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Spinal Cord Disease
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Macroscopic changes in spondylosis of the vertebral column include: Transverse bars occur that may extend across the posterior aspect of the vertebrae and compress the spinal cord. The lateral end of the transverse bars may encroach on an intervertebral foramen and compress the nerve root.Localized bosses occur centrally or laterally, which may compress the spinal cord.Intervertebral disc protrusions are commonly associated with the bars and bosses.Frequently, these lesions are found at more than one vertebral level.
Blocks of Nerves of the Trunk
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
The spinal nerves are formed by the union of the dorsal and ventral roots of the spinal cord (see Part One, Section I). There are usually 31 pairs of spinal nerves, 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal, emerging from the intervertebral foramina, close to the transverse processes of the vertebrae. They divide rapidly into four main branches, the meningeal, the dorsal and ventral rami, and the ramus communicans.
Anatomy for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Vasudha Singhal, Sarabpreet Singh
The vertebral arch is formed by a pair of pedicles, and a pair of laminae, along with two transverse processes pointing laterally, and a spinous process pointing posteriorly. Articular processes—two superior and two inferior—are located at the junction of lamina and pedicles, and articulate with their counterparts on the vertebrae above and below. The part of the vertebra located between the superior and inferior articular processes of the facet joint is called the pars interarticularis. The facet joints between the articular facets of the adjacent vertebrae are strengthened by various ligaments—ligamentum flavum (between adjacent laminae), interspinous and supraspinous ligaments (between the spinous processes), and intertransverse ligaments (between the transverse processes). In between each pair of vertebrae, there are the intervertebral foramina on each side, which allow for the exit of spinal nerves.
Advantages and feasibility of intercostal nerve block in uniportal video-assisted thoracoscopic surgery (VATS)
Published in Postgraduate Medicine, 2023
The 4th or 5th intercostal space is used as the surgical incision site in uniportal VATS in clinical practice. Intraoperative injury to the intercostal nerve may lead to postoperative pain. The intercostal nerve is a mixed nerve branch formed by the union of the anterior and posterior roots after the thoracic spinal cord. Each intercostal nerve emerges from the intervertebral foramen and travels at the lower edge of the rib angle to the costal groove accompanying the intercostal artery. The pain felt by the nerve endings travels from the intercostal nerve to the nerve roots, spinal cord, and cerebral cortex. Therefore, ICNB is performed primarily from the rib angle. In addition, the adjacent intercostal skin is innervated by the intercostal nerve; therefore, the surrounding skin should also be blocked. Various regional analgesic techniques have been used to improve postoperative pain management in VATS and promote the normalization of the concept of rapid recovery [23,24].
Treatment of Sciatica and Lumbar Radiculopathy with an Intervertebral Foramen Opening Protocol: Pilot Study in a Hospital Emergency and In-patient Setting
Published in Physiotherapy Theory and Practice, 2023
Michael Shacklock, Marinko Rade, Siniša Poznic, Anita Marčinko, Michael Fredericson, Heikki Kröger, Markku Kankaanpää, Olavi Airaksinen
While we do not know of any studies that show monitoring compliance influences outcomes, anecdotally, it may be easier to study the above treatment in a controlled medical and inter-disciplinary environment (hospital in-patients) where radiology and electrophysiology could be used for diagnosis and patient’s activities and treatments monitored. Pilot studies can use a power analysis for planning clinical trials. The calculation incorporates interactions between significance (p value), magnitude of treatment response (effect size) and sample size. Our intention was to use this study for planning future randomized control trials on the opener protocol, including determination of sample size. The aims were therefore to perform a pilot study before proceeding to a randomized controlled trial so as to: 1) propose a protocol of intervertebral foramen opening; 2) investigate if the protocol could be studied in a controlled hospital environment; 3) observe any adverse effects; and 4) ascertain if beneficial outcomes were associated with the opener protocol and e. establish effect sizes, study power and the sample required for future studies.
An open-label non-inferiority randomized trail comparing the effectiveness and safety of ultrasound-guided selective cervical nerve root block and fluoroscopy-guided cervical transforaminal epidural block for cervical radiculopathy
Published in Annals of Medicine, 2022
Xiaohong Cui, Di Zhang, Yongming Zhao, Yongsheng Song, Liangliang He, Jian Zhang
The pain severity was assessed using NRS ranging from 0 (no pain) to 10 (worst possible pain). Successful pain relief was predefined as a ≥ 50% reduction in NRS score compared with the baseline value. To estimate functional disability, the neck disability index (NDI) which was considered a reliable and valid instrument for assessing cervical spine disorders was employed. The final NDI score was acquired by adding all scores from the ten questions including seven functional activity-related, two symptom-related, and one concentration-related question. According to anatomic landmarks, the intervertebral foramen area was classified into (1) extraforaminal space defined as the area outside the lateral bisector of articular pillars; (2) epidural space defined as the area within the medial bisector of articular pillars; (3) foraminal space defined as the area between the lateral and medial bisector of articular pillars (Figure 2 (b)). After the intervention, two experienced reviewers who were blinded to the treatment arm retrospectively analysed the saved FL images which were consensually classified into one of the following predefined patterns: (1) extraforaminal; (2) epidural; (3) foraminal. The optimal contrast distribution was considered as dye dispersion reaching the foraminal space or the epidural space. The rate of satisfactory contrast penetration was predefined as (number of “epidural” type + number of “epidural and foraminal” type + number of “foraminal” type)/total number. Procedure time and side effects were also recorded.