Revisión sistemática de las aplicaciones y límites de la impresión 3D en la cirugía de raquis / Systematic review of the utility and limits of 3D printing in spine surgery

Objetivo: El objetivo principal de este estudio ha sido demostrar por qué la impresión aditiva permite hacer más visibles y entendibles los procesos patológicos quirúrgicos complejos que afectan al raquis, aumentando la precisión, la seguridad y la fiabilidad del procedimiento quirúrgico.MetodologíaSe realizó una revisión sistemática de los trabajos publicados en los últimos 10 años, sobre la cirugía de raquis asistida por impresión 3D, de acuerdo con la declaración PRISMA 2020. Con las palabras clave «printing 3D» y «spine surgery» se hicieron búsquedas en las bases de datos Pubmed, Embase, Cochrane Database of Systematic Reviews, Google Scholar y Opengrey, que se completó con la búsqueda manual a través de la lista de referencias bibliográficas de los artículos que fueron seleccionados siguiendo los criterios de inclusión y exclusión definidos.ResultadosDel análisis de los 38 estudios seleccionados resultó que la impresión 3D es útil en la planificación quirúrgica, en la enseñanza médica, en la relación médico-paciente, así como en el diseño de plantillas de navegación e implantes de raquis y, en investigación, ofreciendo un magnífico apoyo al proceder quirúrgico.ConclusionesEl uso de biomodelos impresos de forma tridimensional permite: hacer más visibles y entendibles los procesos patológicos quirúrgicos complejos que afectan al raquis; aumentar la exactitud, precisión y seguridad del procedimiento quirúrgico; y abrir la posibilidad de poner en práctica tratamientos personalizados, fundamentalmente en la cirugía tumoral. (AU)

Objective: The main objective of this study has been to demonstrate why additive printing allows to make complex surgical pathological processes that affect the spine more visible and understandable, increasing precision, safety and reliability of the surgical procedure.MethodsA systematic review of the articles published in the last 10 years on 3D printing-assisted spinal surgery was carried out, in accordance with PRISMA 2020 declaration. Keywords «3D printing» and «spine surgery» were searched in Pubmed, Embase, Cochrane Database of Systematic Reviews, Google Scholar and Opengrey databases, which was completed with a manual search through the list of bibliographic references of the articles that were selected following the defined inclusion and exclusion criteria.ResultsFrom the analysis of the 38 selected studies, it results that 3D printing is useful in surgical planning, medical teaching, doctor–patient relationship, design of navigation templates and spinal implants, and research, optimizing the surgical process by focusing on the patient, offering magnificent support during the surgical procedure.ConclusionsThe use of three-dimensional printing biomodels allows: making complex surgical pathological processes that affect the spine more visible and understandable; increase the accuracy, precision and safety of the surgical procedure, and open up the possibility of implementing personalized treatments, mainly in tumor surgery. (AU)

Systematic review of the utility and limits of 3D printing in spine surgery.

OBJECTIVE: The main objective of this study has been to demonstrate why additive printing allows to make complex surgical pathological processes that affect the spine more visible and understandable, increasing precision, safety and reliability of the surgical procedure. METHODS: A systematic review of the articles published in the last 10 years on 3D printing-assisted spinal surgery was carried out, in accordance with PRISMA 2020 declaration. Keywords "3D printing" and "spine surgery" were searched in Pubmed, Embase, Cochrane Database of Systematic Reviews, Google Scholar and Opengrey databases, which was completed with a manual search through the list of bibliographic references of the articles that were selected following the defined inclusion and exclusion criteria. RESULTS: From the analysis of the 38 selected studies, it results that 3D printing is useful in surgical planning, medical teaching, doctor-patient relationship, design of navigation templates and spinal implants, and research, optimizing the surgical process by focusing on the patient, offering magnificent support during the surgical procedure. CONCLUSIONS: The use of three-dimensional printing biomodels allows: making complex surgical pathological processes that affect the spine more visible and understandable; increase the accuracy, precision and safety of the surgical procedure, and open up the possibility of implementing personalized treatments, mainly in tumor surgery.

