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Daher M, Rezk A, Baroudi M, Balmaceno-Criss M, Gregorczyk JG, McDermott JR, Mcdonald CL, Lafage R, Lafage V, Daniels AH, Diebo BG. Lumbar Spondylolisthesis Grading: Current Standards and Important Factors to Consider for Management. World Neurosurg 2024; 190:311-317. [PMID: 39094941 DOI: 10.1016/j.wneu.2024.07.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
Spondylolisthesis is a common condition with a prevalence of 4-6% in childhood and 5-10% in adulthood. The Meyerding Classification, developed in 1932, assigns grades (I to V) based on the degree of slippage observed on standing, neutral lateral lumbar radiographs. Despite its historical significance and reliability, more factors should be evaluated to predict spondylolisthesis progression, especially in low-grade cases. The manuscript highlights areas for improvement in spondylolisthesis classification, emphasizing the need for considering factors beyond vertebral slippage. Factors such as global and segmental alignment, pelvic incidence, overhang, the number of affected levels, and the use of lateral flexion-extension radiographs to assess for stability using the kyphotic angle and slippage degree are identified as crucial in predicting progression and determining effective management strategies.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Anna Rezk
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Makeen Baroudi
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jerzy George Gregorczyk
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jake R McDermott
- Orthopedics Department, SUNY Downstate Medical School, New York, New York, USA
| | - Christopher L Mcdonald
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, New York, USA
| | - Virginie Lafage
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, New York, USA
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Follett M, Karamian B, Liu N, Alamin T, Wood KB. Reliability of semi-automated spinal measurement software. Spine Deform 2024; 12:323-327. [PMID: 38214827 DOI: 10.1007/s43390-023-00795-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/18/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE In the treatment of patients with adult spinal deformity, analysis of spinopelvic balance is essential in clinical assessment and surgical planning. There is currently no gold standard for measurement, whether done by hand or with digital software. New semi-automated software exists that purports to increase efficiency, but its reliability is unknown in the literature. METHODS Full spine X-rays were retrospectively reviewed from 25 adult patients seen between 2014 and 2017. Patients were included if they had > 5 cm of sagittal imbalance and radiographs of sufficient quality to perform balance measurements, without prior surgical spinal fusion and/or instrumentation. Spinopelvic parameters were measured in two radiographic programs: one with basic, non-spine-specific measurement tools (eUnity, Client Outlook, Waterloo, Canada); and a second with spine-specific semi-automated measurement tools (Sectra, Sectra AB, Linköping, Sweden). Balance parameters included SVA, PI, PT, and LL. Data were compared by examining inter-rater and inter-program reliability using interclass correlation coefficient (ICC). RESULTS The subjects' mean age was 67.9 ± 13.8 years old, and 32% were male. The inter-program reliability was strong, with ICC values greater than 0.91 for each parameter. Similarly, there was strong inter-observer reliability with ICC values greater than 0.88. These results persisted on delayed repeat measurement (p < 0.001 for all measurements). CONCLUSION There is excellent inter-observer and inter-program reliability between the basic PACS and semi-automated programs. These data demonstrate that the purported efficiency of semi-automated measurement programs does not come at the cost of measurement reliability.
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Affiliation(s)
- Matthew Follett
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway St, Redwood City, CA, 94063, USA
| | - Brian Karamian
- Department of Spine Surgery, Rothman Orthopaedic Institute, 925 Chestnut St, Philadelphia, PA, 19107, USA
| | - Ning Liu
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway St, Redwood City, CA, 94063, USA
| | - Todd Alamin
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway St, Redwood City, CA, 94063, USA
| | - Kirkham B Wood
- Department of Orthopaedic Surgery, Stanford Medicine, 450 Broadway St, Redwood City, CA, 94063, USA.
