Feasibility and safety of ultrasound-guided caudal epidural glucocorticoid injections

Objectives: To assess the feasibility and safety of caudal epidural glucocorticoid injections performed with ultrasound guidance.

Methods: We studied 30 patients with low back pain and nerve root pain related to disk herniation or associated with lumbar spinal stenosis. A caudal epidural injection was performed under ultrasound guidance. Prednisolone acetate, 5 ml, was administered with 10 ml of saline and 5 ml of iodinated contrast agent, providing an epidurogram. Acceptability of the procedure by the patient was assessed. Adverse events occurring immediately after the procedure and within the first month were collected.

Results: The sacral hiatus was identified in 29 (96.6%) patients. Mean distance between the two sacral cornua was 1.42 cm (range, 0.83-2.13) and mean diameter of the sacral hiatus was 0.60 cm (0,2-1.28). The injection proved feasible in 28 of the 29 patients. The epidurogram indicated that the injection was successful in 27 patients. Mean procedure duration was 15 minutes (30-10). No cerebrospinal fluid reflux occurred. Blood reflux was noted in 9/29 patients and resolved in eight upon needle repositioning. All patients deemed the procedure acceptable. No complications were recorded during the first month.

Conclusion: Ultrasound-guided caudal glucocorticoid injection is a fast, easy-to-perform, well accepted procedure. In our study, an epidurogram confirming that the needle was in the epidural space was obtained in 27 of 28 patients.