The Posterior Epidural Ligaments: A Cadaveric and Histological Investigation in the Lumbar Region

Abstract

Purpose. Incidental durotomy is a relatively common complication for patients undergoing posterior spinal surgery. Delineating anatomical variants in the posterior lumbar spinal canal is crucial in reducing future rates of incidental durotomy. Materials and Methods. The ligamentous attachments between the dura mater and ligamentum flavum in the lumbar region of 17 soft-fixed cadavers were investigated. The lumbar vertebral columns were removed, and cross-sectional dissection was performed at levels L1-S1. Anterior retraction of the dorsal dura mater identified attachments between the dorsal surface of the dura mater and the ligamentum flavum. Histological staining of the ligamentous attachments was carried out with hematoxylin and eosin (H&E) and elastic van Gieson (EVG). Results. Posterior epidural ligaments were present in 9 (52.9%) cadavers. Nine (9) separate ligaments were identified in these cadavers, with 3 (33.3%) at L3/L4, 5 (55.5%) at L4/L5, and 1 (11.1%) at L5/S1. Histology confirmed the presence of poorly differentiated collagen-based connective tissue, distinct from the normal anatomy. Conclusions. This study confirms the presence of multiple dorsomedial posterior epidural ligaments at the main sites for posterior spinal surgery (L3-S1). An intraoperative awareness of the variability of such connections may be an important step in reducing static rates of incidental durotomy.

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

“…This study has confirmed the presence of the posterior epidural ligament in the thoracic region, using gross inspection and histological analysis. The findings of this study are consistent with those of Connor et al [4], which showed the presence of the PEL in the lumbar region. Histology on transverse sections confirmed that the structure of the thoracic PEL described here was similar to that of the PEL in the lumbar region.…”

“…Collagen fibres were also present, but appear as smaller bundles. The similarities between the ligaments described in this study, and those described by Connor et al [4], suggest that the PEL is a consistent structure, variably present in the posterior epidural space of the lumbar and thoracic regions.…”

“…The identification of the posterior epidural ligament (PEL) by Connor et al [4], as distinct from the anterior or lateral Hoffman's ligaments [5,12], showed that connections exist between the dural sheath and ligamentum flavum in the lumbar spine. Connor et al [4] described the PEL as a substantial structure connecting the dural sheath to the ligamentum flavum. Such connections between the dura and ligamentum flavum may be implicated in incidental durotomy during posterior approach spinal surgery.…”

“…The PEL may also help to support and protect the spinal cord and dural sheath [12], as well as aiding the circulation of cerebrospinal fluid (CSF) in the spinal subarachnoid space, as the thoracic spine is flexed and rotated [13]. The work of Connor et al [4] showed the presence of the PEL in the lumbar region. The aim of the present study was to investigate the presence, and histological structure, of the PEL in the thoracic spinal region.…”

Regional and age features of the structure of connective tissues structures of the epidurals pace of the human spinal cord

“…[15] и ряд других исследований [6,16] продемонстрировали высокую эффективность чрескожного и эндоскопического эпидурального адгезиолиза в купировании болевого синдрома. изучение заднего эпидурального пространства поясничного отдела позвоночника взрослых людей без признаков его заболеваний и предшествующих операций выявило наличие соединительнотканных связок различной формы между дорсальной поверхностью твердой мозговой оболочки и желтой связкой [17]. Существует мнение [18], что твердая оболочка спинного мозга плотно прикреплена с помощью соединительнотканных структур только к задней продольной связке и при этом не имеет других связей со стенками позвоночного канала.…”