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Hu Z, Qian Z, Li W, Li J, Tang Z, Ling C, Xu Y, Liu Z, Zhu Z, Qiu Y. Preoperative supine pelvic incidence predicts standing pelvic incidence following S2AI fixation in patients with adult spinal deformity: a prospective study. 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 2024; 33:1816-1820. [PMID: 38485780 DOI: 10.1007/s00586-024-08195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/28/2024] [Accepted: 02/13/2024] [Indexed: 06/18/2024]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE The aim of this study was to investigate the PI change in different postures and before and after S2‑alar‑iliac (S2AI) screw fixation, and to investigate whether pre-op supine PI could predict post-op standing PI. Previous studies have reported PI may change with various positions. Some authors postulated that the unexpected PI change in ASD patients could be due to sacroiliac joint laxity, S2-alar-iliac (S2AI) screw placement, or aggressive sagittal cantilever technique. However, there was a lack of investigation on how to predict post-op standing PI when making surgical strategy. METHODS A prospective case series of ASD patients undergoing surgical correction with S2AI screw placement was conducted. Full-spine X-ray films were obtained at pre-op standing, pre-op supine, pre-op prone, as well as post-op standing postures. Pelvic parameters were measured. Spearman correlation analysis was used to determine relationships between each parameter. RESULTS A total of 83 patients (22 males, 61females) with a mean age of 58.4 ± 9.5 years were included in this study. Pre-op standing PI was significantly lower than post-op standing PI (p = 0.004). Pre-op prone PI was significantly lower than post-op standing PI (p = 0.001). By contrast, no significant difference was observed between pre-op supine and post-op standing PI (p = 0.359) with a mean absolute difference of 2.2° ± 1.9°. Correlation analysis showed supine PI was significantly correlated with post-op standing PI (r = 0.951, p < 0.001). CONCLUSION This study revealed the PI changed after S2AI screw fixation. The pre-op supine PI can predict post-op standing PI precisely, which facilitates to provide correction surgery strategy with a good reference for ideal sagittal alignment postoperatively.
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Affiliation(s)
- Zongshan Hu
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhikai Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Weibiao Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ziyang Tang
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Chen Ling
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Yanjie Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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MohammadiNasrabadi A, Moammer G, Quateen A, Bhanot K, McPhee J. Landet: an efficient physics-informed deep learning approach for automatic detection of anatomical landmarks and measurement of spinopelvic alignment. J Orthop Surg Res 2024; 19:199. [PMID: 38528514 DOI: 10.1186/s13018-024-04654-7] [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: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 03/27/2024] Open
Abstract
PURPOSE An efficient physics-informed deep learning approach for extracting spinopelvic measures from X-ray images is introduced and its performance is evaluated against manual annotations. METHODS Two datasets, comprising a total of 1470 images, were collected to evaluate the model's performance. We propose a novel method of detecting landmarks as objects, incorporating their relationships as constraints (LanDet). Using this approach, we trained our deep learning model to extract five spine and pelvis measures: Sacrum Slope (SS), Pelvic Tilt (PT), Pelvic Incidence (PI), Lumbar Lordosis (LL), and Sagittal Vertical Axis (SVA). The results were compared to manually labelled test dataset (GT) as well as measures annotated separately by three surgeons. RESULTS The LanDet model was evaluated on the two datasets separately and on an extended dataset combining both. The final accuracy for each measure is reported in terms of Mean Absolute Error (MAE), Standard Deviation (SD), and R Pearson correlation coefficient as follows: [ S S ∘ : 3.7 ( 2.7 ) , R = 0.89 ] ,[ P T ∘ : 1.3 ( 1.1 ) , R = 0.98 ] , [ P I ∘ : 4.2 ( 3.1 ) , R = 0.93 ] , [ L L ∘ : 5.1 ( 6.4 ) , R = 0.83 ] , [ S V A ( m m ) : 2.1 ( 1.9 ) , R = 0.96 ] . To assess model reliability and compare it against surgeons, the intraclass correlation coefficient (ICC) metric is used. The model demonstrated better consistency with surgeons with all values over 0.88 compared to what was previously reported in the literature. CONCLUSION The LanDet model exhibits competitive performance compared to existing literature. The effectiveness of the physics-informed constraint method, utilized in our landmark detection as object algorithm, is highlighted. Furthermore, we addressed the limitations of heatmap-based methods for anatomical landmark detection and tackled issues related to mis-identifying of similar or adjacent landmarks instead of intended landmark using this novel approach.
