Accuracy of Intraoperative Computed Tomography Assisted Dorsal Instrumentation in Spinal Revision Surgery

Abstract Purpose Instrumentation in spinal revision surgery is considered challenging. Altered or missing anatomical landmarks hinder the surgeons' intraoperative orientation. In recent history, the importance of navigated approaches to spinal screw placement is constantly increasing. A growing number of medical centers have introduced intraoperative CT (iCT) navigation as a new clinical standard. In this study, we compare the accuracy of dorsal iCT-navigated instrumentation in revision surgery versus primary interventions. Methods Between September 2017 and January 2019, we prospectively analyzed a consecutive series of dorsal instrumentation using iCT. Patients with previous operative interventions in the relevant spinal segments were included in the revision group and compared with a previously assessed group of primary interventions (nonrevision group). Each screw was assessed individually by an independent observer, making use of a modified Gertzbein and Robbins classification. Results In this period, 39 patients were treated in the revision group with a total amount of 269 implanted screws. We achieved an overall accuracy of 95.91% compared with 95.12% in the nonrevision group (46 patients, 287 screws). We found no significant difference in accuracy between the two groups or any anatomical region of the spine. Conclusion In summary, iCT-navigated screw placement yields a good accuracy in spinal revision surgery, without significant difference to primary interventions.

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Assessment of extracranial-intracranial bypass in Moyamoya disease using 3T time-of-flight MR angiography: Comparison with CT angiography

VASA ◽

10.1024/0301-1526/a000363 ◽

2014 ◽

Vol 43 (4) ◽

pp. 278-283 ◽

Cited By ~ 8

Author(s):

Qian Chen ◽

Rongfeng Qi ◽

Xiaoqing Cheng ◽

Changsheng Zhou ◽

Song Luo ◽

...

Keyword(s):

Image Quality ◽

Moyamoya Disease ◽

Mr Angiography ◽

Time Of Flight ◽

Consecutive Series ◽

Tof Mra ◽

Bypass Patency ◽

Significant Difference ◽

Contrast Technique ◽

Vessel Integrity

Background: To evaluate the value of time-of-flight MR angiography (TOF MRA) for the assessment of extracranial-intracranial (EC-IC) bypass in Moyamoya disease in comparison with computed tomography angiography (CTA). Patients and methods: A consecutive series of 23 patients with Moyamoya disease were analyzed retrospectively. Twenty three patients underwent 25 procedures of extracranial-intracranial bypass. Cranial CTA was performed within one week after the surgery to assess bypass patency. Then TOF MRA was scanned within 24 h after CTA on a 3T MRI system. Using 5-point scales (0 = poor to 4 = excellent), two radiologists rated the image quality and vessel integrity of bypass for three segments (extracranial, trepanation, intracranial). Results: Image quality was high in both CTA and TOF MRA (mean quality score 3.84 ± 0.37 and 3.8 ± 0.41), without statistical difference (p = 0.66). Mean scores of TOF MRA with respect to bypass visualization were higher than CTA in the intracranial segment (p = 0.026). No significant difference of bypass visualization regarding the extracranial and trepanation segments was found between TOF MRA and CTA (p = 0.66 and p = 0.34, respectively). For the trepanation segment, TOF MRA showed pseudo lesions in 2 of all 25 cases. Conclusions: 3T TOF MRA, a non-contrast technique not exposing the patients to radiation, proved to be at least equal to CTA for the assessment of EC-IC bypass, and even superior to CTA with respect to the intracranial segment. In addition, readers should be aware of a potential overestimation showing focal pseudo lesions of the bypass at the trepanation segment in TOF MRA.

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Comparative study of Clinical Characteristics in Patients with Mild and Severe Reflux Esophagitis

Acta Marisiensis - Seria Medica ◽

10.2478/amma-2020-0002 ◽

2020 ◽

Vol 66 (1) ◽

pp. 19-22

Author(s):

Melania Macarie ◽

Simona Maria Bataga ◽

Monica Pantea ◽

Razvan Opaschi ◽

Simona Mocan ◽

...

