6/21/2023 0 Comments Side effects after lumbar puncture![]() The artery enters the spinal canal through a single intervertebral foramen in 85% of individuals between T9 and L2 and is located 63% of the time on the left side. Of particular interest is the artery of Adamkiewicz, which is the largest radiculomedullary artery and major supplier of the anterior spinal artery in the lumbar region. The radiculomedullary artery branches into the anterior spinal artery. The radiculopial artery branches into the posterior spinal arteries. Of those that remain 4–8 will supply the anterior spinal artery and 10–20 will supply the posterior spinal arteries. During development most of these branches regress leaving a few left behind to provide blood for the spinal cord. At the start of embryological development, each segmental artery has a branch that supplies the spinal cord. An “outside in” simplified algorithm can best describe it: aorta → segmental artery (31 pairs (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal)) → radicular artery (supplies dorsal and ventral nerve roots) → radiculopial artery or radiculomedullary → posterior (paired) or anterior (single) spinal artery. The vascular anatomy of the spinal cord is segmental and based on the embryological development of the body. The foramen allows for the passage of the spinal nerve, the dorsal root ganglion, the segmental spinal artery, the communicating veins between the internal and external plexuses, the recurrent meningeal (sinu-vertebral) nerves, and the transforaminal ligaments. The fascia and psoas muscle form the lateral border, while the medial border contains the dural sleeve. It is formed by the pedicles of adjacent vertebrae above and below, the vertebral body of the superior and inferior vertebrae (mostly of the superior vertebra) and intervertebral disc anteriorly, and the articular processes forming the zygapophyseal joint posteriorly. The anatomy of the lumbar intervertebral foramen is complicated. The epidural space contains loose areolar connective tissue, semi-liquid fat, lymphatics, arteries, an extensive plexus of veins, and the spinal nerve roots as they exit the dural sac and pass through the intervertebral foramina. ![]() The space communicates freely with the paravertebral space through the intervertebral foramina. The epidural space surrounds the dural sac and is bounded by the posterior longitudinal ligament anteriorly, the ligamentum flavum and the periosteum of the laminae posteriorly, and the pedicles of the spinal column and the intervertebral foramina containing their neural elements laterally. A transforaminal injection is an approach toward the epidural space via the intervertebral foramen where the spinal nerves exit. By definition, an interlaminar injection is an approach to the dorsal epidural space going through the space between the lamina of the vertebrae. The goal is to deliver steroids and anesthetics into the epidural space around the spinal nerves and other spinal structures. ![]() Lumbar epidural steroid injections have been used in the treatment of lumbar radicular pain and other spinal pain syndromes. Most if not all complications can be avoided by careful technique with accurate needle placement, sterile precautions, and a thorough understanding of the relevant anatomy and contrast patterns on fluoroscopic imaging. Complications from lumbar epidural injections are extremely rare. We performed a comprehensive literature review through a Medline search for relevant case reports, clinical trials, and review articles. The objective of this article is to review the complications of lumbar interlaminar and transforaminal epidural injections and discuss the potential pitfalls related to these procedures. Potential risks include infection, hematoma, intravascular injection of medication, direct nerve trauma, subdural injection of medication, air embolism, disc entry, urinary retention, radiation exposure, and hypersensitivity reactions. Complications from these procedures arise from needle placement and the administration of medication. ![]() appliedradiology.Lumbar interlaminar and transforaminal epidural injections are used in the treatment of lumbar radicular pain and other lumbar spinal pain syndromes. ![]() The lumbar epidural blood patch: A primer. Cerebrospinal fluid leakage: Indications, technique and results of treatment with a blood patch. en/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Infections You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. ![]()
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