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1.
AANA J ; 91(1): 63-70, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36722785

RESUMO

Currently, there are approximately 1.62 million instrumented spinal surgeries performed each year in the United States. Complex procedures such as wide exposures and composite osteotomies, compounded by the spine's extensive vascular network, often result in major blood loss and increased fibrinolysis. Substantial intraoperative blood loss often necessitates blood transfusion and is a significant predictor of postoperative morbidity. Antifibrinolytic medications have been utilized prophylactically to reduce perioperative blood loss, particularly in surgeries where excessive blood loss is common. Tranexamic acid (TXA), a lysine analog that reversibly binds to plasminogen, inhibits the activation of plasminogen to plasmin, delaying clot degradation. The intravenous and topical administration of TXA during the perioperative period safely and effectively reduces blood loss, transfusion requirements, and/or hospital length of stay in patients undergoing major or complex spine surgery. Although the use of TXA for multilevel spine surgery is increasing, there remains widespread equivocality regarding ideal dosing regimens. Recent evidence suggests that high-dose TXA significantly reduces perioperative blood loss when compared with low-dose TXA, with no increase in perioperative morbidity and mortality. Translating this evidence into sustained change in clinical practice has the potential to improve both outcomes and blood product utilization in patients undergoing major or complex spine surgery.


Assuntos
Antifibrinolíticos , Coluna Vertebral , Ácido Tranexâmico , Humanos , Administração Intravenosa , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Período Perioperatório , Ácido Tranexâmico/uso terapêutico , Coluna Vertebral/cirurgia
2.
Anaesthesiologie ; 72(2): 143-154, 2023 02.
Artigo em Alemão | MEDLINE | ID: mdl-36695838

RESUMO

Over the past 20 years improvements in surgical techniques and perioperative patient care have led to a considerable increase in surgical procedures of the spine worldwide. Therefore, the spectrum was extended from minimally invasive procedures up to complex operations over several segments of the spinal column with high loss of blood and complex perioperative management. This article presents the principal pillars of preoperative, intraoperative and postoperative management relating to spinal surgery. Furthermore, procedure-specific features, such as airway management in cervical spine instability or implementation of intraoperative neuromonitoring are dealt with in detail.


Assuntos
Anestesia , Escoliose , Humanos , Monitorização Intraoperatória/métodos , Coluna Vertebral/cirurgia , Escoliose/cirurgia , Assistência Perioperatória
3.
Clin Nucl Med ; 48(2): 107-111, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36607360

RESUMO

PURPOSE OF THE REPORT: Reduced bone mineral density is a major public health dilemma with high prevalence. Vertebral fracture (VF) is an independent risk factor for fragility fracture. Lateral vertebral assessment (LVA) in dual-energy x-ray absorptiometry is a reliable, low-radiation, accurate, and cost-effective method for VF assessment. PATIENTS AND METHODS: Five hundred seventy-five scans of oncologic and nononcologic patients were retrospectively reviewed irrespective of age or sex. Patients' symptoms, bone mineral density, and risk factors were also evaluated. Scans in which LVA was not acquired or had previously known VFs were excluded. RESULTS: The mean age of patients was 66 ± 11.5 years. Eleven percent of patients had VFs on LVA, of which 7 were excluded due to known VFs. Ten percent had new VFs, most of whom were women (n = 42). The most common risk factor was secondary osteoporosis in women and rheumatoid arthritis in men. Sixty-eight percent of the patients had solitary fractures, whereas 32% had multiple fractures. Most of these patients had underlying osteopenia (n = 19). FRAX was calculated twice: once with the history of personal fracture marked and the other time unmarked as these would not have been discovered if LVA was not acquired. Statistically significant mean percent difference of 5.4% was found in probability of major osteoporotic fracture and 2.1% in the mean risk of hip fracture. CONCLUSIONS: In our population, 10% patients had unsuspected VFs on LVA in dual-energy x-ray absorptiometry scan. Most of these were nononcologic patients with associated risk factors. Based on the FRAX tool, there is a significant difference in the 10-year risk of fracture when unsuspected fractures discovered on LVA are marked.


