Spine
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The authors studied the vascular anatomy of the thoracic and lumbar spine in cadavers related to the clinical use of total en bloc spondylectomy in malignant vertebral tumors. ⋯ Total en bloc spondylectomy conducted posteriorly is less likely to damage the thoracic aorta from T1 to T4 but, distal to T5, the aorta must be carefully retracted anteriorly before manipulation of the affected vertebra(e). For a malignant tumor involving L1 or L2, the medial and, occasionally, the intermediate crura of the diaphragm and the first two lumbar arteries must be treated carefully before spondylectomy. Malignant tumors involving the L3 and L4 vertebral bodies can be approached with a total en bloc spondylectomy technique only when the inferior vena cava has been safely retracted anteriorly.
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This study retrospectively analyzed the outcome of unilateral vertebral artery ligation during cervical spine surgery. ⋯ A vertebral artery could be ligated uneventfully when the diameter of the vertebral artery was not larger than the one not involved. Where vertebral artery ligation could not be avoided, it should be confirmed by preoperative angiogram that the other vertebral artery is large enough and that simultaneous occlusion testing of the involved vertebral artery is uneventful.
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Andreas Vesalius was born in Brussels on December 31, 1514. After having spent some disappointing years at the Universities of Louvain and Paris, he graduated as Doctor of Medicine in Padua on December 5, 1537. The next day he was appointed as a teacher of both human anatomy and surgery. ⋯ Like Copernicus, Kepler, Bruno, and Galileo, Vesalius was one of the initiators of the new science. The tables of osteology and of the spine in Fabrica and Epitome are most impressive. Much of the nomenclature used for the spine today can be credited to him.
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Review Case Reports
Bilateral vertebral artery lesion after dislocating cervical spine trauma. A case report.
This case report illustrates the problems associated with diagnosis and management of vertebral artery injuries resulting from dislocating cervical spine trauma. ⋯ The possibility of the complication of a vertebral artery lesion should be kept in mind when examining patients with cervical spine trauma, especially in patients with fracture-dislocation. Immediate identification by vertebral angiography, magnetic resonance imaging, or thin-slice computed tomography scan is necessary for optimal management of this injury.