Systematic Review of Caudal Epidural Injections
in the Management of Chronic Low Back Pain
Authors: Conn Ann 
Published: March 2021

Background: Caudal epidural injection of local anesthetics with or without steroids is one of
the most commonly used interventions in managing chronic low back and lower extremity pain.
However, there has been a lack of well-designed randomized, controlled studies to determine the
effectiveness of caudal epidural injections in various conditions — disc herniation and radiculitis, post-lumbar laminectomy syndrome, spinal stenosis, and chronic low back pain of disc origin
without disc herniation or radiculitis.
Study Design: A systematic review of caudal epidural injections with or without steroids in
managing chronic pain secondary to lumbar disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and discogenic pain without disc herniation or radiculitis.
Objective: To evaluate the effect of caudal epidural injections with or without steroids in managing
various types of chronic low back and lower extremity pain emanating as a result of disc herniation or
radiculitis, post-lumbar laminectomy syndrome, spinal stenosis, and chronic discogenic pain.
Methods: A review of the literature was performed according to the Cochrane Musculoskeletal Review Group Criteria as utilized for interventional techniques for randomized trials and the
Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies.
The level of evidence was classified as Level I, II, or III based on the quality of evidence developed
by the U.S. Preventive Services Task Force (USPSTF).
Data sources included relevant literature of the English language identified through searches of
PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of
known primary and review articles.
Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6
months and long-term ≥ 6 months). Secondary outcome measures of improvement in functional
status, psychological status, return to work, and reduction in opioid intake were utilized.
Results: The evidence showed Level I for short- and long-term relief in managing chronic low
back and lower extremity pain secondary to lumbar disc herniation and/or radiculitis and discogenic pain without disc herniation or radiculitis. The indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing low back pain of post-lumbar laminectomy syndrome and
spinal stenosis.
Limitations: The limitations of this study include the paucity of literature, specifically for chronic pain without disc herniation.
Conclusion: This systematic review shows Level I evidence for relief of chronic pain secondary
to disc herniation or radiculitis and discogenic pain without disc herniation or radiculitis. Further,
the indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing chronic pain
of post lumbar laminectomy syndrome and spinal stenosis.
Key words: Chronic low back pain, lower extremity pain, lumbar disc herniation, lumbar radiculitis, lumbar discogenic pain, post lumbar laminectomy or surgery syndrome, spinal stenosis,
caudal epidural injections, steroids, local anesthetic