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Li AY, McCarthy L, Hrabarchuk E, Spiera Z, Marayati NF, Schupper AJ, Hannah TC, Genadry L, Ali M, Quinones A, Kalagara R, Baron R, Sideras P, Naidich TP, Choudhri TF. Novel Grading Scales for Static and Flexion-Extension Magnetic Resonance Imaging in Patients with Cervical Spondylotic Myelopathy. World Neurosurg 2023; 173:e218-e227. [PMID: 36787858 DOI: 10.1016/j.wneu.2023.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Flexion-extension magnetic resonance imaging (MRI) has potential to identify cervical pathology not detectable on conventional static MRI. Our study evaluated standard quantitative and novel subjective grading scales for assessing the severity of cervical spondylotic myelopathy in dynamic sagittal MRI as well as in static axial and sagittal images. METHODS Forty-five patients underwent both conventional and flexion-extension MRI prior to anterior cervical discectomy and fusion from C4 through C7. In addition to measuring Cobb angles and cervical canal diameter, grading scales were developed for assessment of vertebral body translation, loss of disc height, change in disc contour, deformation of cord contour, and cord edema. Data were collected at all levels from C2-C3 through C7-T1. Variations in measurements between cervical levels and from flexion through neutral to extension were assessed using Mann-Whitney, Kruskal-Wallis, and two-way ANOVA tests. RESULTS Cervical canal diameter, vertebral translation, and posterior disc opening changed significantly from flexion to neutral to extension positions (P < 0.01). When comparing operative versus nonoperative cervical levels, significant differences were found when measuring sagittal cervical canal dimensions, vertebral translation, and posterior disc opening (P < 0.01). Degenerative loss of disc height, disc dehydration, deformation of ventral cord contour, and cord edema were all significantly increased at operative levels versus nonoperative levels (P < 0.01). CONCLUSIONS Flexion-extension MRI demonstrated significant changes not available from conventional MRI. Subjective scales for assessing degenerative changes were significantly more severe at levels with operative cervical spondylotic myelopathy. The utility of these scales for planning surgical intervention at specific and adjacent levels is currently under investigation.
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Affiliation(s)
- Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eugene Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zachary Spiera
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Naoum Fares Marayati
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Theodore C Hannah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lisa Genadry
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Baron
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Panagiotis Sideras
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas P Naidich
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Su ML, Liu ZH, Tu PH, Huang YC. Dynamic cervical flexion/extension atlantodental interval and functional outcome of the Harms technique for posterior C1/2 fixation: A retrospective analysis of 16 atlantoaxial subluxation cases in a tertiary medical center. Neurochirurgie 2021; 68:168-174. [PMID: 34774580 DOI: 10.1016/j.neuchi.2021.10.003] [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: 08/26/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to assess the relationship between the atlantodental interval (ADI) on dynamic flexion/extension cervical radiographs and functional outcomes of posterior spinal fixation by the Harms technique for atlantoaxial subluxation (AAS). Dynamic flexion/extension on cervical radiographs is a standard assessment for evaluation of C1/2 instability in AAS patients. Most studies focused on postoperative ADI and functional outcome, including pain and fusion rate; only few studies compared dynamic ADI change pre- to post-operatively. MATERIAL AND METHODS Retrospectively, we reviewed the medical records of 16 patients who underwent posterior spinal fixation in our center from 2018 to 2019. We used dynamic cervical flexion/extension radiographs to assess the pre- to postoperative change at 12 months in ADI of flexion (ADIf), ADI of extension (ADIe), ADI between flexion/extension (ADIΔ), C1/2 fusion rate and functional outcomes measured by the modified Japanese Orthopaedic Association scale (mJOA scale). Postoperative CT at 3∼12 months assessed screw positioning on the Gertzbein and Robbins classification. RESULTS In the 16 patients included in this study, ADIf, ADIe and ADIΔ were significantly reduced, from respectively 8.0mm, 5.0mm and 3.0mm preoperatively to 4.6mm, 3.8mm and 0.8mm at 12 months' follow-up. The fusion rate was 81% and the mJOA score recovery rate was 34.9±14.7%. Although the screw malposition rate was higher than in other studies in C1(10%) and C2(20%), there were no new neurologic deficits or worsening of symptoms at follow-up. CONCLUSIONS The ADIΔ showed significant reduction, showing that the Harms technique of posterior spinal fixation can effective in maintaining the stability of the atlantoaxial joint and improving functional outcome.
