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He P, Yang Y, Wang M, Li D, Yuan H, Wang J, He Q, Feng D, Liu X. Is the disappearance of the cervical flexion-relaxation phenomenon associated with cervical degeneration in healthy people? 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; 33:2997-3007. [PMID: 38869650 DOI: 10.1007/s00586-024-08355-x] [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: 09/11/2023] [Revised: 05/06/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE This study aims to explore the differences in cervical degeneration between healthy people with and without cervical flexion-relaxation phenomenon (FRP) and to identify whether the disappearance of cervical FRP is related to cervical degeneration. METHODS According to the flexion relaxation ratio (FRR), healthy subjects were divided into the normal FRP group and the abnormal FRP group. Besides, MRI was used to evaluate the degeneration of the passive subsystem (vertebral body, intervertebral disc, cervical sagittal balance, etc.) and the active subsystem (deep flexors [DEs], deep extensors [DFs], and superficial extensors [SEs]). In addition, the correlation of the FRR with the cervical degeneration score, C2-7Cobb, Borden method, relative total cross-sectional area (rTCSA), relative functional cross-sectional area (rFCSA), and fatty infiltration ratio (FIR) was analyzed. RESULTS A total of 128 healthy subjects were divided into the normal FRP group (n=52, 40.63%) and the abnormal FRP group (n=76, 59.38%). There were significant differences between the normal FRP group and the abnormal FRP group in the cervical degeneration score (z=-6.819, P<0.001), C2-7Cobb (t=2.994, P=0.004), Borden method (t=2.811, P=0.006), and FIR of DEs (t=-4.322, P<0.001). The FRR was significantly correlated with the cervical degeneration score (r=-0.457, P<0.001), C2-7Cobb (r=0.228, P=0.010), Borden method (r=0.197, P=0.026), and FIR of DEs (r=-0.253, P=0.004). CONCLUSION The disappearance of cervical FRP is related to cervical degeneration. A new hypothesis mechanism for FRP is proposed. The cervical FRP test is an effective and noninvasive examination for the differential diagnosis of healthy people, people with potential NSNP, and patients with NSNP.
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Affiliation(s)
- Peifeng He
- Department of Orthopaedic Surgery, Chengdu 363 Hospital of Southwest Medical University, Chengdu City, China
| | - Yunbo Yang
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Minglang Wang
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Dan Li
- Department of Rehabilitation, Southwest Medical University, Luzhou City, China
| | - Hao Yuan
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Jianxiong Wang
- Department of Rehabilitation, Southwest Medical University, Luzhou City, China
| | - Qiang He
- Department of Orthopaedic Surgery, Bazhong City Traditional Medical Hospital, Bazhong City, China
| | - Daxiong Feng
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China.
| | - Xuanwen Liu
- Department of Orthopaedic Surgery, Chengdu 363 Hospital of Southwest Medical University, Chengdu City, China.
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Haselhuhn JJ, Soriano PBO, Grover P, Dreischarf M, Odland K, Hendrickson NR, Jones KE, Martin CT, Sembrano JN, Polly DW. Spine surgeon versus AI algorithm full-length radiographic measurements: a validation study of complex adult spinal deformity patients. Spine Deform 2024; 12:755-761. [PMID: 38336942 DOI: 10.1007/s43390-024-00825-y] [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: 08/22/2023] [Accepted: 01/06/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Spinal measurements play an integral role in surgical planning for a variety of spine procedures. Full-length imaging eliminates distortions that can occur with stitched images. However, these images take radiologists significantly longer to read than conventional radiographs. Artificial intelligence (AI) image analysis software that can make such measurements quickly and reliably would be advantageous to surgeons, radiologists, and the entire health system. MATERIALS AND METHODS Institutional Review Board approval was obtained for this study. Preoperative full-length standing anterior-posterior and lateral radiographs of patients that were previously measured by fellowship-trained spine surgeons at our institution were obtained. The measurements included lumbar lordosis (LL), greatest coronal Cobb angle (GCC), pelvic incidence (PI), coronal balance (CB), and T1-pelvic angle (T1PA). Inter-rater intra-class correlation (ICC) values were calculated based on an overlapping sample of 10 patients measured by surgeons. Full-length standing radiographs of an additional 100 patients were provided for AI software training. The AI algorithm then measured the radiographs and ICC values were calculated. RESULTS ICC values for inter-rater reliability between surgeons were excellent and calculated to 0.97 for LL (95% CI 0.88-0.99), 0.78 (0.33-0.94) for GCC, 0.86 (0.55-0.96) for PI, 0.99 for CB (0.93-0.99), and 0.95 for T1PA (0.82-0.99). The algorithm computed the five selected parameters with ICC values between 0.70 and 0.94, indicating excellent reliability. Exemplary for the comparison of AI and surgeons, the ICC for LL was 0.88 (95% CI 0.83-0.92) and 0.93 for CB (0.90-0.95). GCC, PI, and T1PA could be determined with ICC values of 0.81 (0.69-0.87), 0.70 (0.60-0.78), and 0.94 (0.91-0.96) respectively. CONCLUSIONS The AI algorithm presented here demonstrates excellent reliability for most of the parameters and good reliability for PI, with ICC values corresponding to measurements conducted by experienced surgeons. In future, it may facilitate the analysis of large data sets and aid physicians in diagnostics, pre-operative planning, and post-operative quality control.
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Affiliation(s)
- Jason J Haselhuhn
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Paul Brian O Soriano
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | | | | | - Kari Odland
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Nathan R Hendrickson
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Kristen E Jones
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Christopher T Martin
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - Jonathan N Sembrano
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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Kedar E, Ezra D, Pelleg-Kallevag R, Stein D, Peled N, May H, Hershkovitz I. Capturing the cervical spine shape: Angular measurements versus geometric morphometric methods. Clin Anat 2024. [PMID: 38655670 DOI: 10.1002/ca.24166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
The cervical spine manifests a wide shape variation. However, the traditional methods to evaluate the cervical spine curve were never tested against its actual shape. The study's main aim was to determine whether the shape classification of the cervical spine, based on traditional angular measurements, coincides with each other and with the shape captured by the 2D landmark-based geometric morphometric method. The study's second aim was to reveal the associations between the cervical spine shape and the demographic parameters, the head's position, and the spine's sagittal balance. CT scans of the cervical spine of 163 individuals were evaluated to achieve these goals. The shape was assessed by measuring the C2-C7 Cobb angle (CA), the C2-C7 posterior tangent angle (PTA), the curvedness of the arch, and by a 2D landmark-based geometric morphometric method. The position of the head and the sagittal balance of the spine were evaluated by measuring the foramen magnum-C2 Cobb angle (FMCA) and the T1 slope angle (T1SA), respectively. Based on the size of the angle measured, each individual was classified into one of the three cervical 'shape groups' (lordotic, straight, and kyphotic). We found that cervical lordosis was the dominant shape regardless of the measuring methods utilized (46.6%-54.6%), followed by straight neck (28.2%-30.1%), and kyphosis (15.3%-25.2%); however, about a third of the 163 individuals were classified into a different shape group using the CA and PTA methods. The cervical spine angle was sex-independent and age-dependent. The T1SA was significantly correlated with CA and PTA (r = 0.640 and r = 0.585, respectively; p < 0.001). In conclusion, the cervical spine shape evaluation is method-dependent and varies with age.
