scholarly journals Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study

2020 ◽  
Author(s):  
Carlos Eduardo Barsotti ◽  
Bruno Moreira Gavassi ◽  
Francisco Eugenio Prado ◽  
Bernardo Nogueira Batista ◽  
Raphael de Resende Pratali ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Diagnostic Accuracy ◽  
Nerve Injury ◽  
Sagittal Plane ◽  
False Negative ◽  
Pedicle Screws ◽  
Axial Plane ◽  
Diagnostic Study ◽  
Cross Sectional ◽  
Curve Magnitude

Abstract Background: To investigate in the conventional techniques of the pedicle screws using triggered screw electromyography (t-EMG), considering different threshold cutoffs: 10, 15, 20 25 mA, for predicting pedicle screw positioning during surgery of the adolescent with idiopathic scoliosis (AIS). Methods: Sixteen patients (4 males, 12 females, average age 16.6 years) were included, with an average curve magnitude of 50 degrees and placement of 226 pedicle screws. Each screw was classified as “at risk for nerve injury” (ARNI) or “no risk for nerve injury” (NRNI) using CT and the diagnostic accuracy of EMG considering different threshold cutoffs (10,15, 20 and 25 mA) in the axial and Sagittal planes for predicting screw positions ARNI was investigated. Results: The EMG exam accuracy, in the axial plane, 90.3% screws were considered NRNI. In the sagittal plane, 81% pedicle screws were considered NRNI. A 1-mA decrease in the EMG threshold was associated with a 12% increase in the odds of the screw position ARNI. In the axial and sagittal planes, the ORs were 1.09 and 1.12, respectively. At every threshold cutoff evaluated, the PPV of EMG for predicting screws ARNI was very low in the different threshold cutoff (10 and 15); the highest PPV was 18% with a threshold cutoff of 25 mA. The PPV was always slightly higher for predicting screws ARNI in the sagittal plane than in the axial plane. In contrast, there was a moderate to high NPV (78%-93%) for every cutoff analyzed. Conclusions: EMG had a moderate to high accuracy for positive predicting value screws ARNI with increase threshold cutoffs of 20 and 25 mA. In addition, showed to be effective for minimizing false-negative screws ARNI in the different threshold cutoffs of the EMG in adolescent with idiopathic scoliosis (AIS).

scholarly journals Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study

2020 ◽  
Author(s):  
Carlos Eduardo Barsotti ◽  
Bruno Moreira Gavassi ◽  
Francisco Eugenio Prado ◽  
Bernardo Nogueira Batista ◽  
Raphael de Resende Pratali ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Diagnostic Accuracy ◽  
Nerve Injury ◽  
Predictive Value ◽  
Sagittal Plane ◽  
False Negative ◽  
Pedicle Screws ◽  
Diagnostic Study ◽  
Cross Sectional

Abstract Background: To investigate electromyography (EMG) thresholds for predicting pedicle screw positioning during adolescent idiopathic scoliosis (AIS) surgery.Methods: 16 patients were included. Each screw was classified as “at risk for nerve injury” (ARNI) or “no risk for nerve injury” (NRNI) using CT and the diagnostic accuracy of EMG thresholds for predicting screw positions ARNI was investigated.Results: 226 pedicles were analyzed. In the axial plane, 204 (90.3%) screws were considered as NRNI, and 22 (9.7%), as ARNI. In the sagittal plane, 183 (81%) pedicle screws were considered as NRNI, and 43 (19%), as ARNI. We observed a significant association between EMG responses and screw positioning ARNI. A 1-mA decrease in EMG threshold corresponded to a 12% increase in the odds of screw position ARNI (OR=1.12; p<.001). The positive predictive value of EMG for diagnosing ARNI was very low, with the highest 18% corresponding to a cutoff of 25 mA, but the negative predictive value was moderate to high (78%-93%) for every cutoff.Conclusions: EMG had a poor accuracy for predicting screws ARNI but was effective for minimizing false-negative screws ARNI.

