scholarly journals Robot-assisted Anterior Odontoid Screw for the Treatment of Type Ⅱ Odontoid Fractures: Safety and Effectiveness Analysis

2021 ◽  
Author(s):  
Songchuan Zhao ◽  
Yang Bo ◽  
Jinpeng Du ◽  
Liang Yan ◽  
Dingjun Hao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Operation Time ◽  
Soft Tissue Injuries ◽  
Healing Time ◽  
X Rays ◽  
Robot Assisted ◽  
Odontoid Fractures ◽  
Mayo Score ◽  
Bone Cortex ◽  
Post Traumatic

Abstract Background: Anterior odontoid screw fixation is considered to be preferred surgical treatment for the type Ⅱ odontoid fractures. However, due to the high difficulty to insert odontoid screw with barehand, the high risk of screw misalignment and damage to surrounding important tissue structures, we urgently need robot-assisted screw insert navigation technology to improve the safety and accuracy of inserting odontoid screws.Methods: We retrospectively analyzed 7 patients with type II odontoid fractures who underwent Tinavi robot-assisted screw insert technology from May 2018 to May 2019 at our hospital. All patients had received 64-row CT scans and 3D reconstructions completed preoperatively, and magnetic resonance (MRI) were performed to verify the severity of odontoid fractures, soft tissue injuries and vertebral artery height. Postoperative CT was repeated in 6 months after surgery to evaluate cervical stability and confirm whether the screw had breached the bone cortex, the accuracy of screw placement based on Rampersaud A-D grade. Functional recovery was assessed using the post-traumatic Mayor scoring system for the cervical spine.Results: All 7 patients successfully completed the robot-assisted operation without nerve and blood vessel damage. What is the operation time 103.3 minutes, intraoperative blood loss 11.1 ml. The angulation and displacement of the fracture were basically corrected by closed reduction during the operation. Postoperative CT of these 7 patients showed that the cervical spine was stable, the accuracy of “perfect” and “clinically acceptable” odontoid screw implantation was 100% (7/7), none of the seven odontoid screws breached the bone cortex. Reexamination of X-rays showed that the fractures were all healed, and the average fracture healing time was average 13.7weeks (12-15weeks). During the follow-up period, 7 patients had no surgical complications, postoperative cervical spine trauma mayo score: excellent in 6 cases and good in 1 case. Conclusion: Tinavi robot-assisted screw insert technology is a minimally invasive, accurate, safe and feasible method for the treatment of type Ⅱ odontoid fractures.

Functional Radiographic Examination of the Cervical Spine in Patients with Post-Traumatic Headache

Cephalalgia ◽  
1990 ◽  
Vol 10 (6) ◽  
pp. 295-303 ◽  
Author(s):  
Ole Kudsk Jensen ◽  
Tummas Justesen ◽  
Frank Farsø Nielsen ◽  
Kim Brixen
Keyword(s):  
Cervical Spine ◽  
Negative Correlation ◽  
Significant Negative Correlation ◽  
Radiographic Examination ◽  
Control Group ◽  
Segmental Motion ◽  
X Rays ◽  
Post Traumatic ◽  
Ear Symptoms ◽  
Visual Disturbances

The segmental extension-flexion motion of the cervical spine and the overall C1–C7 motion were measured on functional X-rays in 19 patients with post-traumatic headache and 19 age-and sex-matched controls. The extension-flexion C1–C7 motion was reduced in patients with post-traumatic headache due to reduced motion in three segments: C2–C3, C5–C6 ( p < 0.05), and C6–C7 ( p < 0.01). In both groups a negative correlation between the C1–C7 motion and age was found, but the regression coefficients were different. Only in the control group could a negative correlation between segmental motion and age be demonstrated. In the patients with post-traumatic headache a statistically significant negative correlation between the log(pain index) and the age-corrected C1–C7 motion was found ( p < 0.04). On the segmental level a negative correlation between the log (pain index) and the age-corrected C1–C2 and C5–C6 motion could be demonstrated ( p < 0.05). Regarding C6–C7 there was a tendency to negative correlation. Furthermore, a negative correlation between the frequency of associated symptoms (dizziness, visual disturbances and ear symptoms) and the age-corrected C5–C6 motion was found. Consequently the decrement of motion primarily affected C2–C3, C5–C6, and C6–C7, whereas the analysis of correlation with pain index indicated C1–C2 and C5–C6 (C6–C7) as the most important segments involved.

