Anatomy of the posterolateral spinal epidural ligaments

Abstract

Background: The epidural ligaments (ELs) (of Hofmann) were described as fibrous bands interconnecting the ventrolateral spinal dura and the posterior longitudinal ligament below L1. They are hardly ever discussed in the literature or considered in hypothesis-driven basic science experiments or spine biomechanical models. Methods: Intraoperative photographs were obtained to illustrate a group of posterolateral spinal ELs. In addition, electronic database searches (PubMed, Ovid Embase, and SCOPUS) were utilized to summarize the anatomy, and relevant clinical and surgical factors impacting these ELs. Results: ELs attach circumferentially at most spinal levels. They anchor the nerve root sleeves ventrally, and therefore, may play a role in the some idiopathic neurologic deficits (e.g., postoperative radiculopathies, C5 palsies) in patients without radiological compression. The posterolateral ELs originate on the dura dorsal to the nerve root sleeves and insert on the ipsilateral lamina, interlaminar ligament, and facet capsule. They appear to be continuous with the peridural membrane, a fibrovascular sheath that surrounds the thecal sac and serves as a scaffold for the internal vertebral venous plexus of Batson and epidural fat. Conclusion: The spinal ELs should be divided sharply during surgery to prevent durotomies, especially in patients with advanced spondylosis and facet arthropathy. Disconnecting these ligaments releases the thecal sac laterally and ventrally, allowing for medial mobilization when performing discectomies or for working in the ventral epidural space.

Bone‐to‐Bone Ligament Preserving Laminoplasty with Ultrasonic Osteotome Assistance for Intraspinal Tumors: A Technical Note and Clinical Follow‐Up

“…The epidural space increased further in the prone position 10 . The epidural space consists of an epidural membrane and ligament 11 . The epidural space is filled with a semi‐fluid fat structure 12,13 .…”

“…10 The epidural space consists of an epidural membrane and ligament. 11 The epidural space is filled with a semi-fluid fat structure. 12,13 In addition, the dura can withstand 3-6 mm of pushing with a 21-gauge puncture needle without being punctured despite being only 0.15-0.25 mm thick.…”

Anterior-to-Posterior Epidural Migration of a Lumbar Disc Herniation at L1-L2: A Case Report

“…They were initially described as only localized ventrally to the nerve roots below the L1 spinal level [9][10]. Their variation has been further investigated demonstrating variability in most spinal levels and circumferentially interconnecting with the spinal dura [9,11]. Different anatomic variation has been described, including anterior, lateral, or posterior to the spinal dura [2].…”

Imaging of Sequestered Lumbar Discs

“…경막내공간은 경막내 거미막외 공간(intradural extra-arachnoid space)과 경막내 거미막내 공간(intradural intra-arachnoid space) 혹은 거미막하공간(subarachnoid space)으로 다시 나뉘며, 거미막하공간에는 척수와 뇌척수액이 위치해있다. 척수에서는 앞 뿌리(ventral root)와 뒤 뿌리(dorsal root)가 갈라져 나온 후 다시 바깥쪽에서 합류하여 척수신경(spinal nerve)을 형성하고, 합쳐진 척수신경은 다시 추간공으로 빠져나간다( 10 11 ).…”