Keyword(s):

Risk Factors ◽

Sex Ratio ◽

Hiatal Hernia ◽

Statistical Significance ◽

Erosive Esophagitis ◽

Male Gender ◽

Consecutive Series ◽

Study Group ◽

Entire Study ◽

Significant Difference

AbstractObjective: This study aims to determine the correlation between risk factors and erosive esophagitis development.Methods: We conducted a retrospective observational study on a consecutive series of 19.672 patients who underwent upper gastrointestinal endoscopy between 01.01.2011-31.12.2017. A total of 3005 patients, diagnosed with erosive esophagitis, were included in the present study and stratified according to Los Angeles classification.Results: During the studied period we found 3005 patients with erosive esophagitis, sex ratio male to female was 1.3/1, the most common forms of esophagitis being grade A and B: 74.54% patients with esophagitis grade A, 14.80% patients with grade B; 5.29% patients were with grade C and 5.35% patients with esophagitis grade D. In severe esophagitis the male predominance was more prevalent (249 males, 71 female), with a sex ratio 3.50/1. The correlation of male gender with severe esophagitis was highly statistically significant (p < 0.0001, OR 2.97; 95% CI 2.25-3.91). Hiatal hernia was diagnosed in 1171 patients, the presence of large hiatal hernias, being an important predictor, with statistical significance (p < 0.0001, OR 3.41; 95% CI 2.22-5.21), for severe esophagitis development. Incidence of Helicobacter pylori infection was 11.51%, in the entire study group, with no statistical significant difference between patients with mild or severe esophagitis (12.02% vs 7.18%).Conclusion: Erosive esophagitis is a frequent disease, the most common forms being grade A and B. Male gender and the presence of hiatal hernia are the most important risk factors for erosive esophagitis development, in our study group.

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Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

Neurosurgical FOCUS ◽

10.3171/2020.6.focus20361 ◽

2020 ◽

Vol 49 (3) ◽

pp. E11 ◽

Cited By ~ 1

Author(s):

Yoshifumi Kudo ◽

Ichiro Okano ◽

Tomoaki Toyone ◽

Akira Matsuoka ◽

Hiroshi Maruyama ◽

...

Keyword(s):

Revision Surgery ◽

Spinal Canal ◽

Interbody Fusion ◽

Decompression Surgery ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Posterior Decompression ◽

Lateral Lumbar Interbody Fusion ◽

Significant Difference ◽

Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

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Clinically applicable artificial intelligence system for dental diagnosis with CBCT

Scientific Reports ◽

10.1038/s41598-021-94093-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Matvey Ezhov ◽

Maxim Gusarev ◽

Maria Golitsyna ◽

Julian M. Yates ◽

Evgeny Kushnerev ◽

...

Keyword(s):

State Of The Art ◽

Model Development ◽

Clinical Effectiveness ◽

Anatomical Landmarks ◽

Periapical Lesion ◽

Artificial Intelligence System ◽

Intelligence System ◽

Significant Difference ◽

Diagnostic Capabilities ◽

Lesion Localization

AbstractIn this study, a novel AI system based on deep learning methods was evaluated to determine its real-time performance of CBCT imaging diagnosis of anatomical landmarks, pathologies, clinical effectiveness, and safety when used by dentists in a clinical setting. The system consists of 5 modules: ROI-localization-module (segmentation of teeth and jaws), tooth-localization and numeration-module, periodontitis-module, caries-localization-module, and periapical-lesion-localization-module. These modules use CNN based on state-of-the-art architectures. In total, 1346 CBCT scans were used to train the modules. After annotation and model development, the AI system was tested for diagnostic capabilities of the Diagnocat AI system. 24 dentists participated in the clinical evaluation of the system. 30 CBCT scans were examined by two groups of dentists, where one group was aided by Diagnocat and the other was unaided. The results for the overall sensitivity and specificity for aided and unaided groups were calculated as an aggregate of all conditions. The sensitivity values for aided and unaided groups were 0.8537 and 0.7672 while specificity was 0.9672 and 0.9616 respectively. There was a statistically significant difference between the groups (p = 0.032). This study showed that the proposed AI system significantly improved the diagnostic capabilities of dentists.

