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Chen HB, Huang YL, Chen M, Wu HB. Reducing decompression levels by diffusion tensor imaging and conventional magnetic resonance imaging in degenerative lumbar spinal stenosis. Br J Neurosurg 2024; 38:265-271. [PMID: 33538210 DOI: 10.1080/02688697.2020.1861432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The selection of a correct level in lumbar spinal stenosis (LSS) remains a common problem and is critically important to the effectiveness of this surgical treatment. Surgery is invasive, and extended laminectomy may lead to secondary surgical complications. The application of diffuse tensor imagining (DTI) and paraspinal mapping (PM) in addition to conventional magnetic resonance imaging (cMRI) may be helpful in this respect. However, the superiority of cMRI + DTI over cMRI+ (DTI or PM) in reducing decompression has not yet been established. METHODS We compared the surgical levels, determined by cMRI + DTI and cMRI+ (DTI or PM) (self-control). Treatment outcome measurements were performed at two weeks, three months, six months, and twelve months postoperatively. RESULTS The surgical levels determined by cMRI ± DTI showed less than that determined by cMRI± (DTI or PM) with statistically significant differences (p value = 0.0199) and cMRI ± PM with no statistically significant differences (p value = 0.5503). CONCLUSIONS The effectiveness of cMRI ± DTI in the reduction of the surgical levels in degenerative lumbar spinal stenosis is superior than that of cMRI± (DTI or PM).
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Affiliation(s)
- Hua-Biao Chen
- Departments of Orthopaedic Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, People's Republic of China
| | - Yu-Liang Huang
- Departments of Orthopaedic Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, People's Republic of China
| | - Min Chen
- Departments of Orthopaedic Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, People's Republic of China
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Is EE, Aksu S, Karamursel S, Ketenci A, Sindel D. Effectiveness of transcranial direct current stimulation in chronic pain and neurogenic claudication related to lumbar spinal stenosis. Neurol Sci 2024; 45:769-782. [PMID: 38091212 DOI: 10.1007/s10072-023-07248-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/01/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) is a promising non-invasive brain stimulation technique for treating chronic pain, yet its effectiveness in chronic lower extremity pain due to lumbar spinal stenosis (LSS) has not been studied. This research aimed to investigate the impact of tDCS on pain, walking capacity, functional status, and quality of life in LSS patients. PATIENTS AND METHODS In this prospective, randomized, double-blind, sham-controlled study, 32 LSS patients received either real or sham tDCS over the motor cortex contralateral to the patient's painful lower extremity for 10 consecutive weekdays (10 sessions). Evaluations were conducted at baseline, post-session, and 1-3 months later. The pain was evaluated by Visual Analog Scale (VAS), walking duration and distance by Treadmill Walking Test, functional status by Modified Oswestry Disability Questionnaire (MODQ) and quality of life by Short Form-36 (SF-36). RESULTS In-group comparisons, active tDCS showed sustained analgesic effects for 3-month post-treatment, distinct from sham. After the final session, active group exhibited significantly better asymptomatic walking distance and duration. Active stimulation led to notably lower MOLBDQ scores after 1 month. Significant improvements in SF-36 subscales were seen after 3 months, especially in pain, physical functioning, and general health. Positive tDCS effects on pain, claudication, and some quality of life aspects were evident at 3 months, while functional status improvements were mainly limited to 1 month. CONCLUSION tDCS shows potential as a safe, non-invasive technique for alleviating chronic LSS-related pain, enhancing mobility, functionality, and quality of life. TRIAL REGISTRATION Clinicaltrials.gov ID: NCT03958526.
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Affiliation(s)
- Enes Efe Is
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Turkiye, Sisli Hamidiye Etfal Teaching and Research Hospital, Seyrantepe Campus, Cumhuriyet Ve Demokrasi Avenue, Sariyer, Istanbul, 34485, Turkey.
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Serkan Aksu
- Department of Physiology, Mugla Sitki Kocman University Faculty of Medicine, Mugla, Turkey
- Department of Physiology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sacit Karamursel
- Department of Physiology, Koc University School of Medicine, Istanbul, Turkey
| | - Aysegul Ketenci
- Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Istanbul, Turkey
| | - Dilsad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Hermansen E, Indrekvam K, Weber C, Brisby H. Postoperative Dural Sac Cross-Sectional Area as an Association for Outcome After Surgery for Lumbar Spinal Stenosis: Clinical and Radiologic Results From the NORDSTEN-Spinal Stenosis Trial (Spine, May 15, 2023). Spine (Phila Pa 1976) 2024; 49:E10. [PMID: 37823287 DOI: 10.1097/brs.0000000000004850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Erland Hermansen
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Norway
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Clemens Weber
- Department of Neurosurgery, Stavanger University Hospital, Norway
- Department of Quality and Health Technology, University of Stavanger, Norway
| | - Helena Brisby
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopedics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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Yuan H, Yi X. Lumbar Spinal Stenosis and Minimally Invasive Lumbar Decompression: A Narrative Review. J Pain Res 2023; 16:3707-3724. [PMID: 37954472 PMCID: PMC10637222 DOI: 10.2147/jpr.s428112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 11/14/2023] Open
Abstract
Background Lumbar spinal stenosis (LSS) is a common pain condition that causes lumbar back pain, radiating leg pain, and possible functional impairment. MILD is an emerging minimally invasive treatment for LSS. It is an image-guided percutaneous procedure designed to debulk hypertrophied ligamentum flavum. However, the exact short- and long-term efficacy, safety profile, indication criteria, and certain procedure details reported in medical literature vary. Objective This narrative review was to elucidate efficacy, safety profile, certain procedure details, advantages, and limitations of MILD. Study Design This is a narrative review. Setting All included articles are clinic trials including analytic studies and descriptive studies. Methods PubMed, Cochrane Library, and Scopus were searched. Only clinical trials of MILD procedure were included. Information of indications, contraindications, VAS scores, ODI scores, effective rate, efficacy durations, and certain procedure details was focused on. Results According to the literature, for the MILD procedure, the VAS score could be reduced from a pre-treatment level of 6.3-9.6 to a post-treatment level of 2.3-5.8. The ODI score could be reduced from a pre-treatment level of 38.8-55.3 to a post-treatment level of 27.4-39.8. The effective rate of the MILD procedure was reported to be 57.1%-88%. A 2-year postoperative stability of efficacy was also supported. One RCT study testified superior efficacy of MILD over epidural steroid injection. Limitations There is few high-quality literature in the review. Moreover, the long-term efficacy of MILD cannot be revealed according to the current literature. Conclusion Based on the reviewed literature, MILD is an effective and safe procedure. MILD can reduce pain intensity and improve functional status significantly. Therefore, it is a preferable option for LSS patients who failed conservative treatments, but not for those who require immediate invasive decompression surgery.
