Diagnosis Of Spinal Diseases Research Articles

Atlas-Free Cervical Spinal Cord Segmentation on Midsagittal T2-Weighted Magnetic Resonance Images.

An automatic atlas-free method for segmenting the cervical spinal cord on midsagittal T2-weighted magnetic resonance images (MRI) is presented. Pertinent anatomical knowledge is transformed into constraints employed at different stages of the algorithm. After picking up the midsagittal image, the spinal cord is detected using expectation maximization and dynamic programming (DP). Using DP, the anterior and posterior edges of the spinal canal and the vertebral column are detected. The vertebral bodies and the intervertebral disks are then segmented using region growing. Then, the anterior and posterior edges of the spinal cord are detected using median filtering followed by DP. We applied this method to 79 noncontrast MRI studies over a 3-month period. The spinal cords were detected in all cases, and the vertebral bodies were successfully labeled in 67 (85%) of them. Our algorithm had very good performance. Compared to manual segmentation results, the Jaccard indices ranged from 0.937 to 1, with a mean of 0.980 ± 0.014. The Hausdorff distances between the automatically detected and manually delineated anterior and posterior spinal cord edges were both 1.0 ± 0.5 mm. Used alone or in combination, our method lays a foundation for computer-aided diagnosis of spinal diseases, particularly cervical spondylotic myelopathy.

Four-Joint Based Motion Capture for Spinal Disease Prevention System

ABSTRACTBad posture triggers spinal diseases by forming a twisted or crooked body. Therefore, it is vital for modern people mostly living a sedentary lifestyle to have correct posture. Thanks to rising demand in the health care sector and advancement of information technology these days, the development of a self-coaching system is underway using motion capture technology. With the self-coaching system applied to rehabilitation exercises or the sports field, subjects using the system can practice and learn rehabilitation exercises or sports motions on their own without any help. It is necessary to acquire and analyze motion data both from experts for coaching purposes and users who are being coached in order to develop the self-coaching system. The existing motion capture system has a drawback in that it is difficult to make smooth and natural motions because it uses heavy machines or a wired system. In this paper, we proposed a reasonably priced motion capture system requiring less preparation time and measurement space by using small-sized and lightweight microelectromechanical systems-based wireless inertial sensors to address the problems with the existing motion capture system. The analysis results show that the motion data of four joints acquired through the embodied system can be applied to the self-coaching system, and users can employ the system for spinal disease diagnosis themselves.

Measurements and Classifications in Spine Imaging

Imaging criteria and radiologic measurements play a key role in the diagnosis of spinal diseases. In addition, they often create the basis of classification systems that determine the severity of the disease and thereby enable a stage-related therapy. A clearly defined nomenclature for imaging findings as well as standardized and thoroughly evaluated methods of measurement are necessary to achieve a sufficiently high diagnostic accuracy. Various specialized committees dealing with the diagnosis of spinal diseases have made efforts within the last years to develop diagnostic standards. This review provides an overview of radiologic measurements and classification systems that are currently used for the diagnosis of scoliosis and degenerative diseases of the lumbar spine.

Development of Korean spine database and ontology for realizing e-Spine

By 2026, Korea is expected to surpass the UNs definition of an aged society and reach the level of a super-aged society. As a result, degenerative spinal disease and the related surgical procedures will increase exponentially. To prevent unnecessary spinal surgery and support scientific diagnosis of spinal disease and systematic prediction of treatment effects, we have been developing e-Spine which is a computerized simulation model of human spines. In this paper, we present the Korean spine database and ontology that are used as a background data for realizing e-Spine. Generally, Korean physical function is different from foreign physical function. For example, ossification of posterior longitudinal ligament is only occurred in Asians. However, developed countries are currently constructing digital human data to improve the medical and biomedical researches, while the digital human data for Korean are inadequate. Therefore, we constructed Korean spine database on Korean with normal spine or degenerative spinal diseases. To date, we have collected spine data from 72 cadavers and 298 patients. The spine data consists of 2D images such as CT, MRI, or X-ray, 3D shapes, geometry data and property data. The volume and quality of Korean spine database are now the worlds highest. Also, we constructed spinal ontology to provide a wealth of information related to spine. The spinal ontology contains anatomy of spine, method of treatment, cause, classification information related to spine. Finally, we implemented a management service for efficiently searching and managing the data. As a result, our database and ontology will offer great value and utility in the diagnosis, treatment, and rehabilitation of patients suffering from spinal diseases.