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Affiliation(s)
- AliAsghar MohammadiNasrabadi
- Department of Systems Design Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Gemah Moammer
- Department of Spine Surgery, Grand River Hospital (GRH), 835 King St W, Kitchener, ON, N2G 1G3, Canada
| | - Ahmed Quateen
- Department of Spine Surgery, Grand River Hospital (GRH), 835 King St W, Kitchener, ON, N2G 1G3, Canada
| | - Kunal Bhanot
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - John McPhee
- Department of Systems Design Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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Pizones J, Chang DG, Suk SI, Izquierdo E. Current biomechanical theories on the etiopathogenesis of idiopathic scoliosis. Spine Deform 2024; 12:247-255. [PMID: 37975988 DOI: 10.1007/s43390-023-00787-7] [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: 08/04/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE There is great controversy about the etiologic origin of adolescent idiopathic scoliosis. Multiple theories have been suggested, including metabolic aspects, endocrine dysfunction, neurological central abnormalities, genetic predisposition and epigenetic factors involved in the development of scoliosis. However, there has always been speculations based on human biomechanical behavior. METHODS In this article, we performed a literature review on the biomechanical traits of human posture, and the proposed theories that explain the special characteristics present in idiopathic scoliosis. RESULTS The current theory on the etiopathogeneis of AIS suggests that dorsally directed shear loads acting on a preexisting axial plane rotation, in a posteriorly inclined sagittal plane of a growing patient, together with disc maturation, collagen quality at this phase of development and immaturity of proprioception, is the perfect scenario to spark rotational instability and create the three-dimensional deformity that defines idiopathic scoliosis. CONCLUSION The unique spinal alignment of human bipedalism, gravity and muscle forces acting straight above the pelvis to preserve an upright balance, and the instability of the soft tissue in a period of growth development, is an appealing cocktail to try to explain the genesis of this condition in humans.
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Affiliation(s)
- Javier Pizones
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, 50834, Korea
| | - Se-Il Suk
- Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, 50834, Korea
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Giai Via R, Migliorini F, Bosco F, Onorato F, Secco DC, Giustra F, Lavia AD, Giachino M, Massè A. Superior outcomes of total hip arthroplasty without prior lumbar arthrodesis: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:699-711. [PMID: 37847406 PMCID: PMC10857961 DOI: 10.1007/s00590-023-03761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE The number of patients undergoing total hip arthroplasty (THA) surgery after previous lumbar arthrodesis (LA) is rising. Literature suggests that LA may significantly impact pelvic biomechanics and potentially compromise the success of prosthetic hip replacement. This study aims to evaluate complication rates, dislocation rates, and revision rates in patients with prior LA undergoing THA surgery compared to those undergoing THA surgery without prior LA. METHODS A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A PICOS template was developed to ensure a structured approach. The search for relevant studies was performed across five databases, including Pubmed, Scopus, Embase, Medline, and Cochrane. The selected articles were evaluated based on the Levels of Evidence (LoE) criteria. The Coleman Methodology Score (mCMS) was employed to analyze the retrospective studies. This systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that allowed for a meta-analysis performed using R software, a p < 0.05 was considered statistically significant. RESULTS The final analysis included seventeen studies comprising a total of 3,139,164 cases of THA. Among these cases, 3,081,137 underwent THA surgery alone, while 58,027 patients underwent THA with a previous LA. The study investigated various factors, including dislocation rates, revision rates, and complication, as well as the surgical approach and type of implant used, for both the THA-only group and the group of patients who underwent THA with prior LA. The analysis revealed a statistically significant difference (p < 0.05) for all variables studied, favoring the group of patients who underwent THA alone without prior LA. CONCLUSIONS This systematic review and meta-analysis demonstrated a statistically significant superiority in all analyzed outcomes for patients who underwent THA-only without prior LA. Specifically, patients with isolated THA implants experienced significantly lower incidences of THA dislocation, wound complications, periprosthetic joint infection, revision, and mechanical complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Riccardo Giai Via
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
| | - Francesco Bosco
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy.
