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Park JH, Kim DH, Chai JW, Kim HJ, Seo J, Son JY. [Imaging Evaluation of Early and Long-Term Complications Associated with the Postoperative Spine]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:36-53. [PMID: 38362387 PMCID: PMC10864152 DOI: 10.3348/jksr.2023.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/14/2024] [Indexed: 02/17/2024]
Abstract
As the number of spinal surgeries being performed expands, the number of medical imaging procedures such as radiography, CT, and MRI is also increasing, and the importance of their interpretation is becoming more significant. Herein, we present the radiological findings of a variety of complications that can occur after spinal surgery and discuss how effectively and accurately they can be diagnosed through imaging. In particular, this study details the characteristic imaging findings specific to the early and long-term postoperative periods. Early complications of spinal surgery include improper placement of surgical instruments (instrument malpositioning), seromas, hematomas, pseudomeningoceles, and infections in the region surrounding the surgical site. Conversely, long-term complications may include osteolysis around surgical instruments, failure of fusion, adjacent segment disease, and the formation of epidural fibrosis or scar tissue. A precise understanding of the imaging assessments related to complications arising after spinal surgery is crucial to ensure timely and accurate diagnosis, which is necessary to achieve effective treatment.
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Kwofie M, Policeni B. Reconstructive Surgeries After Head And Neck Trauma: Imaging Appearances. Semin Roentgenol 2023; 58:311-330. [PMID: 37507172 DOI: 10.1053/j.ro.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/10/2023] [Accepted: 04/22/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Michael Kwofie
- Department of Radiology, The University of Iowa Hospital and Clinics, Iowa City, IA.
| | - Bruno Policeni
- Department of Radiology, The University of Iowa Hospital and Clinics, Iowa City, IA
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Girão MMV, Miyahara LK, Dwan VSY, Baptista E, Taneja AK, Gotfryd A, do Amaral E Castro A. Imaging features of the postoperative spine: a guide to basic understanding of spine surgical procedures. Insights Imaging 2023; 14:103. [PMID: 37278946 DOI: 10.1186/s13244-023-01447-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 06/07/2023] Open
Abstract
Spinal surgical procedures are becoming more common over the years, and imaging studies can be requested in the postoperative setting, such as a baseline study when implants are used, or when there is a new postoperative issue reported by the patient or even as routine surveillance. Therefore, it helps the surgeon in the appropriate management of cases. In this context, there is increasing importance of the radiologist in the adequate interpretation of postoperative images, as well as in the choice of the most appropriate modality for each case, especially among radiographs, computed tomography, magnetic resonance imaging and nuclear medicine. It is essential to be familiar with the main types of surgical techniques and imaging characteristics of each one, including the type and correct positioning of hardware involved, to differentiate normal and abnormal postoperative appearances. The purpose of this pictorial essay is to illustrate and discuss the more frequently used spine surgical interventions and their imaging characteristics, with an emphasis on classical decompression and fusion/stabilization procedures. KEY POINTS: Plain radiographs remain the main modality for baseline, dynamic evaluation, and follow-ups. CT is the method of choice for assessing bone fusion, hardware integrity and loosening. MRI should be used to evaluate bone marrow and soft tissue complications. Radiologists should be familiar with most performed spinal procedures in order to differentiate normal and abnormal. CRITICAL RELEVANCE STATEMENT: This article discusses the main surgical procedures involved in the spine, which can be didactically divided into decompression, stabilization-fusion, and miscellaneous, as well as the role of diagnostic imaging methods and their main findings in this context.
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Affiliation(s)
| | - Lucas Kenzo Miyahara
- Federal University of São Paulo, Rua Napoleão de Barros, n° 800, São Paulo, 04024-002, Brazil.
| | | | | | - Atul Kumar Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Adham do Amaral E Castro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Federal University of São Paulo, Rua Napoleão de Barros, n° 800, São Paulo, 04024-002, Brazil
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Smith E, Hegde G, Czyz M, Grainger M, James S, Botchu R. A guide to assessing post-operative complications following en bloc spinal resection. J Clin Orthop Trauma 2021; 23:101653. [PMID: 34745878 PMCID: PMC8551820 DOI: 10.1016/j.jcot.2021.101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022] Open
Abstract
En-bloc resection of spinal tumours is a complex procedure with significant morbidity and mortality. The extensive resection leaves a large soft tissue and osseous defect requiring reconstruction. Following en-bloc resection, there may be complications relating to both the removal of the tumour and the subsequent reconstruction. This paper outlines the imaging appearances of the frequently encountered complications in our experience. The primary aim is to improve the confidence of the radiologist when reporting imaging following spinal en-bloc resection, however we believe this is also useful for the spinal and orthopaedic surgeons in assessing the patients following en block resection.
