Spine Healing Therapy

Dorn Spinal Therapy

Dorn Spinal Therapy has been in uses in the past 40 years. The credit of this method goes to Dieter Dorn, who has made a significant impact in the medical field. DORN- Method has been used on various patients where results could get witnessed instants. Due to the impact, this method has brought in the country. It has been declared the standard practice in treating Pelvical Disorders, Spinal, and Back pain. Dieter Dorn first used this method on his family, which was a sign of confidence in a method, which later gained much attention from different people in the country and also globally. Every day Dorn was able to offer treatment to 15- 20 patients in a day. His services were purely free which attracted attention both in the local and also global. The primary treatment that DORN-Method which could be treated using this method include spine healing therapy, misalignments of the spine, resolving pelvis and joints, and also solving out significant problems which could get attributed to vertebrae. Read more here...

Dorn Spinal Therapy Summary


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Vascular Supply Of The Spinal Cord

Spinal Cord White Ramus

There is only one anterior spinal artery, which arises from the vertebral arteries. It supplies the ventral two-thirds of the spinal cord. B. Posterior spinal arteries. There are two posterior spinal arteries that arise from the vertebral arteries or the posterior inferior cerebellar arteries. They supply the dorsal one-third of the spinal cord. 2. This artery is clinically important because it makes a major contribution to the anterior spinal artery. It also provides the main blood supply to the lower part of the spinal cord. 3. Ligation of the great radicular artery during resection of an abdominal aortic aneurysm may result in anterior spinal artery syndrome. Clinical findings include paraplegia, impotence, loss of voluntary control of the bladder and bowel (incontinence), and loss of pain and temperature sensation (although vibration and proprioception sensation are retained). III. THE SPINAL NERVE (Figures 2-1A and 2-2). There are 31 pairs of spinal...

Meninges Ventricles and Cerebrospinal Fluid

Meninges Ventricle

MENINGES are three connective tissue membranes that surround the spinal coal and brain. 1. The pia mater is a delicate, highly vascular layer of connective tissue. It closely covers t he surface of the brain and spinal cord. 1. The subarachnoid space (Figure 2-1) lies between the pia mater and the arachnoid. It terminates at the level of the second sacral vertebra. It contains the cerebrospinal fluid (CSF). b. In the spinal cord, it is a clinically insignificant potential space. b. The spinal epidural space contains fatty areolar tissue, lymphatics, and venous plexuses. The epidural space may be injected with a local anesthetic to produce a paravertebral (saddle) nerve block. E. Meningitis is inflammation of the pia-arachnoid area of the brain, the spinal cord, or both. Spinal cistern Figure 2-1. The subarachnoid spaces and cisterns of the brain and spinal cord. Cerebrospinal fluid is produced in the choroid plexuses of the ventricles. It exits the fourth ventricle, circulates in...

Management of spinal injury

Recognition of the presence or risk of spinal injury is essential at all levels of the health care system. The only resource needed for this is training. Included in this is the necessity to monitor neurological function at regular intervals, such as hourly, in the acute phase of injury, and this should be considered essential for all levels of care. It is increasingly recognized that patients with spinal cord injury, especially acute cervical spinal cord injury, may experience severe hypotension and severe problems in maintaining an airway and adequate ventilation. The risk of further neurological deterioration is increased when the ABC's of trauma management are neglected. Therefore, as with prevention of secondary brain injury, recognition of the importance of these factors in patients with spinal injury is deemed essential at all hospital levels. For several years, there has been an international movement towards a uniform methodology for the classification and scoring of acute...

Cerebrospinal Fluid Marker Concentrations

Endodermal Sinus Tumor Cns

The evaluation of cerebrospinal fluid (CSF) for P-hCG can be a valuable tool in the diagnosis of CNS metastases from GCTs. In patients in whom P-hCG is the predominant marker, measurement of CSF P-hCG may detect patients with CNS involvement with metastatic disease that is below the limits of detection by CT.6 The original work undertaken by Bagshawe and colleagues29,30 (in the era prior to CT and MRI) suggested that a high CSF P-hCG level was predictive of CNS disease. The cutoff for prediction of the presence of CNS metastases was where the CSF concentration exceeded 2 of the serum concentration. In confirmation of this finding, investigators at Memorial Sloan-Kettering Cancer Center reported that a CSF concentration greater than 2 of the serum concentration was of positive predictive value for CNS metastases at autopsy or on imaging studies (Table 17-4).4 Similarly, Kaye and colleagues found that a CSF P-

Movements of the lumbar spine

There are three main movements of the lumbar spine. As there is minimal rotation, which mainly occurs at the thoracic spine, rotation is not so important. The movements that should be tested, and their normal ranges are as follows Fig. 33.5 (a) Degrees of movement of the lumbar spine flexion and extension (b) degree of lateral flexion of the lumbar spine REPRODUCED FROM C. KENNA AND J. MURTAGH, BACK PAIN AND SPINAL MANIPULATION, BUTTERWORTHS, SYDNEY, 1989, WITH PERMISSION

Preexisting Spinal Problems That Increase Trauma Risk

Fig. 14.18a In ankylosing spondylitis, also called Bech-terew disease, slowly progressive ossification of the complete ligamentous apparatus of the spinal column occurs. You have already seen the prototypical appearance of the bamboo spine in Fig. 8.44b, p. 146. Note the fracture at the C6 7 level after a minor trauma in this patient. b In Forestier disease only the anterior longitudinal ligament of the spinal column ossifies, but the effect is the same the spine loses all its elasticity. Every motion that results in any significant axial loading force on the spine constitutes a considerable fracture risk for these patients. Minor trauma has led to a fracture of the C7 in this case.

Ventricles And Cerebrospinal Fluid

Lateral Aqueduct

Interconnected cavities called ventricles (ven'tri-klz) are located within the cerebral hemispheres and brain stem (fig. 11.3 and reference plates 53 and 54). These spaces are continuous with the central canal of the spinal cord and are filled with cerebrospinal fluid. To central canal of spinal cord To central canal of spinal cord The fourth ventricle is located in the brain stem just in front of the cerebellum. A narrow canal, the cerebral aqueduct (aqueduct of Sylvius), connects it to the third ventricle and passes lengthwise through the brain stem. This ventricle is continuous with the central canal of the spinal cord and has openings in its roof that lead into the subarachnoid space of the meninges. Tiny, reddish cauliflowerlike masses of specialized capillaries from the pia mater, called choroid plexuses, (ko'roid plek'sus-ez) secrete cerebrospinal fluid. These structures project into the cavities of the ventricles (fig. 11.4). A single layer of specialized ependymal cells (see...

Spinal Canal Stenosis

True Spondylolisthesis

Fig. 8.38a You are looking at an axial CT image through a lower lumbar vertebral body. The spinal canal is severely stenosed by the bone itself there is no sign of degeneration. This spinal canal stenosis is congenital in nature. Back problems are unavoidable and preprogrammed in these patients. b The vacuum phenomenon in this disk is well seen as well as the hypertrophic degenerative change in the intervertebral joints and the thickening of the posterior longitudinal ligament (the ligament that forms the posterior border of the spinal canal). This spinal canal stenosis is acquired and is due to chronic degenerative change. Fig. 8.40a The lumbar spine film of this patient shows no abnormality. A disk herniation is evident on MRI. The increases in transparency in projection over the upper and middle vertebral body are due to intestinal gas. b This axial CT image demonstrates the massive posterior prolapse of disk material into the spinal canal. The thecal sac is compressed and along...

Spinal Column Trauma in Spinal Canal Stenosis

Narrow Spinal Column

Fig. 11.51 a The spinal canal of this patient is extremely narrow secondarily to severe degenerative changes of the cervical spine with associated malalign-ment. Additional minor trauma was sufficient to induce a severe spinal cord injury with transverse paralysis. b In another patient who sustained minor trauma, signal changes can be seen in the spinal cord extending inferior to the level of the preexisting spinal canal stenosis. In this case the anterior spinal artery, which provides crucial blood supply to the cervical and upper thoracic spinal cord, has been compressed. Ischemia of the spinal cord is a feared complication (anterior spinal artery syndrome). Particularly if radicular symptoms are present, imaging findings and clinical symptoms should be seen in conjunction with the imaging findings to come to a sound and correct diagnosis. Many people have one or several herniated disks without ever developing any associated symptoms. Therefore, only the presence of both radicular...

Spinal trauma and preexisting spinal canal stenosis In a

Lower Ray After Bowel Resection

Stenotic spinal canal even minor trauma may induce major cord damage. This can be due to sudden compression of the whole myelon (Fig. 11.51a) or the focal compression of the anterior spinal artery (Fig. 11.51b). I Extradural Spinal Tumor Fig. 11.49a The spinal cord on this sagittal T1-weighted contrast-enhanced MR image is compressed considerably by the soft tissue component of a plasmacytoma. Plasmacytoma frequently causes destruction of the cancellous and cortical bone. b The coronar-yT1-weighted MRI section after contrast administration reveals a Pancoast tumor, a mass originating in the pulmonary apex that may invade the spinal canal through the neuroforamina and subsequently may cause spinal cord compression. Cranially it involves the brachial plexus and can present with Horner syndrome. I Intradural Spinal Tumor a Spinal meningioma a Spinal meningioma Fig. 11.50a This spinal meningioma is even detectable on the lumbar radiograph (left) because its slow growth has forced the...

Structure Of The Spinal Cord

Gray matter of the spinal cord consists of neuronal cell bodies and is divided into the dorsal horn, ventral horn, and lateral horn. 2. White matter of the spinal cord consists of neuronal fibers and is divided into the dorsal funiculus, ventral funiculus, and lateral funiculus. 3. The ventral median fissure is a distinct surface indentation that is present at all levels of the spinal cord. It is related to the anterior spinal artery. 4. The dorsal median fissure is a surface indentation that is less distinct than the ventral median fissure. It is present at all levels of the spinal cord. 6. The conus medullaris is the end of the spinal cord. It is located at vertebral level LI in the adult and at vertebral level L3 in the newborn. 7. The cauda equina consists of the dorsal and ventral nerve roots of spinal nerves L2 through coccygeal 1. These nerve roots travel in the subarachnoid space below the conus medullaris. 5. The subarachnoid space is located between the arachnoid and the pia...

