1
|
Lin RT, Dalton JF, Como CJ, Chang AY, Tang MY, Oyekan AA, Sadhwani S, Wawrose RA, Lee JY, Shaw JD. Formal Radiologist Interpretations of Intraoperative Spine Radiographs Have Low Clinical Value. Spine (Phila Pa 1976) 2024; 49:933-940. [PMID: 38407343 DOI: 10.1097/brs.0000000000004973] [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: 12/11/2023] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To evaluate the clinical relevance, usefulness, and financial implications of intraoperative radiograph interpretation by radiologists in spine surgery. SUMMARY OF BACKGROUND DATA Due to rising health care costs, spine surgery is under scrutiny to maximize value-based care. Formal radiographic analysis remains a potential source of unnecessary health care costs, especially for intraoperative radiographs. MATERIALS AND METHODS A retrospective cohort analysis was performed on all adult elective spine surgeries at a single institution between July 2020 and July 2021. Demographic and radiographic data were collected, including intraoperative localization and post-instrumentation radiographs. Financial data were obtained through the institution's price estimator. Radiographic characteristics included time from radiographic imaging to completion of radiologist interpretation report, completion of radiologist interpretation report before the conclusion of surgical procedure, clinical relevance, and clinical usefulness. Reports were considered clinically relevant if the spinal level of the procedure was described and clinically useful if completed before the conclusion of the procedure and deemed clinically relevant. RESULTS Four hundred eighty-one intraoperative localization and post-instrumentation radiographs from 360 patients revealed a median delay of 128 minutes between imaging and completion of the interpretive report. Only 38.9% of reports were completed before the conclusion of surgery. There were 79.4% deemed clinically relevant and only 33.5% were clinically useful. Localization reports were completed more frequently before the conclusion of surgery (67.2% vs. 34.4%) but with lower clinical relevance (90.1% vs. 98.5%) and clinical usefulness (60.3% vs. 33.6%) than post-instrumentation reports. Each patient was charged $32 to $34 for the interpretation fee, cumulating a minimum total cost of $15,392. CONCLUSIONS Formal radiographic interpretation of intraoperative spine radiographs was of low clinical utility for spine surgeons. Institutions should consider optimizing radiology workflows to improve timeliness and clinical relevance or evaluate the necessity of reflexive consultation to radiology for intraoperative imaging interpretation to ensure that value-based care is maximized during spine surgeries. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Ryan T Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Jonathan F Dalton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Christopher J Como
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Audrey Y Chang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Melissa Yunting Tang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Anthony A Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Shaan Sadhwani
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Richard A Wawrose
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Joon Y Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| |
Collapse
|
2
|
Bode T, Zoroofchi S, Vettorazzi E, Droste JN, Welsch GH, Schwesig R, Marshall RP. Functional analysis of postural spinal and pelvic parameters using static and dynamic spinometry. Heliyon 2024; 10:e29239. [PMID: 38633646 PMCID: PMC11021985 DOI: 10.1016/j.heliyon.2024.e29239] [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: 09/13/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
Background Spinometry is a radiation-free method to three-dimensional spine imaging that provides additional information about the functional gait patterns related to the pelvis and lower extremities. This radiation-free technology uses the surface topography of the trunk to analyze surface asymmetry and identify bony landmarks, thereby aiding the assessment of spinal deformity and supporting long-term treatment regimes. Especially reliable dynamic spinometric data for spine and pelvis are necessary to evaluate the management of non-specific back pain. Research aim This study aims to generate reliable dynamic spinometric data for spine and pelvis parameters that can serve as reference data for future studies and clinical practice. Methods This study assessed 366 subjects (185 females) under static and 360 subjects (181 females) under dynamic (walking on a treadmill at 3 km/h and 5 km/h) conditions. The DIERS Formetric 4Dmotion® system uses stripes of light to detect the surface topography of the spine and pelvis and identifies specific landmarks to analyze the spine during standing and walking. Results Relevant gender effects were calculated for lordotic angle (ηp2 = 0.22) and pelvic inclination (ηp2 = 0.26). Under static conditions, female subjects showed larger values for both parameters (lordotic angle: 41.6 ± 8.60°; pelvic inclination: 25.5 ± 7.49°). Regarding speed effects, three relevant changes were observed (sagittal imbalance: ηp2 = 0.74, kyphotic angle: ηp2 = 0.13, apical deviation: ηp2 = 0.11). The most considerable changes were observed between static condition and 3 km/h, especially for sagittal imbalance and lordotic angle. For these parameters, relevant effect sizes (d > 0.8) were calculated between static and 3 km/h for males and females. Concerning clinical vertebral parameters, only lordotic angle and pelvic inclination were correlated with each other (r = 0.722). Conclusion This study generated a gender-specific reference database of asymptomatic individuals for static and dynamic spinometry. It demonstrated that the DIERS Formetric 4Dmotion® system could capture natural changes in static and dynamic situations and catalogue functional adaptations of spino-pelvic statics at different speeds. The lordotic angle is an indirect marker of pelvic inclination, allowing spinometry to identify individuals at risk even under dynamic conditions.