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Affiliation(s)
- Einat Kedar
- Department of Anatomy and Anthropology, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Shmunis Family Anthropology Institute, Dan David Center for Human Evolution and Biohistory Research, Tel Aviv University, Tel Aviv, Israel
| | - David Ezra
- School of Nursing Sciences, Tel Aviv Yaffo Academic College, Tel Aviv, Israel
| | - Ruth Pelleg-Kallevag
- Department of Anatomy and Anthropology, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Shmunis Family Anthropology Institute, Dan David Center for Human Evolution and Biohistory Research, Tel Aviv University, Tel Aviv, Israel
- Department of Physical Therapy, Zefat Academic College, Jerusalem, Israel
| | - Dan Stein
- Department of Anatomy and Anthropology, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Nathan Peled
- Radiology Department, Elisha Medical Hospital, Haifa, Israel
| | - Hila May
- Department of Anatomy and Anthropology, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Shmunis Family Anthropology Institute, Dan David Center for Human Evolution and Biohistory Research, Tel Aviv University, Tel Aviv, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Shmunis Family Anthropology Institute, Dan David Center for Human Evolution and Biohistory Research, Tel Aviv University, Tel Aviv, Israel
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Singh H, Kukowski NR, Lunati MP, Dawes A, Kim CH, Kim S, Rhee JM. Porous 3D Printed Titanium Cages in Anterior Cervical Discectomy and Fusion are Associated With Less Subsidence, Improved Maintenance of Segmental Lordotic Correction, and Similar Clinical Outcomes as Allograft. Global Spine J 2024; 14:878-888. [PMID: 36062347 PMCID: PMC11192133 DOI: 10.1177/21925682221124527] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY-DESIGN Retrospective chart review. OBJECTIVES Investigate radiographic and clinical outcomes of 3D printed titanium cages (3DTC) vs allograft in patients undergoing Anterior cervical discectomy and fusion (ACDF). METHODS Consecutive series of patients undergoing ACDF with 3DTC were compared to patients using corticocancellous allograft. Cage subsidence, fusion status, sagittal alignment, and patient-reported-outcomes. Radiographic evaluation was performed on the closing intraoperative x-ray and compared to films at 6-weeks, 6-months, and 1-year. Cage subsidence was calculated based on the amount of settling into superior and inferior endplates compared to the intraoperative x-ray. Fusion was assessed based on < 1 mm of flexion/extension motion. Sagittal alignment parameters and patient-reported-outcomes were measured. RESULTS Seventy six-patients/(120 levels) in 3DTC group and 77-patients/(115 levels) in allograft group were evaluated. No significant differences were noted in patient demographics, level fused or the number of levels fused between the groups. The most common level fused was C5-6. 3DTC had a significantly lower subsidence rate at all-time points as compared to allograft (P < .001). 3DTC maintained segmental lordosis better than allograft at all-time points including 1-year postop (P < .001). No significant differences were noted in fusion rate for 3DTC vs allograft at 6-months (P > .05). There were no significant differences in patient-reported-outcomes. CONCLUSION 3D printed titanium cages had similar patient-reported outcomes and fusion rates as allograft, but less subsidence at all-time points. 3D printed titanium cages better maintained the segmental lordosis at the operative level at all-time points. Although longer term evaluation is needed, based on these results, 3DTC appear to be viable graft options for ACDF that better maintain disc space height and improve segmental lordotic interbody correction.
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Affiliation(s)
- Hardeep Singh
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | | | - Matthew P. Lunati
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Alexander Dawes
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Chi Heon Kim
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - Sungkyu Kim
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - John M. Rhee
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
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Karabag H, Iplikcioglu AC. Upper and lower cervical alignment parameters measured on supine magnetic resonance imaging with the occipital slope as a key marker of cervical alignment. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:61-65. [PMID: 38644912 PMCID: PMC11029111 DOI: 10.4103/jcvjs.jcvjs_185_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 04/23/2024] Open
Abstract
Objectives Cervical spine alignment is evaluated by measuring the cervical angles or parameters on standing plain radiography. In this study, we aimed to evaluate mainly the upper cervical alignment and the correlation between upper and lower cervical sagittal parameters measured on supine magnetic resonance imaging (MRI). Materials and Methods Cervical MRIs of 210 outpatients were reviewed to measure the upper and lower cervical sagittal parameters. Their mean values were compared with normative values measured on standing X-ray from the literature. Correlations between the parameters were analyzed using the Pearson's correlation coefficient. Results The C0 slope was correlated with all other parameters, except for the C2-7 sagittal vertical axis. The strongest correlations (r > 0.500) were between the CL and C2 slope, between the CO2 and C0 slope, and between the C2 slope and C0 slope. Conclusion On supine MRI, the C0 slope is a key marker of cervical spinal alignment. A strong correlation was observed between the C2 slope and C0 slope; therefore, the relationship between upper and lower cervical alignment could be assessed using slopes on MRI.
