Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review

Purpose!#!Traumatic cranio-cervical instability in childhood is rare and constitutes a challenge for the treating surgeon. The aim of therapy is to restore cervical stability without limiting the range of motion. The goal of this systematic review was to find out whether, over the last 10 years, halo fixation (HF) could still be considered a successful treatment option without major risks or complications.!##!Methods!#!We analyzed studies describing the use of HF in traumatic injuries of the cranio-cervical junction in children under the age of 17. Searches were performed in PubMed, MEDLINE and Embase databases for the years from 2010 to 2020. The general success rate, the success rate related to underlying pathologies, and complication rates were evaluated.!##!Results!#!The main indications for HF range from pre-surgical correction to postoperative fusion support. C2 is the most frequently injured vertebra in children. The overall success rate of HF was very high. Evaluation according to the underlying pathology showed that, except for atlanto-occipital dislocation, HF generates high fusion rates among different patient cohorts, mainly in C2 vertebra injuries and atlantoaxial rotatory subluxation. Only minor complications were reported, such as pin infections.!##!Conclusion!#!The current data show that, when used according to the appropriate indication, HF is an effective conservative treatment option for cranio-cervical instability, associated with only minor complications

Cervical spine injuries requiring surgery in a Level I trauma centre in a major German city

Background!#!Cervical spine injuries (CSI) are rare in trauma patients, at about 9.2-16.5/100,000 inhabitants in Scandinavia and Canada, and the annual incidence of CSI surgeries in Norway is around 3.0/100,000 inhabitants. However, despite their rarity, the incidence of CSI has increased, thereby assuming an increasing need for surgery. Outside of Scandinavia, no data about the incidence of CSI and subsequent surgeries exist. Therefore, this study aimed to analyse CSI epidemiology and surgery in a German city with a Level I trauma centre both to understand the injury and improve needs-based planning.!##!Methods!#!This retrospective, monocentre study included all patients who presented with CSI from 2012-2017 at a university hospital with a Level I trauma centre in a major German city and had permanent residency within the city. Based on the assumption that the patients represented all CSI injuries in the city, as they were treated at the only available Level I trauma centre, the annual incidence of surgeries and neurologic deficits due to CSI were calculated.!##!Results!#!A total of 465 patients with 609 CSI were identified. Of these patients, 61 both received surgery and resided in the city (mean age, 68.1 ± 18.3 years; 26 female, 35 male). The incidence of CSI surgeries was calculated as 3.24/100,000 person years (1.75/100,000 in the upper and 1.54/100,000 in the subaxial cervical spine). Neurologic deficits occurred in 0.64/100,000 person years. The incidence of both surgeries and neurologic deficits showed no significant changes over the 6-year study period.!##!Conclusions!#!Compared to Scandinavia, an increasing annual incidence for CSI surgeries and neurologic deficits were found. For long-term demand planning with adaptability to demographic changes, cross-regional studies including long-term follow-up are necessary

Mumford–Shah Model for One-to-one Edge Matching

Abstract—This paper presents a new algorithm based on the Mumford–Shah model for simultaneously detecting the edge features of two images and jointly estimating a consistent set of transformations to match them. Compared the current asymmetric methods in the literature, this fully symmetric method allows one to determine one-to-one correspondences between the edge features of two images. The entire variational model is realized in a multi-scale framework of the Finite Element approximation. The optimization process is guided by an EM type algorithm and an adaptive generalized gradient flow to guarantee a fast and smooth relaxation. The algorithm is tested on T1 and T2 magnetic resonance image (MRI) data to study the parameter setting. We also present promising results of four applications of the proposed algorithm: inter-object mono-modal registration, retinal image registration, matching digital photographs of neurosurgery with its volume data and motion estimation for frame interpolation. Index Terms—Image registration, edge detection, Mumford– Shah mode

Antithrombotic Therapy in Spinal Surgery Does Not Impact Patient Safety-A Single Center Cohort Study.

Objective Antithrombotic therapy is common in older patients to avoid thromboembolic events. Careful planning is required, particularly in the perioperative environment. There are no clearly date guidelines on the best timing for interrupting the use of anticoagulation in the case of spinal surgery. This study evaluates early per procedural clinical outcomes in patients whose antithrombotic therapy was interrupted for spinal surgery. Methods This is a retrospective cohort study. All patients who underwent dorsal instrumentation from January 1, 2019 to December 31, 2020 were included. In group A, vitamin K antagonists (VKA) were suspended for 5 days and direct oral anticoagulants (DOAC) for 3 days. In group B, antiplatelet agents (APA) were paused for at least 7 days before surgery to prevent perioperative bleeding. Patients not taking anticoagulation medication were gathered into control group C. We analyzed demographic data, ASA status, blood loss, comorbidities, duration of surgery, blood transfusion, length of hospital stay, complications, thromboembolism, and 30 day in-hospital mortality. Multivariate analyses from the three groups were further analyzed and conducted. Results A total of 217 patients were operated and included. Twenty-eight patients taking VKA/DOAC (group A), 37 patients using APA (group B), and 152 patients without anticoagulation (group C) underwent spinal surgery. Those using anticoagulants were significantly older and often with multimorbidity, but did not differ significantly in procedural bleeding, time of surgery, length of hospital stay, complication rate, thromboembolism, or 30 day in-hospital mortality (p > 0.05). Conclusion Our data show that dorsal instrumentation safely took place in patients whose antithrombotic therapy was interrupted

A Variational Framework for Joint Image

In this paper we propose a new symmetrical framework that solves image denoising, edge detection and non--rigid image registration simultaneously. This framework is based on the Ambrosio--Tortorelli approximation of the Mumford--Shah model. The optimization of a global functional leads to decomposing the image into a piecewise--smooth representative, which is the denoised intensity function, and a phase field, which is the approximation of the edge-set. At the same time, the method seeks to register two images based on the segmentation results. The key idea is that the edge set of one image should be transformed to match the edge set of the other. The symmetric non--rigid transformations are estimated simultaneously in two directions. One consistency functional is designed to constrain each transformation to be the inverse of the other. The optimization process is guided by a generalized gradient flow to guarantee smooth relaxation. A multi--scale implementation scheme is applied to ensure the e#ciency of the algorithm. We have performed preliminary medical evaluation on T1 and T2 MRI data, where the experiments show encouraging results