Surgical and radiologic anatomy : SRA
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Various methods of preoperative planning have been described for the correction of spinal sagittal deformities. They are reliable on condition that the thoracolumbar spine is totally fused and enable only the simulation of pedicle subtraction osteotomy (PSO). In this study, a new theoretical planning that can be used regardless of the etiology of the deformity and the type of osteotomy is described and assessed. ⋯ The preoperative planning enables the surgeon to estimate the clinical effects of the different surgical techniques in order to choose the best procedure for a given patient.
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This study aims to report the topography of the extrapelvic part of the pudendal nerve (EPPN) and its relationship with the sacrospinous ligament and the pudendal artery. ⋯ The topographic variations of the EPPN are large and complicate its surgical and radiological approach.
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Sacral approach to epidural space produces reliable and effective block of sacral nerves. It is necessary to have a detailed knowledge of sacral hiatus (SH) for optimal access into sacral epidural space. This study was undertaken to evaluate various landmarks of SH. ⋯ Single bony landmark may not help in locating SH because of anatomical variations. Depth of hiatus less than 3 mm may be one of the causes for failure of needle insertion. Surrounding bony irregularities, different shapes of hiatus and defects in dorsal wall of sacral canal should be taken into consideration before undertaking caudal epidural block so as to avoid its failure.
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Bilateral variations in the formation and branching of brachial plexus are extremely rare. Multiple bilateral variations in brachial plexus right from divisions to branching pattern were observed during the dissection in an adult male cadaver. Lateral and medial cord formation showed deviation from the usual pattern. ⋯ Anomalous origin of many other branches on both sides was encountered. It is extremely uncommon to find so many variations in one body and bilateral variations are still too rare. Understanding of such variations is clinically important for diagnosing unexplained clinical signs and symptoms as well as during nerve blocks and certain surgical procedures around the neck and proximal arm.
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The aim was to evaluate the reliability of Tuffier's line usually used as sole method to identify lumbar spinous process for a correct needle placement. Fifty-eight cadaver specimens were placed in a lateral position and a flexion in the lumbar spine performed to achieve a neutralization of the lumbar lordosis. The iliac crests were palpated and the lumbar spinous process marked on the intercristal line with a pin; all specimens were dissected and the marked spinous process documented. ⋯ The inferior edge of the L4 spinous process was hit in male 4 times (6.90%) and in female cadavers 12 times (20.69%). In the fifth lumbar spinous process, pins were placed five times in female cadavers (8.62%) and in only one male cadaveric specimen (3.72%). In conclusion, the accuracy of the focused lumbar spinous process depends on the right bedding and the orientation of the given landmarks, so Tuffier's line stays the most important tool for anesthetists if palpation is performed very precisely.