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Montazeri M, Khajouei R. Determining the Effect of the Picture Archiving and Communication System (PACS) on Different Dimensions of Users' Work. Radiol Res Pract 2022; 2022:4306714. [PMID: 35265375 PMCID: PMC8901356 DOI: 10.1155/2022/4306714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/22/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
The impact of the picture archiving and communication system (PACS) on healthcare costs, information access, image quality, and user workflow has been well studied. However, there is insufficient evidence on the effect of this system on different dimensions of the users' work. The objective of this study was to evaluate the impact of the PACS on different dimensions of users' work (external communication, service quality, user intention to use the PACS, daily routine, and complaints on users) and to compare the opinions of different groups of users about the PACS. This study was performed on the PACS users (n = 72) at Kerman University of Medical Sciences, including radiologists, radiology staff, ward heads, and physicians. Data were collected using a questionnaire consisting of two parts: demographic information of the participants and 5-point Likert scale questions concerning the five dimensions of users' work. Data were analyzed using descriptive statistics, ANOVA, and Pearson's correlation coefficient statistical tests. The mean of scores given by the PACS users was 4.31 ± 0.86 for external communication, 4.18 ± 0.96 for user intention to use the PACS, 3.91 ± 0.7 for service quality, 3.16 ± 0.56 for daily routine, and 3.08 ± 1.05 for complaints on users. Radiologists and radiology staff had a more positive opinion about the PACS than other clinicians such as physicians (P < 0.01, CI = 95%). Factors such as user age (P < 0.01, CI = 95%), job (P < 0.001, CI = 95%), work experience (P < 0.001, CI = 95%), and PACS training method (P=0.037, CI = 95%) were related to the impact of the PACS on different dimensions of users' work. This study showed that the PACS has a positive effect on different dimensions of users' work, especially on external communication, user intention to use the system, and service quality. It is recommended to implement PACSs in medical centers to support users' work and to maintain and strengthen the capabilities and functions of radiology departments.
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Affiliation(s)
- Mahdieh Montazeri
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Hresko MT, Deckey DG, Hinchcliff E, Kalish LA. Comparative Sacral Morphology in Spondylolisthesis Patients. Spine Deform 2019; 7:945-949. [PMID: 31732006 DOI: 10.1016/j.jspd.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Retrospective comparative case series. OBJECTIVES Evaluation of sacral morphology in spondylolisthesis patients compared with asymptomatic controls. SUMMARY OF BACKGROUND DATA Patients with spondylolisthesis are known to differ from asymptomatic controls in sagittal plane anatomy, but few studies examine the coronal and axial plane differences in these cohorts. METHODS This is a retrospective evaluation of magnetic resonance imaging of the lumbosacral spine in 29 spondylolisthesis patients and an asymptomatic cohort (n = 154). Measurements of the linear distance and angular position of L5 and sacrum were performed in the sagittal, coronal, and axial planes. Receiver operating characteristic (ROC) curve analysis quantified these associations. High- and low-grade spondylolisthesis patients were compared with two-sample t-tests. All p-values are two-sided and considered significant when p < .05. RESULTS Axial measurements showed the distance of the right to left anterior ala and the L5 body width did not differ between the cohorts. Sacroiliac (SI) joint angles in the spondylolisthesis cohort were closer to the true sagittal plane than in the controls 109° versus 121° (p < .001). In the sagittal plane, the linear measurement of the ratio of the midpoint anteroposterior width L5 to the sacral end plate was larger in the high-grade patients than the low-grade patients and controls. In addition, the kyphosis between S1-S2 and S2-S3 was larger in the spondylolisthesis cohort. CONCLUSIONS The SI joints in patients with spondylolisthesis were orientated closer to the sagittal plane than in the controls. An awareness of this positioning may be important in surgical implant insertion as well as rehabilitation of hip extensor weakness. The main anatomical differences found in this study were in the sagittal plane. Sacral end plate abnormalities were well visualized and consistent with radiographic findings in the literature. LEVEL OF EVIDENCE Level III, diagnostic.
