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1.
J Pediatr Orthop ; 42(2): e188-e191, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34995261

RESUMO

STUDY DESIGN: Multicenter retrospective study. BACKGROUND: Recent studies have demonstrated diminishing returns in patients with early onset scoliosis (EOS) undergoing repeated lengthening of growing rods. Little is known about whether this same phenomenon occurs in patients with lax connective tissue disease (CTD). The primary purpose of this study is to investigate whether EOS patients with connective tissue laxity disorders have diminishing returns during growth friendly surgery. METHODS: CTD EOS patients below 10 years old, underwent growth friendly spine surgery with distal anchors and at least 1 proximal spine anchor, and had minimum follow-up of 5 years were included in this study. Coronal T1-S1 height at preindex surgery, postindex, and every available lengthening was assessed. Mean coronal height change during early set distractions and late set distractions were calculated for the cohort. To account for varying distraction intervals, we normalized the distractions by the time interval. The outcome parameter was T1-S1 height gain, mm/year. RESULTS: Twenty-one CTD patients were included in this study. Total coronal height (T1-S1) was 26.7MHCcm before index, 32.2 cm at D1-D3, 34.7 cm at D4-D6, and 36.7 cm at D7-L10. There were no significant differences in coronal height gains between early and late distractions (P=0.70). Moreover, when normalized for time, there was no significant difference in net gain per year at different lengthening time points for the CTD group, P=0.59. CONCLUSION: There is no evidence of diminishing returns in coronal T1-S1 height gain in patients with EOS in the setting of CTD. LEVEL OF EVIDENCE: Level III.


Assuntos
Doenças do Tecido Conjuntivo , Escoliose , Criança , Seguimentos , Humanos , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Resultado do Tratamento
2.
J Clin Neurosci ; 95: 112-117, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34929633

RESUMO

Myocardial infarction (MI), and its predictive factors, has been an understudied complication following spine operations. The objective was to assess the risk factors for perioperative MI in elective spine surgery patients as a retrospective case control study. Elective spine surgery patients with a perioperative MI were isolated in the NSQIP. The relationship between MI and non-MI spine patients was assessed using chi-squared and independent samples t-tests. Univariate/multivariate analyses assessed predictive factors of MI. Logistic regression with stepwise model selection was employed to create a model to predict MI occurrence. The study included 196,523 elective spine surgery patients (57.1 yrs, 48%F, 30.4 kg/m2), and 436 patients with acute MI (Spine-MI). Incidence of MI did not change from 2010 to 2016 (0.2%-0.3%, p = 0.298). Spine-MI patients underwent more fusions than patients without MI (73.6% vs 58.4%, p < 0.001), with an average of 1.03 levels fused. Spine-MI patients also had significantly more SPO (5.0% vs 1.8%, p < 0.001) and 3CO (0.9% vs 0.2%, p < 0.001), but less decompression-only procedures (26.4% vs 41.6%, p < 0.001). Spine-MI underwent more revisions (5.3% vs 2.9%, p = 0.003), had greater invasiveness scores (3.41 vs 2.73, p < 0.001) and longer operative times (211.6 vs 147.3 min, p < 0.001). Mortality rate for Spine-MI patients was 4.6% versus 0.05% (p < 0.001). Multivariate modeling for Spine-MI predictors yielded an AUC of 83.7%, and included history of diabetes, cardiac arrest and PVD, past blood transfusion, dialysis-dependence, low preoperative platelet count, superficial SSI and days from operation to discharge. A model with good predictive capacity for MI after spine surgery now exists and can aid in risk-stratification of patients, consequently improving preoperative patient counseling and optimization in the peri-operative period.