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Affiliation(s)
- Hamza Karabag
- Department of Neurosurgery, Faculty of Medicine, Harran University, Şanlıurfa, İstanbul, Turkey
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Davies BM, Banerjee A, Mowforth OD, Kotter MRN, Newcombe VFJ. Is the type and/or co-existence of degenerative spinal pathology associated with the occurrence of degenerative cervical myelopathy? A single centre retrospective analysis of individuals with MRI defined cervical cord compression. J Clin Neurosci 2023; 117:84-90. [PMID: 37783068 DOI: 10.1016/j.jocn.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) arises from spinal degenerative changes injuring the cervical spinal cord. Most cord compression is incidental, referred to as asymptomatic spinal cord compression (ASCC). How and why ASCC differs from DCM is poorly understood. In this paper, we study a local cohort to identify specific types and groups of degenerative pathology more likely associated with DCM than ASCC. METHODS This study was a retrospective cohort analysis (IRB Approval ID: PRN10455). The frequency of degenerative findings between those with ASCC and DCM patients were compared using network analysis, hierarchical clustering, and comparison to existing literature to identify potential subgroups in a local cohort (N = 155) with MRI-defined cervical spinal cord compression. Quantitative measures of spinal cord compression (MSCC and MCC) were used to confirm their relevance. RESULTS ELF (8.7 %, 95 % CI 3.8-13.6 % vs 35.7 %, 95 % CI 27.4-44.0 %) Congenital Stenosis (3.9 %, 95 % CI 0.6-7.3 % vs 25.0 %, 95 % CI 17.5-32.5 %), and OPLL (0.0 %, 95 % CI 0.0-0.0 % vs 3.6 %, 95 % CI 0.3-6.8 %) were more likely in patients with DCM. Comparative network analysis indicated loss of lordosis was associated with ASCC, whilst ELF with DCM. Hierarchical Cluster Analysis indicated four sub-groups: multi-level disc disease with ELF, single-level disc disease without loss of lordosis and OPLL with DCM, and single-level disc disease with loss of lordosis with ASCC. Quantitative measures of cord compression were higher in groups associated with DCM, but similar in patients with single-level disc disease and loss of lordosis. CONCLUSIONS This study identified four subgroups based on degenerative pathology requiring further investigation.
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Affiliation(s)
- Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK.
| | - Arka Banerjee
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Mark R N Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
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Xu C, Shen Q, Xu J, Ma J, Ye J, Mo W. Comparison of Cervical Sagittal Parameters Between Radiographs and Magnetic Resonance Images in Patients With Cervical Spondylotic Myelopathy. Global Spine J 2023; 13:1932-1937. [PMID: 34919463 PMCID: PMC10556888 DOI: 10.1177/21925682211062498] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Observational study. OBJECTIVE As an important consideration of surgery, cervical sagittal balance is believed to be better assessed using standing radiograph than supine magnetic resonance imaging (MRI). However, few studies have researched this. Our study aimed to observe the correlations and differences in cervical sagittal parameters between radiograph and MRI in patients with cervical spondylotic myelopathy (CSM), and evaluate whether the change of position affects them. METHODS We analyzed 84 patients, measuring Cobb angle (CA), T1 slope (T1S), neck tilt (NT), and thoracic inlet angle (TIA). Inter- and intra-parameter analyses were performed to identify any difference between standing radiograph and supine MRI. Statistical correlations and differences between the parameters were compared. RESULTS There were excellent inter-observer agreement for each parameter (interclass correlation coefficient >.75), and significant differences were observed in each parameter between radiograph and magnetic resonance imaging (P < .05). Strong correlations were noted between the same parameters in radiograph and MRI. Cobb angle, T1S, and neck tilt were significantly correlated with thoracic inlet angle on both radiograph and MRI, and CA was significantly correlated with T1S on both radiograph and MRI (r: -1.0 to -.5 or .5 to 1.0). CONCLUSION Supine MRI obviously underestimated the value of CA, T1S, and TIA. Therefore, standing cervical radiographs should be obtained in CSM patients to assess and determine surgical strategy, not only supine MRI. Moreover, we observed that NT and TIA were not constant morphological parameters.
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Affiliation(s)
- Chongqing Xu
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qixing Shen
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jinhai Xu
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junming Ma
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Ye
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Mo
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Liu X, Jin L, Jiang C, Jiang X, Chen Z, Cao Y. Characteristics of cervical intervertebral disc signal intensity: an analysis of T2-weighted magnetic resonance imaging in 5843 asymptomatic Chinese subjects. 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 2023; 32:2415-2424. [PMID: 37156851 DOI: 10.1007/s00586-023-07742-0] [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: 11/29/2022] [Revised: 03/08/2023] [Accepted: 04/22/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE The study aimed to observe cervical intervertebral discs (IVDs) in asymptomatic subjects and to explore the factors associated with cervical intervertebral disc degeneration (IVDD). METHODS Cervical spine MRI of 5843 subjects was retrospectively analyzed. On the sagittal T2-weighted MR images, the mean signal intensities of the nucleus pulposus were obtained. Standard signal intensity (SSI) of intervertebral discs was defined as the ratio of mean disc signal intensity to mean CSF signal intensity. RESULTS In subjects under 70 years old, the SSI of IVD was lowest at the C5/6 level. In those over 70, the SSI of IVD was similar among the disc levels from C2/3 to C7/T1. The disc SSI decreased significantly with age in both genders. In subjects under 70 years old, the SSI of the discs at each level was higher in females than in males. In those over 70 years old, no difference was found in disc SSI between two genders at most disc levels. Logistic regression analysis showed that kyphotic and straight cervical spine, obesity and older age were associated with higher risk of having lower disc SSI. CONCLUSION To our knowledge, this is the largest cross-sectional study using MRI-based quantitative assessment to characterize cervical IVDD in asymptomatic subjects. Cervical IVDD was shown to progress with age and significantly correlated with gender, BMI and cervical alignment. Early intervention of related factors may help delay cervical IVDD and prevent future neck and shoulder pain.
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Affiliation(s)
- Xinhua Liu
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lixia Jin
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chang Jiang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoxing Jiang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zixian Chen
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Yuanwu Cao
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China.
