Failure Of Segmentation Research Articles

Comparative benchmarking of failure detection methods in medical image segmentation: Unveiling the role of confidence aggregation

Semantic segmentation is an essential component of medical image analysis research, with recent deep learning algorithms offering out-of-the-box applicability across diverse datasets. Despite these advancements, segmentation failures remain a significant concern for real-world clinical applications, necessitating reliable detection mechanisms. This paper introduces a comprehensive benchmarking framework aimed at evaluating failure detection methodologies within medical image segmentation. Through our analysis, we identify the strengths and limitations of current failure detection metrics, advocating for the risk-coverage analysis as a holistic evaluation approach. Utilizing a collective dataset comprising five public 3D medical image collections, we assess the efficacy of various failure detection strategies under realistic test-time distribution shifts. Our findings highlight the importance of pixel confidence aggregation and we observe superior performance of the pairwise Dice score (Roy et al., 2019) between ensemble predictions, positioning it as a simple and robust baseline for failure detection in medical image segmentation. To promote ongoing research, we make the benchmarking framework available to the community.

Hierarchical structure-based model for importance and reliability assessment of water distribution networks

The Segment-Valve (SV) model can be utilized to analyze the reliability of water distribution networks (WDNs). However, it often focuses on the impact of segment failures on themselves. The isolation of segments in the WDNs not only affects the segments themselves but also influences other segments through which the water supply path passes. Therefore, considering the water supply path and the interaction between upstream and downstream segments, we convert the loops in the SV graph to nodes to simplify them, clearly describing the segmented hierarchy and its interconnections in a tree-like form, termed SV-tree. Based on the SV-tree and complex network theory, a method is proposed to estimate the supply shortage rate using betweenness centrality to provide a detailed analysis for local importance on example WDNs. Meanwhile, new analysis indicators that can reflect the global reliability of the WDNs are constructed from the mutual influence between segments and the difficulty for users to obtain water. The results demonstrate the efficacy of the new importance assessment indicator across various WDNs configurations, and its calculation time is much lower than that of hydraulic simulation. In addition, the reliability assessment indicators are more practical and can effectively identify problems existing in the WDNs.

Automated ventricular segmentation and shunt failure detection using convolutional neural networks.

While ventricular shunts are the main treatment for adult hydrocephalus, shunt malfunction remains a common problem that can be challenging to diagnose. Computer vision-derived algorithms present a potential solution. We designed a feasibility study to see if such an algorithm could automatically predict ventriculomegaly indicative of shunt failure in a real-life adult hydrocephalus population. We retrospectively identified a consecutive series of adult shunted hydrocephalus patients over an eight-year period. Associated computed tomography scans were extracted and each scan was reviewed by two investigators. A machine learning algorithm was trained to identify the lateral and third ventricles, and then applied to test scans. Results were compared to human performance using Sørensen-Dice coefficients, calculated total ventricular volumes, and ventriculomegaly as documented in the electronic medical record. 5610 axial images from 191 patients were included for final analysis, with 52 segments (13.6% of total data) reserved for testing. Algorithmic performance on the test group averaged a Dice score of 0.809 ± 0.094. Calculated total ventricular volumes did not differ significantly between computer-derived volumes and volumes marked by either the first reviewer or second reviewer (p > 0.05). Algorithm detection of ventriculomegaly was correct in all test cases and this correlated with correct prediction of need for shunt revision in 92.3% of test cases. Though development challenges remain, it is feasible to create automated algorithms that detect ventriculomegaly in adult hydrocephalus shunt malfunction with high reliability and accuracy.

Experimental investigation on damage development and failure mechanism of shield tunnel lining under internal blast considering stratum-structure interaction

