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Adam Sewell MD

CAUDAL STEROID INJECTION

This treatment is a combination of a steroid and a local anesthetic that is delivered to your lower back to treat chronic back and lower extremity pain.

Most Common Conditions Treated Are:

Sciatica/Lumbar Radiculitis –This is a condition that is characterized by pain, weakness, or sensory changes along the sciatic nerve pathway in the lower extremity. Pain typically radiates down the back of the buttock into the lower leg and foot. Some people describe the sensory changes as “pins and needles” and “sharp shooting pain”.

Herniated/Bulging Disc (most common cause of sciatica) – Disk disease is one of the most common causes of chronic lower back pain and accounts for approximately 10% of all low back pain complaints. Between the vertebrae (spine bones), are discs that cushion impact received by the spinal column. Since the discs are designed to be pliable and supportive, they have a tendency to herniate (or bend/squeeze) backwards through the outer ligaments, causing irritation to adjacent nerves.

Degenerative Lumbar Spinal Stenosis (DLSS) – DLSS is a narrowing of the spinal canal, causing nerve impingement or encroachment. Spinal stenosis can result in persistent pain in the lower back and lower extremities, like the legs and feet. Those affected often complain of difficulty walking, chronic back and leg pain, and decreased sensation in the lower extremities. All of this results in diminished physical activity. Many people with spinal stenosis present with bilateral (both left and right) lower extremity pain radiation.

Procedure:

Caudal epidural steroid injections involve injecting a steroid into the epidural space, where the irritated nerve roots are located. The caudal injection is performed through the sacral opening. The combination treats low back pain. It has, both, a long-lasting steroid and an anesthetic (Lidocaine, Bupivacaine). The steroid reduces inflammation and irritation, while the anesthetic interrupts the pain-spasm cycle and nociceptor transmission (Boswell 2007). The medicines spread to the most painful levels of the spine, reducing inflammation and irritation. The entire procedure usually takes less than 15 minutes.

Epidural steroid injections often result in a rapid relief of symptoms. This allows patients to experience enough relief to become active and resume their normal daily activities.

A large study in 2005, included two hundred and twenty-eight patients with a clinical diagnosis of unilateral sciatica, who experienced a 75% improvement in pain over a placebo group in a three week period, when they received a caudal steroidal injection.  (Arden 2005).

This technique can be combined with other medications as well and a small catheter. Additionally, an Epidural Lysis or Racz Procedure can be performed to remove any pain-causing scar tissue. Scar tissue often results from prolonged irritation, inflammation, or previous surgery in the area and should be removed for effective pain management to continue.

Benefits:

Low back pain (LBP) is one of the most difficult conditions for physicians to treat. Commonly LBP goes into remission with periods of decreased or absent symptoms, but the pain can return, causing a chronic pain syndrome.

Treatment for LBP is specific to the type of injury presented. There are several options available ranging from surgery to acupuncture to physical therapy. Surgical procedures are typically done when conservative options are exhausted and are not successful in reducing pain. Surgery is also indicated when the LBP is causing new weakness, bowel or bladder incontinence, spinal instability, or infection. Potential causes for these changes include severe lumbar disc herniation, vertebral body fracture or displacement, and progressive spinal stenosis.

Degenerative lumbar spinal stenosis (DLSS) is the most common reason adults over the age of sixty-five receive spinal surgery (Barre 2004). More recently, a large study has shown that fluoroscopically (x-ray) guided, caudal epidural injections represent a relatively safe option for the management of DLSS generated pain (Barre 2004).

Risks:

Many people are afraid to undergo spinal surgery because of the risks perceived to be associated with it. However, the risks associated with Caudal Steroid Injections are low. This pain treatment is considered an appropriate non-surgical treatment for many patients who suffer from unrelenting back pain. Rare complications of the injection can include bleeding, infection, headaches, and nerve damage. The medications used can also cause pharmacological complications. These risks include allergic reaction, high blood sugar, decreased immune response, and the potential for weight gain. Along with proper technique, the procedural risks are reduced by using fluoroscopic guidance (x-ray/camera) to position the needle and monitor the proper spread of medication.

Outcome:

Many patients who receive Caudal Steroidal Injections enjoy improved function and diminished pain for years and can benefit from additional procedures for prolonged relief (Barre 2004).

If your pain has lasted longer than four weeks or is severe in nature you should see a pain specialist about the most appropriate treatment options. Early intervention may decrease the chances of developing a worsening chronic pain syndrome.

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