Delayed cauda equina syndrome by nerve root incarceration after caudal epidural block: A case report

Abstract

Introduction and importance: Caudal epidural block has been commonly practiced in recent years and is used for management of pain before surgery and chronic back pain in adult spine diseases.

Case presentation: A 58-year-old man visited the outpatient clinic complaining of recently aggravated severe low back pain, saddle anesthesia, and unbearable radiating pain in his left leg, with a previous history of caudal epidural block. He had problems with bladder and bowel function. Emergency exploration for cauda equina syndrome (CES) was performed. Decompression, extradural herniation, and entrapment of a cauda equina filament through a dural defect were observed, and surgical reduction with dural repair was performed.

Clinical discussion: The clinical signs at onset suggested cauda equina dysfunction after caudal epidural block. Magnetic resonance imaging showed spinal canal stenosis with a paracentral herniated intervertebral disc at the L4-L5 level without any other dural or nerve root abnormality. Exploration was the only option to identify the lesion.

Conclusion: This is the first case report of CES caused by extradural nerve root herniation and strangulation after caudal epidural block.

Keywords: Cauda equina syndrome; Caudal epidural block; Complication; Nerve root herniation.