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1.
Angle Orthod ; 91(3): 307-312, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33909876

RESUMO

OBJECTIVES: To develop a prediction model that combined information derived from chronological age, sex, and the cervical vertebral maturation (CVM) method to predict the pubertal spurt in mandibular growth. MATERIALS AND METHODS: A total of 50 subjects (29 females, 21 males) were selected from the American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection, the University of Michigan Growth Study, and the Denver Child Growth study. A total of 456 lateral cephalograms were analyzed, and a multilevel logistic model was applied. The outcome variable was the presence or absence of the mandibular pubertal growth peak. The predictive variables were chronological age up to the third order, sex, presence or absence of CS 3 interactions between age and sex, age and CS 3, sex and CS 3. RESULTS: The mean age ± standard deviation (SD) at the first cephalogram was 8.2 ± 0.5 years, whereas the mean age at the last cephalogram was 16.5 ± 1.1 years. The mean interval ± SD between two consecutive cephalograms was 1.0 ± 0.1 years. The mean age ± SD at the lateral cephalogram obtained immediately before the mandibular pubertal growth peak was 12.1 ± 1.1 years for females and 13.2 ± 0.8 years for males. The greatest increase in mandibular length occurred after CS 3 in 78% of the subjects. The presence of CS 3, age, second-order age, sex, and the interaction between age and sex were all statistically significant predictors of the mandibular pubertal growth spurt. CONCLUSIONS: CS 3, chronological age, and sex can be used jointly to predict the pubertal peak in mandibular growth.


Assuntos
Vértebras Cervicais , Mandíbula , Determinação da Idade pelo Esqueleto , Cefalometria , Vértebras Cervicais/diagnóstico por imagem , Criança , Feminino , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Reprodutibilidade dos Testes
2.
Praxis (Bern 1994) ; 110(6): 324-335, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33906439

RESUMO

Acute Traumatic Central Cord Syndrome: Etiology, Pathophysiology, Clinical Manifestation, and Treatment Abstract. The acute traumatic central cord syndrome (ATCCS) represents an injury to the spinal cord with disproportionately greater motor impairment of the upper than the lower extremities, with bladder dysfunction and with varying degrees of sensory loss below the level of the respective lesion. The mechanism of ATCCS is most commonly a traumatic hyperextension injury of the cervical spine at the base of an underlying spondylosis and spinal stenosis. The mean age is 53 years, and segments C4 to Th1 are most frequently affected. In addition to medical history and clinical examination, the definitive diagnosis is made by magnetic resonance imaging, where T2-hyperintense lesions are typically observed in the affected spinal cord segment. Surgical decompression (and fusion) of the respective segment is recommended to prevent repetitive trauma to the spinal cord and to stop progression of clinical symptoms. Patients with diagnosed ATCCS and who are treated adequately usually have a good prognosis.


Assuntos
Síndrome Medular Central , Traumatismos da Medula Espinal , Estenose Espinal , Síndrome Medular Central/diagnóstico , Síndrome Medular Central/etiologia , Síndrome Medular Central/terapia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/cirurgia , Estenose Espinal/diagnóstico , Estenose Espinal/etiologia , Estenose Espinal/cirurgia
3.
Zhongguo Gu Shang ; 34(4): 360-2, 2021 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-33896137

RESUMO

OBJECTIVE: To explore the correlation between the curvature of the cervical spine and the degree of cervical disc bulging in young patients with cervical pain. METHODS: The clinical data of 539 young patients with neck pain from January 2015 to December 2018 were retrospectively analyzed. There were 251 males and 288 females, aged 18 to 40 (32.2±6.3) years old. The cervical curvature and cervical disc bulging were measured by cervical X-ray and MRI. According to cervical curvature, the patients were divided into 175 cases of cervical lordosis group (cervical curvature > 7 mm), 163 cases of cervical erection group (0

Assuntos
Cifose , Lordose , Adolescente , Adulto , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Cervicalgia/diagnóstico por imagem , Estudos Retrospectivos , Adulto Jovem
4.
Zhongguo Gu Shang ; 34(4): 372-7, 2021 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-33896140

