Incidence of Epidural Catheter Breakage in the Spine
Epidural catheter breakage with a retained fragment in the spinal canal is an extremely rare complication, though the exact incidence rate is not well-established in the literature.
What the Evidence Shows
The available evidence consists primarily of isolated case reports rather than large epidemiological studies, which indicates this is an uncommon event:
- Case report literature only: Multiple case reports from 2008-2022 describe individual instances of catheter breakage, but none provide population-based incidence data 1, 2, 3, 4, 5
- Described as "extremely rare": The medical literature consistently characterizes this complication using terms like "extremely rare" and notes it is "under-reported" 2, 3, 5
Related Catheter Complications with Known Incidence
While catheter breakage incidence is unknown, other catheter-related complications have documented rates that provide context:
- Complete catheter dislodgement at the skin: Occurs in approximately 0.53% of patients 6
- Catheter migration out of intended space: Reported in 16.3% of catheter failures 6
- Overall intrathecal catheter failure rate: Approximately 5.7% 7
Risk Factors for Catheter Breakage
When breakage does occur, specific technical factors are implicated:
- Excessive catheter insertion depth: Advancing the catheter too far into the epidural space increases breakage risk 4
- Resistance during insertion or removal: Encountering resistance and continuing with force can lead to shearing 2
- Improper removal technique: Removing the catheter through the Tuohy needle or applying excessive traction increases breakage risk 2, 4
- Catheter knotting: Excessive advancement can cause the catheter to form knots, making removal difficult 4
Clinical Implications
If catheter breakage occurs, management depends on fragment location:
- Fragment outside the spinal canal with no skin breach: Conservative management is reasonable 1
- Fragment within the spinal canal: Early surgical removal is advised, preferably within days to prevent dural adhesions 1, 5
- Asymptomatic patients: May be managed conservatively if the fragment is confirmed to be outside the spinal canal radiologically 1, 4
Prevention Strategies
To minimize this already rare complication:
- Limit catheter insertion depth: Insert only 3-5 cm into the epidural space 8
- Never withdraw catheter through the needle: Always remove needle and catheter together if resistance is encountered 2, 4
- Use gentle traction only: Avoid forceful pulling during removal 4
- Clear documentation: Mark and document catheter depth at skin level 8