Spinal health in 40 patients in the initial stage of laboural life. Morfogeometric, biological and environmental study.

INTRODUCTION: Assuming that spinal shape is a genetic expression, its analysis and acquired factors could assess their respective contribution to early spine deterioration. MATERIAL AND METHODS: A geometric morphometric analysis was retrospectively performed on sagittal lumbar MRI of young patients with back pain to identify lumbar spine shape changes. Using Geometric Morphometrics, findings were analyzed with anthropometric, radiological, and clinical variables. RESULTS: 80 cases under 26 years of age were collected, 55 men (mean age 22.81) and 25 women (mean age 23.24). MRI abnormalities were reported in 57.5%: single altered disc (N=17), root compromises (N=8), and transition anomalies (35%).In the non-normal MRI subgroup, shape variation included: increased lordosis, enlarged vertebral body, canal stenosis, and lumbarization of S1. In non-Spanish origin patients, lumbar straightening and segmental deformities were prevalent. Morphometrics findings showed that lumbosacral transition anomalies are frequently underreported. CONCLUSIONS: Genetic factors could be the main determinants of abnormality in MRIs under 26 years. The primary markers are transitional abnormalities, segmental deformities, and canal stenosis. In foreign populations, shape changes could suggest spine overload at an early age.

Body Mass Index and sagittal lumbar balance. A geometric morphometrics approach

Geometric Morphometrics (GM) offers a new and interactive way for shape analysis, rarely used in spine morphology study. We used GM to investigate the relationships between being overweight and lumbar sagittal configuration. Age, sex, weight, height and BMI of 152 consecutive spine MRI were retrospectively collected. 66 landmarks were digitized on each midsagittal T2-weighted images. Procrustes superimpositions, Principal Component analysis (PCA), Canonical Variate analysis (CVA), and other multivariate techniques were used to find mean shape consensus and possible shape-BMI covariations. A strong correlation between sagittal lumbar shape and BMI was found. Morphological changes such as telescoping, lordosis and variations in vertebral-disk shape were found to be related with BMI, as well as other common variables such as sex and age. GM helps understand the way in which being overweight influences the lumbar shape. These techniques offer a powerful, reproducible and dynamically interactive method to explore spine shape, with diagnostic, therapeutic and preventive implications. A more extensive use of Geometric Morphometrics in spine shape investigation is proposed

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Lesión medular con normalidad radiológica. Etiología, diagnóstico y problemática médico-legal / Spinal cord injury and normal neuroimaging. Aetiology, diagnosis and medico-legal issues

La objetivación de las lesiones espinales o medulares en accidentes es un tema clásico de discusión tanto en Medicina Asistencial como en Medicina Forense. Un problema particular son los pacientes con daño medular sintomático y neuroimagen normal. Estos casos se denominan con los acrónimos SCIWORA («spinal cord injury without radiographic abnormality»), SCIWNA («spinal cord injury without neuroimaging abnormality») y SCIWORET («spinal cord injury without radiologic evidence of trauma»). Nuestro propósito es revisar los aspectos clínicos, radiológicos y médico-legales de estos cuadros, desconocidos muchas veces para quien no trata habitualmente lesionados medulares. El objetivo principal está centrado en los aspectos médico-legales de estos cuadros. Nuestros resultados cuestionan algunos aspectos del reciente sistema para la valoración de los daños y perjuicios causados a las personas en accidentes de circulación (Ley 35/2015), en los llamados traumatismos cervicales menores. En consecuencia, el tratamiento que la reciente legislación española da a dichos traumatismos podría necesitar ser revisada (AU)

The objective demonstration of minor spinal and spinal-cord lesions following accidents is a classic discussion issue in both Clinical and Forensic Medicine. Particular problems are the patients with symptomatic spinal cord damage and normal neuroimaging. These situations are usually named with acronyms: SCIWORA ("spinal cord injury without radiographic abnormality"), SCIWNA ("apinal cord injury without neuroimaging abnormality"), and SCIWORET ("spinal cord injury without radiological evidence of trauma"). Our purpose is to review the main clinical, radiological, and medico-legal features of these conditions, often unknown by those who are not used to treating spinal cord lesions. The main objective is focused on the medico-legal problems of these conditions. The results of our review places under question some aspects of the recent 35/2015 Spanish Law on accidents compensation, in particular when dealing with minor spinal injuries. Therefore, a review of the recent Spanish law's statements about spinal minor injuries compensation is required (AU)

Are Modic Changes Able to Help Us in Our Clinical Practice? A Study of the Modic Changes in Young Adults During Working Age.