scholarly journals Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Eduardo Barsotti ◽  
Bruno Moreira Gavassi ◽  
Francisco Eugenio Prado ◽  
Bernardo Nogueira Batista ◽  
Raphael de Resende Pratali ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Diagnostic Accuracy ◽  
Pedicle Screws ◽  
Diagnostic Study ◽  
Cross Sectional ◽  
Scoliosis Treatment

scholarly journals Adolescent idiopathic scoliosis detection and referral trends: impact treatment options

2020 ◽  
Vol 9 (1) ◽  
pp. 75-84
Author(s):  
Alison Anthony ◽  
Reinhard Zeller ◽  
Cathy Evans ◽  
Jennifer A. Dermott
Keyword(s):  
Family History ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Geographic Location ◽  
Initial Assessment ◽  
Brace Treatment ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Curve Magnitude

Abstract Study design Retrospective cross-sectional study. Objective To analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines. Summary of background data There is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection. Methods We performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10–18 years, with scoliosis greater than 10°, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude. Results During the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7° more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence. Conclusion The majority of AIS patients present too late for effective management with bracing. Level of evidence III.

scholarly journals DIAGNOSTIC ACCURACY OF 99 MTC LABELLED UBIQUICIDIN (29-41) SPECT/CT FOR DIAGNOSIS OF OSTEOMYELITIS IN DIABETIC FOOT

2021 ◽  
Vol 71 (3) ◽  
pp. 1015-19
Author(s):  
Muhammad Atif ◽  
Fida Hussain ◽  
Zaigham Salim Dar ◽  
Jameela Khatoon ◽  
Saadia Ajmal ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diabetic Foot ◽  
Predictive Value ◽  
Gold Standard ◽  
Soft Tissues ◽  
Bone Biopsy ◽  
False Negative ◽  
Armed Forces ◽  
True Negative ◽  
Cross Sectional

Objective: To determine diagnostic accuracy of 99mTc labelled Ubiquicidin (29-41) SPECT/CT for detection of osteomyelitis in diabetic foot patients by taking bone biopsy as gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology, from Apr 2017 to Mar 2018. Methodology: Study assessed 122 patients of both genders, aged between 30-80 years (mean age=55.3 years), presenting with diabetic foot ulcers having suspicion of osteomyelitis, by 99mTc-Ubiquicidin (29-41) SPECT/CT followed by bone biopsy (histopathology and culture) taken as gold standard. Results: Among 122 patients [94 male (77%) and 28 female (23%)], osteomyelitis was histopathologically confirmed in 113 patients. 107 out of these patients were positive for osteomyelitis on 99mTc-UBI (29-41) SPECT/CT (true positives) while 6 were false negative. Out of 9 patients declared negative for osteomyelitis on histopathology and culture, 8 were negative on 99mTc-UBI (29-41) SPECT/CT as well (true negative) while only 1 case came out to be positive (false positive). Thus, the 99mTc-UBI (29-41) scan showed 94.6% sensitivity, 88.89% specificity, 99% positive predictive value, 57% negative predictive value with overall 94.2% diagnostic accuracy. Conclusion: 99mTc labelled Ubiquicidin (29-41) SPECT/CT scan can precisely localize infective focus, in diabetic foot osteomyelitis, with simultaneous discrimination between bone and soft tissues.

Diagnostic Accuracy of MRC in Benign and ML in Obstructive Jaundice Patients, Taking Histopathology as Gold Standard

2021 ◽  
Vol 15 (12) ◽  
pp. 3421-3423
Author(s):  
Kamran Naseem ◽  
Malik Mudasir Hassan ◽  
Sarah Nisar
Keyword(s):  
Magnetic Resonance ◽  
Obstructive Jaundice ◽  
Diagnostic Accuracy ◽  
Gold Standard ◽  
False Negative ◽  
Magnetic Resonance Cholangiopancreatography ◽  
True Negative ◽  
Cross Sectional ◽  
Standard Material ◽  
Malignant Lesions

