Bilateral Pars Research Articles

Investigating cross-sectional and longitudinal relationships between brain structure and distinct dimensions of externalizing psychopathology in the ABCD sample.

Externalizing psychopathology in childhood is a predictor of poor outcomes across the lifespan. Children exhibiting elevated externalizing symptoms also commonly show emotion dysregulation and callous-unemotional (CU) traits. Examining cross-sectional and longitudinal neural correlates across dimensions linked to externalizing psychopathology during childhood may clarify shared or distinct neurobiological vulnerability for psychopathological impairment later in life. We used tabulated brain structure and behavioural data from baseline, year 1, and year 2 timepoints of the Adolescent Brain Cognitive Development Study (ABCD; baseline n = 10,534). We fit separate linear mixed effect models to examine whether baseline brain structures in frontolimbic and striatal regions (cortical thickness or subcortical volume) were associated with externalizing symptoms, emotion dysregulation, and/or CU traits at baseline and over a two-year period. The most robust relationships found at the cross-sectional level was between cortical thickness in the right rostral middle frontal gyrus and bilateral pars orbitalis was positively associated with CU traits (β = |0.027-0.033|, pcorrected = 0.009-0.03). Over the two-year follow-up period, higher baseline cortical thickness in the left pars triangularis and rostral middle frontal gyrus predicted greater decreases in externalizing symptoms ((F = 6.33-6.94, pcorrected = 0.014). The results of the current study suggest that unique regions within frontolimbic and striatal networks may be more strongly associated with different dimensions of externalizing psychopathology. The longitudinal findings indicate that brain structure in early childhood may provide insight into structural features that influence behaviour over time.

Comparative analysis of cortical anatomy inmale participants with internet gaming disorder or tobacco use disorder: Insights fromnormative modeling.

Research on individual differences in brain structural features of internet gaming disorder (IGD) and established addictions such as tobacco use disorder (TUD) is currently limited. This study utilized normative modeling to analyze the cortical thickness (CT) development patterns of male patients with IGD and TUD, aiming to provide further insights into whether IGD qualifies as an addiction. Surface-based brain morphometry (SBM) was used to calculate CT from T1-weighted magnetic resonance imaging data of 804 male participants (665 healthy individuals, 68 IGD and 71 TUD). Gaussian process regression was employed to generate normative models of CT development. Deviation maps were produced to depict deviations of IGD and TUD participants from the typical developmental patterns. Both addiction groups exhibited widespread cortical thinning, particularly in regions such as the bilateral temporal pole and medial orbitofrontal cortex. The TUD group demonstrated a higher degree of individualization and limited spatial overlap compared to the IGD group. Opposite trends in CT changes were observed between the two groups in the bilateral pericalcarine cortex and pars triangularis. These findings regarding the similarities and differences between IGD and TUD provide support for the idea that IGD shares common features with substance-related addictions and contribute to a deeper understanding of the neural mechanisms underlyingIGD.

The effect of C2 screw type on perioperative outcomes and long-term stability after C2-T2 posterior cervical decompression and fusion.

To determine if C2 pedicle versus pars screw type predicts change in fusion status, C2 screw loosening, cervical alignment, and patient-reported outcomes measures (PROMs) after C2-T2 posterior cervical decompression and fusion (PDCF). All adult patients who underwent C2-T2 PCDF for myelopathy or myeloradiculopathy between 2013-2020 were retrospectively identified. Patients were dichotomized by C2 screw type into bilateral C2 pedicle and bilateral C2 pars screw groups. Preoperative and short- and long-term postoperative radiographic outcomes and PROMs were collected. Univariate and multivariate analysis compared patient factors, fusion status, radiographic measures, and PROMs across groups. A total of 159 patients met the inclusion/exclusion criteria (76 bilateral pedicle screws, 83 bilateral pars screws). Patients in the C2 pars relative to C2 pedicle screw group were on average more likely to have bone morphogenic protein (p = 0.001) and four-millimeter diameter rods utilized intraoperatively (p = 0.033). There were no significant differences in total construct and C2-3 fusion rate, C2 screw loosening, or complication and revision rates between C2 screw groups in univariate and regression analysis. Changes in C2 tilt, C2-3 segmental lordosis, C0-2 Cobb angle, proximal junctional kyphosis, atlanto-dens interval, C1 lamina-occiput distance, C2 sagittal vertical axis, C2-7 lordosis, and PROMs at all follow-up intervals did not vary significantly by C2 screw type. There were no significant differences in fusion status, hardware complications, and radiographic and clinical outcomes based on C2 screw type following C2-T2 PCDF. Accordingly, intraoperative usage criteria can be flexible based on patient vertebral artery positioning and surgeon comfort level.

