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Caudal epidural injections
  1. N J SHEEHAN
  1. Department of Rheumatology
  2. Edith Cavell Hospital
  3. Bretton Gate
  4. Peterborough PE3 9GZ, UK
  1. njsheehan{at}doctors.org.uk

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Price et al recommend that caudal epidural injections should be carried out withx ray screening.1 In practice the technique is often performed in the outpatient clinic, where screening facilities are not usually available.

I have reviewed the outcome of 44 unscreened caudal epidural injections given to 34 patients in my outpatient clinic in the 12 months from July 1999 to June 2000. Patient selection was principally on the basis of unilateral nerve root pain in the leg in the presence of symmetrical straight leg raising. However, nine patients had asymmetrically reduced straight leg raising and four of those with full straight leg raising had pain in the L4 dermatome, mostly with a positive femoral nerve stretch test on the affected side. Spinal mobility and the presence or absence of a neurological deficit did not influence the decision to offer an epidural injection.

The procedure was carried out with the patient lying prone on …

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