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Medicina (Kaunas, Lithuania) Sep 2022Background and Objectives: In the literature, spinal navigation and robot-assisted surgery improved screw placement accuracy, but the majority of studies only...
Background and Objectives: In the literature, spinal navigation and robot-assisted surgery improved screw placement accuracy, but the majority of studies only qualitatively report on screw positioning within the vertebra. We sought to evaluate screw placement accuracy in relation to a preoperative trajectory plan by three-dimensional quantification to elucidate technical benefits of navigation for lumbar pedicle screws. Materials and Methods: In 27 CT-navigated instrumentations for degenerative disease, a dedicated intraoperative 3D-trajectory plan was created for all screws. Final screw positions were defined on postoperative CT. Trajectory plans and final screw positions were co-registered and quantitatively compared computing minimal absolute differences (MAD) of screw head and tip points (mm) and screw axis (degree) in 3D-space, respectively. Differences were evaluated with consideration of the navigation target registration error. Clinical acceptability of screws was evaluated using the Gertzbein−Robbins (GR) classification. Results: Data included 140 screws covering levels L1-S1. While screw placement was clinically acceptable in all cases (GR grade A and B in 112 (80%) and 28 (20%) cases, respectively), implanted screws showed considerable deviation compared to the trajectory plan: Mean axis deviation was 6.3° ± 3.6°, screw head and tip points showed mean MAD of 5.2 ± 2.4 mm and 5.5 ± 2.7 mm, respectively. Deviations significantly exceeded the mean navigation registration error of 0.87 ± 0.22 mm (p < 0.001). Conclusions: Screw placement was clinically acceptable in all screws after navigated placement but nevertheless, considerable deviation in implanted screws was noted compared to the initial trajectory plan. Our data provides a 3D-quantitative benchmark for screw accuracy achievable by CT-navigation in routine spine surgery and suggests a framework for objective comparison of screw outcome after navigated or robot-assisted procedures. Factors contributing to screw deviations should be considered to assure optimal surgical results when applying navigation for spinal instrumentation.
Topics: Humans; Lumbar Vertebrae; Pedicle Screws; Retrospective Studies; Spinal Fusion; Spine; Tomography, X-Ray Computed
PubMed: 36143877
DOI: 10.3390/medicina58091200 -
Forensic Sciences Research 2022This study sought to provide an up-to-date review of the importance of anatomy to human identification, focusing on the usefulness of anatomical knowledge about the head... (Review)
Review
This study sought to provide an up-to-date review of the importance of anatomy to human identification, focusing on the usefulness of anatomical knowledge about the head and neck bones and teeth to sex estimation in routine forensic anthropology methods. A detailed search of osteology applications in forensic sex estimation was conducted through the electronic databases for the 10 years prior to July 2020. Relevant articles and classic literature on the subject were gathered and are outlined in this review. Among the available literature, several metric analyses showed accuracy superior to 80% in sexual diagnosis. Angles measured from the inclination of glabellae and analysis of the external frontal bone surface through three-dimensional computer-aided design emerge as reliable cranial indexes for sex estimation. In the mandible, the condylar and coronoid height, bigonial width, and coronion-gonion distance express significant sexual dimorphism. Measurements of the canine are the best option for sex estimation using teeth, as well as the thickness of the dentine or enamel of incisors. The axis vertebra surpasses other neck bones for sex estimation due to its atypical shape and the presence of the odontoid process. Metric analyses based on anatomy can provide reliable accuracy in sexual diagnosis. Adequate training and anatomical knowledge can reduce bias and interobserver differences, and the use of three-dimensional models and computed tomography images can enhance the accuracy of these methods for sex estimation. However, every method should be validated before being applied to a different population. Key Points• Anatomy-based metric analyses can provide reliable accuracy in forensic sex estimation. • Glabellae inclination, external frontal bone surface, mandible, and canine teeth measurements can reach accuracies superior to 80% in sexual diagnosis.• The use of three-dimensional models and computed tomography images can enhance accuracy in sex estimation.• Every method should be validated before being applied to a different population.
PubMed: 35341126
DOI: 10.1080/20961790.2021.1889136 -
Orthopaedic Surgery Feb 2022This study sought to investigate and evaluate a modified axial translaminar screw fixation for treating odontoid fractures. We performed a retrospective study at Wenzhou...