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy.
| | - Francesco Onorato
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Davide Carlo Secco
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | | | - Matteo Giachino
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Alessandro Massè
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
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Hu Z, Tseng CC, Li J, Qian Z, Tang Z, Ling C, Xu Y, Liu Z, Zhu Z, Qiu Y. Dynamic change of pelvic incidence after long fusion to pelvis with S2-alar-iliac screw: a 2-year follow-up study. 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 2022; 31:3566-3572. [PMID: 36178546 DOI: 10.1007/s00586-022-07391-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Pelvic incidence (PI) is a key morphological parameter that reflects the relation between the sacrum and iliac wings. It is well accepted that PI remains constant after reaching maturity. However, recent studies indicated that PI might be altered after lumbosacral fusion. Additionally, it remains uncertain on the long-term influence of long fusion to pelvis with S2-alar-iliac screw on PI in patients with adult spinal deformity (ASD). STUDY DESIGN A retrospective study. OBJECTIVE To investigate whether and how PI would change during the follow-up in ASD patients who underwent S2AI fixation and to identify factors associated with the change in PI. METHODS We retrospectively reviewed all ASD patients who underwent spinal surgery using S2AI screws between November 2014 and January 2017 at our institution. Patients with minimum follow-up of two years were included. The following sagittal radiographic parameters were measured: PI, Lumbar lordosis (LL), pelvic tilt (PT), PI-LL, sagittal vertical axis (SVA) at pre-op, post-op and 2-year follow-up. According to the changes in PI at immediate post-operation, patients were classified into two groups; Group A: Changes of PI less than or equal 5° and Group B: Changes of PI greater than 5°. RESULTS A total of 82 ASD patients (Group A: 32, Group B: 50; mean age of 53.5 ± 12.6 years) with a mean follow-up period of 30.2 ± 9.2 months were included in this study. At immediate post-operation, Group A showed no significant change in PI (45.7° ± 11.4° to 45.3° ± 11.2°, p = 0.749); while Group B had a significant decrease in PI (51.6° ± 14.5° to 40.9° ± 14.0°, p < 0.001). At the last follow-up, 48% patients (24/50) in Group B had a significant increase in PI (32.8° ± 6.4° to 45.8° ± 11.2°, p < 0.001). Intergroup analysis showed that ΔPI, post-op PI, post-op PT and age were significantly different between both groups. In addition, pre-op PI, post-op PI, post-op PT, post-op PI-LL were significantly correlated with ΔPI at last follow-up. Also, logistic regression analysis showed that post-op PI was the associated risk factor (OR = 0.865, p = 0.024) for PI-LL mismatch. CONCLUSION Our study showed that PI decreased in more than half of ASD patients immediately after spinal surgery using S2AI screws. Approximately 48% of them were able to recover during the 2-year follow-up. Lower pre-op PI, post-op PI and PT were found to be strongly associated with the return of PI. Thus, these current findings indicated that patients with a high PI at pre-operation should not be over-corrected to avoid PI-LL mismatch postoperatively.
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Affiliation(s)
- Zongshan Hu
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Chang-Chun Tseng
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhikai Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Ziyang Tang
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Chen Ling
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Yanjie Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Deng Z, Wang L, Wang L, Yang X, Wang L, Liu L, Song Y. Incidence and risk factors of postoperative medial shoulder imbalance in Lenke Type 2 adolescent idiopathic scoliosis with lateral shoulder balance. BMC Musculoskelet Disord 2022; 23:947. [PMID: 36324134 PMCID: PMC9628036 DOI: 10.1186/s12891-022-05882-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/11/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In clinical practice, there are a significant percentage of Lenke 2 AIS patients suffered from medial shoulder imbalance (MSI) despite achieving good lateral shoulder balance (LSB) following surgery. However, there are few studies evaluating the features of the medial shoulder. The objective of this study was to determine the incidence and independent risk factors of MSI with LSB after Lenke 2 AIS corrective surgery. METHODS One hundred and twenty Lenke 2 AIS patients with LSB at the last follow-up were reviewed from 2009 to 2018. Preoperative, and 3-month and the last postoperative follow-up radiographs were measured using a number of specific measurements. At the last follow-up, patients were divided into medial shoulder balance (MSB) group and the MSI group according to whether the T1 tilt was greater than 3°. A stepwise multiple linear regression analysis was used to examine the independent risk factors for MSI. Scoliosis Research Society (SRS)-30 questionnaire was used to assess clinical outcomes. RESULTS Up to 69.2% of patients suffered from MSI with LSB after Lenke Type 2 AIS corrective surgery. Multiple regression showed that postoperative upper instrumented vertebra tilt (UIVt), proximal thoracic curve (PTC), the ratio of PTC and main thoracic curves (PTC/MTC) and T2 vertebra rotation ratio (T2-VR) were significant predictors for MSI (UIVt: b = 0.398, p < 0.001; PTC/MTC: b = 2.085, p < 0.001; PTC: b = 0.155, p < 0.001; T2-VR: b = 3.536, p = 0.008; adjusted R2 = 0.711). 72 patients completed the SRS-30 questionnaire survey, and the MSB group were scored the higher (p ≤ 0.001) in self-image domain (4.18 ± 0.43 vs. 3.70 ± 0.35), satisfaction domain (4.39 ± 0.54 vs. 3.95 ± 0.46) and total average (4.31 ± 0.23 vs. 4.11 ± 0.19). CONCLUSION Although the patients with Lenke 2 AIS achieve LSB after corrective surgery, up to 69.2% of them suffered from MSI. Postoperative UIVt, PTC, PTC/MTC and T2-VR were significant predictors for MSI. Sufficient correction of these variables may facilitate the achievement of MSB.
