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Caudal Epidural Steroid Injection: Fluoroscopy 

Caudal Epidural Steroid Injection: Fluoroscopy
Caudal Epidural Steroid Injection: Fluoroscopy
Multimodality Imaging Guidance in Interventional Pain Management

Imanuel R. Lerman

, David Hiller

, and Joseph Walker


The caudal epidural steroid injection can be a routine procedure. However, the underlying anatomy of the sacral hiatus is highly variable and can be difficult to visualize under fluoroscopy. The “blind” palpation technique has repeatedly been shown to be inferior, resulting in significantly more complications, when compared to employing contrast-enhanced fluoroscopic guidance. Ultrasound image guidance can accurately localize the sacral hiatus more consistently than the palpation technique. However, ultrasound guidance does not improve the accuracy of proper needle placement, as ultrasound cannot visualize the needle or injectate after the needle has passed under the apex of the sacral hiatus. Fluoroscopic guidance is necessary to visualize the needle and to confirm that the needle tip is extradural, extravascular, and in the epidural space, and it is likely to remain the gold standard imaging modality when carrying out caudal epidural steroid injection.

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