Collapse
Affiliation(s)
- Tobias Bode
- Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Schima Zoroofchi
- Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jan-Niklas Droste
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- BG Klinikum Hamburg-Boberg, Bergedorfer Str. 10, 21033, Hamburg, Germany
| | - Götz H. Welsch
- Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - René Schwesig
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Robert Percy Marshall
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| |
Collapse
|
3
|
Oakley PA, Moustafa IM, Haas JW, Betz JW, Harrison DE. Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison. J Clin Med 2024; 13:2149. [PMID: 38610914 PMCID: PMC11012400 DOI: 10.3390/jcm13072149] [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: 02/22/2024] [Revised: 03/23/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Forward head posture (FHP) and altered cervical lordotic curvatures are common spine displacements often associated with neck pain and disability. Two primary categories for determining FHP exist: radiographic and postural measurements. Methods: This study investigated the correlation between the craniovertebral angle (CVA), the radiographically measured C2-C7 sagittal vertical axis (SVA), and cervical lordosis (absolute rotation angle: ARA C2-C7) in a sample of participants with chronic myofascial pain (CMP). In 120 participants, we performed both a postural measurement of the CVA and a lateral cervical radiograph, where the C2-C7 SVA and ARA C2-C7 were measured. A linear-regression R2 value to assess the correlation between the CVA, C2-C7 SVA, and ARA C2-C7 was sought. Results: A statistically significant weak linear fit was identified (Spearman's r = 0.549; R2 = 0.30, p < 0.001) between the CVA and C2-C7 SVA, having considerable variation between the two measures. A statistically significant linear fit (very weak) was identified for the lordosis ARA C2-C7 and the CVA: Spearman's r = 0.524; R2 = 0.275; p < 0.001. A value of 50° for the CVA corresponded to a value of 20 mm for the C2-C7 SVA on an X-ray. Conclusion: While the CVA and radiographic C2-C7 SVA are weakly correlated in an individual, they seem to represent different aspects of sagittal cervical balance. The CVA cannot replace radiographically measured cervical lordosis. We recommend that more emphasis be given to radiographic measures of sagittal cervical alignment than the CVA when considering patient interventions.
Collapse
Affiliation(s)
- Paul A. Oakley
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA; (P.A.O.); (J.W.H.); (J.W.B.)
- Private Practice, Newmarket, ON L3Y 8Y8, Canada
- Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada
| | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Jason W. Haas
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA; (P.A.O.); (J.W.H.); (J.W.B.)
| | - Joseph W. Betz
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA; (P.A.O.); (J.W.H.); (J.W.B.)
