scholarly journals MRI-Based Classification Scheme for Degenerative Cervical Spinal Stenosis (DCSS Classification)

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Leimert M ◽  
◽  
Hamann I ◽  
Bostelmann R ◽  
von Sachsen S ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Interobserver Reliability ◽  
Treatment Decision ◽  
Treatment Decision Making ◽  
Main Class ◽  
Mri Scans ◽  
Cervical Spinal Stenosis ◽  
Magnetic Resonance Imaging Mri ◽  
Representative Image ◽  
Low K

Background: The severity of Degenerative Cervical Spinal Stenosis (DCSS) is currently assessed by determining the sagittal diameter of the spinal canal, the degree of narrowing, and the level of stenosis using magnetic resonance imaging (MRI). The aim of our study was to develop and evaluate an optimized, MRI-based classification of DCSS to support treatment decision-making. Methods: We analyzed preoperative MRI scans of 75 patients to determine key morphological features of DCSS. Based on the features found, a classification was proposed and tested on ten representative image sets by 53 neurosurgeons to determine practicability and inter-observer reliability. Results: DCSS extended over one (13 and 17 % of pat.), two (23 and 31 % of pat.) or three (39 and 52 % of pat.). Thickening of the ligaments was observed in 71%, scoliosis in 3% and grade I spondylolisthesis in 11% of the patients. The DCSS classification has three main Types (A, B, C), which differ in the extent of the stenoses and thickening of the ligaments. Each main class has 2-3 subtypes depending on the position of the stenosis (lateral/medial) and the number of stenotic segments. An additional suffix indicates the presence of concomitant pathology (spondylolisthesis, scoliosis). 26 (49 %) neurosurgeons rated the classification as useful. For the main classes, interobserver reliability was fair (k=0.23). For subtype and concomitant pathology, interobserver reliability was low (k=0.14). Conclusions: In the study a new classification system for degenerative spinal stenoses was developed, which combines anatomical and clinical defect characteristics. Deviations in the classification result from a strict subdivision, so that adjustments are necessary.

scholarly journals Unraveling a rare cause of spinal stenosis: Coexistent AL and ATTR amyloidosis involving the ligamentum flavum

2022 ◽  
Vol 13 ◽  
pp. 12
Author(s):  
Amandeep Godara ◽  
Andy Y. Wang ◽  
Knarik Arkun ◽  
Teresa Fogaren ◽  
Adnan S. Qamar ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Protein Misfolding ◽  
Ligamentum Flavum ◽  
Treatment Decision ◽  
Amyloid Deposition ◽  
Decompression Surgery ◽  
Treatment Decision Making ◽  
Amyloid Deposits ◽  
Different Types ◽  
A Site

Background: Amyloidosis is a protein misfolding disorder that leads to the deposition of beta-pleated sheets of a fibrillar derivative of various protein precursors. Identification of the type of precursor protein is integral in treatment decision-making. The presence of two different types of amyloid in the same patient is unusually rare, and there are no previous reports of two different types of amyloid deposition in the ligamentum flavum (LF) in the same patient. Case Description: Here, we describe two patients with spinal stenosis who underwent laminectomies and were found to have AL and ATTR amyloid deposits in the LF. Conclusion: As the spine is becoming recognized as a site for ATTRwt amyloid deposition, patients undergoing spinal decompression surgery may potentially benefit from evaluation for amyloidosis in the LF.

Assessment of the ABC/2 Method of Epidural Hematoma Volume Measurement as Compared to Computer-Assisted Planimetric Analysis

2015 ◽  
Vol 18 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Ting-Ting Hu ◽  
Ling Yan ◽  
Peng-Fei Yan ◽  
Xuan Wang ◽  
Ge-Fen Yue
Keyword(s):  
Decision Making ◽  
Epidural Hematoma ◽  
Interobserver Reliability ◽  
Treatment Decision ◽  
Volume Measurement ◽  
Computer Assisted ◽  
Hematoma Volume ◽  
Data Set ◽  
Treatment Decision Making ◽  
The Difference

Background and Objective: Epidural hematoma volume (EDHV) is an independent predictor of prognosis in patients with epidural hematoma (EDH) and plays a central role in treatment decision making. This study’s objective was to determine the accuracy and reliability of the widely used volume measurement method ABC/2 in estimating EDHV by comparing it to the computer-assisted planimetric method. Methods: A data set of computerized tomography (CT) scans of 35 patients with EDH was evaluated to determine the accuracy of ABC/2 method, using computer-assisted planimetric technique to establish the reference criterion of EDHV for each patient. Another data set was constructed by randomly selecting 5 patients then replicating each case twice to yield 15 patients. Intra- and interobserver reliability were evaluated by asking four observers to independently estimate EDHV for the latter data set using the ABC/2 method. Results: Estimation of EDHV using the ABC/2 method showed high intra- and interobserver reliability (intra-class correlation coefficient = .99). These estimates were closely correlated with planimetric measures ( r = .99). But the ABC/2 method generally overestimated EDHV, especially in the nonellipsoid-like group. The difference between the ABC/2 measures and planimetric measures was statistically significant ( p < .05). Conclusions: The ABC/2 method could be used for EDHV measurement, which would contribute to treatment decision making as well as clinical outcome prediction. However, clinicians should be aware that the ABC/2 method results in a general volume overestimation. Future studies focusing on justification of the technique to improve its accuracy would be of practical value.

