3651
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Novara G, Checcucci E, Crestani A, Abrate A, Esperto F, Pavan N, De Nunzio C, Galfano A, Giannarini G, Gregori A, Liguori G, Bartoletti R, Porpiglia F, Scarpa RM, Simonato A, Trombetta C, Tubaro A, Ficarra V. Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic? Eur Urol 2020; 78:786-811. [PMID: 32616405 PMCID: PMC7301090 DOI: 10.1016/j.eururo.2020.06.025] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Context Coronavirus disease 2019 (COVID-19) pandemic has caused increased interest in the application of telehealth to provide care without exposing patients and physicians to the risk of contagion. The urological literature on the topic is sparse. Objective To perform a systematic review of the literature and evaluate all the available studies on urological applications of telehealth. Evidence acquisition After registration on PROSPERO, we searched PubMed and Scopus databases to collect any kind of studies evaluating any telehealth interventions in any urological conditions. The National Toxicology Program/Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies was used to estimate the risk of bias. A narrative synthesis was performed. Evidence synthesis We identified 45 studies (11 concerning prostate cancer [PCa], three hematuria management, six urinary stones, 14 urinary incontinence [UI], five urinary tract infections [UTIs], and six other conditions), including 12 randomized controlled trials. The available literature indicates that telemedicine has been implemented successfully in several common clinical scenarios, including the decision-making process following a diagnosis of nonmetastatic PCa, follow-up care of patients with localized PCa after curative treatments, initial diagnosis of hematuria, management diagnosis and follow-up care of uncomplicated urinary stones and uncomplicated UTIs, and initial evaluation, behavioral therapies, and pelvic floor muscle training in UI patients, as well as follow-up care after surgical treatments of stress urinary incontinence or pelvic organ prolapse. The methodological quality of most of the reports was good. Conclusions Telehealth has been implemented successfully in selected patients with PCa, UI, pelvic organ prolapse, uncomplicated urinary stones, and UTIs. Many urological conditions are suitable for telehealth, but more studies are needed on other highly prevalent urological malignant and benign conditions. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine. More robust data on long-term efficacy, safety, and health economics are necessary. Patient summary The diffusion of coronavirus disease 2019 (COVID-19) infections has recently increased the interest in telehealth, which is the adoption of telecommunication to deliver any health care activity. The available literature indicates that telemedicine has been adopted successfully in selected patients with several common clinical urological conditions, including prostate cancer, uncomplicated urinary stones, uncomplicated urinary infections, urinary incontinence, or pelvic organ prolapse. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine, but more robust data on long-term efficacy, safety, and costs are necessary.
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Affiliation(s)
- Giacomo Novara
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Italy.
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Alberto Abrate
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre, "Santa Maria della Misericordia" Hospital, Udine, Italy
| | | | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, Urologic Unit, University of Pisa, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Alchiede Simonato
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Urology Unit, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
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3652
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Chiari 1 Formation Redefined-Clinical and Radiographic Observations in 388 Surgically Treated Patients. World Neurosurg 2020; 141:e921-e934. [PMID: 32562905 DOI: 10.1016/j.wneu.2020.06.076] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The subject of Chiari formation is revisited and redefined. Results of surgical treatment of patients with Chiari formation by atlantoaxial fixation are presented. METHODS Results were analyzed of 388 patients with Chiari formation surgically treated during 2010 to June 2019. RESULTS Two hundred and sixty-six patients had syringomyelia. Two hundred and three patients had no craniovertebral bone abnormality and 74 patients had group A and 111 patients had group B basilar invagination. Twenty-nine patients had been earlier treated by foramen magnum decompression surgery with or without duroplasty. Clinical parameters, analysis of video recordings both before and after surgery, and patient self-assessment were included in the analysis of outcome. Immediate postoperative and sustained clinical improvement was observed in 385 patients (99.4%). CONCLUSIONS Satisfactory clinical outcome in most patients after atlantoaxial fixation and without any manipulation of neural structures, dura, or bone in the region of foramen magnum consolidates the viewpoint that atlantoaxial instability is the nodal point of pathogenesis of Chiari 1 formation. The study suggests that Chiari 1 formation may be a secondary natural neural alteration in the face of atlantoaxial instability. The role of foramen magnum decompression surgery needs to be reassessed.
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3653
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Ahn TK, Kim KT, Joshi HP, Park KH, Kyung JW, Choi UY, Sohn S, Sheen SH, Shin DE, Lee SH, Han IB. Therapeutic Potential of Tauroursodeoxycholic Acid for the Treatment of Osteoporosis. Int J Mol Sci 2020; 21:ijms21124274. [PMID: 32560070 PMCID: PMC7349164 DOI: 10.3390/ijms21124274] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023] Open
Abstract
Tauroursodeoxycholic acid (TUDCA) is a US FDA-approved hydrophilic bile acid for the treatment of chronic cholestatic liver disease. In the present study, we investigate the effects of TUDCA on the proliferation and differentiation of osteoblasts and its therapeutic effect on a mice model of osteoporosis. Following treatment with different concentrations of TUDCA, cell viability, differentiation, and mineralization were measured. Three-month-old female C57BL/6 mice were randomly divided into three groups (n = 8 mice per group): (i) normal mice as the control group, (ii) ovariectomy (OVX) group (receiving phosphate-buffered saline (PBS) treatment every other day for 4 weeks), and (iii) OVX group with TUDCA (receiving TUDCA treatment every other day for 4 weeks starting 6 weeks after OVX). At 11 weeks post-surgery, serum levels of procollagen type I N-terminal propeptides (PINP) and type I collagen crosslinked C-telopeptides (CTX) were measured, and all mice were sacrificed to examine the distal femur by micro-computed tomography (CT) scans and histology. TUDCA (100 nM, 1 µM) significantly increased the proliferation and viability of osteoblasts and osteoblast differentiation and mineralization when used in vitro. Furthermore, TUDCA neutralized the detrimental effects of methylprednisolone (methylprednisolone-induced osteoblast apoptosis). In the TUDCA treatment group the PINP level was higher and the CTX level was lower, but these levels were not significantly different compared to the PBS treatment group. Micro-CT and histology showed that the TUDCA treatment group preserved more trabecular structures in the distal femur compared to the PBS treatment group. In addition, the TUDCA treatment group increased the percentage bone volume with respect to the total bone volume, bone mineral density, and mice distal femur trabeculae compared with the PBS treatment group. Taken together, our findings suggest that TUDCA may provide a favorable effect on bones and could be used for the prevention and treatment of osteoporosis.
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Affiliation(s)
- Tae-Keun Ahn
- Department of Orthopedic Surgery, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam-si, Gyeonggi-do 13496, Korea; (T.-K.A.); (D.-E.S.)
| | - Kyoung-Tae Kim
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu 41944, Korea
| | - Hari Prasad Joshi
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
| | - Kwang Hwan Park
- Department of Orthopedic Surgery, Yonsei University, Severance Hospital, Seoul 03772, Korea;
| | - Jae Won Kyung
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
| | - Un-Yong Choi
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
| | - Seil Sohn
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
| | - Seung-Hun Sheen
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
| | - Dong-Eun Shin
- Department of Orthopedic Surgery, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam-si, Gyeonggi-do 13496, Korea; (T.-K.A.); (D.-E.S.)
| | - Soo-Hong Lee
- Department of Medical Biotechnology, Dongguk University-Seoul, Seoul 04620, Korea
- Correspondence: (S.-H.L.); (I.-B.H.); Tel.: +82-2-2260-3114 (S.-H.L.); +82-31-780-1924 (I.-B.H.); Fax: +82-2-2277-1274 (S.-H.L.); +82-31-780-5269 (I.-B.H.)
| | - In-Bo Han
- Department of Neurosurgery, CHA University School of medicine, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do 13496, Korea; (H.P.J.); (J.W.K.); (U.-Y.C.); (S.S.); (S.-H.S.)
- Correspondence: (S.-H.L.); (I.-B.H.); Tel.: +82-2-2260-3114 (S.-H.L.); +82-31-780-1924 (I.-B.H.); Fax: +82-2-2277-1274 (S.-H.L.); +82-31-780-5269 (I.-B.H.)
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3654
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Wu PH, Kim HS, Lee YJ, Kim DH, Lee JH, Jeon JB, Raorane HD, Jang IT. Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note. Brain Sci 2020; 10:brainsci10060373. [PMID: 32549320 PMCID: PMC7348812 DOI: 10.3390/brainsci10060373] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Severe collapsed disc secondary to degenerative spinal conditions leads to significant foraminal stenosis. We hypothesized that uniportal posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling technique could be safely applied to the collapsed disc space to improve patients’ pain score, restore disc height, and correct the segmental angular parameters. Methods: We included patients who met the indication criteria for lumbar fusion and underwent uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with pre-operative Computer Tomography mid disc height of less than or equal to 5 mm and MRI of Grade 3 Foraminal Stenosis. Visual analogue scale and computer tomography pre-operative and post-operative sagittal disc height in the anterior, middle and posterior part of the disc; sagittal focal segmental angle; mid coronal disc height and coronal wedge angles were evaluated. Results: 30 levels of Endo-TLIF were included, with a mean follow up of 12 months. The mean improvement in decreasing pain score was 2.5 ± 1.1, 3.2 ± 0.9 and 4.3 ± 1.0 at 1 week post operation, 3 months post operation and at final follow up, respectively, p < 0.05. There was significant increase in mid sagittal computer tomographic anterior, middle and posterior disc height of 6.99 ± 2.30, 6.28 ± 1.44, 5.12 ± 1.79 mm respectively, p < 0.05. CT mid coronal disc height showed an increase of 7.13 ± 1.90 mm, p < 0.05. There was a significant improvement in the CT coronal wedge angle of 2.35 ± 4.73 and the CT segmental focal sagittal angle of 1.98 ± 4.69, p < 0.05. Conclusion: Application of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion in patients with severe foraminal stenosis secondary to severe collapsed disc space significantly relieved patients’ pain and restored disc height without early subsidence or exiting nerve root dysesthesia in our cohort of patients.
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Affiliation(s)
- Pang Hung Wu
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
- National University Health System, JurongHealth Campus, Orthopaedic Surgery, Singapore 609606, Singapore
| | - Hyeun Sung Kim
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
- Correspondence:
| | - Yeon Jin Lee
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| | - Dae Hwan Kim
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| | - Jun Hyung Lee
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| | - Jun Bok Jeon
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| | - Harshavardhan Dilip Raorane
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| | - Il-Tae Jang
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
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3655
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Sultan AS, Elgharib MA, Tavares T, Jessri M, Basile JR. The use of artificial intelligence, machine learning and deep learning in oncologic histopathology. J Oral Pathol Med 2020; 49:849-856. [PMID: 32449232 DOI: 10.1111/jop.13042] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recently, there has been a momentous drive to apply advanced artificial intelligence (AI) technologies to diagnostic medicine. The introduction of AI has provided vast new opportunities to improve health care and has introduced a new wave of heightened precision in oncologic pathology. The impact of AI on oncologic pathology has now become apparent, and its use with respect to oral oncology is still in the nascent stage. DISCUSSION A foundational overview of AI classification systems used in medicine and a review of common terminology used in machine learning and computational pathology will be presented. This paper provides a focused review on the recent advances in AI and deep learning in oncologic histopathology and oral oncology. In addition, specific emphasis on recent studies that have applied these technologies to oral cancer prognostication will also be discussed. CONCLUSION Machine and deep learning methods designed to enhance prognostication of oral cancer have been proposed with much of the work focused on prediction models on patient survival and locoregional recurrences in patients with oral squamous cell carcinomas (OSCC). Few studies have explored machine learning methods on OSCC digital histopathologic images. It is evident that further research at the whole slide image level is needed and future collaborations with computer scientists may progress the field of oral oncology.
