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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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Infective: Tuberculosis: 30-year-old male with backache. Sagittal T1-weighted (A) and T2-weighted (B) images of thoracic spine showing abnormal signal in the posterior half of T8 vertebral body and in spinous processes of T7 and T8 vertebrae (arrows). Localized posterior epidural abscess (elbow arrow) at T7-8 level is seen compressing the cord with edema in cord
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Figure 22: Infective: Tuberculosis: 30-year-old male with backache. Sagittal T1-weighted (A) and T2-weighted (B) images of thoracic spine showing abnormal signal in the posterior half of T8 vertebral body and in spinous processes of T7 and T8 vertebrae (arrows). Localized posterior epidural abscess (elbow arrow) at T7-8 level is seen compressing the cord with edema in cord

Mentions: Spinal tuberculosis classically affects the discovertebral region with involvement of two contiguous vertebral bodies and destruction of intervening disc (spondylodiscitis), however, several vertebrae, skip lesions, or single vertebral body may be involved. It may be associated with paravertebral, subligamentous, or anterior epidural soft tissue/abscess. Dorsolumbar region is the most commonly affected.[28] Occasionally, isolated involvement of the neural arch or posterior elements may be seen. MRI findings include erosion of lamina, posterior epidural soft tissue/abscess, and pyomyositis along the posterior spinal muscles. The posterior epidural soft tissue/abscess may compress upon the spinal cord and spastic lower limb weakness may ensue [Figures 10–12]. Pateints with neurological deficits need emergent decompressive laminectomy.[29]


Imaging in spinal posterior epidural space lesions: A pictorial essay
Infective: Tuberculosis: 30-year-old male with backache. Sagittal T1-weighted (A) and T2-weighted (B) images of thoracic spine showing abnormal signal in the posterior half of T8 vertebral body and in spinous processes of T7 and T8 vertebrae (arrows). Localized posterior epidural abscess (elbow arrow) at T7-8 level is seen compressing the cord with edema in cord
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 22: Infective: Tuberculosis: 30-year-old male with backache. Sagittal T1-weighted (A) and T2-weighted (B) images of thoracic spine showing abnormal signal in the posterior half of T8 vertebral body and in spinous processes of T7 and T8 vertebrae (arrows). Localized posterior epidural abscess (elbow arrow) at T7-8 level is seen compressing the cord with edema in cord
Mentions: Spinal tuberculosis classically affects the discovertebral region with involvement of two contiguous vertebral bodies and destruction of intervening disc (spondylodiscitis), however, several vertebrae, skip lesions, or single vertebral body may be involved. It may be associated with paravertebral, subligamentous, or anterior epidural soft tissue/abscess. Dorsolumbar region is the most commonly affected.[28] Occasionally, isolated involvement of the neural arch or posterior elements may be seen. MRI findings include erosion of lamina, posterior epidural soft tissue/abscess, and pyomyositis along the posterior spinal muscles. The posterior epidural soft tissue/abscess may compress upon the spinal cord and spastic lower limb weakness may ensue [Figures 10–12]. Pateints with neurological deficits need emergent decompressive laminectomy.[29]

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