Caudal Epidural Steroid Injection: Procedure, Benefits, and Risks
Updated: 4 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
A caudal epidural steroid injection (CESI) is a minimally invasive outpatient procedure for lower back and leg pain caused by inflamed spinal nerves. Using X-ray guidance, a provider injects steroid medicine into the epidural space just above the tailbone. Many people feel relief within two to three days, but a CESI usually provides temporary relief rather than a cure.
What the research says
Epidural steroid injections give small short-term benefits for sciatica-type pain. A Cochrane review of 25 placebo-controlled trials (2,470 participants; caudal, interlaminar and transforaminal approaches) found that epidural corticosteroid injections probably slightly reduced leg pain at short-term follow-up (mean difference −4.93 on a 0–100 scale, 95% CI −8.77 to −1.09) and disability (−4.18, 95% CI −6.04 to −2.17). The authors noted the effects are small and may not be clinically important to many patients (PubMed: Oliveira et al., Cochrane Database Syst Rev, 2020).
For caudal injections specifically, the evidence is stronger for some uses than others. A systematic review of 23 publications found moderate-quality evidence that caudal injections with a two-day indwelling catheter help disc herniation with radicular pain and chronic post-surgical back pain at 3, 6 and 12 months, and low-quality evidence for other techniques. Reported success rates ranged from 40% to 58% at three months (PubMed: Nagpal et al., Interv Pain Med, 2022).
What happens during a caudal epidural steroid injection?
A caudal epidural steroid injection delivers anti-inflammatory medicine, typically a corticosteroid, into the epidural space, the area around the spinal nerves, to ease pain from irritated or inflamed nerve roots. “Caudal” means “toward the tail”: the needle enters through the sacral hiatus, an opening toward the bottom of the sacrum and just above the tailbone, which gives a path to the lowest spinal nerves.
The injection is mainly used to manage sciatica or radiculopathy, where nerves in the lower spine are pinched or inflamed and pain may extend into the leg. By reducing the swelling around those nerves, it can relieve discomfort and improve mobility. CESIs are generally safe and minimally invasive, and it is wise to have the injection done by a provider who performs it often.
Procedure Phase | Primary Actions Involved |
Preparation | You lie face-down on an X-ray table; the area is cleaned and the skin is numbed with a local anesthetic. |
Visualization | Contrast dye is injected and fluoroscopy (live X-ray) confirms where the needle is. |
Injection | Steroid medicine is delivered into the target epidural space. |
Recovery | A short monitoring period, then same-day discharge with driving restrictions. |
What conditions do caudal epidural steroid injections treat?
Caudal epidural steroid injections treat nerve-related pain in the lower back and legs, often caused by spine changes that put pressure on nerve roots. These include:
Herniated or degenerative disks.
Lumbar spinal stenosis, a narrowing of the spinal canal.
Spondylolisthesis, where a vertebra slips out of place.
Facet joint syndrome and lumbar spondylosis.
Failed back surgery syndrome (post-laminectomy syndrome).
What is a caudal epidural steroid injection procedure like?
Before the injection, your provider reviews your health history and medicines. Tell them about all medicines and supplements, because some thin the blood and raise bleeding risk, and you may be asked to stop certain ones a few days beforehand. Tell them if you are or might be pregnant, since the imaging used may be harmful to a developing baby. Arrange for someone to take you home.
In most cases the steps are:
You change into a gown and lie face-down on an X-ray table, with a pillow under your abdomen if it helps.
The skin of your lower back is cleaned.
A local anesthetic numbs the skin so you do not feel pain from the injection.
A needle places contrast dye into the epidural space to help the tissues show up on imaging.
Short pulses of X-ray (fluoroscopy) show exactly where the medicine should go.
Steroid medicine is injected into the epidural space. You may feel some pressure, and it is important not to move.
The needle is removed and a sterile dressing is placed.
The whole process usually takes only 15 to 30 minutes, and you are monitored for 15 to 20 minutes afterward before going home.
What are the risks of a caudal epidural steroid injection?
Caudal epidural steroid injections are usually safe, but they carry some risks that you should discuss with your provider. Possible side effects include:
A temporary increase in pain before the steroid starts to work.
