Article Text

Download PDFPDF
Labor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal
  1. David M. Dickerson, MD*,
  2. Ran Dai, MD*,
  3. Barbara M. Scavone, MD* and
  4. William McDade, MD, PhD
  1. *Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
  2. Ochsner Health System, New Orleans, LA
  1. Address correspondence to: David M. Dickerson, MD, Department of Anesthesia and Critical Care, University of Chicago, 5841 S Maryland Ave, MC 4028, Chicago, IL 60637 (e-mail: ddickerson{at}


Abstract Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. Magnetic resonance imaging revealed a congenitally narrowed spinal canal because of short pedicle syndrome. Epidural injectate occupies and compresses a percentage of the spinal canal and its neuronal contents. This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis. We believe a similar mechanism may explain the pain that patients sometimes experience after administration of large epidural volumes.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • The authors declare no conflict of interest.