With the expansion of international terrorism and the potential threat of attacks against civil infrastructure, the dynamic response and failure modes of underground tunnels under explosive loads have become a prominent research topic. The high cost and inherent danger associated with explosion experiments have limited current research on tunnel internal explosions, particularly in the context of scaled model tests of shield tunnels. This study presents a series of scaled model tests under 1g-condition simulating internal blast events within a shield tunnel based on the prototype of the Shantou Bay Tunnel, considering the influences of surrounding stratum and equivalent explosive yield. Three different TNT explosive yields are considered in the model tests, namely 0.2, 0.4, and 1.0 kg. The model tests focus on the damage behavior and collapse modes of the shield tunnel lining under internal explosive loads. The model tests reveal that the shield tunnel is prone to damage at the joints of the tunnel crown and shoulder when subjected to internal explosive loads, with the upper half of the tunnel lining experiencing segment collapse, while the lower half remains largely undamaged. As the TNT equivalent increases, the damage area at the tunnel joints expands, and the number of segment failures in the upper half of the tunnel rises, transitioning from a damaged state to a collapsed state. The influence of “stratum-structure” interaction is investigated by comparing two models, one with overburden soil and the other positioned at the ground surface. The model tests reveal that the presence of soil pressure and confinement can significantly enhance the tunnel resistance to internal blast loads. Based on the observation of the model tests, five different damage modes of segment joints under internal explosion are proposed in this study.

Anomaly detection via Gumbel Noise Score Matching.

We propose Gumbel Noise Score Matching (GNSM), a novel unsupervised method to detect anomalies in categorical data. GNSM accomplishes this by estimating the scores, i.e., the gradients of log likelihoods w.r.t. inputs, of continuously relaxed categorical distributions. We test our method on a suite of anomaly detection tabular datasets. GNSM achieves a consistently high performance across all experiments. We further demonstrate the flexibility of GNSM by applying it to image data where the model is tasked to detect poor segmentation predictions. Images ranked anomalous by GNSM show clear segmentation failures, with the anomaly scores strongly correlating with segmentation metrics computed on ground-truth. We outline the score matching training objective utilized by GNSM and provide an open-source implementation of our work.

Investigation of shaft and segment failure in co-rotating twin-screw extruder

This research is focused on identifying the reasons behind the failure of the shaft and screw segment associated with the ABS plastic material co-rotating twin-screw extruder. These steel parts failed during production and after only 12 days of operation. To understand the failure causes, their chemical composition was examined initially. The results showed that the chemical composition of the analyzed parts meets the design and standard of BS EN 4957 (2018). Subsequently, a detailed study of the fracture cross-section of both pieces was conducted, along with microscopic and mechanical tests, to gather comprehensive information on the failure reasons. The findings indicate that the initiation of the cracks is linked to the presence of coarse carbide deposits, leading to micro-cracks on the surface of the shaft. Under torsional-bending cyclic loading, these cracks expanded as low-cycle fatigue fractures. When the fatigue crack reached its critical extent, rapid and abrupt crack propagation and failure ensued. Furthermore, defects like holes and coarse sediments within the segment also contributed to the conditions conducive to rapid crack growth and failure. In conclusion, to prevent future accidents and issues with comparable equipment, various safety measures and recommendations were introduced.

Investigation of local mechanical behavior during the shear process of rough rock joints using DEM

Rough joints are prevalent in natural rock masses, and their shear mechanical properties are crucial for ensuring the safety and stability of these masses. Existing studies often neglect the contribution of various joint asperities to shear stress resistance. This study addresses this gap by eluci-dating the local shear mechanisms of different asperities in rough joints throughout the shear process. This was achieved through a combination of quantitative and qualitative analyses using the Discrete Element Method (DEM). Initially, Barton's ten standard roughness joint profiles were dig-itized, and rough joints were modeled using the Modified Smooth Joint Model (MSJM). Direct shear tests on joint specimens under constant nor-mal stress were performed using servo-controlled methods. Subsequently, the shear stress behavior was analyzed in relation to the test results. The failure modes of the joint specimens were examined in detail using crack tracking and force chain analysis. The study also explored the relation-ship between the number of cracks and shear stress. Additionally, variations in average stress across ten different segments of joints during shear were monitored using the measuring circle function. The shear resistance contributions of local joint segments were quantitatively assessed using three stress indices: maximum stress, upper limit of maximum stress, and the distribution range of maximum stress. The Joint Roughness Coeffi-cient (JRC) of joints was found to correlate well with these indices. Overall, the progressive failure of local joint segments was analyzed both qual-itatively and quantitatively. The study confirmed that the local shear mechanisms of different joint segments during the shear process are distinct.

