Clinical application of Grunenwald incision in cervicothoracic junction surgery / 中华胸心血管外科杂志

Objective:To investigate the clinical application of Grunenwald incision in cervicothoracic junction surgery.Methods:The clinical data of 25 patients with cervicothoracic junction tumor and 1 patient with cervicothoracic junction trauma in the single treatment group of Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University from December 2011 to September 2021 were analyzed retrospectively, including 19 males and 7 females, aged 9-73 years old. Among the 26 patients, there were 9 cases of upper mediastinal tumor, 6 cases of superior sulcus tumor, 4 cases of thyroid tumor invading the upper mediastinal, 4 cases of chest wall tumor, 2 cases of esophageal cancer combined with supraclavicular lymph node metastasis, and 1 case of foreign body penetrating injury at the cervicothoracic junction. Grunenwald incision or additional posterolateral thoracic incision, median sternal incision, neck collar incision were used in all patients. The degree of tumor resection was evaluated. The operation time, intraoperative blood loss, length of hospital stay were observed, and the postoperative follow-up was analyzed.Results:There was no perioperative death in the whole group. 14 cases were treated with Grunenwald incision alone, 6 cases with additional posterolateral chest incision, 4 cases with additional neck collar incision, and 2 cases with additional median sternal incision. The tumors were completely resection in 22 cases, palliative tumor resection in 3 cases, and complete foreign body removal in 1 case. Postoperative pathology included 4 cases of schwannoma; 3 cases of lung adenocarcinoma, thyroid cancer and myofibroblastoma, respectively; 2 cases of supraclavicular lymph node metastasis of esophageal cancer and lung squamous carcinoma, respectively; 1 case of large cell neuroendocrine carcinoma, metastatic carcinoma of the first rib after lung squamous cell carcinoma, ganglioneuroma, nodular goiter, hemangioma, well differentiated liposarcoma, vascular endothelial tumor and cavernous angioma, respectively. The operation time was 120-430 min, with a mean of(226.92±88.40)min. The intraoperative blood loss was 100-1 000 ml, with a mean of(273.46±196.34)ml. The length of hospital stay was 6-26 days, with a mean of(12.73±4.46 )days. 26 patients were followed up for 6-130 months, with a mean of(57.88±43.64) months. During the follow-up period, 6 patients died.Conclusion:Grunenwald incision can provide good exposure of the structures near the cervicothoracic junction, preserve the integrity of sternoclavicular joint, reduce shoulder deformity, and has advantages for patients with cervicothoracic junction tumors, high rib resection, and cervicothoracic junction trauma.

Analysis of setup errors of postoperative intensity-modulated radiotherapy immobilized with integrated cervicothoracic board (mask) system in breast cancer patients / 中华放射肿瘤学杂志

Objective:To investigate the setup errors of postoperative radiotherapy immobilized with integrated cervicothoracic board (mask) system in breast cancer patients.Methods:Thirty-two breast cancer patients treated with postoperative radiotherapy immobilized with integrated cervicothoracic board (mask) system were prospectively recruited in this study. Breast/chest wall (cw) and supra/infraclavicular nodal region (sc) were irradiated with intensity-modulated radiotherapy. CBCT location verification in radiotherapy and target areas of the breast/chest wall and upper and lower collarbone were carried out, respectively. The consistency between setup errors and the position of the upper and lower target areas of 239 CBCT images was analyzed.Results:The translational setup errors of the breast/chest wall in the X-cw (left-right), Y-cw (superior-inferior), Z-cw (anterior-posterior) directions were (1.84±2.36) mm, (1.99±2.48) mm, and (1.75±1.86) mm, respectively. The translational setup errors of the supra/infraclavicular nodal region in the X-sc (left-right), Y-sc (superior-inferior), Z-sc (anterior-posterior) directions were (1.98±2.44) mm, (1.98±2.48) mm, and (1.71±1.79) mm, respectively. The differences of translational setup errors between the breast/chest wall and supra/infraclavicular nodal region in the X, Y, Z directions were (0.38±0.66) mm, (0.07±0.41) mm, and (0.45±0.92) mm, respectively. Conclusion:For the breast cancer patients treated with postoperative radiotherapy covering breast/chest wall and supra/infraclavicular nodal region, the integrated cervicothoracic board (mask) immobilization system provides good reproducibility and yields Sfew setup errors.

