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 and is used to treat low back pain. This injection includes 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.
The following patients should not have this injection: if you are allergic to any of the medications to be injected, if you are on a blood-thinning medication (. Coumadin, injectable Heparin), or if you have an active infection going on. With blood thinners like Coumadin, your doctor may advise you to stop this for 4-7 days beforehand or take “bridge therapy” with Lovenox prior to the procedures. Anti-platelet drugs like Plavix may have to be stopped for 5-10 days prior to the procedure. Aspirin should be stopped for cervical procedures for 10 days prior, but not for Lumbar.
Epidural steroid injections are commonly prescribed for patients with a disc injury or spinal arthritis causing nerve irritation, and generally consist of local anesthetic (numbing medication such as lidocaine) and cortisone (a steroid that reduces inflammation and pain). Lidocaine is often injected initially so patients experience minimal, if any, pain during the procedure. The injection may be performed by placing the needle posteriorly between the spine bones (Translaminar or interlaminar) and injecting the medicine into the space around the spinal nerves. A transforaminal ESI means the injection is placed slightly to one side of the spine, and the medicine is injected near the ruptured disc and inflamed spinal nerve. A caudal ESI is performed by placing the needle near the tailbone, and injecting the medicine into the region of the sacral nerves and lower lumbar spinal nerves. Epidural steroid injections, as well as most spinal injections, are performed using a special x-ray guidance system called fluoroscopy. This allows the doctor to immediately see an x-ray image on a television screen and inject the medicine precisely into the right spot. The procedure time is often less than 10-15 minutes.