Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Embalming”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources
PubMed2005

Regional morphology of the transversus abdominis and obliquus internus and externus abdominis muscles.

BACKGROUND: The mechanisms by which the abdominal muscles move and control the lumbosacral spine are not clearly understood. Descriptions of abdominal morphology are also conflicting and the regional anatomy of these muscles has not been comprehensively examined. The aim of this study was to investigate the morphology of regions of transversus abdominis and obliquus internus and externus abdominis. METHODS: Anterior and posterolateral abdominal walls were dissected bilaterally in 26 embalmed human cadavers. The orientation, thickness and length of the upper, middle and lower fascicles of transversus abdominis and obliquus internus abdominis, and the upper and middle fascicles of obliquus externus abdominis were measured. FINDINGS: Differences in fascicle orientation, thickness and length were documented between the abdominal muscles and between regions of each muscle. The fascicles of transversus abdominis were horizontal in the upper region, with increasing inferomedial orientation in the middle and lower regions. The upper and middle fascicles of obliquus internus abdominis were oriented superomedially and the lower fascicles inferomedially. The mean vertical dimension of transversus abdominis that attaches to the lumbar spine via the thoracolumbar fascia was 5.2 (SD 2.1) cm. Intramuscular septa were observed between regions of transversus abdominis, and obliquus internus abdominis could be separated into two distinct layers in the lower and middle regions. INTERPRETATION: This study provides quantitative data of morphological differences between regions of the abdominal muscles, which suggest variation in function between muscle regions. Precise understanding of abdominal muscle anatomy is required for incorporation of these muscles into biomechanical models. Furthermore, regional variation in their morphology may reflect differences in function.

Abdominal Muscles↗
PubMed2006

Morphological muscle and joint parameters for musculoskeletal modelling of the lower extremity.

BACKGROUND: To assist in the treatment of gait disorders, an inverse and forward 3D musculoskeletal model of the lower extremity will be useful that allows to evaluate if-then scenarios. Currently available anatomical datasets do not comprise sufficiently accurate and complete information to construct such a model. The aim of this paper is to present a complete and consistent anatomical dataset, containing the orientations of joints (hip, knee, ankle and subtalar joints), muscle parameters (optimum length, physiological cross sectional area), and geometrical parameters (attachment sites, 'via' points). METHODS: One lower extremity, taken from a male embalmed specimen, was studied. Position and geometry were measured with a 3D-digitizer. Optotrak was used for measurement of rotation axes of joints. Sarcomere length was measured by laser diffraction. FINDINGS: A total of 38 muscles were measured. Each muscle was divided in different muscle lines of action based on muscle morphology. 14 Ligaments of the hip, knee and ankle were included. INTERPRETATION: The presented anatomical dataset embraces all necessary data for state of the art musculoskeletal modelling of the lower extremity. Implementation of these data into an (existing) model is likely to significantly improve the estimation of muscle forces and will thus make the use of the model as a clinical tool more feasible.

Aged↗
PubMed2004

A finite element model of blunt traumatic aortic rupture.

OBJECTIVE: Blunt traumatic aortic rupture has a scene survival of 2-5% and is present in 20% of all automobile fatalities. The manner in which the forces from a range of thoracic impacts are transduced through the thoracic cavity to produce consistent injury to the aortic isthmus remains uncertain. Our objective was to create and evaluate a computer based finite element (FE) model of the aorta and observe its behavior during blunt traumatic impacts. METHODS: A finite element model of the thorax including details of the heart, aorta and pertinent thoracic structures was created and run under the FE code LS-DYNA3D. The motion response of the heart following a simulated thoracic impact was extracted from the thorax model and applied in a second more detailed model of the heart and aorta in order to investigate the stresses acting through the aortic isthmus during simulated thoracic impacts. RESULTS: Simulated impact studies show that the predicted peak chest compression of the thorax model matched the measured responses from non-embalmed human cadaver impact studies by Kroell et al., 1974. The more detailed heart-aorta model predicted maximum stresses at the isthmus and pulmonary artery bifurcation the sites of most common trauma injury. CONCLUSIONS: Analysis of the response of the finite element heart-aorta model during blunt thoracic trauma demonstrates its potential for predicting major vessel injury. The model will be helpful in the design of impact protection systems.

Accidents, Traffic↗
PubMed2004

Preanalytic aspects in postmortem toxicology.

