The posterior epidural space lies between the posterior dura mater and the ligamentum flavum and laminae, containing epidural fat, the posterior internal vertebral venous plexus, and radicular vessels. It is wider and more clinically accessible than the anterior epidural space, being the target for epidural steroid injections, spinal cord stimulator lead placement, and epidural catheter insertion.
The posterior epidural space is entered via the interlaminar or transforaminal route for epidural steroid injections in lumbar radiculopathy and spinal stenosis. Its fat content varies with BMI and age — obese patients have proportionally larger posterior epidural fat pads. Loss of resistance technique identifies entry into this space. The space narrows in spinal stenosis as ligamentum flavum hypertrophy compresses it. Spinal cord stimulator leads are placed in this space for chronic pain management.
Expanding haematoma in the posterior epidural space from coagulopathy or iatrogenic vessel injury producing progressive myelopathy, requiring urgent MRI and emergency surgical decompression.
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