Caudal Epidural Steroid Injections for Herniated Disc

 Herniated discs are a common source of lower back and leg pain, often impacting mobility, sleep, and everyday activities. In cases where conservative management does not bring sufficient ease, image-guided injections — such as caudal epidural steroid injections — may be considered as part of a broader treatment plan.

At Joint Injections, we specialise in ultrasound-guided musculoskeletal injections, offering precision-led interventions tailored to individual clinical needs. This blog explores caudal epidural steroid injections in the context of herniated disc, providing an in-depth overview of the condition, relevant anatomy, the injection technique, and what to expect during the process.

Understanding Herniated Discs

A herniated disc, also known as a slipped or prolapsed disc, occurs when the inner gel-like material (nucleus pulposus) protrudes through a tear in the outer fibrous layer (annulus fibrosus) of the intervertebral disc.

This condition can irritate or compress nearby spinal nerves, potentially leading to:

  • Low back pain
  • Pain radiating to the leg (sciatica)
  • Numbness or tingling in the leg or foot
  • Muscle weakness

Most commonly, herniations occur in the lumbar spine, particularly between L4–L5 and L5–S1.

Spinal Anatomy: Key Concepts

The spine consists of a column of vertebrae separated by intervertebral discs, which act as shock absorbers. Each vertebra has a central canal housing the spinal cord or nerve roots, and spinal nerves exit through openings called foramina.

Key anatomical structures involved in caudal epidural injections include:

  • Epidural space — the area surrounding the dura mater of the spinal cord
  • Caudal canal (sacral canal) — the lowest portion of the epidural space, located just above the coccyx
  • Sacral hiatus — an opening at the lower end of the sacrum used as the entry point for caudal epidural access

The caudal approach provides a pathway for introducing medication into the epidural space, targeting inflamed or irritated nerve roots from below.

Management of Herniated Discs

Initial management of herniated discs often includes:

  • Rest and activity modification
  • Exercise and posture advice
  • Heat or cold therapy

If symptoms persist, image-guided steroid injections may be considered to support comfort and allow further rehabilitation efforts. These injections do not remove the herniated disc but may help reduce inflammation around the affected nerves.

What Is a Caudal Epidural Steroid Injection?

A caudal epidural steroid injection involves the introduction of corticosteroid medication (often with a local anaesthetic) into the epidural space through the sacral hiatus, located at the base of the spine.

This approach is designed to target:

  • Inflammation affecting the lumbar nerve roots
  • Pain radiating into the legs or buttocks
  • Symptoms arising from herniated discs, spinal canal narrowing, or post-surgical scarring

At Joint Injections, we use ultrasound guidance to assist with accurate needle placement, minimising anatomical guesswork and enhancing procedural confidence.

Ultrasound Guidance: Enhancing Precision

Traditionally, caudal epidural injections have been performed using landmark-based techniques. However, at Joint Injections, we adopt ultrasound-guided techniques to provide:

  • Real-time visualisation of soft tissues, sacral hiatus, and surrounding structures
  • Minimally invasive access without ionising radiation
  • Greater comfort for patients by reducing procedural variability

Ultrasound allows the clinician to confirm needle entry into the sacral canal and observe medication spread in the caudal space. In patients with altered anatomy or previous surgery, ultrasound may offer added reassurance.

The Procedure: Step-by-Step

1. Clinical Assessment

Your appointment begins with a detailed consultation, including:

  • Symptom history
  • Physical examination
  • Consideration of medication use or relevant medical history

A focused ultrasound scan may be performed to assess the spine and aid in planning.

2. Consent and Preparation

Once the procedure is deemed appropriate, your clinician will explain:

  • The purpose of the injection
  • The substances being used
  • The technique and anatomical site
  • Possible risks and expected outcomes

Consent is obtained prior to continuing.

3. Positioning and Aseptic Preparation

  • You will be asked to lie on your stomach (prone position).
  • The lower back and sacral area are cleaned with antiseptic.
  • A sterile drape and ultrasound probe cover are used.
  • Ultrasound gel is applied for clear imaging.

