Correlation Analysis of Surgical Efficacy and Risk Factors of Cervical Spondylotic Myelopathy with High Signal Intensity on MRI-T2WI

Objectives: Objectives: The purpose of this study was to investigate the surgical efficacy and risk factors of cervical spondylotic myelopathy (CSM) patients with increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI-T2WI). Methods: We compared the surgical outcomes of CSM patients with and without ISI. In addition, we compared the efficacy of anterior and posterior cervical decompression in CSM patients with ISI. We also analyzed the risk factors of MRI-T2WI ISI in CSM patients. Results: The incidence of ISI among 153 CSM patients was 71.89%. The JOA score and JOA remission rate were better in the ISI-free than ISI group. The postoperative JOA score and JOA remission rate were better in the posterior than anterior approach surgery group. The disease duration and vertebral canal volume were risk factors for ISI in CSM patients. Conclusion: Among patients with CSM, the prognosis is worse for those with than without ISI. Posterior cervical decompression surgery produces a better curative effect than does anterior cervical decompression surgery in CSM patients with ISI. CSM patients who have a long disease duration and small vertebral canal volume should undergo surgical treatment as early as possible.

Anatomical features of the canine C2-C3 spinal cord vascular environment

OBJECTIVE Interarcuate branch (IAB) is a vascular structure, particularly developed in C2-3 intervertebral space, forming a dorsal bridge that connects ventral venous plexi in the vertebral canal. While precisely described in the human, the precise anatomical features of IABs have not been reported in the veterinary literature. The purpose of this study is to describe the features and relations of IABs in the C2-3 vertebral canal. ANIMALS 10 dogs were enrolled; 5 dogs for necropsy and 5 dogs for histology. PROCEDURES The ventral venous plexi in the cervical spine of 5 dogs were injected with latex and underwent vertebral canal dissection for visual assessment of the IAB. Two out of 5 dogs were injected with the addition of barium sulfate and underwent a CT scan. The C2-3 regions of 5 small-breed dogs were harvested for histological examinations. RESULTS IABs arose from the ventral venous plexus at the level of the intervertebral vein; they originated from 2 separate branches located caudally and cranially to the intervertebral foramen, forming a ventrodorsal triangle surrounding the spinal nerve root. No dorsal anastomosis was observed on the CT scan nor at dissection but were observed histologically. A cervical fibrous sheath was observed all around the vertebral canal. CLINICAL RELEVANCE IABs are voluminous venous structures at the C2-3 intervertebral space in dogs and found within a split of the cervical fibrous sheath, which is adherent to the interarcuate ligament and the ligamentum flavum. This anatomical description is paramount when planning an approach to the C2-3 intervertebral space.

Kraniovertebral Bileşke Kemiklerinin Morfometrik Özellikleri

Introduction: The craniovertebral junction comprises the occipital bone, atlas, axis and supporting ligaments. Surgical interventions for treatment of instability, require knowledge of morphometric properties of this area. Therefore, the aim of the present study was to evaluate adult dried human skulls to analyze morphometric features of the bones that joined the craniovertebral junction. Materials and Methods: Morphometric analysis was performed on dry bones which found in the excavations. 9 occipital bone, 18 atlas and 16 axis were measured. Differences between measurements were determined using t-tests and were considered significant at p<0.05. Results: The distance between both tips of the transverse processes (p<0.001), the distance between both outermost edges of the transverse foramen (p=0.011), the distance between both innermost edges of the transverse foramen (p=0.013), the maximum transverse diamater of the vertebral canal (p=0.014), the maximum anteroposterior diameter of the vertebral canal (p=0.014) and the width of the inferior articular facet (left p<0.001 and right p=0.005) were found significantly shorter in females atlases. The width of the dens axis (p<0.001), the height of the corpus axis (p=0.034), the distance from lateral most edge of the transvers process to midline (left p=0.049), the length of the inferior articular facet (left p=0.004, right p=0.005), the width of the superior articular facet (right p=0.007) were found significantly shorter in females axises. Conclusion: Morphometric analysis is very important in the development and improvement of surgical techniques. In this context, the results of our study can contribute to developments in this area. Keywords: Atlas, axis, occipital bone, craniovertebral junction

Evaluation of a Novel Dorsal-Cemented Technique for Atlantoaxial Stabilisation in 12 Dogs

Dorsal atlantoaxial stabilisation (DAAS) has mostly been described to treat atlantoaxial instability using low stiffness constructs in dogs. The aim of this study was to assess the feasibility and surgical outcome of a rigid cemented DAAS technique using bone corridors that have not previously been reported. The medical records of 12 consecutive dogs treated with DAAS were retrospectively reviewed. The method involved bi-cortical screws placed in at least four of eight available bone corridors, embedded in polymethylmethacrylate. Screw placement was graded according to their position and the degree of the breach from the intended bone corridor. All DAAS procedures were completed successfully. A total of 72 atlantoaxial screws were placed: of those, 51 (70.8%) were optimal, 17 (23.6%) were suboptimal, and 4 (5.6%) were graded as hazardous (including 2 minor breaches of the vertebral canal). Surgical outcome was assessed via a review of client questionnaires, neurological examination, and postoperative CT images. The clinical outcome was considered good to excellent in all but one case that displayed episodic discomfort despite the appropriate atlantoaxial reduction. A single construct failure was identified despite a positive clinical outcome. This study suggests the proposed DAAS is a viable alternative to ventral techniques. Prospective studies are required to accurately compare the complication and success rate of both approaches.

