Change of sagittal spinal alignment and its association with pain and function after lumbar surgery augmented with an interspinous implant

Background: Interspinous spacer/implants like the Device for Intervertebral Assisted Motion (DIAM™) are controversially yet commonly used in the surgical treatment of lumbar degenerative pathologies. Criticism is based on ill-defined indications, lack of superiority over decompression, and a poorly understood mechanical effect. Yet, continued use by surgeons implies their perceived clinical merit. We examined radiographic spinal alignment for 12 months, and pain and function for 24 months, after DIAM-augmented surgery to improve the understanding of the mechanical effect relating to clinical outcomes in patients. Methods: We undertook a single-surgeon prospective, longitudinal study of 40 patients (20 F, 20 M) who received DIAM-augmented surgery in treatment of their symptomatic lumbar degenerative condition. Outcomes measured included sagittal spinal alignment (lumbar lordosis, sacral inclination, primary (PDA), supradjacent (SDA) disc angles, and regional sagittal balance (RSB; standing lateral radiographs), and back and leg pain (visual analogue scale; VAS) and function (Oswestry Disability Index; ODI). Responders were identified as those with clinically meaningful improvement to pain (>20%) and function (>15%) at 24 months postoperatively; features of sagittal spinal alignment between responders and non-responders were examined. Results: Sagittal alignment was unchanged at 12 months. At 6 weeks postoperatively, PDA (mean (SD)) reduced by 2.2° (4.0°; p < 0.01) and more-so in back pain non-responders (3.8° (3.2°)) than responders (0.7° (4.4°); p < 0.05). Positive preoperative RSB in responders (26.7Rmm (42.3Rmm); Rmm is a system-relative measure) decreased at 6 weeks (by 3.1Rmm (9.1Rmm)). Non-responders had a negative RSB preoperatively (−1.0Rmm (32.0Rmm)) and increased at 6 weeks (11.2Rmm (15.5Rmm); p < 0.05). Clinically meaningful improvement for the whole cohort for back pain and function were observed to 24 months (back pain: 25.0% (28.0); function: 15.4% (17.6); both p < 0.0001). Conclusions: Unaltered sagittal alignment at 12 months was not related to symptoms after DIAM-augmented lumbar surgery. Subtle early flattening at the index disc angle was not maintained. Preoperative and early post-operative sagittal alignment may indicate response after DIAM-augmented surgery for mixed lumbar pathologies. Further investigation toward defining indications and patient suitability is warranted

Role of Platelet-Rich Plasma Application on Mesh-Tissue Integration: Peran Aplikasi Platelet-Rich Plasma pada Integrasi Mesh dengan Jaringan

AbstractObjective: To review the advantage of PRP use on mesh-augmented surgery.Methods: Literature review of PRP application of mesh.Results: The application of PRP on mesh shows potential promising outcome.Conclusion: PRP may improve the mesh-tissue integration.Keywords: mesh-augmented surgery, pelvic organ prolapse, platelet-rich plasma, wound healing.AbstrakTujuan: Untuk menganalisa keuntungan penggunaan PRP pada pembedahan rekonstruktif dengan mesh.Metode: Kajian pustaka dari penggunaan PRP pada pembedahan rekonstruktif dengan mesh.Hasil: Aplikasi PRP pada mesh menunjukkan hasil yang positif.Kesimpulan: Aplikasi PRP dapat meningkatkan integrasi mesh dengan jaringanKata kunci: pembedahan rekonstruksi dengan mesh, penyembuhan luka, platelet-rich plasma, prolaps organ panggul

Data-driven simulation for augmented surgery

International audienceTo build an augmented view of an organ during surgery, it is essential to have a biomechanical model with appropriate material parameters and boundary conditions , able to match patient specific properties. Adaptation to the patient's anatomy is obtained by exploiting the image-rich context specific to our application domain. While information about the organ shape, for instance, can be obtained preoper-atively, other patient-specific parameters can only be determined intraoperatively. To this end, we are developing data-driven simulations, which exploit information extracted from a stream of medical images. Such simulations need to run in real-time. To this end we have developed dedicated numerical methods, which allow for real-time computation of finite element simulations. The general principle consists in combining finite element approaches with Bayesian methods or deep learning techniques, that allow to keep control over the underlying computational model while allowing for inputs from the real world. Based on a priori knowledge of the mechanical behavior of the considered organ, we select a constitutive law to model its deformations. The predictive power of such constitutive law highly depends on the knowledge of the material parameters and A. Mendizaba

Static Voronoi-Based Target Expansion Technique for Distant Pointing

International audienceAddressing the challenges of distant pointing, we present the feedforward static targeting assistance technique VTE: Voronoi-based Target Expansion. VTE statically displays all the activation areas by dividing the total screen space into areas such that there is only one target inside each area, also called Voronoi tessellation. The key benefit of VTE is in providing the user with an immediate understanding of the targets' activation boundaries before the pointing task even begins: VTE then provides static targeting assistance for both phases of a pointing task, the ballistic motion and the corrective phase. With the goal of making the environment visually uncluttered, we present a first user study to explore the visual parameters of VTE that affect the performance of the technique. In a second user study focusing on static versus dynamic assistance, we compare VTE with Bubble Ray, a dynamic Voronoi-based targeting assistance technique for distant pointing. Results show that VTE significantly outperforms the dynamic assistance technique and is preferred by users both for ray-casting pointing and relative pointing with a hand-controlled cursor