The preanalytic phase has been recognized to have a substantial role for the quality and reliability of analytical results, which very much depend on the type and quality of specimens provided. There are several unique challenges to select and collect specimens for postmortem toxicology investigation. Postmortem specimens may be numerous, and sample quality may be quite variable. An overview is given on specimens routinely collected as well as on alternative specimens that may provide additional information on the route of administration, a long term or a recent use/exposure to a drug or poison. Autolytic and putrefactive changes limit the selection and utility of specimens. Some data from case reports as well as experimental investigations on drug degradation and/or formation during putrefaction are discussed. Diffusion processes as well as postmortem degradation or formation may influence ethanol concentration in autopsy specimens. Formalin fixation of specimens or embalmment of the corpse may cause considerable changes of initial drug levels. These changes are due to alterations of the biological matrix as well as to dilution of a sample, release or degradation of the drug or poison. Most important seems a conversion of desmethyl metabolites to the parent drug. Some general requirements for postmortem sampling are given based on references about specimen collection issues, for a harmonized protocol for sampling in suspected poisonings or drug-related deaths does not exist. The advantages and disadvantages of specimen preservation are shortly discussed. Storage stability is another important issue to be considered. Instability can either derive from physical, chemical or metabolic processes. The knowledge on degradation mechanisms may enable the forensic toxicologist to target the right substance, which may be a major break down product in the investigation of highly labile compounds. Although it is impossible to eliminate all interfering factors or influences occurring during the preanalytic phase, their consideration should facilitate the assessment of sample quality and the analytical result obtained from that sample.

Autolysis↗
PubMed2005

Implantation of radio frequency identification device (RFID) microchip in disaster victim identification (DVI).

The tsunami catastrophe of December 2004 left more than 200,000 dead. Disaster victim identification (DVI) teams were presented with the unprecedented challenge of identifying thousands of mostly markedly putrefied and partially skeletised bodies. To this end, an adequate body tagging method is essential. Conventional body bag tagging in terms of writing on body bags and placing of tags inside body bags proved unsatisfactory and problem prone due to consequences of cold storage, formalin (formaldehyde) embalming and body numbers inside storage facilities. The placement of radio frequency identification device (RFID) microchips inside victim bodies provided a practical solution to problems of body tagging and attribution in the DVI setting encountered by the Austrian DVI team in Thailand in early 2005.

Austria↗
PubMed2006

Lateral femoral cutaneous nerve and iliac crest bone grafts--anatomical and clinical considerations.

This study investigates the topographical relationship of the lateral femoral cutaneous nerve (LFCN) to the anterior iliac crest and its clinical relevance in the context of bone graft harvesting. In the anatomical part of the study, LFCN was dissected and its course investigated in 34 human formalin-embalmed cadavers. In the clinical part, data of patients who underwent an iliac crest bone grafting procedure were collected and analysed. The obtained results were then compared with the results of other investigators published in the medical literature. From 34 nerves, the lateral branch of 1 LFCN (2.9%) crossed the anterosuperior iliac spine (ASIS) prominence at a distance less than 5mm superolaterally from the most anterior point of the spine. All other nerves ran below the inguinal ligament with an average distance of 14.6mm in the inferomedial direction from the spine. In 4 out of 298 patients (1.3%) who underwent harvesting of monocortical bone grafts from the inner table of the ilium, sensory disturbances in the dermatome of LFCN were observed. After a maximum period of 12 months all sensory disturbances resolved so that no case of permanent sensory impairment was recorded. The relatively low incidences of iatrogenic LFCN damage can be attributed to a standardized surgical concept which employs a lateral incision and layer by layer dissection to the periosteum/iliacal fascia level in order to identify the nerves potentially crossing the iliac crest above the ASIS.

Adolescent↗
PubMed2006

Degradation and detoxification of formaline wastewater by advanced oxidation processes.

In this study, advanced oxidation processes (AOPs) utilizing the combinations of UV/H(2)O(2), Fenton, photo-Fenton and the combination of Fenton/photo-Fenton reactions were investigated in lab-scale experiments for the degradation of formaline wastewater. The studied toxic chemicals were formaldehyde and methanol in mixture solution, so-called formalin, which is the embalming agent in mortuaries. The experimental results showed that the photo-Fenton process was the most effective treatment process among the studied AOPs. Pseudo-first-order degradation rate constants of formaldehyde and methanol were obtained from batch experimental data. In the combination of Fenton/photo-Fenton reactions, the results show that applying UV light at an early stage of the reaction might not be necessary for a speedy oxidation reaction of the Fenton process. With Fenton and photo-Fenton processes, mineralization of formaline wastewater can be achieved, as no residual TOC is detected in the effluent after the reaction period. It is suggested that Fenton and photo-Fenton processes are viable techniques for the formaline wastewater treatment as they were able to provide high degradation of formaldehyde and methanol with relatively low toxicity of the by-products in the effluent.

