Virgilio Matheus MD FACS Orlando Health Neurosurgery Anatomy Coronal Sagittal Anatomy Anatomy Anatomy Dermatomes Thoracic Spine Pathology Common radiological terms ID: 1036107
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1. THORACIC SPINE Principles and pathologyVirgilio Matheus, MD, FACSOrlando Health Neurosurgery
2. AnatomyCoronal Sagittal
3. Anatomy
4. Anatomy
5. Anatomy- Dermatomes
6. Thoracic Spine PathologyCommon radiological termsSpondylosis: (aka osteoarthritis) refers to degenerative changes of the spinal stuctures )discs, facets, vertebral bodies). Very vague term and number one source of non surgical back painSpondylolisthesis: Refers to slippage of one vertebrae over another. Can be forward (antero) or posterior (retro) and is graded I-IV being I the mildest. Several etiologies. Foraminal stenosis: stricture of the foramen from where nerve roots exit the spine, leads to radiculopathy.Central canal stenosis: thoracic leads to compression of the spinal cord (myelopathy). Can be due to bulging discs, facet hypertrophy, osteophytes and/or thickened ligamentum flavum, tumors, abscess, fractures, hematoma
7. Thoracic Spine PathologyCommon radiological termsScoliosis: refers to curvature of the spine (> 10 degrees Cobb angle). Most common in adults is degenerative. Myelomalacia: refers to spinal cord signal changes on MRI. Usually represents contusions of the spinal cord Syringomyelia: cystic formation within the spinal cordDisc dessication: aged disc, doesn’t imply stenosis of any kind
8. Thoracic Spine PathologyCongenitalDegenerativeTraumaTumorInfectionInflammatoryVascular
9. Thoracic Spine PathologyCongenitalScoliosisDyastematomyeliaSpinal stenosis (epidural lipomatosis, short pedicle syndrome)Dysraphism (dermoid cyst)Tethered spinal cord
10. Thoracic Spine PathologyDegenerativeScoliosisStenosis
11. Thoracic Spine PathologyTraumaFracturesSubluxationsCompressionScoliosis
12. Thoracic Spine PathologyTumorPrimary vs. metastaticEpidural vs. intraduralIntramedullary vs. extramedullary
13. Thoracic Spine PathologyInfectionDiscitisOsteomyellitisEpidural abscess
14. Thoracic Spine PathologyInflammatoryHyperkyphosis (Scheuermann’s kyphosis)Ankylosing spondylitisRheumatoid arthritisDISHOPLL
15. Thoracic Spine PathologyVascularDural A-V fistulaArterio-venous malformationsSpinal infarct
16. Thoracic Spine PathologyTreatment optionsCongenital bracing-surgeryDegenerative PT-Pain Management-SurgeryTrauma bracing- surgeryTumor XRT- chemo- surgeryInfection Abx- surgeryInflammatory Immunotherapy-PT-surgeryVascular embolization-XRT-surgery
17. Conservative options:Multimodal pain managementPhysical therapyBracing
18. Thoracic pathology surgical options Surgical tools include: hooks, wiring, bands, screws, rods, cages, spacersSurgical techniques include: Laminectomies, corpectomies, Osteotomy : Ponte, Smith-Peterson, Pedicle substraction, Vertebral body resectionRod manipulation: derotation, cantilever, in situ bending
19. Thoracic pathology treatmentSurgical options:Focal decompressionShort segment stabilizationDeformity correction
20. THANKS