Caudal Epidural Steroid Injection

Diseases for which injection may help:

• Lumbar spinal stenosis
• Lumbar radiculopathy
• Lumbar discogenic pain
• Lumbar herniated nucleus pulposus
• Lumbar spondylosis
• Post laminectomy syndrome
• Lumbar degenerative disc disease

Reason for injection: 

• Caudal epidural steroid injections treat pain in the low back and or legs
• Pain comes from problems in the spine, the nerves traveling through the spine, or the lumbar discs that are between the spinal vertebra bodies
• Conservative measures such as ice, rest, anti-inflammatory medication, neuropathic medication, and physical therapy are tried first
• Injection is used because of prior back surgery or because pain is thought to be due to the sacral nerves
• Sometimes these procedures result in less or no medication for your pain
• Procedures can sometime even help you avoid surgery

Description of procedure: 

• Performed in a surgery center as an outpatient procedure at Moores Cancer Center
• Check in 30 minutes before procedure; staff will answer any questions before procedure
• Your back will be cleaned with antiseptic solution and an x-ray will identify spot for injection
• Local anesthetic numbs the skin and a needle will be used to enter the epidural space
• Small amount of x-ray contrast will be injected into the needle to confirm needle is in right place
• Some patients feel pressure in the back or down their legs when medication is injection
• A small Band-Aid will be applied to your back and you will be taken back to recovery
• Discharge instructions will be reviewed and you will be able to go home as soon as you are ready

Preop instructions:

• Suggested you have a driver
• Review all your medication with us before the procedure
• If you take medication that affect your ability to form a blood clot (anticoagulants, such as Coumadin, Plavix, Lovenox) a specific plan should be in place - consult with physician
• All other medications should be taken as normal unless your physician tells you otherwise
• If you have any questions about your medications, please call the pain clinic (858) 657-6035

Post op instructions: 

• Take it easy day of injection and return back to normal activity the following day
• You may return to physical therapy after the injection, but let your therapist know you have undergone procedure

Potential side effects or risks:

• Site of injection can be sore after
• During first week pain may increase due to injection
• Ice, heat, and gentle massage can help prevent and or treat pain
• Sometimes pain relief from the steroids takes three to seven days to appear
• Patients sometime complain of red rash, which will go away on its own without treatment
• Patients who have diabetes can have an increase in their blood sugar due to the steroid and should pay close attention to their blood sugars
• Other risks include nerve damage, infection, bleeding, nerve damage, bowel/bladder problems, and sexual dysfunctions
• Please discuss any questions or concerns with your physician

Follow up and further care: 

• After the procedure you will be given instructions on how and when to follow up
• If another physician referred you directly to the procedure clinic, you will be asked to follow up with them
• If this is the first injection you may be prescribed two or three repeat injections over the next
• two to three months based on results
• If you get longer relief and the pain is reduced, some patients can get up to four or five injections spaced out over a year