Epidural space as a starling resistor and elevation of inflow resistance in a diseased epidural space

Distribution of solution in the epidural space: Examination by cryomicrotome section

“…Spread away from an area of high injectate pressure will be directed into the various passages according to the subtle forces compressing their opposing surfaces. 10 Consistent with this mechanism is the observation that rivulet-like fingers of spread are most evident at the margins of distribution where fluid pressure is lowest. The result is a variable pattern akin to the passage of liquid between 2 opposing layers of clear plastic wrap spread on a tabletop.…”

Acute Monoplegia After Lysis of Epidural Adhesions: A Case Report

“…This phenomenon is known as "loculation". 8 McLain et al has reported a case of acute, transient paraplegia after epidural steroid injection in a patient with multiple back surgeries. 9 Radiographic studies post-procedure might have suggested loculation of injected fluid causing compression with consequent neurological deficit.…”

Cervical Spinal Canal Loculation and Secondary Ischemic Cord Injury – PVCS – Perivenous Counter Spread – Danger Sign!

“…There is some evidence that the epidural space normally has compartments, and when fluid is injected, it sequentially fills these compartments as the pressure in each compartment exceeds the pressure needed to break tissue barriers to intercompartmental flow. 6 Normally, the pressures that develop are inconsequential, but in the presence of pathology, the pressure can result in significant cord injury and neurological malfunction.…”

“…Bring the chin to the shoulder, continuously flexing and rotating the head. 6 Movement of the patient's head and neck changes the size of the neuroformina; the foramina get larger on flexion and smaller on extension 7 ( Figure 2). This increase in foraminal size is enhanced with flexion and rotation of the head.…”