Each Of The Thirty-one Segments Of The Spinal

Each of the thirty-one segments of the spinal cord gives rise to a pair of_. 2. The bulge in the spinal cord that gives off nerves to the upper limbs is called the_ 3. The bulge in the spinal cord that gives off nerves to the lower limbs is called the_ 4. The_is a groove that extends the length of the spinal cord posteriorly. 5. In a spinal cord cross section, the posterior_of the gray matter appear as the upper 6. The cell bodies of motor neurons are found in the_horns of the spinal cord. 7. The_connects the gray matter on the left and right sides of the spinal cord. 8. The_in the gray commissure of the spinal cord contains cerebrospinal fluid and is 9. The white matter of the spinal cord is divided into anterior, lateral, and posterior_. 4. follows irregular contours of spinal cord surface 5. contains cerebrospinal fluid

Positional Changes Of The Spinal Cord Figure 123

Fetal Conus Medullaris

At week 8, the spinal cord extends the entire length of the vertebral canal as spinal nerves exit the intervertebral foramina near their level of origin. This condition does not persist owing to the disproportionate growth of the vertebral column during the fetal period. Figure 12-3. The end of the spinal cord (conns medullaris) is shown in relation to the vertebral column and meninges. (A) Week 8. (B) Week 24. (C) Newborn. (D) Adult. As the vertebral column grows, nerve roots (especially those of the lumbar and sacral segments) are elongated to form the cauda equina. The SI nerve root is shown as an example. (Modified from Moore KL and Persaud TVN The Developing Human, 6th ed. Philadelphia, WB Saunders, 1998, p 459.) B. At birth, the end of the spinal cord (conus medullaris) extends to the L3 vertebral level. C. In adults, the end of the spinal cord (conus medullaris) extends to the L1-L2 interspace. E. An extension of the pia mater forms the filum terminale, which anchors the...

Spinal Nerve Injuries

Birth injuries, dislocations, vertebral fractures, stabs, gunshot wounds, and pressure from tumors can all injure spinal nerves. Suddenly bending the neck, called whiplash, can compress the nerves of the cervical plexuses, causing persistent headache and pain in the neck and skin, which the cervical nerves supply. If a broken or dislocated vertebra severs or damages the phrenic nerves associated with the cervical plexuses, partial or complete paralysis of the diaphragm may result. thigh, calf, ankle, and foot. Sciatica is most common in middle-aged people, particularly distance runners. It usually compresses spinal nerve roots between L2 and S1, some of which contain fibers of the sciatic nerve. Rest, drugs, or surgery are used to treat sciatica.

The Ventricles Of The Brain And Cerebrospinal Fluid

Cerebrospinal fluid originates from a choroid plexus located in the roof of each ventricle. The choroid plexus is a highly vascularized network of capillaries and nonconducting nerve cells. Cerebrospinal fluid is formed by filtration and secretion from each choroid plexus. Cerebrospinal fluid formed in the lateral ventricles flows into the third ventricle by way of the foramen of Monro and joins the fluid from the third ventricle. The fluid then moves down the aqueduct of Sylvius into the fourth ventricle joining the fluid from the fourth ventricle. The fluid then circulates into the subarachnoid space. The cerebrospinal fluid flows down the posterior aspect of the spinal cord, up the anterior surface of the spinal cord, and around the anterior surface of the brain. Most of the cerebrospinal fluid is absorbed into the sagittal sinus (a blood vascular cavity just under the sagittal suture of the cranium) through finger like projections of the arachnoid mater called arachnoid...

Auxiliary Lines for the Evaluation of the Cervical Spine

Posterior Atlanto Dental

Fig. 14.12a The auxiliary lines for the evaluation of the configuration of the lateral cervical spine run (from anterior to posterior) along the anterior edges of the vertebral bodies, along the posterior edges of the vertebral bodies, and along the anterior contour of the posterior vertebral arches. Another auxiliary line the Chamberlain auxiliary line courses from the hard palate to the occiput. The apex of the dens should not traverse it. Another important point is the atlanto-dental distance (arrow) it may not exceed 4 mm. Finally, the prevertebral soft tissue rim above the level of the esophageal inlet (about C4 5) may not exceed 7 mm in adults. b In the anterior-posterior projection, imagine lines along the spinous processes (do not get thrown off by bifid processes ) and the intervertebral joints. The well-centered position of the dens axis (arrow) relative to the atlanto-occipital joints and to the C1-C2 intervertebral joints is checked with care. (But beware Is the patient...

Ligamentary Injury of the Cervical Spine

Photo Cervical Mri After Whiplash

Spinal column injuries caudal to C3 Giufeng realizes that the so-called normal spine begins at C3. Starting at that level the spinal injuries are categorized as The involvement of the posterior edge of the vertebral body is, of course, essential because it indicates a potential hazard to the spinal canal. Fractures of the lower cervical spine mostly evolve in flexion-distraction movement patterns (type B). Any restriction of the spinal column flexibility, such as seen in ankylosing spondylitis (Fig. 14.18a) or Forrestier disease (Fig. 14.18b), increases the risk of unstable fractures even after minor trauma. While Giufeng is still busy studying the radiograph, Greg has already ordered a repeat study C6 and C7 are not depicted at all. The new radiograph is performed as an oblique view because, even with two strong trauma surgeons pulling the patient's shoulders footward, the cervi-cothoracic transition zone could not be adequately imaged on the lateral projection. The new finding...

Removal Of Spinal Cord In Adults

Spinal Cord Removal

Removal of the spinal cord has been traditionally neglected by general pathologists but can be accomplished very easily within 10-15 min by the use of an oscillating saw, as described below. This should be part of every autopsy. This methods allows easy exposure of the uppermost cervical spine and allows direct visualization of the craniocervical junction it is therefore recommended in cases in which neck injuries are suspected (flexion and extension neck injuries), in cases of craniocervical instability and in special situations, for example, when an occipital encephalocele needs to be excised or in situ exposure of an Arnold-Chiari malformation is required. A myelomeningocele also can be removed more easily by the posterior approach (see below). Many morticians object to the routine use of this method, because embalming fluids tend to leak from the incision on the back. Therefore, if embalming is planned, this approach should be chosen only when strictly indicated. Posterior...

The Human Spinal Cord

Referring to figure 4-4, you can see that the typical vertebra has a large opening called the vertebral (or spinal) foramen. Together, these foramina form the vertebral (spinal) canal for the entire vertebral column. The spinal cord, located within the spinal canal, is continuous with the brainstem. The spinal cord travels the length from the foramen magnum at the base of the skull to the junction of the first and second lumbar vertebrae. (1) Enlargements. The spinal cord has two enlargements. One is the cervical enlargement, associated with nerves for the upper members. The other is the lumbosacral enlargement, associated with nerves for the lower members. (2) Spinal nerves. A nerve is a bundle of neuron processes which carry impulses to and from the CNS. Those nerves arising from the spinal cord are spinal nerves. There are 31 pairs of spinal nerves. b. A Cross Section of the Spinal Cord (figure 11-6). The spinal cord is a continuous structure which runs...

Typical Spinal Nerve

In the human body, every spinal nerve has essentially the same construction and components. By learning the anatomy of one spinal nerve, you can understand the anatomy of all spinal nerves. a. Parts of a Typical Spinal Nerve (figure 11-8). Like a tree, a typical spinal nerve has roots, a trunk, and branches (rami). Figure 11-8. A typical spinal nerve with a cross section of the spinal cord. Figure 11-8. A typical spinal nerve with a cross section of the spinal cord. (1) Coming off of the posterior and anterior sides of the spinal cord are the posterior (dorsal) and anterior (ventral) roots of the spinal nerve. An enlargement on the posterior root is the posterior root ganglion. A ganglion is a collection of neuron cell bodies, together, outside the CNS. (2) Laterally, the posterior and anterior roots of the spinal nerve join to form the spinal nerve trunk. The spinal nerve trunk of each spinal nerve is located in the appropriate intervertebral foramen of the vertebral column. (An...

Cerebrospinal Fluid

A clear fluid called cerebrospinal fluid (CSF) is found in the cavities of the CNS. CSF is found in the ventricles of the brain (para 11 -9d), the subarachnoid space (para 11-11b(2)), and the central canal of the spinal cord (para 11 -10b(1)). CSF and its associated structures make up the circulatory system for the CNS.

Lateral Radiograph of the Cervical Spine

By now the lateral radiograph of the cervical spine is ready for inspection. The trauma surgeons and the anesthesiologist want to know how careful they have to be during repositioning of the patient and whether the stiff collar can be taken off. The radiograph of the cervical spine is always difficult to evaluate and any mistakes can be fatal. f Twenty percent of all polytraumatized patients have an i injury of the cervical spine, a dislocation injury (particularly in deceleration trauma), or a compression injury due to extreme axial loading forces impacting vertebral bodies in the longitudinal direction. It is therefore crucial to check the cervical spine with great care. Definition, outline of all vertebral bodies, and posterior elements and their alignment must be smooth and harmonic

Intradural spinal tumor

Intradural extramedullary spinal tumor The most frequent intradural extramedullary spinal solid tumor is the spinal meningioma. It is a slow-growing tumor that may also expand the spinal canal (Fig. 11.50a see also p. 241). Metas-tases often spread via the CSF also settle in the thecal sac (Fig. 11.50b). They are a feared complication, particularly in pediatric tumors of the posterior fossa. Intramedullary spinal tumor intramedullary spinal masses tend to be primary CNS-type tumors such as astrocytomas and ependymomas. Metastases are also seen (Fig. 11.50c).

