title: The morphology and clinical significance of the dorsal meningovertebra ligaments in the lumbosacral epidural space.
abstract: METHODS
  A dissection-based study of 30 embalmed cadavers.
  
  
  OBJECTIVE
  To determine the morphology and morphometry of the dorsal meningovertebral ligaments in the lumbosacral segments and to discuss their clinical significance.
  
  
  BACKGROUND
  Postoperative cerebrospinal fluid leakage is associated with longer hospital stays and significant implications for the patient, the surgeons, and society as a whole. To protect the dural sac during lumbar surgery, knowledge of the surgical anatomy of the dorsal meningovertebral ligaments is crucial.
  
  
  METHODS
  A total of 30 adult embalmed cadavers (52-70 yr of age; mean age of 64 yr) were used. The vertebral canal was divided to expose the dural sac and the spinal nerve roots, and the spinal cord was removed. The morphology, quantity, and attachment of the dorsal meningovertebral ligaments in the lumbosacral region were observed, and the length, width, or diameter and thickness of the ligaments were measured with vernier calipers.
  
  
  RESULTS
  The dorsal meningovertebral ligaments in the lumbosacral region connect the dura to the ligamenta flava or the lamina. The number of the attachment points on the ligamenta flava was relatively larger than that on the lamina, and the occurrence rate of dorsal meningovertebral ligaments was 97% at L5-S1. The thickest ligaments were observed at the L5 and S1 vertebrae. The length of the ligaments varied from 5.16 to 40.24 mm, and the ligaments extended caudally from their origin on the dura to their attachment to the lamina or the ligamentum flavum. The morphology of the dorsal meningovertebral ligaments was divided into 5 types: strip type, cord type, "Y"-shaped type, grid type, and thin slice type.
  
  
  CONCLUSIONS
  The dorsal meningovertebral ligaments may contribute to dura laceration and epidural hemorrhage during flavectomy and laminectomy, and an appreciation of this relationship might help reduce the risk of such complications.
authors.affiliation: Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, China.
authors.forename: Benchao
authors.initials: B
authors.lastname: Shi
authors.forename: Xiangming
authors.initials: X
authors.lastname: Li
authors.forename: Hongliang
authors.initials: H
authors.lastname: Li
authors.forename: Zihai
authors.initials: Z
authors.lastname: Ding
mesh_terms: D000368:Aged; D002102:Cadaver; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery; D004824:Epidural Space / Q000033:anatomy & histology* / Q000601:surgery; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D017843:Ligamentum Flavum / Q000033:anatomy & histology* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000033:anatomy & histology* / Q000601:surgery; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D013126:Spinal Nerve Roots / Q000033:anatomy & histology / Q000601:surgery