Does intervertebral disc degeneration in adolescent idiopathic scoliosis correlate with patient-reported pain scores? A review of 968 cases

PurposeReport the rate and severity of degenerative disc disease (DDD) in non-surgical adolescent idiopathic scoliosis (AIS) patients and correlate these findings with patient-reported symptomatology scores. Additionally, to quantify the rate of concurrent pathological radiological findings in this group.MethodsThis was a retrospective chart review study at a single tertiary centre. AIS patients aged 10–16 who had received a whole spine MRI between September 2007 and January 2019 and who had not received surgical intervention to their spine were included. MRI scan reports were screened to extract those who had evidence of DDD. These were then reviewed by a blinded second reviewer who graded every disc using the Pfirrmann grading system. SRS-22 scores were extracted for patients when available.ResultsIn total, 968 participants were included in the study. Of these, 93 (9.6%) had evidence of DDD, which was Pfirrmann grade ≥ 3 in 28 (2.9%). The most commonly affected level was L5/S1 (59.1% of DDD cases).A total of 55 patients (5.7%) had evidence of syringomyelia, 41 (3.4%) had evidence of spondylolisthesis (all L5/S1), 14 (1.4%) had bilateral L5 pars defects, and 5 (0.5%) had facet joint degeneration. Spondylolisthesis and bilateral pars defects were more common in patients with DDD identified on MRI scan (p < 0.001 and p = 0.04, respectively).Function (p = 0.048) and pain (p = 0.046) scores were worse in patients with DDD.ConclusionWe present a baseline for the rate and severity of DDD in the non-operative AIS cohort. This should assist in decision-making and counselling of patients prior to surgery.Level of evidenceIII.

Frontal mechanisms underlying primate calls recognition by humans.

The ability to process verbal language seems unique to humans and relies not only on semantics but on other forms of communication such as affective vocalizations, that we share with other primate species-particularly great apes (Hominidae). To better understand these processes at the behavioral and brain level, we asked human participants to categorize vocalizations of four primate species including human, great apes (chimpanzee and bonobo), and monkey (rhesus macaque) during MRI acquisition. Classification was above chance level for all species but bonobo vocalizations. Imaging analyses were computed using a participant-specific, trial-by-trial fitted probability categorization value in a model-based style of data analysis. Model-based analyses revealed the implication of the bilateral orbitofrontal cortex and inferior frontal gyrus pars triangularis (IFGtri) respectively correlating and anti-correlating with the fitted probability of accurate species classification. Further conjunction analyses revealed enhanced activity in a sub-area of the left IFGtri specifically for the accurate classification of chimpanzee calls compared to human voices. Our data-that are controlled for acoustic variability between species-therefore reveal distinct frontal mechanisms that shed light on how the human brain evolved to process vocal signals.

Outcome and safety of secondary pars plana capsulotomy in patients with posterior capsular opacity following extracapsular cataract extraction

