title: Filum Terminale Needle Placement During Caudal Epidural Steroid Injection.
abstract: OBJECTIVE
  Caudal 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.
  
  
  METHODS
  Single case report.
  
  
  METHODS
  Beth Israel Deaconess Medical Center.
  
  
  METHODS
  A 69-year-old woman who suffered from chronic low back and leg pain from lumbosacral radiculopathy, failed back surgery syndrome, and lumbar facet arthropathy.
  
  
  METHODS
  Caudal epidural steroid injection.
  
  
  METHODS
  Patient safety.
  
  
  RESULTS
  The needle and catheter placement were confirmed via intrathecal contrast spread to be in the filum terminale, which prompted abortion of the procedure.
  
  
  CONCLUSIONS
  Although 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.
authors.affiliation: Division of Pain Medicine, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Ramsook
authors.affiliation: Division of Pain Medicine, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: David
authors.initials: D
authors.lastname: Spinner
authors.affiliation: Division of Pain Medicine, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Rajiv R
authors.initials: RR
authors.lastname: Doshi
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects; D002420:Cauda Equina / Q000293:injuries*; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D017116:Low Back Pain / Q000188:drug therapy*; D008161:Lumbosacral Region; D009339:Needles; D011843:Radiculopathy / Q000188:drug therapy*; D013256:Steroids / Q000008:administration & dosage
chemical_list: D013256:Steroids
keywords: Catheter Placement; Filum Terminale; Lumbosacral Radiculopathy;  Caudal Epidural Steroid Injection