Spinal dural sac termination and internal filum terminale fusion

Pokanan, Siriwut; Borsu, Hasuenah; Hansasuta, Ake

doi:10.1002/ca.23438

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…The terminal portion of the sac was cone‐shaped, and its narrowing, as a rule, begins at the level of L5 and S1 vertebrae. Numerous other studies using imaging (Soleiman et al, 2005) or cadavers have also confirmed that the termination of dura occurs at S2 in >80% of cases (Pokanan, Borsu, & Hansasuta, 2019). Moreover, termination levels do not vary with subject sex, but they do so with subject age (Soleiman et al, 2005).…”

Section: Discussionmentioning

confidence: 78%

Imaging anatomy of the vertebral canal for trans‐sacral hiatus puncture of the lumbar cistern

2020

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A standard lumbar puncture may be impossible for many anatomic or technical reasons. Previous accounts of caudal epidural anesthesia and other procedures via the sacral hiatus prompted us to test if image‐guided percutaneous trans‐sacral hiatus access to the lumbosacral subarachnoid cistern would be anatomically feasible. To study vertebral canal morphometry and curvature, we analyzed midsagittal computed tomography‐myelogram images of 40 normal subjects and digitally measured sacral curvatures between S1 to S5 and S2 to S4 using two methods whereby a lower angle signifies a straighter sacrum. We measured midsagittal vertebral canal area, hiatus width, dural sac termination levels, and distance from sacral hiatus to the dural sac tip (needle distance). Subjects were F:M = 25:15, with a mean age of 44.9 years. The two S1–S5 full sacral curvature mean angles were 57.3° and 60.4°. Almost all sacral hiatuses were at S4, and dural sac terminations were at S1–S2. The mean S2–S4 sacral curvature was 25.1°, and the mean needle distance was 57.7 mm. Using two‐way analysis of variance, there were significant sex differences for needle distances (p = .001), and full and limited sacral curvatures (p = .02, and p = .046, respectively). There were no significant linear regression correlations between age and sacral curvature, needle distance, canal area, or hiatus width. Therefore, despite a frequently prominent full sacral curvature, the combination of S1–S2 dural sac termination plus a relatively straight trajectory of the lower vertebral canal between S2 and S4 support the theoretical feasibility of percutaneous trans‐sacral hiatus and vertebral canal access to the lumbosacral cistern using a standard spinal needle.

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Section: Discussionmentioning

confidence: 78%

Imaging anatomy of the vertebral canal for trans‐sacral hiatus puncture of the lumbar cistern

2020

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“…Several studies have determined the termination level of DS in adults by conducting cadaveric and MRI-based studies in different populations [ 4 , 5 , 8 , 15 ]. We conducted a cross-sectional MRI-based study in the previously unstudied Saudi population to observe and document the termination level of the DS.…”

Section: Discussionmentioning

confidence: 99%

“…Practitioners were previously relying on cadaveric assessment. However, it was discovered to be limited clinical benefit [ 4 , 5 ]. Other forms of practice included an invasive procedure known as myelography.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Level of Dural Sac Tip in Saudi Population: A Magnetic Resonance Imaging Study

Jawad¹,

Alhomoud²,

Alfaraj³

et al. 2022

Cureus

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Background For the success of procedures such as caudal block, craniospinal irradiation (CSI), and management of lower back pain and to minimize the risk of dural puncture the exact level of dural sac (DS) termination should be known. Objective The evaluation of DS tip location in the Saudi population and exploring possible significant factors that could be used as predictors in clinical prognosis. Methods A total of 200 patients’ lumbar sagittal Weighted T2 Magnetic Resonance Imaging (MRI) study were randomly selected from a single-center hospital in-between 2020 and 2021. The DS tip location was determined by generating a perpendicular line from the longitudinal axis of its termination to the corresponding level. Then naming it after an intervertebral disk or a corresponding vertebrate that is divided into three thirds (upper, middle, and lower). Results In most cases, the level of DS termination is at the middle part of S2 (26.5%), followed by the upper part of S2 (25.1%), and the lower part of S2 (20%). In Saudi nationals, the DS tip was in the middle S2 level at 21.5%, upper S2 level at 19.1%, and lower S2 level at 17%. Factors such as age, sex, cause of referral, and nationality had no statistical significance in relation to DS tip location. Conclusion The DS termination level in the Saudi population ranges from disk between L5-S1 to the lower third of S3. Moreover, nationality, age, and cause of referral were not significant in determining the DS termination level. Therefore, it is still important to individualize patients’ treatment by using MRI for each case that requires it.

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Spinal dural sac termination and internal filum terminale fusion

Cited by 2 publications

References 15 publications

Imaging anatomy of the vertebral canal for trans‐sacral hiatus puncture of the lumbar cistern

Imaging anatomy of the vertebral canal for trans‐sacral hiatus puncture of the lumbar cistern

Evaluation of the Level of Dural Sac Tip in Saudi Population: A Magnetic Resonance Imaging Study

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