This study sought to investigate and evaluate a modified axial translaminar screw fixation for treating odontoid fractures. We performed a retrospective study at Wenzhou Medical University Affiliated Second Hospital between March 2016 and June 2018. We retrospectively collected and analyzed the medical records of 23 cases with odontoid fractures. All patients were identified as type II odontoid fractures without neurological deficiency and serious diseases following the classification of Anderson. The average age, gender ratio, and body mass index (BMI) were 54.3 ± 11.1 years, 12 men to 11 women, and 22.6 ± 2.4 kg/m , respectively. Patients in this study accepted screw fixation using our modified axial translaminar screw fixation combined with atlas pedicle or lateral mass screw fixation. Within the technique, a small cortical "window" was dug in the middle of the axial contralateral lamina, such that the screws in the lamina were visualized to prevent incorrectly implanting the posterior spinal canal through the visualized "window." A total of 46 bone screws were accurately inserted into the axial lamina without using fluoroscopy. The length of all translaminar screws ranged between 26 and 30 mm, while the diameter was 3.5 mm. During the follow-up survey, the visual analog scale (VAS) and neck disability index (NDI) were measured. We provide a simple modification of Wright's elegant technique with the addition of "visualized windows" at the middle of the axial lamina. In all patients, screws were inserted accurately without bony breach and the screw angle was 56.1 ± 3.0°. Mean operative time was 102 ± 28 min with an average blood loss of 50 ± 25 mL. Postoperative hemoglobin and mean length of hospital stay were 12.0 ± 1.4 g/dL and 10.4 ± 3.4 days, respectively. The average follow-up time of all cases was 14.7 months and no internal fixation displacement, loosening, or breakage was found. All patients with odontoid fractures reported being satisfied with the treatment during the recheck period and good clinical outcomes were observed. At 1, 6, and 12 months, NDI and VAS showed that the symptoms of neck pain and limitations of functional disability improved significantly during follow-up. Our results suggest that the modified translaminar screw fixation technique can efficiently treat Anderson type II odontoid fracture, followed by the benefits of less soft tissue dissection, simple operation, no fluoroscopy, and accurate placement of screws.
Topics: Adult; Aged; Bone Screws; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Odontoid Process; Retrospective Studies; Spinal Fractures; Spinal Fusion; Treatment Outcome
PubMed: 34914198
DOI: 10.1111/os.13012 -
Scientific Reports Jul 2023Severe injury occurs in the lung after acute spinal cord injury (ASCI) and autophagy is inhibited. However, rapamycin-activated autophagy's role and mechanism in lung...
Severe injury occurs in the lung after acute spinal cord injury (ASCI) and autophagy is inhibited. However, rapamycin-activated autophagy's role and mechanism in lung injury development after ASCI is unknown. Preventing lung injury after ASCI by regulating autophagy is currently a valuable and unknown area. Herein, we aimed to investigate the effect and possible mechanism of rapamycin-activated autophagy on lung damage post-ASCI. An experimental animal study of rapamycin's effect and mechanism on lung damage after ASCI. We randomly divided 144 female wild-type Sprague-Dawley rats into a vehicle sham group (n = 36), a vehicle injury group (n = 36), a rapamycin sham group (n = 36), and a rapamycin injury group (n = 36). The spine was injured at the tenth thoracic vertebra using Allen's method. At 12, 24, 48, and 72 h after surgery, the rats were killed humanely. Lung damage was evaluated via pulmonary gross anatomy, lung pathology, and apoptosis assessment. Autophagy induction was assessed according to LC3, RAB7, and Beclin 1 levels. ULK-1, ULK-1 Ser555, ULK-1 Ser757, AMPK α and AMPK β1/2 were used to investigate the potential mechanism. After rapamycin pretreatment, the lung showed no obvious damage (e.g., cell death, inflammatory exudation, hemorrhage, and pulmonary congestion) at 12 h and 48 h after injury and Beclin1, LC3 and RAB7 levels increased. After rapamycin pretreatment, ULK-1, ULK-1 Ser555, and ULK-1 Ser757 levels increased at 12 h and 48 h after injury compared with the vehicle group, but they decreased at 12 h after injury compared with the rapamycin sham group. After rapamycin pretreatment, AMPKα levels did not change significantly before and after injury; however, at 48 h after injury, its level was elevated significantly compared with that in the vehicle group. Rapamycin can prevent lung injury after ASCI, possibly via upregulation of autophagy through the AMPK-mTORC1-ULK1 regulatory axis.
