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Thoracic Spine Anatomy

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81. Rheumatoid Arthritis, Spine

be made. There is a close correlation between the severity of cervical myelopathy and the degree of compression as demonstrated by MRI. Besides influencing the selection of patients for spinal surgery, MRIs can help in planning surgical procedures, especially those in patients with more than 2 levels of cord compression. [ , , ] Computed tomography allows for a very precise assessment of bone structure of the whole cervical spine. The anatomy of the atlantoaxial joint is more visible than on plain (...) and lumbar spine are reported only infrequently. Alterations at the discovertebral junctions have also been noted. Intervertebral disk-space narrowing, irregularity of the subchondral margins of the vertebral bodies, erosion, and sclerosis can be evident on radiography. Patients with RA who are receiving corticosteroid medication are predisposed to ischemic necrosis of bone. Although the femoral head is the usual site for this, vertebral bodies in the thoracic and lumbar regions of the spine can

2014 eMedicine Radiology

82. Lumbar Spine Fractures and Dislocations (Treatment)

resuscitated, plain films of the cervical, thoracic, and lumbosacral spine should be obtained. When possible, a detailed history should be obtained to ascertain the mechanism of injury and the relative force sustained. Individuals who sustain falls often have hyperflexion injuries at the thoracolumbar region in association with pelvic and lower-extremity fractures. Persons who wore seat belts during motor vehicle accidents often have distraction injuries or associated cervical spine injuries (...) at the thoracolumbar junction and neurologic deficits. In contrast with patients with spinal cord injuries at the cervical and thoracic spine, patients with nerve root compression at the lumbosacral region often achieve better outcomes following surgical decompression. The effect of the timing of decompressive surgery on the rate of neurologic recovery also has remained unclear. [ , ] Improved neurologic function has been reported with early and late decompression. Most studies have reported on the neurologic

2014 eMedicine Surgery

83. Lumbar Spine Fractures and Dislocations (Overview)

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 (...) Lumbar Spine Fractures and Dislocations (Overview) Lumbar Spine Fractures and Dislocations: Background, Anatomy, Pathophysiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI2NDE5MS1vdmVydmlldw== processing

2014 eMedicine Surgery

84. Lower Cervical Spine Fractures and Dislocations (Overview)

Lower Cervical Spine Fractures and Dislocations (Overview) Lower Cervical Spine Fractures and Dislocations: Background, Anatomy, Pathophysiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) , resulting in bony or soft-tissue injury; however, the presence of multiple traumatic injuries may distract the examiner from the cervical spine. In the evaluation of the patient, examining the cervical spine is a high priority and must take precedence. The cervical spine is important to consider in positioning the head in space. The dominant motion in the lower cervical spine is flexion-extension, but the cervical spine's anatomy permits a fair amount of motion in all planes. In high-speed injuries

2014 eMedicine Surgery

85. Thoracic Outlet Syndrome (Treatment)

Res . 2000 May-Jun. 31(3):258-62. . Cherington M, Happer I, Machanic B, et al. Surgery for thoracic outlet syndrome may be hazardous to your health. Muscle Nerve . 1986 Sep. 9(7):632-4. . Abe M, Ichinohe K, Nishida J. Diagnosis, treatment, and complications of thoracic outlet syndrome. J Orthop Sci . 1999. 4(1):66-9. . Bowen BC, Pattany PM, Saraf-Lavi E, Maravilla KR. The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimaging Clin N Am . 2004 Feb. 14(1):59-85, vii-viii. . Chen DJ (...) angiography of thoracic outlet syndrome: functional anatomy. AJR Am J Roentgenol . 2000 Jun. 174(6):1667-74. . Roos DB. Edgar J. Poth Lecture. Thoracic outlet syndromes: update 1987. Am J Surg . 1987 Dec. 154(6):568-73. . Roos DB. New concepts of thoracic outlet syndrome that explain etiology, symptoms, diagnosis and treatment. Vasc Surg . 1979. 13:313-21. Rowbotham M, Harden N, Stacey B. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA . 1998 Dec 2. 280(21):1837

