Skip Navigation



BJA Advance Access published online on April 7, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei133
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
94/6/852    most recent
aei133v1
Right arrow E-Letters: Submit a response to the article
Right arrow E-letters: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Lirk, P.
Right arrow Articles by Moriggl, B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lirk, P.
Right arrow Articles by Moriggl, B.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted February 23, 2005

Laboratory Investigation

Incidence of lower thoracic ligamentum flavum midline gaps{dagger}

P. Lirk 1*, J. Colvin 1, B. Steger 1, H.-P. Colvin 1, C. Keller 1, J. Rieder 1, C. Kolbitsch 1, and B. Moriggl 2

1 Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
2 Institute of Anatomy, Histology and Embryology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria

* To whom correspondence should be addressed.
P. Lirk, E-mail: philipp.lirk{at}uibk.ac.at


  Abstract

Background. Lower thoracic epidural anaesthesia and analgesia (EDA) has gained increasing importance in perioperative pain therapy. The loss-of-resistance technique used to identify the epidural space is thought to rely on the penetration of the ligamentum flavum. Investigations at the cervical and lumbar regions have demonstrated that the ligamentum flavum frequently exhibits incomplete fusion at different vertebral levels. Therefore, the aim of this study was to directly investigate the incidence of lower thoracic ligamentum flavum midline gaps in embalmed cadavers.

Methods. Vertebral column specimens were obtained from 47 human cadavers. Ligamentum flavum midline gaps were recorded between the vertebral levels T6 and L1.

Results. The incidence of midline gaps/number of viable specimens at the following levels was: T6-7: 2/45 (4.4%), T7-8: 1/47 (2.1%), T8-9: 2/45 (4.4%), T9-10: 7/39 (17.9%), T10-11: 12/34 (35.2%), T11-12: 10/35 (28.5%), T12/L1: 6/38 (15.8%).

Conclusions. In the present study we have determined the frequency of lower thoracic ligamentum flavum midline gaps. Gaps are less frequent than at cervical levels, but more frequent than at lumbar levels. Peak incidence was found in the region between T10 and T12. Using a strict midline approach, one cannot therefore rely on the ligamentum flavum to impede entering the epidural space in all patients.

Keywords: anaesthetic techniques, extradural; anatomy; model, cadaver; spinal cord, extradural space.
{dagger} Presented in abstract form at the IARS 78th Clinical and Scientific Congress, Tampa Bay, Florida, USA, 2004.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Br J AnaesthHome page
H.-G. Ryu, J.-H. Bahk, C.-J. Lee, and Y.-J. Lim
The coiling length of thoracic epidural catheters: the influence of epidural approach angle
Br. J. Anaesth., March 1, 2007; 98(3): 401 - 404.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
R. Mahajan, R. Gupta, and A. Sharma
Complications after thoracic epidural anesthesia.
Anesth. Analg., April 1, 2006; 102(4): 1292 - 1293.
[Full Text] [PDF]

E-letters:

Read all E-letters

Hanging drop technique for high thoracic epidurals
Tim Strang, et al.
British Journal of Anaesthesia, 9 Nov 2005 [Full text]

Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.