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Thoracic Spine Anatomy

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61. Diffuse Idiopathic Skeletal Hyperostosis Association With Thoracic Spine Kyphosis: A Cross-sectional Study for the Health Aging and Body Composition Study. Full Text available with Trip Pro

of older individuals. Characteristics of DISH (ossifications between vertebral segments) reflect changes of spine anatomy and physiology that may be associated with Cobb angle of kyphosis.Using data from 1172 subjects aged 70 to 79 years, we measured DISH and Cobb angle of kyphosis from computed tomographic lateral scout scans. Characteristics of participants with and without DISH were assessed using the χ² and t tests. Association between DISH and Cobb angle was analyzed using linear regression. Cobb (...) angle and DISH relationship was assessed at different spine levels (thoracic and lumbar).DISH was identified on computed tomographic scout scan in 152 subjects with 101 cases in only the thoracic spine and 51 in both thoracic and lumbar spine segments. The mean Cobb angle of kyphosis in the analytic sample was 31.3° (standard deviation = 11.2). The presence of DISH was associated with a greater Cobb angle of 9.1° and 95% confidence interval (95% CI) (5.6-12.6) among African Americans and a Cobb

2014 Spine

62. Optimal Approach to Circumferential Decompression and Reconstruction for Thoracic Spine Metastatic Disease. (Abstract)

QOL.For ambulatory patients, an anterior approach resulted in a slightly higher QOL, and for nonambulatory patients, a posterior approach was favored, but these differences were not statistically significant.Using a decision-analytic model, we found no significant difference in QOL resulting from anterior versus posterior approaches to metastatic lesions in the thoracic spine. Decisions should instead be based on surgeon comfort, tumor characteristics, anatomy of the lesion, patient-related factors (...) Optimal Approach to Circumferential Decompression and Reconstruction for Thoracic Spine Metastatic Disease. Circumferential decompression has been demonstrated to be the first-line therapy for patients with metastatic tumors in the thoracic spine requiring surgical intervention. However, there is significant debate regarding whether these tumors are best accessed anteriorly utilizing a thoracotomy or posteriorly. We used decision analysis to determine which approach yields greater health

2014 Annals of Surgical Oncology

63. Morphological characteristics of diffuse idiopathic skeletal hyperostosis in the cervical spine. Full Text available with Trip Pro

Morphological characteristics of diffuse idiopathic skeletal hyperostosis in the cervical spine. Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior ossification of the spine and can lead to dysphagia and airway obstruction. The morphology of the newly formed bone in the cervical spine is different compared to the thoracic spine, possibly due to dissimilarities in local vascular anatomy. In this study the spatial relationship of the new bone with the arterial system (...) . The ossifications were non-flowing in the sagittal view and no segmental vessels were observed. Substantial displacement of the trachea/esophagus was present in the group with DISH compared to the controls.The hyperostosis at the cervical level was symmetrically distributed anterior to the vertebral bodies without a flowing pattern, in contrast to the asymmetrical flowing pattern typically found in the thoracic spine. The hypothesis that the vascular system acts as a natural barrier against new bone formation

2017 PLoS ONE

64. Visualisation of facet joint recesses of the cadaveric spine: a micro-CT and sheet plastination study Full Text available with Trip Pro

Visualisation of facet joint recesses of the cadaveric spine: a micro-CT and sheet plastination study The size and shape of a joint cavity are the key determinates for the mobility of the joint. The anatomy and configuration of the facet joint (FJ) recesses at different levels of the spine remain unclear and controversial. The aim of this study was to identify the configuration of the FJ recesses in the cervical, thoracic and lumbar spine using a combination of micro-CT and sheet plastination (...) the spine. The optimal needle approach to the FJ cavity was via an anterolateral or posterolateral recess at the cervical level, along the tip of the inferior articular process at the thoracic level and via the posteromedial recess at the lumbar level. (2) The FJ cavity did not communicate with the retrodural space.The anatomical features of the FJ recesses at different levels of the spine confirm no direct communication between the FJ cavity and retrodural space.