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Zhou Z, Lin F, Zhang Y, Jin Z, Liu D, Deng Y, Wang X, Zhou X. Correlation and reliability of cervical sagittal alignment parameters between plain radiographs and multipositional MRI images. Spinal Cord 2023; 61:307-312. [PMID: 37005475 DOI: 10.1038/s41393-023-00895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To assess the validity and reliability of cervical sagittal alignment parameters from multipositional magnetic resonance imaging (MRI) and dynamic cervical radiography. SETTING Hospital in Suzhou, China. METHODS Patients who underwent both multipositional MRI and dynamic plain radiography of the cervical spine within a 2-week interval between January 2013 and October 2021 were retrospectively enrolled in this study. The C2-7 angle, C2-7 cervical sagittal vertical axis (C2-7 SVA), T1 slope (T1S), cervical tilt, cranial tilt, and K-line tilt were measured in three different positions (neutral, flexion, and extension) with multipositional MRI and dynamic radiography. Inter- and intraobserver reliabilities were assessed by intraclass correlation coefficients (ICCs). Pearson correlation coefficients were used for statistical analyses. RESULTS A total of 65 (30 males and 35 females) patients with a mean age of 53.4 years (range 23-69 years) were retrospectively enrolled in this study. Significant positive correlations were noted regarding all parameters between the plain radiographs and multipositional MRI images. Inter- and intraobserver reliabilities were excellent for all cervical sagittal alignment parameters measured in the two imaging modalities. All cervical sagittal parameters had significant positive correlations with those from multipositional MRI in all three positions (p < 0.05). Pearson correlation coefficients demonstrated moderate and strong correlations between the two examinations. CONCLUSIONS Cervical sagittal alignment parameters measured on multipositional MRI could reliably substitute for those measured on plain radiographs. Multipositional MRI is a valuable, radiation-free alternative for diagnostic evaluation in degenerative cervical diseases.
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Affiliation(s)
- Zhiqiang Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Fanguo Lin
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yao Zhang
- Department of Orthopedics, Suqian First Hospital, Suqian, China
| | - Zhigao Jin
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dong Liu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yekun Deng
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaotong Wang
- Department of Hepatology and Gastroenterology, The Affiliated Infectious Hospital of Soochow University, Suzhou, China.
| | - Xiaozhong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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Baker JF. Analysis of Sagittal Thoracic Inlet Measures in Relation to Anterior Access to the Cervicothoracic Junction. Global Spine J 2023; 13:705-712. [PMID: 34018449 DOI: 10.1177/21925682211005730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective radiographic study. OBJECTIVE The aim of this study was to define the association between thoracic inlet measures in relation to anterior access to the cervicothoracic junction. METHODS Trauma CT scans in patients >16 years were analyzed. The projection angle (PA), defined as the angle subtended by a line along the superior endplate of the vertebral body and the line from the anterosuperior corner of the vertebral body to the manubrium, was measured at C7, T1 and T2; angles were positive if the projection was above the manubrium. Thoracic inlet angle (TIA), thoracic inlet distance (TID) and pelvic incidence (PI) were measured. RESULTS 65 scans were assessed (33 males; mean age 47.7 years (s.d. 8.7)). The mean TIA 79.9° (s.d. 13.4°; range 52.6° - 112.2°), mean TID 66.1 mm (s.d. 6.6 mm) and mean PI was 50.5° (s.d. 10.2°). Mean values for the projection angles at C7, T1 and T2 were 24.2°, 7.6° and -8.3° respectively. PA were positive in 95% at C7, 73% at T1 and 30% at T2. PA at each level correlated significantly with age (mean r=-0.371; P = .015) and TIA (mean r=-0.916; P < .001) but neither TID nor PI. TIA correlated with age (r = 0.328; P = .008). CONCLUSIONS The projection angles of the CTJ vertebrae are influenced by thoracic inlet angle and a lesser degree age. Understanding sagittal spinal parameters in the CTJ can aid in planning surgical strategy and approach.
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Affiliation(s)
- Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Goh BC, Lightsey HM, Lopez WY, Tobert DG, Fogel HA, Cha TD, Schwab JH, Bono CM, Hershman SH. Magnetic Resonance Imaging Is Inadequate to Assess Cervical Sagittal Alignment Parameters. Clin Spine Surg 2023; 36:E70-E74. [PMID: 35969678 DOI: 10.1097/bsd.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/29/2022] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective radiographic study. OBJECTIVE To evaluate cervical sagittal alignment measurement reliability and correlation between upright radiographs and magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA Cervical sagittal alignment (CSA) helps determine the surgical technique employed to treat cervical spondylotic myelopathy. Traditionally, upright lateral radiographs are used to measure CSA, but obtaining adequate imaging can be challenging. Utilizing MRI to evaluate sagittal parameters has been explored; however, the impact of positional change on these parameters has not been determined. METHODS One hundred seventeen adult patients were identified who underwent laminoplasty or laminectomy and fusion for cervical spondylotic myelopathy from 2017 to 2019. Two clinicians independently measured the C2-C7 sagittal angle, C2-C7 sagittal vertical axis (SVA), and the T1 tilt. Interobserver and intraobserver reliability were assessed by intraclass correlation coefficient. RESULTS Intraobserver and interobserver reliabilities were highly correlated, with correlations greater than 0.85 across all permutations; intraclass correlation coefficients were highest with MRI measurements. The C2-C7 sagittal angle was highly correlated between x-ray and MRI at 0.76 with no significant difference ( P =0.46). There was a weaker correlation with regard to C2-C7 SVA (0.48) and T1 tilt (0.62) with significant differences observed in the mean values between the 2 modalities ( P <0.01). CONCLUSIONS The C2-C7 sagittal angle is highly correlated and not significantly different between upright x-ray and supine MRIs. However, cervical SVA and T1 tilt change with patient position. Since MRI does not accurately reflect the CSA in the upright position, upright lateral radiographs should be obtained to assess global sagittal alignment when planning a posterior-based cervical procedure.
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Affiliation(s)
- Brian C Goh
- Harvard Combined Orthopaedic Residency Program
| | | | | | - Daniel G Tobert
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Harold A Fogel
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Thomas D Cha
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christopher M Bono
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Stuart H Hershman
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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İplikçioğlu AC, Karabağ H. Analysis of Components of Upper Cervical Lordosis in Asymptomatic Lordotic and Kyphotic Subjects. World Neurosurg 2023; 171:e852-e858. [PMID: 36608798 DOI: 10.1016/j.wneu.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Upper cervical lordosis (CL) can be divided into 2 components: C2 slope (C2S) and McGregor slope (MGS) or C0-1 and C1-2 angles. The aim of this study was to investigate the components of upper CL in asymptomatic kyphotic and lordotic subjects. METHODS CL, C0-2 Cobb angle, MGS, C2S, C1 Slope, C0-1 Cobb angle, C1-2 Cobb angle, T1 slope angular parameters, and the C2-7 sagittal vertical axis distance of 78 asymptomatic subjects were measured. RESULTS Sixty subjects had lordotic curvature and 18 had kyphotic curvature. There was a significant difference between the kyphotic and lordotic groups in all parameters, except for C0-1 Cobb angle and C2-7 sagittal vertical axis. In lordotic subjects, MGS and C2S accounted for 58% and 42% of the C0-2 angle, whereas in kyphotic subjects, 86% of C0-2 was accounted for by C2S. There was a strong negative correlation between C2S and MGS. CONCLUSIONS In asymptomatic subjects, as CL decreases, MGS decreases, C2S increases, and the C0-2 angle turns down on the horizontal plane to maintain the horizontal gaze. Turning down the C0-2 angle is more important than its value for maintaining horizontal gaze; thus, the slopes (MGS and C2S) can better represent the upper and lower cervical alignment than angle values can. The relationship between upper and lower cervical alignment should be evaluated in terms of slope angles rather than simple angles. The lack of significant difference between the C0-1 angles in the kyphotic and lordotic groups suggests that only the C1-2 angle is involved in the compensatory mechanism for the horizontal gaze.
