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BACKGROUND: Large territory middle cerebral artery (MCA) ischaemic strokes account for around 10% of all ischaemic strokes and have a particularly devastating prognosis when associated with malignant oedema. Progressive cerebral oedema starts developing in the first 24 to 48 hours of stroke ictus with an associated rise in intracranial pressure. The rise in intracranial pressure may eventually overwhelm compensatory mechanisms leading to a cascading secondary damage to surrounding unaffected parenchyma. This downward spiral can rapidly progress to death or severe neurological disability. Early decompressive craniectomy to relieve intracranial pressure and associated tissue shift can help ameliorate this secondary damage and improve outcomes. Evidence has been accumulating of the benefit of early surgical decompression in stroke patients. Earlier studies have excluded people above the age of 60 due to associated poor outcomes; however, newer trials have included this patient subgroup. This review follows a Cochrane Review published in 2012. OBJECTIVES: To assess the effectiveness of surgical decompression in people with malignant oedema after ischaemic stroke with regard to reduction in mortality and improved functional outcome. We also aimed to examine the adverse effects of surgical decompression in this patient cohort. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL; 2022, Issue 7 of 12), MEDLINE Ovid, Embase Ovid, Web of Science Core Collection, Scopus databases, ClinicalTrials.gov, and the WHO ICTRP to July 2022. We also reviewed the reference lists of relevant articles. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing decompressive craniectomy with medical management to best medical management alone for people with malignant cerebral oedema after MCA ischaemic stroke. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results, assessed study eligibility, performed risk of bias assessment, and extracted the data. The primary outcomes were death and death or severe disability (modified Rankin Scale (mRS) > 4) at 6 to 12 months follow-up. Other outcomes included death or moderate disability (mRS > 3), severe disability (mRS = 5), and adverse events. We assessed the certainty of the evidence using the GRADE approach, categorising it as high, moderate, low, or very low. MAIN RESULTS: We included nine RCTs with a total of 513 participants included in the final analysis. Three studies included patients younger than 60 years of age; two trials accepted patients up to 80 years of age; and one trial only included patients 60 years or older. The majority of included trials (six) mandated a time from stroke ictus to treatment of < 48 hours, whilst in two of them this was < 96 hours. Surgical decompression was associated with a reduction in death (odds ratio (OR) 0.18, 95% confidence interval (CI) 0.12 to 0.27, 9 trials, 513 participants, P < 0.001; high-certainty evidence); death or severe disability (mRS > 4, OR 0.22, 95% CI 0.15 to 0.32, 9 trials, 513 participants, P < 0.001; high-certainty evidence); and death or moderate disability (mRS > 3, OR 0.34, 95% CI 0.22 to 0.52, 9 trials, 513 participants, P < 0.001; moderate-certainty evidence). Subgroup analysis did not reveal any significant effect on treatment outcomes when analysing age (< 60 years versus ≥ 60 years); time from stroke ictus to intervention (< 48 hours versus ≥ 48 hours); or dysphasia. There was a significant subgroup effect of time at follow-up (6 versus 12 months, P = 0.02) on death as well as death or severe disability (mRS > 4); however, the validity of this finding was affected by fewer participant numbers in the six-month follow-up subgroup. There was no consistent reporting of per-participant adverse event rates in any of the included studies, which prevented further analysis. AUTHORS' CONCLUSIONS: Surgical decompression improves outcomes in the management of malignant oedema after acute ischaemic stroke, including a considerable reduction in death or severe disability (mRS > 4) and a reduction in death or moderate disability (mRS > 3). Whilst there is evidence that this positive treatment effect is present in patients > 60 years old, it is important to take into account that these patients have a poorer prospect of functional survival independent of this treatment effect. In interpreting these results it must also be considered that the data demonstrating benefit are drawn from a unique patient subset with profound neurological deficit, reduced level of consciousness, and no pre-morbid disability or severe comorbidity.
