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PubMedDate not supplied

Ultrasound-guided periradicular injections in the middle to lower cervical spine: an imaging study of a new approach.

BACKGROUND AND OBJECTIVES: The objective of this study was to show the efficacy of ultrasound in facilitating the performance of a simulated cervical periradicular injection in cadavers. METHODS: A total of 40 ultrasound-guided examinations at 4 levels (C3 to C7) were performed on 4 embalmed cadavers. The cervical spinal nerves were located with ultrasound. First, the transverse process of each level was taken as a sonoanatomic landmark. The most lateral aspect of the transverse process of the seventh cervical vertebra was then established as the reference point. Ipsilateral distances (A, B, C, and D) between this point and each one of the transverse processes of the cervical spine up to the third vertebra were then computed. Subsequently, coronal computed tomography (CT) scans were taken to verify these distances. In a second part, a spinal needle was advanced under ultrasound guidance to the spinal nerves C5 to C8 on both sides of one cadaver. The exact placement of the needle tips was checked by CT. RESULTS: The transverse processes were identified in all cadavers. In 5 attempts, a depiction of the spinal nerves was not possible. Ultrasound and CT provided the same mean measurements of 1.1 cm, 2.1 cm, 3.1 cm, and 4.1 cm for distances A, B, C, and D, respectively. All 8 needle tips were placed within 5 mm dorsal to the spinal nerve and less than 5 mm away from the posterior tubercle of each level's transverse process, as also verified by CT. CONCLUSIONS: This preclinical study suggests that ultrasound is a useful guiding tool for periradicular injections in the cervical spine.

Cervical Vertebrae↗
PubMedDate not supplied

Value of intraoperative true lateral radiograph of C2 pedicle for C1-2 transarticular screw insertion.

BACKGROUND CONTEXT: Transarticular C1-2 screws are widely used in posterior cervical spine instrumentation. Injury to the vertebral artery during insertion of transarticular Cl-2 screw remains a serious complication. Use of a computer-assisted surgery system decreases this complication considerably. However, this system encounters problems in ensuring complete accuracy because of positional variations during preoperative and intraoperative imaging generation. Therefore, intraoperative fluoroscopy still is one of the commonly used methods to guide insertion of transarticular Cl-2 screw. Evaluation of a true lateral radiographic view of the C2 pedicle for screw trajectory during C1-2 transarticular screw insertion may help to minimize this potential complication. PURPOSE: To evaluate the value of intraoperative true lateral radiograph of the C2 pedicle for screw trajectory during C1-2 transarticular screw insertion. STUDY DESIGN: To compare the height of the C2 pedicle area allowing instrumentation on true lateral view radiograph of the C2 pedicle and computed tomographic (CT) scan with multiplanar reconstruction. METHODS: Twenty embalmed human cadaveric cervical spine specimens were used to insert a total of 40 C1-2 transarticular screws using Magerl and Seemann technique. One side of the C2 transverse foramen was filled with radiopaque material (lead oxide) to simulate the artery and to demarcate the danger zone for better visualization on radiography. Measurements and calculation of the mean and standard deviation of the height of the area allowing instrumentation of the C2 pedicle were done on true lateral view radiograph of the C2 pedicle, the sagittal and 30 degrees sagittal views relative to the frontal plane passing exactly through the center of the C2 pedicle of CT scans. Student t test was applied to calculate the statistical significance of measured values. Statistical significance was defined as p or=.36. Using sagittal CT scan views, the height of pedicles was 7.71+/-0.7 mm (right) and 7.58+/-1.01 mm (left), p>or=.23. On 30 degrees sagittal CT scan views, the height of pedicles was 7.84+/-1.00 mm (right) and 7.76+/-1.02 mm (left), p>or=.27. The p value was >or=.78, >or=.56, and >or=.49 for true lateral radiographic view and sagittal CT scan view, true lateral radiographic view and 30 degrees sagittal CT scan view, and sagittal CT scan view and 30 degrees sagittal CT scan views, respectively. On lateral view of cervical spine, the decline angle of the transarticular screw was 51.3+/-0.50 degrees (right) and 50.68+/-0.41 degrees (left), p>or=.17. Mean decline angle was 51+/-0.43 degrees . On the anteroposterior (AP) view, radiograph median angle was 6.87+/-0.53 degrees (right) and 6.0+/-0.59 degrees (left), p>or=.25. Mean median angle was 6.44+/-0.62 degrees. CONCLUSIONS: True lateral radiographic views of the pedicles provide useful information for defining screw trajectory intraoperatively. Using this view along with AP and lateral view of cervical spine and preoperative three-dimensional CT scan may narrow the margin of error in this delicate area.