Development of the Korean Spine Database and Automatic Surface Mesh Intersection Algorithm for Constructinge-Spine Simulator

By 2026, Korea is expected to surpass the UN’s definition of an aged society and reach the level of a superaged society. With an aging population come increased disorders involving the spine. To prevent unnecessary spinal surgery and support scientific diagnosis of spinal disease and systematic prediction of treatment outcomes, we have been developinge-Spine, which is a computer simulation model of the human spine. In this paper, we present the Korean spine database and automatic surface mesh intersection algorithm to constructe-Spine. To date, the Korean spine database has collected spine data from 77 cadavers and 298 patients. The spine data consists of 2D images from CT, MRI, or X-ray, 3D shapes, geometry data, and property data. The volume and quality of the Korean spine database are now the world’s highest ones. In addition, our triangular surface mesh intersection algorithm automatically remeshes the spine-implant intersection model to make it valid for finite element analysis (FEA). This makes it possible to run the FEA using the spine-implant mesh model without any manual effort. Our database and surface mesh intersection algorithm will offer great value and utility in the diagnosis, treatment, and rehabilitation of patients suffering from spinal diseases.

A comparison of magnetic resonance imaging sequences in evaluating pathological changes in the canine spinal cord

This paper discusses 28 canine patients subjected to low-field magnetic resonance imaging (MRI) of the spinal cord for neurological indications. The authors describe and compare the used MRI sequences with an indication of the most effective sequences in MRI examinations that require short scanning time. The most effective sequences supporting a quick diagnosis of spinal diseases in dogs were SE (spin echo), FSE (fast spin echo) and 3D HYCE (hybrid contrast enhancement).

Clinical Technique: Myelography in Rabbits

Spinal disease in rabbits is most often the result of trauma; however, other causes have been reported including congenital defects and degenerative spinal diseases. Diagnosis of spinal disease is based on history, physical and neurologic examination findings, and imaging. Fractures and luxations of the spine are often apparent on plain radiographs; however, myelography is used to determine if the lesion is causing spinal cord compression that may be amenable to surgical decompression. Unless intervertebral discs are mineralized, they are not visible when viewing plain radiographic images; therefore, myelography may be useful to diagnose spinal cord compression from a herniated disc. Myelography can also define lesions that do not result in a disruption of the osseous vertebral architecture such as tumors and granulomas. In rabbits, myelography is performed when the animal is under general anesthesia and in lateral recumbency. A nonionic iodinated contrast agent is injected into the subarachnoid space, usually at the level of the lumbar spine, to outline the spinal cord and identify cord compressive or disruptive lesions.

Follow‐up evaluation of radiation‐induced DNA damage in CSF disseminated high‐grade glioma using phospho‐histone H2AX antibody

Cytological examination of cerebrospinal fluid (CSF) is used not only for the diagnosis of spinal disease, but also to assess the postoperative effect of treatment. We experienced a case of high-grade glioma in disseminated CSF, and retrospectively examined the clinical, pathological and cytological features. We further investigated radiation-induced DNA damage in glioma cells using phospho-Histone H2AX antibody. A five-year-old boy received a clinical diagnosis of optic nerve glioma, and was followed-up for three months after chemotherapy. Magnetic resonance imaging was repeated, revealing abnormalities in other brain areas. The pathological diagnosis was anaplastic astrocytoma. CSF dissemination was detected, and increases in the number and mitosis of tumor cells were observed in CSF cytology. After radiotherapy the tumor cells in CSF decreased markedly. On cytomorphologic and immunocytochemical evaluation post-irradiation, tumor cells showed vacuolation of both the nucleus and cytoplasm, degeneration of nuclear chromatin, and alteration of the phospho-Histone H2AX expression, compared with tumor cells before the irradiation. CSF cytology is an effective means of evaluating DNA damage in tumor cells after irradiation, and may be useful in assessing the therapeutic response.