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Affiliation(s)
- E. Smith
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - G. Hegde
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - M. Czyz
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - M. Grainger
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - S.L. James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK,Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Imaging Assessment of the Postoperative Spine: An Updated Pictorial Review of Selected Complications. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9940001. [PMID: 34113681 PMCID: PMC8154286 DOI: 10.1155/2021/9940001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 02/05/2023]
Abstract
Imaging of the postoperative spine requires the identification of several critical points by the radiologist to be written in the medical report: condition of the underlying cortical and cancellous bone, intervertebral disc, and musculoskeletal tissues; location and integrity of surgical implants; evaluation of the success of decompression procedures; delineation of fusion status; and identification of complications. This article presents a pictorial narrative review of the most common findings observed in noninstrumented and instrumented postoperative spines. Complications in the noninstrumented spine were grouped in early (hematomas, pseudomeningocele, and postoperative spine infection) and late findings (arachnoiditis, radiculitis, recurrent disc herniation, spinal stenosis, and textiloma). Complications in the instrumented spine were also sorted in early (hardware fractures) and late findings (adjacent segment disease, hardware loosening, and implant migration). This review also includes a short description of the most used diagnostic techniques in postoperative spine imaging: plain radiography, ultrasound (US), computed tomography (CT), magnetic resonance (MR), and nuclear medicine. Imaging of the postoperative spine remained a challenging task in the early identification of complications and abnormal healing process. It is crucial to consider the advantages and disadvantages of the imaging modalities to choose those that provide more accurate spinal status information during the follow-up. Our review is directed to all health professionals dealing with the assessment and care of the postoperative spine.
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Shepard N, Samim M, Kim Y, Razi A. A Practical Approach to Spine Magnetic Resonance Imaging. JBJS Rev 2021; 8:e0099. [PMID: 32224632 DOI: 10.2106/jbjs.rvw.19.00099] [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]
Abstract
Magnetic resonance imaging (MRI) plays an important role in the evaluation of patients with spine disorders, providing excellent evaluation of both normal and pathologic anatomy. Interpreting MRI findings can be difficult as anatomic abnormalities may not correlate with clinical symptoms and MRI may show abnormal findings in asymptomatic individuals. Using a systematic approach to interpreting a spinal MRI can help to achieve an accurate diagnosis and guide therapeutic decision-making, surgical intervention, and treatment monitoring.
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Affiliation(s)
- Nicholas Shepard
- Departments of Orthopedic Surgery (N.S. and Y.K.) and Radiology (M.S.), NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Mohammad Samim
- Departments of Orthopedic Surgery (N.S. and Y.K.) and Radiology (M.S.), NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Yong Kim
- Departments of Orthopedic Surgery (N.S. and Y.K.) and Radiology (M.S.), NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Afshin Razi
- Department of Orthopedic Surgery, Maimonides Hospital Center, Brooklyn, New York
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Luna LP, Dua SG, Kocak M, Lovblad KO, Fontes R, Guryildirim M. Imaging Evaluation of the Spinal Hardware: What Residents and Fellows Need to Know. Curr Probl Diagn Radiol 2020; 50:675-686. [PMID: 33143951 DOI: 10.1067/j.cpradiol.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
We provide a comprehensive review of the purpose and expected imaging findings of different types of spinal instrumentation. We also demonstrate the imaging evaluation for optimal positioning and assessment of hardware failure.
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Affiliation(s)
- Licia P Luna
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | - Sumeet G Dua
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL
| | - Mehmet Kocak
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL
| | - Karl-Olof Lovblad
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL
| | - Ricardo Fontes
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Melike Guryildirim
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD.
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Abstract
OBJECTIVE. The purpose of this article is to provide a review of the imaging of spine fixation hardware. CONCLUSION. As the prevalence of neck and back pain continues to increase, so does the number of surgical procedures used to treat such pain. Accordingly, new techniques and hardware designs are used, and the hardware will be seen on postoperative imaging. It is critical that radiologists understand the appropriate imaging modalities for the assessment of spine fixation hardware, recognize the normal imaging appearance of such hardware, and be able to detect hardware-related complications.
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Ghodasara N, Yi PH, Clark K, Fishman EK, Farshad M, Fritz J. Postoperative Spinal CT: What the Radiologist Needs to Know. Radiographics 2020; 39:1840-1861. [PMID: 31589573 DOI: 10.1148/rg.2019190050] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
During the past 2 decades, the number of spinal surgeries performed annually has been steadily increasing, and these procedures are being accompanied by a growing number of postoperative imaging studies to interpret. CT is accurate for identifying the location and integrity of implants, assessing the success of decompression and intervertebral arthrodesis procedures, and detecting and characterizing related complications. Although postoperative spinal CT is often limited owing to artifacts caused by metallic implants, parameter optimization and advanced metal artifact reduction techniques, including iterative reconstruction and monoenergetic extrapolation methods, can be used to reduce metal artifact severity and improve image quality substantially. Commonly used and recently available spinal implants and prostheses include screws and wires, static and extendable rods, bone grafts and biologic materials, interbody cages, and intervertebral disk prostheses. CT assessment and the spectrum of complications that can occur after spinal surgery and intervertebral arthroplasty include those related to the position and integrity of implants and prostheses, adjacent segment degeneration, collections, fistulas, pseudomeningoceles, cerebrospinal fluid leaks, and surgical site infections. Knowledge of the numerous spinal surgery techniques and devices aids in differentiating expected postoperative findings from complications. The various types of spinal surgery instrumentation and commonly used spinal implants are reviewed. The authors also describe and illustrate normal postoperative spine findings, signs of successful surgery, and the broad spectrum of postoperative complications that can aid radiologists in generating reports that address issues that the surgeon needs to know for optimal patient management.©RSNA, 2019.
