ArticleThe Korean journal of pain2014
Anatomic variations of cervical and high thoracic ligamentum flavum.
Article in The Korean journal of pain, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 36 citations in OpenAlex.
- Anatomical Study of the Retrodural Space of Okada in the Cervical Region: 3D Micro-CT Findings.Clinical anatomy (New York, N.Y.) · 2025Article
- Anatomy and biomechanics of posterior ligamentous complex of the human spine: a narrative review.Surgical and radiologic anatomy : SRA · 2025Review
- Comprehensive review of the cervical ligamenta flava.Surgical and radiologic anatomy : SRA · 2025Review
- FACTFINDERS FOR PATIENT SAFETY: Minimizing risks with cervical epidural injections.Interventional pain medicine · 2024Article
- Safety of cervical transforaminal epidural steroid injections.Interventional pain medicine · 2024Article
- Prediction of the Cervical Epidural Space Depth from the Skin Using Cervical X-Ray, During Cervical Epidural Block with Paramedian Approach.Journal of pain research · 2023Article
- Histologic Observation and Significance of Sympathetic Nerve Fiber Distribution on Human Cervical Ligamentum Flavum.Orthopaedic surgery · 2020Article
- Method to Reduce the False-Positive Rate of Loss of Resistance in the Cervical Epidural Region.Pain research & management · 2016Article
- Guides for pain clinicians?The Korean journal of pain · 2014Article
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEpidural blocks are widely used for the management of acute and chronic pain. The technique of loss of resistance is frequently adopted to determine the epidural space. A discontinuity of the ligamentum flavum may increase the risk of failure to identify the epidural space. The purpose of this study was to investigate the anatomic variations of the cervical and high thoracic ligamentum flavum in embalmed cadavers.
methodsVertebral column specimens of 15 human cadavers were obtained. After vertebral arches were detached from pedicles, the dural sac and epidural connective tissue were removed. The ligamentum flavum from C3 to T6 was directly examined anteriorly.
resultsThe incidence of midline gaps in the ligamentum flavum was 87%-100% between C3 and T2. The incidence decreased below this level and was the lowest at T4-T5 (8%). Among the levels with a gap, the location of a gap in the caudal third of the ligamentum flavum was more frequent than in the middle or cephalic portion of the ligamentum flavum.
conclusionsThe cervical and high thoracic ligamentum flavum frequently has midline intervals with various features, especially in the caudal portion of the intervertebral space. Therefore, the ligamentum flavum is not always reliable as a perceptible barrier to identify the epidural space at these vertebral levels. Additionally, it may be more useful to insert the needle into the cephalic portion of the intervertebral space than in the caudal portion.
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