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

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.

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.

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.

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