Dura-to-Spinal Cord Distance at Different Vertebral Levels in Indian Children: A Retrospective Computerized Tomography Scan-Based Study.

Background: Neuraxial techniques provide good postoperative analgesia for painful procedures in the pediatric population. However, any injury to the spinal cord can lead to irreversible long-term effects. Aims: We aimed to evaluate dura-to-cord (DTC) distance from computerized tomography (CT) images of thoracolumbar spine in pediatric age group (1-16 years) at T8-9, T9-10, and L1-2 interspaces to identify the safe space for epidural insertion in Asian children. Settings and Design: It was a retrospective study including 141 children aged 1-16 years who underwent routine CT scan of the thoracolumbar region for unrelated diagnostic indications. Materials and Methods: Patients with spinal abnormalities were excluded. Sagittal CT images of the thoracolumbar spine were obtained to calculate the DTC at T8-9, T9-10, and L1-2 interspaces. The measurements at all levels were obtained perpendicular to the long axis of the vertebral body. Statistical Analysis Used: Continuous data were depicted as mean with standard deviations. The categorical data were presented as counts with percentages. Results: The mean DTC distance at T8-9, T9-10, and L1-2 interspaces was 3.51 ± 0.98 mm (95% confidence interval [CI]: 3.35-3.67), 2.73 ± 0.94 mm (95% CI: 2.57-2.89), and 2.83 ± 1.08 mm (95% CI: 2.66-3.02), respectively. A significant difference was found between the genders at T9-10 (P = 0.02) and L1-2 levels (P = 0.04). No difference in DTC was found in toddlers, preschool children, school-going children, and adolescents. DTC at T8-9 showed a significant correlation with age (R 2 = 0.0479; P = 0.04), weight (R 2 = 0.038; P = 0.02), and height (R 2 = 0.037; P = 0.03). Conclusion: Thoracic epidural space can be used in children and adolescents for epidural catheter placement. T8-9 level showed maximum DTC distance and significant correlation with age, height, and weight in CT imaging in the present study.