Full-scale loading test for shield tunnel segments: Load-bearing performance and failure patterns of lining structures

To explore the load-bearing performance and the failure patterns of the lining structures, a full-scale loading test on the three-ring staggered assembled shield tunnel segments is carried out through a hydraulic loading system. In the experimental study, the segments’ internal force, convergence deformation, and displacement, and the bolts’ internal force, are analyzed. According to the experimental results, the relationship between internal force and deformation is obtained to determine the residual bearing capacity of the shield tunnel at each stage. Three stages are specified for the evolution of the segment’s maximum bending moment during the loading process, in which, the elastic stage is the main and longest stage, in which the bending moment of the segment increases the most. There are two stages for convergence deformation development and segment misalignment development. At the end of loading, the segment’s maximum positive and negative convergence values reach 61.22 and −57.69 mm, respectively. Besides, the maximum segment misalignment is 3.67 mm, which occurs in the direction of 90°. The segment cracks when its maximum convergence value reaches 25.03 mm. Moreover, there are signs of fracturing on the waist joint of the segment when its maximum convergence value reaches 32.73 mm. The concrete at the waist joint starts fracturing in pieces when the segment’s maximum convergence value reaches 38.93 mm, which is defined as the type of shear failure. Finally, the bearing capacity of shield tunnels during segment failure period can be evaluated by using the corresponding relationship between deformation and internal force.

Multirod posterior occipitocervical instrumentation constructs: a biomechanical analysis and initial case series of 10 patients with complex craniocervical pathology

BACKGROUND CONTEXTStabilization of the occipitocervical (OC) junction with posterior instrumentation plays a vital role in addressing a spectrum of pathologies. Due to limited bone surfaces of the occiput and C1 lamina, achieving union across the OC junction is challenging. PURPOSETo explore the biomechanics and a clinical series of patients treated with multirod constructs across the OC junction using a novel occipital plate with single- and dual-headed, modular tulip heads. STUDY DESIGN/SETTINGBiomechanical analysis and retrospective case series. PATIENT SAMPLEAdults at a single institution who underwent posterior cervical multirod constructs across the OC junction. OUTCOME MEASURESOC–C4 range of motion (ROM), maximum von Mises stress on the rods, and adjacent segment ROMs and intradiscal parameters. Patient demographics, revision operations, rod breakages, wound complications. METHODSA validated occiput-cervical finite element (FE) model was used to simulate OC–C4 cervical fixation under multidirectional pure moment loading. A total of 4 rod configurations were simulated: (A) 2-rod-Ti (4.0 mm titanium rods); (B) 2-rod-CoCr (3.5 mm cobalt chrome rods); (C) 3-rods (4.0 mm titanium rods); (D) 4-rods (4.0 mm titanium rods). The aforementioned measures were compared. A retrospective analysis was also performed of adults at a single institution who underwent posterior cervical multirod constructs across the OC junction. RESULTSBiomechanically, lowest primary rod stresses were observed for 3- and 4-rod constructs. Compared to 2-rod-Ti (121.8 MPa), 2-rod-CoCr showed a 43.2% stress increase in the rods, while 3- and 4-rods experienced rod stress reductions of 20% and 23.2%, respectively. No appreciable differences in OC–C4 ROM, C4–5 ROM, and C4–5 discal stresses were found between multirod and 2-rod constructs. Maximum occipital and C4 screw stresses were decreased in multirod constructs compared to 2-rods, with least stresses noted in the 4-rod construct. Maximum plate stresses were slightly increased in the 4-rod construct compared to 2- and 3-rod fixation, though the forces were largely similar among the constructs. Ten patients (average age 66.4±10.6 years; 8 males) were assessed clinically. Nine of the ten operations were for primary stabilization of pathological fractures and associated craniocervical and/or atlantoaxial instability using 4-rods across the OC junction. At an average follow-up time of 1.58±0.5 years (range, 1–2.3 years), there were no instrumentation failures, no adjacent segment failures, and no wound complications. CONCLUSIONSIn this proof-of-concept investigation, multiple rods (3- and 4-rods) across the OC junction using a novel occipital plate with single- and dual-headed, modular tulips was safe and effective in stabilizing the OC junction. Accompanying FE analysis demonstrated that multirod constructs decreased primary rod stresses and had lower stresses on occipital and C4 screws compared to 2-rod constructs, while occipital plate stresses were largely similar. Additional clinical studies are needed to confirm these findings and to determine the ultimate utility of multirod constructs across the OC junction.

