Abstract
BackgroundWe herein provide an analysis of lumbar epidural catheterization, which outlines a detailed anatomical description of the epidural anatomy, and may improve the success rate of neuraxial cannulation.MethodsLumbar epidural catheters were placed in 50 adult embalmed cadavers. After catheterization, the lumbar dura and connecting structures between the epidural space and the vertebral body were separated. The positional relationship between the catheter and the posterior epidural space were observed and photographed.ResultsAmongst the 50 specimens, the epidural catheter curled into a circle in three cases, entered the intervertebral foramen in two cases, and caused epidural venous damage in five cases.ConclusionsMeningo-vertebral ligaments exist in the posterior epidural space and connect to the venous plexus, which may contribute to epidural catheter failure, uneven distribution of anaesthesia and epidural hemorrhage. Our study provides anaesthesiologists with a better understanding of the anatomy and may mitigate complications of lumbar epidural catheter placement.
Highlights
We provide an analysis of lumbar epidural catheterization, which outlines a detailed anatomical description of the epidural anatomy, and may improve the success rate of neuraxial cannulation
The catheter tip was attached to the meningo-vertebral ligaments and curled into a circle in three cases, with one catheter twisted into a “9” shape (Fig. 1)
The catheter tip was in close proximity to the nerve roots near the intervertebral foramen (Fig. 2), and perforation of the vertebral venous plexus was observed in five cases (Fig. 3)
Summary
We provide an analysis of lumbar epidural catheterization, which outlines a detailed anatomical description of the epidural anatomy, and may improve the success rate of neuraxial cannulation. Meningo-vertebral ligaments have been described between the dura mater and the lumbosacral spinal canal [1]. These structures may be responsible for intermittent failure of epidural catheterization. To explore the anatomical reasons for epidural catheterization failure, reveal the relationship between the dorsal meningovertebral ligaments, and thereby lower the failure occurrence rate and its related complications. This research simulated the insertion of epidural catheters in cadaveric specimens and observed the relationship between the relevant structures
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