Retrodural space of Okada in the posterior ligamentous complex region: clinical and anatomical findings relevant to lumbar interlaminar epidural injection
Authors' conclusion
Degenerative and pathological facet joint changes were associated with a higher incidence of spread into the retrodural space during epidural injection.
Study context
- Population
- Patients undergoing fluoroscopy-guided lumbar interlaminar epidural injection; lumbar spine specimens from 16 embalmed cadavers
- Participants
- 605 epidural injections
- Outcome
- Contrast spread into the facet joints during epidural injection
Methodological detailsfluoroscopic image review, micro-CT imaging, histological evaluation, sectional dissection
- Fluoroscopic image review
- micro-CT imaging
- Histological evaluation
- Sectional dissection
Main finding
As reported in the abstract
Inadvertent spread into the facet joints
- Injections with inadvertent spread into the facet joints
- 36 (5.9%)
- Facet joint pathologies associated with inadvertent spread into the facet joints (multivariate analysis), OR 4.382, 95% CI 1.160 to 16.558
- p=0.029
Observational data: associations, not effects.
Further findings
Anatomy of the retrodural space (cadavers)
- Micro-CT and histology consistently showed a retrodural space between the ligamentum flavum and interspinous ligament
- Various communication routes in the posterior ligamentous complex leading to this space in specimens with degenerative and pathological changes
Original publication
Retrodural space of Okada in the posterior ligamentous complex region: clinical and anatomical findings relevant to lumbar interlaminar epidural injection. Reg Anesth Pain Med. Published 14 October 2022. doi:10.
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