DOCSLIB.ORG

The Pathology of Vascular Disorders of the Spinal Cord Trevor Hughes, M.D

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Pathology of Vascular Disorders of the Spinal Cord Trevor Hughes, M.D PAPERS READ AT THE 1964 SCIENTIFIC MEETING 207 ROMANES, G. J. (Scotland) thought the answer to that was Yes. The grey matter was much more vascular in capillary veins than the white matter. WOLMAN, L. (England) said he was particularly interested in the difference between anterior and posterior horns, where they had the concentration of nerve cells. Did the capillary network correlate with the increased number of nerve cells? Was there any difference? ROMANES, G. J. (Scotland) replied that if one took the actual density of nerve cells the density would be in the anterior horn, in areas where there were big motor cells taking up a great deal of room. In the posterior horn the density of nerve cells was quite high. If one counted these they were higher in the posterior horn in the intermediate region than they were in the lateral part of the anterior horn in the lumbar enlargement. What was interesting was the fact that the tip of the posterior horn was supplied from the posterior spinal vessels, while one had the remainder of the grey matter supplied from the perforating branches of the anterior spinal artery but, where they joined, there was no evidence of junction; there must be anastomosis of capillary fields, because there was no break that one could see, and yet on injecting one vessel one filled one territory and on injecting the other one filled another territory. WOLMAN, L. (England). It looked the same in both anterior and posterior horn? ROMANES, G. J. (Scotland). Agreed. He had not done actual measurements of density. Horn Cragie had done quite a lot of this at one time, measuring the lengths of capillaries in a given volume of grey and white matter, but as far as he could recall the figures did not seem to show any difference. THE PATHOLOGY OF VASCULAR DISORDERS OF THE SPINAL CORD TREVOR HUGHES, M.D. By J. The Radcliffe Infirmary, Oxford THE spinal cord has one of the most complex blood supplies of any part of the body and it is necessary to understand some of its complexity before turning to the problem of its vascular disorders. At this meeting we have been fortunate in hear­ ing Professor Romanes' excellent account of the anatomy of the spinal cord vascular supply. Reflecting on the complicated pattern of blood supply I should like to pick out the features that have a special importance in the pathology of vascular disorders of the spinal cord: The multiplicity of feeding sources into the spinal arterial system. This I. forms a powerful reserve of arterial supply immune except to interruption at specially vulnerable places. 2. The dependence on a moderate number of tributary arteries of inconstant position and which are relatively so large that the other tributaries may be interrupted with impunity. The strict division into anterior and posterior spinal artery territories which 3. supply two-thirds and one-third of the cross-sectional area respectively. The absence of significant anastomosis between anterior and posterior 4. spinal artery circumferentially around the cord. (But the anterior spinal PARAPLEGIA 208 artery does make a good anastomosis with the posterior spinal arteries around the Cauda equina.) The overwhelming importance in the whole system of the single anterior 5. spinal artery. The reserve of venous drainage so that venous obstruction rarely damages 6. the spinal cord. The possible sites of obstruction to the vascular supply of the spinal cord may be grouped under seven headings. In group we have the aorta to which the sub­ clavian artery is added. The internal iliacs couldI be included but in this context are of no importance. Group 2 consists of the vertebral arteries whose peculiar anatomical situation merits separate consideration. In group are the paired aortic 3 branches such as the intercostals and the lumbar arteries and in group are the 4 radicular tributaries to the anterior and posterior spinal arteries, these tributaries accompanying the nerve roots through the intervertebral foramina. Group 5 comprises the anterior and posterior spinal arteries, and group 6 all the small spinal arteries arising from the anterior and posterior spinal arteries. In group 7 are the veins of the spinal cord. TABLE Vascular Disorders of the Spinal Cord (Analysis of 28 necropsies selected from a 2o-year period) 1----- Number Site of Lesion Cause I � a:��_ __ f C ' 1 I __ I '- --------- - -;�A�rta I Atheroma . 3 (5 cases) Dissecting aneurysm 1 I Trauma 1 I 2 Vertebrals Trauma 2 1 . (2 cases) Intercostals Thoraco-Iumbar sympathectomy 1 3· I (I case) 8 I 4. Radicular tributaries Malignant infiltration . I (10 cases) Tuberculosis (Psoas abscess) . 