Removal Of Spinal Cord In Infants

ANTERIOR APPROACH The basic principle is the same as in adults. The incomplete calcification of the spinal column permits the use of a scalpel blade instead of an oscillating saw blade. Fig. 6-8. Removal of cervical spine. Upper, scalpel blade is used to separate bone block at an intervertebral disk. Lower, bone block to be removed is reflected upward forcefully to break off at high cervical level. This method is faster, but not suitable when examination of the cervical spine (e.g., for fractures or disk protrusion) is necessary. Notice continuity of cervical roots with spinal cord. Fig. 6-8. Removal of cervical spine. Upper, scalpel blade is used to separate bone block at an intervertebral disk. Lower, bone block to be removed is reflected upward forcefully to break off at high cervical level. This method is faster, but not suitable when examination of the cervical spine (e.g., for fractures or disk protrusion) is necessary. Notice continuity of cervical roots with spinal cord....

Spinal Nerves

Thirty-one pairs of spinal nerves originate from the spinal cord. They are mixed nerves, and they provide two-way communication between the spinal cord and parts of the upper and lower limbs, neck, and trunk. Spinal nerves are not named individually but are grouped by the level from which they arise, with each nerve numbered in sequence (fig. 11.30). Thus, there are eight pairs of cervical nerves (numbered C1 to C8), twelve pairs of thoracic nerves (numbered T1 to T12), five pairs of lumbar nerves (numbered L1 to L5), five pairs of sacral nerves (numbered S1 to S5), and one pair of coccygeal nerves (Co). The nerves arising from the superior part of the spinal cord pass outward almost horizontally, whereas those from the inferior portions of the spinal cord descend at sharp angles. This arrangement is a consequence of growth. In early life, the spinal cord extends the entire length of the vertebral column, but with age, the column grows more rapidly than the cord. Thus, the adult...

Plate 27 Spinal Cord

The spinal cord is organized into two discrete parts. The outer part, called the white matter of the cord because of its appearance in unfixed specimens, contains ascending and descending nerve fibers. Some of the fibers go to and from the brain, whereas others connect different levels of the spinal cord. The inner part of the spinal cord, called the gray matter because of its appearance in unfixed specimens, contains the cell bodies of neurons as well as nerve fibers. The gray matter forms an H-or butterfly-shaped pattern surrounding the central canal. The gray matter is described as having dorsal (posterior) horns and ventral (anterior) horns. The ventral horns contain the large cell bodies of motor neurons, whereas the dorsal horns contain neurons that receive, process, and retransmit information from the sensory neurons whose cell bodies are located in the dorsal root ganglia. The size of the gray matter (and, therefore, the size of the spinal cord) is different at different...

Spinal anaesthesia

This is the deliberate injection of local anaesthetic into the cerebrospinal fluid (CSF) by means of a lumbar puncture. It is normally given as a single injection, but can be used in conjunction with epidural anaesthesia (combined spinal-epidural anaesthesia) for longer procedures. The incidence of headache following dural puncture is dependent on the size and type of spinal needle. Not Pencil-tip, spinal needles, such as Whiteacre and Sprotte, split, rather than cut, the dura and also reduce the risk of headache. Local anaesthetic solutions for spinal anaesthesia are isobaric or hyperbaric with respect to the CSF. Isobaric solutions are claimed to have a more predictable spread in the CSF, independent of the position of the patient. Hyperbaric solutions are produced by the addition of glucose and their spread is partially influenced by gravity. Many factors determine the distribution of local anaesthetic solutions in the CSF this makes prediction of the level of blockade difficult...

Spinal Trauma

Cervical spine (C-spine) injuries are present in around 1-2 of all blunt trauma patients and 5-10 of patients with head trauma. It is important to maintain C-spine precautions, document a complete neurologic exam, and assess the respiratory status frequently since high spinal injuries can impair breathing. The patient may be cleared clinically if there is no C-spine pain, a full range of motion, no tenderness to palpation, no intoxication or altered mental status, no distracting injury, and no neurologic deficits. In all other cases, C-spine x-rays must be obtained and the full cervical spine seen, including C7-T1. In patients with a fracture on plain films or those with a neurologic deficit, neurosurgery should be called immediately. Extensive diagnostic investigations, including CT or MRI, may be required. Spinal Cord Injury (SCI) Syndromes Compression of the cord or spinal artery occlusion results in loss of all motor and sensory function below the lesion other than position sense...

Bone Cartilage and Ligaments

Lateral Meniscus Popliteus

Those found in wrists and ankles are boxlike in appearance. Flat bones form the roof of the skull, sternum, the ribs, and the scapula. They protect the underlying soft tissues from the forces of impact. They also offer an extensive surface area for the attachment of skeletal muscles. Irregular bones such as the vertebrae of the spinal column have complex shapes with short, flat, and irregular surfaces. Sutural bones are small, flat, and oddly shaped bones of the skull in the suture line. Finally, sesamoid bones such as the patellae are usually small, round, and flat. They develop inside tendons. Cartilage is a gelatinous matrix that covers bone surfaces at a large number of articulations. It is glassy smooth, glistening, and bluish-white in appearance. It is found in the connections between the ribs and the sternum, and on the surface of articulating bones of the shoulder and hip joints, elbow, knee, and the wrist. Cartilage pads are positioned between spinal vertebrae. One important...

Adaptive Bayesian Segmentation

FIGURE 2 Results of the adaptive fuzzy c-means algorithm on double-echo MR data. (a) PD-weighted MR image after preprocessing, (b) T2-weighted MR image after preprocessing, (c) maximum membership segmentation computed using AFCM, (d) gray matter fuzzy membership function, (e) white matter fuzzy membership function, (f) cerebrospinal fluid fuzzy membership function.

Treatment Prion Diseases

One goal of medical management is to prevent the infectious spread of prion diseases. Prions can be transmitted from one organism to another if nervous system tissue containing PrPSc from an infected patient is transferred to another patient. Thus, the equipment used in neurosurgery, corneal transplants, and depth electrodes must be decontaminated by methods that inactivate prions if they have come in contact with a patient with a prion disease. Procedures for decontaminating operating and autopsy rooms have been developed and are unique for prions (Committee on Health Care Issues, American Neurological Association, 1986 Steelman, 1999) Universal precautions should be used when handling cerebrospinal fluid, optic tissue, blood, and urine. Cerebrospinal fluid and optic tissue have the highest titers of infectious prions, but small amounts of infectious prions have been found in other tissues, blood, and urine (Committee on Health Care Issues, American Neurological Association, 1986)....

Osteopenia Osteoporosis

The following tests should be performed on all patients with AIDS a lumbar spine X-ray in the standard anteroposterior and lateral views, bone density measurement (DEXA scan) of the lumbar spine and hip and laboratory blood tests, including calcium, phosphate and alkaline phosphatase. Osteopenia should be treated with 1000 I.E. vitamin D daily and a calcium-rich diet or calcium tablets with a dose of 1200 mg day. Patients should be advised to exercise and give up alcohol and nicotine. In cases with osteoporosis, aminobiphosphonates should be added. Because testosterone suppresses osteoclasts, hypogonadism should be treated (Cheonis 2002, Cheonis 2000, Mondy 2003, Tebas 2000).

Systemic Manifestations

More than 30 of skeletal TB cases involve the spine (tuberculous spondylitis or Pott's disease). The most commonly affected area is the lower thoracic spine, followed by the lumbar, cervical, and sacral areas. The mode of spread to the spine is usually hematogenous, but it also can result from contiguous disease or lymphatic spread from TB pleuritis. In contrast to common bacterial causes of spinal osteomyelitis that initially present as discitis with adjacent vertebral body involvement, TB spondylitis typically begins within the anterior vertebral body. With time, spread to the adjacent disc and vertebra occurs, and vertebral body wedging develops. Pott's disease is a disease of older age in developed countries and presents with local symptoms of pain and stiffness without systemic manifestations such as fever or weight loss. Initial roentgenograms can be negative. Thus, the diagnosis can be difficult to make, and late complications often appear. These can include...

Nerve Fiber Classification

Like nerve fibers, nerves that conduct impulses into the brain or spinal cord are called sensory nerves, and those that carry impulses to muscles or glands are termed motor nerves. Most nerves, however, include both sensory and motor fibers, and they are called mixed nerves. Nerves originating from the brain that communicate with other body parts are called cranial nerves, whereas those originating from the spinal cord that communicate with other body parts are called spinal nerves. The nerve fibers within these structures can be subdivided further into four groups as follows 1. General somatic efferent fibers carry motor impulses outward from the brain or spinal cord to skeletal muscles and stimulate them to contract. 2. General visceral efferent fibers carry motor impulses outward from the brain or spinal cord to various smooth muscles and glands associated with 3. General somatic afferent fibers carry sensory impulses inward to the brain or spinal cord from receptors in the skin...

Amorphous Silicon Detectors

The Cyberknife localization method can, in principle, be used wherever radio-opaque features are associated with an anatomical target, a concept that would allow the extension of radiosurgical technique to extracranial sites. The Cyberknife has already been used to treat sites within the spine 9-11 , lung, and pancreas. To overcome the above limitations, the previous cameras in the Cyberknife have been replaced with flat-panel amorphous silicon X-ray cameras (dpiX, Palo Alto, CA) 12,13 . These devices have a pixel pitch of 0.125 mm and acquire flat images that avoid distortions inherent to lensed or X-ray image intensifier techniques. When images from these sensors are processed by the new 6D registration software, a tenfold improvement in spatial resolution is achieved. The new imaging software and hardware have been specifically designed to provide variable fields of view and magnification ranges that can be adapted to multiple anatomical locations. For example, amorphous-silicon...