- Private Practice, Boise, ID 83709, USA
| | - Deed E. Harrison
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA; (P.A.O.); (J.W.H.); (J.W.B.)
| |
Collapse
|
4
|
Bayartai ME, Luomajoki H, Aliverti A, LoMauro A, Tringali G, Sartorio A. Spinal Postures and Mobility in Children with Achondroplasia vs. Age- and Sex-Matched Healthy Individuals: A Preliminary Report. J Clin Med 2024; 13:2135. [PMID: 38610900 PMCID: PMC11012898 DOI: 10.3390/jcm13072135] [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: 02/28/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Achondroplasia is a rare genetic disease, yet the most common form of dwarfism, characterized by limb shortening and disproportionate short stature along with musculoskeletal changes, such as postural deviations. Although postural changes in the spine in children with achondroplasia have been well investigated, little is known about the association of achondroplasia with spinal movements/mobility. Methods: This preliminary study aims to explore the association of achondroplasia with spinal mobility in children with achondroplasia compared to age- and sex-matched healthy individuals. Spinal posture and mobility were assessed using a radiation-free back scan, the Idiag M360 (Idiag, Fehraltorf, Switzerland). Between-group differences were determined using a two-way analysis of variance. Results: Children with achondroplasia had smaller thoracic lateral flexion [difference between groups (Δ) = 20.4°, 95% CI 0.1°-40.6°, p = 0.04], lumbar flexion (Δ = 17.4°, 95% CI 5.5°-29.4°, p = 0.006), lumbar extension (Δ = 14.2°, 95% CI 5.7°-22.8°, p = 0.002) and lumbar lateral flexion (Δ = 19.6°, 95% CI 10.7°-28.4°, p < 0.001) than age- and sex-matched healthy individuals, except for thoracic extension (Δ = 16.5°, 95% CI 4.4°-28.7°, p = 0.009) which was greater in children with achondroplasia. No differences were observed in global spinal postures between the two groups. Conclusions: Spinal mobility appears to be more influenced by achondroplasia than global spinal postures in childhood. These results also highlight the importance of considering the musculoskeletal assessment of segmental spinal postures and rehabilitative interventions aimed at promoting spinal flexibility in children with achondroplasia.
Collapse
Affiliation(s)
- Munkh-Erdene Bayartai
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, 8400 Winterthur, Switzerland;
- Department of Physical and Occupational Therapy, School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia
| | - Hannu Luomajoki
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, 8400 Winterthur, Switzerland;
| | - Andrea Aliverti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (A.A.); (A.L.)
| | - Antonella LoMauro
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (A.A.); (A.L.)
| | - Gabriella Tringali
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, 28824 Piancavallo-Verbania, Italy; (G.T.); (A.S.)
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, 28824 Piancavallo-Verbania, Italy; (G.T.); (A.S.)
| |
Collapse
|
5
|
Bayartai ME, Luomajoki H, Tringali G, De Micheli R, Grugni G, Sartorio A. Differences in spinal postures and mobility among adults with Prader-Willi syndrome, essential obesity, and normal-weight individuals. Front Endocrinol (Lausanne) 2023; 14:1235030. [PMID: 37800136 PMCID: PMC10548364 DOI: 10.3389/fendo.2023.1235030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Spinal kinematics/motion are reported to be altered in adolescents and adults with essential obesity, while no information is available in patients with Prader-Willi syndrome so far. The aim of this study was to examine cross-sectionally the characteristics of spinal postures and mobility in 34 patients with PWS, in 35 age- and sex-matched adults with essential obesity, and in 37 normal-weight individuals. Methods Spinal posture and mobility were assessed using a radiation-free back scan, the Idiag M360 (Idiag, Fehraltorf, Switzerland). Differences in spinal posture and mobility between the three groups were determined using a two-way analysis of variance. Results Adults with Prader-Willi syndrome had greater thoracic kyphosis [difference between groups (Δ) = 9.60, 95% CI 3.30 to 15.60, p = 0.001], less lumbar lordosis (Δ = -6.50, 95% CI -12.70 to -0.30, p = 0.03) as well as smaller lumbar and hip mobility than those with normal weight. Discussion Although the characteristics of the spine in patients with Prader-Will syndrome appear to be similar to that found in subjects with essential obesity, Prader-Willi syndrome was found to influence lumbar movements more than thoracic mobility. These results provide relevant information about the characteristics of the spine in adults with Prader-Willi syndrome to be taken into careful consideration in the management of spinal conditions. These findings also highlight the importance of considering the musculoskeletal assessment of spinal postures and approaches targeting spinal and hip flexibility in adults with Prader-Willi syndrome.