Concept Graph Neural Networks for Surgical Video Understanding

We constantly integrate our knowledge and understanding of the world to enhance our interpretation of what we see. This ability is crucial in application domains which entail reasoning about multiple entities and concepts, such as AI-augmented surgery. In this paper, we propose a novel way of integrating conceptual knowledge into temporal analysis tasks via temporal concept graph networks. In the proposed networks, a global knowledge graph is incorporated into the temporal analysis of surgical instances, learning the meaning of concepts and relations as they apply to the data. We demonstrate our results in surgical video data for tasks such as verification of critical view of safety, as well as estimation of Parkland grading scale. The results show that our method improves the recognition and detection of complex benchmarks as well as enables other analytic applications of interest

Computer- and robot-assisted Medical Intervention

Medical robotics includes assistive devices used by the physician in order to make his/her diagnostic or therapeutic practices easier and more efficient. This chapter focuses on such systems. It introduces the general field of Computer-Assisted Medical Interventions, its aims, its different components and describes the place of robots in that context. The evolutions in terms of general design and control paradigms in the development of medical robots are presented and issues specific to that application domain are discussed. A view of existing systems, on-going developments and future trends is given. A case-study is detailed. Other types of robotic help in the medical environment (such as for assisting a handicapped person, for rehabilitation of a patient or for replacement of some damaged/suppressed limbs or organs) are out of the scope of this chapter.Comment: Handbook of Automation, Shimon Nof (Ed.) (2009) 000-00

Intra-operative Update of Boundary Conditions for Patient-specific Surgical Simulation

Patient-specific Biomechanical Models (PBMs) can enhance computer assisted surgical procedures with critical information. Although pre-operative data allow to parametrize such PBMs based on each patient's properties, they are not able to fully characterize them. In particular, simulation boundary conditions cannot be determined from pre-operative modalities, but their correct definition is essential to improve the PBM predictive capability. In this work, we introduce a pipeline that provides an up-to-date estimate of boundary conditions, starting from the pre-operative model of patient anatomy and the displacement undergone by points visible from an intra-operative vision sensor. The presented pipeline is experimentally validated in realistic conditions on an ex vivo pararenal fat tissue manipulation. We demonstrate its capability to update a PBM reaching clinically acceptable performances, both in terms of accuracy and intra-operative time constraints

Principles of Strabismus Surgery for Common Horizontal and Vertical Strabismus Types

Strabismus can be distressing to our patients, yet often challenging to treat even in experienced hands. The goal of this chapter is to clearly and concisely share with the reader strategies and strabismus surgical techniques in common horizontal and vertical strabismus, that will improve the care of our patients. We describe indications for strabismus surgery, how to plan for successful surgery results and do’s and don’ts regarding effective surgical procedures. This includes incision techniques, muscle tightening and weakening procedures and transposition surgery, for rectus as well as oblique muscles. Advice on how to avoid complications of strabismus surgery is also provided. The chapter is based on evidence-based medicine where available and consensus and/or common sense advice is provided where evidence-based medicine is not available. It is the intent of this chapter to be a practical, usable guide helpful for surgeons of diverse experience, from resident ophthalmologists to the expert strabismologist

Kestenbaum procedure with posterior fixation suture for anomalous head posture in infantile nystagmus

The purpose of this study was to report the effect of combining the Kestenbaum procedure with posterior fixation suture for infantile horizontal nystagmus with anomalous head posture (AHP) in children. Nine consecutive patients who underwent combined Kestenbaum procedure plus posterior fixation suture to the recessed muscles at the same time were retrospectively studied. All patients were orthotropic before surgery and were followed for at least 6 months. Pre- and postoperative AHP and binocular corrected visual acuity (BCVA), and ocular alignment were assessed. Mean age at surgery was 4.8 ± 1.5 years. The average follow-up was 29.7 months. The average head turn preoperatively was 27.4° and postoperatively 7.2°. The average net change in AHP was 24.8° (P = 0.008). Seven of 9 patients (78%) achieved a residual head turn of 10° or less. The average Log Mar BCVA was 0.33 preoperatively and 0.31 postoperatively (P = 0.68). Only 1 patient needed additional surgery for residual horizontal AHP. No patient developed strabismus. Combined Kestenbaum procedure with posterior fixation suture was an effective and stable procedure in reducing AHP of the range of 20° to 35° in children with infantile nystagmus

Long-term outcome of strabismus and ptosis surgery in a mother and daughter with congenital fibrosis of extraocular muscles

Background. Congenital fibrosis of extraocular muscles (CFEOM) is a very rare congenital condition, characterized by variable amounts of restriction of the extraocular muscles, with or without ptosis. The aim of this report was to deseribe a severe, atypical, exposure-induced corneal stromal lysis in two patients. Case report. A mother and a daughter with a severe CFEOM were presented. The surgery of both extraocular muscles and ptosis led to a fair outcome in mother even 30 years after, and a very good outcome in daughter 4 years after the treatment. Conclusion. Though frequently challenging and disappointing the outcome of surgery of both extraocular muscles and ptosis in CFEOM can be favorable even in rather severe cases. To the best of our knowledge, the atypical keratolysis we described has not been highlighted in the literature on CFEOM so far