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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thoracic ratios (TRs) were measured segmentally (T1-12) in the chest radiographs of 412 children aged 0-17 years attending hospital with minimal disorder or diseases (boys 193, girls 219). A new method for measuring TRs was used which calculates the width of the left hemithorax, the right hemithorax and the total thorax relative to T1-T12 distance. The data were analysed in 3 age groups--infancy, childhood and puberty, after the classification of Karlberg (1989). The findings are as follows. 1. The chest broadens from T1 to about T10-11. 2. Between infancy and childhood, relative to its length the chest narrows from above downwards and particularly in the lower chest (T5-12 average diminution, boys 9.5%, girls 9.8%). In the upper chest, the narrowing is more marked in girls than boys (T1-4 average diminution, boys 5.1%, girls 8.2%). 3. Between childhood and puberty, the girl's but not the boy's chest narrows further in its lower half (below T6 average diminution 3.3%). At T6 and above there is no detectable change in the relative width of the chest in either boys or girls. 4. The relative narrowing of the chest during growth appears to result from several mechanisms: (1) elevation of upper rib-vertebra angles (above 90 degrees); (2) drooping of lower rib-vertebra angles (below 90 degrees); and (3) linear rib growth being impaired relative to thoracic spinal growth in the lower ribcage (T6-12) of girls between childhood and puberty (Grivas et al. 1991 d). 5. The hypothesis is suggested that the relative narrowing of the lower chest with increasing age reduces the rotational inertia of the thorax in gait. There is a greater need for such reduction in girls because of the greater rotational inertia generated by the mass of their larger pelves. This hypothesis provides a mechanical explanation for the proportionate change in the girl's lung in the later stages of growth (Simon et al. 1972). 6. Developmentally, the left hemithorax is ahead of the right hemithorax in childhood. 7. Thoracic asymmetry favouring the right chest is found, and more so in puberty than childhood which is connected with the larger size of the thorax and lung in the adult. 8. The evidence suggests that hemithoracic development is caudocranial; this is consistent with an adaptation of the human ribcage to control spinal rotation and counterrotation when bipedal gait was acquired in evolution. 9. In progressive infantile idiopathic scoliosis, the upper chest is funnel-shaped.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:A segmental analysis of thoracic shape in chest radiographs of children. Changes related to spinal level, age, sex, side and significance for lung growth and scoliosis. 181 Sep 28

Thoracic spine (T1-T10) fractures can be considered a specific entity owing to the anatomic features of the rib cage and the spinal canal. During a nine year period, the authors treated 105 such fractures. The thoracic spine fractures included 57 (54.2 per cent) compression fractures, 21 (20 per cent) comminuted (burst) fractures, 3 (2.8 per cent) flexion-distraction fractures, and 24 (23 per cent) fracture-dislocations. Five lesions, termed "fracture-dislocations by an oblique shearing force", were characterized by considerable displacement and the absence of neurologic injury. 35.2 per cent of the patients had injuries at multiple levels. The frequency of associated thoracic (26.5 per cent) and scapular injuries (20 per cent) reflected involvement of the entire thoracic cage. The frequency of neurologic impairment (30.4 per cent including 20 per cent complete paraplegia) reflects the particular vulnerability of the dorsal spinal cord. 32 per cent of the patients presented one or more thoracic effusions (hemomediastinum, hemothorax) related to parietal hematoma and/or hematoma at the fracture site. Functional management of 47 patients led to recovery of a painless spine without kyphotic deformity. Conservative treatment was often difficult because of associated parietal lesions; the 10 patients treated in this manner had only moderate reductions that maintained poorly in time, but had no major painful sequellae. A posterior approach was used for 42 patients with unstable or neurotoxic fractures because this permitted a complete decompression down to the posterior wall, when necessary by a "wide laminectomy". The anterior approach was reserved for purely anterior compression (3 cases) or residual compression after an initial posterior procedure (2 cases). Cotrel-Dubousset instrumentation (used in 7 cases) was particularly indicated because it offers the advantages of Harrington rods (31 cases) while providing better stabilization. This prevented later loss of reduction and obviated the need for a postoperative brace.
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PMID:[Fractures of the thoracic spine (T1-T10). Apropos of 105 cases]. 259 50