scholarly journals MRI and Targeted Biopsy Essential Tools for an Accurate Diagnosis and Treatment Decision Making in Prostate Cancer

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1551
Author(s):  
Suraj Samtani ◽  
Mauricio Burotto ◽  
Juan Carlos Roman ◽  
Daniela Cortes-Herrera ◽  
Annerleim Walton-Diaz
Keyword(s):  
Prostate Cancer ◽  
Treatment Decision ◽  
Resonance Imaging ◽  
Extracapsular Extension ◽  
Treatment Decision Making ◽  
Trus Biopsy ◽  
Promising Tool ◽  
Magnetic Resonance Imaging Mri

Prostate cancer (PCa) is one of the most frequent causes of cancer death worldwide. Historically, diagnosis was based on physical examination, transrectal (TRUS) images, and TRUS biopsy resulting in overdiagnosis and overtreatment. Recently magnetic resonance imaging (MRI) has been identified as an evolving tool in terms of diagnosis, staging, treatment decision, and follow-up. In this review we provide the key studies and concepts of MRI as a promising tool in the diagnosis and management of prostate cancer in the general population and in challenging scenarios, such as anteriorly located lesions, enlarged prostates determining extracapsular extension and seminal vesicle invasion, and prior negative biopsy and the future role of MRI in association with artificial intelligence (AI).

Patient Involvement in Treatment Decision Making Can Help or Hinder Placebo Analgesia

2014 ◽  
Vol 222 (3) ◽  
pp. 165-170 ◽  
Author(s):  
Andrew L. Geers ◽  
Jason P. Rose ◽  
Stephanie L. Fowler ◽  
Jill A. Brown
Keyword(s):  
Patient Involvement ◽  
Cold Water ◽  
Prior Experience ◽  
Water Immersion ◽  
Treatment Decision ◽  
Cold Water Immersion ◽  
Not Given ◽  
Placebo Analgesia ◽  
Treatment Decision Making ◽  
Immersion Experience

Experiments have found that choosing between placebo analgesics can reduce pain more than being assigned a placebo analgesic. Because earlier research has shown prior experience moderates choice effects in other contexts, we tested whether prior experience with a pain stimulus moderates this placebo-choice association. Before a cold water pain task, participants were either told that an inert cream would reduce their pain or they were not told this information. Additionally, participants chose between one of two inert creams for the task or they were not given choice. Importantly, we also measured prior experience with cold water immersion. Individuals with prior cold water immersion experience tended to display greater placebo analgesia when given choice, whereas participants without this experience tended to display greater placebo analgesia without choice. Prior stimulus experience appears to moderate the effect of choice on placebo analgesia.

Patients’ practices for taking the initiative in decision-making in outpatient psychiatric consultations

2017 ◽  
Vol 13 (2) ◽  
pp. 169-184 ◽  
Author(s):  
Shuya Kushida ◽  
Takeshi Hiramoto ◽  
Yuriko Yamakawa
Keyword(s):  
Decision Making ◽  
Conversation Analysis ◽  
Treatment Decision ◽  
Close Inspection ◽  
Important Resource ◽  
Treatment Decision Making ◽  
The Way

In spite of increasing advocacy for patients’ participation in psychiatric decision-making, there has been little research on how patients actually participate in decision-making in psychiatric consultations. This study explores how patients take the initiative in decision-making over treatment in outpatient psychiatric consultations in Japan. Using the methodology of conversation analysis, we analyze 85 video-recorded ongoing consultations and find that patients select between two practices for taking the initiative in decision-making: making explicit requests for a treatment and displaying interest in a treatment without explicitly requesting it. A close inspection of transcribed interaction reveals that patients make explicit requests under the circumstances where they believe the candidate treatment is appropriate for their condition, whereas they merely display interest in a treatment when they are not certain about its appropriateness. By fitting practices to take the initiative in decision-making with the way they describe their current condition, patients are optimally managing their desire for particular treatments and the validity of their initiative actions. In conclusion, we argue that the orderly use of the two practices is one important resource for patients’ participation in treatment decision-making.

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