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Giunta G, Kapila A, Brussaard C, Nistor A, De Baerdemaeker R, Zeltzer A, Hamdi M. Redefining the vascular anatomy of the medial gastrocnemius muscle: A computed tomography angiography study. J Plast Reconstr Aesthet Surg 2023; 83:165-171. [PMID: 37276735 DOI: 10.1016/j.bjps.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The medial gastrocnemius (GN) muscle flap is a historical reconstructive option in lower limb reconstruction. The flap is proximally based on the medial sural artery, and it is assumed not possible to harvest a distally based flap because of the absence of other minor pedicles. The aim of this study is to investigate the presence and the anatomy of a distal secondary pedicle given off by the posterior tibial artery (PTA). METHODS A retrospective CTA study was performed of 120 limbs between April 2018 and June 2020. 3D reconstruction was performed to delineate the anatomy of the distal secondary pedicle, if present. The distance of the pedicle, if found, from the intermalleolar line to the patella was noted. The number of pedicles, if multiple, was documented, as well as branches to the soleus muscle and the skin. RESULTS A distal pedicle to the gastrocnemius muscle was found in 64% of limbs. The average location from the intermalleolar line is 168 mm. The branching pattern from the PTA showed an isolated vessel going to the distal medial gastrocnemius (32.8%), two branches to the medial gastrocnemius and skin (39.3%), two branches to the medial gastrocnemius and soleus (24.6%), and three branches to the medial gastrocnemius, soleus, and the skin (3.3%). CONCLUSIONS This study confirms the presence of the secondary axial distal pedicle of the GN muscle. Furthermore, this study confirms that there is a likely association between the distal medial gastrocnemius pedicle and the PTA skin perforators.
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Affiliation(s)
- Gabriele Giunta
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Ayush Kapila
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carola Brussaard
- Department of Radiology, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alexandru Nistor
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Randy De Baerdemaeker
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Assaf Zeltzer
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Moustapha Hamdi
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital (UZ) Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
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Nair S, Srivastava N, Brijith KVR, Aishwarya JG. Surgical Landmarks for Parapharyngeal Internal Carotid Artery During Extended Endoscopic Surgery of Nasopharynx: A Cadaveric and Radiological Study. Indian J Otolaryngol Head Neck Surg 2022; 74:4525-4532. [PMID: 36742694 PMCID: PMC9895682 DOI: 10.1007/s12070-021-02508-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023] Open
Abstract
Nasopharynx is a complex region situated at the center of skull surrounded by various vital neurovascular structures. Surgical access to the nasopharyngeal space poses significant challenges due to the position of the internal carotid artery (ICA). Open approaches to nasopharynx utilize the lateral to medial anatomy but the endoscopic endo-nasal approach warrants knowledge about the medial to lateral anatomy. In this study we attempted to find the consistent surgical landmarks for parapharyngeal portion of internal carotid artery at the level of nasopharynx by means of cadaveric and radiological study. Eight fresh frozen cadavers (16 sides) and 30 CT angiography (60 sides) were included in the anatomical and radiological study respectively. Superior aspect of the torus tubarius was taken as the reference point in cadaveric study and C1-C2 interspace was used as the reference point for the radiological study. The distance between the ICA to the landmarks such as fossa of Rosenmullaer, torus tubarius, medial and lateral pterygoid plates were recorded. The mean distance of ICA to the fossa of Rosenmuller was 8.5 ± 1.4 mm and 9.1 ± 1.1 mm in the cadaveric and radiological study respectively. The mean distance between ICA to torus tubarius was 19.8 ± 1.3 mm in cadaveric and 20.6 ± 1.0 mm in radiological study. The mean distance of ICA to medial and lateral pterygoid plates were 25.3 ± 1.4 mm and 18.2 ± 1.4 mm in the cadaveric study and 25.9 ± 1.2 mm and 18.8 ± 1.3 mm in the radiological study respectively. On correlating the measurements between cadaveric and radiological study, the p values were not statistically significant (p > 0.05). The closest landmark to the ICA was the fossa of Rosenmuller. ICA was located at the same sagittal plane as that of the lateral pterygoid plate. The nasopharynx is a complex anatomical region closely related to ICA. Inadvertent injury to ICA is one of the dreaded complications of nasopharyngeal surgery. Fossa of Rosenmuller is only few millimeters away from the ICA and must be treated very cautiously. During the endoscopic approach, the ICA is at the sagittal plane as of the lateral pterygoid plate. This must be kept in mind when advancing toward the ICA by keeping intact the lateral pterygoid plate when possible and one should stay in the plane of medial pterygoid plate as the ICA lies posterolateral to it. Cadaveric dissections supported by radiological data would definitely aid surgeons to successfully perform surgeries in nasopharynx.
