Patterns of Epidural Patch Distribution: The Influence of Spinal Level, Injection Technique, and Patch Volume/Composition on Craniocaudal and Ventral Epidural Dispersion.

Daniel Montes, Samantha L Pisani Petrucci, Debayan Bhaumik, Nadya Andonov, Peter Lennarson, Andrew L Callen
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Abstract

Background and purpose: Epidural patching with autologous blood and/or fibrin sealant is a common treatment for spinal cerebrospinal fluid (CSF) leaks, yet the factors influencing patch distribution remain poorly understood. This study aimed to analyze the craniocaudal (CC) and ventral epidural (VE) extent of epidural patch material and investigate the impact of variables such as patch volume, composition, spinal level of injection, and patient habitus on distribution patterns.

Materials and methods: This retrospective, cross-sectional cohort study included patients who underwent CT-guided epidural patching from January to September 2024. Inclusion criteria were age ≥18 years, dorsal interlaminar (DI) or transforaminal (TFO) epidural patching using blood, fibrin, or both, and immediate post-patch imaging capturing the entire patch extent. Patch distribution was assessed for CC and VE spread. Statistical analyses included linear and logistic regression models, with multivariate analyses adjusting for confounders.

Results: Of 152 patients patched during the study period, 33 met inclusion criteria (mean age 45.4 years; 84.1% female) with 44 spinal levels patched: cervical (6.8%), thoracic (68.2%), and lumbar (25%). Mean patch volume (PV) per needle was 7.2 mL, with a mean CC spread of 4.6 spinal levels. There was a positive relationship between PV and CC spread across all spinal levels (β = 0.29, p = 0.001). Patches in the cervical region demonstrated the highest CC spread efficiency (0.77 levels/mL) compared to thoracic (0.56 levels/mL) and lumbar patches (0.47 levels/mL; p < 0.01). DI injections achieved greater CC spread but less VE dispersion than TFO injections (5.0 vs. 3.2 levels; p = 0.02; 58.8% vs 70.0%, p = 0.52). VE spread occurred in 61.4% of cases and followed a non-linear pattern along the spine, with an inflection point at T3.

Conclusions: The distribution of epidural patch material is influenced by spinal level, PV, composition, and injection approach. Cervical patches provide the greatest spread efficiency relative to volume, while DI approaches enhance craniocaudal spread but reduce ventral dispersion.

Abbreviations: CSF = cerebrospinal fluid; CC = craniocaudal; VE = ventral epidural; DI = dorsal interlaminar; TFO = transforaminal.

硬膜外贴片分布模式:脊髓水平、注射技术和贴片体积/组成对颅侧和腹侧硬膜外分散的影响。
背景和目的:用自体血液和/或纤维蛋白密封剂进行硬膜外补片是治疗脊髓脑脊液(CSF)泄漏的常用方法,但影响补片分布的因素尚不清楚。本研究旨在分析硬膜外贴片材料的颅侧(CC)和腹侧(VE)范围,并探讨贴片体积、成分、脊髓注射水平和患者习惯等变量对其分布模式的影响。材料和方法:这项回顾性、横断面队列研究纳入了2024年1月至9月接受ct引导硬膜外补片的患者。纳入标准为年龄≥18岁,使用血液、纤维蛋白或两者同时进行背椎间膜(DI)或经椎间孔(TFO)硬膜外贴片,贴片后立即成像捕捉整个贴片范围。斑块分布评估CC和VE的传播。统计分析包括线性和逻辑回归模型,以及调整混杂因素的多变量分析。结果:研究期间152例患者中,33例符合纳入标准(平均年龄45.4岁;84.1%的女性),有44个脊柱节段修补:颈椎(6.8%)、胸椎(68.2%)和腰椎(25%)。平均每针补片体积(PV)为7.2 mL,平均CC扩散4.6个脊柱水平。PV和CC在所有脊柱节段的扩散呈正相关(β = 0.29, p = 0.001)。与胸椎(0.56个水平/mL)和腰椎(0.47个水平/mL)相比,颈部斑块显示出最高的CC扩散效率(0.77个水平/mL);P < 0.01)。与TFO注射相比,DI注射获得了更大的CC扩散,但VE弥散度更低(5.0比3.2;P = 0.02;58.8% vs 70.0%, p = 0.52)。61.4%的病例发生VE扩散,沿脊柱呈非线性模式,在T3处出现拐点。结论:硬膜外贴片材料的分布受脊柱水平、PV、成分和注射方式的影响。相对于容积而言,颈部贴片提供了最大的扩散效率,而DI入路增强了颅侧扩散,但减少了腹侧弥散。缩写:CSF =脑脊液;CC =颅侧;VE =腹侧硬膜外;DI =背侧层间层;经椎间孔。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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