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Affiliation(s)
- Nevil Ghodasara
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
| | - Paul H Yi
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
| | - Karen Clark
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
| | - Elliot K Fishman
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
| | - Mazda Farshad
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
| | - Jan Fritz
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
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11
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Wanivenhaus F, Buck FM, Betz M, Farshad-Amacker NA, Farshad M. Reliability of postoperative MR imaging in the determination of level and side of lumbar spinal decompression surgery. Acta Radiol 2017; 58:581-585. [PMID: 27516606 DOI: 10.1177/0284185116661881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Magnetic resonance imaging (MRI) is the diagnostic modality of choice in defining soft tissue compromise of the spinal canal. Purpose To evaluate the reliability of postoperative MRI in the determination of level and side of lumbar spinal decompression surgery, investigated by two reviewers, in different levels of training and specialization. Material and Methods Postoperative MR images of 86 patients who underwent spinal decompression (single level, n = 70; multilevel, n = 16; revision decompression, n = 9) were reviewed independently by an experienced musculoskeletal radiologist and a fourth-year orthopedic surgery resident. The level (single or multiple) and side of previous surgical decompression were determined and compared to the surgical notes. We examined factors that may have influenced the reliability, including demographics, type of surgical decompression, use of a drain, and time interval from surgery to MRI. Results Significantly fewer levels were correctly determined by the resident (77/86 cases, 89.5%) compared with the radiologist (84/86 cases, 97.7%) ( P = 0.014). The resident interpreted significantly more MR images incorrectly in cases where a drain was used (n = 8; P < 0.001). Re-decompression cases were interpreted incorrectly significantly more often by both the radiologist (n = 2, P = 0.032) and the resident (n = 4, P = 0.014). Conclusion Determination of the level and side operated on in previous lumbar spinal decompression surgery on MRI has a high reliability, especially when performed by a musculoskeletal radiologist. However, this reliability is decreased in cases involving surgical drainage and same-level revision surgery.
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Affiliation(s)
- Florian Wanivenhaus
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Florian M Buck
- Department of Radiology, Balgrist University Hospital, University of Zurich, Switzerland
| | - Michael Betz
- Spine Division, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Nadja A Farshad-Amacker
- Institute for Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Spine Division, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
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Caranci F, Leone G, Ugga L, Cesarano E, Capasso R, Schipani S, Bianco A, Fonio P, Briganti F, Brunese L. Imaging of post-surgical treatment and of related complications in spinal trauma. Musculoskelet Surg 2017; 101:63-73. [PMID: 28168635 DOI: 10.1007/s12306-017-0457-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 11/26/2022]
Abstract
Spinal trauma is a devastating event with a high morbidity and mortality. The rationale of imaging is to diagnose the traumatic abnormalities and characterize the type of injury, to estimate the severity of the lesions, to evaluate the potential spinal instability. In case of spinal instability, the goals of operative treatment are decompression of the spinal cord canal and stabilization of the disrupted vertebral column. Particularly, diagnostic imaging, mainly by CT and MR, has a main role in the post-treatment evaluation. The neuroradiological evaluation of the postoperative spine requires a general knowledge of the surgical approach to each spinal region and of the normal temporal evolution of expected postoperative changes. The neuroradiologist should evaluate the devices implanted, their related complications and promptly alert the surgeon of acute complications, mainly vascular and infective. During the follow-up, it is mandatory to know and search chronic complications as pseudomeningocele, accelerated degenerative disease, arachnoiditis, peridural fibrosis. Knowledge of specific complications relating to each surgical approach will assist the neuroradiologist in interpretation of postoperative images.
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Affiliation(s)
- F Caranci
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy.
| | - G Leone
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Ugga
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - E Cesarano
- Radiology Section, Health Service, Navy Command of Brindisi, Brindisi, Italy
| | - R Capasso
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - S Schipani
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
| | - A Bianco
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
| | - P Fonio
- Radiology Unit, Department of Surgical Sciences, University of Torino, Turin, Italy
| | - F Briganti
- Neuroradiology Unit, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via F. De Sanctis 1, 86100, Campobasso, Italy
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Santos Armentia E, Prada González R, Silva Priegue N. La columna poscirugía. RADIOLOGIA 2016; 58 Suppl 1:104-14. [DOI: 10.1016/j.rx.2015.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/29/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
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