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Affiliation(s)
- M Timothy Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - David G Deckey
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; Tufts Medical School, 145 Harrison Avenue, Boston, MA 02111, USA
| | - Emily Hinchcliff
- MD Anderson Hospital, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Leslie A Kalish
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Challenges of Implementing Picture Archiving and Communication System in Multiple Hospitals: Perspectives of Involved Staff and Users. J Med Syst 2019; 43:182. [PMID: 31093803 DOI: 10.1007/s10916-019-1319-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
Today, despite the advantages of the PACS system, its implementation in some healthcare organizations faces many challenges. One of the important factors in the successful implementation of a PACS system is identifying and prioritizing the challenges from the perspectives of involved staff and user of this system. Therefore, the aim of this study was to determine and compare the challenges of implementing PACS from perspectives these users in educational hospitals. This study was conducted on all IT and medical equipment staff, and radiology residents (n = 140) in Kerman University of Medical Sciences (KUMS) and Shiraz University of Medical Sciences (SUMS) in 2016. The data were collected through two researcher-made questionnaires. Their validity was approved by radiologists, IT staff, and medical informatics specialists and their reliability through calculation of Cronbach's Alpha (0.969 and 0.795). We used Multivariate Analysis of Variance (MANOVA) to compare the scores given by three groups of participants in the challenges and Univariate Analysis of Variance (ANOVA) to compare the scores in two universities. The participants believed that technical challenges were more important than other challenges (x̄=3.74, SD = 0.7). IT experts (x̄=3.87, SD = 1) and radiology residents (x̄=3.95, SD = 0.9) gave the higher scores to the "shortage of high quality monitors" factor and medical equipment experts (x̄=4.26, SD = 0.87) to the "low speed of communication networks" factor among all technical challenges. The mean scores given to technical (x̄=76.1, SD = 13.5) and managerial (x̄=16, SD = 5.9) challenges in SUMS were more than the scores of the same challenges in KUMS (x̄=69.9, SD = 15.7) and (x̄=11.9, SD = 6.4) (p < 0.05). The technical challenges are the most common challenges to PACS implementation, and different universities experience different levels of technical challenges. Eliminating implementation challenges can reduce the risk of failure in the utilization process. Based on the results of this study, providing necessary infrastructures such as appropriate monitors and upgraded IT equipment can prevent many of the PACS implementation challenges.
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Criteria for surgical reduction in high-grade lumbosacral spondylolisthesis based on quality of life measures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2060-2069. [DOI: 10.1007/s00586-019-05954-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 03/01/2019] [Accepted: 03/14/2019] [Indexed: 11/26/2022]
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Surgical Treatment of Developmental Spondylolisthesis: Contemporary Series With a Two-Surgeon Team. Spine Deform 2019; 7:275-285. [PMID: 30660222 DOI: 10.1016/j.jspd.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/04/2018] [Accepted: 08/05/2018] [Indexed: 11/20/2022]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To report operative outcomes of contemporary surgical treatment of spondylolisthesis in the pediatric population. SUMMARY OF BACKGROUND DATA Surgical treatment of developmental spondylolisthesis is controversial, with limited data on complication and reoperation rates. METHODS A retrospective study followed pediatric patients with either L5-S1 high-grade spondylolisthesis (HGS) or L5-S1 symptomatic low-grade spondylolisthesis (LGS) for a minimum of two years. All patients underwent a contemporary, single-stage decompression, partial reduction, and posterior instrumented fusion (DRPF) or in situ stabilization by a combined orthopedic and neurosurgeon team at a single institution during 2005-2015. Clinical examination and radiographic data were collected preoperatively and at discharge, 1 year, 2 years, and terminal visit (defined as the last follow-up at >2 years). RESULTS Thirty-four patients (79% HGS), mean (±standard deviation) age at surgery 13.5 (±3.3) years, were followed for 4.8 (±2.3) years. The patients who underwent DRPF (n = 26) had mean lumbosacral angle increase from 79.8° (±20.8) to 92.5° (±16.1) (p < .001) and mean listhesis reduce from 63.2% (±21.9) to 26.0% (±20.1) (p < .001). Preoperatively, 18 (53%) had neurologic symptoms. At one- and two-year follow-up, new or residual neurologic symptoms were present in four patients (12%) (p < .001). Postoperative symptoms were not significantly related to amount of reduction. Sixteen (47%) underwent reoperation at an average of 24.8 months, 10 for planned prominent instrumentation removal, and 6 for true complications. CONCLUSIONS Surgical reduction and decompression of spondylolisthesis in the pediatric population restores spinopelvic alignment. We found no evidence that a greater amount of reduction was associated with a higher incidence of postoperative complications. However, patients should be advised that prominent instrumentation may require future removal. Although previous reports suggest complication rates and permanent neurologic sequelae in up to 20% after operative treatment of spondylolisthesis, our results suggest that a contemporary approach with a two-surgeon team may provide improved results. LEVEL OF EVIDENCE Level IV.
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