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Edema Encefálico , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Pessoa de Meia-Idade , Edema Encefálico/etiologia , Edema Encefálico/cirurgia , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/cirurgia , Descompressão Cirúrgica/efeitos adversos , EdemaRESUMO
PURPOSE: This study aims to review the literature that compares the accuracy of Anterior Segment-Optical Coherence Tomography (AS-OCT) against gonioscopy in detecting eyes with angle closure. It is currently unclear how AS-OCT fits into clinical practice for detecting angle closure. This is a systematic review and meta-analysis. METHODS: A literature search was performed on Medline, Embase, Scopus and the Cochrane Central Register of Controlled Trials to identify studies that investigated the diagnostic accuracy of AS-OCT in detecting eyes with angle closure as diagnosed by gonioscopy. Eligible studies included in the analysis met stringent inclusion criteria determining the sensitivity and specificity of AS-OCT. RESULTS: The initial search identified 727 studies, of which 23 were included in the final analysis. We found substantial variation in the parameters being studied and methodologies. The sensitivity of AS-OCT ranged from 46 to 100% (median 87%). Twenty-one studies identified parameters that showed sensitivity above 80%. The specificity ranged from 55.3 to 100% (median 84%). CONCLUSION: AS-OCT demonstrates good sensitivity for detecting angle closure. It may provide an avenue to address high rates of undiagnosed angle closure, such as found in developing Asian countries. However, AS-OCT is not yet able to replace gonioscopy. Clinicians should consider whether the diagnostic accuracy of AS-OCT is acceptable for their specific clinical use before adopting it. More studies are needed to determine the utility of AS-OCT, including longitudinal studies to determine the significance of eyes classified to have closed angles by AS-OCT but open on gonioscopy.
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Glaucoma de Ângulo Fechado , Tomografia de Coerência Óptica , Segmento Anterior do Olho/diagnóstico por imagem , Glaucoma de Ângulo Fechado/diagnóstico , Gonioscopia , Humanos , Pressão IntraocularRESUMO
BACKGROUND: Cerebellar liponeurocytoma is a rare entity with fewer than 100 reported cases and series in the available literature to date. Although the cerebellum remains the typical primary site, the entity has been shown to demonstrate increased aggressiveness and malignant progression with multiple recurrences. CASE DESCRIPTION: We present a unique case in a 64-year-old gentleman of a cerebellar liponeurocytoma with multiple recurrences and progressive anaplasia. The tumor showed anaplastic features at first presentation and recurred in a more aggressive fashion in a short 2-year period despite surgical debulking and post-operative radiotherapy. It re-recurred within 6 months with subsequent re-debulking without further radiotherapy. At latest follow-up almost 3 years since surgical management of the patient's second recurrence, the patient remains well with minimal neurological impairment and no radiological signs of recurrence. CONCLUSION: Cerebellar liponeurocytoma may present with increasingly atypical histological features that may warrant more aggressive post-operative treatment to prevent disease recurrence and clinical deterioration. This may include a more aggressive surgical resection margin and consideration of adjuvant radiotherapy in all cases.
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Neoplasias Cerebelares , Neurocitoma , Neoplasias Cerebelares/patologia , Cerebelo/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neurocitoma/diagnóstico , Neurocitoma/patologia , Neurocitoma/terapiaRESUMO
BACKGROUND: Musculoskeletal disorders can contribute to injurious falls and incur significant societal and healthcare burdens. Identification of fallers from non-fallers through wearable-based gait analysis can facilitate timely intervention to assist mobility and prevent falls whilst improving care and attention for high fall-risk patients. In this study, we use wearable sensor-based gait analysis to introduce a novel variable to assess walking stability in fallers and non-fallers - the Walking Orientation Randomness Metric. The WORM score quantifies the stability, or 'figure-of-eight' motion of a subject's trunk during walking as an indicator of a falls-predictive (pathological) gait. METHODS: WORM is calculated as the 'figure-of-eight' oscillation mapped out in the transverse-plane by the upper body's centre-point during a walking bout. A sample of patients presenting to the Prince of Wales Hospital (Sydney, Australia) with a primary diagnosis of "falls for investigation" and age-matched healthy controls (non-fallers) from the community were recruited. Participants were fitted at the sternal angle with the wearable accelerometer, MetaMotionC (Mbientlab Inc., USA) and walked unobserved (at self-selected pace) for 5-50 m along an obstacle-free, carpeted hospital corridor. RESULTS: Participants comprised of 16 fallers (mean age: 70 + 17) and 16 non-fallers (mean age: 70 + 9) based on a recent fall(s) history. The (median) WORM score was 17-fold higher (p < 0.001) in fallers (3.64 cm) compared to non-fallers (0.21 cm). ROC curve analyses demonstrate WORM can discriminate fallers from non-fallers (AUC = 0.97). Diagnostic analyses (cut-off > 0.51 cm) show high sensitivity (88%) and specificity (94%). CONCLUSION: In this pilot study we have introduced the WORM score, demonstrating its discriminative performance in a preliminary sample size of 16 fallers. WORM is a novel gait metric assessing walking stability as measured by truncal way during ambulation and shows promise for objective and clinical evaluation of fallers.
