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An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain - Part 2 - Guidance and Recommendations Objective: To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain. Methodology: Systematic assessment of the literature. Evidence: I. LumbarSpine • The evidence for accuracy of diagnostic selective nerve root blocks is limited; whereas for lumbar provocation (...) disc decompression, and implantable therapies. V. MAnAGEMEnT of LoW BACK PAIn Low back pain is the most common of all spinal, and even chronic, pain problems. Lumbar intervertebral discs, facet joints, sacroiliac joints, ligaments, fascia, muscles, and nerve root dura have been shown to be capable of transmitting pain in the lumbarspine with resulting symptoms of low back pain and lower extrem- ity pain (8,10,11,13,17,33,36,374,551). Lumbar disc herniation and spinal stenosis are di- agnosed
Chest pain Chest pain - NICE CKS Share Chest pain: Summary Chest pain refers to pain in the thorax. It can be classified by: Cause (such as cardiac or non-cardiac). Type (such as localized or poorly localized, pleuritic or non-pleuritic). Cardiac causes of chest pain include: Acute coronary syndrome (unstable angina and myocardial infarction). Stable angina. Other cardiac causes, such as dissecting thoracic aneurysm, pericarditis, cardiac tamponade, myocarditis, acute congestive cardiac failure (...) , or arrhythmias. Respiratory causes of chest pain include: Pulmonary embolus, pneumothorax or tension pneumothorax, community-acquired pneumonia, asthma, or pleural effusion. Other causes of chest pain include: Gastroenterological causes, such as acute pancreatitis, oesophageal rupture, peptic ulcer disease, gastro-oesophageal reflux, oesophageal spasm, or oesophagitis. Musculoskeletal causes, such as rib fracture, costochondritis, spinal disorders (disc prolapse, cervical spondylosis, facet joint dysfunction
% freedom from all-cause mortality and a 99% freedom from thoracic aortic aneurysm-related mortality. At one or more time points ≤1 year, type I endoleak (all distal) was observed in 4 patients, type III endoleak in 2, and aneurysm growth in 4. Five patients experienced stroke ≤1 year (2 procedure-related). No aortic rupture, paraplegia, paralysis, or permanent spinal cord injury was observed ≤1 year.Early outcomes after Zenith Alpha implantation appear promising and suggest expanded thoracic (...) One-year outcomes from the international multicenter study of the Zenith Alpha Thoracic Endovascular Graft for thoracic endovascular repair. This study evaluated the safety and effectiveness of the Zenith Alpha Thoracic Endovascular Graft (Cook Medical, Bloomington, Ind) for the treatment of descending thoracic aortic aneurysms and large ulcers.The Zenith Alpha Thoracic Endovascular Graft, with a 16F to 20F delivery system, was developed to address vascular access issues associated with larger
subsurface anatomy and allow tracking the position of surgical instruments in real-time, using an intraoperative non-contact optical imaging system during spinal surgical procedures. This is based on the completed preliminary study of 40 spinal procedures. The specific research aim is as follows: Validate the ability of the BBL surgical navigation prototype to function as the sole navigation system during spinal surgical procedures. The study will focus on testing the robustness of the system (...) Information Go to Publications: Merloz P, Tonetti J, Eld A, et al, Computer-assisted versus manual spine surgery: Clinical report, Springer Berlin, 1997. Zdichaversusky M, Blauth M, Knop C, Graessner M, Herrmann H, Krettek C, Bastian L, Accuracy of Pedicle Screw Placement in ThoracicSpine Fractures, European Journal of Trauma, 30:234-240, 2004. Layout table for additonal information Responsible Party: Dr. Victor Yang, Senior Scientist, Physical Sciences Platform, Sunnybrook Health Sciences Centre
Rib head dislocation causing spinal canal stenosis in a child with neurofibromatosis, type 1 A 10-year-old female with neurofibromatosis type 1 and severe dystrophic scoliosis presented with a two-month history of difficulty ambulating due to low back pain. The patient did not have any neurological symptoms. MRI of the thoracolumbar spine demonstrated subluxation of the right posterior tenth and eleventh ribs through their respective neural foramina, with mild mass effect on the thecal sac (...) of transverse processes, and penciling of the apical ribs. These changes can alter the articulation of the rib along the transverse process. The enlarged foramina can also create a larger space into which a rib may displace. As a result, in most reported cases, the subluxed ribs were on the convex apex of the curve in the mid-to-lower thoracic region. The risk of cord injury from rib head dislocation makes the complete depiction of the anatomy essential for proper surgical management.
