The caudal epidural space is the inferior extent of the epidural space accessed via the sacral hiatus, containing epidural fat, the sacral venous plexus, and the sacral nerve roots. It is the route for caudal epidural steroid injection and caudal anaesthesia, providing access to the L4-S1 epidural space without lumbar puncture.
| Location | Sacral canal, below the end of the dural sac (about S2) down to the sacral hiatus |
|---|---|
| Parts |
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| Connections |
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| Blood Supply | Lateral sacral arteries; Median sacral artery |
The lowest part of the epidural space. Injections through the sacral hiatus spread upward here (caudal block), widely used in children and for low back and leg pain.
Caudal epidural injection is performed with the patient prone, needle inserted through the sacral hiatus at 45 degrees, confirmed by loss of resistance and injection of contrast under fluoroscopy. It is preferred over lumbar interlaminar injection in post-laminectomy syndrome where scar tissue obliterates the lumbar epidural space. Spinal cord stimulator lead placement may use the caudal route. Anatomical variants including sacral canal agenesis or closed hiatus require CT-guided approaches.
Inability to access the caudal epidural space from sacral hiatus anatomical variants, requiring imaging-guided confirmation of correct needle placement or alternative lumbar epidural approach.
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