Parasympathetic Division

The preganglionic fibers of the parasympathetic division (craniosacral division) arise from neurons in the mid-brain, pons, and medulla oblongata of the brain stem and from the sacral region of the spinal cord (fig. 11.40). From there, they lead outward on cranial or sacral nerves to ganglia located near or within various organs (terminal ganglia). The short postganglionic fibers continue from the ganglia to specific muscles or glands within these organs (fig. 11.41). Parasympathetic preganglionic axons are usually myelinated, and the parasympathetic post-ganglionic fibers are unmyelinated. 75 of all parasympathetic fibers.) Preganglionic fibers arising from the sacral region of the spinal cord lie within the branches of the second through the fourth sacral spinal nerves, and they carry impulses to viscera within the pelvic cavity (see fig. 11.40).

Management of head injury

Intracranial pressure (ICP) monitoring for appropriate indications (e.g. Glasgow coma scale less than 9 and abnormal CT scan of the head) and the ability to treat raised ICP through such means as sedation, osmotic diuresis (with mannitol), paralysis, cerebrospinal fluid (CSF) drainage and hyperventilation are deemed desirable at the tertiary care level. They are also desirable at the specialist-level hospital if a neurosurgeon is present. They are also desirable at the specialist-level hospital if a general surgeon with considerable neurosurgical expertise is available, in a setting in which facilities for referral to a tertiary centre are limited.

Thoracic pain of lower cervical origin

The pain from the lower cervical spine can also refer pain to the anterior chest, and mimic coronary ischaemic pain. The associated autonomic nervous system disturbance can cause considerable confusion in making the diagnosis. The medical profession tends to have a blind spot about various pain syndromes in the chest, especially the anterior chest and upper abdomen, caused by the common problem of dysfunction of the thoracic spine. Doctors who gain this insight are amazed at how often they diagnose the cause that previously did not enter their 'programmed' medical minds. Physical therapy to the spine can be dramatically effective when used appropriately. Unfortunately, many of us associate it with quackery. It is devastating for patients to create doubts in their minds about having a 'heart problem' or an 'anxiety neurosis' when the problem is spinal and it can be remedied simply ( Chapter 34 ). Lumbar spinal dysfunction Typical examples of referral and radicular pain patterns from...

Physical Characteristics

Hornbills have patches of bare skin around the eyes and throat and long eyelashes on their upper lids. To support their head and large bill, they have strong neck muscles and two neck vertebrae, bones in the spinal column, connected together. Hornbill plumage, feathers, is not very colorful, usually with areas of black, white, gray, or brown. The color and size of plumage and the shape of the casque identifies the age and sex. Hornbills vary in size and shape, from 11.8 to 47.3 inches (30 to 120 centimeters) long, and weigh between 3.5 ounces and 13.25 pounds (100 grams and 6 kilograms). Males are larger and heavier than females and have bills that are up to 30 percent longer.

Retrogasserian Glycerol Rhizolysis

As the needle tip punctures the foramen, a slight contraction of the masseter muscle is often felt as a gentle bite on the surgeon's gloved finger. Intravenous sedation is given for this step. As the trocar is removed from the needle, cerebrospinal fluid may drip from its lumen, but this finding is not essential for correct placement and may occur even if the needle is lateral to the intended target. Indeed if glycerol has been previously injected, cerebrospinal fluid may not flow from the trigeminal cistern at all.

General Functions of the Nervous System

Nissl Bodies

The organs of the nervous system can be divided into two groups. One group, consisting of the brain and spinal cord, forms the central nervous system (sen'tral ner'vus sis'tem) or CNS, and the other, composed of the nerves (cranial and spinal nerves) that connect the central nervous system to other body parts, is called the peripheral nervous system (pe-rif'er-al ner'vus sis'tem) or The nervous system includes the central nervous system (brain and spinal cord) and the peripheral nervous system (cranial nerves and spinal nerves). The nervous system includes the central nervous system (brain and spinal cord) and the peripheral nervous system (cranial nerves and spinal nerves). Dendrites are usually highly branched, providing receptive surfaces to which processes from other neurons communicate. (In some kinds of neurons, the cell body itself provides such a receptive surface.) Often the den-drites have tiny, thornlike spines (dendritic spines) on their surfaces, which are contact points...

What Are Carrot Shaped Brain Tumors

High Grade Large Cell Malignancy

Composed of oval to carrot-shaped cells, with a dense speckled nucleus and tapering eosinophilic cytoplasm (see Fig. 1.11) 46 . Some tumors have cells with a more glial appearance and more background fibrillar-ity or more epithelioid cells and architecture. Perivas-cular pseudorosettes, which are commonly observed, are circular arrangements of tumor cells that send processes towards vessel walls, creating a perivascu-lar ''nuclear-free zone'' that can be noted at low-power. Less commonly, true ependymal rosettes, surrounding a true lumen, can be observed. Ependymomas are usually GFAP positive. Anaplastic ependymomas (WHO grade III) have additional features such as increased cellularity, mitotic activity, pleomorphic nuclei, vascular hyperplasia, nuclear atypia, and necrosis. Myxopapillary ependymomas are WHO grade I tumors that arise in the lower spine within the cauda equina. They display an admixture of fibrillated and epithelioid cells with an exuberant connective tissue stroma....

Selection ofthe Administration Route

When tumor cells penetrate into the intrathecal and subarachnoid space and metastasize along the leptomeninges, the subsequent neoplastic meningitis carries a dramatically poor outcome despite chemotherapy and radiotherapy of the entire neuroaxis. MAbs administered into the intrathecal or intraventricular compartments circulate via the cerebrospinal fluid (CSF) stream along the brain and spine to the disseminated leptomeningeal tumor cells (7). However, one must bear in mind that compounds injected in the lumbar area may not effectively reach the lateral ventricles because of a unidirectional flow pattern (45).

History And Physical Examination

The physical examination should be thorough. The position of the hip at rest should be noted, as it may indicate the underlying pathology. For example, a hip that is abducted, flexed, and externally rotated achieves the greatest capsular volume, suggesting an effusion or synovitis. The patient's gait should be noted. Examination of the lumbar spine including motor function, sensation, range of motion, reflexes, and straight-leg raises must be performed to rule out lumbar spine pathology as the cause of symptoms. Leg-length discrepancies should be assessed 12,13 .

Ventricular System

Internal Capsule Hemorrhage

CEREBROSPINAL FLUID is a colorless acellular fluid. It flows through the ventricles and into the subarachnoid space. Cerebrospinal Fluid Profiles in Subarachnoid Hemorrhage, Bacterial Meningitis, and Viral Encephalitis Cerebrospinal Fluid Profiles in Subarachnoid Hemorrhage, Bacterial Meningitis, and Viral Encephalitis

Neuroimaging And Initial Treatment

The most sensitive technique to diagnose medulloblastoma is neuro-imaging with contrast-enhanced MRI 1,3-5,13,17 . MRI is more sensitive than CT for tumors within the posterior fossa and has the added benefit of midsagittal images. Hydrocephalus (75 to 85 per cent of cases) is clearly demonstrated with either modality. On T2 images, the tumor is a heterogeneous high signal lesion within the cerebellum (midline or hemispheric). Regions of calcification, cyst, necrosis, or hemorrhage are not common. On T1 images, the mass appears hypointense or isointense compared to surrounding brain. After administration of gadolinium, there is heterogeneous tumor enhancement in at least 90 per cent of the cases 13,17 . Peritumoral edema is often present, contributing to compression or displacement of the fourth ventricle. It is important to carefully review the brain MRI for leptomeningeal enhancement and infiltration into the brainstem, since this information is important for tumor staging and risk...

Intradiscal Electrothermal Annuloplasty And Nucleoplasty

Radiofrequenz Nucleoplasty

Heary reviewed presentations on experience with IDET at the 2000 North American Spine Society meeting (65). One such presentation noted that, of 170 of 259 patients treated with IDET by 28 physicians, 76 responded in a 6-month follow-up survey that their pain was reduced (66). Despite this and other positive reports, Heary urged caution in adopting the procedure because there was no information from well-controlled studies, and he considered the underlying scientific rationale questionable at best and perhaps incorrect. The contraindications of IDET have not yet been firmly established, but the criteria used to exclude subjects from trials include herniations larger than 4 mm, sequestered disc herniations (when pulposus material separates from the disc nucleus and floats in the spinal column), previous lower back surgery, vertebral canal stenosis, spondylolisthesis at the site, scoliosis, compression radiculopathy, pregnancy, and certain allergies. Complication rates have been low,...

Clinical Correlations

Variations of spina bifida and encephalocele. SP spinal cord CSF cerebrospinal fluid V ventricle. (Modified from Haines DE edj Fundamental Neuroscience. New York, Churchill Livingstone, 1997, p 69.) 2. Spina bifida with meningocele occurs when the meninges project through a vertebral defect and form a sac filled with CSF. The spinal cord remains in its normal position. 3. Spina bifida with meningomyelocele (Figure 12-6 B). This form occurs when the meninges and spinal cord project through a vertebral defect to form a sac. Figure 12-6. (A) Spina bifida occulta. Note the presence of the bony vertebral bodies (VB) along the entire length of the vertebral column. However, the bony spinous processes terminate much higher (*) because the vertebral arches fail to form properly. This creates a vertebral defect. The spinal cord is intact. B) Spina bifida with meningomyelocele as seen on an ultrasonogram of a 14-week-old fetus. Note the cyst-like protrusion (m meningomyelocele) and...

Metabolic Disorders Are Associated With Each Reaction Of The Urea Cycle

A deficiency of or-nithine transcarbamoylase (reaction 2, Figure 29-9) produces this X chromosome-linked deficiency. The mothers also exhibit hyperammonemia and an aversion to high-protein foods. Levels of glutamine are elevated in blood, cerebrospinal fluid, and urine, probably due to enhanced glutamine synthesis in response to elevated levels of tissue ammonia. Citrullinemia. In this rare disorder, plasma and cerebrospinal fluid citrulline levels are elevated and 1-2 g of citrulline are excreted daily. One patient lacked detectable argininosuccinate synthase activity (reaction 3, Figure 29-9). In another, the Km for citrulline was 25 times higher than normal. Citrulline and argini-nosuccinate, which contain nitrogen destined for urea synthesis, serve as alternative carriers of excess nitrogen. Feeding arginine enhanced excretion of citrulline in these patients. Similarly, feeding benzoate diverts ammonia nitrogen to hippurate via glycine (see Figure 31-1)....