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Affiliation(s)
- Hongjie Yuan
- Department of Pain Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xiaobin Yi
- Pain Division, Department of Anesthesiology, Washington University in St Louis, St Louis, MO, USA
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Ito S, Nakashima H, Segi N, Ouchida J, Oda M, Yamauchi I, Oishi R, Miyairi Y, Mori K, Imagama S. Automated Detection and Diagnosis of Spinal Schwannomas and Meningiomas Using Deep Learning and Magnetic Resonance Imaging. J Clin Med 2023; 12:5075. [PMID: 37568477 PMCID: PMC10419638 DOI: 10.3390/jcm12155075] [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: 06/24/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Spinal cord tumors are infrequently identified spinal diseases that are often difficult to diagnose even with magnetic resonance imaging (MRI) findings. To minimize the probability of overlooking these tumors and improve diagnostic accuracy, an automatic diagnostic system is needed. We aimed to develop an automated system for detecting and diagnosing spinal schwannomas and meningiomas based on deep learning using You Only Look Once (YOLO) version 4 and MRI. In this retrospective diagnostic accuracy study, the data of 50 patients with spinal schwannomas, 45 patients with meningiomas, and 100 control cases were reviewed, respectively. Sagittal T1-weighted (T1W) and T2-weighted (T2W) images were used for object detection, classification, training, and validation. The object detection and diagnosis system was developed using YOLO version 4. The accuracies of the proposed object detections based on T1W, T2W, and T1W + T2W images were 84.8%, 90.3%, and 93.8%, respectively. The accuracies of the object detection for two spine surgeons were 88.9% and 90.1%, respectively. The accuracies of the proposed diagnoses based on T1W, T2W, and T1W + T2W images were 76.4%, 83.3%, and 84.1%, respectively. The accuracies of the diagnosis for two spine surgeons were 77.4% and 76.1%, respectively. We demonstrated an accurate, automated detection and diagnosis of spinal schwannomas and meningiomas using the developed deep learning-based method based on MRI. This system could be valuable in supporting radiological diagnosis of spinal schwannomas and meningioma, with a potential of reducing the radiologist's overall workload.
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Affiliation(s)
- Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan (Y.M.)
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan (Y.M.)
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan (Y.M.)
| | - Jun Ouchida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan (Y.M.)
| | - Masahiro Oda
- Information Strategy Office, Information and Communications, Nagoya University, Nagoya 464-8601, Japan
| | - Ippei Yamauchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan (Y.M.)
| | - Ryotaro Oishi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan (Y.M.)
| | - Yuichi Miyairi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan (Y.M.)
| | - Kensaku Mori
- Information Strategy Office, Information and Communications, Nagoya University, Nagoya 464-8601, Japan
- Department of Intelligent Systems, Nagoya University Graduate School of Informatics, Nagoya 464-8601, Japan
- Research Center for Medical Bigdata, National Institute of Informatics, Tokyo 101-8430, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan (Y.M.)
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Bharadwaj UU, Christine M, Li S, Chou D, Pedoia V, Link TM, Chin CT, Majumdar S. Deep learning for automated, interpretable classification of lumbar spinal stenosis and facet arthropathy from axial MRI. Eur Radiol 2023; 33:3435-3443. [PMID: 36920520 PMCID: PMC10566647 DOI: 10.1007/s00330-023-09483-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To evaluate a deep learning model for automated and interpretable classification of central canal stenosis, neural foraminal stenosis, and facet arthropathy from lumbar spine MRI. METHODS T2-weighted axial MRI studies of the lumbar spine acquired between 2008 and 2019 were retrospectively selected (n = 200) and graded for central canal stenosis, neural foraminal stenosis, and facet arthropathy. Studies were partitioned into patient-level train (n = 150), validation (n = 20), and test (n = 30) splits. V-Net models were first trained to segment the dural sac and the intervertebral disk, and localize facet and foramen using geometric rules. Subsequently, Big Transfer (BiT) models were trained for downstream classification tasks. An interpretable model for central canal stenosis was also trained using a decision tree classifier. Evaluation metrics included linearly weighted Cohen's kappa score for multi-grade classification and area under the receiver operator characteristic curve (AUROC) for binarized classification. RESULTS Segmentation of the dural sac and intervertebral disk achieved Dice scores of 0.93 and 0.94. Localization of foramen and facet achieved intersection over union of 0.72 and 0.83. Multi-class grading of central canal stenosis achieved a kappa score of 0.54. The interpretable decision tree classifier had a kappa score of 0.80. Pairwise agreement between readers (R1, R2), (R1, R3), and (R2, R3) was 0.86, 0.80, and 0.74. Binary classification of neural foraminal stenosis and facet arthropathy achieved AUROCs of 0.92 and 0.93. CONCLUSION Deep learning systems can be performant as well as interpretable for automated evaluation of lumbar spine MRI including classification of central canal stenosis, neural foraminal stenosis, and facet arthropathy. KEY POINTS • Interpretable deep-learning systems can be developed for the evaluation of clinical lumbar spine MRI. Multi-grade classification of central canal stenosis with a kappa of 0.80 was comparable to inter-reader agreement scores (0.74, 0.80, 0.86). Binary classification of neural foraminal stenosis and facet arthropathy achieved favorable and accurate AUROCs of 0.92 and 0.93, respectively. • While existing deep-learning systems are opaque, leading to clinical deployment challenges, the proposed system is accurate as well as interpretable, providing valuable information to a radiologist in clinical practice.
