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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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Benign lesions: Lipomatosis: Sagittal T1-weighted (A), T2-weighted (B), T2 fat saturated (C), and axial T2-weighted (D) images of lumbar spine in a 11-month-old female showing excessive fat in the posterior epidural space (arrow), which also extends laterally and causes scalloping of vertebral bodies (curved arrow). It is associated with filum terminale lipoma (arrowhead). Also note lipomatous tissue in both paraspinal and psoas muscles (elbow arrow)
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Figure 24: Benign lesions: Lipomatosis: Sagittal T1-weighted (A), T2-weighted (B), T2 fat saturated (C), and axial T2-weighted (D) images of lumbar spine in a 11-month-old female showing excessive fat in the posterior epidural space (arrow), which also extends laterally and causes scalloping of vertebral bodies (curved arrow). It is associated with filum terminale lipoma (arrowhead). Also note lipomatous tissue in both paraspinal and psoas muscles (elbow arrow)

Mentions: MRI is the imaging modality of choice to assess the extradural fat as well as compression on cord and nerve roots. Epidural lipomatosis is chararcterized by hyperintense signal both on T1W and T2W images, which is supressed on fat-saturated images. The lesion causes circumferential compression of the dural sac [Figures 13–16]. In the lumbar canal, the dural sac appears geometric, polygonal, spiculated and Y-shaped due to the variable presence of meningovertebral ligaments epidural space anchoring the dura mater with the osteofibrous walls of the lumbar canal.[32] Epidural fat thickness greater than 7 mm is diagnostic of spinal epidural lipomatosis [Figure 15].[31] Treatment depends on the severity of symptoms. Decompressive laminectomy is needed with resection of epidural lipomatosis in patients with neurodeficits. Weight reduction, treatment for Cushing's syndrome, and weaning and stoppage of exogenous steroids constitute conservative therapy.[33]


Imaging in spinal posterior epidural space lesions: A pictorial essay
Benign lesions: Lipomatosis: Sagittal T1-weighted (A), T2-weighted (B), T2 fat saturated (C), and axial T2-weighted (D) images of lumbar spine in a 11-month-old female showing excessive fat in the posterior epidural space (arrow), which also extends laterally and causes scalloping of vertebral bodies (curved arrow). It is associated with filum terminale lipoma (arrowhead). Also note lipomatous tissue in both paraspinal and psoas muscles (elbow arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 24: Benign lesions: Lipomatosis: Sagittal T1-weighted (A), T2-weighted (B), T2 fat saturated (C), and axial T2-weighted (D) images of lumbar spine in a 11-month-old female showing excessive fat in the posterior epidural space (arrow), which also extends laterally and causes scalloping of vertebral bodies (curved arrow). It is associated with filum terminale lipoma (arrowhead). Also note lipomatous tissue in both paraspinal and psoas muscles (elbow arrow)
Mentions: MRI is the imaging modality of choice to assess the extradural fat as well as compression on cord and nerve roots. Epidural lipomatosis is chararcterized by hyperintense signal both on T1W and T2W images, which is supressed on fat-saturated images. The lesion causes circumferential compression of the dural sac [Figures 13–16]. In the lumbar canal, the dural sac appears geometric, polygonal, spiculated and Y-shaped due to the variable presence of meningovertebral ligaments epidural space anchoring the dura mater with the osteofibrous walls of the lumbar canal.[32] Epidural fat thickness greater than 7 mm is diagnostic of spinal epidural lipomatosis [Figure 15].[31] Treatment depends on the severity of symptoms. Decompressive laminectomy is needed with resection of epidural lipomatosis in patients with neurodeficits. Weight reduction, treatment for Cushing's syndrome, and weaning and stoppage of exogenous steroids constitute conservative therapy.[33]

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