Collapse
Affiliation(s)
- Munkh-Erdene Bayartai
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, (ZHAW), Winterthur, Switzerland
- Department of Physical and Occupational Therapy, School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Hannu Luomajoki
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, (ZHAW), Winterthur, Switzerland
| | - Gabriella Tringali
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
| | - Roberta De Micheli
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
| | - Graziano Grugni
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Division of Auxology, Piancavallo-Verbania, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
| |
Collapse
|
6
|
Bayartai ME, Luomajoki H, Tringali G, De Micheli R, Abbruzzese L, Sartorio A. Differences in spinal posture and mobility between adults with obesity and normal weight individuals. Sci Rep 2023; 13:13409. [PMID: 37591910 PMCID: PMC10435449 DOI: 10.1038/s41598-023-40470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
The aim of this study was to cross-sectionally investigate the relationships between obesity and spinal posture as well as mobility by comparing the spinal parameters between adults with obesity and normal-weight individuals. The spinal parameters were measured in 71 adults with obesity and 142 normal-weight individuals using a radiation-free back scan, the Idiag M360. Differences in spinal posture and movements between the two groups were determined using a two-way analysis of variance. Adults with obesity had greater thoracic kyphosis [difference between groups (Δ) = 6.1°, 95% CI 3.3°-8.9°, p < 0.0001] and thoracic lateral flexion (Δ = 14.5°, 95% CI 5.1°-23.8°, p = 0.002), as well as smaller thoracic flexion (Δ = 3.5°, 95% CI 0.2°-6.9°, p = 0.03), thoracic extension (Δ = 4.1°, 95% CI 1.1°-7.1°, p = 0.008), lumbar flexion (Δ = 10.4°, 95% CI 7.7°-13.5°, p < 0.0001), lumbar extension (Δ = 4.8°, 95% CI 2.2°-7.4°, p = 0.0003) and lumbar lateral flexion (Δ = 12.8°, 95% CI 9.8°-15.7°, p = < 0.0001) compared to those with normal weight. These findings provide relevant information about the characteristics of the spine in adults with obesity to be taken into careful consideration in the prescription of adapted physical activities within integrated multidisciplinary pathways of metabolic rehabilitation.
Collapse
Affiliation(s)
- Munkh-Erdene Bayartai
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, ZHAW, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland.
- Department of Physical and Occupational Therapy, School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
| | - Hannu Luomajoki
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, ZHAW, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland
| | - Gabriella Tringali
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
| | - Roberta De Micheli
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
| | - Laura Abbruzzese
- Istituto Auxologico Italiano, IRCCS, Division of Eating and Nutrition Disorders, Piancavallo-Verbania, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
| |
Collapse
|
7
|
Wagner DT, Tilmans L, Peng K, Niedermeier M, Rohl M, Ryan S, Yadav D, Takacs N, Garcia-Fraley K, Koso M, Dikici E, Prevedello LM, Nguyen XV. Artificial Intelligence in Neuroradiology: A Review of Current Topics and Competition Challenges. Diagnostics (Basel) 2023; 13:2670. [PMID: 37627929 PMCID: PMC10453240 DOI: 10.3390/diagnostics13162670] [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: 05/16/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
There is an expanding body of literature that describes the application of deep learning and other machine learning and artificial intelligence methods with potential relevance to neuroradiology practice. In this article, we performed a literature review to identify recent developments on the topics of artificial intelligence in neuroradiology, with particular emphasis on large datasets and large-scale algorithm assessments, such as those used in imaging AI competition challenges. Numerous applications relevant to ischemic stroke, intracranial hemorrhage, brain tumors, demyelinating disease, and neurodegenerative/neurocognitive disorders were discussed. The potential applications of these methods to spinal fractures, scoliosis grading, head and neck oncology, and vascular imaging were also reviewed. The AI applications examined perform a variety of tasks, including localization, segmentation, longitudinal monitoring, diagnostic classification, and prognostication. While research on this topic is ongoing, several applications have been cleared for clinical use and have the potential to augment the accuracy or efficiency of neuroradiologists.