RESUMO

OBJECTIVE: Using the method of finite element analysis, to compare the biomechanical properties between the plate deviating from the long axis of the cervical spine and the standard placement of the plate in the anterior cervical fusion surgery. METHODS: A healthy female volunteer was selected and CT scan (C1-T1) was performed. Using Mimics 19.0, Geomagic Studio 2015, Solidworks 2018, Ansys Workbench 17.2 to establish a lower cervical spine (C3-C7) model and to verify the reliability of the model. Subsequently, anterior cervical plates of different angles and lengths were placed to establish an anterior cervical discectomy fusion (ACDF) model. Applying 73.6 N axial pressure and 1 NM pure moment on C3 to make the model produce flexion, extension, lateral bending and rotation activities, observed the model stress cloud diagram and recorded the maximum stress value of the instrument and the intervertebral mobility. RESULTS: The lower cervical spine (C3-C7) finite element model was established and verified against the published literature on the range of motion (ROM) of cervical spine. Effect of steel plate offset axis on stress distribution, maximum stress value and intervertebral ROM of internal fixation apparatus was minimal, and the mechanical effect of steel plate offset was less in double section steel plate than in single section steel plate. CONCLUSION: Little effect on the mechanical stability of the cervical spine was anticipated when the anterior cervical plate was not perfectly aligned with the long axis of the cervical spine. If the tilt of the plate in clinical surgery is less than 20°, there is no need to readjust the position of the plate.


Assuntos
Vértebras Cervicais , Fusão Vertebral , Fenômenos Biomecânicos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Análise de Elementos Finitos , Humanos , Amplitude de Movimento Articular , Reprodutibilidade dos Testes
5.
J Orofac Orthop ; 82(3): 187-197, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33725143

RESUMO

PURPOSE: The aim of this study was to comparatively evaluate hand-wrist bones, cervical vertebrae and tooth development stages according to skeletal classification. METHODS: The orthodontic initial records of 297 patients were used and separated into three groups according to the skeletal malocclusion. Three groups including 99 people each were sampled representing malocclusions with Angle classes I, II and III, respectively. The panoramic, cephalometric and hand-wrist radiographs of all patients included in this study were used to compare dental and skeletal maturation indicators. Calcification of teeth was rated according to the system of Demirjian. To evaluate the stage of skeletal maturation hand-wrist radiographs were analyzed according to the Grave and Brown method. Also, Hassel and the Farman method was used to classifying vertebral developmental stages. Spearman rank correlation tests, as well as Fisher exact χ2 tests with r×c tables, were used for the comparison of categorical variables. RESULTS: Hand-wrist, vertebral and dental development stages showed a statistically significant relationship (p < 0.01) for both genders and in all malocclusions. The association between the different maturation indicators used in this study and the type of malocclusion was also statistically significant for both genders. It was observed that the peak period of skeletal maturation according to the hand-wrist radiograph findings correlated with the cervical vertebrae stage C3 in girls (63.2%) and C2-C3 in boys (43.5-43.5%). The weakest correlation was seen between the dental development stages and the skeletal developmental stages in the class II group (r = 0.443-0.220 [girls]; r = 0.604-0.410 [boys]). CONCLUSION: The use of the dental development stage as a reliable indicator of maturation was limited. According to the Demirjian method, the calcification stage of the second molar might indicate that the individual is in the pubertal peak period.


Assuntos
Má Oclusão , Dente , Determinação da Idade pelo Esqueleto , Calcificação Fisiológica , Cefalometria , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Má Oclusão/diagnóstico por imagem , Dente/diagnóstico por imagem , Punho/diagnóstico por imagem
6.
Zhongguo Gu Shang ; 34(1): 45-50, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33666019

