Caudal Sacral Hiatus Epidural Injections

The patient is placed in a prone position, and the sacral hiatus is palpated and marked with a blunt marker to indent the skin. Before sterile preparation of this site, gauze pads may be placed in the gluteal fold to prevent excess Betadine and alcohol from draining to the perineum and genitals. After sterile preparation is performed, a fenes-trated drape is placed, and a 22-gauge spinal needle is advanced ven-trally and rostrally from the midline overlying the sacral hiatus. The needle is advanced by using intermittent AP and lateral fluoroscopic imaging to document positioning of the tip within the caudal sacral canal. The needle should not be advanced above the S2-S3 level, to prevent inadvertent thecal puncture. Then 4 to 6 mL of nonionic, iodinated contrast is injected to exclude venous opacification and to document

Selective Nerve Root Injection
Figure 9.4. (A) AP radiograph during injection of contrast media for a transforaminal injection at L5-S1. (B) After injection of 5 mL of contrast medium, contrast is seen along the L5 nerve root and within the epidural space from L2-3 to the L5-S1 level.
Transforaminal Epidural Block

Figure 9.5. Radiographs taken during a transforaminal S1 injection: (A) AP and (B) oblique. A small amount of the mixture of contrast and therapeutic agents is used for a selective S1 nerve block. For a transforaminal S1 epidural injection, a larger volume is used to achieve epidural reflux and wider distribution of the therapeutic agents.

Figure 9.5. Radiographs taken during a transforaminal S1 injection: (A) AP and (B) oblique. A small amount of the mixture of contrast and therapeutic agents is used for a selective S1 nerve block. For a transforaminal S1 epidural injection, a larger volume is used to achieve epidural reflux and wider distribution of the therapeutic agents.

Caudal EpiduralSacral Transforaminal Injection

dispersal of injected materials within the caudal epidural space. Following filming, the therapeutic substances are administered, and a postinjection epidurogram is obtained to document dispersal of injec-tate. The volume of contrast and therapeutic agents is the same as that used for interlaminar injections.

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  • Boyd Kennedy
    Where is a caudal injection on body?
    8 years ago

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