Aged↗
PubMedDate not supplied

Biomechanical evaluation of pedicle screws versus pedicle and laminar hooks in the thoracic spine.

BACKGROUND CONTEXT: Pedicle screws have been shown to be superior to hooks in the lumbar spine, but few studies have addressed their use in the thoracic spine. PURPOSE: The objective of this study was to biomechanically evaluate the pullout strength of pedicle screws in the thoracic spine and compare them to laminar hooks. STUDY DESING/SETTING: Twelve vertebrae (T1-T12) were harvested from each of five embalmed human cadavers (n=60). The age of the donors averaged 83+8.5 years. After bone mineral density had been measured in the vertebrae (mean=0.47 g/cm(3)), spines were disarticulated. Some pedicles were damaged during disarticulation or preparation for testing, so that 100 out of a possible 120 pullout tests were performed. METHODS: Each vertebra was secured using a custom-made jig, and a posteriorly directed force was applied to either the screw or the claw. Constructs were ramped to failure at 3 mm/min using a Mini Bionix II materials testing machine (MTS, Eden Prairie, MN). RESULTS: Pedicle claws had an average pullout strength of 577 N, whereas the pullout strength of pedicle screws averaged 309 N. Hooks installed using the claw method in the thoracic spine had an overwhelming advantage in pullout strength versus pedicle screws. Even in extremely osteoporotic bone, the claw withstood 88% greater pullout load. CONCLUSION: The results of this study indicate that hooks should be considered when supplemental instrumentation is required in thoracic vertebrae, especially in osteoporotic bone.

Biomechanical Phenomena↗
PubMed2004

A review and meta-analysis of formaldehyde exposure and leukemia.

Most reviews on the carcinogenicity of formaldehyde have focused on cancers of the respiratory tract because these cancer sites were thought to be most biologically plausible. However, two recent updated large industrial studies have found positive associations between some measures of formaldehyde exposure and increased leukemia, although another recent update of a large study did not find any association. We examine 18 epidemiology studies of workers exposed to formaldehyde where leukemia rates were reported. We summarize the findings across studies by using meta-analytic techniques to calculate the meta-relative risk values (mRR), confidence intervals, and heterogeneity of the risk estimates for several study characteristics. We also determine if publication or reporting biases may be affecting the estimates. We found a small increase in rate of leukemia overall among embalmers (mRR = 1.6, 95%CI 1.2-6.0), and pathologists/anatomists (mRR = 1.4, 95%CI 1.0-1.9). Industrial workers, who have been reported to have the highest formaldehyde exposures, had a mRR of 0.9 (95%CI 0.8-1.0). There was increased risk with increasing exposure in two large industrial studies, although the increased risk is one of these studies was not seen when an external comparison group is used. Also, another large industrial study with more highly exposure workers found decreased risk of leukemia among the highest exposed group. The long latency for leukemia deaths observed in the two industrial studies that reported increased risk was not consistent with a chemical carcinogen such as benzene. We found limited evidence of publication or reporting bias. On balance, these data do not provide consistent support for a relationship between formaldehyde exposure and leukemia risk.

Data Interpretation, Statistical↗
PubMed1994

Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis.