RESUMO

OBJECTIVE: To compare accuracy of anterior cervical pedicle screws between assist of rapid prototyping 3D guide plate and free-hand insertion, and evaluate the safety of two methods. METHODS: Eight adult cervical cadaver specimens after formaldehyde immersion, including 4 males and 4 females, aged 32 to 65(40.3±5.6) years old. After X-ray examination to exclude bone damage and deformity, 4 of them (3D guide plate group) randomly selected were for CT scan to obtain DICOM format data, and the data was imported into Mimics software for model, designed the ideal entry point and nail path for anterior cervicaltranspedicular screw (ATPS). After obtaining the personalized guide plate of the nail channel, it was exported as STL data, and the individual guide plate was printed by rapid prototyping and 3D printing technology. In turn, with the assistance of 3D guide plates, one-to-one personalized ATPS screws were placed on the four lower cervical cadaver specimens. Another 4 (free-hand group) lower cervical cadaver specimens were implanted with ATPS screws using free-hand technique. All specimens were performed CT thin-layer scanning and three-dimensional reconstruction after operation. The Tomasino method was used to evaluate the safety of the screws on the CT cross-sectional and sagittal images, to determine whether there was a cortical puncture of the lower and inner edges of the pedicle. According to the CT rating results, gradeⅠandⅡwere safe, and grade Ⅲ- Ⅴ were dangerous.And the accuracy of screws was recorded and analyzed between two groups. RESULTS: Two screws were inserted in each segment from C3 to C7 in 8 adult cadavers. A total of 80 screws were inserted, 40 in the 3D guide plate group, and 40 in the free-hand group. The Tomasino screw rating method was used to evaluate the safety of screw, 21 screws were gradeⅠ, 14 screws were gradeⅡ, 3 screws were grade Ⅲ, 1 screw was grade Ⅳ, 2 screws were grade Ⅴ in 3D guide plate group, while 14 screws were gradeⅠ, 8 screws were gradeⅡ, 8 screws were grade Ⅲ, 6 screws were grade Ⅳ, 2 screws were grade Ⅴ in free-hand group. The safety rate of 3D guide plate group was 87.5%, and 55.0% of the free hand group (χ2=8.7, P=0.003). CONCLUSION: The 3D printing rapid prototyping guide plate assisted insertion of the anterior cervical pedicle screw can significantly improve the accuracy and safety, and provide a theoretical basis for further clinical application.


Assuntos
Vértebras Cervicais , Parafusos Pediculares , Adulto , Idoso , Placas Ósseas , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Impressão Tridimensional
7.
BMC Surg ; 21(1): 170, 2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33781244

RESUMO

BACKGROUND: For a long time, surgical difficulty is mainly evaluated based on subjective perception rather than objective indexes. Moreover, the lack of systematic research regarding the evaluation of surgical difficulty potentially has a negative effect in this field. This study was aimed to evaluate the risk factors for the surgical difficulty of anterior cervical spine surgery (ACSS). METHODS: This was a retrospective cohort study totaling 291 consecutive patients underwent ACSS from 2012.3 to 2017.8. The surgical difficulty of ACSS was defined by operation time longer than 120 min or intraoperative blood loss equal to or greater than 200 ml. Evaluation of risk factors was performed by analyzing the patient's medical records and radiological parameters such as age, sex, BMI, number of operation levels, high signal intensity of spinal cord on T2-weighted images, ossified posterior longitudinal ligament (OPLL), sagittal and coronal cervical circumference, cervical length, spinal canal occupational ratio, coagulation function index and platelet count. RESULTS: Significant differences were reported between low-difficulty and high-difficulty ACSS groups in terms of age (p = 0.017), sex (p = 0.006), number of operation levels (p < 0.001), high signal intensity (p < 0.001), OPLL (p < 0.001) and spinal canal occupational ratio (p < 0.001). Multivariate logistic regression analysis revealed that number of operation levels (OR = 5.224, 95%CI = 2.125-12.843, p < 0.001), high signal intensity of spinal cord (OR = 4.994, 95%CI = 1.636-15.245, p = 0.005), OPLL (OR = 6.358, 95%CI = 1.932-20.931, p = 0.002) and the spinal canal occupational ratio > 0.45 (OR = 3.988, 95%CI = 1.343-11.840, p = 0.013) were independently associated with surgical difficulty in ACSS. A nomogram was established and ROC curve gave a 0.906 C-index. There was a good calibration curve for difficulty estimation. CONCLUSION: This study indicated that the operational level, OPLL, high signal intensity of spinal cord, and spinal canal occupational ratio were independently associated with surgical difficulty and a predictive nomogram can be established using the identified risk factors. Optimal performance was achieved for predicting surgical difficulty of ACSS based on preoperative factors.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nomogramas , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 100(13): e25349, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787636

RESUMO

RATIONALE: Videofluoroscopic swallowing study (VFSS) is a noninvasive radiographic procedure that examines the oral, pharyngeal, and cervical esophageal stages of swallowing. Tracheoesophageal fistula (TEF) is difficult to diagnose depending on its size and location. However, how VFSS can be of benefit in the diagnosis of TEF has not been reported yet. PATIENT CONCERNS: A 64-year-old man who had been tracheostomized post spinal tumor resection surgery at the cervical level 1 to 2, had his tracheostomy tube removed approximately 25 years ago. After decannulation, he reported coughing while swallowing food, foreign sensation in the neck and repeated bouts of pneumonia ever since. DIAGNOSIS: VFSS revealed, for the first time, acquired TEF after tracheostomy decannulation as the cause of repetitive aspiration pneumonia. INTERVENTION: VFSS was performed in this case. OUTCOMES: In the background of suspected TEF based on VFSS results, the patient underwent a computed tomography scan of the chest and airway in the prone position, followed by bronchoscopy, which confirmed the existence of a TEF. He then underwent primary closure of the fistula. The patient had an uneventful recovery and is currently symptom-free 10 months after the surgery. LESSONS: This case alerts clinicians to the possibility of TEF as a diagnosis when the aspirate leaks from the upper esophagus and through the posterior wall of trachea in the esophageal phase of VFSS.


