HISTORY OF EVOLUTION OF POSTERO-LATERAL APPROACHES TO THE THORACIC SPINE: FROM CURE OF POTT’S DISEASE TO EPIDURAL TUMOR RESECTION

Author(s):  
Filippo Gagliardi ◽  
Edoardo Pompeo ◽  
Pierfrancesco De Domenico ◽  
Silvia Snider ◽  
Francesca Roncelli ◽  
...  

Since the end of the nineteenth century, the wide dissemination of Pott’s disease has ignited debates about which should be the ideal route to perform ventrolateral decompression of the dorsal rachis in case of paraplegia due to spinal cord compression in tuberculosis spondylitis. It was immediately clear that the optimal approach should be the one minimizing the surgical manipulation on both neural and extra-neural structures, while optimizing the exposure and surgical maneuverability on the target area. The first attempt was reported by Victor Auguste Menard in 1894, who described, for the first time, a completely different route from traditional laminectomy, called costotransversectomy. The technique was conceived to drain tubercular paravertebral abscesses causing paraplegia without manipulating the spinal cord. Over the following decades many other routes have been described all over the world, thus demonstrating the wide interest on the topic. Surgical development has been marked by the new technical achievements and by instrumental/technological advancements, until the advent of portal surgery and endoscopy-assisted techniques. Authors retraced the milestones of this history up to the present days, through a systematic review on the topic.

2018 ◽  
Vol 16 (2) ◽  
pp. 274-274
Author(s):  
Simone E Dekker ◽  
Chad A Glenn ◽  
Thomas A Ostergard ◽  
Osmond C Wu ◽  
Fernando Alonso ◽  
...  

Abstract This 3-dimensional operative video illustrates resection of 2 cervical spine schwannomas in a 19-yr-old female with neurofibromatosis type 2. The patient presented with lower extremity hyperreflexity and hypertonicity. Magnetic resonance imaging (MRI) demonstrated 2 contrast-enhancing intradural extramedullary cervical spine lesions causing spinal cord compression at C4 and C5. The patient underwent a posterior cervical laminoplasty with a midline dural opening for tumor resection. Curvilinear spine cord compression is demonstrated in the operative video. After meticulous dissection, the tumors were resected without complication. The dural closure was performed in watertight fashion followed by laminoplasty using osteoplastic titanium miniplates and screws. Postoperative MRI demonstrated gross total resection with excellent decompression of the spinal cord. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.


Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1275-1279 ◽  
Author(s):  
Michael J. Alexander ◽  
Peter M. Grossi ◽  
Robert F. Spetzler ◽  
Cameron G. McDougall

Abstract OBJECTIVE AND IMPORTANCE Spinal cord involvement in Klippel-Trenaunay-Weber (KTW) syndrome is rare. Cases of intradural spinal cord arteriovenous malformations (AVMs) have been associated with this syndrome. Likewise, cases of epidural hemangioma and angiomyolipoma have been reported to occur at the same segmental level as cutaneous hemangioma in KTW syndrome. This report details a rare case of an extradural thoracic AVM in a patient with KTW syndrome. CLINICAL PRESENTATION A 30-year-old man presented with a 10-month history of progressive myelopathy, bilateral lower-extremity weakness, and numbness, with the right side affected more than the left. His symptoms had progressed to the point that he was unable to walk. The patient had the characteristic manifestations of KTW syndrome, including numerous cutaneous angiomas and cavernomas, limb hypertrophy and syndactyly, and limb venous malformations. A magnetic resonance imaging scan and subsequent angiogram demonstrated a large extradural AVM causing cord compression at the T3–T4 levels. INTERVENTION The patient underwent two separate endovascular procedures, including embolization of upper thoracic and thyrocervical trunk feeders. Subsequently, he underwent T1–T4 laminectomy and microsurgical excision of the AVM. Clinically, the patient improved such that he could walk without assistance. CONCLUSION KTW syndrome represents a spectrum of clinical presentations. Although involvement of the spinal cord is uncommon, the manifestations of this syndrome may include both intradural and extradural AVMs in addition to various tumors.


