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What is a Caudal Epidural?

Caudal Epidural

A Caudal Epidural spinal injection allows temporary or even prolonged relief for chronic back pain. Nowadays, specialists frequently apply the caudal epidural infiltration due to its multiple benefits. This injection contains a mixture of local anaesthetics and corticosteroids. This is applied in the epidural space in the lower part of the spinal canal in the sacral region. 

We mostly use it in cases of referred low back pain to lower limbs linked to the narrow lumbar canal, to discopathies and to patients with postoperative fibrosis.

Patients experience great improvement thanks to the anti-inflammatory effect, and also by the mechanical effect (by decompression of a nervous structure by the volume of the injected liquid). Besides, it enhances local vascularization and generates analgesia.

Indications

Our specialists consider assess you carefully before performing a caudal epidural. For instance, the symptoms and also findings from imaging studies. A patient with the following features is a candidate for this procedure:

• Pain that has spread to one or both lower limbs.
• If can be performed at any stage
• In case that pain increases with standing posture and especially when walking.
• When it has not responded to other non-invasive forms of treatment (drugs and rehabilitative physical therapy).

 

 

Contraindications

There are some specific cases when it is not recommended to perform caudal epidural. They are the following:

-Infection close to the injection site.
-In patients undergoing treatment with anticoagulant and/or platelet antiaggregants. In these cases, the pre-puncture treatment must be modified.
-In patients who are allergic to local anaesthetics and corticosteroids.

-Systemic diseases: hypovolemias, hemodynamic or cardiac disorders, endocranial hypertension, among others.

The procedure

This technique requires that the specialist punctures the sacrococcygeal hiatus in order to access the lumbar epidural space. This hiatus is an inverted V-shaped recess in the posterior wall of the sacral canal.
We place the patient in prone position on a stretcher and must stay 15-20 min after performing the technique under control.

Complications

Complications are extremely rare in expert hands. For instance the following:
• Vasovagal syncope (fainting).
• Headache, nausea and vomiting.
• Systemic complications of corticosteroids: regressive proximal myopathy,  water retention, arterial hypertension, decompensation of the diabetic patient.
• Epidural hematoma (0.001%) extremely rare.
• Infection (epidural abscess) is exceptional.
• Accidental puncture of the dura that occurs with headache and leakage of the cerebrospinal fluid that disappears in a lying position.

At the London Spine Unit, we have some of the best specialists to perform caudal epidural. Book an appointment to get a checkup.

 

When do we do a caudal epidural?

We mostly use it in cases of referred low back pain to lower limbs linked to the narrow lumbar canal, to discopathies and to patients with postoperative fibrosis. Patients experience great improvement thanks to the anti-inflammatory effect, and also by the mechanical effect (by decompression of a nervous structure by the volume of the injected liquid). Besides, it enhances local vascularization and generates analgesia.

What are the indications of caudal epidural?

Our specialists consider a set of aspects to perform caudal epidural. For instance, the symptoms and also findings from imaging studies. A patient with the following features is a candidate for this procedure: • Pain that has spread to one or both lower limbs. • it can be performed at any time. • In case that pain increases with standing posture and especially when walking. • When it has not responded to other non-invasive forms of treatment (drugs and rehabilitative physical therapy).

How is the caudal epidural procedure?

This technique requires that the specialist punctures the sacrococcygeal hiatus in order to access the lumbar epidural space. This hiatus is an inverted V-shaped recess in the posterior wall of the sacral canal. We place the patient in prone position on a stretcher and must stay 15-20 min after performing the technique under XRAY control.

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