Model for the Failure Prediction Mechanism of In-Service Pipelines Based on IoT Technology

With the rapid increase in pipeline mileage in China, the accurate prediction of corrosion issues in in-service pipelines has become crucial for ensuring safe pipeline operation. Traditional pipeline leakage monitoring methods are significantly limited by human factors and equipment precision, making it challenging to predict and identify leakage points accurately. Therefore, aligned with the trend of intelligent pipeline development, this study aims to construct a failure pressure prediction mechanism model for corroded pipelines based on IoT technology. This model leverages intelligent sensing and prediction to assess the safety status of corroded pipeline sections. Ultrasonic phased array technology detects specific corrosion points and detailed defect parameters within pipeline sections. The parameters are then utilized in the Simdroid domestic finite element analysis model to simulate the ultimate burst pressure of the pipeline. A single-variable approach is employed to analyze the sensitivity of different parameters to the pipeline’s ultimate burst pressure, with the minimum burst pressure point of multi-point corroded sections selected as the overall segment failure pressure. Finite element simulation data are integrated into a neural network database to predict the pipeline failure pressure. The real-time operational data of the pipeline are monitored using negative-pressure wave sensing. The operational pressure of the corroded points is compared with the algorithm-predicted failure pressure; if the values approach a critical threshold, an alarm is triggered. Moreover, the remote control terminals evaluate the pipeline’s self-rescue time, providing a buffer for pipeline leakage self-rescue. The failure prediction mechanism model for in-service pipelines was applied to the Fujian–Guangdong branch of the West–East Gas Pipeline III to verify its accuracy and feasibility. The research results offer technical support for the maintenance and emergency repair of pipeline leakage scenarios, leveraging intelligent pipeline technology to reduce costs and increase the efficiency of pipeline operations, thereby supporting the sustainable development of China’s oil and gas pipelines with theoretical and technical backing.

Posterior Corrective Surgery for Type II Congenital Kyphosis: SRS-Schwab Grade 4 Osteotomy or Vertebral Column Resection?

Surgical decision-making for congenital kyphosis (CK) with failure of anterior segmentation (type II) has been contradictory regarding the trade-off between the pursuit of correction rate and the inherent risk of the osteotomy procedure. This study was designed to compare the clinical and radiographic measurement in type II CK underwent SRS-Schwab Grade 4 osteotomy and vertebral column resection (VCR), the most-adapted osteotomy techniques for CK, and to propose the strategy to select between the two procedures. This retrospective observational comparative study evaluated surgical outcomes in type II CK patients underwent VCR or SRS-Schwab Grade 4 osteotomy at our institution between January 2015 and January 2020. Patients operated with VCR and SRS-Schwab Grade 4 osteotomy were allocated to Group 1 and Group 2 respectively. Radiographic parameters and SRS-22 quality of life metrics were assessed at pre-operation, post-operation, and during follow-up visits for both groups, allowing for a comprehensive comparison of surgical outcomes. Thirty-one patients (19 patients in Group 1 and 12 patients in Group 2) aged 16.3 ± 10.4 years were recruited. Correction of segmental kyphosis was similar between groups (51.1 ± 17.6° in Group 1 and 48.4 ± 19.8° in Group 2, p = 0.694). Group 1 had significantly longer operation time (365.9 ± 81.2 vs 221.4 ± 78.9, p < 0.001) and more estimated blood loss (975.2 ± 275.8 ml vs 725.9 ± 204.3 mL, p = 0.011). Alert event of intraoperative sensory and motor evoked potential (SEP and MEP) monitoring was observed in 1 patient of Group 2. Both groups had 1 transient post operative neurological deficit respectively. SRS-Schwab Grade 4 osteotomy was suitable for kyphotic mass when its apex is the upper unsegmented vertebrae or the neighboring disc, or when the apical vertebrae with an anterior/posterior (A/P) height ratio of vertebral body higher than 1/3. VCR is suitable when the apex is located within the unsegmented mass with its A/P height ratio lower than 1/3. Proper selection of VCR and SRS-Schwab Grade 4 osteotomy according to our strategy, could provide satisfying radiographic and clinical outcomes in type II CK patients during a minimum of 2 years follow-up. Patients undergoing VCR procedure might have longer operation time, more blood loss and higher incidence of peri- and post-operative complications.

