Epidural steroid injections for pain management are some of the most commonly performed procedures for pain relief across the country on a daily basis. Epidurals for pain have been performed for over 50 years, and represent an excellent method for achieving pain relief, avoiding surgery and getting patients back to work and playing with their kids.
Of the three varieties of performing an epidural steroid injection, the caudal type is widely considered to be the easiest to perform. It is also unique in that it can easily be performed for those with post surgery pain that have hardware in place, and also represents an excellent procedure for those with nerve root compression at multiple spinal levels (e.g. spinal stenosis).
Caudal epidurals are performed in an outpatient setting such as in procedure room or ambulatory surgery center. Patients are placed in the prone position on a well padded table that allows x-ray beams to go through. Most modern pain management doctors in Los Angeles use fluoroscopy, which is a real time form of x-ray. This ensures the highest accuracy available.
Los Angeles pain clinic doctors placed a needle into lowest level of the spine, through an opening known as the sacral hiatus. Once the needle has reached through the entry point, contrast is placed to make sure that adequate gravitation of the medicine will occur. A larger amount of numbing medicine and steroid is placed when compared to the other two varieties of epidurals since the medicine is expected to cover a broader area than those types.
Hundreds of studies have looked at the effectiveness of caudal epidural injections for different types of pain. Overall, results have been extremely favorable for both short and long-term relief of sciatica and disc herniation related pain. A series of injections may be necessary for continued pain relief, however, results show that 60 to 90% of patients can achieve excellent pain relief for these conditions, with most studies showing a one year time point.
There are also studies looking at outcomes for spinal stenosis and post surgical pain, such as with failed back surgery syndrome. There are studies showing significantly beneficial pain relief for these conditions for both the short and long-term.
One area where the results have been noticeable but only fair have been for back pain due to discogenic disease or facet arthritis. Some studies have shown some benefit, but nowhere near as excellent results as for the other conditions. It would be better to perform a medial branch block or facet injection in these circumstances.
Complications associated with caudal epidural steroid injections are unusual. There is a low risk of infection, nerve injury, bleeding or failure to achieve pain relief. There are some potential transient complications associate with steroid medication, which may include weight gain, water retention, elevation of blood sugars and possibly some facial flushing.
Overall, the benefits of caudal epidural injections far outweigh the low risk of complications.
The bottom line with caudal epidural steroid injections is that they offer significant advantages in certain situations compared to the interlaminar and transforaminal variety of epidurals. They have shown excellent short and long-term results for sciatica and disc herniation related pain, and significant benefit for conditions where multiple nerve roots are being pinched such as with spinal stenosis.
In addition, they represent the only universal way of administering an epidural after failed back surgery with instrumentation being in place, and also the medication can reach the front area of the epidural canal whereas the other two cannot.
So there are significant benefits compared to the other varieties of epidural injections for numerous circumstances, and caudal epidurals have secured their place in the field of pain management by being able to achieve their main objective, which is pain relief, surgery avoidance and patient satisfaction.
If you or a loved one is suffering from acute or chronic back or leg pain due to spinal stenosis, a pinched nerve, failed back surgery and more, let the California Pain Network help you. The Network connects those in pain with pain management Los Angeles and Santa Monica trust.
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