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vertebral removal with exposed spinal cord

Samer S Ghostine, Paul E Kaloostian, Christ Ordookhanian, Sean Kaloostian, Parham Zarrini, Terrence Kim, Stephen Scibelli, Scott J Clark-Schoeb, Srinath Samudrala, Carl Lauryssen, Amandip S Gill, Patrick J Johnson
The surgical repair of atlantoaxial instabilities (AAI) presents complex and unique challenges, originating from abnormalities and/or trauma within the junction regions of the C1-C2 atlas-axis, to surgeons. When this region is destabilized, surgical fusion becomes of key importance in order to prevent spinal cord injury. Several techniques can be utilized to provide for the adequate fusion of the atlantoaxial construct. Nevertheless, many individuals have less than ideal rates of fusion, below 35%-40%, which also involves the C2 nerve root being sacrificed...
November 29, 2017: Curēus
Jian-Min Chen, Guo-Yin Liu, Yong Zhang, Jian-Ning Zhao
Surgery is the preferred method for the treatment of spinal canal disease, surgical method involves laminectomy and laminoplasty. The ideal spinal surgery not only should fully expose the spinal canal, completely resect the occupied position and remove the spinal cord compression, but also should maintain the stability of spinal biomechanics. Because of the different realization of clinician to safeguard and rebuild the spinal stabilization during opertion of spinal canal disease, and choice of surgical method and how to maintain the stability of spine biomechanics has become a hot of research in this field...
February 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Xu Tao, Yang Ming-Kun, Sheng Wei-Bin, Guo Hai-Long, Kan Rui, Tu Lai-Yong
The study aims to determine the expression of telomerase reverse transcriptase (TERT) in the glial scar following spinal cord injury in the rat, and to explore its relationship with glial scar formation. A total of 120 Sprague-Dawley rats were randomly divided into three groups: SCI only group (without TERT interference), TERT siRNA group (with TERT interference), and sham group. The TERT siRNA and SCI only groups received spinal cord injury induced by the modified Allen's weight drop method. In the sham group, the vertebral plate was opened to expose the spinal cord, but no injury was modeled...
September 2013: Neurochemical Research
Benchao Shi, Xiangming Li, Hongliang Li, Zihai Ding
STUDY DESIGN: A dissection-based study of 30 embalmed cadavers. OBJECTIVE: To determine the morphology and morphometry of the dorsal meningovertebral ligaments in the lumbosacral segments and to discuss their clinical significance. SUMMARY OF BACKGROUND DATA: Postoperative cerebrospinal fluid leakage is associated with longer hospital stays and significant implications for the patient, the surgeons, and society as a whole. To protect the dural sac during lumbar surgery, knowledge of the surgical anatomy of the dorsal meningovertebral ligaments is crucial...
August 15, 2012: Spine
Masashi Neo, Ryo Asato, Shunsuke Fujibayashi, Hiromu Ito, Mitsuru Takemoto, Takashi Nakamura
STUDY DESIGN: Technical note. OBJECTIVE: To introduce the application of navigation system with software for brain surgery to the upper cervical spine of patients who have previously had occipitocervical (O-C) fusion. SUMMARY OF BACKGROUND DATA: The anterior approach to the spine using a navigation system with software for spine surgery is difficult because the registration tends to be inaccurate. However, after O-C fusion, the upper cervical spine is considered part of the skull, and a navigation system with software for brain surgery in which the registration is performed using the head with several markers attached to it can be applied...
October 15, 2009: Spine
Andrea Messina, Maria Carmela Bruno, Philippe Decq, Andre Coste, Luigi Maria Cavallo, Enrico de Divittis, Paolo Cappabianca, Manfred Tschabitscher
Different disorders may produce irreducible atlanto-axial dislocation with compression of the ventral spinal cord. Among the surgical approaches available for a such condition, the transoral resection of the odontoid process is the most often used. The aim of this anatomical study is to demonstrate the possibility of an anterior cervico-medullary decompression through an endoscopic endonasal approach. Three fresh cadaver heads were used. A modified endonasal endoscopic approach was made in all cases. Endoscopic dissections were performed using a rigid endoscope, 4 mm in diameter, 18 cm in length, with 0 degree lenses...
