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[Is posterior lumbar epidural space partitioned?].

P Morisot1

  • 1Département d'Anesthésie-Réanimation, Hôpital Cochin-Port-Royal, Paris.

Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1992
PubMed
Summary

The posterior lumbar epidural space (PLES) anatomy is debated, with a medial partition suggested by imaging and surgery. Histology indicates fatty tissue, not a fixed partition, explains observed PLES variations.

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Area of Science:

  • Anatomy
  • Radiology
  • Anesthesiology

Background:

  • The anatomy of the posterior lumbar epidural space (PLES) is of interest to anatomists, surgeons, radiologists, and anesthesiologists.
  • Previous studies suggest a medial partition in the PLES, observed via epidurography and intraoperative findings.
  • Discrepant descriptions arise from different specialist perspectives on PLES anatomy.

Purpose of the Study:

  • To clarify the anatomical reality of a medial partition within the posterior lumbar epidural space.
  • To reconcile differing observations of the PLES based on various anatomical and imaging techniques.
  • To investigate the role of fatty tissue and dural folds in PLES morphology.

Main Methods:

  • Review of existing anatomical studies, including epidurography, CT scans, laminectomy observations, and cadaveric resin casts.
  • Analysis of epiduroscopy findings in cadavers.
  • Consideration of histological data on PLES composition.

Main Results:

  • Previous imaging and surgical observations suggested a medial partition (plica mediana dorsalis durae matris) in the PLES.
  • Experimental attempts to confirm this partition using resin casts yielded unconvincing results.
  • Epiduroscopy in cadavers suggested the presence of the PMD and a connective tissue band, but technical limitations affected image quality.

Conclusions:

  • The PLES is a virtual space primarily filled with fatty tissue, which can be compressed or altered.
  • Observed PLES partitions may be artifacts of injected substances (contrast or anesthetic) deforming the fatty tissue and dura.
  • Histological evidence suggests fatty tissue, not a rigid partition, accounts for the variable PLES morphology seen in imaging and surgery.

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