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Caudal epidurals: the accuracy of blind needle placement and the value of a confirmatory epidurogram

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Abstract

The objective of this study was to assess the accuracy of blind placement of caudal epidural needles and the usefulness of the radio-contrast epidurogram. The study involves a prospective case series of 147 consecutive patients with radiological assessment of blind needle placement and epidurogram assessing the accuracy of blind needle placement in caudal epidurals. When the surgical miss rate (26%) and failure of flow of the therapeutic agents (6%) are combined, it can be deduced that up to 32% of non-radiologically guided caudal epidurals may fail to deliver the therapeutic agents to the site of pathology. There was no significant difference in the accuracy of needle placement in adequately trained and experienced middle grade surgeons when compared with consultant surgeons performing these procedures regularly. In conclusion, we recommend radiological guidance and use of epidurogram as the gold standard for the administration of caudal epidurals to increase the likelihood of successful delivery of the therapeutic agents to the site of pathology during the procedure.

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Authors and Affiliations

  1. Spinal Surgery Service, Orthopaedic Department, Dorset County Hospital NHS Foundation Trust, Dorset County Hospital, Williams Avenue, Dorchester, Dorset, DT1 2JY, UK

    Guy Barham & Andrew Hilton

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  1. Guy Barham
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  2. Andrew Hilton
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Correspondence to Guy Barham.

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Barham, G., Hilton, A. Caudal epidurals: the accuracy of blind needle placement and the value of a confirmatory epidurogram. Eur Spine J 19, 1479–1483 (2010). https://doi.org/10.1007/s00586-010-1469-8

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  • DOI: https://doi.org/10.1007/s00586-010-1469-8

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