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

ABSTRACT

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.