Artificial neural networks for the detection of odontoid fractures using the Konstanz Information Miner Analytics Platform.

STUDY DESIGN: An experimental study. PURPOSE: This study aimed to investigate the potential use of artificial neural networks (ANNs) in the detection of odontoid fractures using the Konstanz Information Miner (KNIME) Analytics Platform that provides a technique for computer-assisted diagnosis using radiographic X-ray imaging. OVERVIEW OF LITERATURE: In medical image processing, computer-assisted diagnosis with ANNs from radiographic X-ray imaging is becoming increasingly popular. Odontoid fractures are a common fracture of the axis and account for 10%-15% of all cervical fractures. However, a literature review of computer-assisted diagnosis with ANNs has not been made. METHODS: This study analyzed 432 open-mouth (odontoid) radiographic views of cervical spine X-ray images obtained from dataset repositories, which were used in developing ANN models based on the convolutional neural network theory. All the images contained diagnostic information, including 216 radiographic images of individuals with normal odontoid processes and 216 images of patients with acute odontoid fractures. The model classified each image as either showing an odontoid fracture or not. Specifically, 70% of the images were training datasets used for model training, and 30% were used for testing. KNIME's graphic user interface-based programming enabled class label annotation, data preprocessing, model training, and performance evaluation. RESULTS: The graphic user interface program by KNIME was used to report all radiographic X-ray imaging features. The ANN model performed 50 epochs of training. The performance indices in detecting odontoid fractures included sensitivity, specificity, F-measure, and prediction error of 100%, 95.4%, 97.77%, and 2.3%, respectively. The model's accuracy accounted for 97% of the area under the receiver operating characteristic curve for the diagnosis of odontoid fractures. CONCLUSIONS: The ANN models with the KNIME Analytics Platform were successfully used in the computer-assisted diagnosis of odontoid fractures using radiographic X-ray images. This approach can help radiologists in the screening, detection, and diagnosis of acute odontoid fractures.

Cervical spine fracture in diffuse idiopathic skeletal hyperostosis: A bibliometric analysis.

Objective: The study aimed to assess and investigate cervical spine fracture in diffuse idiopathic skeletal hyperostosis and to identify research trends in cervical spine fracture in diffuse idiopathic skeletal hyperostosis in countries around the world using bibliometric analysis. Method: We examined bibliometric data obtained from the Scopus database collection for the periods 1 January 2000 and 1 January 2022. Authors, institutions, nations, publications, keywords, and references were noted and analyzed. The total number of research articles published on the subject of diffuse idiopathic skeletal hyperostosis was used to calculate the amount of research on that subject undertaken in the study period. A sample of the publication data collected from the Scopus database was then analyzed using the Bibliometric program and used to develop a relationship chart using the Bibliometrix and VOSviewer programs. Results: The number of citations was assumed to be a qualitative measure of the publication. We estimated the impact of the research using several metrics, including the H-index, in the bibliometric analysis of authors, geographic areas, institutes, and references. A total of 52 studies related to cervical spine fractures in diffuse idiopathic skeletal hyperostosis were identified. Only 5.12% of those studies were cited in other publications, for a total of 1410 citations in publications by 342 authors, of whom only two authors had published a single study. Co-authorships occurred at 7.273%. Diseases common in elderly males were often studied retrospectively, and "Diffuse Idiopathic Skeletal Hyperostosis" was a frequently mentioned keyword. Conclusion: The findings of this study provide insights into authors, institutions, key publications, and research trends related to diffuse idiopathic skeletal hyperostosis and can potentially serve as a guide for further studies in the field. The bibliometric analysis of cervical spine fractures in patients with diffuse idiopathic skeletal hyperostosis highlights important contributors, influential papers, geographical trends, and study characteristics in this area of research.

Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review.

