Measurement of Shift of the Cauda Equina in the Subarachnoid Space by Changing Position

Takiguchi, Tetsuo; Yamaguchi, Shigeki; Tezuka, Masatomo; Kitajima, Toshimitsu

doi:10.1097/aap.0b013e3181ac7bff

Cited by 23 publications

(31 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, as found in their subsequent study on eight immobile patients [7], this value was 50.10 mm in the lower thoracic region (T4/T5 and below), with excursions of the same size along the left/right axis, thus setting the lower limits on the size of bulk cord motions in those directions. Much larger changes (millimetre-scale) in the A/P position of the spinal cord relative to the dura were found in patients who purposely changed posture or carried out flexion/extension manoeuvres during imaging [8,9]. See also the reviews of Harrison et al [10] and Cox [11].…”

Section: Discussionmentioning

confidence: 95%

MR-based measurement of spinal cord motion during flexion of the spine: implications for intradural spinal cord stimulator systems

Viljoen¹,

Smittkamp²,

Dalm³

et al. 2013

Journal of Medical Engineering & Technology

View full text Add to dashboard Cite

This study develops a means of delivering electrical stimuli directly to the pial surface of the spinal cord for treatment of intractable pain. This intradural implant must remain in direct contact with the cord as it moves within the spinal canal. Therefore, magnetic resonance imaging was used to measure the movement of the spinal cord between neutral and flexed-back positions in a series of volunteers (n = 16). Following flexion of the back, the mean change in the pedicle-to-spinal cord dorsal root entry zone distance at the T10-11 level was (8.5 ± 6.0) mm, i.e. a 71% variation in the range of rostral-caudal movement of the spinal cord across all patients. There will be a large spectrum of spinal cord strains associated with this observed range of rostral-caudal motions, thus calling for suitable axial compliance within the electrode bearing portion of the intradural implant.

show abstract

Section: Discussionmentioning

confidence: 95%

MR-based measurement of spinal cord motion during flexion of the spine: implications for intradural spinal cord stimulator systems

Viljoen¹,

Smittkamp²,

Dalm³

et al. 2013

Journal of Medical Engineering & Technology

View full text Add to dashboard Cite

show abstract

“…In the inferior thoracic segment the deviation was of only 1.0 mm [23]. Forced flexion of the spine moves the spinal cord and cauda equina anteriorly (ventrally) while the forced flexion of the limbs provides the forward movement of the whole medula anteriorly [23].…”

Section: Anatomy Through Imagementioning

confidence: 99%

“…So, bending the column forward facilitates the introduction of the needle into the subarachnoid space in the lumbar segment not providing protection to the medulla [22]. The spinal medula and the cauda equina move inside the canal, depending on the gravity, when the patient assumes lateral decubitus, occurring it in all its extension, being it greater at L2-L3 with a mean movement of 3.4±1.0 mm [23]. In the inferior thoracic segment the deviation was of only 1.0 mm [23].…”

Section: Anatomy Through Imagementioning

confidence: 99%

“…Anatomy studies about the medular cone has demonstrated that the cauda equina has a dinamic attitude that varies with the position assumed by the patient [22,23]. So, bending the column forward facilitates the introduction of the needle into the subarachnoid space in the lumbar segment not providing protection to the medulla [22].…”

Section: Anatomy Through Imagementioning

confidence: 99%

“…The spinal medula and the cauda equina move inside the canal, depending on the gravity, when the patient assumes lateral decubitus, occurring it in all its extension, being it greater at L2-L3 with a mean movement of 3.4±1.0 mm [23]. In the inferior thoracic segment the deviation was of only 1.0 mm [23]. Forced flexion of the spine moves the spinal cord and cauda equina anteriorly (ventrally) while the forced flexion of the limbs provides the forward movement of the whole medula anteriorly [23].…”