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Affiliation(s)
- Ahmed S Sultan
- School of Dentistry, University of Maryland, Baltimore, MD, USA
| | | | - Tiffany Tavares
- School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Maryam Jessri
- Oral Health Centre of Western Australia, Perth, WA, Australia
| | - John R Basile
- School of Dentistry, University of Maryland, Baltimore, MD, USA.,University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA
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3656
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Overview of Minimally Invasive Spine Surgery. World Neurosurg 2020; 142:43-56. [PMID: 32544619 DOI: 10.1016/j.wneu.2020.06.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/21/2022]
Abstract
Minimally invasive spine surgery (MISS) has continued to evolve over the past few decades, with significant advancements in technology and technical skills. From endonasal cervical approaches to extreme lateral lumbar interbody fusions, MISS has showcased its usefulness across all practice areas of the spine, with unique points of access to avoid pertinent neurovascular structures. Adult spine deformity has also recognized the importance of minimally invasive techniques in its ability to limit complications and to provide adequate sagittal alignment correction and improvements in patients' functional status. Although MISS has continued to make significant progress clinically, consideration must also be given to its economic impact and the learning curve surgeons experience in adding these procedures to their armamentarium. This review examines current innovations in MISS, as well as the economic impact and future directions of the field.
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3657
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Srinivasaiah B, Deora H. Anesthetic Management of Neurosurgery Patients in COVID-19 Pandemic in an Emergency Setting. J Neurosci Rural Pract 2020; 11:514-516. [PMID: 33144783 PMCID: PMC7595786 DOI: 10.1055/s-0040-1713342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Bharath Srinivasaiah
- Department of Neuro-anesthesia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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3658
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Liu N, Zhang Z, Li L, Shen X, Sun B, Wang R, Zhong H, Shi Q, Wei L, Zhang Y, Wang Y, Xu C, Liu Y, Yuan W. MicroRNA-181 regulates the development of Ossification of Posterior longitudinal ligament via Epigenetic Modulation by targeting PBX1. Theranostics 2020; 10:7492-7509. [PMID: 32685001 PMCID: PMC7359103 DOI: 10.7150/thno.44309] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/02/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives: Ossification of the posterior longitudinal ligament (OPLL) presents as the development of heterotopic ossification in the posterior longitudinal ligament of the spine. The etiology of OPLL is genetically linked, as shown by its high prevalence in Asian populations. However, the molecular mechanism of the disease remains obscure. In this study, we explored the function and mechanism of OPLL-specific microRNAs. Methods: The expression levels of the ossification-related OPLL-specific miR-181 family were measured in normal or OPLL ligament tissues. The effect of miR-181a on the ossification of normal or pathogenic ligament cells was tested using real-time polymerase chain reaction (PCR), Western blot, alizarin red staining and alkaline phosphatase (ALP) staining. The candidate targets of miR-181 were screened using a dual luciferase reporter assay and functional analysis. The link between miR-181a and its target PBX1 was investigated using chromatin immunoprecipitation, followed by real-time PCR detection. Histological and immunohistochemical analysis as well as micro-CT scanning were used to evaluate the effects of miR-181 and its antagonist using both tip-toe-walking OPLL mice and in vivo bone formation assays. Results: Using bioinformatic analysis, we found that miR-181a-5p is predicted to play important roles in the development of OPLL. Overexpression of miR-181a-5p significantly increased the expression of ossification-related genes, staining level of alizarin red and ALP activity, while the inhibition of miR-181a-5p by treatment with an antagomir had the opposite effects. Functional analysis identified PBX1 as a direct target of miR-181a-5p, and we determined that PBX1 was responsible for miR-181a-5p's osteogenic phenotype. By chromatin immunoprecipitation assay, we found that miR-181a-5p controls ligament cell ossification by regulating PBX1-mediated modulation of histone methylation and acetylation levels in the promoter region of osteogenesis-related genes. Additionally, using an in vivo model, we confirmed that miR-181a-5p can substantially increase the bone formation ability of posterior ligament cells and cause increased osteophyte formation in the cervical spine of tip-toe-walking mice. Conclusions: Our data unveiled the mechanism by which the miR-181a-5p/PBX1 axis functions in the development of OPLL, and it revealed the therapeutic effects of the miR-181a-5p antagomir in preventing OPLL development both in vivo and in vitro. Our work is the first to demonstrate that microRNA perturbation could modulate the development of OPLL through epigenetic regulation.
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Affiliation(s)
- Ning Liu
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
| | - Zicheng Zhang
- Undergraduate Brigade, Changhai Hospital Affiliated to Second Military Medical University, 168th Chang Hai Road, Shanghai, 200433, China
| | - Li Li
- Research Center of Developmental Biology, Second Military Medical University, 800th Xiang Yin Road, Shanghai, 200433, PR China
| | - Xiaolong Shen
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
| | - Baifeng Sun
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
| | - Ruizhe Wang
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
| | - Huajian Zhong
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
| | - Qianghui Shi
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
| | - Leixin Wei
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
| | - Yizhi Zhang
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
| | - Yue Wang
- Research Center of Developmental Biology, Second Military Medical University, 800th Xiang Yin Road, Shanghai, 200433, PR China
| | - Chen Xu
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
| | - Yang Liu
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
| | - Wen Yuan
- Department of Orthopedics, Changzheng Hospital Affiliated to Second Military Medical University, 415th Feng Yang Road, Shanghai, 200003, PR China
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3659
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Luo J, Yang K, Zhong Y, Ye Y, Xiao C, Zeng Q, Yin W, Huang W, Liu W. Hirayama Disease Treated by Anterior Cervical Diskectomy and Fusion: Case Report and Literature Review. World Neurosurg 2020; 141:171-174. [PMID: 32540286 DOI: 10.1016/j.wneu.2020.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We present the case of a 19-year-old boy who had the classic radiologic and clinical presentations of Hirayama disease treated with anterior cervical diskectomy and fusion (ACDF). We also propose ACDF as promising surgery for the treatment of Hirayama disease. Hirayama disease is an initially progressive disease caused by cervical neck flexion compressing the anterior horns of the lower cervical spinal cord. CASE DESCRIPTION Our patient presented with an insidious, progressive weakness in his right hand, which had been ongoing for 1 year. Physical examination revealed various degrees of right forearm and hand muscle wasting, and decreased right hand extend power with motor grade Ш. Cervical flexed magnetic resonance imaging showed a spinal cord was being compressed-most noticeably at the level of the fifth cervical vertebral body-and that the dorsal epidural space was abnormally expanding. The patient underwent ACDF at the C4-6 level. The pain and paresthesia improved immediately after the surgery. His motor grade improved immediately after the operation, and there were improvements of a modest reversal of muscle wasting at 1 year postoperatively. CONCLUSIONS ACDF could be considered as an effective treatment option for the treatment of Hirayama disease. Our patient's finger function improved. Therefore we believe that anterior fusion might be the best choice of treatment.
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Affiliation(s)
- Jiaquan Luo
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, P.R. China
| | - Kanghua Yang
- Department of Sports Medicine, Ganzhou People's Hospital, Ganzhou, P.R. China
| | - Yanchun Zhong
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, P.R. China
| | - Yongjun Ye
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, P.R. China
| | - Chunlin Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, P.R. China
| | - Qingshen Zeng
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, P.R. China
| | - Wenchao Yin
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, P.R. China
| | - Weimin Huang
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, P.R. China
| | - Wuyang Liu
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, P.R. China.
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3660
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Yang F, Chen R, Gu D, Ye Q, Liu W, Qi J, Xu K, Fan X. Clinical Comparison of Full-Endoscopic and Microscopic Unilateral Laminotomy for Bilateral Decompression in the Treatment of Elderly Lumbar Spinal stenosis: A Retrospective Study with 12-Month Follow-Up. J Pain Res 2020; 13:1377-1384. [PMID: 32606904 PMCID: PMC7295456 DOI: 10.2147/jpr.s254275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/22/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose Although lumbar spinal stenosis (LSS) is the most common spinal disease in the elderly, there is still a confusion about the appropriate surgical treatment strategy. The aim of this study was to compare the safety and efficacy of full-endoscopic and microscopic unilateral laminotomy for bilateral decompression (ULBD) for LSS in elderly patients. Patients and Methods A retrospective analysis of 61 consecutive elderly patients with LSS who underwent either full-endoscopic (FE group) or microscopic (Micro group) unilateral laminotomy for bilateral decompression was performed. Clinical data were assessed before 2 weeks, 3 months, 6 months and 12 months after surgery using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) and the modified MacNab criteria. Results There are no significant differences in VAS (back and leg) and ODI between the two groups. However, the VAS back pain in the FE group was significantly improved compared to the Micro group at 2 weeks. The rate of excellent or good outcomes was 87.88% and 85.71% in the FE and Micro group, respectively (P>0.05). The hospital stay and early ambulation in FE group were shorter than those in Micro group, but the operation time was longer (P<0.05). The complications between the FE group (18.18%) and the Micro group (17.86%) were minor (P>0.05). Conclusion Both full-endoscopic and microscopic decompression have achieved favorable clinical results in treating elderly lumbar spinal stenosis, and the complications are minor. Full-endoscopic decompression has the advantages of small incision and rapid recovery, which can be used as an alternative for the treatment of lumbar spinal stenosis, especially the elderly with comorbidities.
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Affiliation(s)
- Fei Yang
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Rigao Chen
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Dangwei Gu
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Qingqing Ye
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Wei Liu
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Jianhua Qi
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Kai Xu
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Xiaohong Fan
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
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3661
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Park BJ, Hyun SJ, Wui SH, Jung JM, Kim KJ, Jahng TA. Surgical Outcomes and Complications Following All Posterior Approach for Spinal Deformity Associated with Neurofibromatosis Type-1. J Korean Neurosurg Soc 2020; 63:738-746. [PMID: 32512989 PMCID: PMC7671774 DOI: 10.3340/jkns.2019.0218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/19/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives The purpose of this study was to evaluate surgical outcomes and complications of spinal deformity associated with neurofibromatosis type-1 (NF-1).
Methods From 2012 to 2018, patients suffering from spinal deformity associated with NF-1 who underwent surgical correction were identified. Demographic data and radiographic measures were retrospectively reviewed. Pre- and postoperative whole spine radiograph images were used to determine both coronal and sagittal Cobb angles. All of patients underwent 3-dimentional computed tomographic scan and magnetic resonance imaging scan to confirm dystrophic features. For evaluation of clinical outcomes, we surveyed the pre- and postoperative scoliosis research society-22r (SRS-22r) score.
Results Seven patients with spinal deformity associated with NF-1 were enrolled in this study. The mean age of patients was 29.5±1.2 years old. The mean follow-up period was 2.8±1.4 years. The apex of the deformity was located in cervicothoracic (n=1), thoracic (n=4), and lumbar region (n=2). Most patients have poor bone quality and decreased bone mineral density with average T-score of -3.5±1.0. All patients underwent surgical correction via posterior approach. The pre- and postoperative mean coronal and sagittal Cobb angle was 61.6±22.6° and 34.6±38.1°, 56.8±18.5° and 40.2±9.1°, respectively. Mean correction rate of coronal and sagittal angle was 44.7% and 23.1%. Ultimate follow-up SRS-22r score (average score, 3.9±0.4) improved comparing to preoperative score (average score, 3.3±0.9). Only one patient received revision surgery due to rod fracture. No serious complication occurred, such as neurological deficit, and viscerovascular injury.
Conclusion The surgical correction of patients having spinal deformity associated with NF-1 is challenging, however the radiographic and clinical outcomes are satisfactory. The all posterior approach can be a safe and effective surgical option for patients having dystrophic curves associated with NF-1.