Assuntos
Deglutição/fisiologia , Fístula Traqueoesofágica/diagnóstico , Traqueostomia/efeitos adversos , Broncoscopia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Esôfago/diagnóstico por imagem , Esôfago/fisiologia , Fluoroscopia/métodos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Traqueia/fisiologia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/fisiopatologia
9.
Medicine (Baltimore) ; 100(12): e25202, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761705

RESUMO

ABSTRACT: To introduce a novel technique of using individualized 3D printing occipitocervical fusion instrument (3D-OCF) for the treatment of upper cervical deformity with atlantoaxial joint dislocation.The surgery for deformity of the craniocervical junction area is a challenge in the field of spine. If the surgical deviation is too large to injure the spinal cord or vertebral artery, it will cause catastrophic damage to the patient. Therefore, it is controversial whether these patients should undergo surgical treatment. We provide a novel surgical approach for the challenging upper cervical surgery through 3D-OCF and a typical patient.We present a 54-year-old female patient, who suffered from dizziness and numbness in her limbs for 8 months. After the patient was admitted, we performed the three-dimensional CT scan, modeled using Mimics software 17.0, and designed customized occipitocervical fusion instrument. Besides, we repeatedly perform simulated surgery based on 3D-printed models before surgery.The operative time was 142 minutes and the intraoperative blood loss was 700 mL. X-ray showed reduction of atlantoaxial dislocation and accurate position of internal fixation. The patient's symptoms were significantly relieved: the sensation of dizziness and numbness of limbs was obviously relieved, and the sense of banding in chest, abdomen, and ankle was disappeared. At the last follow-up, imaging showed that 3D-OCF had bone-integration and Syringomyelia was disappeared. The patient's cervical JOA (Japanese Orthopaedic Association) score increased from 10 points to 17 points.Individualized 3D-OCF can improve the safety and accuracy of upper cervical surgery, reduce the operative time and the number of fluoroscopy. Our study provides a novel surgical approach for the challenging upper cervical surgery.


Assuntos
Articulação Atlantoaxial/anormalidades , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Osso Occipital/cirurgia , Impressão Tridimensional , Fusão Vertebral/instrumentação , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/patologia , Perda Sanguínea Cirúrgica , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/patologia , Pessoa de Meia-Idade , Osso Occipital/diagnóstico por imagem , Duração da Cirurgia , Ossificação Heterotópica/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X
10.
Zhonghua Wai Ke Za Zhi ; 59(3): 216-221, 2021 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-33685056

RESUMO

Objectives: To establish a geometric model of the atlantoaxial dislocation and basilar invagination reduction,and examine its value for clinical application. Methods: A retrospective analysis of 35 patients with atlantoaxial dislocation and basilar invagination admitted to the Department of Neurosurgery,First Affiliated Hospital of Chongqing Medical University from May 2018 to May 2020 was conducted.There were 5 males and 30 females,aged (48±15) years(range: 19 to 69 years). The geometric model of the atlantoaxial reduction was established based on the mid-sagittal section of the cervical spine. The relevant data were calculated according to the geometric model before operation,and the fusion cage of the corresponding height was placed into C1-2 facet joint of patient for quantitative reduction. The theoretical reset value, actual reset value, postoperative symptoms and complications were collected. The paired t-test was used to compare the difference between theoretical and actual reset value to verify the reliability of the geometric model. Results: The theoretical vertical reduction distance of all patients was (5.79±2.96) mm(range:1.52 to 10.96 mm),and the actual vertical reduction distance was (7.43±2.96)mm(range: 1.40 to 12.77 mm),and there was no statistical difference between them(t=-1.96,P=0.069).The theoretical reduction angle was (10.80±2.24)°(range: 7.09 to 14.86°), the actual reduction angle was (10.64±7.00)°(range: 3.50 to 20.50°),and there was no statistical difference between them (t=0.09, P=0.933). At 6 months follow-up, 35 patients achieved satisfactory atlanto-axial joint fusion, and the symptoms were relieved. No internal fixation system displacement, fracture, wound infection and other complications occurred. Conclusion: This geometric model can estimate the vertical reduction distance and the reduction angle of the axial before operation,and provide a reference for the height of the fusion cage so as to avoid under or over-reduction.