Formaldehyde↗
PubMed2004

Anatomic study of variations of hypothenar muscles and arborization patterns of the ulnar nerve in the hand.

PURPOSE: To show the variations in the hypothenar muscles and the arborization patterns of the ulnar nerve and to investigate the relationship between the hypothenar muscles and the ulnar nerve. METHODS: We performed an anatomic study of 35 hands from embalmed cadavers. After dissecting the ulnar side of the hand we recorded the number of hypothenar muscles and their variations, the site of the hiatus for the deep branch of the ulnar nerve, and the branching patterns of the ulnar nerve in each hand. We then investigated the relationship between the variations in the hypothenar muscles and the arborization patterns of the ulnar nerve. RESULTS: The abductor digiti minimi (ADM) had 1 belly in 6 hands, 2 bellies in 28 hands, and 3 bellies in 1 hand. The flexor digiti minimi brevis was absent in 8 hands, had 1 belly in 24 hands, and had 2 bellies in 3 hands. The opponens digiti minimi had 2 layers of origin and the deep branch of the ulnar nerve passed between these 2 layers in all hands. We classified the structural patterns of the hiatus into 3 types, the arborization patterns of the ulnar nerve into 5 types, and the branching patterns of the motor branch to the ADM into 4 types according to their morphologic characteristics. We found variations of the arborization pattern in which the deep branch originated from the ulnar trunk of the ulnar nerve distal to bifurcation in 3 hands, a communicating branch was present between the 2 sensory branches to the fingers in 3 hands, and the ulnar sensory branch pierced the ADM in 2 hands. CONCLUSIONS: We confirmed that the anatomic relationship between the ulnar nerve and the hypothenar muscle is complex and that the formation of the hiatus varies. This knowledge can assist the surgeon in the diagnosis and treatment of conditions associated with the ulnar aspect of the hand.

Aged↗
PubMed2005

The vascular anatomy of the abductor digiti minimi and the flexor digiti minimi brevis muscles.

PURPOSE: The abductor digiti minimi (ADM) and the flexor digiti minimi (FDM) brevis muscles could be used as flaps with their low functional morbidity, especially in severe crushed injuries of the hand. The vascular anatomy of both of the muscles were investigated to classify the muscles according to the Mathes-Nahai classification. METHODS: Nine cadavers embalmed with formaline were dissected under loupe magnification (x4) from the wrist proximally to the proximal phalanx of the small finger distally, delineating the branches of the ulnar artery along the ADM and FDM muscles. RESULTS: The dissections and the microangiography of the muscles revealed 1 major and 2 minor pedicles. Both of the muscles could be classified as type II muscles according to the Mathes-Nahai classification. CONCLUSIONS: The vascular pattern of the ADM muscle has been described previously, this study explored the vascular anatomy of the FDM muscle. The information regarding the vascular supplies of these muscles could be of help to the clinician when manipulating the muscles. The FDM muscle could be a suitable alternative for the ADM muscle in opponensplasty. When the pedicles are preserved the muscles could be used--based proximally or distally.

Adult↗
PubMed2005

Locking versus nonlocking T-plates for dorsal and volar fixation of dorsally comminuted distal radius fractures: a biomechanical study.

PURPOSE: To see if locking volar plates approach the strength of dorsal plates on a dorsally comminuted distal radius fracture model. Volar plates have been associated with fewer tendon complications than dorsal plates but are thought to have mechanical disadvantages in dorsally comminuted distal radius fractures. Locking plates may increase construct strength and stiffness. This study compares dorsal and volar locking and nonlocking plates in a dorsally comminuted distal radius fracture model. METHODS: Axial loading was used to test 14 pairs of embalmed radii after an osteotomy simulating dorsal comminution and plating in 1 of 4 configurations: a standard nonlocking 3.5-mm compression T-plate or a 3.5-mm locking compression T-plate applied either dorsally or volarly. Failure was defined as the point of initial load reduction caused by bone breakage or substantial plate bending. RESULTS: No significant differences in stiffness or failure strength were found between volar locked and nonlocked constructs. Although not significant, the stiffness of dorsal locked constructs was 51% greater than that of the nonlocked constructs. Locked or nonlocked dorsal constructs were more than 2 times stiffer than volar constructs. The failure strength of dorsal constructs was 53% higher than that of volar constructs. Failure for both volar locked and nonlocked constructs occurred by plate bending through the unfilled hole at the osteotomy site. Failure for both dorsal locked and nonlocked constructs occurred by bone breakage. CONCLUSIONS: Locking plates failed to increase the stiffness or strength of dorsally comminuted distal radius fractures compared with nonlocking plates. Failure strength and stiffness are greater for locked or nonlocked dorsal constructs than for either locked or nonlocked volar constructs. Whether the lower stiffness and failure strength are of clinical significance is unknown. The unfilled hole at the site of comminution or osteotomy is potentially a site of weakness in both volar locked and nonlocked plates.