STUDY DESIGN: Modic changes [vertebral endplate spinal changes (VESC)] have been related to degenerative disk disease, and in past decades it was thought that their presence justified the surgical treatment, in particular spinal fusion. OBJECTIVE: The aim of the present study is to investigate its prevalence and features in a population of young workers suffering from low back pain, and explore the eventual relationship with the treatment applied in each case. BACKGROUND DATA: We conducted a retrospectively review of 450 magnetic resonance images from our hospital, in patients with low back pain or sciatica and age below 40. MATERIALS AND METHODS: Age, sex, symptoms predominance, concurrence with other spine disease, VESC type, evolution, level/s of involvement and placement, affected disk location and extent of the disease, disk height, and status of the endplate were recorded. The applied treatment was divided in groups according to the degree of invasiveness of the procedure. RESULTS: Prevalence of VESC was 13.05% predominant in patients over 30 years, and 100% associated to disk degenerative changes. Most frequent features were: type I (54%), lower lumbar region (98%), along with a decreased disk height (68%), and distortion of the disk endplates (98%, P<0.01). The patients with VESC presented a favorable outcome with conservative treatment, but were more frequently associated with invasive treatment, compared with non-VESC patients (P<0.024). CONCLUSIONS: VESC prevalence increases with age, underlying the degenerative causative etiology. Surgical indication should not be stated on the basis of the VESC findings alone, the main factor for indicating surgery depends more on other associated degenerative spinal changes.

El esguince cervical como accidente laboral. Epidemiología y resultados de un protocolo de abordaje multiaxial / Whiplash as a work-related injury. Epidemiology and results of a multiaxial management protocol

Introducción. En España más de un 10% de los accidentes de circulación tienen la consideración de accidentes de trabajo. Entre sus consecuencias un buen número son esguinces cervicales. Sin embargo, pese a su incidencia y repercusión socioeconómica existe poca literatura sobre el esguince cervical laboral. En el presente trabajo revisamos una extensa muestra de estos casos con el objetivo de aportar información sobre el tema, hasta ahora escasa, así como valorar si el perfil de los traumatismos cervicales menores laborales difiere de los no laborales. Material y métodos. Se analizan 690 casos de esguinces cervicales que tuvieron la consideración de accidente laboral, valorados y tratados según un protocolo multiaxial recientemente publicado. El análisis se extiende a la revisión de la literatura al respecto. Resultados. Los resultados muestran particularidades en el grupo laboral, como cifras de baja laboral superiores en conductores, plazos de incapacidad temporal diferentes por profesiones o día del accidente. Algunas lesiones concurrentes como: hernia de disco, síndrome de encrucijada cervicotorácica y afección de hombro se asociaron a periodos de incapacidad temporal más prolongados. La existencia de accidentes laborales previos se asoció también a periodos de baja más dilatados. Conclusiones. Se enfatiza la necesidad de compartir las bases de datos existentes para identificar la incidencia y repercusión de los esguinces cervicales laborales dentro del total de accidentes de circulación. Se detectan algunas deficiencias como falta de información, dispersión de las bases institucionales y discrepancias entre las fuentes en la literatura. Se subraya la importancia de las enfermedades posganglionares y extracervicales, así como de la hernia discal en las evoluciones más prolongadas. Se resalta la utilidad del modelo multiaxial en el diagnóstico, tratamiento y valoración del esguince cervical para reducir el periodo de baja, las secuelas y también para entender la singularidad de los esguinces cervicales laborales (AU)