Removal Of Brain In Adults

Coronal Mastoid Incision

Ideally, sawing should be stopped just short of cutting through the inner table of the cranium, which will easily give way with the use of a chisel and a light blow with a mallet. Leaving the dura and underlying leptomeninges intact allows to view the brain with the overlying cerebrospinal fluid (CSF) still in the subarachnoid space. To obtain this view, after removal of the skull cap, the dura must be cut with a pair of scissors along the line of sawing and reflected. Cranial nerves VII, VIII, IX, X, XI, and XII are then cut identifying each one in sequence. The vertebral arteries are severed with scissors as they emerge into the cranial cavity. Then, the cervical part of the spinal cord is cut across as caudally as possible, but too oblique a plane of sectioning should be avoided. Curved scissors will be best for this purpose. If a critical lesion exists in the region, a cross-section perpendicular to the neuroaxis at the pontomedullary junction or higher may be elected in order to...

Glutamatergic Dysregulation In Ethanoldependent Patients

Clinical research studies have begun to document the enhancement in glutamatergic function during withdrawal. Postmortem studies of ethanol-dependent individuals suggest that the Bmax or KD of NMDA receptors are increased in cortical structures alcoholics (43,44). In vivo, ethanol withdrawal increases cerebrospinal fluid glutamate levels (45), consistent with preclinical evidence of enhanced glutamate release (46,47). Repeated episodes of withdrawal may promote the initiation of forms of neural sensitization that may contribute to increased startle magnitude (48) and enhanced seizure risk (49,50). It is possible that withdrawal-related neuroplasticity contributes to associative learning, as might be reflected in drug-craving (51).

Upper thoracic pain

Dysfunction of the joints of the upper thoracic spine usually gives rise to localised pain and stiffness posteriorly but also can cause distal symptoms, probably via the autonomic nervous system. A specific syndrome called the T4 syndrome 2 has been shown to cause vague pain in the upper limbs and diffuse, vague head and posterior neck pain.

Cross Sectional Anatomy of the Brain

Mid Sagittal Brain Fornix

Midsagittal magnetic resonance imaging section through the brain stem and diencephalon. Note the cerebrospinal fluid tract lateral ventricle, interventricular foramen of Monro, third ventricle, cerebral aqueduct, fourth ventricle, foramen of Magendie, cerebellomedullary cistern, and spinal subarachnoid space. Note also the relation between the optic chiasm, infundibulum, and hypophysis (pituitary gland). Spinal cord Subarachnoid space Figure 1-3. Midsagittal magnetic resonance imaging section through the brain stem and diencephalon. Note the cerebrospinal fluid tract lateral ventricle, interventricular foramen of Monro, third ventricle, cerebral aqueduct, fourth ventricle, foramen of Magendie, cerebellomedullary cistern, and spinal subarachnoid space. Note also the relation between the optic chiasm, infundibulum, and hypophysis (pituitary gland). Spinal cord Subarachnoid space

Axial Image Through The Midbrain Mamillary Bodies And Optic Tract Figures 110 111 112 and 113 The location of the

Cerebral Aqueduct Axial

Axial magnetic resonance imaging (MR1) section at the level of the midbrain and mamillary bodies. Because of the high iron content, the red nuclei, mamillary bodies, and substantia nigra show a reduced MR1 signal in T2-weighted images. Flowing blood in the cerebral vessels stands out as a signal void. Cerebrospinal fluid produces a strong signal in the ventricles and cisterns. Figure 1-11. Axial magnetic resonance imaging (MR1) section at the level of the midbrain and mamillary bodies. Because of the high iron content, the red nuclei, mamillary bodies, and substantia nigra show a reduced MR1 signal in T2-weighted images. Flowing blood in the cerebral vessels stands out as a signal void. Cerebrospinal fluid produces a strong signal in the ventricles and cisterns.

Clinical Procedures

Spinal Anaesthetic Subarachnoid Space

Lumbar puncture (Figure 2-4) can be performed to withdraw cerebrospinal fluid or to inject an anesthetic (e.g., spinal anesthesia). 2. The needle passes through the following structures skin superficial fascia supraspinous ligament interspinous ligament ligamentum flavum epidural space containing the internal vertebral venous plexus dura mater arachnoid subarachnoid space containing cerebrospinal fluid. B. Spinal anesthesia (spinal block, or saddle block) 1. Spinal anesthesia is produced by injecting anesthetic into the subarachnoid space it may be used during childbirth. 2. Sensory nerve fibers for pain from the uterus travel with the pelvic splanchnic nerves (parasympathetic) to spinal levels S2 4 from the cervix, and may be responsible for referred pain to the gluteal region and legs. Sensory nerve fibers for pain also travel with the hypogastric plexus and lumbar splanchnic nerves (sympathetic) to spinal levels LI-3 from the fundus and body of the uterus and oviducts, and may...

Combined Motor And Sensory Lesions

Spinal cord hemisection (Brown-Sequard syndrome) see Figure 8-2E is caused by damage to the following structures B. Ventral spinal artery occlusion (see Figure 8-2F) causes infarction of the anterior two-thirds of the spinal cord, but spares the dorsal columns and horns. It results in damage to the following structures E. Friedreich's ataxia has the same spinal cord pathology and symptoms as subacute combined degeneration. F. Multiple sclerosis (see Figure 8-2B). Plaques primarily involve the white matter of the cervical segments of the spinal cord. The lesions are random and asymmetric. F. The protein level in the cerebrospinal fluid is elevated, but without pleocytosis (albu-minocytologic dissociation). B. The nucleus pulposus impinges on the spinal roots, resulting in spinal root symptoms (i.e., paresthesias, pain, sensory loss, hyporeflexia, and muscle weakness). VI. CAUDA EQUINA SYNDROME (SPINAL ROOTS L3 TO CO) results usually from a nerve root tumor, an ependymoma, a dermoid...

Clinical Considerations

Rectal Nerve Block

Figure 16-2. (A) Administration of a pudendal nerve block transvaginal and lateral to the labia majora. The ischial spine (not shown) is a good anatomic landmark. (B) The path of the pudendal nerve (curved arrow) as it passes out of the pelvic cavity through the greater sciatic foramen (posterior to the ischial spine) and returns to the pelvic cavity through the lesser sciatic foramen as it proceeds to the perineum. SS sacrospinous ligament ST sacrotuberous ligament. (C) The perineum in the lithotomy position. The posterior labial (PL) and inferior rectal (IR) nerves are terminal branches of the pudendal nerve. In addition, the ilioinguinal nerve ( L), genitofemoral nerve (GF), and perineal branch of the posterior femoral cutaneous nerve (PFC), which also must be anesthetized by cutaneous injection of 1 lidocaine to obtain complete anesthesia of the perineal region, are shown. Labels L1, L2, L3, S2, S3, S4, and S5 indicate the dermatomes of the perineal region. (A reprinted with...

What is Your Diagnosis

Spinal Dysraphism

Arnold-Chiari malformations The Arnold-Chiari I malformation is a complex group of malformations characterized by the downward displacement of the cerebellar tonsils and the medulla oblongata into the cervical spinal canal (Fig. 11.46c). Arnold-Chiari II malformations are more complex and include spinal dysraphism and menin-goceles or myelomeningoceles. Fig. 11.46a This meningocele presents itself as a dorsal outpouching of the dura through an osseous defect. The dural pouch is filled with CSF. b On this axial CT image the vermis is missing, the fourth ventricle is enlarged, and the temporal horns are dilated considerably, indicative of hydrocephalus. This is a patient with Dandy-Walker complex. c Descent of cerebellum and brainstem into the spinal canal is characteristic of the Arnold-Chiari malformation. There is also an associated malformation of the osseous craniocervical junction zone. d The corpus callosum is missing completely (arrow, left image) on this coronal MR image...

Sequences of CNS myelination

Myelin sheaths appear in the motor root fibers of the spinal nerves at the end of the fourth fetal month, while the sensory fibers begin to myelinate at the end of the fifth month. The motor nerve roots reach their adult pattern of myelination at about term while the sensory nerve rootlets continue to myelinate for several months after birth. Among the cranial nerves, the roots of the eighth pair are the first to show myelinated fibers. At the end of the fifth fetal month, the roots of both divisions of the eighth nerve are myelinated. The oculomotor nerves (III, IV, VI) and the motor division of the trigeminal nerve myelinate next, at about the same time. As in the spinal roots, the cranial motor roots seem to myelinate at a faster pace than the sensory roots. The cycle of myelinadon of the cranial nerve roots appears to be completed early in the first postnatal year. Except for the dorsal root fibers in the posterior columns of the spinal cord, there are no myelinated fibers in the...

Combined Ocular Motor Nerve Palsies

Tested by observing for intorsion of the affected eye in downgaze. If multiple ocular motor nerve palsies are indeed present, a thorough history and examination, neuroimaging of the rostral brainstem, cavernous sinuses, and orbits, and examination of the cerebrospinal fluid (CSF) are typically necessary to distinguish between the myriad possible localizations and etiologies. Prompt diagnosis is particularly important for children with infections or pituitary apoplexy the latter is often accompanied by severe headache, ophthalmoplegia caused by rapid expansion into the cavernous sinus, and rapid mental status deterioration. Acute hemorrhagic conjunctivitis caused by enterovirus 70 can be accompanied by dysfunction of any of the cranial or spinal motor nerves,220,246,513 resulting in a polio-like paralysis (radiculomyelitis) in approximately 1 in 10,000 patients infected with this virus.535 Cranial nerve involvement occurred in 50 of the patients in one series.246 Solitary seventh or...

