and produces the desired effects quickly. Many patients immediately notice a reduction in pain and are almost immediately able to resume normal functioning.
One report that investigated epidural steroid injections found that almost three quarters of the study sample noted a significant improvement in their daily functioning after treatment. A recent meta-analysis investigated the effectiveness of caudal steroid injections over the past ten years; the findings support the use of steroid injections for pain management.
It is believed that epidural steroid injections help relieve nerve pain by way of their anti-inflammatory action. In addition to their anti-inflammatory properties, steroids possess other characteristics that may help to relieve pain.
For instance, steroids act to provide stabilization of the membranes of the nerves and help to inhibit ion conduction. These two mechanisms of action are viable explanations as to how epidural steroid injections help to provide pain relief.
What is a Caudal Epidural Steroid Injection?
How a Caudal Steroid Injection is Performed
The spinal cord is surrounded by cerebrospinal fluid (CSF) that acts to protect the nerve bundles in the vertebral canal.
The spinal cord and nerve bundles are held in place by a durable membrane, and outside of this membrane is the epidural space.
This is where the caudal steroid injection is given as it is where the irritated nerve roots are located.
A caudal steroid injection includes two kinds of medication: a steroid and an anesthetic (i.e. lidocaine). The steroid is injected to help reduce inflammation and irritation of the affected area while the anesthetic is believed to interrupt nociceptor transmission, helping to reduce pain. Caudal steroid injections are usually only injected into the areas that are the most inflamed. This is to help reduce patient exposure to steroids.
Caudal steroid injections are relatively non-invasive, easy to perform in an outpatient setting, and are usually painless. It is expected that patients who receive a steroid injection will feel an instantaneous reduction or possibly an elimination of pain after the injection. There is some evidence to suggest that patients who only report a modest decrease in pain to the initial steroid injection may benefit from having several injections over the course of a year.
Conditions Related to Caudal Steroid Injection
Caudal steroid injections are often used to treat nerve pain in the lower extremities and back.
A variety of other conditions can be effectively treated with caudal steroid injections, including:
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Lumbar radiculopathies
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Degenerative spinal stenosis
Conclusions
Nerve pain that is associated with irritation and compression of the lumbar spinal nerves can be treated with a relatively non-invasive and quick caudal steroid injection.
When spinal nerves are irritated or compressed, patients may report pain radiating to the buttocks and even into the lower extremities.
Steroid injections are thought to provide pain relief by exerting their anti-inflammatory effects around the injection site.
Many patients report an almost immediate reduction in pain following a caudal steroid injection.
Oftentimes, patients will report long-term pain relief benefits following caudal steroid injections. However, for those who do not report long-term relief, multiple injections can be offered, as this is a safe and effective treatment option. Patients are encouraged to discuss their pain symptoms with their physician to determine if a caudal steroid injection may be beneficial for their condition.
References
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Andreisek G, Jenni M, Klingler D, Wertli M, Elliott M, Ulbrich EJ, Winklhofer S, Steurer J. Access routes and reported decision criteria for lumbar epidural drup injections: A systematic literature review. Skeletal Radiol;2013:42(12)1683-92.
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Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: Evidence-based practice guidelines in the management of chronic spinal pain. American Society of Pain Physicians. Pain Physician. 2007;10(1):7-111.
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Cervera-Irimia J Tome-Bermejo F. Caudal epidural steroid injection in the treatment of chronic discogenic low back pain. Comparative, prospective and randomized study. Rev Esp Cir Ortop Traumatol. 2013;57(5):324-332.
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Friedman JH, Dighe G. Systematic review of caudal epidural injections in the management of chronic back pain. RI Med J. 2013;96(1):12-6.
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Manchikant L, Cash KA, McManus CD, Pampati V. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain. J Pain Res. 2012;5:381-90.
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Manchikanti L, Falco FJ, Pampati V, Cash KA, Benyamin RM, Hirsch JA. Cost utility analysis of caudal epidural injections in the treatment of lumbar disc herniation, axial or discogenic low back pain, central spinal stenosis, and post lumbar surgery syndrome. Pain Physician. 2013;16(3):E129-43.
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Murakibhavi VG, Khemka AG. Caudal epidural steroid injection: A randomized controlled trial. Evid Based Spine Care J. 2011;2(4):19-26.
The long-term effectiveness of steroid injections is not completely clear. While some patients report long-term pain relief benefits following their injection, some have not.
However, patients can have several injections over a one-year period if they do not receive long-term relief as these injections are generally regarded as safe.
