Thoracolumbar Spine Anatomy and Pathology - 77 Year Old

Degenerated Lower Lumbar Spine 77 year old

Sagittal section through a moderately degenerated lower lumbar spine of a 77-year old man

Sagittal section through a moderately degenerated lower lumbar spine of a 77–year–old man who had a history of intermittent claudication. This section is carried through the lateral recesses of L4–L5 and L5–S1. The L4–L5 disc is grossly disrupted and protrudes both anteriorly (underneath the anterior longitudinal ligament) and posteriorly into the lateral recess, abutting the markedly thickened and infolding ligamentum flavum, thereby completely blocking the epidural veins which are engorged both above and below this obstruction level. The L5–S1 disc is completely resorbed with total loss of disc height. Focal endplate sclerosis and erosions of the endplates are obvious. A (probably still contained) disc herniation tracks inferiorly and reaches the ligamentum flavum, again obstructing the epidural veins at this level. This two–level spinal canal obstruction is thought to cause a more pronounced vascular congestion because the segmental drainage is blocked. The L4, L5 and S1 roots are not compressed. Anteriorly, the iliac artery (red) and iliac vein (black) snugly follow the spine, illustrating that an anterior annulus violation during spinal instrumentation could cause severe vascular injury.

Updated on: 11/05/18

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