Assuntos
Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Absorciometria de Fóton/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Estudos Retrospectivos , Coluna Vertebral , Densidade Óssea , Fraturas por Osteoporose/diagnóstico por imagem , Fatores de Risco
4.
Sci Rep ; 13(1): 638, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36635323

RESUMO

Patients with ossification of the ligamentum flavum (OLF) in the lumbar spine may be at high risk of developing concomitant ossification of the entire spinal ligament, but the etiology remains unclear. We investigated the propensity for spinal ligament ossification in asymptomatic subjects with lumbar OLF using the data of 595 Japanese individuals receiving medical check-ups, including computed tomography (CT) scanning. The severity of OLF (total number of intervertebral segments with OLF) of the entire spine on CT was quantified using an OLF index. Subjects with OLF were grouped according to this index: localized OLF (n = 138), intermediate OLF (n = 70), and extensive OLF (n = 31). The proportion of subjects with lumbar OLF increased with increasing OLF index (localized 13.7%, intermediate 41.4%, and extensive 70.9%). Multiple regression analysis found that lumbar OLF index was associated with thoracic OLF index, and co-existence of ossification of the posterior longitudinal ligament (OPLL) of the thoracic and lumbar spine. This study showed that subjects with more multilevel lumbar OLF were more likely to develop multilevel thoracic OLF and to have coexisting OPLL. Patients with lumbar OLF may be a distinctive subgroup with a strong tendency to ossification of the entire spinal ligament.


Assuntos
Ligamento Amarelo , Ossificação do Ligamento Longitudinal Posterior , Ossificação Heterotópica , Humanos , Osteogênese , Ligamento Amarelo/diagnóstico por imagem , Coluna Vertebral , Ligamentos , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/complicações
5.
Sensors (Basel) ; 23(2)2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36679454

RESUMO

Wearable devices are becoming ubiquitous and can be used to better estimate postures and movements to reduce the risk of injuries. Thirty-three participants were recruited in this study to perform two daily repetitive patient transfer tasks while the full body movements were acquired using a set of magneto-inertial wearable devices. The use of wearable devices allowed for the estimation of the forces provoked on the lower back during the entire task performance. In postures where the forces exceeded the warning threshold found in the literature, healthcare workers were considered to have a greater risk of injury. Additionally, the maximum force exerted by each hand to avoid injury to the spinal column was also estimated. Knowing the key anthropometric variables associated with musculoskeletal disorders (MSDs) will enable engineers and researchers to design better assistive devices and injury prevention programs in diverse workplaces.


Assuntos
Dorso , Pessoal de Saúde , Humanos , Fenômenos Biomecânicos , Coluna Vertebral , Análise e Desempenho de Tarefas
6.
Sensors (Basel) ; 23(2)2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36679564

RESUMO

In view of the fact that the aerial images of UAVs are usually taken from a top-down perspective, there are large changes in spatial resolution and small targets to be detected, and the detection method of natural scenes is not effective in detecting under the arbitrary arrangement of remote sensing image direction, which is difficult to apply to the detection demand scenario of road technology status assessment, this paper proposes a lightweight network architecture algorithm based on MobileNetv3-YOLOv5s (MR-YOLO). First, the MobileNetv3 structure is introduced to replace part of the backbone network of YOLOv5s for feature extraction so as to reduce the network model size and computation and improve the detection speed of the target; meanwhile, the CSPNet cross-stage local network is introduced to ensure the accuracy while reducing the computation. The focal loss function is improved to improve the localization accuracy while increasing the speed of the bounding box regression. Finally, by improving the YOLOv5 target detection network from the prior frame design and the bounding box regression formula, the rotation angle method is added to make it suitable for the detection demand scenario of road technology status assessment. After a large number of algorithm comparisons and data ablation experiments, the feasibility of the algorithm was verified on the Xinjiang Altay highway dataset, and the accuracy of the MR-YOLO algorithm was as high as 91.1%, the average accuracy was as high as 92.4%, and the detection speed reached 96.8 FPS. Compared with YOLOv5s, the p-value and mAP values of the proposed algorithm were effectively improved. It can be seen that the proposed algorithm improves the detection accuracy and detection speed while greatly reducing the number of model parameters and computation.