Objectives: Posterior capsular opacity is a major delayed complication seen in patients following cataract extraction. Neodymium-doped Yttrium Aluminium Garnet laser capsulotomy is the standard procedure for capsulotomy; however, its high cost and unavailability in the developing countries makes it important for us to find an alternative, effective and safe method that will help reduce the burden of severe visual impairment and blindness in individuals who have had cataract extraction. The aim of the study was to showcase the effectiveness, outcome and safety of pars plana capsulotomy in reducing the burden of visual impairment and blindness occurring after cataract extraction due to posterior capsular opacity amongst patients. Materials and Methods: This is a hospital-based retrospective study, where the clinic, ward and theatre registers of patients who had secondary pars plana capsulotomy in the past 3 years (2019–2022) due to posterior capsular opacity were reviewed. Patient’s folders who had pars plana capsulotomy with incomplete records were excluded as well as patients who had diabetes, glaucoma, corneal opacity and age-related macular degenerations. The frequency, age distribution, duration from cataract extraction to presentation with posterior capsule opacification (PCO), the grading and morphology of PCO were all noted. The pre- and post-operative visual acuity (VA) was also recorded alongside the pre- and post-operative intraocular pressure (IOP). We also documented intra- and post-operative complications that were seen in these patients. Data were analysed using SPSS package version 23 (SPSS Inc. Illinois, Chicago), and values were expressed as simple frequencies and proportions. Paired t-test was used to test the statistical significance with P &lt; 0.05. Results: A total of 36 patients records were reviewed; capsulotomy was performed in all age groups with the majority done in individuals 60–69 years – 11 eyes (26.8%). A total of 41 eyes of 36 patients had undergone secondary pars plana capsulotomy. Five (13.9%) patients had bilateral pars plana capsulotomy on different occasions. The mean age was 45.3 ± 26.9 years. There were 22 (53.7%) females and 19 (46.3%) males. Female-to-male ratio was 1.2:1. About 75.6% presented between 1 and 5 years after cataract surgery; mean duration for presentation with posterior capsular opacity after cataract extraction was 2.0 years ± 1.6 months. The majority 31 (75.6%) had their pars plana capsulotomy done under topical anaesthesia. VA at presentation was found to be below 3/60 in 17 (41.5%) eyes. After pars plana capsulotomy, VA improvement was seen – 6/6–6/12 in 23 (56.1%) eyes. Grade of PCO revealed that 15 (36.6%) eyes had Grade 2 PCO and the Elschnig pearls were the most common morphological form seen in 30 (73.2%) eyes. Most eyes had normal IOP post-operatively 38 (92.7%); there was a transient increase in IOP in 3 (7.3%) eyes. There were no complications recorded in most eyes 27 (66%). The most common of the few complications seen was subconjunctival haemorrhages in 6 (14.6%) eyes which resolved within a week of follow-up. Conclusion: Pars plana capsulotomy is a safe, easy and effective alternative for posterior capsulotomy and will be useful in resource-poor settings.

Selective thoracolumbar fusion in adult spinal deformity double curves with circumferential minimally invasive surgery: 2-year minimum follow-up.

Selection of the upper instrumented vertebra (UIV) level for adult spinal deformity (ASD) remains controversial. Although selective fusion attempts have been described for fractional curves or adolescent curves, no authors have described selective thoracolumbar fusion performance for ASD with double curves. This study evaluated the clinical impact of selective fusion constructs within the lower thoracic and/or lumbar spine on ASD with double curves. A retrospective review was performed on an ASD (Cobb angle > 20°, sagittal vertical axis [SVA] > 50 mm, and pelvic incidence minus lumbar lordosis mismatch [PI-LL] > 10°) database consisting of 438 patients who underwent correction with circumferential minimally invasive surgery (CMIS) between 2007 and 2020. The inclusion criteria were ASD double curves (lumbar Cobb angle > 35° and thoracic Cobb angle > 30°), 4 or more levels fused, and minimum 2-year follow-up. Analyses were performed on spinopelvic data and clinical outcome scores. Complications were recorded, specifically the need for revision surgery and hardware-related complications. Twenty-one ASD double curve patients underwent selective correction with a mean ± SD (range) follow-up of 91 ± 43 (24-174) months. A total of 141 levels were fused with a mean of 6.7 ± 1.3 (4-8) levels. T10 was the most proximal and most common UIV (10/21 [48%]). Pelvic fixation was performed in 12 patients (57%). Significant improvements in lumbar Cobb angle, thoracic Cobb angle, coronal balance, lumbar lordosis, thoracic kyphosis, SVA, and PI-LL were achieved. The uninstrumented thoracic spine demonstrated 14.5° of mean coronal correction and a mean increase of 9.4° in kyphosis. Significant improvements in visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were observed. Four patients required revision for the following reasons: 1) superficial wound infection requiring irrigation and debridement; 2) bilateral L5 pars fractures requiring L5-S1 anterior lumbar interbody fusion and pelvic fixation; 3) adjacent-segment degeneration at L5-S1 requiring anterior lumbar interbody fusion and pelvic fixation; and 4) proximal junctional kyphosis requiring revision fusion to include the entire thoracic curve. There were no instances of hardware failure such as rod breakage or screw loosening. Selective thoracolumbar fusion with CMIS for ASD double curves can provide significant clinical improvements. Despite limiting fusion constructs to within the lower thoracic and/or lumbar spine, significant correction can be observed in the uninstrumented thoracic curve. The rate of mechanical complications was low, and the 2-year follow-up results suggested that limited fusion constructs are viable options for ASD double curve patients.