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Affiliation(s)
- M-L Su
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Z-H Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - P-H Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-C Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chamnan R, Chantarasirirat K, Paholpak P, Wiley K, Buser Z, Wang JC. Occipitocervical measurements: correlation and consistency between multi-positional magnetic resonance imaging and dynamic radiographs. 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; 29:2795-2803. [PMID: 32318836 DOI: 10.1007/s00586-020-06415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/12/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the reliability and validity of the multi-positional magnetic resonance imaging in measuring occipitocervical parameters using the standard cervical dynamic radiographs as a reference. METHODS Patients were included if they underwent both dynamic radiograph and cervical multi-positional MRI within a 2-week interval from January 2013 to December 2016. Twelve occipitocervical parameters were measured on both image modalities in all positions (neutral, flexion and extension): Posterior Atlanto-Dental Interval, Anterior Atlanto-Dental Interval (AADI), Dens-to-McRae distance, Dens-to-McGregor distance, Occipito-atlantal Cobb angle (C01 angle), Occipito-axis Cobb angle (C02 Cobb angle), Atlas-axis Cobb angle (C12 angle), Redlund-Johnell, Modified Ranawat, Clivus canal angle, Occiput inclination, and Occiput cervical distance. Pearson correlation and linear regression analysis were used to evaluate the correlation of both modalities for each parameter. A p value of < 0.05 was considered statistically significant. RESULTS Cervical images of 70 patients were measured and analyzed. There was a significant positive correlation between dynamic X-ray and multi-positional MRI for all parameters (p < 0.05) except AADI. Dens-to-McGregor distance and Redlund-Johnell parameter demonstrated a very strong correlation in the neutral position (r = 0.72, r = 0.79 respectively) and moderate to very strong correlation(r > 0.4) for Modified Ranawat, Clivus canal angle, C02 Cobb angle and C02 distance in all neck position. The intra-class correlation (ICC) of intra- and inter-observer showed good to excellent reliability, and ICCs were 0.67-0.98. CONCLUSIONS Multi-positional MRI can be a reliable imaging option for diagnosis of occipitocervical instability or basilar invagination compared to standard dynamic radiographs.
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Affiliation(s)
- Rattanaporn Chamnan
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-4513, Los Angeles, CA, 90033, USA
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kunlavit Chantarasirirat
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-4513, Los Angeles, CA, 90033, USA
- Department of Orthopaedic Surgery, Somdech Phra Pinklao Hospital, 504 Taksin Road, Bukkalo Thonburi, Bangkok, Thailand
| | - Permsak Paholpak
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-4513, Los Angeles, CA, 90033, USA
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kevin Wiley
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-4513, Los Angeles, CA, 90033, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-4513, Los Angeles, CA, 90033, USA.
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St., HC4 - Suite 5400A., Los Angeles, CA, 90003, USA.
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-4513, Los Angeles, CA, 90033, USA
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Shi J, Ermann J, Weissman BN, Smith SE, Mandell JC. Thinking beyond pannus: a review of retro-odontoid pseudotumor due to rheumatoid and non-rheumatoid etiologies. Skeletal Radiol 2019; 48:1511-1523. [PMID: 30868232 DOI: 10.1007/s00256-019-03187-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 02/02/2023]
Abstract
Retro-odontoid pseudotumor, or mass-like retro-odontoid soft tissue thickening, is an uncommon but important imaging finding that may be associated with rheumatoid arthritis, crystal deposition diseases, as well as non-inflammatory conditions such as cervical degenerative changes and mechanical alterations. Retro-odontoid pseudotumor is commonly associated with atlantoaxial microinstability or subluxation. MRI and CT have an important role in the detection and diagnosis of retro-odontoid pseudotumor. However, due to a wide range of imaging characteristics and ambiguous etiology, it is a frequently misunderstood entity. The purpose of this article is to review relevant anatomy of the craniocervical junction; describe various imaging appearances, pathophysiology and histology in both rheumatoid and non-rheumatoid etiologies; and discuss differential diagnosis of retro-odontoid pseudotumor in order to help guide clinical management.