scholarly journals Effectiveness of vascularized and conventional bone grafting in achieving union in humeral pseudarthrosis

2021 ◽  
Vol 27 (2) ◽  
pp. 182-186
Author(s):  
I.O. Golubev ◽  
◽  
A.R. Sarukhanyan ◽  
M.M. Merkulov ◽  
O.M. Bushuev ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Bone Defects ◽  
Healing Time ◽  
Humeral Fractures ◽  
X Rays ◽  
Single Institution ◽  
Technical Errors ◽  
Post Traumatic ◽  
Humeral Nonunion ◽  
Vascularized Bone

Introduction Humeral fractures comprise from 5 % to 8 % of all fractures. Nonunion rate of humeral fractures is 5.5–8.7% with open reduction and internal fixation (ORIF) technique and 3–5.6 % with the use of locked intramedullary nailing technique. Its frequent causes are infection, poor vascularity, severe comminution or technical errors. Purpose Analysis of effectiveness of vascularized bone grafting and non-vascularized bone grafting in humeral nonunion and defect treatment. Material and methods Surgical management of 69 patients with humeral nonunion was performed from 2010 to 2017 at a single institution in two groups. Vascularized bone grafts were used in 41 cases and non-vascularized ones in 28 cases. X-rays and CT-scans of all the patients were studied. Results In the vascularized bone grafting group, union was achieved in 36 cases (88 %) after four to 6 months; in non-vascularized bone group union was achieved in 20 cases (71 %) after eight to 12 months. Conclusion In post-traumatic humeral nonunion and bone defects, after two or more failed surgical procedures performed previously, vascularized bone grafting yields more satisfactory results and reduces the total healing time.

scholarly journals Diagnostic Accuracy of Dual-Layer Spectral CT Using Electron Density Images to Detect Post-Traumatic Prevertebral Hematoma of the Cervical Spine

2021 ◽  
Author(s):  
Sam Sedaghat ◽  
Patrick Langguth ◽  
Naomi Larsen ◽  
Graeme Campbell ◽  
Marcus Both ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Diagnostic Accuracy ◽  
Electron Density ◽  
Diagnostic Value ◽  
Minimum Thickness ◽  
Rater Reliability ◽  
Key Points ◽  
Significant Difference ◽  
Post Traumatic ◽  
Conventional Ct

Purpose To investigate the diagnostic value of dual-layer spectral detector computed tomography (SDCT) in detecting posttraumatic prevertebral hematoma of the cervical spine by including electron density images. Methods 38 patients with post-traumatic imaging of the cervical spine were included in this study and received both SDCT and MRI examinations. MRI was set as the reference and combined conventional/electron density (C + ED) images were compared to conventional CT (CCT) images alone. Results A total of 18 prevertebral hematomas were identified. Reader 1 identified 14 of 18 and reader 2 15 of 18 prevertebral hematomas by using C + ED reconstructions. Readers 1 and 2 detected 6 and 9 of 18 hematomas on CCT, respectively. CCT showed a sensitivity of 33–50 % and a specificity of 75–80 %, while for C + ED reconstructed images the sensitivity was 77–83 % and the specificity was 85–90 %. Accuracy increased from 55–66 % to 84 % by using C + ED images. The minimum thickness for detecting hematoma on C + ED images was 3 mm. The sizes of prevertebral hematoma on CCT/C + ED were not significantly under- or overestimated compared to the MRI reference. There was a significant difference between the two readers for measuring hematoma sizes on CCT (p = 0.04). Readers showed an excellent inter-rater reliability (kappa = 0.82) for C + ED images and a moderative inter-rater reliability (kappa = 0.44) for CCT. Conclusion With SDCT, the diagnostic accuracy for detecting post-traumatic prevertebral hematoma is improved by using combined conventional and electron density reconstructions compared to conventional images alone. Key Points:  Citation Format

