Caudal Epidural Steroid Injections for Herniated Disc

 A herniated disc in the lower back can be a persistent source of discomfort, often affecting walking, sitting, and sleep. When non-invasive strategies do not provide sufficient relief, image-guided injections may be considered as part of a structured approach to managing symptoms.

At Alton Pain Clinic, we specialise in ultrasound-guided musculoskeletal and spinal injections, offering a clinician-led service tailored to each individual’s clinical needs. This blog explores the role of caudal epidural steroid injections in the context of herniated discs, including spinal anatomy, technique, clinical use, and what patients can expect from the procedure.

What Is a Herniated Disc?

A herniated disc — commonly referred to as a slipped or prolapsed disc — occurs when the soft inner core of an intervertebral disc (the nucleus pulposus) protrudes through the tougher outer ring (annulus fibrosus).

This can place pressure on nearby spinal nerves or trigger inflammation, often leading to symptoms such as:

  • Lower back pain
  • Pain radiating down the leg (sciatica)
  • Numbness or tingling
  • Weakness in the leg or foot


Herniated discs most commonly affect the lumbar spine, particularly at levels L4–L5 and L5–S1.

A Brief Overview of Spinal Anatomy

The spine consists of a column of bones (vertebrae), separated by discs that act as shock absorbers. Nerve roots branch out from the spinal cord through small openings between these bones.

Important structures in relation to caudal epidural injections include:

  • Epidural space — the outermost part of the spinal canal, surrounding the dura
  • Sacral canal — the lowest segment of the spinal canal, situated within the sacrum
  • Sacral hiatus — an opening at the base of the sacrum that allows access to the epidural space via the caudal route

A caudal approach to the epidural space is often used to deliver medication to the lower lumbar region in a controlled, minimally invasive manner.

Managing a Herniated Disc

Conservative management is typically the first step and may include:

  • Rest and activity modification
  • Back strengthening exercises
  • Posture training

If these measures are not sufficient, image-guided steroid injections may be considered. These injections are used to address inflammation around the spinal nerves and are not intended to remove or “fix” the disc itself.

What Is a Caudal Epidural Steroid Injection?

A caudal epidural steroid injection involves the introduction of steroid medication — often mixed with local anaesthetic — into the epidural space via the sacral hiatus at the base of the spine.

This technique can help target:

  • Nerve irritation related to herniated discs
  • Sciatic-type symptoms
  • Inflammation of the lower spinal nerve roots
  • Post-surgical fibrosis or canal narrowing

At Alton Pain Clinic, we perform ultrasound-guided caudal epidural injections, allowing for accurate and safe delivery of medication to the appropriate area.

The Role of Ultrasound Guidance

Traditionally, caudal epidural injections were performed using anatomical landmarks. However, ultrasound has become increasingly valuable due to its real-time imaging capabilities.

Benefits of ultrasound-guided caudal injections at Alton Pain Clinic include:

  • Visualisation of the sacral hiatus and sacral cornua
  • Avoidance of adjacent structures such as vessels or soft tissues
  • No radiation exposure
  • Clear monitoring of the needle entry into the caudal canal

Ultrasound guidance supports a more individualised, informed, and comfortable experience for patients.

The Injection Procedure

Here is what typically occurs during an ultrasound-guided caudal epidural steroid injection at Alton Pain Clinic:

1. Clinical Consultation

  • A full review of your symptoms, medical history, and previous imaging (e.g. MRI or CT) is performed.
  • A physical examination may be carried out.
  • Diagnostic ultrasound may be used to assess the region prior to the procedure.

2. Consent and Preparation

  • The procedure is explained in detail, including its purpose and any possible risks.
  • Questions are welcomed, and informed consent is obtained.
  • You will be positioned lying face-down.

3. Sterile Technique

  • The lower back and sacral area are cleaned with an antiseptic solution.
  • Ultrasound gel is applied, and the ultrasound probe is covered with a sterile sheath.