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Affiliation(s)
- Upasana Upadhyay Bharadwaj
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA.
| | - Miranda Christine
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Steven Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
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The current state of radiodiagnostics of degenerative changes in the lumbar spine (literature review). ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.6.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Examination of the spine using radiological methods remains the most frequently conducted study in the outpatient practice of almost any radiologist. In most cases, changes in the spine are degenerative and dystrophic in nature. These changes in the spine are the leading cause of loss of activity among adults and the elderly, and cover a wide range of age-related structural changes. It is of great importance to understand the possibilities and limitations of radiological methods of diagnostics. The description of morphological changes observed in degenerative and dystrophic changes requires the use of unified terminology and classifications among clinicians and radiologists.The aim. To present modern concepts in the assessment of degenerative changes of the spine using radiological methods. A description of the standardized international nomenclature of intervertebral disc pathology and current classifications of spinal canal stenosis are presented.Material and methods. For literature search, we used electronic databases MEDLINE (PubMed), eLibrary, EMBASE and Cochrane Library with a selection of sources published from 2000 to 2021. We analyzed the works devoted to the diagnosis of degenerative changes in lumbar spine and to degenerative stenosis.Conclusion. The key to productive communication between physicians is the uniformity or standardization of terminology and definitions used. It is important that the protocol of description, its terms, semantic expressions be uniform and understandable to specialists who are involved in the diagnosis and treatment of the spine. Magnetic resonance imaging is a valuable method in the diagnosis of degenerative changes of the spinal column, but it has its limitations.
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Bharadwaj UU, Ben-Natan AR, Huang J, Pedoia V, Chou D, Majumdar S, Link TM, Chin CT. Evaluation of 2 Novel Ratio-Based Metrics for Lumbar Spinal Stenosis. AJNR Am J Neuroradiol 2022; 43:1530-1538. [PMID: 36109122 PMCID: PMC9575539 DOI: 10.3174/ajnr.a7638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/25/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Quantitative metrics of the dural sac such as the cross-sectional area are commonly used to evaluate central canal stenosis. The aim of this study was to analyze 2 new metrics to measure spinal stenosis on the basis of the ratio between the dural sac and disc cross-sectional areas (DDRCA) and the dural sac and disc anterior-posterior diameters (DDRDIA) and compare them with established quantitative metrics of the dural sac. MATERIALS AND METHODS T2-weighted axial MR images (n = 260 patients) were retrospectively evaluated, graded for central canal stenosis as normal (no stenosis), mild, moderate, or severe from L1/L2 through L5/S1 with 1 grade per spinal level and annotated to measure the DDRCA and DDRDIA. Thresholds were obtained using a decision tree classifier on a subset of patients (n = 130) and evaluated on the remaining patients (n = 130) for accuracy and consistency across demographics, anatomic variation, and clinical outcomes. RESULTS DDRCA and DDRDIA had areas under the receiver operating characteristic curve of 98.6 (97.4-99.3) and 98.0 (96.7-98.9) compared with dural sac cross-sectional area at 96.5 (95.0-97.7) for binary classification. DDRDIA and DDRCA had κ scores of 0.75 (0.71-0.79) and 0.80 (0.75-0.83) compared with dural sac cross-sectional area at 0.62 (0.57-0.66) for multigrade classification. No significant differences (P > .1) in the area under the receiver operating characteristic curve were observed for the DDRDIA across variations in the body mass index. The DDRDIA also had the highest area under the receiver operating characteristic curve among symptomatic patients (visual analog scale ≥ 7) or patients who underwent surgery. CONCLUSIONS Ratio-based metrics (DDRDIA and DDRCA) are accurate and robust to anatomic and demographic variability compared with quantitative metrics of the dural sac and better correlated with symptomatology and surgical outcomes.
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Affiliation(s)
- U U Bharadwaj
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - A R Ben-Natan
- Neurological Surgery (A.R.B.-N., J.H., D.C.), University of California San Francisco, San Francisco, California
| | - J Huang
- Neurological Surgery (A.R.B.-N., J.H., D.C.), University of California San Francisco, San Francisco, California
| | - V Pedoia
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - D Chou
- Neurological Surgery (A.R.B.-N., J.H., D.C.), University of California San Francisco, San Francisco, California
| | - S Majumdar
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - T M Link
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
| | - C T Chin
- From the Departments of Radiology and Biomedical Imaging (U.U.B., V.P., S.M., T.M.L., C.T.C.)
