J Korean Soc Spine Surg.  2019 Sep;26(3):69-75. 10.4184/jkss.2019.26.3.69.

Caudal Epidural Injection with a Catheter in Patients with Failure of Conventional Epidural Blocks

• Ahn TK
• Yang JS
• Kim TH
• Kim MW
• Shin DE

• KMID: 2459755
• DOI: http://doi.org/10.4184/jkss.2019.26.3.69

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
The purpose of this study was to analyze and report the results of caudal epidural injections using a catheter in patients in whom conventional epidural block had failed. SUMMARY OF LITERATURE REVIEW: Epidural nerve block is often used to treat chronic back pain and radicular pain in degenerative lumbar disease, and percutaneous epidural neuroplasty or surgery may be an alternative if it fails.
MATERIALS AND METHODS
In total, 146 patients who were treated with caudal epidural block using a catheter were recruited for this study from January 1, 2015 to June 30, 2019. Forty-five patients who had not undergone any epidural block in the past were excluded from the study. Among patients who did not have a fracture and were followed up for at least 1 month, the medical records of 61 patients with degenerative disc herniation, spondylosis, and stenosis were reviewed retrospectively. Visual analogue scale (VAS) scores were evaluated before and after the procedure.
RESULTS
Of the 61 patients who had undergone epidural block through a transforaminal caudal approach with no pain control effect, there were 18 males and 43 females. Their mean age was 66.3 years and the average follow-up period was 2.64 months. There were 46 cases of spinal stenosis, 33 cases of spondylosis, 2 cases of spondylolisthesis, 9 cases of disc herniation and 1 case of ankylosing spondylitis. The mean number of epidural blocks was 5.85 (times) before the procedure. The mean initial VAS score was 5.34 and the final follow-up VAS score was 2.70. There was a significant difference between before and after the procedure (p<0.05). The mean duration of effect after the procedure was 1.84 months and the mean number of procedures was 2.30. After the procedure, there were 4 cases of surgical treatment, 2 cases of neuroplasty, and 3 cases of epidural block using other methods over more than 1 year of follow-up.
CONCLUSIONS
The result of this clinical study suggests that caudal epidural injections using a catheter may be effective for patients with low back pain who have not responded to previous epidural blocks before surgical treatment.

Keyword

Back pain; Catheter; Epidural block; Caudal block

MeSH Terms

Back Pain
Catheters*
Clinical Study
Constriction, Pathologic
Female
Follow-Up Studies
Humans
Injections, Epidural*
Low Back Pain
Male
Medical Records
Nerve Block
Retrospective Studies
Spinal Stenosis
Spondylitis, Ankylosing
Spondylolisthesis
Spondylosis

Figure

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  Fig. 1. (A) Caudal catheter (EPINA PLUS, Ace Medical. Seoul, Korea). (B) The patient's position during a caudal epidural injection with a catheter.

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  Fig. 2. Case of epidural block using a caudal catheter. The patient had received transforaminal epidural block twice. (A, B) Sagittal and axial views on magnetic resonance imaging, showing degenerative spondylosis, central stenosis, and foraminal stenosis. (C) Post C-arm image. The contrast medium diffused well after the caudal epidural injection using a caudal catheter.

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  Fig. 3. Comparison of initial and final follow-up visual analogue scale (VAS) scores.

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