This systematic review summarizes existing evidence and outlines the benefits of artificial intelligence-assisted spine surgery. The popularity of artificial intelligence has grown significantly, demonstrating its benefits in computer-assisted surgery and advancements in spinal treatment. This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a set of reporting guidelines specifically designed for systematic reviews and meta-analyses. The search strategy used Medical Subject Headings (MeSH) terms, including "MeSH (Artificial intelligence)," "Spine" AND "Spinal" filters, in the last 10 years, and English- from January 1, 2013, to October 31, 2023. In total, 442 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 220 that matched the criteria, of which 11 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. In total, 11 studies met the eligibility criteria. Analysis of these studies revealed the types of artificial intelligence-assisted spine surgery. No evidence suggests the superiority of assisted spine surgery with or without artificial intelligence in terms of outcomes. In terms of feasibility, accuracy, safety, and facilitating lower patient radiation exposure compared with standard fluoroscopic guidance, artificial intelligence-assisted spine surgery produced satisfactory and superior outcomes. The incorporation of artificial intelligence with augmented and virtual reality appears promising, with the potential to enhance surgeon proficiency and overall surgical safety.

Endoscopic carpal surgery in carpal tunnel syndrome: A systematic review.

Objective: Endoscopic carpal tunnel release has become increasingly popular and has shown the advantage of early recovery of hand function with minimal morbidity. In this systematic review, we aimed to summarize the currently available data and describe the reported advantages and disadvantages of endoscopic carpal tunnel surgery for treating carpal tunnel syndrome. Methods: In this study, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, which is a set of reporting requirements for systematic reviews and meta-analyses. The search strategy with MeSH terms was "MeSH (carpal tunnel syndrome) AND (endoscopic)" Filters: in the last 5 years, English-on February 27th, 2022. A total of 131 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 39 that matched the criteria, of which 14 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. Results: A total of 14 studies met the eligibility criteria. Analysis of those studies found that all types of portals in endoscopic carpal tunnel release reduced postoperative pain at a short-term follow-up. There was no evidence to suggest the superiority of the single- or two-portal techniques in terms of outcomes. In terms of pain relief, symptom resolution, patient satisfaction, duration to return to work, and adverse events, this early use of endoscopic carpal tunnel release produced satisfactory outcomes. Further studies comparing the number of portals are needed. Conclusion: Endoscopic carpal tunnel surgery for treating carpal tunnel syndrome is effective and both single- and dual-portal techniques provide advantages in terms of early recovery and minimal morbidity.

Automatic Detection, Classification, and Grading of Lumbar Intervertebral Disc Degeneration Using an Artificial Neural Network Model.

BACKGROUND AND OBJECTIVES: Intervertebral disc degeneration (IDD) is a common cause of symptomatic axial low back pain. Magnetic resonance imaging (MRI) is currently the standard for the investigation and diagnosis of IDD. Deep learning artificial intelligence models represent a potential tool for rapidly and automatically detecting and visualizing IDD. This study investigated the use of deep convolutional neural networks (CNNs) for the detection, classification, and grading of IDD. METHODS: Sagittal images of 1000 IDD T2-weighted MRI images from 515 adult patients with symptomatic low back pain were separated into 800 MRI images using annotation techniques to create a training dataset (80%) and 200 MRI images to create a test dataset (20%). The training dataset was cleaned, labeled, and annotated by a radiologist. All lumbar discs were classified for disc degeneration based on the Pfirrmann grading system. The deep learning CNN model was used for training in detecting and grading IDD. The results of the training with the CNN model were verified by testing the grading of the dataset using an automatic model. RESULTS: The training dataset of the sagittal intervertebral disc lumbar MRI images found 220 IDDs of grade I, 530 of grade II, 170 of grade III, 160 of grade IV, and 20 of grade V. The deep CNN model was able to detect and classify lumbar IDD with an accuracy of more than 95%. CONCLUSION: The deep CNN model can reliably automatically grade routine T2-weighted MRIs using the Pfirrmann grading system, providing a quick and efficient method for lumbar IDD classification.

Minimally invasive carpal tunnel release: A clinical case study and surgical technique.