1 I ! I Herpes Zoster I I 5· Anterior spinal artery Thrombosis (Idiopathic) I I, (4 cases) Thrombosis (Cervical Spondylosis) I 2I Ischaemia (Cervical Spondylosis) I Small spinal arteries Tuberculosis meningitis 3 6. (4 cases) Syphilis (Erb's) . I Veins Foix-Alajouanine disease 2I 7. (2 cases) I I Total. 28 _____L ----�--- --� The series of cases that I now wish to present to you has been gathered from the material of our neuropathology department at Oxford and comprises 28 necropsied cases drawn from a twenty-year period. The table shows these 28 cases divided into the groups that I have enumerated. I propose to deal with each group in turn but have selected one case from each group for detailed description. PAPERS READ AT THE 1964 SCIENTIFIC MEETING 209 Group Aortic Cases. Aortic atheroma is very common, but it is rare for the clinical workerI. to attribute spinal cord ischaemia to this cause. In three cases severe aortic atheroma had caused ischaemic areas in the spinal cord, the clinical course being an ill-defined chronic paraparesis. The commonest aortic cause of acute spinal cord ischaemia is probably dissecting aneurysm, in which the dissection of the tunica media by a haematoma compresses the origins of the intercostal or lumbar arteries. In these cases the clinical signs of neurological involvement are often slight and scrutiny of the spinal cord shows only trivial findings. But when an important intercostal or lumbar artery is blocked extensive spinal cord infarction can occur. The case I now wish to describe was most unusual in being caused by aortic trauma. It has been described in more detail elsewhere (Hughes, 1964a). A 62-year-old housewife crashed her car into a shop, sufferinginjuries to herCase chest Report. and a lacerated chin. Although momentarily unconscious she was able to walk away from her car and an ambulance took her to hospital. On admission she was found to have fractures of the 2nd, 3rd and 4th ribs anteriorly with a progressive left haemothorax necessitating a thoracotomy the following day. Removal of two litres of blood from the left hemithorax disclosed a 2·s-cm. tear in the pleura over the aorta just above the diaphragm, and extensive mediastinal bruising. With massive blood trans­ fusion her general condition was restored but on the 4th post-operative day impaired movement of the legs was noticed and a full neurological examination the following morn­ ing showed complete paralysis of the legs and absence of all sensation up to the level of T3. Plain X-rays of the spine showed no fracture and a myelogram did not demonstrate any evidence of spinal block. On the 6th post-operative day the patient's blood pressure suddenly collapsed and IS minutes later she died. At necropsy the thoracic aorta showed a transverse intimal tear almost encircling the aorta at a level 4 cm. below the origin of the left subclavian artery. The tear was plugged with thrombus continous with a large mural haematoma in the damaged tunica media and adventitia. At their origin the 2nd, 3rd, 4th and Sth intercostal arteries were surrounded and compressed by the mural haematoma. The spinal cord showed extensive infarction from T3 to T7 (not examined caudal to T7) the whole diameter of the cord being involved. Neurones were absent and the myelin and axons broken up with a perivascular polymorph reaction but few lipid phagocytes. A round infarcted area was present in the posterior columns of C7 and minor ischaemic changes in C7, C8, TI and T2. Group Vertebral Artery Cases. My experience with obstruction of the vertebral artery2. (Hughes, 1964b) is confined to two almost identical cases one of which I shall describe. A S2-year-old factory worker was knocked down by a car, being momentarilyCase Report. unconscious and having scalp lacerations, fractures of the left humerus and right clavicle and intra-abdominal bleeding from a ruptured spleen. With splenectomy and massive transfusion his general condition improved but the following day it was clear he had a partial cord transection causing a quadriparesis. Initially affecting the lower cervical cord segments it then spread upwards causing respiratory difficulty resulting in his death on the third day after his accident. The most interesting necropsy findings were in the cervical spine. The prevertebral muscles were infiltrated with haematoma which covered a tear through the CS-6 intervertebral disc. The spine was mobile due to this and to loosening of the capsular ligament around the intervertebral joints. No fractures could be seen and the spinal canal was not otherwise abnormal. When the vertebral arteries were exposed they were seen to be kinked as they passed through the region of the disc tear. The left vertebral artery was partially torn and embedded in blood clot. The 210 PARAPLEGIA spinal cord externally showed slight swelling and a bloodless anterior spinal artery from C4 to C7. The sections showed ischaemic changes from CI to C3 then frank infarction from C4 to C6. Group Intercostal Arteries.
