How many levels does the epidural pass through?

Skin -- supraspinal ligament -- intervertebral ligament -- ligamentum flavum -- epidural space

Skin is generally broken with a thicker needle, so there is no sense of breakthrough;

When the needle encounters resistance it means it has reached the supraspinal ligament, it has passed through the supraspinal ligament, and usually the needle is held in place, which is what we call a clamp.

You don't feel anything unusual when you go through the intervertebral ligament;

When resistance is encountered again, the ligamentum flavum has been reached (although there may be no resistance when crossing the ligamentum flavum), and there is a distinct feeling of frustration after crossing, indicating that the epidural space has been reached.

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