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Caudal Epidural Injections

Caudal epidural injections is a procedure of injecting substances (usually a combination of xylocaine mixed with diluted dextrose solution) to relieve pain in the low back below the level of the spinal cord right at the base of the tail bone.

What conditions does it help with

  1. Spinal stenosis – or narrowing of the spinal canal causing low back and nerve pain down the legs
  2. Disc related pain – from locally inflamed spinal discs
  3. Degenerative low back pain including bone spurs – which is not often helped and my even be harmed by surgery because of the danger of dealing with surgery near those hypersensitive nerves
  4. Postherpetic neuralgia
  5. Lumbar radiculopathy
  6. Diabetic polyneuropathy
  7. Post surgical spinal pain
  8. Complex regional pain syndrome


  1. Local infection
  2. Sepsis – a serous widespread blood infection
  3. Pilonidal cyst
  4. Other congenital abnormal low spine problems

What about the procedure itself?

Caudal epidural injection is a safe procedure when performed by a trained and highly skilled physician who has an in depth knowledge of anatomy and experience using this injection technique. The use of needles involves some risks but complications are rare.

Solutions have been shown to be safe and do not contain cortisone which can cause degeneration of joint and ligament tissue. The most common side effect is discomfort from the injections as well as temporary soreness, and occasional bruising. Although injection discomfort cannot be eliminated it is usually well tolerated in most cases. Local anesthetic is often used prior to the injections to decrease discomfort.

The procedure itself is ultrasound guided to ensure accuracy of the injection which is visualized on the screen. The area is injected just above the bottom edge of your tailbone. This injection spreads upwards to the area needing the relief. Patients are able to go home right after the procedure and pain relief can start almost immediately.

A light meal and plenty of water about 1-2 hours before the procedure is recommended. Water improves hydration and lessens the discomfort of the injections and food reduces the likelihood of dizziness or fainting. Most people can drive after the procedure but occasionally some people are very prone to faintness so if you are, please arrange for someone to drive you home after the treatment.

Caudal epidurals cannot cure every painful spinal condition but most patients treated by this will benefit tremendously. Treatments occur at intervals usually every 2 weeks and many people see longer lasting relief start after the third injection. Most people get longer term relief after an average of 7 treatments..

What are the major risks of Caudal Epidurals?

Risks are very low (less than 1%) with this procedure. They include:

Infection due to the needling. Therefore do not go into public swimming pools, hot tubs or lakes for 3-5 days after each treatment. Showering the day of or the next day is fine.

  1. Bruising – temporary
  2. Nerve irritation – this is temporary
  3. Allergic reaction – if you are allergic to corn or xylocaine
  4. Spinal headache – very rare since I am injecting below the level where the dura ends but even if it happens it is temporary and passes.