Assuntos
Articulação Atlantoaxial , Luxações Articulares , Modelos Biológicos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Adulto , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/etiologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Adulto Jovem
11.
JAMA ; 325(10): 942-951, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687463

RESUMO

Importance: Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction worldwide. It remains unknown whether a ventral or dorsal surgical approach provides the best results. Objective: To determine whether a ventral surgical approach compared with a dorsal surgical approach for treatment of cervical spondylotic myelopathy improves patient-reported physical functioning at 1 year. Design, Setting, and Participants: Randomized clinical trial of patients aged 45 to 80 years with multilevel cervical spondylotic myelopathy enrolled at 15 large North American hospitals from April 1, 2014, to March 30, 2018; final follow-up was April 15, 2020. Interventions: Patients were randomized to undergo ventral surgery (n = 63) or dorsal surgery (n = 100). Ventral surgery involved anterior cervical disk removal and instrumented fusion. Dorsal surgery involved laminectomy with instrumented fusion or open-door laminoplasty. Type of dorsal surgery (fusion or laminoplasty) was at surgeon's discretion. Main Outcomes and Measures: The primary outcome was 1-year change in the Short Form 36 physical component summary (SF-36 PCS) score (range, 0 [worst] to 100 [best]; minimum clinically important difference = 5). Secondary outcomes included 1-year change in modified Japanese Orthopaedic Association scale score, complications, work status, sagittal vertical axis, health resource utilization, and 1- and 2-year changes in the Neck Disability Index and the EuroQol 5 Dimensions score. Results: Among 163 patients who were randomized (mean age, 62 years; 80 [49%] women), 155 (95%) completed the trial at 1 year (80% at 2 years). All patients had surgery, but 5 patients did not receive their allocated surgery (ventral: n = 1; dorsal: n = 4). One-year SF-36 PCS mean improvement was not significantly different between ventral surgery (5.9 points) and dorsal surgery (6.2 points) (estimated mean difference, 0.3; 95% CI, -2.6 to 3.1; P = .86). Of 7 prespecified secondary outcomes, 6 showed no significant difference. Rates of complications in the ventral and dorsal surgery groups, respectively, were 48% vs 24% (difference, 24%; 95% CI, 8.7%-38.5%; P = .002) and included dysphagia (41% vs 0%), new neurological deficit (2% vs 9%), reoperations (6% vs 4%), and readmissions within 30 days (0% vs 7%). Conclusions and Relevance: Among patients with cervical spondylotic myelopathy undergoing cervical spinal surgery, a ventral surgical approach did not significantly improve patient-reported physical functioning at 1 year compared with outcomes after a dorsal surgical approach. Trial Registration: ClinicalTrials.gov Identifier: NCT02076113.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Medidas de Resultados Relatados pelo Paciente , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Espondilose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Seguimentos , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Radiografia , Medula Espinal/diagnóstico por imagem , Resultado do Tratamento
12.
Medicine (Baltimore) ; 100(4): e24207, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530213

RESUMO

ABSTRACT: Currently, minute structures, such as cervical nerve roots, can be viewed using magnetic resonance imaging (MRI) sequences; however, studies comparing multiple sequences in the same set of patients are rare. The aim of the study is to compare the diagnostic values of three 3.0-T MRI sequences used in the imaging of cervical nerve roots.This study included 2 phases. In the first phase (n = 45 patients), the most optimal MRI sequence was determined. In the second phase, this MRI sequence was compared with surgical results (n = 31 patients). The three-dimensional double-echo steady-state (3D-DESS), multi-echo data image combination (MEDIC), and 3D sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE) sequences were performed to analyze the image quality. Furthermore, the most optimal MRI sequence was compared with surgical results to determine the agreement rate.The image quality scores of the 3 sequences were significantly different (P < .05). The score for 3D-DESS sequence was superior to that of MEDIC sequence, while the score for 3D-SPACE sequence was the worst. For visualization of compressed nerve roots, 3D-DESS sequence was superior to the other 2 sequences in terms of the total quality score and compressed nerve root score. Therefore, 3D-DESS sequence was used for MRI in 31 patients with cervical spondylosis in the second phase of this study. The diagnostic agreement rate was 93.5%.This study concluded that in patients with cervical radiculopathy, the 3D-DESS sequence is superior to the MEDIC and 3D-SPACE sequences and shows a high agreement rate with the surgical diagnosis.


