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Imaging in spinal posterior epidural space lesions: A pictorial essay

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ABSTRACT

Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.

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Degenerative: Herniated disc: Sagittal T1-weighted (A), T2-weighted (B) and post-contrast T1-weighted fat saturated (C) images of lumbar spine showing posterior protrusion of L4-5 disc with posterior osteophyte (arrow) along with elongated posterior epidural soft tissue lesion (elbow arrow), which appears isointense on T1-weighted and heterogeneously hyperintense on T2.weighted and peripheral rim enhancement, causing severe canal stenosis. Note Type II fatty Modic degenerative changes at L4-5 end plates (arrowhead)
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Figure 5: Degenerative: Herniated disc: Sagittal T1-weighted (A), T2-weighted (B) and post-contrast T1-weighted fat saturated (C) images of lumbar spine showing posterior protrusion of L4-5 disc with posterior osteophyte (arrow) along with elongated posterior epidural soft tissue lesion (elbow arrow), which appears isointense on T1-weighted and heterogeneously hyperintense on T2.weighted and peripheral rim enhancement, causing severe canal stenosis. Note Type II fatty Modic degenerative changes at L4-5 end plates (arrowhead)

Mentions: A degenerated disc may herniate into the anterior epidural space by virtue of perforation of the annulus fibrosis and posterior longitudinal ligament and loose contact with its parent disc (sequestration).[9] Once in the anterior epidural space, the disc fragment may migrate cranially, caudally, or laterally. Movement further posteriorly is restricted by meningovertebral ligaments. Migration to the posterior epidural space is a rare event. MRI with contrast is needed to diagnose this accurately. The disc fragment is hypointense on T1-weighted (T1W) images and hyperintense on T2W images compared to the parent disc. Reparative process, inflammation, and granulation tissue surround the disc fragment accounting for its peripheral enhancement. A tract-like enhancement extending from the outer aspect of the degenerated intervertebral disc to the posterior epidural space, indicating the route of migration virtually clinches the diagnosis[9] [Figures 3 and 4].


Imaging in spinal posterior epidural space lesions: A pictorial essay
Degenerative: Herniated disc: Sagittal T1-weighted (A), T2-weighted (B) and post-contrast T1-weighted fat saturated (C) images of lumbar spine showing posterior protrusion of L4-5 disc with posterior osteophyte (arrow) along with elongated posterior epidural soft tissue lesion (elbow arrow), which appears isointense on T1-weighted and heterogeneously hyperintense on T2.weighted and peripheral rim enhancement, causing severe canal stenosis. Note Type II fatty Modic degenerative changes at L4-5 end plates (arrowhead)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036327&req=5

Figure 5: Degenerative: Herniated disc: Sagittal T1-weighted (A), T2-weighted (B) and post-contrast T1-weighted fat saturated (C) images of lumbar spine showing posterior protrusion of L4-5 disc with posterior osteophyte (arrow) along with elongated posterior epidural soft tissue lesion (elbow arrow), which appears isointense on T1-weighted and heterogeneously hyperintense on T2.weighted and peripheral rim enhancement, causing severe canal stenosis. Note Type II fatty Modic degenerative changes at L4-5 end plates (arrowhead)
Mentions: A degenerated disc may herniate into the anterior epidural space by virtue of perforation of the annulus fibrosis and posterior longitudinal ligament and loose contact with its parent disc (sequestration).[9] Once in the anterior epidural space, the disc fragment may migrate cranially, caudally, or laterally. Movement further posteriorly is restricted by meningovertebral ligaments. Migration to the posterior epidural space is a rare event. MRI with contrast is needed to diagnose this accurately. The disc fragment is hypointense on T1-weighted (T1W) images and hyperintense on T2W images compared to the parent disc. Reparative process, inflammation, and granulation tissue surround the disc fragment accounting for its peripheral enhancement. A tract-like enhancement extending from the outer aspect of the degenerated intervertebral disc to the posterior epidural space, indicating the route of migration virtually clinches the diagnosis[9] [Figures 3 and 4].

View Article: PubMed Central - PubMed

ABSTRACT

Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.

No MeSH data available.


Related in: MedlinePlus