2018 BMJ Open Sport — Exercise Medicine

65. Scoliosis convexity and organ anatomy are related. Full Text available with Trip Pro

: the convexity of the thoracic curve is predominantly to the right in PCD patients that were 'randomized' to normal organ anatomy and to the left in patients with situs inversus totalis. (...) Scoliosis convexity and organ anatomy are related. Primary ciliary dyskinesia (PCD) is a respiratory syndrome in which 'random' organ orientation can occur; with approximately 46% of patients developing situs inversus totalis at organogenesis. The aim of this study was to explore the relationship between organ anatomy and curve convexity by studying the prevalence and convexity of idiopathic scoliosis in PCD patients with and without situs inversus.Chest radiographs of PCD patients were

2017 European Spine Journal

66. Better with Ultrasound: Lumbar Puncture. (Abstract)

Better with Ultrasound: Lumbar Puncture. The performance of a lumbar puncture is generally associated with a high rate of success and a favorable risk profile. Nonetheless, the use of ultrasound for procedural guidance has been demonstrated to reduce the rate of failure and the risk of specific complications, especially in patients with difficult surface anatomy. Many individual ultrasound techniques have been described in the literature; this article presents a systematic approach (...) for incorporating these tools into bedside practice and includes a series of illustrative figures and narrated video presentations to demonstrate the techniques described.Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

2018 Chest

67. CRACKCast E043 – Spinal Injuries

, ETOH and failure to use restraints Other common causes in order: falls, violence, sporting activities 80% of spinal injuries are men 1) Describe the anatomical contents of the anterior, middle and posterior spinal columns (aka 3 column model of Denis) Anterior: alternative vertebral bodies and intervertebral disks surrounded by annulus fibrosis and anterior longitudinal ligament Middle: posterior portion of annulus and post vertebral wall, posterior longitudinal ligament, spinal cord, paired (...) Stable provided posterior column remains intact and loss of no more than half vertebral height or multiple in a row Flexion teardrop – flexion forces cause anterior displacement of small wedge Highly unstable – usually involves anterior and posterior ligament disruption Clay-Shoveler’s fracture: named as such for miner lifting a heavy shovelful in forced flexion, now MC is forced deceleration in MVC’s Oblique fracture of base of spinous process – stable as single column Spinal subluxation – pure

2016 CandiEM

68. Thoracic Spine, Trauma

of postoperative fixation. In cases of multiple system trauma thoracic spinal fractures may be first discovered during the performance of CT of the chest and abdomen. Some authors have advocated a careful review of the axial CT images obtained in the typical CT trauma series without the additional use of thin section reformatted images. [ ] In a study by Gross, the reformatting of chest CT scans and abdominopelvic CT scans were shown to provide improved sensitivity in detecting thoracic and lumbar spine (...) be rudimentary. Each rib is attached to the vertebral body by 2 joint cavities. The lateral costotransverse ligament, the articular capsule, the superior costotransverse ligament, and the intra-articular ligament provide flexible stability between the transverse process and the rib facets. Depictions of the anatomy of the thoracic spine and vertebra are provided in the images below. Thoracic spine trauma. Drawing of the thoracolumbar spine viewed from an oblique frontal projection. SC indicates the spinal

2014 eMedicine Radiology

69. Thoracic Spine Fractures and Dislocations (Diagnosis)

instrumentation for spine trauma. J Trauma . 2006 May. 60(5):1047-52. . Ibrahim FM, Abd El-Rady Ael-R. Mono segmental fixation of selected types of thoracic and lumbar fractures; a prospective study. Int Orthop . 2016 Jun. 40 (6):1083-9. . Ma LT, Gong Q, Li T, Song YM, Pei FX, Zhao XD, et al. Relationship between the angle of vertebral screws and spinal lateral angulation after fixation of thoracolumbar fractures via an anterior approach. Genet Mol Res . 2014 Oct 7. 13 (4):8135-46. . Fischer S, Vogl TJ (...) > Thoracic Spine Fractures and Dislocations Updated: Oct 16, 2018 Author: Brian J Page, MD; Chief Editor: Murali Poduval, MBBS, MS, DNB Share Email Print Feedback Close Sections Sections Thoracic Spine Fractures and Dislocations Overview Background Thoracic spine fractures, especially those resulting from high energy, can be devastating, often resulting in permanent neurologic injury. Neurologic deficit is encountered in 10-25% of all spinal column injuries, irrespective of the level of injury. A deficit

