The posterior epidural ligament in the thoracic region: a cadaveric and histological study

Abstract

The existence of posterior epidural ligaments (PEL) has been established in the lumbar region, but they have hitherto not been shown to exist in the thoracic vertebral column. Their identification is of clinical significance in respect to incidental durotomy and the circulation of cerebro-spinal fluid. Fourteen thoracic spine sections were dissected by cutting through the intervertebral disc and separating the ligamentum flavum from the vertebra above. The dural sheath was gently retracted anteriorly to identify macroscopic connections between the ligamentum flavum and the dura. Macroscopic connections observed were dissected out, retaining some dural sheath and ligamentum flavum. Histological staining with haematoxylin and eosin (H&E) and Miller's elastin stain was used to investigate cellular connections. Thoracic PELs were positively identified in five of the fourteen cadavers (35.7%). Histology showed similarities between the thoracic and lumbar PELs. Fifteen separate PELs were identified within these five thoracic sections. The thoracic PEL has sufficient tensile strength to present a risk to the integrity of the dural sheath during surgery, and surgeons should be aware of these connections when operating on the thoracic spine. PELs may also contribute to the circulation of CSF in the spinal subarachnoid space.

The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 1

“…PLL and NRDL constitute a system that can uniquely influence the dural and muscular system, as the movement of the vertebrae stimulates the change of myofascial and fascial tension (muscles and ligaments). The ligamenta flava has a close relationship with the dural tissue at the cervical level and throughout the vertebral tract, through the posterior epidural ligaments (PELs) [29]. The suboccipital muscles merge with the occipitofrontalis or epicranius muscle; this muscle covers the occipital-parietal-frontal area, through a muscular area (occipital and frontal) and an aponeurosis below the galea capitis or aponeurotic galea [7].…”