Cadaver dissection.
To examine the potential points of spinal nerve entrapment and the articular branches in the thoracic spine.
Despite many cadaver studies focused on the cervical and lumbar spinal ...nerves, detailed anatomy of the thoracic nerve branches is missing from the viewpoint of painful neuropathy on the thoracic region.
A total of 120 pairs of thoracic spinal nerves out of 10 donated cadavers were dissected. Detailed anatomy of the posterior ramus and medial/lateral branches and their fine branches in the entire thoracic region was investigated by both macroscopic and stereomicroscopic dissections.
The posterior ramus of the thoracic nerve passed through the narrow space between the bony structures and adjacent fibrous tissue. It is sent to the first branch, which is called "the descending branch," before bifurcating into medial and lateral branches. The medial branch runs posterolaterally, then turns medially along the edge of multifidus, and passes between that and semispinalis, whereas the lateral branch runs underneath the intertransverse ligament. Both medial and lateral cutaneous branches penetrated the thoracolumbar fascia, and the medial cutaneous branch penetrated the tendinous portion of back muscles.
Several points might be listed as potential sites of entrapment along the course of the posterior ramus of the thoracic nerve and its branches, leading to the cause of thoracic back pain. In addition, the articular branch entering the facet (zygapophyseal) joint originated from the descending branch, which was the first branch of the posterior ramus.
The purpose of this study was to compare the degree of enlargement of the spinal canal between two methods of cervical laminoplasty (open-door laminoplasty and double-door laminoplasty) and to ...determine their appropriate surgical indications based on the results. Tension-band laminoplasty (TBL, one method of open-door type) was performed in 33 patients and double-door laminoplasty (DDL) in 20 patients. The operation level ranged from C2 to C7 in all patients. The width of the spinal canal and the inclination angle of the lamina at the C5 and C6 levels were measured using a computer software program (Image J) and pre- and postoperative CT films. Concerning the degree of enlargement of the spinal canal, the mean expansion ratio at the C5 level was 148.9% in TBL and 148.2% in DDL, and there was no significant difference between them. However, at the C6 level, it was 159.0% in TBL and 140.3% in DDL, which was significantly larger in TBL than DDL (
p
< 0.05). The increase of inclination angle of the lamina was 11.0° in TBL and 19.0° in DDL at the C5 level, and 9.2° in TBL and 19.3° in DDL at the C6 level. At both the C5 and C6 levels, it was significantly larger in DDL than TBL (
p
< 0.0001). In conclusion, the appropriate surgical indications of TBL were considered to be (1) cervical spondylotic myelopathy (CSM) combined with hemilateral radiculopathy, (2) severe prominence of ossification of the posterior longitudinal ligament (OPLL), and (3) patients with tiny spinous processes who cannot undergo DDL. Those of DDL were considered to be (1) usual CSM, (2) small and slight prominence of OPLL, (3) CSM combined with bilateral radiculopathy, and (4) cervical canal stenosis combined with instability necessitating posterior spinal instrumentation surgery.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose: The purposes of this study were to understand the clinical consequences of arthrofibrosis following surgical reduction of ankle fractures and to examine the effectiveness of arthroscopic ...debridement. Methods: Subjects included 33 patients (26 males, 7 females) aged 14 to 78 years (mean, 40.2 years) who had undergone open reduction and internal fixation of ankle fractures between May 2000 and May 2003. Arthroscopic examination was performed at the time of implant removal after an average of 12.4 months (range, 6 to 43 months), and abnormal fibrous tissue, when present, was removed through arthroscopy. The mean follow-up period after arthroscopy was 43.7 months (range, 22 to 68 months). Clinical outcomes before and after arthroscopy were evaluated with the American Orthopaedic Foot and Ankle Society scale and our own functional evaluation method. Arthroscopic findings, including the degree of articular cartilage damage and the quantity of fibrous tissue, were scored on a 3-point scale. Results: Functional deterioration of the ankle joint was observed in 27% of subjects. Arthroscopy showed articular cartilage damage in 33% of patients and arthrofibrosis in 73%. In patients with functional deterioration, the rate of articular cartilage damage was 78%, and arthrofibrosis was present in all cases. Furthermore, when extensive fibrosis and impingement on the articular surface were present, 88% of patients showed impaired articular function. Arthroscopic debridement of fibrous tissue resulted in improved articular function in 89% of patients with functional deterioration of the ankle joint before arthroscopy. Conclusions: Arthrofibrosis following ankle fracture causes an unfavorable surgical outcome, and arthroscopic debridement of fibrous tissue is an effective means of improving articular function. Level of Evidence: Level IV, therapeutic case series.
We report two cases of the spontaneous recurrent hemarthrosis of the knee. In these cases lateral meniscus was severely torn and a small tubular soft tissue with pulsation was identified on the ...synovium in the posterolateral corner during arthroscopic surgery of the knee joint. Gentle grasping of this tissue by forceps led to pulsating bleeding, which stopped by electrocoagulation. This soft tissue was considered a source of bleeding, since no recurrence of hemarthrosis was observed for more than four years after surgery. It was highly probable that this soft tissue was the ruptured end of the lateral inferior genicular artery or its branch. This case report strongly supports the theory that the bleeding from the peripheral arteries of the posterior portion of the lateral meniscus is the cause of spontaneous recurrent hemarthrosis of the knee.