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Affiliation(s)
- Satish Nair
- Department of ENT-HNS, Apollo Hospitals,, Opp. IIM, Bannerghatta Road, Bangalore, Karnataka, 560076 India
| | - Namrata Srivastava
- Department of ENT-HNS, Apollo Hospitals,, Opp. IIM, Bannerghatta Road, Bangalore, Karnataka, 560076 India
| | - K. V. R. Brijith
- Department of ENT-HNS, Apollo Hospitals,, Opp. IIM, Bannerghatta Road, Bangalore, Karnataka, 560076 India
| | - J. G. Aishwarya
- Department of ENT-HNS, Apollo Hospitals,, Opp. IIM, Bannerghatta Road, Bangalore, Karnataka, 560076 India
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Kumar R, Harode HA, Vora R, Javia M. Variations in the shape of foramen magnum at the base of human skulls among Indians in Rajasthan. Bioinformation 2022; 18:488-491. [PMID: 36945222 PMCID: PMC10024773 DOI: 10.6026/97320630018488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
Variations in the shape of foramen magnum can affect the normal anatomy of vital structures passing through it. Therefore, it is of interest to evaluate the various shapes of foramen magnum by using CT scans performed in patients of Indian population to establish clinical correlation. A total of 314 CT images of human skull base obtained from the Department of Radio-diagnosis, Geetanjali Medical College and Hospital, Udaipur, Rajasthan were used in the present study. All the patients' CT scans were observed to determine the shape of foramen magnum. They were classified into one of the following shapes: Oval, round, tetragonal, egg shaped, hexagonal, pentagonal and irregular. The shapes of the foramen magnum in CT scans were oval in 39.09%, round in 22.61%, tetragonal in 12.10%, hexagonal in 10.51%, irregular in 7.96%, pentagonal in 5.41% and egg shaped in 1.59% CT images. Data shows that it is easy to operate at the base of skull in case of round, oval and hexagonal shape foramen magnum, as the working space is more in these shapes.
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Affiliation(s)
- Raj Kumar
- Department of Anatomy, Shantabaa Medical College & General Hospital, Amreli, Gujarat 365601 India
| | - Hemant Ashish Harode
- Department of Anatomy, Zydus Medical College & Hospital, Dahod, Gujarat 389151 India
| | - Rakesh Vora
- Department of Anatomy, Shantabaa Medical College & General Hospital, Amreli, Gujarat 365601 India
| | - Mayankkumar Javia
- Department of Anatomy, Shantabaa Medical College & General Hospital, Amreli, Gujarat 365601 India
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Rodaix C, Auregan JC, Lhuaire M, Feydy A, Soubeyrand M, Biau D. The proximal vastus lateralis flap: An anatomical and radiological study. Morphologie 2021; 106:75-79. [PMID: 33745847 DOI: 10.1016/j.morpho.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Soft-tissue reconstruction following acetabular or proximal femur resection for bone tumors is challenging. The vastus lateralis flap has been proposed as an advancement or rotational flap to cover soft-tissue defects for such locoregional indications. We performed an anatomical and a radiological study to assess the vascularization of the proximal vastus lateralis muscle achieved through the transverse branch of the lateral circumflex femoral artery in order to decrease the morbidity of the classical flap retrieval technique. MATERIAL AND METHODS Five fresh adult cadavers were dissected bilaterally. Each vastus lateralis dissection was prealably injected with contrast-media agent through the lateral circumflex artery and CT scan images was recorded. A descriptive and an analytical study were carried out. RESULTS The median length and width of the entire muscle were 31.2cm (Q1-Q3: 29.7-33.3) and 12.7cm (Q1-Q3: 7.0-14.9), respectively; the median surface area of the entire vastus lateralis muscle was 282cm2 (Q1-Q3: 172.6-455.6) cm2. The median length and width of the perfused area were 13.3cm (Q1-Q3: 12.3-16.6) and 9.4cm (Q1-Q3: 6.9-8.8) cm, respectively; the median surface of the perfused area was 89.4cm2 (Q1-Q3: 67.4-110.5) cm2. The mean length of the pedicle measured on the CT scan was 6.3cm (95% CI: 5.5-7.1). CONCLUSION The proximal vastus lateralis flap as a pedicled muscular flap supplied by the transverse branch of the lateral circumflex femoral artery is a muscular flap that can be used by reconstructive and orthopaedic surgeons to repair soft-tissue defects around the hip joint without undue damage to the functional apparatus of the knee.