Deep Learning Algorithm Based on Analysis the Effect of Posterior Cervical Vertebral Canal Decompression Angioplasty in the Treatment of Ossification of Posterior Longitudinal Ligament of Cervical Spine by CT Image

Original Article Deep learning algorithm based on analyzing the effect of posterior cervical vertebral canal decompression angioplastyin the treatment of ossification of posterior longitudinalligament of cervical spine by CT image Yang Liu1, Jianjun Kong2 ABSTRACTObjective: The paper uses the convolutional neural network algorithm in the deep learning algorithm to explore the therapeutic effect of surgical treatment of hyperextension injuries associated with ossification of the posterior longitudinal ligament of the cervical spine. Methods: In this retrospectively analyzed study 27 patients with hyperextension injury of the posterior longitudinal ligament of the cervical spine were selected from our hospital between August 2018 to July 2020. It included 21 males and 6 females; aged 36-79 years, with an average of 55.9 years. Results: Follow-up time of patients was 3-39 months, with an average of 17.4 months. The JOA score after surgery was significantly better than that before surgery (P﹤0.01), which was statistically significant; the improvement of JOA in patients undergoing anterior therapy was better than that in patients undergoing posterior therapy, which was statistically significant; the JOA improved in patients with minor violent injuries. The situation is significantly better than severe violent injuries, with statistical significance. The rate of postoperative JOA improvement was significantly correlated with the degree of nerve function retention of the injured spinal cord before surgery (P﹤0.01), and there was no significant correlation between the degree of spinal stenosis caused by ossification and the postoperative JOA improvement of patients.Conclusion: Convolutional neural network algorithm in the deep learning algorithm based on the cervical spine posterior longitudinal ligament ossification hyperextension injury was significantly improved after surgery. The less preoperative neurological damage, the postoperative neurological function, the degree of improvement, there was no significant correlation between the degree of spinal stenosis and the improvement of postoperative spinal cord function. For patients with ossification of the posterior longitudinal ligament, if there are neurological symptoms, early surgical treatment is recommended to relieve the compression, so as to prevent irreversible neurological damage caused by trauma. KEYWORDS: Cervical spine, Ossification of posterior longitudinal ligament, Hyperextension injury, Spinal stenosis rate, JOA improvement rate. doi: https://doi.org/10.12669/pjms.37.6-WIT.4857How to cite this:Liu Y, Kong J. Deep learning algorithm based on analyzing the effect of posterior cervical vertebral canal decompression angioplasty in the treatment of ossification of posterior longitudinal ligament of cervical spine by CT image. Pak J Med Sci. 2021;37(6):1630-1635. doi: https://doi.org/10.12669/pjms.37.6-WIT.4857 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Morphometrical Study of the Lumbar Segment of the Internal Vertebral Venous Plexus in Dogs: A Contrast CT-Based Study

The internal vertebral venous plexus (IVVP) is a thin-walled, valveless venous network that is located inside the vertebral canal, communicating with the cerebral venous sinuses. The objective of this study was to perform a morphometric analysis of the IVVP, dural sac, epidural space and vertebral canal between the L1 and L7 vertebrae with contrast-enhanced computed tomography (CT). Six clinically healthy adult dogs weighing between 12 kg to 28 kg were used in the study. The CT venographic protocol consisted of a manual injection of 880 mgI/kg of contrast agent (587 mgI/kg in a bolus and 293 mgI/mL by continuous infusion). In all CT images, the dimensions of the IVVP, dural sac, and vertebral canal were collected. Dorsal reconstruction CT images showed a continuous rhomboidal morphological pattern for the IVVP. The dural sac was observed as a rounded isodense structure throughout the vertebral canal. The average area of the IVVP ranged from 0.61 to 0.74 mm2 between L1 and L7 vertebrae (6.3–8.9% of the vertebral canal), and the area of the dural sac was between 1.22 and 7.42 mm2 (13.8–72.2% of the vertebral canal). The area of the epidural space between L1 and L7 ranged from 2.85 to 7.78 mm2 (27.8–86.2% of the vertebral canal). This CT venography protocol is a safe method that allows adequate visualization and morphometric evaluation of the IVVP and adjacent structures.