The epidural space (extradural space) is the potential space between the dura mater of the spinal cord and the periosteum of the vertebral canal. It contains epidural fat, the epidural venous plexus (Batson plexus), spinal nerve root sleeves, and small arteries. The space is widest in the lumbar region (approximately 5-6 mm posterior midline) and narrows in the thoracic and cervical regions.
The epidural space is the target for epidural anaesthesia and analgesia, used in obstetric pain management, thoracic and abdominal surgery, and post-operative pain control. The loss-of-resistance technique (to air or saline) identifies entry into the space as the needle passes through the ligamentum flavum. The epidural venous plexus is valveless and connects the pelvis to the intracranial venous sinuses (Batson pathway for metastatic spread). Epidural haematoma from anticoagulation or spinal cord injury compresses the cord and requires emergency decompression. Epidural abscess from haematogenous or contiguous spread causes progressive cord compression.
Spontaneous epidural haematoma in anticoagulated patients or those with coagulopathy produces rapid posterior cord compression with acute onset of back pain followed by ascending weakness and sensory loss; emergency MRI confirms the haematoma and surgical decompression within 12 hours is the determinant of neurological recovery.
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