Objectives: To find out the diagnostic accuracy of magnetic resonance cholangiopancreatography in benign and malignant lesions in patients of obstructive jaundice, taking histopathology as gold standard. Material and methods: This cross sectional study was conducted at Department of Radiology, Bahawal Victoria Hospital, Bahawalpur October 2019 to April 2020. A total of 164 patients with suspected cases of obstructive jaundice and age 25-65 years of either gender were included. Then magnetic resonance cholangiopancreatography (MRCP) was performed in every patient by 1.5 Tesla MR System using a torso phased-array coil. After this, each patient was undergone operation in the concerned ward. Findings of MRCP were compared with the findings of histopathology. Results: In MRCP positive patients, 78 were true positive (TP) and 13 were false positive (FP). Among 73, MRCP negative patients, 08 were false negative (FN) whereas 65 were True Negative (TN). Overall specificity, sensitivity, NPV, PPV and diagnostic accuracy of magnetic resonance cholangiopancreatography in benign and malignant lesions in patients of obstructive jaundice, taking histopathology as gold standard was 90.70%, 83.33%, 85.71%, 89.04% and 87.20% respectively. Conclusion: This study concluded that magnetic resonance cholangiopancreatography (MRCP) is the non-invasive modality of choice with diagnostic accuracy in diagnosing in benign and malignant lesions in obstructive jaundice patients. Keywords: obstructive jaundice, sensitivity, magnetic resonance imaging.

scholarly journals Positioning of pedicle screws in adolescent idiopathic scoliosis using electromyography

2015 ◽  
Vol 14 (2) ◽  
pp. 97-100
Author(s):  
Bruno Moreira Gavassi ◽  
Raphael de Rezende Pratali ◽  
Carlos Eduardo Gonçales Barsotti ◽  
Ricardo José Rodriguez Ferreira ◽  
Francisco Prado Eugenio dos Santos ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Prospective Observational Study ◽  
Sagittal Plane ◽  
Pedicle Screws ◽  
Neurological Damage ◽  
Single Institution ◽  
Ideal Position ◽  
Safe Technique

<sec><title>OBJECTIVE:</title><p> To analyze the occurrence of poor positioning of pedicle screws inserted with the aid of intraoperative electromyographic stimulation in the treatment of Adolescent Idiopathic Scoliosis (AIS).</p></sec><sec><title>METHODS:</title><p> This is a prospective observational study including all patients undergoing surgical treatment for AIS, between March and December 2013 at a single institution. All procedures were monitored by electromyography of the inserted pedicle screws. The position of the screws was evaluated by assessment of postoperative CT and classified according to the specific AIS classification system.</p></sec><sec><title>RESULTS:</title><p> Sixteen patients were included in the study, totalizing 281 instrumented pedicles (17.5 per patient). No patient had any neurological deficit or complaint after surgery. In the axial plane, 195 screws were found in ideal position (69.4%) while in the sagittal plane, 226 screws were found in ideal position (80.4%). Considering both the axial and the sagittal planes, it was observed that 59.1% (166/281) of the screws did not violate any cortical wall.</p></sec><sec><title>CONCLUSION:</title><p> The use of pedicle screws proved to be a safe technique without causing neurological damage in AIS surgeries, even with the occurrence of poor positioning of some implants.</p></sec>

Diagnostic Accuracy of Ultrasonography for Detection of AT by Taking Surgical Findings as Gold Standard

2021 ◽  
Vol 15 (11) ◽  
pp. 3093-3095
Author(s):  
Iqra Rafique ◽  
Anam Manzoor ◽  
Sana Naseer
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Gold Standard ◽  
False Negative ◽  
Achilles Tendinopathy ◽  
Military Hospital ◽  
True Negative ◽  
Cross Sectional ◽  
Female Ratio ◽  
Standard Design