Assuntos
Algoritmos , Tecnologia de Sensoriamento Remoto , Reconhecimento Psicológico , Rotação , Coluna Vertebral
7.
Spine (Phila Pa 1976) ; 48(4): 240-246, 2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36692155

RESUMO

BACKGROUND CONTEXT: Adult spinal deformity (ASD) is a prevalent condition often requiring surgical intervention. Improved outcomes among ASD patients have been shown to correlate with postoperative spinopelvic parameters, yet little is currently known about the role of postural stability and balance assessment for ASD patients. PURPOSE: Explore early changes in postural stability following ASD correction. STUDY DESIGN: Prospective cohort study. PATIENT SAMPLE: Sixteen adult patients who underwent four-level or greater posterolateral fusion to address global spinal malalignment and 14 healthy controls with no known spinal deformity nor surgery. OUTCOME MEASURES: Postural stability parameters, spinopelvic parameters preoperatively and postoperatively. METHODS: Force plate balance assessment was completed where participants and healthy controls were instructed to stand with their hands at their sides, standing still, with eyes open. Center of pressure (COP), center of gravity (COG), and cone of economy (COE) parameters were analyzed with paired and unpaired t tests with an alpha of 0.05. RESULTS: Preoperatively, ASD patients demonstrated more COG (P=0.0244) and sagittal and coronal head (P<0.05) sway than healthy controls. Postoperatively, ASD patients exhibited less COP (P=0.0308), COG (P=0.0276) and head (P=0.0345) sway. Compared to healthy controls, ASD patients postoperatively exhibited similar postural stability, aside from COP and COG sway amplitudes (P<0.05), and coronal head sway (P=0.0309). Pelvic incidence-lumbar lordosis and sagittal vertical axis improved from 16.2° to 4.8° (P<0.01) and 82.2 to 22.5 mm (P<0.01), respectively. CONCLUSION: We report a novel early improvement in postural stability, comparable to healthy controls, following ASD correction that may be related to improved spinopelvic alignment. Force plate evaluation may be a useful tool for ASD patients postoperatively. Future clinical trials assessing the impact of postural stability on clinical and radiographic outcomes are warranted.


Assuntos
Lordose , Fusão Vertebral , Adulto , Humanos , Estudos Prospectivos , Projetos Piloto , Complicações Pós-Operatórias , Lordose/cirurgia , Coluna Vertebral , Estudos Retrospectivos
8.
Spine (Phila Pa 1976) ; 48(4): 288-294, 2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36692159

RESUMO

STUDY DESIGN: A retrospective analysis of magnetic resonance imaging (MRI). OBJECTIVE: The study aimed to evaluate the performance of a convolutional neural network (CNN) to differentiate spinal pyogenic spondylitis from Modic change on MRI. We compared the performance of CNN to that of four clinicians. SUMMARY OF BACKGROUND DATA: Discrimination between pyogenic spondylitis and spinal Modic change is crucial in clinical practice. CNN deep-learning approaches for medical imaging are being increasingly utilized. METHODS: We retrospectively reviewed MRIs from pyogenic spondylitis and spinal Modic change patients. There were 50 patients per group. Sagittal T1-weighted (T1WI), sagittal T2-weighted (T2WI), and short TI inversion recovery (STIR) MRIs were used for CNN training and validation. The deep learning framework Tensorflow was used to construct the CNN architecture. To evaluate CNN performance, we plotted the receiver operating characteristic curve and calculated the area under the curve. We compared the accuracy, sensitivity, and specificity of CNN diagnosis to that of a radiologist, spine surgeon, and two orthopedic surgeons. RESULTS: The CNN-based area under the curves of the receiver operating characteristic curve from the T1WI, T2WI, and STIR were 0.95, 0.94, and 0.95, respectively. The accuracy of the CNN was significantly greater than that of the four clinicians on T1WI and STIR (P<0.05), and better than a radiologist and one orthopedic surgeon on the T2WI (P<0.05). The sensitivity was significantly better than that of the four clincians on T1WI and STIR (P<0.05), and better than a radiologist and one orthopedic surgeon on the T2WI (P<0.05). The specificity was significantly better than one orthopedic surgeon on T1WI and T2WI (P<0.05) and better than both orthopedic surgeons on STIR (P<0.05). CONCLUSION: We differentiated between Modic changes and pyogenic spondylitis using a CNN that interprets MRI. The performance of the CNN was comparable to, or better than, that of the four clinicians.


