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Thoracic Spine Anatomy

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161. Vertical Expandable Prosthetic Titanium Rib (VEPTR) for Thoracic Insufficiency Syndrome

to TIS patients with poor pulmonary function at enrollment progressive decline in pulmonary function progressive chest wall and/or spinal deformity lack of appropriate increase in thoracic volume during growth Document efficacy of expansion thoracoplasty for TIS patients Condition or disease Intervention/treatment Thoracic Insufficiency Syndrome (TIS) Device: Synthes VEPTR (Vertical Expandable Prosthetic Titanium Rib) Study Design Go to Layout table for study information Study Type : Observational (...) thoracoplasty therapy to TIS patients meeting certain criteria (provided in description below) [ Time Frame: Enrollment (Baseline), Serial Observation Postop (Change from baseline at: 6 week, 12 week, 6 month, and every 6 months after that.) ] Offer expansion thoracoplasty therapy to TIS patients with poor pulmonary function at enrollment progressive decline in pulmonary function progressive chest wall and/or spinal deformity lack of appropriate increase in thoracic volume during growth Document efficacy

2014 Clinical Trials

162. Quality Improvement Guidelines for the Performance of Inferior Vena Cava Filter Placement for the Prevention of Pulmonary Embolism

of a Green- ?eld ?lter to the pulmonary artery: a case report. J Vasc Surg 1986; 3:929–931. 41. LaPlante JS, Contractor FM, Kiproff PM, Khoury MB. Migration of the Simon nitinol vena cava ?lter to the chest. AJR Am J Roentgenol 1993; 160:385–386. 1504 Quality Improvement Guidelines: IVC Filters for PE Prevention Caplin et al JVIR42. Loesberg A, Taylor FC, Awh MH. Dislodgment of inferior vena caval ?lters during “blind” insertion of central venous catheters. AJR Am J Roentgenol 1993; 161:637–638. 43 (...) Quality Improvement Guidelines for the Performance of Inferior Vena Cava Filter Placement for the Prevention of Pulmonary Embolism STANDARDS OF PRACTICE Quality Improvement Guidelines for the Performance of Inferior Vena Cava Filter Placement for the Prevention of Pulmonary Embolism Drew M. Caplin, MD, Boris Nikolic, MD, MBA, Sanjeeva P. Kalva, MD, Suvranu Ganguli, MD, Wael E.A. Saad, MD, and Darryl A. Zuckerman, MD, for the Society of Interventional Radiology Standards of Practice Committee

2011 Society of Interventional Radiology

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

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 (...) diseases. Each parameter showed the unique change pattern according to the spinal level regardless of curvature shape, direction, or magnitude. In particular, chord length (CL) in MD and CG scoliosis was lower than in adolescent idiopathic scoliosis (AIS) and CP, and pedicle rib unit length was lower in CG scoliosis than in the other diseases (p<.05). Comparisons of convex and concave anatomies in AIS showed that inner pedicle width (PWI) and outer pedicle width (PWO) were wider for convex side, CL

2013 The Spine Journal

164. Thoracic Outlet Syndrome (Follow-up)

):77-9. . Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg . 1976 Dec. 132(6):771-8. . Esposito MD, Arrington JA, Blackshear MN, Murtagh FR, Silbiger ML. Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA. J Magn Reson Imaging . 1997 May-Jun. 7(3):598-9. . Al-Shekhlee A, Katirji B. Spinal accessory neuropathy, droopy shoulder, and thoracic outlet syndrome. Muscle Nerve . 2003 Sep. 28(3):383-5 (...) . . Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery . 2004 Oct. 55(4):897-902; discussion 902-3. . Safran MR. Nerve injury about the shoulder in athletes. Part 2: long thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet syndrome. Am J Sports Med . 2004 Jun. 32(4):1063-76. . Parziale JR, Akelman E, Weiss AP, Green A. Thoracic outlet syndrome. Am J Orthop . 2000 May. 29(5):353-60. . Rutherford RB, Cronewett JL, Gloviczki P. Vascular Surgery . 5th ed. Philadelphia, Pa: WB