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Affiliation(s)
- Junzi Shi
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Joerg Ermann
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Barbara N Weissman
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Stacy E Smith
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Tu A, Melamed E, Krieger MD. Dynamic MRI in the Evaluation of Atlantoaxial Stability in Pediatric Down Syndrome Patients. Pediatr Neurosurg 2019; 54:12-20. [PMID: 30677764 DOI: 10.1159/000495788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 11/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Down syndrome is the most common inherited disorder. Some patients develop atlantoaxial instability. Existing screening guidelines were developed prior to availability of MRI. We present predictors for deficit using dynamic MRI of the craniocervical junction. METHODS A retrospective review of Down syndrome patients from 2001 to 2015 was carried out. Patients were considered symptomatic if they had clinical deficits or signal change on MRI. Measurements were taken at the atlantoaxial junction and structural abnormalities noted. Analysis was performed with SPSS. RESULTS A total of 36 patients were included. Patients averaged 93 months of age with a follow-up of 57 months. No asymptomatic patients developed myelopathy during follow-up. During dynamic imaging, symptomatic patients had greater changes in space available for the cord (SAC) (5.2 vs. 2.7 mm; p < 0.001) and atlantodental interval (ADI) (2.8 vs. 1.3 mm; p = 0.04). These patients were also more likely to have a bony anomaly (50 vs. 13%; p = 0.03). CONCLUSION This study characterizes the range of motion seen on dynamic MRI and provides parameters that can be used to distinguish patients at risk for neurologic injury. Changes greater than 3 mm in ADI or 5 mm in SAC during dynamic MRI or any bony abnormality warrants further investigation. Patients without these features may be able to avoid an unnecessary intervention.
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Affiliation(s)
- Albert Tu
- Children's Hospital of Los Angeles, Los Angeles, California, USA, .,Children's Minnesota, St. Paul, Minnesota, USA,
| | - Edward Melamed
- Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Mark D Krieger
- Children's Hospital of Los Angeles, Los Angeles, California, USA
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The Relationship Between Basilar Invagination and Chiari Malformation Type I: A Narrative Review. ACTA NEUROCHIRURGICA SUPPLEMENT 2019; 125:111-118. [DOI: 10.1007/978-3-319-62515-7_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Liao S, Schneider NRE, Hüttlin P, Grützner PA, Weilbacher F, Matschke S, Popp E, Kreinest M. Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction-A study in two new cadaveric trauma models. PLoS One 2018; 13:e0195215. [PMID: 29624623 PMCID: PMC5889057 DOI: 10.1371/journal.pone.0195215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/13/2018] [Indexed: 12/11/2022] Open
Abstract
Background Unstable conditions of the craniocervical junction such as atlanto-occipital dislocation (AOD) or atlanto-axial instability (AAI) are severe injuries with a high risk of tetraplegia or death. Immobilization by a cervical collar to protect the patient from secondary damage is a standard procedure in trauma patients. If the application of a cervical collar to a patient with an unstable craniocervical condition may cause segmental motion and secondary injury to the spinal cord is unknown. The aim of the current study is (i) to analyze compression on the dural sac and (ii) to determine relative motion of the cervical spine during the procedure of applying a cervical collar in case of ligamentous unstable craniocervical junction. Methods and findings Ligamentous AOD as well as AOD combined with ligamentous AAI was simulated in two newly developed cadaveric trauma models. Compression of the dural sac and segmental angulation in the upper cervical spine were measured on video fluoroscopy after myelography during the application of a cervical collar. Furthermore, overall three-dimensional motion of the cervical spine was measured by a motion tracking system. In six cadavers each, the two new trauma models on AOD and AOD combined with AAI could be implemented. Mean dural sac compression was significantly increased to -1.1 mm (-1.3 to -0.7 mm) in case of AOD and -1.2 mm (-1.6 to -0.6 mm) in the combined model of AOD and AAI. Furthermore, there is a significant increased angulation at the C0/C1 level in the AOD model. Immense three-dimensional movement up to 22.9° of cervical spine flexion was documented during the procedure. Conclusion The current study pointed out that applying a cervical collar in general will cause immense three-dimensional movement. In case of unstable craniocervical junction, this leads to a dural sac compression and thus to possible damage to the spinal cord.
