…they are also a treatment for sciatica and lower back pain.
A technique that has pleasantly surprised me due to its good results for lower back pain and sciatica is the caudal epidural injection or caudal epidural block.
In our spine unit, we recommend it to treat pain resulting from inflammation of the elements within the spinal canal:
- In cases of disc herniation or protrusion, it is the disc that compresses or irritates the nerves.
- When there is canal stenosis with narrowing of the passage area, it is usually the ligaments and osteophytes.
The epidural injection is performed through the sacral hiatus, which is an access point to the canal located at the beginning of the intergluteal line, and which is usually safer than the usual epidural access because it contains fewer nerves and blood vessels.
After administering local anesthetic to the skin, with the help of an ultrasound scanner, we insert a spinal needle and, through it, slide the epidural catheter until it reaches the level of inflammation. Corticosteroids are then injected to reduce inflammation, and local anesthetic is administered to block the pain signal transmitted by the nerves to the brain.
This is a procedure that must be performed under conditions of maximum sterility, and for this reason, we carry it out in the operating room. Its duration is less than half an hour, and the patient remains awake throughout the procedure.
At the end of the technique, the patient must remain lying down for half an hour in the observation room for the drugs to diffuse, and after this period, it is checked that the anesthetic has not caused numbness in the legs, and the patient is discharged. If any nerve block occurs, it generally resolves spontaneously within 6-12 hours.
After discharge, we usually recommend 24-48 hours of rest, and then the patient can resume normal life and even their sports activities.
Caudal infiltration offers us many advantages for treating our patients’ pain:
- It is a pain treatment we offer, but it also serves as a diagnostic test, as it tells us if the spinal problem is truly located in the lumbar canal.
- It is very safe because it does not penetrate the dura mater, and there are almost no nervous structures in the caudal area of the sacrum.
- It is minimally painful and can be performed with local anesthesia and without hospitalization.
- It does not preclude other pain techniques or, if a surgical spinal intervention is indicated later.
How long can I expect symptoms to improve?
The effect of the drugs is temporary and usually lasts 3 to 6 weeks. If the result is good but the effect wears off, the technique can be repeated.
The success of the procedure depends primarily on the correct indication, as it is not suitable for treating all spinal problems. As explained, epidural block is very effective for inflammation originating from the lumbar canal.
In cases of very large herniations or severe canal stenosis, the technique may not be successful because it is truly time to surgically address the problem.
