Caudal Epidural Steroid Injection

Chapter 5 Caudal Epidural Steroid Injection



Justin J. Petrolla, Michael B. Furman


The caudal epidural steroid injection is one of the oldest interventional techniques used to treat lumbar spinal pain. Caudal epidural injections are indicated for radicular symptoms with or without axial pain as a result of a lumbosacral cause. A caudal approach may be the only way to access the epidural space in patients who have previously had surgery performed on the lumbar spine.


Because the procedure is not selective, volumes as high as 10 cc have been used to reach more superior lumbar structures. Of course, larger volumes necessitate less concentrated injectate. The injectate volume may be determined after observing contrast flow relative to target structures. Occasionally, a catheter can be used to achieve better epidural flow to a specific location (e.g., beyond surgical scarring) with lower and more concentrated injectate volumes. With the approach described in this chapter, there is no specific trajectory view. The palpation of the sacral hiatus in combination with imaging is required to determine the proper insertion site for the caudal epidural procedure. The anteroposterior (AP) view is used to keep the needle midline and avoid advancing the needle too far cephalad. The lateral view is used to access the sacral hiatus and to avoid going ventrally into the viscera or too shallow dorsally.


Note: Please see page ii for a list of anatomical terms/abbreviations used in this book.



image Trajectory View (Figure 5–1)


No trajectory view is available for this technique.



Palpation


The physician must palpate the sacral hiatus with a gloved hand because this is the entry point for the spinal needle. Although the sacral hiatus can be visualized fluoroscopically (not shown), we recommend palpatory confirmation.



image Optimal Needle Position in Multiplanar Imaging (Figure 5–2)



image

Figure 5–1 After palpating the sacral hiatus, a needle is placed so it enters the hiatus with a shallow angle.


image image image

Figure 5–2 A, Fluoroscopic image of a lateral view with the needle in position at the sacral hiatus. B, Radiopaque structures, lateral view. C, Radiolucent structures, lateral view.



image Notes on Initial Needle Entry




image Note the angle of the needle that is required to enter the sacral hiatus.


image Care must be taken so that the needle correctly enters the sacral hiatus.

Related posts:

Cervical Spinal Cord Stimulation Thoracic Zygapophysial Joint Intraarticular Injection, Posterior Approach Thoracic Transforaminal Epidural Steroid Injection, Infraneural Approach Cervical Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy and Nerve Injection, Posterior Approach Thoracic Interlaminar Epidural Steroid Injection, Paramedian Approach Cervical Discography/Disc Access

Stay updated, free articles. Join our Telegram channel
Tags:
Dec 23, 2015 | Posted by in INTERVENTIONAL RADIOLOGY | Comments Off on Caudal Epidural Steroid Injection

Full access? Get Clinical Tree
Get Clinical Tree app for offline access