Management of lumbar bone stress injury in cricket fast bowlers and other athletes.

Recent guidelines (including a special series in The Lancet) have emphasised a minimal role for imaging when assessing low back pain in adults, as the majority of patients will have non-specific findings on imaging that do not correlate well with pain. To assess whether the diagnosis of lumbar bone stress injuries in young athletes should be considered an exception to the recommendation to avoid imaging for low back pain in adults. Narrative review. Early lumbar bone stress injury diagnosis has been available via traditional MRI sequences (and its precursor Single Photon Emission Computed Tomography (SPECT)) for 25-30 years. MRI assessments using bone window sequences (such as Volumetric Interpolated Breath-hold Examination (VIBE)) have allowed a better understanding of the diagnosis and prognosis of lumbar bone stress injury in young athletes. MRI with bone sequences has allowed non-radiating scans to serially follow the healing of unilateral stress fractures. In the majority of cases, non-chronic unilateral fractures can heal; however, this takes three-six months rather than the six-ten weeks that would be the typical unloading period if using symptoms (only) as a guide. The use of MRI to provide evidence of bony healing (as opposed to fibrous union, which creates the pars defect that predisposes to further bone stress lesions) can lead to better long-term outcomes in athletes. There is evidence to flag this as a structural lesion which is both painful and, more importantly, can heal/resolve if managed correctly. Therefore it represents an important 'specific' diagnostic subset within adult low back pain. Structural (rather than functional) management of bone stress injuries in high-demand athletes, such as cricket pace bowlers, is in contrast to the recommendation of functional management for general back pain in adults. Structural management is justified when there are demonstrable superior outcomes of having better structure. Although this has not yet been shown in randomised trials of elite athletes, apparent lengthier Test cricket careers of pace bowlers who do not have pars defects suggest better athletic outcomes if bony healing is achieved. For lower demand young adults, or athletes with established bilateral pars defects, functional management may be more pragmatic.

Biomechanical Effects of a Novel Pedicle Screw W-Type Rod Fixation for Lumbar Spondylolysis: A Finite Element Analysis.

Lumbar spondylolysis involves anatomical defects of the pars interarticularis, which causes instability during motion. The instability can be addressed through instrumentation with posterolateral fusion (PLF). We developed a novel pedicle screw W-type rod fixation system and evaluated its biomechanical effects in comparison with PLF and Dynesys stabilization for lumbar spondylolysis via finite element (FE) analysis. A validated lumbar spine model was built using ANSYS 14.5 software. Five FE models were established simulating the intact L1-L5 lumbar spine (INT), bilateral pars defect (Bipars), bilateral pars defect with PLF (Bipars_PLF), Dynesys stabilization (Bipars_Dyn), and W-type rod fixation (Bipars_Wtyp). The range of motion (ROM) of the affected segment, the disc stress (DS), and the facet contact force (FCF) of the cranial segment were compared. In the Bipars model, ROM increased in extension and rotation. Compared with the INT model, Bipars_PLF and Bipars_Dyn exhibited remarkably lower ROMs for the affected segment and imposed greater DS and FCF in the cranial segment. Bipars_Wtyp preserved more ROM and generated lower stress at the cranial segment than Bipars_PLF or Bipars_Dyn. The injury model indicates that this novel pedicle screw W-type rod for spondylolysis fixation could return ROM, DS, and FCF to levels similar to preinjury.

