Caudal Epidural Steroid Injection (Caudal ESI)
If you are living with lower back pain that radiates down the leg — affecting your ability to walk, move freely, or carry out daily activities — a Caudal Epidural Steroid Injection (Caudal ESI) may be an effective treatment option for you. This is particularly relevant for patients who continue to experience persistent pain following spinal surgery, or for those who have not achieved adequate relief through medication or physiotherapy alone.
What Is a Caudal ESI?
A Caudal ESI is a targeted interventional procedure in which a mixture of corticosteroid and local anaesthetic is injected directly into the epidural space — the area surrounding the spinal cord and nerve roots — accessed through a small natural opening at the base of the sacrum (the tailbone).
The procedure works by delivering anti-inflammatory medication precisely to the site of nerve irritation or compression, with three primary goals:
- Reduce nerve inflammation — directly decreasing swelling and inflammation around compressed or irritated nerve roots in the lower spine
- Relieve pain — providing targeted relief from lower back pain and leg pain caused by nerve involvement
- Restore mobility and quality of life — helping patients regain the ability to walk, move, and engage in daily activities with greater ease and comfort
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Who Is This Procedure Suitable For?
Caudal ESI is appropriate for patients with lower back pain radiating into the leg, arising from:
- Herniated disc or lumbar spinal stenosis — where disc material or narrowed spinal canal compresses the nerve roots that supply the leg
- Failed Back Surgery Syndrome (FBSS) — persistent chronic pain that remains following spinal surgery, where structural causes have been addressed but pain has not fully resolved
- Patients who have not responded to conservative treatment — including oral medication and physiotherapy
The Procedure (Approximately 15–20 Minutes)
This is a safe, minimally invasive outpatient procedure. General anaesthesia is not required and patients can go home the same day.
- The patient lies face down on the procedure table
- The physician cleans the skin at the injection site and applies local anaesthetic to minimise discomfort
- Using real-time fluoroscopy (live X-ray) combined with contrast dye, the physician confirms the precise position of the epidural space before any medication is delivered — ensuring accurate and safe needle placement
- The corticosteroid and local anaesthetic mixture is injected directly to the area of nerve inflammation
The entire procedure typically takes 15–20 minutes from start to finish.
Expected Outcomes
- Immediate effect: The local anaesthetic component produces an immediate reduction in pain shortly after the injection. This rapid initial response also serves a diagnostic purpose — confirming that the targeted area is the true source of the patient's pain.
- Sustained effect: The corticosteroid begins reducing inflammation progressively, with its full anti-inflammatory effect developing over the following few days. Patients who respond well typically experience meaningful pain relief lasting 3–6 months or longer, depending on the underlying condition and individual response.
- Individual variation: Treatment outcomes vary between patients. Some achieve substantial long-lasting relief after a single injection; others may benefit from repeat procedures at appropriate intervals as advised by the physician.
Post-Procedure Care
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- Day of procedure:
- Rest for the remainder of the day
- Avoid strenuous physical activity and heavy lifting
- Do not drive yourself home — arrange for a companion or use public transport - The following day: Most patients can return to their normal daily routine.
- Injection site discomfort: Mild soreness, tightness, or aching at the injection site is normal and expected. This typically resolves on its own within 2–3 days.
- Follow-up: If you have any concerns about your recovery or the degree of pain relief you experience, contact your physician. Noting the onset, degree, and duration of pain relief in the days following the procedure is helpful information for planning the next step in your treatment.
Pain Management at Bangkok Interventional Clinic
At Bangkok Interventional Clinic, we focus on personalised, in-depth pain management tailored to each individual.
- All patients are evaluated and treated by a board-certified pain specialist, ensuring accuracy, safety, and effective care.
- Targeted interventional procedures for fast and effective symptom relief
- Patient education to support sustainable, long-term self-care
Our goal is to meaningfully improve the quality of life of every patient we treat. If you are living with pain that affects your daily life, the right diagnosis and the right treatment plan are where change begins.