Thoracic spondylotic myelopathies are exceptional, only 29 observations could be found in the literature; we intend to describe three new cases here. The patients, two women and one man, 64, 69 and 72 years old, complained of weakness of the lower limbs, more marked on one side, which had been progressing slowly from several months to eight years. Examination revealed asymmetrical paraparesis with distal sensitivity deficits without thoracic sensory level. In the first case, the myelography remained virtually unchanged in front of T11, T12; in the second and third cases, there was slight extradural compression at T9 and T10 respectively. Magnetic Resonance Imaging (M.R.I.) performed in two patients was evocative of a thoracic disk herniation. A chest CT scan enabled us to establish correct diagnosis: in the three cases irregular hypertrophy of the posterior elements was evident at T11 and T12, T9 and T10, T10 and T11 respectively, with osteophytes originating in the articular process and deeply embedded in the spinal canal. Decompressive laminectomy associated with medial facetectomy resulted in the gradual improvement of walking in all three patients. Myelography and MRI are both useful in demonstrating the level compression, usually situated in the low thoracic spine, however only the CT allows differential diagnosis with other etiologies, especially anterior compression such as disk herniation.
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PMID:[Myelopathies caused by dorsal spinal canal spondylotic stenosis. 3 cases and a review of the literature]. 269 79

A case of spinal dumbbell shaped melanotic schwannoma was reported. A 58-year-old housewife had a 3-months history of progressive gait disturbance. She also complained of mild backache and numbness in both legs. Her family history was not remarkable. When examined on admission, October 10, 1982, mild weakness of both legs with spasticity and sensory impairment below the level of T10 dermatome without sacral sparing were evident. Her deep tendon reflexes were hyperactive on both sides and plantar responses were extensor bilaterally. Sphincteric disturbance was not significant. The function of her cranial nerves was intact. She had neither cutaneous lesions, abdominal mass nor organomegaly. Thoracic plain X-rays revealed erosion of the right side vertebral body and pedicle of the 10th thoracic vertebra. Myelography disclosed a complete block at the same level by an epidural mass. On CT-myelogram, soft tissue density mass compressing the thoracic cord was apparent in the right epidural space of the spinal canal which extended to the paravertebral region through the right intervertebral foramen. Partial destruction of the body and the right side pedicle was easily recognized. Laminectomy from T9 to T11 exposed a large extradural mass which was encapsulated, elastic soft and pigmented in nature. The tumor was dumbbell shaped and extended to the right paravertebral region through the intervertebral foramen. Costotransversectomy was performed to excise the mass entirely. Following the total removal of the tumor, internal fixation was carried out by means of Harrington instrumentation with methylmethacrylate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spinal melanotic schwannoma: report of a case]. 306 Jul 51

