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Journal of Neuro-oncology Jun 2018The spine is the third most common site for distant metastasis in cancer patients with approximately 70% of patients with metastatic cancer having spinal involvement.... (Review)
Review
The spine is the third most common site for distant metastasis in cancer patients with approximately 70% of patients with metastatic cancer having spinal involvement. Positron emission tomography (PET), combined with computed tomography (CT) or magnetic resonance imaging (MRI), has been deeply integrated in modern clinical oncology as a pivotal component of the diagnostic work-up of patients with cancer. PET is able to diagnose several neoplastic processes before any detectable morphological changes can be identified by anatomic imaging modalities alone. In this review, we discuss the role of PET/CT and PET/MRI in the diagnostic management of non-osseous metastatic disease of the spinal canal. While sometimes subtle, recognizing such disease on FDG PET/CT and PET/MRI imaging done routinely in cancer patients can guide treatment strategies to potentially prevent irreversible neurological damage.
Topics: Humans; Magnetic Resonance Imaging; Multimodal Imaging; Positron-Emission Tomography; Spinal Canal; Spinal Neoplasms; Tomography, X-Ray Computed
PubMed: 29484521
DOI: 10.1007/s11060-018-2794-8 -
AJNR. American Journal of Neuroradiology Sep 2019Quantitative imaging biomarkers have not been established for the diagnosis of spinal canal stenosis. This work aimed to lay the groundwork to establish such biomarkers...
BACKGROUND AND PURPOSE
Quantitative imaging biomarkers have not been established for the diagnosis of spinal canal stenosis. This work aimed to lay the groundwork to establish such biomarkers by leveraging the developments in machine learning and medical imaging informatics.
MATERIALS AND METHODS
Machine learning algorithms were trained to segment lumbar spinal canal areas on axial views and intervertebral discs on sagittal views of lumbar MRIs. These were used to measure spinal canal areas at each lumbar level (L1 through L5). Machine-generated delineations were compared with 2 sets of human-generated delineations to validate the proposed techniques. Then, we use these machine learning methods to delineate and measure lumbar spinal canal areas in a normative cohort and to analyze their variation with respect to age, sex, and height using a variable-intercept mixed model.
RESULTS
We established that machine-generated delineations are comparable with human-generated segmentations. Spinal canal areas as measured by machine are statistically significantly correlated with height ( < .05) but not with age or sex.
CONCLUSIONS
Our machine learning methodology demonstrates that this important anatomic structure can be accurately detected and quantitatively measured without human input in a manner comparable with that of human raters. Anatomic deviations measured against the normative model established here could be used to flag spinal stenosis in the future.
Topics: Adult; Aged; Female; Humans; Lumbar Vertebrae; Machine Learning; Magnetic Resonance Imaging; Male; Middle Aged; Reference Values; Spinal Canal; Spinal Stenosis
PubMed: 31467240
DOI: 10.3174/ajnr.A6174 -
Current Medical Imaging 2021The two of the most common indications for magnetic resonance (MR) imaging of the cervical spine include acute spine trauma and degenerative disease.
BACKGROUND
The two of the most common indications for magnetic resonance (MR) imaging of the cervical spine include acute spine trauma and degenerative disease.
OBJECTIVE
We aimed to correlate the measurements of the free area of the spinal canal (FASC), a new approach to the cervical spinal canal compromise, with the Torg´s ratio quantification of the cervical spine.
METHODS
A cross-sectional study including 50 cervical-spine MR evaluations of patients with acute cervical trauma or degenerative disease was performed. We used multivariate analysis of covariance (MANCOVA) to identify the type of lesion, intervertebral level and gender differences between FASC and Torg´s ratio quantification of the cervical spine; age was the controlled covariate. Correlates between FASC and Torg´s ratio were obtained at each intervertebral level.
RESULTS
There was a non-significant interaction between the type of lesion, gender and intervertebral levels between FASC and Torg´s ratio measurements, F (8, 456) 0.260, p = .978; Wilks' Lambda 0.991; with a small effect size (partial η = .005). Among the main effects, only the gender was statistically significant: F (2, 228) = 3.682, p = .027. The age (controlled covariate) was non-significantly related to FASC and Torg´s ratio quantification: F (2, 228) = .098, p = .907. The Pearson´s correlation coefficient depicted a poor, non-significant agreement between FASC and Torg´s ratio.