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Affiliation(s)
- Byoung-Joo Park
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong-Hyun Wui
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Myung Jung
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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3662
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Heo DH, Lee DK, Lee DC, Kim HS, Park CK. Fully Endoscopic Transforaminal Lumbar Discectomy for Upward Migration of Upper Lumbar Disc Herniation: Clinical and Radiological Outcomes and Technical Considerations. Brain Sci 2020; 10:brainsci10060363. [PMID: 32532092 PMCID: PMC7349390 DOI: 10.3390/brainsci10060363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
Microdiscectomy for the upward migration of upper lumbar herniated discs has a high risk of isthmus and facet injury. Fully endoscopic transforaminal discectomy can preserve normal bony structures during discectomy. The purpose of this study was to assess the clinical and radiological outcomes of fully endoscopic transforaminal discectomy for upward migrated upper lumbar herniated discs. All patients had upward migrated disc herniation from L1–L2 to L3–L4 levels and were treated using fully endoscopic transforaminal discectomy under local anesthesia. All enrolled patients were monitored for more than 12 months. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) of pain. Surgery-related complications were analyzed. In addition, radiological outcomes were investigated using postoperative magnetic resonance imaging (MRI) and lumbar dynamic X-ray. Twenty-eight patients were enrolled in this study. ODI and VAS significantly decreased after endoscopic transforaminal discectomy. Migrated ruptured disc particles were completely removed and confirmed on postoperative MRI in 26 of the 28 patients. Even though small remnant disc particles were detected in two patients, symptoms improved after endoscopic transforaminal discectomy. Early recurrence of herniated disc occurred at the operated segment in one patient. There were no significant complications associated with fully endoscopic transforaminal discectomy. Three patients experienced a postoperative transient tingling sensation and numbness of the leg. Fully endoscopic transforaminal lumbar discectomy may be an effective and alternative treatment option for upward migrated disc herniation in the upper lumbar area. In addition, fully endoscopic transforaminal lumbar discectomy may prevent complications associated with general endotracheal anesthesia and injuries of the isthmus and the facet joint.
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Affiliation(s)
- Dong Hwa Heo
- Department of Neurosurgery, Spine center, The Leon Wiltse Memorial Hospital, Suwon 16444, Korea; (D.H.H.); (D.K.L.); (C.K.P.)
| | - Dong Keun Lee
- Department of Neurosurgery, Spine center, The Leon Wiltse Memorial Hospital, Suwon 16444, Korea; (D.H.H.); (D.K.L.); (C.K.P.)
| | - Dong Chan Lee
- Department of Neurosurgery, Spine center, The Leon Wiltse Memorial Hospital, Suwon 16444, Korea; (D.H.H.); (D.K.L.); (C.K.P.)
- Correspondence: ; Tel.: +82-1577-8382
| | - Hyeun Sung Kim
- Department of Neurosurgery, Gangnam Nanoori Hospital, Seoul 06048, Korea;
| | - Choon Keun Park
- Department of Neurosurgery, Spine center, The Leon Wiltse Memorial Hospital, Suwon 16444, Korea; (D.H.H.); (D.K.L.); (C.K.P.)
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3663
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Kim HS, Wu PH, Lee YJ, Kim DH, Jang IT. Technical Considerations of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion: A Review of Its Early Clinical Results in Application in Adult Degenerative Scoliosis. World Neurosurg 2020; 145:682-692. [PMID: 32531438 DOI: 10.1016/j.wneu.2020.05.239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Uniportal endoscopic posterolateral lumbar interbody fusion (Endo-TLIF) provides one of the least invasive forms of minimally invasive surgery, allowing large size cages which are commercially available for open and tubular microscopic transforaminal lumbar interbody fusion (TLIF) to be inserted through this approach. We studied the effect of such a technique on a series of patients with low-grade degenerative scoliosis. METHODS Endo-TLIF was applied to patients who had 10°-40° of degenerative adult scoliosis. Pre- and postoperative 1-week, 3-month, and final follow-up clinical status of visual analog scale, Oswestry Disability Index, perioperative complications, and Macnab criteria were collected. Roentgenogram to assess changes in Cobb angles was done. RESULTS There was statistically significant improvement of preoperative, 1-week postoperative, 3-month postoperative, and final follow-up mean of visual analog scale scores with 7.72 (5-10), 3.68 (3-6), 2.88 (2-4), and 1.96 (1-3), respectively, and with Oswestry Disability Index mean of 70.4 (52-86), 35.12 (26-56), 27.68 (24-38), and 24 (20-28), respectively (P < 0.05). In terms of Macnab criteria, 100% had good to excellent result. In terms of scoliosis measured by Cobb angle, there was statistically significant improvement. CONCLUSIONS Endo-TLIF is a safe and effective procedure in mild to moderate degenerative scoliosis with good early clinical results and improvement in coronal Cobb angle. It can be considered as an option if a short segment(s) fusion is planned for adult degenerative scoliosis.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea.
| | - Pang Hung Wu
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea; JurongHealth Campus, Orthopaedic Surgery, National University Health System, Singapore
| | - Yeon Jin Lee
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea
| | - Dae Hwan Kim
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea
| | - Il Tae Jang
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea
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3664
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Chambers JA, Seastedt KP, Raymundo-Grinstead J. An Example of 3-D Printing for Expeditionary Medicine: The Air Force Retractor. Mil Med 2020; 185:e565-e567. [PMID: 32279075 DOI: 10.1093/milmed/usz449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Future challenges for the U.S. Department of Defense (DoD) include operating in a contested environment against near-peer adversaries. Providing casualty care in an anti-access/area denial (A2/AD) region would be potentially challenged by impaired logistical ability to reconstitute supplies or adapt to evolving needs. Additive manufacturing (AM), also known as 3D printing, offers an ability to regenerate stocked items as well as modify them or even create novel products de novo. MATERIALS AND METHODS This article discusses relevant technology and applications for deployed medical forces. Additionally, as proof of concept, we outline our design process for a novel 3D-printed surgical retractor. RESULTS Our "Air Force Retractor" prototype highlights the potential of using AM to create or augment surgical instruments downrange. CONCLUSIONS This paper encourages further investigation of the use of AM/3D printing downrange to create surgical instruments and medical supplies in austere, A2/AD, and other logistically challenging environments. Not only would this support regeneration of supplies, but also modification and even creation of novel products to adapt to changing needs. If 3D files could be created of common surgical instruments for print on designated resins downrange, and FDA approval obtained, an online library of files could be created for easy access to DoD members across the globe to support our nation's commitment to provide the best possible care for service members any time, any place.
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Affiliation(s)
- James A Chambers
- 380th Expeditionary Medical Group, Al Dhafra Air Base, Abu Dhabi, United Arab Emirates
| | - Kenneth P Seastedt
- 11th Surgical Operations Squadron, 1060 W. Perimeter Rd, Joint Base Andrews, MD 20762
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3665
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Sairyo K, Yamashita K, Manabe H, Ishihama Y, Sugiura K, Tezuka F, Takata Y, Sakai T, Omichi Y, Takamatsu N, Hashimoto A, Maeda T. A novel surgical concept of transforaminal full-endoscopic lumbar undercutting laminectomy (TE-LUL) for central canal stenosis of the lumbar spine with local anesthesia : A case report and literature review. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 66:224-229. [PMID: 31656278 DOI: 10.2152/jmi.66.224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Full-endoscopic spinal surgery was first developed for the lumbar herniated nucleus pulposus. Mainly, there are two types in the full-endoscopic lumbar surgery : i.e., transforaminal (TF) and interlaminar approach. The surgery can be done under the local anesthesia for the TF approach ; therefore, we need to further develop the TF approach to variety of the spinal disorders. Recently, the TF full-endoscopic surgery has been applied for the spinal canal stenosis. First, transforaminal full-endoscopic lumbar foraminoplasty for the foraminal stenosis ; then, transforaminal lumbar lateral recess decompression for the lateral recess stenosis has been developed. Finally, we have developed the surgical technique to decompress the central stenosis via TF approach under the local anesthesia. Prior to initiate the clinical case, we have attempted the lumbar undercutting laminectomy using a fresh cadaveric spine. After we technically confirmed that the transforaminal full-endoscopic lumbar undercutting laminectomy (TE-LUL) is possible, we applied the technique to the patient whose lung capacity did not allow general anesthesia. The 72 years old female patient with central canal stenosis could be improved her left leg pain and muscle weakness after TE-LUL under the local anesthesia. In this paper, we introduce the surgical technique of the TE-LUL and discuss of the efficacy of the TE-LUL. J. Med. Invest. 66 : 224-229, August, 2019.
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Affiliation(s)
- Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Hiroaki Manabe
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | | | - Kosuke Sugiura
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Yasuyuki Omichi
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | | | - Ayaka Hashimoto
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Tokushima University, Tokushima, Japan
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3666
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Hu X, Li R, Wu Y, Li Y, Zhong X, Zhang G, Kang Y, Liu S, Xie L, Ye J, Xiao J. Thermosensitive heparin-poloxamer hydrogel encapsulated bFGF and NGF to treat spinal cord injury. J Cell Mol Med 2020; 24:8166-8178. [PMID: 32515141 PMCID: PMC7348165 DOI: 10.1111/jcmm.15478] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/18/2020] [Accepted: 05/24/2020] [Indexed: 01/10/2023] Open
Abstract
The application of growth factors (GFs) for treating chronic spinal cord injury (SCI) has been shown to promote axonal regeneration and functional recovery. However, direct administration of GFs is limited by their rapid degradation and dilution at the injured sites. Moreover, SCI recovery is a multifactorial process that requires multiple GFs to participate in tissue regeneration. Based on these facts, controlled delivery of multiple growth factors (GFs) to lesion areas is becoming an attractive strategy for repairing SCI. Presently, we developed a GFs‐based delivery system (called GFs‐HP) that consisted of basic fibroblast growth factor (bFGF), nerve growth factor (NGF) and heparin‐poloxamer (HP) hydrogel through self‐assembly mode. This GFs‐HP was a kind of thermosensitive hydrogel that was suitable for orthotopic administration in vivo. Meanwhile, a 3D porous structure of this hydrogel is commonly used to load large amounts of GFs. After single injection of GFs‐HP into the lesioned spinal cord, the sustained release of NGF and bFGF from HP could significantly improve neuronal survival, axon regeneration, reactive astrogliosis suppression and locomotor recovery, when compared with the treatment of free GFs or HP. Moreover, we also revealed that these neuroprotective and neuroregenerative effects of GFs‐HP were likely through activating the phosphatidylinositol 3 kinase and protein kinase B (PI3K/Akt) and mitogen‐activated protein kinase/extracellular signal‐regulated kinase (MAPK/ERK) signalling pathways. Overall, our work will provide an effective therapeutic strategy for SCI repair.