Collapse
Affiliation(s)
- Daniel T. Wagner
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Luke Tilmans
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Kevin Peng
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | | | - Matt Rohl
- College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Sean Ryan
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Divya Yadav
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Noah Takacs
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Krystle Garcia-Fraley
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Mensur Koso
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Engin Dikici
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Luciano M. Prevedello
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| | - Xuan V. Nguyen
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA (L.M.P.)
| |
Collapse
|
8
|
Nicholson LL, Rao PJ, Lee M, Wong TM, Cheng RHY, Chan C. Reference values of four measures of craniocervical stability using upright dynamic magnetic resonance imaging. LA RADIOLOGIA MEDICA 2023; 128:330-339. [PMID: 36715785 PMCID: PMC10020271 DOI: 10.1007/s11547-023-01588-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 01/04/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE To establish reference ranges for four most commonly used diagnostic measures of craniocervical instability (CCI) in three cervical sagittal positions. This necessitated development of a reliable measurement protocol using upright, dynamic MRI (udMRI), to determine differences in the extent of motion between positions, and whether age and sex correlate with these measures. MATERIALS AND METHODS Deidentified udMRIs of 50 adults, referred for reasons other than CCI, were captured at three positions (maximal flexion, maximal extension and neutral). Images were analyzed, providing measures of basion-axial interval, basion-axial angle, basion-dens interval (BDI) and the Grabb-Oakes line (GOL) for all three positions (12 measures per participant). All measures were independently recorded by a radiologist and neurosurgeon to determine their reliability. Descriptive statistics, correlations, paired and independent t-tests were used. Mean (± 2 SD) identified the reference range for all four measures at each craniocervical position. RESULTS The revised measurement protocol produced inter-rater reliability indices of 0.69-0.97 (moderate-excellent). Fifty adults' (50% male; mean age 41.2 years (± 9.7)) reference ranges for all twelve measures were reported. Except for the BDI and GOL when moving between neutral and full flexion, significant extents of movement were identified between the three craniocervical positions for all four measures (p ≤ 0.005). Only a minor effect of age was found. CONCLUSIONS This is the first study to provide a rigorous standardized protocol for four diagnostic measures of CCI. Reference ranges are established at mid and ends of sagittal cervical range corresponding to where exacerbations of signs and symptoms are commonly reported.
Collapse
Affiliation(s)
- Leslie L Nicholson
- School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia.
| | - Prashanth J Rao
- Macquarie University Hospital, Macquarie Park, NSW, Australia
- Faculty of Medicine and Health, Macquarie University, Macquarie Park, NSW, Australia
| | - Matthew Lee
- Radiology, Western Imaging Group, Blacktown, NSW, Australia
| | - Tsz Ming Wong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Regen Hoi Yan Cheng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Cliffton Chan
- School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
9
|
Yazici A, Yerlikaya T. The relationship between the degeneration and asymmetry of the lumbar multifidus and erector spinae muscles in patients with lumbar disc herniation with and without root compression. J Orthop Surg Res 2022; 17:541. [PMID: 36514168 PMCID: PMC9749279 DOI: 10.1186/s13018-022-03444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The determination of muscle pathologies in lumbar disc herniation (LDH) and other conditions with low back pain is important for understanding low back problems and determining appropriate treatment methods. In patients with lumbar disc herniation with radiculopathy, elucidating the effect of root compression on the severity of muscle degeneration may predict the importance of alleviating root compression. For this purpose, magnetic resonance imaging (MRI) was used to compare the degeneration and