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RESEARCH PRODUCT
Case series of fluoroscopic findings and 3D reconstruction of human spinal MRIs of the space of Okada.
Miguel A ReinaAndré P. BoezaartOlga C. NinMartín AvellanalAlberto Prats-galinoJose De AndresR. Shane Tubbssubject
musculoskeletal diseasesMaleFacet (geometry)HistologyContrast MediaInjections EpiduralFacet joint03 medical and health sciences0302 clinical medicineImaging Three-DimensionalLumbar facet jointImage Interpretation Computer-AssistedmedicineHumansLoss of resistanceAgedRetrospective Studies0303 health sciencesLumbar Vertebraebusiness.industry3D reconstruction030206 dentistryGeneral MedicineAnatomyMiddle Agedmusculoskeletal systemMagnetic Resonance ImagingEpidural spaceContrast mediummedicine.anatomical_structure030301 anatomy & morphologyFluoroscopyLumbar spineFemaleAnatomybusinessExtravasation of Diagnostic and Therapeutic Materialsdescription
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.
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2020-06-17 | Clinical anatomy (New York, N.Y.)REFERENCES |