Assuntos
Coluna Vertebral , Espondilite , Humanos , Estudos Retrospectivos , Coluna Vertebral/patologia , Redes Neurais de Computação , Imageamento por Ressonância Magnética/métodos
9.
Sci Rep ; 13(1): 1283, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36690704

RESUMO

The CT syndesmophyte score (CTSS) can evaluate spinal progression more precisely than mSASSS in ankylosing spondylitis (AS); however, it is complex and time consuming. Here, we propose a simplified CTSS (sCTSS) for measuring spinal structural changes in AS. Patients with AS were recruited from a single tertiary hospital. Baseline and 2-year follow-up whole spine CT images were used to calculate CTSS and sCTSS. The sCTSS used the anterior and posterior vertebral corners, and ranged 0-184. Intraclass correlation coefficients (ICC) were calculated, as well as the smallest detectable changes. Fifty AS patients were included. For reader 1, the mean sCTSS at baseline and 2-year follow-up were 11.7 ± 14.6 and 15.8 ± 16.1, whereas those for reader 2 were 12.0 ± 12.5 and 15.8 ± 15.7, respectively. The ICCs for CTSS at baseline and at 2-year follow-up were 0.97 (95% confidence interval [CI] 0.96-0.99) and 0.98 (0.97-0.99), respectively, and that for changes over the 2 years was 0.48 (95% CI 0.23-0.67). For sCTSS, the ICCs were 0.96 (95% CI 0.92-0.97), 0.97 (95% CI 0.94-0.98), and 0.58 (95% CI 0.36-0.74), respectively. Detection rates for syndesmophyte progression were comparable between CTSS and sCTSS. The detection rate for syndesmophytes on only lateral side was 13.2 and 11.4%, and 11.4 and 15.2% at baseline and 2-year follow-up (reader 1 and 2). sCTSS and CTSS showed similar detection rates for syndesmophyte progression. sCTSS may be a reliable method for evaluating spinal structural damage in AS.


Assuntos
Espondilite Anquilosante , Humanos , Progressão da Doença , Índice de Gravidade de Doença , Coluna Vertebral , Tomografia Computadorizada por Raios X/métodos
10.
BMC Musculoskelet Disord ; 24(1): 29, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36639811

RESUMO

PURPOSE: The prevalence of degenerative spinal deformity (DSD) and the increased cost of correction surgery impose substantial burdens on the health care and insurance system. The aim of our study was to investigate the effects of the implementation of Enhanced Recovery After Surgery (ERAS) protocol on postoperative outcomes after complex spinal surgery. METHODS: A retrospective analysis of prospectively established database of DSD was performed. The consecutive patients who underwent open correction surgery for degenerative spinal deformity between August 2016 and February 2022 were reviewed. We extracted demographic data, preoperative radiographic parameters, and surgery-related variables. The ERAS patients were 1:1 propensity-score matched to a historical cohort by the same surgical team based on age, gender, BMI, and number of levels fused. We then compared the length of hospital stay (LOS), physiological functional recovery, and the rates of complications and readmissions within 90 days after surgery between the groups. RESULTS: There were 108 patients included, 54 patients in the ERAS cohort, and 54 patients matched control patients in the historical cohort. The historical and ERAS cohorts were not significantly different regarding demographic characteristics, comorbidities, preoperative parameters, operative time, and reoperation rate (P > 0.05). Patients in the ERAS group had significantly shorter postoperative LOS (12.0 days vs. 15.1 days, P = 0.001), average days of drain and urinary catheters placement (3.5 days vs. 4.4 days and 1.9 days vs 4.8 days, respectively), and lower 90-day readmission rate (1.8% vs. 12.9%, P = 0.027). The first day of assisted-walking and bowel movement occurred on average 1.9 days (2.5 days vs. 4.4 days, P = 0.001) and 1.7 days (1.9 days vs. 3.6 days, P = 0.001) earlier respectively in the ERAS group. Moreover, the rate of postoperative urinary retention (3.7% vs. 16.7%, P = 0.026) and surgical site infection (0% vs. 7.4%, P = 0.046) were significantly lower with ERAS protocol applied. CONCLUSIONS: Our study confirmed that the ERAS protocol was safe and essential for patients undergoing thoracolumbar deformity surgery for DSD. The ERAS protocol was associated with a shorter postoperative LOS, a lower rate of 90-day readmission, less rehabilitation discharge, and less postoperative complications.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Fusão Vertebral , Humanos , Estudos Retrospectivos , Coluna Vertebral , Infecção da Ferida Cirúrgica , Recuperação de Função Fisiológica , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos
11.
J Zoo Wildl Med ; 53(4): 817-822, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36640085