Effect of modified cervicothoracic compression band on physical condition of patients with endoscopic radical thyroidectomy via breast areola approach / 中国实用护理杂志

Objective:To investigate the effect of modified cervicothoracic compression band on successful hemostasis and postoperative complications of patients with endoscopic radical thyroidectomy via breast areola approach and to provide reference for postoperative nursing of thyroid cancer.Methods:A total of 128 patients with endoscopic radical thyroidectomy via breast areola approach from October 2018 to October 2019 in the Second Affiliated Hospital of Zhejiang University School of Medicine were selected and divided into experimental group(64 cases) and control group (64 cases) by random digits table method. Patients in the control group were fixed with wide adhesive tape for hemostasis, while patients in the experimental group wore modified cervicothoracic compression band. The postoperative complications between two groups were recorded, in addition, the physical condition and comfort of patients was assessed by Edmonton Symptom Assessment System (ESAS) and Kolcaba General Comfort Questionnaire (GCQ), respectively.Results:There was no sigrificance in the score of ESAS, GCQ on the 1st day before the operation between the two groups ( P>0.05). The median score of happiness in ESAS was 6.0 points in the experimental group on the 3rd day after the operation, significantly higher than 4.0 points in the control gorup, the difference was statistically significant ( Z value was 2.919, P<0.01). The physiological, psychological, social, cultural and environmental comfort, total GCQ scores were (10.73±2.35), (24.41±4.99), (23.09±2.11), (20.17±2.32), (78.41±6.49) points in the experimental group and (8.41±2.23), (22.42±4.79), (21.22±2.73), (19.20±2.97), (71.25±6.92) points in the control group, the differences were statistically significant ( t values were 2.058-6.031, P<0.05 or 0.01). The incidence of contact dermatitis, pressure purpura and tension blister were 0, 3.1% (2/64), 0 in the experimental group and 6.3% (4/64), 12.5% (8/64), 7.8% (5/64) in the control group, the differences were statistically significant ( χ2 values were 4.129, 3.095, 5.203, P<0.05). Conclusions:Modified cervicothoracic compression band can significantly alleviate the symptoms of postoperative patients with endoscopic radical thyroidectomy, reduce postoperative complications and improve patient comfort.

Surgical strategies and approaches for the management of tumors at cervicothoracic junction / 中华胸心血管外科杂志

Objective:To investigate the surgical treatment of the tumors at cervicothoracic junction.Methods:A retrospective analyses was performed for 63 patients with tumors at the cervicothoracic junction receiving surgery from Mar 2008 to May 2020 in the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University. Clinical data about manifestation, surgical approach, resection degree and pathological types were collected. There were 43 cases of asymptomatic patients and 20 cases of patients with ≥1 clinical manifestations. Twenty two patients receiving radical resection with video-assisted thoracoscopic surgery. Anterior approach was the most popular treatment in open surgery (24 cases, 38.1%), and 8 cases of anterolateral approach(6 cases of Hemiclamshell incisions, 2 cases of trap-door incisions), 1 case of posterior approach, 2 cases of posterolateral approach and 1 case of supraclavicular combined posterolateral approach.Results:Pathological examination suggested 61 cases of radical resection and 2 cases of microscopic residual. Neurilemmoma was the most common pathological type (27 cases, 42.9%), the second common pathological type was tumor originated from fibrous tissues (6 cases, 9.5%). The 3-year overall survival rate of those 63 patients was 88.9%, while the 5-year overall survival rate was 84.1%.Conclusion:Tumors involving the cervicothoracic junction are characterized as special location, complicated anatomy and various histopathological subtypes. Individualized approach and surgery improve safety and normalization of tumors at cervicothoracic junction treatment.