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Wang Y, Zhan Y, Jin X, Shen D, Wang L, Cao T, Jiang H. Electrophysiological Characteristics of Cervical Spinal Stenosis. Appl Bionics Biomech 2022; 2022:7522664. [PMID: 35795257 PMCID: PMC9251139 DOI: 10.1155/2022/7522664] [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: 03/04/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate electrophysiological characteristics of patients with cervical spinal stenosis (CSS) due to cervical disc herniation. Methods A total of 51 patients with CSS diagnosed in our hospital from January 2018 to March 2020 were selected. According to magnetic resonance imaging (MRI), the degree of spinal cord compression was divided into 1-3 grades, namely, group A (MRI grade 1), group B (MRI grade 2), and group C (MRI grade 3), with 17 cases in each group. Subsequently, we analyzed the correlation of the degree of spinal cord compression with the general information, clinical data, and electromyography (EMG) of patients. Results Compared with group A and group B, group C had the longest disease course [(48.06 ± 17.71) months], the lowest JOA score (4.59 ± 2.15), and the highest number of positive results of EMG (EMG: A/B/C, 25/51/77); there were significant differences among the 3 groups. And group C had the higher number of positive cases of both upper and lower limbs in SEP test compared with the other two groups (SEP: A/B/C: 12/18/29: χ 2 = 7.559, P = 0.023). According to correlation analysis, MRI grading had no association with gender, age, and spinal canal diameter/volume but was positively correlated with disease course and negatively correlated with JOA score. Conclusion This study primarily verifies that higher MRI grade of CSS is associated with longer disease duration and lower JOA score and EMG. The obtained results secondarily demonstrate the correlation between abnormal neurological status and the MRI grade.
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Affiliation(s)
- Yanrong Wang
- Department of Electromyography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yinping Zhan
- Department of Electromyography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xiaolan Jin
- Department of Electromyography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Dandan Shen
- Department of Electromyography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Ling Wang
- Department of Electromyography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Tingting Cao
- Department of Electromyography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Hong Jiang
- Department of Electromyography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
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Imaging of the Aging Spine. Radiol Clin North Am 2022; 60:629-640. [DOI: 10.1016/j.rcl.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ito S, Ando K, Kobayashi K, Nakashima H, Oda M, Machino M, Kanbara S, Inoue T, Yamaguchi H, Koshimizu H, Mori K, Ishiguro N, Imagama S. Automated Detection of Spinal Schwannomas Utilizing Deep Learning Based on Object Detection From Magnetic Resonance Imaging. Spine (Phila Pa 1976) 2021; 46:95-100. [PMID: 33079909 DOI: 10.1097/brs.0000000000003749] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of magnetic resonance imaging (MRI) was conducted. OBJECTIVE This study aims to develop an automated system for the detection of spinal schwannoma, by employing deep learning based on object detection from MRI. The performance of the proposed system was verified to compare the performances of spine surgeons. SUMMARY OF BACKGROUND DATA Several MRI scans were conducted for the diagnoses of patients suspected to suffer from spinal diseases. Typically, spinal diseases do not involve tumors on the spinal cord, although a few tumors may exist at the unexpectable level or without symptom by chance. It is difficult to recognize these tumors; in some cases, these tumors may be overlooked. Hence, a deep learning approach based on object detection can minimize the probability of overlooking these tumors. METHODS Data from 50 patients with spinal schwannoma who had undergone MRI were retrospectively reviewed. Sagittal T1- and T2-weighted magnetic resonance imaging (T1WI and T2WI) were used in the object detection training and for validation. You Only Look Once version3 was used to develop the object detection system, and its accuracy was calculated. The performance of the proposed system was compared to that of two doctors. RESULTS The accuracies of the proposed object detection based on T1W1, T2W1, and both T1W1 and T2W1 were 80.3%, 91.0%, and 93.5%, respectively. The accuracies of the doctors were 90.2% and 89.3%. CONCLUSION Automated object detection of spinal schwannoma was achieved. The proposed system yielded a high accuracy that was comparable to that of the doctors.Level of Evidence: 4.
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Affiliation(s)
- Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Oda
- Department of Intelligent Systems, Nagoya University Graduate School of Informatics, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Inoue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidetoshi Yamaguchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kensaku Mori
- Department of Intelligent Systems, Nagoya University Graduate School of Informatics, Nagoya, Japan
- Reseach Center for Medical Bigdata, National Institute of Informatics, Tokyo, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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El Tabl MA, El Sisi YB, Al Emam SE, Hussen MA, Saif DS. Evaluating the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function. EGYPTIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1186/s41984-020-00087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Management of lumbar canal stenosis should be started with conservative treatment and preferably with a multimodal approach, but in cases of severe pain with extensive neurogenic claudication symptoms, surgical intervention is indicated. This retrospective study targets to evaluate the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function.
Methods
Data of 184 patients of the study groups were divided into group A (data from patients who underwent laminectomy and foraminotomy only) and group B (data from patients who underwent laminectomy and foraminotomy with spinal fixation). Preoperative, operative, postoperative (PO), and follow-up data were extracted and analyzed from files of patients fulfilling the inclusion criteria.