Safety and Tolerability of TAR-302-5018 in Subjects With Neurogenic Detrusor Overactivity Resulting From Spinal Cord Injury Safety and Tolerability of TAR-302-5018 in Subjects With Neurogenic Detrusor Overactivity Resulting From Spinal Cord Injury - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached (...) the maximum number of saved studies (100). Please remove one or more studies before adding more. Safety and Tolerability of TAR-302-5018 in Subjects With Neurogenic Detrusor Overactivity Resulting From Spinal Cord Injury The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03168828 Recruitment Status : Active
Change in Lung Volume Following Thoracoscopic Anterior Spinal Fusion Surgery: A 3-Dimensional Computed Tomography Investigation. Lung volumes and thoracicanatomy were measured from low-dose computed tomography (CT) scans preoperatively and 2 years following thoracoscopic anterior spinal fusion (TASF) for adolescent idiopathic scoliosis (AIS).The aim of this study was to assess changes in lung volume after TASF surgical correction.AIS patients are known to have decreased pulmonary function (...) as a consequence of their spinal and ribcage deformity. Several studies have evaluated changes in pulmonary function clinically after scoliosis correction surgery showing varied results. To date, there have been no published studies using CT to evaluate lung volume changes following TASF.Twenty-three female AIS patients with both pre- and 2 years postoperative low-dose CT scans were selected from an ethically approved, historical databank. Three-dimensional lung volumes were reconstructed to determine
, Garland LW. Aortic injury: comparison of supine and upright portable chest films to evaluate the widened mediastinum. Ann Emerg Med. 1984;13(10):896-899. 15. Khosla A, Ocel J, Rad AE, Kallmes DF. Correlating first- and second-rib fractures noted on spine computed tomography with major vessel injury. Emerg Radiol. 2010;17(6):461-464. 16. Barrios C, Malinoski D, Dolich M, Lekawa M, Hoyt D, Cinat M. Utility of thoracic computed tomography after blunt trauma: when is chest radiograph enough? Am Surg (...) definitive studies. ? MRA chest without and with IV contrast 7 This procedure should be performed on patients with contraindication to CTA. O Aortography thoracic 6 ??? CT chest without IV contrast 5 ??? US echocardiography transesophageal 5 O MRA chest without IV contrast 5 O Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level ACR Appropriateness Criteria ® 2 Blunt Chest Trauma — Suspected Aortic Injury BLUNT CHEST TRAUMA — SUSPECTED
Cerebral Spinal Fluid Cerebral Spinal Fluid Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Cerebral Spinal Fluid Cerebral Spinal (...) Fluid Aka: Cerebral Spinal Fluid , CSF II. Definitions Cerebrospinal Fluid Clear, colorless fluid produced in the plexus within the walls of the s Flows through the s within the subarachnoid space Surrounds and protects the brain and spinal cord III. Physiology Plexus: Formation of CSF Tufts of capillaries in s Produces CSF at 20 ml/hour (up to 500 ml/day) Pathway See for CSF flows down Magendie and Luschka canals and via subarachnoid space around the brain and spinal cord CSF Reabsorption CSF
Computed tomography of the thorax in rabbits: a prospective study in ten clinically healthy New Zealand White rabbits Literature investigating the normal cross-sectional anatomy of rabbits with computed tomography (CT) is sparse and incomplete. The purpose of the present study was to investigate the normal thoracic structures, in particular the cranial thorax, with CT angiography in 10 clinically healthy New Zealand White (NZW) rabbits.Absolute and relative measurements of the trachea, heart (...) , thoracic caudal vena cava and aorta, right and left principal bronchi, right and left caudal lobar bronchi and the accompanying branches of the right and left pulmonary artery and vein, right and left lung volume and lung density were taken. The three lobes of the thymus (right ventral, right dorsal and left thoracic lobes) were identified in all rabbits. Both the right dorsal and left thoracic lobes of the thymus extended between the heart and thoracic wall in all individuals with the left lobe
