scholarly journals Tissue discrimination by bioelectrical impedance during PLL resection in anterior decompression surgery for treatment of cervical spondylotic myelopathy

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Fuqiang Shao ◽  
He Bai ◽  
Muyao Tang ◽  
Yuan Xue ◽  
Yu Dai ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cortical Bone ◽  
Dura Mater ◽  
Nerve Root ◽  
Annulus Fibrosus ◽  
Bioelectrical Impedance ◽  
Biological Tissues ◽  
Decompression Surgery ◽  
Anterior Cervical Decompression ◽  
Significant Difference

Abstract Background The electrical properties of biological tissues differ depending on their physical properties. This study aimed to explore if bioelectrical impedance (modulus and phase) would discriminate tissues relevant to resection of the posterior longitudinal ligament (PLL) in anterior cervical decompression surgery. Methods PLL resection via an anterior approach was performed on the C4/5 segments in six mini-pigs. The bioelectrical impedance measurements were performed for two tissue groups (annulus fibrosus, endplate cartilage, sub-endplate cortical bone, and PLL; PLL, dura mater, spinal cord, and nerve root) using a novel probe and a precision inductance-capacitance-resistance meter. For each group, impedance was analyzed in terms of modulus and phase along a broad spectrum of frequencies (200–3000 kHz) using a nonparametric statistical analysis (Kruskal-Wallis). Results The analysis showed a clear difference among the tissues. The modulus and phase show the same changing trend with frequency and present lower values at higher frequencies. Among annulus fibrosus, endplate cartilage, sub-endplate cortical bone, and PLL, it was possible to discriminate each tissue at every frequency point, considering the phase (p < 0.05), while this was not always the case (i.e., annulus fibrosus vs PLL at frequency of 200 kHz, 400 kHz, and 3000 kHz, p > 0.05) for modulus. Among PLL, dura mater, spinal cord, and nerve root, for every comparison, a statistically significant difference was reported in the modulus, phase, or both (p < 0.05). Conclusions The results indicated the potential of bioelectrical impedance to provide real-time tissue differentiation and enhance safe PLL resection in anterior cervical decompression surgery, particularly in robot-assisted minimally invasive surgery (RMIS).

Damage Accumulation Modeling and Rate Dependency of Spinal Dura Mater

2017 ◽  
Author(s):  
Nicole L. Ramo ◽  
Snehal S. Shetye ◽  
Christian M. Puttlitz
Keyword(s):  
Spinal Cord ◽  
Strain Rate ◽  
Dura Mater ◽  
Damage Accumulation ◽  
Biological Tissues ◽  
Material Behavior ◽  
Failure Behavior ◽  
Strain Rates ◽  
Rate Dependent ◽  
Damage Accumulation Modeling

As the strongest of the meningeal tissues, the spinal dura mater plays an important role in the overall behavior of the spinal cord-meningeal complex (SCM). It follows that the accumulation of damage affects the dura mater’s ability to protect the cord from excessive mechanical loads. Unfortunately, current computational investigations of spinal cord injury etiology typically do not include post-yield behavior. Therefore, a more detailed description of the material behavior of the spinal dura mater, including characterization of damage accumulation, is required to comprehensively study spinal cord injuries. Continuum mechanics-based viscoelastic damage theories have been previously applied to other biological tissues, however the current work is the first to report damage accumulation modeling in a SCM tissue. Longitudinal samples of ovine cervical dura mater were tensioned-to-failure at one of three strain rates (quasi-static, 0.05/sec, and 0.3/sec). The resulting stress-strain data were fit to a hyperelastic continuum damage model to characterize the strain-rate dependent sub-failure and failure behavior. The results show that the damage behavior of the fibrous and matrix components of the dura mater are strain-rate dependent, with distinct behaviors when exposed to strain-rates above that experienced during normal voluntary neck motion suggesting the possible existence of a protective mechanism.