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Caminhada , Dispositivos Eletrônicos Vestíveis , Acidentes por Quedas/prevenção & controle , Marcha , Humanos , Projetos PilotoRESUMO
BACKGROUND: Wearables consist of numerous technologies that are worn on the body and measure parameters such as step count, distance travelled, heart rate and sleep quantity. Recently, various wearable systems have been designed capable of detecting spinal posture and providing live biofeedback when poor posture is sustained. It is hypothesised that long-term use of these wearables may improve spinal posture. RESEARCH QUESTIONS: To (1) examine the capabilities of current devices assessing spine posture, (2) to identify studies implementing such devices in the clinical setting and (3) comment on the clinical practicality of integration of such devices into routine care where appropriate. METHODS: A comprehensive systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) across the following databases: PubMed; MEDLINE; EMBASE; Cochrane; and Scopus. Articles related to wearables systems able to measure spinal posture were selected amongst all published studies dated from 1980 onwards. Extracted data was collected as per a predetermined checklist including device types, study objectives, findings and limitations. RESULTS: A total of 37 articles were extensively reviewed and analysed in the final review. The proposed wearables most commonly used Inertial Measurement Units (IMUs) as the underlying technology. Wearables measuring spinal posture have been proposed to be used in the following settings: post-operative rehabilitation; treatment of musculoskeletal disorders; diagnosis of pathological spinal posture; monitoring of progression of Parkinson's Disease; detection of falls; workplace occupational health and safety; comparison of interventions. CONCLUSIONS: This is the first and only study to specifically review wearable devices that monitor spinal posture. Our findings suggest that currently available devices are capable of assessing spinal posture with good accuracy in the clinical setting. However, further validation regarding the long-term use of these technologies and improvements regarding practicality is required for commercialisation.
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Biorretroalimentação Psicológica/instrumentação , Postura , Coluna Vertebral/fisiopatologia , Dispositivos Eletrônicos Vestíveis , Desenho de Equipamento , Humanos , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Resultado do TratamentoRESUMO
BACKGROUND: The purpose of this systematic review was to evaluate the accuracy and reliability of wearable devices for objective gait measurement of Lumbar Spinal Stenosis (LSS) patients, with a focus on relevant gait metrics. METHODS: Systematic searches were conducted of five electronic databases to identify studies that assessed gait metrics by wearable or portable technology. Data was collected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. RESULTS: Four articles were identified for inclusion in this review. The objectives, methodology and quality of the studies varied. No single gait metric was investigated in all four studies, making comparison difficult. The most relevant metrics reported included gait cycle, gait velocity, step length and cadence, which were reported in two studies. Two studies explored gait symmetry. Differences between LSS patients and normal healthy subjects are demonstrable using wearable technology. CONCLUSIONS: The measurements of gait cycle, cadence, step length, gait velocity, and number of steps with wearable devices can be used in the gait measurement of LSS patients for initial assessment, and objective outcomes following interventions. However, data and analysis are limited, and further studies are necessary to comment on reliability.