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Affiliation(s)
- Shiyao Liao
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Niko R. E. Schneider
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Petra Hüttlin
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Paul A. Grützner
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Frank Weilbacher
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Stefan Matschke
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Erik Popp
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Michael Kreinest
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
- * E-mail:
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Liao S, Schneider NRE, Weilbacher F, Stehr A, Matschke S, Grützner PA, Popp E, Kreinest M. Spinal movement and dural sac compression during airway management in a cadaveric model with atlanto-occipital instability. 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 2017; 27:1295-1302. [DOI: 10.1007/s00586-017-5416-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/11/2017] [Indexed: 12/19/2022]
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Pinter NK, McVige J, Mechtler L. Basilar Invagination, Basilar Impression, and Platybasia: Clinical and Imaging Aspects. Curr Pain Headache Rep 2016; 20:49. [DOI: 10.1007/s11916-016-0580-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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10
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Dynamic Compression of the Spinal Cord by Paraspinal Muscles following Cervical Laminectomy: Diagnosis Using Flexion-Extension MRI. Case Rep Radiol 2015; 2015:275623. [PMID: 25984378 PMCID: PMC4423003 DOI: 10.1155/2015/275623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI. The use of kinematic MRI to diagnose postoperative complications, specifically dynamic compression, is not as well documented. The authors describe a case of dynamic spinal cord compression by the paraspinal muscles causing worsening myelopathy following cervical laminectomy. This was only diagnosed with flexion-extension MRI. Methods. The patient was a 90-year-old male presenting to the neurosurgery clinic with functional decline and cervical spondylotic myelopathy. Results. A multilevel laminectomy was performed. Following surgery the patient had progressive weakness and worsening myelopathy. No active cord compression was seen on multiple MRIs obtained in a neutral position, and flexion-extension X-rays did not show instability. A kinematic MRI demonstrated dynamic compression of the spinal cord only during neck extension, by the paraspinal muscles. To relieve the compression, the patient underwent an instrumented fusion, with cross-links used to buttress the paraspinal muscles away from the cord. This resulted in neurologic improvement. Conclusions. We describe a novel case of spinal cord compression by paraspinal muscles following cervical laminectomy. In individuals with persistent myelopathy or delayed neurologic decline following posterior decompression, flexion-extension MRI may prove useful in diagnosing this potential complication.
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Dugailly PM, Sobczak S, Lubansu A, Rooze M, Jan SS, Feipel V. Validation protocol for assessing the upper cervical spine kinematics and helical axis: An in vivo preliminary analysis for axial rotation, modeling, and motion representation. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2014; 4:10-5. [PMID: 24381450 PMCID: PMC3872654 DOI: 10.4103/0974-8237.121617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Context: The function of the upper cervical spine (UCS) is essential in the kinematics of the whole cervical spine. Specific motion patterns are described at the UCS during head motions to compensate coupled motions occurring at the lower cervical segments. Aims: First, two methods for computing in vitro UCS discrete motions were compared to assess three-dimensional (3D) kinematics. Secondly, the same protocol was applied to assess the feasibility of the procedure for in vivo settings. Also, this study attempts to expose the use of anatomical modeling for motion representation including helical axis. Settings and Design: UCS motions were assessed to verify the validity of in vitro 3D kinematics and to present an in vivo procedure for evaluating axial rotation. Materials and Methods: In vitro kinematics was sampled using a digitizing technique and computed tomography (CT) for assessing 3D motions during flexion extension and axial rotation. To evaluate the feasibility of this protocol in vivo, one asymptomatic volunteer performed an MRI kinematics evaluation of the UCS for axial rotation. Data processing allowed integrating data into UCS 3D models for motion representation, discrete joint behavior, and motion helical axis determination. Results: Good agreement was observed between the methods with angular displacement differences ranging from 1° to 1.5°. Helical axis data were comparable between both methods with axis orientation differences ranging from 3° to 6°. In vivo assessment of axial rotation showed coherent kinematics data compared to previous studies. Helical axis data were found to be similar between in vitro and in vivo evaluation. Conclusions: The present protocol confirms agreement of methods and exposes its feasibility to investigate in vivo UCS kinematics. Moreover, combining motion analysis, helical axis representation, and anatomical modeling, constitutes an innovative development to provide new insights for understanding motion behaviors of the UCS.