Topics: Female; Animals; Rats; Lung Injury; AMP-Activated Protein Kinases; Rats, Sprague-Dawley; Spinal Cord Injuries; Beclin-1; Excipients; Sirolimus; Thoracic Vertebrae
PubMed: 37393367
DOI: 10.1038/s41598-023-37884-6 -
Global Spine Journal Sep 2022A retrospective study.
STUDY DESIGN
A retrospective study.
OBJECTIVE
To investigate the effect of pedicle subtraction osteotomy (PSO) level on the surgical outcomes in ankylosing spondylitis-related thoracolumbar kyphosis with the same curve pattern.
METHODS
ankylosing spondylitis (AS) patients with thoracolumbar kyphosis, who underwent 1-level lumbar PSO between March 2006 and June 2017, were retrospectively reviewed. Criteria for curve-matched thoracolumbar kyphosis were: (1) have same level of preoperative apex (pre-apex); (2) have similar global kyphosis (GK, the angle between the superior/inferior endplate of the maximally tilted upper and lower end vertebra) (the difference of GK less than 15˚). The radiographic parameters measured were sagittal vertical axis (SVA, the horizontal distance between the C7 plumb line and the posterosuperior corner of the S1), GK, thoracic kyphosis (TK, the angle between the T5 superior endplate and the T12 inferior endplate), lumbar lordosis (LL, the angle between the L1 and S1 superior endplate), sacral slope (SS, the angle between the sacral endplate and the horizontal line), pelvic tilt (PT, the angle between the vertical and the line joining the midpoint of the sacral plate and hip axis), and pelvic incidence (PI, the angle between the line vertical to the superior margin of S1 and the line connecting the sacral plate midpoint with the hip joint axis). All of these parameters and health-related quality of life (HRQoL, evaluated by preoperative and the last follow-up questionnaires including ODI and VAS) scores were collected before surgery and at the last follow-up. According to their osteotomy level, patients were devided into 2 sub-groups (L1 group and L2 group), and differences of these mentioned parameters between 2 groups were compared.
RESULTS
26 curve-matched patients were recruited with a mean follow-up of 37.2 months. All patients improved significantly after surgery in HRQoL scores (VAS 1.6 vs 5.4, < 0.001; ODI 11.9 vs 26.4, < 0.001). Except for TK and PI, those radiographic parameters were also observed to be significantly changed after surgery. Compared to L2 group, PSO at L1 may have larger correction of TK (ΔTK -6.8 vs -0.3°, = 0.164), PI (ΔPI -7.4 vs -0.7°, = 0.364) and smaller correction of SVA (ΔSVA -105.3 vs -128.5 mm, = 0.096), LL (ΔLL -31.1 vs -43.0°, = 0.307) and SS (ΔSS 6.9 vs 12.2°, = 0.279) but had no statistical significance.
CONCLUSION
The results of this investigation showed that in AS-related thoracolumbar kyphosis patients with the same curve pattern, the different levels of osteotomy had little effect on the improvement of surgical outcomes. However, osteotomy at L2 is more likely to obtain a larger correction of SVA compared to osteotomy at L1.
PubMed: 33648363
DOI: 10.1177/2192568220980716 -
Is it meaningful and necessary to avoid the seventh cervical vertebra in long level cervical fusion?Turkish Neurosurgery Nov 2023Posterior cervical fusion (PCF) and decompression procedures, which are increasingly performed, can cause multilevel degenerative cervical pathologies or deformities...
AIM
Posterior cervical fusion (PCF) and decompression procedures, which are increasingly performed, can cause multilevel degenerative cervical pathologies or deformities secondary to advanced age. Therefore, while considering the surgical site for multilevel PCF, the inclusion of the C7 vertebra can cause a dilemma. In this study, the clinical and radiological results of patients who underwent multilevel PCF with different end levels (C6 or C7) were compared.