1. The role of descending brain stem modulatory systems in the development of persistent behavioral hyperalgesia and dorsal horn hyperexcitability was studied in rats with unilateral hindpaw inflammation. Inflammation was induced by intraplantar injection of complete Freund's adjuvant (CFA, 0.05 ml of an 1:1 oil/saline emulsion, 25 micrograms Mycobacterium), or lambda carrageenan (1 mg/ 0.1 ml saline). Thermal hyperalgesia was assessed by testing paw withdrawal latency (PWL) to a noxious heat stimulus. Superficial dorsal horn nociceptive (nociceptive specific, NS, and wide dynamic range, WDR) neuronal activity in the lumbar spinal cord was recorded extracellularly in chloralose-anesthetized rats. 2. Bilateral lesions of the dorsolateral funiculus (DLFX) at the T10 level were made in 13 rats, and the development of thermal hyperalgesia in these rats was compared with sham-operated or nonoperated control rats. In rats receiving a 0.05-ml CFA injection, a similar magnitude of hyperalgesia developed in the inflamed paw in DLFX (n = 7) and control (n = 8) rats. In addition, there appeared to be a contralateral hyperalgesia that was most apparent between 2 and 24 h after injection of CFA in DLFX rats. The CFA-induced contralateral effects were significantly different (P < 0.05) from the control rats at 2 and 6 h. 3. The intensity of the thermal stimulus was reduced and a low dose of carrageenan (1 mg) was injected into one hindpaw to further reveal the potentiation of hyperalgesia in DLFX rats. Throughout the 0.5- to 4-h time period after the injection of carrageenan, the PWL of the inflamed paws in DLFX rats (n = 6) was significantly shorter than that of control rats (n = 10; 2-way analysis of variance, F1,14 = 14.04, P < 0.01), suggesting the enhancement of hyperalgesia in DLFX rats. A hyperalgesia on the noninflamed paws was also more apparent in this experiment in DLFX rats, when compared with control rats. DLFX did not affect the baseline PWL of the rats. 4. A reversible spinalization was produced by application of a local anesthetic, lidocaine (2%, 0.1 ml), onto the dorsal surface of the thoracic cord (T10-12). This procedure produced thoracic spinal block that lasted for 90 min. The effects of thoracic lidocaine block on nociceptive neuronal activity were studied in 11 neurons (NS = 7, WDR = 4) in CFA-inflamed rats and 10 neurons (NS = 6, WDR = 4) in noninflamed naive rats. After the thoracic lidocaine block, rats showed increases in background activity, expansion of the receptive fields, and increased responses to noxious thermal, mechanical, and electrical stimuli. 5. Quantitative comparison revealed that the mean change in background firing rate of dorsal horn neurons was greater in inflamed [NS: 18.3 +/- 0.4 Hz, (mean +/- SE) n = 7; WDR: 10.9 +/- 0.7 Hz, n = 4] than that in noninflamed (NS: 2.3 +/- 0.3 Hz, n = 6; WDR: 3.3 +/- 0.4 Hz, n = 4) rats (P < 0.01, t-test) after thoracic lidocaine block. Thoracic saline application produced a 2.8 +/- 0.4 Hz decrease in background activity (2 NS and 2 WDR units). The expansion of the receptive fields after thoracic lidocaine block was also greater in inflamed (NS: 141 +/- 9% control, n = 6; WDR: 240 +/- 36% control, n = 4) than in noninflamed (NS: 114 +/- 9% control, n = 6; WDR: 167 +/- 21% control, n = 4) rats (P < 0.05, t-test). Thoracic saline did not produce a significant change in the receptive field size (105 +/- 9%, n = 4). The increases in responses to noxious thermal and mechanical stimuli after thoracic lidocaine block were also significantly greater in inflamed than in noninflamed rats (P < 0.01). There was no significant difference in the increase in responses to electrical stimulation of the sciatic nerve after lidocaine between inflamed and noninflamed rats.(ASTRACT TRUNCATED)
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PMID:Enhanced descending modulation of nociception in rats with persistent hindpaw inflammation. 893 Feb 52

Four cases of thoracic spondylotic myelopathy are reported, one man and three women, respectively 61, 66, 67 and 76 years old. Clinical presentation was numbness and weakness in the lower limbs in two cases, weakness alone in one and numbness alone in the last one. Diagnosis was settled by both myelography and CT-myelogram in three cases, by both MRI and CT-scan in the other one. The involved thoracic levels were both T9-T10 and T10-T11 for two cases and T11-T12 for the other one. The stenosis was due to hypertrophic ossification of the ligamentum flavum in three cases and to osteophytic changes in one. A laminectomy was performed for each patient and three patients had a significant recovery and the fourth a mild one. Thoracic myelopathy is an uncommon disease which requires a meticulous study of myelogram and now MRI to be recognized and to be cured by laminectomy. As for cervical myelopathy, it results from mechanical and ischemic factors which can lead to a definitive myelomalacia.
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PMID:[Thoracic spondylotic myelopathies. Apropos of 4 new cases]. 908 41

Cadaveric pedicle screw placement guided by the measurements from axial computed tomography (CT) scans in the thoracic spine was assessed in this study. Axial CT scans were performed on four cadaveric thoracic spines, and the measurements included the pedicle transverse angle, inner pedicle width, and distance between the midline of the vertebra and the pedicle axis on the dorsal aspect of the lamina. With utilization of the data from CT scans, screws were directly placed into the thoracic pedicle from T1 to T10. Screw penetration of the pedicle was determined by gross examination. The results showed that the largest pedicle transverse angle was found at the levels of T1-2, and the smallest occurred at the T3 through T8 levels. The value of the pedicle inner width was quite different between specimens with a minimum of 3.0 mm at T4 and a maximum of 9.2 mm at T10. Gross examination of the pedicle showed that 13 (16.3%) of 80 screws penetrated the pedicle wall, with a Grade I penetration in 11 pedicles and a Grade II penetration in 2 pedicles. Screw penetration of the medial wall was found in four pedicles and penetration of the lateral wall was noted in nine pedicles. No screw penetration of the superior and inferior walls of the pedicle was identified in any of the four specimens. Thoracic pedicle screw placement guided by the measurements from axial CT scans significantly reduced the incidence of pedicle penetration. Axial CT measurements of the pedicle inner diameter and transverse angle as well as the starting point for screw insertion are recommended if pedicle screw fixation is intended in the thoracic spine.
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PMID:Thoracic pedicle screw placement guided by computed tomographic measurements. 1038 75