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Affiliation(s)
- Pierre-Michel Dugailly
- Laboratory of Functional Anatomy, Department of Physiotherapy and Rehabilitation, Faculty of Motor Sciences, Free University of Brussels, Brussels, Belgium ; Research Unit of Osteopathy, Department of Osteopathic Sciences, Faculty of Motor Sciences, Free University of Brussels, Brussels, Belgium
| | - Stéphane Sobczak
- Laboratory of Anatomy, Biomechanics and Organogenesis, Department of Anatomy, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Alphonse Lubansu
- Laboratory of Anatomy, Biomechanics and Organogenesis, Department of Anatomy, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Marcel Rooze
- Laboratory of Functional Anatomy, Department of Physiotherapy and Rehabilitation, Faculty of Motor Sciences, Free University of Brussels, Brussels, Belgium ; Laboratory of Anatomy, Biomechanics and Organogenesis, Department of Anatomy, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Sergevan Sint Jan
- Laboratory of Anatomy, Biomechanics and Organogenesis, Department of Anatomy, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Department of Physiotherapy and Rehabilitation, Faculty of Motor Sciences, Free University of Brussels, Brussels, Belgium ; Laboratory of Anatomy, Biomechanics and Organogenesis, Department of Anatomy, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
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Kozić D, Bjelan M, Njagulj V, Lučić M, Semnic M, Cupara S. Isolated inflammatory arthritis of the atlantooccipital joint confused with migraine. J Rheumatol 2013; 40:2097-8. [PMID: 24293620 DOI: 10.3899/jrheum.121374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Duško Kozić
- Associate Professor, Oncology Institute of Vojvodina, Diagnostic Imaging Center, Sremska Kamenica; and University of Novi Sad, School of Medicine, Novi Sad, Serbia
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Osmotherly PG, Farrell SF, Digby SD, Rowe LJ, Buxton AJ. The Influence of Age, Sex, and Posture on the Measurement of Atlantodental Interval in a Normal Population. J Manipulative Physiol Ther 2013; 36:226-31. [DOI: 10.1016/j.jmpt.2013.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 02/01/2013] [Accepted: 02/07/2013] [Indexed: 12/01/2022]
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Matys T, Horsburgh A, Kirollos RW, Massoud TF. The aqueduct of Sylvius: applied 3-T magnetic resonance imaging anatomy and morphometry with neuroendoscopic relevance. Neurosurgery 2013; 73:ons132-40; discussion ons140. [PMID: 23615083 DOI: 10.1227/01.neu.0000430286.08552.ca] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aqueduct of Sylvius (AqSylv) is a structure of increasing importance in neuroendoscopic procedures. However, there is currently no clear and adequate description of the normal anatomy of the AqSylv. OBJECTIVE To study in detail hitherto unavailable normal magnetic resonance imaging morphometry and anatomic variants of the AqSylv. METHODS We retrospectively studied normal midsagittal T1-weighted 3-T magnetic resonance images in 100 patients. We measured widths of the AqSylv pars anterior, ampulla, and pars posterior; its narrowest point; and its length. We recorded angulation of the AqSylv relative to the third ventricle as multiple deviations of the long axis of the AqSylv from the Talairach bicommissural line. We statistically determined age- and sex-related changes in AqSylv morphometry using the Pearson correlation coefficient. We measured angulation of the AqSylv relative to the fourth ventricle and correlated this to the cervicomedullary angle (a surrogate for head position). RESULTS Patients were 13 to 83 years of age (45% male, 55% female). Mean morphometrics were as follows: pars anterior width, 1.1 mm; ampulla width, 1.2 mm; pars posterior width, 1.4 mm; length, 14.1 mm; narrowest point, 0.9 mm; and angulation in relation to the third and fourth ventricles, 26° and 18°, respectively. Age correlated positively with width and negatively with length of the AqSylv. There was no correlation between AqSylv alignment relative to the foramen magnum and the cervicomedullary angle. CONCLUSION Normative dimensions of the AqSylv in vivo are at variance with published cadaveric morphometrics. The AqSylv widens and shortens with cerebral involution. Awareness of these normal morphometrics is highly useful when stent placement is an option during aqueductoplasty. Reported data are valuable in guiding neuroendoscopic management of hydrocephalus and aqueductal stenosis.
