Table of Contents
ISRN Anatomy
Volume 2013 (2013), Article ID 424058, 4 pages
http://dx.doi.org/10.5402/2013/424058
Research Article

The Posterior Epidural Ligaments: A Cadaveric and Histological Investigation in the Lumbar Region

1Division of Biomedical Sciences (Anatomy), St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK
2Department of Orthopaedics, St. George’s Healthcare NHS Trust, London SW170QT, UK
3Department of Histopathology, Frimley Park Hospital NHS Trust, London GU16 7UJ, UK

Received 22 July 2013; Accepted 21 August 2013

Academic Editors: N. Boari, E. Dennett, M. Guvencer, and P. Hebbard

Copyright © 2013 M. J. Connor et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. Incidental durotomy is a relatively common complication for patients undergoing posterior spinal surgery. Delineating anatomical variants in the posterior lumbar spinal canal is crucial in reducing future rates of incidental durotomy. Materials and Methods. The ligamentous attachments between the dura mater and ligamentum flavum in the lumbar region of 17 soft-fixed cadavers were investigated. The lumbar vertebral columns were removed, and cross-sectional dissection was performed at levels L1-S1. Anterior retraction of the dorsal dura mater identified attachments between the dorsal surface of the dura mater and the ligamentum flavum. Histological staining of the ligamentous attachments was carried out with hematoxylin and eosin (H&E) and elastic van Gieson (EVG). Results. Posterior epidural ligaments were present in 9 (52.9%) cadavers. Nine (9) separate ligaments were identified in these cadavers, with 3 (33.3%) at L3/L4, 5 (55.5%) at L4/L5, and 1 (11.1%) at L5/S1. Histology confirmed the presence of poorly differentiated collagen-based connective tissue, distinct from the normal anatomy. Conclusions. This study confirms the presence of multiple dorsomedial posterior epidural ligaments at the main sites for posterior spinal surgery (L3-S1). An intraoperative awareness of the variability of such connections may be an important step in reducing static rates of incidental durotomy.