The Korean Journal of Pain

  • 제27권4호
  • /
  • Pages.321-325
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  • 2014
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  • 2005-9159(pISSN)
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  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
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Anatomic Variations of Cervical and High Thoracic Ligamentum Flavum

  • Yoon, Sang Pil (Department of Anatomy, Jeju National University, School of Medicine) ;
  • Kim, Hyun Jung (Department of Anesthesiology and Pain Medicine, Jeju National University, School of Medicine) ;
  • Choi, Yun Suk (Department of Anesthesiology and Pain Medicine, Jeju National University, School of Medicine)
  • 투고 : 2014.04.07
  • 심사 : 2014.07.29
  • 발행 : 2014.10.01
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초록

Background: Epidural blocks are widely used for the management of acute and chronic pain. The technique of loss of resistance is frequently adopted to determine the epidural space. A discontinuity of the ligamentum flavum may increase the risk of failure to identify the epidural space. The purpose of this study was to investigate the anatomic variations of the cervical and high thoracic ligamentum flavum in embalmed cadavers. Methods: Vertebral column specimens of 15 human cadavers were obtained. After vertebral arches were detached from pedicles, the dural sac and epidural connective tissue were removed. The ligamentum flavum from C3 to T6 was directly examined anteriorly. Results: The incidence of midline gaps in the ligamentum flavum was 87%-100% between C3 and T2. The incidence decreased below this level and was the lowest at T4-T5 (8%). Among the levels with a gap, the location of a gap in the caudal third of the ligamentum flavum was more frequent than in the middle or cephalic portion of the ligamentum flavum. Conclusions: The cervical and high thoracic ligamentum flavum frequently has midline intervals with various features, especially in the caudal portion of the intervertebral space. Therefore, the ligamentum flavum is not always reliable as a perceptible barrier to identify the epidural space at these vertebral levels. Additionally, it may be more useful to insert the needle into the cephalic portion of the intervertebral space than in the caudal portion.

키워드

참고문헌

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피인용 문헌

  1. Guides for Pain Clinicians? vol.27, pp.4, 2014, https://doi.org/10.3344/kjp.2014.27.4.311
  2. Feasibility of Contralateral Oblique Fluoroscopy-guided Cervical Interlaminar Steroid Injections vol.16, pp.7, 2015, https://doi.org/10.1111/papr.12341
  3. Incidence of Inadvertent Dural Puncture During CT Fluoroscopy–Guided Interlaminar Epidural Corticosteroid Injections in the Cervical Spine: An Analysis of 974 Cases vol.209, pp.3, 2017, https://doi.org/10.2214/AJR.16.17738
  4. Method to Reduce the False-Positive Rate of Loss of Resistance in the Cervical Epidural Region vol.2016, pp.None, 2014, https://doi.org/10.1155/2016/9894054
  5. Cervical Epidural Depth: Correlation Between Cervical MRI Measurements of the Skin-to-Cervical Epidural Space and the Actual Needle Depth During Interlaminar Cervical Epidural Injections vol.19, pp.5, 2014, https://doi.org/10.1093/pm/pnx066
  6. Letter to the Editor Regarding a Recent Article: Cervical Epidural Depth: Correlation Between Cervical MRI Measurements of the Skin-to-Cervical Epidural Space and the Actual Needle Depth During Interl vol.20, pp.9, 2014, https://doi.org/10.1093/pm/pnz163
  7. Histologic Observation and Significance of Sympathetic Nerve Fiber Distribution on Human Cervical Ligamentum Flavum vol.12, pp.6, 2014, https://doi.org/10.1111/os.12802