Caudal Canal Injections

  • Juan Felipe Vargas-Silva
  • Philip PengEmail author


Caudal canal injection offers an alternative approach to access the epidural space, especially when other approaches (interlaminar or transforaminal) are not feasible because of difficult anatomy. It is imperative to ensure an accurate placement of the needle to a successful procedure. The relevant anatomy, sonoanatomy, and a stepwise approach for needle placement into the caudal canal are described in this chapter.


Injections Epidural Anesthesia Caudal Ultrasonography Low back pain Sciatica Spinal stenosis 

Suggested Reading

  1. Bagheri H, Govsa F. Anatomy of the sacral hiatus and its clinical relevance in caudal epidural block. Surg Radiol Anat. 2017;39(9):943–51.CrossRefPubMedGoogle Scholar
  2. Chen CP, Tang SF, Hsu T, Tsai W, Liu H, Chen MJ, et al. Ultrasound guidance in caudal epidural needle placement. Anesthesiology. 2004;101(1):181–4.CrossRefPubMedGoogle Scholar
  3. Colimon FJ, Villalobos FJ. Epidural steroid injections: evidence and technical aspects. Tech Reg Anesth Pain Manag. 2010;14(3):113–9.CrossRefGoogle Scholar
  4. Fukazawa K, Matsuki Y, Ueno H, Hosokawa T, Hirose M. Risk factors related to accidental intravascular injection during caudal anesthesia. J Anesth. 2014;28(6):940–3.CrossRefPubMedGoogle Scholar
  5. Liu J, Zhou H, Lu L, Li X, Jia J, Shi Z, et al. The effectiveness of transforaminal versus caudal routes for epidural steroid injections in managing lumbosacral radicular pain: a systematic review and meta-analysis. Medicine (Baltimore). 2016;95(18):e3373.CrossRefGoogle Scholar
  6. Ogoke BA. Caudal epidural steroid injections. Pain Physician. 2000;3(3):305–12.PubMedGoogle Scholar
  7. Parr AT, Manchikanti L, Hameed H, et al. Caudal epidural injections in the management of chronic low back pain: a systematic appraisal of the literature. Pain Physician. 2012;15:E159–98.PubMedGoogle Scholar
  8. Rho ME, Tang C. The efficacy of lumbar epidural steroid injections: transforaminal, interlaminar, and caudal approaches. Phys Med Rehabil Clin N Am. 2011;22(1):139–48.CrossRefPubMedGoogle Scholar
  9. Woon JT, Stringer MD. Clinical anatomy of the coccyx: a systematic review. Clin Anat. 2012;25(2):158–67.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Surgery and Image Guided Therapy, Pain ClinicHospital Pablo Tobón UribeMedellinColombia
  2. 2.Department of Anesthesia and Pain ManagementToronto Western Hopsital and Mount Sinai Hospital, University of TorontoTorontoCanada

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