asymmetries of the lumbar musculus multifidus (MF) and lumbar musculus erector spinae (ES) muscles in patients with lumbar discopathy without root compression (radiculopathy) and in patients with lumbar discopathy with root compression (radiculopathy). METHODS The patients were examined in two groups: 56 patients with lumbar discopathy and no radiculopathy (Non-rad group) and 51 patients with lumbar discopathy and radiculopathy (Rad group). On axial MRI sections passing through the centre of the disc at the L3-S1 level, the asymmetry, cross-sectional area (CSA), fat infiltration, and total CSA (TCSA = MF + ES) of the MF and ES muscles were measured and compared. RESULTS No difference was seen between the groups with respect to the CSA values of the right and left MF and left ES, but a significant difference was found in the right ES CSA (p = 0.021). The CSA and TCSA of the MF and ES showed no asymmetry according to group. Severe fat infiltration of > 50% in the right and left MF and left ES was found in the Rad group at a higher rate than in the Non-rad group. Fat infiltration was significantly positively correlated with age, body mass index, and the duration of pain (p < 0.001, p < 0.001, p = 0.004, respectively). CONCLUSIONS The study results showed a correlation between LDH and paraspinal muscle degeneration, while no correlation was found with asymmetry. Severe (> 50%) fat infiltration is associated with root compression, and the severity of fat filtration increases in the presence of root compression. The development of more severe degeneration due to denervation associated with root compression plays a role in the emergence of this situation. Therefore, in patients with lumbar disc herniation with radiculopathy, it can be foreseen that to stop and correct severe fat infiltration and muscle degeneration, first, nerve root compression should be corrected with appropriate medical treatment methods, and in patients in whom there is no response, the pressure should be alleviated with appropriate surgical methods.
Collapse
Affiliation(s)
- Alikemal Yazici
- grid.412132.70000 0004 0596 0713Faculty of Medicine, Orthopaedics and Traumatology Department, Near East University, Nicosia, Cyprus ,Orthopaedics and Traumatology Department, Buyuk Anadolu Hospital, Samsun, Turkey
| | - Tuba Yerlikaya
- grid.412132.70000 0004 0596 0713Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Near East University, Nicosia, Cyprus
| |
Collapse
|
10
|
Naidoo N, Khan R, Abdulwahab T, Almqvist KF, Lakshmanan J, Prithishkumar IJ. A novel reconstructive approach of the lumbar vertebral column from 2D MRI to 3D models. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
Bayartai ME, Schaer CE, Luomajoki H, Tringali G, De Micheli R, Sartorio A. Differences in spinal posture and mobility between children/adolescents with obesity and age-matched normal-weight individuals. Sci Rep 2022; 12:15570. [PMID: 36114222 PMCID: PMC9481592 DOI: 10.1038/s41598-022-19823-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
The aim of this study was to cross-sectionally explore the association of obesity with spinal posture and mobility, commonly associated with musculoskeletal problems, by comparing the spinal parameters between 90 obese and 109 normal-weight children and adolescents. A non-invasive electromechanical device, the Idiag M360 (Idiag, Fehraltorf, Switzerland), was used to measure the spinal parameters. An age-and-sex-adjusted two-way analysis of variance (ANOVA) was used to determine postural and mobility differences between the two groups. Children and adolescents with obesity had significantly greater thoracic kyphosis [difference between groups (Δ) = 13.00, 95% CI 10.10–15.80, p < 0.0001] and thoracic extension (Δ = 6.50, 95% CI 2.90–11.60, p = 0.005), as well as smaller mobility in thoracic flexion (Δ = 5.00, 95% CI 1.20–8.80, p = 0.01), thoracic lateral flexion (Δ = 17.70, 95% CI 11.60–23.80, p < 0.0001), lumbar flexion (Δ = 12.10, 95% CI 8.70–15.50, p < 0.0001), lumbar extension (Δ = 7.10, 95% CI 3.10–12.20, p = 0.003) and lumbar lateral flexion (Δ = 9.10, 95% CI 5.50–12.80, p < 0.0001) compared to the normal-weight children and adolescents. These findings provide important information about the characteristics of the spine in children and adolescents with obesity and unique insights into obesity-related mechanical challenges that the spine has to withstand and strategies designed to improve spinal mobility in this young population.