2014 eMedicine.com

86. Thoracic Outlet Syndrome (Overview)

of thoracic outlet syndrome. J Orthop Sci . 1999. 4(1):66-9. . Bowen BC, Pattany PM, Saraf-Lavi E, Maravilla KR. The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimaging Clin N Am . 2004 Feb. 14(1):59-85, vii-viii. . Chen DJ, Chuang DC, Wei FC. Unusual thoracic outlet syndrome secondary to fractured clavicle. J Trauma . 2002 Feb. 52(2):393-9. . Cherington M, Wilbourn AJ. Neurovascular compression in the thoracic outlet syndrome. Ann Surg . 1999 Dec. 230(6):829-30. . Dawson DM (...) of diabetic peripheral neuropathic pain. Pain Med . 2005 Sep-Oct. 6(5):346-56. . Rayan GM. Thoracic outlet syndrome. J Shoulder Elbow Surg . 1998 Jul-Aug. 7(4):440-51. . Remy-Jardin M, Remy J, Masson P, et al. Helical CT angiography of thoracic outlet syndrome: functional anatomy. AJR Am J Roentgenol . 2000 Jun. 174(6):1667-74. . Roos DB. Edgar J. Poth Lecture. Thoracic outlet syndromes: update 1987. Am J Surg . 1987 Dec. 154(6):568-73. . Roos DB. New concepts of thoracic outlet syndrome that explain

2014 eMedicine.com

87. Thoracic Outlet Syndrome (Overview)

bundle, which is particularly aggravated with arm elevation (abduction). [ ] Previous Next: Epidemiology Frequency United States The inability to make a definitive and accurate diagnosis makes determination of the exact prevalence of this condition impossible. The prevalence of nonspecific thoracic outlet syndrome (TOS) has been reported as high as 23% of soft-tissue injuries of the cervical spine. TOS is overlooked or misdiagnosed commonly, especially upon presentation to the emergency department (...) . Clin Sports Med . 1999 Apr. 18(2):361-78. . Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg . 1976 Dec. 132(6):771-8. . Roos DB. Thoracic outlet syndrome is underdiagnosed. Muscle Nerve . 1999 Jan. 22(1):126-9; discussion 137-8. . Sucher BM. Palpatory diagnosis and manipulative management of carpal tunnel syndrome: Part 2. 'Double crush' and thoracic outlet syndrome. J Am Osteopath Assoc . 1995 Aug. 95(8):471-9. . Sucher

2014 eMedicine.com

88. Thoracic Disc Injuries (Overview)

Thoracic Disc Injuries (Overview) Thoracic Disc Injuries: Background, Epidemiology, Functional Anatomy Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTYxNjgtb3ZlcnZpZXc= processing > Thoracic Disc Injuries (...) intervention. [ ] (See also the articles and [in the Radiology section], [in the Sports Medicine section], [in the Neurosurgery section], and [in the Orthopedic Surgery section], as well as and on Medscape.) For patient education resources, see the , , , and , as well as and . Next: Epidemiology Frequency United States The incidence of thoracic disc injuries is 1 in 1 million persons per year, and these injuries account for 0.25-0.75% of all disc herniations. [ ] Previous Next: Functional Anatomy

2014 eMedicine.com

89. Thoracic Discogenic Pain Syndrome (Overview)

annually. Although the frequency of thoracic discectomies is increasing, they are still performed much less frequently than discectomies in the cervical or lumbar regions. These procedures represent approximately 0.13-0.15% of admissions for disc disease and from 0.2% to 4% of all discectomies. Previous Next: Functional Anatomy The thoracic region of the spine is relatively inflexible and functions primarily to provide erect posture and assist in weight bearing of the trunk, head, and upper extremities (...) Thoracic Discogenic Pain Syndrome (Overview) Thoracic Discogenic Pain Syndrome: Background, Epidemiology, Functional Anatomy Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTYyODQtb3ZlcnZpZXc= processing