Numerical Investigation of Spinal Cord Injury After Flexion-Distraction Injuries At the Cervical Spine

2021 ◽  
Author(s):  
Marie-Helene Beausejour ◽  
Eric Wagnac ◽  
Pierre-Jean Arnoux ◽  
Jean-Marc Mac-Thiong ◽  
Yvan Petit
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
White Matter ◽  
Cervical Spinal Cord ◽  
Element Model ◽  
Von Mises Stress ◽  
Study Objective ◽  
Cord Injury ◽  
Post Traumatic

Abstract Flexion-distraction injuries frequently cause traumatic cervical spinal cord injury (SCI). Post-traumatic instability can cause aggravation of the secondary SCI during patient's care. However, there is little information on how the pattern of disco-ligamentous injury affects the SCI severity and mechanism. This study objective was to analyze how different flexion-distraction disco-ligamentous injuries affect the SCI mechanisms during post-traumatic flexion and extension. A cervical spine finite element model including the spinal cord was used and different combinations of partial or complete intervertebral disc (IVD) rupture and disruption of various posterior ligaments were modeled at C4-C5, C5-C6 or C6-C7. In flexion, complete IVD rupture combined with posterior ligamentous complex rupture was the most severe injury leading to the most extreme von Mises stress (47 to 66 kPa), principal strains p1 (0.32 to 0.41 in white matter) and p3 (-0.78 to -0.96 in white matter) in the spinal cord and to the most important spinal cord compression (35 to 48 %). The main post-trauma SCI mechanism was identified as compression of the anterior white matter at the injured level combined with distraction of the posterior spinal cord during flexion. There was also a concentration of the maximum stresses in the gray matter after injury. Finally, in extension, the injuries tested had little impact on the spinal cord. The capsular ligament was the most important structure in protecting the spinal cord. Its status should be carefully examined during patient's management.

The Isolated Scapho-Trapezio-Trapezoid Ligament Injury

1993 ◽  
Vol 18 (6) ◽  
pp. 730-735 ◽  
Author(s):  
A. C. MASQUELET ◽  
F. STRUBE ◽  
J. Y. NORDIN
Keyword(s):  
Chronic Pain ◽  
Middle Finger ◽  
Tendon Sheath ◽  
Thenar Eminence ◽  
Ligament Injury ◽  
Pinch Strength ◽  
X Rays ◽  
Complete Rupture ◽  
Trapezoid Ligament ◽  
Post Traumatic

Isolated injuries of the scapho-trapezial ligament complex are not well recognized. The ligament complex comprises the stout scapho-trapezial ligament, the floor of the flexor carpi radialis (FCR) tendon sheath and the scapho-capitate ligament. Between August 1991 and May 1992, we diagnosed and treated four cases of partial chronic post-traumatic lesions of this ligament complex. There was chronic pain at the base of the thenar eminence and instability of the thumb-index-middle finger pinch. Standard X-rays were normal. The diagnosis of ligament rupture was confirmed by mid-carpal arthrography showing filling of the sheath of FCR tendon. Surgical exploration showed complete rupture of the tendon sheath of FCR in two cases, associated in the other two cases with complete rupture of the scapho-trapezial ligament. Direct repair of the ligamentous elements was performed in all cases. The tendon of FCR was sutured to the tubercle of scaphoid to protect and to reinforce the ligament repair. The patients have been followed-up for between 6 and 12 months. All four patients recovered normal pinch strength to the middle finger. One patient suffered from chronic pain at work.

