Clinical implications of epidural fat in the spinal canal. A scanning electron microscopic study

Reina, M. A., Franco, C. D., Maches, F., Lopez, A., De Andres, J. A. and van Zundert, A. (2009) Clinical implications of epidural fat in the spinal canal. A scanning electron microscopic study. Acta Anaesthesiologica Belgica, 60 1: 7-17.

Author Reina, M. A.
Franco, C. D.
Maches, F.
Lopez, A.
De Andres, J. A.
van Zundert, A.
Title Clinical implications of epidural fat in the spinal canal. A scanning electron microscopic study
Journal name Acta Anaesthesiologica Belgica   Check publisher's open access policy
ISSN 0001-5164
Publication date 2009
Year available 2009
Sub-type Critical review of research, literature review, critical commentary
Open Access Status
Volume 60
Issue 1
Start page 7
End page 17
Total pages 11
Place of publication Brussels, Belgium
Publisher Acta Medica Belgica
Language eng
Formatted abstract
Background and objectives: This review of articles summarizes recent developments in relation to fat located in the epidural space and also in dural sleeves of spinal nerve roots in order to improve our understanding of the clinical effects of the epidural blockade.

Method: Medline search was carried cross-matching of the following words: "epidural fat", "epidural space", "adipose tissue" and "fat cells" from 1966 to 2008 in which articles referring to different pathologies that alter the epidural fat were also reviewed. Techniques used by different authors included the use of samples from dissections, cryomicrotome sections, as well as light and electron microscopy.

Results: Fat in the epidural space has a metameric distribution along the spinal canal that can be altered in some pathological conditions. Epidural fat is not evenly distributed. At cervical level fat is absent while in the lumbar region, fat in the anterior and posterior aspects of the epidural space forms two unconnected structures. Fat cells are found also in the thickness of dural sleeves enveloping spinal nerve roots but not in the region of the dural sac. Epidural lipornatosis is characterized by an increase in epidural fat content. When a patient has a combination of kyphosis and scoliosis of the spine, the epidural fat distributes asymmetrically. Spinal stenosis is frequently accompanied by a reduction in the amount of epidural fat around the stenotic area.

Conclusions: The epidural space contains abundant epidural fat that distributes along the spinal canal in a predictable pattern. Fat cells are also abundant in the dura that forms the sleeves around spinal nerve roots but they are not embedded within the laminas that form the dura mater of the dural sac. Drugs stored in fat, inside dural sleeves, could have a greater impact on nerve roots than drugs stored in epidural fat, given that the concentration of fat is proportionally higher inside nerve root sleeves than in the epidural space, and that the distance between nerves and fat is shorter. Similarly, changes in fat content and distribution caused by different pathologies may alter the absorption and distribution of drugs injected in the epidural space
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Original title entered : The presence of fat in the epidural space and other neighboring structures - Potential Clinical Implications

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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Created: Wed, 20 May 2015, 14:36:34 EST by Andre Van Zundert on behalf of Anaesthesiology and Critical Care - RBWH