Morphometric analysis of cervical disc space height and interpedicular distance using computed tomography.

Background: This study utilized computed tomography (CT) to establish normative radiographic morphometric measurements of cervical disc space height (DSH) and interpedicular distance (IPD) and document the influence of patient sex, race, ethnicity, and anthropometric characteristics. Methods: Cervical CTs of 1000 patients between 18 and 35 years of age without known spinal pathology were reviewed. Statistical analyses included the assessment of associations between patient height, weight, sex, race, and ethnicity regarding DSH and IPD. Results: Irrespective of disc level, average DSH measurements were as follows: anterior height of 2.6 ± 1.0 mm, middle height of 4.1 ± 1.2 mm, and posterior height of 1.8 ± 1.0 mm. IPD was only measured between C3 and C7 vertebrae, and irrespective of disc level, the mean IPD measurement was 21.1 ± 1.5 mm. Significant differences for anterior, middle, posterior DSH, and IPD were observed in all disc levels. Significant differences in DSH and IPD were observed for all anthropometric factors of sex, race, and ethnicity relative to vertebral level. Males had significantly larger DSH and IPD measurements across all vertebral levels compared to females. Caucasians had larger DSH and IPD at select vertebral levels compared to African Americans and Hispanics. Conclusion: This study describes measurements of DSH and IPD between C2 and T1 levels in 1000 healthy 18-35-year-old subjects without known pathology. DSH and IPD measurements varied based on patient sex, race, ethnicity, and disc level.

Morphometric analysis of cervical neuroforaminal dimensions from C2-T1 using computed tomography of 1,000 patients.

BACKGROUND: Race and sex differences are not consistently reported in the literature. Fundamentally, anatomical differences of cervical neuroforaminal dimensions (CNFD) amongst these groups would be important to know. PURPOSE: To establish normative radiographic morphometric measurements of CNFD and uncover the influence of patient sex, race, and ethnicity while also considering anthropometric characteristics. STUDY DESIGN: Retrospective radiographic morphometric study. PATIENT SAMPLE: A total of 1,000 patients between 18 and 35 years of age who were free of spinal pathology. OUTCOME MEASURES: Foraminal height, axial width, and area of cervical neural foramen. METHODS: Cervical CTs were reviewed to measure CNFD, defined as follows: foraminal height, axial width, and area. Statistical analyses were performed to assess associations between CNFD, and patient height, weight, sex, race, and ethnicity. RESULTS: CNFD measurements followed a bimodal distribution pattern moving caudally from C2-T1. Irrespective of disc level, cervical CNFD were as follows: left and right widths of 6.6±1.5 and 6.6±1.5 mm, heights of 9.4±2.4 and 9.4±3.2 mm, and areas of 60.0±19.5 and 60.6±20.7 mm2. Left and right foraminal width were highest at C2-C3 and lowest at C3-C4. Left and right foraminal height were highest at C7-T1 and C6-C7, respectively and lowest at C3-C4. Left and right foraminal areas were highest at C2-C3 and lowest at C3-C4. Significant differences were observed for all CNFD measurements across disc levels. CNFD did not vary based on laterality. Significant CNFD differences were observed with respect to patient sex, race, and ethnicity. Male height and area were larger compared to females. In contrast, female foraminal width was larger compared to males. The Asian cohort demonstrated the largest foraminal widths. White and Hispanic patients demonstrated the largest foraminal heights and areas. Black patients demonstrated the smallest foraminal widths, heights, and areas. Patient height and weight were only weakly correlated with CNFD measurements across all levels from C2-T1. CONCLUSIONS: This study describes 36,000 normative measurements of 12,000 foramina from C2-T1. CNFD measurements vary based on disc level, but not laterality. Contrasting left- versus right-sided neuroforamina of the same level may aid in determining the presence of unilateral stenosis. Patient sex, race, and ethnicity are associated with CNFD, while patient anthropometric factors are weakly correlated with CNFD.

Biomedical Approaches and Disparities in HIV Prevention.

Human immunodeficiency virus (HIV) remains a significant public concern, with certain groups disproportionately impacted. Pre-exposure prophylaxis (PrEP) for HIV prevention was approved by the Food and Drug Administration in 2012. However, stark disparities persist in PrEP access and uptake, leaving those at highest risk of acquiring HIV without knowledge of, access to, and uptake of PrEP. Nurses play a key role in eliminating the causes of these disparities that occur at the individual, provider, and systemic level. It is imperative that we increase PrEP knowledge, access, and use, especially in groups most at risk for acquiring HIV.