Full text
Available for:
DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Abstract Background context No previous reports have described a metastatic tumor located in the ossification of the ligamentum flavum (OLF). Purpose To report an extremely rare case of metastatic ...tumor located in the OLF. Study design Case report. Methods We report a case of a 54-year-old man who sustained paraparesis attributable to spinal cord compression because of OLF in the thoracic spine. Results The OLF at T3/T4 and T5/T6, together with the laminae of T3–T6, was resected. Histologically, the removed section mainly consisted of mature bone with some elastic fiber and fibrocartilage. Tumor cells with a tubular construction, compatible with metastatic adenocarcinoma, were also observed in the OLF. These findings are consistent with metastatic prostate cancer in the OLF. Eleven months after surgery, the patient showed improvement in gait disturbance and bladder-bowel disturbance that existed before surgery. Conclusion This is the first case of metastatic tumor located in the OLF.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Introduction
The underlying risks of asymptomatic embolization during high‐power short‐duration (HPSD) ablation for atrial fibrillation remain unclear. We aimed to evaluate microembolic signals ...(MESs) during HPSD ablation with power settings of 50 and 90 W in comparison with those during cryoballoon (CB) ablation using a novel carotid ultrasound‐Doppler system that classifies solid and air bubble signals using real‐time monitoring.
Methods and Results
Forty‐seven patients underwent HPSD ablation using radiofrequency (RF), and 13 underwent CB ablation. MESs were evaluated using a novel pastable soft ultrasound probe equipped with a carotid ultrasound during pulmonary vein isolation. We compared the detailed MESs and their timing between RF and CB ablations. The number of MESs and solid signals were significantly higher in the RF group than in CB group (209 ± 229 vs. 79 ± 32, p = .047, and 83 ± 89 vs. 28 ± 17, p = .032, respectively). In RF ablation, the number of MESs, solid, and bubble signals per ablation point, or per second, was significantly higher at 90 W than at 50 W ablation. The MESs, solid, and bubble signals were detected more frequently in the bottom and anterior walls of the left pulmonary vein (LPV) ablation. In contrast, many MESs were observed before the first CB application and decreased chronologically as the procedure progressed. Signals were more prevalent during the CB interval rather than during the freezing time. Among the 28 patients, 4 exhibited a high‐intensity area on postbrain magnetic resonance imaging (MRI). The MRI‐positive group showed a trend of larger signal sizes than did the MRI‐negative group.
Conclusion
The number of MESs was higher in the HPSD RF group than in the CB group, with this risk being more pronounced in the 90 W ablation group. The primary detection site was the anterior wall of the LPV in RF and the first interval in CB ablation.
Microembolic signals (MESs) detected during pulmonary vein isolation (PVI) with a high‐power short‐duration (HPSD) and cryoballoon (CB) ablations on carotid ultrasound evaluation. The number of MESs was higher in the HPSD radiofrequency (RF) group than in the CB group, with this risk being more pronounced in the 90 W ablation group. The primary detection site of MESs was the anterior wall of the left pulmonary vein (LPV) in RF and the first interval in CB ablation.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
A15-year-old girl who developed traumatic iliacus hematoma and complete paralysis of the quadriceps muscle is reported. The current case and literature review revealed that incomplete quadriceps ...paralysis associated with traumatic iliacus hematoma is likely to progress to complete paralysis in days or weeks as a result of increased intracompartmental pressure. However, surgical decompression of the femoral nerve could produce good results even in patients who have complete quadriceps paralysis preoperatively.
Full text
Available for:
FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, UL, UM, UPUK, VKSCE, ZAGLJ
To clarify the response of frozen shoulder (FS) to intraarticular injections of high-molecular-weight sodium hyaluronate (HA), a mixture of 2.5 ml of HA and 1.5 ml of 1% lidocaine was injected into ...the glenohumeral joint of 11 patients with FS, 8 of whom received five weekly injections. The patients were assessed using the Japanese Orthopaedic Association shoulder score (JOA score) before the first injection, 1 week after the first injection, and 1 week after the final injection. Following each clinical evaluation, the patients underwent dynamic magnetic resonance imaging enhanced with Gd-DTPA, and the coefficient of enhancement (CE) in the glenohumeral synovium was calculated, with the examiners blinded to the clinical information. The JOA score tended to be greater and the CE smaller after injection than before injection. The changes in the CE following both single and repeated injections were negatively correlated with changes in the JOA score. Thus, clinical improvement in patients with FS was associated with a decrease in the CE. Because the CE depends on the degree of synovitis, the therapeutic effect of intraarticular HA injection for FS results, at least in part, from suppression of synovitis in the glenohumeral joint through an antiinflammatory effect.
Full text
Available for:
FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, UL, UM, UPUK, VKSCE, ZAGLJ
PDF