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Affiliation(s)
- Xiaoli Hu
- Department of Anesthesia, The First Affiliated Hospital, Gannan Medical University, Ganzhou, China.,Molecular Pharmacology Research Center, School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, China
| | - Rui Li
- Department of Anesthesia, The First Affiliated Hospital, Gannan Medical University, Ganzhou, China.,Molecular Pharmacology Research Center, School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, China.,School of Chemistry, Sun Yat-sen University, Guangzhou, China
| | - Yanqing Wu
- The Institute of Life Sciences, Engineering Laboratory of Zhejiang Province for Pharmaceutical Development of Growth Factors, Biomedical Collaborative Innovation Center of Wenzhou, Wenzhou University, Wenzhou, China
| | - Yi Li
- Department of Anesthesia, The First Affiliated Hospital, Gannan Medical University, Ganzhou, China
| | - Xingfeng Zhong
- Department of Anesthesia, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Guanyinsheng Zhang
- Department of Anesthesia, The First Affiliated Hospital, Gannan Medical University, Ganzhou, China
| | - Yanmin Kang
- Department of Anesthesia, The First Affiliated Hospital, Gannan Medical University, Ganzhou, China
| | - Shuhua Liu
- Department of Anesthesia, The First Affiliated Hospital, Gannan Medical University, Ganzhou, China
| | - Ling Xie
- Molecular Pharmacology Research Center, School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, China
| | - Junming Ye
- Department of Anesthesia, The First Affiliated Hospital, Gannan Medical University, Ganzhou, China
| | - Jian Xiao
- Molecular Pharmacology Research Center, School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, China.,The Institute of Life Sciences, Engineering Laboratory of Zhejiang Province for Pharmaceutical Development of Growth Factors, Biomedical Collaborative Innovation Center of Wenzhou, Wenzhou University, Wenzhou, China
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3667
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Obrero-Gaitán E, Molina F, Del-Pino-Casado R, Ibáñez-Vera AJ, Rodríguez-Almagro D, Lomas-Vega R. Visual Verticality Perception in Spinal Diseases: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:E1725. [PMID: 32503240 PMCID: PMC7356295 DOI: 10.3390/jcm9061725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/26/2022] Open
Abstract
Patients diagnosed with traumatic or non-traumatic spinal pain and idiopathic scoliosis frequently suffer from imbalance. The evaluation of the perception of verticality by means of visual tests emerges as a quick and easy tool for clinical management of the balance disorders. Several studies have assessed the visual perception of verticality in spinal diseases obtaining controversial results. The aim of our study is to analyze the perception of visual verticality in subjects with several spinal diseases in comparison with healthy subjects. A meta-analysis was carried out. PubMed MEDLINE, Scopus, WoS, CINAHL, and SciELO databases were searched until January 2020. The standardized mean difference (SMD) was calculated to analyze differences between patients and healthy controls. Fifteen studies with a total of 2052 patients were included. In comparison with healthy subjects, a misperception of verticality was found in patients with spinal pain when the perception of the verticality was assessed with the rod and frame test (SMD = 0.339; 95% confidence interval (CI) = 0.181, 0.497; p < 0.001). It seems that the perception of visual verticality is not altered in patients with idiopathic scoliosis (p = 0.294). The present meta-analysis shows a misperception of visual verticality only in patients with spinal pain.
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Affiliation(s)
- Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (A.J.I.-V.); (D.R.-A.); (R.L.-V.)
| | - Francisco Molina
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (A.J.I.-V.); (D.R.-A.); (R.L.-V.)
| | - Rafael Del-Pino-Casado
- Department of Nursing, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain;
| | - Alfonso Javier Ibáñez-Vera
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (A.J.I.-V.); (D.R.-A.); (R.L.-V.)
| | - Daniel Rodríguez-Almagro
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (A.J.I.-V.); (D.R.-A.); (R.L.-V.)
| | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (E.O.-G.); (A.J.I.-V.); (D.R.-A.); (R.L.-V.)
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3668
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Endo T, Tominaga T. Use of an endoscope for spinal intradural pathology. JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:495-501. [PMID: 32656387 PMCID: PMC7340816 DOI: 10.21037/jss.2020.01.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/24/2019] [Indexed: 05/29/2023]
Abstract
The endoscope has been increasingly used to treat various spinal diseases. However, the application of spinal endoscopy in an intradural lesion has been less common compared to that of an epidural counterpart. The authors reviewed existing literature describing spinal endoscopy as an aid in surgical treatment for intradural pathologies. Importantly, available literature indicated the safety and feasibility of spinal endoscopy for intradural lesions. Especially, an endoscope was utilized for intradural subarachnoid cystic lesions, tethered cord syndrome, extramedullary tumors, spinal arteriovenous malformations, and cordectomy for intractable pain. The results of this review should enhance further development and broaden application of an endoscope for various intradural pathologies.
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Affiliation(s)
- Toshiki Endo
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
- Department of Neurosurgery, Tohoku University, Graduate school of Medicine, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
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3669
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Huang WC, Chen YC, Tu TH, Chang HK, Kuo CH. Letter to the Editor. Indolent clinical and radiological effects of cervical disc arthroplasty. J Neurosurg Spine 2020; 32:984-985. [PMID: 32005009 DOI: 10.3171/2019.11.spine191369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wen-Cheng Huang
- 1Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chun Chen
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 3Taipei Veterans General Hospital, Taipei, Taiwan
- 4Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- 1Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- 1Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Hung Kuo
- 1Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 5School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
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3670
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Yamaguchi S, Menezes AH, Shimizu K, Woodroffe RW, Helland LC, Hitchon PW, Howard MA. Differences and characteristics of symptoms by tumor location, size, and degree of spinal cord compression: a retrospective study on 53 surgically treated, symptomatic spinal meningiomas. J Neurosurg Spine 2020; 32:931-940. [PMID: 32005026 DOI: 10.3171/2019.12.spine191237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The differences in symptoms of spinal meningiomas have rarely been discussed from the perspective of tumor characteristics. The main purpose of this paper was to define the differences, if any, in symptoms in patients with spinal meningiomas with respect to tumor size, location, and degree of spinal cord compression. The authors also sought the threshold of spinal cord compression that causes motor weakness. METHODS The authors conducted a retrospective study of 53 cases of spinal meningiomas that were surgically treated from 2013 to 2018. Symptoms related to the tumor were classified as motor weakness, sensory disturbance, pain, and bowel/bladder dysfunction. Based on MR images, tumor location was classified by spinal level and by its attachment to the dura mater. Tumor dimensions were also measured. Occupation ratios of the tumors to the spinal canal and degree of spinal cord flattening were sought from the axial MR images that showed the highest degree of spinal cord compression. RESULTS Motor weakness and sensory disturbance were significantly more common in thoracic spine meningiomas than in cervical spine meningiomas (p < 0.001 and p = 0.013, respectively), while pain was more common in meningiomas at the craniovertebral junction (p < 0.001). The attachment, height, width, depth, and volume of the tumor showed no significant difference irrespective of the presence or absence of each symptom. In cases of motor weakness and sensory disturbance, occupation ratios and spinal cord flattening ratios were significantly larger. However, these ratios were significantly smaller in the presence of pain. Multivariate logistic regression analysis revealed that occupation ratio independently contributed to motor weakness (OR 1.14, p = 0.035) and pain (OR 0.925, p = 0.034). Receiver operating characteristic curve analysis suggested that occupation ratio with a value of 63.678% is the threshold for the tumor to cause motor weakness. CONCLUSIONS The study showed the difference in clinical presentation of spinal meningiomas by spinal level, occupation ratio, and spinal cord flattening ratio. An occupation ratio of approximately 64% could be utilized as the threshold value of tumor growth to cause motor weakness. Tumor growth in the cervical spine might cause pain symptoms before causing motor weakness. The relationship between the tumor and its symptomatology should be discussed with respect to tumor size relative to the surrounding spinal canal.
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Affiliation(s)
- Satoshi Yamaguchi
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Arnold H Menezes
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Kiyoharu Shimizu
- 2Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Royce W Woodroffe
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Logan C Helland
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Patrick W Hitchon
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Matthew A Howard
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
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3671
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Kokubo R, Kim K, Isu T, Morimoto D, Iwamoto N, Morita A. Quality of life effects of pain from para-lumbar- and lower extremity entrapment syndrome and carpal tunnel syndrome and comparison of the effectiveness of surgery. Acta Neurochir (Wien) 2020; 162:1431-1437. [PMID: 31965318 DOI: 10.1007/s00701-020-04226-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/13/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We compared the preoperative quality of life (QOL) of patients with carpal tunnel syndrome, lower extremity-, and para-lumbar entrapment syndrome, and the effect of surgery on their QOL. PATIENTS AND METHODS We prospectively enrolled 66 consecutive patients who underwent surgery for carpal tunnel syndrome (group 1, n = 23), lower extremity entrapment syndrome (group 2, n = 22), and para-lumbar entrapment syndrome (group 3, n = 21). Their pre- and postoperative overall health status was assessed on the Medical Outcomes Study Short-Form 36 Health Survey, v2 (SF-36). RESULTS Except for the mental component summary, the preoperative score for items rated on the SF-36 was significantly lower in group 3 than in groups 1 and 2 (p < 0.05). In all 66 patients, the scores for bodily pain (BP) and the physical component summary (PCS) were significantly lower (p < 0.05) than the national standard, as was the score for physical functioning (PF) in groups 2 and 3. After surgery, PF of group 2 and PF, BP, and PCS of group 3 improved significantly (p < 0.05). CONCLUSION The detrimental QOL effects are stronger in patients with para-lumbar- or lower extremity entrapment syndrome than in patients with carpal tunnel syndrome.
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Affiliation(s)
- Rinko Kokubo
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, 1715, Kamagari, Inzai City, Chiba, Japan.
| | - Kyongsong Kim
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, 1715, Kamagari, Inzai City, Chiba, Japan
| | - Toyohiko Isu
- Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Japan
| | | | - Naotaka Iwamoto
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
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3672
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Zhang JJY, Lee KS. Letter: Cost-Effectiveness Research in Neurosurgery: We Can and We Must. Neurosurgery 2020; 86:E587-E588. [PMID: 32078673 DOI: 10.1093/neuros/nyaa044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John J Y Zhang
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Keng Siang Lee
- Bristol Medical School Faculty of Health Sciences University of Bristol Bristol, United Kingdom
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3673
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Percutaneous endoscopic lumbar discectomy in the elderly: An effective treatment for prolapsed disc: Consideration on 75 case. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2020. [DOI: 10.1016/j.inat.2019.100655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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3674
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Iwai H, Inanami H, Koga H. Comparative study between full-endoscopic laminectomy and microendoscopic laminectomy for the treatment of lumbar spinal canal stenosis. JOURNAL OF SPINE SURGERY 2020; 6:E3-E11. [PMID: 32656392 DOI: 10.21037/jss-20-620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Lumbar spinal canal stenosis (LSCS) is a common disease in the elderly. Although surgical decompression using a posterior approach is commonly used to treat LSCS, there are several different strategies. We compared the outcomes of uniportal full-endoscopic laminectomy (FEL) and microendoscopic laminectomy (MEL) for treating LSCS. Methods FEL was performed using a 6.4-mm working channel endoscope and MEL was performed using a 16-mm diameter tubular retractor and endoscope. Patients with LSCS treated with FEL (n=60) and MEL (n=54) in our hospital during the same period were retrospectively reviewed. Patient background information and operative data were collected. The satisfaction score was also recorded at discharge and 3 months postoperatively. Results The mean operation time for FEL and MEL was 77.8 min and 54.6 min, respectively. The mean hospital stay after FEL and MEL surgery was 2.1 days and 4.7 days, respectively. These outcomes were significantly different between the two approaches. The satisfaction scores at both stages were not significantly different between the two groups. A dural tear occurred in one patient who underwent FEL and three patients who underwent MEL, but no symptoms resulted from the tear. Although postoperative hematoma occurred in seven who underwent FEL and two who underwent MEL, only one patient who underwent FEL required operative evacuation of the hematoma. Conclusions FEL using a 6.4-mm working channel endoscope can be used to treat patients with LSCS. Shortening of the operation time and prevention of postoperative hematoma are essential for this approach to be completely superior to MEL.