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Affiliation(s)
- C Rodaix
- Department of Orthopedic and Traumatology Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - J-C Auregan
- Department of Orthopedic and Traumatology Surgery, Hôpital Antoine Béclère, Clamart, France
| | - M Lhuaire
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital européen Georges-Pompidou, AP-HP, Paris, France; Institute of Anatomy, URDIA, EA4465, UFR Biomédical des Saints-Pères, Université de Paris, Paris, France.
| | - A Feydy
- Department of Orthopedic, Oncologic and Traumatology Surgery Hôpital Cochin, AP-HP, Paris, France
| | - M Soubeyrand
- Department of Orthopedic Surgery Clinique Saint-Jean Ermitage, Melun, France
| | - D Biau
- Department of Orthopedic, Oncologic and Traumatology Surgery Hôpital Cochin, AP-HP, Paris, France
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Abstract
Low levels of phosphate in blood secondary to a lack of phosphorous reabsorption in the renal tubule cause hypophosphataemic rickets. To increase blood calcium levels, bone calcium is released into the bloodstream by increasing the activity of osteoclasts in the bones. These alterations in bone metabolism lead to delayed growth and small height, diffuse bone pain, bone fragility with microfractures, and frequent fractures and bone deformities. Although management of some of these conditions is mainly conservative, in cases of bone deformities or severe osteomalacia surgery should be considered: from minimally invasive surgical techniques of guided growth in patients with less deformity and open physeal cartilage to correction osteotomies in three-dimensional deformities. This article briefly reviews the indications for surgery procedures to be performed in these patients, highlighting when to use aggressive and non-aggressive approaches.
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Zhang R, Gao H, Li H, Xing T, Jia C, Zhang J, Dong F, Shen C. Differences in bone mineral density of trajectory between lumbar cortical and traditional pedicle screws. J Orthop Surg Res 2019; 14:128. [PMID: 31072395 PMCID: PMC6507139 DOI: 10.1186/s13018-019-1169-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/26/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cortical bone trajectory (CBT) has been well-known in spine surgery for obtaining improved fixation while minimizing soft tissue dissection. This study was designed to compare the bone mineral density (BMD) between the CBT and traditional trajectory (TT) by using Hounsfield unit (HU) values and identify the ideal decades of patients and the suitable lumbar segments using this CBT technology from a radiological standpoint. METHODS Patients were selected randomly from an institutional database based on age (evenly distributed by a decade of life) and gender. A total of 240 healthy patients had a computed tomography (CT) scan of the chest, abdomen, and pelvis. For each patient, axial slices of every vertebra were cut in two planes: one horizontal to the pedicle representing the plane wherein pedicle screws were inserted using the TT and the other in a caudocranial plane representing the plane wherein pedicle screws were inserted using the CBT. For each trajectory, a region of interest (ROI) was selected within the area wherein the screws were inserted. A CT number (HU values) was then calculated within each ROI to represent bone density. RESULTS HU values measured at the ROI of CBT were significantly greater than those of the traditional pedicle screw in all age groups, and the specific value (ratio of the HU values of CBT/the HU values of TT) between CBT and TT was 1.92. A significant difference was observed between male and female. The HU values of CBT and TT of males were generally higher than those of females (males: CBT/TT 1.89 ± 0.45; Females: CBT/TT 1.95 ± 0.47). The specific value in HU values significantly increased with increasing age (p = 0.000) and cauda lumbar level (p = 0.000) in males and females. CONCLUSION BMD, as measured by HU values for the ROI of the CBT screw, was significantly greater than that of the traditional pedicle screw, especially in old patients and cauda lumbar segments.