Introduction and importance: Carpal tunnel syndrome (CTS) is the most prevalent type of median nerve entrapment neuropathy. CTR surgery with a single limited incision is becoming more widely accepted. A better recovery, less pillar pain, less scarring, and an earlier return to work are the key benefits of single limited incision. This study provides an inquiry report on the surgical method, surgical advice, and outcomes of single limited incision minimally invasive carpal tunnel release for CTS. Case presentation: A 60-year-old female developed carpal tunnel syndrome (CTS). Patient received minimally invasive carpal tunnel release using single limited incision following the failure non operative treatment and the patient was able to return to work with excellent 1-year outcomes. The patient was extremely satisfied with this operative technique. Clinical discussion: This case highlights a successful outcome of a minimal invasive surgery in CTS. Visual efficiency during surgery and full transverse carpal ligament release are both improved with this technique which requires only a single limited incision. The transverse carpal ligament is totally released with this approach. During the operation, median nerves and superficial palmar arches are not injured. Conclusion: This technique has been shown to be effective and safe for minimal invasive surgery. This technique could be of interest to surgeons performing minimal invasive surgery who treat CTS.

An Unusual Chordoma of the Odontoid Process: A Case Report and Literature Review.

The aim of this study is to present a rare case of chordoma in the odontoid process in which the tumor involved the odontoid process and compressed the spinal cord at the craniocervical junction. We report on the effectiveness and successful outcome of anterior microscopic tumor resection combined with posterior occipitocervical fixation and review the current standard treatment. A 39-year-old man presented with sudden dyspnea and quadriparesis caused by an unknown tumor compression at C2. Radiographic examination revealed a large destructive mass at C2 and heterogeneous enhancement. The patient received urgent surgical intervention by microscopic-assisted anterior tumor resection and posterior spinal fixation from the occiput to the C5 level. The pathohistologic reports for cytokeratins, epithelial membrane antigen, and S-100 protein were positive. The final diagnosis was chordoma of the odontoid process. At the 2-year follow-up, the patient's condition had improved, and a postoperative MRI showed no indication of tumor regrowth. Chordoma of the odontoid process or C2 body is very rare. The current standard management is wide tumor resection to prevent recurrence. The combined approach of anterior tumor resection with microscopic assistance and posterior stabilization of the occiput to C5 is the optimal treatment for this condition.

Spinal nerve compression after malunion of vertical sacrum fractures.

INTRODUCTION AND IMPORTANCE: Unstable pelvic ring injuries often occur in high energy traumas. Vertical sacrum fracture is an associated injury. This report describes a late spinal nerve compression that occurred following surgical reduction and fixation of pelvic ring injuries caused by traumatic L5-S1 disc herniation and malposition of the sacral fracture. CASE PRESENTATION: A 61-year-old female presented with radiculopathy in her right leg after surgical reduction and fixation of a sacral and pelvic fracture. Physical examination revealed numbness and weakness of the right leg. Radiographic studies showed spinal compression caused by a fracture spike from the malunion of the sacrum and protruding disc from the L5/S1 level. The fracture spikes were removed by laminectomy and discectomy after which the patient's condition had improved and she had no recurrent symptoms at the one-year follow-up. CLINICAL DISCUSSION: Malunion of a posterior pelvic ring fracture and a herniated adjacent intervertebral disc can cause sacral nerve root compression. This complication can be managed and satisfactory results achieved by surgical intervention. CONCLUSION: Traumatic L5-S1 disc herniation and malposition following surgical reduction and fixation of a sacrum fracture can be avoided. Posterior decompression by laminectomy and discectomy is an effective alternative treatment for patients with this condition.

An unusual presentation of thoracic diffuse idiopathic skeletal hyperostosis (DISH) and video-assisted thoracoscopic surgery (VATS).

