Intraoperative 3D Imaging Reduces Pedicle Screw Related Complications and Reoperations in Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis : A Retrospective Study

Widely used surgical treatment for adolescent idiopathic scoliosis (AIS) is posterior spinal fusion using pedicle screw instrumentation (PSI). Two-dimensional (2D) or three-dimensional (3D) navigation is used to track the screw positioning during surgery. In this study, we evaluated the screw misplacement, complications, and need for reoperations of intraoperative 3D as compared to 2D imaging in AIS patients. There were 198 adolescents, of which 101 (51%) were evaluated with 2D imaging and 97 (49%) with 3D imaging. Outcome parameters included radiographic correction, health-related quality of life (HRQOL), complications, and reoperations. The mean age was 15.5 (SD 2.1) years at the time of the surgery. Forty-four (45%) patients in the 3D group and 13 (13%) patients in the 2D group had at least one pedicle screw repositioned in the index operation (p < 0.001). Six (6%) patients in the 2D group, and none in the 3D group had a neurological complication (p = 0.015). Five (5%) patients in the 2D group and none in the 3D group required reoperation (p = 0.009). There were no significant differences in HRQOL score at two-year follow-up between the groups. In conclusion, intraoperative 3D imaging reduced pedicle screw-related complications and reoperations in AIS patients undergoing PSI as compared with 2D imaging.Peer reviewe

Intraoperative 3D Imaging Reduces Pedicle Screw Related Complications and Reoperations in Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis : A Retrospective Study

Widely used surgical treatment for adolescent idiopathic scoliosis (AIS) is posterior spinal fusion using pedicle screw instrumentation (PSI). Two-dimensional (2D) or three-dimensional (3D) navigation is used to track the screw positioning during surgery. In this study, we evaluated the screw misplacement, complications, and need for reoperations of intraoperative 3D as compared to 2D imaging in AIS patients. There were 198 adolescents, of which 101 (51%) were evaluated with 2D imaging and 97 (49%) with 3D imaging. Outcome parameters included radiographic correction, health-related quality of life (HRQOL), complications, and reoperations. The mean age was 15.5 (SD 2.1) years at the time of the surgery. Forty-four (45%) patients in the 3D group and 13 (13%) patients in the 2D group had at least one pedicle screw repositioned in the index operation (p < 0.001). Six (6%) patients in the 2D group, and none in the 3D group had a neurological complication (p = 0.015). Five (5%) patients in the 2D group and none in the 3D group required reoperation (p = 0.009). There were no significant differences in HRQOL score at two-year follow-up between the groups. In conclusion, intraoperative 3D imaging reduced pedicle screw-related complications and reoperations in AIS patients undergoing PSI as compared with 2D imaging.Peer reviewe

Intraoperative 3D Imaging Reduces Pedicle Screw Related Complications and Reoperations in Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis: A Retrospective Study

Widely used surgical treatment for adolescent idiopathic scoliosis (AIS) is posterior spinal fusion using pedicle screw instrumentation (PSI). Two-dimensional (2D) or three-dimensional (3D) navigation is used to track the screw positioning during surgery. In this study, we evaluated the screw misplacement, complications, and need for reoperations of intraoperative 3D as compared to 2D imaging in AIS patients. There were 198 adolescents, of which 101 (51%) were evaluated with 2D imaging and 97 (49%) with 3D imaging. Outcome parameters included radiographic correction, health-related quality of life (HRQOL), complications, and reoperations. The mean age was 15.5 (SD 2.1) years at the time of the surgery. Forty-four (45%) patients in the 3D group and 13 (13%) patients in the 2D group had at least one pedicle screw repositioned in the index operation (p < 0.001). Six (6%) patients in the 2D group, and none in the 3D group had a neurological complication (p = 0.015). Five (5%) patients in the 2D group and none in the 3D group required reoperation (p = 0.009). There were no significant differences in HRQOL score at two-year follow-up between the groups. In conclusion, intraoperative 3D imaging reduced pedicle screw-related complications and reoperations in AIS patients undergoing PSI as compared with 2D imaging

XXII International Conference on Mechanics in Medicine and Biology - Abstracts Book

This book contain the abstracts presented the XXII ICMMB, held in Bologna in September 2022. The abstracts are divided following the sessions scheduled during the conference