Assuntos
Procedimentos Cirúrgicos Eletivos , Infarto do Miocárdio , Estudos de Casos e Controles , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Coluna Vertebral/cirurgia
3.
Spine (Phila Pa 1976) ; 47(1): E1-E9, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34468439

RESUMO

STUDY DESIGN: Cohort study. OBJECTIVE: Our goal was to verify the validity of the global alignment and proportion (GAP) score, SRS-Schwab, and Roussouly theoretical apex of lordosis in predicting mechanical complications in adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: Achieving adequate sagittal alignment is critical to obtain favorable outcomes in ASD surgery. It has been proposed that mechanical complications are largely secondary to postoperative spinal alignment. METHODS: Retrospective review of consecutive primary ASD cases that underwent deformity correction in the same institution over a 5-year period. Association between the 6-week postoperative spinal alignment classification and occurrence of mechanical complications on the last follow-up was assessed using logistic regressions. The discriminant capacity was assessed using the receiver operating characteristic (ROC) curve analysis. RESULTS: 58.3% (N = 49/84) of patients presented with mechanical complications and 32.1% (N = 27/84) underwent revision surgery. GAP score did not show discriminant ability to predict complications (AUC = 0.53, 95% confidence interval [CI] = 0.40-0.66, P = 0.58). Conversely, the SRS-Schwab sagittal modifier score demonstrated a statistically significant (although modest) predictive value for mechanical complications (AUC = 0.67, 95% CI = 0.54-0.79, P = 0.008). There was a significant association between pelvic tilt (PT) (P = 0.03) and sagittal vertical axis (SVA) (P = 0.01) at 6 weeks postoperatively and the occurrence of later mechanical complications. There was no significant association between matched Roussouly theoretical apex of lordosis and final outcome (P = 0.47). CONCLUSION: The results point to the complexity of mechanical failure and the high likelihood that causative factors are multifactorial and not limited to alignment measures. GAP score should be used with caution as it may not explain or predict mechanical failure based on alignment in all populations as originally expected. Future studies should focus on etiology, surgical technique, and patient factors in order to generate a more universal score that can be applied to all populations.Level of Evidence: 4.


Assuntos
Lordose , Fusão Vertebral , Adulto , Estudos de Coortes , Humanos , Lordose/etiologia , Lordose/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia
4.
Spine (Phila Pa 1976) ; 47(2): 128-135, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34690329

RESUMO

STUDY DESIGN: Expert consensus study. OBJECTIVE: This expert panel was created to establish best practice guidelines to identify and treat patients with poor bone health prior to elective spinal reconstruction. SUMMARY OF BACKGROUND DATA: Currently, no guidelines exist for the management of osteoporosis and osteopenia in patients undergoing spinal reconstructive surgery. Untreated osteoporosis in spine reconstruction surgery is associated with higher complications and worse outcomes. METHODS: A multidisciplinary panel with 18 experts was assembled including orthopedic and neurological surgeons, endocrinologists, and rheumatologists. Surveys and discussions regarding the current literature were held according to Delphi method until a final set of guidelines was created with over 70% consensus. RESULTS: Panelists agreed that bone health should be considered in every patient prior to elective spinal reconstruction. All patients above 65 and those under 65 with particular risk factors (chronic glucocorticoid use, high fracture risk or previous fracture, limited mobility, and eight other key factors) should have a formal bone health evaluation prior to undergoing surgery. DXA scans of the hip are preferable due to their wide availability. Opportunistic CT Hounsfield Units of the vertebrae can be useful in identifying poor bone health. In the absence of contraindications, anabolic agents are considered first line therapy due to their bone building properties as compared with antiresorptive medications. Medications should be administered preoperatively for at least 2 months and postoperatively for minimum 8 months. CONCLUSION: Based on the consensus of a multidisciplinary panel of experts, we propose best practice guidelines for assessment and treatment of poor bone health prior to elective spinal reconstructive surgery. Patients above age 65 and those with particular risk factors under 65 should undergo formal bone health evaluation. We also established guidelines on perioperative optimization, utility of various diagnostic modalities, and the optimal medical management of bone health in this population.Level of Evidence: 5.


Assuntos
Conservadores da Densidade Óssea , Fraturas Ósseas , Osteoporose , Absorciometria de Fóton , Adulto , Idoso , Densidade Óssea , Humanos , Osteoporose/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia
5.
Neurosurg Clin N Am ; 33(1): 49-59, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34801141

RESUMO

Connective tissue disorders represent a varied spectrum of syndromes that have important implications for the spine deformity surgeon. Spine surgeons must be aware of these diverse and global manifestations of disease because they have significant impact on perioperative and postoperative outcomes.


