NERVOUS FACTORS OF ARTERIAL HYPERTENSION PROSPECTS FOR PREVENTION AND REHABILITATION

The article provides a theoretical analysis of the causes of arterial hypertension, describes a three-month observation of the initial stage of the development of hypertension and experiments on non-drug normalization of blood pressure on a group of volunteers. It has been shown that arterial hypertension is associated with spastic conditions of the intervertebral muscles in the lower thoracic spine, which lead to compression of the sympathetic nerves that control the transport of water through the kidneys and disturb the balance of fluid circulation through the circulatory system. The possibility of prevention of arterial hypertension and non-drug rehabilitation of patients with this disease has been shown.

PATHOPHYSIOLOGICAL COMPONENTS OF ARTERIAL HYPERTENSION. PROSPECTS FOR PREVENTION AND REHABILITATION

The article provides a theoretical analysis of the causes of arterial hypertension, describes a 3-month observation of the initial stage of the development of hypertension and experiments on non-drug normalization of blood pressure on a group of volunteers. We show that arterial hypertension is associated with spastic conditions of the intervertebral muscles in the lower thoracic spine, which leads to compression of sympathetic nerves that control the transport of water through the kidneys, which in turn upsets the balance of fluid circulation through the circulatory system.Theoretical analysis and experimental data made it possible to formulate a hypothesis about the dominant role of disorders in the activity of the sympathetic part of the nervous system in the development of primary and persistent arterial hypertension. The possibility of prevention of arterial hypertension and non-drug rehabilitation of patients with this disease has been shown.

Progressive enlargement of thoracic ossification of the ligamentum flavum in professional baseball pitchers: a report of two cases

Both systemic and local factors might influence the development of ossification of the ligamentum flavum (OLF); however, whether specific physical activities play a role in the development of OLF remains unclear. This report presents two cases of thoracic radiculopathy owing to progressive enlargement of thoracic OLF within a few years in Japanese professional baseball pitchers. Two left-handed, Japanese, professional baseball pitchers in their 20s experienced thoracic radiating pain. Mild hypesthesia of the lower thoracic vertebral levels was observed, and an increase in the size of the OLF within a few years was identified in the lower thoracic spine using computed tomography and magnetic resonance imaging. Neither patient exhibited myelopathy and were, therefore, treated conservatively. Both patients were able to return to playing in top condition within 4 months after onset. The findings in these cases suggest that thoracic OLF might increase in size and become exacerbated in certain individuals, such as professional pitchers, who experience repeated, localized, mechanical stress on the thoracic spine, irrespective of age.

NERVOUS COMPONENT OF ARTERIAL HYPERTENSION. PROSPECTS FOR PREVENTION AND REHABILITATION

The article provides a theoretical analysis of the causes of arterial hypertension, describes a 3-month observation of the initial stage of the development of hypertension and experiments on non-drug normalization of blood pressure on a group of volunteers. It was shown that arterial hypertension is associated with spastic conditions of the intervertebral muscles in the lower thoracic spine, which lead to compression of sympathetic nerves that control the transport of water through the kidneys and disturb the balance of fluid circulation through the circulatory system. Theoretical analysis and experimental data made it possible to formulate a hypothesis about the dominant role of disorders in the activity of the sympathetic part of the nervous system in the development of primary and persistent arterial hypertension. The possibility of prevention of arterial hypertension and non-drug rehabilitation of patients with this disease has been shown

PATHOPHYSIOLOGICAL COMPONENTS OF ARTERIAL HYPERTENSION.PROSPECTS FOR PREVENTION AND REHABILITATION

The article provides a theoretical analysis of the causes of arterial hypertension, describes a 3month observation of the initial stage of the development of hypertension and experiments on non-drug normalization of blood pressure on a group of volunteers. We show that arterial hypertension is associated with spastic conditions of the intervertebral muscles in the lower thoracic spine, which leads to compression of sympathetic nerves that control the transport of water through the kidneys, which in turn upsets the balance of fluid circulation through the circulatory system. Theoretical analysis and experimental data made it possible to formulate a hypothesis about the dominant role of disorders in the activity of the sympathetic part of the nervous system in the development of primary and persistent arterial hypertension. The possibility of prevention of arterial hypertension and non-drug rehabilitation of patients with this disease has been shown.

