Filum Terminale Needle Placement during Caudal Epidural Steroid Injection: A Case Report

Ramsook RR, Spinner D and Doshi RR

Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, USA
Division of Pain Medicine, Beth Israel Deaconess Medical Center, USA

^*Correspondance to: Ryan R. Ramsook 

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Abstract:

Objective: Caudal epidural steroid injections (ESI) are a commonly utilized and efficacious means in which to treat radicular leg symptoms arising from the lumbo-sacral spine. Touhy needles are placed via fluoroscopic guidance with utilization of live fluoroscopy to ensure epidural administration of medication. This is a case report of direct needle and catheter placements into and through the filum terminale during a caudal approach to the epidural space.Design: Single case report.Setting: Beth Israel Deaconess Medical Center.Patient: A 69-year-old woman, who suffered from chronic low back and leg pain from lumbosacral radiculopathy, failed back surgery syndrome and lumbar facet arthropathy.Interventions: Caudal epidural steroid injection.Outcome Measures: Pain reduction.Results: The needle and catheter placement were confirmed via intrathecal contrast spread to be in the filum terminale, which resulted in the abortion of the procedure. Conclusions: This case illustrates a rare incidence of catheter placement directly into the filum terminale during a routine caudal ESI. Despite a relatively safe and routine intervention, care must be taken to ensure proper placement of needle, catheter and injectate. While contrast is injected to ensure appropriate epidural spread, we present, to the best of our knowledge, the first occasion of a needle being inserted directly into the filum terminale during a caudal ESI.

Keywords:

Caudal epidural steroid injection; Filum terminale; Catheter placement, Lumbosacral radiculopathy

Cite the Article:

Ramsook RR, Spinner D, Doshi RR. Filum Terminale Needle Placement during Caudal Epidural Steroid Injection: A Case Report. Ann Clin Case Rep. 2016; 1: 1034.