Factors affecting accuracy and fusion rate in lumbosacral fusion surgery - a preclinical and clinical study

Lumbosacral fusion surgery is indicated in symptomatic degenerative lumbosacral disorder, when the origin of pain is demonstrated to lie within the restricted number of functional spinal units and when the pain is refractory to the conservative treatment, to eliminate painful motion of the spinal units. Inaccurate placement of pedicle screws may cause neurological symptoms, and result in early hardware failure and return of spinal instability symptoms. All spinal instrumentation eventually fails without solid bony fusion, and the presence of symptomatic bony non-union at least a year after fusion surgery is defined as pseudoarthrosis. Bioactive glasses (BAGs) are synthetic, biocompatible, osteoconductive and osteostimulative materials with angiogenic and antibacterial properties, able to bond to bone. In a study of 147 patients and 837 pedicle screws placed due to degenerative lumbosacral spine disorder, 14.3 % breached the pedicle. New neurological symptoms corresponding to the breach were observed in 25.9 % of patients with pedicle breach, and 89.2 % of the symptomatic breaches were either medially or inferiorly. A preclinical controlled study of novel BAG S53P4 putty showed good biocompatibility, slightly higher intramedullary ossification of putty group compared to the control group, and that the binder agent did not disturb formation of new bone in vivo. The interbody fusion rate was 95.8 % with BAG S53P4 putty as bone graft expander with autograft in clinical lumbosacral interbody fusion, indicating at least as good interbody fusion results as the presently used materials. One early operative subsidence remaining unchanged over the study period was observed with putty.Lannerangan luudutusleikkausten tarkkuuteen ja luutumiseen vaikuttavat tekijät Lannerangan luudutusleikkaus voidaan tehdä oireisessa lannerangan rappeumasairaudessa, kun kivun syyn on osoitettu sijaitsevan rajallisessa määrässä selkärangan toiminnallisia yksikköjä ja kun kipu ei vähene leikkauksettomilla hoidoilla. Leikkauksella voidaan poistaa kipua tuottava selkärangan toiminnallisten yksikköjen liike. Epätarkka pedikkeliruuvien asettaminen voi aiheuttaa neurologisia oireita ja johtaa nopeaan kiinnitysosien irtoamiseen ja rangan epätukevuusoireiden palaamiseen. Suuri osa selkärangan kiinnityslaitteista irtoaa lopulta, jollei luutumista kiinnitettyjen kohtien välillä tapahdu. Vuoden kuluttua luudutusleikkauksesta oireista luutumatonta kiinnityskohtaa nimitetään pseudoartroosiksi. Bioaktiiviset lasit ovat synteettisiä, bioyhteensopivia, osteokonduktiivisia ja osteostimulatiivisia materiaaleja, joilla on angiogeenisiä ja antibakteerisia ominaisuuksia, ja ne voivat sitoutua suoraan luuhun. 147 potilaalle lannerangan rappeumasairauden vuoksi asetetut 837 pedikkeliruuvia käsittävän tutkimuksen mukaan 14.3 % ruuveista rikkoi luisen pedikkelin seinämän. 25.9 %:lla potilaista, joilla ruuvi läpäisi pedikkelin seinämän, ilmeni uusia neurologisia oireita, ja 89.2 %:lla oireisista potilaista pedikkeliruuvi läpäisi pedikkelin seinämän mediaalisesti tai inferiorisesti. Prekliinisessä kontrolloidussa tutkimuksessa uudenlainen bioaktiivisesta lasista valmistettu S53P4 luunkorviketahna todettiin bioyhteensopivaksi, ja sen avulla saavutettiin hieman vertailuryhmää parempi luutuminen luuydinontelossa. Tahnan sidosaineen ei eläinkokeessa todettu häiritsevän luun muodostumista. Kliinisessä tutkimuksessa saavutettiin 95.8 %:n luutuminen käytettäessä S53P4 biolasitahnaa yhdessä oman luun kanssa lannerangan nikamasolmujen välisessä luudutuksessa. Siten yhdessä oman luun kanssa käytettäessä S53P4 biolasitahnalla saadaan aikaan vähintään yhtä hyvä nikamasolmujen välinen luutuminen kuin nykyisin käytettävillä synteettisillä luunkorvikkeilla. Tutkimuksessa todettiin yksi leikkauksen yhteydessä tapahtunut nikamasolmujen välisen implantin päätelevyyn painuminen, jonka suuruus ei muuttunut seurantakuvantamisissa

