Caudal Steroid Injections

Lower back pain can be problematic for both the patient and the provider. Not only is it one of the most common pain conditions to treat, it is also one of the most difficult conditions to treat. The majority of people will experience lower back pain at some point in their life, with about one in five people experiencing chronic lower back pain. Thankfully, there are treatment options available to help alleviate the pain. The California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, and Chula Vista areas is well equipped to treat all forms of lower back pain with a goal to help their patients experience pain-free living. 

What is a Caudal Steroid Injection?

A caudal steroid injection is an injection of steroid medication into the caudal space in the lower back, which is located at the very end of the tailbone. This location is particularly important for treating low back pain because there are spinal nerves that run through the epidural space that connect with the legs. If these nerves become inflamed, you could experience leg or back pain. The injection is placed in the epidural space around the spine, which decreases the nerve pain. 

Caudal steroid injections are made up of a combination of a steroid and a local anesthetic, which helps to reduce inflammation and reduce pain. This specific injection helps to treat chronic back pain as well as lower extremity pain. 

What Conditions Does a Caudal Steroid Injection Treat?

Caudal steroid injections help to treat symptoms of pain that originates in the caudal area. Most pain sensations feel like either sharp and shooting pain, or pins and needles, that travel down the buttock into the legs. This pain is generally referred to as sciatica or lumbar radiculitis, which describes the type of pain versus a specific condition. The pain can lead to weakness or sensory changes along the sciatic nerve pathway in the lower back and lower legs, and can be caused by the following conditions: 

• Herniated discs: discs are cushions located in between the vertebrae in the spinal column that help to minimize impact on the spine. Due to the fact that these discs are pliable, there is opportunity for them to herniate or slip out of place when added pressure is applied. This causes pressure on surrounding nerves. Herniated disc is the most common cause of chronic low back pain and sciatica, and accounts for an estimated 10% of all low back complaints. 
• Spinal stenosis: spinal stenosis occurs as a result of a narrowing of the spinal canal, which puts pressure on the nerves. The main cause of spinal stenosis is wear and tear over the years, and is the main reason a person over the age of 65 receives spinal surgery. Spinal stenosis can cause severe lower back and lower extremity pain, with patients reporting difficulty walking, chronic low back and leg pain and decreased sensation in the lower extremities that ultimately leads to a decrease in physical activity and quality of life. While treatment does help to alleviate symptoms, some cases of constant sciatica pain can lead to a chronic pain condition. 
• Failed back syndrome or post laminectomy syndrome: this describes a surgery that was successful, but that did not have the desired results so the pain symptoms persist. Even after surgery, the pain can be similar or worse than before surgery, causing patients to search for other pain relief methods. 
• Degenerative disc disease: also referred to as Osteoarthritis of the spine, degenerative disc disease usually occurs in the neck or lower back. Caudal injections are especially helpful if degenerative disc disease has resulted in a herniated disc or if bone spurs develop and irritate nerve roots or the spinal cord. 

What Does a Caudal Steroid Injection Procedure Involve?

The caudal steroid injection procedure is a minimally-invasive and quick procedure that is performed in an out-patient setting, meaning that you can return home the same day. The patient will lie face down on an X-ray table and the provider will clean the injection area on the back before applying a topical anesthetic to numb the area. Some patients can also opt for a mild sedative if they are feeling anxious about the procedure. 

Once comfortable, the provider will use X-ray guidance to inject a die into the epidural space to confirm the correct injection location, and will then inject a combination of a long-lasting steroid and an anesthetic, which helps to provide pain relief and reduce inflammation. 

Providers might also choose to perform the Racz Catheter Procedure (Epidural Neurolysis), which is used to remove scar tissue around nerves in the epidural space of the spine so that the injected medication can work more efficiently. 

The entire caudal steroid injection procedure takes about 15 minutes. Most patients experience immediate pain relief, although they might feel sore at the injection site once the anesthetic wears off. Complete pain relief should be felt within 10 days. You should take the first day or two to rest, and use ice or over-the-counter medications to mitigate any post-injection pain. Normal activities can be continued the day after the procedure. 

What are the Risks and Benefits of Caudal Steroid Injections?

Caudal steroid injections are a popular option for patients who don’t want to (or can’t) undergo spinal surgery, who haven’t found relief with other conservative methods, or who don’t want to rely on taking medications long term. They are also a great option for improving function while experiencing pain relief, which helps patients take advantage of physical therapy efforts more comfortably. 

Studies have shown that not only are they a great tool for providing immediate relief of pain symptoms, caudal steroid injections also provide short-term lower back pain relief as well as effectively managing chronic pain in the long term. 

Due to the fact that it is a minimally-invasive treatment option, the associated risks are low. These could include: 

• Bleeding at the injection site
• Infection at the injection site
• Headaches
• Nerve damage

There are also potential risks with the medication itself, including: 

• High blood sugar
• Allergic reaction
• Short-term decreased immune system
• Possibility of weight gain

These risks should be as low as possible due to the fact that the provider uses X-ray guidance to expertly place the injection needle, and reviews the patient’s medical and health history prior to injection. 

If you are experiencing lower back pain and pain in the lower extremities, and haven’t been able to find relief with at-home methods, it’s important to reach out to your healthcare provider. Not only does treatment success rate increase when begun as quickly as possible, your pain management specialist will also help to ensure that the cause of the pain doesn’t get worse, leading to more issues and an increase of chronic pain. Please schedule an appointment today with the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, and Chula Vista areas so that we may help you experience pain relief.