Document Type

Article

Language

eng

Publication Date

7-1999

Publisher

Lippincott Williams and Wilkins

Source Publication

Regional Anesthesia and Pain Medicine

Source ISSN

1098-7339

Original Item ID

DOI: 10.1016/S1098-7339(99)90103-7

Abstract

Background and Objectives.

Important issues regarding the spread of solutions in the epidural space and the anatomy of the site of action of spinal and epidural injections are unresolved. However, the detailed anatomy of the spinal canal has been incompletely determined. We therefore examined the microscopic anatomy of the spinal canal soft tissues, including relationships to the canal walls.

Methods.

Whole mounts were prepared of decalcified vertebral columns with undisturbed contents from three adult humans. Similar material was prepared from a macaque and baboon immediately on death to control for artifact of tissue change after death. Other tissues examined included nerve root and proximal spinal nerve complex and dorsal epidural fat obtained during surgery. Slides were examined by light microscopy at magnifications of 10-40×.

Results.

There is no fibrous tissue in the epidural space. The epidural fat is composed of uniform cells enclosed in a fine membrane. The dorsal fat is only attached to the canal wall in the dorsal midline and is often tenuously attached to the dura. The dura is joined to the canal wall only ventrally at the discs. Veins are evident predominantly in the ventral epidural space. Nerve roots are composed of multiple fascicles which disperse as they approach the dorsal root ganglion. An envelope of arachnoid encloses the roots near the site of exit from the dura.

Conclusions.

These features of the fat explain its semifluid consistency. Lack of substantial attachments to the dura facilitate movement of the dura relative to the canal wall and allow distribution of injected solution. Fibrous barriers are an unlikely explanation for asymmetric epidural anesthesia, but the midline fat could impede solution spread. Details of nerve-root structure and their envelope of pia-arachnoid membrane may be relevant to anesthetic action.

Comments

Accepted version. Regional Anesthesia and Pain Medicine, Vol 24, No. 4 (July/August 1999): 303-310. Publisher link. © 1999 Churchill Livingstone Inc., Medical Publishers. Used with permission.

Jeffrey M. Toth was affiliated with the Medical College of Wisconsin at the time of publication.

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