2,899 research outputs found

    MRI-based Surgical Planning for Lumbar Spinal Stenosis

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    The most common reason for spinal surgery in elderly patients is lumbar spinal stenosis(LSS). For LSS, treatment decisions based on clinical and radiological information as well as personal experience of the surgeon shows large variance. Thus a standardized support system is of high value for a more objective and reproducible decision. In this work, we develop an automated algorithm to localize the stenosis causing the symptoms of the patient in magnetic resonance imaging (MRI). With 22 MRI features of each of five spinal levels of 321 patients, we show it is possible to predict the location of lesion triggering the symptoms. To support this hypothesis, we conduct an automated analysis of labeled and unlabeled MRI scans extracted from 788 patients. We confirm quantitatively the importance of radiological information and provide an algorithmic pipeline for working with raw MRI scans

    Spinal involvement in mucopolysaccharidosis IVA (Morquio-Brailsford or Morquio A syndrome): presentation, diagnosis and management.

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    Mucopolysaccharidosis IVA (MPS IVA), also known as Morquio-Brailsford or Morquio A syndrome, is a lysosomal storage disorder caused by a deficiency of the enzyme N-acetyl-galactosamine-6-sulphate sulphatase (GALNS). MPS IVA is multisystemic but manifests primarily as a progressive skeletal dysplasia. Spinal involvement is a major cause of morbidity and mortality in MPS IVA. Early diagnosis and timely treatment of problems involving the spine are critical in preventing or arresting neurological deterioration and loss of function. This review details the spinal manifestations of MPS IVA and describes the tools used to diagnose and monitor spinal involvement. The relative utility of radiography, computed tomography (CT) and magnetic resonance imaging (MRI) for the evaluation of cervical spine instability, stenosis, and cord compression is discussed. Surgical interventions, anaesthetic considerations, and the use of neurophysiological monitoring during procedures performed under general anaesthesia are reviewed. Recommendations for regular radiological imaging and neurologic assessments are presented, and the need for a more standardized approach for evaluating and managing spinal involvement in MPS IVA is addressed

    A Predictive Model for Assessment of Successful Outcome in Posterior Spinal Fusion Surgery

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    Background: Low back pain is a common problem in many people. Neurosurgeons recommend posterior spinal fusion (PSF) surgery as one of the therapeutic strategies to the patients with low back pain. Due to the high risk of this type of surgery and the critical importance of making the right decision, accurate prediction of the surgical outcome is one of the main concerns for the neurosurgeons.Methods: In this study, 12 types of multi-layer perceptron (MLP) networks and 66 radial basis function (RBF) networks as the types of artificial neural network methods and a logistic regression (LR) model created and compared to predict the satisfaction with PSF surgery as one of the most well-known spinal surgeries.Results: The most important clinical and radiologic features as twenty-seven factors for 480 patients (150 males, 330 females; mean age 52.32 ± 8.39 years) were considered as the model inputs that included: age, sex, type of disorder, duration of symptoms, job, walking distance without pain (WDP), walking distance without sensory (WDS) disorders, visual analog scale (VAS) scores, Japanese Orthopaedic Association (JOA) score, diabetes, smoking, knee pain (KP), pelvic pain (PP), osteoporosis, spinal deformity and etc. The indexes such as receiver operating characteristic–area under curve (ROC-AUC), positive predictive value, negative predictive value and accuracy calculated to determine the best model. Postsurgical satisfaction was 77.5% at 6 months follow-up. The patients divided into the training, testing, and validation data sets.Conclusion: The findings showed that the MLP model performed better in comparison with RBF and LR models for prediction of PSF surgery.Keywords: Posterior spinal fusion surgery (PSF); Prediction, Surgical satisfaction; Multi-layer perceptron (MLP); Logistic regression (LR) (PDF) A Predictive Model for Assessment of Successful Outcome in Posterior Spinal Fusion Surgery. Available from: https://www.researchgate.net/publication/325679954_A_Predictive_Model_for_Assessment_of_Successful_Outcome_in_Posterior_Spinal_Fusion_Surgery [accessed Jul 11 2019].Peer reviewe

    Trauma, Tumors, Spine, Functional Neurosurgery

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    This book is written for graduate students, researchers, and practitioners who are interested in learning how the knowledge from research can be implemented in clinical competences. The first section is dedicated to deep brain stimulation, a surgical procedure which is the paramount example of how clinical practice can take advantage from fundamental research. The second section gathers four chapters on four different topics and illustrates how significant is the challenge to translate scientific advances into clinical practice because the route from evidence to action is not always obvious. It is hoped that this book will stimulate the interest in the process of translating research into practice for a broader range of neurosurgical topics than the one covered by this book, which could result in a forthcoming more comprehensive publication

    MRI evaluation on exit foramina and lateral recess in patients who undergo posterior lumbar interbody fusion in Hospital Raja Perempuan Zainab II