Recent Advances in Laparoscopic Surgery

The implementation of laparoscopy has revolutionized surgery over the past few years, incorporating significant benefits for the patient. However, this evolution has also entailed many technical obstacles for surgeons. This book is for readers wanting to learn more about recent surgical techniques and technologies. Topics cover novel sophisticated approaches for single-site surgery, natural orifice transluminal endoscopic surgery, and transanal surgery, among others. Also included are reviews of new innovative surgical devices, robotic platforms, and methodological guidelines for improving surgical performance and surgeon ergonomics

Cortical mapping of the neuronal circuits modulating the muscle tone. Introduction to the electrophysiological treatment of the spastic hand

L'objectiu d'aquest estudi es investigar l'organització cortical junt amb la connectivitat còrtico-subcortical en subjectes sans, com a estudi preliminar. Els mapes corticals s'han fet per TMS navegada, i els punts motors obtinguts s'han exportant per estudi tractogràfic i anàlisi de las seves connexions. El coneixement precís de la localització de l'àrea cortical motora primària i les seves connexions es la base per ser utilitzada en estudis posteriors de la reorganització cortical i sub-cortical en pacients amb infart cerebral. Aquesta reorganització es deguda a la neuroplasticitat i pot ser influenciada per els efectes neuromoduladors de la estimulació cerebral no invasiva.The purpose of this study is to investigate the motor cortex organisation together with the cortico-subcortical connectivity in healthy subjects, as a preliminary study. Cortical maps have been performed by navigated TMS and the motor points have been exported to DTI to study their subcortical connectivity. The precise knowledge of localization of the primary motor cortex area and its connectivity is the base to be used in later studies of cortical and subcortical re-organisation in stroke patients. This re-organisation is due to the neuroplascity and can be influenced by the neuromodulation effects of the non-invasive cerebral stimulation therapy by TMS

Navigoidun transkraniaalisen magneettistimulaation käyttö ennen leikkausta tehtävissä toiminnallisten aivokuorialueiden kartoituksissa epilepsiapotilailla