Introduction. In Spain, more than 10% of road traffic accidents are legally deemed work-related accidents, with whiplash being one of the main resulting injuries. Nevertheless, despite its high incidence and socio-economic repercussions, there are very few studies of work-related whiplash in the literature. In this paper, we review a large sample of these cases with the aim of broadening our scarce knowledge of the subject, and to ascertain whether the profile of work-related whiplash differs from non-work-related whiplash. Material and methods. We studied 690 cases of whiplash deemed to be workplace accidents that were assessed and treated following a recently-published multiaxial protocol. The analysis extended to a review of the applicable literature. Results. The results revealed several peculiarities in the work-related whiplash group, such as higher rates of sick leave for drivers and differing length of temporary disability according to profession or day of the accident. Some whiplash-related injuries, such as disc herniation, thoracic outlet syndrome or shoulder injuries, were associated with longer periods of temporary incapacity. A history of previous work-related accidents was also associated with longer sick leave. Conclusions. We emphasise the need to share the existing databases in order to identify the rate and repercussion of work-related whiplash compared to all road traffic accidents. Certain deficiencies were found, such as a lack of information, dispersion of the institutional databases and discrepancies between the available sources. The relevance of postganglionic and extracervical conditions are underlined, together with disc herniation, in cases with longer clinical courses. A multiaxial model for diagnosing, treating and assessing work-related whiplash is proposed as a method to minimise sick leave, sequelae and to understand the singular profile of work-related whiplash (AU)

Hernias encefálicas. Clasificación, neuropatología y problemas medicolegales / Brain herniations. Classification, Neuropathology and medico-legal problems

Las hernias cerebrales son la causa inmediata del fallecimiento en muchas lesiones neurológicas. Algunos protocolos recientes de actuación neuroquirúrgica han originado nuevas modalidades, como por ejemplo en el llamado síndrome del trefinado. Se requiere, pues, una revisión actualizada del tema, máxime cuando tiene importantes implicaciones medicolegales. Nuestro objetivo es revisar las clasificaciones, adaptarlas a los avances en Neurorradiología y Neurocirugía, y analizar su problemática medicolegal. La actualización de la clasificación y un conocimiento detallado de la fisiopatología de las hernias cerebrales constituyen la mejor orientación para la resolución de problemas forenses en lo relativo a etiología, causalidad y secuelas de las lesiones encefálicas (AU)

Brain herniation is the immediate cause of death in most of neurological lesions. Some recent neurosurgical protocols have promoted new kinds of herniation, like those that occur in the so-called syndrome of the threphined. Therefore, an up-to-date revision of this subject is required in regard of its important medico-legal implications. Our aim is to review the present classifications, adapting them to Neuroimaging and Neurosurgical advances, and analyzing the medical-legal issues of brain herniation. The problems extend not only to Pathology, but also to Clinical Forensic subjects. An up-to-date classification and a more detailed knowledge of the brain herniations physiology and pathology are the best tools to address their forensic problems, in particular those related with etiology, causation and sequels of brain lesions (AU)

Dispositivos interespinosos y hernia discal. Estudio morfogeométrico y clínico de 71 casos tratados con microdiscectomía L4-L5 asociada a colocación de espaciador / Interspinous spacers and disc herniation. Geomorphometric and clinical study of 71 cases treated by L4-L5 microdiscectomy associated to spacer placement