OBJECTIVE: This study examines the anatomic factors that could explain the mechanical basis for transmission of abdominal pressure to the urethra. STUDY DESIGN: Dissection of 19 embalmed and 42 fresh cadavers and examination of 13 sets of serial pelvic sections were performed to study the structures involved in urethral support. The effect of simulated increases in abdominal pressure on the pelvic floor and urethra was observed in fresh specimens. RESULTS: The urethra lies on a supportive layer that is composed of the endopelvic fascia and the anterior vaginal wall. This layer gains structural stability through its lateral attachment to the arcus tendineus fascia pelvis and levator ani muscle. Pressure from above compresses the urethra against this hammock-like supportive layer, compressing its lumen closed. The stability of the suburethral layer depends on the intact connection of the vaginal wall and endopelvic fascia to the arcus tendineus fasciae pelvis and levator ani muscles. CONCLUSION: Increases in urethral closure pressure during a cough probably arise because the urethra is compressed against a hammock-like supportive layer, rather than the urethra being truly "intraabdominal."

Abdomen↗
PubMed1997

The functional anatomy of the urethra: role of the pubourethral ligaments.

OBJECTIVE: This clinical study examines and defines the functional anatomy of the urethra as it relates to the Valsalva and Kegel maneuvers and to urethral stability. STUDY DESIGN: Dissection of embalmed cadavers and examination of 60 patients were performed to study adjunct structures in urethral stability. Provocative maneuvers (Valsalva and Kegel) were used in all 60 patients. Urethral prolapse was graded with use of the international Continence-Society classification. RESULTS: Cadaveric dissection confirmed the structural anatomy of the pubourethral muscles and ligaments. Physical examination in 30 patients revealed a lack of urethral stability in all patients with stress urinary incontinence. In 30 patients acting as normal controls, no urinary incontinence was present, and all maintained urethral stability with provocation. The urethrovesical junction was mobile in all patients in performing a Valsalva maneuver. CONCLUSION: Intact pubourethral ligamentous and muscular attachments aid in stabilizing the urethra to its normal anatomic position. This helps maintain continence.

Female↗
PubMed2003

[Renal artery vascularization in the African black. Report of 44 dissections].

Studies on the anatomy of the renal arteries in Black Africans being scarce, the authors have made their contribution to the knowledge of the renal arteries. They have provided a comparison between the anatomy of the renal arteries studied in the literature in relation to a white patient and black patient. It is a prospective study based on the change in the number of the renal arteries of 44 Black Africans' maccabees quite fresh, not yet embalmed that have been dissected in order, as received in the anatomy laboratory of Abidjan. That work has allowed to notice some results that are more or less similar to those revealed in the literature, i.e. in 80% of the cases, the kidney is irrigated by an artery, and in 20% of the cases, we have more than one artery for one kidney. No kidney is vascularized by more than two arteries. These results underline how important it is to have good anatomical knowledge of this region in renal surgery. This is possible thanks to medical imagery and arteriography which helps in preventing operative accidents and in preserving the kidney.

Adult↗
PubMed1998

CT-based analysis of the geometry of the distal femur.

When applying minimally invasive techniques (MIO, Minimally Invasive Osteosynthesis) to the fixation of the distal femur, the surgeon has access to a limited number of anatomical landmarks: namely the articular surface of the distal femur and a small portion of the distal lateral femoral cortex. A detailed knowledge of the local anatomy facilitates the technique and prevents complications. Using Kirschner wires placed at set positions in the distal femur, we analyzed the measurements obtained from the 3D reconstructed helical CT scans of 33 embalmed femora and we report on the anatomy of the distal femur as it relates to supracondylar fracture fixation.

Femur↗
PubMed2001

Mechanical properties of cancellous bone in the human mandibular condyle are anisotropic.

