The Peridural Membrane of the Spinal Canal: A Critical Review

Abstract

There exists substantial evidence that a peridural membrane (PM) is present in the spinal canal of humans and, like the pleura and peritoneum, has one or more physiologic functions. Innervation of the PM suggests that it may become a source of pain if injured. Although debated, the physiology of this structure has important implications with respect to neuraxial distribution of drugs and for back and radiating pain. This review, separated into embryological, anatomic, and physiologic discussions, provides an in-depth summary of the observations of this connective tissue. The discrepancies between accounts are highlighted within each section. Focused research to clearly elucidate the true nature of the PM, especially as related to neuraxial distribution of drugs and back and radiating pain, is warranted.

Ventral Epidural Filling Technique in Interlaminar Epidural Steroid Injection

“…[3][4][5] Botwin et al 6 reported only 9 of 25 (36%) cases of ventral spread in dorsal interlaminar ESI. [3][4][5] Botwin et al 6 reported only 9 of 25 (36%) cases of ventral spread in dorsal interlaminar ESI.…”

“…[3][4][5] Thus, the ventral epidural space can be a preferred target to fi ll and distribute the injectate. [3][4][5] Thus, the ventral epidural space can be a preferred target to fi ll and distribute the injectate.…”

Epiduroscopy for Patients With Lumbosacral Radicular Pain

“…Touching epidural structures with the tip of the scope enables assessment of the precise source of the radicular pain by reproducing the patient's pain. In this respect, epiduroscopy is also superior to MRI or clinical examination …”

“…The epidural tissue comprises loose areolar connective tissue and varying amounts of fatty tissue, which acts as a lubricant for the movements of the nerve roots in the spinal canal. Attention has recently been called to the presence of a peridural membrane . The literature frequently reported the presence of ventral or dorsal septa in the epidural space.…”

The Peridural Membrane of the Human Spine is Well Innervated

“…The membrane has been described in detail by anatomist of the 19th and 20th century (Luschka, ; Hovelaque, ; Frykholm, ) and more recently by several other investigators (Ansari et al, ; Wiltse et al, ; Loughenbury et al, ; Breit et al, ). In comparative biology, the peridural membrane is referred to as the endorachis (Wiedersheim, ; Kappers, ).…”