Fractura de "clay shoveler" como consecuencia de un accidente de trabajo en un peón agrícola: reporte de un caso / Clay shoveler's fracture as a result of a work injury in a manual laborer: case report

Resumen La fractura de "clay shoveler" es una fractura poco frecuente de la apófisis espinosa de las vértebras cervicales o torácicas superiores, más comúnmente entre C6 y T6 producida de manera aguda o crónica por fuerzas rotacionales ejercidas a nivel cervical en la labor de "palear", aunque también se han reportado casos asociados a la práctica de algunos deportes. Se presenta el caso de un péon agrícola de 43 años de edad que consulta por cervicalgia y sensación de inmovilidad luego de un movimiento brusco durante un levantamiento de tierra con pala, siendo que el ente asegurador no establece relación de causalidad, por lo que demanda a nivel judicial para valoración médico legal, documentándose fractura de "clay shoveler" en C7 y T1 según estudios radiológicos. La valoración médico legal del caso, que se sustentó en la documentación médica y estudios radiológicos, permitió determinar que la lesión evidenciada era consecuencia del accidente laboral reportado, estableciéndose la relación causal.

Abstract Clay shoveler's fracture is an infrequent lesion of the spinous process of the cervical or upper thoracic vertebrae, mainly between C6 and T6, produced acutely or chronically because of rotational forces exerted at the cervical level during shoveling, but some cases have been reported as a result of the practice of sports. We present the case of a 43-year old manual laborer who consulted because of cervical pain and range of motion limitation after a sudden move performed during shoveling, diagnosed with a clay shoveler's fracture in C7 and T1, treated conservatively. The patient was discharged after finishing treatment, since the insurance company dismissed causality. The medico legal assessment of the case, based on medical documentation, radiological findings and an Orthopedics consult, helped stablish causality since it was determined that the fracture was a result of the accident reported.

Outcome following cervicothoracic junction fusion in T1 pathological fracture of breast cancer spinal metastases: a case report

The cervicothoracic junction (CTJ) is defined as the area extending from vertebral segment C7 to T2. Spinal metastases of CTJ are rare, range from 10% to less than 20%. A 47-year-old woman complained sensory and motor disturbance since 3 weeks prior to admission. History of lump on the left breast was confirmed. Neurological deficit was confirmed as ASIA C at the time of diagnosis. MRI finding suggest fracture of T1 vertebral body with kypothic angle 28° that causing anterior compression of spinal cord. The patient underwent decompression and posterior fusion from C4 to T4. A biopsy sample was also collected from the spine and left breast to confirm the diagnosis. Patient evaluation was done during discharge and at certain points of follow-up for improvement on its neurological, pain, and functional status. An MRI evaluation was performed to evaluate spinal stability and fusion. Significant improvements were observed in patient ambulatory and pain status. Cervicothoracic junction fusion procedure is a considerable choice for the management of pathological vertebral fractures with cervicothoracic junction involvement caused by spinal metastases of breast cancer.

Evaluation of Results of Anterior Cervicothoracic Junction Decompression & Fusion (ACTJDF) of C7-T1-T2 Spinal Tuberculosis by Transmanubrial Transclavicular Approach.

Spinal tuberculosis is the most frequently encountered & destructive form of skeletal tuberculosis. We wanted to evaluate the advantages of transmanubrial transclavicular approach in the surgical management of the pathologies (mainly tuberculosis) at the cervicothoracic junction (C7,T1-2).METHODSFrom June 2013 to August 2019, thirty patients with tuberculosis of CTJ presented to SCBMC & H and were operated with transmanubrial transclavicular approach. Debridement with corpectomy of tuberculosis of C7-T1 and T1 vertebral bodies were followed by fusion of C6-T2 and C7-T2 vertebra respectively with the help of titanium mesh cage and anterior cervical plating. Advantages & limitations of this surgical approach were evaluated retrospectively. Visual analogue scoring & Frankel scoring were used for assessing postoperative clinical outcome.RESULTSAll 30 cases were of tuberculosis of CTJ involving either C7-T1 or T1-T2. They presented with a permutation combination of upper thoracic pain, paraparesis, and collapse of vertebra & cord compression. All patients were followed up for 12.37 ± 5.38 months on average (range 4 -24 m). The mean postoperative visual analogue scale score was 7.86 ± 1.02 (range 6-10) preoperatively, which improved to 3.27 ± 0.88 (range 0-5) postoperatively at final evaluation (p<0.005). There was also postoperative increase in Frankel score in seventeen cases (56%). Three patients developed temporary hoarseness postoperatively, two cases got infected (one superficial & one deep) & one patient died. There was no non-union or persistent pain at manubrium or clavicle end.CONCLUSIONSThe transmanubrial transclavicular approach for tuberculosis of CTJ lesions can achieve favourable clinical outcomes by providing wide exposure, direct decompression of lesions, fusions and less complications as compared to standard approaches.

