earticle

영어

Although percutaneous epidural neuroplasty (PEN) is generally safe, rare complications such as catheter breakage can occur during the procedure. In this report, we present a case of epidural catheter breakage with a retained fragment in the epidural space during lumbar PEN. A 61-year-old male with a history of lumbar posterior decompression presented to the pain clinic. He complained with low back and left leg pain. A PEN targeting left L5 was planned. In the prone position, a Tuohy 18G needle was inserted via the transforaminal approach at the left L5-S1 level. Following needle placement, an epidural catheter (Perifix®) was advanced through the needle. However, advancing the catheter was challenging. Consequently, repositioning of the Tuohy needle was attempted. During the withdrawal of the catheter through the needle, an unintentional breakage of the epidural catheter occurred. After stopping the procedure, an immediate ultrasound examination, a CT scan, and a contrast-enhanced MRI were conducted. However, these tests also failed to identify the residual catheter. After hospitalization, a conservative management was performed. During the hospital stay, no complications arose. Three months after discharge, a follow-up CT scan revealed an epidural linear opacification of the remnant catheter at the L4 level. Up to 1-year follow-up periods, the patient remained asymptomatic. In conclusion, the risk of epidural catheter breakage during PEN should always be considered.