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    Background: Low back pain due to degenerative lumbar spine is one of the most common presenting complaints in out-patient and orthopaedic clinics. While most cases usually resolve in few weeks, 2% of them develop radiculopathy and need further radiological investigations. Regardless of age and occupation of patients, back pain is a common cause of disability and gives a great personal and social impact to the individual and families, and economic burden to the society. Magnetic Resonance Imaging (MRI) is the gold standard imaging modality for investigation of degenerative disc disease for its superior soft tissue contrast, multiplanar imaging capability and non-ionizing property. Changes of degenerative intervertebral discs are well-demonstrated. Disc herniations, thickened ligamentum flavum and osteophytosis cause narrowing of neuroforamina, and further compromise the spinal cord and exiting nerve roots. Therefore, MRI is valuable to determine the degree of stenosis and level of compression, and hence, used as a guide to aid plan of surgical decompression. Posterior Lumbar Interbody Fusion (PLIF) is one of the surgical technique of nerve root decompression using posterior approach. In PLIF procedure, incision is made at midline at the back. This is followed by laminectomy to gain access to the intervertebral disc space. Discectomy is then performed and disc materials are replaced with disc spacer to restore disc height. It was postulated that PLIF procedure is able to restore foraminal height and therefore relieved nerve root compression without foraminotomy. Objectives: To study the improvement of exit foramina and lateral recess stenosis in patients with back pain who underwent Posterior Lumbar Interbody Fusion (PLIF), using MRI as diagnostic tool, to correlate the MRI findings with clinical symptoms and to determine whether disc spacer height is a good predictor for improvement of lateral recess and exit foramina. Methodology: It is a cross-sectional, observational study of patients with back pain due to degenerative disc disease who underwent Posterior Lumbar Interbody Fusion (PLIF) in Hospital Raja Perempuan Zainab II from June 2007 till June 2010. Patients’ clinical symptoms were assessed using Oswestry Disability Index (ODI) pre- and postprocedure. MRI lumbosacral pre and post PLIF were analysed in axial and sagittal views. The depth of the lateral recess and exit foramina were measured at mid zone, exit zone and far lateral zone, and compared pre and post PLIF. The height of the disc spacer was measured at mid sagittal views. Mean difference of lateral recess and exit foramina size before and after procedure were analysed using paired t-test, and correlated with ODI score using Pearson’s correlation test. Correlation test was also used to determine whether disc spacer height is a good predictor for improvement of lateral recess and exit foramina size. Results: From 39 patients underwent PLIF in Hospital Raja Perempuan Zainab II, 25 patients fulfilled the inclusion criteria with 43 lumbar segments available for analysis. Increment of lateral recess and exit foramina measurements post PLIF were observed at all levels which was statistically significant (p0.05). It was also noted that the height of the disc spacer was not a predictor for increment of exit foramen (p>0.05) Conclusion: Posterior Lumbar Interbody Fusion is proven to restore depth of lateral recess and exit foramen. Patients underwent PLIF had significant good surgical outcome. The difference of disc spacer height used in the procedure did not determine the increment of exit foramina. Therefore, current practice of using disc spacer height according to adjacent disc height is an acceptable method

    Spine Surgery

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    We are very excited to introduce this new book on spinal surgery, which follows the curriculum of the EUROSPINE basic and advanced diploma courses. The approach we take is a purely case-based one, in which each case illustrates the concepts surrounding the treatment of a given pathology, including the uncertainties and problems in decision-making. The readers will notice that in many instances a lack of evidence for a given treatment exists. So decisions taken are usually not a clearcut matter of black or white, but merely different shades of gray. Probably in a lot of cases, there is often more than one option to treat the patient. The authors were asked to convey this message to the reader, giving him a guidance as what would be accepted within the mainstream. In addition, the reader is provided with the most updated literature and evidence on the topic. Most of the authors are teachers in the courses of EUROSPINE or other national societies with often vast clinical experience and have given their own perspective and reasoning. We believe that the readers will profit very much from this variety and bandwidth of knowledge provided for them in the individual chapters. We have given the authors extensive liberty as to what they consider the best solution for their case. It is thus a representative picture of what is considered standard of care for spine pathologies in Europe. We hope that this book will be an ideal complement for trainees to the courses they take. Munich, Germany Bernhard Meyer Offenbach, Germany Michael Rauschman

    Clinical and Radiological Correlation of Degenerative Lumbar Canal Stenosis with Outcome of Various Modalities of Treatment

