What is a Caudal Steroid Injection?

Caudal steroid injections explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s Top Pain Doctors

Caudal Steroid InjectionCaudal steroid injections are a form of low back treatment that typically involve the combination of anaesthetics and steroids to reduce or relieve nerve pain. Chronic back pain, especially in the lower region, is a commonly reported complaint. The occurrence of lower back pain in adults is estimated to be between 40% and 70%. Caudal steroid injections have been shown to be especially effective at treating chronic lower back pain.

It has also been well documented that epidural steroid injections are commonly utilized to treat acute and chronic pain. This approach is gaining popularity and it is probably because it is a relatively quick procedure that provides patients with rapid and lasting pain relief. In actuality, most patients experience an almost immediate effect after receiving a steroid injection. As a result, many individuals can begin to resume their daily activities directly after undergoing this procedure.

According to a recent study regarding epidural steroid injections, approximately 75% of the patients experienced a significant improvement in mobility and quality of life after treatment. An additional meta-analysis study reviewed reports from over the last ten years regarding the effectiveness of caudal steroid injections. The findings support previous information which indicated that steroid injections are useful for managing pain.

The exact mechanism of action is not clearly understood, but it is proposed that steroid injections have anti-inflammatory properties that lead to the reduction of both nerve pain and inflammation. However, steroids have additional properties that appear to contribute to the effectiveness. For instance, steroids also have the ability to stabilize nerve membranes and hinder ion conduction; both of these processes are associated with the reduction of pain.

The mechanism behind the long-term effects of steroid injections is also unclear. This is because some individuals experience relief that last for long periods, while others do not. Despite the difference in long-term effects, steroid injections are safe and patients who did not experience pain relief for long periods after the initial injection may receive repeated treatments over one year in order to manage their pain.

How is a Caudal Steroid Injection Performed?

Cerebrospinal FluidThe spinal cord is surrounded by what is known as cerebrospinal fluid (CSF). This fluid protects nerve bundles in the spinal cord. The spinal cord is encased within the spinal canal and held firmly in place by a robust membrane. The area just outside of this membrane, called the epidural space, is the region that steroids are injected into. The roots of the irritated nerves are located in this area and delivering the steroid to the roots leads to the alleviation of pain. However, additional pain-relieving medications are also administered during the procedure. More specifically, steroids are administered to decrease painful inflammation and irritation of the nerve roots and an anaesthetic (e.g. Lidocaine) is injected as well. The anaesthetic is believed to alleviate pain by disrupting nociceptor transmission. Steroids are generally only administered to regions where significant inflammation is present as a means of reducing the amount of medication that healthy nerve roots and tissue will be exposed to.

Caudal steroid injections are non-surgical procedures that are easily administered in outpatient settings and are practically painless. Based on previous reports, most patients who receive steroid injections generally experience an immediate decrease or complete alleviation of pain after the injection. According to a study that evaluated the administration of repeated injections, receiving several injections over a one year period tends to increase the effects. This improves the chances that a patient who only moderately responded to the initial injection will experience complete pain relief.

Conditions Related to Caudal Steroid Injections

Herniated DiscCaudal steroid injections are typically performed by anaesthesiologists to manage nerve pain in the lower back. There are various conditions that can be treated with caudal steroid injections.

Common conditions include:

  • A bulging or herniated disc
  • Sciatica or lumbar radiculitis
  • Degenerative lumbar spinal stenosis

Conclusion

Caudal steroid injections are a form of pain treatment that is quick and practically painless. This procedure is typically performed when irritated and compressed nerve roots along the spinal cord are causing pain. The nerves extend into the lower regions of the body and this often causes pain that radiates down the buttocks and the legs.

The effectiveness of steroid injections is attributed to their anti-inflammatory properties, but literature indicates that the exact mechanism is unclear. Most patients who receive caudal steroid injections experience immediate pain relief and can quickly return to their normal daily routines.

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References

  1. Andreisek G, Jenni M, Klingler D, Wertli M, Elliott M, Ulbrich EJ, Winklhofer S, Steurer J. Access routes and reported decision criteria for lumbar epidural drup injections: A systematic literature review. Skeletal Radiol; 2013:42(12)1683-92.
  2. Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: Evidence-based practice guidelines in the management of chronic spinal pain. American Society of Pain Physicians. Pain Physician. 2007;10(1):7-111.
  3. Cervera-Irimia J Tome-Bermejo F. Caudal epidural steroid injection in the treatment of chronic discogenic low back pain. Comparative, prospective and randomized study. Rev Esp Cir Ortop Traumatol. 2013;57(5):324-332.
  4. Friedman JH, Dighe G. Systematic review of caudal epidural injections in the management of chronic back pain. RI Med J. 2013;96(1):12-6.
  5. Manchikant L, Cash KA, McManus CD, Pampati V. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain. J Pain Res. 2012;5:381-90.
  6. Manchikanti L, Falco FJ, Pampati V, Cash KA, Benyamin RM, Hirsch JA. Cost utility analysis of caudal epidural injections in the treatment of lumbar disc herniation, axial or discogenic low back pain, central spinal stenosis, and post lumbar surgery syndrome. Pain Physician. 2013;16(3):E129-43.
  7. Murakibhavi VG, Khemka AG. Caudal epidural steroid injection: A randomized controlled trial. Evid Based Spine Care J. 2011;2(4):19-26.