Dura to spinal cord distance at different vertebral levels in children and its implications on epidural analgesia: A retrospective MRI‐based study

Abstract

The present study reports that the largest dura to spinal cord distance is found at the T level, and the shortest dura to spinal cord distance at the L level. There appears to be substantially more room in the dorsal subarachnoid space at the thoracic level. The risk of spinal cord damage resulting from accidental epidural needle advancement may be greater in the lumbar region due to a more dorsal location of the spinal cord in the vertebral canal compared to the thoracic region.

Dura-to-spinal cord distance at different vertebral levels in Indian children: A retrospective computerized tomography scan-based study

“…found the mean DTC distance using MRI to be 5.0 ± 1.6 mm at T 9–10 (range of 1.2–8.1 mm) and 3.6 ± 1.2 mm at L 1–2 (range of 1.2–6.8 mm) in children aged <8 years. [ 6 ] The values obtained in our study were lower. This could be due to different ethnicity and also difference in the mean height and weight of Asian children when compared to the Western pediatric population.…”

“…Although the DTC distance has been found to be widest at mid-thoracic level by few studies,[ 6 9 10 ] the increased angulation and longer needle path can prove to be an uphill task for accurate placement of epidural needle in a single attempt in children, more so under general anesthesia (GA). The ease of epidural insertion with the midline approach in low-thoracic region is akin to the lumbar region as the angulation of the spinous processes is same at both the levels.…”

“…Radiologically, the DTC was marked as the measurement from the ligamentum flavum toward the dura till the spinal cord posterior margin [ Figure 1 ]. [ 6 ] All the measurements were taken using the electronic caliper available in our PACS workstation. Sagittal reformatted images in the midline section were used with optimal magnification for accurate measurement.…”

“…measured the DTC at T 6–7 , T 9–10 , and L 1–2 interspaces using magnetic resonance imaging (MRI) images in 88 children <8 years of age and found the maximum DTC at the T 6–7 level and least at the L 1–2 level. [ 6 ]…”

Comparison of the skin-to-epidural space distance at the thoracic and lumbar levels in children using magnetic resonance imaging

“…The cohort for the current study included data and MR images from patients who had been included in two previous studies. [ 11 15 ] Patients with any history indicative of spinal pathology (scoliosis, tethered cord, spina bifida, myelomeningocele, tumors of the spinal cord or vertebral bodies, spinal metastatic disease) or poor image quality were excluded.…”