Delayed C5 Palsy After Anterior Cervical Decompression Surgery: Preoperative Foraminal Stenosis and Postoperative Spinal Cord Shift Increase the Risk of Palsy

2018 ◽  
Vol 120 ◽  
pp. e1107-e1119 ◽  
Author(s):  
Hajime Takase ◽  
Hidetoshi Murata ◽  
Mitsuru Sato ◽  
Takahiro Tanaka ◽  
Ryohei Miyazaki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Decompression Surgery ◽  
Foraminal Stenosis ◽  
C5 Palsy ◽  
Anterior Cervical Decompression ◽  
Spinal Cord Shift

scholarly journals P.171 Primary motor cortex metabolite levels correlate with dexterity following spinal surgery for degenerative cervical myelopathy

2021 ◽  
Vol 48 (s3) ◽  
pp. S68-S69
Author(s):  
AC Friesen ◽  
SA Detombe ◽  
S Kalsi-Ryan ◽  
D Wong ◽  
W Ng ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Motor Cortex ◽  
Cervical Myelopathy ◽  
Primary Motor Cortex ◽  
Metabolite Profile ◽  
Resonance Spectroscopy ◽  
Decompression Surgery ◽  
Postoperative Changes ◽  
Significant Difference ◽  
Degenerative Cervical Myelopathy

Background: Spinal cord compression from degenerative cervical myelopathy is characterized by progressive loss of hand dexterity, alongside changes in the metabolite profiles in the brain and spinal cord. Correlating the changing metabolite profile with measures of dexterity following decompression surgery may assist in identifying which patients may benefit most from surgery. Methods: Thirty operative myelopathy patients consented to receive spectroscopy and GRASSP-M dexterity assessments both preoperatively and 6-weeks postoperatively. Magnetic resonance spectroscopy (TE=135) was performed in the motor cortex using a 3 Tesla Siemens MRI scanner at Robarts Research Institute. Spearman correlations were used to evaluate associations between metabolite levels and dexterity (p<0.05 was considered significant). Paired two-tailed Student t-tests were used to assess for postoperative changes in metabolite levels. Results: Postoperatively, we observed a statistically significant (p<0.05) negative correlation (r=-0.44) between the N-acetylaspartate-to-creatine ratio (NAA/Cr) and GRASSP-M dexterity scores. There was no significant difference in NAA, Cr, or NAA/Cr postoperatively. Conclusions: These findings demonstrate that patients with lower postoperative NAA/Cr usually have better recovery of dexterity. This link between the myelopathic metabolite profile and clinically meaningful dexterity values requires further investigation to understand the role of both NAA and Cr in mechanisms of postoperative recovery from myelopathy.

scholarly journals Deep Learning-Based Cervical Spine Posterior Percutaneous Endoscopic Disc Nucleus Resection for the Treatment of Cervical Spondylotic Radiculopathy

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Yang Zhang ◽  
Hengjie Zhu ◽  
Zheng Zhou ◽  
Yinming Sun ◽  
Xiang Shen ◽  
...  
Keyword(s):  
Deep Learning ◽  
Cervical Spine ◽  
Cervical Radiculopathy ◽  
Surgical Instruments ◽  
Decompression Surgery ◽  
Average Height ◽  
Cervical Spondylotic Radiculopathy ◽  
Anterior Cervical Decompression ◽  
Significant Difference

In the past 10 years, the technology of percutaneous spine endoscopy has been continuously developed. The indications have expanded from simple lumbar disc herniation to various degenerative diseases of the cervical, thoracic, and lumbar spine. Traditional surgery for the treatment of cervical radiculopathy includes anterior cervical decompression surgery, anterior cervical decompression plus fusion surgery, and posterior limited fenestration surgery. This article mainly studies the treatment of cervical spondylosis caused by radiculopathy caused by the nucleus resection of the posterior cervical spine percutaneous spinal endoscopy based on deep learning. In the PPECD group, the height of the intervertebral cavity was measured before the operation and during the final follow-up, and the height change of the intervertebral cavity was evaluated. The relative angle and relative displacement of the sagittal plane of the operation segment in the PPECD group were measured, and the stability was evaluated. Using the cervical spine X-ray Kelvin degeneration evaluation criteria, before and during the final follow-up operation, the degeneration of the adjacent segments of the two groups was evaluated. A retrospective analysis of 26 cases of cervical radiculopathy that met the criteria for diagnosis, inclusion, and exclusion was reviewed. Among them, 11 cases were treated with PPECD surgery; 15 cases were treated with ACDF surgery. According to the evaluation method of Odom, the excellent rate and the good rate of the two groups were compared. According to the location of the lesion, the nerve detection or dull tip device is exposed under the armpit or shoulder of the nerve root, and the protruding nucleus pulposus tissue is explored and removed, and annulus fibrosus is performed as needed. After hemostasis was detected, the surgical instruments were removed and the surgical incision was completely sutured. Before the operation and 3 months after the operation, the final follow-up made no significant difference in the overall average height of the intervertebral cavity (F = 2.586, P > 0.05 ). The results show that posterior foramen expansion is an effective surgical method for the treatment of cervical spondylotic radiculopathy, but surgical adaptation requires strict management. In order to achieve satisfactory results, appropriate cases must be selected.

