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Thoracic Spine Anatomy

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721. The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. (PubMed)

, lumbosacral angle, lumbar lordosis, thoracic kyphosis, and grade of spondylolisthesis. All measurements were done by the same individual and compared to those of an adult and child reference population.The pelvic shape, best quantified by the pelvic incidence angle, determines the position of the sacral endplate. The spine reacts to this position by adapting through lumbar lordosis, the amount of lordosis increasing as the sacral slope increases in order to balance the trunk in the upright position (...) . Pelvic incidence, sacral slope, pelvic tilt, and lumbar lordosis are found to be significantly greater in subjects with developmental spondylolisthesis, while thoracic kyphosis is significantly lower when compared to a reference population. Furthermore, the differences between the two populations increase in a direct linear fashion as the severity of the spondylolisthesis increases, suggesting that pelvic anatomy has a direct influence on the development of a spondylolisthesis. Studies also indicate

2005 Spine

722. Epidural analgesia after spinal surgery via intervertebral foramen. (PubMed)

thoracic spine and retraction of the left lower lobe of the lung. Despite initially planning opioid-based postoperative analgesia, a joint anaesthetic and surgical decision was made to use epidural analgesia in an attempt to avoid potential postoperative respiratory complications. Because of the surgical anatomy of the correction, the catheter was inserted via the T11 intervertebral foramen. A bolus of bupivacaine 0.25% intraoperatively with a postoperative infusion of bupivacaine 0.167 (...) Epidural analgesia after spinal surgery via intervertebral foramen. Patients undergoing major spinal surgery may experience significant postoperative pain. Epidural analgesia has previously been shown to be safe and effective and may confer some advantages over opioid-based postoperative analgesia. We discuss the case of a 47-yr-old female patient undergoing the prolonged anterior component of a lower thoracic/upper lumbar spine correction involving the stripping of the diaphragm from the lower

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2005 British Journal of Anaesthesia

723. Posterior compact Cotrel-Dubousset instrumentation for occipitocervical, cervical and cervicothoracic fusion (PubMed)

. The patients were observed postoperatively for an average of 31 months (range 25-44 months) and evaluated both clinically and radiographically using the following parameters: spine anatomy and reconstruction, sagittal profile, neurologic status, functional level, complications and status of arthrodesis. All patients but one (who died) achieved a solid arthrodesis based on plain and flexion/extension roentgenograms. Cervical lordosis (skull-C7) and cervicothoracic kyphosis (C7-T2) was improved (...) . The results of this study demonstrate that cervical CCD instrumentation applied in the region of the skull to the upper thoracic region for various disorders is a simple and safe instrumentation that restores lateral spine alignment, improves the potential for a solid fusion and offers sufficient functional results in the vast majority of the operated patients. However, the use of hooks in spinal stenosis is contraindicated.

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2001 European Spine Journal

724. Role of Multimodality Intraoperative Neurophysiological Monitoring during Embolisation of a Spinal Cord Arteriovenous Malformation: A Paradigmatic Case (PubMed)

(CSEPs) or muscle motor evoked potentials (mMEPs) are used independently, they can mislead the interpretation of provocative tests. This report illustrates the specific but complementary role played by provocative tests using CSEPs and mMEPs during embolisation of a low thoracic spinal cord AVM. We present the case of a 46 year old male with six year history of right lower extremity weakness. At that time, Magnetic Resonance (MR) imaging of the spine disclosed an intramedullary AVM at T11. He (...) artery (ASA) at T9. Conversely, provocative tests with Lidocaine performed from a right posterior spinal artery (PSA) feeder to the AVM nidus resulted in a significant (> 50%) decrease of CSEPs, while mMEPs remained unchanged. The repeatedly positive tests warranted further investigation of the vascular anatomy which disclosed a normal right PSA distal to the nidus; the distal normal PSA was protected with coils. A repeated Lidocaine test was negative and the posterior feeder was embolised

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2001 Interventional Neuroradiology