Load more

Recommended publications
  • Nuclear Expression of PG-21, SRC-1, and Pcreb in Regions of the Lumbosacral Spinal Cord Involved in Pelvic Innervation in Young Adult and Aged Rats
    Original Article http://dx.doi.org/10.5115/acb.2012.45.4.241 pISSN 2093-3665 eISSN 2093-3673 Nuclear expression of PG-21, SRC-1, and pCREB in regions of the lumbosacral spinal cord involved in pelvic innervation in young adult and aged rats Richard N. Ranson1,2, Jennifer H. Connelly1, Robert M. Santer1, Alan H. D. Watson1 1Cardiff School of Biosciences, Cardiff University, Cardiff,2 School of Applied Sciences, Northumbria University, Newcastle upon Tyne, UK Abstract: In rats, ageing results in dysfunctional patterns of micturition and diminished sexual reflexes that may reflect degenerative changes within spinal circuitry. In both sexes the dorsal lateral nucleus and the spinal nucleus of the bulbospongiosus, which lie in the L5-S1 spinal segments, contain motor neurons that innervate perineal muscles, and the external anal and urethral sphincters. Neurons in the sacral parasympathetic nucleus of these segments provide autonomic control of the bladder, cervix and penis and other lower urinary tract structures. Interneurons in the dorsal gray commissure and dorsal horn have also been implicated in lower urinary tract function. This study investigates the cellular localisation of PG-21 androgen receptors, steroid receptor co-activator one (SRC-1) and the phosphorylated form of c-AMP response element binding protein (pCREB) within these spinal nuclei. These are components of signalling pathways that mediate cellular responses to steroid hormones and neurotrophins. Nuclear expression of PG-21 androgen receptors, SRC-1 and pCREB in young and aged rats was quantified using immunohistochemistry. There was a reduction in the number of spinal neurons expressing these molecules in the aged males while in aged females, SRC-1 and pCREB expression was largely unchanged.
    [Show full text]
  • Motor Tracts
    Motor tracts There are two major descending tracts Pyramidal tracts (Corticospinal ) : Conscious control of skeletal muscles Extrapyramidal: Upper motor Subconscious neurons. regulation of balance, muscle tone, eye, hand, and upper limb position: Vestibulospinal tracts Lower motor neurons. Reticulospinal tracts Rubrospinal tracts Tectospinal tracts Extrapyramidal tracts arise in the brainstem, but are under the influence of the cerebral cortex Rexed laminae • Lamina 8: motor interneurons, Commissural nucleus • Lamina 9: ventral horn, LMN, divided into nuclei: Ventromedial : all segements (extensors of vertebral coloumn) Dorsomedial : (T1-L2) intercostals and abdominal muscles Ventrolateral: C5-C8 (arm) L2-S2 (thigh) Dorsolateral: C5-C8 (Forearm), L3-S3 (Leg) Reterodorsolateral: C8-T1 (Hand), S1-S2 (foot) Central: Phrenic nerve (C3-C5) • Lamina X : Surrounds the central canal – the grey commissure Motor neurons of anterior horn Medial group: (All segments) Lateral group: only enlargements Muscle spindles are sensory receptors within the belly of a muscle that primarily detect changes in the length of this muscle. Each muscle spindle consists of an encapsulated cluster of small striated muscle fibers (" intrafusal muscle fibers ") with somewhat unusual structure (e.g., nuclei may be concentrated in a cluster near the middle of the fiber's length). The skeletal muscle is composed of: Extrafusal fibers (99%): innervated by alpha motor neurons . Intrafusal fibers (1%): innervated by gamma motor neurons . depend on the muscle spindle receptors Activating alpha motor neurons Directly through supraspinal centers: Descending motor pathways (UMN) Indirectly through Muscle spindles Stretch reflex: skeletal muscles are shorter than the distance between its origin and insertion Gamma loop Gamma fibers activate the muscle fibers indirectly, while alpha fibers do it directly.