2014 eMedicine.com

90. Thoracic Outlet Syndrome (Follow-up)

. Muscle Nerve . 1986 Sep. 9(7):632-4. . Abe M, Ichinohe K, Nishida J. Diagnosis, treatment, and complications of thoracic outlet syndrome. J Orthop Sci . 1999. 4(1):66-9. . Bowen BC, Pattany PM, Saraf-Lavi E, Maravilla KR. The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimaging Clin N Am . 2004 Feb. 14(1):59-85, vii-viii. . Chen DJ, Chuang DC, Wei FC. Unusual thoracic outlet syndrome secondary to fractured clavicle. J Trauma . 2002 Feb. 52(2):393-9. . Cherington M, Wilbourn AJ (...) , Pritchett YL, Wang F. A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med . 2005 Sep-Oct. 6(5):346-56. . Rayan GM. Thoracic outlet syndrome. J Shoulder Elbow Surg . 1998 Jul-Aug. 7(4):440-51. . Remy-Jardin M, Remy J, Masson P, et al. Helical CT angiography of thoracic outlet syndrome: functional anatomy. AJR Am J Roentgenol . 2000 Jun. 174(6):1667-74. . Roos DB. Edgar J. Poth Lecture. Thoracic outlet syndromes

2014 eMedicine.com

91. Thoracic Outlet Syndrome (Diagnosis)

bundle, which is particularly aggravated with arm elevation (abduction). [ ] Previous Next: Epidemiology Frequency United States The inability to make a definitive and accurate diagnosis makes determination of the exact prevalence of this condition impossible. The prevalence of nonspecific thoracic outlet syndrome (TOS) has been reported as high as 23% of soft-tissue injuries of the cervical spine. TOS is overlooked or misdiagnosed commonly, especially upon presentation to the emergency department (...) . Clin Sports Med . 1999 Apr. 18(2):361-78. . Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg . 1976 Dec. 132(6):771-8. . Roos DB. Thoracic outlet syndrome is underdiagnosed. Muscle Nerve . 1999 Jan. 22(1):126-9; discussion 137-8. . Sucher BM. Palpatory diagnosis and manipulative management of carpal tunnel syndrome: Part 2. 'Double crush' and thoracic outlet syndrome. J Am Osteopath Assoc . 1995 Aug. 95(8):471-9. . Sucher

2014 eMedicine.com

92. Thoracic Outlet Syndrome (Diagnosis)

of thoracic outlet syndrome. J Orthop Sci . 1999. 4(1):66-9. . Bowen BC, Pattany PM, Saraf-Lavi E, Maravilla KR. The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimaging Clin N Am . 2004 Feb. 14(1):59-85, vii-viii. . Chen DJ, Chuang DC, Wei FC. Unusual thoracic outlet syndrome secondary to fractured clavicle. J Trauma . 2002 Feb. 52(2):393-9. . Cherington M, Wilbourn AJ. Neurovascular compression in the thoracic outlet syndrome. Ann Surg . 1999 Dec. 230(6):829-30. . Dawson DM (...) of diabetic peripheral neuropathic pain. Pain Med . 2005 Sep-Oct. 6(5):346-56. . Rayan GM. Thoracic outlet syndrome. J Shoulder Elbow Surg . 1998 Jul-Aug. 7(4):440-51. . Remy-Jardin M, Remy J, Masson P, et al. Helical CT angiography of thoracic outlet syndrome: functional anatomy. AJR Am J Roentgenol . 2000 Jun. 174(6):1667-74. . Roos DB. Edgar J. Poth Lecture. Thoracic outlet syndromes: update 1987. Am J Surg . 1987 Dec. 154(6):568-73. . Roos DB. New concepts of thoracic outlet syndrome that explain

