Incidence of lower thoracic ligamentum flavum midline gaps.
نویسندگان
چکیده
BACKGROUND Lower thoracic epidural anaesthesia and analgesia (EDA) has gained increasing importance in perioperative pain therapy. The loss-of-resistance technique used to identify the epidural space is thought to rely on the penetration of the ligamentum flavum. Investigations at the cervical and lumbar regions have demonstrated that the ligamentum flavum frequently exhibits incomplete fusion at different vertebral levels. Therefore, the aim of this study was to directly investigate the incidence of lower thoracic ligamentum flavum midline gaps in embalmed cadavers. METHODS Vertebral column specimens were obtained from 47 human cadavers. Ligamentum flavum midline gaps were recorded between the vertebral levels T6 and L1. RESULTS The incidence of midline gaps/number of viable specimens at the following levels was: T6-7: 2/45 (4.4%), T7-8: 1/47 (2.1%), T8-9: 2/45 (4.4%), T9-10: 7/39 (17.9%), T10-11: 12/34 (35.2%), T11-12: 10/35 (28.5%), T12/L1: 6/38 (15.8%). CONCLUSIONS In the present study we have determined the frequency of lower thoracic ligamentum flavum midline gaps. Gaps are less frequent than at cervical levels, but more frequent than at lumbar levels. Peak incidence was found in the region between T10 and T12. Using a strict midline approach, one cannot therefore rely on the ligamentum flavum to impede entering the epidural space in all patients.
منابع مشابه
Guides for Pain Clinicians?
which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Although there have been debates and different practice guidelines on the indication of epidural blocks for pain management [1], there remain patients for whom few alternative options are available, including painless delivery and some postoperative patients...
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ورودعنوان ژورنال:
- British journal of anaesthesia
دوره 94 6 شماره
صفحات -
تاریخ انتشار 2005