AB140. SOH26AB_0073. Ultrasound-guided caudal epidural hydrodissection: a case report

Background: Little is known regarding ultrasound-guided caudal epidural hydrodissection. This case illustrates the opportunities with this emerging modality.

Case Description: An 82-year-old woman presented with chronic back and lower limb pain. She had a magnetic resonance imaging (MRI), which showed lumbar canal stenosis and multilevel degenerative changes. Her pain had not responded to conservative management such as physiotherapy or traditional analgesics. Hydrodissection is a minimally invasive technique involving the injection of fluid to separate fascial layers and release entrapped nerves and tendons.Dynamic ultrasound scanning was performed to identify the caudal epidural space. The skin was prepared using ChloraPrep. Ultrasound guidance was used throughout until the needle was positioned in the caudal space. After confirming the needle tip position, 10 mL of 5% dextrose was injected for hydrodissection and with good visualization of the distribution of the injectate solution. A sustained analgesic effect was reported when followed up in the pain clinic outpatient department (OPD) at 6 weeks. Functional outcomes, including range of motion and daily activities, improved substantially. No complications were reported.

Conclusions: Ultrasound-guided hydrodissection has not yet been described as a treatment approach specifically for lumbar canal stenosis. In our patient’s case, it was an effective pain-relieving therapy, but more studies are needed to evaluate its efficacy

Keywords: Caudal; epidural; hydrodissection; lower limb pain; case report