Assuntos
Tecido Conjuntivo , Coluna Vertebral , Tecido Conjuntivo/cirurgia , Humanos , Coluna Vertebral/cirurgia
6.
Behav Neurol ; 2021: 2684855, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34777631

RESUMO

Spine surgeries impose risk to the spine's surrounding anatomical and physiological structures especially the spinal cord and the nerve roots. Intraoperative neuromonitoring (IONM) is a technology developed to monitor the integrity of the spinal cord and the nerve roots via the surgery. Transcranial motor evoked potential (TcMEP) (one of the IONM modalities) is adopted to monitor the integrity of the motor pathway of the spinal cord and the motor nerve roots. Recent research suggested that the IONM is conducive as a prognostic tool towards the patient's functional outcome. This paper summarizes the researches of IONM being adopted as a prognostic tool. In addition, this paper highlights the problems associated with the signal parameters as the improvement criteria in the previous researches. Lastly, we review the challenges of TcMEP to achieve a prognostic tool focusing on the factors that could interfere with the generation of a stable TcMEP response. The final section will discuss recommendations for IONM technology to achieve an objective prognostic tool.


Assuntos
Potencial Evocado Motor , Monitorização Neurofisiológica Intraoperatória , Humanos , Procedimentos Neurocirúrgicos , Medula Espinal , Coluna Vertebral/cirurgia
7.
Medicine (Baltimore) ; 100(41): e27515, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731139

RESUMO

ABSTRACT: Retrospective cohort studyTo characterize the learning curve of a spine surgeon during the first 2 years of independent practice by comparing to an experienced colleague. To stratify learning curves based on procedure to evaluate the effect of experience on surgical complexity.The learning curve for spine surgery is difficult to quantify, but is useful information for hospital administrators/surgical programs/new graduates, so appropriate expectations and accommodations are considered.Data from a retrospective cohort (2014-2016) were analyzed at a quaternary academic institution servicing a geographically-isolated, mostly rural area. Procedures included anterior cervical discectomy and fusion, posterior cervical decompression and stabilization, single and 2-level posterior lumbar interbody fusion, lumbar discectomy, and laminectomy. Data related to patient demographics, after-hours surgery, and revision surgery were collected. Operative time was the primary outcome measure, with secondary measures including cerebrospinal fluid leak and early re-operation. Time periods were stratified into 6 month quarters (quarter [Q] 1-Q4), with STATA software used for statistical analysis.There were 626 patients meeting inclusion criteria. The senior surgeon had similar operative times throughout the study. The new surgeon demonstrated a decrease in operative time from Q1 to Q4 (158 minutes-119 minutes, P < .05); however, the mean operative time was shorter for the senior surgeon at 2 years (91 minutes, P < .05). The senior surgeon performed more revision surgeries (odds ratio [OR] 2.5 [95% confidence interval [CI] 1.7-3.6]; P < .001). Posterior interbody fusion times remained longer for the new surgeon, while laminectomy surgery was similar to the senior surgeon by 2 years. There were no differences in rates of cerebrospinal fluid leak (OR 1.2 [95% CI 0.6-2.5]; P > .05), nor reoperation (OR 1.16 [95% CI 0.7-1.9]; P > .05) between surgeons.A significant learning curve exists starting spine practice and likely extends beyond the first 2 years for elective operations.


Assuntos
Vazamento de Líquido Cefalorraquidiano/epidemiologia , Associações de Prática Independente/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Coluna Vertebral/cirurgia , Cirurgiões/estatística & dados numéricos , Adulto , Idoso , Canadá/epidemiologia , Vértebras Cervicais/cirurgia , Competência Clínica/estatística & dados numéricos , Descompressão Cirúrgica/métodos , Discotomia/métodos , Discotomia/tendências , Feminino , Humanos , Associações de Prática Independente/tendências , Laminectomia/métodos , Curva de Aprendizado , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/tendências , Estudos Retrospectivos , População Rural , Fusão Vertebral/métodos
9.
J Orthop Surg (Hong Kong) ; 29(3): 23094990211042237, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34592859

