The level of termination of the dural sac by MRI and its clinical relevance in caudal epidural block in adults

Şenoğlu, Nimet; Şenoğlu, Mehmet; Özkan, Fuat; Kesilmez, C.; Kızıldağ, Betül; Çelık, Mustafa

doi:10.1007/s00276-013-1108-2

Cited by 35 publications

(41 citation statements)

References 17 publications

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“…The dural sac usually terminates between S1 and S2 vertebra, with the majority at S2 [8, 9, 15, 16]. In 1 to 5% of patients, the dural sac terminates at S3 or below [15, 16].…”

Section: Anatomymentioning

confidence: 99%

“…In 1 to 5% of patients, the dural sac terminates at S3 or below [15, 16]. In addition, 1 to 5% of patients with low back pain or sciatica have a sacral Tarlov cyst [15–17], a perineural cyst that communicates with the dural sac and is filled with cerebrospinal fluid (CSF).…”

Section: Anatomymentioning

confidence: 99%

“…In addition, 1 to 5% of patients with low back pain or sciatica have a sacral Tarlov cyst [15–17], a perineural cyst that communicates with the dural sac and is filled with cerebrospinal fluid (CSF). More than 40% of the sacral Tarlov cysts are located at or below the S3 level [15, 16]. The lower the dural sac termination or the Tarlov cyst is located, the more likely dural puncture or intrathecal injection might occur during caudal epidural block.…”

Section: Anatomymentioning

confidence: 99%

“…In an Indian cadaver study, the average distance was 32 ± 12 mm, ranging from 5.8 to 60.0 mm [8]. Using magnetic resonance imaging (MRI) for measurement, this distance was 60.3 ± 13.1 mm, ranging from 34 to 80 mm in a British study [9], and 44.6 ± 11.8 mm, ranging from 10 to 80 mm in a Turkish study [16]. As shown by these reports, the distance between the dural sac termination and the apex of the sacral hiatus could be as short as less than 6 mm in some individuals.…”

Section: Anatomymentioning

confidence: 99%

See 3 more Smart Citations

Caudal Epidural Block: An Updated Review of Anatomy and Techniques

Kao

Lin

2017

BioMed Research International

104

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Caudal epidural block is a commonly used technique for surgical anesthesia in children and chronic pain management in adults. It is performed by inserting a needle through the sacral hiatus to gain entrance into the sacral epidural space. Using conventional blind technique, the failure rate of caudal epidural block in adults is high even in experienced hands. This high failure rate could be attributed to anatomic variations that make locating sacral hiatus difficult. With the advent of fluoroscopy and ultrasound in guiding needle placement, the success rate of caudal epidural block has been markedly improved. Although fluoroscopy is still considered the gold standard when performing caudal epidural injection, ultrasonography has been demonstrated to be highly effective in accurately guiding the needle entering the caudal epidural space and produce comparative treatment outcome as fluoroscopy. Except intravascular and intrathecal injection, ultrasonography could be as effective as fluoroscopy in preventing complications during caudal epidural injection. The relevant anatomy and techniques in performing the caudal epidural block will be briefly reviewed in this article.

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“…The dural sac usually terminates between S1 and S2 vertebra, with the majority at S2 [8, 9, 15, 16]. In 1 to 5% of patients, the dural sac terminates at S3 or below [15, 16].…”

Section: Anatomymentioning

confidence: 99%

Section: Anatomymentioning

confidence: 99%

Section: Anatomymentioning

confidence: 99%

Section: Anatomymentioning

confidence: 99%

See 2 more Smart Citations

Caudal Epidural Block: An Updated Review of Anatomy and Techniques

Kao

Lin

2017

BioMed Research International

104

View full text Add to dashboard Cite

show abstract

“…Hence, most of the radiographic studies, instead, reported the DS termination. This anatomy was rather relevant to caudal epidural block than FT fusion site (Macdonald et al, ; Binokay et al, ; Senoglu et al, ). Their results were in concordance with cadaveric studies with most of the DS terminated at or below S1/S2 disk space.…”

Section: Discussionmentioning

confidence: 99%

Spinal dural sac termination and internal filum terminale fusion

Pokanan

Borsu²,

Hansasuta

2019

Clinical Anatomy

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Surgery for tethered spinal cord caused by thickened filum terminale (FT) is frequently performed through S1 laminectomy based on the assumption that the internal FT (FTi) fuses with dura mater at S2 vertebral level. Literature on specific study for the site of its fusion and dural sac (DS) termination was rather limited. Moreover, there is no large anatomical study in Asian population. To determine the anatomy, examination of the FTi fusion site, as well as the region at which DS ended, was undertaken. From 80 embalmed cadavers, the majority of FTi fusion occurred at, or below, S1/S2 disk space (62.5%) which was less frequent than previous reports (70%-90%). In addition, there was 11.3% of the fila that fused above S1. Regarding the DS termination, it was found at, or below, S1/S2 disk space in 76.3% with one subject (1.3%) at L5/S1 disk space. With modest differences compared with non-Asian cadaveric data, our results offer pertinent information to surgeons performing tethered cord release. One ought to keep in mind that small, but not negligible, percentage of FTi can fuse with dura mater above S1 level; hence, more rostral laminectomy at L5 may be required. Clin. Anat. 33:558-561, 2020.

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Sacral Epidural Block

Tanoue

2019

Nerve Blockade and Interventional Therapy

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The level of termination of the dural sac by MRI and its clinical relevance in caudal epidural block in adults

Abstract: Knowledge of the level of termination of the DS, the distance between the upper margin of the sacrococcygeal membrane and the DS, and the presence of Tarlov cysts on MRI images of before CEB is very important and might decrease the risk of dural puncture.

Cited by 35 publications

References 17 publications

Caudal Epidural Block: An Updated Review of Anatomy and Techniques

Caudal Epidural Block: An Updated Review of Anatomy and Techniques

Spinal dural sac termination and internal filum terminale fusion

Sacral Epidural Block

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