Historical Perspective

This historical perspective traces the history of the development of pathoanatomically based spinal disease diagnosis and the subsequent use of these diagnoses for scientific and social purposes. Spinal diagnostic categories have been used positively to guide both clinical (including their use as the primary units of investigation in many epidemiological and evidence-based projects) and basic science (studying the pathoanatomic disease outside of the patient) research programs--the aim being the improvement of patient care and outcomes. They are also used socially to confer/reject acceptability to patient behavior; to justify health policy decisions; to structure medical relationships; to shape medical/institutional infrastructure; to direct patient care via guideline establishment; and to manage health care. The positive and negative implications of the use of spinal disease categories are discussed.

CT Perfusion in Spinal Disease: An Adjunct Tool to Vertebral Body Biopsy

Routine diagnostic techniques are inadequate for diagnosis of spinal diseases. The purpose of this study was to determine whether CT perfusion can differentiate inflammatory diseases like tuberculosis from neoplastic diseases of spine. Thirty-two patients with vertebral body lesions associated with paraspinal mass underwent CT guided bone biopsy and histopathological evaluation. CT perfusion was done in all patients before doing biopsy. Perfusion parameters like blood volume (BV), blood flow (BF) and time to peak (TTP) were calculated and correlated with histopathology. Statistical analysis was done using Mann-Whitney test. p value <0.05 was considered significant. Of 32 cases, 20 had tuberculous osteomyelitis and 12 neoplastic disease (seven metastasis, three plasmacytoma, one each lymphoma and chordoma). Mean rBF was [inflammatory lesions, 1.459 and neoplastic lesions, 18.080 (p<0.000). Mean rBV was (inflammatory disease, 2.8589 and neoplastic lesions, 12.2133 (p<0 .000)). Mean rTTP was [inflammatory pathology, 1.041 and neoplastic pathology, 0.703(p<0.079)]. This shows the deconvolution-based CTP technique's potential for noninvasive diagnosis of at least all inflammatory lesions affecting the spine that are associated with paraspinal mass. Validation of the use of deconvolution CTP parameters for differentiation of inflammatory from neoplastic pathology may permit this technique to be used as an adjunct tool when biopsy when routine imaging findings are inconclusive.

Diagnosis of Spinal Disease with Ultrafine Flexible Fiberscopes in Patients with Chronic Pain

Spinal epidural and subarachnoid spaces were observed with the newly developed fine flexible fiberscopes in 55 patients with chronic pain. To evaluate the fiberscopes as diagnostic tools for spinal canal disease. Fine flexible fiberscopes make it possible to visualize the entire length of the spinal subarachnoid space without major complications, and they may be of value for the diagnosis of certain spinal canal diseases. The epidural and subarachnoid spaces were accessed by fine flexible fiberscopes (Purely Fine [PF] types) in the initial 45 patients and by those equipped with a tip-steering function and a working channel (Medical Science [MS] types) in the later 10 patients, respectively. The procedures were based on those of continuous epidural or subarachnoid block. Normal and abnormal subarachnoid spaces were clearly observed. When the MS types were used, the intended sites of the spinal structures could be more easily approached. In 12 patients, new diagnoses were made (chronic arachnoiditis 9, subarachnoid cyst 2, old subdural hematoma 1) that could not be found by magnetic resonance imaging or computed tomography. Additionally, chronic arachnoiditis was found in 2 patients with spinal trauma. Pathologic changes were confirmed by fiberscopic examination in 16 patients (arachnoiditis 11, spinal trauma 2, arteriovenous malformation 2, subarachnoid cyst 1). No pathologic changes could be detected in 27 patients with spinal canal stenosis, disc herniation, reflex sympathetic dystrophy, or posttraumatic pain syndrome. There were no significant differences in incidence of new diagnoses between the PF and MS types of fiberscopes. There were no major complications. There were 2 cases of light fever in the initial 10 patients and 7 cases of headache in the initial 14 patients. Only 4 cases of headache were observed in the subsequent 41 patients, in whom 20 mL of saline was injected into the epidural space. These fine flexible fiberscopes may provide new diagnostic and interventional tools for spinal canal diseases, provided skilled techniques are applied.

