Background. Chronic low back pain (CLBP) is one of the most common skeletal muscular diseases with a high economic burden on different societies. One of the more commonly used interventional treatments for managing CLBP is the caudal epidural injection. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of caudal epidural injection in the treatment of CLBP. Methods. Following PRISMA guidelines, a systematic review and meta-analysis were conducted, encompassing randomized controlled trials (RCTs) and cohort studies published through December 2025. PubMed, Scopus, Web of Science, and the Cochrane Library were used to identify relevant research usingpredetermined search terms. The outcomes measured were pain score, functional improvement (as assessed by the Oswestry Disability Index (ODI)), pain relief, and adverse events. Results. We included 13 studies with 1,061 patients. The results showed that the pain score was notsignificantly different at baseline and 2 weeks between both groups, but was significantly lower at 1 month, 3 months, 6 months, and 1 year in the caudal group than the control group (95% CI = –2.09: –0.06, –1.79: –0.34, –2.18: –0.42, and –1.35: –0.34, respectively). Pain relief was significantly higher in the caudal group than the control group (RR = 1.96; 95% CI = 0.62:6.17, I2 = 77%). ODI at baseline was not significantly different between the two groups, but was significantly lower at 1 month, 3 months, and 6 months in the caudal group than in the control group (95% CI = –12.82: –2.10, –12.89: –3.77, and –13.75: –3.47, respectively). There was no significant difference in complications between the two groups. Conclusion. This meta-analysis demonstrates that caudal epidural injections provide significant intermediateterm pain relief and functional improvement in patients with CLBP compared with the control group.
Elmaadawi et al. (Sun,) studied this question.