Development of a support tool for the clinical diagnosis of symptomatic lumbar intra- and/or extra-foraminal stenosis.

BACKGROUND: Not all lumbar intra- and/or extra-foraminal stenosis (LIEFS) on MRI is symptomatic. Therefore, the establishment of clinical diagnostic tools that can identify patients with symptomatic LIEFS is crucial in the clinical setting. The aim of this study was to develop a support tool for clinical diagnosis of LIEFS. METHODS: Patients with L5 radiculopathy alone were prospectively enrolled. Fifty-one patients with lumbar spinal canal stenosis only at the L4-5 level and 49 patients with LIEFS only at the L5-S1 level were extracted from this cohort. We compared the two groups with regard to 12 variables--three subjective and three objective items from the Japanese Orthopaedic Association (JOA) score; Kemp's sign; results of the lumbar flexion test, Bonnet test, and Freiberg test; pain on sitting; and pain when recumbent--to determine which factors were associated with a high index of clinical suspicion of LIEFS. RESULTS: The significant predictors of a final diagnosis of LIEFS were identified as follows: pain when recumbent, Freiberg and Bonnet test results, and pain on sitting. To develop a diagnostic tool, a scoring system (0-20 points) was formulated on the basis of the contribution ratios of these risk factors. To determine the contribution ratio, an integer score was assigned to the identified risk factors as follows: pain when recumbent = 9 points, Freiberg = 5 points, Bonnet = 3 points, and pain on sitting = 3 points. The Hosmer-Lemeshow statistic for this scoring system was p = 0.063, and confirmed that it was a good model. Receiver operating characteristic (ROC) curve analysis demonstrated a cut-off value of 5 points, an area under the ROC curve of 0.87435, sensitivity of 75.5 %, and specificity of 82.3 %. CONCLUSIONS: We believe that the use of this tool in the clinical setting will improve the accuracy of diagnosing symptomatic LIEFS, which will lead to improved quality of patient care.

Interactive bone drilling using a 2D pointing device to support Microendoscopic Discectomy planning.

PURPOSE: To support preoperative planning of bone drilling for Microendoscopic Discectomy, we present a set of interactive bone-drilling methods using a general 2D pointing device. METHODS: Unlike the existing methods, our framework has the following features: (1) the user can directly cut away arbitrary 3D regions on the volumetrically rendered image, (2) in order to provide a simple interface to end-users, our algorithms make 3D drilling possible through only a general-purpose wheel mouse, (3) to reduce both over-drilling and unnatural drilling of an unintended region, we introduce a smart depth control to ensure the continuity of the cutting operation and (4) a GPU-based rendering scheme for high-quality shading of clipped boundaries. RESULTS: We applied our techniques to some CT data of specific patients. Several experiments confirmed that the user was able to directly drill a 3D complex region on a volumetrically rendered lumber spine through simple mouse operation. Also, our rendering scheme clearly visualizes time-varying drilled surfaces at interactive rates. By comparing simulation results to actual postoperative CT images, we confirmed the user interactively simulates similar cutting to that carried out in real surgery. CONCLUSION: We concluded our techniques perform mouse-based, direct drilling of complex 3D regions with high-quality rendering of drilled boundaries and contribute to preoperative planning of Microendoscopic Discectomy.