Objetivo: Una indicación controvertida de los espaciadores interespinosos es su utilización complementaria a la discectomía. Actualmente, no existen evidencias sólidas de la eficacia de dicha asociación, lo que podría derivar de la variabilidad en la colocación del espaciador, limitando su labor biomecánica. El presente trabajo busca identificar y analizar la variabilidad de emplazamiento de un espaciador interespinoso, y determinar su relación con el resultado clínico. Material y método: Se estudiaron 71 casos de hernia discal L4-L5 intervenidos en nuestro hospital mediante discectomía y colocación de espaciador interespinoso. Se utilizaron técnicas de morfometría geométrica: análisis procrustes y componentes principales. Se comparan los resultados morfológicos con la lordotización, distracción quirúrgica, así como con variables clínicas (índice de Herron y Turner). Resultados: Se identificó significativa variabilidad morfológica tanto en forma de traslación cráneo-caudal como rotación horaria-antihoraria en la posición del implante. Esta variación no se correlacionó con el resultado clínico, pero sí con variables anatómicas (grado de lordosis), y con aspectos quirúrgicos (distracción adicional del implante). Se detectó, igualmente, un emplazamiento ligeramente diferente en los casos con recidiva. Conclusiones: La morfometría geométrica permite objetivar una elevada variabilidad morfológica en el emplazamiento de los espaciadores interespinosos, que, sin embargo, no parece influir en el resultado clínico, dependiendo más bien del grado de lordosis y distracción. Se apreciaron diferencias de emplazamiento en los casos que recidivaron. Para valorar la eficacia de los espaciadores como complemento de la cirugía discal se requieren estudios con mayor número de casos, que necesariamente deben incluir análisis de variables morfológicas

Objective: A controversial indication of interspinous spacers is their use as a complement to discectomy. At the present time, there is no solid clinical evidence of effectiveness of that association, which might result from variability in spacer positioning, restricting its correct biomechanical actions. In this study our goal was to identify and analyse the variability in the placement of an interspinous spacer, and to investigate its relationship with the clinical results. Materials and methods. We performed a retrospective study on X-ray films from 71 patients suffering from disc herniation in L4-L5 who underwent surgery in our hospital, consisting of: microdiscectomy and biomed interspinous spacer implantation. The geomorphometric techniques used to analyse the data were procrustes superimposition and principal components analysis. We compared the clinical results (using the Herron and Turner scale), segmental lordosis and surgical distraction with the geomorphometric parameters. Results. Significant morphological variability was found in the implant position showing cephalo-caudal translation and clockwise-counterclockwise rotations. This variability did not correlate with clinical results. A relationship with anatomical features (lordosis) and additional surgical distraction was identified. A different morphology of implant-segment configuration was identified in cases with recurrence of disc herniation. Conclusions: Geometric morphometrics allowed identifying high variability in the final placement of interspinous spacers. Nevertheless, it seems not to be related to the clinical outcome, depending rather on the degree of lordosis and distraction. Some differences in segment-implant morphology were identified in cases with recurrences. To assess the effectiveness of spacers, larger studies including morphological and clinical variables are required

[Interspinous spacers and disc herniation. Geomorphometric and clinical study of 71 cases treated by L4-L5 microdiscectomy associated to spacer placement]. / Dispositivos interespinosos y hernia discal. Estudio morfogeométrico y clínico de 71 casos tratados con microdiscectomía L4-L5 asociada a colocación de espaciador.

OBJECTIVE: A controversial indication of interspinous spacers is their use as a complement to discectomy. At the present time, there is no solid clinical evidence of effectiveness of that association, which might result from variability in spacer positioning, restricting its correct biomechanical actions. In this study our goal was to identify and analyse the variability in the placement of an interspinous spacer, and to investigate its relationship with the clinical results. MATERIALS AND METHODS: We performed a retrospective study on X-ray films from 71 patients suffering from disc herniation in L4-L5 who underwent surgery in our hospital, consisting of: microdiscectomy and biomed interspinous spacer implantation. The geomorphometric techniques used to analyse the data were procrustes superimposition and principal components analysis. We compared the clinical results (using the Herron and Turner scale), segmental lordosis and surgical distraction with the geomorphometric parameters. RESULTS: Significant morphological variability was found in the implant position showing cephalo-caudal translation and clockwise-counterclockwise rotations. This variability did not correlate with clinical results. A relationship with anatomical features (lordosis) and additional surgical distraction was identified. A different morphology of implant-segment configuration was identified in cases with recurrence of disc herniation. CONCLUSIONS: Geometric morphometrics allowed identifying high variability in the final placement of interspinous spacers. Nevertheless, it seems not to be related to the clinical outcome, depending rather on the degree of lordosis and distraction. Some differences in segment-implant morphology were identified in cases with recurrences. To assess the effectiveness of spacers, larger studies including morphological and clinical variables are required.