Ultrafine flexible spinal endoscope (myeloscope) and discovery of an unreported subarachnoid lesion.

Introduction of a new diagnostic procedure and a report on its usefulness. To introduce a new endoscope (myeloscope) developed for the examination of the spinal canal and to present a previously unreported subarachnoid condition as a cause of paraparesis revealed by it. In spite of the availability of advanced imaging technology, there still exists a significant number of patients with spinal diseases in whom a diagnosis cannot be made. Direct visualization of the pathologic area is required in these patients. Recent advances in fiberoptics have made this possible. The endoscope consisted of a fiberscope with an external diameter of 0.5, 0.9, or 1.4 mm. It was inserted into the subarachnoid space in the lumbar spine and carefully advanced cranially. Since 1987, this examination has been performed on 18 patients aged 7 to 69 years who had pain or other neurologic symptoms of unknown origin. The surface of the spinal cord, roots, properties of the arachnoid membrane, and small vessels could be observed clearly. The scope could be advanced as far as the upper cervical spine. Cotton-candy-like proliferation of fibrous tissue was identified by myeloscopy in four paraparetic patients who had clinical and radiologic features similar to those of a spinal cord herniation. The fibrous tissue beat on the spinal cord with the pulsation of the spinal fluid. Resection of the fibrous tissue with conventional surgery resulted in neurologic improvement. Complications included one case of meningitis in the early period and five cases of postspinal headache. No nerve injury was apparent. Myeloscopy provides detailed information about the subarachnoid space and even reveals dynamic conditions that cannot be identified during open surgery or at autopsy. It will bring new concepts to the diagnosis of spinal diseases.

The current role of CT myelography and myelography in neurosurgical practice

S. Naderi Marmara University Hospital, Department of Neurosurgery, Altunizade, Istanbul, Turkey V. K. H. Sonntag ( ) Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA Mailing address: 1 c/o Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013-4496, USA Tel.: (602) 406-3593 Fax: (602) 406-4104 e-mail: neuropub@mha.chw.edu The correct diagnosis of spinal disease with nerve root and/or spinal cord compression depends on the precise correlation between neurological findings and accurate radiographic imaging studies. To evaluate the exact clinical value of any diagnostic modality, one must know its sensitivity (reflection of false negatives) and specificity (reflection of false positives). For many years myelography, computed tomography (CT), and CT myelography have been the modalities of choice for evaluation of spinal disease. Today at many institutions magnetic resonance (MR) imaging has replaced myelography, CT myelography, and to some extent, CT for diagnosis of the spinal disorder. MR imaging has the advantages of multiplanar display and lack of ionizing radiation. It can provide sequences that reveal information, such as amount of hydration, about the spinal cord, the nerve root, and the disc itself. However, MR imaging, like CT, has significant false positive and false negative rates. To our knowledge, the main drawback of MR imaging is its insensitivity in detecting detailed anatomy of the bony narrowing at the neural foramen and lateral recess. The occurrence of false positives and false negatives necessitates the usage of complementary or supplementary diagnostic modalities such as CT, CT myelography, and myelography. This article reviews four reports that compare MR imaging with some of these other imaging modalities and is intended to inform neurosurgeons about the current role of CT myelography and myelography in neurosurgical cases. Introduction

Myelography: current status and post-marketing experience with iotrolan

There are three imaging modalities for the diagnosis of spinal diseases: magnetic resonance imaging (MRI), computed tomography (CT) and myelography. The choice of modality is influenced by factors including diagnostic accuracy cost, radiation dose and invasiveness. For many indications, MRI has advantages over CT and myelography and is the modality of choice, and there is likely to be a trend away from myelographic examinations. In cases where myelography is indicated, it is of prime importance to reduce the frequency and severity of adverse events. During phase III and IV trials, involving over 2000 patients, general and neural tolerance of iotrolan was shown to be significantly better than iopamidol or metrizamide. These results were confirmed by post-marketing reporting over 5 years with more than 1.5 million applications of iotrolan. Iotrolan 240 and 300 were concluded to be the “gold-standard” contrast agents, showing advantages in myelography over monomeric contrast agents, especially at high doses.

