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Tumours
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Heledd Havard, William Aston, Timothy WR Briggs
Fine needle aspiration (FNA) is not used in sarcoma diagnosis and is largely reserved to diagnosing carcinoma. A thicker-bore needle (11G or 13G), capable of boring through the outside of the lesion and taking core biopsies such as a Jamshidi needle (Figure 2.1), is preferable.
Percutaneous Lumbar Pedicle Screws
Published in Alexander R. Vaccaro, Christopher M. Bono, Minimally Invasive Spine Surgery, 2007
Daniel R. Fassett, Darrel S. Brodke
A 1-cm vertical incision is made through the skin and dorsal fascia centered on the location of the pedicle based on fluoroscopy. A spinal-access (e.g., Jamshidi) needle, a cannulated needle similar to a biopsy needle used in transpedicular biopsies, is placed through this stab incision and slowly directed toward the entry point for the pedicle. It is recommended that this needle be advanced under direct lateral fluoroscopic visualization as the surgeon is gaining experience with this technique to avoid interlaminar placement with possible dural violation and cord injury. On the lateral view, the cephalad–caudal angulation of the spinal-access needle can be adjusted for appropriate trajectory through the pedicle. Tactile feedback should allow the surgeon to determine when the spinal-access needle is on bone. Once the needle is docked on bone, fluoroscopy is adjusted to an AP image to determine the medial–lateral relationship of the spinal-access needle with the pedicle. We recommend adjusting the spinal-access needle to a point on the lateral margin of the pedicle to reduce the risk for medial pedicle breakout and allow for maximal medial angulation of the pedicle screws into the vertebral body to reduce the risk of lateral screw breakout from the vertebral body (Fig. 4).
Reduction and Fixation of Sacroiliac joint Dislocation by the Combined Use of S1 Pedicle Screws and an Iliac Rod
Published in Kai-Uwe Lewandrowski, Donald L. Wise, Debra J. Trantolo, Michael J. Yaszemski, Augustus A. White, Advances in Spinal Fusion, 2003
Kai-Uwe Lewandrowski, Donald L. Wise, Debra J. Trantolo, Michael J. Yaszemski, Augustus A. White
After the correct level of surgery is determined by orthogonal C-arm views, the midline is palpated and marked. Next, using the AP view, the skin is marked just lateral to the lateral border of the pedicle. Slight medial angulation of the instruments during pedicle cannulation is necessary. A 1 cm stab wound incision is created over this mark. The spinal, or Jamshidi, needle is then inserted. It should be angled approximately 10 degrees toward the midline in the thoracic and lumbar spine. In the lower lumbar spine, particularly at L5, more medial orientation may be needed. The needle should be advanced into the bone about 2-3 mm. The location is then checked on both radiographic views to confirm proper orientation. The Jamshidi needle is slowly advanced with a gentle twisting motion. Tactile feedback should help guide the instrument within bone. However, this may be difficult to discern because of decreased bone density. Sudden “giving way” can indicate that the pedicle borders have been violated. Radiographic appearance of optimal needle placement is the tip within the confines of the pedicle at all times. Gentle tapping of the needle into the bone with a light mallet can also be used.
A simple technique for easier anterior odontoid screw fixation
Published in British Journal of Neurosurgery, 2019
Mohamed F. Khattab, Ahmed Nageeb Mahmoud, Ahmed Saeed Younis, Youssry El-Hawary
Major limitations of the anterior odontoid screw fixation are the need for intact integrity of the transverse ligament and attaining normal alignment of the fracture preoperatively. With our method of exposure of the C2-3 disc and C3 vertebral body, we are able to anchor a midline Jamshidi needle on the C2 anterior end plate and body which helps us to smoothly drill the guide wire into the middle of dens with good C2 body cortical purchase thereby minimizing the risk of drill bit and or screw break out. The use of the bone marrow biopsy (Jamshidi) needle with beveled end helps in easy, simple and correct insertion of the guide in a midline trajectory. Fine tunning of the position can be achieved by rotating the jamshidi needle as needed. The use of Jamshidi needle decreases the risk of multiple trials by the guide wire which decreases the risk of soft tissue injury and the risk of guide wire kinking and breakage which occurred in three cases which were not included in our series, but did not occur with the use Jamshidi needle.
Evaluation of sensitivity and specificity of bone marrow trephine biopsy tests in an Indian teaching hospital
Published in Alexandria Journal of Medicine, 2018
Sima Chauhan, Sarita Pradhan, Ripunjaya Mohanty, Abhishek Saini, Kumudini Devi, Mahesh Chandra Sahu
The clinical indications, physical findings and peripheral smear findings of patients were compiled. Under local anesthesia (2% xylocaine, 2% lignocaine) infiltration of periosteal region, the BMA and BMB were done from posterior superior iliac spine, by using jamshidi needle. Patient is made to lie on their side (lateral decubitus position). A Bone marrow aspiration needle was inserted through the skin with pressure until it abuts the bone. The needle was advanced through the bony cortex and in the marrow cavity with twisting motion of the hand and wrist of the clinician. After the needle tip reaches the marrow cavity, a syringe was attached to the back of the jamshidi needle and aspiration done. A twisting motion is performed during the aspiration to avoid excess content of blood in the sample. For BMA procedure, Jamshidi needle (13 G for children, 11 G for adults) and Illinois needle size 18 were used. Subsequently 0.25–0.5 ml aspirate was withdrawn using a 2 ml plastic syringe and smears were prepared immediately. Trephine BMB was done using Jamshidi biopsy needle and at the same incision but approximately 0.5–1.0 cm away from aspiration site to avoid getting a haemorrhagic biopsy. In patients of thrombocytopenia, 5 minof firm pressure was applied at the end of the procedure. At the same time patients were asked to lie down on their back for further 10–15 min for prolonged pressure. Aspiration smears were stained with Giemsa stain after being fixed in alcohol. Prussion blue stain for iron store assessment and grading was done routinely. Biopsy specimen was fixed using 10% buffered formalin and decalcified using 10% formic acid for 24 h and processed by preparing paraffin wax embedding sections. Histological sections were made approximately 1–2 µm thick. Haematoxylin and eosin (H&E) stain was used and reticulin fibres were stained with Gomori’s silver impregnation method routinely. Immuno histo chemistry (IHC) was done as and when required.