725. Regional differences within the human supraspinous and interspinous ligaments: a sheet plastination study (PubMed)

throughout the thoracolumbar spine. Study of the dense connective tissue organization in the posterior ligamentous system was carried out on two cadavers serially sectioned into thin (2.5-mm) epoxy resin plastinated slices. Additional observations were taken from a gross anatomical study of the midline anatomy in two adult cadavers. The results show that the spinal attachments of trapezius, rhomboideus major and splenius cervicis combine with the deep fascia to form the supraspinous ligament in the upper (...) thoracic spine. The posterior layer of the thoracolumbar fascia makes a major contribution to the supraspinous and interspinous ligaments in the lower thoracic spine. In addition to the posterior layer of thoracolumbar fascia, longissimus thoracis and multifidus combine to form the lumbar supraspinous and interspinous ligaments. Their spinal attachments produce a system of dense connective tissue with marked regional variation in fiber orientation and arrangement. The findings support the description

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2002 European Spine Journal

726. Color Doppler ultrasonography for evaluation of internal mammary artery application in adolescent female patients with right-convex thoracic idiopathic scoliosis. (PubMed)

to the mammary gland. However, no measurements of anatomic and hemodynamic parameters of internal mammary artery have been made to justify or to reject the hypothesis of asymmetric blood flow volume to the breasts and costosternal junction in female adolescent scoliotics. Color Doppler Ultrasonography is a well established noninvasive method to assess vessel anatomy and hemodynamics.Twenty female adolescents with right thoracic scoliosis and 16 comparable female individuals without spine deformity were (...) Color Doppler ultrasonography for evaluation of internal mammary artery application in adolescent female patients with right-convex thoracic idiopathic scoliosis. Prospective comparative study.To establish the use of Color Doppler Ultrasonography to investigate internal mammary artery.Breast asymmetry in female adolescents with right convex idiopathic scoliosis was supposed to be linked with anatomic and functional asymmetry of the internal mammary artery that is the main supplier

2003 Spine

727. Pullout strength of thoracic pedicle screw instrumentation: comparison of the transpedicular and extrapedicular techniques. (PubMed)

Pullout strength of thoracic pedicle screw instrumentation: comparison of the transpedicular and extrapedicular techniques. In vitro biomechanical comparison of two methods of pedicle screw placement in cadaveric thoracic spine vertebrae.Compare the biomechanical integrity of extrapedicular and transpedicular screw fixation under axial and sagittal pullout loads.Extrapedicular screw placement has been advocated as a safe and effective alternative to the transpedicular screw in thoracic (...) vertebrae. Rigorous biomechanical comparison of these two techniques is presently lacking in the literature.Thirty-seven vertebral bodies were dissected from six cadaveric thoracic spines. Each body had two polyaxial 5.0-mm screws placed: one transpedicular and one extrapedicular. The 62 screws were randomly designated for one of two loading methods: axial or sagittal. Failure load (N), taken as maximum force on the load-deformation curve, and stiffness (N/mm), calculated between 50 N and 400 N, were

2006 Spine

728. Anterior vertebral body screw position placed thoracoscopically: a function of anatomy and surgeon experience in a porcine model. (PubMed)

screw insertion point and trajectory.To investigate whether the position of thoracoscopically placed screws is related to the portion of the thoracic spine instrumented and to the experience of the surgeon and to define the ideal starting position and direction of anterior thoracic screws in a porcine model.Anterior screw insertion using a thoracoscopic approach is generally considered to be technically demanding and potentially dangerous. To our knowledge, there is no study analyzing the proper (...) position of anterior vertebral screws using thoracoscopic technique and no study analyzing the ideal starting position of anterior vertebral body screws.In Study 1, 26 pigs were assigned to two groups (early experience, n = 16; late experience, n = 10) and underwent thoracoscopic anterior instrumentation and fusion from T5 to T10. The screw position was determined in the sagittal plane and in the frontal plane, respectively. In Study 2, 10 thoracic pig spines (T3-T12) were obtained. Each vertebra