Intracranial Germinoma

Given the exquisite sensitivity of intracranial germinomas (ICGs) to both radiation and chemotherapy, the role for radical surgery is questionable. Sawa-mura and colleagues retrospectively reviewed the experience of 29 patients who underwent surgery for germinoma and found that radical resection offered no benefit in either response rate or overall survival when compared to biopsy alone.93 Because of the potential risks of radical surgery (including seeding of the cerebrospinal fluid), once a diagnosis of germinoma is confirmed, further surgical resection should not be undertaken. need radiation treatment to the entire craniospinal axis as well as to the primary tumor site. High rates of long-term disease-free survival can be achieved in this group of patients when the entire neuraxis is appropriately treated.99 However, the role for prophylactic spinal irradiation (PSI) in patients in whom there is no evidence of disseminated disease is questionable. In the above-mentioned study by...

Trigonocephaly And Angels Kisses

Craniorachischisis Congenital failure of closure of the skull and spinal column. gastroschisis Congenital fissure of the abdominal wall not involving the site of insertion of the umbilical cord, and usually accompanied by protrusion of the small and part of the large intestine. genu recurvatum Hyperextension of the knee. genu valgum Outward bowing of knee bow-leg. genu varum Inward deviation of the knee knock-knee. gibbus Extreme kyphosis or hump deformity of the spine in which there is a sharply angulated segment, the apex of the angle being posterior. glabella The most prominent midline point between the eyebrows. glossoptosis Downward displacement or retraction of the tongue sometimes held by a frenulum. gnathion The lowest median point on the inferior border of the hydrocephaly Abnormal increase in the amount of cerebrospinal fluid kyphoscoliosis Abnormal curvature of the spinal column, both antero- posteriorly and laterally. kyphosis Curvature of the spine in the anteroposterior...

Normal and Abnormal Hair Patterns

A widow's peak along the frontal scalp line is probably the result of the bilateral periorbital fields of hair growth suppression intersecting lower than usual on the forehead. This can occur when the periorbital fields of hair growth suppression are smaller than usual, or when they are widely spaced. Wide spacing also explains the association between ocular hypertelorism and widow's peak. The only common anomaly of the posterior hairline is low placement with a squared distribution, which may be seen in Turner syndrome, in Noonan syndrome, and with abnormalities of cervical spine fusion or segmentation.

Dentatothalamic Pathway

Medulloblastomas are malignant and constitute 20 of all brain tumors in children. They are believed to originate from the superficial granule layer of the cerebellar cortex. They usually obstruct the passage of cerebrospinal fluid (CSF). As a result, hydrocephalus occurs.

Schwann Cells Electrically Excitable

Camillo Golgi

There are two major classes of cells in the brain - neurones and glia (Figure 1.1). The fundamental difference between these lies in their electrical excitability -neurones are electrically excitable cells whereas glia represent nonexcitable neural cells. Neurones are able to respond to external stimulation by generation of a plasmalemmal 'all-or-none' action potential, capable of propagating through the neuronal network, although not all neurones generate action potentials. Glia are unable to generate an action potential in their plasma membrane (although they are able to express voltage-gated channels). Glial cells are populous (as they account for 90 per cent of all cells in the human brain) and diverse. In the central nervous system (CNS) they are represented by three types of cells of neural (i.e. ectodermal) origin, often referred to as 'macroglial cells' (which may also be properly called 'neuroglial cells'). These are the astrocytes, the oligodendrocytes and the ependymal...

Radiologic Evaluation And Modality Overview

Piriformis Muscle Radiology

When screening radiographs are negative, the next useful imaging modality is generally magnetic resonance imaging using unilateral direct MR arthro-graphy of the hip for the evaluation of intra-articular pathology or screening MR of the pelvis for extra-articular sources of pain. However, radiographs or MRI of the lumbar spine, sacroiliac joints, femur thigh, or knee may be needed to evaluate for referred pain. Under fluoroscopic guidance, sterile conditions, and local anesthetic, we advance a 22-gauge spinal needle via an anterior or anterolateral approach targeting the mid- to proximal aspect of the femoral neck (Fig. 2). The femoral artery is palpated before injection to avoid injury, but at this level the vessels are usually located more medial. The patient is positioned with the hip internally rotated and knee mildly flexed and supported with a foam pad to expose the femoral neck and increase laxity to the anterior capsule. Sterile extension tubing is used to connect the needle...

Varicella Zoster Virus Infections during Pregnancy

John Kennedy Death Body

Most cases of CVS have been reported on the basis of the described main clinical symptoms without laboratory evidence of intrauterine infection. However, the causal relationship between maternal varicella infection and congenital abnormalities would be most convincingly verified by detection of the virus, viral antigens or viral DNA in the infant. With the use of polymerase chain reaction (PCR) and nucleic acid hybridization assays, VZV DNA can be detected in fetal or infantile tissue samples, cerebrospinal fluid and or amniotic Skin lesions (cicatricial scars, skin loss) Neurological defects or diseases (cortical atrophy, spinal cord atrophy, limb paresis, seizures, microcephaly, Horner's syndrome, encephalitis, dysphagia) Eye diseases (microphthalmia, enophthalmia, chorioretinitis,

Pharmacological Toxicological Effects

Pseudohypericin has been shown to be a corticotropin-releasing factor (CRF)1 receptor antagonist. CRF has been implicated as a pathogenic factor in affective disorders, with elevated levels that are normalized after treatment with antidepressants found in the cerebrospinal fluid of patients with depression. CRF acts on CRF1 receptors in the pituitary gland to stimulate the release of adrenocoticotropic hormone, which stimulates the release of glu-cocorticoid stress hormones from the adrenal glands (19). It is possible that St. John's wort's activity comes from pseudohypericin's ability to block the CRF1 receptor.

Muscle Groups and Movement

Estambres Insertos

Major muscle groups of the body are shown in Fig. 1.11. The axial musculature begins and ends on the axial skeleton. Belonging to the group of axial musculature are the muscles of the head and neck that move the face, tongue, and larynx. The muscles of the spine include flexor and extensor muscles of the head, neck, and spinal column. The oblique and rec-tus muscles form the muscular walls of the trunk. In the chest area these muscles are partitioned by the ribs, but over the abdominal surface, they form broad muscular sheets. Trunk muscles keep the internal organs of the body intact, and in that function, they are similar to the corset that nineteenth-century women were obliged to wear in the Western world. Rectus abdominis is an axial muscle group that is arranged in parallel between the chest and the pelvis. It originates at the hip bone and inserts at ribs five through seven and at the lower tip of the sternum. It is responsible for spinal forward flexion and is used to contract...

Medicolegal Forms With Legal Analysis P-47

For removal, prosthetic repair, and specimen preparation, see p. 95. Submit samples of cartilage of diarthrodial joints and from adjacent tendons for histologic study. Prepare frontal section through spine. For removal of cerebrospinal fluid, see p. 104. Freeze samples for biochemical study. These specimens should be collected using aseptic technique for tissue culture for chromosome analysis and biochemical studies (see Chapter 10). See above under Note. Brain, spinal cord, and peripheral nerves Amyloid associated with senile plaques or neurofibrillary tangles congophilic angiopathy (4). Spinal cord compression (5). Peripheral amyloid neuropathy. Amyloid in bone marrow, synovium, and carpal tunnel. Bone may contain osteolytic tumor (multiple myeloma*). Villarejo F, Perez Diaz C, Perla C, Sanz J, Escalona J, Goyenechea F. Spinal cord compression by amyloid deposits. Spine 1994 19 1178-1181.

And Removal Of Bone Specimens

Oscillating Saws The Stryker autopsy saw (Stryker Corporation, 420 Alcott Street, Kalamazoo, MI) still is the most popular tool in this class. The blade of this saw cuts bone by high-speed oscillation. Blades of various shapes with round cutting edges can be attached to the arbor, depending on the size and location of the bone specimen to be removed. One of the largest blades ( 1105) is used for the anterior removal of the spinal column (see Chapter 6). Temporal bones are removed with a trephine (Schuknecht temporal trephine, Stryker Corporation). According to the specifications, this trephine cuts about 4.5 cm deep and removes a specimen about 3.7 cm in diameter. Band Saws This type of saw is ideal if one wishes to prepare even section through large bones such as the femur or the spinal column. Band saws also are preferred for cutting small specimens into thin slices for histologic preparations. Unfortunately, they are difficult to clean and hazardous to operate. Because of the...

Level Set Methods Incorporating Generic Constraints

We have developed a coupled surfaces approach for automatically segmenting a volumetric layer from a 3D image 43-45 . This approach uses a set of coupled differential equations, with each equation determining the evolution or propagation of a surface within a level set framework. In the case of the cortex, one surface attempts to localize the white matter gray matter (WM GM) inner cortical boundary and the other the gray matter cerebrospinal fluid (GM CSF) outer boundary. Coupling between the surfaces incorporates the notion of an approximately fixed thickness separating the surfaces everywhere in the cortex. This soft constraint helps in ensuring that the GM CSF boundary is captured even in the deeper cortical folds in the brain. A further assumption is that across each surface there is a local difference in the gray-level values, while in between the two surfaces there is a homogeneity of gray levels. By evolving two embedded surfaces simultaneously, each driven by its own...

Argentina Biosurveillance

Diseases appearing on only one list (not included in the table) Nipah virus (CDC C list) coccidiomycosis and dengue (NATO) Machupo (USAMRIID) acquired immunodeficiency syndrome (AIDS), amebiasis, Campylobacter, carbon monoxide poisoning, Chlamydia trachomatis, congenital rubella syndrome, food poisoning, giardiasis, Haemophilus influenza type B (HIB), hepatitis A, hepatitis B, hepatitis C, Kawasaki syndrome, Legionnaires' disease, leptospirosis, Lyme disease, lymphogranuloma venereum, malaria, measles, meningitis, mumps, neisseria gonorrhea, neisseria meningitis in blood or cerebrospinal fluid, pertussis, poliomyelitis, rabies, Reye syndrome, rheumatic fever, rubella, syphilis, tetanus, toxic shock syndrome, toxoplasmosis, and trichinosis (Reportable List).