RESUMO

Raccoon dogs (Nyctereutes procyonoides koreensis), which belong to the Canidae family, are the second most injured wildlife animals rescued by the Gangwon Wildlife Medical Rescue Center. Various imaging evaluation methods including echocardiography have been developed, but thoracic radiography remains essential for the diagnosis and management of heart disease in dogs. In particular, vertebral heart scale (VHS) measurement is usually used to evaluate the dimensions of the heart silhouette on thoracic radiographs and can measure cardiomegaly more objectively. The VHS of 50 raccoon dogs without cardiac diseases were measured using thoracic radiography in right lateral (RL) and ventrodorsal (VD) recumbent positions. The VHS in the RL view of 50 raccoon dogs was 9.03 ± 0.52 vertebrae (v), which was slightly smaller than the VHS measured in the VD view of 46 raccoon dogs (9.79 ± 0.84 v). In addition, the thoracic morphology of raccoon dogs was determined to be intermediate (thoracic depth-to-width ratio, 0.75-1.25), and thoracic morphology, gender, and weight were not significantly correlated with VHS. The VHS of raccoon dogs in this study will help veterinarians diagnose potential cardiac diseases in raccoon dogs.


Assuntos
Cardiopatias , Cães Guaxinins , Animais , Coração/diagnóstico por imagem , Coração/anatomia & histologia , Animais Selvagens , Cardiopatias/veterinária , Coluna Vertebral , República da Coreia
12.
Pain Res Manag ; 2023: 1157611, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36643939

RESUMO

Objective: To explore the influence and potential factors of the bone cement dispersion state on residual pain after vertebral augmentation. Methods: The cases included in this retrospective cohort study were patients treated with vertebral augmentation (VA) for osteoporotic vertebral compression fractures (OVCFs) between July 2018 and June 2021. According to the type of cement diffusion distribution, the patients were divided into a sufficient diffusion group (Group A) and an insufficient diffusion group (Group B). The differences in the baseline data, visual analog scale (VAS), Oswestry disability index score (ODI), injured vertebral height (IVH), and local kyphosis angle (LKA) between the two groups were analyzed. Assessments were performed preoperatively on the 2nd day postoperation and at the last follow-up. The imaging data of injured vertebrae were accurately reconstructed by a GE AW4.7 workstation, and the differences in the vertebral body volume, bone cement volume, and bone cement volume ratio were compared between the groups. Result: After screening, 36 patients were included. (1) The postoperative VAS and ODI scores of the two groups were significantly improved compared with the preoperative scores. (2) On the 2nd day postoperation and the last follow-up, the VAS and ODI scores of Group A were significantly different from those of Group B, and Group A outperformed Group B. (3) The IVH and LKA of the two groups were improved after the operation, and no significant difference was found between the groups. (4) Significant differences were found in the bone cement volume and bone cement volume ratio between the groups, and Group A was larger than Group B. Conclusions: Sufficient bone cement diffusion can reduce residual pain after vertebral augmentation.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Cimentos Ósseos/uso terapêutico , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Coluna Vertebral , Dor
13.
Sci Rep ; 13(1): 598, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36635361