The objective of the present study was (1) to test the hypothesis that the elastic and failure properties of the cancellous bone of the mandibular condyle depend on the loading direction, and (2) to relate these properties to bone density parameters. Uniaxial compression tests were performed on cylindrical specimens (n=47) obtained from the condyles of 24 embalmed cadavers. Two loading directions were examined, i.e., a direction coinciding with the predominant orientation of the plate-like trabeculae (axial loading) and a direction perpendicular to the plate-like trabeculae (transverse loading). Archimedes' principle was applied to determine bone density parameters. The cancellous bone was in axial loading 3.4 times stiffer and 2.8 times stronger upon failure than in transverse loading. High coefficients of correlation were found among the various mechanical properties and between them and the apparent density and volume fraction. The anisotropic mechanical properties can possibly be considered as a mechanical adaptation to the loading of the condyle in vivo.

Aged↗
PubMed2003

Measuring morphological parameters of the pelvic floor for finite element modelling purposes.

The goal of this study was to obtain a complete data set needed for studying the complex biomechanical behaviour of the pelvic floor muscles using a computer model based on the finite element (FE) theory. The model should be able to predict the effect of surgical interventions and give insight into the function of pelvic floor muscles. Because there was a lack of any information concerning morphological parameters of the pelvic floor muscle structures, we performed an experimental measurement to uncover those morphological parameters. Geometric parameters as well as muscle parameters of the pelvic floor muscles were measured on an embalmed female cadaver. A three-dimensional (3D) geometric data set of the pelvic floor including muscle fibre directions was obtained using a palpator device. A 3D surface model based on the experimental data, needed for mathematical modelling of the pelvic floor, was created. For all parts of the diaphragma pelvis, the optimal muscle fibre length was determined by laser diffraction measurements of the sarcomere length. In addition, other muscle parameters such as physiological cross-sectional area and total muscle fibre length were determined. Apart from these measurements we obtained a data set of the pelvic floor structures based on nuclear magnetic resonance imaging (MRI) on the same cadaver specimen. The purpose of this experiment was to discover the relationship between the MRI morphology and geometrical parameters obtained from the previous measurements. The produced data set is not only important for biomechanical modelling of the pelvic floor muscles, but it also describes the geometry of muscle fibres and is useful for functional analysis of the pelvic floor in general. By the use of many reference landmarks all these morphologic data concerning fibre directions and optimal fibre length can be morphed to the geometrical data based on segmentation from MRI scans. These data can be directly used as an input for building a mathematical model based on FE theory.

Aged↗
PubMed1999

Measuring muscle and joint geometry parameters of a shoulder for modeling purposes.

An extensive set of muscle and joint geometry parameters was measured of the right shoulder of an embalmed male. For all muscles the optimal muscle fiber length was determined by laser diffraction measurements of sarcomere length. In addition, tendon length and physiological cross-sectional area were determined. The parameter set was needed to enhance the reliability of a computer model of the shoulder (Van der Helm, 1994a,b Journal of Biomechanics 27, 527-550, 551-569). With the model, an abduction of the arm was simulated in seven positions, at 30 degrees intervals. In each of the simulated arm positions, actual sarcomere lengths were calculated from the lengths of 104 muscle elements, distributed over 16 shoulder muscles. For most muscle elements, the simulated abduction appeared to take place within the sarcomere length range in which the muscle elements can exert force. The muscle elements can then act on the ascending limb as well as on the plateau and on the descending limb of the relative force-length curves of sarcomeres. The produced data set is not only important for the refinement of shoulder modeling, but also for functional analyses of shoulder movements in general.

Cadaver↗
PubMed1997

Immunohistochemical localisation of neuropeptides and nitric oxide synthase in sural nerves from Egyptian mummies.

