By Alberto Alexandre, Albino Bricolo, Hanno Millesi
The papers during this quantity summarize information regarding the newest and potent concepts for treating diffcult sensible difficulties and painful occasions through the use of minimally invasive spinal surgical procedure recommendations. Spinal endoscopy either for diagnostic and therapy reasons is gifted in addition to microsurgical operations for spinal difficulties, intradiscal concepts for the therapy of disc degenerative pathology, and dynamic stabilization recommendations including an updated overview of physiopathology of the ailments. New developments in peripheral nerve surgical procedure are provided. additionally the matter of stressful nerve lesions in several anatomical districts is analyzed with specific awareness at the topic of thoracic outlet syndrome. The posttraumatic features of this sickness are mentioned either in admire of its causative mechanisms, and its medicolegal points.
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Extra info for Advanced Peripheral Nerve Surgery and Minimal Invasive Spinal Surgery
About 12% to 20% of patients present overt neurologic signs. Sensory impairment following a particular nerve root distribution of the upper extremities, reduced motor strength of the upper extremities, and diminished reﬂexes have been described. Many patients have sensations of tingling and numbness in the hands, particularly of the ulnar two ﬁngers. These symptoms can be attributed to nerve root stretch or compression. More commonly they are C. Schenardi intermittent and aren’t associated with overt neurologic signs .
The walls of the endoneurium are entirely covered by a basal lamina which surrounds the outer plasma membrane surface of the Schwann cells, the endoneurial vessels and the perineurial cells apparently forming a stabilizing structure. Endoneurial ﬂuid circulation depends on two major forces, net hydrostatic pressure and net osmotic pressure. The lack of lymphatics in nerve fascicles might render the removal of endoneurial ﬂuid di‰cult. Perineurium creates a ﬂuid environment around the nerve ﬁbres of optimal composition for transmission of electrical impulses .
Pathophysiological mechanism When a car is hit from behind, the body, supported by the seatback and seatbelt, accelerates while the head, not supported, remains still. Thus the head actually is pushed backwards and the neck becomes hyperextended . The headrest limits excessive movements and so prevents structural damage to the column but it permits enough movement to induce the stretching of the neck muscles and brachial plexus trunks. The suspected pathophysiological mechanism is based on the fact that at the moment of the traumatic event two di¤erent, yet interrelated, events take place: 1) sudden and forceful anterior contraction of neck muscles due to their sudden and intense stretching 2) lenghtening of brachial plexus trunks to adjust to neck movement The sliding capacity of the nerve trunks inside the interscalenic space becomes limited due to muscular contraction and, consequently, two di¤erent types of nerve injury develop: 1) compression injury due to forceful muscular contraction (continued contraction) 23 2) traction injury due to limited mobility of nerve trunks at compression site.