2014 eMedicine Surgery

70. Thoracic Spine Fractures and Dislocations (Overview)

instrumentation for spine trauma. J Trauma . 2006 May. 60(5):1047-52. . Ibrahim FM, Abd El-Rady Ael-R. Mono segmental fixation of selected types of thoracic and lumbar fractures; a prospective study. Int Orthop . 2016 Jun. 40 (6):1083-9. . Ma LT, Gong Q, Li T, Song YM, Pei FX, Zhao XD, et al. Relationship between the angle of vertebral screws and spinal lateral angulation after fixation of thoracolumbar fractures via an anterior approach. Genet Mol Res . 2014 Oct 7. 13 (4):8135-46. . Fischer S, Vogl TJ (...) > Thoracic Spine Fractures and Dislocations Updated: Oct 16, 2018 Author: Brian J Page, MD; Chief Editor: Murali Poduval, MBBS, MS, DNB Share Email Print Feedback Close Sections Sections Thoracic Spine Fractures and Dislocations Overview Background Thoracic spine fractures, especially those resulting from high energy, can be devastating, often resulting in permanent neurologic injury. Neurologic deficit is encountered in 10-25% of all spinal column injuries, irrespective of the level of injury. A deficit

2014 eMedicine Surgery

71. Thoracic Spine Fractures and Dislocations (Treatment)

of an active infection. Guidelines on management of thoracolumbar burst fractures are available from the Congress of Neurological Surgeons, [ ] and guidelines on management of spinal cord injury (SCI) are available from AOSpine [ , , , , , ] (see ). Timing of surgical treatment The literature regarding the timing of surgical intervention for thoracic and lumbar fractures with an acute spinal cord injury (SCI) is scarce. However, several studies have looked at the timing of surgery in cervical spine trauma (...) purchase through all three columns. Because of this increased rigidity, fewer segments may be needed for stable fixation, allowing preservation of more motion segments. Preserving motion segments is less important in the thoracic spine; little motion is lost in comparison with the cervical and lumbar segments. However, limiting instrumentation of distal segments is important with thoracolumbar injuries. [ , , , ] Thoracic pedicle screw placement can be challenging because of the smaller dimensions

2014 eMedicine Surgery

72. Thoracic Spine Fractures and Dislocations (Follow-up)

of an active infection. Guidelines on management of thoracolumbar burst fractures are available from the Congress of Neurological Surgeons, [ ] and guidelines on management of spinal cord injury (SCI) are available from AOSpine [ , , , , , ] (see ). Timing of surgical treatment The literature regarding the timing of surgical intervention for thoracic and lumbar fractures with an acute spinal cord injury (SCI) is scarce. However, several studies have looked at the timing of surgery in cervical spine trauma (...) purchase through all three columns. Because of this increased rigidity, fewer segments may be needed for stable fixation, allowing preservation of more motion segments. Preserving motion segments is less important in the thoracic spine; little motion is lost in comparison with the cervical and lumbar segments. However, limiting instrumentation of distal segments is important with thoracolumbar injuries. [ , , , ] Thoracic pedicle screw placement can be challenging because of the smaller dimensions