Author(s):  
Laszlo Perecz

The situation of Hungarian philosophy can be best illustrated by two sayings: ‘there are Hungarian philosophers, but there is no Hungarian philosophy’, and ‘a certain period of Hungarian philosophy stretches from Descartes to Kant’. The two ideas are closely connected. Thus on the one hand, there is such a thing as Hungarian philosophy: there are scientific-educational institutions in philosophical life and there are philosophers working in these institutions. On the other hand, there is no such thing as Hungarian philosophy: it is a history of adoption, largely consisting of attempts to introduce and embrace the great trends of Western thought. After some preliminaries in the medieval and early-modern periods, Hungarian philosophy started to develop at the beginning of the nineteenth century. As a result of the reception of German idealism – the so-called Kant debate and Hegel debate – the problems of philosophy were formulated as independent problems for the first time, and a philosophical language began to evolve. After an attempt to create a ‘national philosophy’ – and after some outstanding individual achievements – the institutionalization of Hungarian philosophy accelerated at the end of the century. The early years of the twentieth century brought the first heyday of philosophy to Hungary, with the rapid reception of new idealist trends and notable original contributions. In the period between the two wars the development stopped: many philosophers were forced to emigrate, and Geistesgeschichte (the history of thought) became prevalent in philosophical life. Following the communist take-over, the institutions of ‘bourgeois’ philosophy were eliminated, and Marxism-Leninism, which legitimated political power, took a monopolistic position. During this period, the only significant works created were in the tradition of critical Marxism and philosophical opposition. The changes in 1989 regenerated the institutional system, and the articulation of international contemporary trends – analytic philosophy, hermeneutic tradition and postmodernism – came to the fore. Besides some works by thinkers in exile, Hungarian philosophy has produced only one achievement which can be considered significant at an international level: the oeuvre of György (Georg) Lukács.


2020 ◽  
Vol 11 (2) ◽  
pp. 101-103
Author(s):  
Rishav Mukherjee ◽  
Sampurna Chowdhury

A 23 year old female presented with acute onset paraparesis. She denied any history of fever, weight loss or drenching night sweats. Neither did she have any obvious lymphadenopathy on general examination. Chest Xray was however suggestive of mediastinal widening and her MRI spine showed metastases with superior mediastinal SOL. Biopsy of this SOL ultimately revealed classical Hodgkin lymphoma. Thus this was a very unusual initial presentation of Hodgkin lymphoma presenting as Epidural Spinal Cord Compression. Hasenclever IPS score was 2. Patient was treated with radiotherapy followed by ABVD chemotherapy and achieved remission in 3months.


1984 ◽  
Vol 11 (1-2) ◽  
pp. 95-116
Author(s):  
Werner Bahner

Summary The Renaissance constitutes a new phase in the history of linguistics. The study of modern languages in particular contributed to enlarge the scope of philological concern as scholars try to promote and to codify a young national language. During this time philologists give particular attention to the origin of these vernaculars, distinguishing the different stages in their evolution and developing an especial awareness of chronology. For the representatives of a national philology, Latin is the starting point, the mould according to which the vernaculars are described and classified. Soon, however, more and more traits are recognized which are particular to these living languages, and which do not agree with the traditions of Latin grammar. On the one hand, modifications on the theoretical level are called for, and, on the other, there is a good opportunity to demonstrate the particularity of a given vernacular. All these tendencies can be found for the first time in the writings on Cas-tillian by the great philologist Antonio de Nebrija (1444–1522). Nebrija recognized a series of phonetic correspondences which, much later in the 19th century, are transformed into ‘phonetic laws’ by a rigorous methodology. In so doing the elaboration of orthographic principles had been for him a stimulus for his explications. In his “Diálogo de la lengua”, Juan de Valdés (devoted himself more extensively to the social aspects of Castillian, to linguistic changes, and to the historical causes for the distribution of Romance languages on the Iberian peninsula, stressing expecially the role of the ‘Reconquista’. The work of Bernardo José de Aldrete (1560–1641) offers a synthesis of all these efforts concerning the evolution of Castillian. He discusses all the substrata and superstrata of the language, sketches the different stages of development of his native tongue, examines Old Castillian with the help of medieval texts, and exploits what Nebrija had noted about the phonetic correspondences. In terms of scholarship, Aldrete’s work constitutes the culmination point in the movement engaged in supporting the rights of the Castillian language et in documenting its sovereignity vis-à-vis the Latin tradition.