Section: Anatomy Through Imagementioning

confidence: 99%

See 2 more Smart Citations

Thoracic Spinal Anesthesia

2016

JACCOA

View full text Add to dashboard Cite

In 1909 Thomas Jonnesco published his interesting paper under the title General spinal anesthesia through an approach of the subarachnoid space at a thoracic level, providing condition for surgery on the skull, head, neck and thorax. Etherington-Wilson proposed explaining the various possibilities for the spinal anesthesia. Leonardo da Vinci was considered the discoverer of Human and animal Anatomy. Image techniques have opened a gret new field for the study of anatomy in the living man. The modern means of image, associated to computed means have facilitated the evaluation of the CSF volume, through antero-posterior and height measures of the subarachnoid space based on bi-dimentional studies of MRI. The studies of the thoracic column with MRI show that exist a space between the dura-mater and the spinal cord (medula). Thoracic ouncture performed with needles proved safe and without neurological injury. Thoracic spinal anesthesia is a viable procedure, with a low incidence of hypotension and did not present any neurologic problem.

show abstract

Pythagoras and Cosines: The skin–dural sac distance and optimal angles in paramedian spinal anesthesia

Puigdellı́vol-Sánchez

Reina

Sala‐Blanch

et al. 2016

Clinical Anatomy

View full text Add to dashboard Cite

The classical recommendation for paramedian approaches is needle insertion 1-2 cm paramedian and an angle of 10°-15° medial-cephalad to the plane of the back, but contact with vertebrae is frequent. A mathematical approach to individualizing punctures is proposed on the basis of skin-dural sac distance (d): Optimal angle ∼ inverse cosine [d/ √(1+d^2) ] and the distance covered by the needle ∼ √(1+d^2) for 1 cm paramedian punctures. The inferred angles were compared to optimal angles leading to the central dorsal part of the dural sac from 1 to 2 cm paramedian, measured by Magnetic Resonance Imaging (MRI) in seven cases and in a short stature volunteer (1.58 m, Body Mass Index (BMI) 23.2), to study supine and fetal positions using both closed MR and ultrasound. The average (d) decreased rostrally [6.8 cm (L4-L5)-4.3 cm (T11-T12)] while the mean optimal incidence angles increased [8.3°-16.5° (L4-L5) to 12.7°-24.1° (T11-T12) at 1-2 cm paramedian, respectively] and coincided with the estimated angles with a correlation coefficient = 0.98. In the volunteer, the optimal lateromedial angles increased from 14.4° to 26.7° (L3-L4) to 17.1°-30.3° (T11-T12) for a (d) = 3.7 cm (L3-L4)-3.1 cm (T11-T12) and increased ≤3.7° and ≤5.1° at 1 and 2 cm paramedian, respectively, in fetal positions in MR. Ultrasound yielded comparable figures. The range of possible angles for dural punctures is wider at 1 cm paramedian in lower approaches in lateral decubitus [from 3.6° at T12L1 (12.2°-15.8°) to 9° at L3L4 (8.8°-18.7°)]. The classically recommended angles of 10°-15° differ from the optimal angles, particularly in small patients, suggesting the need for ultrasound guidance or for inferring angles prior to spinal anesthesia. Clin. Anat. 29:1046-1052, 2016. © 2016 Wiley Periodicals, Inc.

show abstract

Measurement of Shift of the Cauda Equina in the Subarachnoid Space by Changing Position

Abstract: The present study using MRI showed dynamical movement of the spinal cord and cauda equina due to changing position. The most obvious movements by changing from supine to lateral decubitus position and fully flexed legs were observed at the L2/3 and L1/2 levels, respectively.

Cited by 23 publications

References 6 publications

MR-based measurement of spinal cord motion during flexion of the spine: implications for intradural spinal cord stimulator systems

MR-based measurement of spinal cord motion during flexion of the spine: implications for intradural spinal cord stimulator systems

Thoracic Spinal Anesthesia

Pythagoras and Cosines: The skin–dural sac distance and optimal angles in paramedian spinal anesthesia

Contact Info

Product

Resources

About