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Fulltext Safety of thoracic pedicle screw application using the funnel technique in Asians: a cadaveric evaluation

Chan CY, Kwan MK, Saw LB

Eur Spine J, 2010 Jan;19(1):78-84.
PMID: 19763636 DOI: 10.1007/s00586-009-1157-8

The objective of this cadaveric study is to determine the safety and outcome of thoracic pedicle screw placement in Asians using the funnel technique. Pedicle screws have superior biomechanical as well as clinical data when compared to other methods of instrumentation. However, misplacement in the thoracic spine can result in major neurological implications. There is great variability of the thoracic pedicle morphometry between the Western and the Asian population. The feasibility of thoracic pedicle screw insertion in Asians has not been fully elucidated yet. A pre-insertion radiograph was performed and surgeons were blinded to the morphometry of the thoracic pedicles. 240 pedicle screws were inserted in ten Asian cadavers from T1 to T12 using the funnel technique. 5.0 mm screws were used from T1 to T6 while 6.0 mm screws were used from T7 to T12. Perforations were detected by direct visualization via a wide laminectomy. The narrowest pedicles are found between T3 and T6. T5 pedicle width is smallest measuring 4.1 +/- 1.3 mm. There were 24 (10.0%) Grade 1 perforations and only 1 (0.4%) Grade 2 perforation. Grade 2 or worse perforation is considered significant perforation which would threaten the neural structures. There were twice as many lateral and inferior perforations compared to medial perforations. 48.0% of the perforations occurred at T1, T2 and T3 pedicles. Pedicle fracture occurred in 10.4% of pedicles. Intra-operatively, the absence of funnel was found in 24.5% of pedicles. In conclusion, thoracic pedicle screws using 5.0 mm at T1-T6 and 6.0 mm at T7-T12 can be inserted safely in Asian cadavers using the funnel technique despite having smaller thoracic pedicle morphometry.

Matched MeSH terms: Thoracic Vertebrae/anatomy & histology; Thoracic Vertebrae/radiography; Thoracic Vertebrae/surgery*
Double neural tube defect: a case report and discussions on neural tube development

Vashu R, Liew NS

Childs Nerv Syst, 2010 May;26(5):697-701.
PMID: 20225088 DOI: 10.1007/s00381-010-1093-2

Double neural tube defect is a rare congenital problem. A case illustration and current literatures on neural tube closure theory are discussed. The available theories are summarised and compared with regard to the case report.

Matched MeSH terms: Thoracic Vertebrae
Fulltext Bilateral epidural extension of thoracic capillary vertebral (intraosseous) hemangioma mimicking spinal meningioma

Kan CH, Saw CB, Rozaini R, Fauziah K, Ng CM, Saffari MH

Med J Malaysia, 2008 Jun;63(2):154-6.
PMID: 18942307 MyJurnal

We describe a rare case of vertebra (intraosseous) hemangioma with bilateral and symmetrical epidural extension causing cord compression in a 24-year-old woman. The epidural component was isointense to cord on both T1 and T2 sequences, and enhanced markedly and homogenously following gadolinium administration. The gradual in onset and progressive nature with the typical enhancing pattern lead the neurosurgeon to the more common diagnosis of spinal meningioma. Epidural extension of vertebral hemangiomas causing cord compression is rarely reported. Review of literatures reveal that cases that have been reported are of unilateral extension into epidural space and of cavernous type. This is the first case report of capillary vertebral (intraossous) hemangioma with bilateral extension through both intervetebral foramen into the epidural space causing myelopathy.

Matched MeSH terms: Thoracic Vertebrae
Posterior Spinal Fusion in a Scoliotic Patient With Congenital Heart Block Treated With Pacemaker: An Intraoperative Technical Difficulty

Wong TS, Abu Bakar J, Chee KH, Hasan MS, Chung WH, Chiu CK, et al.

Spine (Phila Pa 1976), 2019 02 15;44(4):E252-E257.
PMID: 30086081 DOI: 10.1097/BRS.0000000000002828

STUDY DESIGN: Case report.
OBJECTIVE: To describe the technical difficulties on performing posterior spinal fusion (PSF) on a pacemaker-dependent patient with complete congenital heart block and right thoracic scoliosis.
SUMMARY OF BACKGROUND DATA: Congenital complete heart block requires pacemaker implantation at birth through thoracotomy, which can result in scoliosis. Corrective surgery in this patient was challenging. Height gain after corrective surgery may potentially cause lead dislodgement. The usage of monopolar electrocautery may interfere with the function of the implanted cardiac device.
METHODS: A 17-year-old boy was referred to our institution for the treatment of right thoracic scoliosis of 70°. He had underlying complete congenital heart block secondary to maternal systemic lupus erythematosus. Pacemaker was implanted through thoracotomy since birth and later changed for four times. PSF was performed by two attending surgeons with a temporary pacing inserted before the surgery. The monopolar electrocautery device was used throughout the surgery.
RESULTS: The PSF was successfully performed without any technical issues and complications. Postoperatively, his permanent pacemaker was functioning normally. Three days later, he was recovering well and was discharged home from hospital.
CONCLUSION: This case indicates that PSF can be performed successfully with thoughtful anticipation of technical difficulties on a pacemaker-dependent patient with underlying congenital heart block.
LEVEL OF EVIDENCE: 5.