CONCLUSION
FASC provides an integrative evaluation of the cervical spinal canal compromise in acute, cervical spine trauma and degenerative disease. Further observations and correlation with specific neurological symptoms, surgical findings and clinical outcomes are necessary to assess the usefulness of FASC in clinical settings.
Topics: Cervical Vertebrae; Cross-Sectional Studies; Humans; Magnetic Resonance Imaging; Spinal Canal; Spinal Stenosis
PubMed: 32684153
DOI: 10.2174/1573405616666200720002059 -
Medicina 2023
Topics: Humans; Exostoses, Multiple Hereditary; Spinal Canal
PubMed: 37379552
DOI: No ID Found -
British Journal of Neurosurgery Apr 2019Several cervical laminectomy techniques have been described. One commonly used method involves making bilateral trough laminotomies using either a Kerrison rongeur or a...
BACKGROUND
Several cervical laminectomy techniques have been described. One commonly used method involves making bilateral trough laminotomies using either a Kerrison rongeur or a high speed burr, and then removing the lamina en-bloc. Alternatively, some surgeons prefer to thin the lamina with the burr, and then remove the lamina in a piecemeal fashion using Kerrison rongeurs. Some surgeons have warned against the potential risk of iatrogenic spinal cord injury from inserting the Kerrison footplate into a stenotic canal. We aim to quantify the amount of canal encroachment for various methods of cervical laminectomies.
METHODS
Three attending spine surgeons and two fellows each performed laminectomies using C5 sawbones models. The canal was completely filled with modeling putty to simulate a stenotic spinal cord. Bilateral trough laminotomies were performed using a 1 mm Kerrison, a 2 mm Kerrison, and a 3 mm matchstick high-speed burr. Piecemeal laminectomies were performed with a 2 mm Kerrison. A blinded spine surgery fellow performed all quantitative measurements. Three blinded researchers qualitatively ranked the amount of "canal encroachment".
RESULTS
The average canal encroachment was 0.50 ± 0.45mm for the burr, 1.37 ± 0.68 mm for the 1 mm Kerrison, and 1.47 ± 0.37 mm for the 2 mm Kerrison (p = .002). There was a statistically significant difference between the burr and 1 mm Kerrison (p = .01) and between the burr and the 2 mm Kerrison (p = .001). There was no statistical difference between the 1 mm and 2 mm Kerrison (p = .78). The mean rank of the burr group, the Kerrison rongeur group, and the piecemeal group were 1.41, 1.94, and 2.65, respectively, on an ordinal scale of 1-3.
CONCLUSION
When performing a trough laminotomy, the high-speed burr results in less canal encroachment compared to 1 mm or 2 mm Kerrison rongeurs. In the setting of a stenotic spinal canal, spine surgeons should consider using the burr to perform laminectomy to minimize the degree of canal encroachment.
Topics: Cervical Vertebrae; Decompression, Surgical; Equipment Design; Humans; Laminectomy; Models, Anatomic; Neurosurgical Procedures; Risk; Spinal Canal; Spinal Cord Injuries; Spinal Stenosis; Surgeons; Surgical Instruments
PubMed: 30681374
DOI: 10.1080/02688697.2018.1559274 -
Journal of Neurosurgery. Spine Jan 2021Whereas the benefits of indirect decompression after lateral lumbar interbody fusion are well known, the effects of anterior lumbar interbody fusion (ALIF) have not yet...
OBJECTIVE
Whereas the benefits of indirect decompression after lateral lumbar interbody fusion are well known, the effects of anterior lumbar interbody fusion (ALIF) have not yet been verified. The purpose of this study was to evaluate the clinical and radiological effects of indirect decompression after ALIF for central spinal canal stenosis. In this report, along with the many advantages of the anterior approach, the authors share cases with good outcomes that they have encountered.
METHODS
The authors performed a retrospective analysis of 64 consecutive patients who underwent ALIF for central spinal canal stenosis with instability and mixed foraminal stenosis between January 2015 and December 2018 at their hospital. Clinical assessments were performed using the visual analog scale score, the Oswestry Disability Index, and the modified Macnab criteria. The radiographic parameters were determined from pre- and postoperative cross-sectional MRI scans of the spinal canal and were compared to evaluate neural decompression after ALIF. The average follow-up period was 23.3 ± 1.3 months.
