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Kyphotic Deformity of the Spine
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
After three weeks, he was taken to the operating room for the instrumented posterior spinal fusion from T2 down to T12. He was placed in 15 pounds of traction after positioning. Interestingly, our neurophysiologic monitoring team noted an improvement in his motor signals relative to the data obtained at the time of his previous neurosurgical procedures and when traction was applied. The spine was exposed with care taken to isolate and protect the syringo-pleural shunt. While the facet joints had been preserved with the previous laminectomy, they had become elongated across the apex of the deformity. Pedicle screws were placed where technically possible, as the CT scan demonstrated markedly abnormal anatomy and several of the pedicles could not accommodate screws. We preserved the supraspinous and interspinous ligaments between T1 and T2. He tolerated the procedure well, did not receive a blood transfusion, and had stable monitoring signals throughout. His postoperative radio-graphs (Figure 19.4a, b) show that the kyphosis had improved to 65°. His sagittal balance (as evaluated by C7 relative to the postero-superior corner of the sacrum) had improved but was still not normal.
Spinal Injuries
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The spinal cord extends from the foramen magnum, through the spinal canal to terminate between T12 and L3 (usually the lower margin of the L1 vertebral body). Below this level, the canal contains the lumbar, sacral and coccygeal spinal nerves (the cauda equina nerve roots). The spinal cord is surrounded by cerebrospinal fluid contained within the dura mater. There is an epidural space between the dura mater and the bony canal containing extradural fat and blood vessels. The spinal canal diameter varies along the length of the spine with the narrowest areas in the sub-axial cervical and thoracic regions. Pre-existing degeneration can cause further narrowing of the spinal canal and hence fractures of the cervical and thoracic spine are frequently complicated by spinal cord injury.7
Education on Palliative and End-of-Life Care
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Christopher M. Wilson, Amy J. Litterini
A helpful case example to employ was one discussed in Chapter 6. JP is a 59-year-old male who is an executive in an automobile manufacturing company. He has been previously diagnosed with lung cancer with spinal metastases. At the level of the T12 vertebrae, the spinal metastases have begun to encroach on the spinal cord causing progressive lower extremity paralysis and an inability to walk. As the therapist, you continue to identify that JP is exacerbating his pain substantially by performing in therapy and physicalactivity, however, JP’s goals are to continue to work on ambulation. In your professional experience, you feel that ambulation may not be an achievable goal and that he may be making his quality of life worse by increasing his pain and potentially exacerbating his lower extremity paralysis.
Effects of backrest and seat-pan inclination of tractor seat on biomechanical characteristics of lumbar, abdomen, leg and spine
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Qichao Wang, Yihuan Huo, Zheng Xu, Wenjie Zhang, Yujun Shang, Hongmei Xu
Figure 18 shows the analysis results of load on the driver's thoracic spine segment. The force on thoracic vertebrae gradually increases from the top to the bottom, with the T12 segment bearing the largest force, which is consistent with the normal physiological structure of thoracic vertebrae. When the backrest inclination angle is small, the force on the lower thoracic segment will increase, and correspondingly the force on the upper thoracic segment such as T2 segment will decrease, which is also in accordance with the physiological distribution of thoracic segments. When the inclination angle of the backrest is 0°, the upper thoracic segment is under low pressure. With the increase of backrest inclination angle, the force on the T12, T10 and T9 segments increases slowly at a constant rate, and that on the T2 segment shows a significant increase. The main reason is that the support force provided by the seat backrest is gradually distributed evenly to thoracic vertebral segments with increasing backrest inclination, and the force of the backrest on the human thoracic vertebrae is gradually transferred to the upper thoracic vertebrae and tends to be stable.
Control strategy for intraspinal microstimulation based on central pattern generator
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Xiongjie Lou, Yan Wu, Song Lu, Xiaoyan Shen
The purpose of this experiment was to obtain the angle sequence of the right hindlimb knee joint of SCI rats under the stimulation of positive and negative PA sequences. Five Sprague Dawley rats of both sexes, weighing approximately 250 g, were used as experimental subjects and numbered 1–5. Chloral hydrate (10%) was intraperitoneally injected into the rats. After anaesthesia administration and preoperative skin preparation, the skin surface of the rats was disinfected with 75% alcohol, and the epidermis was cut off. The segment lamina of the T12 − T13 vertebrae was removed to expose the spinal cord, and the T9 segment of the spinal cord was hammered at a height of 6.25 mm using a 10 g hammer with a diameter of 2.5 mm. The ankle, knee, and hip joints of the rats' right hindlimbs were marked.
Rapid progression of acute cervical syringomyelia: A case report of delayed complications following spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2022
Chenghua Yuan, Jian Guan, Fengzeng Jian
The incidence of post-traumatic syringomyelia varies between 0.3–3.2% and a varying interval between an SCI and the initial presentation of syringomyelia from months to years has been reported,6 but there are limited reports of delayed post-traumatic syringobulbia.7,8 Briefly, a patient with syringobulbia was reported,8 in whom symptomatic regression and a significant reduction in syrinx size occurred after a syringo-peritoneal shunt surgery. Fourteen years before admission, the patient underwent spinal instrumentation surgery for thoracolumbar fractures. A similar case was described involving a T12 compression fracture 30 years prior to the development of new symptoms, with weakness and sensory impairment in the patient’s left arm for 5 years.9 MRI results revealed a syringobulbia. During surgery, the thickened arachnoid membrane was cut, and the foramen of Magendie was explored. Post-operatively, symptoms abated and the syrinx diminished. Unfortunately, the patient's symptoms gradually worsened; it is not clear why the surgery did not target the level of fracture.