320 Deep-Learning Cortical Thickness Analysis as Predictor for Shunt Surgery Effectiveness in Possible iNPH Patients

INTRODUCTION: While optimal treatment for iNPH is quite known, diagnosis remains a topic of debate, with different procedures suggested as potential predictors for shunt surgery effectiveness. Various tests, biomarkers, and neuroimaging techniques can be used; however, the diagnostic accuracy is below optimal when performed with neuroimaging techniques alone and not always cost-effective when achieved with CSF biomarkers. Quantitative computational methods for cortical thickness analysis have become available in the last decade, and they only require regularly available T1-weighted brain MR images. METHODS: We analyzed 294 total patients referred to our clinic from January 2015 until December 2021. After exclusion criteria, the final sample consisted of 98 possible iNPH patients: 64 were diagnosed as probable iNPH and underwent VPS surgery, while 34 did not receive a surgical indication after diagnostic procedures. We investigated differences in cortical thickness for all possible iNPH patients using a public deep-learning based neuroimaging pipeline composed by an advanced semantic segmentation neural network architecture and automated surface-based cortical thickness analysis. RESULTS: In 38 total patients with a negative CSFTT or not responsive to shunt surgery, a significant localized cortical thinning was seen in the lateral surface of the frontal and parietal lobes (bilateral superior and middle frontal gyrus, bilateral pars opercularis, bilateral superior parietal gyrus, bilateral supramarginal gyrus, left inferior parietal gyrus, bilateral precuneus). CONCLUSIONS: Preoperative cortical thickness is a feasible analysis that might be useful in defining the optimal therapeutic plan for possible iNPH patients. A large multicentric study is encouraged to elucidate specific patterns and ratios of cortical thickness that might be used as potential predictors for shunt surgery effectiveness.

The 'candy cane' technique for construct augmentation and correction of severe angular chin-on-chest kyphoscoliosis.

To manage severe angular chin-on-chest deformity. A single midline incision and periosteal dissection were utilized to expose from C2 to T6. Bilateral C2 pars screws, C3 to C7 lateral mass screws, and T1 to T6 pedicle screws were placed. Following the placement of screws, multiple two column posterior osteotomies and interlaminar decompressions from C6 to T3 were performed to amplify both the sagittal and coronal corrections. Titanium rods were utilized in light of the patient's known osteopenia and nickel allergy. As such, the construct was augmented via the use of a third accessory rod. This third titanium rod was placed into a supplementary translaminar screw with three connectors to the right-sided main rod. Once the lordotic configuration of the contralateral main rod was secured, an additional corrective maneuver of gentle distraction across this third rod was employed to assist with coronal correction. In this patient with osteopenia, a known nickel allergy, and significant cervical imbalance, the Candy Cane construct allowed for a durable correction of the severe sagittal and coronal plane deformity. The chin-brow angle was corrected by 44°. The coronal Cobb angle improved by 10°. On long-term follow-up, the patient reported continued satisfaction with the operation and was able to perform his activities of daily living. A one-stage, posterior approach along with construct augmentation, with a third rod hooked into a supplementary C2 translaminar screw, can be employed for the correction of chin-on-chest kyphoscoliosis.

Does Chemical Shift Magnetic Resonance Imaging Improve Visualization of Pars Interarticularis Defect?

Introduction A unilateral or bilateral pars interarticularis defect (spondylolysis) is a leading cause of axial back pain in adolescent athletes. Currently, a spectrum of imaging modalities is used for assessment of pars interarticularis defects. Objectives The aim of this study is to compare the accuracy of chemical shift sequence (magnetic resonance imaging [MRI]) technique to conventional MRI sequences in the detection of pars defects. Patients and Methods Conventional T1, T2, and short tau inversion recovery sagittal and axial, as well as "in-" and "out-" phase chemical shift sagittal MRI sequences of 70 consecutive patients referred for low back pain were reviewed. Demographic details, clinical indication, and presence/diagnosis of pars defects using a 5-point Likert scale on both conventional and chemical shift MRI sequences. Spearman's correlation was used for statistical analysis. Intraclass correlation coefficient analysis was evaluated to assess the intraclass reliability between observers. Data were analyzed using DATAtab web-based statistics software (2022). Results A total of 70 patients with an average age of 54.34 years with a female predominance were included. There were 11 pars defects in the cohort. Both in and out phases of chemical shift imaging were able to identify pars defect and intact pars. However, out phase was relatively better in delineating pars defects, while the in phase was superior in identifying an intact pars, though this was not statistically significant. There was good intra- and interobserver reliabilities. Conclusion Chemical shift MRI sequence is a quicker, complementary technique to assess and analyze pars interarticularis confidently than conventionally utilized MRI sequences in patients being evaluated for axial back pain.

