• Ryan R Ramsook, David Spinner, and Rajiv R Doshi.
• Division of Pain Medicine, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
• Pain Med. 2017 Aug 1; 18 (8): 1464-1466.

ObjectiveCaudal epidural steroid injections (ESIs) are commonly used to treat lumbar radicular pain. Touhy needles are placed under live fluoroscopic guidance 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.DesignSingle case report.SettingBeth Israel Deaconess Medical Center.PatientA 69-year-old woman who suffered from chronic low back and leg pain from lumbosacral radiculopathy, failed back surgery syndrome, and lumbar facet arthropathy.InterventionsCaudal epidural steroid injection.Outcome MeasuresPatient safety.ResultsThe needle and catheter placement were confirmed via intrathecal contrast spread to be in the filum terminale, which prompted abortion of the procedure.ConclusionsAlthough caudal ESI is 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, it serves also to reveal unexpected and unwanted spread. We present the first report of a needle being inserted directly into the filum terminale during a caudal ESI.© 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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