Simulación en patología espinal / Simulation in spinal diseases

La columna es terreno abonado para la simulación, involucrando a diferentes Especialistas (traumatólogos, neurocirujanos, rehabilitadores, médicos de familia, etc.). La simulación requiere la producción intencional de síntomas exagerados o falsos respondiendo a un incentivo externo. Sin embargo, en la práctica, hay dificultades en la demostración de dichos requisitos. Esto origina que algunos simuladores no resulten identificados y que pacientes no simuladores con actitud incongruente sean etiquetados de rentistas, originando distrés iatrógeno y exposición a litigación. Se analiza la simulación en el raquis, proponiendo una modificación terminológica, así como una nueva estrategia de diagnóstico, para evitar errores y reducir tanto el distrés iatrógeno como la ligitabilidad. Basándonos en la experiencia clínico-forense de los autores, se analiza la bibliografía y se propone una semiología uniforme. El abordaje es multidimensional y la estrategia de diagnóstico basada en: anamnesis, exploración y pruebas complementarias, adaptando sus resultados a una terminología uniforme con significado preciso de signos y síntomas (AU)

Simulation is frequent in spinal disease, resulting in problems for specialists like Orthopedic Surgeons, Neurosurgeons, Reumatologists, etc. Simulation requires demonstration of the intentional production of false or exaggerated symptoms following an external incentive. The clinician has difficulties in demonstrating these criteria, resulting in misdiagnosis of simulation or misinterpretation of the normal patient as a simulator, with the possibility of iatrogenic distress and litigation. We review simulation-related problems in spine, proposing a terminological, as well as a diagnostic strategy including clinical and complementary diagnosis, as a way to avoid misinterpretation and minimize the iatrogenic distress and liability. Based on the clinical-forensic author's expertise, the literature is analyzed and the terminology readdressed to develop new terms (inconsistencies, incongruences, discrepancies and contradictions). Clinical semiology and complementary test are adapted to the new scenario. Diagnostic strategy relies on anamnesis, clinical and complementary tests, and adapting them to a uniform terminology with clear meaning of signs and symptoms (AU)

Simulation in spinal diseases.

Simulation is frequent in spinal disease, resulting in problems for specialists like Orthopedic Surgeons, Neurosurgeons, Reumathologists, etc. Simulation requires demonstration of the intentional production of false or exaggerated symptoms following an external incentive. The clinician has difficulties in demonstrating these criteria, resulting in misdiagnosis of simulation or misinterpretation of the normal patient as a simulator, with the possibility of iatrogenic distress and litigation. We review simulation-related problems in spine, proposing a terminological, as well as a diagnostic strategy including clinical and complementary diagnosis, as a way to avoid misinterpretation and minimize the iatrogenic distress and liability Based on the clinical-Forensic author's expertise, the literature is analyzed and the terminology readdressed to develop new terms (inconsistences, incongruences, discrepancies and contradictions). Clinical semiology and complementary test are adapted to the new scenario. Diagnostic strategy relies on anamnesis, clinical and complementary tests, adapting them to a uniform terminology with clear meaning of signs and symptoms.

Estudio preliminar de casos y controles de la morfología axial L4-L5 en la hernia de disco / Preliminary case-control study of axial L4- L5 morphology in disc herniation