Cervicothoracic Junction Approach using Modified Anterior Approach: J-type Manubriotomy and Low Cervical Incision / 대한신경손상학회지

Spinal surgery of the anterior aspect of the cervicothoracic junction is difficult and has technological challenges because of the kyphotic alignment of the upper thoracic spine. This approach requires knowledge of the cervicothoracic regional anatomy. Surgery in this region is rare because of its indications; despite this rarity, surgeons must be prepared to expose this region. In addition, surgery in this region demands extensive opening of the surgical field and results in severe postoperative pain. Therefore, a less invasive procedure must be considered. Six cases of cervicothoracic lesion operation have been reported. The patients were successfully treated using an anterior modified approach (J-type manubriotomy). Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinct advantage of a stable anterior implant bone construction while preserving the posterior osseo-ligamentous tension band. Moreover, the modified anterior approach (J-type manubriotomy) provides the same exposure of the cervicothoracic junction without a full median sternotomy and avoids injury to subclavian vessels during resection of the clavicle or sternoclavicular junction. Therefore, the anterior cervical approach combined with J-type manubriotomy allows extensive exposure of the cervicothoracic junction and causes less complications. We performed preoperative radiological evaluation to identify the cases in which J-type manubriotomy was necessary.

Long-term follow-up on MURCS (Müllerian duct, renal, cervical somite dysplasia) association and a review of the literature

Müllerian duct aplasia-renal aplasia-cervicothoracic somite dysplasia (MURCS) association is a unique development disorder with four common types of malformations that include uterine aplasia or hypoplasia, renal ectopy or agenesis, vertebral anomalies, and short stature. The majority of MURCS patients are diagnosed with primary amenorrhea from late-adolescence. However, a few cases with MURCS association are not well diagnosed during childhood and long-term outcomes are not well reported. We report a case of an 8-year-old girl with MURCS association who presented with recurrent urinary tract infections and multiple congenital malformations, and who was followed for 10 years until adulthood. MURCS association should be considered as one of the differential diagnoses when evaluating prepubertal females with vertebral and renal malformations.

Comparison of Three Different Options for C7 Posterior Vertebral Anchor in the Indian Population—Lateral Mass, Pedicle, and Lamina: A Computed Tomography-Based Morphometric Analysis

STUDY DESIGN: Radiological cohort study. PURPOSE: The options of posteriorly stabilizing C7 vertebra include using lateral mass, pedicle or lamina, as bony anchors. The current study is a computed tomography (CT)-based morphometric analysis of C7 vertebra of 100 Indian patients and discusses the feasibility of these different techniques. OVERVIEW OF LITERATURE: C7 is a peculiar vertebra with unique anatomy, which poses challenges for each of these fixation modalities. There are no reports available in the literature, which discuss and compare the feasibility of diverse posterior C7 fixation techniques in Indian population. METHODS: We included 100 consecutive cervical spine CT scans of Indian patients performed between July 2016 and September 2016. We excluded CT scans with any significant congenital anomaly or other pathological lesions of C7 and patients with non-Indian ethnicity. Regarding screw placement, we assessed and studied various dimensions of the C7 lateral mass, pedicles, and laminae in relevant sections. RESULTS: The mean age of our patients was 49.5±16.1 years. We included 56 male and 44 female patients. The mean anteroposterior and mediolateral dimensions of the lateral mass were 11.38±1.76 and 12.91±1.82 mm, respectively. The mean length of the lateral mass screw (Magerl technique) was 12.17±1.9 mm; 92% of patients could accommodate a lateral mass screw at least 10-mm long (unicortical), whereas 48% could accommodate a screw (unicortical) longer than 12 mm. Foramen transversarium was found in 30.5% of lateral masses. The mean outer and inner cortical widths of the pedicles were 6.5±0.71 mm and 3.72±0.61 mm, respectively. Approximately 58% of pedicles could accommodate 3.5-mm screws (based on the inner cortical pedicle width). The outer cortical and inner cortical widths of the laminae were 6.21±1.2 mm and 3.23±0.9 mm, respectively. Subsequently, 37% of the laminae could accommodate 3.5-mm screws. The mean angle of intralaminar screw trajectory was 50.7°±5.1°, and the mean length of the intralaminar screw was 32.6±3.05 mm. In addition, 96.4% and 60.7% of male patients could accommodate lateral mass screws longer than 10 mm and 12 mm, respectively. However, only 86.4% and 31.8% of female patients could accommodate 10- and 12-mm long lateral mass screws, respectively. Furthermore, 75% of male patients and 36% of female patients had pedicles that could accommodate 3.5-mm diameter screws, and 48.2% of male patients had laminae that could accommodate 3.5-mm screws; however, only 22.7% of female patients could accommodate 3.5-mm laminar screws. CONCLUSIONS: Based on our CT-guided morphometric analysis, 92% and 48% of Indian patients could accommodate at least 10- and 12-mm long lateral mass screws, and 58% of pedicles and 37% of laminae could accommodate 3.5-mm screws. Thus, lateral mass screws (between 10- and 12-mm long) seem to be the safest feasible option for C7 fixation. In case of the need for an alternative mode of stabilization (pedicle or intralaminar screw), particularly in female patients, careful preoperative planning with a CT scan is of utmost importance.

