Tratamiento del Dolor


En esta sección se ponen a disposición de todos los usuarios y pacientes, una lista de publicaciones relacionadas con la Patología Traumática en los que han participado activamente miembros del equipo médico de la Unidad de Neurocirugía

 

The Evolving Treatment of Pain.- Epidural Fat: Considerations for Minimally Invasive Spinal Injection and Surgical Therapies

José De Andrés, Miguel Angel Reina, Fabiola Machés, Riánsares Arriazu Navarro, Rafael García de Sola, Anna Oliva, & Alberto Prats-Galino


Resumen:

A large number of patients that come to Hospital for radicular pain are treated with minimally invasive spinal injection or minimally invasive procedures that embody a growing number of surgical techniques. In both techniques, the knowledge of the epidural fat and other surrounding anatomic structures may be of interest as the epidural fat has its role in the distribution of the medication and in surgical procedures. There are areas in the epidural space consisting of a genuine space filled with adipose tissue, veins and nerves and other areas where the dural sac rests on the vertebral bodies, vertebral pedicles, vertebral laminae and the ligamentum flavum. Nerve roots cuffs are lateral prolongations of dura mater, arachnoid lamina and pia mater that enclose nerve roots in their way across the epidural space towards the intervertebral foramen and dorsal root ganglion located within the in- tervertebral foramen. There is adipose tissue surrounding all mentioned structures and fibrous ligaments attaching nerve root cuffs to bones. Lumbar epidural fat has a metameric and discontinuous topography, it varies along the spinal canal and also in pathology of the spine, altering the amount and distribution of fat around the affected area. Transforaminal or translaminar injection approaches to dorsal root ganglion and dorsal nerve root are both, valid alternatives to treat radiculopathy. The transforaminal technique, in general offers greater selectivity than the trans- laminar approach. However, depending on the area affected, it is important to asses which way may be more suit- able for delivering a solution in the affected level. The transforaminal offers an easier approach to the preganglionic and ganglion areas, whereas the translaminar technique reaches the epidural, preganglionar space and less frequently the ganglionic area. The distribution of epidural fat tissue may influence the surgical strategy aiming at protecting neural structures.
Epidural lipomatosis, epidural fat, spinal injection, minimally invasive.

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