Biomechanical Phenomena↗
PubMed2006

Anatomic study of arborization patterns of the ulnar artery in Guyon's canal.

PURPOSE: To show variations in arborization patterns of the ulnar artery in Guyon's canal and to investigate the relationship between the hypothenar muscles and the ulnar artery. METHODS: Thirty-five embalmed cadaveric hands were dissected and the existence and course of the superficial and deep palmar branches of the ulnar artery and the site of feeding branches to the hypothenar muscles were recorded. The anatomic relationship between the ulnar artery and the hypothenar muscle variations also was investigated. RESULTS: Four arborization patterns were identified. In type 1UA (n = 17 hands), an artery accompanying the deep branch of the ulnar nerve (AADBUN) formed a deep palmar arch (DPA). In type 2UA (n = 11 hands) the AADBUN continued to the feeding artery of the abductor digiti minimi and the distal deep palmar branch of the ulnar artery (DDPBUA) branched off distally. This arterial structure formed a DPA. In type 3UA (n = 6 hands) both the AADBUN and DDPBUA formed DPAs. In type 4UA(n = 1 hand), the AADBUN continued to the feeding artery of the abductor digiti minimi with no DDPBUA and therefore no DPA. A dorsal perforating artery of the ulnar artery also was found in 4 hands. This branch came from the AADBUN at the level of the distal edge of the pisiform and merged with the dorsal carpal arterial arch. We also investigated the relationship between the structural pattern of the hiatus for the deep branch of the ulnar nerve and ulnar artery variation but found no association. The most common pattern observed was a type 1 hiatus with a type 1UA arborization pattern. CONCLUSIONS: Our study confirmed considerable variations in the arborization pattern of the ulnar artery in Guyon's canal. To avoid injury to the arterial branches during surgery in this region care must be taken with respect to variations of the ulnar artery in Guyon's canal.

Cadaver↗
PubMedDate not supplied

An anatomic and biomechanic study of the wrist extensor retinaculum septa and tendon compartments.

PURPOSE: The anatomy of the extensor retinaculum of the wrist has been described previously; the purpose of this study was to describe the specific anatomy of the septal attachments on the radius and to investigate the mechanical strength of each septal attachment on the radius and each of the 6 compartments of the extensor retinaculum. METHODS: Thirty-four wrists from 24 fresh-frozen and 10 embalmed cadavers were used. First, anatomic measurements of the individual extensor retinaculum septums were performed with calipers and a 3-dimensional digitizer. Next each extensor retinaculum septum was excised as a bone-retinaculum-bone autograft and was tested in tension to failure with a materials testing machine. Finally the 6 extensor retinaculum compartments were tested to failure. RESULTS: Septum 1/2 had the largest radial surface area and septum 3/4 had the smallest. Septum 1/2 also was found to have the highest failure strength at 51.3 +/- 15.3 N. In compartment testing, compartments 1 and 2 had the highest overall resistance to failure and compartment 5 had the lowest. Compartment 6, which was thought to be the weakest because of clinically observed subluxation of the extensor carpi ulnaris tendon, had stronger failure data than expected. CONCLUSIONS: This study offers detailed analysis of the extensor retinaculum compartments and 3-dimensional anatomy of the septal attachments. Clinically this study lends insight to the strength of bone-retinaculum-bone autografts and the etiology of extensor carpi ulnaris subluxation.

Aged↗
PubMedDate not supplied

The coracoid impingement of the subscapularis tendon: a cadaver study.

