Estimating lumbar epidural space depth in infants and children of Korea / 대한마취과학회지

BACKGROUND: Lumbar epidural block is now a popular technique for anesthesia and post operative analgesia. It may be helpful for prevention of complication during this procedure to know the depth from the skin to the lumbar epidural space before the procedure. This study was undertaken to evaluate the depth from the skin to the lumbar epidural space and to determine any potential relationship between a patient's data (age, weight, and height) and the measured depth in Korean children. METHODS: We investigated the electronic records of 662 Korean children who were received urologic surgeries with epidural catheterization for postoperative analgesia. The patients' gender, age, weight, height and epidural depth were recorded and analyzed with multiple linear regression test using SPSS 13.0 (SPSS Co., Ilinois, USA). RESULTS: The patient's age and weight were significantly correlated to the skin-epidural space depth in Korean children. Body weight was more significant variable than age on the epidural depth. The empirical formula derived from the results was as follow; epidural depth (mm) = 9 + 0.5 x body weight (kg) - 0.2 x age (months). CONCLUSIONS: We suggest that the depth of skin-lumbar epidural space can be estimated with the empirical formula based on body weight and age.

The Anatomy of the Lumbar Epidural Space using Magnetic Resonance Imaging / 대한마취과학회지

MRI(Magnetic Resonance Imaging) have provided for greater image resolution, detailed tissue contrast without use of contrast media and images acquired in any plane. The purpose of this study was to examine the anatomy and dimension of the epidural space using MRI(Magnetic Resonance Imaging) and to compare the information obtained with that from other investigative technique. The anatomy of the lumbar epidural space was studied retrospectively using lumbar MRI scans of 90 patients. The epidural width(E.W.) is divided into three distance between the anterior surface of the ligamentum flavum and the dura at the caudal end of the lumbar segment(A), at the mid point of the ligamentum flavum(B) and at the cranial end of the lumbar segment(C). The distance from skin to supraspinous ligament(S-L) and from supraspinous ligament to epidural space(L-E) were measured. And then with adding both the distance, We measured the distance from skin to epidural space(S-E). Results were as follows; I) Posterior to the dural sac, epidural fat which is of high signal(white) on Tlw(T1 weighted) image is demonstrated at levels Tl I-T12 to L5-Sl giving 'Saw toothed' pattem to the epidural space. The fat is divided into segments by the interposing laminar, and the epidural space is deeper at cranial end than caudal end. 2) It was the relatively wide epidural space in L2-3 and L3-4 level, and the narrowest epidural space in L5-Sl level. 3) The distance from skin to supraspinous ligament was noted marked variation(2-40mm) according to the individual disparity. And the distance from supraspinous ligament to epidural space is 17-43mm. In distance from skin to epidural space, the most narrow place is Ll-21evel (37.95+/-7.65mm). The most deep place is IA-5 level(46.35+/-7.20mm). As the age increase, epidural width is decreased at L3-4 level (p<0.05).

Paragonimiasis on lumbar epidural space: A case report / 대한정형외과학회잡지

Paragonimus westermani mainly infests the lung parenchyma, and it is also causes ectopic parasitism of various sites, such as brain, liver and subcutaneous tissue but there have been no reports in literature about paragonimiasis infesting lumbar epidural space. A 58-year-old housewife complained of lumbago and radiating pain to both lower extremities for 20 years. Calcified extradural masses were found by preoperative plain X-ray, myelogram, and CT scan. Intraoperatively, cystic mass in the epidural space at L2-3 was found and confirmed to be paragonimiasis by histopathological study. A case of ectopic paragonimiasis in the lumbar epidural space at L2-3 level is presented.