A novel technique for posterior lumbar interbody fusion to obtain a good local lordosis angle: anterior-release posterior lumbar interbody fusion.

Herein, we describe a novel posterior lumbar interbody fusion (PLIF) technique with annulus fibrosus (AF) release and the use of expandable cages (called "anterior-release PLIF" [ARPLIF]). In this technique, posterior column osteotomy (PCO) and AF release provide excellent intervertebral mobility. AF release involves circumferentially peeling off the AF above or below the endplate between the fixed vertebrae under radiographic guidance without cutting the AF and anterior longitudinal ligament. Subsequently, high-angle variable-angle expandable cages are used to simultaneously expand both sides before inserting the percutaneous pedicle screws and correcting to achieve good local lumbar lordosis. PCO and AF release achieve excellent intervertebral mobility. Intervertebral mobility and simultaneous expansion of both cages disperse the force on the endplates, reducing cage subsidence, and the high-angle cages facilitate high intervertebral angle creation. The novel ARPLIF intervertebral manipulation technique can promote good local lumbar lordosis formation.

Anterior Placement of Cages in Posterior Lumbar Interbody Fusion for Obtaining Good Lumbar Lordosis Formation.

Introduction: Posterior lumbar interbody fusion (PLIF) is a common treatment for nerve root disease associated with lumbar foraminal stenosis or lumbar spondylolisthesis. At our institution, PLIF is usually performed with high-angle cages and posterior column osteotomy (PLIF with HAP). However, not all patients achieve sufficient segmental lumbar lordosis (SLL). This study determined whether the location of PLIF cages affect local lumbar lordosis formation. Methods: A total of 59 patients who underwent L4/5 PLIF with HAP at our hospital, using the same titanium control cage model, were enrolled in this cohort study. The mean ratio of the distance from the posterior edge of the cage to the posterior wall of the vertebral body/vertebral length (RDCV) immediately after surgery was 16.5%. The patients were divided into two groups according to RDCV <16.5% (group P) and ≥16.5% (group G). The preoperative and 6-month postoperative slip rate (%slip), SLL, local disk angle (LDA), ratio of disk height/vertebral height (RDV), 6-month postoperative RDCV, ratio of cage length/vertebral length (RCVL), and ratio of posterior disk height/anterior disk height at the fixed level (RPA) were evaluated via simple lumbar spine X-ray. The preoperative and 6-month postoperative Japanese Orthopedic Association (JOA) and low back pain visual analog scale (VAS) scores were also evaluated. Results: Groups G and P included 31 and 28 patients, respectively. The preoperative %slip, SLL, LDA, RDV, JOA score, and low back pain VAS score were not significantly different between the groups. In groups G and P, 6-month postoperative %slip, SLL, LDA, RDV, RDCV, RCVL, and RPA were 3.3% and 7.9%, 18.6° and 15.4°, 9.7° and 8.0°, 36.6% and 40.3%, 21.1% and 10.1%, 71.4% and 77.0%, and 56.1% and 67.7%, respectively. The 6-month postoperative SLL, LDA, RDV, RDCV, RCVL, and RPA significantly differed (p=0.03, 0.02, 0.02, <0.001, <0.001, and <0.001, respectively). Conclusions: Anterior PLIF cage placement relative to the vertebral body is necessary for good SLL in PLIF.

Visually induced symptoms questionnaire (VISQ): A subjective evaluation method for biomedical effects induced by stereoscopic 3D video.

The purpose of this paper is to establish an easy-to-use questionnaire for subjective evaluations of visually induced motion sickness (VIMS) and visual fatigue caused by stereoscopic 3D (s3D) images. We reviewed previously used questionnaires and extracted 51 important subjective evaluation items from them. We then recruited 251 participants to observe 3D images designed to easily induce sickness or visual fatigue, and we asked them to respond to the 51 items. As a result of exploratory factor analysis, four factors were extracted according to their factor loadings, and the number of items was reduced to 21. Further processing by confirmatory factor analysis led to the selection of 15 items. Comparing mean ratings for each factor before and after item reduction indicated that item reduction did not significantly affect the participant responses. Therefore, the 15-item Visually Induced Symptoms Questionnaire (VISQ), can be used to evaluate VIMS and s3D visual fatigue.

Differential diagnosis between metastatic and osteoporotic vertebral fractures using sagittal T1-weighted magnetic resonance imaging.

