Medullary Cone Movement in Subjects with a Normal Spinal Cord and in Patients with a Tethered Spinal Cord

Witkamp, T. D.; Vandertop, W. P.; Beek, F. J. A.; Notermans, N. C.; Gooskens, R H J M; Waes, P F van

doi:10.1148/radiology.220.1.r01jl06208

Cited by 33 publications

(32 citation statements)

References 20 publications

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Section: Discussionmentioning

confidence: 99%

“…Many factors associated with neuraxial anaesthesia have been studied including the structures at the level of the termination of the spinal cord and dural sac [11], vertebral level and shape of the conus medullaris [12], shape of the epidural space [13][14][15], and distance from the skin to the epidural or subarachnoid spaces [16][17][18][19]. However, the effect of body position relevant to neuraxial blockade has not been well studied [20][21][22][23][24], especially in children.Ultrasonography, which is a well-established method of investigating the spinal canal, spinal cord, and meningeal coverings in infants and children, has the advantage of being real time, non invasive and safe [25][26][27]. It allows detection of congenital malformations such as myelocele, myelomeningocele, spinal lipoma, dorsal dermal sinus, tight filum terminale syndrome, diastematomyelia, hydromyelia and syringomyelia.…”

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confidence: 99%

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The effect of flexion on the level of termination of the dural sac in paediatric patients

et al. 2009

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SummaryAlthough the anatomy of the spinal cord and its associated structures have been well defined, the effects of body position relevant to neuraxial blockade have not been elucidated. This study was designed to determine the effect of body position on the end of the dural sac in children. After induction of anaesthesia, ultrasound examination was performed to evaluate the location of the dural sac end in the lateral position with a straight back and knee, and in the lateral position with the knees, legs, and neck flexed. The level of the end of the dural sac was determined in relation to the vertebrae. Our data demonstrate that the dural sac shifts significantly cephalad in the lateral flexed position used for neuraxial blockade (p < 0.001). These results suggest that the safety margin to avoid dural puncture during hiatal or S2-3 approach for caudal block can be increased in younger children. Dural puncture is a serious technical complication during single-shot caudal block, which is the most common regional technique for postoperative analgesia for paediatric subumbilical surgery. The prevalence of dural puncture associated with caudal analgesia is relatively low. It has only been shown in several case reports [1,2] or at a rate of 1.2% in previous large-scale studies [3,4]. In the study of 760 children, Busoni did not find any case of dural puncture and Dalens [5] reported only one dural puncture in his series of 750 paediatric caudals. Sometimes it is difficult to identify the sacral hiatus and the caudal space due to variations of anatomical structures or obesity. In these cases, a trans-sacral approach to caudal block, described by Busoni [6], may be used as an alternative method. Although no dural puncture was reported in several trans-sacral approach studies [6][7][8], the risk of dural puncture is a possibility. It is known that the end of the dural sac is located at the S4 level just after birth, then ascends to the S2 level as the child grows [9].The anatomy of the spinal cord and its associated structures have been well defined [10], largely based on post-mortem or imaging studies in the supine or prone positions. Many factors associated with neuraxial anaesthesia have been studied including the structures at the level of the termination of the spinal cord and dural sac [11], vertebral level and shape of the conus medullaris [12], shape of the epidural space [13][14][15], and distance from the skin to the epidural or subarachnoid spaces [16][17][18][19]. However, the effect of body position relevant to neuraxial blockade has not been well studied [20][21][22][23][24], especially in children.Ultrasonography, which is a well-established method of investigating the spinal canal, spinal cord, and meningeal coverings in infants and children, has the advantage of being real time, non invasive and safe [25][26][27]. It allows detection of congenital malformations such as myelocele, myelomeningocele, spinal lipoma, dorsal dermal sinus, tight filum terminale syndrome, diastematomyelia, hydromyelia and syri...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The effect of flexion on the level of termination of the dural sac in paediatric patients

et al. 2009

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“…Intraoperative MRI imaging of a prone-positioned patient is even more difficult and inspiratory motion artifacts are unavoidable (12). Our experience shows that IOUSG offers greater practicality since ultrasound is readily ambulatory, less time-consuming and relatively cheaper.…”

Section: Discussionmentioning

confidence: 90%

Is intraoperative ultrasound required in cervical spinal tumors ? a prospective study

Toktaş¹,

Şahi̇n²,

Koban³

et al. 2012

Turkish Neurosurgery

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AIm:To determine the role of intraoperative ultrasonography (IOUSG) in the surgical management of patients with intradural spinal tumors. mAteRIAl and methods: Twenty-six patients with intradural spinal cord tumors were surgically treated under intraoperative ultrasonographic guidance between January 2007 and May 2011. Guidance with IOUSG was used in 26 patients, of which 14 fourteen had extramedullary and 12 had intramedullary tumors. Intraoperative ultrasound assistance was used to localize each tumor exactly before opening the dura. The extent of tumor resection was verified using axial and sagittal sonographic views. The extent of tumor resection achieved with IOUSG guidance was assessed on postoperative early control MRI sections.Results: Total tumor resection was achieved in 22 (84%) of 26 cases. All of the residual tumors were typically intramedullary and infiltrative. The sensitivity of IOUSG for the determination of the extent of resection was found to be 92%. Ultrasonography was found to be effective in identification of tumor boundaries and protection of spinal cord vessels. The average time spent for IOUSG assessment was 7 minutes. ConClusIon:Intraoperative ultrasonography is practical, reliable and highly sensitive for spinal cord surgery. It not only enhances surgical orientation, but also reduces morbidity and helps to resect the tumor completely.

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“…[22][23][24] However, there is still no uniform definition of tethering or of the diagnostic approach. 25,26 To include cervical tethering in our list of differential diagnosis, we would have expected changes to the neurologic status of the upper extremities and we would not be able to explain why the straight leg raising test so constantly reproduced the symptoms. However, we agree that the MRI of the cervical spine suggests the possibility of cervical tethering, and the findings are quite comparable to the examples given in the paper of Lee et al 11 Lumbar tethering also was not on our list of problems.…”

Section: Discussionmentioning

confidence: 99%

Management of degenerative changes and stenosis of the lumbar spinal canal secondary to cervical spinal cord injury

Abel

Bazo²,

Kluger

et al. 2003

Spinal Cord

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We describe the case of a 47-year-old female who sustained a C5/6 fracture with C6 complete spinal cord injury 26 years ago. She presented with increased spasticity of the lower extremities, the abdominal wall and episodes of autonomic dysreflexia. Imaging of the spine revealed posttraumatic kyphosis at the level of the injury and degenerative changes of the lumbar spine with marked facet joint hypertrophy at the level of L4/5 causing severe spinal canal stenosis. Discussants of this case comment on the possible pathophysiological mechanisms causing autonomic dysreflexia, especially the development of degenerative changes, Charcot arthropathy and the role of tethering mechanisms. The diagnostic options and management approaches are also discussed.

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Medullary Cone Movement in Subjects with a Normal Spinal Cord and in Patients with a Tethered Spinal Cord

Cited by 33 publications

References 20 publications

The effect of flexion on the level of termination of the dural sac in paediatric patients

The effect of flexion on the level of termination of the dural sac in paediatric patients

Is intraoperative ultrasound required in cervical spinal tumors ? a prospective study

Management of degenerative changes and stenosis of the lumbar spinal canal secondary to cervical spinal cord injury

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