Caudal epidural injection
A caudal epidural injection is a minimally invasive spine procedure that delivers local anaesthetic and anti-inflammatory steroid medication directly into the lowest part of the epidural space to alleviate lower back and nerve root pain.
Caudal epidural injection overview
The epidural space surrounds the spinal cord and spinal nerves, running from the base of the skull down to the sacrum (the triangular bone at the base of the spine). A caudal epidural injection target the caudal space, located just above the tailbone (coccyx), which provides a direct gateway to access inflamed spinal nerves in the lower lumbar and sacral regions. The procedure combines two key medications: Local anaesthetic: Provides immediate, short-term pain relief by numbing the local area and blocking nerve pain signals. Corticosteroid medication: A long-acting anti-inflammatory agent that reduces swelling, irritation, and tissue pressure around compressed spinal nerves and facet joints over the subsequent weeks.
Why might I need a caudal epidural injection?
A caudal epidural is typically recommended when conservative measures, such as oral anti-inflammatory medications, rest, and physical therapy, have failed to control symptoms, or as an alternative to spinal surgery. It is commonly used to manage conditions including:
- Lumbar sciatica / Radiculopathy: Nerve root inflammation causing sharp, shooting pain down the buttock and legs.
- Lumbar spinal stenosis: Narrowing of the spinal canal causing leg pain, numbness, and heavy leg sensations during walking.
- Slipped or herniated discs: Disc material pressing against spinal nerves in the lower back.
- Facet joint osteoarthritic pain: Chronic pain originating from the small articulating joints at the back of the lumbar spine.
- Post-surgical spine pain: Persistent low back or nerve discomfort following previous spinal operations.
What does the procedure involve?
A caudal epidural injection is performed as a day-case procedure in a specialised treatment room or operating theater, allowing you to return home the same day.
Before the procedure
You will be placed lying on your stomach (prone) on an X-ray table with a pillow under your hips for comfort. The procedure is typically performed under local anaesthetic, often combined with light conscious sedation so that you remain relaxed and sleepy throughout.
Important notice: If there is any possibility that you might be pregnant, please inform your consultant beforehand. Fluoroscopic X-ray imaging should be avoided, particularly during the first trimester of pregnancy.
During the procedure
- Antiseptic preparation: The skin over the lower back and buttock area is thoroughly cleansed with an antiseptic solution and draped with sterile towels.
- Local numbing: A small amount of local anaesthetic is injected into the skin over the sacral hiatus (the lower sacral opening) to ensure minimal discomfort.
- Image guidance (Fluoroscopy): Using live X-ray guidance, the specialist precisely advances a fine needle into the caudal epidural space.
- Contrast verification: A tiny amount of iodine-based radiopaque contrast dye is injected to confirm accurate positioning within the epidural space and ensure the medication spreads around the affected nerve roots and facet joints.
- Medication delivery: Once correct placement is verified, the combination of steroid and local anaesthetic is gently injected.
The injection itself takes around 15 to 30 minutes, though your total hospital stay will be a few hours to allow for pre-procedure checks and post-treatment recovery monitoring.
Is it painful?
You may feel a brief sting or pinch when the local skin anaesthetic is administered. During the main injection, you might experience a mild sensation of pressure or fullness in your lower back or a temporary aching sensation down your leg as the fluid fills the epidural space.
Sedation and local numbing keep discomfort minimal. You may experience mild soreness at the injection site for a day or two after the procedure, which can be easily managed with rest and standard over-the-counter painkillers.
What are the risks?
A caudal epidural injection is a routinely performed, safe procedure. Complications are rare, but potential risks include:
- Temporary lack of pain relief: The injection may not prove effective for everyone (around 75% of patients experience a significant reduction in pain).
- Temporary leg weakness or numbness: Caused by the local anaesthetic spreading to motor nerves; this typically resolves within a few hours as the anaesthetic wears off.
- Localized infection: A very minor risk (between 1 in 1,000 and 1 in 10,000 cases) at the injection site or within the epidural space.
- Headache (Dural puncture): Accidental puncture of the sac containing spinal fluid can cause a post-dural headache, which usually settles with rest and fluids.
- Steroid-related side effects: Mild, temporary symptoms such as facial flushing, transient mood changes, fluid retention, or temporary spikes in blood sugar levels (important for diabetic patients).
- Allergic reaction: Minor reactions to the contrast dye, antiseptic, or injected medications.
Your specialist will discuss all potential risks with you in detail during your consultation prior to the procedure.
Recovery and follow-up care for caudal epidural injection
Rest comfortably at home. Avoid driving, operating machinery, drinking alcohol, or making important legal decisions while recovering from sedation. Apply an ice pack (wrapped in a towel) over the injection site for 15 minutes at a time to ease localised soreness.
Keep daily movements light and avoid heavy lifting, vigorous exercise, or long travel journeys for a few days. You can gradually return to routine daily activities as comfort allows.
Targeted physical therapy usually resumes or begins 4 to 5 days after the injection, capitalising on reduced pain levels to strengthen core and back muscles.
