Are Caudal Epidural Steroid Injections Effective for Chronic Lumbar Radiculopathy?

Patients who are dealing with sciatica of a chronic nature often turn to epidural steroid injections for relief. Interestingly, there are 3 different methods that are well known of performing epidural steroid injections.

All 3 of these epidural steroid injection methods work by decreasing swelling and inflammation of the nerve roots in the space around the dural sac, which is known as the epidural space.

The 1st type of epidural injections that has been utilized for decades is an inter-laminar epidural injection. These used to be performed without x-ray guidance in the office by using simply feel. Some doctors still perform them without x-ray guidance, however, it has been shown that without it 30% of the time the injection misses the epidural space. So most doctors in this day and age do use fluoroscopic guidance for placement.

With interlaminar epidural injections, the steroid is placed in the epidural space right over the dural sac, which is an inexact science. Most of the time, the nerve root that is being compressed is actually being pinched as it exits from the epidural space. So the steroid that is injected actually has a bit of a ways to travel to reach the area of the problem.

This brings us to the 2nd type of epidural steroid injection, which is a trans-foraminal type of injection. This injection has become much more popular over last decade and allows injection doctors to place the steroid medication closer to the area of nerve root compression. Steroid medication can bathe the pinched nerve and decrease inflammation and swelling nicely. Along with the steroid medication, numbing medication is typically injected as well which can help to "break the cycle of pain" and let the steroid do it's thing.

The 3rd type of epidural steroid injection is a caudal injection and involves placing the needle through the sacral hiatus and injecting a large volume of both numbing medicine and steroid medication. This is an inexact science with the hope being that the injection of a large amount of medication will seep into the problem areas where nerve roots are being compressed. There is some literature showing that caudal epidural steroids can work very well for acute lumbar radiculopathy.

A new study that was published by the Massachusetts Medical Society looked at treatment of chronic lumbar radiculopathy by caudal epidural steroid injections. This trial was performed in Norway and looked at caudal epidural steroid injections versus saline injections in patients who had over 12 weeks of lumbar property. Patients were followed for a period of one year. At the one year point half of the study participants reported feeling a lot better, and only 27% maintain persistent radiculopathy.

The interesting point here is that there was not a significant difference between the control group versus the steroid group. Therefore the conclusion is that caudal epidural steroid injections were ineffective for chronic lumbar radiculopathy. Therefore, it would probably be more pertinent in these chronic situations to utilize one of the other methods of epidural steroid injections. This would be either the interlaminar variety or the transforaminal injections.