scholarly journals Damage Accumulation Modeling and Rate Dependency of Spinal Dura Mater

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Nicole Ramo ◽  
Snehal S. Shetye ◽  
Christian M. Puttlitz
Keyword(s):  
Spinal Cord ◽  
Strain Rate ◽  
Dura Mater ◽  
Damage Accumulation ◽  
Biological Tissues ◽  
Material Behavior ◽  
Failure Behavior ◽  
Strain Rates ◽  
Rate Dependent ◽  
Damage Accumulation Modeling

As the strongest of the meningeal tissues, the spinal dura mater plays an important role in the overall behavior of the spinal cord-meningeal complex (SCM). It follows that the accumulation of damage affects the dura mater's ability to protect the cord from excessive mechanical loads. Unfortunately, current computational investigations of spinal cord injury (SCI) etiology typically do not include postyield behavior. Therefore, a more detailed description of the material behavior of the spinal dura mater, including characterization of damage accumulation, is required to comprehensively study SCI. Continuum mechanics-based viscoelastic damage theories have been previously applied to other biological tissues; however, the current work is the first to report damage accumulation modeling in a tissue of the SCM complex. Longitudinal (i.e., cranial-to-caudal long-axis) samples of ovine cervical dura mater were tensioned-to-failure at one of three strain rates (quasi-static, 0.05/s, and 0.3/s). The resulting stress–strain data were fit to a hyperelastic continuum damage model to characterize the strain-rate-dependent subfailure and failure behavior. The results show that the damage behavior of the fibrous and matrix components of the dura mater are strain-rate dependent, with distinct behaviors when exposed to strain rates above that experienced during normal voluntary neck motion suggesting the possible existence of a protective mechanism.

Dry Needling Can Be An Alternative Treatment for Hemifacial Spasm

2020 ◽  
Vol 6 (2) ◽  
pp. 20-28
Author(s):  
Selly Marisdina ◽  
Henry Sugiharto ◽  
A Pradian
Keyword(s):  
Botulinum Toxin ◽  
Hemifacial Spasm ◽  
Alternative Treatment ◽  
Epidemiological Data ◽  
Clinical Severity ◽  
Decompression Surgery ◽  
Dry Needling ◽  
Significant Difference ◽  
Microvascular Decompression Surgery ◽  
Botulinum Toxin Injections

Back Ground: Hemifacial spasm is one of movement disorder case that commonly found in daily clinical practice. Epidemiological data are very limited, the average prevalence is 11 per 100,000 population, 14.5 per 100,000 in women and 7.4 per 100,000 in men. In Germany, the estimated prevalence is 8000 to 9000 peoples.1 The incidence of women is more than that of men with a ratio of 2:1. Based on Yaltho and Jankovic study in 2011, out of 215 patients, the ratio of men to women was 1:1.8.2 One study in Indonesia also reported that most of the subjects were female (64.7%).3 Treatment with botulinum toxin injections is preferred to microvascular decompression surgery therapy, but this injection is only effective in a few months and quite expensive. This study is the first study to assess the effectiveness of dry needling on clinical improvement of hemifacial spasm compared to standard therapy of botulinum toxin injection.Methods: The study design was quasi experimental. Total of 24 subjects were divided into two groups. The first group underwent dry needling intervention while the other had botulinum injection. Clinical severity before and after treatment in both groups was assessed using Jankovic and HFS7 scores.Results: In dry needling group there were significant differences between Jankovic and HFS7 score at baseline and at week 1, 2, 3 and 4. While in botox group significant differences were also Jankovic and HFS7 score at baseline and at weeks 2 and 4. There were also a significant difference of Jankovic and HFS7 score when we compared dry needling group to botulinum toxin group.Conclusion: Dry needling can be an alternative treatment for hemifacial spasm, although clinical improvements based on Jankovic and HFS7 scores in dry needling group were not as effective as those with botulinum toxin injections.

