Anatomical and surgical study of volume determination of the anterolateral epidural space nerve root L5/S1 under the aspect of epidural perineural injection in minimal invasive treatment of lumbar nerve root compression

Abstract

Herniated intervertebral disc causes in a great number of cases of lumbar nerve root compression, especially in the segment L5/S1. Other reasons responsible for stress to the lumbar spinal root are the spinal canal stenosis and the postdiscotomy syndrome. For patients without neurological deficiencies, the conservative treatment includes different epidural injection techniques. Steroids are often applied. A specific injection technique needing only a small drug amount is the epidural perineural approach using a special two-needle technique. The anatomical spaces of the nerve roots have received little attention in therapy. We have determined the anterolateral epidural space nerve volume of the nerve root L5/S1, and compared the data collected in an anatomical study with operative measurements during discectomy. The volume determination in the human cadavers was performed with liquid silicone filling the anterolateral space after dissection. The in vivo measurements were performed during surgery at the site of the anterolateral space after discectomy. The anatomical studies showed us a mean value volume of 1.1 ml. The surgical volume determinations result in a mean volume of 0.9 ml. A better understanding of the anterolateral epidural space may allow a reduction of the injection volume in the conservative nerve root compression treatment, especially using the epidural perineural technique, avoiding the risk of side effects of high doses of steroids.

Efficacy of Adjuvant 10% Hypertonic Saline in Transforaminal Epidural Steroid Injection: A Retrospective Analysis

“…Park et al (32) reported that 3 mL injected media by a transforaminal approach reached the inferior pedicle and medial superior pedicle in 95.3% of cases. Also, Teske et al (33) reported that a mean volume of anterolateral epidural space at L5/S1 was 1.1 mL by anatomical determination and 0.9 mL by surgical determination. In our present study, injected volumes were equal to or greater than 3 mL in both groups, so the injected volume in both groups is thought to be sufficient to cover the lesions.…”

Epidural Lysis of Adhesions and Percutaneous Neuroplasty

“…This volume of this space has been measured to be 1.1 ml anatomically and 0.9 ml surgically [34]. Lysis of adhesions via the caudal approach may be difficult in patients with epidural adhesions at this location and the S1 foraminal approach may be used to achieve lysis and fluid foraminotomy at this level [35].…”

Epidural Lysis of Adhesions and Percutaneous Neuroplasty

“…The area at the L5S1 anterolateral epidural space is frequently occupied with epidural adhesions which are associated with pain and a lack of contrast filling on epidurography. This volume of this space has been measured to be 1.1 ml anatomically and 0.9 ml surgically [34]. Lysis of adhesions via the caudal approach may be difficult in patients with epidural adhesions at this location and the S1 foraminal approach may be used to achieve lysis and fluid foraminotomy at this level [35].…”