scholarly journals Computerized Tomographic Morphometric Analysis of the Cervical Spine

2012 ◽  
Vol 6 (1) ◽  
pp. 250-254 ◽  
Author(s):  
DS Evangelopoulos ◽  
P Kontovazenitis ◽  
S Kouris ◽  
X Zlatidou ◽  
LM Benneker ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Preoperative Planning ◽  
Morphometric Study ◽  
Detailed Knowledge ◽  
Cervical Canal ◽  
X Rays ◽  
Transverse Foramen ◽  
Male And Female ◽  
Canal Diameter ◽  
Significant Difference

Background: Detailed knowledge of cervical canal and transverse foramens’ morphometry is critical for understanding the pathology of certain diseases and for proper preoperative planning. Lateral x-rays do not provide the necessary accuracy. A retrospective morphometric study of the cervical canal was performed at the authors’ institution to measure mean dimensions of sagittal canal diameter (SCD), right and left transverse foramens’ sagittal (SFD) and transverse (TFD) diameters and minimum distance between spinal canal and transverse foramens (dSC-TF) for each level of the cervical spine from C1-C7, using computerized tomographic scans, in 100 patients from the archives of the Emergency Room. Results: Significant differences for SCD were detected between C1 and the other levels of the cervical spine for both male and female patients. For the transverse foramen, significant differences in sagittal diameters were detected at C3, C4, C5 levels. For transverse diameters, significant differences at C3 and C4 levels. A significant difference of the distance between the transverse spinal foramen and the cervical canal was measured between left and right side at the level of C3. This difference was equally observed to male and female subjects. Conclusion: CT scan can replace older conventional radiography techniques by providing more accurate measurements on anatomical elements of the cervical spine that could facilitate diagnosis and preoperative planning, thus avoiding possible trauma to the vertebral arteries during tissue dissection and instrument application.

Is Robot-assisted Radical Cystectomy the Preferred Minimal Invasive Procedure for Non-advanced Bladder Urothelial Carcinoma(T1-T2N0M0)? A Single Center Retrospective Study.

2020 ◽  
Author(s):  
Ming Xiao ◽  
Zhaohui Zhong ◽  
Jiannan Ren ◽  
Wei Xiong
Keyword(s):  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Operation Time ◽  
Invasive Procedure ◽  
Minimal Invasive ◽  
Postoperative Treatment ◽  
Transfusion Rate ◽  
Robot Assisted ◽  
Bladder Urothelial Carcinoma ◽  
Hospitalization Costs

Abstract Background: To investigate the perioperative efficacy and cost of robot-assisted radical cystectomy(RARC) and laparoscopic RC(LRC) in patients with non-advanced bladder urothelial carcinomaMethods: 156 patients with non-advanced bladder urothelial carcinoma undergoing minimally invasive radical cystectomy in our center between January 2015 and April 2020 were included. Perioperative data and hospitalization expenses were extracted from our database. All analyses were performed using SPSS 23.0 software, and p < 0.05 was considered statistically significant.Results: The proportion of male patients was 86.5%(135/156) and the median age was 65(IQR 59-71) years old. RARC had a lower PSM rate (0 vs 5.3%,P=0.051), longer median operation time(370 vs 305 min,P<0.001) and higher median hospitalization cost(20565.2 vs 15532.4$,P<0.001). There were no significant differences in intraoperative transfusion rate, anesthesia resuscitation in ICU, postoperative hospital stay, 30-d complications and postoperative treatment expenses between the two groups(P=0.815,0.715, 0.817,0.92 and 0.543,respectively.)Conclusion: Short operation time and low hospitalization costs are favorable factors for LRC, but RARC may be the preferred surgical procedure for non-advanced bladder urothelial carcinoma considering the potentially low PSM rate.Trial registration: A complete informed consent was obtained from the patient and their families before the surgery.Informed consent was signed for all patients.This study was approved by the Ethics Review Committee of the Second Xiangya Hospital of Central South University

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