Paleopathology is a well established science with numerous papers and books on the subject but, in contrast, paleoneurobiology is almost non-existent. We examined sections of sural nerves obtained from seven embalmed Egyptian mummies and one naturally desiccated Peruvian mummy, immunohistochemically stained for several neurochemicals. Immunoreactivity for type I nitric oxide synthase (NOS), protein gene-product 9.5, galanin, and calcitonin gene-related peptide immunoreactivity was observed in the nervi nervorum. No immunoreactivity was seen using antibodies directed against substance P, vasoactive intestinal polypeptide or neuropeptide Y. NOS-immunoreactivity was also observed in biopsied samples of contemporaneous human sural nerves. Thus, using a standard immunohistochemical technique it was possible to detect neurochemicals in ancient sural nerves that had been preserved by mummification. Furthermore, the finding of NOS in the ancient nerves led to its detection in contemporaneous sural nerves.

Egypt↗
PubMed1997

An anatomical study of the palmar ligamentous structures of the carpal canal.

To determine which structures should be divided for complete release of the carpal canal, we studied the palmar structures in 12 embalmed and eight fresh cadaveric hands. In all hands, fibres run transversely between the thenar and hypothenar fascia, distal to the flexor retinaculum in a layer separate from it. In fresh cadaveric hands, we first released only the flexor retinaculum as in endoscopic management of carpal tunnel syndrome and then these distal fibres. When the flexor retinaculum was released, the mean distance between the sectioned ends of the flexor retinaculum was 1.3 mm. When the distal fibres were also divided, the mean distance was 6.6 mm. We conclude that release of both the flexor retinaculum and the distal transversely running fibres is essential for complete release of the carpal canal in endoscopic surgery.

Aged↗
PubMed2000

The sternoclavicular joint: variants of the discus articularis.

OBJECTIVE: To study the anatomy of the sternoclavicular joint, its discus and its variations.Design. Anatomical study (macroscopic dissection). BACKGROUND: Textbooks on manual therapy give different descriptions of the movements of this joint. These apparent contradictions could be due to poor understanding of the anatomy of this joint resulting in ignoring specific movement patterns under particular conditions. METHODS: Macroscopic dissection of 22 embalmed sternoclavicular joints. RESULTS: The sternoclavicular and the costoclavicular parts of the discus always were quite distinct in orientation, thickness, surface and consistency. The sternoclavicular part was attached to the dorso-cranial part of the extremitas sternalis claviculae by a broad insertion in which several small blood vessels are visible. This part is grossly vertical, thicker than the lateral part and has a fibrous aspect. The costoclavicular part of the discus is always thinner than the sternoclavicular part. Sometimes it is reduced to a fine translucent pellet or is perforated. Subsynovial vascular arcades run along the insertion of the discus on the joint capsule, both on sternal and on clavicular sides. The costosternal articular surface can be divided into a sternal and a costal segment, separated by a vascular zone. CONCLUSIONS: Findings suggest different functions of the distinct parts of the joint. The smooth aspect of the lateral segment of the costosternal articular surface and of the costoclavicular part of the discus could be an argument to consider a functionally distinct costoclavicular compartment. The insertion of the discus on the clavicula strongly suggests that small movements take place between clavicula and discus and that the discus itself is moved only when the increasing amplitude stretches this insertion. We hypothesise that all midrange movements take place between the convex inferior edge of the clavicula and the costoclavicular part of he discus and that larger elevation depression and pro- and retraction movement take place, respectively, between clavicula and discus or discus and sternum. In three specimens we observed a previously not described arterial ramus articularis originating from the left thyrocervical trunk.RelevanceThese findings might explain differences of the arthrokinematic behaviour of this joint between midrange and full range motions.

Dissection↗
PubMed2003

Reduced mechanical load decreases the density, stiffness, and strength of cancellous bone of the mandibular condyle.