Assuntos
Vértebras Cervicais/inervação , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Imagem por Ressonância Magnética/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Radiculopatia/diagnóstico , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Imageamento Tridimensional/estatística & dados numéricos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/cirurgia , Adulto Jovem
14.
Medicine (Baltimore) ; 100(6): e24705, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578609

RESUMO

RATIONALE: Pneumococcal meningitis generally develops from bacteremia and is often complicated by multiple organ infection. PATIENT CONCERNS: A 62-year-old man with no previous medical history developed progressive disturbance of consciousness preceded by high-grade fever and headache for a few days. DIAGNOSIS: The patient was diagnosed with pneumococcal meningitis based on meningeal irritation, polymorphonuclear cell-predominant pleocytosis of the cerebrospinal fluid (CSF) and a positive pneumococcal urinary antigen test at a different hospital. Despite the administration of meropenem and vancomycin, his consciousness worsened, and the patient was transferred to our hospital. Marked nuchal stiffness was noted. The patient showed a disturbance of consciousness, with a Glasgow Coma Scale score of E3V2M5. No significant cranial nerve palsy, motor weakness or sensory impairment was observed. CSF examination showed polynuclear cell-predominant pleocytosis of 755/µL. Transthoracic echocardiography revealed infectious endocarditis. INTERVENTIONS: After the detection of penicillin-susceptible Streptococcus pneumoniae, the antibiotic regimen was changed to aminobenzylpenicillin 12 g/d and ceftriaxone 4 g/d, which improved the patient's consciousness and CSF findings. However, marked neck stiffness and neck pain persisted; we performed a systemic investigation that revealed cervical vertebral osteomyelitis and aortic aneurysm. OUTCOMES: After surgical treatment, the patient achieved complete remission of both conditions. LESSONS: We should consider vertebral osteomyelitis as a potential complication of meningitis when nuchal stiffness persists despite an improvement in meningitis.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Meningite Pneumocócica/complicações , Osteomielite/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem
15.
Neurosciences (Riyadh) ; 26(1): 89-92, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33530049

RESUMO

Sprengel deformity is a congenital anomaly arising mainly in the shoulder girdle, associated with elevation of dysplastic scapula. skeletal anomalies, mainly Klippel-Feil syndrome, hemivertebrae, and omovertebral bone may be present along Sprengel anomaly. The omovertebral bone is an abnormal bone that originates from the superomedial edge of the scapula with different insertion points along the posterior cervical spine, seen in about third of the patients with Sprengel anomaly. While cosmetic to functional impairment is a common presentation to the omovertebral bone, cervical myelopathy is a rare presentation. Here, we described our experience, management and follow up of 13-year-old boy presented with cervical myelopathy secondary to the omovertebral bone.


Assuntos
Medula Cervical/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Anormalidades Congênitas/diagnóstico por imagem , Laminectomia , Escápula/anormalidades , Articulação do Ombro/anormalidades , Doenças da Medula Espinal/etiologia , Adolescente , Medula Cervical/cirurgia , Vértebras Cervicais/cirurgia , Anormalidades Congênitas/cirurgia , Humanos , Masculino , Escápula/diagnóstico por imagem , Escápula/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
16.
Spine (Phila Pa 1976) ; 46(5): E310-E317, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534441