Lumbar Radiological Pseudo-Bulging Patterns

Objective: The most interesting humanoid fracture is probably the pars interarticularis defect. The main aim of our study is to describe the pseudo-bulging patterns in sagittal images in magnetic resonance imaging (MRI). Thus, it aims to increase pars interarticularis defects recognizability with MRI. Radiation exposure in tomography may be eliminated. Materials and Methods: Our study is single-center, non-randomized, retrospective, and observational. Level of pars interarticularis defect, complete-incomplete formation, presence of pedicular involvement, and unilateral or bilateral pars interarticularis defect were observed and noted in lumbar tomography. Pseudobulging patterns were observed on lumbar magnetic resonance imaging. Adobe Photoshop® 2023 was used to filter the pseudo-bulging images. The shape and form of the pseudo-bulging patterns were observed and noted. Descriptive statistics were used in our study. Results: Various pars interarticularis defects were detected in 24 patients on computed tomography images. 14 were female and 10 were male. In our study, pseudo-bulging patterns revealed a distinctive appearance in 21 of 24 cases. We defined 4 different pseudo-bulging shapes and forms. Conclusion: We revealed four different pseudo-bulging patterns in sagittal MRI images of patients with confirmed pars interarticularis defects by tomography. Learning the pseudo-bulging patterns and shapes will facilitate the identification of the pars interarticularis defect on the MRI.

Midlife and current physical activity is associated with functional brain connectivity in older age

AbstractBackgroundPrevious studies have shown a physically active lifestyle in both midlife and later life to benefit cognition and brain health in older age. However, exploring the influence of physical activity engagement on functional brain connectivity is needed to fully understand the neural mechanism underlying the effect of physical engagement. Additionally, in order to give lifestyle advice to different age groups, it is important to understand the unique contributions of physical activity at different life stages, which has rarely been examined.MethodThe current study investigated the effect of self‐reported midlife and current physical activity engagement on functional connectivity among 105 cognitively high functioning older adults (age = 66.6±4.1). Self‐reported midlife and current moderate‐to‐vigorous physical activity (MVPA) were recorded using the Lifetime Total Physical Activity Questionnaire. We included covariates in all analyses (i.e., age, sex, years of education, socioeconomic status, genetic risk of Alzheimer’s disease (i.e., APOE ε4 carrier status). Five regions of interest (ROIs) were selected based on previous literature on the relationship between exercise and brain health which included: prefrontal (i.e., bilateral superior frontal, middle frontal, and pars opercularis of the inferior frontal gyrus), and bilateral hippocampus.ResultResults showed that people who were active in midlife had greater functional connectivity between middle frontal gyrus and superior parietal region, postcentral gyrus (Voxel p&lt;0.005, Cluster p&lt;0.05 FDR corrected; figure 1a) than people who were relatively inactive in midlife. This effect stayed the same after controlling for current MVPA time. Secondly, the results showed that people who were active currently have greater functional connectivity between hippocampus and frontal pole (Voxel p&lt;0.005, Cluster p&lt;0.05 FDR corrected; figure 1b). Currently active participants also showed greater functional connectivity between pars triangularis of the inferior frontal gyrus, and bilateral middle temporal region, and frontal pole (Voxel p&lt;0.001, Cluster p&lt;0.05 FDR corrected; figure1c) compared to currently inactive participants, which stayed consistent after controlling for midlife MVPA time.ConclusionAs a conclusion, although midlife and current MVPA time were positively associated with each other, they both influence brain functional connectivity in later life independently. The results emphasize the importance of keeping a physically active lifestyle across midlife and into later life.

Percutaneous Direct Pars Repair in Young Athletes.