Collapse
|
12
|
Shelke Y, Chakraborty C. Augmented Reality and Virtual Reality Transforming Spinal Imaging Landscape: A Feasibility Study. IEEE COMPUTER GRAPHICS AND APPLICATIONS 2021; 41:124-138. [PMID: 32746083 DOI: 10.1109/mcg.2020.3000359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article discusses a systematic review of the state-of-the-art on augmented reality (AR) and virtual reality (VR) in spinal navigation, where early clinical validations have shown promising outlook on accuracy and scalability parameters. The objective of this research is to evaluate clinical relevance for AR-VR enabled spinal surgical technologies and develop an economic feasibility model for stakeholders, such as patients, hospitals, and research organizations with technology adoption. From the influencing parameters, we identified the research gaps that can be explored going forward and a list of high priority research challenges that could provide an attractive research and development investment case for industry players.
Collapse
|
13
|
Bratke G, Rau R, Kabbasch C, Zäske C, Maintz D, Haneder S, Große Hokamp N, Persigehl T, Siedek F, Weiss K. Speeding up the clinical routine: Compressed sensing for 2D imaging of lumbar spine disc herniation. Eur J Radiol 2021; 140:109738. [PMID: 33945923 DOI: 10.1016/j.ejrad.2021.109738] [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: 02/11/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Increasing economic pressure and patient demands for comfort require an ever-increasing acceleration of scan times without compromising diagnostic certainty. This study tested the new acceleration technique Compressed SENSE (CS-SENSE) as well as different reconstruction methods for the lumbar spine. METHODS In this prospective study, 10 volunteers and 14 patients with lumbar disc herniation were scanned using a sagittal 2D T2 turbo spin echo (TSE) sequence applying different acceleration factors of SENSE and CS-SENSE. Gradient echo (GRE), autocalibration (CS-Auto) and TSE prescans were tested for reconstruction. Images were analysed by two readers regarding anatomical delineation, diagnostic certainty (for patients only) and image quality as well as objectively calculating the root mean square error (RMSE), structural similarity index (SSIM), SNR and CNR. The Friedman test and Chi-squared were used for ordinal, ANOVA for repeated measurements and Tukey Kramer test for continuous data. Cohen's kappawas calculated for interreader reliability. RESULTS CS-SENSE outperformed SENSE and CS-Auto regarding RMSE (e.g. CS-SENSE 1.5: 43.03 ± 11.64 versus SENSE 1.5: 80.41 ± 17.66; p = 0.0038) and SSIM as well as in the subjective rating for CS-SENSE 3 TSE. In the patient setting image quality was unchanged in all subjective criteria up to CS-SENSE 3 TSE (all p > 0.05) compared to standard T2 with 43 % less scan time while the GRE prescan only allowed a reduction of 32 %. CONCLUSION Combining a TSE prescan with CS-SENSE enables significant scan time reductions with unchanged ratings for lumbar spine disc herniation making this superior to the currently used SENSE acceleration or GRE reconstructions.
Collapse
Affiliation(s)
- Grischa Bratke
- Department of Radiology, University of Cologne, Cologne, Germany.
| | - Robert Rau
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
| | | | - Charlotte Zäske
- Department of Radiology, University of Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University of Cologne, Cologne, Germany
| | - Stefan Haneder
- Department of Radiology, University of Cologne, Cologne, Germany
| | | | | | - Florian Siedek
- Department of Radiology, University of Cologne, Cologne, Germany
| | | |
Collapse
|
14
|
Preoperative imaging of spinopelvic pathologies : State of the art. DER ORTHOPADE 2020; 49:849-859. [PMID: 32944784 DOI: 10.1007/s00132-020-03982-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The field of musculoskeletal diagnostics and personalized medicine has undergone a revolutionary transformation due to a deeper understanding of skeletal biomechanics and due to technological advancements. Analogous to this transformation, our understanding of spinopelvic conditions has experienced a paradigm shift in terms of both static and dynamic changes in spinopelvic pathologies and enabled a more accurate delineation of the drivers of disability. The purpose of this review is to describe the standard and state of the art of preoperative diagnostic and planning methods for common spinopelvic pathologies and to discuss both the added clinical value and limitations. The rationale is to accelerate the accurate and timely diagnosis and as well as the efficient and safe preoperative workflow.