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Affiliation(s)
- Zhipeng Deng
- grid.412901.f0000 0004 1770 1022Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041 Chengdu, Sichuan China
| | - Liang Wang
- grid.412901.f0000 0004 1770 1022Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041 Chengdu, Sichuan China
| | - Linnan Wang
- grid.412901.f0000 0004 1770 1022Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041 Chengdu, Sichuan China
| | - Xi Yang
- grid.412901.f0000 0004 1770 1022Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041 Chengdu, Sichuan China
| | - Lei Wang
- grid.412901.f0000 0004 1770 1022Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041 Chengdu, Sichuan China
| | - Limin Liu
- grid.412901.f0000 0004 1770 1022Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041 Chengdu, Sichuan China
| | - Yueming Song
- grid.412901.f0000 0004 1770 1022Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041 Chengdu, Sichuan China
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van der Gronde BATD, Schlösser TPC, van Erp JHJ, Snijders TE, Castelein RM, Weinans H, de Gast A. Current Evidence for Spinopelvic Characteristics Influencing Total Hip Arthroplasty Dislocation Risk. JBJS Rev 2022; 10:01874474-202208000-00004. [PMID: 36000764 DOI: 10.2106/jbjs.rvw.22.00038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Decreased pelvic mobility and pelvic retroversion may result from spinal degeneration and lead to changes in the orientation of the acetabular implant after total hip arthroplasty (THA). While multiple patient and surgery-related factors contribute to THA dislocations, there is increasing evidence that sagittal spinopelvic dynamics are relevant for THA stability. The aim of this systematic review was to assess the relationship between previously described sagittal spinopelvic characteristics and implant dislocations after primary THA. METHODS A comprehensive literature search in the PubMed and Embase databases was conducted for studies reporting on spinopelvic morphology, alignment, pathology, or surgery and THA dislocations. Risk of bias was assessed using the MINORS criteria. Because of high heterogeneity in study methodology, a synthesis of best evidence was performed. Odds ratios (ORs), relative risks (RRs), and effect sizes (g) were calculated. RESULTS Fifteen studies (1,007,900 THAs) with quality scores of 15 to 23 out of 24 were included. Nine different spinopelvic alignment parameters (8 studies, g = 0.14 to 2.02), spinal pathology (2 studies, OR = 1.9 to 29.2), and previous spinal fusion surgery (8 studies, OR = 1.59 to 23.7, RR = 3.0) were found to be related to THA dislocation. Conflicting results were found for another sagittal pelvic morphology parameter, pelvic incidence. CONCLUSIONS Several sagittal spinopelvic patient characteristics were found to be related to THA dislocation, and the associated risks were greater than for other patient and surgery-related factors. Future research is needed to determine which of those characteristics and parameters should be taken into account in patients undergoing primary THA. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- B A T D van der Gronde
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
| | - T P C Schlösser
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J H J van Erp
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands.,Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T E Snijders
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
| | - R M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Weinans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Biomechanical Engineering, Technical University Delft, Delft, the Netherlands
| | - A de Gast
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
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Castelein RM, Pasha S, Cheng JC, Dubousset J. Idiopathic Scoliosis as a Rotatory Decompensation of the Spine. J Bone Miner Res 2020; 35:1850-1857. [PMID: 32697856 DOI: 10.1002/jbmr.4137] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022]
Abstract
Many years of dedicated research into the etiology of idiopathic scoliosis have not led to one unified theory. We propose that scoliosis is a mechanical, rotatory decompensation of the human spine that starts in the transverse, or horizontal, plane. The human spine is prone to this type of decompensation because of its unique and individually different, fully upright sagittal shape with some preexistent transverse plane rotation. Spinal stability depends on the integrity of a delicate system of stabilizers, in which intervertebral disc stiffness is crucial. There are two phases in life when important changes occur in the precarious balance between spinal loading and the disc's stabilizing properties: (i) during puberty, when loads and moment arms increase rapidly, while the disc's "anchor," the ring apophysis, matures from purely cartilaginous to mineralized to ultimately fused to the vertebral body, and (ii) in older age, when the torsional stiffness of the spinal segments decreases, due to disc degeneration and subsequent laxity of the fibers of the annulus fibrosus. During these crucial periods, transverse plane vertebral rotation can increase during a relatively brief window in time, either as adolescent idiopathic or degenerative de novo scoliosis. Much more is known of the biomechanical changes that occur during disc aging and degeneration than of the changing properties of the disc during maturation. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saba Pasha
- Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jack Cy Cheng
- Department of Orthopaedics and Traumatology, S. H. Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, Hong Kong.,Joint Scoliosis Research Center of The Chinese University of Hong Kong-Nanjing University, The Chinese University of Hong Kong, Shatin, Hong Kong
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IS (Idiopathic Scoliosis) etiology: Multifactorial genetic research continues. A systematic review 1950 to 2017. J Orthop 2020; 21:421-426. [PMID: 32943828 DOI: 10.1016/j.jor.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022] Open
Abstract
Objective IS (idiopathic scoliosis) is a common spinal condition occurring in otherwise completely healthy adolescents. The root cause of IS remains unclear. This systematic review will focus on an update of genetic factors and IS etiology. Though it is generally accepted that the condition is not due to a single gene effect, etiology studies continue looking for a root cause including genetic variants. Though susceptibility from multiple genetic components is plausible based on known family history data, the literature remains unclear regarding multifactorial genetic influences. The objective of this study was to critically evaluate the evidence behind genetic causes (not single gene) of IS through a systematic review and strength-of-study analysis of existing genetic and genome-wide association studies (GWAS). We used the protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methods PubMed was searched for the terms IS, scoliotic, spinal curve, genetic, gene, etiology, polymorphisms. Articles were assessed for risk-of-bias. Level-of-evidence grading was completed via Oxford Centre for Evidence-Based Medicine criteria. The assessment scores factor strength of a study in determining a positive or negative association to a gene etiology. Results After screening of 36 eligible papers, 8 relevant studies met inclusion criteria at this time, 3 were in favor of a genetic factor for IS, whereas 5 studies were against it. Conclusion Based on the literature analyzed, there is moderate evidence with a low risk-of-bias that does not clarify a genetic cause of IS. The 2 studies in favor of a genetic etiology were completed in homogeneous populations, limiting their generalizability. Relying on a genetic etiology alone for IS may over simplify its multifactorial nature and limit appreciation of other influences.
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van Erp JHJ, Gielis WP, Arbabi V, de Gast A, Weinans H, Arbabi S, Öner FC, Castelein RM, Schlösser TPC. Unravelling the knee-hip-spine trilemma from the CHECK study. Bone Joint J 2020; 102-B:1261-1267. [PMID: 32862680 DOI: 10.1302/0301-620x.102b9.bjj-2019-1315.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aetiologies of common degenerative spine, hip, and knee pathologies are still not completely understood. Mechanical theories have suggested that those diseases are related to sagittal pelvic morphology and spinopelvic-femoral dynamics. The link between the most widely used parameter for sagittal pelvic morphology, pelvic incidence (PI), and the onset of degenerative lumbar, hip, and knee pathologies has not been studied in a large-scale setting. METHODS A total of 421 patients from the Cohort Hip and Cohort Knee (CHECK) database, a population-based observational cohort, with hip and knee complaints < 6 months, aged between 45 and 65 years old, and with lateral lumbar, hip, and knee radiographs available, were included. Sagittal spinopelvic parameters and pathologies (spondylolisthesis and degenerative disc disease (DDD)) were measured at eight-year follow-up and characteristics of hip and knee osteoarthritis (OA) at baseline and eight-year follow-up. Epidemiology of the degenerative disorders and clinical outcome scores (hip and knee pain and Western Ontario and McMaster Universities Osteoarthritis Index) were compared between low PI (< 50°), normal PI (50° to 60°), and high PI (> 60°) using generalized estimating equations. RESULTS Demographic details were not different between the different PI groups. L4 to L5 and L5 to S1 spondylolisthesis were more frequently present in subjects with high PI compared to low PI (L4 to L5, OR 3.717; p = 0.024 vs L5 to S1 OR 7.751; p = 0.001). L5 to S1 DDD occurred more in patients with low PI compared to high PI (OR 1.889; p = 0.010), whereas there were no differences in L4 to L5 DDD among individuals with a different PI. The incidence of hip OA was higher in participants with low PI compared to normal (OR 1.262; p = 0.414) or high PI (OR 1.337; p = 0.274), but not statistically different. The incidence of knee OA was higher in individuals with a high PI compared to low PI (OR 1.620; p = 0.034). CONCLUSION High PI is a risk factor for development of spondylolisthesis and knee OA. Low pelvic incidence is related to DDD, and may be linked to OA of the hip. Level of Evidence: 1b Cite this article: Bone Joint J 2020;102-B(9):1261-1267.