Matched MeSH terms: Thoracic Vertebrae
Elective proximal lower limb amputation in spinal cord injury patients with chronic pressure ulcers: improve quality of life, function, and shorten hospital stay. Case report

Yusmido YA, Hisamud-Din N, Mazlan M

Eur J Phys Rehabil Med, 2014 Oct;50(5):557-60.
PMID: 24694951

Pressure ulcers are common among patients with spinal cord injury and can be very challenging to treat. The treatment involves multidisciplinary approach and ranges from simple pressure relieve and wound dressings to a more radical treatment like proximal lower limb amputations, especially in chronic cases with potential detrimental effects to physical and mental health.

Matched MeSH terms: Thoracic Vertebrae
Perioperative complications after surgical correction in neuromuscular scoliosis

Mohamad F, Parent S, Pawelek J, Marks M, Bastrom T, Faro F, et al.

J Pediatr Orthop, 2007 Jun;27(4):392-7.
PMID: 17513958

To evaluate the perioperative complications associated with surgical correction in neuromuscular scoliosis and to identify the risk factors associated with these complications.

Matched MeSH terms: Thoracic Vertebrae
Fulltext Aberrant left brachiocephalic vein is a contraindication for anterior cervicothoracic approach

Ong EKS, Wong TS, Chung WH, Chiu CK, Saw A, Hasan MS, et al.

J Orthop Surg (Hong Kong), 2019 10 17;27(3):2309499019879213.
PMID: 31615339 DOI: 10.1177/2309499019879213

Aberrant left brachiocephalic vein is a rare condition. Its occurrence in patients requiring anterior cervicothoracic approach for severe kyphoscoliosis has not been described. A 16-year-old male with neurofibromatosis and severe upper thoracic kyphoscoliosis presented to us with curve progression. Halo gravity traction was attempted but failed to achieve significant correction. Subsequently, he underwent halo-pelvic traction and later Posterior Spinal Fusion (PSF) from C2 to T10. Second-stage anterior cervicothoracic approach with anterior fibula strut grafting was planned; however, preoperative computed tomography angiography revealed an aberrant left brachiocephalic vein with an anomalous retrotracheal and retroesophageal course, directly anterior to the T5/T6 vertebrae (planned anchor site for fibula strut graft) before draining into superior vena cava. Therefore, surgery was abandoned due to the risks associated with this anomaly. Aberrant left brachiocephalic vein is rare, the presence of which could be a contraindication for anterior cervicothoracic approach. Assessment of the anterior neurovascular structures is crucial in preoperative planning.

Matched MeSH terms: Thoracic Vertebrae
Fulltext COBB syndrome treated by staged intravascular embolisation and surgery

Sayuthi S, Moret J, Pany A, Sobri A, Shafie M, Abdullah J

Med J Malaysia, 2006 Jun;61(2):239-41.
PMID: 16898321 MyJurnal

A 28-year old Malay man with evidence of an upper motor neuron cord lesion was diagnosed to have a C7 to T2 spinal arterio-venous malformation and associated cutaneous vascular lesion. He finally agreed for treatment after 5 years of progressive spastic right lower limb weakness leading to inability to mobilize. A two staged intravascular procedure was done followed by surgery with recovery of ASIA impairment scale grade B.

Matched MeSH terms: Thoracic Vertebrae
Intramedullary spindle cell hemangioendothelioma of the thoracic spinal cord--case report

Abdullah JM, Mutum SS, Nasuha NA, Biswal BM, Ariff AR

Neurol. Med. Chir. (Tokyo), 2002 Jun;42(6):259-63.
PMID: 12116532

A 28-year-old Malay man presented with progressive paraparesis over a period of 6 months. Magnetic resonance imaging of the spine revealed a thoracic intramedullary spinal cord tumor at the T-7 level with homogeneous enhancement following intravenous gadolinium administration. Laminectomy and partial decompression of the tumor was performed. Histological examination of the tumor revealed features of spindle cell hemangioendothelioma. The patient was managed with limited field radiotherapy followed by systemic interferon therapy. Good neurological improvement was seen subsequently. The patient has survived 48 months with growth restraint at the primary site, although residual neurological deficit persists. Immunotherapy should be considered as a treatment modality for intramedullary hemangioendothelioma of the spinal cord after surgery and radiotherapy.

Matched MeSH terms: Thoracic Vertebrae
Fulltext The impact of personal and environmental factors on the rehabilitation of persons with neglected spinal cord injury in Malaysia

Hanapi NHM, Zainin ES, Aziz MHA, Darus D

Spinal Cord Ser Cases, 2019;5:10.
PMID: 30701087 DOI: 10.1038/s41394-019-0154-3

Introduction: Managing neglected spinal cord injury (SCI) patients in a rural setting can be challenging due to a lack of resources and the unique personal and environmental contextual factors that may hinder rehabilitation. This article aims to identify the contextual factors and their impact on successful rehabilitation.
Case presentation: A middle-aged man from a rural area had suffered a neglected traumatic SCI and was first seen by the rehabilitation team 17 years post injury. He had a T7 AIS A paraplegia and was bedridden with multiple secondary complications. He was admitted with goals of optimizing his health, initiating basic spinal rehabilitation and improving his functional status. By 1 month, the patient made gradual improvement of his mobility and ADL but requested discharge despite not having achieved his rehab goals. We identified the factors that contributed to his poor motivation to be more functionally independent. Personal factors include poor educational level, his background personality and erratic health-seeking behaviour. Environmental factors included poor family and financial support, physical barriers, lack of work opportunities and facilities for people with disability, poor community support and acceptance and poor healthcare facilities and expertise.
Discussion: The patient's personal and environmental factors affected the delivery of SCI management, spinal rehabilitation and management of secondary comorbidities. Awareness of early spinal rehabilitation among the rural community and healthcare authorities is crucial to promote better implementation of policies, services or programs to support people with SCI.

Matched MeSH terms: Thoracic Vertebrae