2014 eMedicine.com

165. Thoracic Outlet Syndrome (Follow-up)

A, Katirji B. Spinal accessory neuropathy, droopy shoulder, and thoracic outlet syndrome. Muscle Nerve . 2003 Sep. 28(3):383-5. . Illig KA, Donahue D, Duncan A, et al. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. J Vasc Surg . 2016 Sep. 64 (3):e23-35. . Levin LS, Dellon AL. Pathology of the shoulder as it relates to the differential diagnosis of thoracic outlet compression. J Reconstr Microsurg . 1992 Jul. 8(4):313-7. . Plewa MC, Delinger M. The false-positive (...) comprising the thoracic outlet in 250 human cadavers and 72 surgical cases of thoracic outlet syndrome. Eur J Cardiothorac Surg . 1998 Apr. 13(4):353-60. . Richardson AB. Thoracic outlet syndrome in aquatic athletes. 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

2014 eMedicine.com

166. Thoracic Outlet Syndrome (Follow-up)

the effectiveness of chronic noncancer pain control: a chart review. Anesth Analg . 2000 Apr. 90(4):933-7. . Kashyap VS, Ahn SS, Machleder HI. Thoracic outlet neurovascular compression: approaches to anatomic decompression and their limitations. Semin Vasc Surg . 1998 Jun. 11(2):116-22. . Barolat G. Spinal cord stimulation for chronic pain management. Arch Med 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, Chuang DC, Wei FC. Unusual thoracic outlet syndrome secondary to fractured clavicle. J Trauma . 2002 Feb. 52(2):393-9. . Cherington M, Wilbourn AJ

2014 eMedicine.com

167. Thoracic Outlet Syndrome (Diagnosis)

to cervical rib in young athletes. Am J Sports Med . 1988 Jan-Feb. 16(1):77-9. . Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg . 1976 Dec. 132(6):771-8. . Esposito MD, Arrington JA, Blackshear MN, Murtagh FR, Silbiger ML. Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA. J Magn Reson Imaging . 1997 May-Jun. 7(3):598-9. . Al-Shekhlee A, Katirji B. Spinal accessory neuropathy, droopy shoulder (...) Thoracic Outlet Syndrome (Diagnosis) Thoracic Outlet Syndrome: Practice Essentials, 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTY0MTItb3ZlcnZpZXc= processing > Thoracic Outlet

2014 eMedicine.com

168. Thoracic Outlet Syndrome (Diagnosis)

). [ , ] Next: Pathophysiology Thoracic outlet syndrome (TOS) involves compression, injury, or irritation to the neurovascular structures at the root of the neck or upper thoracic region, bounded by the anterior and middle scalenes; between the clavicle and first rib (with possible enlargement/hypertrophy of the subclavius); or beneath the pectoralis minor muscle. Some authors define the thoracic outlet as an opening bordered by the first rib laterally, the vertebral column medially (...) 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

2014 eMedicine.com

169. Thoracic Disc Injuries (Diagnosis)

The thoracic discs are unusually stable compared with the cervical and lumbar discs. The stability of the thoracic discs is secondary to the surrounding rib cage, with the stabilizing effect of the rib articulations. However, the blood supply of the thoracic spine is more tenuous than the cervical and lumbar spine, especially at the T4-T9 watershed area, which is more prone to ischemic injury. Previous Next: Sport-Specific Biomechanics The facet orientation in the thoracic spine is vertical, with a slight (...) medial angulation. This orientation allows for easier lateral bending and rotation versus pure bending. Biomechanical studies have shown that intervertebral discs are at the highest risk of injury when combined with bending and torsional forces. Therefore, the thoracic spine discs are at a decreased risk of injury because of the decreased bending potential in this segment of the spine. The spinal cord-to-canal ratio (the ratio of the cross-sectional area of the cord to the cross-sectional area

