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Epidural Venous Plexus

plexus venosus epiduralis

The epidural venous plexus occupies the epidural space surrounding the dural sac, formed by the anterior internal vertebral veins and their transverse connections. It is most prominent anterolaterally, where it flanks the posterior longitudinal ligament, and laterally in the lateral recesses adjacent to the nerve roots.

Region: Lower Back

Clinical Relevance

Clinical Notes

The epidural venous plexus is an important technical consideration in epidural injections and spinal surgery. Inadvertent venous puncture during epidural catheter placement produces bloody tap and systemic local anaesthetic toxicity risk. In posterior spinal surgery, epidural bleeding from the plexus is controlled with bipolar cautery and haemostatic agents. Epidural venous engorgement in pregnancy and inferior vena cava obstruction increases epidural injection difficulty.

Pathology

Common Injuries & Conditions

Epidural Venous Injection

Intravascular injection into the epidural venous plexus during epidural block, producing systemic local anaesthetic toxicity from rapid drug absorption into the valveless plexus communicating with the thoracic and hepatic veins.