Results
Primary outcome was at least 50% improvement of pain severity regarding numeric rating scale (NRS) and Oswestry disability index (ODI) score at 6-months PO compared to preoperative scores. Operative time was significantly longer in group B than group A. Immediate PO data regarding PO analgesic requirement, amount of wound drainage, and PO hospital stay showed non-significant difference between both groups. There was a statically significant improvement of EHL muscle strength regarding Odom’s scoring in group B in which the success rate for pain improvement was 81.8% and for disability was 66.8%. There were insignificant differences in patient’s satisfaction to surgery with variable ages, a significant outcome in females and in patients with fewer levels of affection of both groups.
Conclusion
The present study reported the efficacy and safety of the laminectomy, foraminotomy, discectomy, and medial facetectomy with spinal fixation using trans-pedicular screws for management of patients with spinal canal stenosis.
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Formica M, Quarto E, Zanirato A, Mosconi L, Vallerga D, Zotta I, Baracchini ML, Formica C, Felli L. Lateral Lumbar Interbody Fusion: What Is the Evidence of Indirect Neural Decompression? A Systematic Review of the Literature. HSS J 2020; 16:143-154. [PMID: 32523482 PMCID: PMC7253558 DOI: 10.1007/s11420-019-09734-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the past decade, lateral lumbar interbody fusion (LLIF) has gained in popularity. A proposed advantage is the achievement of indirect neural decompression. However, evidence of the effectiveness of LLIF in neural decompression in lumbar degenerative conditions remains unclear. QUESTIONS/PURPOSES We sought to extrapolate clinical and radiological results and consequently the potential benefits and limitations of LLIF in indirect neural decompression in degenerative lumbar diseases. METHODS We conducted a systematic review of the literature in English using the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. Scores on the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain were extracted, as were data on the following radiological measurements: disc height (DH), foraminal height (FH), foraminal area (FA), central canal area (CA). RESULTS In the 42 articles included, data on 2445 patients (3779 levels treated) with a mean follow-up of 14.8 ± 5.9 months were analyzed. Mean improvements in VAS back, VAS leg, and ODI scale scores were 4.1 ± 2.5, 3.9 ± 2.2, and 21.9 ± 7.2, respectively. Post-operative DH, FH, FA, and CA measurements increased by 68.6%, 21.9%, 37.7%, and 29.3%, respectively. CONCLUSION Clinical results indicate LLIF as an efficient technique in indirect neural decompression. Analysis of radiological data demonstrates the effectiveness of symmetrical foraminal decompression. Data regarding indirect decompression of central canal and lateral recess are inconclusive and contradictory. Bony stenosis appears as an absolute contraindication. The role of facet joint degeneration is unclear. This systematic review provides a reference for surgeons to define the potential and limitations of LLIF in indirect neural elements decompression.
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Affiliation(s)
- Matteo Formica
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, GE Italy
| | - Emanuele Quarto
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, GE Italy
| | - Andrea Zanirato
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, GE Italy
| | - Lorenzo Mosconi
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, GE Italy
| | - Davide Vallerga
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, GE Italy
| | - Irene Zotta
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, GE Italy
| | | | - Carlo Formica
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, MI Italy
| | - Lamberto Felli
- Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, GE Italy
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The Functional Relevance of Diffusion Tensor Imaging in Patients with Degenerative Cervical Myelopathy. J Clin Med 2020; 9:jcm9061828. [PMID: 32545316 PMCID: PMC7355923 DOI: 10.3390/jcm9061828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
(1) Background: In addition to conventional magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) has been investigated as a potential diagnostic and predictive tool for patients with degenerative cervical myelopathy (DCM). In this preliminary study, we evaluated the use of quantitative DTI in the clinical practice as a possible measure to correlate with upper limbs function. (2) Methods: A total of 11 patients were enrolled in this prospective observational study. Fractional anisotropy (FA) values was extracted from DTI data before and after surgery using a GE Signa 1.5 T MRI scanner. The Nine-Hole Peg Test and a digital dynamometer were used to measure dexterity and hand strength, respectively. (3) Results: We found a significant increase of FA values after surgery, in particular below the most compressed level (p = 0.044) as well as an improvement in postoperative dexterity and hand strength. Postoperative FA values moderately correlate with hand dexterity (r = 0.4272, R2 = 0.0735, p = 0.19 for the right hand; r = 0.2087, R2 = 0.2265, p = 0.53 for the left hand). (4) Conclusion: FA may be used as a marker of myelopathy and could represent a promising diagnostic value in patients affected by DCM. Surgical decompression can improve the clinical outcome of these patients, especially in terms of the control of finger-hand coordination and dexterity.
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Zileli M, Crostelli M, Grimaldi M, Mazza O, Anania C, Fornari M, Costa F. Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X 2020; 7:100073. [PMID: 32613187 PMCID: PMC7322797 DOI: 10.1016/j.wnsx.2020.100073] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/13/2020] [Indexed: 11/26/2022] Open
Abstract
Lumbar spinal stenosis (LSS) is defined as a degenerative disorder showing a narrowing of the spinal canal. The diagnosis is straightforward in cases with typical neurogenic claudication symptoms and unequivocal imaging findings. However, not all patients present with typical symptoms, and there is obviously no correlation between the severity of stenosis and clinical complaint. The radiologic diagnosis of LSS is widely discussed in the literature. The best diagnostic test for the diagnosis of LSS is magnetic resonance imaging (MRI). However, canal diameter measurements have not gained much consensus from radiologists, whereas qualitative measures, such as cerebrospinal fluid space obliteration, have achieved greater consensus. Instability can best be defined by standing lateral radiograms and flexion-extension radiograms. For cases showing typical neurogenic claudication symptoms and unequivocal imaging findings, the diagnosis is straightforward. However, not all patients present with typical symptoms, and there is obviously no correlation between the severity of stenosis (computed tomography and MRI) and clinical complaint. In fact, recent MRI studies have shown that mild-to-moderate stenosis can also be found in asymptomatic individuals. Routine electrophysiological tests such as lower extremity electromyography, nerve conduction studies, F-wave, and H-reflex are not helpful in the diagnosis and outcome prediction of LSS. The electrophysiological recordings are complementary to the neurologic examination and can provide confirmatory information in less obvious clinical complaints. However, in the absence of reliable evidence, imaging studies should be considered as a first-line diagnostic test in the diagnosis of degenerative LSS.