RESUMO

Purpose: To assess whether the magnitude of lengthening in magnetically controlled growing rod (MCGR) surgeries has an immediate or delayed effect on spinal off-loading. Methods: 9 whole porcine spines were instrumented using two standard MCGRs from T9 to L5. Static compression testing using a mechanical testing system (MTS) was performed at three MCGR lengthening stages (0 mm, 2 mm, and 6 mm) in each spine. At each stage, five cycles of compression at 175N with 25 min of relaxation was carried out. Off-loading was derived by comparing the load sustained by the spine with force applied by the MTS to the spine. Micro-CT imaging was subsequently performed. Results: The mean load sustained by the vertebral body before lengthening was 39.69N, and immediately after lengthening was 25.12N and 19.91N at 2 mm and 6 mm lengthening, respectively; decreasing to 10.07N, 8.31N, and 8.17N after 25 minutes of relaxation, at 0 mm, 2 mm, and 6 mm lengthening stages, respectively. There was no significant difference in off-loading between 2 mm and 6 mm lengthening stages, either instantaneously (p = 0.395) or after viscoelastic relaxation (p = 0.958). CT images showed fractures/separations at the level of pedicle screws in six spines and in the vertebral body's growth zone in five spines after 6 mm MCGR lengthening. Conclusion: This study demonstrated MCGRs cause significant off-loading of the spine leading to stress shielding. 6 mm of lengthening caused tissue damage and microfractures in some spines. There was no significant difference in spine off-loading between 2 mm and 6 mm MCGR lengthening, either immediately after lengthening or after viscoelastic relaxation.


Assuntos
Procedimentos Ortopédicos , Parafusos Pediculares , Escoliose , Animais , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Suínos
10.
In Vivo ; 35(6): 3575-3579, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34697197

RESUMO

BACKGROUND/AIM: It is important to perform early intervention on bone metastases using multidisciplinary approaches, however it is difficult to hold frequent meetings between patients and clinicians. We aimed to evaluate the usefulness of a specialized outpatient clinic on bone metastasis, instead of the multidisciplinary approach currently in practice. PATIENTS AND METHODS: We included 31 patients with vertebral metastases of various carcinomas, undergoing surgical treatment by spine surgeons. We divided the patients into two groups before and after their visit to the specialized outpatient clinic (pre and post groups), and compared their clinical characteristics. RESULTS: The post group demonstrated a longer period from consulting the spine surgeon to the surgery than the pre group (p=0.0129). A multivariate logistic regression analysis revealed that the period from spine surgeon consultation to surgery was significantly associated with a specialized outpatient clinic visit (p=0.0460). CONCLUSION: Specialized outpatient clinics on bone metastasis could possibly reduce the burden on spinal surgeons.


Assuntos
Neoplasias Ósseas , Cirurgiões , Instituições de Assistência Ambulatorial , Neoplasias Ósseas/cirurgia , Humanos , Coluna Vertebral/cirurgia
11.
Rev Assoc Med Bras (1992) ; 67(3): 390-394, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468603

RESUMO

OBJECTIVE: The aim of this study is to analyze the relations of heart-type fatty acid-binding protein (H-FABP) and brain-type fatty acid-binding protein (B-FABP) with postoperative cognitive dysfunction (POCD) in elderly patients undergoing spinal surgery. METHODS: One hundred and twenty-five patients who underwent spinal surgery were enrolled in this study. According to whether patients had POCD within 5 days after surgery, the participants were divided into POCD group and non-POCD group. Before surgery and 6 h after surgery, the serum H-FABP and B-FABP contents were detected. RESULTS: There were 33 (26.4%) patients in POCD group, and 92 (73.60%) patients in non-POCD group. After surgery, the serum H-FABP and B-FABP contents in POCD group were significantly higher than those before surgery, respectively (p<0.05), and those in non-POCD group were significantly lower than those before surgery, respectively (p<0.05). After surgery, the serum H-FABP and B-FABP contents in POCD group were significantly higher than those in non-POCD group, respectively (p<0.05). CONCLUSION: The serum H-FABP and B-FABP contents are positively related to the occurrence of POCD in elderly patients undergoing spinal surgery.