Clinical Features of Herniated Disc at Cervicothoracic Junction Level Treated by Anterior Approach

OBJECTIVE: The anterior approach for C7-T1 disc herniation may be challenging because of obstruction by the manubrium and the narrow operative field. This study aimed to investigate the clinical and neurological outcomes of anterior approach for C7-T1 disc herniation. METHODS: We retrospectively evaluated 13 patients who underwent the anterior approach for C7-T1 disc herniation by a single surgeon within a period of 11 years (2003-2014). The minimum follow-up duration was 6 months. We describe the clinical presentation, radiographic findings, neurological outcome, and related complications. RESULTS: Of 372 patients with single-level anterior discectomy and fusion or artificial disc replacement for cervical disc herniation, 13 (3.5%) had C7-T1 disc herniation. The main clinical presentation was unilateral motor weakness in intrinsic hand muscles (11 patients), along with numbness, pain, and tingling sensation that radiate down the arm to the little finger. Most of the patients improved after surgery via the anterior approach. Ten patients underwent successful anterior discectomy and fusion by the standard supramanubrial Smith-Robinson approach, but 2 needed additional manubriotomy and sternotomy. In 1 patient, we performed surgery at a wrong level because the correct level was difficult to identify intraoperatively. Two patients had transient vocal dysfunction, but none had major complications related to injuries of the great vessels such as the thoracic duct or esophagus. CONCLUSION: For patients who require direct anterior decompression for C7-T1 disc herniation, the anterior approach is relatively feasible. However, care should be taken to overcome physical constraints by the manubrium and slope.

Posterior Trans-Dural Repair of Iatrogenic Spinal Cord Herniation after Resection of Ossification of Posterior Longitudinal Ligament

Iatrogenic spinal cord herniation is a rare complication following spinal surgery. We introduce a posterior trans-dural repair technique used in a case of thoracic spinal cord herniation through a ventral dural defect following resection of ossification of the posterior longitudinal ligament (OPLL) in the cervicothoracic spine. A 51-year-old female was suffering from paraplegia after laminectomy alone for cervicothoracic OPLL. Magnetic resonance imaging revealed a severely compressed spinal cord with pseudomeningocele identified postoperatively. Cerebrospinal fluid leak and iatrogenic spinal cord herniation persisted despite several operations with duroplasty and sealing agent. Finally, the problems were treated by repair of the ventral dural defect with posterior trans-dural duroplasty. Several months after surgery, the patient could walk independently. This surgical technique can be applied to treat ventral dural defect and spinal cord herniation.