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Affiliation(s)
- Hiroki Iwai
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
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3675
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MacLean MA, Touchette CJ, Han JH, Christie SD, Pickett GE. Gender differences in the surgical management of lumbar degenerative disease: a scoping review. J Neurosurg Spine 2020; 32:799-816. [PMID: 32005013 DOI: 10.3171/2019.11.spine19896] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite efforts toward achieving gender equality in clinical trial enrollment, females are often underrepresented, and gender-specific data analysis is often unavailable. Identifying and reducing gender bias in medical decision-making and outcome reporting may facilitate equitable healthcare delivery. Gender disparity in the utilization of surgical therapy has been exemplified in the orthopedic literature through studies of total joint arthroplasty. A paucity of literature is available to guide the management of lumbar degenerative disease, which stratifies on the basis of demographic factors. The objective of this study was to systematically map and synthesize the adult surgical literature regarding gender differences in pre- and postoperative patient-reported clinical assessment scores for patients with lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis). METHODS A systematic scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, Embase, and the Cochrane Registry of Controlled Trials were searched from inception to September 2018. Study characteristics including patient demographics, diagnoses, procedures, and pre- and postoperative clinical assessment scores (pain, disability, and health-related quality of life [HRQoL]) were collected. RESULTS Thirty articles were identified, accounting for 32,951 patients. Six studies accounted for 84% of patients; 5 of the 6 studies were published by European groups. The most common lumbar degenerative conditions were disc herniation (59.0%), disc degeneration (20.3%), and spinal canal stenosis (15.9%). The majority of studies reported worse preoperative pain (93.3%), disability (81.3%), and HRQoL (75%) among females. The remainder reported equivalent preoperative scores between males and females. The majority of studies (63.3%) did not report preoperative duration of symptoms, and this represents a limitation of the data. Eighty percent of studies found that females had worse absolute postoperative scores in at least one outcome category (pain, disability, or HRQoL). The remainder reported equivalent absolute postoperative scores between males and females. Seventy-three percent of studies reported either an equivalent or greater interval change for females. CONCLUSIONS Female patients undergoing surgery for lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis) have worse absolute preoperative pain, disability, and HRQoL. Following surgery, females have worse absolute pain, disability, and HRQoL, but demonstrate an equal or greater interval change compared to males. Further studies should examine gender differences in preoperative workup and clinical course.
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Affiliation(s)
- Mark A MacLean
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Charles J Touchette
- 2Division of Neurosurgery, Universitaire de Sherbrooke, Centre de recherche du Centre Hospitalier, Sherbrooke, Quebec, Canada
| | - Jae H Han
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Sean D Christie
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Gwynedd E Pickett
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
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3676
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Pao JL, Lin SM, Chen WC, Chang CH. Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis. JOURNAL OF SPINE SURGERY 2020; 6:438-446. [PMID: 32656381 DOI: 10.21037/jss.2020.03.08] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Unilateral biportal endoscopic (UBE) decompression is a minimally invasive (MI) approach to treat degenerative lumbar canal stenosis (DLCS). Decompression can be performed in a clear and magnified surgical field with proper control of normal saline inflow and outflow. Methods Clinical and radiographic data of 81 consecutive patients of DLCS treated between July 2018 and Feb 2019 using UBE techniques were reviewed. They were 38 males and 43 females with an average age of 70.2. Sixty-nine had pure canal stenosis and 12 patients had associated spondylolisthesis. Bilateral decompression via unilateral laminotomy was performed from the side on patients with more severe neurological symptoms. This is a retrospective study from chart review and image analysis. Therefore, we don't have formal ethical information for this study, and it is not mandatory in our hospital. Results At the final follow-up, the mean VAS for low back pain was improved from 4.3±3.0 to 1.2±1.0 and the VAS for leg symptoms was improved from 7.3±2.2 to 0.9±0.7. The mean JOA score and ODI was significantly improved from 13.3±7.9 to 25.3±5.0 and from 54.6±16.9 to 14.6±12.6, respectively. Modified Macnab criteria were excellent in 47 patients (58.0%), good in 29 (35.8%), fair in 5 (6.2%). The average hospital stay was 3.6±2.4 days. MRI before and after the operation showed the cross-sectional dural area (CSDA) was significantly increased from 71.4±36.5 to 177.3±59.2 mm2, corresponding to a 201.9%±188.0% increase. The percentage of facet joint preservation was 84.2% on the approach side and 92.9% on the contralateral side. Complications included 4 dural tears, 1 transient motor weakness, 1 inadequate decompression, and 1 epidural hematoma. Conclusions With UBE techniques, decompression for DLCS can be performed safely and effectively. The soft tissue and facet joint destruction are minimized; therefore, it is possible to avoid spinal fusion as well as to preserve the segmental stability.
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Affiliation(s)
- Jwo-Luen Pao
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei
| | - Shang-Ming Lin
- Department of Materials and Textiles, Oriental Institute of Technology, New Taipei
| | - Wen-Chi Chen
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei
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3677
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Bae J, Chachan S, Shin SH, Lee SH. Transforaminal endoscopic thoracic discectomy with foraminoplasty for the treatment of thoracic disc herniation. JOURNAL OF SPINE SURGERY 2020; 6:397-404. [PMID: 32656377 DOI: 10.21037/jss.2019.11.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Symptomatic thoracic disc herniation (TDH) is a rare clinical entity and surgical intervention for it is even more uncommon. Despite several surgical techniques being described for thoracic discectomy, considering the unique surgical challenges, none of them have been accepted universally. Minimally invasive techniques have brought in a paradigm shift in the management of cervical/lumbar spinal disorders and similar techniques have been extrapolated to the thoracic region too. The purpose of this paper is to describe our technique, surgical experience, and the clinical results of transforaminal endoscopic thoracic discectomy (TETD). Methods Consecutive patients who underwent TETD (2001-2018) were reviewed. Patients who had a minimum of 6 months of follow-up, and without cervical and lumbar spine surgery or trauma during the follow-up period were included in the study. TETD was performed in patients who presented with symptomatic disc herniation of the thoracic spine and did not respond to conservative treatments. Patients with calcified disc herniation or concomitant ossification of the posterior longitudinal ligament (OPLL) were excluded. Under local anesthesia and intravenous sedation, a 4.7-mm endoscope (TESSYS, Joimax GmbH, Germany) was introduced via transforaminal approach with foraminoplasty using reamer. Patient outcome was evaluated using visual analogue scale (VAS) and Oswestry disability index (ODI) scores. Patient satisfaction was measured using Macnab's criteria. Results Ninety-two consecutive patients (mean age was 48.9 years, 57 males) who underwent TETD from 2001 to 2018 met the inclusion criteria. Patients underwent surgery at different levels: 16 patients for T2-3 to T5-6 level, 41 cases for T6-7 to T8-9, and 35 patients for T9-10 to T12-L1. During follow-up for an average of 38.4 months, all patients showed a significant improvement of pain (7.6 to 1.6 in VAS and 68.2 vs. 13.2 for ODI, P<0.05 for both). There was one patient who had transient motor weakness. Conclusions TETD for soft, paramedian or lateral symptomatic TDH is a feasible and effective minimally invasive treatment option with favorable clinical results.
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Affiliation(s)
- Junseok Bae
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
| | - Sourabh Chachan
- Department of Orthopedic Surgery, Narayana Superspeciality Hospital, Gurugram, India
| | - Sang-Ha Shin
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
| | - Sang-Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
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3678
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Stienen MN, Hausmann ON. The History, Present, and Future of Spine Surgery in Switzerland. Neurospine 2020; 17:357-364. [PMID: 32615696 PMCID: PMC7338962 DOI: 10.14245/ns.2040278.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Martin N. Stienen
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Oliver N. Hausmann
- Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
- Department of Neurosurgery, Inselspital Berne, University of Berne, Berne, Switzerland
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3679
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Scientific View on Endoscopic Spine Surgery: Can Spinal Endoscopy Become a Mainstream Surgical Tool? World Neurosurg 2020; 145:708-711. [PMID: 32497847 DOI: 10.1016/j.wneu.2020.05.238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 11/20/2022]
Abstract
With the health care environment becoming increasingly patient centric and cost-conscious, interest levels in spinal endoscopy are at an all-time high. Patient demand for the least invasive procedures combined with surgeon desire to maximally shorten the postoperative recovery period has further driven this surgical evolution. Mounting scientific evidence demonstrates the noninferiority and perhaps even superiority of endoscopic techniques to more conventional spinal surgery for the treatment of spinal stenosis and disc herniations. Although higher level evidence is much needed to support the clinical utility of the latest endoscopic techniques and surgical indications, it appears that the entrance of spinal endoscopy into the mainstream arena of spinal surgery is inevitable.
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3680
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Kim HS, Raorane HD, Wu PH, Yi YJ, Jang IT. Evolution of endoscopic transforaminal lumbar approach for degenerative lumbar disease. JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:424-437. [PMID: 32656380 PMCID: PMC7340818 DOI: 10.21037/jss.2019.11.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/05/2019] [Indexed: 01/13/2023]
Abstract
Endoscopic spine surgery has evolved dramatically in last 30 years; with the development of new improved endoscopic optics and instrumentation limitation of endoscopic spine surgery has significantly reduced. The transforaminal approach has been limited in its indications due to its optimized approach and obstacles of bony or neural structures. As the initial transforaminal approach is based on the inside out technique, there were many limitations on the indications. Outside-in approach has been developed to address these limitations. However, the outside-in approach was not free from anatomical obstacles. The mobile outside-in approach technique has advantage of both inside-out and outside-in technique. It is equally safe as inside-out technique and provides an easy handling of structures, while it is equally versatile as outside-in technique in managing different types of disc prolapse such as central, paracentral, foraminal, far lateral, and up and down migration, and in high-canal compromise cases. The mobile outside in technique, however, demands a longer learning curve and beginners need to be patient while learning the technique.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Hospital Gangnam, Seoul, Republic of Korea
| | | | - Pang Hung Wu
- Department of Neurosurgery, Nanoori Hospital Gangnam, Seoul, Republic of Korea
| | - Yeon Jin Yi
- Department of Neurosurgery, Nanoori Hospital Gangnam, Seoul, Republic of Korea
| | - Il Tae Jang
- Department of Neurosurgery, Nanoori Hospital Gangnam, Seoul, Republic of Korea
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3681
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Comparison of Deep-Learning and Conventional Machine-Learning Methods for the Automatic Recognition of the Hepatocellular Carcinoma Areas from Ultrasound Images. SENSORS 2020; 20:s20113085. [PMID: 32485986 PMCID: PMC7309124 DOI: 10.3390/s20113085] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022]
Abstract
The emergence of deep-learning methods in different computer vision tasks has proved to offer increased detection, recognition or segmentation accuracy when large annotated image datasets are available. In the case of medical image processing and computer-aided diagnosis within ultrasound images, where the amount of available annotated data is smaller, a natural question arises: are deep-learning methods better than conventional machine-learning methods? How do the conventional machine-learning methods behave in comparison with deep-learning methods on the same dataset? Based on the study of various deep-learning architectures, a lightweight multi-resolution Convolutional Neural Network (CNN) architecture is proposed. It is suitable for differentiating, within ultrasound images, between the Hepatocellular Carcinoma (HCC), respectively the cirrhotic parenchyma (PAR) on which HCC had evolved. The proposed deep-learning model is compared with other CNN architectures that have been adapted by transfer learning for the ultrasound binary classification task, but also with conventional machine-learning (ML) solutions trained on textural features. The achieved results show that the deep-learning approach overcomes classical machine-learning solutions, by providing a higher classification performance.
