A Noninvasive Assistant System in Diagnosis of Lumbar Disc Herniation

The purpose of this study is the application of pressure sensors in diagnostics and evaluation of the accuracy diagnostics of lumbar disc herniation at levels L4/L5 and L5/S1 using the aforementioned platform. The motivation behind the idea to apply the pressure measurement platform is the fact that the motor weakness of plantar and dorsal flexia of the feet is one of the absolute indications for the operative treatment of patients with lumbar disc herniation at the indicated levels. In patients, MRI diagnosis of the lumbosacral spine served as the ground truth in the diagnosis of herniation at L4/L5 and L5/S1 levels. The inclusive criteria for the study were the proven muscle weakness based on manual muscle tests performed prior to surgery, after seven days of surgery and after physical therapy. The results obtained with the manual muscular test were compared with the results obtained using our platform. The study included 33 patients who met the inclusion criteria. The results of the measurements indicate that the application of our platform with pressure sensors has the same sensitivity diagnostics as a manual muscle test, when done preoperatively and postoperatively. After physical therapy, pressure sensors show statistically significantly better sensitivity compared to the clinical manual muscle test. The obtained results are encouraging in the sense that the pressure platform can be an additional diagnostic method for lumbar disc herniation detection and can indicate the effectiveness of operative treatment and physical therapy after operation. The main advantage of the system is the cost; the whole system with platform and sensors is not expensive

Locating and categorizing causes of discomfort during transport of patients to medical facilities

This article presents geographic information system usage in transportation management for comfort calculations, analysing vehicle vibration data measured during patient transportation. The main goal of this article is to develop a methodology for automatic discomfort cause recognition (DCR) that may be tested under real life conditions. We analysed differences between uncomfortable locations detected by passengers during patient transportation (according to their subjective opinions) and uncomfortable locations detected by the measurement system. The measuring system is based on the three-axis accelerometer which is used to determine road comfort values for specific locations gathered by a GPS module. The results obtained were compared with data collected by passengers. During driving, when they experienced discomfort, passengers marked locations in near real time using the GIS. The data thus obtained were analysed with the data obtained by DCR. For the first time, the application of GIS provides analytical tools to create spatial data and define spatial data relations that determine comfort. Testing under real conditions, involving three separate cases, shows a high degree of correlation between the results. The proposed system allows dynamic comfort threshold criteria management and provides a visual representation of summarized tabular data

Standardna lumbalna diskektomija nasuprot mikrodiskektomiji – razlike u ishodu liječenja i stopi reoperacije

Microdiscectomy (MD) is accepted nowadays as the operative method of choice for lumbar disc herniation, but it is not rare for neurosurgeons to opt for standard discectomy (SD), which does not entail the use of operating microscope. In our study, differences in disc herniation recurrence and clinical outcome of surgical treatment of lumbar disc herniation with and without the use of operating microscope were assessed. Our study included 167 patients undergoing lumbar disc surgery during a three-year period (SD, n=111 and MD, n=56). Clinical outcome assessments were recorded by patients via questionnaire forms filled out by patients at three time points. Operation duration, length of hospital stay and revision surgeries were also recorded. According to study results, after one-year follow up there was no statistically significant difference between the SD and MD groups in functional outcome. However, we recorded a statistically significant difference in leg pain reduction in favor of the MD group. According to the frequency of reoperations with the mean follow up period of 33.4 months, there was a statistically significant difference in favor of the MD group (SD 6.3% vs. MD 3.2%). There appears to be no particular advantage of either technique in terms of functional outcome since both result in good overall outcome. However, we choose MD over SD because it includes significantly lower recurrent disc herniation rate and higher reduction of leg pain.Mikrodiskektomija (MD) je danas prihvaćena kao operativna metoda izbora u liječenju lumbalne diskus hernije, ali se neurokirurzi nerijetko odlučuju za standardnu diskektomiju (SD) koja ne podrazumijeva upotrebu operativnog mikroskopa. U našoj studiji smo nastojali uočiti razlike vezano za rekurentnu diskus herniju i funkcionalni ishod kirurškog liječenja lumbalne diskus hernije uz uporabu operativnog mikroskopa i bez nje. Naša studija je uključila 167 bolesnika koji su podvrgnuti operaciji lumbalne diskus hernije tijekom trogodišnjeg razdoblja (SD, n=111 i MD, n=56). Ishod liječenja procjenjivao se pomoću upitnika koji su bolesnici ispunjavali u tri vremenske točke. Vrijeme trajanja operacije, dužina hospitalizacije i reoperacije su također bilježeni. Nakon godinu dana praćenja prema našim rezultatima nije bilo statistički značajne razlike između skupina SD i MD u funkcionalnom ishodu liječenja, ali je zabilježena statistički značajna razlika u smanjenju boli u nozi u korist skupine MD. Prema učestalosti reoperacija s prosječnim razdobljem praćenja od 33,4 mjeseca, utvrđena je statistički značajna razlika u korist skupine MD (SD, 6,3% i MD, 3,2%). Nijednoj operativnoj tehnici ne može se dati prednost u smislu funkcionalnog ishoda liječenja, jer obje daju odlične rezultate. Ipak, naš izbor je mikrodiskektomija zbog niže stope rekurentne diskus hernije i višeg stupnja smanjenja boli u nozi

