In epidural lumbar puncture, all structure are pierced except:
**Core Concept**
Epidural lumbar puncture involves inserting a needle into the epidural space, which surrounds the dura mater and the spinal cord. The procedure requires careful identification of anatomical structures to avoid complications.
**Why the Correct Answer is Right**
During an epidural lumbar puncture, the following structures are pierced in sequence: skin, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, and dura mater. However, the spinal cord itself is not pierced, as the epidural space is located outside the dural sac. The spinal cord ends at the level of the conus medullaris, typically around L1-L2 in adults.
**Why Each Wrong Option is Incorrect**
* **Option A:** Not applicable, as the question does not provide a distractor.
* **Option B:** This option is incorrect, as the dura mater is indeed pierced during an epidural lumbar puncture.
* **Option C:** This option is incorrect, as the ligamentum flavum is pierced before entering the epidural space.
* **Option D:** This option is incorrect, as the spinal cord is not pierced during an epidural lumbar puncture.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that the spinal cord ends at a variable level, typically around L1-L2 in adults, and the epidural space is located outside the dural sac. This knowledge helps avoid accidental puncture of the spinal cord during procedures like epidural lumbar puncture or epidural anesthesia.
**Correct Answer:** D. Spinal cord