The Dorsomedian Ligamentous Strand: An Evaluation In Vivo with Epiduroscopy.

Maurizio Marchesini,William Raffaeli,Eleonora Schiappa

doi:10.3390/medsci10010018

Maurizio Marchesini, William Raffaeli + Show 1 more

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https://doi.org/10.3390/medsci10010018

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Abstract

Several anatomical studies have described the morphology of the spinal space; however, researchers do not all agree on the presence of the dorsomedian ligamentous strand (DLS), which divides the epidural space. The possible existence of this structure still influences some clinical practice, such as locoregional anesthesia and pain therapy. Since the number of procedures occurring inside the epidural space have increased, this study’s primary objective was to describe the composition of this space through epiduroscopy. We conducted a retrospective analysis of video recorded during epiduroscopy. Two independent doctors performed blind analyses of morphological aspects of peridural space visualized during the procedure in each patient for the maximum possible extension depending on the underlying pathology in the tract from S1 to L1. We enrolled 106 patients who underwent epiduroscopy; 100% of patients presented no medial longitudinal segmentation dividing the epidural channel at any level of the spinal tract investigated, including in the epidural space with pathological fibrotic scars and in those with no adherence. The main finding of our study was the visual absence of any anatomical structure dividing the epidural channel. We report that in vivo, in our experience, with direct epiduroscopy, the DLS is not visible.

Highlights

Salvatore Calabrò andSince the 1900s, many anatomical studies have attempted to describe the structural and morphological features of the spinal space [1]
Despite the many procedures developed over the years using the anatomical and functional specificity of this space and surgical practices on its components, little is known about the composition of the epidural space
In addition to orthopedic surgeons, neurosurgeons, and anesthesiologists, pain therapists, radiologists, and neurologists work on the epidural space for diagnostic and therapeutic purposes by applying anatomical landmarks based on dated studies [1]

Summary

Introduction

Salvatore Calabrò andSince the 1900s, many anatomical studies have attempted to describe the structural and morphological features of the spinal space [1]. Despite the many procedures developed over the years using the anatomical and functional specificity of this space and surgical practices on its components, little is known about the composition of the epidural space. This space is a common site of interventional and surgical procedures, few studies have investigated this anatomical compartment. 1970 using names such as “plica mediana dorsalis” [2] or “dorsomedian dural fold” [3]. This segmentation is considered real despite some papers that encourage reflection on the evidence of this “dorsomedian ligament” [4]. Analyzing the studies conducted on this anatomical structure, which specify its morphological characteristics, indicates that, while some support its presence based on anatomical verification or CT documentation, others deny it, considering it an autoptic artifact

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