Spinal dysraphism in congenital scoliosis and kyphosis: a retrospective analysis in an Indian population.

Early recognition is crucial for occult spinal dysraphism associated with congenital spinal deformities. There is limited literature available on its occurrence in congenital scoliosis and kyphosis in the Indian population. Our study involved a retrospective review of 247 children who presented at a single centre. We analyzed their demographics and clinical and radiological findings, which included the type of deformity, its location, vertebral anomaly, Cobb angle, and MRI findings. The deformities were categorized as congenital scoliosis or congenital kyphosis with failure of formation, failure of segmentation, or both. A total of 247 cases were examined (congenital scoliosis-229, congenital kyphosis-18). The average age was sevenyears (range 0.8 to 19years, SD 4.6). The mean Cobb angle at presentation in the congenital scoliosis group was 49.4° (range 8 to 145°, SD 23.77) for those with abnormal MRI and 42.45° (range 5 to 97°, SD 20.09) for those with normal MRI. For the congenital kyphosis group, the mean K angle at presentation was 47.7° (range 14 to 110°, SD 33.33) for those with abnormal MRI and 47.36° (range 15 to 70°, SD 16.63) for those with normal MRI. Abnormal MRI results were observed in 130 of the patients (congenital scoliosis-53.7%, congenital kyphosis-38.8%). The highest incidence of abnormal MRI findings was observed in the failure of segmentation (66.6%) and mixed (65%) types. Deformities in the dorsal region had the highest incidence (61.9%). The most common dysraphism instances were diastematomyelia and tethered cord. There was a significant correlation between type of deformity and presence of dysraphism. This is the largest case series of congenital scoliosis and kyphosis reported from India. We found a high incidence of occult spinal dysraphism as compared to other published series. Occult spinal dysraphism is more common in the thoracic region. Diastematomyelia followed by tethered cord was the most common anomaly observed. We recommend MRI screening of whole spine and craniovertebral junction.

Genetic insights into the ‘sandwich fusion’ subtype of Klippel–Feil syndrome: novel FGFR2 mutations identified by 21 cases of whole-exome sequencing

BackgroundKlippel–Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of two or more cervical vertebrae during early prenatal development. This fusion results from a failure of segmentation during the first trimester. Although six genes have previously been associated with KFS, they account for only a small proportion of cases. Among the distinct subtypes of KFS, “sandwich fusion” involving concurrent fusion of C0-1 and C2-3 vertebrae is particularly noteworthy due to its heightened risk for atlantoaxial dislocation. In this study, we aimed to investigate novel candidate mutations in patients with “sandwich fusion.”MethodsWe collected and analyzed clinical data from 21 patients diagnosed with “sandwich fusion.” Whole-exome sequencing (WES) was performed, followed by rigorous bioinformatics analyses. Our focus was on the six known KFS-related genes (GDF3, GDF6, MEOX1, PAX1, RIPPLY2, and MYO18). Suspicious mutations were subsequently validated through in vitro experiments.ResultsOur investigation revealed two novel exonic mutations in the FGFR2 gene, which had not previously been associated with KFS. Notably, the c.1750A > G variant in Exon 13 of FGFR2 was situated within the tyrosine kinase domain of the protein, in close proximity to several established post-translational modification sites. In vitro experiments demonstrated that this certain mutation significantly impacted the function of FGFR2. Furthermore, we identified four heterozygous candidate variants in two genes (PAX1 and MYO18B) in two patients, with three of these variants predicted to have potential clinical significance directly linked to KFS.ConclusionsThis study encompassed the largest cohort of patients with the unique “sandwich fusion” subtype of KFS and employed WES to explore candidate mutations associated with this condition. Our findings unveiled novel variants in PAX1, MYO18B, and FGFR2 as potential risk mutations specific to this subtype of KFS.

