Effectiveness and safety of a modified (rib ends fixed under transverse process) thoracoplasty for rib hump deformity in adults with severe thoracic scoliosis

OBJECTIVEThe aim of this study was to evaluate the effect of lumbar sacralization on the level of vertebral slip and disc degeneration in patients with L4 spondylolysis.METHODSThe authors analyzed data from 102 cases in which patients underwent surgical treatment for L4 spondylolysis and spondylolisthesis at their institution between March 2007 and September 2016. Lumbar sacralization was characterized by the presence of pseudarthrosis and/or bony fusion between the L5 transverse process and sacrum, and the type of lumbosacral transitional vertebra (LSTV) was evaluated with the Castellvi classification. The amount of vertebral slippage was measured using the Taillard technique and Meyerding grade. Degeneration of the L4–5 segment was quantified using the Pfirrmann and Modic classifications. Patients were divided into 2 groups based on the presence or absence of sacralization, and the amount of vertebral slip and degeneration of the L4–5 segment was compared between groups.RESULTSLumbar sacralization was present in 37 (36%) of 102 patients with L4 spondylolysis. The LSTV was type IIa in 10 cases, type IIb in 7, type IIIa in 2, and type IIIb in 18. The levels of vertebral slip and disc degeneration in the group of patients with sacralization were significantly greater than in the group without sacralization. No significant difference was found between the 2 groups with respect to Modic changes.CONCLUSIONSThe increased stability between a sacralized L5 and the sacrum may predispose the L4–5 segment to greater instability and disc degeneration in patients with L4 spondylolysis.

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Effective erector spinae plane block for postoperative analgesia in a pyothorax patient who underwent emergency re-open thoracotomy—a case report

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-019-0044-8 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Izumi Kawagoe ◽

Daizoh Satoh ◽

Mariko Fukui ◽

Kenji Suzuki ◽

Eiichi Inada

Keyword(s):

Postoperative Analgesia ◽

Transverse Process ◽

Erector Spinae ◽

Open Thoracotomy ◽

Case Presentation ◽

Lung Lobectomy ◽

Erector Spinae Plane Block ◽

Lower Lung ◽

The Right ◽

Vein Stenosis

Abstract Background The appropriate choice of postoperative analgesia for pyothorax surgery is unclear since local infection could contaminate the catheter used for regional blocks and bacteremia can lead to disordered coagulation. We performed erector spinae plane block (ESPB) in a pyothorax patient undergoing emergency re-open thoracotomy. Case presentation An 81-year-old male with internal jugular vein stenosis on aspirin therapy was scheduled for pyothorax drainage and residual middle lobectomy 14 days after he underwent open right lower lung lobectomy for lung cancer. ESPB was performed with injection of 20 ml of 0.375% levobupivacaine at the Th5 transverse process of the right side under ultrasound guidance. Although he needed intravenous pentazocine for pain on postoperative day 0, no more analgesics were required postoperatively. NRS score ranged from 0 to 1 thereafter. Conclusions ESPB provided effective postoperative analgesia following emergency re-open thoracotomy for our pyothorax patient. ESPB might be the appropriate choice for postoperative analgesia following pyothorax surgery.

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Chronic Paroxysmal Hemicrania. VII. Mechanical Precipitation of Attacks: New Cases and Localization of Trigger Points

Cephalalgia ◽

10.1046/j.1468-2982.1984.0402113.x ◽

1984 ◽

Vol 4 (2) ◽

pp. 113-118 ◽

Cited By ~ 11

Author(s):

Ottar Sjaastad ◽

Carsten Saunte ◽

JR Graham

Keyword(s):

Posterior Part ◽

Transverse Process ◽

Trigger Points ◽

Paroxysmal Hemicrania ◽

Sensitive Area ◽

Manual Pressure ◽

Chronic Paroxysmal Hemicrania ◽

Local Tenderness ◽

Symptomatic Side

Two new chronic paroxysmal hemicrania patients are described. In both, attacks can be precipitated mechanically by applying firm manual pressure to certain sensitive points on the neck, i.e. in the C2 area, in the transverse processes of the C4–C5 vertebrae, or beneath the posterior part o15 the skull on the symptomatic side. The most sensitive area seems to be the transverse process of C4–C5. Susceptibility to this type of attack is dependent on the flow of spontaneous attacks; attacks are easily precipitated in a phase with multiple spontaneous attacks, but are not readily precipitated otherwise. Under indomethacin protection, local tenderness is clearly diminished and attacks cannot be precipitated.

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