Cerebral Anatomy at the Macroscopic Level

The human brain is a relatively small organ (around 1400 g) sitting within the skull and protected by membranes called the meninges, which include an external dense outer layer, called the dura mater, a thin inner layer, called the pia mater, and an intermediate layer, the arachnoid, constituted as a layer of fibers. The brain floats in a clear fluid, the cerebrospinal fluid (CSF), which has a protective role against trauma, as well as nourishing and draining functions.

Anatomy And Physiology Of Erection

The nervous system of the penis is in three parts. The parasympathetic nerves are branches of spinal nerves S2-S4, which give rise to the so-called pelvic splanchnic nerves that pass around the posterior aspect of the prostate gland, forming the prostatic plexus. Passing forward, they form the cavernous nerves, which branch into the body of the penis. It is this parasympathetic system that is able to elicit an erection. The sympathetic nerves are branches of the sympathetic chain at levels T11-L2. These pass through the inferior mesenteric plexus, the superior hypogastric plexus, and the pelvic plexus and branch off to the organs involved in ejaculation. Overactivity of the sympathetic system (e.g., in the stressed individual) maintains a persistent state of detumes-cence, although not all sympathetic activity is inhibitory. The sensory nerves of the penis and scrotum are all branches of the pudendal nerve, which can be traced back to branches of S2-S4. With these systems in mind, it...

Surgical Complications

Excessive bleeding is another surgical complication. The procedure does not involve highly vascular areas, but the blind nature of the tunneling rod and catheter placement may prove problematic. Postsurgical formation of a small epidural hematoma can create a medium for bacterial growth a large clot can compress the spinal cord or cauda equina. As mentioned above, if patients have bleeding disorders or are anticoagulated, these represent an absolute contraindication to pump placement. Tissue damage resulting in neurological sequelae such as radiculitis, myelitis, paralysis, and incontinence may also occur 16 . Intrathecal granuloma formation at the catheter tip can present as intractable pain or weakness and have devastating effects 21 . Cerebrospinal fluid leakage and the formation of CSF hygromas is also possible.

The Role Of Mri In The Diagnosis And Prognosis Of Ms

Meningitis Mri Images

Figure 6 Axial fast-fluid-attenuated inversion recovery images (A and B) from a patient with multiple sclerosis. In (A) and (B), multiple sclerosis lesions appear as areas of increased signal. The suppression of the signal of the cerebrospinal fluid allows a better identification of the lesions located in the periventricular and juxtacortical regions. Figure 6 Axial fast-fluid-attenuated inversion recovery images (A and B) from a patient with multiple sclerosis. In (A) and (B), multiple sclerosis lesions appear as areas of increased signal. The suppression of the signal of the cerebrospinal fluid allows a better identification of the lesions located in the periventricular and juxtacortical regions. As shown by several postmortem studies (40-43), the spinal cord is another CNS site frequently involved by MS lesions. Such lesions can be detected by MRI in up to about 90 of patients with established disease (44-49), especially when fast short-tau inversion recovery (fast-STIR) sequences...

Intraoperative Monitoring

May then be stimulated in a bipolar manner by gently lifting the root away from the cerebrospinal fluid and applying a stimulus. The stimulating contacts are separated by 5 to 10 mm, and the voltage is varied throughout the testing procedure. Typically, between 0.2 and 5 volts are required for anterior roots and 20 to 100 volts for posterior roots. The whole posterior root at one level is first stimulated with single pulses to identify its threshold, which usually corresponds to the rootlet threshold. Next, the root is subdivided into its rootlets, which are stimulated in turn. Initial stimulation for each rootlet uses single pulses, delivered individually at gradually increasing voltages until the threshold for muscle contraction is reached. Next, 1-second trains of stimuli are applied at voltages reduced to 30 to 50 of the single pulse threshold, and gradually increased until the threshold for muscle contraction is achieved. Next, at the train threshold, several repetitions are...

Quadruple Contrast Enhancement with MRA and MR Spectroscopic Imaging

Snap Fit Design Calculation

This approach minimized the false tissue classifications by (1) improving the lesion-to-tissue contrast on MR images by developing a fast imaging pulse sequence that incorporated both cerebrospinal fluid signal attenuation and magnetization transfer contrast (see Fig. 3.33) and (2) including information from MR flow images 24 . In pathologically defined abnormalities in the cortical gray matter (GM) and normal volunteers, high resolution MRI and short echo Figure 3.33 An approach is represented to improve the multiple sclerosis lesion-to-tissue contrast using MRA images by a fast imaging pulse sequence incorporating both cerebrospinal fluid signal and flow attenuation with magnetization transfer contrast. The technique suppressed gray matter or white matter and highlighted the lesion-to-tissue contrast. Figure 3.33 An approach is represented to improve the multiple sclerosis lesion-to-tissue contrast using MRA images by a fast imaging pulse sequence incorporating both cerebrospinal...

Costovertebral joint dysfunction

The unique feature of the thoracic spine is the costovertebral joint. Dysfunction of this joint commonly causes localised pain approximately 3-4 cm from the midline where the rib articulates with the transverse process and the vertebral body. In addition it is frequently responsible for referred pain ranging from the midline, posterior to the lateral chest wall, and even anterior chest pain. When the symptoms radiate laterally, the diagnosis is confirmed only when movement of the rib provokes pain at the costovertebral joint. This examination will simultaneously reproduce the referred pain. Figure 34.4 presents the pattern of referred pain from these joints and highlights the capacity of the thoracic spine to refer pain centrally to the anterior chest and upper abdomen. Confusion arises for the clinician when the patient's history focuses on the anterior chest pain and fails to mention the presence of posterior pain, should it be present. The shaded areas on Figure 34.4 represent...

Solutions To Exercises Lesson

The major divisions of the human nervous system are the central nervous system (CNS), the peripheral nervous system (PNS), and the autonomic nervous system (ANS). The CNS is made up of the brain and the spinal cord. (para 11-8) 13. The three major subdivisions of the human brain are the brainstem, the cerebellum, and the cerebrum. The brainstem is that part of the brain remaining after removal of the cerebrum and cerebellum. It is the basal portion. Together with the spinal cord, it is known as the neuraxis. (para 11 -9a) 19. The ventricles of the brain are interconnected hollow spaces filled with CSF. The right and left lateral ventricles are found in the cerebral hemispheres. The lateral ventricles are connected to the third ventricle by the interventricular foramen. The third ventricle is located in the forebrainstem. The third and fourth ventricles are connected by the cerebral aqueduct. The fourth ventricle is located in the hindbrainstem. The fourth ventricle is continuous...

Pernicious Anemia As A Subset Of Megaloblastic Anemias

Pernicious anemia is more common in individuals with Irish and Scandinavian ethnicity. Pernicious anemia patients will experience all of the symptoms of a patient with megaloblastic anemia, but they have a higher tendency for neurological involvement including those already mentioned as well as degeneration of peripheral nerves and the spinal column. Neurological symptoms may be slow to develop but include a vast array of symptomatology. Patients may experience paresthesias in the limbs, an abnormal or clumsy walking pattern or stiffness in the limbs. Treatment will usually reverse these symptoms.

Lesson Assignment

Describe the spinal cord, including the two enlargements, elements of its cross section, and the surrounding vertebral canal. 11-10. Name and identify the main arteries and veins of the brain and briefly describe the blood supply of the spinal cord. 11-11. Describe the formation of cerebrospinal fluid (CSF) and the path of CSF flow. 11-12. Define peripheral nervous system (PNS) and nerve name and briefly describe two categories of PNS nerves describe the anatomy of a typical spinal nerve define reflex and reflex arc briefly describe the components of the general reflex arc.

Partial Volume Classification Approach Using Voxel Histograms

FIGURE 2 One slice of data from a human brain. (a) The original two-valued MRI data. (b) Four of the identified materials, white matter, gray matter, cerebrospinal fluid, and muscle, separated out into separate images. (c) Overlaid results of the new classification mapped to different colors. Note the smooth boundaries where materials meet and the much lower incidence of misclassified samples than in Fig. 5. See also Plate 16.

Neurotransmitter Systems

Neurotransmitters and their neuromodulators. Turnover, release, and binding of neurotransmitter substances constitute important steps in the mechanisms involved in signal transduction between adjacent nerve cells therefore changes in any of them may result in functional alterations. It is well known that many synapses are identified by the neurotransmitter released, thus at terminal regions of different synapses very specific mechanisms are operating to work out these processes, and these include, in addition to the synthesis of neurotransmitters, the activity of degrading and synthesizing enzymes. Complete and reliable analysis to detect neurotransmitter changes occurring at synaptic regions should take into account studies aimed at testing proper functioning at different levels. Thus, precursor availability, synthesis of enzymes, degradation of neuro-transmitters, their storage, reuptake, and ionic regulation refer to the presynaptic area, and free neurotransmitters as well as the...

Rectum Anal Canal And Anus

However, this six-inch tubular structure would actually look a bit wave-like from the front. From the side, one would see that it was curved to conform the sacrum (at the lower end of the spinal column). The final storage of feces is in the rectum. The rectum terminates in the narrow anal canal, which is about one and one-half inches long in the adult. At the end of the anal canal is the opening called the anus. Muscles called the anal sphincters aid in the retention of feces until defecation.