Analysis of 150 cases from measuring sternal angle corresponded to thoracic plane by three-dimensional recon-struction of spiral CT / 局解手术学杂志

Objective To measure the sternal angle corresponded to thoracic plane by three-dimensional reconstruction of spiral CT , and to explore the accurate positioning methods and the preoperative assessment of cervicothoracic junction lesions .Methods Selected 42 cases of normal bone mass , 48 cases with bone loss , and 60 cases of osteoporosis who were diagnosed by dual-energy X-ray absorptiometry , and measured the location of thoracic sternal angle corresponded to the thoracic spine and thoracic kyphosis angle through the volume recon -struction data of the 16-slice spiral CT chest examinations .Results The range of sternal angle corresponded to thoracic plane was measure-ment units ⅢtoⅥ.The measure unit Ⅳwas the most, accounting for about 55%.There was no statistical significance between the position of sternal angle corresponded to thoracic plane and the relationship of bone mass , which required further study .The position of sternal angle corresponded to thoracic plane was associated with the thoracic kyphosis angle .The larger the thoracic kyphosis angle , the lower the corre-sponding position was .Conclusion The thoracic segment corresponded to the sternal angle is not a constant or accurate plane , which is not properly concerned as an accurate positioning mark to the thoracic segment .The measurement of the thoracic sternal angle was corresponded to the thoracic spine location , and its co-relationship evaluation between the thoracic kyphosis angle was vital for the accurately positioning of cervico-thoracic junction area lesions , the pre-assessment methods of surgical treatment , approach selection , and different methods for ster-num and other such contents .This research was of important clinical significance .

Should We Recommend Ultrasonography for an Incidental Thyroid Nodule on Additional Cervicothoracic Sagittal T2-Weighted Image of Lumbar Spine MRI?

PURPOSE: To determine whether we should recommend ultrasonography (US) for an incidental thyroid nodule identified by additional cervicothoracic sagittal T2-weighted image (C-T sag T2WI) of lumbar spine magnetic resonance imaging (MRI). MATERIALS AND METHODS: A retrospective study of 61 patients who underwent both lumbar spine MRI and thyroid US between December 2011 and April 2015 was conducted. For all US-found thyroid nodules > 1 cm, investigators evaluated whether there was any correlation between thyroid nodule detectability by C-T sag T2WI and US features such as echogenicity, composition, or suspicion of malignancy. RESULTS: Solid hypoechoic (2/4; 50%) or mixed echoic nodules (4/8; 50%) appeared to be found relatively more easily by C-T sag T2WI than more benign-looking solid isoechoic (1/4; 25%) or spongiform nodules (0/6; 0%). Among six nodules with ultrasonographic suspicion for malignancy, only one nodule was detected by C-T sag T2WI. CONCLUSION: If an incidental thyroid nodule is seen by C-T sag T2WI, it would be better to recommend thyroid US for identifying malignancy.

Surgical Management with Radiation Therapy for Metastatic Spinal Tumors Located on Cervicothoracic Junction : A Single Center Study

OBJECTIVE: The cervicothoracic junction (CTJ) is a biomechanically and anatomically complex region that has traditionally posed problems for surgical access. In this retrospective study, we describe our clinical experiences of the treatment of metastatic spinal tumors at the CTJ and the results. METHODS: From June 2006 to December 2011, 23 patients who underwent surgery for spinal tumors involving the CTJ were enrolled in our study. All of the patients were operated on through the posterior approach, and extent of resection was classified as radical, debulking, and simple neural decompression. Adjuvant radiation therapy (RT) was also considered. Visual analog scale score for pain assessment and Medical Research Council (MRC) grade for motor weakness were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). RESULTS: Almost all of the patients were operated using palliative surgical methods (91.3%, 21/23). Ten complications following surgery occurred and revision was performed in four patients. Of the 23 patients of this study, 22 showed significant pain relief according to their visual analogue scale scores. Concerning the aspect of neurological and functional recovery, mean MRC grade and ECOG score was significantly improved after surgery (p<0.05). In terms of survival, radiation therapy had a significant role. Median overall survival was 124 days after surgery, and the adjuvant-RT group (median 214 days) had longer survival times than prior-RT (63 days) group. CONCLUSION: Although surgical procedure in CTJ may be difficult, we expect good clinical results by adopting a palliative posterior surgical method with appropriate preoperative preparation and postoperative treatment.

