Korean J Pain.  2013 Apr;26(2):203-206. 10.3344/kjp.2013.26.2.203.

Inadvertent Dural Puncture during Caudal Approach by the Introducer Needle for Epidural Adhesiolysis Caused by Anatomical Variation

• Kim SG
• Yang JY
• Kim DW
• Lee YJ

• KMID: 1978671
• DOI: http://doi.org/10.3344/kjp.2013.26.2.203

Abstract

There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. We report a case of dural puncture by the introducer needle before attempting caudal epidural adhesiolysis, which occurred even though the needle was not advanced upward after penetrating the sacrococcygeal ligament. Dural puncture was caused by a morphological abnormality in the lumbosacral region, with no pathological condition; the dural sac terminal was located more distally than normal. However, dural puncture could have been prevented if we had checked for such an abnormality in the magnetic resonance imaging (MRI) taken before the procedure.

Keyword

anatomical variation; caudal block; dural puncture

MeSH Terms

Humans
Ligaments
Lumbosacral Region
Magnetic Resonance Imaging
Needles
Punctures

Figure

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  Fig. 1 Contrast dye injection to the introducer needle showed a myelogram in the anteroposterior view.

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  Fig. 2 Sagittal T1-weighted (A) and T2-weighted (B) MR images show extension of dural sac to the lower level of sacrum.

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