RESULTS
All clinical parameters, including the visual analog scale score, Oswestry Disability Index, and modified Macnab criteria, improved significantly. The mean operative duration was 254.8 ± 60.8 minutes, and the intraoperative bleeding volume was 179.8 ± 119.3 ml. In the radiological evaluation, radiological parameters of the cross-sections of the spinal canal showed substantial development. The spinal canal size improved by an average of 43.3% (p < 0.001) after surgery. No major complications occurred; however, aspiration guided by ultrasonography was performed in 2 patients because of a pseudocyst and fluid collection.
CONCLUSIONS
ALIF can serve as a suitable alternative to extensive posterior approaches. The authors suggest that ALIF can be used for decompression in central spinal canal stenosis as well as restoration of the foraminal dimensions, thus allowing decompression of the nerve roots.
Topics: Adult; Aged; Constriction, Pathologic; Cross-Sectional Studies; Decompression, Surgical; Female; Humans; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Aged; Radiography; Spinal Canal; Spinal Fusion; Spinal Stenosis
PubMed: 33450734
DOI: 10.3171/2020.7.SPINE191335 -
Nagoya Journal of Medical Science Aug 2022Although decompression surgery for lumbar spinal canal stenosis (LSS) improves leg symptoms, low back pain (LBP), and disability, the factors related to the improvement...
Relationship between changes in physical function parameters and Roland-Morris disability questionnaire score after decompression surgery for lumbar spinal canal stenosis.
Although decompression surgery for lumbar spinal canal stenosis (LSS) improves leg symptoms, low back pain (LBP), and disability, the factors related to the improvement of subjective disability have not been studied sufficiently. The purpose of the study was to clarify the relationship between subjective disability and objective physical function parameters. A total of 51 patients who underwent decompression were included and evaluated preoperatively and 6 and 12 months postoperatively. Patient-reported outcomes related to activity limitation due to LBP were evaluated using Roland-Morris disability questionnaire (RDQ) and VAS (Visual Analog Scale). Physical function was assessed using 6-min walk distance (6MWD) and trunk muscle strength. Univariate analysis and multivariable linear regression analysis were performed to identify significant factors for RDQ score change. The 6- and 12-month postoperative RDQ scores, VAS scores, and trunk extensor strength significantly improved relative to the preoperative values. In the univariate analysis, age, changes in VAS (LBP, leg pain, and numbness) scores, and change in 6MWD were associated with the RDQ score change ( < 0.05). Multivariable linear regression showed that 6MWD changes were significantly associated with RDQ score changes, explaining 41% of the variance in the RDQ score change. This study showed the change in 6MWD was significantly associated with the RDQ score change. Our results suggest that improving 6MWD may reduce disability in activities of daily living.
Topics: Activities of Daily Living; Constriction, Pathologic; Decompression, Surgical; Humans; Lumbar Vertebrae; Spinal Canal; Spinal Stenosis; Surveys and Questionnaires; Treatment Outcome
PubMed: 36237893
DOI: 10.18999/nagjms.84.3.570 -
The Spine Journal : Official Journal of... Oct 2020While burst fracture is a well-known cause of spinal canal occlusion with dynamic, axial spinal compression, it is unclear how such loading mechanisms might cause...
BACKGROUND CONTEXT
While burst fracture is a well-known cause of spinal canal occlusion with dynamic, axial spinal compression, it is unclear how such loading mechanisms might cause occlusion without fracture.
PURPOSE
To determine how spinal canal occlusion during dynamic compression of the lumbar spine is differentially caused by fracture or mechanisms without fracture and to examine the influence of spinal level on occlusion.
STUDY DESIGN
A cadaveric biomechanical study.
METHODS
Twenty sets of three-vertebrae specimens from all spinal levels between T12 and S1 were subjected to dynamic compression using a hydraulic loading apparatus up to a peak velocity between 0.1 and 0.9 m/s. The presence of canal occlusion was measured optically with a high-speed camera. This was repeated with incremental increases of 4% compressive strain until a vertebral fracture was detected using acoustic emission measurements and computed tomographic imaging.
RESULTS
For axial compression without fracture, the peak occlusion (O) was 29.9±10.0%, which was deduced to be the result of posterior bulging of the intervertebral disc into the spinal canal. O correlated significantly with lumbar spinal level (p<.001), the compressive displacement (p<.001) and the cross-sectional area of the vertebra (p=.031).
CONCLUSIONS
Spinal canal occlusion observed without vertebral fracture involves intervertebral disc bulging. The lower lumbar spine tended to be more severely occluded than more proximal levels.