MR imaging of the spine: recent advances in pulse sequences and special techniques.

A number of new techniques have been developed to enhance MR imaging of the spine. Fat-suppression techniques used in conjunction with gadolinium-based contrast material improve visualization of enhancing inflammatory and neoplastic diseases. Fast spin-echo (FSE) sequences can be used to decrease imaging times, to increase resolution, or to improve signal-to-noise ratios on T2-weighted images. In general, FSE images provide a better myelographic effect with reduced magnetic susceptibility compared with gradient-recalled echo (GRE) techniques. With volume GRE sequences, thin contiguous sections can be obtained, and images can be reformatted into multiple planes from a single data set. High-contrast imaging can be accomplished by using three-dimensional (3D) turbo-fast low-angle shot (FLASH) or magnetization prepared rapid acquisition gradient-echo (MP RAGE) techniques with gadolinium contrast enhancement. Finally, CSF flow dynamics within the subarachnoid space and within cystic lesions can be elucidated with phase-contrast techniques. Judicious selection of these methods and other innovative MR techniques is necessary to maximize the potential of MR in diagnosis of spinal disease.

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Twenty one patients who underwent needle biopsies for spinal disease were analyzed. The final diagnoses in these patients were 11 cases of pyogenic osteospondylitis, 3 tuberculous osteospondylitis, 3 metastatic spinal tumors and 4 compression fractures.Ten of the 11 cases with pyogenic osteospondylitis, 2 of 3 tuberculous osteospondylitis, 1 of 3 metastatic spinal tumor and all compression fractures were correctly diagnosed by needle biopsy. Needle biopsy is easy, less invasive and has a high diagnostic ratio, so is useful in the diagnosis of spinal diseases.

Scintigraphy of spinal disorders in adolescents.

Bone scintigraphy in adolescents is useful in helping to differentiate between developmental (atypical lumbar Scheuermann disease), infectious (discitis, osteomyelitis), neoplastic (osteoid osteoma, osteoblastoma), and traumatic (occult fractures, spondylolysis, pseudoarthrosis) disease of the spine. Double-phase (blood pool, delayed images) scintigraphy can characterize the pattern (i.e., linear in fracture, ovoid in nidus of osteoid osteoma). Single-photon emission computed tomography (SPECT) can be helpful in detecting the subtle presence of stress reaction (spondylolyses) not noted on routine planar scintigraphy and radiography. Bone scintigraphy is most beneficial when correlated with other imaging modalities in refining the diagnosis of spinal diseases.

Imaging Modalities for Evaluation of the Spine

The spine can be evaluated by a number of different imaging modalities. Although magnetic resonance imaging has assumed the dominant role in the diagnosis of spinal disease, the individual clinical situation still determines the procedure of choice. This review discusses the different imaging techniques and their currently accepted indications.

Diagnosis of spinal disease in dogs

ABSTRACTDiagnosing spinal conditions in dogs requires an ability to conduct and interpret a neurological examination and a knowledge of ancillary diagnostic tests. This paper discusses the approach to the dog in which spinal disease is suspected, the performance of the neurological examination, and the diagnostic aids available. The differential diagnosis of various presenting syndromes is also considered.

Radiographic examination of the canine spine.

Radiography plays an essential part in the diagnosis of spinal disease in the dog. Careful positioning of the patient and attention to technique are important in obtaining diagnostic films and sedation or general anaesthesia is usually required, especially if the animal is in pain or muscle spasm. Additional information may be obtained by myelography, a technique in which a water-soluble iodine-containing contrast medium is injected into the subarachnoid space via the cisterna magna, under general anaesthesia. The advent of two new contrast media, iopamidol and iohexol, has rendered this a relatively safe procedure which may be carried out in practice. The radiological features of a variety of canine spinal conditions are discussed, including congenital and developmental abnormalities, infective, nutritional and degenerative conditions and trauma and neoplasia.