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Key Words
- CT, Computed tomography
- Canal diameter
- Central stenosis
- DSEP, Dermatomal somatosensory evoked potential
- EMG, Electromyography
- Electrophysiological recordings
- Foraminal stenosis
- IONM, Intraoperative neurophysiological monitoring
- Intraoperative neurophysiological monitoring
- LS, Likert scale
- LSS, Lumbar spinal stenosis
- Lumbar spinal stenosis
- MEP, Motor evoked potential
- MRI, Magnetic resonance imaging
- Motor evoked potentials
- NASS, North American Spine Society
- Natural course
- SSEP, Somatosensory evoked potential
- Somatosensory evoked potentials
- VAS, Visual analog scale
- WFNS, World Federation of Neurosurgical Societies
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Affiliation(s)
- Mehmet Zileli
- Neurosurgery Department, Ege University, Bornova, Izmir, Turkey
| | - Marco Crostelli
- Spine Surgery Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Osvaldo Mazza
- Spine Surgery Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Carla Anania
- Neurosurgery Department, Humanitas Clinical and Research Hospital, Milan, Italy
| | - Maurizio Fornari
- Neurosurgery Department, Humanitas Clinical and Research Hospital, Milan, Italy
| | - Francesco Costa
- Neurosurgery Department, Humanitas Clinical and Research Hospital, Milan, Italy
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Ferretti F, Coluccia A, Gusinu R, Gualtieri G, Muzii VF, Pozza A. Quality of life and objective functional impairment in lumbar spinal stenosis: a protocol for a systematic review and meta-analysis of moderators. BMJ Open 2019; 9:e032314. [PMID: 31753889 PMCID: PMC6886937 DOI: 10.1136/bmjopen-2019-032314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) is a common degenerative spine disease associated with a strong impairment in various quality of life areas, particularly the ability to perform work-related activity. Depression is a condition frequently associated. There is no comprehensive review on quality of life and objective functional impairment in LSS. This paper presents the protocol of the first systematic review and meta-analysis summarising evidence about quality of life and functional impairment in patients with LSS compared with healthy controls. Comorbid depressive disorders, age, gender, LSS duration, disability, pain severity and study methodological quality will be investigated as moderators. METHODS The protocol is reported according to PRISMA-P guidelines. Studies will be included if they were conducted on patients aged 18 years old or older with primary LSS and if they reported data on differences in the levels of quality of life or objective functional impairment between patients with LSS and healthy controls. Independent reviewers will search published/unpublished studies through electronic databases and additional sources, will extract the data and assess the methodological quality. Random-effects meta-analysis will be carried out by calculating effect sizes as Cohen's d indices. Heterogeneity will be examined by the I2 and the Q statistics. Moderators will be investigated through meta-regression. CONCLUSIONS A summary of the evidence on quality of life and functional impairment in LSS may suggest clinical and occupational health medicine strategies aimed to timely detect and prevent these outcomes. Higher percentages of patients with LSS with depression may be expected to be related to poorer quality of life. Depressive comorbidity might impact negatively on quality of life because it is associated with dysfunctional coping, disability and psychophysiological symptoms. ETHICS AND DISSEMINATION The current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals. REVIEW REGISTRATION CRD42019132209.
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Affiliation(s)
- Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Roberto Gusinu
- Health Service Management Board, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Giacomo Gualtieri
- Legal Medicine Unit, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Vitaliano Francesco Muzii
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
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Chen HB, Chen M, Peng HH, Xu QF, Li XC, Bai B. Relationship between the benefits of paraspinal mapping and diffusion tensor imaging and the increase of decompression levels determined by conventional magnetic resonance imaging in degenerative lumbar spinal stenosis. J Orthop Surg Res 2019; 14:23. [PMID: 30670090 PMCID: PMC6341682 DOI: 10.1186/s13018-019-1065-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In lumbar spinal stenosis (LSS), at most times, several levels are impaired and selecting the correct level remains a common problem for surgeons, as surgery remains invasive, and extended laminectomy may lead to secondary surgical complications. Therefore, helping to select the correct level may be useful for surgeons. The use of diffuse tensor imaging (DTI) and paraspinal mapping (PM) in addition to conventional magnetic resonance imaging (MRI) may be helpful (Chen et al., J Orthop Surg Res 11:47, 2016). However, with decompression levels determined by conventional magnetic resonance imaging (MRI) increasing, whether the benefits of reducing decompression level of conventional MRI + (DTI or PM) will be more obvious is unknown. METHODS Reduced surgical levels that were different between levels determined by conventional MRI + (DTI or PM) and conventional MRI + neurogenic examination (NE) between groups were compared. Treatment outcome measures were performed at 2 weeks, 3 months, 6 months, and 12 months postoperatively. RESULTS The reduced levels of three groups showed no statistically significant differences between each other except for two levels and four levels (two levels/three levels, p = 0.085; two levels/four levels, p = 0.039; three levels/ four levels, p = 0.506, respectively). CONCLUSIONS With surgical levels determined by conventional MRI increasing, the benefits of DTI and PM will be uncertainly more obvious.