MATERIAL AND METHODS
We collected radiographs and clinical results of all subjects who underwent level 3 or more PCF for degenerative disease from May 2012 to December 2020. Based on the location of the end of fusion during surgery, patients were divided into C6 (group 1) and C7 patients (group 2). The clinical and radiological results of both groups were compared over two years.
RESULTS
A total of 52 patients met the criteria of this study (21 in group 1 and 31 in group 2). The clinical results demonstrated a statistically significant difference with respect to a lower neck visual analog scale score in group 1 than in group 2 at the last follow-up (p=0.03). With regard to the radiological results, the C2-C7 sagittal vertical axis showed significantly greater values in group 2 than in group 1 at the final follow-up (p=0.02). For thoracic kyphosis (TK), group 2 had lower TK values than group 1 (p=0.03), and the T9 spinopelvic inclination was significantly greater in group 2 than in group 1 (p=0.01).
CONCLUSION
In this study, aggravation of cervical kyphosis and neck pain was observed when C7 was included in multilevel PCF surgery. The inclusion of C7 also affected the thoracolumbar parameters and global spine alignment.
PubMed: 38874250
DOI: 10.5137/1019-5149.JTN.44294-23.3 -
Cureus Apr 2023Introduction The mesopancreas is described as a triangle formed by the superior mesenteric vein, celiac axis (CA), and superior mesenteric artery (SMA). It is the most...
Introduction The mesopancreas is described as a triangle formed by the superior mesenteric vein, celiac axis (CA), and superior mesenteric artery (SMA). It is the most likely site of residual cancer and local recurrence after surgical resection, making it the key site of the current radical resection of pancreatic head cancer. The surgical anatomy of the mesopancreas triangle has not been studied in detail. Furthermore, to the best of our knowledge, no information is available on the impact of obesity on the anatomy of the mesopancreas triangle. Methods Between January 2016 and August 2016, 200 consecutive triple-phase computed tomography scans of the abdomen were performed and included in this retrospective study aiming to define the anatomical relation of the left renal vein (LRV) to the root of the SMA and focusing on the relevance of the LRV as a landmark to guidance for the dissection of the mesopancreas. Furthermore, by studying six surgically relevant anatomical parameters namely the thickness of the areolar tissue separating the LRV from the root of the SMA, IVC from the root of the SMA, the left adrenal vein (LAV) from the root of the SMA, splenic vein from the aorta, and CA from the SMA at two levels, we investigated the impact of obesity on the mesopancreas anatomy. Results The mean distance from the upper border of the LRV to the root of the SMA (LRV-SMA distance) was 2.3 ± 5.4 mm. There was no correlation between this distance and patient's age ( = -0.02), height ( = -0.07), BMI ( = -0.01), visceral fat area ( = -0.04), or abdominal circumference ( = -0.02). There was no correlation between the distance from the IVC to the root of the SMA, and patient's age ( = 0.01), height ( = 0.11), BMI ( = 0.15), or abdominal circumference ( = 0.00). However, there was a negligible correlation between the IVC-SMA distance and patient's visceral fat area ( = 0.15, = 0.036). Conclusion In the current study, the LRV was reliably identified in more than 99% of the studied patients, and in 96% of patients, the LRV crosses anterior to the aorta at the level of the second lumbar vertebra, making it easily accessible following mobilization of the duodenum and the head of the pancreas. The relationship between the LRV and SMA remains unchanged following Kocherization. Most importantly, we demonstrated that the LRV-SMA distance does not correlate with patient's age, height, BMI, visceral fat area, or abdominal circumference. This makes the LRV a reliable landmark in both obese and non-obese patients.
PubMed: 37091486
DOI: 10.7759/cureus.37806 -
Scientific Reports Mar 2021Analysis of scoliosis requires thorough radiographic evaluation by spinal curvature estimation to completely assess the spinal deformity. Spinal curvature estimation...