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Speech Methodologies in Cleft Palate Assessment: A Pilot Project to Compare Two Phonetically Different Sentence Sets

Journal of Clinical Speech and Language Studies ◽

10.3233/acs-2013-20106 ◽

2013 ◽

Vol 20 (1) ◽

pp. 49-72

Author(s):

Jennie Smith ◽

Tim Pring ◽

Debbie Sell

Keyword(s):

Cleft Palate ◽

Pilot Project ◽

Wilcoxon Test ◽

Consecutive Series ◽

Video Recordings ◽

Significant Difference ◽

The Difference ◽

Audio Video ◽

Age Range ◽

The Impact

Objective: To investigate the impact of the phonetic content of two sentence sets on speech outcomes, specifically the effects of nasal phonemes. Method: Audio-video recordings of a consecutive series of 15 participants (age range 4–22 years), with cleft palate (syndromic or non-syndromic), with and without velopharyngeal dysfunction were taken. Participants repeated Sentence Set 1 (with nasals across sentences) and Sentence Set 2 (without nasals except the three nasal target sentences) during a routine speech recording. Two experienced Specialist Speech and Language Therapists, blinded to the study’s purpose, analyzed participants’ speech using the Cleft Audit Protocol for Speech-Augmented (CAPS-A). On day 1, recordings included Sentence Set 1. On day 2, 23 days later, recordings included Sentence Set 2. Main results: The difference between Sentence Set 1 and Sentence Set 2 ‘total scores’ (sum of scores on all CAPS-A parameters) was significant. The Pearson Product Moment showed high correlation. A Wilcoxon test revealed a significant difference between Sets 1 and 2 on the hypernasality parameter, and this alone accounted for the significant difference in total scores. Conclusion: The inclusion or exclusion of nasal consonants in the sentence set significantly affected perceptual ratings of hypernasality but none of the other CAPS-A parameters, highlighting the need for further investigation into perceptual nasality ratings.

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Avascular Spaces of the Female Pelvis—Clinical Applications in Obstetrics and Gynecology

Journal of Clinical Medicine ◽

10.3390/jcm9051460 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1460

Author(s):

Stoyan Kostov ◽

Stanislav Slavchev ◽

Deyan Dzhenkov ◽

Dimitar Mitev ◽

Angel Yordanov

Keyword(s):

Pelvic Surgery ◽

Gynecologic Surgery ◽

Obstetrics And Gynecology ◽

Nerve Sparing ◽

Clinical Anatomy ◽

Anatomical Landmarks ◽

Female Pelvis ◽

Precise Understanding ◽

Significant Difference ◽

Gynecological Diseases

The term “spaces” refers to the areas delimited by at least two independent fasciae and filled with areolar connective tissue. However, there is discrepancy regarding the spaces and their limits between clinical anatomy and gynecologic surgery, as not every avascular space described in literature is delimited by at least two fasciae. Moreover, new spaces and surgical planes have been developed after the adoption of laparoscopy and nerve-sparing gynecological procedures. Avascular spaces are useful anatomical landmarks in retroperitoneal anatomic and pelvic surgery for both malignant and benign conditions. A noteworthy fact is that for various gynecological diseases, there are different approaches to the avascular spaces of the female pelvis. This is a significant difference, which is best demonstrated by dissection of these spaces for gynecological, urogynecological, and oncogynecological operations. Thorough knowledge regarding pelvic anatomy of these spaces is vital to minimize morbidity and mortality. In this article, we defined nine avascular female pelvic spaces—their boundaries, different approaches, attention during dissection, and applications in obstetrics and gynecology. We described the fourth space and separate the paravesical and pararectal space, as nerve-sparing gynecological procedures request a precise understanding of retroperitoneal spaces.

