Anatomy of the lumbar epidural region using magnetic resonance imaging: a study of dimensions and a comparison of two postures

Capogna, Giorgio; Celleno, D.; Simonetti, C; Lupoi, Domenico

doi:10.1016/s0959-289x(97)80005-2

Cited by 31 publications

(19 citation statements)

References 10 publications

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“…Another reason for choosing these levels was that they are the levels of the spine most often affected, due to their dependent position and weight-bearing nature (Borenstein et al, 2004). Previous studies gave thicknesses between 1.8 and 5 mm (Grenier et al, 1987;Olszewski et al, 1996;Capogna et al, 1997;Park et al, 2001). Our results concur with the previous studies.…”

Section: Discussionsupporting

confidence: 93%

The thickness of the ligamentum flavum in relation to age and gender

et al. 2009

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Hypertrophy of the ligamentum flavum (LF) can reduce the diameter of the spinal canal posteriorly. Such stenosis may significantly compress the dural sac and nerve roots, resulting in symptoms, even without a bulging anulus fibrosus or herniated nucleus pulposus. We conducted an anatomical study to determine the influence of age and gender on the thickness of the LF at the lower lumbar levels using magnetic resonance imaging (MRI). The thickness of 1,280 ligaments was determined at the L4-L5 and L5-S1 levels from MRIs. We screened 320 patients (152 males [47.5%] and 168 females [52.5%]) between 21 and 82 years of age. There were no significant differences in LF thickness with respect to gender (P > 0.05). Age was not correlated with the thicknesses of the LF. The left LF at the L4-L5 and L5-S1 levels was significantly thicker than on the right side (P < 0.05). Furthermore, the LF thicknesses at L5-S1 bilaterally were significantly greater than on the corresponding sides at L4-L5 (P < 0.05). The LF is an important anatomical structure, which might cause low back or leg pain. Therefore, the thickness of the LF should be measured and evaluated carefully in the case of spinal stenosis.

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Section: Discussionsupporting

confidence: 93%

The thickness of the ligamentum flavum in relation to age and gender

et al. 2009

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“…Other studies have shown normal thicknesses of the LF, ranging from 1.8 to 5 mm. 4,[9][10][11] Our results for normal LF thickening, showing a mean of 3.1 mm, are similar to the findings in these studies.…”

Section: Discussionsupporting

confidence: 89%

The “Thickened” Ligamentum Flavum: Is It Buckling or Enlargement?

Chokshi¹,

Quencer²,

Smoker³

2010

AJNR Am J Neuroradiol

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“…Many factors associated with neuraxial anaesthesia have been studied including the structures at the level of the termination of the spinal cord and dural sac [11], vertebral level and shape of the conus medullaris [12], shape of the epidural space [13][14][15], and distance from the skin to the epidural or subarachnoid spaces [16][17][18][19]. However, the effect of body position relevant to neuraxial blockade has not been well studied [20][21][22][23][24], especially in children.…”

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confidence: 99%

The effect of flexion on the level of termination of the dural sac in paediatric patients

et al. 2009

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SummaryAlthough the anatomy of the spinal cord and its associated structures have been well defined, the effects of body position relevant to neuraxial blockade have not been elucidated. This study was designed to determine the effect of body position on the end of the dural sac in children. After induction of anaesthesia, ultrasound examination was performed to evaluate the location of the dural sac end in the lateral position with a straight back and knee, and in the lateral position with the knees, legs, and neck flexed. The level of the end of the dural sac was determined in relation to the vertebrae. Our data demonstrate that the dural sac shifts significantly cephalad in the lateral flexed position used for neuraxial blockade (p < 0.001). These results suggest that the safety margin to avoid dural puncture during hiatal or S2-3 approach for caudal block can be increased in younger children. Dural puncture is a serious technical complication during single-shot caudal block, which is the most common regional technique for postoperative analgesia for paediatric subumbilical surgery. The prevalence of dural puncture associated with caudal analgesia is relatively low. It has only been shown in several case reports [1,2] or at a rate of 1.2% in previous large-scale studies [3,4]. In the study of 760 children, Busoni did not find any case of dural puncture and Dalens [5] reported only one dural puncture in his series of 750 paediatric caudals. Sometimes it is difficult to identify the sacral hiatus and the caudal space due to variations of anatomical structures or obesity. In these cases, a trans-sacral approach to caudal block, described by Busoni [6], may be used as an alternative method. Although no dural puncture was reported in several trans-sacral approach studies [6][7][8], the risk of dural puncture is a possibility. It is known that the end of the dural sac is located at the S4 level just after birth, then ascends to the S2 level as the child grows [9].The anatomy of the spinal cord and its associated structures have been well defined [10], largely based on post-mortem or imaging studies in the supine or prone positions. Many factors associated with neuraxial anaesthesia have been studied including the structures at the level of the termination of the spinal cord and dural sac [11], vertebral level and shape of the conus medullaris [12], shape of the epidural space [13][14][15], and distance from the skin to the epidural or subarachnoid spaces [16][17][18][19]. However, the effect of body position relevant to neuraxial blockade has not been well studied [20][21][22][23][24], especially in children.Ultrasonography, which is a well-established method of investigating the spinal canal, spinal cord, and meningeal coverings in infants and children, has the advantage of being real time, non invasive and safe [25][26][27]. It allows detection of congenital malformations such as myelocele, myelomeningocele, spinal lipoma, dorsal dermal sinus, tight filum terminale syndrome, diastematomyelia, hydromyelia and syri...

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Anatomy of the lumbar epidural region using magnetic resonance imaging: a study of dimensions and a comparison of two postures

Cited by 31 publications

References 10 publications

The thickness of the ligamentum flavum in relation to age and gender

The thickness of the ligamentum flavum in relation to age and gender

The “Thickened” Ligamentum Flavum: Is It Buckling or Enlargement?

The effect of flexion on the level of termination of the dural sac in paediatric patients

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