High cervical arteriovenous fistulas fed by dural and spinal arteries and draining into a single medullary vein

2014 ◽  
Vol 20 (3) ◽  
pp. 256-264 ◽  
Author(s):  
Kiyoshi Onda ◽  
Yuichi Yoshida ◽  
Kounosuke Watanabe ◽  
Hiroyuki Arai ◽  
Hideo Okada ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Digital Subtraction ◽  
Spinal Root ◽  
Nerve Roots ◽  
Arteriovenous Fistulas ◽  
Posterior Spinal Arteries ◽  
Operative Findings ◽  
High Cervical

Object The authors previously reported a case of complex arteriovenous fistula (AVF) at C-1 with multiple dural and spinal feeders that were linked with a common medullary venous channel. The purpose of the present study was to collect similar cases and analyze their angioarchitecture to gain a better understanding of this malformation. Methods Three such cases, affecting 2 males and 1 female in their 60s who had presented with hematomyelia (2) or progressive myelopathy (1), were treated surgically, and the operative findings from all 3 cases were compared using digital subtraction angiography (DSA) to determine the angioarchitecture. Results The C-1 and C-2 radicular arteries and anterior and posterior spinal arteries supplied feeders to a single medullary draining vein in various combinations and via various routes. The drainage veins ran along the affected ventral nerve roots and lay ventral to the spinal cord. The sites of shunting to the vein were multiple: dural, along the ventral nerve root in the subarachnoid space, and on the spinal cord, showing a vascular structure typical of dural AVF, that is, a direct arteriovenous shunt near the spinal root sleeve fed by one or more dural arteries and ending in a single draining vein, except for intradural shunts fed by feeders from the spinal arteries. In 2 cases with hemorrhagic onset the drainer flowed rostrally, and in 1 case associated with congestive myelopathy the drainer flowed both rostrally and caudally. Preoperative determination of the shunt sites and feeding arteries was difficult because of complex recruitment of the feeders and multiple shunt sites. The angioarchitecture in these cases was clarified postoperatively by meticulous comparison of the DSA images and operative video. Direct surgical intervention led to a favorable outcome in all 3 cases. Conclusions A high cervical complex AVF has unique angioarchitectural characteristics different from those seen in the other spinal regions.

Anterior Cervical Discectomy With Fusion and Plating for Correction of Degenerative Cervical Kyphosis: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Jeremy M V Guinn ◽  
Brenton Pennicooke ◽  
Joshua Rivera ◽  
Praveen V Mummaneni ◽  
Dean Chou
Keyword(s):  
Spinal Cord ◽  
Informed Consent ◽  
Bone Density ◽  
Surgical Intervention ◽  
Anterior Cervical Discectomy ◽  
Cervical Kyphosis ◽  
Nerve Roots ◽  
Cervical Discectomy ◽  
Cervical Plate ◽  
Sequential Induction

Abstract This surgical video demonstrates the technique for correcting degenerative cervical kyphosis using an anterior cervical discectomy and fusion (ACDF). Degenerative cervical kyphosis can cause radiculopathy, myelopathy, and difficulty holding up one's head. The goal of surgical intervention is to alleviate pain, improve the ability for upright gaze, and decompress the spinal cord or nerve roots. Posterior-only approaches and anterior corpectomies are alternative treatments to address cervical kyphosis. However, an ACDF allows for sequential induction of lordosis via distraction over multiple segments and for further lordosis induction by sequential screw tightening, pulling the spine towards a lordotic cervical plate.1 This video shows 2 cases demonstrating a technique of correcting severe cervical degenerative kyphosis. The video illustrates our initial kyphotic Caspar pin placement coupled with sequential anterior distraction to correct kyphosis. The technique is most useful in patients who have good bone density, nonankylosed facets, and degenerative cervical kyphosis. We have received informed consent of this patient to submit this video.

scholarly journals I. On the spinal-root connections and ganglion-cell connections of the nerve-fibres which produce contraction of the spleen

1896 ◽  
Vol 59 (353-358) ◽  
pp. 287-290
Keyword(s):  
Spinal Cord ◽  
Ganglion Cell ◽  
Dura Mater ◽  
Artificial Respiration ◽  
Lumbar Region ◽  
Spleen Volume ◽  
Nerve Fibres ◽  
Spinal Root ◽  
Nerve Roots

We have investigated, in four dogs, the effects upon the spleen volume of excitation of the thoracic and lumbar nerve-roots. In all four cases the animals were fully anæsthetised, at first with chloroform and afterwards with morphia, and were curarised, artificial respiration being maintained in the usual way. The spinal cord was then exposed in the dorso-lumbar region, and the nerve-roots on both sides tied and cut close to the dura mater, the latter with the enclosed portion of cord being then entirely removed.