July 2007: Neurosurgical Review
H D Jho
In an effort to make thoracic discectomy simple and less invasive while using direct visualization, a 70 degrees -angled lens endoscope has been adopted to visualize the ventral aspect of the spinal cord dura mater during microsurgical thoracic discectomy via a transpedicular approach. The patient is positioned in a 60 degrees forwardly inclined lateral position with the side of the lesion facing upward. After radiographic corroboration of the correct level, a transpedicular approach is made using a 1.5-cm-diameter tubular retractor through a 2-cm-long paramedian transverse skin incision...
February 15, 1998: Neurosurgical Focus
Zeng Ming Xiao, Xin Li Zhan, De Feng Gong, Shi De Li
The anterior aspect of the upper thoracic spine is a difficult region to approach in spinal surgery. Many vital structures including osseus, articular, vascular and nervous ones hinder the exposure. With increasing frequency, spine surgeons are being asked to provide decompression and stabilization in patients with spinal tumors. The traditional exposure is between the esophagus and trachea medially and the left common carotid or the brachiocephalic artery (BCA) laterally, and the disadvantages were that the ligation and section of the left innominate vein is proposed to reach T4 and the injury of the thoracic duct could occur...
March 2007: European Spine Journal
Lin Peng, Song-tao Qi, Zhuang Chen, Wen-feng Fen, Lu-xiong Fang, Li-jing Huang, Jiang-peng Cheng
BACKGROUND: The surgical treatment of intramedullary spinal cord tumor aims at complete removal and minimal postoperative deficit. This study was undertaken to evaluate the microsurgical features of intramedullary spinal cord tumors and the time for surgery and prognosis. METHODS: Twenty-one patients with intramedullary spinal cord tumor who had been treated at Nanfang Hospital, Guangzhou, China since 2000 were studied retrospectively. Fifteen patients were men and 6 women, aged 2 - 60 years (mean 29...
August 20, 2006: Chinese Medical Journal
Sharan Wadhwani, Peter Loughenbury, Roger Soames
STUDY DESIGN: A dissection-based study of 18 embalmed cadavers (7 male, 11 female), mean age 84 (+/-8.4) years. OBJECTIVE: To determine the morphology and morphometry of the anterior dural (Hofmann) ligaments. SUMMARY OF BACKGROUND DATA: The attachment of the posterior longitudinal ligament to the dura mater is poorly understood. Anterior dural ligaments connect the anterior dura to the deep layer of the posterior longitudinal ligament, but appear to be limited to the lumbar region and have been observed to have a craniocaudal orientation...
March 15, 2004: Spine
J C Le Huec, E Lesprit, J P Guibaud, N Gangnet, S Aunoble
The anterior cervicothoracic junction is difficult to expose and many techniques have previously been described. Most of them require an extensile exposure, which can lead to significant morbidity. The aim of this study is to present a less invasive approach, allowing the same exposure on the spine as a larger one. The approach begins with the same incision as the Smith-Robinson technique: a blunt dissection of the posterior face of the manubrium is performed with the finger. An endoscope is inserted through 10-mm trocars, one above the manubrium and the second through the second rib space...
October 2001: European Spine Journal
Z Fang, X Yi, M Li, T Zhu
The surgical approach to the second thoracic vertebral body is difficult from the anterior side. A 38-year-old woman suffering from plasmacytoma in the second thoracic vertebra showed paraplegia for 2 weeks prior to surgery. X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) examinations indicated breakdown of the second thoracic vertebral body and arch, associated with spinal cord compression. A 99mTc bone scintigram showed accumulation only in the second thoracic vertebra. After one course of chemotherapy with cyclophosphamide and prednisone (CP protocol), surgery was carried out...
August 2001: International Journal of Clinical Oncology
E Salas, L N Sekhar, I M Ziyal, A J Caputy, D C Wright
OBJECT: The aim of this study was to describe six variations of the extreme-lateral craniocervical approach, their application, and treatment results. METHODS: During a 4-year period 69 patients underwent surgery in which six variations of the extreme-lateral craniocervical approach were performed. The variations included: the transfacetal approach (TFA), performed to treat four lesions in the upper cervical spine anterior or anterolateral to the spinal cord; the retrocondylar approach, to treat five intradural lesions located anterolateral to the medulla oblongata and six vascular lesions to expose the extradural segment of the vertebral artery (VA); the partial transcondylar approach (PTCA), to treat 18 intradural lesions located anterior to the medulla oblongata; the complete transcondylar approach (CTCA), to treat 13 extradural lesions that involved the lower clivus and anterior upper cervical spine; the extreme-lateral transjugular approach, to treat 14 jugular foramen tumors; and the transtubercular approach with or without division of the sigmoid sinus, to treat complex VA and vertebrobasilar junction aneurysms...
