Dural sac cross-sectional area is a highly effective parameter for spinal anesthesia in geriatric patients undergoing transurethral resection of the prostate: a prospective, double blinded, randomized study

The present study deals with the indication for inferior turbinate surgery in cases of concomitant anterior septal deviation. We define, by acoustic rhinometry, the characteristics of the obstructed nose and define mucosal turbinate hypertrophy. A random sample of 80 patients with nasal obstruction and anteriorly located septal deviation were objectively evaluated by acoustic rhinometry pre– and post–operatively. All had septoplasty and half were randomly selected to have anterior inferior turbinoplasty performed in the side opposite to the major septal deviation. Severe septal deviation, expressed by a minimal cross–sectional area less than 0.4 cm2 was present in 37 patients. In this group inferior turbinate reduction seems advisable. In the wide side, the minimal cross–sectional area and the cross–sectional areas at 3.3 and 4.0 cm from the nostrils increased in the turbinectomy group and decreased in the non–turbinectomy group after correction of the septal deviation. In the group with less pronounced septal deviation no influence of turbinate reduction could be detected.

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Reliability of preoperative MRI findings in patients with lumbar spinal stenosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04949-4 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Hasan Banitalebi ◽

Ansgar Espeland ◽

Masoud Anvar ◽

Erland Hermansen ◽

Christian Hellum ◽

...

Keyword(s):

Spinal Stenosis ◽

Interobserver Agreement ◽

Facet Joint ◽

Cross Sectional Area ◽

Sectional Area ◽

Intraobserver Agreement ◽

Mri Findings ◽

Cross Sectional ◽

Facet Joint Osteoarthritis ◽

Dural Sac

Abstract Background Magnetic Resonance Imaging (MRI) is an important tool in preoperative evaluation of patients with lumbar spinal stenosis (LSS). Reported reliability of various MRI findings in LSS varies from fair to excellent. There are inconsistencies in the evaluated parameters and the methodology of the studies. The purpose of this study was to evaluate the reliability of the preoperative MRI findings in patients with LSS between musculoskeletal radiologists and orthopaedic spine surgeons, using established evaluation methods and imaging data from a prospective trial. Methods Consecutive lumbar MRI examinations of candidates for surgical treatment of LSS from the Norwegian Spinal Stenosis and Degenerative Spondylolisthesis (NORDSTEN) study were independently evaluated by two musculoskeletal radiologists and two orthopaedic spine surgeons. The observers had a range of experience between six and 13 years and rated five categorical parameters (foraminal and central canal stenosis, facet joint osteoarthritis, redundant nerve roots and intraspinal synovial cysts) and one continuous parameter (dural sac cross-sectional area). All parameters were re-rated after 6 weeks by all the observers. Inter- and intraobserver agreement was assessed by Gwet’s agreement coefficient (AC1) for categorical parameters and Intraclass Correlation Coefficient (ICC) for the dural sac cross-sectional area. Results MRI examinations of 102 patients (mean age 66 ± 8 years, 53 men) were evaluated. The overall interobserver agreement was substantial or almost perfect for all categorical parameters (AC1 range 0.67 to 0.98), except for facet joint osteoarthritis, where the agreement was moderate (AC1 0.39). For the dural sac cross-sectional area, the overall interobserver agreement was good or excellent (ICC range 0.86 to 0.96). The intraobserver agreement was substantial or almost perfect/ excellent for all parameters (AC1 range 0.63 to 1.0 and ICC range 0.93 to 1.0). Conclusions There is high inter- and intraobserver agreement between radiologists and spine surgeons for preoperative MRI findings of LSS. However, the interobserver agreement is not optimal for evaluation of facet joint osteoarthritis. Trial registration www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.

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