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Affiliation(s)
| | - Hamza Karabağ
- Department of Neurosurgery, Harran Üniversity, Şanlıurfa, Turkey.
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Karabag H, Iplikcioglu AC, Dusak A, Karayol SS. Pelvic incidence measurement with supine magnetic resonance imaging: A validity and reliability study. Clin Neurol Neurosurg 2022; 222:107424. [PMID: 36030728 DOI: 10.1016/j.clineuro.2022.107424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Classically, pelvic incidence (PI) and other spinopelvic sagittal parameters are measured using plain x-ray obtained with the patient standing. However, it is difficult to obtain a perfect mid-sagittal appearance of the sacral endplate and superimposition of both femoral heads from a plain x-ray. Overlapping of the iliac wings also could obscure the appearance of the sacral endplate. Recent studies showed that MRI was more reliable than x-ray for evaluating some spinal sagittal parameters. To our knowledge, measurements of spinopelvic sagittal parameters using supine MRI have not been reported previously. We assessed the validity and reliability of measurements of spinopelvic sagittal parameters from standing lateral x-rays and supine magnetic resonance imaging (MRI). METHODS We recruited 26 asymptomatic volunteers for this study. Standing lateral lumbosacral radiographs, including femoral heads and spinopelvic MRI images with coronal images of the femoral heads were performed. The anatomic reference point required to measure PI was found on coronal MRI images and transferred to the midline sagittal MRI using the bladder wall as a second reference point. PI, sacral slope (SS), and pelvic tilt (PT) were measured on x-ray and MRI images. Validity and reliability of results also were tested. RESULTS Of 14 males and 12 females (average age, 31.30), PI was obtained from x-ray and MRI in 52. ± 6.89 and 51.42 ± 6.43, respectively. From standing x-ray to supine MRI, PT decreased by 3.16°, while SS increased 2.5°. A paired t-test showed a significant difference between PT values from x-ray and MRI. The correlation was highest between the x-ray and MRI measurements of PI, PT, and SS, respectively. Intraobserver and interobserver reliabilities were between 0.88 and 0.96 on x-ray and MRI. All reliabilities were excellent, although MRI values were higher. CONCLUSION MRI was more reliable in the measurement of spinopelvic parameters than classic standing x-ray examination. Higher reliability and being radiation-free could make MRI a good alternative to standing x-ray.
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Affiliation(s)
- Hamza Karabag
- Department of Neurosurgery, Harran University Faculty of Medicine, Şanlıurfa, Turkey.
| | | | - Abdurrahim Dusak
- Department of Radiology, Harran University Faculty of Medicine, Şanlıurfa, Turkey.
| | - Sunay Sibel Karayol
- Department of Radiology, Harran University Faculty of Medicine, Şanlıurfa, Turkey.
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Karabag H, Celal Iplikcioglu A. Simulating upright cervical lordosis in the supine position. Acta Orthop Belg 2022; 88:293-301. [DOI: 10.52628/88.2.8987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cervical alignment or lordosis evolution is still attained by direct radiography in standing position because an ideal cervical curvature is essential to maintain a horizontal gaze with minimal energy consumption. However, upright cervical lordosis changes in supine position. Anterior fusion surgery and more sophisticated radiological examinations, such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), are performed in lying position. Therefore, if upright cervical alignment can be simulated in the supine position, true (upright) cervical lordosis can be demonstrated on CT and MRI and also a more proper anterior cervical fusion can be performed in operation with better surgical outcomes. Forty-nine (49) adult patients underwent radiological examinations, including upright cervi- cal radiography and three session of supine MRI in different positions. MRI was performed in (1) conventional neutral supine position, (2) supine posi- tion with a 5-cm-high pillow, and (3) supine position with a 10-cm-high pillow under the shoulders. MRI results were analyzed. Wilcoxon, Kolmogorov-Smir- nov, and Spearman correlation tests were used to analyze MRI the validity in compared with those of cervical radiography. Cervical lordosis (C2-C7 Cobb angle) of the radiography group was similar to that of supine MRI group using a 5-cm-high pillow, and they have a strong correlation. The T-1 slope from radiography group was similar to and correlated with that of supine MRI groups with both pillows. Cranial tilt measurements of radiography group were different but correlated with the MRI group using a 5-cm-high pillow. Simulating upright cervical lordosis in the supine position is possible by adding a 5-cm- high pillow under the shoulders of the patients. This simulation reduces the need for direct radiography. Anterior cervical fusion surgery performed in this position can provide better surgical results.
