Caudal epidural steroid injection

A caudal epidural steroid injection (ESI) is done to provide pain relief in the area of low back caused by irritation of the spinal nerves.  The injection provides pain relief by reducing inflammation and irritation of spinal nerves near herniated disc, facet joints, and narrowed spinal canal.

The injection containing a corticosteroid (cortisone) and normal saline are delivered to the nerve through the epidural space at the base of the spine or tailbone (coccyx).

The goal of the treatment is for you to experience enough pain relief to get moving again, resume normal activities, and/or continuing a physical therapy program.

This procedure is usually repeated twice to have better results in few weeks interval.

Caudal epidural steroid injection on left lateral position

Caudal epidural steroid injection


Success rate

The effects of Epidural steroid injection are usually temporary and vary.  Pain relief may last for 1 week or up to 1 year.  According to my experience at best there is a 50 % chance that your pain will get better by 50 % for 6-9 months.  This can be repeated annually if it worked for you.

During the injection

  1. You will be positioned on your side with your legs drawn toward your chest (lateral position).  
  2. The doctor washes your back with an antiseptic solution, and then injects the freezing medication.  This makes the area numb, and it may sting.
  3. Then, the epidural space is located and the steroid medication is injected.  You will feel a sensation of pressure.  The injection takes about 5 minutes.

You may also have some tenderness in the tailbone where the needle was inserted.

When you get home

  • Rest.
  • If you have a bandage, take it off when you go to bed.
  • Do not apply heat to the injection site.
  • Do not have a tub bath or a hot tub for 24 hours after the injection.
  • You can get back to your normal activities and exercises the next day. 

Side effects

You may have some side effects after the injection.  These include:

  • Backache – apply ice to the injection site for 20 minutes every hour if needed.  Wrap the ice pack in a plastic bag or a towel before you apply it.
  • Bleeding- extremely 
  • Infection- extremely small chance.
  • Neurological complication- extremely rare but serious.
  • Numbness or tingling in legs – this may last 6-8 hours and if it last longer please contact Dr. Park.
  • If you have diabetes you may notice an increase in blood sugar for 24 hours after the injection.  Adjust your insulin and check your sugar levels as needed.  Call your family doctor or diabetes specialist if you are unable to control your blood sugar.
  • If you have high blood pressure, it may also temporarily increase.

Call us at (905) 525-8706 or go to the nearest ER if you have:

  • A severe headache
  • A fever greater than 38 degrees
  • Increasing redness at the injection site
  • A severe back pain
  • A persistent new numbness or severe weakness after 6 hours of caudal epidural steroid injection.