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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: Hypertrophied ligamentum flavum: Sagittal T1-weighted (A), T2-weighted (B), and axial T2 fat saturated (C) images of thoracic spine in a 62-year-old male with a known carcinoma of the lung with backache, showing focal hypertrophy of ligamentum flavum (arrow) at T4-5 level effacing the posterior epidural space. No abnormal vertebral signal or soft tissue noted on axial images
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Figure 7: Degenerative: Hypertrophied ligamentum flavum: Sagittal T1-weighted (A), T2-weighted (B), and axial T2 fat saturated (C) images of thoracic spine in a 62-year-old male with a known carcinoma of the lung with backache, showing focal hypertrophy of ligamentum flavum (arrow) at T4-5 level effacing the posterior epidural space. No abnormal vertebral signal or soft tissue noted on axial images

Mentions: Ligamentum flavum drapes the posterolateral aspect of the spinal canal. The bulk of ligament comprises elastin fibres (80%) with remainder being collagen—a fact that contributes to an increased signal on T1W compared to other ligamentous structures in the body. With aging, the ratio of fibres reverses decreasing the elasticity.[10] Along with disc degeneration and facetal arthrosis, hypertrophy of ligamentum flavum contributes to spinal canal stenosis. The mechanism of hypertrophy is unclear, however, it may occur due to chronic inflammation leading to an accumulation of fibrous tissue with scarring.[11] The thickness of ligamentum flavum increases with age and is more pronounced in the lower lumbar levels due to higher mechanical stress.[12] Occasionally, calcium pyrophosphate dehydrate may deposit in the ligamentum flavum that appears hypointense on all sequences on MRI and shows calcification on Computed Tomography (CT) [Figures 5 and 6].


Imaging in spinal posterior epidural space lesions: A pictorial essay
Degenerative: Hypertrophied ligamentum flavum: Sagittal T1-weighted (A), T2-weighted (B), and axial T2 fat saturated (C) images of thoracic spine in a 62-year-old male with a known carcinoma of the lung with backache, showing focal hypertrophy of ligamentum flavum (arrow) at T4-5 level effacing the posterior epidural space. No abnormal vertebral signal or soft tissue noted on axial images
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Degenerative: Hypertrophied ligamentum flavum: Sagittal T1-weighted (A), T2-weighted (B), and axial T2 fat saturated (C) images of thoracic spine in a 62-year-old male with a known carcinoma of the lung with backache, showing focal hypertrophy of ligamentum flavum (arrow) at T4-5 level effacing the posterior epidural space. No abnormal vertebral signal or soft tissue noted on axial images
Mentions: Ligamentum flavum drapes the posterolateral aspect of the spinal canal. The bulk of ligament comprises elastin fibres (80%) with remainder being collagen—a fact that contributes to an increased signal on T1W compared to other ligamentous structures in the body. With aging, the ratio of fibres reverses decreasing the elasticity.[10] Along with disc degeneration and facetal arthrosis, hypertrophy of ligamentum flavum contributes to spinal canal stenosis. The mechanism of hypertrophy is unclear, however, it may occur due to chronic inflammation leading to an accumulation of fibrous tissue with scarring.[11] The thickness of ligamentum flavum increases with age and is more pronounced in the lower lumbar levels due to higher mechanical stress.[12] Occasionally, calcium pyrophosphate dehydrate may deposit in the ligamentum flavum that appears hypointense on all sequences on MRI and shows calcification on Computed Tomography (CT) [Figures 5 and 6].

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