Tenderness or bruising at the injection site.
High blood sugar if you have diabetes, which can last for hours or even days.
A temporary rise in blood pressure and eye pressure if you have glaucoma.
Rare complications include low blood pressure that makes you lightheaded, infection, bleeding around the spinal column, an allergic reaction to the medicine, a spinal headache from fluid leakage (in less than 1% of people), nerve damage, and temporary loss of bladder or bowel control. Too many injections or high steroid doses may weaken the spinal bones or nearby muscles, so most providers limit people to two to three injections per year.
Potential benefits include temporary or longer-term pain relief, better quality of life and daily function, information about where your pain comes from, and possibly reducing the need for more invasive procedures. Results are not guaranteed, so talk to your provider about other options if you notice no change.
Why is care after a caudal epidural steroid injection important?
A CESI is an outpatient procedure, so you go home the same day. Arrange a driver, avoid driving and strenuous activity for the first 24 hours, and expect some soreness near the injection site. You can resume usual activities after 24 hours.
Many people feel relief within two to three days, though it can take up to 10 days to notice a difference. Relief may last weeks to months, rarely up to a year, depending on the cause of the pain. If you still have pain, your provider may recommend up to two more injections, typically two to four weeks apart.
When to Call Your Doctor
Contact your healthcare provider or go to the nearest hospital as soon as possible if, after going home, you have:
A severe headache when standing or sitting that feels better after lying down.
A fever, which could be a sign of infection.
Reduced or complete loss of bladder or bowel control.
Numbness or weakness in your legs, which could be a sign of nerve injury.
Conclusion
Caudal epidural steroid injections can be a useful part of managing chronic lower back and leg pain. By delivering targeted anti-inflammatory medicine, they can ease pain, support daily activities and may reduce the need for more invasive treatment, although they will most likely not cure the pain. Open communication with your healthcare team helps ensure the procedure is used safely and effectively within a broader pain management plan.
Consult your provider: If you have persistent lower back pain that spreads into your legs, talk to your doctor about whether a caudal epidural steroid injection is a suitable option for you.
Frequently Asked Questions
1. What is a caudal epidural steroid injection?
A caudal epidural steroid injection is an injection of anti-inflammatory steroid medicine into the epidural space of the lower back, through an opening near the tailbone called the sacral hiatus.
2. How does the injection help with pain?
The steroid reduces inflammation and swelling around irritated spinal nerves, which can ease pain in the lower back and legs.
3. What conditions does this procedure treat?
Common conditions include sciatica, herniated disks, spinal stenosis, degenerative disk disease and pain after back surgery.
4. Is the procedure painful?
The skin is numbed with a local anesthetic first. You may feel some pressure during the steroid injection, but the procedure is designed to be minimally uncomfortable.
5. How long does the injection take?
The procedure usually takes 15 to 30 minutes, followed by a 15-to-20-minute monitoring period before you go home.
6. When will I feel pain relief?
Many people feel relief within two to three days, although it can take up to ten days to notice a difference.
7. How many injections can I have per year?
Most healthcare providers limit people to two or three injections per year to avoid weakening spinal bones or nearby muscles.
8. What are the common side effects?
Common side effects include a temporary increase in pain, tenderness or bruising at the injection site, and high blood sugar in people with diabetes.
9. Are there serious risks involved?
Serious risks are rare but can include infection, bleeding around the spine, allergic reaction, nerve damage or a spinal headache. Imaging guidance and sterile technique help minimize these risks.
10. Can I drive home after the procedure?
No. Arrange for someone to drive you home, and avoid driving and strenuous activity for at least 24 hours after the injection.
References
Cleveland Clinic. Caudal Epidural Steroid Injection. Cleveland Clinic. Jul. 22, 2024. https://my.clevelandclinic.org/health/procedures/caudal-epidural-steroid-injection
Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;4(4):CD013577. PMID 32271952. https://doi.org/10.1002/14651858.CD013577
Nagpal AS, Vu TN, Gill B, et al. Systematic review of the effectiveness of caudal epidural steroid injections in the treatment of chronic low back or radicular pain. Interv Pain Med. 2022;1(4):100149. PMID 39238877. https://doi.org/10.1016/j.inpm.2022.100149
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
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