4. Ultrasound-Guided Injection

  • The clinician identifies the sacral hiatus and sacral cornua under ultrasound.
  • A fine needle is advanced into the caudal epidural space under continuous imaging.
  • Once correct placement is confirmed, a small volume of steroid and local anaesthetic is gently injected.

5. Post-Procedure Monitoring and Advice

  • You may be observed briefly to ensure you are feeling well.
  • Guidance is provided on activity levels, symptom monitoring, and next steps.

You will typically be able to walk out of the clinic shortly after the procedure.

Medications Used

The injection typically contains:

  • Corticosteroid — used to address inflammation
  • Local anaesthetic — which provides temporary numbing and helps confirm correct placement

The exact combination and dosage are decided by your clinician based on your clinical history and presentation.

What to Expect Afterwards

Responses to caudal epidural steroid injections can vary. Some individuals notice an improvement in symptoms within a few days, while others may have a delayed or limited response.

Following the procedure:

  • Temporary numbness or heaviness in the legs may be experienced due to the local anaesthetic
  • You may be advised to rest on the day of the procedure
  • Return to light activity is usually encouraged the following day
  • Strenuous exercise, bending, or lifting should be avoided for 48 hours unless otherwise advised

Follow-up may be arranged to assess the response and consider future management options.

Benefits of Caudal Epidural Steroid Injections

Caudal epidural injections offer a route to deliver anti-inflammatory medication to a broad region of the lower spine. Although not a curative procedure, this technique may:

  • Support the reduction of inflammation around nerve roots
  • Provide a window for active rehabilitation
  • Offer a non-surgical management option for select individuals

Limitations and Considerations

It is important to view caudal epidural injections as part of a broader care pathway. They are typically used alongside:

  • Strengthening and mobility exercises
  • Activity modification and postural support
  • Further imaging or specialist referral, where appropriate

Some individuals may not find long-term relief from injections alone. The number and frequency of injections are determined based on the condition and individual response, and they are not performed excessively or without clinical indication.

Possible Side Effects

As with any injection procedure, there are potential risks, which are discussed during your consultation. These may include:

  • Temporary increase in discomfort (a steroid “flare”)
  • Headache or dizziness
  • Bleeding or bruising at the injection site
  • Infection (very rare)
  • Temporary numbness or leg heaviness
  • Elevation of blood sugar in individuals with diabetes

At Joint Injections, strict procedural protocols are followed to reduce the risk of complications. All procedures are carried out by experienced clinicians with a background in musculoskeletal ultrasound and injection therapy.

Who Might Benefit from a Caudal Epidural Steroid Injection?

This procedure may be considered for individuals experiencing:

  • Persistent lower back and leg pain
  • Sciatic symptoms due to nerve root irritation
  • Recurrent or chronic lumbar disc issues

A thorough consultation and review of imaging is performed to determine whether the caudal approach is suitable. Alternative injection routes (e.g., transforaminal or interlaminar) may be considered depending on the level and nature of the disc herniation.

Why Choose Joint Injections?

At Joint Injections, we provide a focused, clinician-led service for individuals experiencing joint, nerve, and musculoskeletal discomfort. Our service includes:

  • Experienced clinicians trained in ultrasound-guided injection therapy
  • Real-time diagnostic scanning to support clinical decisions
  • Personalised treatment plans based on your symptoms and imaging
  • Multiple locations for convenience and access
  • A structured, professional environment dedicated to image-guided care

Each individual is assessed and managed with care and transparency. We understand the impact spinal conditions can have and aim to support patients in regaining comfort and function.

Preparing for Your Appointment

To help make the most of your visit:

  • Inform the clinician if you are on anticoagulants or antiplatelet medications
  • Avoid applying creams or lotions to the lower back on the day of the procedure
  • Let the team know if you are pregnant, diabetic, or allergic to any medications

You will be provided with specific pre- and post-injection instructions at your appointment.

Final Thoughts

Caudal epidural steroid injections are a minimally invasive technique used to support the management of lower back and leg pain due to disc-related issues. While not suitable for everyone, this approach can be a useful part of a broader care plan for individuals experiencing discomfort from nerve root irritation or spinal inflammation.

At Joint Injections, we focus on delivering ultrasound-guided precision and professional care. Every injection is planned based on your clinical profile and carried out with careful attention to technique and safety.

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