Anatomy for neurotrauma
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
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.
Discussions (D)
Terence R. Anthoney in Neuroanatomy and the Neurologic Exam, 2017
As one might imagine, the authors of a clinical text may find more than one definition of “peripheral nerve” useful. Thus, it is not uncommon to find different usages in the same text (see, for example, the citations given above from A&V, DeJ, and Haymaker and woodhall [1953]). Daube, Sandok, Reagan, and Westmoreland (1978), in particular, show the ambiguity that can result from nonuniform usage of the term “peripheral nerve.” At one point, they state that “Cranial nerves III through XII … are analogous to other peripheral nerves” (p. 26), suggesting that cranial nerves are peripheral nerves. On the same page, however, we read that “Cranial and peripheral nerves must pass through these surrounding vestments [meninges],” suggesting that cranial nerves are not peripheral nerves. Just a page later, the authors remark that “A series of spinal nerves arises in the spinal canal and exits through the intervertebral foramina” (p. 27). Now we also have to figure out how spinal nerves are related to the enigmatic “peripheral nerves.” If we decide that perhaps peripheral nerves are equivalent to spinal nerves, we may become confused by such phrases as “afferent fibers traveling in cranial, peripheral, and spinal nerves” (p. 40), which clearly imply that peripheral nerves are neither cranial nor spinal.
Reduction and Fixation of Sacroiliac joint Dislocation by the Combined Use of S1 Pedicle Screws and an Iliac Rod
Kai-Uwe Lewandrowski, Donald L. Wise, Debra J. Trantolo, Michael J. Yaszemski, Augustus A. White in Advances in Spinal Fusion, 2003
A primary aim of using interbody fusion cages is to restore the degeneratively decreased disc height. This decompresses the neural structures in the intervertebral foramina. An immediate prerequisite for successful fusion therapy is adequate resistance to subsidence and reconstruction failure. Krammer et al. [80] tested three types of implants in eight single segment lumbar spine specimens. Each specimen underwent a cyclic loading test with the application of 40000 cycles at a rate of 5 Hz. A cyclic axial compression force ranging from 200 to 1000 N was applied while the axial translation was recorded as a measure of the subsidence. The specimens were then tested with increasing axial force until failure. There were only slight differences in subsidence for the various cage designs with the height reduction ranging between 0.9 and 1.4 mm. The median strength ranged from 5486 to 8413 N. No correlation was found between bone mineral density and failure load. Endplate preparation and cage design of the tested implants did not influence the resistance of the segment to cyclic axial compression. Continuously increasing the compressive load revealed that implant-bone failure was not expected within physiological load ranges for any of the tested cage types.
Evaluation of unilateral ultrasound guided paravertebral block for perioperative analgesia in cancer patients undergoing lower limb sparing surgeries: A prospective randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2021
Yasmen F. Mohamed, Sayed M. Abed, Tamer M. Khair, Ahmed Abdalla Mohamed, Enas Samir, Walaa Y. Elsabeeny
Regional blocks are commonly used as part of multimodal analgesia; they exert their action through inhibiting conduction of neural impulses from surgical site to the spinal cord thus decreasing spinal cord sensitization [7,8]. Using regional anesthesia provides better perioperative pain control with attenuation of stress response and reduction of opioids consumption [9]. Various regional anesthetic techniques are commonly used for perioperative pain management in limb-sparing surgeries [10]. One of these techniques is ultrasound guided lumbar paravertebral block (LBVP). The lumbar paravertebral space is bounded medially by the vertebrae, intervertebral disc and intervertebral foramina which connect the space with the epidural space; anterolaterally by psoas major muscle and posteriorly by the transverse process. LPVB is a regional anesthetic technique that involves more precise injection of local anesthetics in close proximity to spinal nerve roots in the paravertebral space, thus increase the efficacy and safety of performed nerve block [11]. This study aims to evaluate the efficacy of unilateral ultrasound guided paravertebral block for perioperative analgesia of lower limb-sparing surgery in adult cancer patients and its effect on decreasing perioperative opioids consumption.
Endoscopic modified total laminoplasty for symptomatic lumbar spinal stenosis
Published in The Journal of Spinal Cord Medicine, 2022
Wen-Jie Du, Jue Wang, Qi Wang, Lian-Jing Yuan, Zhi-Xiang Lu
In this study, we included symptomatic patients whose lumbar spinal X-ray before surgery showed that the spine canal antero-posterior diameter was less than 10 mm, and/or lumbar CT before surgery showed that spine canal cross-sectional area was less than 75 mm2 who had all been treated conservatively for at least three months. Given the limitations of this surgical method and the fact that certain patients could not satisfactorily complete the assessment tasks, patients were excluded from the study if they had simple intervertebral foramen stenosis, tumor, mental illness, severe organic disease, or a history of previous lumbar spinal surgery. All patients were involved in preoperative education before surgery and were informed that they had the right to stop follow-up at any time. This study was approved by the scientific research and clinical trial ethics committee.
Anterolateral approach for subaxial vertebral artery decompression in the treatment of rotational occlusion syndrome: results of a personal series and technical note
Published in Neurological Research, 2021
Sabino Luzzi, Cristian Gragnaniello, Alice Giotta Lucifero, Stefano Marasco, Yasmeen Elsawaf, Mattia Del Maestro, Samer K. Elbabaa, Renato Galzio
Medical history including previous drop attacks or other symptoms related to the vertebrobasilar insufficiency were obtained. Full vestibular and cardiovascular work up, including screening for coagulopathies were carried out. Cervical x-rays that included oblique projections for the intervertebral foramina and flexion-extension dynamic views were obtained for each patient. Static computed tomography (CT) of the cervical spine was always completed alongside a dynamic CT angiography. T1, T2, diffusion weighted images and time-of-flight magnetic resonance imaging (MRI) of the brain and cervical spine were performed in patients that could tolerate it and had no contraindications to it to look for possible pre-existing ischemic lesions. Color Doppler ultrasonography of the VAs was carried out in neutral position and during axial rotation of the head, according to the reported standard of the technique [39]. Non-subtracted and subtracted static and dynamic catheter-based angiography of both VAs were performed in every case, regardless of the findings of the CT-angiography.
Related Knowledge Centers
- Cervical Vertebrae
- Dorsal Root Ganglion
- Lumbar Vertebrae
- Spinal Nerve
- Thoracic Vertebrae
- Vertebra
- Intervertebral Disc
- Spinal Nerve Root
- Meningeal Branches of Spinal Nerve
- Radicular Artery