Lumbar pars defects are common in adolescent athletes and are often due to recurrent axial loading and traumatic stressors. To present an updated case series of young athletes who underwent percutaneous direct pars repair after failure of conservative management. A single-center, nonrandomized, retrospective observation study of athletes who were referred for minimally invasive direct pars repair after failure of at least 6 months of conservative management was performed. Summary demographic information, clinical features of presentation, perioperative and intraoperative radiographic imaging, and visual analog scale back pain scores were collected and analyzed. A total of 21 patients were included (mean age [± SD] 17.47 ± 3.02 years, range 14-25 years), 6 of whom were female (29%). All patients presented with bilateral pars fractures, with L5 being the most frequent level involved (n = 13). The average follow-up time was 31.52 ± 9.38 months (range 3-110 months). The visual analog scale score for back pain was significantly reduced from 7.62 ± 1.83 preoperatively to 0.28 ± 0.56 at the final postoperative examination (P < .01). Fusion was noted in 20 of the 21 patients on final follow-up (95%). Percutaneous direct pars repair is a safe and effective means in treating young adolescents who have failed conservative management. The advantages included minimized muscle and soft tissue dissection, reduced blood loss, and early mobilization and recovery. In young athletes who desire return to high-level physical activity, this surgical technique is of particular benefit and should be considered in this patient population.

37. Anatomic contributions to the stability of the L5-S1 segment under combined shear and compression: implications to isthmic/lytic spondylolisthesis

37. Anatomic contributions to the stability of the L5-S1 segment under combined shear and compression: implications to isthmic/lytic spondylolisthesis

Traumatic spondylolisthesis of axis: clinical and imaging experience at a level one trauma center.

Traumatic spondylolisthesis of the axis (TSA) with bilateral pars interarticularis fracture (a pattern also known as Hangman's fractures) accounts for 4-5% of all cervical fractures. Various classification systems have been described to assist therapeutic decision-making. The goal is to reassess the utility of these classifications for treatment strategy and evaluate additional imaging associations. This is an IRB approved, retrospective analysis of patients with imaging diagnosis of TSA from 2016 to 2019. Consensus reads were performed classifying TSA into various Levine and Edwards subtypes and typical vs. atypical fractures. Other imaging findings such as additional cervical fractures, traumatic brain injury, spinal cord injury, and vertebral artery injury were recorded. Treatment strategy and outcome were reviewed from clinical charts. Fisher exact test was used for statistical analysis. A total of 58 patients were included, with a mean age of 62.7 ± 25years, and male to female ratio of 1:1.2. Motor vehicle collision was the most common cause of TSA. Type I and III injuries were the most and the least common injuries, respectively. Patients with type I injuries were found to have good healing rates with conservative management (p < 0.001) while type IIa and III injuries were managed with surgical stabilization (p = 0.04 and p = 0.01, respectively). No statistical difference was observed in the treatment strategy for type II fractures (p = 0.12) and its prediction of the associated injuries. Atypical fractures were not found to have a higher incidence of SCI (p = 0.31). A further analysis revealed significantly higher-grade vertebral artery injuries (grades III and IV according to Biffl grading) in patients with type IIa and III injuries (p = 0.001) and an 11-fold increased risk of TBI compared to type I and type II fractures (p = 0.013). TSA fracture types were not associated with any clinical outcome. Levine and Edwards type II classification itself is not enough to guide the treatment plan and does not account for associated injuries. Additional imaging markers may be needed.

Clinical Results of Restoration of Pars Interarticularis Defect in Adults with Percutaneous Intralaminar Screw Fixation

This study aims to report the clinical outcomes associated with the percutaneous intralaminar screw repair performed for pars defects in adults. Adult patients who got their lumbar L5 spondylolysis repaired via modified Buck's procedure between 2017 and 2020 were retrospectively evaluated. The preoperative and postoperative clinical outcomes at 1, 3, 6, and 12months were evaluated for patients with and without fusion using the visual analog scale, Oswestry Disability Index, and the Short-Form Health Survey 36 (SF-36). At 12months, the fusion status of all the patients was assessed using bilateral direct X-rays. Thirty patients with spondylolysis were identified (11 men and 19 women). All patients had bilateral L5 pars defects, and at 12months, the fusion rate was 60% (18/30). There was no difference between the fusion and nonfusion groups in terms of their visual analog scale, Oswestry Disability Index, and SF-36 physical component summary and SF-36 mental component summary scores (P>0.05). Within-group comparisons of the 2 groups revealed significant changes at follow-up (P<0.05). Minimally invasive repair of lumbar spondylolysis with percutaneous intralaminar screw fixation restores the motion segment and can provide early resumption of physical activity with minimal muscle damage, smaller skin incision, and less soft tissue dissection.