OBJECTIVE: To investigate the influence of decreased mechanical loading on the density and mechanical properties of the cancellous bone of the human mandibular condyle. DESIGN: Destructive compressive mechanical tests were performed on cancellous bone specimens.Background. Reduced masticatory function in edentate people leads to a reduction of forces acting on the mandible. As bone reacts to its mechanical environment a change in its material properties can be expected. METHODS: Cylindrical bone specimens were obtained from dentate and edentate embalmed cadavers. Mechanical parameters were determined in the axial and in the transverse directions. Subsequently, density parameters were determined according to a method based on Archimedes' principle. RESULTS: The apparent density and volume fraction of the bone were about 18% lower in the edentate group; no age-related effect on density was found. The decrease of bone in the edentate group was associated with a lower stiffness and strength (about 22% and 28%, respectively). The ultimate strain, however, did not differ between the two groups. Both groups had similar mechanical anisotropy; in axial loading the bone was stiffer and stronger than in transverse loading. CONCLUSIONS: Reduced mechanical load had affected the density and herewith the mechanical properties of condylar cancellous bone, but not its anisotropy. RELEVANCE: The change in material properties of the cancellous bone after loss of teeth indicate that the mandibular condyle is sensitive for changes in its mechanical environment. Therefore, changes in mechanical loading of the condyle have to be accounted for in surgical procedures of the mandible.

Aged↗
PubMed2000

Upper limb tension tests as tools in the diagnosis of nerve and plexus lesions. Anatomical and biomechanical aspects.

OBJECTIVE: To analyse the validity of nerve tension tests used in the diagnosis of nerve (root) and plexus lesions of the upper extremity. DESIGN: In six arms of embalmed human bodies, in situ measurements were performed to assess the effect of nerve tension tests on the median, ulnar and radial nerves and the cords of the brachial plexus. BACKGROUND: In clinical practice it is useful to have fast, easy and cheap tests for the diagnosis of nerve (root) lesions of the upper extremity, analogous to Lasègue's Straight Leg Raising test.Methods. The Upper Limb Tension Tests for the median, ulnar and radial nerves, as well as the Upper Limb Tension Tests combined with contralateral rotation and lateral bend of the cervical spine (Upper Limb Tension Test+) were used to generate tension to these nerves. Buckle force transducers were used to assess tensile forces in the nerves and in the medial, lateral and posterior cords of the brachial plexus. RESULTS: Nerve tension introduced in the distal part of the median, ulnar and radial nerves was transmitted upward to the cords of the brachial plexus. Exclusively the median nerve Upper Limb Tension Test and Upper Limb Tension Test+ turned out to be sensitive and specific tension tests. Mechanical tension caused by the Upper Limb Tension Test+ was not significantly higher than that caused by the Upper Limb Tension Tests. The Upper Limb Tension Tests cannot be used to selectively stress cervical nerve roots. The findings justify investigation of exclusively the median nerve Upper Limb Tension Test and Upper Limb Tension Test+ on their clinical validity. RELEVANCE: Before nerve tension tests for the median, ulnar and radial nerves can be introduced to clinical practice it is necessary to assess their validity quantitatively.

Arm↗
PubMed1997

The pullout force for Mitek mini and micro suture anchor systems in human mandibular condyles.

PURPOSE: This study examines the pullout forces and the modes of pullout for the Mitek mini and micro suture anchor systems (Mitek Inc., Norwood, MA) when inserted into the posterior aspect of the condyle. MATERIAL AND METHODS: Twenty mandibular condyles were obtained from embalmed human cadavers. A mini anchor and a smaller micro anchor were threaded with braided size 0 and 3-0 polyester suture, respectively, and placed in the posterior aspect of each condyle. Pullout testing was performed using an Instron materials testing machine. The force and mode of pullout were recorded for each specimen. RESULTS: The findings indicate a significantly greater mean pullout force of 16.02 lbs for the larger mini anchor system as compared with the 10.57 lbs mean pullout force of the micro anchor system. The modes of pullout between these implants were also different. Intact mini suture anchor systems pulled through the cortical bone in 90% of the trials, and suture breakage occurred in 10%. The micro anchors were irreversibly deformed on pullout in 65% of the trials, whereas the suture broke in 25% of the trials, and the intact suture anchor system pulled through the cortical bone in 10%. CONCLUSIONS: The Mitek mini anchor system has a significantly greater pullout force from the mandibular condyle than the micro anchor system.

Adult↗