title: Anatomical and surgical study of volume determination of the anterolateral epidural space nerve root L5/S1 under the aspect of epidural perineural injection in minimal invasive treatment of lumbar nerve root compression.
abstract: Herniated intervertebral disc causes in a great number of cases of lumbar nerve root compression, especially in the segment L5/S1. Other reasons responsible for stress to the lumbar spinal root are the spinal canal stenosis and the postdiscotomy syndrome. For patients without neurological deficiencies, the conservative treatment includes different epidural injection techniques. Steroids are often applied. A specific injection technique needing only a small drug amount is the epidural perineural approach using a special two-needle technique. The anatomical spaces of the nerve roots have received little attention in therapy. We have determined the anterolateral epidural space nerve volume of the nerve root L5/S1, and compared the data collected in an anatomical study with operative measurements during discectomy. The volume determination in the human cadavers was performed with liquid silicone filling the anterolateral space after dissection. The in vivo measurements were performed during surgery at the site of the anterolateral space after discectomy. The anatomical studies showed us a mean value volume of 1.1 ml. The surgical volume determinations result in a mean volume of 0.9 ml. A better understanding of the anterolateral epidural space may allow a reduction of the injection volume in the conservative nerve root compression treatment, especially using the epidural perineural technique, avoiding the risk of side effects of high doses of steroids.
authors.affiliation: Orthopädische Universitätsklinik am St. Josef Hospital, Ruhr Universität Bochum, Gudrunstrasse 56, 44791 Bochum, Germany. wolfram.teske@rub.de
authors.forename: Wolfram
authors.initials: W
authors.lastname: Teske
authors.forename: Sonja
authors.initials: S
authors.lastname: Zirke
authors.forename: Jan
authors.initials: J
authors.lastname: Nottenkämper
authors.forename: Thomas
authors.initials: T
authors.lastname: Lichtinger
authors.forename: Theodoros
authors.initials: T
authors.lastname: Theodoridis
authors.forename: Jürgen
authors.initials: J
authors.lastname: Krämer
authors.forename: Klaus
authors.initials: K
authors.lastname: Schmidt
mesh_terms: D002102:Cadaver; D017586:Diskectomy; D004824:Epidural Space; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000150:complications; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011843:Radiculopathy / Q000209:etiology / Q000601:surgery*; D012447:Sacrum / Q000473:pathology* / Q000601:surgery; D012828:Silicones; D013126:Spinal Nerve Roots / Q000473:pathology* / Q000601:surgery; D013130:Spinal Stenosis / Q000150:complications
chemical_list: D012828:Silicones