Caudal Epidural Injection
What is the epidural space?
The covering over the nerve roots in the spine is called the dura. The space surrounding this dura is called the epidural space. This space is commonly used to deliver medications to the spine. Nerves travel through the epidural space before they travel down into your legs. The nerves leave the spine from small nerve holes, foramen. Inflammation of these nerve roots may cause pain in your hip, buttock and legs. These nerve roots may become inflamed due to irritation from a damaged disc or from contact with a bone spur.
What is a caudal epidural injection and why is it helpful?
A caudal epidural injection places anti-inflammatory medicine into the epidural space to stop nerve root inflammation, therefore hopefully reducing hip, buttock and leg pain. This is more commonly used in those with previous back surgery to avoid the scar tissue at the surgical levels. By stopping or limiting nerve root inflammation we may be able to reduce your pain. The epidural injection may assist the injury to heal by reducing inflammation. Although not always helpful, it usually reduces pain within three to seven days. It may provide permanent relief or provide a period of pain relief that will allow other treatments like physical therapy to be more effective.
What happens during the procedure?
The physician will numb a small area of skin just above the crease in between your buttocks which may sting for a few seconds. Next, the physician will use X-ray guidance to direct a small needle into the epidural space through the tiny bone opening (sacral hiatus) just above the crease in between your buttocks. He will then inject contrast dye to confirm that the medicine spreads to the affected nerve root(s) in the epidural space. If the medicine does not travel high enough to reach the affected nerve root(s) the physician may use a small catheter to reach the target epidural space. After this, the physician will inject a combination of numbing medicine and anti-inflammatory steroid.
What happens after the procedure?
A dressing may be applied to the injection site. You will remain in the office for about 15-20 minutes and the nurse will monitor your blood pressure and pulse. The nurse will review your discharge instructions and you will be able to go home. You may experience numbness or weakness to the affected limb for a few hours after the procedure. If this happens do not walk without assistance. Your physician may refer you to a physical therapist or chiropractor immediately afterwards while the numbing medicine is effective and over the next two weeks
while the cortisone is working. It may be beneficial to repeat the procedure in about two weeks. A series of treatments (up to four injections one to two weeks apart) often proves more helpful than a single injection.
General Pre/Post Instructions
You may eat a light, but not full meal at least one hour before the procedure, unless receiving intravenous sedation. If you are an insulin dependent diabetic do not alter your normal food intake.
Take your routine medications before the procedure (such as high blood pressure and diabetes medications) except for those that need to be discontinued five days before the procedure such as aspirin and all anti-inflammatory medications (e.g. Motrin/Ibuprofen, Aleve, Relafen, Daypro). These medicines may be re-started the day after the procedure. You may take your regular pain medicine as needed before/after the procedure. If you are taking Coumadin, Heparin, Lovenox, Plavix or Ticlid you must notify the office so that the timing of stopping these medications can be explained.
You must bring a driver with you. You may return to your current level of activities the next day including return to work.
Things that may Delay the Procedure
If you are on antibiotics please notify our office; we may delay the procedure. If you have an active infection or fever we will not do the procedure.