. If there is a clinical concern for spinal injury, MRI should be considered in pediatric patients. CT may be used when radiographs of a spinal segment (cervical, thoracic, lumbar, and/or sacral spine) are abnormal, equivocal, or nondiagnostic following a traumatic event. CT can be used for evaluating vertebral compression/insufficiency fractures in both acute and chronic clinical situations [1-15]. 2. Degenerative conditions and osteoarthritis evaluation. CT is often used to study the spine for conditions (...) multi-detector row CT. AJNR 2003;24:13-17. 9. Nunez DB, Jr. Helical CT for the Evaluation of Cervical Vertebral Injuries. Semin Musculoskelet Radiol 1998;2:19-26. 10. Obenauer S, Alamo L, Herold T, Funke M, Kopka L, Grabbe E. Imaging skeletal anatomy of injured cervical spine specimens: comparison of single-slice vs multi-slice helical CT. Eur Radiol 2002;12:2107- 2111. 11. Rivas LA, Fishman JE, Munera F, Bajayo DE. Multislice CT in thoracic trauma. Radiol Clin North Am 2003;41:599-616. 12. Stabler
Primary Failure of Thoracic Epidural Analgesia in Training Centers: The Invisible Elephant? In teaching centers, primary failure of thoracic epidural analgesia can be due to multiple etiologies. In addition to the difficult anatomy of the thoracicspine, the conventional end point-loss-of-resistance-lacks specificity. Furthermore, insufficient training compounds the problem: learning curves are nonexistent, pedagogical requirements are often inadequate, supervisors may be inexperienced (...) , and exposure during residency is decreasing. Any viable solution needs to be multifaceted. Learning curves should be explored to determine the minimal number of blocks required for proficiency. The problem of decreasing caseload can be tackled with epidural simulators to supplement in vivo learning. From a technical standpoint, fluoroscopy and ultrasonography could be used to navigate the complex anatomy of the thoracicspine. Finally, correct identification of the thoracic epidural space should
of 2.5 mm. The sections were examined under a stereomicroscope.Three type II cysts were in the thoracicspine and had a common feature that a clearly identifiable cyst neck connected the cyst body to the subarachnoid space. The dorsal root of the spinal nerve was centered in the cyst neck but spread over the cyst body or traversed the cyst cavity. The meningeal opening of the cyst was located above the inferior border of the vertebral pedicle, thus, the cyst neck hugged around the pedicle and sharply (...) Fine Configuration of Thoracic Type II Meningeal Cysts: Macro-/Microscopic Cadaveric Study Using Epoxy Sheet Plastination. A cadaveric study OBJECTIVE.: The aim of this study was to analyze the in situ macro- and microscopic configuration of the type II cyst and its anatomic relationship with surrounding structures.The lack of consensus of surgical strategy to manage symptomatic type II meningeal cysts (Tarlov cysts) is because our knowledge of type II cyst anatomy remains incomplete. It has
Freehand Thoracic Pedicle Screw Placement: Review of Existing Strategies and a Step-by-Step Guide Using Uniform Landmarks for All Levels Pedicle screw fixation in the thoracicspine presents certain challenges due to the critical regional neurovascular anatomy as well as the narrow pedicular corridor that typically exists. With increased awareness of the dangers of intraoperative radiation, the ability to place pedicle screws with anatomic landmarks alone is paramount. In this study, we (...) reviewed the literature from 1990 to 2015 for studies that included freehand pedicle screw placement in the thoracicspine with special emphasis on entry points and the trajectories of the screws. We excluded studies that used fluoroscopy guidance, navigation techniques, cadaveric and biomechanical articles, case reports, and experimental studies on animals. The search retrieved 40 articles, and after careful selection, seven articles were analyzed. Over 8,000 screws were placed in the different
Placement of Thoracic Pedicle Screws Thoracic pedicle screws have become the spinal anchor of choice because of the superior biomechanics of this technique. It is widely used for the treatment of scoliosis, spinal deformity (such as kyphosis), trauma, tumors, infection, and other pathologies. The technique demands precision as malposition can result in spinal cord or visceral injury with potential catastrophic consequences (death or paralysis). There have been many published articles looking (...) imaging to ensure that they have not cut or plowed out. The results of thoracic pedicle screw placement are specific to the spinal condition treated. For adolescent idiopathic scoliosis, no brace is needed and walking can be progressed as tolerated. With good thoracic screw placement, rehabilitation typically is accelerated because a stable spinal construct is achieved. Most patients are able to walk without any sort of external mobilization or special adjunctive protection.