Assuntos
Disfunção Cognitiva , Complicações Cognitivas Pós-Operatórias , Coluna Vertebral/cirurgia , Idoso , Encéfalo , Disfunção Cognitiva/etiologia , Proteínas de Ligação a Ácido Graxo , Humanos , Complicações Pós-Operatórias/etiologia
13.
Spine (Phila Pa 1976) ; 46(20): 1428-1435, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34559754

RESUMO

STUDY DESIGN: Single-center, investigator-initiated, prospective cohort study. OBJECTIVE: This study aimed to determine patient-reported reasons for persistent opioid use following elective spine surgery, assess the frequency of withdrawal symptoms, and characterize pain-related care sought after discharge. SUMMARY OF BACKGROUND DATA: Patients are often prescribed opioids at discharge from hospital following surgery. Several studies have shown that a large number of patients fail to discontinue opioid treatment and use opioids even months to years after surgery. Spine surgery has proven to be a high-risk procedure in regard to persistent opioid use. There is, however, limited evidence on why patients continue to take opioids. METHODS: Three hundred patients, scheduled to undergo spine surgery at Aarhus University Hospital, Denmark, were included. Baseline characteristics and discharge data on opioid consumption were collected. Data on opioid consumption, patient-reported reasons for opioid use, withdrawal symptoms, and pain-related care sought were collected at 3- and 6-month follow-up via a REDCap survey. RESULTS: Before surgery, opioid use was reported in 53% of patients. Three months after surgery, opioid use was reported in 60% of preoperative opioid-users and in 9% of preoperative opioid non-users. Patients reported the following reasons for postoperative opioid use: treatment of surgery-related pain (53%), treatment of surgery-related pain combined with other reasons (37%), and reasons not related to spine surgery (10%). Withdrawal symptoms were experienced by 33% of patients during the first 3 months after surgery and were associated with failure to discontinue opioid treatment (P < 0.001). Half of patients (52%) contacted health care after discharge with pain-related topics the first 3 months. CONCLUSION: Patients use opioids after spine surgery for reasons other than surgery-related pain. Withdrawal symptoms are frequent even though patients are given tapering plans at discharge. Further studies should address how to facilitate successful and safe opioid tapering in patients undergoing spine surgery.Level of Evidence: 3.


Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Coluna Vertebral/cirurgia
14.
BMJ Open ; 11(9): e044342, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535471

RESUMO

OBJECTIVE: To describe the association between intraoperative tissue oxygenation and postoperative troponin elevation in patients undergoing major spine surgery. We hypothesised that a decrease in intraoperative skeletal muscle tissue oxygenation (SmO2) was associated with the peak postoperative cardiac troponin value. DESIGN: This is a prospective cohort study. SETTING: Single-centre, University of California San Francisco Medical Center. PARTICIPANTS: Seventy adult patients undergoing major elective spine surgery. PRIMARY AND SECONDARY OUTCOME MEASURES: High-sensitivity troponin T (hsTnT) was measured in plasma preoperatively and on the first and second day after surgery to assess the primary outcome of peak postoperative hsTnT. Secondary outcomes included MINS and intensive care unit (ICU) admission within 30 days. Skeletal cerebral tissue oxygenation and SmO2 was measured continuously with near-infrared spectroscopy during surgery. The primary exposure variable was time-weighted area under the curve (TW AUC) for SmO2. RESULTS: Mean age was 65 (33-85) years and 59% were female. No significant association was found between TW AUC for SmO2 and peak hsTnT (Spearman's correlation, rs=0.17, p=0.16). A total of 28 (40%) patients had MINS. ICU admission occurred in 14 (40%) in lower vs 25 (71%) in upper half of patients based on TW AUC for SmO2, p=0.008. CONCLUSIONS: Decrease in SmO2 was not a statistically significant predictor for peak troponin value following major spine surgery but is a potential predictor for other postoperative complications. TRIAL REGISTRATION NUMBER: NCT03518372.


Assuntos
Complicações Pós-Operatórias , Coluna Vertebral , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Prospectivos , Coluna Vertebral/cirurgia , Troponina T
16.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(4): 416-419, 2021 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-34363369

RESUMO

Thermal ablation surgery can effectively eliminate bone tumors in the spine and meanwhile reduce damage to the human body. To realize the computer modeling and simulation of spine thermal ablation surgery, it is necessary to ensure the accuracy of both spine modeling and simulation temperature. This review summarizes the research progress of this field and analyzes the prospects from two aspects: computer modeling based on spine segmentation from medical images and simulation calculation of temperature field in ablation surgery. The research on spine segmentation has made great progress, but there are still some problems that prevent it from being applied in clinical simulation. Related research has been trying to solve the problems. For the ablation surgery of the spine, some researchers have tried ablation simulation and obtained simulation results that are relatively consistent with the actual temperature value.