To study the anatomic relationships and varieties of anterior impingement of the rotator cuff, an examination of 124 shoulder joints from 62 embalmed cadavers was performed. The distance between the lesser tuberosity and the coracoid was measured at different degrees of humeral rotation in the shoulder joint. Neither lateral differences nor differences with respect to donor gender were found in the distance measurements between the coracoid process and the lesser tuberosity for any rotational angle. In addition, no significant differences were found between shoulders with and without rupture of the subscapularis tendon. No lateral dominance was found for the subscapularis tunnel area.

Adult↗
PubMedDate not supplied

The arthroscopic view of the glenohumeral ligaments compared with anatomy: fold or fact?

In a morphologic cadaveric study with observational arthroscopy in living subjects, we tried to resolve the contradiction in the literature with regard to the nature of the glenohumeral ligaments and the difference in observation of the folds during arthroscopic and open surgery. Observation of morphology and functional anatomy of the glenohumeral capsule was performed in 200 non-embalmed cadavers through open dissection (100 specimens) and by arthroscopy (50 specimens) or both (50 specimens), as well as in 100 living subjects undergoing shoulder arthroscopy. In the resting arm position, folds and bands can be observed on the inside of the anteroinferior capsule. When the arm is moved into full abduction and external rotation, however, all bands progressively disappear from sight. The bands generally observed in the shoulder capsule during arthroscopy appear at the site of histologic reinforcements of the capsule but are not the capsular ligaments themselves, as they seem to disappear in certain positions of the humerus. Arthroscopically, it is, therefore, not possible to discern the exact limits of these ligaments. This may give rise to a certain amount of confusion when comparing clinical with anatomic and physiologic studies. On the other hand, their presence or absence in arthroscopic surgery might be of clinical relevance in evaluating capsular tension.

Aged↗
PubMed2005

JC virus genotyping using formalin-fixed, paraffin-embedded renal tissues.

Recently genotyping of JC virus (JCV) DNA in renal tissue was reported to be useful to identify the geographic origin of unidentified cadavers. In the above study, autopsied tissue samples without storage or stored in a frozen state were used. This study examined JCV DNA sequence modifications caused by formalin-fixation, in an attempt to elucidate whether formalin-fixed, paraffin-embedded tissue samples can also be used to determine the genotypes of JCV DNA in the kidney. In four cases, a 610 bp typing region of the JCV genome was PCR-amplified from renal tissues stored for 1 year in three different states: frozen at -80 degrees C [Amaker, B.H., Chandler, F.W., Huey, L.O., Colwell, R.M., 1997. Molecular detection of JC virus in embalmed, formalin-fixed, paraffin-embedded brain tissue. J. Forensic Sci., 1157-1159], formalin-fixed, paraffin-embedded [Ault, G.S., Stoner, G.L., 1992. Two major types of JC virus defined in progressive multifocal leukoencephalopathy brain by early and late coding region DNA sequences. J. Gen. Virol. 73, 2669-2678], and soaked in 5% formalin [Baksh, F.K., Finkelstein, S.D., Swalskey, P.A., Stoner, G.L., Ryschkewitsch, C.F., Randhawa, P.R., 2001. Molecular genotyping of BK and JC virus in human polyomavirus-associated interstitial nephritis after renal transplantation. Am. J. Kidney Dis. 38 (2), 354-365]. The amplified fragments were cloned, and the resultant clones were sequenced. In frozen samples, single sequences ('original' sequences) were detected in all cases. In formalin-fixed, paraffin-embedded samples, not only the original sequences but also those with 1-6 base substitutions were detected. From formalin-soaked samples, the original sequences and those with 1-5 and 10-13 substitutions were detected. The genotyping of JCV DNA was not hampered by the presence of 1-6 substitutions, but a shift in JCV genotypes was observed in sequences with 10-13 substitutions. Thus, it was concluded that the genotypes of JCV DNA in the kidney can be determined only with specimens stored in a frozen state or formalin-fixed for a short time.

Adult↗
PubMed2006

Manual fixation versus locking during upper cervical segmental mobilization. Part 1: an in vitro three-dimensional arthrokinematic analysis of manual flexion-extension mobilization of the atlanto-occipital joint.