The aim of this paper is to demonstrate the unusual MR features of thoracic syringomyelia following TB meningitis and to discuss the neurosurgical aspect of the treatment of this rare entity. Four years after a TB meningitis episode, a 30 year-old female patient developed a progressive spastic paraparesis. MR studies revealed multiloculated syrinxes throughout the thoracic cord. She had a syringo-subarachnoid shunt with a silastic "T" tube inserted. On the first postoperative day, she showed a dramatic neurological improvement, but unfortunately her paraparesis progressed to the preoperative level within a month despite diminished size of the syrinxes on the control MRI examination. Two and a half years after the operation the patient complained of having a burning type of central pain, and further deterioration in neurological function. Thoracic spinal MRI examination demonstrated enlarged syringomyelic cavities. At the second operation syringo-peritoneal shunt insertion was performed via right T10-11 hemilaminectomy using a "T" tube. At present, 4 months after the second operation, the patient's neurological examination demonstrated decreased spasticity, and improved strength in the legs compared to the preoperative level. MRI is the first choice of investigation in detecting TB related myelopathy as it provides a greater detail of pathological changes within and around the spinal cord such as syrinx formation and arachnoiditis. The MR findings are also helpful in deciding the management and predicting the outcome. Presence of multifocal loculations and arachnoid adhesions is the likely cause of treatment failures and poor prognosis.
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PMID:Syringomyelia--as a late complication of tuberculous meningitis. 1108 34

Many Cobb measurements have been reported at various levels for the thoracic kyphosis, but geometric models of the shape of kyphosis are rare. Thoracic vertebral bodies were digitized on 80 normal lateral full-spine radiographs to obtain the mean thoracic kyphosis. Global and segmental angles were determined. Computer iteration processes passed geometric shapes through the posterior body coordinates of the mean thoracic kyphosis to determine the best fit model in the least squares sense. The kyphosis was closely modeled with ellipses. The T1 and T12 areas tended to be flatter in curvature when compared with T2-T11, indicating these are inflection points. Mean global angles were Cobb(T1-T12) = 44.2 degrees, Cobb(T2-T11) = 39.9 degrees, and Cobb(T3-T10) = 33.3 degrees. The T2-T11 kyphotic region was closely modeled with approximately a 70-degree portion of an ellipse, with minor axis to major axis ratios of 0.6 to 0.72, and with major axis parallel to the posterior body margin of T11.
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PMID:Can the thoracic kyphosis be modeled with a simple geometric shape? The results of circular and elliptical modeling in 80 asymptomatic patients. 1213 22

Although radical resection is the best treatment for local aggressive benign tumors or malignant tumors of the spine, total spondylectomy for lower thoracic vertebrae may cause anterior spinal artery syndrome. There are few reports in the literature in which this syndrome has been documented in association with thoracic spondylectomy, although this syndrome is the most common neurologic complication after abdominal aortic surgery. A 50-year-old woman with a giant cell tumor of the thoracic vertebrae was treated by posterior and anterior surgery. Thoracic segmental arteries from T10 to T12 had to be resected bilaterally to dissect the aorta free from the tumor. After resection of all feeding arteries to the tumor, the tumor and entire parts of T10, T11, and T12 were removed. Postoperative neurologic examination disclosed flaccid paralysis of the lower extremities and sphincter incontinence. Although pain and temperature sensation were absent, vibration and position sense were intact, showing anterior spinal artery syndrome. Intraoperative somatosensory-evoked potential monitoring only showed that transient deterioration failed to adequately reflect this neurologic injury. Major reconstructive surgery involving lower thoracic regions may cause anterior spinal artery syndrome. Somatosensory-evoked potential monitoring might not reliably predict overall neurologic outcome involving the blood supply of the lower thoracic regions.
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PMID:Anterior spinal artery syndrome after total spondylectomy of T10, T11, and T12. 1246 71


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