Epidural: Caudal, Lumbar and Transforaminal
The anatomy of the spine
The epidural space stretches from the back of the head to the tailbone. An epidural steroid injection, also known as an ESI, is used to treat different types of pain around the body which has been caused by inflamed, irritated or sensitised spinal nerves. The steroid reduces inflammation and the sensitisation process thereby alleviating pain in the area supplied by the nerves.
There are several common types of epidural steroid injection which target these areas. Caudal and lumbar epidural steroid injection address lower limb and pelvic pain; and a transforaminal epidural steroid injection offers pain management for radicular problems, also known as sciatica, targeting one side of the spine in the neck, thoracic and lumbar regions.
Epidural: caudal, lumbar and transforaminal procedure
A blood pressure cuff and heart rate monitor will be placed on the patient for monitoring purposes. A small needle in the back of your hand canl be used to administer sedation or in case of an emergency.
For a caudal epidural steroid injection, and after the patient is in position on their stomach, the local anaesthetic is administered to the injection site at the sacral hiatus which is located above the opening at the base of the spine. The needle is then inserted through to the caudal epidural space. Contrast dye is used to confirm the correct location before the steroid and anaesthetic medication is injected.
For a lumbar, thoracic or cervical epidural steroid injection, the local anaesthetic is administered to the injection site before the needle is inserted slowly using fluoroscopy as a guide, with contrast dye to confirm the correct location. Once the needle is in the right position, the epidural steroid solution is injected
For a transforaminal epidural steroid injection, the patient will lie on their side or stomach. Following being numbed with anaesthetic, the injection of the needle is performed with guidance from fluoroscopy. After contrast dye has confirmed the correct location of the needle, the doctor injects the mixture of local anaesthetic and a steroid medication into the epidural space where the targeted nerve root is situated.
Patients are then monitored in a recovery area before transfer to the ward and discharge home. Patients may experience a numb feeling for a few hours. Pain at the injection site may increase for a few days. It is advisable to rest for 24 hours and resume stretches and exercises when the pain eases. This window of pain relief should be utilised for performance of strengthening exercises and rehabilitation physiotherapy.
There is a variable response to injection treatment. It is important to discuss both the benefits and risks of the procedure with your doctor before any agreement to undergo the procedure is reached. Although the chance of any complications is generally low, as with all surgical procedures, there is an element of risk involved with epidural steroid injection including failure to get benefit or pain aggravation. There may be an allergic reaction to the steroid or any of the medications, or that the injection causes an infection or bleeding.Paralysis, spinal cord or nerve damage is extremely rare. Epidural steroid administration is common international practice but is not a licensed use of the drug.