Clinical and Radiographic Outcomes of Anterior Lumbar Interbody Fusion With Anterior Plate Fixation.

BACKGROUND: Reports on the outcomes following instrumented anterior lumbar interbody fusion (ALIF) with anterior plate fixation are limited. The aim of this study was to assess the clinical and radiographic outcomes of patients undergoing ALIF with anterior plate fixation.  Methods: Medical records and radiographic imaging were reviewed for 100 patients who received ALIF with anterior plate fixation between 2008 to 2021 and completed at least one year of follow-up and postoperative imaging. Prospectively collected patient data included indication for surgery, BMI, age, number and location of levels treated, complications, reoperation rates, fusion rate, and measurements of global lordosis, disc space height, and segmental angulation.  Results: A total of 100 patients were included in this study. The mean length of follow-up was 81.37 months. Changes in preoperative-to-postoperative Oswestry Disability Index (ODI) and Visual Analog Score (VAS) demonstrated improvements of 30.86% and 18.56%, respectively. Major vascular injuries occurred in 3% of the cases. A hardware failure rate of 5% was observed. The reoperation rate was 10%. The radiographic fusion rate derived from computed tomography (CT) and plain film was 95.45% and 88.87%, respectively. Postoperative global lordosis demonstrated a 6.08% increase. Postoperative segmental angulation measurements increased by 57.74%. No statistically significant differences in clinical or radiographic outcomes were observed based on the spine level of fusion or the number of fusions performed.  Conclusions: ALIF with anterior plate fixation achieved an adequate fusion rate with improvements in ODI and VAS scores meeting minimal clinically important difference thresholds. Postoperative disc space heights demonstrated significant improvements compared to preoperative measurements.

Correlations among Cervical, Thoracic, and lumbar Hounsfield Unit measurements for assessment of bone mineral density.

OBJECTIVE: Bone mineral density assessment using Hounsfield Unit (HU) currently depends upon the availability of computed tomography (CT) of the lumbar spine. The primary aim of this study was to evaluate the associations among HU measurements of the cervical (CHU), thoracic (THU), and lumbar (LHU) spine. The secondary aim of this study was to analyze the influence of patient demographic and anthropometric characteristics on HU measurements. METHODS: Radiographic records of 165 patients who underwent CT of the cervical, thoracic, and lumbar spine were retrieved. The CHU, THU, and LHU were calculated by obtaining the mean signal intensity from the medullary portions of C3-C7, T8-T12, and L1-L4 vertebral bodies. RESULTS: Mean CHU, THU, and LHU values were 266.26 ± 88.69, 165.57 ± 55.06, and 166.45 ± 51.38. Significant differences of 100.69, 99.81, and 0.88 were observed between CHU and THU (p <.001), CHU and LHU (p <.001), and THU and LHU (p =.023). Correlations of 0.574, 0.488, and 0.686 were observed between CHU and THU (p <.001), CHU and LHU (p <.001), and THU and LHU (p <.001). No differences in HU based on sex, age, height, weight, or ethnicity were observed. Multivariate regression models demonstrated R2 values of 0.770 - 0.790 (p <.001) in prediction of LHU. CONCLUSIONS: Hounsfield Unit measurements derived from the cervical and thoracic spine correlate with the validated lumbar Hounsfield Unit. Hounsfield Unit measurements do not vary based on sex, ethnicity, age, height, or weight.

Comparison of L1-S1 neuroforaminal dimensions derived from plain film radiography versus computed tomography.

PURPOSE: To compare measurements of lumbar neuroforaminal dimensions (NFD) derived from plain film radiography (PFR) and computed tomography (CT) of young patients without spinal pathology. METHODS: We analyzed 213 patients between 18 and 35 years of age without spinal pathology who received PFR and CT within one year of each other. NFD were defined as foraminal height, sagittal anterior-to-posterior width, and area. Statistical analyses assessed correlations and differences between PFR- and CT-derived NFD measurements. RESULTS: 111 subjects were female and 102 were male. Significant differences between PFR- and CT-derived NFD measurements were observed for all levels L1-S1, with those for foraminal height listed as follows: 4.10 mm at L1-L2, 1.58 mm at L2-L3, 3.23 mm at L3-L4, 4.27 mm at L4-L5, and 1.75 mm at L5-S1. Regarding foraminal area, these differences were 72.20, 73.45, 61.80, 35.38, and 16.18 mm2, respectively. PFR-derived measurements of NFD were larger compared to those derived from CT across all levels (p < .001). Only weak (0 ≤ r ≤ .4) or moderate (.4 ≤ r ≤ .7) correlations were observed between PFR- and CT-derived NFD measurements for all levels from L1-S1. CONCLUSION: This study describes 9585 measurements from L1-S1 of neuroforaminal measurements derived from CT and plain film radiography from a sample of young patients without spinal pathology. Among these patients, plain film measurements of the neuroforamina are larger compared to those derived from CT for all levels from L1-S1. There is poor correlation and reliability between plain film and CT measurements of neuroforaminal dimensions.