Assuntos
Ablação por Cateter , Hipertermia Induzida , Simulação por Computador , Computadores , Humanos , Coluna Vertebral/cirurgia
17.
Med Phys ; 48(8): 4586-4597, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34214205

RESUMO

PURPOSE: The use of three-dimensional (3D) printing to develop custom phantoms for dosimetric studies in radiotherapy is increasing. The process allows production of phantoms designed to evaluated specific geometries, patients, or patient groups with a defining feature. The ability to print bone-equivalent phantoms has, however, proved challenging. The purpose of this work was to 3D print a series of three similar spine phantoms containing no surgical implants, implants made of titanium, and implants made of carbon fiber, for future dosimetric and imaging studies. Phantoms were evaluated for (a) tissue and bone equivalence, (b) geometric accuracy compared to design, and (c) similarity to one another. METHODS: Sample blocks of PLA, HIPS, and StoneFil PLA-concrete with different infill densities were printed to evaluate tissue and bone equivalence. The samples were used to develop CT to physical (PD) and effective relative electron density (REDeff ) conversion curves and define the settings for printing the phantoms. CT scans of the printed phantoms were obtained to assess the geometry and densities achieved. Mean distance to agreement (MDA) and DICE coefficient (DSC) values were calculated between contours defining the different materials, obtained from design and like phantom modules. HU values were used to determine PD and REDeff and subsequently evaluate tissue and bone equivalence. RESULTS: Sample objects showed linear relationships between HU and both PD and REDeff for both PLA and StoneFil. The PD and REDeff of the objects calculated using clinical CT conversion curves were not accurate and custom conversion curves were required. PLA printed with 90% infill density was found to have a PD of 1.11 ± 0.03 g.cm-3 and REDeff of 1.04 ± 0.02 and selected for tissue- equivalent phantom elements. StoneFil printed with 100% infill density showed a PD of 1.35 ± 0.03 g.cm-3 and REDeff of 1.24 ± 0.04 and was selected for bone-equivalent elements. Upon evaluation of the final phantoms, the PLA elements displayed PD in the range of 1.10 ± 0.03 g.cm-3 -1.13 ± 0.03 g.cm-3 and REDeff in the range of 1.02 ± 0.03-1.06 ± 0.03. The StoneFil elements showed PD in the range of 1.43 ± 0.04 g.cm-3 -1.46 ± 0.04 g.cm-3 and REDeff in the range of 1.31 ± 0.04-1.33 ± 0.04. The PLA phantom elements were shown to have MDA of ≤1.00 mm and DSC of ≥0.95 compared to design, and ≤0.48 mm and ≥0.91 compared like modules. The StoneFil elements displayed MDA values of ≤0.44 mm and DSC of ≥0.98 compared to design and ≤0.43 mm and ≥0.92 compared like modules. CONCLUSIONS: Phantoms which were radiologically equivalent to tissue and bone were produced with a high level of similarity to design and even higher level of similarity of one another. When used in conjunction with the derived CT to PD or REDeff conversion curves they are suitable for evaluating the effects of spinal surgical implants of varying material of construction.


Assuntos
Impressão Tridimensional , Coluna Vertebral , Humanos , Imagens de Fantasmas , Radiometria , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X
18.
Eur Spine J ; 30(9): 2514-2519, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34236504

RESUMO

OBJECTIVE: To identify the different apex and transitional vertebra according to the shape of the pelvis of individuals despite their difference in sagittal alignment using our measurement system. METHODS: Full-spine X-rays using EOS in standard stand-position of 99 volunteers were selected (47 women, 52 men, mean age 31 years old). Validated 3D reconstruction technique allows extraction of spinopelvic parameters, and position and rotation of each vertebra and lumbar disks. Subjects were divided into three groups: low PI (lowPI, n = 37), moderate PI (midPI, n = 52), high PI (highPI, n = 10), with, respectively, a PI below 45°, between 45° and 60° and above 60°. Occurrence of specific position and rotation values of apex and transitional vertebra were assessed in each group. RESULTS: Frequency curves tend to move cranially when the incidence increases except in cervicothoracic where T1 is a constant for all shapes of spine with occurrence approaching 90%. Angulation value of relevant vertebra and lumbar lordosis are significantly positively correlated for the whole population. CONCLUSIONS: Our study allowed the assessment of the distribution of spine curvatures according to the pelvic incidence. It describes the occurrence of localization of the apex and transitional vertebrae according to pelvic incidence. These results should be taken into account during the analysis of the sagittal balance, especially when planning deformity surgery in adults.


