Caudal Epidural Steroid Injections: A Retrospective Pilot Study of Safety and Patient-Reported Outcomes.

Abstract

Background: Caudal epidural steroid injections (ESIs) are commonly used to manage lumbosacral radicular pain and axial low back pain. While they are generally considered safe, real-world data on complication rates and patient-reported outcomes remain limited. This study aimed to evaluate the safety profile and short-term effectiveness of caudal ESIs by reviewing a series of randomly selected cases performed over a six-month period.

Methods: A retrospective chart review was conducted on 40 randomly selected caudal ESI procedures performed between July 1, 2024, and December 31, 2024. All procedures were performed under fluoroscopic guidance using a corticosteroid mixed with local anesthetic and preservative-free normal saline. Charts were reviewed for procedural complications, including dural puncture, neurological injury, and infection. Outcome data, including starting and post-injection pain scores and patient-reported percent relief, were analyzed in patients with complete follow-up at two weeks or by post-procedure phone call.

Results: There were no documented dural puncture, infection, or permanent neurological injury among the 40 cases. Of the 27 patients with complete follow-up data, the average pain score decreased from 8.6 to 2.9 on the numerical rating scale. The average patient-reported percent relief was 67.4%. A total of 24 patients (88.9%) reported at least 50% relief, 3 patients (11.1%) reported complete (100%) relief, and only 1 patient reported no relief (0%).

Conclusion: Caudal ESIs demonstrated a favorable safety profile and were associated with meaningful short-term pain relief in most patients. These findings support the continued use of caudal ESIs as a safe and effective interventional option for appropriately selected patients with lumbosacral pain.