Clinical anatomy : official journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists
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Communication between the lower thoracic paravertebral region and the celiac ganglion through the retrocrural space was investigated. After dye was injected into the endothoracic fascia in the lower thoracic paravertebral region at the T11 level, its spread to the celiac ganglion was examined in fifteen cadavers. The dye reached the celiac ganglion in nine cadavers (60%) by passing through the retrocrural space, along the greater and lesser splanchnic nerves and through the split in the crus of the diaphragm through which the splanchnic nerves traveled. ⋯ In three living subjects the spread of a radio-opaque dye injected in the same manner was studied using 3D-computed tomography. This study confirmed that the radio-opaque dye traveled toward the celiac ganglion along the crus of the diaphragm. From our results we suggest that a fluid communication may exist between the lower thoracic paravertebral region and the celiac ganglion in cadavers and in living humans and that clinicians should be aware of this possible route of spread when administering lower thoracic paravertebral anesthesia.
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There are inconsistencies between the descriptions of the physical connections between the spinal cervical dura and the surrounding tissues. This study was undertaken to clarify the relationship between the spinal dura, the nuchal ligament and the suboccipital muscles. Dissections were performed on embalmed cadavers: in nine the relevant structures were removed en bloc, whereas in one a sagittal section was prepared. ⋯ In addition, there was a connective tissue bridge between the deep aspect of the rectus capitis posterior minor muscle to the transverse fibers of the posterior atlanto-occipital membrane that extended laterally to blend with the perivascular tissue of the vertebral arteries. The present study is, we believe, the first to describe continuity between the nuchal ligament and the dura at the atlanto-occipital interspace, and confirms previous descriptions of similar connections at the atlanto-axial level. Knowledge of the exact attachments of the dura may contribute to understanding the biomechanics of the cervical spine and of the possible etiology of some types of cervicogenic headaches.
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Biography Historical Article
Sir Victor Alexander Haden Horsley (1857-1916): neurosurgeon and neuroscientist.
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Postoperative atrophy of the deep back muscles may be caused by denervation during a dorsomedian approach to the thoracolumbar spine; ensuing instability of the spine with poor clinical results, perhaps due to such muscle loss, has been observed in 11.7% of cases (Sihvonen et al., 1993, Spine 18:575--581). More specifically, this complication may be caused by damaging the medial branches of the posterior rami of the spinal nerves during lateral retraction of the muscles. To investigate the anatomic topography of the medial branches of the posterior rami of the spinal nerves, 18 carbol-formol-fixed specimens were dissected using an operation microscope; also, 3 fresh cadavers were cut in horizontal and vertical planes with a rotary cryotome to confirm the anatomic topography observed in the fixed specimens. ⋯ When the dorsomedian approach to the thoracolumbar spine is enlarged laterally to the articular processes by retracting the paraspinous muscles, the medial branches of the posterior rami of the spinal nerves are endangered. This may cause postoperative pain as well as dynamic instability beyond the corresponding segments. The results of our anatomic study suggest that the posterior surgical midline approach to the thoracolumbar spine should not be enlarged laterally to the articular processes to prevent injury to the medial branches of the posterior rami of the spinal nerves.
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Review Case Reports
Posterior dislocation of the sternoclavicular joint: a case report and review of the clinical anatomy of the region.
Posterior dislocation of the sternoclavicular joint is an uncommon injury. Since 1824, when Sir Astley Cooper described the injury, little more than 100 cases have been described, and the majority of these have been in the last decade, identified by computed tomography. The significant morbidity and mortality associated with this injury is based upon serious damage to important anatomical structures found in the vicinity of the joint. We present a case report, describe the relevant clinical anatomy of this region, and review associated complications.