Korean Registry of Thoracic Endovascular Aortic Repair Timing for Type B Aortic Dissection (K-TEAM Study): A Prospective Multicenter Registry Korean Registry of Thoracic Endovascular Aortic Repair Timing for Type B Aortic Dissection (K-TEAM Study): A Prospective Multicenter Registry - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save (...) this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Korean Registry of Thoracic Endovascular Aortic Repair Timing for Type B Aortic Dissection (K-TEAM Study): A Prospective Multicenter Registry The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details
Subarachnoid-Pleural Fistula: Applied Anatomy of the ThoracicSpinal Nerve Root Subarachnoid-pleural fistula (SPF) is a rare complication of chest or spine operations for neoplastic disease. Concomitant dural and parietal pleural defects permit flow of cerebrospinal fluid into the pleural cavity or intrapleural air into the subarachnoid space. Dural injury recognized intraoperatively permits immediate repair, but unnoticed damage may cause postoperative pleural effusion, intracranial (...) hypotension, meningitis, or pneumocephalus. We review two cases of SPF following surgical intervention for chest wall metastatic disease to motivate a detailed review of the anatomy of neural, osseous, and ligamentous structures at the intervertebral foramen. We further provide recommendations for avoidance and detection of such complication.
MIND Demons for MR-to-CT Deformable Image Registration In Image-Guided Spine Surgery Localization of target anatomy and critical structures defined in preoperative MR images can be achieved by means of multi-modality deformable registration to intraoperative CT. We propose a symmetric diffeomorphic deformable registration algorithm incorporating a modality independent neighborhood descriptor (MIND) and a robust Huber metric for MR-to-CT registration.The method, called MIND Demons, solves (...) . It demonstrated improved registration accuracy in comparison to the reference methods, with mean target registration error (TRE) of 1.5 mm compared to 10.9, 2.3, and 4.6 mm for MI FFD, LMI FFD, and NMI Demons methods, respectively. Validation in clinical studies demonstrated realistic deformation with sub-voxel TRE in cases of cervical, thoracic, and lumbar spine.A modality-independent deformable registration method has been developed to estimate a viscoelastic diffeomorphic map between preoperative MR
Jacobian determinants. It also showed improved registration accuracy in comparison to the reference methods, with mean target registration error (TRE) of 1.7 mm compared to 11.3, 3.1, 5.6, and 2.4 mm for MI FFD, LMI FFD, NMI Demons, and MIND-elastic methods, respectively. Validation in clinical studies demonstrated realistic deformations with sub-voxel TRE in cases of cervical, thoracic, and lumbarspine. (...) MIND Demons: Symmetric Diffeomorphic Deformable Registration of MR and CT for Image-Guided Spine Surgery Intraoperative localization of target anatomy and critical structures defined in preoperative MR/CT images can be achieved through the use of multimodality deformable registration. We propose a symmetric diffeomorphic deformable registration algorithm incorporating a modality-independent neighborhood descriptor (MIND) and a robust Huber metric for MR-to-CT registration. The method, called
procedures were performed through the left side of the chest. Infected tissue was completely debrided and excised. Aortic continuity was restored in situ with a Dacron prosthesis (Macquet Corp, Oakland, NJ). Soft tissue coverage of the prosthesis was performed when anatomy and patient condition permitted. Perioperative outcomes, intermediate-term survival, and reinfection rates were examined.All patients presented with either aneurysm-related symptoms or a clinical picture of sepsis. Diagnosis (...) Outcomes of Open Repair of Mycotic Descending Thoracic and Thoracoabdominal Aortic Aneurysms. The purpose of this study was to evaluate the short- and intermediate-term outcomes of open repair of mycotic thoracic and thoracoabdominal aneurysms. Contemporary surgical and perioperative techniques were utilized.From November 1997 to May 2014, 14 consecutive patients underwent open repair of descending thoracic (n = 9, 64.3%) and thoracoabdominal (n = 5, 35.7%) mycotic aortic aneurysms. All