Split cord malformations are rare spinal dysraphisms in which 2 separate spinal cords are present. Despite its diagnosis in all age groups, split cord malformations are not well described. ⋯ Anesthesiologists may encounter patients with known or unknown split cord malformations without much information to guide clinical decision-making and procedural risks of neuraxial anesthesia. This is the first case to the authors' knowledge of utilizing a caudal epidural injection for pain management in a patient with a diagnosed split cord malformation.