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Affiliation(s)
- Renjie Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China.,Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Hai Gao
- Department of Orthopedics, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei, 230022, Anhui, China.,Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Huimin Li
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China.,Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Tao Xing
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China.,Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Chongyu Jia
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China.,Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Jianxiang Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China.,Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Fulong Dong
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China.,Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Cailiang Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China. .,Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Olewnik Ł, Podgórski M, Polguj M, Topol M. A cadaveric and sonographic study of the morphology of the tibialis anterior tendon - a proposal for a new classification. J Foot Ankle Res 2019; 12:9. [PMID: 30733832 PMCID: PMC6359855 DOI: 10.1186/s13047-019-0319-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/27/2019] [Indexed: 01/11/2023] Open
Abstract
Background The tibialis anterior tendon (TAT) presents little morphological variation. The tibialis anterior muscle originates at the lateral condyle of the tibia, the proximal one-third to two-thirds of the lateral surface of the tibia shaft, and the anterior surface of the interosseous membrane and inserts to the medial cuneiform bone and first metatarsal. The aim of our work is to classify types of TAT insertion by two complimentary methods - anatomical dissection and ultrasound examination. Methods In the first part, classical anatomical dissection was performed on 100 lower limbs (50 right, 50 left) fixed in 10% formalin solution. The morphology of the insertion of the tendon was evaluated and the muscle was subjected to the appropriate morphometric measurements. In the second part, the morphology of the TAT insertion was evaluated in 50 volunteers with ultrasound. Results The tibialis anterior muscle was present in all specimens. In the cadavers, five types of insertion were observed, the most common being Type V: a single band attaching to the medial cuneiform bone (32%). In the sonographic part, Type IV was not observed; however, an additional insertion type was recognised (Type VI), which was characterized by two identical bands attached only to the medial cuneiform bone. The most common type identified by ultrasound was Type II (35%). Conclusion The tibialis anterior tendon presents high morphological variability that can be observed both in cadavers and in vivo by ultrasound examination. Level of evidence II Prospective Comparative Study Electronic supplementary material The online version of this article (10.1186/s13047-019-0319-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Łukasz Olewnik
- 1Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- 2Department of Diagnostic Imaging Lodz, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Michał Polguj
- 3Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Mirosław Topol
- 1Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
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Andrade DC, Borges IC, Vilas-Boas AL, Fontoura MSH, Araújo-Neto CA, Andrade SC, Brim RV, Meinke A, Barral A, Ruuskanen O, Käyhty H, Nascimento-Carvalho CM. Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia. J Pediatr (Rio J) 2018; 94:23-30. [PMID: 28668258 DOI: 10.1016/j.jped.2017.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/18/2017] [Accepted: 01/30/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Community-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria. METHODS The frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2-59 months with or without radiological confirmation (n=249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG. RESULTS Children with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8-4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4-89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation. CONCLUSIONS Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.
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Affiliation(s)
- Dafne C Andrade
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brazil.
| | - Igor C Borges
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brazil
| | - Ana Luísa Vilas-Boas
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brazil
| | - Maria S H Fontoura
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Pediatria, Salvador, BA, Brazil
| | - César A Araújo-Neto
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Medicina Interna e Apoio Diagnóstico, Salvador, BA, Brazil
| | - Sandra C Andrade
- Universidade Federal da Bahia (UFBA), Complexo Hospitalar Professor Edgard Santos (HUPES), Salvador, BA, Brazil
| | - Rosa V Brim
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Medicina Interna e Apoio Diagnóstico, Salvador, BA, Brazil
| | - Andreas Meinke
- Valneva Austria GmbH, Campus Vienna Biocenter 3, Vienna, Austria
| | - Aldina Barral
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Patologia, Salvador, BA, Brazil; Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, BA, Brazil
| | - Olli Ruuskanen
- Turku University and University Hospital, Department of Pediatrics, Turku, Finland
| | - Helena Käyhty
- National Institute for Health and Welfare, Helsinki, Finland
| | - Cristiana M Nascimento-Carvalho