Analysis of scoliosis requires thorough radiographic evaluation by spinal curvature estimation to completely assess the spinal deformity. Spinal curvature estimation gives orthopaedic surgeons an idea of severity of spinal deformity for therapeutic purposes. Manual intervention has always been an issue to ensure accuracy and repeatability. Computer assisted systems are semi-automatic and is still influenced by surgeon's expertise. Spinal curvature estimation completely relies on accurate identification of required end vertebrae like superior end-vertebra, inferior end-vertebra and apical vertebra. In the present work, automatic extraction of spinal information central sacral line and medial axis by computerized image understanding system has been proposed. The inter-observer variability in the anatomical landmark identification is quantified using Kappa statistic. The resultant Kappa value computed between proposed algorithm and observer lies in the range 0.7 and 0.9, which shows good accuracy. Identification of the required end vertebra is automated by the extracted spinal information. Difference in inter and intra-observer variability for the state of the art computer assisted and proposed system are quantified in terms of mean absolute difference for the various types (Type-I, Type-II, Type-III, Type-IV, and Type-V) of scoliosis.
Topics: Adolescent; Humans; Image Interpretation, Computer-Assisted; Scoliosis; Spine
PubMed: 33785803
DOI: 10.1038/s41598-021-86436-3 -
International Journal of Computer... Nov 2020We present a feasibility study for the visuo-haptic simulation of pedicle screw tract palpation in virtual reality, using an approach that requires no manual processing...
PURPOSE
We present a feasibility study for the visuo-haptic simulation of pedicle screw tract palpation in virtual reality, using an approach that requires no manual processing or segmentation of the volumetric medical data set.
METHODS
In a first experiment, we quantified the forces and torques present during the palpation of a pedicle screw tract in a real boar vertebra. We equipped a ball-tipped pedicle probe with a 6-axis force/torque sensor and a motion capture marker cluster. We simultaneously recorded the pose of the probe relative to the vertebra and measured the generated forces and torques during palpation. This allowed us replaying the recorded palpation movements in our simulator and to fine-tune the haptic rendering to approximate the measured forces and torques. In a second experiment, we asked two neurosurgeons to palpate a virtual version of the same vertebra in our simulator, while we logged the forces and torques sent to the haptic device.
RESULTS
In the experiments with the real vertebra, the maximum measured force along the longitudinal axis of the probe was 7.78 N and the maximum measured bending torque was 0.13 Nm. In an offline simulation of the motion of the pedicle probe recorded during the palpation of a real pedicle screw tract, our approach generated forces and torques that were similar in magnitude and progression to the measured ones. When surgeons tested our simulator, the distributions of the computed forces and torques were similar to the measured ones; however, higher forces and torques occurred more frequently.
CONCLUSIONS
We demonstrated the suitability of direct visual and haptic volume rendering to simulate a specific surgical procedure. Our approach of fine-tuning the simulation by measuring the forces and torques that are prevalent while palpating a real vertebra produced promising results.
Topics: Animals; Computer Simulation; Feasibility Studies; Male; Motion; Palpation; Pedicle Screws; Simulation Training; Spinal Fusion; Swine; Torque; User-Computer Interface; Virtual Reality
PubMed: 32959159
DOI: 10.1007/s11548-020-02258-0 -
Cureus Mar 2020Objective The morphology and quantitative anatomy of the axis vertebra (C2) attracts a lot of attention between anatomists, surgeons and radiologists. However, no report...
Objective The morphology and quantitative anatomy of the axis vertebra (C2) attracts a lot of attention between anatomists, surgeons and radiologists. However, no report exists in the literature correlating the height of the dens with the length of the femur. Our paper aims to determine such a correlation. Material and methods An examination of forty-five adult dry skeletons (twenty-three male and twenty-two female) was conducted. The height of the odontoid process of the axis and the maximum length of the femur were measured and statistically analyzed. Results The mean values for the height of the dens were 19.13±2.74 mm and 16.83±2.45 mm concerning the male and female dry skeletons respectively. The mean maximum length of the right femur bone was 43.04±2.32 cm for male and 39.90±2.40 cm for female skeletons. Data analysis revealed a statistically significant correlation (r=0.709, p <0.001) between the height of the odontoid process and the maximum length of the femur bone. A linear regression model expressing this association was created: Femur max length (in cm) = 32.874 + 0.531 x Dens height (in mm). Conclusion We present a new mathematical equation correlating one of the most studied long bones of the skeleton, the femur, with another "long" part of the bony structure of the human body- the C2 odontoid process.
PubMed: 32328383
DOI: 10.7759/cureus.7372