AI Article Synopsis
- The spinal dura is connected to the vertebral column by ligaments that can be disrupted during surgery, leading to complications like CSF leaks.
- Intraoperative imaging and microscopic examination revealed these attachments, but they were not previously documented in neurosurgical literature.
- Understanding these connections is crucial for neurosurgeons to avoid injuries and enhance surgical techniques during lumbar procedures.
Article Abstract
Background: The spinal dura is anchored within the vertebral canal by connective tissue in the epidural space as well as the spinal roots. Inadvertent disruption of these dural attachments may lead to durotomy and cerebrospinal fluid (CSF) leaks. We observed well-developed connective tissue ligaments connecting the lumbar dura to the spinal column and examined these tissues microscopically.
Methods: Intraoperative images were obtained during lumbar laminectomy procedures. They demonstrated connective tissue attachments, linking the lumbar dura to the spinal column in the dorsal midline and dorsolaterally. Tissue samples were obtained and examined microscopically. We then conducted a search of the literature to find references to dural attachments to the spinal column.
Results: Histological examination of the samples showed minimal cellular fibrous tissue. To date no references to these attachments have been made in neurosurgical literature. Previous studies, including live, cadaveric, and radiographic examinations, have demonstrated a dorsomedian fold of dura attached to the junction of the ligamentum flavum, and dorsolateral ligaments that divide the dorsal epidural space into an anterior and posterior compartment.
Conclusions: Epidural fibrous connections or ligaments between the dura and the lumbar spinal column may be of clinical importance to the neurosurgeon. Care should be taken during lumbar procedures not to disrupt or tear these ligaments as this may cause dural tears and CSF leaks. Identifying these ligaments and cutting them sharply may prevent inadvertent durotomies.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144594 | PMC |
| http://dx.doi.org/10.4103/2152-7806.82990 | DOI Listing |
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