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Journal of Clinical Medicine Nov 2023There is a paucity of data regarding the post-operative influence of total hip arthroplasty (THA) on the axial and coronal alignments of the ipsilateral knee. A CT study...
BACKGROUND
There is a paucity of data regarding the post-operative influence of total hip arthroplasty (THA) on the axial and coronal alignments of the ipsilateral knee. A CT study was designed to assess the post-THA changes in axial and coronal knee alignments in low-grade dysplastic hips.
METHODS
Forty Crowe I-II dysplastic hips in 37 patients were assessed: a pre-operative CT scan from the fourth lumbar vertebra to the tibial plateaus was compared to a similar post-operative CT scan performed after a minimum of 2 years after THA.
RESULTS
THA implantation caused significant post-operative changes in terms of the rotation height (2 mm lowering; = 0.003); center of rotation medialization (10 mm medialization; < 0.001); femoral offset (11 mm increase; < 0.001); femoral antetorsion (22° internal rotation; < 0.001), and hip internal rotation (9° internal rotation; < 0.001). The femoral axis angle deviated in the valgus (5.5° ± 1.1°, < 0.001) and the mechanical lateral distal femoral angle deviated in the varus (86° ± 2.7°, = 0.001). The pelvic-tibial alignment changed from 88.2° ± 11.7° to 96° ± 9.3° ( < 0.001). Patellar alignment was not influenced.
CONCLUSIONS
In conclusion, THA imposes significant changes in low-grade dysplastic hips: all the modifications tend to neutralize the coronal alignment and, mostly, the rotational alignment, without substantial and durable variations of the patellofemoral joint. Large clinical trials should confirm whether radiological changes impact anterior knee pain and patellar stability.
PubMed: 38068401
DOI: 10.3390/jcm12237347 -
JMIR Rehabilitation and Assistive... Dec 2023Upper limb motor paresis is a major symptom of stroke, which limits activities of daily living and compromises the quality of life. Kinematic analysis offers an in-depth...
BACKGROUND
Upper limb motor paresis is a major symptom of stroke, which limits activities of daily living and compromises the quality of life. Kinematic analysis offers an in-depth and objective means to evaluate poststroke upper limb paresis, with anticipation for its effective application in clinical settings.
OBJECTIVE
This study aims to compare the movement strategies of patients with hemiparesis due to stroke and healthy individuals in forward reach and hand-to-mouth reach, using a simple methodology designed to quantify the contribution of various movement components to the reaching action.
METHODS
A 3D motion analysis was conducted, using a simplified marker set (placed at the mandible, the seventh cervical vertebra, acromion, lateral epicondyle of the humerus, metacarpophalangeal [MP] joint of the index finger, and greater trochanter of the femur). For the forward reach task, we measured the distance the index finger's MP joint traveled from its starting position to the forward target location on the anterior-posterior axis. For the hand-to-mouth reach task, the shortening of the vertical distance between the index finger MP joint and the position of the chin at the start of the measurement was measured. For both measurements, the contributions of relevant upper limb and trunk movements were calculated.
RESULTS
A total of 20 healthy individuals and 10 patients with stroke participated in this study. In the forward reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 52.5%, SD 24.5% vs mean 85.2%, SD 4.5%; P<.001), whereas the contribution of trunk flexion was significantly larger in stroke participants than in healthy participants (mean 34.0%, SD 28.5% vs mean 3.0%, SD 2.8%; P<.001). In the hand-to-mouth reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 71.8%, SD 23.7% vs mean 90.7%, SD 11.8%; P=.009), whereas shoulder girdle elevation and shoulder abduction were significantly larger in participants with stroke than in healthy participants (mean 10.5%, SD 5.7% vs mean 6.5%, SD 3.0%; P=.02 and mean 16.5%, SD 18.7% vs mean 3.0%, SD 10.4%; P=.02, respectively).
CONCLUSIONS
Compared with healthy participants, participants with stroke achieved a significantly greater distance via trunk flexion in the forward reach task and shoulder abduction and shoulder girdle elevation in the hand-to-mouth reach task, both of these differences are regarded as compensatory movements. Understanding the characteristics of individual motor strategies, such as dependence on compensatory movements, may contribute to tailored goal setting in stroke rehabilitation.
PubMed: 38051570
DOI: 10.2196/50571 -
Clinics in Orthopedic Surgery Dec 2023To evaluate the feasibility of treating odontoid fractures in the Chinese population with two cortical screws based on computed tomography (CT) scans and describe a new...