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Affiliation(s)
- Hua-Biao Chen
- Departments of Spine Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, 41Goose Ridge North Road, 516001, Huizhou City, Guangdong Province, People's Republic of China.
| | - Min Chen
- Departments of Spine Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, 41Goose Ridge North Road, 516001, Huizhou City, Guangdong Province, People's Republic of China
| | - Hong-Hui Peng
- Departments of Spine Surgery, Affiliated Huizhou Central People Hospital, Sun Yat-Sen University and Guangdong Medical University, 41Goose Ridge North Road, 516001, Huizhou City, Guangdong Province, People's Republic of China
| | - Qi-Feng Xu
- Department of Electromyography, First Affiliated Hospital, Guangzhou Medical University, 151Yanjiang Road, 510120, Guangzhou, People's Republic of China
| | - Xin-Chun Li
- Department of Radiology, First Affiliated Hospital, Guangzhou Medical University, 151Yanjiang Road, 510120, Guangzhou, People's Republic of China
| | - Bo Bai
- Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials, First Affiliated Hospital, Guangzhou Medical University, 151Yanjiang Road, 510120, Guangzhou, People's Republic of China.,Department of Orthopaedic, First Affiliated Hospital, Guangzhou Medical University, 151Yanjiang Road, 510120, Guangzhou, People's Republic of China
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18
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Chokshi FH, Kadom N, Dwivedi N, Kundu S, Moussa AY, Tannoury C, Tannoury T. Radiographic Cobb Angle: A Feature of Congenital Lumbar Spine Stenosis. Curr Probl Diagn Radiol 2019; 48:45-49. [PMID: 29422329 DOI: 10.1067/j.cpradiol.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE A low cost, reproducible radiographic method of diagnosing congenital lumbar spinal stenosis (CLSS) is lacking. We hypothesized that the Cobb angle for lumbar lordosis would be smaller in patients with CLSS, based on observations in our spine clinic patient population. Here, we compared lumbar lordosis Cobb angles with the radiographic ratio method in patients with normal spine imaging, degenerative spinal stenosis, and with CLSS. MATERIALS AND METHODS Orthopedic surgeons categorized patients with low back pain as "Normal," "Degenerative spinal stenosis," and "CLSS" based on clinical presentation and findings on lumbar magnetic resonance imaging. We included 30 patients from each cohort who had undergone lateral lumbar spine radiographs and lumbar magnetic resonance imaging. For each lateral radiograph, 2 measurement methods were used (1) 4-line lumbosacral Cobb angle between L2-S1 and (2) the ratio of the anteroposterior vertebral body diameter and spinal canal anteroposterior diameter at the L3 level. We performed logistic regression analyses of CLSS prediction by Cobb angle vs the ratio method in all three cohorts. Covariates included age, gender, and body mass index. RESULTS The radiographic Cobb angles were smaller in CLSS patients when compared to the degenerative disease and normal cohorts: a smaller radiographic Cobb angle showed higher odds ratio (OR) of predicting CLSS diagnosis compared to the radiographic ratio when compared with degenerative disease (OR = 0.28; 95% CI: 0.11-0.78, P = 0.01) and when compared with the normal cohort (OR = 0.46; 95% CI: 0.24-0.92, P = 0.03). Radiographic ratio measurements showed no difference between the three cohorts (P = 0.12). CLSS was associated with male gender (P = 0.04), younger age (P = 0.01), and higher body mass index (P = 0.01). CONCLUSION The radiographic Cobb angle method for lumbar lordosis may be useful for raising the possibility of CLSS as the diagnosis.
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Affiliation(s)
- Falgun H Chokshi
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA.
| | | | - Suprateek Kundu
- Department of Biostatistics and Bioinformatics, Emory University, Rollins School of Public Health, Atlanta, GA
| | - Ahmed Y Moussa
- Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA
| | - Chadi Tannoury
- Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA
| | - Tony Tannoury
- Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA
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Degenerative Disorders of the Spine. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_38-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Degenerative Disorders of the Spine. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Czabanka M, Thomé C, Ringel F, Meyer B, Eicker SO, Rohde V, Stoffel M, Vajkoczy P. [Operative treatment of degenerative diseases of the lumbar spine]. DER NERVENARZT 2018; 89:639-647. [PMID: 29679129 DOI: 10.1007/s00115-018-0523-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Degenerative diseases of the lumbar spine and associated lower back pain represent a major epidemiological and health-related economic challenge. A distinction is made between specific and unspecific lower back pain. In specific lower back pain lumbar disc herniation and spinal canal stenosis with or without associated segment instability are among the most frequent pathologies. Diverse conservative and operative strategies for treatment of these diseases are available. OBJECTIVES The aim of this article is to present an overview of current data and an evidence-based assessment of the possible forms of treatment. MATERIAL AND METHODS An extensive literature search was carried out via Medline plus an additional evaluation of the authors' personal experiences. RESULTS Conservative and surgical treatment represent efficient treatment options for degenerative diseases of the lumbar spine. Surgical treatment of lumbar disc herniation shows slight advantages compared to conservative treatment consisting of faster recovery of neurological deficits and a faster restitution of pain control. Surgical decompression is superior to conservative measures for the treatment of spinal canal stenosis and degenerative spondylolisthesis. In this scenario conservative treatment represents an important supporting measure for surgical treatment in order to improve the mobility of patients and the outcome of surgical treatment. CONCLUSION The treatment of specific lower back pain due to degenerative lumbar pathologies represents an interdisciplinary challenge, requiring both conservative and surgical treatment strategies in a synergistic treatment concept in order to achieve the best results for patients.
