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Continuing Education in Anaesthesia, Critical Care & Pain 2005 5(3):98-100; doi:10.1093/bjaceaccp/mki026
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 5 Number 3 2005 © The Board of Management and Trustees of the British Journal of Anaesthesia [2005]. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Applied epidural anatomy

Jonathan Richardson, MD MRCP FRCA FIPP
Department of Anaesthetics, Bradford Royal Infirmary, Bradford, BD9 6RJ

Gerbrand J Groen, MD PhD
Division of Perioperative and Emergency Medicine, Department of Anaesthesiology and Pain Treatment, University Medical Centre Utrecht, The Netherlands
Tel: 01274 364066 Fax: 01274 366548 E-mail: docjohnnyr@hotmail.com (for correspondence)

The first 10% of the full text of this article appears below.


Key points

Clinicians performing epidural procedures should have a good knowledge of the relevant anatomy.

Radiological screening is helpful for difficult epidural entry.

Maximal neck flexion can almost double the depth of the cervical epidural space.

Spinal endoscopy adds another dimension to epidural catheterization. At present, its main application is in relation to the management and diagnosis of chronic radicular pain.

 


   Anatomy of the epidural space
 
Vertebral column

There are 24 individual vertebrae: seven cervical, 12 thoracic and five lumbar. The five (fused) sacral vertebrae and the coccyx (made up of 3–5 rudimentary vertebrae) are not always classed as being a part of the vertebral column. Vertebral anatomy varies according to each level. The atlas and the axis are highly atypical and the first ‘recognizably normal’ vertebra is . . . [Full Text of this Article]

Spinal nerves

Epidural space

Blood supply

Nerve supply

Lymphatics


   Locating the epidural space
 

   Pathology affecting epidural entry
 

   Epiduroscopy
 

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