Spinal Cord Injury due to Epidural Puncture in a Patient with Spina Bifida Occulta

Abstract

  A woman in her thirties with spina bifida occulta was scheduled for laparoscopic extracorporeal ovarian cystectomy with combined general and epidural anesthesia. After induction of general anesthesia, epidural catheterization was attempted at the level of Th₁₂ to L₁ without awareness of her spina bifida occulta. When a 22 gauge needle 32 mm in length was used to anesthetize the route for insertion of a Tuohy's needle, the needle tip was accidentally inserted into the spinal cord. Postoperative magnetic resonance imaging (MRI) revealed a lesion in the conus medullaris and spina bifida occulta from Th₁₁ to L₂ without deformities in the lower lumbar and sacral vertebrae. Motor disturbance of her right foot continued. Thermal and pin-prick sensations were lost in her lower limb. Consideration of spina bifida occulta in the lower thoracic to higher lumbar vertebrae in the absence of superficial signs is necessary to attempt epidural blocks.