RESUMO

Real haptics is a technology that reproduces the sense of force and touch by transmitting contact information with real objects by converting human movements and the feel of the objects into data. In recent years, real haptics technology has been installed in several surgical devices. A custom-made surgical drill was used to drill into the posterior lamina to verify the time required for penetration detection and the distance the drill advanced after penetration. A surgeon operated with the drill and the same aspects were measured and verified. All experiments were performed on female miniature pigs at 9 months of age with a mean body weight of 23.6 kg (range 9-10 months and 22.5-25.8 kg, n = 12). There were statistically significant differences in the average reaction time and the distance travelled after penetration between a handheld drill and the drill with the penetration detection function (p < 0.001). The reaction time to detect penetration and the distance after penetration were both significantly improved when compared with those of the handheld surgical drill without the penetration detection function, with mean differences of 0.049 ± 0.019 s [95% CI 0.012, 0.086 s] and 2.511 ± 0.537 mm [95% CI 1.505, 3.516 mm]. In this study, we successfully conducted a performance evaluation test of a custom-made haptic interface surgical drill. A prototype high-speed drill with a haptic interface accurately detected the penetration of the porcine posterior lamina.


Assuntos
Interface Háptica , Cirurgiões , Animais , Feminino , Lactente , Suínos , Tato , Percepção do Tato , Interface Usuário-Computador , Coluna Vertebral/cirurgia
14.
BMC Musculoskelet Disord ; 24(1): 57, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36683022

RESUMO

BACKGROUND CONTEXT: Fast-track is an evidence-based multidisciplinary strategy for pre-, intra-, and postoperative management of patients during major surgery. To date, fast-track has not been recognized or accepted in all surgical areas, particularly in orthopedic spine surgery where it still represents a relatively new paradigm. PURPOSE: The aim of this review was provided an evidenced-based assessment of specific interventions, measurement, and associated outcomes linked to enhanced recovery pathways in spine surgery field. METHODS: We conducted a systematic review in three databases from February 2012 to August 2022 to assess the pre-, intra-, and postoperative key elements and the clinical evidence of fast-track protocols as well as specific interventions and associated outcomes, in patients undergoing to spine surgery. RESULTS: We included 57 full-text articles of which most were retrospective. Most common fast-track elements included patient's education, multimodal analgesia, thrombo- and antibiotic prophylaxis, tranexamic acid use, urinary catheter and drainage removal within 24 hours after surgery, and early mobilization and nutrition. All studies demonstrated that these interventions were able to reduce patients' length of stay (LOS) and opioid use. Comparative studies between fast-track and non-fast-track protocols also showed improved pain scores without increasing complication or readmission rates, thus improving patient's satisfaction and functional recovery. CONCLUSIONS: According to the review results, fast-track seems to be a successful tool to reduce LOS, accelerate return of function, minimize postoperative pain, and save costs in spine surgery. However, current studies are mainly on degenerative spine diseases and largely restricted to retrospective studies with non-randomized data, thus multicenter randomized trials comparing fast-track outcomes and implementation are mandatory to confirm its benefit in spine surgery.


Assuntos
Ortopedia , Doenças da Coluna Vertebral , Humanos , Tempo de Internação , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Doenças da Coluna Vertebral/complicações , Coluna Vertebral/cirurgia
15.
BMC Musculoskelet Disord ; 24(1): 20, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36627616

RESUMO

BACKGROUND: Early Onset Scoliosis (EOS) is a progressive spinal deformity in children, and a potentially life-threatening disease. "Growth-friendly" surgical techniques aim to control the deformity, while allowing the spine and trunk to maintain growth. Current "growth-friendly" systems such as the traditional growing rod (TGR) and magnetically controlled growing rod (MCGR) have limitations that reduce their efficacy and cost-effectiveness. Recently, two "growth-friendly" systems have been developed that mitigate many of these limitations, the Spring Distraction System (SDS) and the One Way Self-Expanding Rod (OWSER). The purpose of the multicenter BiPOWR trial is to investigate, describe and compare the 1-year limited-efficacy and -safety of both strategies in the treatment of neuromuscular EOS. METHODS: After informed consent, 28 neuromuscular EOS patients will be randomized to receive either the SDS or the OWSER. Patients and caregivers will be blinded to allocation until after surgery. Primary outcomes will be maintenance of coronal curve correction and the occurrence of serious adverse events. In addition, spinal growth, implant lengthening, and perioperative findings are recorded systematically. At each follow-up moment, the Early Onset Scoliosis Questionnaire (EOSQ-24) will be used to assess health-related quality of life. All outcomes will be compared between groups. DISCUSSION: The BiPOWR trial is the first randomized controlled trial that compares two specific "growth-friendly" implants in a specified EOS population. It will determine the 1-year limited-efficacy and safety of the SDS and OWSER implants. TRIAL REGISTRATION: Clinicaltrials.gov: NCT04021784 (13-06-2019). CCMO registry: NL64018.041.17 (06-05-2019).