Una de las cuestiones discutidas es el papel de los factores genéticos y adquiridos en la etiologia de la hernia de disco. Como expresión genómica, el estudio de la morfología podría clarificar dicho papel. Las recientes técnicas de morfometría geométrica (análisis Procrustes generalizado y estudio de componentes principales, entre otras) permiten analizar la forma desde un enfoque no euclidiano, brindando una nueva via de investigación que puede ser aplicada en el raquis. En el presente trabajo empleamos técnicas de morfometría geométrica para analizar la forma axial L4-L5 en pacientes con hernia de disco (n = 69) y controles sanos (n = 87). Se observó una variabilidad de forma a modo de expansión-contracción coronal, a partir del centro del canal medular. Se hallaron diferencias morfológicas entre los controles y las hernias: potenciales factores de riesgo que afectaron principalmente a las láminas y la orientación interapofisaria, condicionando cambios en la morfología del canal. Los resultados apoyan un origen genético de la variabilidad morfológica, con un importante dimorfismo sexual. No obstante, el cambio más relevante para la discriminación la presencia y la ausencia de hernia fue el tamaño del disco, que varió significativamente con el peso. Nuestros hallazgos contribuyen a mejorar el conocimiento morfológico espinal, y a entender el papel de la forma en la hernia de disco, como expresión de la genética, frente a otros factores etiológicos adquiridos. Las técnicas de morfometría geométrica ofrecen una prometedora vía para la investigación de la columna, recomendándose un mayor uso dada la escasez de publicaciones al respecto...

[Image analysis and processing. Fundaments and applications in neurology and neurosurgery]. / Análisis y proceso de imagen. Fundamentos y aplicaciones en neurología y neurocirugía.

In recent years, image techniques have transformed the diagnosis in Medicine. Nevertheless, they are, by now, far from a widespread clinic and surgical use. Beyond the simple picture inspection, DICOM digital files can be explored by using image analysis/processing techniques in a better way. In practice, clinicians and surgeons usually are limited to 'see' pictures delivered by Radiology. However, image analysis/processing techniques allow the 'client' (neurologist or neuro-surgeon) to accomplish interactive image visualizations, multiplanar or 3D rendering, measurements, pathway visualizations, etc. All these tasks, offer a great advantage in diagnosis, surgical planning, teaching and investigation. This paper revise the fundaments of image analysis techniques in order to emphasize their utility, and to widespread its utilization not in the server (Radiological Department) but, principally, in the client side. Some examples of cranio-spinal pathologies are presented aiming to these objectives.

Análisis y proceso de imagen. Fundamentos y aplicaciones en neurología y neurocirugía / Image analysis and processing. Fundaments and applications in neurology and neurosurgery

Resumen. Las técnicas de diagnóstico por imagen han revolucionado los métodos de detección de enfermedades. Sin embargo, su plena utilización en el ámbito clínico y quirúrgico está lejos de alcanzarse. Más allá de la mera inspección de la imagen, los ficheros digitales pueden explorarse mediante técnicas de análisis y proceso de imagen de una manera muy eficaz. Considerado como un sistema cliente-servidor, el cliente (neurólogo o neurocirujano) sólo puede, habitualmente, visualizar las imágenes suministradas desde el servicio de radiodiagnóstico. Las técnicas de análisis y proceso de imagen, sin embargo, empleadas en el área cliente, permiten visualizaciones interactivas, reconstrucciones, mediciones y otras tareas de gran ayuda en el diagnóstico, planificación operatoria, docencia e investigación. El presente trabajo persigue revisar las bases de estas técnicas, enfatizar su utilidad y extender su empleo no en el lado servidor (radiodiagnóstico), sino en el cliente. Estos procedimientos resultan de especial utilidad en neurociencia. Se analizan diversos ejemplos procedentes de la patología craneoespinal con este objetivo (AU)

Summary. In recent years, image techniques have transformed the diagnosis in Medicine. Nevertheless, they are, by now, far from a widespread clinic and surgical use. Beyond the simple picture inspection, DICOM digital files can be explored by using image analysis/processing techniques in a better way. In practice, clinicians and surgeons usually are limited to ‘see’ pictures delivered by Radiology. However, image analysis/processing techniques allow the ‘client’ (neurologist or neurosurgeon) to accomplish interactive image visualizations, multiplanar or 3D rendering, measurements, pathway visualizations, etc. All these tasks, offer a great advantage in diagnosis, surgical planning, teaching and investigation. This paper revise the fundaments of image analysis techniques in order to emphasize their utility, and to widespread its utilization not in the server (Radiological Department) but, principally, in the client side. Some examples of cranio-spinal pathologies are presented aiming to these objectives (AU)