2014 eMedicine.com

93. Thoracic Disc Injuries (Diagnosis)

Thoracic Disc Injuries (Diagnosis) Thoracic Disc Injuries: Background, Epidemiology, Functional Anatomy Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTYxNjgtb3ZlcnZpZXc= processing > Thoracic Disc Injuries (...) intervention. [ ] (See also the articles and [in the Radiology section], [in the Sports Medicine section], [in the Neurosurgery section], and [in the Orthopedic Surgery section], as well as and on Medscape.) For patient education resources, see the , , , and , as well as and . Next: Epidemiology Frequency United States The incidence of thoracic disc injuries is 1 in 1 million persons per year, and these injuries account for 0.25-0.75% of all disc herniations. [ ] Previous Next: Functional Anatomy

2014 eMedicine.com

94. Thoracic Discogenic Pain Syndrome (Diagnosis)

annually. Although the frequency of thoracic discectomies is increasing, they are still performed much less frequently than discectomies in the cervical or lumbar regions. These procedures represent approximately 0.13-0.15% of admissions for disc disease and from 0.2% to 4% of all discectomies. Previous Next: Functional Anatomy The thoracic region of the spine is relatively inflexible and functions primarily to provide erect posture and assist in weight bearing of the trunk, head, and upper extremities (...) Thoracic Discogenic Pain Syndrome (Diagnosis) Thoracic Discogenic Pain Syndrome: Background, Epidemiology, Functional Anatomy Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTYyODQtb3ZlcnZpZXc= processing

2014 eMedicine.com

95. Thoracic Outlet Syndrome

with a cervical spine view or thoracic inlet view can effectively depict congenital or acquired bony anomalies that aid in the diagnosis of TOS. Cervical ribs, prominent or elongated C7 transverse processes, abnormal or elongated first ribs, and large fracture calluses are easily detected on plain radiographs. Radiography is important if prior images are not available. Such findings may help focus subsequent more complex and more invasive radiologic studies of a particular region. In addition, unsuspected (...) concluded that reconstructed volume-rendering images have the highest sensitivity (95%) and specificity (100%), compared with cross-sectional imaging and image reconstruction with multiplanar and 3-dimensional-shaded surface display techniques. [ ] In another article, Remy-Jardin et al describe changes in the functional anatomy of the thoracic outlet in 79 patients with symptomatic thoracic outlet syndrome who underwent CT angiography. [ , , ] Most clinicians consider arteriography or venography

2014 eMedicine Radiology

96. Sarcoidosis, Thoracic

on coronal images. [ , , ] MRI is also useful in characterizing osseous involvement with sarcoid, particularly in the spine. [ ] Degree of confidence As yet, MRI has not supplanted CT in the evaluation of thoracic sarcoidosis. Technical difficulties still exist with MRI, and cardiorespiratory movement remains a problem in thoracic imaging. In patients with chronic infiltrative lung disease, MRI appears equal to CT in the demonstration of areas of airspace opacification, but it is inferior to CT (...) . Value of MR imaging in the evaluation of chronic infiltrative lung diseases: comparison with CT. AJR Am J Roentgenol . 1992 Jun. 158(6):1205-9. . Cohen NP, Gosset J, Staron RB, Levine WN. Vertebral sarcoidosis of the spine in a football player. Am J Orthop . 2001 Dec. 30(12):875-7. . Gorkem SB, Köse S, Lee EY, Doğanay S, Coskun AS, Köse M. Thoracic MRI evaluation of sarcoidosis in children. Pediatr Pulmonol . 2017 Apr. 52 (4):494-499. . Nakamura T, Sugihara H, Narihara R, et al. Antemortem diagnosis

2014 eMedicine Radiology

97. Clinical anatomy of vertebrae in scoliosis: global analysis in four different diseases by multiplanar reconstructive computed tomography. (PubMed)