Traumatic Bilateral Pars Fracture with Grade-I Spondylolisthesis Treated by Transforaminal (Trans Kambian) Endo Fusion under Epidural Analgesia: A Special Case Report

Traumatic spine injuries are common in young and adult population with worlds incidence estimated annual rate in 10.4–130.6 cases per million [1]. We are presenting a case of traumatic bilateral pars fracture with Grade-I spondylolisthesis treated by Endoscopic Transforaminal (Trans Kambian) spine fusion, under epidural analgesia and neuromonitoring. To the best of our knowledge this is a unique scenario reported for the first time in literature. Lumbar fusion although considered as the gold standard for the degenerative spine disease and Spondylolisthesis, Endoscopic Transforaminal (Trans Kambian) lumbar fusion popularly known as Endofusion/Endo-TLIF (Transforaminal lumbar interbody fusion) is a recent and effective minimally invasive option for certain cases. A 30-year male presented with severe low back pain and decreased sensations over dorsum of right foot after a fall of heavy metal pipe on his lower back. (VAS score 9/10). After thorough preop evaluation patient underwent Endoscopic Transforaminal (Trans Kambian) lumbar discectomy and fusion under epidural analgesia, with visualized endplate preparation. Specially designed Titanium Endo-bullet cage was inserted after percutaneous pedicle screw placement under neuromonitoring. Complete reduction of listhesis was achieved with near total relief in pain. Endoscopic TLIF ensures minimal tissue retraction and minimal alteration of the normal anatomy aiding in faster recovery and minimal blood loss. Patient was mobilized and discharged within 24 hours of surgery. We suggest Endo fusion is a safe and effective day care procedure for cases with traumatic bilateral pars fractures.

Combining quantitative susceptibility mapping to radiomics in diagnosing Parkinson's disease and assessing cognitive impairment.

To explore whether magnetic susceptibility value (MSV) and radiomics features of the nigrostriatal system could be used as imaging markers for diagnosing Parkinson's disease (PD) and its related cognitive impairment (CI). A total of 104 PD patients and 45 age-sex-matched healthy controls (HCs) underwent quantitative susceptibility mapping (QSM). The former completed Hoehn-Yahr Stage and Montreal Cognitive Assessment (MoCA). The patients were divided into several subgroups according to disease stages, courses, and MoCA scores. The ROI was subdivided into the substantia nigra (SN), head of caudate nucleus (HCN), and putamen. The MSVs and radiomics features were obtained from QSM. The multivariable logistic regression (MLR) and support vector machine (SVM) models were constructed to diagnose PD. The correlations between MSVs, radiomics features, and MoCA scores were evaluated. The MSVs in bilateral SN pars compacta (SNc) of PD patients were higher than those of the HCs (p < 0.001). There were differences in some radiomics features between the two groups (p < 0.05). The MSVs of the right SNc and the radiomics features of the right SN had the highest area under the curve (AUC), respectively. The comprehensive MLR model (0.90) and SVM model (0.95) revealed better classification performance than MSVs (p < 0.05) in diagnosing PD. The MSVs from the HCN were negatively correlated with MoCA scores in PD subgroups. There were correlations between radiomics features and MoCA scores in PD patients. Radiomics features and MSVs of the nigrostriatal system from QSM could have crucial role in diagnosing PD and assessing CI. • The MLR and the SVM models have excellent diagnostic performance in the diagnosis of PD. • A PD diagnostic nomogram, created based on MSV and the radiomics scores of SVM model, is very convenient for clinical use. • The radiomics features of the nigrostriatal system based on QSM help to evaluate the cognitive impairment in PD patients.