While the local anaesthetic provides initial relief for a few hours, the anti-inflammatory benefits of the corticosteroid typically take 1 to 2 weeks to take full effect (and up to 4 weeks in some cases).
Working with foot and ankle professionals and teams
Our foot and ankle specialists support professional athletes, sports teams, active individuals and people whose work places high demands on their feet and ankles. Working closely with radiologists, physiotherapists and the wider multidisciplinary team, they provide coordinated care from diagnosis through to rehabilitation, helping each person return safely to sport, work or everyday activities.
The same specialist expertise and collaborative approach are available to every patient, whatever your activity level or recovery goals.
Our Experts - Leaders in Foot and Ankle treatment
How to pay
We offer flexible options depending on how you choose to access care at Fortius. Whichever option you choose, we’ll help make the process clear and straightforward from the start.
Private medical insurance
If your care is covered by private medical insurance, we’ll usually invoice your insurer directly. Please check your policy in advance and request an authorisation code if your insurer requires one. You’ll be responsible for paying any policy excess or costs that aren’t covered by your insurance.
Paying for yourself
You don’t need private medical insurance to access care at Fortius. If you’re paying for your own treatment, our team will explain the costs clearly and provide a personalised quote before you decide whether to go ahead.
Achilles tendon rupture repair FAQs
You must be out of your cast or boot and able to control the vehicle safely, including performing an emergency stop without pain or hesitation. This often takes at least 10 weeks, but you should ask your specialist and check that your insurer is happy for you to drive.
This depends on your job and how you travel to work. You may be able to return to a desk-based role after around four weeks if you can keep your foot raised. A physical job may require 12–16 weeks away from work.
Returning to sport usually takes around six to nine months. Your physiotherapist will help you rebuild calf strength, balance and control before you return safely.
Find a clinic near you
Fortius Clinic London
Our 79,000 sq ft, seven-story, private hospital on Wigmore Street has 39 en-suite inpatient rooms, consultation and treatment rooms, and a physiotherapy suite.
The hospital has a high-spec imaging suite fully equipped with an MRI, CT scanner and X-ray machine. There are three state-of-the-art operating theatres, two anaesthetic rooms and a recovery bay.
Fortius Clinic London has two Mako robots for hip and knee joint replacements.
- 66 Wigmore Street W1U 2SB
- 0203 195 2442
- Outpatient times are Monday to Friday from 8.00am to 8.00pm.
- Sports & Exercise Medicine
- Snow Injuries Clinic
- Tendon Clinic
- MRI Scan
- Ultrasound
- X-Ray
- Physician services
- Rheumatology
- CT Scan
- Image guided injections
- Physiotherapy
- MAKO Robotic Joint Replacement
Fortius Clinic City
Our City Clinic is conveniently located between Bank and Monument stations, within the historic and financial heart of London. At our modern, two-floor facility we have nine consulting rooms, spacious waiting areas, well equipped treatment rooms and an imaging centre.
Explore our City Clinic with our virtual tour.
If you are travelling by Tube, our closest underground stations are Bank and Monument, exit 6 for King William Street.
Should you be travelling by car, the closest parking is a three minute drive away at NCP Car Park London Vintry Thames Exchange. If you are attending clinic on a weekday, please be aware that we are based in the congestion charge zone.
- 75 King William Street EC4N 7BE
- 0203 195 2442
- Outpatient times are Monday to Friday from 8.00am to 8.00pm.
- Snow Injuries Clinic
- Tendon Clinic
- Sports & Exercise Medicine
- MRI Scan
- Ultrasound
- X-Ray
- Physician services
- Rheumatology
Fortius Clinic Wimbledon
Our Wimbledon clinic houses a state-of-the-art imaging centre with a 3T MRI and X-ray scanners, Ultrasound, seven consulting rooms, two spacious waiting areas and well equipped treatment rooms all located on one level, ensuring easy accessibility for all patients.
Our partnership with Spire St Anthony’s Hospital allows us to provide orthopaedic surgery closer to our clinic. We treat a full range of conditions and perform joint replacement surgery using the latest Mako robotic assisted technology.
The building at 22 Worple Road has steps leading up to the front entrance. If you require assistance please inform us before your arrival by calling ahead on 020 3195 2442
- 22 Worple Road SW19 4DD
- 0203 195 2442
- Outpatient times are Monday to Friday from 8.00am to 8.00pm.
- Snow Injuries Clinic
- MRI Scan
- Ultrasound
- X-Ray
Fortius Clinic Marylebone
Our Marylebone Clinic is conveniently located in the historic area between Baker Street and Marylebone High Street, just off Manchester Square, home to the iconic Wallace Collection. We have seven consulting rooms, private waiting areas on each floor, well equipped treatment rooms and diagnostic imaging.
- 17 Fitzhardinge StreetW1H 6EQ
- 020 3195 2442
- Outpatient times are Monday to Friday from 8.00am to 8.00pm.
- MRI Scan
- Ultrasound
- X-Ray
- Physician services
- Rheumatology
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