BACKGROUND
To evaluate the feasibility of treating odontoid fractures in the Chinese population with two cortical screws based on computed tomography (CT) scans and describe a new measurement strategy to guide screw insertion in treating these fractures.
METHODS
A retrospective review of cervical computed tomographic scans of 128 patients (aged 18-76 years; men, 55 [43.0%]) was performed. The minimum external transverse diameter (METD), minimum external anteroposterior diameter (MEAD), maximum screw length (MSL), and screw projection back angle (SPBA) of the odontoid process were measured on coronal and sagittal CT images.
RESULTS
The mean values of METD and MEAD were 10.0 ± 1.1 mm and 12.0 ± 1.0 mm, respectively, in men and 9.2 ± 1.0 mm and 11.0 ± 1.0 mm, respectively, in women. Both measurements were significantly higher in men ( < 0.001). In total, 87 individuals (68%) had METD > 9.0 mm that could accommodate two 3.5-mm cortical screws. The mean MSL value and SPBA range were 34.4 ± 2.9 mm and 13.5°-24.2°, respectively, with no statistically significant difference between men and women.
CONCLUSIONS
The insertion of two 3.5-mm cortical screws was possible for anterior fixation of odontoid fractures in 87 patients (68%) in our study, and there was a statistically significant difference between men and women.
Topics: Female; Humans; Male; Bone Screws; East Asian People; Feasibility Studies; Fracture Fixation, Internal; Fractures, Bone; Odontoid Process; Spinal Fractures; Tomography, X-Ray Computed; Adolescent; Young Adult; Adult; Middle Aged; Aged
PubMed: 38045572
DOI: 10.4055/cios23094 -
Journal of Neurosurgery. Spine Mar 2024The aim of this study was to identify the risk factors for proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), including paraspinal muscle atrophy.
OBJECTIVE
The aim of this study was to identify the risk factors for proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), including paraspinal muscle atrophy.
METHODS
Fifty-seven consecutive patients who underwent a long-instrumented fusion for adult spinal deformity (ASD) with a minimum follow-up of 2 years were included in the study. Patient, surgical, and radiological factors were evaluated. Muscle volume was measured using the muscle/vertebra ratio of the multifidus, erector spinae (ES), and psoas muscles, and muscle function was evaluated using the degree of fat infiltration at the L4-5 level.
RESULTS
The study included 57 consecutive patients: 25 patients in the combined PJK/PJF group (13 with PJK and 12 with PJF) and 32 in the control group (without PJK or PJF). The mean time to onset of PJK and PJF was 15.7 and 1.7 months, respectively. Multivariate analysis showed that greater pre- and postoperative sagittal vertical axis was associated with the occurrence of PJK/PJF. ES muscle atrophy was more significant in the PJK/PJF group than in the control group, and more severe in the PJF than in the PJK group.
CONCLUSIONS
This study showed that PJF occurred much earlier than PJK after ASD surgery. Paraspinal muscle atrophy was identified as a significant risk factor for PJK and PJF, especially PJF. The possibility of PJK and PJF development should be considered when long-segment fusion is planned for patients with paraspinal muscle atrophy.
Topics: Adult; Humans; Paraspinal Muscles; Sarcopenia; Kyphosis; Spine; Risk Factors
PubMed: 38039529
DOI: 10.3171/2023.9.SPINE23531 -
World Neurosurgery Feb 2024To investigate whether retro-odontoid soft-tissue thickness (ROSTT) is associated with cervical degeneration, cervical spine mobility, and sagittal balance of cervical...
OBJECTIVE
To investigate whether retro-odontoid soft-tissue thickness (ROSTT) is associated with cervical degeneration, cervical spine mobility, and sagittal balance of cervical spine.
METHODS
The data of 151 patients who presented at our hospital with cervical spondylosis were reviewed. The ROSTT was measured using T1-weighted sagittal cervical magnetic resonance imaging findings. The assessment of the degree of cervical intervertebral disc degeneration (IVDD) was conducted using sagittal T2-weighted imaging. The T1 slope (T1S), C0-C2 angle, C1-C2 angle, C2-C7 angle, C1-C7 sagittal vertical axis and C2-C7 sagittal vertical axis were measured. The range of motion was assessed by measuring the flexion-extension radiographs. According to the ROSTT, those measuring less than 3 mm were classified as normal group and those measuring larger than 3 mm were classified as thickened group.