CLINICAL SIGNIFICANCE
Clinically, intermittent canal occlusion from disc bulging during dynamic compression may not show any radiographic features. The lower lumbar spine should be a focus of injury prevention intervention in cases of high-rate axial compression.
Topics: Biomechanical Phenomena; Humans; Lumbar Vertebrae; Lumbosacral Region; Spinal Canal; Spinal Fractures
PubMed: 32442519
DOI: 10.1016/j.spinee.2020.05.095 -
The Spine Journal : Official Journal of... Sep 2023Pedicle screws are widely used in spinal surgeries. Pedicle screw fixation has shown better clinical effects than other techniques by providing steady fixation from the...
BACKGROUND CONTEXT
Pedicle screws are widely used in spinal surgeries. Pedicle screw fixation has shown better clinical effects than other techniques by providing steady fixation from the posterior arch to the vertebral body. However, there are several concerns about the impact of pedicle screw instrumentation insertion on vertebral development in young children, including early closure of the neurocentral cartilage (NCC). The effect of pedicle screw insertion in an early age on further growth of the upper thoracic spine is still unclear.
PURPOSE
This study aimed to evaluate the impact of pedicle screw insertion on further growth of the upper thoracic vertebra and spinal canal.
STUDY DESIGN
A retrospective case study.
PATIENT SAMPLE
Twenty-eight patients.
OUTCOME MEASUREMENTS
X-ray and CT parameters including length, height and area of the vertebrae and spinal canal were manually measured.
METHODS
Twenty-eight patients who underwent pedicle screw fixation (T1-T6) before the age of 5 years from March 2005 to August 2019 at Peking Union Medical College Hospital were recruited, and records were retrospectively reviewed. Vertebral body and spinal canal parameters were measured at instrumented and adjacent noninstrumented levels and compared using statistical methods.
RESULTS
Ninety-seven segments met the inclusion criteria (average age at instrumentation 44.57 months, range from 23-60 months). Thirty-nine segments had no screws, and 58 had at least one screw. There was no significant difference between the preoperative and final follow-up values of the measurement of vertebral body parameters. No significant difference was observed between the growth rates in levels with or without screws in pedicle length, vertebral body diameter, or spinal canal parameters.
CONCLUSION
Pedicle screw instrumentation in the upper thoracic spine does not cause a negative effect on the development of the vertebral body and spinal canal in children younger than 5 years old.
Topics: Child; Humans; Child, Preschool; Infant; Pedicle Screws; Retrospective Studies; Thoracic Vertebrae; Spinal Canal; Radiography; Spinal Fusion; Treatment Outcome
PubMed: 37209967
DOI: 10.1016/j.spinee.2023.05.004 -
World Neurosurgery Feb 2021Evaluation of lumbar canal dimensions in a Chicago population born in 2 different decades.
OBJECTIVE
Evaluation of lumbar canal dimensions in a Chicago population born in 2 different decades.
METHODS
This is a retrospective chart review analyzing computed tomography reconstruction from patients born between 1940 and 1949 (older group) and 1970 and 1979 (younger group). The cross-sectional area (CSA) and anterior-posterior diameter (APD) of the lumbar bony canal was measured at each lumbar level at the level of the pedicle.
RESULTS
Our study includes 918 patients, 372 in the young group and 546 in the older group. Older patients have significantly larger CSA and APD at all lumbar levels compared with younger patients. Further, CSA and APD comparisons between ethnicities demonstrate significant differences between individuals of Caucasian, Asian, Hispanic, African American, and Other ethnicities. Lastly, there were no differences in CSA or APD compared with factors known to affect bone health (smoking, steroid use, osteoporosis, cancer history).
CONCLUSIONS
As seen in European cohorts, our data suggest that patients born in the 1940s have both larger canal area and larger anterior-posterior diameter compared with the younger generation. These data suggest that significant differences exist between ethnicities. These differences highlight the importance of studying normal anatomical dimensions within different geographical populations and the importance of studying non-modifiable factors as they relate to spinal dimensions and spine patients. Furthermore, spinal canal growth seems to be negatively influenced in younger generations, a rather unexpected but worrying finding.
Topics: Adult; Black or African American; Aged; Asian; Cohort Effect; Female; Glucocorticoids; Hispanic or Latino; Humans; Lumbar Vertebrae; Male; Middle Aged; Neoplasms; Organ Size; Osteoporosis; Reference Values; Smoking; Spinal Canal; United States; White People
PubMed: 33212280
DOI: 10.1016/j.wneu.2020.11.039