The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: a study using magnetic resonance imaging

Abstract

SummaryThe purpose of this study was to investigate the prevalence of the anatomical abnormalities that can induce inadvertent dural puncture when performing caudal block. The anatomy of the lumbosacral area was evaluated using magnetic resonance imaging. In 2462 of the 2669 patients imaged, the dural sac terminal was located between the upper half of the 1st sacral vertebra and the lower half of the 2nd sacral vertebra. In 22 cases (0.8%), the dural sac terminal and the spinal canal were located at or below the 3rd sacral vertebra, and these were cases of simple anatomical variations. As regards pathologic conditions, there was one case of sacral meningocoele and 46 cases of sacral perineural cyst. In 21 cases (0.8%) out of the 46 perineural cyst cases, the cyst could be found at or below the 3rd sacral vertebra level. Inadvertent dural puncture may happen when performing caudal block in patients with such abnormal anatomy.

Electromyography and A Review of the Literature Provide Insights into the Role of Sacral Perineural Cysts in Unexplained Chronic Pelvic, Perineal and Leg Pain Syndromes

“…It has been reported that 61.2%-87% of patients who harbor TCs are women [5,6,30,48,50]. We found that this number was 74.8% in case reports and 90% in our EMG study.…”

“…Previous studies that analysed the MRIs of patients with lower back pain have reported a prevalence of 1.5%-4.6% [6,22,48,49]. However, because lower back and leg pain are almost always attributed to lumbar degenerative changes or disc problems, these MRIs did not routinely include axial or coronal sequences of the sacrum.…”

Caudal Epidural Block: An Updated Review of Anatomy and Techniques

“…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].…”

Prevalence of Spinal Meningeal Cyst in the Sacrum

“…13,15) Therefore, we reviewed MR-based series of case reports dealing with five or more SMCs (Table 1). [1][2][3][4][6][7][8][9][10][11]13,15,[18][19][20] Our study identified at least 5 cases of multiple SMCs out of 10 cases. Amazingly, not only multiple but also large cysts in Group 3 were found in this study.…”

“…10) Recently, the prevalence of SMC was reported as 46/2669 (1.6%) in Korean adults with low back pain and/or sciatica. 8) Although the exact sequences were not described, conventional sagittal T 1 -and/or T 2 -weighted MR imaging was employed.…”