    [Show full text]
  • Bilateral Variant Testicular Arteries with Double Renal Arteries
    Cases Journal BioMed Central Case Report Open Access Bilateral variant testicular arteries with double renal arteries Sarita Sylvia1, Sridhar Varma Kakarlapudi1, Venkata Ramana Vollala*2, Bhagath Kumar Potu3, Raghu Jetti2, Srinivasa Rao Bolla4, Mohandas Rao5 and Narendra Pamidi2 Address: 1Department of Anatomy, Mahadevappa Rampure Medical College, Gulbarga, India, 2Melaka Manipal Medical College, Manipal, India, 3Kasturba Medical College, Manipal, India, 4Mamata Medical College, Khammam, India and 5Asian Institute of Medicine, Science and Technology, Sungai Petani, Kedah, Malaysia Email: Sarita Sylvia - [email protected]; Sridhar Varma Kakarlapudi - [email protected]; Venkata Ramana Vollala* - [email protected]; Bhagath Kumar Potu - [email protected]; Raghu Jetti - [email protected]; Srinivasa Rao Bolla - [email protected]; Mohandas Rao - [email protected]; Narendra Pamidi - [email protected] * Corresponding author Published: 2 February 2009 Received: 16 December 2008 Accepted: 2 February 2009 Cases Journal 2009, 2:114 doi:10.1186/1757-1626-2-114 This article is available from: http://www.casesjournal.com/content/2/1/114 © 2009 Sylvia et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: The testicular arteries normally arise from the abdominal aorta. There are reports about the variant origin of these arteries. Accessory renal arteries are also a common finding but their providing origin to testicular arteries is an important observation. The variations described here are unique and provide significant information to surgeons dissecting the abdominal cavity.
    [Show full text]
  • ANATOMICAL STUDY of ABDOMINAL AORTA and ITS BRANCHES for MULTIPLE VARIATIONS Mane Uddhav Wamanrao *1, Kulkarni Yashwant Ramakrishna 2
    International Journal of Anatomy and Research, Int J Anat Res 2016, Vol 4(2):2320-27. ISSN 2321-4287 Original Research Article DOI: http://dx.doi.org/10.16965/ijar.2016.205 ANATOMICAL STUDY OF ABDOMINAL AORTA AND ITS BRANCHES FOR MULTIPLE VARIATIONS Mane Uddhav Wamanrao *1, Kulkarni Yashwant Ramakrishna 2. *1 Assistant Professor, Department of Anatomy, Dr. Shankarrao Chavan Government Medical College Nanded, Maharashtra, India. 2 Professor and Head, Department of Anatomy, Government Medical College Chandrapur, Maharashtra, India. ABSTRACT Introduction: Abdominal aorta and its major branches supply oxygenated blood to all the organs in abdominal cavity and lower limbs. Striking variations in the origin and course of the principal branches of abdominal aorta have received the attention of the anatomists and surgeons from long periods. Accurate knowledge of the relationship and course of these arterial conduits and particularly of their variation patterns is of considerable practical importance during laparoscopic and various other surgical procedures. Aim: This study was conducted to find out normal pattern and variations of abdominal aorta and its different branches. Materials and Methods: The variations in the branching pattern of abdominal aorta were studied with meticulous dissection and observation, on total 40 adult cadavers (21 males & 19 females), over the period of two years. Variations of various branches of abdominal aorta were noted. Results: We found absent celiac trunk in 5%, instead of common celiac trunk there were two trunks gastrosplenic and hepatic. Origin of inferior phrenic artery was from celiac trunk in 35% cadavers. Accessory renal arteries were found in 27.5%. Gonadal arteries were originating from renal arteries in 5% cadavers.
    [Show full text]
  • Rare Variation in the Origin of Left Testicular Artery
    Published online: 2020-04-22 NUJHS Vol. 5, No.1, March 2015, ISSN 2249-7110 Nitte University Journal of Health Science Case Report RARE VARIATION IN THE ORIGIN OF LEFT TESTICULAR ARTERY FROM LEFT EXTERNAL ILIAC ARTERY : A CASE REPORT Huban Thomas R1, Prasanna L C2, Vivek Kumar3, Antony Sylvan D'souza4 1 Senior Grade Lecturer, 2 Associate Professor, 3 Post Graduate, 4 Professor & HOD, Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, Karnataka, India. Correspondence : Huban Thomas R Senior Grade Lecturer, Department of Anatomy, Kasturba Medical College, Manipal University, Manipal 576 104, Karnataka, India. Mobile : +91 98443 43546 E-mail : [email protected] Abstract : Testicular artery usually arises from the antero-lateral part of the abdominal aorta below the origin of the renal arteries. Very rarely variations in the origin of the testicular arteries were observed. During routine dissection for undergraduate medical students, an abnormal origin and course of the left side testicular artery was detected in a 55-year-old male cadaver. On the left side, testicular artery arose from the external iliac artery half way before its entry into front of the thigh. Later it runs in the inguinal canal to reach the testis. In contrast, right side testicular artery has normal origin and course. Such variations in the origin and course of the testicular artery are important in surgical and diagnostic interventions to avoid diagnostic and surgical errors to prevent hazardous complications like testicular hypoperfusion and atrophy. Keywords: Rare variation, Testicular artery, External iliac artery Introduction : Medical College, Manipal University, Manipal, we observed The testicular arteries are paired vessels that usually arise an abnormal origin and course of the left side testicular from the abdominal aorta at the second lumbar vertebral artery in a 55-year-old male cadaver.
