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Caudal epidurals

What is a caudal epidural?

Caudal epidural steroid injections have been proven to be beneficial for the treatment of sciatica and back pain caused by disc injuries in the spine. The injection is introduced to the region of the spine where bulging or protruding discs can irritate the spinal nerves. The effect of the epidural injection is to surround these structures with anti-inflammatory steroid which promotes a reduction in swelling and pain.

The solution that is used for caudal epidural injections is a mixture of local anaesthetic and low dose steroid. The injection is introduced just above the coccyx (the tail-bone). The procedure is very straightforward and can be performed safely without the need for overnight stay or general anaesthetic.

Caudal epidurals are not particularly painful, although some patients sometimes feel a sensation of pressure as the fluid is injected. Occasionally the sciatic pain may feel worse temporarily. After the procedure you will be asked to rest at the clinic for a while (usually about half an hour) before going home.

Afterwards you may feel a little numb around the buttocks, and be a little unsteady in the legs. For this reason you are advised not to drive a vehicle or operate machinery until the next day. The benefit of the epidural may appear almost immediately or more commonly it may build up gradually over the next few weeks. It is extremely unlikely that you will experience any other significant side effects.

Because of the steroid component of the injection, some patients occasionally develop a facial flush the next day, which can last 12-24 hours. Rarely some women may notice some disruption of the menstrual cycle for one or two cycles, and this is nothing to worry about. Other possible complications such as infection and allergy are similar to those of any injection and are extremely rare. Allergic reaction occurs in approximately 1 in 7,000 cases and can be dealt with promptly. There is no clear evidence of any long term complication from epidural steroids.

How is a caudal epidural performed?

First of all an injection of local anaesthetic is applied to the skin just above the coccyx. The epidural needle is then introduced into the spinal canal through a ligament. Once the needle is in the correct place the anaesthetic and steroid solution is injected slowly over a period of several minutes. The solution spreads up the spinal canal to reach the level of the third lumbar vertebra. 

Recent controversy

In the last few years there have been several adverse reports about the use of epidural steroid epidurals in the media, causing unnecessary worry in people's minds. Despite their regular use for over 40 years, injectable steroids have never been officially licensed for use in the epidural space. Although a few isolated case reports of a condition called arachnoiditis have appeared there is no evidence of any definite causal link between epidural steroids and arachnoiditis.