Wani Tariq, Beltran Ralph, Veneziano Giorgio, AlGhamdi Faris, Azzam Hatem, Akhtar Nahida, Tumin Dmitry, Majid Yasser, Tobias Joseph D
Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia.
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Paediatr Anaesth. 2018 Apr;28(4):338-341. doi: 10.1111/pan.13339. Epub 2018 Feb 6.
The distance from the dura to spinal cord is not uniform at different vertebral levels. The dura to spinal cord distance may be a critical factor in avoiding the potential for neurological injury caused by needle trauma after a dural puncture. Typically, the greater the dura to spinal cord distance, the larger the potential safety margin. The objective of our study is to measure dura to spinal cord distance at two thoracic levels T - , T - , and one lumbar level L - using MRI images.
Eighty-eight children under the age of 8 years old qualified for the study. The distance from dural side of ligamentum flavum to the posterior margin of the spinal cord was defined as dura to spinal cord distance. Sagittal T -weighted images of the thoracic and lumbar spine were used to measure the dura to spinal cord distance at the T , T , and L interspaces. Measurements were taken perpendicular to long axis of the vertebral body at each level.
The dura to spinal cord distance was 5.9 ± 1.6 mm at T (range: 1.4-9.9 mm), 5.0 ± 1.6 mm at T (1.2-8.1 mm), and 3.6 ± 1.2 mm at L (1.2-6.8 mm). There were no evident differences in dura to spinal cord distance by gender, age, height, or weight.
The present study reports that the largest dura to spinal cord distance is found at the T level, and the shortest dura to spinal cord distance at the L level. There appears to be substantially more room in the dorsal subarachnoid space at the thoracic level. The risk of spinal cord damage resulting from accidental epidural needle advancement may be greater in the lumbar region due to a more dorsal location of the spinal cord in the vertebral canal compared to the thoracic region.
在不同椎体水平，硬脊膜与脊髓之间的距离并不均匀。硬脊膜与脊髓之间的距离可能是避免硬膜穿刺后针头创伤导致神经损伤可能性的关键因素。通常，硬脊膜与脊髓之间的距离越大，潜在的安全 margin 就越大。我们研究的目的是使用 MRI 图像测量两个胸椎水平（T - 、T - ）和一个腰椎水平（L - ）的硬脊膜与脊髓之间的距离。
88 名 8 岁以下儿童符合本研究条件。将黄韧带硬脊膜侧至脊髓后缘的距离定义为硬脊膜与脊髓之间的距离。使用胸椎和腰椎的矢状位 T -加权图像测量 T 、T 和 L 间隙处的硬脊膜与脊髓之间的距离。在每个水平垂直于椎体的长轴进行测量。
T 水平的硬脊膜与脊髓之间的距离为 5.9 ± 1.6 毫米（范围：1.4 - 9.9 毫米），T 水平为 5.0 ± 1.6 毫米（1.2 - 8.1 毫米），L 水平为 3.6 ± 1.2 毫米（1.2 - 6.8 毫米）。硬脊膜与脊髓之间的距离在性别、年龄、身高或体重方面无明显差异。
本研究报告称，T 水平的硬脊膜与脊髓之间的距离最大，L 水平最短。胸椎水平的背侧蛛网膜下腔似乎有更多空间。与胸椎区域相比，由于脊髓在椎管内的位置更靠背侧，腰椎区域因意外硬膜外针推进导致脊髓损伤的风险可能更大。