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Liu C, Wang J, Hou B, Li Y, Morelli JN, Zhang P, Ran J, Li X. Diurnal Variation in Hydration of the Cervical Intervertebral Disc Assessed Using T2 Mapping of Magnetic Resonance Imaging. Korean J Radiol 2022; 23:638-648. [PMID: 35617994 PMCID: PMC9174496 DOI: 10.3348/kjr.2021.0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/10/2022] [Accepted: 04/01/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The study aimed to investigate the diurnal variation in cervical disc hydration and its relationship with cervical degeneration. Materials and Methods C3–C7 discs of 86 prospectively enrolled participants (37 males, 49 females; mean age ± standard deviation, 23.5 ± 2.5 years) were assessed using T2 mapping in the morning and evening. All discs were stratified by Miyazaki grade or C2–C7 Cobb angle and T2 values (T2). The degree of diurnal T2 variation (T2-DDV), defined as (morning T2 – evening T2)/morning T2 × 100%, was measured for the entire disc, annulus fibrosus (AF), nucleus pulposus (NP), and endplate zones. Results T2 of the entire disc decreased significantly after the daytime load (p < 0.001), with a T2-DDV of 13.3% for all discs and 16.0%, 12.2%, and 13.0% for healthy (grade I), mild degenerative (grade II), and advanced degenerative (grade III/IV) discs, respectively. T2 of regional NPs and AFs decreased significantly from morning to evening (p ≤ 0.049) except in the healthy anterior inner AF (p = 0.092). Compared with healthy discs, mild degenerative discs displayed lower T2 and T2-DDV in regional NPs (p < 0.001). Advanced degenerative discs showed higher T2-DDV in the anterior inner AF compared with healthy discs (p = 0.050). Significant diurnal T2 changes in the endplate zones were observed only in healthy discs (p = 0.013). Cervical discs in the low Cobb angle group showed higher T2-DDV in the anterior AFs and anterior NP and lower T2-DDV in the posterior AF than those in the high Cobb angle group (p ≤ 0.041). Conclusion This study characterized the diurnal variation in hydration of the cervical discs as assessed using T2 mapping and revealed early chemo-mechanical coupling dysfunction in degenerating discs. Cervical sagittal alignment on MRI can affect the diurnal stress patterns of the cervical discs. T2 mapping is sensitive to disc biomechanical dysfunction and offers translational potential from biomechanical research to clinical application.
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Affiliation(s)
- Chanyuan Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyi Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bowen Hou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yitong Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - John N Morelli
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peisen Zhang
- Department of Rehabilitation Medicine, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Jun Ran
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoming Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Evaluation Of Cervical Sagittal Parameters On Supine Magnetic Resonance Imaging In Patients With Chiari I Malformation Without Syringomyelia. Neurochirurgie 2022; 68:504-509. [PMID: 35525315 DOI: 10.1016/j.neuchi.2022.04.007] [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: 02/04/2022] [Revised: 03/27/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE . The current study aimed to assess the effects of tonsillar herniation on cervical alignment in Chiari I patients without syringomyelia using new cervical sagittal alignment parameters, such as C0-2 Cobb angle, C2-7 cobb angle, T1 slope, and C2-7 sagittal vertical axis (SVA). METHODS Two spinal surgeons independently evaluated midline T2-weighted sagittal magnetic resonance imaging findings of 28 Chiari I patients without syringomyelia and 40 patients without tonsillar herniation but with similar complaints. Thereafter, the measured C0-2 Cobb angle, C2-7 Cobb angle T1 slope, and C2-7 SVA were compared using the t-test. RESULTS Differences in the mean values for C2-7 Cobb angle, T1 slope, and C2-7 SVA were found between Chiari I patients and those without tonsillar herniation Conclusion: The current study showed that Chiari I patients were less lordotic (kyphotic) compared to subjects without tonsillar herniation.
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17
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Lee HJ, Kim IS, Hong JT. Physiologic Cervical Alignment Change between Cervical Spine X-ray and Computed Tomography. J Korean Neurosurg Soc 2021; 64:784-790. [PMID: 34315198 PMCID: PMC8435648 DOI: 10.3340/jkns.2020.0320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/13/2021] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study was to investigate the correlations among various radiological parameters used to determine cervical alignment from cervical spine radiographs (X-CS) and cervical spine computed tomography (CT-CS), both within and between modalities.
Methods This study included 168 patients (≤60 years old) without a definite whole spine deformity who underwent CT-CS and X-CS. We measured occipital slope (O-s), C1 slope, C2 slope, C7 slope, sella turcica - C7 sagittal vertical axis (StC7-SVA), spinocranial angle, T1 slope, and C27-SVA. We calculated the O-C2 angle, O-C7 angle, and C2-7 angle from the measured parameters and conducted correlation analyses among multiple parameters.
Results The intrinsic correlation features among multiple cervical parameters were very similar for both X-CS and CT-CS. The two SVA parameters (C27-SVA and StC7-SVA) were mainly influenced by the upper cervical slope parameters (r=|0.13–0.74|) rather than the lower slope cervical parameters (r=|0.08–0.13|). The correlation between X-CS and CT-CS for each radiological parameter was statistically significant (r=0.26–0.44) except for O-s (r=0.10) and StC7-SVA (r=0.11).
Conclusion The correlation patterns within X-CS and CT-CS were very similar in this study. The correlation between X-ray and CT was statistically significant for most radiological parameters, and the correlation score increased when the horizontal gaze was consistently maintained. The lower cervical parameters were not statistically associated with translation-related parameters (C2-7 SVA and StC7-SVA). Therefore, the upper cervical segment may be a better predictor for determining head and neck translation.
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Affiliation(s)
- Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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The association between cervical focal kyphosis and myelopathy severity in patients with cervical spondylotic myelopathy before surgery. 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 2021; 30:1501-1508. [PMID: 33640994 DOI: 10.1007/s00586-021-06771-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 01/13/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Cervical focal kyphosis could often be observed in patients with cervical spondylotic myelopathy (CSM). However, the association between it and myelopathy severity remains unclear. This study aims to elucidate the association between cervical focal kyphosis and myelopathy severity before surgery. METHODS A retrospective review of 191 consecutive patients treated for CSM from 2017 to 2019 was surveyed. Seven MRI and five radiographic parameters were measured, clinical parameters were included. Patients were divided into two sagittal focal angle groups (lordosis/kyphosis) and two disc herniation severity groups (severe/non-severe). The potential risk factors of myelopathy symptoms were analysed. RESULTS Significant correlations between cervical sagittal focal angles, several other imaging findings and myelopathy severity were found in both total patients (R2 = 0.51, P < 0.001) and non-severe disc herniation patients (R2 = 0.73, P < 0.001) in multivariate regression models. Compression ratio of spinal cord exhibited the strongest correlation with JOA scores (r = - 0.567, P < 0.001). Cervical focal angles on MRI exhibited a stronger negative correlation with JOA scores (r = - 0.429, P < 0.001) than did angles on the other three postures on radiographs. Dramatic differences in JOA scores could be found in patients with non-severe cervical disc herniation, when a subgroup analysis was performed between cervical lordosis group and more than 4° kyphosis group (14.2 ± 1.7 vs. 11.1 ± 1.7, P < 0.001). CONCLUSION Cervical focal kyphosis associates with severe myelopathy symptoms in patients with CSM, especially without severe disc herniation. This association may indicate an optimal cervical focal angle in surgical plan. It appeared feasible to assess both the cervical focal angles and spinal cord compression on supine MRI.
