Case Report CAUDAL EPIDURAL USING X RAY AND CONTRAST DYE
A 49 year old lady was seen in the Pain Clinic. She had previously been treated by another clinic for her intermittent sciatica-like pain. MRI scan revealed widespread lumbosacral degenerative changes.
On examination, she had no lumbar facet joint or sacroiliac joint tenderness, but described intermittent sciatica-like sensations, in particular in the right posterior leg and foot. This lady had previously been treated with a caudal epidural, which was performed using a blind technique at the previous clinic.
On reviewing this lady, she had failed to improve with conservative management with medication and physiotherapy and was keen to find a minimally invasive alternative. After a review of the patients case, including her MRI scans, the decision was made to proceed with a caudal epidural using contrast dye and x ray guidance. The procedure was performed on an outpatient basis. The sacrococcygeal ligament was identified both by palpation and by x ray guidance. A small amount of local anaesthetic was administered to the skin over this site. A small needle was introduced into the caudal epidural space. 2 mls of contrast dye was injected and an x ray picture taken of the sacrococcygeal region. The dye showed excellent spread into the caudal space. A volume of 30 mls of 0.1% Chirocaine and 80 mg of Depo-Medrone was then carefully introduced.
The lady was seen approximately 8 weeks following her x ray guided procedure and her symptoms had significantly improved. She was able to continue with her physiotherapy based rehabilitation in order to build up her core stability. There was also a significant reduction in the frequency and intensity of the sciatica-like symptoms she had previously experienced.