2014 eMedicine.com

170. 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 (...) : The ratio of the spinal canal to the thoracic spinal cord is smaller than that found in the cervical and lumbar regions. Although the cross-sectional diameter of the thoracic cord is smaller than that of its cervical or lumbar counterparts, the diameter of the spinal canal is proportionally even smaller. Thus, the ratio of the spinal cord to the canal in the thoracic spine is 40%, whereas this ratio in the cervical spine is only 25%. The dentate ligaments situated between the spinal cord and the nerve

2014 eMedicine.com

171. Thoracic Outlet Syndrome (Diagnosis)

, Ahn SS, Machleder HI. Thoracic outlet neurovascular compression: approaches to anatomic decompression and their limitations. Semin Vasc Surg . 1998 Jun. 11(2):116-22. . Barolat G. Spinal cord stimulation for chronic pain management. Arch Med 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, 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

2014 eMedicine.com

172. Thoracic Outlet Syndrome (Treatment)

brachial plexus compression neuropathy due to cervical rib in young athletes. Am J Sports Med . 1988 Jan-Feb. 16(1):77-9. . Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg . 1976 Dec. 132(6):771-8. . Esposito MD, Arrington JA, Blackshear MN, Murtagh FR, Silbiger ML. Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA. J Magn Reson Imaging . 1997 May-Jun. 7(3):598-9. . Al-Shekhlee A, Katirji B. Spinal (...) for Paget-Schroetter syndrome: 50 years' experience. Ann Thorac Surg . 2008 Jul. 86(1):254-60; discussion 260. . Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery . 2004 Oct. 55(4):897-902; discussion 902-3. . Safran MR. Nerve injury about the shoulder in athletes. Part 2: long thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet syndrome. Am J Sports Med . 2004 Jun. 32(4):1063-76. . Parziale JR, Akelman E, Weiss AP, Green A. Thoracic outlet syndrome. Am J Orthop . 2000 May

2014 eMedicine.com

173. Thoracic Outlet Syndrome (Treatment)

-malignant pain: report of 38 cases. Pain . 1986 May. 25(2):171-86. . Quang-Cantagrel ND, Wallace MS, Magnuson SK. Opioid substitution to improve the effectiveness of chronic noncancer pain control: a chart review. Anesth Analg . 2000 Apr. 90(4):933-7. . Kashyap VS, Ahn SS, Machleder HI. Thoracic outlet neurovascular compression: approaches to anatomic decompression and their limitations. Semin Vasc Surg . 1998 Jun. 11(2):116-22. . Barolat G. Spinal cord stimulation for chronic pain management. Arch Med (...) 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

2014 eMedicine.com

174. Thoracic Outlet Syndrome (Treatment)

posture of patient with thoracic outlet syndrome before (left) and after (right) treatment. Notice the release of the pelvis that occurred with the reduction in hyperlordosis, which allowed the shoulder girdle to drop back and open the thoracic outlet. Image courtesy of The Journal of the American Osteopathic Association Mobilization and manipulation procedures (often performed by an osteopathic physician) usually are indicated and necessary to release tight contracted/restricted vertebral segments (...) treatment have been devastating, especially brachial plexopathy (eg, injury to the long thoracic nerve with scapular winging). Generally, surgery is used as a last resort after a prolonged trial (ie, months) of conservative treatment. Some authors have advocated breast reduction in extreme cases, where very large breasts obviously are adding uncontrollable weight loads to the anterior chest wall. Previous Next: Consultations See the list below: Physical medicine and rehabilitation specialists

2014 eMedicine.com

175. Thoracic Outlet Syndrome (Overview)

, Ahn SS, Machleder HI. Thoracic outlet neurovascular compression: approaches to anatomic decompression and their limitations. Semin Vasc Surg . 1998 Jun. 11(2):116-22. . Barolat G. Spinal cord stimulation for chronic pain management. Arch Med 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, 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