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Análise da Marcha/instrumentação , Vértebras Lombares , Estenose Espinal/diagnóstico , Dispositivos Eletrônicos Vestíveis , Humanos , Reprodutibilidade dos Testes , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia , Resultado do TratamentoAssuntos
Edema Encefálico , Craniectomia Descompressiva , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , AVC Isquêmico/cirurgia , Edema Encefálico/etiologia , Edema Encefálico/cirurgia , Descompressão Cirúrgica , Infarto Cerebral/cirurgia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento , Infarto da Artéria Cerebral Média/cirurgiaRESUMO
OBJECTIVE: Current recommendations for traumatic spinal cord injury treatment recommend immediate transfer to a spinal injury unit (SIU) where available following patient stabilisation. Although transfer is dependent on a variety of factors, the largest review was unable to justify implementation of such units on the basis of insufficient and lack of quality data in favour of care at the SIU as opposed to non-SIU centres. Our study sought to investigate: are subspecialty spinal injury units (SIUs) able to provide superior care compared with traditional trauma/rehab units? Is the standard of care of acute spinal cord injured patients to be managed in SIU's? METHOD: A literature search was conducted across five major databases using the key terms: "spinal cord injury" AND "Spinal Injury Unit" OR "spinal rehabilitation" OR "spinal injury centre" OR "specialist care" OR "care requirements." RESULTS: After review of over 500 studies, only 9 met inclusion criteria, 3 of which were past reviews. There were no relevant RCT's obtained. Standardised roles of global SIU units are needed to deliver equitable and high quality care as current evidence demonstrates variable standards of care and service (mean LOS range: 16-174 days). There is low quality evidence supporting earlier admission into SIU units being associated with improved neurological outcome, complication rates and reduced LOS, despite variations in the definition of "early admission" across studies. CONCLUSIONS: Our review demonstrates a lack of standardisation within SIU on a global scale, with significantly different outcomes reported across published studies. New and higher quality evidence directly comparing SIU to non-SIU based care is required. Earlier transfer (<24 h) to SIU following initial injury and stabilisation is advised.
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Atenção à Saúde , Qualidade da Assistência à Saúde , Traumatismos da Medula Espinal/terapia , Centros de Traumatologia , Hospitalização , HumanosRESUMO
BACKGROUND: Established health-related quality of life scores do not consider both subjective and objective indices of health. We propose the subjective and objective quality of life score (SOQOL) for the comprehensive assessment of health-related quality of life and aim to provide normative population data. The SOQOL is compatible with smartphone applications, allowing widespread use on a global scale. METHODS: Normative SOQOL population data was sourced from pre-existing datasets on the EQ-5D-5L, daily step count, and walking speed. Normative values were calculated using weighted grand means. We trialled the SOQOL in a group of five patients presenting to a spinal neurosurgery clinic. RESULTS: SOQOL scores decreased with age, and women had lower scores in every age group. In our case series, the spine patients with the biggest SOQOL deficit compared to age- and sex-matched population averages were found to be surgical while the rest were non-surgical. CONCLUSIONS: The SOQOL shows promise as a simple and effective scoring tool that is compatible with smartphones, potentially useful for screening in primary and specialized care settings, and for assessment following healthcare interventions. This study, however, is preliminary, and the findings are primarily suggestive. They underline the necessity for future, more comprehensive studies to validate and expand upon these initial observations. The conclusion of both this abstract and the full paper will clearly state these limitations and the preliminary nature of the study.
