Caudal epidural steroid injections cpt code

The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.

In fact, the anatomical studies have demonstrated that after the radicular medullary arteries enter the neuroforamen in the anterior aspect of exiting nerve root and dorsal root ganglion, they often travel a distance superiorly and laterally in the lateral epidural space to join the anterior spinal artery supplying the anterior two thirds of the spinal cord. Additionally, in about 63% of cases of cadaver studies, there is a posterior branch of the radicular medullary artery going to the dorsal aspect of the cauda equina. It is conceivable that the epidural needle in the interlaminar lumbar epidural steroid injection will very likely encounter the radicular medullar artery in the lateral aspect of the epidural space or midline posterior epidural space.

Epidural steroid injections are commonly prescribed for patients with a disc injury or spinal arthritis causing nerve irritation, and generally consist of local anesthetic (numbing medication such as lidocaine) and cortisone (a steroid that reduces inflammation and pain). Lidocaine is often injected initially so patients experience minimal, if any, pain during the procedure. The injection may be performed by placing the needle posteriorly between the spine bones (Translaminar or interlaminar) and injecting the medicine into the space around the spinal nerves. A transforaminal ESI means the injection is placed slightly to one side of the spine, and the medicine is injected near the ruptured disc and inflamed spinal nerve. A caudal ESI is performed by placing the needle near the tailbone, and injecting the medicine into the region of the sacral nerves and lower lumbar spinal nerves. Epidural steroid injections, as well as most spinal injections, are performed using a special x-ray guidance system called fluoroscopy. This allows the doctor to immediately see an x-ray image on a television screen and inject the medicine precisely into the right spot. The procedure time is often less than 10-15 minutes.

Epidural injections can be performed from several different approaches; these include a caudal, interlaminar, or transforaminal approach. The approach your provider chooses is based on each individual patient’s clinical presentation, the personal preference and experience of the provider performing the injection, the desired outcome, and most importantly, the risks versus benefits of performing one type of epidural over another. Clinically, the purpose of all epidural injections is to place a mixture of steroid and local anesthetic at the source of the problem to decrease inflammation causing pain, and to promote healing and clinical improvement. The epidural steroid injection involves placing steroid medication in the inflamed area and significantly reduces nerve irritation thus improving pain. This treatment option has the potential to completely resolve pain and ultimately may prevent operative treatment.

Caudal epidural steroid injections cpt code

caudal epidural steroid injections cpt code

Epidural injections can be performed from several different approaches; these include a caudal, interlaminar, or transforaminal approach. The approach your provider chooses is based on each individual patient’s clinical presentation, the personal preference and experience of the provider performing the injection, the desired outcome, and most importantly, the risks versus benefits of performing one type of epidural over another. Clinically, the purpose of all epidural injections is to place a mixture of steroid and local anesthetic at the source of the problem to decrease inflammation causing pain, and to promote healing and clinical improvement. The epidural steroid injection involves placing steroid medication in the inflamed area and significantly reduces nerve irritation thus improving pain. This treatment option has the potential to completely resolve pain and ultimately may prevent operative treatment.

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