2014 eMedicine.com

176. Thoracic Outlet Syndrome (Overview)

to cervical rib in young athletes. Am J Sports Med . 1988 Jan-Feb. 16(1):77-9. . Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg . 1976 Dec. 132(6):771-8. . Esposito MD, Arrington JA, Blackshear MN, Murtagh FR, Silbiger ML. Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA. J Magn Reson Imaging . 1997 May-Jun. 7(3):598-9. . Al-Shekhlee A, Katirji B. Spinal accessory neuropathy, droopy shoulder (...) Thoracic Outlet Syndrome (Overview) Thoracic Outlet Syndrome: Practice Essentials, 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTY0MTItb3ZlcnZpZXc= processing > Thoracic Outlet

2014 eMedicine.com

177. Thoracic Outlet Syndrome (Overview)

). [ , ] Next: Pathophysiology Thoracic outlet syndrome (TOS) involves compression, injury, or irritation to the neurovascular structures at the root of the neck or upper thoracic region, bounded by the anterior and middle scalenes; between the clavicle and first rib (with possible enlargement/hypertrophy of the subclavius); or beneath the pectoralis minor muscle. Some authors define the thoracic outlet as an opening bordered by the first rib laterally, the vertebral column medially (...) 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

2014 eMedicine.com

178. Thoracic Disc Injuries (Overview)

The thoracic discs are unusually stable compared with the cervical and lumbar discs. The stability of the thoracic discs is secondary to the surrounding rib cage, with the stabilizing effect of the rib articulations. However, the blood supply of the thoracic spine is more tenuous than the cervical and lumbar spine, especially at the T4-T9 watershed area, which is more prone to ischemic injury. Previous Next: Sport-Specific Biomechanics The facet orientation in the thoracic spine is vertical, with a slight (...) medial angulation. This orientation allows for easier lateral bending and rotation versus pure bending. Biomechanical studies have shown that intervertebral discs are at the highest risk of injury when combined with bending and torsional forces. Therefore, the thoracic spine discs are at a decreased risk of injury because of the decreased bending potential in this segment of the spine. The spinal cord-to-canal ratio (the ratio of the cross-sectional area of the cord to the cross-sectional area

2014 eMedicine.com

179. 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 (...) : The ratio of the spinal canal to the thoracic spinal cord is smaller than that found in the cervical and lumbar regions. Although the cross-sectional diameter of the thoracic cord is smaller than that of its cervical or lumbar counterparts, the diameter of the spinal canal is proportionally even smaller. Thus, the ratio of the spinal cord to the canal in the thoracic spine is 40%, whereas this ratio in the cervical spine is only 25%. The dentate ligaments situated between the spinal cord and the nerve

2014 eMedicine.com

180. Thoracic Aortic Aneurysm

and/or spinal conditions. (See the 2 images below showing thoracic aortic aneurysm.) Chest radiograph showing widening of the superior mediastinum. Computed tomography scan depicting a descending thoracic aortic aneurysm with mural thrombus at the level of the left atrium. Anatomy Thoracic aneurysms are classified in accordance with the portion of aorta involved: the ascending thoracic aorta, the arch, or the descending thoracic aorta. This anatomic distinction is important because the etiology, natural (...) . Transesophageal echocardiography (TEE), CT scanning, and MRI have been reported to be highly sensitive for the diagnosis of aortic dissection. However, the specificity of CT scanning and MRI is significantly better than that of TEE. [ ] Many thoracic aneurysms are readily visible on chest radiographs. Characteristic findings are widening of the mediastinal silhouette, enlargement of the aortic knob, or displacement of the trachea from the midline. [ ] Lateral films demonstrate loss of the retrosternal air

2014 eMedicine Radiology

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