    [Show full text]
  • Blood Supply to the Human Spinal Cord. I. Anatomy and Hemodynamics
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by IUPUIScholarWorks Clinical Anatomy 00:00–00 (2013) REVIEW Blood Supply to the Human Spinal Cord. I. Anatomy and Hemodynamics 1 1 2 1 ANAND N. BOSMIA , ELIZABETH HOGAN , MARIOS LOUKAS , R. SHANE TUBBS , AND AARON A. COHEN-GADOL3* 1Pediatric Neurosurgery, Children’s Hospital of Alabama, Birmingham, Alabama 2Department of Anatomic Sciences, St. George’s University School of Medicine, St. George’s, Grenada 3Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana The arterial network that supplies the human spinal cord, which was once thought to be similar to that of the brain, is in fact much different and more extensive. In this article, the authors attempt to provide a comprehensive review of the literature regarding the anatomy and known hemodynamics of the blood supply to the human spinal cord. Additionally, as the medical litera- ture often fails to provide accurate terminology for the arteries that supply the cord, the authors attempt to categorize and clarify this nomenclature. A com- plete understanding of the morphology of the arterial blood supply to the human spinal cord is important to anatomists and clinicians alike. Clin. Anat. 00:000–000, 2013. VC 2013 Wiley Periodicals, Inc. Key words: spinal cord; vascular supply; anatomy; nervous system INTRODUCTION (segmental medullary) arteries and posterior radicular (segmental medullary) arteries, respectively (Thron, Gillilan (1958) stated that Adamkiewicz carried out 1988). The smaller radicular arteries branch from the and published in 1881 and 1882 the first extensive spinal branch of the segmental artery (branch) of par- study on the blood vessels of the spinal cord, and that ent arteries such as the vertebral arteries, ascending his work and a study of 29 human spinal cords by and deep cervical arteries, etc.
    [Show full text]
  • Abdominal Aorta - Bilateral Arterial Variations
    Original Research Article Abdominal aorta - Bilateral arterial variations K Satheesh Naik1*, M Gurushanthaiah2 1Assistant professor, Department of Anatomy, Viswabharathi Medical College and General Hospital, Penchikalapadu, Kurnool, Andhrapradesh, INDIA. 2Professor, Department of Anatomy, Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, INDIA Email: [email protected] Abstract Background: The abdominal aorta is an important artery in various abdominal surgeries. Hence, the aim of this study was to observe the variations in the branching pattern of abdominal aorta in cadavers. Material and Methods: We Dissected 40 cadavers of both the sex for Medical under graduates and came across the variations in branching pattern of abdominal aorta in about 3 male cadavers, bilaterally and variations were photographed. Results: In Laparoscopic surgeries and kidney transplantation Variations in the branching pattern of the aorta was clinically important. We observed bilateral accessory renal arteries arising from abdominal aorta; coeliac trunk gives rise to a common arterial trunk, which divides into left inferior phrenic and Left middle suprarenal arteries. Left superior suprarenal artery was arising from left inferior phrenic artery and left inferior suprarenal artery normally arising from left renal artery. We also studied the right inferior phrenic artery arising from abdominal aorta below the origin of coeliac trunk, and gives rise to right superior suprarenal artery. Right inferior suprarenal artery was arising from right accessory renal artery; right middle suprarenal artery was absent. We also observed Right gonadal artery was arising from ventral surface of abdominal aorta and left gonadal artery was arising from right accessory renal artery. Conclusion: The knowledge of arterial variations in radio diagnostic interventions and legating blood vessels in abdominal surgeries is useful for the surgeons.