Collapse
|
15
|
Kearsley R, Elliott S, Smith C, Stocks G. The use of separate-level neuraxial anaesthesia for caesarean delivery in a patient with a history of spinal tuberculosis. Anaesth Rep 2020; 8:e12051. [PMID: 32705084 DOI: 10.1002/anr3.12051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/06/2022] Open
Abstract
We present the case of a 33-year-old parturient who required caesarean delivery at 31 weeks' gestation. She had a history of degenerative disease of the lumbar spine secondary to tuberculosis, acquired as a child in India. Her complex medical history also included ischaemic heart disease and obstructive sleep apnoea, and due to this general anaesthesia was considered to be of high risk. However, regional anaesthesia also posed significant challenges because magnetic resonance imaging of the spine showed a partial collapse with subsequent fusion of second and third lumbar vertebral bodies with thoracolumbar kyphosis. Neuraxial anaesthesia was performed with ultrasound guidance for determining levels and depth of epidural space. An epidural was inserted at the T12-L1 interspace and a spinal anaesthetic block was placed at L4-L5. Delivery and recovery were uneventful. This case highlights the safe and effective use of neuraxial anaesthesia in an asymptomatic patient with treated spinal tuberculosis as well as the usefulness of high-quality imaging of the spine in the decision to perform neuraxial anaesthesia.
Collapse
Affiliation(s)
- R Kearsley
- Department of Anaesthesia Queen Charlottes and Chelsea Hospital London UK
| | - S Elliott
- Department of Anaesthesia Queen Charlottes and Chelsea Hospital London UK
| | - C Smith
- Department of Anaesthesia Queen Charlottes and Chelsea Hospital London UK
| | - G Stocks
- Department of Anaesthesia Queen Charlottes and Chelsea Hospital London UK
| |
Collapse
|
16
|
Ohlendorf D, Gerez A, Porsch L, Holzgreve F, Maltry L, Ackermann H, Groneberg DA. Standard reference values of the upper body posture in healthy male adults aged between 41 and 50 years in Germany. Sci Rep 2020; 10:3823. [PMID: 32123228 PMCID: PMC7052190 DOI: 10.1038/s41598-020-60813-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/17/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Classifications of posture deviations are possible when they can be compared to the standard values for healthy persons. Standard values for healthy male adults aged between 41 and 50 years are currently missing. METHODS 100 healthy volunteers (41-50 years old; 45.37 ± 3.06 years) were included in the study. Their body weight ranged from 68 to 132 kg (88.76 ± 15.93 kg), their heights from 1.64 to 2.0 m (1.81 ± 0.07 m) and the Body Mass Index (BMI) ranged from 19.0 kg/m² to 37.7 kg/m² (26.2 ± 3.96 kg/m²). A three-dimensional back scan was performed to quantify the upper back posture during habitual standing. The upper and lower limit for 95% of the tolerance regions and the left and right limit of the confidence interval were calculated. RESULTS The upper body posture of the subjects was close to the symmetry, or 0°, axis. There was a moderate ventral upper body inclination with a slight left lateral axial deviation and rotation of the spine to the right. An enhanced kyphotic posture was observed in the sagittal plane in the area of the thoracic spine. The shoulder and pelvis areas were almost balanced. CONCLUSION Healthy males between 41 and 50 years were found to have an almost balanced posture with minimal ventral body inclination and a marginal scoliotic deviation. These values allow a comparison with other studies for control and patient data and may serve as basis in both clinical practice and scientific studies.
Collapse
Affiliation(s)
- Daniela Ohlendorf
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany.
| | - Ali Gerez
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - Laurin Porsch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - Fabian Holzgreve
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - Laura Maltry
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - Hanns Ackermann
- Institute of Biostatistics and Mathematical Modeling, Goethe-University, Frankfurt/Main, Theodor-Stern-Kai 7, Building 11A, 60596, Frankfurt/Main, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| |
Collapse
|