Human Lumbar Ligamentum Flavum Anatomy for Epidural Anesthesia: Reviewing a 3D MR-Based Interactive Model and Postmortem Samples.

Anesthesia and Analgesia
Miguel A ReinaAlberto Prats-Galino

Abstract

The ligamentum flavum (LF) forms the anatomic basis for the loss-of-resistance technique essential to the performance of epidural anesthesia. However, the LF presents considerable interindividual variability, including the possibility of midline gaps, which may influence the performance of epidural anesthesia. We devise a method to reconstruct the anatomy of the digitally LF based on magnetic resonance images to clarify the exact limits and edges of LF and its different thickness, depending on the area examined, while avoiding destructive methods, as well as the dissection processes. Anatomic cadaveric cross sections enabled us to visually check the definition of the edges along the entire LF and compare them using 3D image reconstruction methods. Reconstruction was performed in images obtained from 7 patients. Images from 1 patient were used as a basis for the 3D spinal anatomy tool. In parallel, axial cuts, 2 to 3 cm thick, were performed in lumbar spines of 4 frozen cadavers. This technique allowed us to identify the entire ligament and its exact limits, while avoiding alterations resulting from cutting processes or from preparation methods. The LF extended between the laminas of adjacent vertebrae at all vertebral levels of...Continue Reading

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Citations

Dec 27, 2016·Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association·Javid AkhgarHiroaki Nakamura
Jul 22, 2019·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Joe IwanagaR Shane Tubbs
Sep 8, 2020·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Miguel A ReinaAlberto Prats-Galino
Oct 21, 2016·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Anna Puigdellívol-SánchezAlberto Prats-Galino
Jul 4, 2018·Sensors·Benito CarotenutoAndrea Cusano
Dec 3, 2017·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Alberto Prats-GalinoTatjana Stopar Pintarič
Dec 25, 2019·Evidence-based Complementary and Alternative Medicine : ECAM·Xinyue ZhuWeiguang Zhang
Mar 24, 2021·European Journal of Pain : EJP·Irene RiquelmeMiguel A Reina
May 14, 2021·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Jon Jatsu Azkue
Oct 24, 2021·Regional Anesthesia and Pain Medicine·Sue LawrenceDavid Reutens

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