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Affiliation(s)
- Joost H J van Erp
- Clinical Orthopedic Research Center Midden-Nederland, Zeist, Netherlands.,Department of Orthopedics, Diakonessenhuis Utrecht, Netherlands.,Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Willem P Gielis
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vahid Arbabi
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands.,Orthopaedic-BiMechanics Research Group, Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - Arthur de Gast
- Clinical Orthopedic Research Center Midden-Nederland, Zeist, Netherlands.,Department of Orthopedics, Diakonessenhuis Utrecht, Netherlands
| | - Harrie Weinans
- Clinical Orthopedic Research Center Midden-Nederland, Zeist, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Saeed Arbabi
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - F Cumhur Öner
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - René M Castelein
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tom P C Schlösser
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
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Lee CS, Hwang CJ, Jung HS, Lee DH, Park JW, Cho JH, Yang JJ, Park S. Association Between Vertebral Rotation Pattern and Curve Morphology in Adolescent Idiopathic Scoliosis. World Neurosurg 2020; 143:e243-e252. [PMID: 32712411 DOI: 10.1016/j.wneu.2020.07.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although rotation is an important aspect of pathogenesis of adolescent idiopathic scoliosis (AIS), there are no studies demonstrating rotation pattern by directly measuring rotation angle in computed tomography (CT) images. The present retrospective comparative radiographic study was conducted to evaluate the rotation pattern in AIS and its relation to curve morphology and Lenke classification. METHODS The study included 245 patients diagnosed with AIS and evaluated with a preoperative CT scan. Rotation angle of each vertebrae was measured using reconstructed axial CT images. Lenke classification of scoliosis curvature, Cobb angle, location of apical vertebra and end vertebra, level of most rotated vertebra (MRV), and rotational shift vertebra were recorded. Student's t-test, analysis of variance test, and correlation analysis were performed to identify the characteristics of rotation patterns in each Lenke type. RESULTS The rotation angle of MRV was significantly correlated with the Cobb angle. The level of MRV and rotation angle of MRV demonstrated significant correlation in both the main thoracic curve and lumbar curve, which signified that MRV located near the thoracolumbar junction is related to more severe rotational deformity. The level of MRV was also significantly correlated to the Cobb angle in both the main thoracic curve and lumbar curve. The types of structural curves proximal to major structural curves, such as type 2, 4, and 6, demonstrated more severe rotational and coronal plane deformities as compared with types 1, 3, and 5. CONCLUSIONS Curves with different Lenke types demonstrated different levels of MRV and severity of rotation. The results suggest that different center levels of rotation, signified by MRV, are a factor determining curve morphology. The findings would be a basis of connection between 2-dimensional classification and transverse plane deformity.
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Affiliation(s)
- Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyung Seo Jung
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Woo Park
- Department of Orthopedic Surgery, Gangneung Asan Hospital, Gangneung-si, Gangwon-do, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea.
