Vertebral arteries ascend lateral to the cervical spine. Although non-contrasting tomographic studies have attempted to determine the anatomical relationship between these arteries and the spine, the presence and position of the former have yet to be clearly demonstrated. This study was thus aimed to determine the position of the vertebral arteries in relation to the midline, anterior and posterior planes of the vertebral body of each cervical vertebrae. Twenty six adult patients, without lesions that could distort normal anatomy, were employed as subjects and 52 vertebral arteries were analyzed. Two-dimensional computerized tomographies scans were conducted following the injection of an intra-venous contrast. Statistical analyses evaluated the differences between the distances of the vertebral arteries to the various cervical vertebrae. At the level of C1 and C7 the vertebral arteries were found to be farther from the midline plane (p<0.0001), compared to the other levels. The left vertebral artery was also found to be closer to the midline plane of C1 (p=0.0461) than the right artery. As these arteries ascended, greater distances from the anterior plane were verified. Finally, the vertebral arteries migrated dorsally in relation to the posterior plane, reaching significant distances at C1 (smallest distance) and C7 (greatest distance) (p<0.0001 and p<0.0001, respectivelly). The vertebral arteries, therefore, do not seem to follow a linear ascending pathway, distancing themselves from the midline plane at their upper and lower limits. Lateral, dorsal and ventral migrations were observed, in relation to the cervical vertebrae, rendering these arteries less vulnerable ventrally at C1 and at the level of the intervertebral foramina at C7

Las arterias vertebrales ascienden lateralmente a la columna vertebral. Estudios para definir las relaciones entre estos vasos y la columna han sido realizados por medio de exámenes tomográficos no contrastados, no habiendo mostrado directamente la presencia ni la posición de las arterias vertebrales. El objetivo de este estudio es mostrar la localización de las arterias vertebrales en relación a los planos medio, anterior y posterior de los cuerpos vertebrales cervicales. Se trata de un estudio anatómico descriptivo realizado con tomografías computarizadas bidimensionales, después de la inyección de contraste venoso. Se consideraron para este estudio, pacientes adultos, de ambos sexos de quienes fueron evaluadas 52 arterias vertebrales, sin lesiones estructurales que pudieran distorsionar la anatomía normal. Al final, fue efectuada una prueba estadística para evaluar diferencias en las distancias entre las arterias vertebrales y los distintos cuerpos vertebrales cervicales. Fue encontrado que en C1 y C7, las arterias vertebrales están más alejadas del plano mediano que en las demás regiones (p<0,0001). Al nivel de C1, la arteria vertebral izquierda se encuentra más cercana que la arteria vertebral derecha, con respecto al plano mediano (p=0,0461). A medida que ascienden en el cuello, las arterias vertebrales se distancian del plano anterior. Con relación al plano posterior, las arterias vertebrales realizan una migración posterior que muestra diferencia estadística en C7 y C1 (respectivamente p<0,0001 y p<0,0001). A medida que ascienden en el cuello las arterias vertebrales, no tienen trayecto rectilíneo. En los extremos superior e inferior, éstas se apartan del plano mediano. Existen migraciones laterales, posteriores y anteriores con respecto a los planos de los cuerpos vertebrales. Estos desplazamientos dejan las arterias vertebrales menos vulnerables en los abordajes anteriores en C1 y en las descompresiones de forámenes intervertebrales a nivel de C7

Relatamos caso de tratamento cirúrgico com instrumentação anterior em espondilite tuberculosa (mal de Pott), em mulher de 71 anos, que se encontrava em tratamento para tuberculose na forma pulmonar e evoluiu com dor lombar, dificuldade progressiva para deambular, cifose e disfunção vesical. A ressonância magnética revelou lesão nos corpos vertebrais de T12 e L1 com abcesso paravertebral. A paciente foi tratada cirurgicamente por acesso tóraco-abdominal lateral. Os corpos vertebrais foram ressecados, foi instalado uma gaiola vertical (mesh cage) e a coluna foi estabilizada com placa lateral (Z plate) e parafusos fixados em T11 e L2. Essa técnica permite boa artrodese dos corpos vertebrais remanescentes e boa estabilidade da coluna, sem comprometer a eficácia dos tuberculostáticos. A paciente foi avaliada um ano após a operação e não apresentava déficit motor, dor residual e a cifose foi desfeita.

We report a case of a surgical treatment with anterior instrumentation in tuberculous spondylitis (Pott's disease), in a 71 years old woman, that was in treatment for pulmonary tuberculosis, with lumbar pain, progressive disability to walk, kyphotic deformit and vesical dysfunction. Magnetic resonance image presents a lesion in the bodies of T12 and L1, with paravertebral abscess. The patient was treated surgically by transthoracic-abdominal approach. The vertebral bodies were cut off and the spine were instrumented anteriorly with a mesh cage and a Z plate. This procedure permits a good arthrodesis and a immediately stabilization of the spine, without any complication of the infection. The patient was seen a year after the surgery and is free of infection, without motor deficit, pain or reminiscent kyphosis.

Com o advento da tecnologia vídeo-assistida a endoscopia tem assumido importante papel terapêutico na cavidade torácica. Este artigo é uma avaliação crítica da literatura e tem como objetivo demonstrar o estado atual da cirurgia endoscópica direcionada para a coluna torácica. Hérnias discais, deformidades, infecções, tumores, doenças congênitas e traumatismos estão sendo tratados por técnica endoscópica. Na literatura, as vantagens sobre a toracotomia aberta são visibilidade aumentada e reduções em: tempo de recuperação, perda sanguínea, custos, índice de infecção e morbidade pós-operatória. Algumas desvantagens são: intubação seletiva, significativa curva de aprendizado, dificuldades técnicas na operação de crianças muito pequenas, reparação da dura máter e instrumentação. Embora os benefícios sejam aparentemente claros e haja pronunciado grau de entusiasmo, os autores são cautelosos em afirmar que a toracoscopia já é uma alternativa definitiva à toracotomia convencional. A comparação dos resultados entre as técnicas endoscópica e aberta é dificultada pela escassez de estudos comparativos. Os autores, embora otimistas, recomendam análises de mais estudos prospectivos, multicêntricos e randomizados para uma conclusão definitiva.

After the development of video-assisted technology, endoscopic techniques have assumed an important therapeutic role into thoracic cavity. This is a literature review article to show the current state of the endoscopy for thoracic spine. Disc herniations, deformities, infections, tumors, congenital disorders and traumatic events have been treated by endoscopic techniques. On reviewing the literature, the advantages over open approaches are: enhanced visualization, shorter recovery time and decreased blood loss, costs, infection rate and post operative morbidity. Some disadvantages are: one lung anesthesia, significant learning curve, and technical problems in operating on small children, repairing the dura and performing instrumentation. Overall benefits are apparently clear. However, despite the high degree of enthusiasm, authors are cautious to state that endoscopic techniques to the spine already represent a definitive alternative to standard techniques. Comparison between endoscopic and open approaches are still difficult because of the lack of appropriate comparative studies. Authors, although optimistic recommend more prospective, multicentric and randomized studies in order to stand a definitive conclusion.