Spinal extradural arteriovenous fistulas: a clinical and radiological description of different types and their novel treatment with Onyx

2011 ◽  
Vol 15 (5) ◽  
pp. 541-549 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Paul J. Holman ◽  
Chandan Krishna ◽  
Todd W. Trask ◽  
Richard P. Klucznik ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Epidural Space ◽  
Cauda Equina ◽  
Type A ◽  
Mass Effect ◽  
Nerve Roots ◽  
Arteriovenous Shunting ◽  
Arteriovenous Fistulas ◽  
Complex Anatomy ◽  
Different Types

Object Spinal extradural (epidural) arteriovenous fistulas (AVFs) are uncommon vascular lesions of the spine with arteriovenous shunting located primarily in the epidural venous plexus. Understanding the complex anatomical variations of these uncommon lesions is important for management. The authors describe the different types of spinal extradural AVFs and their endovascular management using Onyx. Methods Eight spinal extradural AVFs in 7 patients were studied using MR imaging, spinal angiography, and dynamic CT (DynaCT) between 2005 and 2009. Special consideration was given to the anatomy, pattern of venous drainage, and mass effect upon the nerve roots, spinal cord, and vertebrae. Results The neuroaxial location of the 8 spinal extradural AVFs was lumbosacral in 1 patient, lumbar in 4 patients, thoracic in 2 patients, and cervical in 1 patient. Spinal extradural AVFs were divided into 3 types. In Type A spinal extradural AVFs, arteriovenous shunting occurs in the epidural space and these types have an intradural draining vein causing venous hypertension and spinal cord edema with associated myelopathy or cauda equina syndrome. Type B1 malformations are confined to the epidural space with no intradural draining vein, causing compression of the spinal cord and/or nerve roots with myelopathy and/or radiculopathy. Type B2 malformations are also confined to the epidural space with no intradural draining vein and no mass effect, and are asymptomatic. There were 4 Type A spinal extradural AVFs, 3 Type B1s, and 1 Type B2. Onyx was used in all cases for embolization. Follow-up at 6–24 months showed that 4 patients experienced excellent recovery. Three patients with Type A spinal extradural AVFs attained good motor recovery but experienced persistent bladder and/or bowel problems. Conclusions The current description of the different types of spinal extradural AVFs can help in understanding their pathophysiology and guide management. DynaCT was found to be useful in understanding the complex anatomy of these lesions. Endovascular treatment with Onyx is a good alternative for spinal extradural AVF management.

Spinal dural arteriovenous fistulas and intrathecal venous drainage: correlation between digital subtraction angiography, magnetic resonance imaging, and clinical findings

2012 ◽  
Vol 16 (5) ◽  
pp. 433-440 ◽  
Author(s):  
Steven W. Hetts ◽  
Parham Moftakhar ◽  
Joey D. English ◽  
Christopher F. Dowd ◽  
Randall T. Higashida ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Functional Status ◽  
Digital Subtraction Angiography ◽  
Vertebral Body ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Mri Studies ◽  
Dural Arteriovenous Fistulas ◽  
Vessel Enhancement ◽  
Spinal Dural Arteriovenous Fistulas

Object Spinal dural arteriovenous fistulas (SDAVFs) cause myelopathy through arterialization of the perimedullary venous plexus and venous congestion of the spinal cord. The authors hypothesized that the craniocaudal extent of engorgement of intrathecal draining veins between the fistula site and the point of drainage out of the thecal sac correlates with the degree of myelopathy. Methods A retrospective review of the authors' institution's radiology databases identified 31 patients with SDAVFs who had undergone digital subtraction angiography (DSA) and MRI examinations of the spine. The authors counted the number of vertebral body levels of spinal cord enhancement and intrathecal vessel enhancement on T1-weighted postcontrast MRI studies. They also counted the number of levels of cord hyperintensity and intrathecal flow voids on T2-weighted MRI studies. On DSA, the authors identified the number of vertebral body levels of dilated intrathecal draining veins and outflow points from intrathecal veins to epidural veins. Functional status of the patients at the time of diagnosis was assessed using the Aminoff-Logue scale (ALS). Results Enlargement of the intrathecal draining veins averaged 10 ± 7.7 spinal levels on DSA. Patients with enlarged draining veins extending 10 or more spinal levels on DSA had worse ALS scores (mean gait 3.4, mean micturition 1.5) than patients with draining veins extending fewer than 10 levels (mean gait 1.8, mean micturition 0.6; p = 0.009 and 0.02, respectively). The number of vertebral body levels of enlarged draining veins correlated with the ALS score (gait r = 0.42, p = 0.009; and micturition r = 0.55, p = 0.0006). More extensive enlarged draining veins were associated with more spinal cord T2 hyperintensity, T2 intrathecal flow voids, and T1 vessel enhancement but not cord enhancement. Conclusions The craniocaudal extent of enlarged intrathecal veins draining SDAVF correlates with patient functional status, providing further insight into the pathophysiology of venous hypertensive myelopathy.

Acute Traumatic Cervical Facet Fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 5
Author(s):  
Shankar Gopinat
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Early Surgery ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Spinal Stability ◽  
Fracture Patterns ◽  
Spine Ct ◽  
Cervical Facet

Acute cervical facet fractures are increasingly being detected due to the use of cervical spine CT imaging in the initial assessment of trauma patients. For displaced cervical facet fractures with dislocations and subluxations, early surgery can decompress the spinal cord and stabilize the spine. For patients with non-displaced cervical facet fractures, the challenge in managing these patients is the determination of spinal stability. Although many of the patients with non-displaced cervical facet fractures can be managed with a cervical collar, the imaging needs to be analyzed carefully since certain fracture patterns may be better managed with early surgical stabilization.

