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Dural puncture during lumbar epidural access in the setting of degenerative spondylolisthesis: case series and risk mitigation strategies
  1. Vivek Sindhi1,
  2. Christine G Lim1,
  3. Anver Khan1,
  4. Carlos Pino2 and
  5. Steven P Cohen3,4
  1. 1Department of Anesthesiology & Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
  2. 2Anesthesiology, Naval Medical Center San Diego, San Diego, California, USA
  3. 3Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine and Uniformed Services of the Health Sciences, Baltimore, Maryland, USA
  4. 4Depts of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
  1. Correspondence to Dr Steven P Cohen, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA; scohen40{at}


Degenerative spondylolisthesis is a common back pathology in the general adult population. Patients with this condition may present for epidural steroid injection, epidural blood patch, or epidural analgesia. We report five patients with degenerative spondylolisthesis who experienced inadvertent dural puncture during interlaminar epidural steroid injection attempts: four with intrathecal contrast spread or cerebrospinal backflow into the epidural needle and one with subdural contrast spread. Patients with degenerative spondylolisthesis may be at higher risk for dural puncture due to stretching of the dura and contraction of the epidural space at the translated spinal level. In the following report, we summarize the cases and suggest risk mitigation strategies for both chronic and acute pain physicians.

  • analgesia
  • Back Pain
  • Injections
  • Spinal
  • Anesthesia
  • Conduction

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  • Contributors VS, AK, CGL, CP, and SPC: preparation of manuscript and critical review of contents. SPC: outline and figure concept.

  • Funding SPC received funding from the U.S. Department of Defense, Centers for Rehabilitation Sciences Research, Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR), grant # HU00011920011

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.