Assuntos
Procedimentos Ortopédicos , Escoliose , Criança , Humanos , Escoliose/cirurgia , Qualidade de Vida , Coluna Vertebral/cirurgia , Próteses e Implantes , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
16.
J Orthop Surg Res ; 18(1): 26, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36627668

RESUMO

BACKGROUND: Cancer treatment has recently evolved due to the advances in comprehensive therapies, including chemotherapy and radiotherapy. The aspect of cancer-related bone metastasis has undergone a paradigm shift with the transformation of orthopedic interventions for spinal metastasis. We performed this retrospective observational study to investigate the changes in patient status and metastatic spine-tumor treatment over the past decade. METHODS: We included 186 patients (122 men and 64 women; mean age: 67.6 years) who were referred to our hospital between 2009 and 2018 and were diagnosed and treated for metastatic spinal tumors. We classified the patients into early (81 patients from 2009 to 2013) and late (105 patients from 2014 to 2018) groups. The following components were investigated and compared between the groups: primary tumor, time taken from subjective-symptom onset to hospital visit, primary tumor evaluation during the visit, walking capacity due to lower paralysis during the visit, local treatment details, and post-treatment functional prognosis. RESULTS: Predominant primary tumors with similar trends in both groups included lung cancer, multiple myeloma, and prostate cancer. The percentage of non-ambulatory patients during the consultation was significantly lower in the late group (28% vs. 16%, P = 0.04). Among non-ambulatory patients at the time of hospital visit, the mean time from the primary doctor consultation to our hospital visit was 2.8 and 2.1 days in the early and late groups, respectively. In both groups, surgical procedures were performed promptly on the non-ambulatory patients; however, postoperative lower function did not improve in approximately half of the patients. CONCLUSIONS: Our findings demonstrated that in recent years, patients tended to be referred promptly from their previous doctors under a favorable collaboration system. However, the effectiveness of lower paralysis treatment remains limited, and it is important to raise awareness regarding the importance of early consultation among the general public for earlier detection.


Assuntos
Neoplasias Pulmonares , Neoplasias da Coluna Vertebral , Masculino , Humanos , Feminino , Idoso , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/secundário , Coluna Vertebral/cirurgia , Estudos Retrospectivos , Prognóstico , Neoplasias Pulmonares/terapia
17.
Sci Rep ; 13(1): 479, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36627377

RESUMO

To minimize surgical complications and staged procedures halo-traction is often used during deformity corrections. But the use of halo-traction in the treatment of refractory cervical kyphosis secondary to infections has never been reported. This study investigated the role of halo-traction in the treatment of cervical infection patients associated with refractory kyphosis. We retrospectively reviewed 48 patients with cervical infection associated with refractory kyphosis who were treated in our spine department. Patients were divided into two groups, the traction group (A) and the non-traction group (B). Group A underwent preoperative halo-traction followed by surgery, while group B underwent surgery alone. Between the two groups, we analyzed the kyphosis deformity correction, level of fusions, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), functional improvement by Neck disability index (NDI) score, and complications. Group A had a better correction of kyphosis deformity compared to group B (27.01 ± 11.54)0 versus (18.08 ± 10.04)0 (P = 0.01, Z = - 2.44). No statistically significant differences between the two groups in terms of functional improvement, level of fusions, ESR and CRP. Group B had 3 revision surgery cases. Preoperative halo-traction followed by surgery is superior in kyphosis correction in the treatment of patients with cervical infections with refractory kyphosis.