2014 eMedicine Surgery

73. Lumbar Spine, Trauma

). Lumbar spine trauma. Sagittal multiplanar reformatted CT scan demonstrates a compression fracture of the L1 vertebral body (white arrow). A large fragment of bone projects into the spinal canal (yellow arrow). Although not yet at the point of clinical application, traumatic vertebral body fracture detection software has been reported. The software digitally strips the vertebral body cortex and looks for fractures in the cortical shell and is able to differentiate isolated Denis anterior column (...) fractures (eg, compression-type fractures) from combined anterior and middle column fractures (burst type). The system demonstrated 92% sensitivity for fracture detection and localization of the correct vertebra, with a false-positive occurrence rate of 1.6 per patient. [ ] Many patients who present with lumbar spine injury have pulmonary, rib, or vascular injury. The expense and delay of obtaining routine CT scans of the lumbar spine are not justified. A review of the bone windows of thoracic

2014 eMedicine Radiology

74. Lumbar Spine Fractures and Dislocations (Diagnosis)

fractures of the vertebral column each year, and 11,000 of these patients sustain spinal cord injuries. [ ] The thoracolumbar spine and lumbar spine are the most common sites for fractures because of the high mobility of the lumbar spine compared to the more rigid thoracic spine. [ ] Injury to the cord or cauda equina occurs in approximately 10-38% of adult thoracolumbar fractures and in as many as 50-60% of fracture dislocations. The rate of bony injury without neurologic consequence is undoubtedly (...) of the spine based on the system introduced by Cotrel and Dubousset. This article reviews the diagnosis and management of acute lumbar vertebral fractures. (For more information, see and ) Next: Anatomy Anatomic components The lumbar spine consists of a mobile segment of five vertebrae, which are located between the relatively immobile segments of the thoracic and sacral segments. The thoracic spine is stabilized by the attached rib cage and intercostal musculature, whereas the sacral segments are fused

2014 eMedicine Surgery

75. Lumbar Spine Fractures and Dislocations (Treatment)

into the spinal canal. A tap is then used to create the threads for the screws. Finally, the screws can be placed under continuous fluoroscopic guidance. A depth of 50-75% of the anteroposterior (AP) vertebral body diameter is usually recommended for lumbar fixation, while bicortical screw purchase is recommended for sacral fixation. The position of the screws is then assessed electrophysiologically with a nerve stimulator and radiologically with an AP, lateral, and two-dimensional scan of the spine performed (...) , Hurlbert RJ, Anderson P, Fehlings M, Rampersaud R, Massicotte EM, et al. Neurologic deterioration secondary to unrecognized spinal instability following trauma--a multicenter study. Spine (Phila Pa 1976) . 2006 Feb 15. 31 (4):451-8. . Kinoshita T, Ebara S, Kamimura M, Tateiwa Y, Itoh H, Yuzawa Y, et al. Nontraumatic lumbar vertebral compression fracture as a risk factor for femoral neck fractures in involutional osteoporotic patients. J Bone Miner Metab . 1999. 17 (3):201-5. . Castaño-Betancourt MC

2014 eMedicine Surgery

76. Lumbar Spine Fractures and Dislocations (Overview)

fractures of the vertebral column each year, and 11,000 of these patients sustain spinal cord injuries. [ ] The thoracolumbar spine and lumbar spine are the most common sites for fractures because of the high mobility of the lumbar spine compared to the more rigid thoracic spine. [ ] Injury to the cord or cauda equina occurs in approximately 10-38% of adult thoracolumbar fractures and in as many as 50-60% of fracture dislocations. The rate of bony injury without neurologic consequence is undoubtedly (...) of the spine based on the system introduced by Cotrel and Dubousset. This article reviews the diagnosis and management of acute lumbar vertebral fractures. (For more information, see and ) Next: Anatomy Anatomic components The lumbar spine consists of a mobile segment of five vertebrae, which are located between the relatively immobile segments of the thoracic and sacral segments. The thoracic spine is stabilized by the attached rib cage and intercostal musculature, whereas the sacral segments are fused