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A deep learning tool for fully automated measurements of sagittal spinopelvic balance from X-ray images: performance evaluation. 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 2020; 29:2295-2305. [DOI: 10.1007/s00586-020-06406-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 12/20/2022]
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Zehra U, Cheung JPY, Bow C, Crawford RJ, Luk KDK, Lu W, Samartzis D. Spinopelvic alignment predicts disc calcification, displacement, and Modic changes: Evidence of an evolutionary etiology for clinically-relevant spinal phenotypes. JOR Spine 2020; 3:e1083. [PMID: 32211594 PMCID: PMC7084054 DOI: 10.1002/jsp2.1083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 01/17/2020] [Accepted: 02/01/2020] [Indexed: 01/09/2023] Open
Abstract
Lumbar disc-displacement, Modic changes (MCs), and UTE Disc Sign (UDS) on MRI are clinically relevant spinal phenotypes that can lead to sciatica/LBP. Not all degenerated discs result in disc-displacement, MCs and UDS, suggesting varied etiologies. Spinopelvic parameters have been implicated in various spinal disorders. Pelvic incidence (PI) is "fixed parameter" since skeletal maturity. No study has addressed disc-displacement, MCs and UDS in context of spinopelvic parameters. Therefore, the aim of study was to determine if spinopelvic parameters are associated and predict clinically-relevant MRI-phenotypes. One hundred and eight population-based subjects (mean age: 52.3 years) were recruited. Spondylolisthesis and scoliosis individuals were excluded. Lumbar lordosis (LL), PI, sacral slope (SS), and pelvic tilt (PT) were assessed on lateral plain radiographs. Disc degeneration was assessed and summated, and presence or not of disc-displacement and MCs were noted on T2W MRI. UDS was detected on UTE. Following exclusion criteria, 95 subjects were assessed. Disc-displacement (82.1%), MCs (52.6%), and UDS (37.9%) were associated with lower PI, SS, LL, and LL/PI index. On multivariate analyses, lower PI was significantly related to development of these MRI phenotypes (adjusted OR range:0.95-0.92; P < .05), with critical PI value of 42° or lower exhibiting fourfold increase risk of combined phenotypes (P = .020). Of UDS discs, 39.3% had adjacent MCs and 83.6% had disc-displacement. 87.5% of MC had directly adjacent UDS. The first study to note that PI may "predict" the development of disc-displacement, MCs and UDS, suggesting potential sub-variants and mechanistic susceptibility that may be grounded in spinopelvic evolution. An "evolutionary etiological pathway" of spinal phenotype development is proposed.
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Affiliation(s)
- Uruj Zehra
- Department of AnatomyUniversity of Health SciencesLahorePakistan
| | - Jason P. Y. Cheung
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong
| | - Cora Bow
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong
| | | | - Keith D. K. Luk
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong
| | - William Lu
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong
| | - Dino Samartzis
- Department of Orthopaedic SurgeryRUSH University Medical CenterChicagoIllinoisUSA
- International Spine Research and Innovation InitiativeRUSH University Medical CenterChicagoIllinoisUSA
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Sarwark JF, Castelein RM, Maqsood A, Aubin CE. The Biomechanics of Induction in Adolescent Idiopathic Scoliosis: Theoretical Factors. J Bone Joint Surg Am 2019; 101:e22. [PMID: 30893239 DOI: 10.2106/jbjs.18.00846] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- John F Sarwark
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Ayesha Maqsood
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Three-dimensional pelvic incidence is much higher in (thoraco)lumbar scoliosis than in controls. 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 2018; 28:544-550. [DOI: 10.1007/s00586-018-5718-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 06/25/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
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Schlösser T, Brink R, Castelein R. THE ETIOLOGIC RELEVANCE OF 3-D PATHOANATOMY OF ADOLESCENT IDIOPATHIC SCOLIOSIS. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171604183510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Despite many years of dedicated research into the etiopathogenesis of adolescent idiopathic scoliosis, there is still no single distinct cause for this puzzling condition. In this overview, we attempt to link knowledge on the complex three-dimensional pathoanatomy of AIS, based on our ongoing research in this field, with etiopathogenic questions. Evidence from multiple recent cross-sectional imaging studies is provided that supports the hypothesis that AIS has an intrinsic biomechanical basis: an imbalance between the biomechanical loading of the upright human spine due to its unique sagittal configuration on the one hand, and the body’s compensating mechanisms on the other. The question that remains in the etiology of AIS, and the focus of our ongoing research, is to determine what causes or induces this imbalance.
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Affiliation(s)
| | - Rob Brink
- University Medical Center Utrecht, Netherlands
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