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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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Miscellaneous: Post-traumatic epidural hematoma: 43-year-old male with a known history of ankyosing spondylitis had a trivial fall followed with severe cervical region pain. Sagittal T1-weighted (A), T2-weighted (B) and short T1 inversion recovery (C) images showing loss of cervical lordosis, syndesmophytes along vertebral bodies, as well as osseous fusion of facets on both sides (curved arrow). Posterior epidural soft tissue is seen from C4-T1 levels (arrowhead) indenting on the cord and fracture is seen through C5-6 facet joint (arrow). Edema is seen in interspinous soft tissue (elbow arrow)
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Figure 38: Miscellaneous: Post-traumatic epidural hematoma: 43-year-old male with a known history of ankyosing spondylitis had a trivial fall followed with severe cervical region pain. Sagittal T1-weighted (A), T2-weighted (B) and short T1 inversion recovery (C) images showing loss of cervical lordosis, syndesmophytes along vertebral bodies, as well as osseous fusion of facets on both sides (curved arrow). Posterior epidural soft tissue is seen from C4-T1 levels (arrowhead) indenting on the cord and fracture is seen through C5-6 facet joint (arrow). Edema is seen in interspinous soft tissue (elbow arrow)

Mentions: MRI is the imaging modality of choice in diagnosing spinal epidural hematoma. Cervical or cervicothoracic locations are most common with extension over multiple levels. Spontaneous spinal epidural hematoma [Figures 22 and 23] usually occurs in the posterior epidural space, whereas traumatic epidural hematomas can occur anteriorly or posteriorly, with the former associated with vertebral body fracture. Post-traumatic spinal epidural hematoma [Figure 24] are often associated with vertebral disease such as rheumatoid arthritis or ankylosing spondylitis in elderly patients. In children, spinal epidural hematoma may occur, without any fracture or dislocation of the spine.[54] Post lumbar puncture epidural hematoma, though rare, is a known complication.[55]


Imaging in spinal posterior epidural space lesions: A pictorial essay
Miscellaneous: Post-traumatic epidural hematoma: 43-year-old male with a known history of ankyosing spondylitis had a trivial fall followed with severe cervical region pain. Sagittal T1-weighted (A), T2-weighted (B) and short T1 inversion recovery (C) images showing loss of cervical lordosis, syndesmophytes along vertebral bodies, as well as osseous fusion of facets on both sides (curved arrow). Posterior epidural soft tissue is seen from C4-T1 levels (arrowhead) indenting on the cord and fracture is seen through C5-6 facet joint (arrow). Edema is seen in interspinous soft tissue (elbow arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 38: Miscellaneous: Post-traumatic epidural hematoma: 43-year-old male with a known history of ankyosing spondylitis had a trivial fall followed with severe cervical region pain. Sagittal T1-weighted (A), T2-weighted (B) and short T1 inversion recovery (C) images showing loss of cervical lordosis, syndesmophytes along vertebral bodies, as well as osseous fusion of facets on both sides (curved arrow). Posterior epidural soft tissue is seen from C4-T1 levels (arrowhead) indenting on the cord and fracture is seen through C5-6 facet joint (arrow). Edema is seen in interspinous soft tissue (elbow arrow)
Mentions: MRI is the imaging modality of choice in diagnosing spinal epidural hematoma. Cervical or cervicothoracic locations are most common with extension over multiple levels. Spontaneous spinal epidural hematoma [Figures 22 and 23] usually occurs in the posterior epidural space, whereas traumatic epidural hematomas can occur anteriorly or posteriorly, with the former associated with vertebral body fracture. Post-traumatic spinal epidural hematoma [Figure 24] are often associated with vertebral disease such as rheumatoid arthritis or ankylosing spondylitis in elderly patients. In children, spinal epidural hematoma may occur, without any fracture or dislocation of the spine.[54] Post lumbar puncture epidural hematoma, though rare, is a known complication.[55]

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