Imaging in Thoracic Disc Prolapse: A Study of 25 Patients and Review of Literature

Purpose: Unlike cervical and lumbar disc, thoracic disc prolapse (TDP) has limited literature. Many studies have focused on surgical technique of TDP. The aim of this study is to highlight the radiological features of TDP that would help surgeons in understanding the peculiar features of such uncommon entity and also planning the surgery. Materials and Methods: All the patients surgically treated for TDP between May 2010 and June 2018 were included in the study. A retrospective collection of all the radiographs, CT and MR images were done. Results: A total of 25 subjects, two patients had double level disc prolapse; hence, a total of 27 discs were analyzed. On radiographs, end-plate was concave (n = 9), straight (n = 12), cupid bow shaped (n = 6), calcification in disc space (n = 5), and calcification within the canal (n = 14). EP junction failures were type IA (n = 10), type IB (n = 6), type ID (n = 2), and type II (n = 9). On MRI, central disc prolapse (n = 10), right paracentral (n = 12), and left paracentral (n = 5). According to Pfirmann grading, three discs were Grade 2; five discs as Grade 3; 14 as Grade 4; and five as Grade 5. Fourteen discs had >40% canal occupancy. Schmorl nodes were noted (n = 17). Conclusion: Lower thoracic spine has a higher incidence of TDP. Calcification is commonly seen in cases of TDP, either in the disc space or within the canal. Most of the cases present with >40% of canal occupancy. End plate defect, a variant of schmorl node, may be a possible contributor to disc prolapse. Keywords: Thoracic disc prolapse, radiology, calcification.

Can Machine Learning Accurately Predict Postoperative Compensation for the Uninstrumented Thoracic Spine and Pelvis After Fusion From the Lower Thoracic Spine to the Sacrum?

Study Design: Consecutively collected cases. Objective: To determine if a machine-learning (ML) program can accurately predict the postoperative thoracic kyphosis through the uninstrumented thoracic spine and pelvic compensation in patients who undergo fusion from the lower thoracic spine (T10 or T11) to the sacrum. Methods: From 2015 to 2019, a consecutive series of adult (≥18 years old) patients with adult spinal deformity underwent corrective spinal fusion from the lower thoracic spine (T10 or T11) to the sacrum. Deidentified data was processed by a ML system-based platform to predict the postoperative thoracic kyphosis (TK) and pelvic tilt (PT) for each patient. To validate the ML model, the postoperative TK (T4-T12, instrumented thoracic, and uninstrumented thoracic) and the pelvic tilt were compared against the predicted values. Results: A total of 20 adult patients with a minimum 6-month follow-up (mean: 22.4 ± 11.3 months) were included in this study. No significant differences were observed for TK (predicted 37.6° vs postoperative 38.3°, P = .847), uninstrumented TK (predicted 33.9° vs postoperative 29.8°, P = .188), and PT (predicted 23.4° vs postoperative 22.7°, P = .754). The predicted PT and the TK of the uninstrumented thoracic spine correlated well with postoperative values (uninstrumented TK: R 2 = 0.764, P < .001; PT: R 2 = 0.868, P < .001). The mean error with which kyphosis through the uninstrumented thoracic spine can be measured was 4.8° ± 4.0°. The mean error for predicting PT was 2.5° ± 1.7°. Conclusion: ML algorithms can accurately predict the spinopelvic compensation after spinal fusion from the lower thoracic spine to the sacrum. These findings suggest that surgeons may be able to leverage this technology to reduce the risk of proximal junctional kyphosis in this population.

Thoracic Myelopathy Caused by Ossification of the Yellow Ligament as a Distal Adjacent Segmental Disease after Posterior Cervical-Middle Thoracic Fusion Surgery

Although adjacent segmental disease after posterior thoracic fusion surgery is rare, thoracic myelopathy due to ossification of the yellow ligament in the lower thoracic spine could develop because of mechanical stress when the lower instrumented vertebra has been set to the middle thoracic spine during the initial surgery. We report an extremely rare case of distal adjacent segmental disease after posterior cervical-middle thoracic fusion surgery requiring reoperation after exhibiting thoracic myelopathy due to ossification of the yellow ligament in the lower thoracic spine. An obese 53-year-old man with diabetes had undergone C3-6 laminoplasty and C7-T8 posterior decompression plus fusion due to ossification of the posterior longitudinal ligament at C5-T5. Although the short-term clinical course after the initial surgery was good, symptoms of myelopathy reappeared because of the ossification of the yellow ligament that developed at T9-11 with local flexibility. Thus, reoperation with fusion extension surgery was needed 1 year and 6 months after the initial surgery. Altogether, we recommend careful monitoring of the postoperative clinical progression and, if necessary, reoperation at the earliest.

Case Report: Primary ganglioneuroblastoma occurrence in lower thoracic spine

Ganglioneuroblastoma is a neural tissue neoplasm, which is derived from the neural crest cells. It is mostly seen in the pediatric population but is very rarely found in the lower thoracic spine. Here, we report a rare case of ganglioneuroblstoma occurrence in the lower thoracic spine. A 2.5-year-old boy presented with spinal compression symptoms and on magnetic resonance imaging, a mass was identified over T10 to L1. The tumor showed round blue cells and mature ganglion cells with hypermitotic activity. Immunohistochemical synaptophysin and neurofilament staining was positive, confirming the diagnosis. The patient showed significant improvement after surgical excision of the tumor. This is the first reported case of ganglioneuroblastoma in the lower thoracic spine that was successfully treated in Pakistan.