The anatomy of the peridural membrane of the human spine

Bosscher, Hemmo A.; Grozdanov, Petar; Warraich, Irfan; MacDonald, Clinton C.; Day, Miles

doi:10.1002/ar.24476

Cited by 9 publications

(6 citation statements)

References 35 publications

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“…This "larger" perspective was warranted because following the precise definition provided by Hack et al (1995) experimental evidence exists for an MDB, which includes only fascial connections but not tendinous elements connecting to the dura. The outer surface of the dura has connective tissue ties to the vertebrae and ligamentum flavum (including epidural, Hoffmann's, and meningovertebral ligaments) as well as connective tissue links at the intervertebral foramina (e.g., Bosscher et al, 2021;Kimmell et al, 2011;Tardieu et al, 2016). As such, the presence of a connective tissue link between the dura and the atlantooccipital membrane (or ligamentum flavum) cannot be taken, in and of itself, as evidence of an MDB.…”

Section: Discussionmentioning

confidence: 99%

The morphology of the suboccipital region in snakes, and the anatomical and functional diversity of the myodural bridge

Grondel

Cramberg

Greer

et al. 2021

Journal of Morphology

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The myodural bridge, that is, skeletal muscle fibers attaching to the cervical dura mater, has been described from a variety of mammals and other amniotes. To test an earlier assumption about the presence of the myodural bridge in snakes, a comparative study was designed using a group of Colubrine snakes. Serial histological sections revealed no evidence of the myodural bridge in any of the snakes examined. Further analyses, including histology, computed tomography (CT), and micro-CT imaging of other distantly related snakes, also turned up no evidence of a myodural bridge. The close apposition of adjacent neural arches in snakes may preclude muscle tendons from passing through the intervertebral joint to reach the spinal dura. It is hypothesized that the myodural bridge functions in the clearance of the cerebrospinal fluid (CSF) by creating episodic CSF pressure pulsations, and that snakes are capable of creating equivalent CSF pressure pulsations through vertebral displacement.

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Section: Discussionmentioning

confidence: 99%

The morphology of the suboccipital region in snakes, and the anatomical and functional diversity of the myodural bridge

Grondel

Cramberg

Greer

et al. 2021

Journal of Morphology

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“…This hinders the unequivocal classification of the PDM as a synovial structure. However, results of investigations on the anatomy and physiology of the PDM suggest the importance of the synovial characteristics of the PDM for the normal function of the vertebrate spine and the response to pathology such as infection, inflammation, or neoplasm and warrants further research (Ansari et al, 2012; Bosscher et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…In this investigation, the PDM is defined as a continuous peridural connective tissues sheath that envelops the neural elements in the spinal canal and neural foramen (Figure 2). The epidural venous plexus and the peri‐neural extension of this plexus into the neural foramen are embedded in the connective tissues of the PDM (Bosscher, Grozdanov, MacDonald, Warrach, & Day, 2020) .…”

Section: Discussionmentioning

confidence: 99%

The peridural membrane of the spine has characteristics of synovium

Bosscher

Grozdanov

Warraich

et al. 2020

The Anatomical Record

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Recent investigations have renewed interest in a thin well‐innervated peridural membrane PDM which envelopes the contents of the spinal canal and neural foramen in human. Anatomical relations of the PDM in the neural foramen suggest that the suprapedicular compartment of the neural foramen functions as a joint cavity with PDM as its boundary. Inflamed and sensitized PDM may be a source of common low back pain. The purpose of this investigation is to evaluate PDM in the caudal compartment of the neural foramen of the lumbar spine for histological and immunohistochemical (IHC) characteristics of synovium. Dorsolateral and suprapedicular samples of PDM in the lumbar spine of an unembalmed human cadaver were obtained. Samples were evaluated using hematoxylin and eosin staining (HE) and IHC. Four slices of each sample were analyzed (FDNeurotech). Monoclonal and polyclonal antibodies to CD44 (hyaluronan receptor), CD55 (fibroblast like synoviocyte), CD68 (macrophage like synoviocyte) and HAS2 (hyaluronan synthetase 2) were used. Results were evaluated using A1 Nikon confocal immunofluorescent microscopy. HE staining showed a continuous membrane that contains extensive vascular and lymphatic plexus and duct‐like structures, dense and loose fibrous tissue, adipose tissue and nerve tissue in all samples. CD44 was expressed extensively throughout tissues of PDM in all samples, predominantly in perivascular areas but also in adipose, fibrous and nerve tissue. Numerous CD55 positive cells in layer like formations between and around vessels and in the wall of duct‐like structures and in the outer layers of PDM were seen in all samples. CD68 positive cells were found in all samples, but were sparse and mainly found in the outer layer of the membrane. HAS2 positive cells in layer like distributions between vessels or deep to the outer layer of the membrane were found extensively in all samples. Distributions of CD55 and HAS@ positive columnar cells in walls of duct‐like structures and blood vessels were observed in several samples. The results of this study indicate that PDM has histological and IHC characteristics of synovium. IHC identification of CD68 positive cells in the outer layers of PDM and CD55 throughout the membrane, in conjunction with conventional microscopic evaluation of the membrane, suggests the presence of an intima and subintima in PDM similar to synovium. Indeed, PDM histology similar to synovium has been reported by the author and presence of CD44, CD55, CD68 and HAS2 in synovium has been shown by other investigators. No prior reports on the presence of these markers in PDM are available in the literature. Extensive distribution of HAS2 and CD44 in PDM suggests that PDM plays a role in lubrication and homeostasis of the neural foramen and epidural cavity. Presence of CD68, a marker for macrophages, CD55, a receptor involved in regulation of complement activation and CD44, a receptor for metalloproteinases and other inflammatory mediators, indicates that PDM plays an important role in the inflammatory respo...

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“…The PDM divides the epidural space into two virtual spaces: (1) the outer or external epidural space (between the PDM and the walls of the spinal canal) and (2) the inner epidural space (virtual space between the PDM and dura). [ 1 ] Tributaries to the internal epidural venous plexus of Batson and epidural fat attach dorsally and are embedded within the PDM[ 1 , 13 ] and may track along the ELs. Epidural hemostasis can be achieved by identifying this thin layer of ELs, and gently holding it away from the dura between the blades of the bipolar electrocautery.…”

Section: Surgical Findings With Posterior Elsmentioning

confidence: 99%

Anatomy of the posterolateral spinal epidural ligaments

Santos

Kalhorn

2021

Surgical Neurology International

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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.

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The anatomy of the peridural membrane of the human spine

Cited by 9 publications

References 35 publications

The morphology of the suboccipital region in snakes, and the anatomical and functional diversity of the myodural bridge

The morphology of the suboccipital region in snakes, and the anatomical and functional diversity of the myodural bridge

The peridural membrane of the spine has characteristics of synovium

Anatomy of the posterolateral spinal epidural ligaments

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