Imaging in spinal posterior epidural space lesions: A pictorial essay

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.

Spontaneous Epidural Hematoma of Cervical Spine

“…1 After the introduction of MRI the incidence and number of diagnosed have further increased. [5][6][7] A spinal epidural hematoma can occur in the absence of any trauma or iatrogenic procedures. This definition also includes causes, such as a tumor, coagulopathy, vascular malformation, and cavernous angioma.…”

“…This definition also includes causes, such as a tumor, coagulopathy, vascular malformation, and cavernous angioma. 1,2,4,7 The age of patients has bimodal peaks, with an increase in the second and seventh decades. 7 Halim et al 10 demonstrated that there is no significant correlation with sex and race.…”

“…1,2,4,7 The age of patients has bimodal peaks, with an increase in the second and seventh decades. 7 Halim et al 10 demonstrated that there is no significant correlation with sex and race. 10 SSEH can be clinically presented as transverse myelitis, dissecting aortic aneurysm, ruptured cervical herniated disk, epidural neoplasia, or infection, such as an epidural abscess.…”

“…There is a combination of severe pain and neurologic deficit. Most patients present with severe back or neck pain, often with a radicular component 7 ; however, some cases have been reported without neck pain. 11 After sudden and abrupt pain, motor or sensory deficits occur.…”

“…2,5,6 The radiologic differential diagnoses include epidural abscess and spinal epidural lymphoma. 7 The aim of this study is to report a case of acute SSEH without any previous predisposing factors, with the patient presenting with sudden onset of neck pain followed by motor deficits. The patient was successfully treated surgically.…”