The sacral canal is the continuation of the spinal canal through the sacrum, containing the sacral and coccygeal nerve roots of the cauda equina, the filum terminale, and epidural fat and vessels. It terminates at the sacral hiatus between the sacral cornua, which is the entry point for caudal epidural injections.
The sacral hiatus and caudal canal space are the target for caudal epidural steroid injections, used for L4-S1 radiculopathy and spinal stenosis. Ultrasound or fluoroscopic guidance confirms correct needle placement within the canal. The sacral canal may be compromised by sacral fractures, sacrococcygeal teratomas, and presacral masses. Sacral canal anatomy is highly variable — the hiatus may be absent, bifid, or closed in up to 7% of individuals.
Compression of the sacral canal contents from sacral fracture, tumour, or presacral mass producing cauda equina symptoms including bladder and bowel dysfunction and saddle anaesthesia.
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