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Kim SH, Cho TH, Kim HJ, Kwon HJ, Kwak HH, Shin KJ, Lee YS, Yang HM. Retrodural space of Okada in the posterior ligamentous complex region: clinical and anatomical findings relevant to lumbar interlaminar epidural injection. Reg Anesth Pain Med 2022; 48:22-28. [DOI: 10.1136/rapm-2022-103765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022]
Abstract
BackgroundThe retrodural space of Okada is a potential space posterior to the ligamentum flavum that allows communication with the bilateral facet joints. However, the actual anatomy of this space has not been clearly visualized to date. We sought to investigate the characteristics of patients showing contrast spreading to the facet joint space during epidural injection and to clarify the anatomical structures of the retrodural space and adjacent ligamentous tissues in cadaveric specimens.MethodsFluoroscopic images of patients who underwent fluoroscopy-guided lumbar interlaminar epidural injection were assessed for contrast flow to the facet joints. Patient demographics, preprocedural imaging study findings, and epidural approaches were analyzed. The anatomical study included the sectional dissection, micro-CT imaging, and histological evaluation of lumbar spine specimens from 16 embalmed cadavers.ResultsFluoroscopic images of 605 epidural injections were analyzed. Among them, 36 with inadvertent spread into the facet joints (5.9%) were identified. Multivariate analysis revealed that facet joint pathologies were significantly associated with inadvertent spread into the facet joints (OR 4.382; 95% CI 1.160 to 16.558; p=0.029). Micro-CT and histological findings consistently showed a retrodural space between the ligamentum flavum and interspinous ligament. Various anatomical communication routes in the posterior ligamentous complex leading to this space were observed in specimens with degenerative and pathological changes.ConclusionDegenerative and pathological facet joint changes were associated with a higher incidence of spread into the retrodural space during epidural injection. Our findings confirm anatomical evidence for a false loss of resistance before the needle enters the epidural space.
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Riquelme I, Avellanal M, Boezaart AP, Reina MA. Unexpected injectate spread into the space of Okada during attempted epidural injection: Yet another case. Eur J Pain 2021; 25:1381-1383. [PMID: 33756050 DOI: 10.1002/ejp.1771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Irene Riquelme
- Pain Clinic, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | - Martín Avellanal
- Pain Clinic, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | - André P Boezaart
- Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.,Lumina Pain Medicine Collaborative, Surrey, UK
| | - Miguel A Reina
- Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.,CEU San Pablo University School of Medicine, Madrid, Spain.,Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain
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Won HS, Jang HY, Moon HS, Zhu PB, Kim YD, Kim H. Fluoroscopic Findings of Extra-Cervical Facet Joint Flow and Its Incidence on Cervical Facet Joint Arthrograms. J Clin Med 2020; 9:jcm9123919. [PMID: 33276698 PMCID: PMC7761532 DOI: 10.3390/jcm9123919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022] Open
Abstract
Cervical facet joint (CFJ) syndrome is a common cause of neck pain. For its diagnosis and treatment, CFJ injection with arthrogram is generally performed. This study aimed to investigate the frequency of extra-CFJ flow on CFJ arthrograms during injections and its differences according to age, sex, and cervical vertebral level. We analyzed 760 CFJ arthrograms administrated to 208 patients diagnosed with CFJ syndrome. Arthrograms at each vertebral level were collected to evaluate the normal CFJ and extra-CFJ flow. The primary and secondary outcomes were frequency of extra-CFJ flow according to cervical vertebral level, age, and sex and according to pairwise cervical levels, respectively. Extra-CFJ flow at the cervical spine occurred during 179 injections, and the overall incidence was 3.3–36.2% at different cervical levels. The incidence of extra-CFJ flow at each cervical vertebral level according to age and sex was not significant. Extra-CFJ flow was the highest at C6 and C7, but there was no statistical significance. Extra-CFJ flow was higher at lower vertebral levels (C5–C7) than at upper levels (C3 and C4). Additional clinical studies and anatomical evaluations are needed to support its clinical value and enable the development of new injection techniques.
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Affiliation(s)
- Hyung-Sun Won
- Department of Anatomy, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan, Jeonbuk 54538, Korea; (H.-S.W.); (P.-B.Z.)
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan, Jeonbuk 54538, Korea
| | - Ho-Yeon Jang
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan, Jeonbuk 54538, Korea;
| | - Hyun-Seog Moon
- Joy of the World, Interventional Pain Management Center, 10 Sinchon-ro 35-gil, Seodaemun-gu, Seoul 03774, Korea;
| | - Peng-Bo Zhu
- Department of Anatomy, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan, Jeonbuk 54538, Korea; (H.-S.W.); (P.-B.Z.)
| | - Yeon-Dong Kim
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan, Jeonbuk 54538, Korea
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan, Jeonbuk 54538, Korea;
- Wonkwang Institute of Science, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan, Jeonbuk 54538, Korea
- Correspondence: (Y.-D.K.); (H.K.); Tel.: +82-63-8591562 (Y.-D.K.); +82-2-30103883 (H.K.)
| | - Hyungtae Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro-43-gil, Songpa-gu, Seoul 05505, Korea
- Correspondence: (Y.-D.K.); (H.K.); Tel.: +82-63-8591562 (Y.-D.K.); +82-2-30103883 (H.K.)
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