Normative Measurements of L1 to S1 Neuroforaminal Dimensions Derived From Plain Film Radiography, Computed Tomography, and Magnetic Resonance Imaging.

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To report normative measurements of L1 to S1 lumbar neuroforamina on plain film radiography (PFR), computed tomography (CT), and magnetic resonance imaging (MRI), accounting for patients' sex and ethnicity. BACKGROUND: The quantitative criteria fothe diagnosis of neuroforaminal stenosis remains unknown. Acquiring a thorough understanding of normative foraminal dimensions is a key step in formulating objective parameters for neuroforaminal stenosis. PATIENTS AND METHODS: We measured 988 images from 494 patients between 18 and 35 years old without spinal pathology who received PFR, CT, or MRI within 1 year of each other. Neuroforaminal measurements were defined as the height, area, and sagittal and axial widths. Statistical analyses were performed to assess relationships among PFR, CT, and MRI-derived neuroforaminal measurements, as well as the influence of patients' sex and ethnicity. RESULTS: 330 PFR, 377 CT, and 281 MRI were measured. Of these, 213 PFR and CT, 117 PFR and MRI, and 164 MRI and CT intrapatient images were compared. Statistically significant differences were observed among PFR, CT, and MRI measurements across all levels L1 to S1. PFR measurements were larger compared with those derived from CT and MRI. Weak-to-moderate correlations were observed between PFR and CT, PFR and MRI, and CT and MRI, with the magnitude of correlation decreasing caudally from L1 to S1. Variations in neuroforaminal anatomy were observed based on sex and ethnicity. CONCLUSION: This study reports 25,951 measurements of normal L1 to S1 neuroforaminal anatomy assessed by PFR, CT, and MRI. The values reported in this study may be used as normative reference measurements of the lumbar neuroforamina. PFR measurements of the neuroforamina are larger compared with those derived from CT and MRI across all levels from L1 to S1. There is a poor correlation between PFR, CT, and MRI when measuring the lumbar neuroforamina. Differences in neuroforaminal anatomy are evident based on patients' sex and ethnicity.

Analysis of reasons for medical malpractice litigation due to spinal cord stimulator.

Study design: Retrospective cohort study. Introduction: Malpractice claims analysis is performed by several specialties to improve quality of patient care and to identify areas where physicians can improve their practice to mitigate the incidence of committing malpractice. The Food and Drug Administration has flagged over 80,000 injuries caused by spinal cord stimulator (SCS), making them the 3rd most flagged medical device. This study analyzed malpractice claims due to SCS by querying two legal databases widely used in medicolegal research. Methods: Westlaw Edge and VerdictSearch were queried for malpractice cases filed between the years 2000 and 2022 using the keywords "spinal cord stimulator." Case inclusion criteria was defined as a plaintiff's basis of litigation resting on a claim of medical malpractice due to SCS. Additional data collected included date of case hearing, plaintiff sex and age, defendant specialty, verdict ruling, location of the filed claim, payment or settlement amount, and sustained injuries. Result: Of the 1773 reviewed cases, 45 cases were included and categorized as battery or implantable pulse generator malfunction (35.56 %), lead complications (28.89 %), surgical complications (20.00 %), and miscellaneous (15.56 %). Four (8.89 %) cases resulted in settlement, 11 (24.44 %) in a plaintiff verdict, and 30 (68.00 %) resulted in a defendant verdict. Claims filed due to infection related to SCS were more likely to result in a defendant verdict (p = .047), whereas claims filed due to neurological deficit were more likely to result in a plaintiff verdict (p = .020). The average settlement amount for the 4 cases is $1,975,309.61. Conclusion: Our findings suggest obtaining adequate neuroimaging preoperatively with MRIs, disclosing neurological risks specifically paralysis on informed consent, and evaluating radiography intraoperative and postoperatively with anterior-posterior (AP) and lateral x-ray films to ensure proper SCS placement are practices that may mitigate malpractice due to SCS. Battery defects and lead complications were the most common grounds for SCS-related malpractice claims.