Lumbar Caudal Epidural Steroid Injection
A caudal epidural steroid injection delivers anti-inflammatory medication into the epidural space via the sacral hiatus — a natural opening at the base of the sacrum. This approach is used when the lower lumbar and sacral nerve roots are the source of pain, and provides access to the lower portions of the epidural space with a gentle, well-tolerated technique.
When Is a Caudal Approach Used?
The caudal approach is particularly useful when:
- The lower lumbar levels (L4-L5, L5-S1) or sacral nerve roots are the pain source
- Prior spine surgery has altered anatomy, making interlaminar access more difficult
- Multiple lower lumbar levels need to be treated simultaneously
- Patient anatomy makes other approaches technically challenging
The Procedure
Under fluoroscopic guidance, the needle is placed through the sacral hiatus at the base of the tailbone — a natural opening that provides access to the epidural space. After contrast confirms correct placement, steroid medication is injected to bathe the affected nerve roots.
This approach is generally more comfortable than the interlaminar approach, as the sacral hiatus is relatively easy to access and the needle does not need to pass between vertebrae.
Conditions Treated
- Lumbar disc herniation with sciatica
- Lumbar spinal stenosis with lower extremity symptoms
- Post-laminectomy syndrome (failed back surgery syndrome)
- Sacral nerve root compression
- Diffuse multilevel lumbar disease
Results and Recovery
Results are similar to other epidural steroid approaches — relief typically develops over 1–2 weeks and can last weeks to months. The caudal approach may provide broader coverage of the lower lumbar epidural space and is well-suited for multilevel pathology.
Contact Us
Call 516-492-3100 to discuss whether a caudal epidural injection is appropriate for your pain.