Neurological Recovery in Traumatic Spinal Cord Injury Patient with Delayed Surgical Intervention

2018 ◽  
Vol 1 (2) ◽  
pp. 34
Author(s):  
Mochamad Targib Alatas
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Intervention ◽  
Case Series ◽  
Spinal Cord Injury Patient ◽  
Traumatic Spinal Cord Injury ◽  
Best Interest ◽  
Score Improvement ◽  
Cord Injury ◽  
Injury Patient

Early surgical treatment for traumatic spinal cord injury (SCI) patients has been proven to yield better improvement on neurological state, and widely practiced among surgeons in this field. However, it is not always affordable in every clinical setting. It is undeniable that surgery for chronic SCI has more challenges as the malunion of vertebral bones might have initiated, thus requires more complex operating techniques. In this case series, we report 7 patients with traumatic SCI whose surgical intervention is delayed due to several reasons. Initial motoric scores vary from 0 to 3, all have their interval periods supervised between outpatient clinic visits. On follow up they demonstrate significant neurological development defined by at least 2 grades motoric score improvement. Physical rehabilitation also began before surgery was conducted. These results should encourage surgeons to keep striving for the patient’s best interest, even when the injury has taken place weeks or even months before surgery is feasible because clinical improvement for these patients is not impossible. 

Determination of the speed-time relationship during handcycling in spinal cord injured athletes

2021 ◽  
pp. 1-8
Author(s):  
Diego Antunes ◽  
Eduardo Marcel Fernandes Nascimento ◽  
Gary Brickley ◽  
Gabriela Fischer ◽  
Ricardo Dantas de Lucas
Keyword(s):  
Spinal Cord ◽  
Time Relationship ◽  
Spinal Cord Injured ◽  
Injured Athletes

Utility of RDW in Prediction of Strangulation in Emergency Setting Hernias

2015 ◽  
Vol 100 (9-10) ◽  
pp. 1262-1264
Author(s):  
Okan Akturk ◽  
Baris Dogu Yildiz ◽  
Melih Karabeyoglu ◽  
Isıl Karabeyoglu
Keyword(s):  
Intestinal Ischemia ◽  
Surgical Intervention ◽  
Serum Markers ◽  
Emergency Setting ◽  
Red Cell ◽  
Cell Distribution ◽  
Blood Cell Count ◽  
Distribution Width ◽  
Abdominal Hernias ◽  
Operative Findings

Most of the small bowel obstruction cases are due to adhesions and hernias. Identifying strangulated cases may save patients from consequences of unnecessary operations and save patients who need urgent intervention by early detection. Serum markers of intestinal ischemia may help to identify and detect strangulation. The aim of this study was to identify if certain blood values such as RDW can accurately predict presence of strangulation preoperatively. We reviewed files of 127 patients who were operated because of incarcerated abdominal hernias for serum biomarkers and evaluated them with the operative findings. Our results show that elevation in red cell distribution width and white blood cell count may reflect strangulation. These findings may be useful in identifying the strangulated cases that need urgent surgical intervention.

scholarly journals Targeted axonal import (TAxI) peptide delivers functional proteins into spinal cord motor neurons after peripheral administration

2016 ◽  
Vol 113 (9) ◽  
pp. 2514-2519 ◽  
Author(s):  
Drew L. Sellers ◽  
Jamie M. Bergen ◽  
Russell N. Johnson ◽  
Heidi Back ◽  
John M. Ravits ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Motor Neurons ◽  
Unmet Need ◽  
Nerve Roots ◽  
Biologic Drugs ◽  
Administration Routes ◽  
Macromolecular Drugs ◽  
The Central Nervous System ◽  
Clinical Potential

A significant unmet need in treating neurodegenerative disease is effective methods for delivery of biologic drugs, such as peptides, proteins, or nucleic acids into the central nervous system (CNS). To date, there are no operative technologies for the delivery of macromolecular drugs to the CNS via peripheral administration routes. Using an in vivo phage-display screen, we identify a peptide, targeted axonal import (TAxI), that enriched recombinant bacteriophage accumulation and delivered protein cargo into spinal cord motor neurons after intramuscular injection. In animals with transected peripheral nerve roots, TAxI delivery into motor neurons after peripheral administration was inhibited, suggesting a retrograde axonal transport mechanism for delivery into the CNS. Notably, TAxI-Cre recombinase fusion proteins induced selective recombination and tdTomato-reporter expression in motor neurons after intramuscular injections. Furthermore, TAxI peptide was shown to label motor neurons in the human tissue. The demonstration of a nonviral-mediated delivery of functional proteins into the spinal cord establishes the clinical potential of this technology for minimally invasive administration of CNS-targeted therapeutics.

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