INTRODUCTION AND IMPORTANCE: Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease and Forestier and Rotes-Querol disease, is a systemic condition characterized by calcification and ossification of ligaments and entheses which often mainly affects the thoracic spine. Anterior osteophyte compression of the esophagus resulting in dysphagia and dyspepsia is extremely rare in symptomatic thoracic DISH. CASE PRESENTATION: A 72-year-old male presented with dyspepsia and dysphagia for 10 months. A large beak-like anterior osteophyte, detected by a radiographic study and by a Barium esophagogram test at the T9-T10 level of the thoracic spine, was established by gastrointestinal medicine specialists to be the cause of the symptoms. The large anterior osteophyte was removed using video-assisted thoracoscopic surgery (VATS). At the one-year follow-up, the patient's symptoms had significantly improved and there was no recurrence of the osteophyte or the dyspepsia and dysphagia. CLINICAL DISCUSSION: Thoracic DISH rarely presents with dysphagia and dyspepsia due to the greater mobility of the esophagus in the area of the thoracic spine than in the area of the cervical spine. This is the first reported case of symptomatic thoracic DISH treated by anterior thoracic osteophytectomy with VATS. The treatment was effective with no post-operative complications. CONCLUSION: Anterior thoracic osteophytectomy with VATS is an effective surgical treatment option for this condition.

Anterior screw fixation for type II odontoid process fractures: A single-center experience with the double Herbert screw fixation technique (Retrospective cohort study).

BACKGROUND: In type II odontoid fractures with intact transverse ligament as classified by the Anderson and D'Alonzo system, anterior screw fixation offers the best anatomical and functional results. The goal of this study is to review the results of the double screw technique in anterior odontoid surgery using a headless 3.0-mm.-diameter cannulated Herbert screw on patients with odontoid process fractures. METHODS: From January 2015 through March 2019, 12 cases of acute traumatic type II odontoid fractures were treated with double anterior screw fixation using 3.0-mm Herbert screws, slightly smaller than the standard size for Caucasian populations. The data collected included radiographic measurements, postoperative complications, union rate and clinical outcomes in follow-up examinations over an average of 24-months. RESULTS: The age of the 12 patients, 8 males and 4 females, ranged from 17 to 68 years (mean, 38.42 ± 20.14). The fracture type was type IIa in 4 patients (33.33%) and type IIb in 8 patients (66.67%). The period of follow-up was 15-64 months (mean, 31.42 ± 17.37). All the patients had good clinical results after surgery with no postoperative complications. Eleven cases (92%) had achieved bone union with 1 case (8%) of nonunion. In the nonunion case, the patient was a chronic smoker who continued smoking both during treatment and follow-up. CONCLUSIONS: This series of satisfactory clinical results demonstrates that double anterior screw fixation of type II odontoid process fractures using 3.0-mm screws is highly effective in the Thai population. Headless cannulated cancellous screws provide significant biomechanical strength which is not inferior to the traditional screws.

Anterior cervical spine surgery for treatment of secondary dysphagia associated with cervical myelopathy in patient with Forestier's disease.

INTRODUCTION: and importance: Forestier's disease, also known as a vertebral ankylosing hyperostosis or Diffuse Idiopathic Skeletal Hyperostosis (DISH), is a non-inflammatory enthesopathy that affects primarily elderly males and ossifies the anterolateral spine while sparing the intervertebral discs and joint spaces, especially at the cervical spine. Forestier's disease has resulted in the growth of large anterior cervical osteophytes that may compress the pharyngoesophageal region, producing dysphagia. However, symptomatic Forestier's disease presenting with dysphagia and cervical myelopathy is rarely observed. CASE PRESENTATION: A 48-year-old male presented with progressive dysphagia and cervical myelopathy. Based on the presence of radiographic study, Forestier's disease was suspected. Large anterior cervical osteophytes at C4-C6 levels compressed the pharyngoesophageal structure posteriorly. Multilevel degenerative discs compressing the C4 to C6 spinal cord were also seen on sagittal MRI T2-weighted images. Anterior cervical osteophytectomy with anterior cervical discectomy and fusion (ACDF) were performed. The patient made a complete neurological recovery and had no recurrent symptoms at the 5-year follow-up. The patient was extremely satisfied with this treatment and can improved his quality of life (QOL). CLINICAL DISCUSSION: Treatment of symptomatic Forestier's disease with secondary dysphagia and cervical myelopathy is rare evidenced by the dearth of reports on surgical treatment. Surgical intervention appears to be safe, effective, and able to halt disease progression. CONCLUSION: Anterior cervical osteophytectomy combined with ACDF with plate fixation is a preferred technique in both neural decompression and swallowing improvement. Surgical intervention, we consider, provides superior results than prolonged non-surgical treatments.