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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.

No MeSH data available.


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Degenerative: Synovial cyst: Preoperative scan: Sagittal (A) and axial (B) T2-weighted images in a 59-year-old male patient with lower limb radiculopathy, showing diffuse disc bulge (arrow) at L4-5 level along with moderate degenerative facetal arthropathy (elbow arrow), causing moderate to severe canal and bilateral lateral recess narrowing. Patient underwent decompressive laminectomy at the L4-5 level
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Figure 10: Degenerative: Synovial cyst: Preoperative scan: Sagittal (A) and axial (B) T2-weighted images in a 59-year-old male patient with lower limb radiculopathy, showing diffuse disc bulge (arrow) at L4-5 level along with moderate degenerative facetal arthropathy (elbow arrow), causing moderate to severe canal and bilateral lateral recess narrowing. Patient underwent decompressive laminectomy at the L4-5 level

Mentions: Synovial cyst represents protrusion of synovial membrane from degenerated facet joints into the spinal canal[14] contrary to the ganglion pseudocyst, which represents a cyst that is devoid of synovial lining. Often synovial cysts and ganglion pseudocysts are referred to as juxtafacet cysts. In a review by Bydon et al., 96.2% synovial cysts were located in the lumbar (75.4% at the L4–L5 level), 2.6% in the cervical, and only 1.2% in the thoracic spine.[15] These cysts may be associated with disc degeneration and spondylosis. Synovial cysts [Figures 7 and 8] on MRI show T2 hypointense fibrous/calcified capsule with variable internal signal on T1W and T2W images depending on cysts contents.[16] The cysts may show adhesions to the dura mater and nerve roots.


Imaging in spinal posterior epidural space lesions: A pictorial essay
Degenerative: Synovial cyst: Preoperative scan: Sagittal (A) and axial (B) T2-weighted images in a 59-year-old male patient with lower limb radiculopathy, showing diffuse disc bulge (arrow) at L4-5 level along with moderate degenerative facetal arthropathy (elbow arrow), causing moderate to severe canal and bilateral lateral recess narrowing. Patient underwent decompressive laminectomy at the L4-5 level
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 10: Degenerative: Synovial cyst: Preoperative scan: Sagittal (A) and axial (B) T2-weighted images in a 59-year-old male patient with lower limb radiculopathy, showing diffuse disc bulge (arrow) at L4-5 level along with moderate degenerative facetal arthropathy (elbow arrow), causing moderate to severe canal and bilateral lateral recess narrowing. Patient underwent decompressive laminectomy at the L4-5 level
Mentions: Synovial cyst represents protrusion of synovial membrane from degenerated facet joints into the spinal canal[14] contrary to the ganglion pseudocyst, which represents a cyst that is devoid of synovial lining. Often synovial cysts and ganglion pseudocysts are referred to as juxtafacet cysts. In a review by Bydon et al., 96.2% synovial cysts were located in the lumbar (75.4% at the L4–L5 level), 2.6% in the cervical, and only 1.2% in the thoracic spine.[15] These cysts may be associated with disc degeneration and spondylosis. Synovial cysts [Figures 7 and 8] on MRI show T2 hypointense fibrous/calcified capsule with variable internal signal on T1W and T2W images depending on cysts contents.[16] The cysts may show adhesions to the dura mater and nerve roots.

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