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3682
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Tosic L, Goldberger E, Maldaner N, Sosnova M, Zeitlberger AM, Staartjes VE, Gadjradj PS, Eversdijk HAJ, Quddusi A, Gandía-González ML, Sayadi JJ, Desai A, Regli L, Gautschi OP, Stienen MN. Normative data of a smartphone app-based 6-minute walking test, test-retest reliability, and content validity with patient-reported outcome measures. J Neurosurg Spine 2020; 33:480-489. [PMID: 32470938 DOI: 10.3171/2020.3.spine2084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The 6-minute walking test (6WT) is used to determine restrictions in a subject's 6-minute walking distance (6WD) due to lumbar degenerative disc disease. To facilitate simple and convenient patient self-measurement, a free and reliable smartphone app using Global Positioning System coordinates was previously designed. The authors aimed to determine normative values for app-based 6WD measurements. METHODS The maximum 6WD was determined three times using app-based measurement in a sample of 330 volunteers without previous spine surgery or current spine-related disability, recruited at 8 centers in 5 countries (mean subject age 44.2 years, range 16-91 years; 48.5% male; mean BMI 24.6 kg/m2, range 16.3-40.2 kg/m2; 67.9% working; 14.2% smokers). Subjects provided basic demographic information, including comorbidities and patient-reported outcome measures (PROMs): visual analog scale (VAS) for both low-back and lower-extremity pain, Core Outcome Measures Index (COMI), Zurich Claudication Questionnaire (ZCQ), and subjective walking distance and duration. The authors determined the test-retest reliability across three measurements (intraclass correlation coefficient [ICC], standard error of measurement [SEM], and mean 6WD [95% CI]) stratified for age and sex, and content validity (linear regression coefficients) between 6WD and PROMs. RESULTS The ICC for repeated app-based 6WD measurements was 0.89 (95% CI 0.87-0.91, p < 0.001) and the SEM was 34 meters. The overall mean 6WD was 585.9 meters (95% CI 574.7-597.0 meters), with significant differences across age categories (p < 0.001). The 6WD was on average about 32 meters less in females (570.5 vs 602.2 meters, p = 0.005). There were linear correlations between average 6WD and VAS back pain, VAS leg pain, COMI Back and COMI subscores of pain intensity and disability, ZCQ symptom severity, ZCQ physical function, and ZCQ pain and neuroischemic symptoms subscores, as well as with subjective walking distance and duration, indicating that subjects with higher pain, higher disability, and lower subjective walking capacity had significantly lower 6WD (all p < 0.001). CONCLUSIONS This study provides normative data for app-based 6WD measurements in a multicenter sample from 8 institutions and 5 countries. These values can now be used as reference to compare 6WT results and quantify objective functional impairment in patients with degenerative diseases of the spine using z-scores. The authors found a good to excellent test-retest reliability of the 6WT app, a low area of uncertainty, and high content validity of the average 6WD with commonly used PROMs.
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Affiliation(s)
- Lazar Tosic
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Elior Goldberger
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Nicolai Maldaner
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marketa Sosnova
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anna M Zeitlberger
- 2Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Victor E Staartjes
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Pravesh S Gadjradj
- 3Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ayesha Quddusi
- 5Center for Neuroscience, Queens University, Kingston, Ontario, Canada
| | | | - Jamasb Joshua Sayadi
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
| | - Atman Desai
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Oliver P Gautschi
- 8Neuro and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
- 7Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, California; and
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3683
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Ambrosio L, Vadalà G, Russo F, Papalia R, Denaro V. The role of the orthopaedic surgeon in the COVID-19 era: cautions and perspectives. J Exp Orthop 2020; 7:35. [PMID: 32458150 PMCID: PMC7250587 DOI: 10.1186/s40634-020-00255-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023] Open
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic has revolutionized global healthcare in an unprecedented way and with unimaginable repercussions. Resource reallocation, socioeconomic confinement and reorganization of production activities are current challenges being faced both at the national and international levels, in a frame of uncertainty and fear. Hospitals have been restructured to provide the best care to COVID-19 patients while adopting preventive strategies not to spread the infection among healthcare providers and patients affected by other diseases. As a consequence, the concept of urgency and indications for elective treatments have been profoundly reshaped. In addition, several providers have been recruited in COVID-19 departments despite their original occupation, resulting in a profound rearrangement of both inpatient and outpatient care. Orthopaedic daily practice has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19+ patients. This has made a strong impact on inpatient management, with the need of a dedicated staff, patient isolation and restrictive visiting hour policies. On the other hand, outpatient visits have been limited to reduce contacts between patients and the hospital personnel, with considerable consequences on post-operative quality of care and the human side of medical practice. In this review, we aim to analyze the effect of the COVID-19 pandemic on the orthopaedic practice. Particular attention will be dedicated to opportune surgical indication, perioperative care and safe management of both inpatients and outpatients, also considering repercussions of the pandemic on resident education and ethical implications.
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Affiliation(s)
- Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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3684
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Han S, Park B, Lim JW, Youm JY, Choi SW, Kim DH, Ahn DK. Comparison of Fusion Rate between Demineralized Bone Matrix versus Autograft in Lumbar Fusion : Meta-Analysis. J Korean Neurosurg Soc 2020; 63:673-680. [PMID: 32455520 PMCID: PMC7671781 DOI: 10.3340/jkns.2019.0185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022] Open
Abstract
The demineralized bone matrix (DBM) as the bone graft material to increase the fusion rate was widely used in spinal fusion. The current study aimed to compare the fusion rate of DBM to the fusion rate of autograft in lumbar spine fusion via meta-analysis of published literature. After systematic search, comparative studies were selected according to eligibility criteria. Checklist (risk of bias assessment tool for non-randomized study) was used to evaluate the risk of bias of the included nonrandomized controlled studies. The corresponding 95% confidence interval (95% CI) were calculated. We also used subgroup analysis to analyze the fusion rate of posterolateral lumbar fusion and lumbar interbody fusion. Eight studies were finally included in this meta-analysis. These eight studies included 581 patients. Among them, 337 patients underwent spinal fusion surgery using DBM (DBM group) and 204 patients underwent spinal fusion surgery with mainly autologous bone and without using DBM (control group). There was no significant differences of fusion rate between the two groups in posterolateral fusion analysis (risk ratio [RR], 1.03; 95% CI, 0.90–1.17; p=0.66) and interbody fusion analysis (RR, 1.13; 95% CI, 0.91–1.39; p=0.27). Based on the available evidence, the use of DBM with autograft in posterolateral lumbar spine fusion and lumbar interbody fusion showed a slightly higher fusion rate than that of autograft alone; however, there was no statistically different between two groups.
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Affiliation(s)
- Sanghyun Han
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Bumsoo Park
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jeong-Wook Lim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jin-Young Youm
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seoung-Won Choi
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dae Hwan Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Ahn
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
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3685
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Li R, Wang Z, Ma L, Yang D, Xie D, Zhang B, Ding W. Lumbar Vertebral Endplate Defects on Magnetic Resonance Imaging in Degenerative Spondylolisthesis: Novel Classification, Characteristics, and Correlative Factor Analysis. World Neurosurg 2020; 141:e423-e430. [PMID: 32461177 DOI: 10.1016/j.wneu.2020.05.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Endplate defects are commonly seen in patients with lumbar degenerative disease. However, little is known about the presence of endplate defects in patients with degenerative spondylolisthesis (DS). In the present study, we have introduced a classification system for endplate defects in patients with DS using routine magnetic resonance imaging findings and explored the correlative factors. METHODS Endplate defects were classified into 3 major categories (rim defects, focal defects, and erosive defects) and 5 subtypes (anterior type, posterior type, arc type at the anterior rim, notch type, and Schmorl's nodes). The incidence rates of the endplate defects were compared between the slippage and nonslippage levels. The correlations between the endplate defects and age, sex, disc degeneration, Modic changes (MCs), body mass index, slippage segment, and slippage degree were analyzed. RESULTS Endplate defects were present in 47.43% of the endplates in DS. The most common endplate defects were rim defects. The occurrence of endplate defects, especially anterior defects, was more common at the slippage levels. Endplate defects were associated with age and closely related to MCs and the severity of disc degeneration. The slippage degree, slippage segment, body mass index, and sex differences were not associated with endplate defects in our study. The results obtained using this novel classification system were stable and consistent. CONCLUSIONS The results from the present study have shown that the novel radiological classification system of endplate defects is reliable. Endplate defects were associated with slippage but not with the slippage degree or slippage segment differences in DS. The correlation between endplate defects and age and between MCs and disc degeneration were important features on the magnetic resonance imaging scans of patients with DS.
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Affiliation(s)
- Ruoyu Li
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiwei Wang
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Ma
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dalong Yang
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dongxiao Xie
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Botong Zhang
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenyuan Ding
- Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
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3686
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Molliqaj G, Paun L, Nouri A, Girod PP, Schaller K, Tessitore E. Role of Robotics in Improving Surgical Outcome in Spinal Pathologies. World Neurosurg 2020; 140:664-673. [PMID: 32445895 DOI: 10.1016/j.wneu.2020.05.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The desire to improve accuracy and safety and to favor minimally invasive techniques has given rise to spinal robotic surgery, which has seen a steady increase in utilization in the past 2 decades. However, spinal surgery encompasses a large spectrum of operative techniques, and robotic surgery currently remains confined to assistance with the trajectory of pedicle screw insertion, which has been shown to be accurate and safe based on class II and III evidence. The role of robotics in improving surgical outcomes in spinal pathologies is less clear, however. METHODS This comprehensive review of the literature addresses the role of robotics in surgical outcomes in spinal pathologies with a focus on the various meta-analysis and prospective randomized trials published within the past 10 years in the field. RESULTS It appears that robotic spinal surgery might be useful for increasing accuracy and safety in spinal instrumentation and allows for a reduction in surgical time and radiation exposure for the patient, medical staff, and operator. CONCLUSION Robotic assisted surgery may thus open the door to minimally invasive surgery with greater security and confidence. In addition, the use of robotics facilitates tireless repeated movements with higher precision compared with humans. Nevertheless, it is clear that further studies are now necessary to demonstrate the role of this modern tool in cost-effectiveness and in improving clinical outcomes, such as reoperation rates for screw malpositioning.
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Affiliation(s)
- Granit Molliqaj
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
| | - Luca Paun
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Aria Nouri
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Pierre-Pascal Girod
- Neurosurgical Unit, Innsbruck University Hospital, Faculty of Medicine, Innsbruck, Austria
| | - Karl Schaller
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Enrico Tessitore
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
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3687
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Tacconi L, Spinelli R, Serra G, Signorelli F, Giordan E. Full-Endoscopic Removal of Lumbar Juxtafacet Cysts: A Prospective Multicentric Study. World Neurosurg 2020; 141:e414-e422. [PMID: 32461174 DOI: 10.1016/j.wneu.2020.05.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lumbar juxtafacet cysts are benign lesions that grow at the level of facet joints or within neighboring structures. Recently, there is an ongoing trend toward less invasive procedures for treating degenerative spine diseases. Here we report a multicenter study of full-endoscopic surgery for juxtafacet cyst removal. METHODS We prospectively collected patients with a diagnosis of lumbar juxtafacet cyst surgically treated in 3 institutions between January 2017 and August 2019. Patients of any sex and age were eligible if they had a single level unilateral lumbar juxtafacet cyst, invalidating radicular pain lasting >6 weeks, adequate imaging, and failed percutaneous or conservative treatment. Age at diagnosis; sex; preoperative, postoperative, and 6-month leg pain; surgical and medical complications; spine instability (preoperatively and at 6 and 12 months); and follow-up time were collected. RESULTS Thirty-five patients were enrolled. Median operative time was 78 minutes, and mean leg pain went from a preoperative value of 6.8 (standard deviation [SD] = 1.2) to a postoperative value of 3.4 (SD = 1.1, P < 0.001) to 2.1 (SD = 1.7, P < 0.001) at 6 months. At a median follow-up of 15 months, approximately 89% of patients were pain-free or improved. We had 2 recurrences of radicular pain, treated conservatively. Only 2 surgical complications (6%) occurred: 2 small dural tears, both resolved without further intervention. CONCLUSIONS Full-endoscopic surgery is feasible and safe for juxtafacet cyst removal. Our results are consistent with findings from recent full-endoscopic and series, with outcomes overlapping those reported for open or tubular techniques.
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Affiliation(s)
- Leonello Tacconi
- Neurosurgical Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Friuli Venezia Giulia, Italy
| | - Roberto Spinelli
- Neurosurgical Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Friuli Venezia Giulia, Italy
| | - Gerardo Serra
- Anesthesia and Analgesic Therapy Department, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | | | - Enrico Giordan
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy.
