Question
A 25-year-old man presents to the emergency department complaining of a severe headache, stiff neck, and fever. While waiting for treatment, the patient has a seizure. A neurologist suspects meningitis, and performs this procedure as shown in image on the patient. Immediately after the needle passes through the interlaminar space between the 4th and 5th lumbar vertebrae, which space does it enter?
A. Epidural.
B. Intramuscular.
C. Subarachnoid.
D. Subcutaneous.
Show Answer
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Correct Answer » A
Explanation
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Ans: A. Epidural
This procedure in Lumbar puncture
- Anatomical structures that will be transversed include skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, and dura
Epidural Space
- In the spine, the epidural space is an anatomic space that is the outermost part of the spinal canal.
- It is the space within the canal (formed by the surrounding vertebrae) lying outside the dura mater (which encloses the arachnoid mater, subarachnoid space, the cerebrospinal fluid, and the spinal cord).
Boundaries of the epidural space are as follows:
- Anterior- posterior longitudinal ligaments
- Lateral- pedicles and intervertebral foramina
- Posterior- ligamentum flavum and vertebral laminae.
- The epidural space has been subjected to many clinical manipulations for purposes of anesthesia and analgesia.
- Epidural injection of corticosteroids is one of the most commonly used interventions in managing radicular pain caused by nerve irritation .
- Of the several approaches available to access the lumbar epidural space, the lumbar interlaminar approach(The interlaminar space is the space between the laminae of the lumbar vertebrae) is commonly used, followed by lumbar transforaminal and caudal epidural steroid injections .
- The administration of local anesthetics with or without opioids into the epidural space provides and maintains pain relief during labor, abdominal surgery, pelvis or lower limb.