    [Show full text]
  • Anatomy of the Abdominal Aorta in the Hoary Fox (Lycalopex Vetulus, Lund, 1842)
    1 Anatomy of the abdominal aorta in the hoary fox (Lycalopex vetulus, Lund, 1842) Anatomia da aorta abdominal em raposa-do-campo (Lycalopex vetulus, Lund, 1842) Dara Rúbia Souza SILVA1; Mônica Duarte da SILVA1; Marcos Paulo Batista de ASSUNÇÃO1; Eduardo Paul CHACUR1; Daniela Cristina de Oliveira SILVA2; Roseâmely Angélica de Carvalho BARROS1; Zenon SILVA1 1 Universidade Federal de Goiás, Regional Catalão, Instituto de Biotecnologia, Departamento de Ciências Biológicas, Catalão – GO, Brazil 2 Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Departamento de Anatomia Humana, Uberlândia – MG, Brazil Abstract The hoary fox (Lycalopex vetulus, Lund, 1842) is the smallest Brazilian canid, whose weight varies between 2 and 4 kg, has a slender body, a small head, and a short and blackened snout. Despite being considered an endemic species, little is known about the hoary fox as it is one of the seven less studied canids in the world. Thus, this study aimed to describe the anatomy of the abdominal aorta artery of the hoary fox and to compare it with the pre-established literature data in domestic canids. For this purpose, we used two adult hoary foxes without definite age. We collected the corpses of these animals along roadsides of Catalão-GO, being later fixed and conserved in a 10% formalin solution. The results showed that the abdominal aorta in hoary fox is at the ventral face of the lumbar region vertebral bodies, being slightly displaced to the left of the median plane. The first branch is visceral, named celiac artery, followed by a paired parietal branch: the phrenic abdominal arteries.
    [Show full text]
  • Radiographic Anatomy of the Intervertebral Cervical and Lumbar Foramina 691
    Diagnostic and Interventional Imaging (2012) 93, 690—697 View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector CONTINUING EDUCATION PROGRAM: FOCUS. Radiographic anatomy of the intervertebral cervical and lumbar foramina (vessels and variants) ∗ X. Demondion , G. Lefebvre, O. Fisch, L. Vandenbussche, J. Cepparo, V. Balbi Service de radiologie musculosquelettique, CCIAL, laboratoire d’anatomie, faculté de médecine de Lille, hôpital Roger-Salengro, CHRU de Lille, rue Émile-Laine, 59037 Lille, France KEYWORDS Abstract The intervertebral foramen is an orifice located between any two adjacent verte- Spine; brae that allows communication between the spinal (or vertebral) canal and the extraspinal Spinal cord; region. Although the intervertebral foramina serve as the path traveled by spinal nerve roots, Vessels vascular structures, including some that play a role in vascularization of the spinal cord, take the same path. Knowledge of this vascularization and of the origin of the arteries feeding it is essential to all radiologists performing interventional procedures. The objective of this review is to survey the anatomy of the intervertebral foramina in the cervical and lumbar spines and of spinal cord vascularization. © 2012 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved. The intervertebral foramen is an orifice located between any two adjacent vertebrae that allows communication between the spinal (or vertebral) canal and the extraspinal region. Although the intervertebral foramina serve as the path traveled by spinal nerve roots, vascular structures, including some that play a role in vascularization of the spinal cord, take the same path. Knowledge of this vascularization and of the source of the arteries feeding the spinal cord is therefore essential to all radiologists performing interventional procedures in view of the iatrogenic risks they present.
    [Show full text]
  • The Syndrome of Acute Central Cervical Spinal Cord Injury by Richard C
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.21.3.216 on 1 August 1958. Downloaded from J. Neurol. Neurosurg. Psychiat., 1958, 21, 216. THE SYNDROME OF ACUTE CENTRAL CERVICAL SPINAL CORD INJURY BY RICHARD C. SCHNEIDER, JOHN M. THOMPSON, and JOSE BEBIN From the Departments of Surgery and Sections of Neurosurgery of the University of Michigan Hospital, U.S. Veterans Hospital, and St. Joseph's Mercy Hospital, Ann Arbor, Michigan, and the Wayne County General Hospital, Eloise, Michigan, and the Department ofNeuropathology, University Hospital, Ann Arbor Any discussion of the diagnosis and treatment of tissue. The lower extremities tend to recover motor spinal cord injuries inevitably involves controversial power first, bladder function returns next, and finally strength in the upper extremities reappears, with the matters. Among the foremost of these are the indica- finer finger movements coming back last. The varying tions for (Schneider, 1951, 1955) and the contra- degrees of sensory impairment do not follow any set indications for (Schneider, Cherry, and Pantek, 1954) pattern of recovery." surgical intervention. It seems highly important, therefore, to establish criteria which will assist in It was first thought that the acute central cervical determining whether an operation should or should spinal cord injury was found only in severe hyper- Protected by copyright. not be undertaken. In 1955, a paper was published extension injuries. The importance of suspecting on " The Syndrome of Acute Central Cervical such an injury of the cervical spine in the presence Spinal Cord Injury" (Schneider et al., 1954), a of facial lacerations or contusions of the forehead syndrome the presence of which contraindicated any has been emphasized by Taylor and Blackwood surgical procedure.