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3688
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Piro E, Serra G, Schierz IAM, Giuffrè M, Corsello G. Neonatal ten-year retrospective study on neural tube defects in a second level University Hospital. Ital J Pediatr 2020; 46:72. [PMID: 32448340 PMCID: PMC7247239 DOI: 10.1186/s13052-020-00836-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/19/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Aim of this retrospective study was to describe clinical characteristics, diagnostic work-up, management and follow-up of newborns with neural tube defects (NTDs), admitted to the Mother and Child Department of the University Hospital of Palermo, in a ten years period. METHODS The medical records of 7 newborns (5 males and 2 females) admitted, over a 10-year period from January 2010 to March 2020, to our Department on the first day of life were reviewed. Analyzed data were related to familiar and/or maternal risk factors (consanguinity, maternal preexisting and/or gestational diseases, exposure to teratogen/infectious agents, lack of preconception folic acid supplement), demographic (ethnicity/origin, residence) and clinical features (eventual use of assisted reproduction techniques, prenatal diagnosis, gestational age, fetal presentation, type of delivery, birth weight, preoperative imaging, antibiotics and analgesics use, description of the surgery intervention, length of hospital stay, comorbidities, complications), and follow-up. RESULTS In our sample we observed a wide spectrum of NTDs: 3 newborns had open NTDs, namely myelomeningocele (2 lumbosacral, one of which associated with extradural lipoma, and 1 sacral), and 4 closed ones, including 2 with meningocele (occipital), 1 filar lipoma associated with dermal sinus, and 1 terminal myelocystocele. Our patients were discharged between 8 and 22 days of life. The neurodevelopmental follow-up showed a favorable outcome for 4 of the 7 patients, and the appearance over time of neurological impairment (motor and/or autonomic) in the newborns with open NTDs. CONCLUSIONS This study describes familiar and/or maternal risk factors and demographic and clinical features of a single-center series of newborns with NTDs. It may provide a further outline of the actual phenotypic spectrum of these malformations, and new insights into epidemiological aspects and comprehensive management of the patients, including diagnostic work-up and follow-up evaluations.
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Affiliation(s)
- Ettore Piro
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Piazza delle Cliniche, 2, 90127, Palermo, Italy.
| | - Gregorio Serra
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Piazza delle Cliniche, 2, 90127, Palermo, Italy
| | - Ingrid Anne Mandy Schierz
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Piazza delle Cliniche, 2, 90127, Palermo, Italy
| | - Mario Giuffrè
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Piazza delle Cliniche, 2, 90127, Palermo, Italy
| | - Giovanni Corsello
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Piazza delle Cliniche, 2, 90127, Palermo, Italy
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3689
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Ansari A. Letter to the editor: Cervical spondylotic myelopathy treated with laminectomy versus open-door laminoplasty. Surg Neurol Int 2020; 11:126. [PMID: 32494400 PMCID: PMC7265349 DOI: 10.25259/sni_208_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 11/04/2022] Open
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3690
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Xu G, Liu C, Liang T, Qin Z, Yu CJ, Zhang Z, Jiang J, Chen J, Zhan X. Integrated miRNA-mRNA network revealing the key molecular characteristics of ossification of the posterior longitudinal ligament. Medicine (Baltimore) 2020; 99:e20268. [PMID: 32481304 PMCID: PMC7249941 DOI: 10.1097/md.0000000000020268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ossification of the posterior longitudinal ligament (OPLL) refers to an ectopic ossification disease originating from the posterior longitudinal ligament of the spine. Pressing on the spinal cord or nerve roots can cause limb sensory and motor disorders, significantly reducing the patient's quality of life. At present, the pathogenesis of OPLL is still unclear. The purpose of this study is to integrate microRNA (miRNA)-mRNA biological information data to further analyze the important molecules in the pathogenesis of OPLL, so as to provide targets for future OPLL molecular therapy. METHODS miRNA and mRNA expression profiles of GSE69787 were downloaded from Gene Expression Omnibus database and analyzed by edge R package. Funrich software was used to predict the target genes and transcription factors of de-miRNA. Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis of differentially expressed genes (DEGs) were carried out based on CLUEGO plug-in in Cytoscape. Using data collected from a search tool for the retrieval of interacting genes online database, a protein-protein interaction (PPI) network was constructed using Cytoscape. The hub gene selection and module analysis of PPI network were carried out by cytoHubba and molecular complex detection, plug-ins of Cytoscape software respectively. RESULTS A total of 346 genes, including 247 up-regulated genes and 99 down-regulated genes were selected as DEGs. SP1 was identified as an upstream transcription factor of de-miRNAs. Notably, gene ontology enrichment analysis shows that up- and down-regulated DEGs are mainly involved in BP, such as skeletal structure morphogenesis, skeletal system development, and animal organ morphogenesis. Kyoto Encyclopedia of Genes and Genomes enrichment analysis indicated that only WNT signaling pathway was associated with osteogenic differentiation. Lymphoid enhancer binding factor 1 and wingless-type MMTV integration site family member 2 Wingless-Type MMTV Integration site family member 2 were identified as hub genes, miR-520d-3p, miR-4782-3p, miR-6766-3p, and miR-199b-5p were identified as key miRNAs. In addition, 2 important network modules were obtained from PPI network. CONCLUSIONS In this study, we established a potential miRNA-mRNA regulatory network associated with OPLL, revealing the key molecular mechanism of OPLL and providing targets for future treatment or prevent its occurrence.
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Affiliation(s)
- Guoyong Xu
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Chong Liu
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Tuo Liang
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Zhaojie Qin
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Chao Jie Yu
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Zide Zhang
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Jie Jiang
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Jiarui Chen
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Xinli Zhan
- Guangxi Medical University
- Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
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3691
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Kim HS, Wu PH, Lee YJ, Kim DH, Kim JY, Lee JH, Jeon JB, Jang IT. Safe Route for Cervical Approach: Partial Pediculotomy, Partial Vertebrotomy Approach for Posterior Endoscopic Cervical Foraminotomy and Discectomy. World Neurosurg 2020; 140:e273-e282. [PMID: 32438007 DOI: 10.1016/j.wneu.2020.05.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cervical radiculopathy is a common cervical spine condition. There is a paucity of literature discussing the effect of partial pediculotomy and partial vertebrotomy for posterior endoscopic cervical foraminotomy (PPPV PECF) on cervical radiculopathy. We investigated the radiologic and clinical outcomes of this approach. METHODS This was a retrospective evaluation of 30 cases with cervical radiculopathy who underwent PPPV PECF. Preoperative, postoperative roentgenogram for evaluation of stability, computed tomography (CT) evaluation of foraminal dimensions, and area in sagittal view was performed. Three-dimensional reconstruction area of decompression evaluation was performed. Clinical outcomes of the visual analog scale, Oswestry Disability Index, and Macnab score were evaluated. RESULTS There was no complication and recurrence in our PPPV PECF cohort during the study period. At preoperative, 1 week postoperative, and 3 months postoperative and final follow-up, the mean visual analog scale score had significant improvement, with scores of 7.6, 3.0, 2.1, and 1.7, respectively, P < 0.05, and also the mean Oswestry Disability Index, with scores of 73.9, 28.1, 23.3, and 21.5 respectively, P < 0.05. Macnab criteria showed all patients scoring good and excellent. Radiologic results showed PPPV PECF had a significant increase in decompression in the foramen area in all CT-measured parameters, as compared with the mean preoperative values; 1) sagittal area increased 60.1 ± 23.1 mm2, 2) CT craniocaudal length increased 4.0 ± 1.54 mm, 3) CT ventrodorsal length increased 4.0 ± 1.97 mm, and 4) 3-dimensional CT scan reconstruction decompression area increased 996 ± 266 mm2, P < 0.05. CONCLUSIONS PPPV PECF is a safe route of decompression of cervical spine with good clinical and radiologic outcome.
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Affiliation(s)
- Hyeun Sung Kim
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea.
| | - Pang Hung Wu
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea; National University Health System, JurongHealth Campus, Orthopaedic Surgery, Singapore
| | - Yeon Jin Lee
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea
| | - Dae Hwan Kim
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea
| | - Ji Yeon Kim
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea
| | - Jun Hyung Lee
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea
| | - Jun Bok Jeon
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea
| | - Il-Tae Jang
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea
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3692
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Wang H, Peng J, Zeng Q, Zhong Y, Xiao C, Ye Y, Huang W, Liu W, Luo J. Dynesys system vs posterior decompression and fusion for the treatment of lumbar degenerative diseases. Medicine (Baltimore) 2020; 99:e19784. [PMID: 32481251 PMCID: PMC7249866 DOI: 10.1097/md.0000000000019784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Dynesys dynamic stabilization system is an alternative to rigid instrumentation and fusion for the treatment of lumbar degenerative disease. The purpose of this study is to evaluate the clinical efficacy between Dynesys and posterior decompression and fusion for lumbar degenerative diseases. METHODS The computer was used to retrieve the Cochrane library, Medline, Embase, CNKI, Wanfang database and Chinese biomedical literature database; and the references and main Chinese and English Department of orthopedics journals were manually searched. All the prospective or retrospective comparative studies on the clinical efficacy and safety of Dynesys and posterior decompression and fusion were collected, so as to evaluate the methodological quality of the study and to extract the data. The RevMan 5.2 software was used for data analysis. RESULTS A total of 17 studies were included in the meta-analysis. There were no significant differences in Oswestry disability index and visual analogue score for leg pain, visual analogue score for back pain, L2-S1 ROM between Dynesys and fusion group. Operation time, blood loss, length of stay and complications in the Dynesys group were significantly less than that in the fusion group. Adjacent-segment degeneration in the fusion group was significantly higher than that in the Dynesys group. In addition, postoperative operated segment ROM was significantly less in the fusion group as compared to the Dynesys group. CONCLUSIONS Our meta-analysis suggests that Dynesys system acquires comparable clinical outcomes compared to fusion in the treatment of lumbar degenerative diseases. Moreover, compared with fusion, Dynesys could remain ROM of surgical segments with less operation time, blood loss, length of stay, adjacent-segment degeneration, and lower complication. Further studies with large samples, long term follow up and well-designed are needed to assess the two procedures in the future.
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Affiliation(s)
- Hongbo Wang
- Department of Spine Surgery, Shenzhen Baoan Shajing People's Hospital, Guangzhou Medical University, Shenzhen
| | - Jun Peng
- Department of Spine Surgery, Shenzhen Baoan Shajing People's Hospital, Guangzhou Medical University, Shenzhen
| | - Qingshen Zeng
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Yanchun Zhong
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Chunlin Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Yongjun Ye
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Weimin Huang
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Wuyang Liu
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Jiaquan Luo
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
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3693
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Sato T, Yonezawa I, Akimoto T, Nobuyuki T, Shimamura Y, Muto O, Suzuki T, Momomura R, Uno K, Yamazaki K, Fujiwara K, Misawa A, Kaneko K. Novel Hump Measurement System With a 3D Camera for Early Diagnosis of Patients With Adolescent Idiopathic Scoliosis: A Study of Accuracy and Reliability. Cureus 2020; 12:e8229. [PMID: 32582490 PMCID: PMC7306634 DOI: 10.7759/cureus.8229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) is a potentially progressive deformity, and early detection is crucial for timely intervention. However, the methods and criteria justifying screening for pediatric scoliosis remain controversial. We have, therefore, independently developed a Digital Moiré (DM) as a tool for scoliosis screening. The purpose of this study was to assess the usefulness of DM for scoliosis screening. Methods From March 2016 to March 2017, 126 patients (18 boys, 108 girls, mean age: 13.2 ± 2.2 years) with AIS underwent radiographic imaging of their whole spine. We tested the accuracy and reliability of DM by categorizing the examination results as Class 0 (no abnormality), Class 1 (return visit in one year), and Class 2 (further examination needed) and determined the distribution of the population by Cobb angle. The intra/inter-rater reliability and receiver operating characteristic (ROC) analyses were used to categorize the patients with positive findings into Class 1 or 2. Results Regarding the population distribution per Cobb angle in each of the distributions, 11 patients (8.7%) were Class 0, of which nine and two patients had Cobb angle ≤ 10 ° and > 10 °, respectively. There were 20 (15.9% ) Class 1 cases, of which 17 and three had Cobb angle ≤ 10 ° and > 10 °, respectively. Of the 95 (75.4%) Class 2 cases, five and 90 had a Cobb angle of ≤ 10 ° and > 10 °, respectively. The receiver operating characteristic (ROC) analysis of patients with positive findings showed that the area under the curve (AUC), sensitivity, specificity, and false-positive rate were 0.76, 0.98, 0.53, and 0.47, respectively, when predicting Cobb angle > 10°. Intra-rater and inter-rater reliability were 0.73 and 0.70, respectively. Conclusions This study demonstrated the usefulness of DM for determining whether a child with AIS requires a follow-up observation such as radiograph. Our findings suggest that the novel DM shows high accuracy and reliability for scoliosis screening.
