Epidural space in cervical spine: Review of Traumatic and Non- traumatic Epidural Pathologies.

Congress:

ECR 2020

Poster Number:

C-05986

Type:

Educational Exhibit

Keywords:

Not applicable, Education and training, Artifacts, Acute, Technical aspects, Education, Decision analysis, MR, CT, Neuroradiology spine, Emergency, Anatomy, Neuro

Authors:

A. S. Reda, R. Alamoudi, H. Alabsi, A. Badeeb; Jeddah/SA

DOI:

10.26044/ecr2020/C-05986

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-05986

Fig. 1: illustration of the cervical spine showing normal anatomy of the epidural space...

Fig. 3: illustration of the lateral cervical spine showing pars defect with extension...

Fig. 4: Neck Pain. Axial and sagittal MR T2 of the cervical spine. Normal cervical...

Learning objectives

1- Identify anatomy of the epidural space in cervical spine including normal variants and artifacts in MRI. 2- Discuss imaging features in CT and MRI to detect acute and non-acute pathologies. 3- Discuss utility of cervical spine CT for epidural disease evaluation versus MR

Background

Anatomy: The epidural space is located between the dura mater and the vertebral body.There is no communication between the cervical and intracranial epidural space. (1) [Figure1.] Space of Okada [Figure3] was first described in the cervical spine (2) and spans approximately 5 mm length (3) It connects facets joints, neural foramen, paraspinal musculature and spinous process bursa on same level. This space spreads injected material and infection, into the paraspinal musculature and soft tissues without involvement of the vertebral body, disc, or epidural space. In...

Findings and procedure details

Epidural pathologies Most spinal lesions present with myelopathy and or radiculopathy due to the tight space between the epidural space and the spinal nerves. Herniated Disc: May extend into the epidural space by perforating the intervertebral disc, posterior annulus fibrous and posterior longitudinal ligament. Appears as a disc extrusion, protrusion or sequestration. The sequestered fragment may migrate laterally, cranially or caudally in the epidural space. [Figure 7] Epidural infections: Pyogenic: They can be primary causes, secondary to trauma, surgical intervention, or as a complication of...

Conclusion

Evaluating cervical epidural space is important and is often overlooked. Familiarity with different imaging modality, normal anatomy, common pathologies and imaging pitfalls is essential for accurate interpretations. Missed pathology can lead to dire complications.

Personal information and conflict of interest

A. S. Reda; Jeddah/SA - nothing to disclose R. Alamoudi; Jeddah/SA - nothing to disclose H. Alabsi; Jeddah/SA - nothing to disclose A. Badeeb; Jeddah/SA - nothing to disclose

References

References: Gala FB, Aswani Y. Imaging in spinal posterior epidural, space lesions: A pictorial essay. Indian J Radiol Imaging 2016;26:299-315. 2.V.T. Lehman*, N.S. Murthy, F.E. Diehn, J.T. Verdoorn, T.P. Maus, The posterior ligamentous complex inflammatory syndrome: spread of fluid and inflammation in the retrodural space of Okada,Clin Radiol.2015 May;70(5):528-35. doi: 10.1016/j.crad.2014.12.009. Epub 2015 Jan 7. 3. Naveen S. Murthy, Timothy P. Maus, Charles Aprill, The Retrodural Space of Okada, AJR:196, June 2011 4- Chao D, Nanda A. Spinal epidural abscess: A diagnostic challenge. Am Fam...