Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep 14:16:123283.
doi: 10.52965/001c.123283. eCollection 2024.

Practice Patterns of Physicians who Perform Caudal Epidural Steroid Injections

Ashlyn Brown  1 , Jason Parmar  1 , Suma Ganji-Angirekula  2 , Christopher L Robinson  3 , Rana Al-Jumah  4 , Jatinder Gill  5 , Jamal Hasoon  6
Affiliations

Practice Patterns of Physicians who Perform Caudal Epidural Steroid Injections

Ashlyn Brown et al. Orthop Rev (Pavia). .

Abstract

Introduction: Caudal epidural steroid injections (ESIs) are commonly employed in the management of low back pain and radiculopathy. Despite their widespread use, practice patterns among physicians performing caudal ESIs can vary significantly. This study aims to identify variability in injection techniques utilized by physicians during caudal ESIs, focusing on steroid use, needle selection, and catheter use. This study also looks at major permanent neurological injuries related to caudal ESIs.

Methods: A survey was distributed to a cohort of physicians who regularly perform ESIs. The survey comprised questions regarding the type of needle primarily used, steroid selection, the use of catheters, and major neurological injuries from caudal ESIs. The respondents included a diverse group of pain management physicians from various specialties and practice settings.

Results: The results revealed a predominant preference for the use of particulate steroids (72.41%) when performing caudal ESIs. Additionally, physicians primarily prefer to use spinal needles (72.41%) compared to other needle types. A majority of physicians (65.12%) reported that they never use a catheter when performing caudal ESIs to access higher pathology. Finally, all physician responders (100%) reported that they have never caused a permanent neurological injury when performing a caudal ESI.

Conclusion: This survey provides initial data among physicians who perform caudal ESIs. Our results demonstrate the majority of physicians favor using particulate steroids and a spinal needle, with fewer opting to use a catheter during these procedures. There were no reported major permanent neurological injuries, demonstrating that caudal ESIs are a safe interventional option for managing lumbosacral pain complaints.

Keywords: Caudal epidural steroid injection; chronic pain; epidural steroid injection; interventional pain management; lumbar radiculopathy; sciatica.

PubMed Disclaimer

Figures

Figure I.
Figure I.. Steroid preference when performing caudal ESIs.
72.41% (63 out of 87) use particulate steroids. 25.29% (22 out of 87) use non-particulate steroids. 1.15% (one out of 87) use no steroids. 1.15% (one out of 87) do not perform caudal injections.
Figure II.
Figure II.. Needle preference when performing caudal ESIs.
16.09% (14 out of 87) use a Touhy needle. 72.41% (63 out of 87) use a spinal needle 10.34% (nine out of 87) use a Touhy with a catheter. 1.15% (one out of 87) do not perform caudal injections.
Figure III.
Figure III.. Catheter use when performing caudal ESIs.
34.88% (30 out of 86) use catheters. 65.12% (56 out of 86) do not use catheters.
Figure IV.
Figure IV.. Major neurological injuries
100% (86 out of 86) reported no major neurologic injuries
Figure V.
Figure V.. Physicians by specialty
75% (72 out of 96) Anesthesiologists 18.75% (18 out of 96) Physiatrists 4.17% (four out of 96) Neurologists 1.04% (one out of 96) Radiologists 1.04% (one out of 96) Emergency Medicine
Figure VI.
Figure VI.. Practice setting
52.63% (50 out of 95) Academic based employee 18.95% (18 out of 95) Hospital based employee 20% (19 out of 95) Private practice employee 8.42% (eight out of 95) Private practice owner/partner
See this image and copyright information in PMC

References

    1. INTRASACRAL EPIDURAL INJECTION IN THE TREATMENT OF SCIATICA. Evans W. Dec;1930 The Lancet. 216(5597):1225–9. doi: 10.1016/S0140-6736(00)86498-3. - DOI
    1. Painful radiculopathy treated with epidural injections of procaine and hydrocortisone acetate: results in 113 patients. Goebert H. W., Jallo S. J., Gardner W. J., Wasmuth C. E. 1961Anesth Analg. 40:130–4. doi: 10.1213/00000539-196101000-00017. - DOI - PubMed
    1. Epidural Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Comprehensive Evidence-Based Guidelines. Manchikanti L., Knezevic N. N., Navani A., Christo P. J., Limerick G., Calodney A. K.., et al. Jan;2021 Pain Physician. 24(S1):S27–208. doi: 10.36076/ppj.2021.24.S27-S208. - DOI - PubMed
    1. Comparative Systematic Review and Meta-Analysis of Cochrane Review of Epidural Injections for Lumbar Radiculopathy or Sciatica. Manchikanti L., Knezevic E., Latchaw R. E., Knezevic N. N., Abdi S., Sanapati M. R.., et al. Oct;2022 Pain Physician. 25(7):E889–916. - PubMed
    1. Sicard M. Comptes Renues Seances Soc Biol Ses Fill. Vol. 53. Paris: Les injections medicamenteuse extradurales par voie saracoccygiene; p. 396.

LinkOut - more resources