Savolaine-E-R. Pandya-J-B. Greenblatt-S-H. Conover-S- R. Anatomy of the human lumbar epidural space: new insights using CT-epidurography. Anesthesiology. 1988 Feb. 68(2). P 217-20.
The anatomy of the lumbar epidural space was demonstrated in 40
patients by computed tomography (CT) examinations performed
after epidural injection of noninonic radiographic contrast
material into the sacral caudal canal via percutaneous
catheter. Radiologic evaluation of the epidural space was
performed to evaluate possible disc herniation or other
pathologic encroachments on the epidural space. In all 40
patients, the examinations showed the posterior epidural space
to be divided by the plica mediana dorsalis and an additional
transverse connective tissue plane not previously described.
The compartmentalized nature of the space may be, at times,
responsible for entrapment and coiling of epidural catheters,
despite satisfactory technical performance of catheterization
for epidural anesthesia. Thirty-one of 40 patients demonstrated
a greater amount of fatty tissue within the junctions of the
posterior midline epidural connective tissue structures,
producing a bulky triangular-shaped structure which might be an
impediment to catheterization. The divisions of the anterior
and posterior epidural spaces are seen to be more complex than
previously described.