Finite element analysis on different spine reconstruction methods after total spondylectomy of cervicothoracic spine / 医用生物力学

Objective To establish 3D finite element of human cervicothoracic spine C5-T2 based on CT images, and explore effects on stability of the cervicothoracic spine after total spondylectomy (TS) by using various combinations of internal fixation devices (pedicle screw, titanium mesh, steel plate), including the stress distributions on these internal fixation devices. Methods The intact finite element model of cervicothoracic spine C5-T2 was established and validated by comparing the model’s range of motion (ROM) with that of other in vitro experiments. Then four reconstruction models after TS of cervical spine segment C7 were established: TM+AP+DPS model (titanium mesh + anterior plate + posterior double-segmental pedicle screw), TM+AP+SPS model (titanium mesh + anterior plate + posterior single-segmental pedicle screw), TM+DPS model (titanium mesh + posterior double-segmental pedicle screw), AP+DPS model (anterior plate + posterior double-segmental pedicle screw). ROM of each reconstruction model under flexion, extension, lateral bending and rotation and stress distributions on these internal fixation devices were then analyzed. Results ROM of the reconstruction segments was greatly reduced by over 93% as compare to that of the intact model. Stress concentration phenomenon appeared on the titanium mesh in the TM+AP+SPS model. Conclusions The fixation effects of four reconstruction models are similar. Stresses on 3 DPS fixed-models are more evenly distributed, indicating that the overall stability of DPS fixed-model is superior to that of SPS fixed-model.

Establishment and validation for a 3D finite element model of cervicothoracic junction C5-T2 / 医用生物力学

Objective To establish a 3D finite element model of cervicothoracic spinal segments C5-T2 based on CT images and test its validity and effectiveness. Methods By using the Mimics, Geomagic and Hypermesh software, the 3D model of cervicothoracic spinal segments C5-T2 was reconstructed, repaired and pre-processed. Moment of ±0.5, 1, 1.5, 2 N•m were applied on top of the model to simulate loads produced during the flexion and extension movement of human body. The range of motion (ROM) of the segments C5-T2 during flexion and extension was calculated by ANSYS, and the reliability of the model was verified by comparing the experimental results in the previous literature with the finite element analysis results obtained in this study. Results Under the moment of 1 N•m, the ROMs of C5-6, C6-7, C7-T1 and T1-2 during flexion were 4.30°,3.21°,1.66° and 1.41°, and those during extension were 3.47°, 2.86°, 0.96° and 0.92°, respectively. The maximum stress during flexion appeared on the front of the vertebral body, while that during extension appeared on the back of the vertebral body. The trends of ROM and stress distributions were consistent with results reported in the previous literature. Conclusions The 3D model established in this study is accurate and realistic, and conforms to biomechanical properties of the cervicothoracic spine. The simulation results can be further used to explore clinical pathology of the spine and provide theoretical references for evaluation on cervicothoracic spine surgery.

Expression of progesterone receptor in the cervicothoracic ganglion of female goat / 解剖学报

Objective In order to explore whether neurons in the cervicothoracic ganglion of female goat were equipped with the condition for the role of progesterone .Methods Immunohistochemical SP method was used to detect the expression of progesteron receptor ( PR) in cervicothoracic ganglion of female goats .Results The result indicated that PR-immunoreactive-products were mainly present in the cell bodies of neurons , and satellite cells , Schwann cells , neurapophysis and nerve fiber also had weaker staining .The cell membrane and cytoplasm of neurons represented brown as strong positive ,but the nucleus of neurons showed the presence of heterogeneity , 85.10% neurons ’ nucleus was strong positive,of which 31.91%nucleolus being clear vacuoles were negative;14.90%nucleus displaying vacuolization had no shaining, of which 7.45%nucleolus was strong positive .There were weak positive and flaxen PR-immunoreactive-products in satellite cells, Schwann cells, neurapophysis and nerve fiber .Image analysis shows that PR of neurons was extremely significant compared with other non-nerve cells ( P <0.01 ) . Conclusion The result proved that the sympathetic postganglionic neurons in cervicothoracic ganglion of female goat were the one of main target cells of progesterone ,suggesting that progesterone may be involving in the neuroregulation of cardiac functional activities through affectinng the activities of neurons in the cervicothoracic ganglion of female goat ,and PR in the cervicothoracic ganglion may act as a network node to coordinate endocrine regulation of progesterone and neuroregulation of autonomic nerve on the cardiac functional activities .

