International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access
Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc
Journal website https://www.theijcp.org

Original Article

Volume 11, Number 1, March 2022, pages 2-8


Magnetic Resonance Imaging of the Caudal Epidural Space: Implications for the Clinical Practice Regional Anesthesia in Infants and Children

Figures

Figure 1.
Figure 1. Magnetic resonance imaging showing termination of the spinal cord at L1 and the dural sac at S2 in a 1-year-old patient from the study cohort.
Figure 2.
Figure 2. Technique for measurement of the distance from skin to the termination of the dural sac (yellow line).
Figure 3.
Figure 3. Magnetic resonance imaging showing the end of the spinal cord (1), the termination of the dural sac (2), and the sacrococcygeal ligament (3). These structures were used for the measurements made in the current study.

Tables

Table 1. Patient Demographic and Physical Data
 
VariablesAll (n = 91)Male (n = 47)Female (n = 44)P-value
Distance is listed in millimeters (mm). The data are presented as the mean (standard deviation). BSA: body surface area.
Age (months)45.5 (29.3)47.0 (28.8)44.0 (30.1)0.633
Height (cm)95.2 (25.6)96.8 (24.4)93.5 (26.9)0.543
Weight (kg)16.7 (8.1)17.0 (7.0)16.3 (9.2)0.684
BSA (m2)0.66 (0.24)0.67(0.21)0.64 (0.26)0.629
Spinal cord to dural sac (mm)90.2 (23.7)92.5 (21.8)87.7 (25.6)0.335
Spinal cord to sacral hiatus (mm)109.0 (28.1)111.1 (25.4)106.7 (30.8)0.45
Spinal cord to skin (mm)112.3 (28.0)113.7 (3.7)110.8 (30.8)0.624
Dural sac to sacral hiatus (mm)23.9 (7.2)23.9 (6.3)23.8 (8.2)0.935
Dural sac to skin (mm)33.3 (9.9)31.6 (7.9)35.1 (11.4)0.092

 

Table 2. Descriptive Statistics With Regards to Age
 
Distances (mm)< 6 months (n = 8)> 6 to < 12 months (n = 7)> 12 to < 18 months (n = 9)> 18 to < 24 months (n = 8)> 24 to < 36 months (n = 7)> 36 to < 48 months (n = 6)> 48 to < 60 months (n = 12)> 60 to < 72 months (n = 9)> 72 to < 84 months (n = 18)> 84 months (n = 7)
Distances are shown in millimeters. Q1: first quartile; Q3: third quartile; IQR: interquartile range.
Spinal cord to dural sac
  Median52.554.876.476.878.790.496.8112.4112.6114.9
  IQR (Q1, Q3)39.7, 55.753.9, 69.563.8, 85.376.1, 82.376, 84.984.9, 91.192.1, 108.795.9, 120.1109, 120.2110.4, 121.8
Spinal cord to sacral hiatus (sacrococcygeal membrane)
  Median60.567.692.593.593.1110.7117.2130.6137.2135.4
  IQR (Q1, Q3)53.6, 64.265.8, 81.971.4, 99.989.3, 98.590.9, 95.8107.2, 111.3113.3, 124.4121.4, 133.1129.5, 144.2135, 146.7
Spinal cord to skin
  Median63.374.694.399.898.3113121.3133.9141142.8
  IQR (Q1, Q3)56.1, 68.470.4, 84.974.3, 102.194.9, 100.593.4, 100.5108.6, 113.3115.4, 128.9124.7, 135.2131.7, 150.1138.4, 148.9
Dural sac to sacral hiatus (sacrococcygeal membrane)
  Median13.516.616.821.120.82525.526.331.628.2
  IQR (Q1,Q3)12.2, 14.614.3, 17.915.1, 18.219.2, 22.620.5, 22.621.5, 27.922.7, 26.923.9, 29.427.8, 35.727.1, 35
Dural sac to skin
  Median20.725.225.832.229.432.33235.440.241.4
  IQR (Q1, Q3)19.8, 23.522.1, 34.423.4, 29.327.6, 36.227.1, 33.525.1, 36.330.7, 35.430.1, 40.635.5, 47.937.6, 45.9

 

Table 3. Univariate and Multivariate Linear Regression to Assess the Association Between Age and BSA on Measured Distances
 
Spinal cord to dural sacSpinal cord to sacral hiatusSpinal cord to skinDural sac to sacral hiatusDural sac to skin
β ± SEPR2β ± SEPR2β ± SEPR2β ± SEPR2β ± SEPR2
BSA: body surface area; VIF: variance inflation factor; SE: standard error.
Univariate model
  Age (years)0.71 ± 0.04< 0.0010.770.87 ± 0.04< 0.0010.830.87 ± 0.04< 0.0010.830.20 ± 0.01< 0.0010.680.22 ± 0.03< 0.0010.44
  BSA (m2)81.74 ± 6.11< 0.0010.6797.53 ± 7.11< 0.0010.6898.73 ± 6.89< 0.0010.722.58 ± 2.17< 0.0010.5527.63 ± 3.29< 0.0010.44
Multivariate model
  Age0.52 ± 0.07< 0.0010.790.73 ± 0.08< 0.0010.840.68 ± 0.08< 0.0010.840.17 ± 0.03< 0.0010.690.12 ± 0.050.0140.48
  BSA26.50 ± 9.180.00522.97 ± 9.540.01827.57 ± 9.40.0044.71 ± 3.40.1714.88 ± 9.00.015
  VIF (age, BSA)3.51