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Aplicativos Móveis , Qualidade de Vida , Humanos , Feminino , Instituições de Assistência Ambulatorial , Descanso , SmartphoneRESUMO
BACKGROUND: Surgical procedures involving the hip, knee, or spine represent a majority of orthopaedic procedures performed electively in the health care system. Postoperative care is a key aspect of surgery and mobilisation without injury is the primary objective. Recent advances in wearable technologies allow objective evaluation of walking metrics to inform and guide postoperative care following orthopaedic surgery. PURPOSE: The aim of this scoping review is to explore current applications of wearable devices, objective data capture and gait analysis in monitoring postoperative recovery following commonly performed elective orthopaedic procedures of the hip, knee and spine. METHODS: A search against pre-defined criteria was performed on the following scientific databases from date of inception to February 28th, 2021: Medline (via OvidSP), Embase (via OvidSP) and Cochrane Library (via CENTRAL). Data were collected according to a predetermined checklist including study participants, surgery, wearable device (model), sensor location, and monitoring parameters such as mobility metrics, monitoring timepoints and monitoring duration for each study included in our review. Quality was assessed independently using the Newcastle Ottawa Scale (NOS). CONCLUSIONS: To our knowledge, this is the first review of wearable monitoring (of postoperative recovery) following hip, knee and spine surgery. Patients undergoing elective orthopaedic procedures may benefit from wearable monitoring of their walking health and mobility metrics.
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Procedimentos Ortopédicos , Dispositivos Eletrônicos Vestíveis , Humanos , Articulação do Joelho , Marcha , Coluna VertebralRESUMO
AIMS: The aim of this study is to analyse the demographics, diagnosis, nodal yield, metastatic rates and outcomes of patients undergoing neck dissections within the Waikato Hospital Oral and Maxillofacial Surgery (OMS) Department. METHODS: All patients that underwent neck dissections under the care of OMS at Waikato Hospital between January 2016 and December 2021 were included. Data on patient demographics, diagnosis, surgery details, nodal yields, histological results and clinical outcome were collected retrospectively for analysis. RESULTS: One hundred and five patients and 123 neck dissections were included in the final analysis. The median age was 65 years of age. The average nodal yield from a selective neck dissection of levels I-III was 20.1 and I-IV was 25.4. There was no metastatic nodal disease in level IIb, and only 2 neck dissections with nodal disease in level IV. Complications were mostly associated with free flap reconstruction rather than the neck dissection alone. CONCLUSIONS: The demographics and outcomes of the study cohort are consistent with both the current population and previously published head and neck data. The OMS unit at Waikato Hospital recommends omission of levels IIb and IV in neck dissections for cN0 cases if deemed oncologically safe to do so.
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Neoplasias de Cabeça e Pescoço , Cirurgia Bucal , Humanos , Idoso , Esvaziamento Cervical/métodos , Estudos Retrospectivos , Nova Zelândia/epidemiologia , Pescoço/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgiaRESUMO
We present the case of an 85-year-old woman who presented to our clinic with neurogenic claudication due to lumbar spinal stenosis (LSS) over a period of two years. During this time a series of walking metrics were monitored including daily step count, walking speed, and step length. All metrics showed a deterioration over time and objectively document the disease progression of LSS (initial: walking speed =1.03 m/s, step length =0.49 m, and daily step count =3,136; final: walking speed =0.49 m/s, step length =0.37 m, and daily step count =334). At this time, the patient had also begun experiencing bilateral lower limb weakness and paraesthesia upon exertion, preventing her from mobilizing for more than a few meters at a time. After a shared decision-making process with the patient and her family, surgical management was recommended. The deterioration of the patient's walking metrics matched their increasing requirement for walking assistance, with no walking assistance being needed initially, compared to a four-wheel walker being required in the weeks prior to her surgery. Therefore, the extent of walking deterioration may be able to inform clinical decision-making regarding appropriate walking assistance. To our knowledge, this is the first report that objectively documents the deterioration of LSS using walking metrics for such a prolonged duration of time.
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With the advent of three-dimensional printing, rapid growth in the field and application in spinal and orthopedic surgery has been seen. This technology is now being applied in creating patient-specific implants, as it offers benefits over the generic alternative, with growing literature supporting this. This report details a unique application of virtual surgical planning and manufacture of a personalized implant in a case of cervical disc replacement failure with severe osteolysis and resultant hypermobility. Where this degree of degenerative bone loss would often necessitate a vertebrectomy to be performed, this case highlights the considerable customizability of 3D-printed patient-specific implants to contour to the bony defects, allowing for a smaller and safer operation, with the achievement of stability as early as 3 months after the procedure, by the presence of osseointegration. With increasing developments in virtual planning technology and 3D printing ability, the future of complex spinal revision surgery may adopt these technologies as it affords the patient a faster, safer, and less invasive and destructive procedure.