Individually navigated transcranial magnetic stimulation (nTMS) has been used to locate and map the primary motor cortical areas since the inception of the technique. Recently, it has been added to the pre-surgical routine for epilepsy and brain tumor patients. The accuracy of the mappings in healthy volunteers and brain tumor patients and their feasibility in the pre-surgical evaluation of brain tumor patients have been established. The originating causes for epilepsy are variable and affect the functional localizations in relation to conventional anatomy. A reliable and versatile pre-surgical method for the localization of the functional cortical areas is essential for pre-surgical risk-benefit assessments and it is important to the success of surgical treatments. In this thesis, I describe an nTMS mapping protocol suitable for clinical use and evaluate the accuracy of the motor cortical mappings by comparing the results with the results of direct electrical stimulation of the primary motor cortex. The accuracy, 11 ± 4 mm for the hand and 16 ± 7 mm for the arm muscle groups, is sufficiently good for pre-surgical evaluation in patients with severe epilepsy. With this patient group, the nTMS technique enables the mapping of the abnormally excitable tissue, which has an impact on the interpretation and reliability of the mappings as well. In addition to the mapping of the motor cortical areas, the cortical areas related to speech are of key interest in neurosurgery. The speech-related cortical areas are commonly localized noninvasively with functional magnetic resonance imaging techniques. The dominant hemisphere for language functions can be discriminated with the invasive Wada test in the pre- surgical evaluation of epilepsy patients. Recently, nTMS protocols have been introduced for localization of speech-related cortical areas. The analysis of the nTMS elicited modifications in the language task performance have commonly been analyzed manually from video recordings and the methods for the reliable determination of the nTMS elicited speech-response latencies, their categorization and analysis, have been sparse. In the last part of this dissertation, I developed a semi-automated script for the speech-response latency difference calculation based on the accelerometer signal of the speech-response elicited vibrations of the larynx. The developed script was individually optimized for speech-response detection. According to the presented results the method is capable of determining the speech-response latencies with a sensitivity of 96% and a specificity of 71%, against the manual review from the video and visual observations from the accelerometer signals. Based on the results presented in this thesis, nTMS is a reliable method for the mapping of the functional cortical areas pre-surgically in patients with severe epilepsy. It also enables the mapping of abnormally excitable brain areas.Yksilöllisesti navigoitua transkraniaalista magneettistimulaatiota (nTMS) on käytetty koko menetelmän olemassaolon ajan liikeaivokuoren tarkkaan paikantamiseen, ja viime vuosina menetelmää on ryhdytty käyttämään rutiininomaisesti ennen kirurgista hoitoa epilepsia- ja aivokasvainpotilailla. nTMS-kartoitusten luotettavuus terveillä koehenkilöillä on vakiintunut ja kartoitusten on todettu olevan käyttökelpoisia aivokasvainpotilailla leikkaushoidon suunnittelussa. Vaikeaa epilepsiaa sairastavilla potilailla kohtausten alkusyy voi vaihdella suuresti, millä voi olla vaikutusta aivokuoren toiminnallisten alueiden sijaintiin suhteessa tavanomaiseen anatomiaan. Riittävän monipuolinen ja luotettava toiminnallisten alueiden kartoitus ennen leikkauksen riski-hyötyarviointia ja leikkauspäätöstä on hyödyllistä hoidon onnistumisen kannalta. Tässä väitöskirjatyössä esittelen kliiniseen työhön soveltuvan epilepsiapotilaiden liikeaivokuoren paikannusprotokollan ja osoitan protokollalla saatujen nTMS-kartoitustulosten tarkkuuden vastaavan aivokuoren pinnalta tehtyjen suorien sähköstimulaatioiden tuloksia. Menetelmän tarkkuuden voidaan todeta olevan riittävä leikkaushoidon suunnitteluun vaikeaa epilepsiaa sairastavilla potilailla. nTMS-menetelmällä on mahdollista paikantaa myös epilepsiaa sairastavien potilaiden poikkeavasti ärtyviä aivokuoren alueita. Tällä on merkitystä kartoitustuloksia tulkittaessa ja niiden luotettavuutta arvioitaessa, samoin kuin kirurgisesti poistettavan alueen laajuutta ja kohdennusta määritettäessä. Epilepsiaa sairastavien potilaiden liikeaivokuoren paikantamisen lisäksi mielenkiinnon kohteena on puheen tuottamiseen ja käsittelyyn liittyvien aivokuorialueiden paikannus. Näitä aivokuoren alueita paikannetaan tyypillisesti toiminnallisella magneettikuvantamisella. Leikkaushoitoa suunniteltaessa kielellisiä alueita hallitseva aivopuolisko voidaan erottaa myös Wada-testin avulla. Sarjoittaista nTMS menetelmää hyödyntäviä kielellisten alueiden paikannusprotokollia on kehitetty, mutta niissä stimulaation aiheuttamia muutoksia potilaan suoriutumiseen annetusta tehtävästä on tyypillisesti voitu analysoida vain videotallenteita katsomalla. Erityisesti saatujen puhevasteiden toistettavaan ja objektiiviseen luokitteluun ja analyysiin on ollut tarjolla vain vähän menetelmiä. Analyysin helpottamiseksi kehitin kiihtyvyysanturisignaaliin perustuvan yksilöllisesti optimoidun puoliautomaattisen analysointirutiinin puhevasteiden viive-erojen määritykseen. Tulosten mukaan analysointirutiinin suorituskyky puhevasteiden viiveiden tunnistuksessa oli hyvä (sensitiivisyys 96 % ja spesifisyys 71 % verrattuna manuaaliseen analyysiin videolta ja suoraan signaalista). Väitöskirjassa esitettyjen tulosten perusteella voidaan todeta nTMS-menetelmän olevan käyttökelpoinen ja luotettava tutkimusmenetelmä vaikeaa epilepsiaa sairastavien potilaiden leikkausta edeltävään toiminnallisten alueiden kartoitukseen. nTMS-menetelmällä voidaan saada myös lisätietoa poikkeavan herkästi ärtyvistä aivoalueista