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Affiliation(s)
- M Czabanka
- Klinik und Poliklinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Thomé
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - F Ringel
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - B Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, München, Deutschland
| | - S-O Eicker
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - V Rohde
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - M Stoffel
- Klinik für Neurochirurgie, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland.
| | - P Vajkoczy
- Klinik und Poliklinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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22
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Chaturvedi A, Klionsky NB, Nadarajah U, Chaturvedi A, Meyers SP. Malformed vertebrae: a clinical and imaging review. Insights Imaging 2018; 9:343-355. [PMID: 29616497 PMCID: PMC5991006 DOI: 10.1007/s13244-018-0598-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 12/21/2017] [Accepted: 01/10/2018] [Indexed: 11/29/2022] Open
Abstract
A variety of structural developmental anomalies affect the vertebral column. Malformed vertebrae can arise secondary to errors of vertebral formation, fusion and/or segmentation and developmental variation. Malformations can be simple with little or no clinical consequence, or complex with serious structural and neurologic implications. These anomalies can occasionally mimic acute trauma (bipartite atlas versus Jefferson fracture, butterfly vertebra versus burst fracture), or predispose the affected individual to myelopathy. Accurate imaging interpretation of vertebral malformations requires knowledge of ageappropriate normal, variant and abnormal vertebral morphology and the clinical implications of each entity. This knowledge will improve diagnostic confidence in acute situations and confounding clinical scenarios. This review article seeks to familiarize the reader with the embryology, normal and variant anatomy of the vertebral column and the imaging appearance and clinical impact of the spectrum of vertebral malformations arising as a consequence of disordered embryological development. Teaching points • Some vertebral malformations predispose the affected individual to trauma or myelopathy. • On imaging, malformed vertebrae can be indistinguishable from acute trauma. • Abnormalities in spinal cord development may be associated and must be searched for. • Accurate interpretation requires knowledge of normal, variant and abnormal vertebral morphology.
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Affiliation(s)
- Apeksha Chaturvedi
- Department of Pediatric Radiology, Golisano Children's Hospital, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Nina B Klionsky
- Department of Pediatric Radiology, Golisano Children's Hospital, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
| | | | - Abhishek Chaturvedi
- Department of Pediatric Radiology, Golisano Children's Hospital, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
| | - Steven P Meyers
- Department of Pediatric Radiology, Golisano Children's Hospital, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
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Chokshi FH, Sadigh G, Carpenter W, Allen JW. Diagnostic Quality of 3D T2-SPACE Compared with T2-FSE in the Evaluation of Cervical Spine MRI Anatomy. AJNR Am J Neuroradiol 2017; 38:846-850. [PMID: 28154126 DOI: 10.3174/ajnr.a5080] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/23/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spinal anatomy has been variably investigated using 3D MRI. We aimed to compare the diagnostic quality of T2 sampling perfection with application-optimized contrasts by using flip angle evolution (SPACE) with T2-FSE sequences for visualization of cervical spine anatomy. We predicted that T2-SPACE will be equivalent or superior to T2-FSE for visibility of anatomic structures. MATERIALS AND METHODS Adult patients undergoing cervical spine MR imaging with both T2-SPACE and T2-FSE sequences for radiculopathy or myelopathy between September 2014 and February 2015 were included. Two blinded subspecialty-trained radiologists independently assessed the visibility of 12 anatomic structures by using a 5-point scale and assessed CSF pulsation artifact by using a 4-point scale. Sagittal images and 6 axial levels from C2-T1 on T2-FSE were reviewed; 2 weeks later and after randomization, T2-SPACE was evaluated. Diagnostic quality for each structure and CSF pulsation artifact visibility on both sequences were compared by using a paired t test. Interobserver agreement was calculated (κ). RESULTS Forty-five patients were included (mean age, 57 years; 40% male). The average visibility scores for intervertebral disc signal, neural foramina, ligamentum flavum, ventral rootlets, and dorsal rootlets were higher for T2-SPACE compared with T2-FSE for both reviewers (P < .001). Average scores for remaining structures were either not statistically different or the superiority of one sequence was discordant between reviewers. T2-SPACE showed less degree of CSF flow artifact (P < .001). Interobserver variability ranged between -0.02-0.20 for T2-SPACE and -0.02-0.30 for T2-FSE (slight to fair agreement). CONCLUSIONS T2-SPACE may be equivalent or superior to T2-FSE for the evaluation of cervical spine anatomic structures, and T2-SPACE shows a lower degree of CSF pulsation artifact.
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Affiliation(s)
- F H Chokshi
- From the Department of Radiology and Imaging Sciences, Division of Neuroradiology (F.H.C., G.S., J.W.A.) .,Department of Biomedical Informatics (F.H.C.)
| | - G Sadigh
- From the Department of Radiology and Imaging Sciences, Division of Neuroradiology (F.H.C., G.S., J.W.A.)
| | - W Carpenter
- Department of Radiology and Imaging Sciences, Division of Musculoskeletal Radiology (W.C.)
| | - J W Allen
- From the Department of Radiology and Imaging Sciences, Division of Neuroradiology (F.H.C., G.S., J.W.A.).,Department of Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Georgia
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