{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T08:16:21Z","timestamp":1776932181921,"version":"3.51.2"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T00:00:00Z","timestamp":1600646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Anatomy"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To better understand the unexpected spread of contrast medium observed by conventional fluoroscopic X\u2010ray images during standard neuraxial techniques used in the treatment of pain. The support of 3D reconstruction of MRI images of structures within the lumbar spine was used to better understand the space of Okada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Lumbar facet joint and epidural corticosteroid injections in five patients under fluoroscopic guidance with loss of resistance to air or saline to identify the facet joints or epidural space. Next, in a retrospective study, the authors examined the retrodural space of Okada and the neighboring tissues with 3D reconstruction of spinal MRIs of seven patients without any demonstrable spinal pathology to better understand the characteristics of the space of Okada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Contrast medium spread to the ipsilateral and contralateral sides was observed in five patients. The contralateral spread was thought to be through the retrodural space of Okada, which is a potential space between the anterior surface of the vertebral lamina and the posterior surface of the ligamentum flavum. It facilitates communication between the contralateral articular facet joints of the spine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study provides new evidence for the existence of the space of Okada where an unexpected contralateral spread occurred following facet joint and attempted epidural injection. The 3D reconstructions of MRIs may help us better understand the nature of the retrodural space of Okada and its clinical implications.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ca.23674","type":"journal-article","created":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T14:06:20Z","timestamp":1600697180000},"page":"451-460","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Case series of fluoroscopic findings and <scp>3D<\/scp> reconstruction of human spinal <scp>MRIs<\/scp> of the space of Okada"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9078-1020","authenticated-orcid":false,"given":"Miguel A.","family":"Reina","sequence":"first","affiliation":[{"name":"Clinical Medical Science Department CEU San Pablo University School of Medicine  Madrid Spain"},{"name":"Department of Anesthesiology Madrid\u2010Montepr\u00edncipe University Hospital  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mart\u00edn","family":"Avellanal","sequence":"additional","affiliation":[{"name":"Pain Clinic Unit Hospital Universitario Sanitas La Moraleja  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-1214","authenticated-orcid":false,"given":"Andr\u00e9 P.","family":"Boezaart","sequence":"additional","affiliation":[{"name":"Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology University of Florida College of Medicine  Gainesville Florida USA"},{"name":"Alon P. Winnie Research Institute  Still Bay, Western Province South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1317-1047","authenticated-orcid":false,"given":"R. Shane","family":"Tubbs","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tulane Center for Clinical Neurosciences Tulane University School of Medicine  New Orleans Louisiana USA"},{"name":"Department of Anatomical Sciences St. George's University  St. George's Grenada"},{"name":"Department of Structural &amp; Cellular Biology Tulane University School of Medicine  New Orleans Louisiana USA"},{"name":"Department of Neurosurgery and Ochsner Neuroscience Institute Ochsner Health System  New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9","family":"De Andr\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Management General University Hospital, School of Medicine, University of Valencia  Valencia Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga C.","family":"Nin","sequence":"additional","affiliation":[{"name":"Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology University of Florida College of Medicine  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Prats\u2010Galino","sequence":"additional","affiliation":[{"name":"Laboratory of Surgical Neuro Anatomy, Human Anatomy and Embryology Unit, Faculty of Medicine Universitat de Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,9,21]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"32","article-title":"Espacio Retrodural de Okada: Comunicaci\u00f3n de un Caso","volume":"68","author":"Ayala S.","year":"2017","journal-title":"Revista El Dolor"},{"key":"e_1_2_7_3_1","first-page":"502","article-title":"Incorrect needle position during lumbar epidural steroid administration: Inaccuracy of loss of air pressure resistance and requirement of fluoroscopy and epidurography during needle insertion","volume":"26","author":"Bartynski W. 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