Spinal canal

The spinal cord emerges from the brain stem at the base of the skull and terminates at the second lumbar vertebra. The thoracic spine is most vulnerable to cord compression because of natural kyphosis and because the width of the thoracic spinal canal is the smallest among the vertebrae. Most spinal cord compression is due to adjacent vertebral metastases that compress the spinal cord or from pathologic compression fracture of the vertebra. This results in significant edema and inflammation in the affected area. 

There have been many sporadic reports that lipo-PGEj is effective in fulminant hepatitis, neuralgia associated with herpes zoster, multiple spinal canal stenosis, cerebral infarction, myocardial infarction, chronic renal failure, and bed sores as well as for its registered indications. 

Spinal canal. An increase in fibrinogen concentration is frequently accompanied with the appearance of Froin syndrome—xanthochromia and spontaneous coagulation of the CSF sample. In neuroinfections, an increase in fibrinogen is documented in neurotuberculosis. Nowadays it belongs to the routinely assessed markers (A19). 

Others Intraocular, intraarterial, intrathecal (into the spinal canal). 

Schematic diagram of the typical sites of injection of local anesthetics in and around the spinal canal. When local anesthetics are injected extradurally, it is known as epidural (or caudal) blockade. Injections around peripheral nerves are known as perineural blocks (eg, paravertebral block). Finally, injection into the subarachnoid space (ie, cerebrospinal fluid), is known as spinal blockade.

Epidural nerve block Administration of local anesthesia into the spinal canal between the bony vertebral column and the dura mater (i.e., the injection does not penetrate the spinal membranes but remains above the dura). 

As indicated in Table 2.1, drugs may be injected into veins, muscles, subcutaneous tissue, arteries, or into the subarachnoid space of the spinal canal (intrathecal). For obvious reasons, intraarterial and intrathecal injections are reserved for specialized drug administration requirements, such as regional perfusion of a tumor with a toxic drug or induction of spinal anesthesia, respectively. Therefore, the more routine injection routes are intravenous (IV), intramuscular (IM), and subcutaneous (SC). Because these three modalities involve skin puncture, they carry the risks of infection, pain, and local irritation. 

Figure 3.6 During an epidural, a patient is given a strong anesthetic through an injection into the spinal canal. This allows for pain relief in the lower body (below the point of injection), while the upper body remains unaffected, allowing breathing and heart rate to continue as normal. An epidural is often used to ease the pain of childbirth.

Spinal dural arteriovenous fistulas (SDAVF) are the most frequent (acquired) AVM of the spinal canal and its meninges. In 1977 Kendall and Logue were the first to recognize that this disease, which had formerly been described as so-called retromedullary angiomas, in fact is an AV fistula situated within the dura mater. This was confirmed by Merland et al. in 1980 who pointed out the angiographic characteristics of the disease in detail (Fig. 17.6). 

In a few rare instances, lumbar puncture cannot be performed, because the amount of swelling within the skull is so great that the intracranial pressure (pressure within the skull) is extremely high. This pressure is always measured immediately upon insertion of the LP needle. If it is found to be very high, no fluid is withdrawn, because withdrawal of fluid could cause herniation of the brain stem. Herniation of the brain stem occurs when the part of the brain connecting to the spinal cord is thrust through the opening at the base of the skull into the spinal canal. Such herniation will cause com-... 

The water-soluble iodopyracet was introduced for myelography in 1931 (870). Because of the extreme irritant effects as well as occasional production of some long-term disabilities, it never gained wide use. Iodized oil Lipi-odol was used for myelography with less irritation. Its aftereffects were avoided if the oily medium was removed by aspiration from the spinal canal (871). lophendylate was introduced by Ramsey et al. (872)for myelography in 1944 and proved to be an excellent contrast medium for the entire spinal canal and the basal cisterns. Like the iodized oil, it had to be aspirated to avoid aftereffects (873). Arachnoiditis did develop in some cases in the subarachnoid space because of the presence of residual iophendylate. 

Blood, body fluids, feet, coma, lethargy, poisoning, hallucination, trance, ruling part of parathyroid, pineal, toxins, spinal canal. 

Chordoma Masses or cords of physaliphorous cells Cytokeratin (-I-) S-100 (-i-) EMA (-I-) vimentin (+) Cauda equina clivus spinal canal... 

Approximately 40% of chordomas arise in the clivus 10% arise along cervical, 2% along thoracic, and 2% along lumbar vertebrae and more than 45% arise in the sacral portions of the spinal canal. ... 

Epidermoid cysts are more common in lateral than midline sites, but they have been found in many different locations (see Table 20.13). Common locations are the cerebellopontine angle, around the pons, near the sella, within the temporal lobe, in the diploe, and in the spinal canal. Carcinoma rarely arises within an epidermoid cyst. ... 

A cyst that is located in the posterior or lateral epidural space in the spinal canal and that is lined only by fibrous tissue resembling dura and lacking arachnoid membrane is a meningeal cyst or diverticulum (see Table 20.12). A subdural or subarachnoid cyst that has a thinner wall than the epidural cyst and that protrudes toward brain or spinal cord is an arachnoid cyst. Reactivity for vimen-tin, progesterone receptors, and EMA is common. This inununoreactivity resembles that of arachnoid granulations and meningiomas. Other cysts have variable thickness and are more difficult to categorize. 

The ependymal cells are ciliated cells that line the cavities (ventricles) of the CNS and the spinal cord. In some areas of the brain, the ependymal cells are functionally specialized to elaborate and secrete cerebrospinal fluid (CSF) into the ventricular system. The beating of the ependymal cilia allow for efficient circulation of the CSF throughout the CNS. The CSF acts as both a shock absorber protecting the CNS from mechanical trauma and a system for the removal of metabolic wastes. The CSF can be aspirated from the spinal canal and analyzed to determine whether disorders of CNS function, with their characteristic CSF changes, are present. 

Fig. 7 Schematic representation of (a) the primate Papio ursinus lumbar vertebra and (b) the bone marrow biopsy needle positioning during local administration of naturally derived bone morphogenetic proteins. Insertion of the needle was monitored on X-ray image intensifier. Bottom panel sagittal representation of (a) the lumbar vertebral body and its region of interest (ROI) SC spinal canal.

When a force is applied to the posterosuperior quadrant of the head or when a crown impact is administered while the head is in flexion, the neck is subjected to a combined load of axial compression and forward bending. Anterior wedge frartures of vertebral bodies are commonly seen, but with increased load, burst fractures and fracture-dislocations of the facets can result. The latter two conditions are unstable and tend to disrupt or injure the spinal cord, and the extent of the injury depends on the penetration of the vertebral body or its fragments into the spinal canal. Recent experiments by Pin tar et al. [1989, 1990] indicate that burst fractures of lower cervical vertebrae can be reproduced in cadaveric specimens by a crown impact to a flexed cervical spine. A study by Nightingale et al. [1993] showed that fracture-dislocations of the cervical spine occur very early in the impact event (within the first 10 ms) and that the subsequent motion of the head or bending of the cervical spine cannot be used as a reliable indicator of the mechanism of injury. 

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