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    INTRODUCTION: The Present dissertation is going to be a prospective study of 80 cases of lumbar canal stenosis to be treated for a period of one year (2011-2012) by conservative treatment and operative modalities such as decompressive laminectomy, discectomy, foraminotomy / medial facectomy, excision of hypertrophied ligamentum flavum. AIMS AND OBJECTIVES: 1. To measure spinal canal at the level of disc, lateral recess, interpedicular distance using digital/ plain x ray LS spine, CT LS spine, MRI LS spine &correlation with clinical findings and outcome of various modalities of treatment. 2. To measure body/canal ratio (jones Thompson index) and correlation with clinical findings &outcome of surgery. 3. To illustrate the variations in spinal canal &lateral recess measurements using CT scan, MRI scan & study the statistical significance of the variations. 4. To evaluate the results of surgical treatment in LCS and its correlation with lumbar canal measurement by radiological investigations & clinical findings. 5. To compare the results of conservative and surgical treatment. MATERIALS AND METHODS: This is a randomized study of 80 patients of lumbar canal stenosis of age between 20-60 years which was carried out in department of neurosurgery during the year 2011-2012 at Govt. Stanley Medical College & Hospital, Chennai. Data will be collected from the patients by their history telling, clinical examination & appropriate investigation. Documentation of patients information consisting of the patients particulars, history, clinical findings, investigations, operative procedures and its findings, follow up were recorded on a proforma. CONCLUSIONS: Variations seen in the spinal canal and lateral recess diameter measured by Xray, CT, MRI lumbosacral spine in this study is satistically more significant than any other studies. Significant neurological deficit occurs even with mean spinal canal diameter of 15.1mm in this study when compared to diameter of 12 mm of other studies. Overall good surgical outcome compared to other studies and better surgical results when compared to conservative treatment in this study is due to foraminotomy/medial facectomy done in all cases. Jones Thompson index applied in this study correlates well with clinical neurological deficit as well as with surgical outcome

    Verification Of Measurements Of Lumbar Spinal Dimensions In T1- And T2-weighted Magnetic Resonance Imaging Sequences

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    BACKGROUND CONTEXT: Magnetic resonance imaging (MRI) is commonly used to assess patients with lumbar spinal stenosis. No single MRI sequence has been shown to be superior in spinal canal measurements. There are also cost concerns for the increased clinical and research use of MRI. Using only a single sequence may lower the financial burden; however, this requires spinal canal measurements in both T1 and T2 MRI to be reliable. Evidence for this is currently lacking. PURPOSE: The aim of this study was to determine the intra- and inter-reader reliability of MRI measurements of the lumbar spine and the reliability of measurements using T1- and T2-weighted MRI films. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: Forty-two randomly selected patients who underwent spinal stenosis surgery. OUTCOME MEASURES: Lumbar spinal canal measurements and reliability analysis between T1- and T2-weighted MRI. METHODS: Qualitative ratings of MRI features were performed according to previously published criteria by 2 independent readers (JP-YC, HS). Measurements in axial scan included midline anteroposterior (AP) vertebral body diameter, midvertebral body width, midline AP spinal canal diameter, midline AP dural sac diameter, spinal canal width/interpedicular distance, pedicle width (right and left), and lamina angle. Measurements in the sagittal scan included midline AP body diameter, midvertebral body height, and AP spinal canal diameter. Cronbach alpha was used to characterize intra- and inter-reader reliability for qualitative rating data. Similarly, T1 and T2 comparison also was performed in the same manner. RESULTS: Good to excellent intra- and interobserver reliability was obtained for all measurements. Reliability analysis of all T1 and T2 measurements was excellent. CONCLUSIONS: Either T1 or T2 images can be used for measurements of spinal canal dimensions. These findings are of importance, as not every patient undergoing preoperative MRI assessment will necessarily have both sequences performed and only a single sequence is required for research studies. Our findings are also of relevance in measurement of lumbar canal diameters.postprin

    Prognostic factors in lumbar spinal stenosis surgery. A prospective study of imaging- and patient-related factors in 109 patients who were operated on by decompression

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    Background and purpose A considerable number of patients who undergo surgery for spinal stenosis have residual symptoms and inferior function and health-related quality of life after surgery. There have been few studies on factors that may predict outcome. We tried to find predictors of outcome in surgery for spinal stenosis using patient- and imaging-related factors. Patients and methods 109 patients in the Swedish Spine Register with central spinal stenosis that were operated on by decompression without fusion were prospectively followed up 1 year after surgery. Clinical outcome scores included the EQ-5D, the Oswestry disability index, self-estimated walking distance, and leg and back pain levels (VAS). Central dural sac area, number of levels with stenosis, and spondylolisthesis were included in the MRI analysis. Multivariable analyses were performed to search for correlation between patient-related and imaging factors and clinical outcome at 1-year follow-up. Results Several factors predicted outcome statistically significantly. Duration of leg pain exceeding 2 years predicted inferior outcome in terms of leg and back pain, function, and HRLQoL. Regular and intermittent preoperative users of analgesics had higher levels of back pain at follow-up than those not using analgesics. Low preoperative function predicted low function and dissatisfaction at follow-up. Low preoperative EQ-5D scores predicted a high degree of leg and back pain. Narrow dural sac area predicted more gains in terms of back pain at follow-up and lower absolute leg pain. Interpretation Multiple factors predict outcome in spinal stenosis surgery, most importantly duration of symptoms and preoperative function. Some of these are modifiable and can be targeted. Our findings can be used in the preoperative patient information and aid the surgeon and the patient in a shared decision making process
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