BACKGROUND: Magnetic resonance imaging (MRI) is the most helpful for determining the differential diagnosis between metastatic and osteoporotic vertebral fractures; especially whole spine MRI is effective if patients have multiple spinal metastases. However, it is time-consuming to obtain all planes for all metastatic vertebrae. If we can differentiate these metastatic and osteoporotic vertebral fractures based on only one section and signal intensity, it would save time and be effective for patients with pain. This study investigated the usefulness of sagittal T1-weighted MRI findings in differentiating metastatic and osteoporotic vertebral fractures. METHODS: We retrospectively reviewed patients diagnosed with metastatic or osteoporotic vertebral fractures. Findings characteristic of metastatic fractures were considered: (a) pedicle or posterior element involvement; (b) convex posterior border of the vertebral body; (c) epidural infiltration; and (d) diffuse homogeneous low signal intensity; findings characteristic of osteoporotic compression fractures were also considered: (e) low-signal-intensity band and (f) posterior retropulsion. Chi-square test or Fisher's exact probability test was used to investigate the usefulness of each MRI finding. Intra- and inter-observer reliability analysis was performed. RESULTS: This study comprised 43 patients with metastases (45 vertebrae) and 118 patients with osteoporotic fractures (156 vertebrae). All findings showed significant difference with each fracture (p-value: <0.01 to 0.03). Although each MRI finding exhibited high intra- and inter-observer reliability (κ: 0.66 to 1.00), finding (c) exhibited low reliability. Finding (a) showed high sensitivity (88.9%) and usefulness for screening, and findings (b), (d), (e), and (f) showed high specificity (90.4%-100%) and usefulness for definitive diagnosis. CONCLUSIONS: Characteristic findings with sagittal T1-weighted MRI were useful in the differential diagnosis of metastatic and osteoporotic vertebral fractures. To prevent overlooking metastatic fractures with sagittal T1-weighted MRI, findings of the pedicle or posterior element involvement should be focused on because of its reliability and sensitivity.

Undetectable Changes in Image Resolution of Luminance-Contrast Gradients Affect Depth Perception.

A great number of studies have suggested a variety of ways to get depth information from two dimensional images such as binocular disparity, shape-from-shading, size gradient/foreshortening, aerial perspective, and so on. Are there any other new factors affecting depth perception? A recent psychophysical study has investigated the correlation between image resolution and depth sensation of Cylinder images (A rectangle contains gradual luminance-contrast changes.). It was reported that higher resolution images facilitate depth perception. However, it is still not clear whether or not the finding generalizes to other kinds of visual stimuli, because there are more appropriate visual stimuli for exploration of depth perception of luminance-contrast changes, such as Gabor patch. Here, we further examined the relationship between image resolution and depth perception by conducting a series of psychophysical experiments with not only Cylinders but also Gabor patches having smoother luminance-contrast gradients. As a result, higher resolution images produced stronger depth sensation with both images. This finding suggests that image resolution affects depth perception of simple luminance-contrast differences (Gabor patch) as well as shape-from-shading (Cylinder). In addition, this phenomenon was found even when the resolution difference was undetectable. This indicates the existence of consciously available and unavailable information in our visual system. These findings further support the view that image resolution is a cue for depth perception that was previously ignored. It partially explains the unparalleled viewing experience of novel high resolution displays.

Decoding humor experiences from brain activity of people viewing comedy movies.

Humans naturally have a sense of humor. Experiencing humor not only encourages social interactions, but also produces positive physiological effects on the human body, such as lowering blood pressure. Recent neuro-imaging studies have shown evidence for distinct mental state changes at work in people experiencing humor. However, the temporal characteristics of these changes remain elusive. In this paper, we objectively measured humor-related mental states from single-trial functional magnetic resonance imaging (fMRI) data obtained while subjects viewed comedy TV programs. Measured fMRI data were labeled on the basis of the lag before or after the viewer's perception of humor (humor onset) determined by the viewer-reported humor experiences during the fMRI scans. We trained multiple binary classifiers, or decoders, to distinguish between fMRI data obtained at each lag from ones obtained during a neutral state in which subjects were not experiencing humor. As a result, in the right dorsolateral prefrontal cortex and the right temporal area, the decoders showed significant classification accuracies even at two seconds ahead of the humor onsets. Furthermore, given a time series of fMRI data obtained during movie viewing, we found that the decoders with significant performance were also able to predict the upcoming humor events on a volume-by-volume basis. Taking into account the hemodynamic delay, our results suggest that the upcoming humor events are encoded in specific brain areas up to about five seconds before the awareness of experiencing humor. Our results provide evidence that there exists a mental state lasting for a few seconds before actual humor perception, as if a viewer is expecting the future humorous events.