WE DISCUSS THE anatomy of the thoracic, lumbar, and sacral levels of the spinal cord. Given the nature of endoscopic surgery, it is recommended that the surgeon have thorough knowledge not only of the bony architecture but also of important visceral and other soft tissue structures. It is essential to understand the normal anatomy to recognize the abnormal and anatomic variations. We present the so-called normal anatomic configurations and illustrate how these structures vary at the different levels of the spinal column.
Objective To describe the surgical results of a prospective series of five patients operated according to an approach indication protocol. Methods: Patients were classified according to surgical risk: Group A (high risk) or B (low risk) and subsequently into subgroups according to characteristics of the herniation and ultimately the surgical approach was defined: A.1) calcified central herniations - thoracoscopy; A.2) soft lateral herniations - posterolateral approach; A.3) centrolateral herniations - partial calcification in lateral position - posterolateral approach; higher density central calcification - thoracoscopy; B.1) central or centrolateral calcified herniations - thoracotomy or thoracoscopy; B.2) soft lateral herniations - posterolateral approach. Results: The duration of symptoms ranged from 2 months to 3 years; the age bracket was from 37 to 58 years; sex distribution was 3 female and 2 male patients and the length of hospital stay ranged from 2 to 20 days. The most affected level was T11/12. A patient classified as Group A.3 underwent posterolateral approach. The remaining patients were Group B.1, 3 submitted to thoracotomy and 1 to thoracoscopy. The herniation removal was completed in 5 cases; 3 patients improved and 2 remained stable. The morbidity and the recovery time were higher in patients who underwent anterolateral approaches. Conclusions: Classify patients according to surgical risk and the anatomical characteristics of disc herniation allows for complete decompression, minimizing morbidity and mortality.
Objectives: Review the current, extensive, literature on this topic in order to analyze whether the radiographic criteria mentioned in several studies (kyphosis, wegding of the vertebra, spinal canal compression, and ligament lesion) can be used to indicate instability of the burst fracture and the need for surgical treatment in patients without neurological deficit. Methods: We performed online searches of the Medline, LILACS, and Cochrane Library. Studies that were classified as being of interest were those that met the following inclusion criteria: adult patients; Dennis burst-type or Magerl A3 fracture affecting the thoracolumbar spinal segments; single level, non-pathological or osteoporotic fracture; and normal neurological examination. Results: The final selection included 80 studies that discuss conservative or surgical treatment. Iden-* Efeitos de solução salina hipertônica e manitol em coelhos com hipertensão intracraniana aguda (Resumo).
ResumoMielopatia cervical alta causada por cisto sinovial da articulação atlantoaxial é uma entidade rara e muito pouco descrita na literatura. Os autores descreveram um caso de cisto sinovial localizado posteriormente ao processo odontóide causando compressão bulbo-medular em paciente com 88 anos de idade. O cisto foi removido através de um acesso póstero-lateral direito com hemilaminectomia de C1 e ressecção microcirúrgica transdural. A paciente apresentou uma excelente recuperação. Os aspectos etiológicos e terapêuticos são discutidos.
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