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

2020 ◽  
Vol 49 (3) ◽  
pp. E11 ◽  
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.

scholarly journals Ethnic variation in medial orbital wall anatomy and its implications for decompression surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Minhui Amy Chan ◽  
Farah Ibrahim ◽  
Arjunan Kumaran ◽  
Kailing Yong ◽  
Anita Sook Yee Chan ◽  
...  
Keyword(s):  
Relative Position ◽  
Ethmoid Sinus ◽  
Decompression Surgery ◽  
Ethnic Variation ◽  
Sinus Wall ◽  
Orbital Wall ◽  
Mean Width ◽  
Significant Difference ◽  
The Mean ◽  
Medial Orbital Wall

Abstract Background To describe the inter-ethnic variation in medial orbital wall anatomy between Chinese, Malay, Indian and Caucasian subjects. Methods Single-centre, retrospective, Computed Tomography (CT)-based observational study. 20 subjects of each ethnicity, were matched for gender and laterality. We excluded subjects younger than 16 years and those with orbital pathology. OsiriX version 8.5.1 (Pixmeo., Switzerland) and DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) were used to measure the ethmoidal sinus length, width and volume, medial orbital wall and floor angle and the relative position of the posterior ethmoid sinus to the posterior maxillary wall. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (IBM, USA). Results There were 12 males (60 %) in each group, with no significant difference in age (p = 0.334–0.994). The mean ethmoid sinus length in Chinese, Malay, Indian and Caucasian subjects, using the Chinese as reference, were 37.2, 36.9, 38.0 and 37.4mm, the mean width was 11.6, 10.5, 11.4 and 10.0mm (p = 0.020) and the mean ethmoid sinus volume were 3362, 3652, 3349 and 3898mm3 respectively. The mean medial orbital wall and floor angle was 135.0, 131.4, 131.0 and 136.8 degrees and the mean relative position of posterior ethmoid sinus to posterior maxillary wall were − 2.0, -0.2, -1.5 and 1.6mm (p = 0.003) respectively. Conclusions No inter-ethnic variation was found in decompressible ethmoid sinus volume. Caucasians had their posterior maxillary sinus wall anterior to their posterior ethmoidal walls unlike the Chinese, Malay and Indians. Awareness of ethnic variation is essential for safe orbital decompression.

scholarly journals Correlation between uniocular deviation and duction changes following different decompression surgeries in thyroid eye disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jie Guo ◽  
Xiaofeng Li ◽  
Ruiqi Ma ◽  
Jiang Qian
Keyword(s):  
Computed Tomography ◽  
Lateral Wall ◽  
Contractile Force ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Decompression Surgery ◽  
Inferior Wall ◽  
Orbital Decompression ◽  
Significant Difference ◽  
Ocular Deviation

Abstract Background Postoperative ocular imbalance is an important problem for orbital decompression surgery in thyroid eye disease (TED). The aim of this study was to evaluate the changes in unilateral ocular deviation and duction following orbital decompression and discuss the biomechanics of ocular imbalance. Methods Fifty-four TED patients who underwent unilateral orbital decompression were included. Fifteen patients underwent 1-wall (deep lateral wall) decompression, 18 patients underwent 2-wall (deep lateral and medial wall) decompression and 21 patients underwent 3-wall (deep lateral, medial and inferior wall) decompression. Objective and subjective deviation of the operated eyes were evaluated using the prism test and synoptophore, respectively. Ocular ductions were measured using Hirschberg’s method. The diameters of the extraocular rectus were measured by computed tomography. Results Ocular deviation and duction showed no significant difference after 1-wall decompression (p = 0.25–0.89). Esotropia increased after 2-wall decompression (p = 0.001–0.02), and hypotropia increased after 3-wall decompression (p = 0.02). Adduction increased but abduction decreased following 2-wall and 3-wall decompression (p < 0.05). Infraduction increased following 3-wall decompression (p < 0.001). Additionally, the increase in esotropia was significantly correlated with the increase in adduction and with the decrease in abduction (r = 0.37–0.63, p < 0.05). There were significant correlations between the diameter of the medial rectus and the increase in esotropia, the increase in adduction and the decrease in abduction postoperatively (r = 0.35–0.48, p < 0.05). Conclusions The changes in ocular deviation and duction were different after 1-wall, 2-wall and 3-wall orbital decompression. The increased contractile force of the rectus may be an important reason for strabismus changes after orbital decompression surgery.

scholarly journals Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mohamed I. Refaat ◽  
Amr K. Elsamman ◽  
Adham Rabea ◽  
Mohamed I. A. Hewaidy
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Decompression Surgery ◽  
Microsurgical Decompression ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

Sign in / Sign up

Export Citation Format

Share Document