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Affiliation(s)
- Tomasz Matys
- *Section of Neuroradiology; and ‡Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom; §Department of Radiology, University of Cambridge, Cambridge, United Kingdom
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Ansari MS, Habib SK, Ahmad Siddiqui O, Ahmad Z. Subarachnoid block in a case of rheumatoid arthritis with severe pulmonary fibrosis. BMJ Case Rep 2012; 2012:bcr-2012-006294. [PMID: 23035159 DOI: 10.1136/bcr-2012-006294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis, of unknown aetiology and a propensity to involve almost all organ systems. The anaesthesiologists should be aware of the associated airway pathologies, pain management techniques and adverse effects of drug therapies being used to treat RA. In this respect, we describe a 60-year-old female patient who presented with a diagnosis of RA with pulmonary fibrosis, and was scheduled for orthopaedic surgery for subcapital fracture of femur which was successfully managed using intrathecal bupivacaine and midazolam.
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Martirosyan NL, Cavalcanti DD, Kalani MYS, Maughan PH, Theodore N. Aplasia of the anterior arch of atlas associated with multiple congenital disorders: case report. Neurosurgery 2012; 69:E1317-20. [PMID: 21712741 DOI: 10.1227/neu.0b013e31822a9ab1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Congenital clefts and aplasias of the atlas vertebra are rare. A nonfused posterior arch occurs in 4% of the population; in contrast, a nonfused anterior arch occurs in only 0.1%. To the best of our knowledge, this is the first description of the combination of anterior arch aplasia and a cleft of the posterior arch of the atlas associated with Klippel-Feil and Treacher-Collins syndromes and Sprengel deformity. CLINICAL PRESENTATION An 11-year-old girl presented with neck pain and symptoms of myelopathy, including upper- and lower-extremity paresthesia. Computed tomography revealed significant congenital bony anomalies of the cervical spine, with congenital fusion of C2 through C5. There was aplasia of the anterior ring of C1 (A 2.3-cm gap was present within the anterior aspect of the lateral masses). The posterior elements of C3 and C4 were fused, and signs of Sprengel deformity were present. Magnetic resonance imaging revealed effacement of the ventral cerebrospinal fluid space at the craniocervical junction and mild mass effect at the cervicomedullary junction. Flexion and extension views showed abnormal motion at the craniocervical junction. There was no evidence of atlantoaxial instability, basilar invagination, or Chiari malformation. Occipito-C4-scapular fusion was performed to prevent spinal cord injury and further neurological symptoms. Postoperatively, the patient did extremely well, and her preoperative symptoms resolved. CONCLUSION We describe a rare case of aplasia of the anterior arch of the atlas and posterior arch midline cleft in association with Treacher-Collins syndrome, Klippel-Feil syndrome, and Sprengel deformity. The patient's atlantoaxial instability was managed surgically with a unique construct that provided occipito-C4-scapular fusion.
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Affiliation(s)
- Nikolay L Martirosyan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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Abstract
There has been a great deal of progress in our understanding and management of rheumatoid arthritis in recent years. The peri-operative management of rheumatoid arthritis patients can be challenging and anaesthetists need to be familiar with recent developments and potential risks of this multi system disease.