2014 eMedicine Surgery

77. Lumbar Spine Fractures and Dislocations (Follow-up)

into the spinal canal. A tap is then used to create the threads for the screws. Finally, the screws can be placed under continuous fluoroscopic guidance. A depth of 50-75% of the anteroposterior (AP) vertebral body diameter is usually recommended for lumbar fixation, while bicortical screw purchase is recommended for sacral fixation. The position of the screws is then assessed electrophysiologically with a nerve stimulator and radiologically with an AP, lateral, and two-dimensional scan of the spine performed (...) , Hurlbert RJ, Anderson P, Fehlings M, Rampersaud R, Massicotte EM, et al. Neurologic deterioration secondary to unrecognized spinal instability following trauma--a multicenter study. Spine (Phila Pa 1976) . 2006 Feb 15. 31 (4):451-8. . Kinoshita T, Ebara S, Kamimura M, Tateiwa Y, Itoh H, Yuzawa Y, et al. Nontraumatic lumbar vertebral compression fracture as a risk factor for femoral neck fractures in involutional osteoporotic patients. J Bone Miner Metab . 1999. 17 (3):201-5. . Castaño-Betancourt MC

2014 eMedicine Surgery

78. Spinal Cord, Topographical and Functional Anatomy (Overview)

impairment of , sensory, or function. This review focuses on spinal cord anatomy. Basic clinical descriptions of common patterns of spinal cord involvement are related to essential aspects of spinal cord anatomy. The is located inside the vertebral canal, which is formed by the foramina of 7 cervical, 12 thoracic, 5 lumbar, and 5 sacral vertebrae, which together form the spine. The spinal cord extends from the foramen magnum down to the level of the first and second lumbar vertebrae (at birth, down (...) to second and third lumbar vertebrae). See the image below. Spine, anterior view. The spinal cord is composed of the following 31 segments: 8 cervical (C) segments 12 thoracic (T) segments 5 lumbar (L) segments 5 sacral (S) segments 1 coccygeal (Co) segment - mainly vestigial The spinal nerves consist of the sensory nerve roots, which enter the spinal cord at each level, and the motor roots, which emerge from the cord at each level. The spinal nerves are named and numbered according to the site

2014 eMedicine.com

79. Spinal Cord, Topographical and Functional Anatomy (Treatment)

impairment of , sensory, or function. This review focuses on spinal cord anatomy. Basic clinical descriptions of common patterns of spinal cord involvement are related to essential aspects of spinal cord anatomy. The is located inside the vertebral canal, which is formed by the foramina of 7 cervical, 12 thoracic, 5 lumbar, and 5 sacral vertebrae, which together form the spine. The spinal cord extends from the foramen magnum down to the level of the first and second lumbar vertebrae (at birth, down (...) to second and third lumbar vertebrae). See the image below. Spine, anterior view. The spinal cord is composed of the following 31 segments: 8 cervical (C) segments 12 thoracic (T) segments 5 lumbar (L) segments 5 sacral (S) segments 1 coccygeal (Co) segment - mainly vestigial The spinal nerves consist of the sensory nerve roots, which enter the spinal cord at each level, and the motor roots, which emerge from the cord at each level. The spinal nerves are named and numbered according to the site

2014 eMedicine.com

80. Spinal Cord, Topographical and Functional Anatomy (Follow-up)

impairment of , sensory, or function. This review focuses on spinal cord anatomy. Basic clinical descriptions of common patterns of spinal cord involvement are related to essential aspects of spinal cord anatomy. The is located inside the vertebral canal, which is formed by the foramina of 7 cervical, 12 thoracic, 5 lumbar, and 5 sacral vertebrae, which together form the spine. The spinal cord extends from the foramen magnum down to the level of the first and second lumbar vertebrae (at birth, down (...) to second and third lumbar vertebrae). See the image below. Spine, anterior view. The spinal cord is composed of the following 31 segments: 8 cervical (C) segments 12 thoracic (T) segments 5 lumbar (L) segments 5 sacral (S) segments 1 coccygeal (Co) segment - mainly vestigial The spinal nerves consist of the sensory nerve roots, which enter the spinal cord at each level, and the motor roots, which emerge from the cord at each level. The spinal nerves are named and numbered according to the site

2014 eMedicine.com

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