4. Ultrasound-Guided Injection

  • The clinician identifies the sacral hiatus under ultrasound.
  • A fine needle is inserted into the caudal epidural space under continuous imaging.
  • Once correct needle placement is confirmed, a combination of steroid and local anaesthetic is introduced.

5. Aftercare and Observation

  • You may be observed briefly after the procedure.
  • Post-procedural advice is provided regarding rest, activity, and follow-up.

Medication Used

A typical injection may include:

  • Corticosteroid
  • Local anaesthetic, to provide short-term numbing and assist in confirming correct needle placement

Your clinician will select the medication and dose that are appropriate for your condition and medical history.

What to Expect After the Injection

  • Some individuals feel an improvement within a few days, while others may experience a delayed response.
  • Temporary numbness, tingling, or heaviness in the legs can occur due to the local anaesthetic.
  • It is recommended to rest on the day of the procedure and avoid strenuous activity for the next 48 hours.

Your clinician will provide tailored guidance based on your individual recovery.

Clinical Uses and Advantages

While every patient’s response is unique, caudal epidural steroid injections are often considered in the following situations:

  • Persistent or recurrent low back pain with leg symptoms
  • Sciatica that has not responded to other conservative measures
  • Post-operative spinal discomfort
  • Individuals unable to tolerate or access other types of spinal injection routes

Ultrasound guidance enhances the accuracy and confidence of the procedure, allowing the clinician to confirm needle positioning in real time.

Limitations and Broader Care Approach

These injections are part of a multi-faceted treatment plan, which may also include:

  • Core strengthening and physiotherapy
  • Ergonomic or postural changes
  • Targeted home exercise programmes
  • Review of medications and pain management strategies

It is important to note that injections may not work in all cases, and the response can vary. Repeat injections, if considered, are spaced apart and carefully assessed on an individual basis.

Potential Risks and Considerations

Though generally well tolerated, caudal epidural steroid injections carry some risks. These will be discussed in detail during your consultation and may include:

  • Mild increase in discomfort after the injection (steroid flare)
  • Temporary numbness or tingling in the legs
  • Local bruising or bleeding at the injection site
  • Headache
  • Rare risk of infection
  • Short-term elevation in blood glucose for individuals with diabetes

At Alton Pain Clinic, all procedures are performed using sterile technique and under ultrasound guidance to minimise risks wherever possible.

Is a Caudal Injection Right for You?

A caudal epidural injection may be suitable if:

  • You have ongoing lower back and leg symptoms linked to a disc problem or nerve irritation
  • Conservative management has not brought adequate relief
  • Imaging supports the presence of inflammation or nerve root compression in the lower lumbar region

Your clinician will assess your case in detail before recommending any injection. In some instances, other injection types (e.g. transforaminal) or referrals to spinal specialists may be more suitable.

Why Choose Alton Pain Clinic?

At Alton Pain Clinic, we focus on ultrasound-guided pain management delivered by experienced clinicians. Our service is designed to provide:

  • Comprehensive consultations and personalised care
  • Diagnostic and interventional ultrasound for accurate targeting
  • A calm, professional setting for spinal and joint procedures
  • Clinician-led expertise in spinal and musculoskeletal injections
  • Ongoing support and transparent follow-up

We believe in precision, professionalism, and individualised care throughout your treatment journey.

Preparing for Your Appointment

To help your visit go smoothly:

  • Bring along any recent imaging 
  • Let us know if you are taking any blood-thinning medication
  • Inform the team if you have any known allergies
  • Avoid using body creams or lotions on the lower back on the day of the procedure

You will be given clear pre- and post-injection instructions by our team.

Final Thoughts

Caudal epidural steroid injections can support the management of symptoms arising from herniated discs and associated nerve irritation. When used in the right clinical context, they may offer a minimally invasive route to improve mobility and function — especially when combined with a tailored rehabilitation plan.

At Alton Pain Clinic, we specialise in ultrasound-guided spinal and musculoskeletal procedures, combining diagnostic imaging with expert injection techniques in a patient-focused setting.

If you would like to find out more or book an assessment, our team is here to help guide you every step of the way.

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