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The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Spinal nerves are arranged as follows: 8 pairs of cervical nerves (C1–C8).12 pairs of thoracic nerves (T1–T12).5 pairs of lumbar nerves (L1–L5).5 pairs of sacral nerves (S1–S5).1 pair of coccygeal nerves (Co1).
Fetal and neonatal medicine
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
4.16. A newborn has an asymmetrical Moro reflex. The grasp reflex is preserved for the affected arm, which is weak. There is limitation in abduction and external rotation movements of the shoulder and supination of the forearm. The neurological lesion involvesmotor cortex on contralateral side.third and fourth cervical nerves.fifth and sixth cervical nerves,seventh and eighth cervical nerves.first and second thoracic nerves.
The spinal cord
Published in Nan Stalker, Pain Control, 2018
The three main nerves of the brachial plexus are as follows. The radial nerve. This runs round the back of the humerus and down the outside of the forearm. It supplies the extensor muscles of the elbow, wrist and hand.The ulnar and median nerves. These run down the inside and middle of the limbs respectively and supply the flexor muscles of the wrist and hand. The ulnar nerve crosses in the groove between the back surface of the internal epicondyle of the humerus and the olecranon process.The thoracic nerves. These supply the muscles of the chest and the main part of the abdominal wall.
Influence of ultrasound-guided erector spinae plane block on post-operative pain and diaphragmatic dysfunction in obese patients undergoing repair of Epigastric Hernia
Published in Egyptian Journal of Anaesthesia, 2023
Asmaa Ragab Eid, Mona Blough El Mourad, Salah Eldeen Ibrahim Al Sherief, Shaimaa Waheed Zahra
It is unclear how local anesthetics work or how far they go in an ESP block. In a research using cadavers, Forero et al. [4] injected all samples using US guidance for all interventional operations. By blocking the spinal nerve roots and the branches communicating with the sympathetic ganglia, they showed that local anesthetics infiltrate the thoracic paravertebral region anteriorly through connective tissues and ligaments. Regarding imaging studies, the widespread sensory block found after a single application at T5 TPs propagated craniocaudally in-between C7 and T8, perhaps because of the columnar architecture of the ESM and its retinaculum. This also suggests that the dissemination to the lower thoracic nerves feeding the belly should occur after injection at levels caudal to T5 [2]. In contrast, Ivanusic et al.’s [16] cadaveric research showed that the vertebral column muscles are firmly attached to the TPs, preventing any anterior spread of dye toward the paravertebral space. This would have affected the thoracic spinal nerves. Dorsal ramus blockage was suspected to have occurred behind the costotransverse foramen, with the lateral cutaneous branches of the intercostal nerves likely being involved.
Surgical technique modification of circumferential decompression for thoracic spinal stenosis and clinical outcome
Published in British Journal of Neurosurgery, 2023
Ruofu Tang, Jiawei Shu, Hao Li, Fangcai Li
Ohtsuka et al. developed a single posterior approach for circumferential decompression of thoracic cord and obtained relatively favorable surgical outcomes.3 While reported postoperative complication of paralysis ranged from 11.8% to 33%.9,13 It is supposed that this complication was due to insufficient space and field of view. Liu et al. developed ‘Cave-in’ technique described as5: for anterior decompression process, a cave under the posterior cortex of vertebral body was created firstly. After the separation of adhesions, ossified PLL together with posterior cortex of the vertebral body were pressed down into the cave, followed by total resection. This technique made the spinal cord almost free from disturbance caused by the bur when preforming anterior decompression and relatively favorable neurological outcomes were reported. Kato et al.4 suggested resection of transverse processes and pedicles at circumferential decompression levels when performing laminectomies. They also suggested sacrifice of bilateral thoracic nerves when necessary to create more space for subsequent anterior decompression.
Trans-thoracic versus retropleural approach for symptomatic thoracic disc herniations: comparative analysis of 94 consecutive cases
Published in British Journal of Neurosurgery, 2021
Christian Soda, Franco Faccioli, Nicolò Marchesini, Umberto M. Ricci, Marco Brollo, Luciano Annicchiarico, Cristiano Benato, Ivan Tomasi, Giampietro P. Pinna, Marco Teli
Thoracic disc herniations (TDHs) can be incidentally found in MRIs of asymptomatic subjects.1 Symptomatic TDHs represent a rarity in the daily practice of spinal surgeons (0.5% to 1.4% of all disc surgical procedures2). Compared to disc herniations in the cervical and lumbar spine, TDHs are less frequent probably due to the anatomy, physiology and biomechanics of the thoracic spine3. The overall prevalence of symptomatic TDHs is 1/103 to 1/105 in the general population; males are affected more frequently than females, the highest incidence is between 40 and 50 years of age and the site most commonly involved is the caudal thoracic spine.2 Only a small percentage of TDHs becomes symptomatic. Symptoms are thought to be caused either by direct compression of the spinal cord and/or thoracic nerves, or by chronic ischaemia.4–11 Upper motor neuron symptoms typical of TDHs include lower limbs weakness or paralysis, sphincter disorders, alteration of balance and proprioception and dorsal root pain. Occasionally, an acute ischaemic injury can occur and patients can present with acute paraplegia.12–14