Application to Medical Image Segmentation

A classical problem with numerous clinical applications is the segmentation of brain imaging data with respect to the tissue classes gray matter, white matter, and cerebrospinal fluid (CSF). Several other structures such as meninges or venous blood may be introduced as additional segmentation classes. However, these additional classes comprise only a small part of the total brain volume. Furthermore, for most of the clinical applications, the focus of interest is reduced to gray- and white-matter structures. Therefore, we assigned these minor additional classes to CSF.

Percutaneous Cordotomy Technique

The patient should have been fasting for 5 hours preoperatively. In CT-guided PC, contrast material should be administered into the subarachnoid space of the spinal cord by lumbar puncture (7-8 ml of 240 mg l Iohexol) 20 to 30 minutes before the operation. If lumbar puncture cannot be tolerated, contrast material (5 ml Iohexol) is injected at the C1-C2 level. The patient is placed in the supine position, and the upper cervical spine must be kept in a horizontal position, particularly for X-ray-guided cordotomy (Fig. 1A, B). In conventional lateral and anterior cordotomy, the head is flexed and fixed. In CT-guided cordotomy, the procedure is performed in the CT unit with the patient in the supine position. The head is placed on the head holder, flexed and fixed with a fixation band. Local anesthesia is usually adequate, but neuroleptic anesthesia may be used if necessary. General anesthesia is used by some surgeons 22 , although rarely, but is not recommended by the author because of...

Royal Marsden Pilot Study

In contrast, tamoxifen exerted antiestrogenic or estrogenic effects on bone density, depending on menopausal status. In premenopausal women, early findings demonstrated a small but significant (p < 0.05) loss of bone in both the lumbar spine and hip at 3 years. In contrast, postmenopausal women had increased bone mineral density in the spine (p < 0.005)

HHV6 association with CFS

Research performed by Knox et al. (1998) demonstrated active HHV-6 infection in 37 of CFS patients this is significantly higher than in control subjects. Longitudinal observations from this study indicated that active HHV-6 infection was intermittent and the viral load variable. When patients with prominent CNS complaints were considered separately, 56 had evidence of active HHV-6 infection, suggesting that selection for CFS with CNS involvement co-selected for active HHV-6 infection. The cerebrospinal fluid examination of these patients demonstrated that 20 (7 35) were positive for HHV-6 DNA, and because the spinal fluid specimens were acellular, the presence of HHV-6 DNA suggested active CNS infection. In another study of patients, who met the CDC criteria for CFS, 25 (20 81) were found to have active HHV-6 infection in peripheral blood leukocytes compared to 2 (1 55) of healthy control subjects (Knox et al., 1998). When cerebro-spinal fluids from CFS patients were analyzed for...

Psychological Wellbeing And Quality Of Life

The direct mechanism behind alterations in perceived QoL remain unknown. Recently GH treatment of GH-deficient adults has been shown to alter levels of vasoactive intestinal polypeptide and the dopamine metabolite, homovanillic acid, as well as elevating P-endorphin levels in cerebrospinal fluid, but whether these changes are responsible for improvement in mood and well-being is not yet known (7). GH, IGF-1, and the IGF-binding proteins may have direct effects on the nervous system. In addition abnormal sleep patterns have been described in GH-deficient adults with a restoration to normal patterns following GH replacement (8).

Ghd And Osteoporosis Childhood Onset GHD and Osteoporosis

Studies of adult patients with a history of childhood-onset GHD also demonstrate relative osteopenia compared to age-matched controls. Degerblad et al. (18) studied six young adults who had previously received GH replacement for GHD. Bone density of the proximal and distal forearm, primarily reflecting cortical and trabecular bone, respectively, was markedly diminished compared with healthy controls. A larger study of 30 GH-deficient men, 18-46 yr, reached a similar conclusion. Despite a history of GH replacement, bone density in the proximal forearm, distal forearm, and lumbar spine of these patients was significantly lower than normal (19). To determine whether pituitary deficiencies other than GH were responsible for the lower bone density seen in the patients, the eight patients with isolated GH deficiency were analyzed separately. In this subgroup, bone density at all sites remained below that of the normal controls, although because of the small sample size, this difference...

GH Administration in Adult Onset GHD

This was not found in patients with a history of treated acromegaly who had normal levels of IGF-1 (40). Interestingly, acromegalic patients who were simultaneously hypogonadal, displayed diminished spinal bone density despite the increase in cortical bone density (40). Studies of GH administration in patients with adult-onset GHD have shown results consistent with those in childhood-onset patients. Initial short-term studies have shown GH-induced increases in bone turnover, while subsequent longer-term, often noncontrolled studies have demonstrated improvements in bone density. Bengtsson and coworkers have published three studies of GH administration in patients with adult-onset GHD that have included evaluations of bone turnover markers and bone density. The first of these involved 10 patients and demonstrated GH-induced increases in osteocalcin and the aminoterminal propeptide of type 3 procollagen within 6 wk with further increases noted at 6 mo...

Adult Onset GHD and Osteoporosis

One study of 95 adults, ranging in age from 21-74 yr and identified as GH deficient on the basis of provocative tests, showed low bone density of the lumbar spine compared to normal controls. This significant deficit in bone density persisted when patients with untreated hypogonadism were excluded (20). Two smaller studies showed reduced bone density of the total body (21), femoral neck, Ward's triangle, and greater trochanter (22) in patients with adult-onset GHD compared to normals. In both of these studies, a significant correlation was found between bone density and serum levels of IGF-1, an integrated marker of GH secretion. Because patients with adult-onset GH deficiency were by definition endocrinologically intact through adolescence, they presumably had normal skeletal development and reached a normal peak bone mass. Therefore, osteopenia in such patients, can only be explained on the basis of accelerated loss of bone during adulthood. Adult-onset GHD is often associated with...

Atraumatic Instability

Once the static stabilizers of the hip including the iliofemoral ligament and labrum are injured, the hip must rely more on the dynamic stabilizers for stability. It is hypothesized that when capsular laxity is present, the psoas major, a dynamic stabilizer of the hip, contracts to provide hip stability. Over time, this condition can lead to stiffness, coxa saltans, or flexion contractures of the hip 14 . In addition, due to the origin of this muscle from the lumbar spine, a chronically contracted or tightened psoas major may be a major contributor to low back pain. Thus, hip instability or capsular laxity can trigger a whole spectrum of disorders that the physician must take into consideration when considering various treatment options.

Osteoporosis Prevention

In a recent trial by Atkinson et al, loss of lumbar spine bone mineral content and bone mineral density was significantly reduced in women taking red clover-derived isoflavones (43.5 mg day) compared to placebo in a double-blind, placebo-controlled, randomised trial in 205 women over 12 months (Atkinson et al 2004c). Bone formation markers were also significantly increased however, no improvement in hipbone mineral content or bone mineral density was noted. A double-blind study of 46 postmenopausal women investigated the effects of a red clover isoflavone preparation (Rimostil) containing genistein, daidzein, formononetin and biochanin A after a single-blind placebo phase and followed by a single-blind washout phase. Patients were randomly assigned to receive 28.5 mg, 57 mg or 85.5 mg phyto-oestrogens daily for a 6-month period. After the test period, the bone mineral density of the proximal radius and ulna rose significantly, by 4.1 with a dose of 57 mg day and by 3.0 with a dose of...

Thoracic disc protrusion

Fortunately, a disc protrusion in the thoracic spine is uncommon. This reduced incidence is related to the firm splintage action of the rib cage. Most disc protrusions occur below T9, with the commonest site, as expected, being T11-T12. The common presentation is back pain and radicular pain that follows the appropriate dermatome. However, disc lesions in the thoracic spine are prone to produce spinal cord compression, manifesting as sensory loss, bladder incontinence and signs of upper motor neurone lesion. The disc is relatively inaccessible to surgical intervention, but over the past decade there has been a significant improvement in the surgical treatment of thoracic disc protrusions, due to the transthoracic lateral approach.

Thoracic back pain in children

The most common cause of thoracic back pain in children is 'postural backache', also known as 'TV backache', which is usually found in adolescent schoolgirls and is a diagnosis of exclusion. Important, although rare, problems in children include infections (tuberculosis, discitis and osteomyelitis) and tumours such as osteoid osteoma and malignant osteogenic sarcoma. Dysfunction of the joints of the thoracic spine in children and particularly in adolescents is very common and often related to trauma such as a heavy fall in sporting activities or falling from a height, e. g. off a horse. Fractures, of course, have to be excluded. Inflammatory disorders to consider are juvenile ankylosing spondylitis and spinal osteochondritis (Scheuermann's disorder), which may affect adolescent males in the lower thoracic spine (around T9) and thoracolumbar spine. The latter condition may be asymptomatic, but can be associated with back pain, especially as the patient grows older. It is the commonest...

Probability diagnosis

The commonest cause of low back pain is vertebral dysfunction, which then has to be further analysed. Muscle or ligamentous tears or similar soft tissue injuries are uncommon causes of back pain alone they are generally associated with severe spinal disruption and severe trauma such as that following a motor vehicle accident. In the lumbar spine most problems originate from either the apophyseal joints or the intervertebral Degenerative changes in the lumbar spine (lumbar spondylosis) are commonly found in the older age group. This problem, and one of its complications, spinal canal stenosis, is steadily increasing along with the ageing population.

Thoracic back pain

Since learning about the various causes of chest wall pain I am continually amazed about the number of pain syndromes that I am diagnosing as originating from the thoracic spine. I wonder what I was thinking beforehand. Thoracic (dorsal) back pain is common in people of all ages including children and adolescents. Dysfunction of the joints of the thoracic spine, with its unique costovertebral joints (which are an important source of back pain), is very commonly encountered in medical practice, especially in people whose lifestyle creates stresses and strains through poor posture and heavy lifting. Muscular and ligamentous strains may be common, but they rarely come to light in practice because they are self-limiting and not severe. This dysfunction can cause referred pain to various parts of the chest wall and can mimic the symptoms of various visceral diseases such as angina, biliary colic and oesophageal spasm. In similar fashion, heart and gall bladder pain can mimic spinal pain.

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