RESULTS
The thickened group had larger cervical IVDD grade, age, C2-C7 angle, and T1S compared to the normal group (all P < 0.05). Additionally, the C0-C2 angle was significantly smaller in the thickened group than in the normal group (P < 0.05). ROSTT showed a negative correlation with C0-C2 angle (r = -0.181, P < 0.05), but positive correlations with both C2-C7 angle (r = 0.255, P < 0.05) and T1S (r = 0.240, P < 0.05). Furthermore, ROSTT was positively correlated with age (r = 0277, P < 0.05) and cervical IVDD grade (Spearman, r = 0.299, P < 0.05).
CONCLUSIONS
Cervical sagittal balance and cervical degeneration have a significant impact on ROSTT. Patients with a higher T1S and severe cervical degeneration are more likely to result in greater ROSTT.
Topics: Humans; Odontoid Process; Neck; Cervical Vertebrae; Magnetic Resonance Imaging; Radiography; Intervertebral Disc Degeneration; Retrospective Studies; Lordosis
PubMed: 38008169
DOI: 10.1016/j.wneu.2023.11.088 -
European Spine Journal : Official... Mar 2024Os odontoideum refers to a rounded ossicle detached from a hypoplastic odontoid process at the body of the axis. The aetiology has been debated and believed to be either... (Review)
Review
INTRODUCTION
Os odontoideum refers to a rounded ossicle detached from a hypoplastic odontoid process at the body of the axis. The aetiology has been debated and believed to be either congenital or acquired (resulting from trauma). Os odontoideum results in incompetence of the transverse ligament and thus predisposes to atlantoaxial instability and spinal cord injury.
METHODS/RESULTS
Three cases of children with severe dystonic cerebral palsy presenting with myelopathic deterioration secondary to atlantoaxial instability due to os odontoideum are presented. This observation supports the hypothesis of os odontoideum being an acquired phenomenon, secondary to chronic excessive movement with damage to the developing odontoid process.
CONCLUSION
In children with cerebral palsy and dystonia, pre-existing motor deficits may conceal an evolving myelopathy and result in delayed diagnosis of clinically significant atlantoaxial subluxation.
Topics: Child; Humans; Dystonia; Cerebral Palsy; Magnetic Resonance Imaging; Atlanto-Axial Joint; Axis, Cervical Vertebra; Spinal Cord Diseases; Odontoid Process; Joint Instability
PubMed: 37994987
DOI: 10.1007/s00586-023-08044-1 -
Journal of Oral Rehabilitation Mar 2024Temporomandibular disorders are the most common condition affecting the orofacial region, resulting in pain and dysfunction.
BACKGROUND
Temporomandibular disorders are the most common condition affecting the orofacial region, resulting in pain and dysfunction.
OBJECTIVE
This study aimed to elucidate the ambiguous association between cervical features and temporomandibular disorders by measuring the rotations between the skull-atlas, atlas-axis and mandible-atlas and examining the relationship between these rotations and temporomandibular disorders.
METHODS
Cone-beam computed tomography (CBCT) images from 176 patients, 97 females and 79 males with an average age of 25.7 years were used in this study. The patients were divided into two groups: those with joint dysfunction (n = 88) and those without (n = 88). The study employed various methods to determine rotations in the skull-atlas, atlas-axis and mandible atlas based on anatomical landmarks and measurements. These methods include the use of specific planes, angles and distances to identify and measure rotation. Data analysis was performed using the TURCOSA statistical software (Turcosa Analytics Ltd Co, Turkey, www.turcosa.com.tr).
RESULTS
The results showed that the degree of rotation between the skull and the atlas was higher in the TMD group than in the control group (p < .001). Similarly, Atlas-axis rotation was significantly higher in the TMD group (p < .001). However, no significant difference was found between mandible atlas rotations in the two groups (p = .546). The study also found a significant difference between the direction of rotation between the atlas and axis and the direction of mandible atlas rotation (p < .001) as well as between skull and atlas rotations and mandible-atlas rotations (p < .001).
CONCLUSION
Overall, the study suggests that there is a relationship between the skeletal structures of the cranio-cervico-mandibular system and TMD. Skull-atlas and atlas-axis rotations may play an important role in the aetiology of TMD in individuals with TMD. Therefore, it is important to evaluate rotations in the skull-atlas-axis region for the treatment of TMD.