Assuntos
Cifose , Anormalidades Musculoesqueléticas , Escoliose , Fusão Vertebral , Tração , Humanos , Proteína C-Reativa , Cifose/cirurgia , Estudos Retrospectivos , Escoliose/cirurgia , Fusão Vertebral/métodos , Coluna Vertebral , Resultado do Tratamento , Tração/métodos
18.
Circ Cardiovasc Imaging ; 16(1): e014544, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36649457

RESUMO

BACKGROUND: Elevated metabolic activity of amygdala is known to be related to atherosclerotic cardiovascular event by increasing inflammatory cell production from bone marrow. We tried to identify the factors of metabolic activity in the amygdala, vertebrae, liver, spleen, and internal carotid artery related to the future vascular events after stroke. METHODS: A total of 110 patients with acute stroke were included (72±10 years of age, 39% women) and underwent whole-body 18F-fluorodeoxyglucose (FDG) positron emission tomography between August 1, 2015 and February 28, 2020. We compared the FDG uptake in the amygdala, vertebrae, liver, spleen, and internal carotid artery between patients with and without recurrent vascular event. Cox proportional hazards model was used to identify factors related to recurrent stroke and vascular event. RESULTS: During the median follow-up period of 18 months, 22 patients experienced vascular events, including 15 stroke recurrence. Patients with recurred vascular event had a significantly higher FDG uptake in the amygdala and vertebrae than those without. The Cox proportional hazard model including diabetes, renal function, and carotid stenosis showed that a higher FDG uptake in the amygdala was independently associated with total vascular events (hazard ratio, 3.11 [95% CI, 1.11-8.70]) and higher FDG uptake in the vertebrae with stroke recurrence (hazard ratio, 4.94 [95% CI, 1.29-18.9]). CONCLUSIONS: The increased metabolic activities of the vertebrae and amygdala are related to future vascular event among stroke survivors.


Assuntos
Fluordesoxiglucose F18 , Acidente Vascular Cerebral , Humanos , Feminino , Masculino , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Tomografia por Emissão de Pósitrons , Coluna Vertebral , Tonsila do Cerebelo , Compostos Radiofarmacêuticos
19.
Math Biosci Eng ; 20(1): 283-295, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36650766

RESUMO

Accidents have contributed a lot to the loss of lives of motorists and serious damage to vehicles around the globe. Potholes are the major cause of these accidents. It is very important to build a model that will help in recognizing these potholes on vehicles. Several object detection models based on deep learning and computer vision were developed to detect these potholes. It is very important to develop a lightweight model with high accuracy and detection speed. In this study, we employed a Mask RCNN model with ResNet-50 and MobileNetv1 as the backbone to improve detection, and also compared the performance of the proposed Mask RCNN based on original training images and the images that were filtered using a Gaussian smoothing filter. It was observed that the ResNet trained on Gaussian filtered images outperformed all the employed models.


Assuntos
Coluna Vertebral , Cidades , Distribuição Normal
20.
Math Biosci Eng ; 20(1): 1420-1433, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36650817

RESUMO

Blood cell image segmentation is an important part of the field of computer-aided diagnosis. However, due to the low contrast, large differences in cell morphology and the scarcity of labeled images, the segmentation performance of cells cannot meet the requirements of an actual diagnosis. To address the above limitations, we present a deep learning-based approach to study cell segmentation on pathological images. Specifically, the algorithm selects UNet++ as the backbone network to extract multi-scale features. Then, the skip connection is redesigned to improve the degradation problem and reduce the computational complexity. In addition, the atrous spatial pyramid pooling (ASSP) is introduced to obtain cell image information features from each layer through different receptive domains. Finally, the multi-sided output fusion (MSOF) strategy is utilized to fuse the features of different semantic levels, so as to improve the accuracy of target segmentation. Experimental results on blood cell images for segmentation and classification (BCISC) dataset show that the proposed method has significant improvement in Matthew's correlation coefficient (Mcc), Dice and Jaccard values, which are better than the classical semantic segmentation network.


Assuntos
Algoritmos , Células Sanguíneas , Diagnóstico por Computador , Coluna Vertebral , Processamento de Imagem Assistida por Computador
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