BACKGROUND: Segmental manual spinal mobilization techniques are used to restrict the effects of interventions to one spinal segment. It is, however, not known whether it is possible to generate such a localization of effects. Segmental motion in the cervical spine was previously studied by applying pure moments of force on cadaver specimens. So far, no studies have been performed on the segmental three-dimensional (3D)-kinematic aspects of cervical manual flexion-extension mobilization. METHODS: 3D-aspects of manual flexion-extension motion in the atlanto-occipital and atlanto-axial segments were analysed in vitro using an electromagnetic tracking device. Segmental bony reference points were registered using a 3D-digitizing stylus to define bone-embedded coordinate frames. Six spinal specimens--five embalmed and one fresh--were analysed in this study. Segmental motions were analysed in the atlanto-occipital and the atlanto-axial joints during manual mobilization through the full range of flexion-extension mobility. The 3D-kinematic analysis of two different segmental mobilization techniques--manual fixation of C1 versus locking of the inferior cervical spine--is presented. RESULTS: A significant reduction (P<0.05) of the associated axial rotation and lateral bending motions was observed during the manual fixation technique without influencing the main motion component of flexion-extension. The locking technique did not significantly influence the movements on the mobilized atlanto-occipital segment, but reduced all movement components in the atlanto-axial joint. INTERPRETATIONS: The results suggest that, for manual segmental flexion-extension mobilization of the upper cervical spine, manual fixation or locking might be chosen in different situations according to the desired effects.

Atlanto-Occipital Joint↗
PubMed2006

Manual fixation versus locking during upper cervical segmental mobilization. Part 2: an in vitro three-dimensional arthrokinematic analysis of manual axial rotation and lateral bending mobilization of the atlanto-axial joint.

BACKGROUND: Three-dimensional kinematic aspects of coupled motion during manual cervical mobilization have not previously been studied. Using an in vitro 3D-motion analysis method, the kinematic effects of two different segmental techniques for axial rotation and lateral bending mobilization of the upper cervical spine were investigated as a second part of the study (in part one, kinematic effects of flexion-extension mobilization have been investigated). METHODS: Axial rotation and lateral bending mobilization of the atlanto-occipital and atlanto-axial segments were analysed in vitro using an electromagnetic tracking device. Local reference frames were defined based on bony reference points that were registered using a 3D-digitizing stylus. Five embalmed and one fresh specimen were analysed. Segmental motion was registered simultaneously in the atlanto-occipital and the atlanto-axial joints during manual mobilization through the full range of axial rotation and lateral bending mobility. The 3D-kinematic aspects during regional mobilization were compared with those during segmental mobilization with manual fixation and during segmental mobilization using a locking technique. RESULTS: During both segmental axial rotation techniques of the atlanto-axial joint, a significant reduction of the coupled lateral bending and flexion-extension motion was observed. The locking technique also induced an increase in the main axial rotation component. During lateral bending mobilization of the atlanto-axial joint, the manual fixation technique reduced the effect on the coupled flexion-extension component significantly. INTERPRETATIONS: These results suggest that for manual segmental axial rotation and lateral bending mobilization of the upper cervical spine segmental manual fixation or locking may be preferred in different situations depending on the desired effects. This study brings additional information to the data provided by part 1 of this study on the 3D-arthrokinematic effects of flexion-extension mobilization.

Atlanto-Axial Joint↗
PubMed2005

Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections.

Cervical transforaminal epidural steroid injections are performed for the treatment of radicular pain. Multiple recent case reports have raised safety concerns regarding neurologic deficits such as anterior spinal artery syndrome and cerebellar injury after these injections. To investigate the potential causes of these injuries, an anatomic study was conducted. In this study of 10 embalmed cadavers, the cervical intervertebral foramina were examined to determine if the ascending or deep cervical arteries supplied radicular or segmental medullary arteries potentially susceptible to cannulation or needle trauma during transforaminal injection. In two specimens, dissection was carried down to the spinal cord, demonstrating the anterior spinal, radicular, and segmental medullary arteries. Of 95 intervertebral foramina dissected, 21 had an arterial vessel proximal to the posterior aspect of the foraminal opening. Seven of these 21 were spinal branches that entered the foramen posteriorly, potentially forming radicular or segmental medullary vessels to the spinal cord. One additional ascending cervical artery formed a segmental medullary artery that joined the anterior spinal artery. This would only be injured by anterior needle misplacement. Of the seven foraminal branches, three were included in the deep dissections. Two contributed to segmental medullary arteries and one to a radicular artery. Variable anastomoses between the vertebral and cervical arteries were found. Therefore, it is possible to introduce steroid particles into the vertebral circulation via the cervical arteries. Critical arteries are located in the posterior aspect of the intervertebral foramen and may be vulnerable to injection or injury during transforaminal epidural steroid injection.

Aged↗