Lumbar caudal epidural steroid injection is an outpatient nonsurgical minimally invasive procedure that is done at the lumbar epidural space to help reduce inflammation and relieve pain at the lower back and leg.
It is a common method which is used to treat inflammation and pain associated with lower back, buttock and down towards the leg.
The procedure entails injecting both a corticosteroid and an anesthetic numbing agent into the epidural space to reduce inflammation and relief the pain.
What leads to pain at the lumbar epidural region?
The spinal nerves may become inflamed due to the narrowing of the passageway where the nerve passes through in and out of the spine.
Narrowing of the passageway may be as a result of bone spurs, discs herniation, spinal stenosis, joint cysts, thickening of the ligaments or abnormal alignments of the vertebral column.
If a disc tear, chemicals inside the disc may leak out, causing the nerve root or dura to irritate and inflame. A large disc tear may also lead to bulging of the disc, causing the nerve root to inflame and also lead to pain.
The epidural space is an area between the bony vertebra and the protective sac of the spinal nerves that are filled with fat. The epidural space provides cushioning for the nerves and the spinal cord.
Who is an ideal candidate for Lumbar caudal epidural steroid injection?
Patients who are going through long-term pains at their lumbar back area are generally ideal candidates for this procedure. However, patients with any of these conditions below are rightful candidates for this procedure:
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Herniated disc
When a disc is herniated, the disc could rupture which causes chemicals to leak out of the disc. The chemicals cause irritation to the nerve roots and lead to inflammation. The disc may also bulge out which could inflame the surrounding nerves.
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Spinal stenosis
This is the narrowing of the spinal passageway and nerve root canal which lead to lower back pain and leg pain.
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Degenerative disc
Aging of the intervertebral disc could lead to breakdown or collapse of the disc space, growth of bone spurs or tears in the annulus.
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Spondylolisthesis
This is the weakness or fracture between the upper facets and the lower facets of the vertebra. The vertebra may slip forward and compress the nerve roots which lead to pain.
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Sciatica
This is mostly caused by the compression of the first sacral nerve.
Patients with bleeding problems, infections, diabetes may not be eligible for the procedure. Pregnant women may also not be eligible and should speak with their doctors first.
Before the procedure
Before undergoing the procedure, your doctor will first need to review your medical history and previous imaging tests to ascertain the best approach for the treatment.
If you are on a blood-thinning medication, you may have to stop taking it for several days before the procedure. It is very important that you inform your doctor about any medications that you are currently taking. Also, inform your doctor of any allergies you may have.
Bring someone or a family member along with you when coming to the clinic on the day of the procedure. This is important because you can’t drive home by yourself after the procedure. Someone else needs to drive you home.
Be at the clinic at least 30 minutes before the start of the procedure.
How is Lumbar caudal epidural steroid injection procedure done?
The procedure is done with the patient lying on the stomach on the procedure table. A local anesthetic is used to numb the area at the injection site. This is to reduce discomfort and pain. The patient is meant to stay conscious all through the procedure.
The doctor then inserts a needle with the aid of a fluoroscope into the epidural space. The fluoroscope helps the doctor to see through the skin so as to know if the needle is in the right position. The doctor may inject a contrast dye to see the position of the needle more clearly.
When the doctor sees through the monitor that the needle is in the right position, a corticosteroid medication such as triamcinolone, methyl-prednisolone or dexamethasone is applied to reduce the inflammation and an anesthetic agent such as lidocaine or bupivacaine is also applied to heal the pain.
The medication injected will often spread over several spinal segments and cover both sides of the spinal canal. The injected might also be injected at either side of the spinal canal so that the medication can get to each canal.
After the medication has been successfully injected, the doctor will then slowly remove the needle and clean up the skin around the injection site.
The procedure usually takes between 20 – 40 minutes to complete.
After Lumbar caudal epidural steroid injection
After the procedure, the patient will be taken to a recovery room and monitored for about 30 minutes. Some patients may be able to walk around after the procedure. Patients may feel soreness or irritation at the injection site. This may be for a few minutes or hours and can be relieved by applying ice pack.
The patient will be given instructions to follow and may also be given a pain diary to record the pain level and recovery process.
The corticosteroid will usually start working within 1–3 days, hence the patient might start to feel an increase in pain as the anesthetic starts to wear off.
You need to ask someone to drive you home due to the effect of the medication used.
Results of the procedure
Many patients experience pain reliefs after undergoing this procedure. Duration of the pain relief varies depending on individual patients and the severity of the nerve damage. Pain relief could last for several weeks to years.
Potential risks and complications that could occur
This procedure is generally a safe procedure, however, some patients might experience some side effects such as:
- Anxiety
- Steroid flush
- Inability to sleep well
- Changes in the menstrual cycle
- Elevated blood such in diabetic patients
- Mood swings
- Water retention
- Weight gain
- Numbness or mild muscle weakness
- Bleeding
- Infection
- Allergic reaction
- Rare cases of nerve damage or paralysis