Topics: Male; Female; Humans; Adult; Retrospective Studies; Temporomandibular Joint Dysfunction Syndrome; Mandible; Temporomandibular Joint Disorders; Temporomandibular Joint
PubMed: 37983893
DOI: 10.1111/joor.13622 -
BMC Geriatrics Nov 2023Different treatment options are discussed for geriatric odontoid fracture. The aim of this study was to compare the treatment options for geriatric odontoid fractures.
BACKGROUND
Different treatment options are discussed for geriatric odontoid fracture. The aim of this study was to compare the treatment options for geriatric odontoid fractures.
METHODS
Included were patients with the following criteria: age ≥ 65 years, identification of seniors at risk (ISAR score ≥ 2), and odontoid fracture type A/B according to Eysel and Roosen. Three groups were compared: conservative treatment, surgical therapy with ventral screw osteosynthesis or dorsal instrumentation. At a follow-up examination, the range of motion and the trabecular bone fracture healing rate were evaluated. Furthermore, demographic patient data, neurological status, length of stay at the hospital and at the intensive care unit (ICU) as well as the duration of surgery and occurring complications were analyzed.
RESULTS
A total of 72 patients were included and 43 patients could be re-examined (range: 2.7 ± 2.1 months). Patients with dorsal instrumentation had a better rotation. Other directions of motion were not significantly different. The trabecular bone fracture healing rate was 78.6%. The patients with dorsal instrumentation were hospitalized significantly longer; however, their duration at the ICU was shortest. There was no significant difference in complications.
CONCLUSION
Geriatric patients with odontoid fracture require individual treatment planning. Dorsal instrumentation may offer some advantages.
Topics: Humans; Aged; Spinal Fractures; Conservative Treatment; Odontoid Process; Fractures, Bone; Fracture Fixation, Internal; Treatment Outcome
PubMed: 37968595
DOI: 10.1186/s12877-023-04472-2 -
European Radiology Experimental Nov 2023Automated segmentation of spinal magnetic resonance imaging (MRI) plays a vital role both scientifically and clinically. However, accurately delineating posterior spine...
BACKGROUND
Automated segmentation of spinal magnetic resonance imaging (MRI) plays a vital role both scientifically and clinically. However, accurately delineating posterior spine structures is challenging.
METHODS
This retrospective study, approved by the ethical committee, involved translating T1-weighted and T2-weighted images into computed tomography (CT) images in a total of 263 pairs of CT/MR series. Landmark-based registration was performed to align image pairs. We compared two-dimensional (2D) paired - Pix2Pix, denoising diffusion implicit models (DDIM) image mode, DDIM noise mode - and unpaired (SynDiff, contrastive unpaired translation) image-to-image translation using "peak signal-to-noise ratio" as quality measure. A publicly available segmentation network segmented the synthesized CT datasets, and Dice similarity coefficients (DSC) were evaluated on in-house test sets and the "MRSpineSeg Challenge" volumes. The 2D findings were extended to three-dimensional (3D) Pix2Pix and DDIM.
RESULTS
2D paired methods and SynDiff exhibited similar translation performance and DCS on paired data. DDIM image mode achieved the highest image quality. SynDiff, Pix2Pix, and DDIM image mode demonstrated similar DSC (0.77). For craniocaudal axis rotations, at least two landmarks per vertebra were required for registration. The 3D translation outperformed the 2D approach, resulting in improved DSC (0.80) and anatomically accurate segmentations with higher spatial resolution than that of the original MRI series.
CONCLUSIONS
Two landmarks per vertebra registration enabled paired image-to-image translation from MRI to CT and outperformed all unpaired approaches. The 3D techniques provided anatomically correct segmentations, avoiding underprediction of small structures like the spinous process.
RELEVANCE STATEMENT
This study addresses the unresolved issue of translating spinal MRI to CT, making CT-based tools usable for MRI data. It generates whole spine segmentation, previously unavailable in MRI, a prerequisite for biomechanical modeling and feature extraction for clinical applications.
KEY POINTS
• Unpaired image translation lacks in converting spine MRI to CT effectively. • Paired translation needs registration with two landmarks per vertebra at least. • Paired image-to-image enables segmentation transfer to other domains. • 3D translation enables super resolution from MRI to CT. • 3D translation prevents underprediction of small structures.
Topics: Image Processing, Computer-Assisted; Retrospective Studies; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Spine
PubMed: 37957426
DOI: 10.1186/s41747-023-00385-2