Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Laminectomia/métodos , Vértebras Lombares/cirurgia , Microcirurgia/métodos , Síndromes de Compressão Nervosa/cirurgia , Raízes Nervosas Espinhais/cirurgia , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Síndromes de Compressão Nervosa/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Raízes Nervosas Espinhais/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The osseous boundaries of the intervertebral compartment are described. Measurements of the pedicles demonstrate that their configuration determines the shape of the intervertebral compartment. The pedicles originate in the upper lumbar spine (L 1 and L 2) in a vertical direction from the posterior aspects of the vertebral bodies. In the caudal lumbar spine (L 4 and L 5) the origin of the pedicles is more oblique and thereby moves much more laterally and ventrally. As a consequence the horizontal extension of the pedicles is increasing in the lower lumbar spine. In the upper lumbar region the intervertebral compartment corresponds more to a foramen, in the lower lumbar spine more to a canal. The resulting clinical relevance for the length of the intervertebral compartment and the nerve root course is discussed.
Assuntos
Vértebras Lombares/anatomia & histologia , Sacro/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biometria , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The main aim in the surgery of the canalicular and extracanalicular lumbar disc herniation is to remove safely the hidden fragment without complete destruction of the normal facet joint, without damage to the nerve root and with minimal compromise of the stability of the spinal column. This report describes a lateral approach for operations of extracanalicular lumbar disc herniations in which full visual control allows a decompression of the respective spinal nerve or ganglion and removal of the herniated disc. With this approach, there is minimal resection of bone and facet joint and minimal risk of injury to neural structures. If necessary, this approach can easily be combined with the classical interlaminar exposure.
Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Microcirurgia/métodos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The case is reported of a 32-year-old woman with polyneuropathy, organomegaly, edema, endocrinopathy, dark skin and solitary myeloma with monoclonal gammopathy of IgG/lambda type. More than 100 cases of this rare disorder have been observed up to now, mainly in Japan. In recent reviews the terms POEMS-syndrome or Crow-Fukase-syndrome have been used. Local radiotherapy of the myeloma led to lasting regression of symptoms. Studies with immunocytochemistry and immunoelectroblotting revealed specific antibody activity against hypophysis, suggesting that the pathologic monoclonal myeloma antibodies may damage the neuroendocrinic centers in hypothalamus and hypophysis as the primary target. Most of the multisystemic symptoms would thus be explained as secondary alterations.