2009 ◽  
Vol 42 (9) ◽  
pp. 1167-1192 ◽  
Author(s):  
Orfeo Fioretos

Rules governing the corporate identity of multinational companies are national in nature, with the one exception of the European Company Statute. For the first time in the history of capitalism, this statute enables companies to jettison national rules of incorporation in favor of an international legal identity. This article explains why the statute was the most protracted legislative initiative in the history of European integration and why its final form served significantly to constrain the international market for corporate identity in Europe. Its explanations are anchored in an institutional theory of government behavior that draws on the varieties of capitalism and historical institutionalism traditions. The article concludes with suggestions for how these traditions can be extended beyond their normal purview as a means to giving analytical and substantive nuance to the study of international rule-making.


Neurosurgery ◽  
1986 ◽  
Vol 19 (4) ◽  
pp. 614-616 ◽  
Author(s):  
Alison R. Calkins ◽  
Margaret A. Olson ◽  
James H. Ellis

Abstract From December 1981 through August 1984, 24 patients with spinal cord compression syndrome due to epidural neoplasms were evaluated for radiotherapy with clinical examination, radiographs of the spine, and myelography. All plain films were reviewed, and mock radiotherapy fields designed using specific criteria for margins. The same patients were reviewed a second time considering the additional information provided by myelography. The initial treatment fields were found to be inadequate in 69% of the patients. Even in patients with discrete bony lesions, the results of myelography affected the treatment 45% of the time. A history of previous spinal irradiation significantly influenced port design in only 1 of the 7 patients who had received previous radiotherapy. Although invasive, myelography is essential in planning the treatment of spinal cord compression.


Author(s):  
Dmytro Savon

Relevance and scientific novelty of the selected subject for the research. In the Ukrainian musicology, the motets written by Johann Bach were mainly studied from the compositional means standpoint, considering the system of polyphony, the role of chorale and fugue in dramaturgy as well as the composition of works. Scientists have not previously researched the motets performance specificity. Meanwhile, motets, particularly the one reviewed in the article “Jesu, meine Freude”, are among the most frequently performed works of the choral repertoire. For the first time in the Ukrainian musicology, three edited versions of the motet “Jesu, meine Freude” are analyzed from the standpoint of historically oriented performance. Based on the study of editors’ comments and source literature (mostly German), the question of compliance of the musical text with the task of performing reconstruction of the baroque vocal and choral style was studied. The aim of the article lies in the need to find out specificity of the editors’ interpretation of motet “Jesu, meine Freude” written by Johann Bach and suitability extent of different edited versions for the historical reconstruction of the vocal-choral style of the German Baroque. During the development of particular article, such methods were utilized: historical — the history of edited versions of “Jesu, meine Freude” motet was traced, comparative — the comparative analysis of three edited versions of motet “Jesu, meine Freude” written by Johann Bach (Franz Wulner, Konrad Ameln and Mykhailo Berdennykov) was completed. Main results and conclusions. According to the completed comparative analysis, the first two of the three considered edited versions are textual, while the third one is adopted for performing. Textual versions are characterized by the preservation of the composer’s text in the smallest details, including comments to clearly identify the extent of changes made by the editor in the text. The peculiarities of the version adopted for performing contain the large amount of remarks added by the editor, covering dynamic shades, strokes, tempo notation, etc. It is noted that the choice of version type is determined by performance goals: to perform the works of Johann Bach in an authentic manner, the conductor should focus on facsimile versions, and if they are absent (as in the case of the “Jesu, meine Freude” motet), the one should use textual type of edited versions. The version developed for performing cannot correspond to the authentic performing, as the first does not reflect specific tendencies of the time when it was created. It is specified that the conductor should be familiar with the peculiarities of fixing the means of performance in the musical text of the Baroque era.


2014 ◽  
Vol 21 (11) ◽  
pp. 3661-3667 ◽  
Author(s):  
Jun Qian ◽  
Juehua Jing ◽  
Dasheng Tian ◽  
Huilin Yang

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