RESUMO

STUDY DESIGN: A retrospective case-control study. OBJECTIVE: Investigating the correlation between the facet tropism (FT) and subaxial cervical disc herniation (CDH). SUMMARY OF BACKGROUND DATA: Although debatable, it was widely reported that FT was associated with lumbar disc herniation. However, the exact correlation between FT and subaxial CDH is still unclear. METHODS: Two-hundred patients with any disc herniation at C3/4, C4/5, C5/6, or C6/7 and 50 normal participants without CDH (normal control group) were included in this study. For patients, the cervical levels with CDH and the levels without herniation were classified into the "herniation group" and "patient control group," respectively. Bilateral facet joint angles at C3/4, C4/5, C5/6, and C6/7 on sagittal, axial, and coronal planes were measured on computed tomography (CT). The disc degeneration at each level was assessed on magnetic resonance imaging (MRI). RESULTS: Both the mean difference between left and right facet angles and tropism incidence in herniation group were significantly greater than those in two control groups whenever at C3/4, C4/5, C5/6, or C6/7 level and whenever on sagittal, axial, or coronal plane. The mean differences of angles and tropism incidences in most patient control groups were not significantly greater than those of corresponding normal control groups. The incidence of greater facet angle at the left or right side was not significantly different among the left, central, and right herniation groups. The mean disc degeneration grades in both herniation and patient control groups were significantly higher than those in normal control groups while no difference between herniation and patient control groups. CONCLUSION: The FT on the sagittal, axial, and coronal planes are all associated with CDH in the subaxial cervical spine. The greater facet angle at the left or right side does not affect the side of herniation. The severity of cervical disc degeneration is not associated with FT.Level of Evidence: 3.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Tropismo/fisiologia , Articulação Zigapofisária/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Deslocamento do Disco Intervertebral/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Articulação Zigapofisária/fisiopatologia
17.
Yonsei Med J ; 62(3): 240-248, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33635014

RESUMO

PURPOSE: This study aimed to present our experience with failures in C-TDR and revision surgery outcomes. MATERIALS AND METHODS: We retrospectively examined patients who underwent revision surgery due to the failure of C-TDR between May 2005 to March 2019. Thirteen patients (8 males and 5 females) were included in this study. The mean age was 46.1 years (range: 22-61 years), and the average follow-up period was 19.5 months (range: 12-64 months). The outcome measures of pre- and post-operative neck and arm pain using a visual analogue scale (VAS) and functional impairment were assessed using a modified Japanese Orthopedic Association (JOA) scale and the Neck Disability Index (NDI). RESULTS: The main complaints of patients were posterior neck pain (77%), radiculopathy (62%), and/or myelopathy (62%). The causes of failure of C-TDR were improper indications for the procedure, osteolysis and mobile implant use, inappropriate techniques, and postoperative infection. The most common surgical level was C5-6, followed by C4-5. After revision surgery, the neck and arm pain VAS (preoperative vs. postoperative: 5.46 vs. 1.31; 4.86 vs. 1.08), a modified JOA scale (14.46 vs. 16.69), and the NDI (29.77 vs. 9.31) scores were much improved. CONCLUSION: C-TDR is good surgical option. However, it is very important to adhere to strict surgical indications and contraindications to avoid failure of C-TDR. The results of reoperations were good regardless of the approach. Therefore, various reoperation options could be considered in patients with failed C-TDR.


Assuntos
Reoperação , Substituição Total de Disco , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
18.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 26-32, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448195

RESUMO

Objective: To explore the influence factors of anterior bone loss (ABL) after cervical disc arthroplasty (CDA) and effects of ABL on the clinical and radiographic outcomes. Methods: One hundred and fifty-five patients who underwent single-level Prestige-LP CDA between January 2008 and December 2017 and met the inclusive criteria were enrolled in the study. Perioperative data of patients were collected. The Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and the visual analogue scale (VAS) score were used for clinical outcomes evaluation. Radiographic parameters including cervical lordosis, C 2-7 range of motion (ROM), disc angle, segmental ROM, and the lengths of the upper and lower endplates were assessed on the X-ray films. Device-related complications, including ABL, subsidence, radiographic adjacent segment pathology, and heterotopic ossification, were recorded. Univariate analysis was used to analyze the related factors, and logistic regression analysis was used to screen the influence factors. Patients were grouped according to whether ABL occurred after operation, and the differences in clinical and imaging evaluation parameters were compared. Results: There were 94 cases (60.6%) in the ABL group and 61 cases (39.4%) in the non-ABL group. Univariate analysis showed the significant differences in age, body mass index (BMI), and intraoperative blood loss between the two groups ( P<0.05). However, there was no significant difference in gender, bone mineral density (T value), preoperative blood calcium level, preoperative blood phosphorus level, preoperative alkaline phosphatase level, operative segment, operative time, and follow-up time between the two groups ( P>0.05). Multivariate analysis showed that the age and BMI were influence factors for ABL after CDA ( P<0.05). The JOA score, NDI, and VAS score significantly improved in both groups at 3 months after operation ( P<0.05), and the scores were further improved at last follow-up ( P<0.05). There was no significant difference in JOA score, NDI, and VAS score between the two groups before and after operation ( P>0.05). The preoperative cervical lordosis was significantly smaller in the ABL group than in the non-ABL group ( t=-2.402, P=0.018). At last follow-up, the segmental ROM was significantly greater in the ABL group than in the non-ABL group ( P<0.05), and the lengths of the upper and lower endplates were less in the ABL group than in the non-ABL group ( P<0.05). No significant difference in the other radiographic parameters between the two groups were found ( P>0.05). Prosthesis subsidence occurred in 5 cases (3.2%), including 3 cases in the ABL group and 2 cases in the non-ABL group; the difference between the two groups was not significant ( P=1.000). Heterotopic ossification occurred in 67 cases (43.2%), including 32 cases in the ABL group and 35 cases in the non-ABL group; the difference between the two groups was significant ( χ 2=8.208, P=0.004). High-grade heterotopic ossification was detected in 26 cases (13 cases in the ABL group and 13 cases in the non-ABL group). Twenty-nine cases (18.7%) had radiographic adjacent segment pathology, including 15 cases in the ABL group and 14 cases in non-ABL group; the difference between the two groups was not significant ( χ 2=1.190, P=0.276). Conclusion: The incidence of ABL after CDA was relatively high, which mainly occurred within 3 months after operation, and no longer progressing with stable radiographic features after the first 12 months. Age and BMI were independent influence factors for ABL. ABL does not affect the clinical outcomes but may preserve more ROM of prostheses.