Assuntos
Lordose , Curvaturas da Coluna Vertebral , Adulto , Feminino , Humanos , Lordose/diagnóstico por imagem , Lordose/epidemiologia , Lordose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pelve/diagnóstico por imagem , Radiografia , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia
19.
Int J Clin Pract ; 75(10): e14602, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34228856

RESUMO

OBJECTIVE: We compared inhalational and total intravenous anaesthesia about haemodynamic stability and oxidative stress response in vertebral surgery. BACKGROUNDS AND METHODS: Fifty-nine elective vertebral surgery patients were randomly divided into propofol (Group P) and desflurane (Group D) groups. Intraoperative haemodynamic parameters, preoperative and post-operative native thiol, total thiol, disulfide, C-reactive protein (CRP), albumin, cortisol and catalase levels were studied. RESULTS: Post-operative native thiol and total thiol values in Group P were higher (P = .044 and P = .031). Post-operative albumin value in Group P was lower than the preoperative value (P < .001). The post-operative CRP and albumin values in Group D were lower than the preoperative value. The cortisol value was high (P = .03, P < .001 and P < .001). The post-operative albumin value in Group P was higher (P = .03). There is a positive correlation between CRP and disulfide values (P = .017), between albumin and native thiol values (P < .001), between total thiol value (P < .001), between the cortisol value and the disulfide/native thiol value (P = .002) and between native/total thiol value (P = .003) and a negative correlation between disulfide/native thiol value (P = .005), between disulfide/total thiol value (P = .003) and between the native/total thiol value (P = .001). CONCLUSION: Dynamic thiol/disulfide haemostasis reflects oxidative stress. Propofol positively contributes to oxidative stress in elective vertebral surgery.


Assuntos
Anestesia por Inalação , Albumina Sérica Humana , Biomarcadores/metabolismo , Homeostase , Humanos , Estresse Oxidativo , Albumina Sérica Humana/metabolismo , Coluna Vertebral/metabolismo , Coluna Vertebral/cirurgia
20.
Int J Comput Assist Radiol Surg ; 16(10): 1641-1651, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34302263

RESUMO

PURPOSE: In adolescent idiopathic scoliosis (AIS), non-invasive surgical techniques such as anterior vertebral body tethering (AVBT) enable to treat patients with mild and severe degrees of deformity while maintaining lower lumbar motion by avoiding spinal fusion. However, multiple features and characteristics affect the overall patient outcome, notably the 3D spine geometry and bone maturity, but also from decisions taken intra-operatively such as the selected tethered vertebral levels, which makes it difficult to anticipate the patient response. METHODS: We propose here a forecasting method which can be used during AVBT surgery, exploiting the spatio-temporal features extracted from a dynamic networks. The model learns the corrective effect from the spine's different segments while taking under account the time differences in the initial diagnosis and between the serial acquisitions taken before and during surgery. Clinical parameters are integrated through an attention-based decoder, allowing to associate geometrical features to patient status. Long-term relationships allow to ensure regularity in geometrical curve prediction, using a manifold-based smoothness term to regularize geometrical outputs, capturing the temporal variations of spine correction. RESULTS: A dataset of 695 3D spine reconstructions was used to train the network, which was evaluated on a hold-out dataset of 72 scoliosis patients using the baseline 3D reconstruction obtained prior to surgery, yielding an overall reconstruction error of [Formula: see text]mm based on pre-identified landmarks on vertebral bodies. The model was also tested prospectively on a separate cohort of 15 AIS patients, demonstrating the integration within the OR theatre. CONCLUSION: The proposed predictive network allows to intra-operatively anticipate the geometrical response of the spine to AVBT procedures using the dynamic features.


Assuntos
Escoliose , Fusão Vertebral , Adolescente , Humanos , Movimento (Física) , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Vértebras Torácicas , Resultado do Tratamento , Corpo Vertebral
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