Methods available to ensure accurate delivery of caudal epidural injection: Case Report and Short Review

This paper reports a case of unusual spread of injectate during caudal epidural injection hitherto unreported in the literature and a review of the methods described to ensure accurate delivery of injectate.A 78 yrs old woman with an eight week history of bilateral burning leg pain and paraesthesia, on a background of chronic longstanding low back pain underwent a series of investigations including a plain x-ray examination and MRI scanning showing multiple level disc degeneration and facet joint arthrosis leading to lateral recess and exit foraminal stenosis at multiple levels. A caudal epidural procedure was performed under fluoroscopic guidance. Contrast passed anterolaterally through an anterior sacral foramen and a subsequent CT scan clarified distribution of contrast medium exclusively into the left piriformis muscle. A subsequent interlaminar epidural injection successfully alleviated the patient’s symptoms.