A caudal injection is a medical procedure that manages pain, particularly in the lower back and legs. It involves delivering anti-inflammatory medication, often corticosteroids and local anesthetics, into a specific area at the base of the spine. This targeted approach reduces inflammation and discomfort from various spinal conditions. The procedure is typically outpatient, allowing individuals to return home the same day.
Understanding the Caudal Space
The caudal space, also known as the sacral epidural space, is at the bottom of the spine, above the tailbone (coccyx) and within the sacrum bone. This area contains an opening called the sacral hiatus, which serves as a natural entry point to the epidural space. The epidural space is a region surrounding the spinal cord and its nerves.
The sacral hiatus is bordered by two bony projections called sacral cornua. Injecting medication into this lower part of the epidural space allows it to spread upwards, reaching irritated or inflamed spinal nerves in the lower back. This anatomical access allows caudal injections to deliver pain-relieving substances directly to the affected neural structures.
Conditions Treated with Caudal Injections
Caudal injections treat chronic pain originating from the lower back, buttocks, or legs. They address pain caused by inflammation and irritation of spinal nerve roots. Conditions such as sciatica, involving radiating pain down the leg due to sciatic nerve compression, are frequently treated.
The injections also help manage discomfort from lumbar radiculopathy, where nerve roots in the lower spine become inflamed or compressed. Other indications include pain from herniated or bulging discs, spinal stenosis, and degenerative disc disease. The anti-inflammatory medication works to reduce swelling around the affected nerves, thereby lessening pain and improving function.
The Caudal Injection Procedure
Before a caudal injection, the patient lies face down on a treatment table. The medical professional cleans and sterilizes the injection site. A local anesthetic is then administered to numb the skin and superficial tissues, minimizing discomfort during the needle insertion.
Using imaging guidance, such as fluoroscopy or ultrasound, the physician carefully inserts a thin needle into the sacral hiatus, accessing the caudal epidural space. A contrast dye may be injected to confirm the correct needle placement within the epidural space. Once confirmed, a mixture of corticosteroid and a local anesthetic is slowly injected. The procedure usually takes about 15 to 30 minutes.
What to Expect After a Caudal Injection
Following a caudal injection, patients are monitored for a short period before being discharged. It is common to experience mild soreness or bruising at the injection site, which usually resolves within a few days. Patients are advised to avoid strenuous activity and driving for at least 24 hours after the procedure.
Pain relief from the injection may not be immediate; it often takes two to three days for the medication to begin reducing inflammation, with the full effect potentially noticeable within a week or up to 10 days. Some individuals might experience a temporary increase in pain before the steroid medication takes effect. Other temporary side effects can include facial flushing, temporary numbness, or weakness in the legs due to the local anesthetic. Patients should contact their healthcare provider if they experience severe headaches, fever, or new or worsening numbness or weakness in their legs.