The internal vertebral venous plexus (Batson's plexus) consists of two anterior and two posterior longitudinal veins running within the spinal canal, connected by transverse anastomoses and communicating freely with the basivertebral veins, the intervertebral veins, and the external vertebral plexus. Being valveless, it allows bidirectional flow under varying abdominal pressures.
| Origin | Valveless venous network within the vertebral canal |
|---|---|
| Course | Lies in the epidural space as anterior and posterior longitudinal channels joined by transverse connections, extending from the foramen magnum to the sacrum and draining through intervertebral veins |
| Branches |
|
The internal vertebral (epidural, Batson) venous plexus is valveless and communicates with the pelvic, abdominal and thoracic veins, which helps explain the spread of prostate, breast, lung and thyroid cancers to the spine. It is the usual source of spinal epidural haematoma in anticoagulated patients and after trauma or spinal procedures. During epidural anaesthesia, puncture of these veins gives a bloody tap, and injection into them can cause local anaesthetic toxicity; the veins are engorged in pregnancy and when the inferior vena cava is obstructed, which raises this risk. In spinal surgery, bleeding from the plexus is controlled with bipolar diathermy and haemostatic agents.
Bleeding from the plexus into the epidural space, linked to anticoagulation, trauma or spinal procedures, can compress the cord or cauda equina and needs emergency surgical decompression.
Accidental injection of local anaesthetic into an epidural vein during epidural block can cause systemic toxicity with seizures or arrhythmia, which is why test doses and aspiration are used.
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