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Management of Ballistic Face and Neck Trauma in an Austere Setting
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Damage to a vertebral artery that is actively bleeding in an austere environment without access to endovascular angiographic embolisation requires surgical exploration. The proximal portion of the vertebral artery enters the spinal transverse process at the level of C6. It is usually impossible to get access distal to that point. The most practical method is to ligate the vertebral artery at its origin on the second part of the subclavian and then occlude the vertebral foramen with bone wax.
Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
The anterior approach is the fastest and simplest way to remove the cord because the cadaver does not have to be turned. The peripheral nerves can be followed after the removal of the cord. A detailed examination of the vertebral bodies is also possible. Removal of only a part of the cord is another option with this approach, but it is generally better to take the entire cord. The lumbar–sacral muscles are easily removed from the spine by the saw. Depending on the technique used (Letulle, for instance), the cord can often be removed whole, free from any muscular connections. Freeing the cauda equina from the sacral bone requires some time, as it is difficult to use the saw inside the pelvic cavity. In rare cases, it will be necessary to remove a bone wedge near the midline and then remove the remaining side of the sacrum with a rongeur. This is the best way to avoid damaging nerve roots as they traverse the vertebral foramen. The cauda equina is covered by the dura mater, and it should be lifted out the spinal canal with as many spinal ganglions as possible (Figures 2.145 and 2.146).
The Musculoskeletal System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
A long bone consists of two parts, the diaphysis, which is the shaft or main body of the bone, and the epiphysis, the end of the bone. Yellow bone marrow, consisting primarily of fat cells, is found in the marrow cavity in the center of long bones, while the epiphysis is filled with red marrow that produces blood cells. Vertebrae consist of a rounded body at the front and a spring arch at the back. Through the center is the vertebral foramen, the opening that houses the spinal cord. Spiny projections called processes project from the vertebrae to allow attachment of muscles and ligaments. Discs of cartilage between the vertebrae act as shock absorbers.
Comparison of Ultrasound-Guided Erector Spinae Plane Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia after Laparoscopic Cholecystectomy: A Randomized, Controlled Trial
Published in Journal of Investigative Surgery, 2022
Halime Ozdemir, Coskun Araz, Omer Karaca, Emin Turk
It has been stated that in addition to the wide spread of the local anesthetic in ESPB and the block being close to the vertebral foramen, it also contributes to the pneumoperitoneum in LC. Unilateral ESPB has also been reported to form a blockade over the contraletaral dermatomes [20]. In addition, Altiparmak et al. stated that that the local anesthetic spread into the epidural space as a result of the increase in intra-abdominal pressure with the pneumoperitoneum; thus, the unilateral block caused sensorial blockade over the dermatomes on the opposite side [23]. The authors also noted that left-side positioning increased the craniocaudal spread of the local anesthetic while the reverse Trendelenburg position might limit the cephalad spread and efficiency of the local anesthetic in interfascial block [24]. On the other hand, in STAPB, the local anesthetic does not spread to a wide area or cross over to the other side and form a sensory blockade. Thus, by reducing the need and consumption of opioids, ESPB acts on pain, which is one of the most important factors that delays ERAS, and it reduces postoperative complications according to the ERAS protocol and allows for early mobilization and discharge.
The effects of a positional feedback device on rollator walker use: a validation study
Published in Assistive Technology, 2021
Courtney Golembiewski, John Schultz, Timothy Reissman, Harold Merriman, Julie Walsh-Messinger, Kurt Jackson, Kimberly Edginton Bigelow
Published clinical recommendations provide guidance on using rolling walkers (O’Sullivan & Schmitz, 2000; Pierson, 2002). When ambulating, rolling walker users should have their hands positioned so that the walker height is at the wrist joint line with both elbows bent to 20° to 30°. Their feet should be positioned between the posterior wheels of the rolling walker. These guidelines are intended to enable individuals to use the walker more comfortably and more safely, putting them in a favorable position where wrist and back pain are minimized and the user is in greater control of the walker for maneuvering and balance recovery if needed. Despite the common acceptance of these clinical guidelines, they should be approached cautiously since there is little empirical data to support them. Given the complex interaction between the individual, the device and the environment, optimal fitting and positioning that maximizes safety and comfort are likely to be different for each individual. For example, an individual with a thoracic spine compression fracture may be encouraged to walk closer to the walker with a more upright posture to reduce anterior vertebral body compressive forces while a person with spinal stenosis may be instructed to walk further from the walker with a more flexed posture to reduce narrowing of the vertebral foramen. Additional factors such as limb strength, postural control, anthropometrics, flooring, and environmental conditions may also influence walker fitting and positioning recommendations.
Is fusion the most suitable treatment option for recurrent lumbar disc herniation? A systematic review
Published in Neurological Research, 2020
Shahswar Arif, Zarina Brady, Yavor Enchev, Nikolay Peev
Average complication rate recorded for PLIF (36.8%) was 28.4% higher than the average complication rate for TLIF. Similarly, Mehta et al. (2013) recorded PLIF to be associated with an increased rate of nerve root injury and durotomy in comparison to TLIF [46]. TLIF’s superiority was also reflected in the comparative study conducted by Li et al. (2016), which recorded 30.5% higher complication rate for PLIF versus TLIF [43]. The authors suggested that complications such as transient neurological deficit could be due to the overt medial retraction of the thecal sac during the surgery [37]. In comparison, such complications are avoided in TLIF approaches as the disc space is accessed through the far lateral area of vertebral foramen, minimising thecal manipulation [47]. Li et al. reported a higher dural tear rate in PLIF cohort versus TLIF, owing to scar adhesion to the dura. As the dural tears were repaired intraoperatively, subsequently prolonging the surgery [43]. Lequin et al. (2014) reported instability of 3.8% [45].