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Affiliation(s)
- Tatsuya Sato
- Orthopaedic Surgery, Juntendo University School of Medicine, Bunkyo-ku, JPN
| | - Ikuho Yonezawa
- Orthopaedics, Sangubashi Spine Surgery Hospital, Tokyo, JPN
| | | | - Terada Nobuyuki
- Science and Engineering: Biomedical Engineering, Toyo University, Bunkyo-ku, JPN
| | | | - Osamu Muto
- Orthopaedic Surgery, Juntendo University, Bunkyo-ku, JPN
| | | | - Rei Momomura
- Orthopaedic Surgery, Juntendo Unversity, Bunkyo-ku, JPN
| | - Koki Uno
- Orthopaedic Surgery, Kobe Medical Center, Kobe, JPN
| | - Ken Yamazaki
- Iwate Spinal Scoliosis Center, Tochinai Daini Hospital, Takizawa, JPN
| | - Kenta Fujiwara
- Orthopaedic Surgery, Osaka Medical College, Takatsuki, JPN
| | - Akiko Misawa
- Orthopaedic Surgery, Prefectural Center on Development and Disability, Akita, JPN
| | - Kazuo Kaneko
- Orthopaedic Surgery, Juntendo Unversity, Bunkyo-ku, JPN
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3694
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Detection and Diagnosis of Breast Cancer Using Artificial Intelligence Based assessment of Maximum Intensity Projection Dynamic Contrast-Enhanced Magnetic Resonance Images. Diagnostics (Basel) 2020; 10:diagnostics10050330. [PMID: 32443922 PMCID: PMC7277981 DOI: 10.3390/diagnostics10050330] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/24/2022] Open
Abstract
We aimed to evaluate an artificial intelligence (AI) system that can detect and diagnose lesions of maximum intensity projection (MIP) in dynamic contrast-enhanced (DCE) breast magnetic resonance imaging (MRI). We retrospectively gathered MIPs of DCE breast MRI for training and validation data from 30 and 7 normal individuals, 49 and 20 benign cases, and 135 and 45 malignant cases, respectively. Breast lesions were indicated with a bounding box and labeled as benign or malignant by a radiologist, while the AI system was trained to detect and calculate possibilities of malignancy using RetinaNet. The AI system was analyzed using test sets of 13 normal, 20 benign, and 52 malignant cases. Four human readers also scored these test data with and without the assistance of the AI system for the possibility of a malignancy in each breast. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were 0.926, 0.828, and 0.925 for the AI system; 0.847, 0.841, and 0.884 for human readers without AI; and 0.889, 0.823, and 0.899 for human readers with AI using a cutoff value of 2%, respectively. The AI system showed better diagnostic performance compared to the human readers (p = 0.002), and because of the increased performance of human readers with the assistance of the AI system, the AUC of human readers was significantly higher with than without the AI system (p = 0.039). Our AI system showed a high performance ability in detecting and diagnosing lesions in MIPs of DCE breast MRI and increased the diagnostic performance of human readers.
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3695
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
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3696
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Doerr SA, De Silva T, Vijayan R, Han R, Uneri A, Ketcha MD, Zhang X, Khanna N, Westbroek E, Jiang B, Zygourakis C, Aygun N, Theodore N, Siewerdsen JH. Automatic analysis of global spinal alignment from simple annotation of vertebral bodies. J Med Imaging (Bellingham) 2020; 7:035001. [PMID: 32411814 DOI: 10.1117/1.jmi.7.3.035001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 04/27/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: Measurement of global spinal alignment (GSA) is an important aspect of diagnosis and treatment evaluation for spinal deformity but is subject to a high level of inter-reader variability. Approach: Two methods for automatic GSA measurement are proposed to mitigate such variability and reduce the burden of manual measurements. Both approaches use vertebral labels in spine computed tomography (CT) as input: the first (EndSeg) segments vertebral endplates using input labels as seed points; and the second (SpNorm) computes a two-dimensional curvilinear fit to the input labels. Studies were performed to characterize the performance of EndSeg and SpNorm in comparison to manual GSA measurement by five clinicians, including measurements of proximal thoracic kyphosis, main thoracic kyphosis, and lumbar lordosis. Results: For the automatic methods, 93.8% of endplate angle estimates were within the inter-reader 95% confidence interval ( CI 95 ). All GSA measurements for the automatic methods were within the inter-reader CI 95 , and there was no statistically significant difference between automatic and manual methods. The SpNorm method appears particularly robust as it operates without segmentation. Conclusions: Such methods could improve the reproducibility and reliability of GSA measurements and are potentially suitable to applications in large datasets-e.g., for outcome assessment in surgical data science.
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Affiliation(s)
- Sophia A Doerr
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, MD, United States
| | - Tharindu De Silva
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, MD, United States
| | - Rohan Vijayan
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, MD, United States
| | - Runze Han
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, MD, United States
| | - Ali Uneri
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, MD, United States
| | - Michael D Ketcha
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, MD, United States
| | - Xiaoxuan Zhang
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, MD, United States
| | - Nishanth Khanna
- Johns Hopkins University, Department of Radiology and Radiological Science, Baltimore, MD, United States
| | - Erick Westbroek
- Johns Hopkins University, Department of Neurosurgery, Baltimore, MD, United States
| | - Bowen Jiang
- Johns Hopkins University, Department of Neurosurgery, Baltimore, MD, United States
| | - Corinna Zygourakis
- Johns Hopkins University, Department of Neurosurgery, Baltimore, MD, United States
| | - Nafi Aygun
- Johns Hopkins University, Department of Radiology and Radiological Science, Baltimore, MD, United States
| | - Nicholas Theodore
- Johns Hopkins University, Department of Neurosurgery, Baltimore, MD, United States
| | - Jeffrey H Siewerdsen
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, MD, United States.,Johns Hopkins University, Department of Radiology and Radiological Science, Baltimore, MD, United States.,Johns Hopkins University, Department of Neurosurgery, Baltimore, MD, United States
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3697
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The Application of Artificial Neural Networks and Logistic Regression in the Evaluation of Risk for Dry Eye after Vitrectomy. J Ophthalmol 2020; 2020:1024926. [PMID: 32377409 PMCID: PMC7191413 DOI: 10.1155/2020/1024926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/02/2020] [Indexed: 11/17/2022] Open
Abstract
Supervised machine-learning (ML) models were employed to predict the occurrence of dry eye disease (DED) after vitrectomy in this study. The clinical data of 217 patients receiving vitrectomy from April 2017 to July 2018 were used as training dataset; the clinical data of 33 patients receiving vitrectomy from August 2018 to September 2018 were collected as validating dataset. The input features for ML training were selected based on the Delphi method and univariate logistic regression (LR). LR and artificial neural network (ANN) models were trained and subsequently used to predict the occurrence of DED in patients who underwent vitrectomy for the first time during the period. The area under the receiver operating characteristic curve (AUC-ROC) was used to evaluate the predictive accuracy of the ML models. The AUCs with use of the LR and ANN models were 0.741 and 0.786, respectively, suggesting satisfactory performance in predicting the occurrence of DED. When the two models were compared in terms of predictive power, the fitting effect of the ANN model was slightly superior to that of the LR model. In conclusion, both LR and ANN models may be used to accurately predict the occurrence of DED after vitrectomy.
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3698
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Jannelli G, Nouri A, Molliqaj G, Grasso G, Tessitore E. Degenerative Cervical Myelopathy: Review of Surgical Outcome Predictors and Need for Multimodal Approach. World Neurosurg 2020; 140:541-547. [PMID: 32389875 DOI: 10.1016/j.wneu.2020.04.233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022]
Abstract
Degenerative cervical myelopathy is the most common cause of spinal cord injury in the elderly population in the developed world, and it significantly affects the quality of life of patients and their caregivers. Surgery remains the only treatment option able to halt disease progression and provide neurological recovery for most patients. Although it has remained challenging to predict exactly who will experience improvement after surgery, increasingly it has been shown that clinical, imaging, and electrophysiological factors can predict, with relatively good capacity, those more likely to benefit. Clinically, the baseline neurological impairment appears to be strongly related to the outcome, and the magnetic resonance imaging findings of T1-weighted hypointensity and the length of T2-weighted hyperintensity appear to be the most prognostic. In this context, electrophysiology findings (both motor and sensory evoked potentials) have shown some predictive capacity. However, large studies are lacking. Although multivariate models have been conducted using clinical and magnetic resonance imaging data, no multimodal prediction models are available that encompass the predictive capacity of clinical, imaging, and electrophysiological data. In the present review, we examined the rationale for clinical, imaging, and electrophysiological usage in clinical practice and discussed a model of multimodal assessment for the management of degenerative cervical myelopathy.
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Affiliation(s)
- Gianpaolo Jannelli
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
| | - Aria Nouri
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Granit Molliqaj
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Giovanni Grasso
- Section of Neurosurgery, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Enrico Tessitore
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
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3699
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Gembruch O, Ahmadipour Y, Lemonas E, Müller O. The Anterior Transarticular Fixation of C1/C2 in the Elderly With Dens Fractures. Int J Spine Surg 2020; 14:162-169. [PMID: 32355621 DOI: 10.14444/7031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Anterior transarticular screw fixation (ATSF) of C1/C2 can be used for the treatment of unstable dens fractures. Here, we evaluated the feasibility of an anterior C1/C2 fixation in elderly patients with unstable dens fractures. Furthermore, we tried to analyze safe entry zones for ATSF surgery. Methods A consecutive cohort of 13 patients with unstable dens fractures were treated with ATSF of C1/C2 between January 2015 and October 2016. If necessary, an additional screw was placed into the odontoid process. The placement was radiographically analyzed using the 3D Arcadis Orbic (Siemens, Erlangen, Germany). Additionally, computed tomography scans of the cervical spine from 50 trauma patients were analyzed to evaluate safe entry zones for anterior odontoid screw fixation and for ATSF. Results ATSF was performed in 13 cases (7 female, 6 male; mean age 81.80 years). One screw had to be corrected intraoperatively due to initial malplacement. Neurological deficits or an injury of the vertebral artery were not observed. All patients suffered from swallowing difficulties during the postoperative course, without lesions of the esophagus or the trachea. In 4 patients (30.8%), an additional posterior fixation was offered to the patients due to progressive loosening of the screws.The anatomical-radiographic analyzes revealed a significantly shallower angle of trajectory for anterior odontoid screw fixation (24.9° ± 5.85°) than for ATSF (39.1° ± 6.44° (left); 40.5° ± 6.79° (right) P = 0.02). Conclusions The ATSF of C1/C2 might be a valuable option in the treatment of instable C1/C2 fractures, especially in the elderly or in patients with short necks and/or high body mass index due to the steeper trajectory compared with odontoid screw placement. Yet available screws seem to be of inferior resistance compared with the biomechanical properties of a dorsal fixation. Further studies should focus on screws with better mechanical properties and probably additional cement augmentation. Level of Evidence 4.
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Affiliation(s)
- Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elias Lemonas
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Müller
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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3700
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Mowforth OD, Starkey ML, Kotter MR, Davies BM. Letter to the Editor. The need for research prioritization in cervical myelopathy. J Neurosurg Spine 2020; 32:777-779. [PMID: 31899877 DOI: 10.3171/2019.11.spine191300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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