    [Show full text]
  • Complications During Anterior Surgery of the Lumbar Spine: an Anatomically Based Study and Review
    Neurosurg Focus 7 (6):Article 9, 1999 Complications during anterior surgery of the lumbar spine: an anatomically based study and review Srinath Samudrala, M.D., Larry T. Khoo, M.D., Seung C. Rhim, M.D., and Richard G. Fessler, M.D. Department of Neurosurgery, University of Southern California Medical School, Los Angeles, California; and Department of Neurosurgery, University of Florida Medical School, Gainesville, Florida Procedures involving anterior surgical decompression and fusion are being performed with increasing frequency for the treatment of a variety of pathological processes of the spine including trauma, deformity, infection, degenerative disease, failed-back syndrome, discogenic pain, metastases, and primary spinal neoplasms. Because these operations involve anatomy that is often unfamiliar to many neurological and orthopedic surgeons, a significant proportion of the associated complications are not related to the actual decompressive or fusion procedure but instead to the actual exposure itself. To understand the nature of these injuries, a detailed anatomical study and dissection was undertaken in six cadaveric specimens. Critical structures at risk in the abdomen and retroperitoneum were identified, and their anatomical relationships were categorized and photographed. These structures included the psoas muscle, kidneys, ureters, diaphragm and crura, esophageal hiatus, thoracic duct, greater splanchnic nerves, phrenic nerves, sympathetic chains, medial arcuate ligament, superior and inferior hypogastric plexus, segmental and radicular vertebral vessels, aorta, vena cava, median sacral artery, common iliac vessels, iliolumbar veins, lumbosacral plexus, and presacral hypogastric plexus. Based on these dissections and an extensive review of the literature, the authors provide a detailed anatomically based discussion of the complications associated with anterior lumbar surgery.
    [Show full text]
  • Multiple Variations of the Branches of Abdominal Aorta
    eISSN 1308-4038 International Journal of Anatomical Variations (2010) 3: 88–90 Case Report Multiple variations of the branches of abdominal aorta Published online June 23rd, 2010 © http://www.ijav.org Mehmet Fatih INECIKLI [1] ABSTRACT [2] Ilker Mustafa KAFA Multiple variations were found in a 54-year-old male cadaver during routine dissections of abdominal Murat UYSAL [2] retroperitoneal region. Right inferior phrenic artery was arising from right renal artery, while the right middle Sinan BAKIRCI [2] and superior suprarenal artery branched from the right inferior phrenic artery. Left inferior phrenic artery [2] was originating from the abdominal aorta below celiac trunk. The left middle suprarenal artery appeared as Ibrahim Hakan OYGUCU the branch of celiac trunk. Double left renal artery was arising separately from the left side of the aorta. The upper left renal artery showed approximately 80º of kinking which then crossed the lower one and entered to the inferior pole of hilum of kidney. Left testicular artery was originating from the upper left renal artery after this kinking. The left and right fourth lumbar arteries and median sacral artery have branched from a common trunk posterior to the abdominal aorta. Departments of Radiology [1] and Anatomy [2], Uludag University, Faculty of Medicine, Bursa, TURKEY. In spite of these abundant variations in the branches, abdominal aorta itself did not show any variation, spanning normally between the levels of T12–L4 vertebrae. The variations of abdominal aorta may have clinical importance, especially in surgical and radiologic investigations. © IJAV. 2010; 3: 88–90. Ilker Mustafa Kafa, MD Department of Anatomy Uludag University Faculty of Medicine Gorukle, 16059, Bursa, TURKEY.
    [Show full text]