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Affiliation(s)
- R Samanta
- Department of Anaesthesia, Peterborough City Hospital, Peterborough, UK
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Ji-Hong F, Li-Ping W, Yi-Kai L, Bo-Jin L, Das M, Xiao-Yong F. Variable morphology of the axis vertebrae in 100 specimens: implications for clinical palpation and diagnostic imaging. J Manipulative Physiol Ther 2010; 33:125-31. [PMID: 20170778 DOI: 10.1016/j.jmpt.2009.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 08/12/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate and measure the variable morphologies of axis vertebrae and explore the clinical significance of variations as it may pertain to clinical palpation and diagnostic imaging. METHODS The common variable morphologies in 100 specimens of intact dry adult axis vertebrae (Chinese) were investigated and measured. The frequencies in deviation of odontoid processes, deviation of spinous processes, and presence of bifid spinous processes were observed. The distances between the apices of transverse processes and inferior articular facets were also measured. RESULTS Variable morphologies of C2 that we observed were deviation of odontoid processes (14 cases, 14.0%), deviation of spinous processes (3 cases, 3.0%), and bifid spinous processes (95 cases, 95.0%). Of the bifid spinous processes, 56 had a process on the left side equal to the right side, 21 were longer on the left, and 18 were longer on the right. The distances between apices of transverse processes and inferior articular facets in the left side of C2 were 17.67 +/- 2.47 mm, and that of the right side were 17.81 +/- 2.55 mm. CONCLUSIONS Because variable morphology of the axis is common, congenital deviation of the odontoid process, deviation of the spinous process, and asymmetrical bifid spinous processes should be taken into account during clinical palpation and diagnostic imaging.
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Affiliation(s)
- Fan Ji-Hong
- Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
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Younes M, Belghali S, Kriâa S, Zrour S, Bejia I, Touzi M, Golli M, Gannouni A, Bergaoui N. Compared imaging of the rheumatoid cervical spine: Prevalence study and associated factors. Joint Bone Spine 2009; 76:361-8. [DOI: 10.1016/j.jbspin.2008.10.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2008] [Indexed: 10/21/2022]
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High mortality rate in rheumatoid arthritis with subluxation of the cervical spine: a cohort study of operated and nonoperated patients. Spine (Phila Pa 1976) 2008; 33:2278-83. [PMID: 18784629 DOI: 10.1097/brs.0b013e31817f1a17] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In a prospective cohort study 532 patients with rheumatoid arthritis (RA) and subluxations of the cervical spine were consecutively collected during 1974-1999. OBJECTIVE The aims of the study were to assess important factors affecting the mortality rate and the timing of surgical intervention. SUMMARY OF BACKGROUND DATA The average follow-up time from the first visit to death or to the end of the study was 8.5 (SD, 5.7) years. Of the 217 operated patients 144 (66%) died, and of the 315 nonoperated patients 137 (43%) died. METHODS Patients were selected for operative intervention based on anterior, vertical and subaxial subluxations, pain, and/or cervical neurology. Survival analyses were used for comparisons between patients with RA and the normal population, and between the operated and those treated conservatively. RESULTS The survival rate for all RA patients was significantly reduced when compared with average survival in Norway (P < 0.001). The operated group had a significantly lower survival rate than the nonoperated group. In patients with severe instability of the cervical spine, the defined selection criteria for surgical intervention were specific. By comparison of calculated propensity scores, the operated and nonoperated groups were too different to be directly comparable. After surgery only 11 patients (5%) experienced residual pain in the neck or neurologic symptoms. None of these patients were alive at the end of the study, signifying that residual pain or neurologic symptoms are poor prognostic signs (P = 0.015). In the operated group, anterior subluxation and vertical settling greater than the lower indication limits did not have a significant influence on the survival rate, but there was a reduced survival for patients with subaxial subluxations. A clear association was found between increased vertical settling and sudden death. CONCLUSION RA with neck involvement is a progressive and serious condition with reduced lifetime expectancy. Hence, our interpretation is that operative intervention improves local symptoms and most likely changes the condition from worse to better by increasing lifetime expectancy in high risk patients. Since the per- and postoperative complications are few, a changed attitude toward more liberal indications for earlier surgery may reduce the symptoms and the mortality rate even more.
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Anaesthesiological problems in patients with rheumatoid arthritis undergoing orthopaedic surgeries. Clin Rheumatol 2008; 27:553-6. [DOI: 10.1007/s10067-008-0839-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 12/22/2007] [Accepted: 01/04/2008] [Indexed: 10/22/2022]
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Cheng JS, Liu F, Komistek RD, Mahfouz MR, Sharma A, Glaser D. Comparison of cervical spine kinematics using a fluoroscopic model for adjacent segment degeneration. J Neurosurg Spine 2007; 7:509-13. [DOI: 10.3171/spi-07/11/509] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this cervical spine kinematics study the authors evaluate the motions and forces in the normal, degenerative, and fused states to assess how alteration in the cervical motion segment affects adjacent segment degeneration and spondylosis.