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â¢The proposed GSi algorithm aims to objectively evaluate the walking impairment associated with lumbar disc herniation (LDH).â¢GSi is calculated as deviation from mean (age-matched) normative values for gait velocity, step time asymmetry and step length asymmetry.â¢Clinical performance was assessed in a prospective, single surgeon series of 33 lumbar disc herniation (LDH) patients.â¢GSi was lower in LDH participants with significant distribution between surgical and conservative management subgroups.
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OBJECTIVE: Using a chest-based inertial wearable sensor, we examined the quantitative gait patterns associated with lumbar disc herniation (LDH), lumbar spinal stenosis (LSS), and chronic mechanical low back pain (CMLBP). 'Pathological gait signatures' were reported as statistically significant group difference (%) from the 'normative' gait values of an age-matched control population. METHODS: A sample of patients presenting to the Prince of Wales Private Hospital (Sydney, Australia) with primary diagnoses of LDH, LSS, or CMLBP were recruited. Spatial, temporal, asymmetry, and variability metrics were compared with age-matched (±2 years) control participants recruited from the community. Participants were fitted at the sternal angle with an inertial measurement unit, MetaMotionC, and walked unobserved (at a self-selected pace) for 120 m along an obstacle-free, carpeted hospital corridor. RESULTS: LDH, CMLBP, and LSS groups had unique pathological signatures of gait impairment. The LDH group (n = 33) had marked asymmetry in terms of step length, step time, stance, and single-support asymmetry. The LDH group also involved gait variability with increased step length variation. However, distinguishing the CMLBP group (n = 33) was gait variability in terms increased single-support time variation. The gait of participants with LSS (n = 22) was both asymmetric and variable in step length. CONCLUSIONS: Wearable sensor-based accelerometry was found to be capable of detecting the gait abnormalities present in patients with LDH, LSS, and CMLBP, when compared to age-matched controls. Objective and quantitative patterns of gait deterioration uniquely varied between these subtypes of lumbar spine disease. With further testing and validation, gait signatures may aid clinical identification of gait-altering pathologies.
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Deslocamento do Disco Intervertebral , Dor Lombar , Estenose Espinal , Dispositivos Eletrônicos Vestíveis , Marcha , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico , Dor Lombar/complicações , Dor Lombar/diagnóstico , Vértebras Lombares , Estenose Espinal/complicações , Estenose Espinal/diagnósticoRESUMO
Objectives: To collate the current state of knowledge and explore differences in the spatiotemporal gait patterns of degenerative lumbar spine diseases: lumbar spinal stenosis (LSS), lumbar disc herniation (LDH) and low back pain (LBP). Background: LBP is common presenting complaint with degenerative lumbar spine disease being a common cause. In particular, the gait patterns of LSS, LDH and mechanical-type (facetogenic and discogenic) LBP is not established. Methods: A search of the literature was conducted to determine the changes in spatial and temporal gait metrics involved with each type of degenerative lumbar spine disease. A search of databases including Medline, Embase and PubMed from their date of inception to April 18th, 2021 was performed to screen, review and identify relevant studies for qualitative synthesis. Seventeen relevant studies were identified for inclusion in the present review. Of these, 5 studies investigated gait patterns in LSS, 10 studies investigated LBP and 2 studies investigated LDH. Of these, 4 studies employed wearable accelerometry in LSS (2 studies) and LBP (2 studies). Conclusions: Previous studies suggest degenerative diseases of the lumbar spine have unique patterns of gait deterioration. LSS is characterised by asymmetry and variability. Spatiotemporal gait deterioration in gait velocity, cadence with increased double-support duration and gait variability are distinguishing features in LDH. LBP involves marginal abnormalities in temporal and spatial gait metrics. Previous studies suggest degenerative diseases of the lumbar spine have unique patterns of gait deterioration. Gait asymmetry and variability, may be relevant metrics for distinguishing between the gait profiles of lumbar spine diseases.