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A Novel Placement Technique of S2 Screw (from S2 to Promontorium) and Double Screwing from S2

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1728987 ◽

2021 ◽

Author(s):

Sedat Dalbayrak ◽

Ahmet Öğrenci ◽

Ezgi Akar ◽

Orkun Koban ◽

Mesut Yılmaz

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Revision Surgery ◽

Chronic Low Back Pain ◽

Screw Placement ◽

Low Back ◽

Screw Loosening ◽

Dynamic Instrumentation ◽

Placement Technique

AbstractSince pseudoarthrosis or screw loosening is frequently seen in lumbosacral stabilizations ending in S1, S2 screws are used more frequently to support S1 screws. This study aims to describe a new screw placement technique and location from S2. Revision surgery was applied to the patient who had previously undergone surgery with the rigid instrumentation system and encountered pseudoarthrosis during the follow-up period. Instrumentation was performed from S2 to the promontorium. The patient’s chronic low back pain arising due to pseudoarthrosis was reduced and a strong lumbosacral dynamic instrumentation was performed to the patient. Dual screw placement from S2 and/or screw placement in the S2-promontorium direction is a new alternative to provide a powerful instrumentation.

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Outcomes of Revision of Interposition Implant Trapeziometacarpal Arthroplasty

Hand ◽

10.1177/15589447211028920 ◽

2021 ◽

pp. 155894472110289

Author(s):

Simo Mattila ◽

Eero Waris

Keyword(s):

Revision Surgery ◽

Trapeziometacarpal Osteoarthritis ◽

Primary Arthroplasty ◽

Significant Difference ◽

Functional Scores ◽

Ceramic Implants ◽

Evaluation Measure ◽

Surgery Rates ◽

Implant Dislocation ◽

Surgical Unit

Background Implant arthroplasties for trapeziometacarpal osteoarthritis are often associated with high complication and revision surgery rates. There are no previous studies reporting revision outcomes of failed interposition implant arthroplasty. Methods A patient register search was done for all implant arthroplasties performed for trapeziometacarpal osteoarthritis during a 10-year period in a single hand surgical unit. Altogether, 32 patients had primary interposition implant arthroplasty (Artelon 22, Pyrosphere 6, Ortosphere 2, and Pyrodisk 2), and 19 of these patients had revision surgery with 23 revision procedures performed. In all, 15 of the revised 19 patients were reexamined clinically (Connolly-Rath score, Quick Disabilities of the Arm Shoulder and Hand, patient evaluation measure, the visual analog score for pain, thumb range of motion and strength measurements) and radiographically. Results The indication for revision surgery was pain alone or implant dislocation accompanied by pain in all cases. Thirteen of the revised 15 patients reported functional deficit and pain after revision. There was no statistically significant difference in the revision outcomes between patients operated on primarily with the Artelon implant versus pyrocarbon/ceramic implants. Compared to previous studies on revision surgery and primary trapeziometacarpal arthroplasty, our results showed slightly higher pain and poorer functional scores. Conclusions Interposition implant arthroplasty may yield high revision rates. The results after revision surgery may be worse than previously described, and there may also be a tendency for worse results than those of primary arthroplasty. Interposition implant arthroplasty should always be thoroughly contemplated.

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Effect of Silver Nitrate Application on the Success of Endoscopic Dacryocystorhinostomy

American Journal of Rhinology and Allergy ◽

10.1177/19458924211042786 ◽

2021 ◽

pp. 194589242110427

Author(s):

Yaser S. Çetin ◽

Ramazan Akın ◽

Ufuk Düzenli ◽

Mahfuz Turan ◽

Nazım Bozan

Keyword(s):

