Spina Bifida Occulta and Epidural Anesthesia

Abstract

  Spina bifida occulta shows a minor bony defect in the spinous process and laminae by radiographical examination, with no neurological deficit. Spinal bifida is usually observed in the lumbo-sacral region, with or without cutaneous manifestations such as a lipoma, a skin dimple, or a pileous skin, sometimes including low-placed conus medullaris descending into the sacrum, and rarely observed in the thoraco-lumbar region, with no cutaneous manifestations. Attempted epidural puncture at the level of the lesion with no sense of the spinous process may result in dural tap and spinal cord injury because of the absence of the epidural space. When epidural or spinal anesthesia is indicated, spinal anesthesia may be preferable following some reports of clinical practice.
  Epidural puncture is performed in anesthetized adults in England, however, the German Society for Anesthesiology and Intensive Care Medicine has developed guidelines stating that general anesthesia is an absolute contraindication to placement of a thoracic epidural catheter in adult patients. According to the authorities on epidural anesthesia, it is not recommended to perform epidural puncture on anesthetized adults, in order to avoid spinal cord injury.