Assuntos
Degeneração do Disco Intervertebral , Substituição Total de Disco , Artroplastia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Seguimentos , Humanos , Degeneração do Disco Intervertebral/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 33-38, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448196

RESUMO

Objective: To compare the predictive abilities of O-C2 angle (O-C2a), O-EA angle (O-EAa), and Oc-Ax angle (Oc-Axa) for development of dysphagia in patients after occipitocervical fusion (OCF). Methods: Between April 2010 and May 2019, 114 patients who underwent OCF and met the selection criteria were selected as the research objects. Among them, 54 were males and 60 were females; they were 14-76 years old, with an average of 50.6 years old. The follow-up time was 13-122 months (median, 60.5 months). The O-C2a, O-EAa, Oc-Axa, and the narrowest oropharyngeal airway space (nPAS) were measured by the lateral X-ray films before operation and at last follow-up, and the differences before and after operation (dO-C2a, dO-EAa, dOc-Axa, and dnPAS) were calculated. Patients were divided into two groups according to whether they had developed postoperative dysphagia. The general data including age, gender, fixed segment, proportion of patients with rheumatoid arthritis (RA), atlantoaxial subluxation (AS), and combined with anterior release surgery (ARS), and imaging indicators were compared between the two groups. The correlations between dO-C2a, dO-EAa, and dOc-Axa and dnPAS in 114 patients were analyzed to further compare the predictive value of three imaging indicators for occurrence of dysphagia after OCF. Results: Dysphagia occurred after OCF in 31 cases with the incidence of 27.2%. There was significant difference in gender between the dysphagia group and the non-dysphagia group ( χ 2=7.940, P=0.005). There was no significant difference between the two groups in age, fixed segment, the proportion of patients with RA, the proportion of patients with AS, and the proportion of patients combined with ARS ( P>0.05). There was no significant difference in O-C2a and Oc-Axa of 114 patients before operation and at last follow-up ( P>0.05). The differences in O-EAa and nPAS were significant ( P<0.05). There was no significant difference in preoperative O-EAa, Oc-Axa, and nPAS between the dysphagia group and the non-dysphagia group ( P>0.05); the difference in the O-C2a was significant ( t=2.470, P=0.016). At last follow-up, the differences in the above imaging indicators were significant ( P<0.05). There were significant differences in the dO-C2a, dO-EAa, dOc-Axa, and dnPAS between the two groups ( P<0.05). Correlation analysis showed that the dO-C2a, dO-EAa, dOc-Axa were all positively correlated with dnPAS ( P<0.05). The dO-C2a≤-5°, postoperative O-EAa≤100°, postoperative Oc-Axa≤65° were all related to postoperative dysphagia ( P<0.05), and the highest risk factor suffering postoperative dysphagia was dO-C2a ≤-5° with a significant OR of 14.4. Conclusion: The dO-C2a, postoperative O-EAa, and postoperative Oc-Axa can be used as the predictive indexes of dysphagia after OCF, among which dO-C2a has the highest predictive value.


Assuntos
Transtornos de Deglutição , Luxações Articulares , Fusão Vertebral , Adolescente , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Adulto Jovem
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