Silver Nitrate ◽

Success Rate ◽

Postoperative Period ◽

Revision Surgery ◽

Granuloma Formation ◽

Stent Insertion ◽

Group Iii ◽

Group I ◽

Significant Difference ◽

Silicone Stent

Objectives To compare the clinical outcomes of patients undergoing additional procedures in endoscopic endonasal dacryocystorhinostomy (End-DCR) surgery and discuss the factors affecting the success of End-DCR surgery in light of relevant literature. Methods The study included 155 patients who underwent End-DCR surgery in our clinic due to epiphora. This was a prospective randomized, single-blind, controlled trial. Group I (control) included 54 patients who did not undergo silicone stent insertion or silver nitrate application, group II included 51 patients who underwent silicone stent insertion only, and group III included 50 patients who underwent silver nitrate application only. Statistical analysis was performed on follow-up data regarding anatomic and functional success rates. Results Revision surgery was performed in 16 patients who developed persistent epiphora in the postoperative period, including 6 in group I, 7 in group II, and 3 in group III ( P = .4). The most common reason for revision surgery was stenosis of the neo-ostium ( n = 8), followed by granulation tissue formation ( n = 5) and synechia formation ( n = 3). Granuloma formation was the most common postoperative complication, and a significant difference was found among the groups with regard to granuloma formation ( P = .04). At postoperative month 12, the functional success rate was estimated to be 88%, 86%, and 94%, and the anatomic success rate was estimated to be 94%, 92%, and 96% in groups I, II, and III, respectively, with no significant difference, found among the 3 groups with regard to both rates ( P = .79 and P = .76, respectively). Conclusion The results indicated that stenting and silver nitrate application did not affect surgical success. Our preliminary results on silver nitrate cauterization showed that it is an effective, inexpensive, and practical method to reduce granulation formation in the postoperative period.

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Recurrent Instability after Arthroscopic Glenoid Labral Repair with a Minimum of Three Points of Fixation: Do the Number of Anchors or Fixation Points Correlate to Outcomes?

Surgical Technology Online ◽

10.52198/21.sti.38.os1411 ◽

2021 ◽

Author(s):

Sean Mc Millan ◽

Brian Fliegel ◽

Michael Stark ◽

Elizabeth Ford ◽

Manuel Pontes ◽

...

Keyword(s):

Shoulder Instability ◽

Statistical Significance ◽

Labral Repair ◽

Secondary Outcome ◽

Consecutive Series ◽

Recurrent Instability ◽

Significant Difference ◽

Fixation Points ◽

Definition Of ◽

Shoulder Score

Introduction: The goal of this study was to evaluate the recurrence rate of instability following arthroscopic Bankart repairs in regard to the number and types of fixation utilized. A Bankart lesion is a tear in the anteroinferior capsulolabral complex within the shoulder, occurring in association with an anterior shoulder dislocation. These injuries can result in glenoid bone loss, decreased range of motion, and recurrent shoulder instability. Successful repair of these lesions has been reported in the literature with repair constructs that have three points of fixation. However, the definition of “one point of fixation” is yet to be fully elucidated. Materials and Methods: A consecutive series of arthroscopically repaired Bankart lesions were evaluated pertaining to the points of fixation required to achieve shoulder stability. This included the number, position, and types of anchors used. Patients consented to complete a series of surveys at a minimum of two years postoperatively. The primary outcome was to determine recurrent instability via the UCLA Shoulder Score, the ROWE Shoulder Instability Score, and the Oxford Shoulder Score. A secondary outcome included pain on a Visual Analog Scale (VAS). Results: There were 116 patients reviewed, 46 patients achieved three points of fixation in their surgical repair via two anchors and 70 patients achieved a similar fixation with three or more anchors. There was no significant difference in the mean age, gender, or body mass index (BMI). Patients receiving two anchors demonstrated recurrent instability 8.7% of the time (4 of 46 patients). Patients who received three or more anchors demonstrated recurrent instability 8.6% of the time (6 of 70 patients). Overall, there was no statistical significance between the number/types of anchors used. Between the two cohorts, there was no statistically significant difference found between VAS, ROWE, UCLA, and Oxford Scores. There was a significant difference in pain reported on the VAS scale with an average VAS score of 0.43 versus 2.5 in those without and with recurrent instability respectively. Conclusion: Contention still exists surrounding the exact definition of “a point of fixation” in arthroscopic Bankart repairs. Three-point constructs can be created through a variety of combinations including anchors and sutures, ultimately achieving the goal of a stable shoulder.

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