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We report the case of a 46-year-old male with long-standing low back pain who presented with a deterioration of symptoms characterised by back and right leg pain corresponding to the L4 and L5 dermatomes. An MRI scan revealed severe central and lateral recess stenosis at L4/5 secondary to a large central disc protrusion. We remotely monitored activity and general health metrics over a time-period exceeding two years. This is the first study to monitor these metrics remotely and continuously in the surgical spine patient. Over this time, he received several interventions including a spinal cord stimulator implant, and an L4/5 microdiscectomy. We tracked his fluctuating health status using the Oura Ring [objectively measuring metrics including step count, sleep patterns, heart rate (HR), heart-rate variability (HRV), and respiratory rate (RR)] and with daily self-reported scores on the Visual Analogue Scale. The Oura Ring is a convenient and lightweight wearable device that is worn on any finger. Taken together, metrics provided a comprehensive picture of deterioration and recovery, paralleling key events in the patient's history. The use of wearable devices is feasible in enabling long-term remote continuous monitoring. This may assist surgeons and rehabilitation providers in identifying early deterioration and monitoring the post-intervention course of recovery.
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BACKGROUND: The purpose of this scoping review was to explore the current applications of objective gait analysis using inertial measurement units, custom algorithms and artificial intelligence algorithms in detecting neurological and musculoskeletal gait altering pathologies from healthy gait patterns. METHODS: Literature searches were conducted of four electronic databases (Medline, PubMed, Embase and Web of Science) to identify studies that assessed the accuracy of these custom gait analysis models with inputs derived from wearable devices. Data was collected according to the preferred reporting items for systematic reviews and meta-analysis statement guidelines. RESULTS: A total of 23 eligible studies were identified for inclusion in the present review, including 10 custom algorithms articles and 13 artificial intelligence algorithms articles. Nine studies evaluated patients with Parkinson's disease of varying severity and subtypes. Support vector machine was the commonest adopted artificial intelligence algorithm model, followed by random forest and neural networks. Overall classification accuracy was promising for articles that use artificial intelligence algorithms, with nine articles achieving more than 90% accuracy. CONCLUSIONS: Current applications of artificial intelligence algorithms are reasonably effective discrimination between pathological and non-pathological gait. Of these, machine learning algorithms demonstrate the additional capacity to handle complicated data input, when compared to other custom algorithms. Notably, there has been increasing application of machine learning algorithms for conducting gait analysis. More studies are needed with unsupervised methods and in non-clinical settings to better reflect the community and home-based usage.
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Background: Tumefactive demyelinating lesions (TDL) share similar clinical features and magnetic resonance imaging (MRI) characteristics with high grade glioma (HGG). This study develops an approach to navigating this diagnostic dilemma, with significant treatment implications as the management of both entities is drastically different. Methods: A retrospective analysis of 41 TDLs and 91 HGG with respect to demographics, presentation and classical MRI characteristics was performed. A diagnostic pathway was then developed to help diagnose TDLs based on whole neuraxis MRI and cerebrospinal fluid (CSF) examination. Results: The diagnosis of TDL is more likely than HGG in younger females who present with subacute or chronic symptoms. MRI characteristics favoring TDL over HGG include smaller size, open rim enhancement, little or no associated edema or mass effect and the presence of a T2 hypointense rim. MRI of the whole neuraxis for detection of other lesions typical of multiple sclerosis (MS), in combination with a lumbar puncture (LP) showing positive CSF-specific oligoclonal bands (OCB), was positive in 90% of the TDL cohort. Conclusion: The diagnostic pathway, proposed on the basis of specific clinicoradiological features, should be followed in patients with suspected TDL. If MRI demonstrates other lesions typical of MS and LP demonstrates positive CSF-specific OCBs, then patients should undergo a short course of IV steroids to look for clinical improvement. Patients, who continue to deteriorate, do not demonstrate other lesions on MRI or where the LP is negative for CSF-specific OCB, should be considered for biopsy if safe to do so. This pathway will give the patients the best chance at neurological preservation.