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Sonographically Guided Caudal Epidural Steroid Injections

Royal National Hospital for Rheumatic Diseases, Bath, England.

Address correspondence and reprint requests to Rainer Klocke, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BA1 1RL, England. E-mail: rainer.klocke{at}rnhrd-tr.swest.nhs.uk.

Objective. Caudal epidural steroid injections are used for the symptomatic treatment of radicular lumbosacral pain syndromes, but incorrect injection placement has been recognized as a common problem with the routinely used unguided technique. We aimed to explore the use of sonography to facilitate this procedure. Methods. In patients with clinically unreliable anatomic landmarks, high-resolution real-time sonography was used to identify those landmarks and to assist in correct needle placement. Results. Sonography enabled localization of the sacral hiatus landmarks. We found this method particularly useful for guiding needle placement in patients with moderate obesity. Conclusions. Real-time sonography can facilitate caudal epidural steroid injections.

Key Words: caudal epidural injection • interventional sonography • sciatica