2004 Spine

729. Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. (PubMed)

Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Posterior instrumentation through the pedicle is a common surgery. Understanding the morphometry of the pedicle and the anatomy of adjacent neural structures should help decrease the risk of postoperative complications. T1-L5 segments from 15 sets of human vertebrae were separated into individual vertebrae and the morphometric characteristics of the thoracic (...) and lumbar spine and the safe zone of the pedicle were analyzed. T11-L5 segments from six human cadavers were dissected. Measurements were taken from the pedicle to the dura and nerve roots superiorly, inferiorly, medially, and laterally, and the transverse angles of the nerve roots were measured. Pedicles were widest in L5 and narrowest in T4 in the transverse plane, and widest in T11 or T12 and narrowest in T1 in the sagittal plane. In individual pedicle, the ranges of the safe zone width and height

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2007 European Spine Journal

730. Regional differences in anatomical landmarks for placing anterior instrumentation of the thoracic spine in both normal patients and patients with adolescent idiopathic scoliosis. (PubMed)

Regional differences in anatomical landmarks for placing anterior instrumentation of the thoracic spine in both normal patients and patients with adolescent idiopathic scoliosis. A retrospective analysis of patients who had magnetic resonance imaging (MRI) of the thoracic spine, comparing those with a normal straight spine and those with a right thoracic adolescent idiopathic scoliosis (AIS).To analyze the position of the rib head with respect to the spinal canal and vertebral body in normal (...) patients and those with right thoracic AIS using MRI.When placing anterior vertebral body screws in thoracic AIS, the most cephalad screws are most at risk for loosening because of smaller vertebral body size and the position of the rib heads, which may obscure more of the vertebral bodies. To our knowledge, there are no studies defining the relationship of the rib head to the vertebral anatomy in thoracic AIS.Transverse MRIs of the vertebral bodies from the 4th thoracic (T4) vertebra to the 12th

2006 Spine

731. An extrapedicular approach to the placement of screws in the thoracic spine: an anatomic and radiographic assessment. (PubMed)

An extrapedicular approach to the placement of screws in the thoracic spine: an anatomic and radiographic assessment. A radiographic and anatomic study of an extrapedicular method of screw placement in cadaveric thoracic spines.To evaluate an alternative method of thoracic vertebral body screw fixation using an extrapedicular screw technique. To evaluate the anatomic safe zones and proper starting point for this alternative approach to the placement of screw fixation in the thoracic (...) in the thoracic spine. Biomechanical evaluations are presently being conducted to evaluate the use of extrapedicular thoracic screw fixation.

2003 Spine

732. Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. (PubMed)

Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. This paper details the quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae (C3-T12) of Chinese Singaporean subjects based on 220 vertebrae from 10 cadavers. The purpose of the study was to measure the linear dimensions, angulations and areas of individual vertebra, and to compare the data with similar studies performed on Caucasian specimens. Measurements were (...) , was found from T8 to T12. According to the findings, the use of a transpedicle screw may not be feasible. The results can also provide more accurate modelling for analysis and design of spinal implants and instrumentations, and also allow more precise clinical diagnosis and management of the spine in Chinese Singaporeans.

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2004 European Spine Journal

733. Identification of thoracic intervertebral spaces by means of surface anatomy: a magnetic resonance imaging study. (PubMed)

Identification of thoracic intervertebral spaces by means of surface anatomy: a magnetic resonance imaging study. Successful thoracic epidural analgesia depends on the sensory blockage of specific dermatomes following appropriate placement of the epidural catheter. This study aimed to ascertain how accurately anaesthesiologists identify thoracic intervertebral spaces, and whether counting from the prominent vertebra is easier than using the iliac crest as an anatomical landmark.Five (...) identified. The counting reference point was the only variable studied with a significant influence on error. The accuracy increased when the iliac crest was used as an anatomical landmark rather than the prominent vertebra (odds ratio, 0.29). The majority (76.4%) of all the incorrectly placed capsules were found cephalad to the intended level.We recommend that the caudal of two to three possible interspaces should be used when placing an epidural catheter in the thoracic spine. Because of the inaccurate

