{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:27:01Z","timestamp":1760171221224,"version":"3.40.5"},"reference-count":46,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T00:00:00Z","timestamp":1611360000000},"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":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>We have previously described arachnoid sleeves around cauda equina nerve roots, but at that time we did not determine whether injections could be performed within those sleeves. The purpose of this observational study was to establish whether the entire distal orifice of a spinal needle can be accommodated within an arachnoid sleeve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>We carefully dissected the entire dural sacs off four fresh cadavers, opened them by longitudinal incision, and immersed them in saline. Under direct vision, we penetrated the cauda equina roots nerves traveling almost vertically downward at 30 locations each with a 27\u2010 and a 25\u2010G pencil\u2010point needle (60 punctures total). We captured the images with a stereoscopic camera.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The nerve root offered no noticeable resistance to needle entry. Although the arachnoid sleeves could not be identified with the naked eye, they were translucent but visible under microscopy. In 21 of 30 attempts with a 27\u2010gauge needle, and in 20 of 30 attempts with a 25\u2010gauge needle, the distal orifice of the spinal needle was completely within the arachnoid sleeve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>It seems possible to accommodate the distal orifice of a 25\u2010 or a 27\u2010gauge pencil\u2010point spinal needle completely within the space of the arachnoid sleeve. An injection within this sleeve could potentially lead to a neurological syndrome, as we have previously proposed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ca.23721","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T23:59:14Z","timestamp":1610755154000},"page":"748-756","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Spinal arachnoid sleeves and their possible causative role in cauda equina syndrome and transient radicular irritation syndrome"],"prefix":"10.1002","volume":"34","author":[{"given":"Irene","family":"Riquelme","sequence":"first","affiliation":[{"name":"Pain Clinic, Hospital Universitario Sanitas La Moraleja  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9078-1020","authenticated-orcid":false,"given":"Miguel A.","family":"Reina","sequence":"additional","affiliation":[{"name":"CEU\u2010San\u2010Pablo University School of Medicine  Madrid Spain"},{"name":"Department of Anesthesiology, Madrid\u2010Montepr\u00edncipe University Hospital  Madrid Spain"},{"name":"Department of Anesthesiology University of Florida College of Medicine  Gainesville Florida USA"}],"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. 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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, West Indies Grenada"},{"name":"Department of Structural and 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"},{"name":"Department of Neurology Tulane University School of Medicine  New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Carrera","sequence":"additional","affiliation":[{"name":"Neuroscience, Embryology, Molecular Oncology and Clinical Anatomy Group (NEOMA), School of Medicine University of Girona  Girona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Reina","sequence":"additional","affiliation":[{"name":"Neuroscience, Embryology, Molecular Oncology and Clinical Anatomy Group (NEOMA), School of Medicine University of Girona  Girona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,1,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2002.2520_35.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200210000-00071"},{"key":"e_1_2_9_4_1","first-page":"1445","article-title":"Cauda equina syndrome following combined spinal and epidural anesthesia with levobupivacaine","volume":"79","author":"Carron M.","year":"2013","journal-title":"Minerva Anestesiologica"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000184126.57327.C3"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000281908.48784.91"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199809000-00012"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200012000-00031"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199709000-00031"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-199611000-00026"},{"key":"e_1_2_9_11_1","first-page":"363","article-title":"Hyperosmolarity does not contribute to transient radicular irritation after spinal anesthesia with hyperbaric 5% lidocaine","volume":"20","author":"Hampl K. 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