An anatomical study of lumbar epidural catheterization

BACKGROUND: We herein provide an analysis of lumbar epidural catheterization, which outlines a detailed anatomical description of the epidural anatomy, and may improve the success rate of neuraxial cannulation. METHODS: Lumbar epidural catheters were placed in 50 adult embalmed cadavers. After catheterization, the lumbar dura and connecting structures between the epidural space and the vertebral body were separated. The positional relationship between the catheter and the posterior epidural space were observed and photographed. RESULTS: Amongst the 50 specimens, the epidural catheter curled into a circle in three cases, entered the intervertebral foramen in two cases, and caused epidural venous damage in five cases. CONCLUSIONS: Meningo-vertebral ligaments exist in the posterior epidural space and connect to the venous plexus, which may contribute to epidural catheter failure, uneven distribution of anaesthesia and epidural hemorrhage. Our study provides anaesthesiologists with a better understanding of the anatomy and may mitigate complications of lumbar epidural catheter placement.