Clinical anatomy of vertebrae in scoliosis: global analysis in four different diseases by multiplanar reconstructive computed tomography. Few accurate analyses of clinically useful vertebral anatomy have been conducted, and most have focused on thoracic idiopathic scoliosis.To evaluate the different anatomic characteristics in scoliosis by disease type and level.Observational cohort study.Forty-eight patients with scoliosis were included in this study.Subjects underwent computed tomography (CT (...) ) of the whole spine.Forty-eight patients with scoliosis were included in this study: 15 adolescent idiopathic, 11 cerebral palsy (CP), 10 muscular dystrophy (MD), and 12 congenital (CG) scoliosis patients with similar demographics. Subjects underwent CT of the whole spine, preoperatively. Eight anatomic parameters were measured in multiplanar reconstructive CT images, and statistical analysis was performed to investigate differences.In general, values in the anatomic parameters were similar for the four

2013 The Spine Journal

98. Anatomy of large animal spines and its comparison to the human spine: a systematic review. (PubMed)

Anatomy of large animal spines and its comparison to the human spine: a systematic review. Animal models have been commonly used for in vivo and in vitro spinal research. However, the extent to which animal models resemble the human spine has not been well known. We conducted a systematic review to compare the morphometric features of vertebrae between human and animal species, so as to give some suggestions on how to choose an appropriate animal model in spine research. A literature search (...) of all English language peer-reviewed publications was conducted using PubMed, OVID, Springer and Elsevier (Science Direct) for the years 1980-2008. Two reviewers extracted data on the anatomy of large animal spines from the identified articles. Each anatomical study of animals had to include at least three vertebral levels. The anatomical data from all animal studies were compared with the existing data of the human spine in the literature. Of the papers retrieved, seven were included in the review

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2010 European Spine Journal

99. Langerhans cell histiocytosis of spine: a comparative study of clinical, imaging features, and diagnosis in children, adolescents, and adults. (PubMed)

and was the only presenting symptom in some patients. Restricted motion of spine was the most frequent symptom secondary to pain. Thirty-seven patients presented with neurologic symptoms. Adult patients were more likely to suffer neurologic deficits (p<.005). The distribution of lesions revealed predominance in the cervical spine, followed by thoracic and lumbosacral spine. Plain radiology of children and adolescents with spinal LCH usually revealed a typical vertebral plana, but the adult patients represented (...) of the spine were neck or back pain, followed by restricted motion of spine, neurologic symptoms, and deformity. Neurologic deficits were more frequent in adult patients. Vertebral plana is the typical imaging feature in children and adolescent patients but seldom in adults. Computed tomography is best for characterizing anatomy of the involved vertebra, and MRI is best for delineating marrow and soft tissue. The oversleeve-like sign on MRI may be a feature of spinal LCH as well as vertebra plana

2013 The Spine Journal

100. The Safety and Accuracy of Freehand Pedicle Screw Placement in the Subaxial Cervical Spine: A Series of 45 Consecutive Patients. (PubMed)

The Safety and Accuracy of Freehand Pedicle Screw Placement in the Subaxial Cervical Spine: A Series of 45 Consecutive Patients. Retrospective cohort study.To assess the safety and accuracy of subaxial cervical pedicle screw placement with freehand technique and to report the technical nuances.Although the efficacy and safety of freehand screw fixation in thoracic and lumbar vertebrae is proven, reports on this technique of screw insertion in the subaxial cervical spine are lacking.From March (...) 2012 to September 2013, 45 consecutive patients underwent posterior cervical fusion. The diagnoses were trauma (22 patients), degenerative disease (18 patients), discitis/osteomyelitis (2 patients), pathological fracture (2 patients), and postlaminoplasty kyphosis (1 patient). Preoperative computed tomography (CT) was performed in all patients. We included patients whose outer diameter of the pedicle was greater than 3.0 mm. The standard entry points were modified according to the CT anatomy

2013 Spine

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