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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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Infective: Pyogenic abscess: Sagittal (A) and axial (B) Computed tomography scan showing hypodense fluid collection in the posterior epidural space with compression of cord anteriorly. Thick enhancing dura is also seen (arrow). Few enlarged cervical nodes are seen (asterisk)
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Figure 13: Infective: Pyogenic abscess: Sagittal (A) and axial (B) Computed tomography scan showing hypodense fluid collection in the posterior epidural space with compression of cord anteriorly. Thick enhancing dura is also seen (arrow). Few enlarged cervical nodes are seen (asterisk)

Mentions: The abscess extends laterally and vertically in the epidural space and may occasionally involve the whole length of the spinal canal. Most epidural abscesses are located at the thoracic or lumbar level because the epidural space is larger in these areas.[24] In adults, they are predominantly located anteriorly, whereas a posterior location is more common in children. Moreover, in children, these abscesses tend to be more extensive.[25] Restricted diffusion on MRI confirms the presence of a pyogenic abscess [Figure 9]. The main determinant of outcome for patients with a spinal epidural abscess is the neurologic status at the time of diagnosis.[23] Combined surgical drainage and prolonged antibiotic therapy remain the ideal treatment.


Imaging in spinal posterior epidural space lesions: A pictorial essay
Infective: Pyogenic abscess: Sagittal (A) and axial (B) Computed tomography scan showing hypodense fluid collection in the posterior epidural space with compression of cord anteriorly. Thick enhancing dura is also seen (arrow). Few enlarged cervical nodes are seen (asterisk)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 13: Infective: Pyogenic abscess: Sagittal (A) and axial (B) Computed tomography scan showing hypodense fluid collection in the posterior epidural space with compression of cord anteriorly. Thick enhancing dura is also seen (arrow). Few enlarged cervical nodes are seen (asterisk)
Mentions: The abscess extends laterally and vertically in the epidural space and may occasionally involve the whole length of the spinal canal. Most epidural abscesses are located at the thoracic or lumbar level because the epidural space is larger in these areas.[24] In adults, they are predominantly located anteriorly, whereas a posterior location is more common in children. Moreover, in children, these abscesses tend to be more extensive.[25] Restricted diffusion on MRI confirms the presence of a pyogenic abscess [Figure 9]. The main determinant of outcome for patients with a spinal epidural abscess is the neurologic status at the time of diagnosis.[23] Combined surgical drainage and prolonged antibiotic therapy remain the ideal treatment.

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