The Value of Additional Cervicothoracic Spine Sagittal T2-weighted Images Included in Routine Lumbar Spine MR Imaging

PURPOSE: To evaluate the usefulness of cervicothoracic spine sagittal T2-weighted images (CT SAG T2WIs) included in routine lumbar spine MRI. MATERIALS AND METHODS: Institutional review board approval was obtained and informed consents were waived for this retrospective study. The study group comprised 2,113 patients who underwent lumbar spine MRI from January 2005 to December 2005. CT SAG T2WIs were added in the routine lumbar spine MRIs. Radiologic reports were reviewed retrospectively for pathologic lesions on CT SAG T2WIs by one radiologist. Information of additional cervical or thoracic spine MRI and/or CT for further evaluation of positive findings on CT SAG T2WIs and their treatment were collected by retrospectively reviewing medical records. RESULTS: The CT SAG T2WIs revealed 142 pathologic lesions in 139 (6.58%) of the 2,113 patients. They were easily obtained without positional change in a scan time of less than 2 minutes. Additional cervical or thoracic spine MRI and/or CT for positive findings on CT SAG T2WIs were performed in 13 patients. Seven patients underwent surgical treatment. CONCLUSION: CT SAG T2WIs included in routine lumbar spine MRI were useful in finding the pathologic lesions in cervicothoracic spine for the patients who assumed to have lesions in lumbar spine.

Bocio Cervicotorácico ¿De qué depende el abordaje torácico?

Antecedentes: No hay una norma definida sobre qué enfermos requieren abordaje torácico. La experiencia basada en evidencia V, indica que la mayoría de los cirujanos lo realiza solo en el 2% de los enfermos. Objetivo: Descubrir factores clínicos, radiológicos y patológicos que pueden predecir la necesidad de un abordaje combinado o torácico puro en los bocios cervicotorácicos. Diseño: Retrospectivo. Observacional. Lugar de aplicación: Hospital Público de atención terciaria de tumores. Población: 54 enfermos, (51.8%) masculinos, con una relación 1/1. La edad media fue 57.8 años. 16/54 (29.6%) eran recidivados. 44 (81.5%) portaban tumores benignos y el resto malignos. Métodos: En 29.6% fue necesario ingresar al tórax. Se efectuó esternotomía en 10, manubriotomía en 4 y toracotomía lateral en 2. Se efectuó tiroidectomía total en 72.2%. Resultados: Se registraron complicaciones en 10/54 (18.5%) y secuelas en 8/54 (14.8%). Entre las primeras, la más frecuente fue la hipocalcemia en 6 (11.1%), seguida por sangrado en 2 (3.7%). Entre las secuelas, se registra hipocalcemia definitiva en 5, secuela recurrencial en 2. La supervivencia global a 5 años de los enfermos portadores de patología maligna fue 25%. Conclusiones: El término cervicotorácico parece ser el más abarcativo. Los pacientes que requirieron abordaje torácico fueron adultos de ambos géneros. El abordaje cervical resolvió la mayoría de los casos. Pero el 90% de las neoplasias malignas necesitó alguna forma de abordaje torácico expresada con significación estadística. Los bocios extendidos a la carina, aberrantes o del mediastino posterior, requirieron siempre abordaje torácico. La toracotomía lateral quedó reservada para bocios aberrantes y mediastinales posteriores.

Background: Only 2% of cervicothoracic goiters are resected through a thoracic approach. There are no strict guidelines that dictate the need for this surgical approach. Objective: Investigate clinical, radiographic factors associated with the need for a thoracic approach in cervicothoracic goiters. Design: Retrospective - Observational. Setting: Public tertiary care head and neck referral center. Population: 54 patients, 51.8 male with a rate 1/1. mean age was 57.8 years, 29.6% recurred goiters, 81.5% was benign and hte rest malign tumours. Methods: In 29.6% a thoracic approach was needed: sternotomy in 10, manubriotomy in 4 and lateral thoracotomy in 2. Total thyroidectomy was used i n72.2%. Results: There were complications in 10 and sequelas in 8. 5 years overall survival in malignant tumors was 25%. Conclusions: Cervicothoracic seems to be most appropriate term. Patients who needed thoracic approach were adult of both genders. Cervical approach solve most of cases. But 90% of malignant tumours needed any type of thoracic approach statiscally significant expressed. Carinal extension, aberrant or posterior goiters, always needed a thoracic approach. Lateral thoracotomy was reserved only for the last two types of goiters.