Sonographically Guided Caudal Epidural Steroid Injections

Abstract

Real-time sonography can facilitate caudal epidural steroid injections.

Ultrasound Guided Spine Injections: Advancement Over Fluoroscopic Guidance?

“…Yet even with experienced physicians, the failure rate of the placement of needles into the caudal epidural space has been reported as 25-38 % [15,36]. Thus, US offers a useful tool for appropriate needle placement for caudal epidural injections [37].…”

“…With the clear evidence of the reliable role of US guidance in increasing the efficacy and safety of diagnostic and therapeutic peripheral nerve blocks and spinal anesthesia [9][10][11][12], there has been a growing interest in the use of US guidance with interventional spinal procedures. Although fluoroscopy remains the most frequently used imaging technique employed by interventional spine physicians [13,14 •• ], reports of the use of US guidance have begun to emerge [15][16][17][18]. Thus, it is timely to review the scientific and clinical value of US guidance in the most commonly utilized procedures of the spine.…”

“…However, the authors did note that inadvertent intravenous injection, which may occur in 5-9 % of caudal epidural procedures, is a major limitation that cannot be avoided with this particular technique. This is particularly important because aspiration or return of blood does not appear to be very sensitive or specific for intravenous positioning of the needle [15].…”

“…Klocke et al [15] were the first authors to describe the use of US to identify the sacral hiatus landmarks to facilitate real-time guidance of injections into the caudal epidural space in a small group of patients. However, the authors did note that inadvertent intravenous injection, which may occur in 5-9 % of caudal epidural procedures, is a major limitation that cannot be avoided with this particular technique.…”

“…The caudal approach to the epidural space via the sacral hiatus is often preferred by non-interventionalists because it carries a lower risk of inadvertent thecal sac puncture and intrathecal injection [15] and greater ease of execution in patients with a history of spinal surgery [34].…”