April 1999: Journal of Neurosurgery
H D Jho
In an effort to make thoracic discectomy simple and less invasive while using direct visualization, a 70 degrees-angled lens endoscope has been adopted to visualize the ventral aspect of the spinal cord dura mater during microsurgical thoracic discectomy via a transpedicular approach. The patient is positioned in a 60 degrees forwardly inclined lateral position with the side of the lesion facing upward. After radiographic corroboration of the correct level, a transpedicular approach is made using a 1.5-cm-diameter tubular retractor through a 2-cm-long paramedian transverse skin incision...
July 1997: Journal of Neurosurgery
G M Hutchins, M Meuli, C Meuli-Simmen, M A Jordan, D S Heffez, K J Blakemore
Experimental studies have shown that there is a potential to attempt in utero repair of myelomeningocele in human fetuses. To provide a better understanding of the pathology of these lesions we prospectively studied eight stillborn human fetuses with myelomeningocele autopsied at The Johns Hopkins Hospital. The intact vertebral column with surrounding structures was removed, processed as a single block, and prepared as serial histologic sections. Study of the slides showed in all cases that in the center of the myelomeningocele the vertebral arch was open, the arrangement of meninges was such that the dura mater was open and in continuity with the deep layers of the dermis, and the pia mater was open and in continuity with a layer consisting of the superficial dermis and the epidermis...
September 1996: Pediatric Pathology & Laboratory Medicine
R Xu, N A Ebraheim, M C Nadaud, R A Yeasting, S Stanescu
STUDY DESIGN: This study analyzed anatomic parameters between the midpoint of cervical vertebral lateral masses as seen on the superficial, posterior aspect of the mass and cervical nerve roots. Posterior cervical dissection was performed, with the midpoint of the lateral masses kept intact and the nerve roots exposed. OBJECTIVE: To quantitatively determine the location of the cervical nerve roots and the transverse foramina, indicating vertebral artery placement relative to the posterior aspect of the cervical spine...
November 1, 1995: Spine
B George, G Lot
Oblique transcorporeal drilling is a new surgical technique in which the transverse foramina with the vertebral artery and lateral aspects of the bodies of the cervical vertebrae are exposed; it allows to drill out obliquely from the antero-lateral to the opposite postero-lateral corner, half of one or several cervical vertebral bodies. The technique is shortly described and its indications are discussed. It can mainly be applied to release osteophytic compression and to remove anteriorly developed tumors. The advantages are to work in a wide field with all important structures kept medially and protected and to keep a sufficient portion of the vertebral bodies to preserve the spine stability...
December 1994: Minimally Invasive Neurosurgery: MIN
S Rossitti
The thoracic spine may be approached by different ways: posterior, posterolateral, anterolateral and anteriorly, with associated removal of diverse osseous structures as facet joints, costal processes, pedicles and ribs, subsequently imposing the use of diverse fusion procedures in some cases. The extreme lateral approach to the thoracic disc space produces minimum disruption of the normal spinal musculoskeletal anatomy, avoids retraction of the spinal cord and preserves the intercostal neurovascular bundle and the segmental radicular arteries...
June 1994: Arquivos de Neuro-psiquiatria
L Zhou, S Li, H Guo
A surgical approach to the anterior lower brainstem and upper cervical spinal cord consists of a fashion of unilateral suboccipital scalp flap, exposure and resection of the suboccipital bone and hemilamina of C1, removal of occipital condyle and the lateral mass of C1 (occasionally). The satisfaction of exposing the anterolateral portion of lower brainstem and upper cervical spinal cord can be obtained with minimal retraction of the nervous tissue. 13 patients, 9 with tumors, 2 with giant vertebral aneurysms, 2 with craniocervical malformations, underwent this operative procedure with no surgical mortality and morbidity which related to the approach...
April 1995: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
H Iizuka, T Nakamura, S Kadoya
A case of spinal dumbbell shaped melanotic schwannoma was reported. A 58-year-old housewife had a 3-months history of progressive gait disturbance. She also complained of mild backache and numbness in both legs. Her family history was not remarkable. When examined on admission, October 10, 1982, mild weakness of both legs with spasticity and sensory impairment below the level of T10 dermatome without sacral sparing were evident. Her deep tendon reflexes were hyperactive on both sides and plantar responses were extensor bilaterally...
September 1988: No Shinkei Geka. Neurological Surgery
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