Objective: To assess the diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy by taking surgical findings as gold standard. Design of the Study: It was a descriptive cross-sectional study. Study Settings: This study was carried out at Department Of Diagnostic Radiology And Diagnostic Imaging Combined Military Hospital, Lahore from 23rd December 2017 to 22nd June 2018. Material and Methods: A total of 70 patients of age 20-70 years, of either gender presenting with severe pain and swelling in area of Achilles tendon were included. Patients with heel pain having concurrent heel ulcer, eczematous changes or calcaneal fractures, muscular dystrophy and previous surgery were excluded. All the patients were then underwent ultrasonography and findings were noted for presence or absence of Achilles tendinopathy. Each Ultrasonographic finding were compared with surgical findings. Results of the Study: Mean age was 41.24 ± 10.34 years. Out of these 70 patients, 46 (65.71%) were male and 24 (34.29%) were females with male to female ratio of 1.9:1. In USG positive patients, 40 (True Positive) had Achilles tendinopathy and 04 (False Positive) had no Achilles tendinopathy on surgical findings. Among, 26 USG negative patients, 03 (False Negative) had Achilles tendinopathy on surgical findings whereas 23 (True Negative) had no Achilles tendinopathy on surgical findings. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy by taking surgical findings as gold standard was 93.02%, 85.19%, 90.91%, 88.46% and 90.0% respectively. Conclusion: This study concluded that diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy is quite high. Keywords: Achilles tendinopathy, ultrasonography, sensitivity.

scholarly journals Diagnostic accuracy of three prevailing rapid antigen tests for detection of SARS-CoV-2 infection in the general population: cross sectional study

2021 ◽  
Author(s):  
Roderick P Venekamp ◽  
Irene K Veldhuijzen ◽  
Karel GM Moons ◽  
Wouter van den Bijllaardt ◽  
Suzan D Pas ◽  
...  
Keyword(s):  
Viral Load ◽  
Diagnostic Accuracy ◽  
False Negative ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Predictive Values ◽  
Routine Sampling ◽  
Antigen Tests

Objective To assess the diagnostic accuracy of three rapid antigen tests (Ag-RDTs) for detecting SARS-CoV-2 infection in the general population. Design Cross-sectional study with follow-up using pseudonymised record linkage. Setting Three Dutch public health service COVID-19 test sites. Participants Consecutively included individuals aged 16 years and older presenting for SARS-CoV-2 testing. Main outcome measures Sensitivity, specificity, positive and negative predictive values of BD-Veritortm System (Becton Dickinson), PanBio (Abbott), and SD-Biosensor (Roche Diagnostics), applying routinely used sampling methods (combined oropharyngeal and nasal [OP-N] or nasopharyngeal [NP] swab), with molecular testing as reference standard. For SDBiosensor, the diagnostic accuracy with OP-N sampling was also assessed. A viral load cutoff (≥5.2 log10 SARS-CoV-2 E-gene copies/mL) served as a proxy of infectiousness. Results SARS-CoV-2 prevalence and overall sensitivities with 95% confidence intervals were 188/1441 (13.0%) and 129/188 (68.6% [61.5%-75.2%]) for BD-Veritor, 173/2056 (8.4%) and 119/173 (68.8% [61.3%-75.6%]) for PanBio, and 215/1769 (12.2%) and 160/215 (74.4% [68.0%-80.1%]) for SD-Biosensor with routine sampling, and 164/1689 (9.7%) and 123/164 (75.0% [67.7%-81.4%]) for SD-Biosensor with OP-N sampling. In those symptomatic or asymptomatic at sampling, sensitivities were 72.2%-83.4% and 54.0%-55.9%, respectively. With a viral load cut-off, sensitivities were 125/146 (85.6% [78.9%-90.9%]) for BD-Veritor, 108/121 (89.3% [82.3%-94.2%]) for PanBio, 160/182 (87.9% [82.3%-92.3%]) for SD-Biosensor with routine sampling, and 118/141 (83.7% [76.5%-89.4%]) with OP-N sampling. Specificities were >99%, and positive and negative predictive values >95%, for all tests in most analyses. 61.3% of false negative Ag-RDT participants returned for testing within 14 days (median of 3 days, interquartile range 3) of whom 90.3% tested positive. Conclusions The overall sensitivities of the three Ag-RDTs were 68.6%-75.0%, increasing to at least 85.6% after the viral load cut-off was applied. For SD-Biosensor, the diagnostic accuracy with OP-N and NP sampling was comparable. Over 55% of false negative Ag-RDT participants tested positive during follow-up.

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