Non-invasive improved technique for lumbar discus hernia classification based on fuzzy logic

This paper presents the improved technique for classification of the type of lumbar discus hernia based on fuzzy logic. The reduced mobility of the foot is one of the symptoms of the disease that occurs because of the displaced discs in the space of two vertebrae. This fact was used for non-invasive discus hernia diagnosis by measuring force values from four sensors placed on both feet (first, second and fourth metatarsal head as well as the heel). Hardware and software systems were constructed for the doctor to perform the measurements and have a graphical representation during the measuring procedure. The procedure included measuring force values of 18 subjects during normal standing, standing on forefeet and heels. All subjects were diagnosed by a specialist with either L4/L5 or L5/S1 discus hernia. Filtering and further preprocessing of acquired values included separation of forefeet and heel segments that were used as inputs to fuzzy system. The results showed that the accuracy of such a fuzzy system was around 72%, and the proposed system correctly recognizes healthy individuals. Obtained information about forces on characteristic points on the foot represents useful data in diagnosis which further can be processed in order to be a supportive tool to doctors

An Early Disc Herniation Identification System for Advancement in the Standard Medical Screening Procedure Based on Bayes Theorem

The aim of this research was to analyze objectively the process of disc herniation identification using Bayes Theorem. One of the symptoms of discus hernia is muscle weakness on the foot that is caused by displaced discs in the space of two vertebrae. This fact is used by experts in initial diagnosis of herniated discs and we used it to create non-invasive platform for the same purposes by measuring force values from four sensors placed on both feet (first, second, and fourth metatarsal head as well as the heel). Dataset consisted of several minute force recordings of 56 subjects with discus hernia and 15 healthy individuals during normal standing, standing on forefeet and heels. The subjects were diagnosed by a specialist with either L4/L5 or L5/S1 discus hernia. Collected recordings were processed in several steps including filtering, extraction of forefeet and heel recordings, classification of average values for forefeet, and heel sensors to the groups with or without foot muscle weakness. Application of Bayes Theorem on the attributes of interest showed average 78.3 accuracy with 62.6 sensitivity and 80.9 specificity, while application of naive Bayes Network showed average 83.1 accuracy with 57.6 sensitivity and 88.2 specificity. Very weak or no correlation was observed between gender and disc hernia diagnosis (or obesity type and disc hernia diagnosis). Obtained results show that this method can be used in initial screening of patients and be a supportive tool to doctors to send the same patients for further examination

To wait for a spontaneous recovery of the third cranial nerve palsy occurring after the coiling of a PcomA aneurysm or to implement surgical treatment? A case report

Introduction. In the last two decades a method of endovascular embolization has been imposed as a method of choice in the treatment of unruptured intracranial aneurysms. Therefore, the problem of treating posterior communicating artery (PComA) aneurysms presenting with the third cranial nerve (TCN) palsy has become even more complex. The case of a patient reported in the paper itself has presented a dilemma of whether to wait for spontaneous resolution of ophthalmoplegia developed after the coiling of a PComA aneurysm or whether to implement an early surgical treatment. Case report. An unruptured saccular aneurysm, directed inferolaterally in the right internal carotid artery (ICA) segment in the position of the PcomA origin, was diagnosed in a 58-year-old male patient. The aneurysm was measuring 9 mm in diameter while the neck was measuring 5 mm. The day before the planned embolization, the patient developed ipsilateral ophthalmoparesis, whereas the first day after the endovascular procedure was completed, the patient developed right-sided complete ophthalmoplegia. Ten weeks after the endovascular embolization our team decided to perform a microsurgical treatment including aneurysm clipping and coil extraction. Eighteen months after the surgery, the patient made a full recovery of the functions of musculus (m) levator palpabrae, m. rectus medialis and pupillary function, with a partial recovery of the functions of m. obliqus inferior, m. rectus inferior and m. rectus superior. Conclusion. According to medical research and literature, the partial recovery of the TCN palsy is expected to happen in the first few weeks after embolization. Despite the completion of endovascular treatment progression of ophthalmoparesis to ophthalmoplegia without any simptoms of clinical improvement after 10 weeks is considered to be an indicator of longstanding TCN compression, which can lead to irreversible nerve damage. Despite the increase in the use of an endovascular embolization method in the treatment of PComA aneurysms preceeded by the TCN palsy, neurosurgical treatment is believed to have been necessary. Still, there is one question left to be answered - did we react too late in this particular case