Methods
Fluoroscopic images obtained in 30 individuals (10 in each group with disease at C5–6) undergoing flexion/extension motions were collected. Kinematic data were obtained from the fluoroscopic images and analyzed with an inverse dynamic mathematical model of the cervical spine that was developed for this analysis.
Results
During 20° flexion to 15° extension, average relative angles at the adjacent levels of C6–7 and C4–5 in the fused patients were 13.4° and 8.8° versus 3.7° and 4.8° in the healthy individuals. Differences at C3–4 averaged only about 1°. Maximum transverse forces in the fused spines were two times the skull weight at C6–7 and one times the skull weight at C4–5, compared with 0.2 times the skull weight and 0.3 times the skull weight in the healthy individuals. Vertical forces ranged from 1.6 to 2.6 times the skull weight at C6–7 and from 1.2 to 2.5 times the skull weight at C4–5 in the patients who had undergone fusion, and from 1.4 to 3.1 times the skull weight and from 0.9 to 3.3 times the skull weight, respectively, in the volunteers.
Conclusions
Adjacent-segment degeneration may occur in patients with fusion due to increased motions and forces at both adjacent levels when compared with healthy individuals in a comparable flexion and extension range.
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Affiliation(s)
- Joseph S. Cheng
- 1Department of Neurosurgery, Vanderbilt University Medical Center, Nashville; and
| | - Fei Liu
- 2Department of Mechanical, Aerospace and Biomedical Engineering, the University of Tennessee, Knoxville, Tennessee
| | - Richard D. Komistek
- 2Department of Mechanical, Aerospace and Biomedical Engineering, the University of Tennessee, Knoxville, Tennessee
| | - Mohamed R. Mahfouz
- 2Department of Mechanical, Aerospace and Biomedical Engineering, the University of Tennessee, Knoxville, Tennessee
| | - Adrija Sharma
- 2Department of Mechanical, Aerospace and Biomedical Engineering, the University of Tennessee, Knoxville, Tennessee
| | - Diana Glaser
- 2Department of Mechanical, Aerospace and Biomedical Engineering, the University of Tennessee, Knoxville, Tennessee
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Duan S, Huang X, Lin Q, Chen G. Clinical Significance of Articulating Facet Displacement of Lateral Atlantoaxial Joint on 3D CT in Diagnosing Atlantoaxial Subluxation. J Formos Med Assoc 2007; 106:840-6. [DOI: 10.1016/s0929-6646(08)60049-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gupta V, Khandelwal N, Mathuria SN, Singh P, Pathak A, Suri S. Dynamic Magnetic Resonance Imaging Evaluation of Craniovertebral Junction Abnormalities. J Comput Assist Tomogr 2007; 31:354-9. [PMID: 17538278 DOI: 10.1097/01.rct.0000238009.57307.26] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the role of dynamic magnetic resonance imaging (MRI) in craniovertebral junction (CVJ) abnormalities. MATERIALS AND METHODS Twenty-five patients with suspected CVJ abnormalities underwent dynamic MRI of the CVJ, and in 20 of these patients, noncontrast computed tomography scan of the CVJ was done. The images were evaluated for atlantoaxial instability (AAI), spinal canal narrowing, cord compression, presence of altered cord signal intensity, and bony abnormalities in neutral, flexion, and extension. RESULTS Dynamic MRI detected 15 cases of AAI (10 fixed and 5 mobile AAI), 21 patients had varying degrees of spinal canal narrowing. Five patients showed increased narrowing on flexion/extension. Two patients demonstrated direct cord compression in flexion, whereas in neutral position, only dural compression was seen. One patient had cord compression on extension that was not seen in neutral or flexed position. CONCLUSION Dynamic MRI was able to detect cases of cord compression that were not seen in neutral position and was diagnostic in all cases of mobile AAI where mobility at this joint affects the treatment options. Dynamic MRI is extremely useful for evaluating craniovertebral junction abnormalities and, in particular, cord compression.
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Affiliation(s)
- Vivek Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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