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Pediatria, Salvador, BA, Brazil
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Yamada K, Abe Y, Satoh S, Yanagibashi Y, Hyakumachi T, Masuda T. A novel diagnostic parameter, foraminal stenotic ratio using three-dimensional magnetic resonance imaging, as a discriminator for surgery in symptomatic lumbar foraminal stenosis. Spine J 2017; 17:1074-1081. [PMID: 28366688 DOI: 10.1016/j.spinee.2017.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 03/01/2017] [Accepted: 03/15/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT No previous studies have reported the radiological features of patients requiring surgery in symptomatic lumbar foraminal stenosis (LFS). PURPOSE This study aims to investigate the diagnostic accuracy of a novel technique, foraminal stenotic ratio (FSR), using three-dimensional magnetic resonance imaging for LFS at L5-S by comparing patients requiring surgery, patients with successful conservative treatment, and asymptomatic patients. STUDY DESIGN This is a retrospective radiological comparative study. PATIENT SAMPLE We assessed the magnetic resonance imaging (MRI) results of 84 patients (168 L5-S foramina) aged ≥40 years without L4-L5 lumbar spinal stenosis. The foramina were divided into three groups following standardized treatment: stenosis requiring surgery (20 foramina), stenosis with successful conservative treatment (26 foramina), and asymptomatic stenotic foramen (122 foramina). OUTCOME MEASURES Foraminal stenotic ratio was defined as the ratio of the length of the stenosis to the length of the foramen on the reconstructed oblique coronal image, referring to perineural fat obliterations in whole oblique sagittal images. We also evaluated the foraminal nerve angle and the minimum nerve diameter on reconstructed images, and the Lee classification on conventional T1 images. MATERIALS AND METHODS The differences in each MRI parameter between the groups were investigated. To predict which patients require surgery, receiver operating characteristic (ROC) curves were plotted after calculating the area under the ROC curve. RESULTS The FSR showed a stepwise increase when comparing asymptomatic, conservative, and surgical groups (mean, 8.6%, 38.5%, 54.9%, respectively). Only FSR was significantly different between the surgical and conservative groups (p=.002), whereas all parameters were significantly different comparing the symptomatic and asymptomatic groups. The ROC curve showed that the area under the curve for FSR was 0.742, and the optimal cutoff value for FSR for predicting a surgical requirement in symptomatic patients was 50% (sensitivity, 75%; specificity, 80.7%). CONCLUSIONS The FSR determined LFS requiring surgery among symptomatic patients, with moderate accuracy. Foramina occupied ≥50% by fat obliteration were likely to fail conservative treatment, with a positive predictive value of 75%.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido 061-1449, Japan; Department of Orthopaedic Surgery, Osaka City University, Osaka 545-8585, Japan.
| | - Yuichiro Abe
- Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido 061-1449, Japan
| | - Shigenobu Satoh
- Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido 061-1449, Japan
| | - Yasushi Yanagibashi
- Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido 061-1449, Japan
| | - Takahiko Hyakumachi
- Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido 061-1449, Japan
| | - Takeshi Masuda
- Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido 061-1449, Japan
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Wu AM, Chi YL, Ni WF, Huang YX. The feasibility and radiological features of sacral alar iliac fixation in an adult population: a 3D imaging study. PeerJ 2016; 4:e1587. [PMID: 26855859 PMCID: PMC4741063 DOI: 10.7717/peerj.1587] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/20/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Surgical treatments for adult spinal deformities often include pelvic fixation, and the feasibility of sacral-2 alar iliac (S2AI) screw fixation has been shown previously. However, sometimes S2AI screw fixation cannot be applied due to the presence of an osteolytic lesion or trauma or because the biomechanical properties of only an S2AI screw is insufficient. Therefore, we questioned the feasibility of using sacral AI screws in other segments and determined whether S3AI and S4AI screws have the potential to be used for sacral fractures. The aim of this study was to investigate the feasibility and radiological features of sacral AI fixation in S1-S4 in an adult population using 3D imaging techniques. METHODS Computed tomography (CT) scans were taken of 45 patients and were imported into Mimics (Version 10.01, Materialise, Belgium) software to reconstruct the 3D digital images. Next, a cylinder (radius of 3.5 mm) was drawn to imitate the screw trajectory of a S1-4 AI screw, and every imitated screw in each segment was adjusted to a maximum upward and downward angle to acquire the feasible region. The parameters of the S1-4AI screw trajectories were measured. RESULTS Sacral AI screws could be successfully imitated using 3D digital imaging. The S4AI screw trajectory could be obtained in 19 of 45 patient images (42.2%), while the feasibility rates of S1AI, S2AI, and S3AI screw fixation were 100%, 100%, and 91.1% (41/45), respectively. The feasible regions of S1AI, S2AI, and S3AI screw trajectories were wide enough, while the adjustable angle of S4AI screws was very small. CONCLUSION It is feasible to place S1-2AI screws in the entire adult population and S3-4AI screws in some of the adult population. Furthermore, our study suggested that 3D digital images are suitable to study the feasibility of new screw fixation.
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