Case series of fluoroscopic findings and 3D reconstruction of human spinal MRIs of the space of Okada.

Autor: Reina MA; Clinical Medical Science Department, CEU San Pablo University School of Medicine, Madrid, Spain.; Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain., Avellanal M; Pain Clinic Unit, Hospital Universitario Sanitas La Moraleja, Madrid, Spain., Boezaart AP; Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.; Alon P. Winnie Research Institute, Still Bay, Western Province, South Africa., Tubbs RS; Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.; Department of Anatomical Sciences, St. George's University, St. George's, Grenada.; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA., De Andrés J; Department of Anesthesiology, Critical Care and Pain Management, General University Hospital, School of Medicine, University of Valencia, Valencia, Spain., Nin OC; Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA., Prats-Galino A; Laboratory of Surgical Neuro Anatomy, Human Anatomy and Embryology Unit, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Clinical anatomy (New York, N.Y.) [Clin Anat] 2021 Apr; Vol. 34 (3), pp. 451-460. Date of Electronic Publication: 2020 Sep 21.
DOI: 10.1002/ca.23674
Abstrakt: Objective: To better understand the unexpected spread of contrast medium observed by conventional fluoroscopic X-ray images during standard neuraxial techniques used in the treatment of pain. The support of 3D reconstruction of MRI images of structures within the lumbar spine was used to better understand the space of Okada.
Methods: Lumbar facet joint and epidural corticosteroid injections in five patients under fluoroscopic guidance with loss of resistance to air or saline to identify the facet joints or epidural space. Next, in a retrospective study, the authors examined the retrodural space of Okada and the neighboring tissues with 3D reconstruction of spinal MRIs of seven patients without any demonstrable spinal pathology to better understand the characteristics of the space of Okada.
Results: Contrast medium spread to the ipsilateral and contralateral sides was observed in five patients. The contralateral spread was thought to be through the retrodural space of Okada, which is a potential space between the anterior surface of the vertebral lamina and the posterior surface of the ligamentum flavum. It facilitates communication between the contralateral articular facet joints of the spine.
Conclusions: This study provides new evidence for the existence of the space of Okada where an unexpected contralateral spread occurred following facet joint and attempted epidural injection. The 3D reconstructions of MRIs may help us better understand the nature of the retrodural space of Okada and its clinical implications.
(© 2020 Wiley Periodicals LLC.)
Databáze: MEDLINE
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