2006 Acta Anaesthesiologica Scandinavica

734. The relation between organ anatomy and pre-existent vertebral rotation in the normal spine: magnetic resonance imaging study in humans with situs inversus totalis. (PubMed)

. The mean vertebral rotation angles differed significantly from zero degrees rotation at the mid and lower thoracic levels, with a maximum rotation of 2.7 degrees at level T7 (P < 0.001).The normal spine of humans with a situs inversus totalis shows a pre-existent pattern of vertebral rotation opposite of what is seen in humans with normal organ anatomy. This study shows a relation between the asymmetrical position of the thoracic organs and pre-existent vertebral rotation in the normal spine. (...) The relation between organ anatomy and pre-existent vertebral rotation in the normal spine: magnetic resonance imaging study in humans with situs inversus totalis. In this cross-sectional magnetic resonance imaging study, vertebral rotation was measured in the transverse plane of the normal, nonscoliotic spine of persons with a complete mirror image reversal of the internal body organs, called situs inversus totalis.To determine if a pattern of rotation exists in the normal spine of persons

2007 Spine

735. Mechanoreceptor endings of the cervical, thoracic, and lumbar spine. (PubMed)

Mechanoreceptor endings of the cervical, thoracic, and lumbar spine. 7634025 1995 09 14 2018 11 13 1541-5457 15 1995 The Iowa orthopaedic journal Iowa Orthop J Mechanoreceptor endings of the cervical, thoracic, and lumbar spine. 147-55 McLain R F RF Department of Orthopaedic Surgery, University of California, Davis Sacramento 95817, USA. Raiszadeh K K eng Journal Article United States Iowa Orthop J 8908272 1541-5457 IM Adolescent Adult Cervical Vertebrae innervation Humans Lumbar Vertebrae (...) innervation Mechanoreceptors anatomy & histology Middle Aged Thoracic Vertebrae innervation 1995 1 1 1995 1 1 0 1 1995 1 1 0 0 ppublish 7634025 PMC2329086 Acta Anat (Basel). 1965;62(4):568-83 4163342 Acta Physiol Scand. 1960 Oct 31;50:167-74 13726250 J Physiol. 1969 Aug;203(2):317-35 5796466 Physiotherapy. 1972 Mar 10;58(3):94-9 4604122 J Neurophysiol. 1975 Nov;38(6):1448-63 1221082 J Neurophysiol. 1975 Nov;38(6):1473-84 1221084 Am J Anat. 1978 Nov;153(3):431-42 707322 J Anat. 1979 Dec;129(Pt 4):719-29

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1995 The Iowa orthopaedic journal

736. Trauma to the thoracic and lumbar spine in the adolescent (PubMed)

Trauma to the thoracic and lumbar spine in the adolescent During adolescence the spine undergoes rapid growth and changes in anatomy and biomechanical properties. Fractures of the adolescent spine are relatively uncommon but may give rise to serious problems. This review describes thoracolumbar fractures in adolescents with respect to epidemiology, anatomy, mechanisms of injury, clinical and radiologic assessment, and nonoperative and operative treatment. The treatment of these injuries follows

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2001 Canadian Journal of Surgery

737. Complexity of the thoracic spine pedicle anatomy (PubMed)

Complexity of the thoracic spine pedicle anatomy Transpedicular screw fixation provides rigid stabilization of the thoracolumbar spine. For accurate insertion of screws into the pedicles and to avoid pedicle cortex perforations, more precise knowledge of the anatomy of the pedicles is necessary. This study was designed to visualize graphically the surface anatomy and internal architecture of the pedicles of the thoracic spine. Fifteen vertebrae distributed equally among the upper, middle (...) techniques utilized in transpedicular screw fixation in the thoracic spine. Information documenting the three-dimensional complexity of pedicle anatomy should be valuable for surgeons and investigators interested in spinal instrumentation.

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1997 European Spine Journal

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