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Wang Z, Wang ZW, Fan XW, Liu Z, Sun JY, Ding WY, Yang DL. Influence of SCA on clinical outcomes and cervical alignment after laminoplasty in patients with multilevel cervical spondylotic myelopathy. J Orthop Surg Res 2021; 16:49. [PMID: 33436024 PMCID: PMC7802161 DOI: 10.1186/s13018-021-02200-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background To study the impact of changes in spino-cranial angle (SCA) on sagittal alignment and to investigate the relationship between SCA and Neck Disability Index (NDI) scores after laminoplasty (LP) Material and methods In total, 72 patients with multilevel cervical spondylotic myelopathy (MCSM) after laminoplasty (LP) were retrospectively enrolled. Based on the optimal cut-off values of preoperative SCA, patients were classified into low SCA and high SCA groups. Radiographic data were measured, including spino-cranial angle (SCA), T1-slope (T1s), C2–7 lordosis (CA), T1s minus CA (T1sCA), and C2–7 sagittal vertical axis (cSVA). JOA and NDI scores were both applied to assess postoperative and follow-up clinical efficacy. Pearson correlation coefficient and linear regression analysis were respectively calculated between radiographic data and between SCA and NDI. Results The preoperative SCA was significantly correlated with T1s (r = − 0.795), CA (r = − 0.857), and cSVA (r = 0.915). A receiver operating characteristic (ROC) curve model predicted a threshold of SCA (value of 85.2°). At the follow-up period, patients with lower SCA had a higher T1s and CA and a lower cSVA, simultaneously accompanied by greater △T1s, △CA, and △cSVA. The linear regression model demonstrated that SCA in the higher group was positively correlated with NDI, and patients with higher SCA had worse NDI scores (pre: p < 0.001; post: p < 0.001; F/U: p = 0.003) and greater changes of NDI (post: p < 0.010; F/U: p = 0.002). Conclusion SCA may be a good predictor of evaluating sagittal balance and planning surgery. Changes in sagittal alignment in the low SCA group were affected more easily, and a higher SCA was associated with worse quality of life. Laminoplasty could be a good choice for patients with lower SCA.
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Affiliation(s)
- Zheng Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Zhi-Wei Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Xi-Wen Fan
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Zhen Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Jia-Yuan Sun
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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Rydman E, Elkan P, Eneqvist T, Ekman P, Järnbert-Pettersson H. The significance of cervical sagittal alignment for nonrecovery after whiplash injury. Spine J 2020; 20:1229-1238. [PMID: 32058085 DOI: 10.1016/j.spinee.2020.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Whiplash-associated disorder is a common cause of chronic neck pain. Several radiological cervical angular variables are suggested to have constitutional characteristics, that is, them being minimally influenced by body positioning. However, the association between these variables and pain conditions remains poorly understood. To our knowledge, no previous studies have investigated the association between constitutional angular variables and the outcome after whiplash trauma. PURPOSE Our objectives were (1) to study the inter-rater agreement of sagittal radiologic variables between 2 raters and (2) to investigate any association between these variables and self-perceived nonrecovery after whiplash injury. STUDY DESIGN Prospective cohort study. PATIENT SAMPLE Forty-six patients aged 16 to 70 years, attending an emergency department after a motor vehicle accident resulting in neck pain were recruited. OUTCOME MEASURES Self-perceived nonrecovery (yes/no) was the primary outcome measure. The secondary outcome measure was pain level on a numeric rating scale. METHODS The participants underwent computed tomography scans in a supine position. Sagittal alignment variables (T1 slope, neck tilt, thoracic inlet angle [TIA], and C2-C7 angle) on the computed tomography scans were measured by 2 independent raters. Inter-rater agreement was tested with a paired sample t test and Bland-Altman plots for each variable. The patients were followed up after 6 months. RESULTS No systematic differences for the assessed variables were found between the 2 raters. The overall nonrecovery rate was 28%. For the group with low neck tilt, the nonrecovery rate was 50% (95% CI: 36%-78%) and for the group with high neck tilt, 8% (95% CI: 3%-25%). The nonrecovery rate for the group low TIA was 50% (95% CI 29%-72%) and for those with high TIA 14% (95% CI 4%-26%). The associations remained significant after adjustments for possible confounders. The inter-rater analysis shows satisfactory agreement without proportional bias. CONCLUSIONS This study indicates the existence of an association between the constitutional sagittal alignment of the cervical spine and the outcome after whiplash injuries.
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Affiliation(s)
- Eric Rydman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Peter Elkan
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Ted Eneqvist
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Per Ekman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Li W, Li F, Yang X, Yu S, Chen W, Chen Q. Magnetic Resonance Imaging Research of Thoracic Inlet Parameters in the Cervical and Cervicothoracic Spine in Degenerative Cervical Spondylosis. World Neurosurg 2020; 136:e586-e592. [PMID: 31958587 DOI: 10.1016/j.wneu.2020.01.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the thoracic inlet angle (TIA) and its related parameters in the cervical and cervical-thoracic vertebrae in patients with degenerative cervical spondylosis (DCS) and explore the association of the TIA, tilt angle of the neck, and tilt angle of the first thoracic spine with the cervical degeneration score. METHODS Patients with DCS were included from January 2014 to December 2017. The relevant parameters were assessed on T2-weighted magnetic resonance imaging. The association of cervical parameters with the cervical degeneration score was examined by multiple linear regression model. RESULTS A total of 204 patients (126 men) were eligible and enrolled, with a mean age of 55-56 years. Men had significantly higher thoracic inlet parameters than women (all P < 0.05). Thoracic inlet parameters were positively correlated with age (all P < 0.05). After adjustment for age and sex, the significant association between the TIA and cervical or cervical-thoracic spine degeneration scores was not observed in all vertebrae. Meanwhile, men had higher vertebral height (VH) and intervertebral disk height (IVDH) than women. Only the VHs of C7, T1, and T2 and the IVDHs of C6-7, T1-2, and T2-3 were significantly and positively associated with the TIA (all P < 0.05). CONCLUSIONS Age was positively correlated with thoracic inlet parameters in patients with DCS. Men had significantly higher thoracic inlet parameters than women because the men had higher VHs and IVDHs. However, the TIA was not associated with the level of cervical disk degeneration. The clinical relevance of these findings has not been established.
