The Termination Stage of the Dural Sac Related to Caudal Epidural Block in Lumbosacral Transitional Vertebrae: A Comparability between Sacralization and Lumbarization Teams.
Ache Doctor. 2018 Jan;21(1):73-82
Authors: Jeon JY, Jeong YM, Lee SW, Kim JH, Choi HY, Ahn Y
BACKGROUND: Lumbosacral transitional vertebrae (LSTV) are a comparatively widespread variant and have been thought-about as one of many causes for again ache. It’s not uncommon for clinicians to come across sufferers with LSTV who require caudal epidural block (CEB) for ache administration.
OBJECTIVE: We investigated the termination degree of the dural sac (DS) and anatomical options of the lumbosacral area related to CEB in sufferers with LSTV and in contrast these findings between sacralization and lumbarization teams.
STUDY DESIGN: A retrospective analysis.
SETTING: A college hospital with inpatient and outpatient LSTV instances presenting low again ache.
METHODS: 4 hundred ninety-four LSTV sufferers had been included and categorized into sacralization (n = 201) or lumbarization teams (n = 293). Magnetic resonance imaging (MRI) of all the LSTV sufferers had been reviewed to find out the extent of DS termination, the shortest distance between the apex of the sacral hiatus and DS, and the presence and the caudal degree of sacral perineural cysts. Every lumbosacral vertebra column was divided into three equal parts (higher, center, and decrease thirds). The MRI findings in each of the teams had been in contrast and analyzed.
RESULTS: The distribution frequency of the degrees of DS termination demonstrated a big distinction between the two teams. The imply caudal DS degree within the lumbarization group was considerably decrease than the sacralization group (decrease third of the S2 [131 of 293 patients] vs. decrease third of the S1 [78 of 201 patients]). The DS terminated on the S3 in additional than 19% of the lumbarization group, whereas in just one case of the sacralization group. Though the incidence of perineural cysts was not considerably completely different between the two teams, the imply degree of caudal margin of perineural cysts within the lumbarization group was considerably decrease than the sacralization group (center third of the S3 [10 of 28 cases] vs. center third of the S2 [11 of 25 cases]).
LIMITATIONS: This research reveals a number of limitations together with the sensible problem of correct enumeration of the transitional section and the constraints on generalizability posed by the single-country research.
CONCLUSION: When planning CEB for sufferers with LSTV, pre-procedural MRI to test the anatomical constructions, together with the extent of DS termination and caudal margin of perineural cysts, can be of nice use for decreasing the chance of sudden dural puncture throughout the process, particularly within the lumbarization instances.
KEY WORDS: Termination of the dural sac, dural sac termination, lumbosacral transitional vertebrae, transitional vertebra, caudal epidural block.
PMID: 29357336 [PubMed – in process]