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Affiliation(s)
- Wanli Li
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
| | - Fangcai Li
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiaobo Yang
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Shunjie Yu
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Weishan Chen
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Qixin Chen
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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Marques C, Granström E, MacDowall A, Moreira NC, Skeppholm M, Olerud C. Accuracy and Reliability of X-ray Measurements in the Cervical Spine. Asian Spine J 2019; 14:169-176. [PMID: 31668048 PMCID: PMC7113471 DOI: 10.31616/asj.2019.0069] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/04/2019] [Indexed: 12/30/2022] Open
Abstract
Study Design This study is a post hoc analysis of a multicenter prospective randomized controlled trial which compared artificial disc replacement and anterior cervical discectomy and fusion. Purpose Useful radiographic parameters for assessing cervical alignment include the Cobb angles, T1 slope (T1S), occipitocervical inclination (OCI), K-line tilt (KLT), and cervical sagittal vertical axis (cSVA). This study aimed to determine measurement accuracy and reliability for these parameters. Overview of Literature Various authors have assessed repeatability by comparing different methods of measurement, but knowledge of measurement error and minimal detectable change is scarce. Methods We evaluated 758 lateral cervical radiographs. One medical student and one spine surgeon (i.e., measured ×2 within 4 weeks) independently measured the parameters obtaining 5,850 values. Standard error of measurement (SEm) and minimum detectable change (MDC) were calculated for each parameter. The accuracy and reliability of the Cobb angle measurements were calculated for the different types of angles: cervical lordosis, prosthesis angle, segmental angle with two bone surfaces (SABB), and segmental angle with one bone and one metal surface. Reliability was determined with intraclass correlation coefficient (ICC). Results SEm was 1.8° and MDC was 5.0° for the Cobb angle, with an intraobserver/interobserver ICC of 0.958/0.886. All the different subtypes of Cobb angles had an ICC higher than 0.950, except SABB (intraobserver/interobserver ICC of 0.922/0.716). The most accurate and reliable measurement was for KLT. Conclusions This study provides normative data on SEm and MDC for Cobb angles, T1S, KLT, OCI, and cSVA in cervical lateral radiographs. Reliability was excellent for all parameters except SABB (e.g., good).
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Affiliation(s)
- Catarina Marques
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Emma Granström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Nuno Canto Moreira
- Pediatric Radiology Section, Department of Clinical Neuroscience, K8, Karolinska Universitetssjukhuset Solna, Stockholm, Sweden
| | - Martin Skeppholm
- Department for Learning, Informatics, Management and Ethics, Medical Management Center, Health Economics and Health Evaluation Research Group, Karolinska Institutet, Stockholm, Sweden
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Rao H, Huang Y, Lan Z, Xu Z, Li G, Xu W. Does Preoperative T1 Slope and Cervical Lordosis Mismatching Affect Surgical Outcomes After Laminoplasty in Patients with Cervical Spondylotic Myelopathy? World Neurosurg 2019; 130:e687-e693. [DOI: 10.1016/j.wneu.2019.06.193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
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Can C2-6 Cobb Angle Replace C2-7 Cobb Angle?: An Analysis of Cervical Kinetic Magnetic Resonance Images and X-rays. Spine (Phila Pa 1976) 2019; 44:240-245. [PMID: 30015714 DOI: 10.1097/brs.0000000000002795] [Citation(s) in RCA: 14] [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 Retrospective study of consecutive 113 cervical kinetic magnetic resonance images (kMRIs) and 57 radiographs. OBJECTIVE To elucidate the relationship between C2-6 or C2-7 Cobb angle and cervical sagittal alignment parameters using kMRI, and evaluate the visibility of C6 and C7 inferior endplates on cervical radiographs. SUMMARY OF BACKGROUND DATA Several studies have used C2-6 Cobb angle instead of C2-7 Cobb angle as C7 inferior endplate is not always visible because of overlying shadows. However, the relationship between C2-6 or C2-7 Cobb angle and cervical sagittal alignment parameters remains unclear. Moreover, visibility of C6 inferior endplate remains unknown. METHODS C2-6 Cobb angle, C2-7 Cobb angle, occiput-C2 angle, Atlas-dens interval (ADI), narrowest oropharyngeal airway space (nPAS), cervical sagittal vertical axis (cSVA), cervical tilt, cranial tilt, neck tilt, thoracic inlet angle (TIA), and T1 slope were measured using kMRI, and analyzed for their relationship with C2-6 or C2-7 Cobb angle. Visibility rates of C6 or C7 inferior endplates were evaluated using cervical radiographs. RESULTS Linear regression analysis showed high association between C2-6 and C2-7 Cobb angle (R = 0.696, P < 0.01). C2-6 Cobb angle was significantly correlated with occiput-C2 angle, TIA, T1 slope, neck tilt, cSVA, and cervical tilt; but not with nPAS, ADI, and cranial tilt. C2-7 Cobb angle resembled C2-6 Cobb angle regarding the relationships with other parameters. In our study, 94.7% C6 and 50.9% C7 inferior endplate were clearly visible; 1.8% C6 and 24.6% C7 inferior endplate were invisible. Chi-square test and residual analysis showed significant difference between the two groups (P < 0.01). CONCLUSION C2-6 Cobb angle highly resembled C2-7 Cobb angle regarding its relationships with parameters of craniovertebral, cervical and thoracic inlet alignment. C2-6 Cobb angle could be an alternative to C2-7 Cobb angle because of its significantly higher visibility rate. LEVEL OF EVIDENCE 3.
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Kim HS, Kim TH, Park MS, Kim SW, Chang HG, Kim JH, Ahn JH, Chang IB, Song JH, Oh JK. K-line tilt as a novel radiographic parameter in cervical sagittal alignment. 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; 27:2023-2028. [DOI: 10.1007/s00586-018-5634-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/05/2018] [Accepted: 05/11/2018] [Indexed: 11/30/2022]
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Oshina M, Tanaka M, Oshima Y, Tanaka S, Riew KD. Correlation and differences in cervical sagittal alignment parameters between cervical radiographs and magnetic resonance images. 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; 27:1408-1415. [DOI: 10.1007/s00586-018-5550-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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