Simulation Analysis of Influence of Accident Conditions on Hydraulic Reliability of Gas Pipe Network

Taking reliability as the starting point, based on Pipeline Studio software and combined with the actual situation of medium-pressure gas pipe network in Weidu District, Xuchang City, the operation conditions of gas pipe network under design conditions and accident conditions were simulated, and the accident conditions were assumed to be the shutdown of important pipe segments for reasons or the failure of the pipe segment with the maximum flow rate. According to the simulated hydraulic calculation results, the overall gas supply capacity of the pipeline network is comprehensively evaluated and analyzed, and the conclusion is reached that the pipe network can meet the requirements of normal and accident conditions by properly enlarging the pipe diameter closer to the gas source point.

Influence of foundation pit excavation on the internal force of adjacent shield segment structure

As subway line density increases, excavation of foundation pits around tunnels unavoidably triggers soil disturbance. This consequently alters the on-site strain and distortion fields of the soil, resulting in internal force modifications in the tunnel shield segment and joint failure. To maintain tunnelling structure safety through numerous foundation pit diggings, this study uses a real-world project as its model. Leveraging the tunnel convergent deformation results derived from prior analyses with PLAXIS 3D software, the Midas GTS software is utilized to explore the alterations in internal forces and joint failure patterns of the tunnel subjected to convergent deformations of 4cm and 5cm. The findings are as follows: (i) Under the effect of a vertical load, the segment deformation takes on a transverse elliptical shape. (ii) The majority of joint failure is primarily focused around the foundation pit excavation area, where the base of the arch opens inwardly, and the midsection of the arch expands outwardly. (iii) The stress on the structure escalates as the extent of foundation pit excavation increases.

Investigation of loading intensity effect (LIE) on the failure mechanism of shield tunnel subjected to fire

The overload damage seriously threatens the service life of the tunnel structure, and the elevated temperatures under the extreme load of fire pose a more serious threat to the structure. In this study, a thermal–mechanical methodology is proposed to analyze the combined effects of loading intensity and fire on tunnel structures. The methodology is also validated by experimental studies. Impacts of loading intensity effect (LIE) on temperature distribution, deformation development and inner force distribution are discussed respectively. Results indicate that LIE aggravates heat flow invasion, making uneven temperature distribution of the segmental ring. On the other hand, LIE has a direct influence on the development of mid-span deformation of lining segments, and induces the failure of lining segments due to excessive deformation at the initial stage of heating. higher loading intensity induces a higher initial axial stress level of the tunnel structure. It is also found that the failure of the segmental ring can be attributed to the development of plastic hinges originated from the coupled thermo-mechanical effect. The findings not only reveal the combined effects of overload damage and fire on tunnel structures, but also provide valuable insights on fire prevention in case of tunnel fire.

New information on paleopathologies in non-avian theropod dinosaurs: a case study on South American abelisaurids

Studies on pathological fossil bones have allowed improving the knowledge of physiology and ecology, and consequently the life history of extinct organisms. Among extinct vertebrates, non-avian dinosaurs have drawn attention in terms of pathological evidence, since a wide array of fossilized lesions and diseases were noticed in these ancient organisms. Here, we evaluate the pathological conditions observed in individuals of different brachyrostran (Theropoda, Abelisauridae) taxa, including Aucasaurus garridoi, Elemgasem nubilus, and Quilmesaurus curriei. For this, we use multiple methodological approaches such as histology and computed tomography, in addition to the macroscopic evaluation. The holotype of Aucasaurus shows several pathognomonic traits of a failure of the vertebral segmentation during development, causing the presence of two fused caudal vertebrae. The occurrence of this condition in Aucasaurus is the first case to be documented so far in non-tetanuran theropods. Regarding the holotype of Elemgasem, the histology of two fused vertebrae shows an intervertebral space between the centra, thus the fusion is limited to the distal rim of the articular surfaces. This pathology is here considered as spondyloarthropathy, the first evidence for a non-tetanuran theropod. The microstructural arrangement of the right tibia of Quilmesaurus shows a marked variation in a portion of the outer cortex, probably due to the presence of the radial fibrolamellar bone tissue. Although similar bone tissue is present in other extinct vertebrates and the cause of its formation is still debated, it could be a response to some kind of pathology. Among non-avian theropods, traumatic injuries are better represented than other maladies (e.g., infection, congenital or metabolic diseases, etc.). These pathologies are recovered mainly among large-sized theropods such as Abelisauridae, Allosauridae, Carcharodontosauridae, and Tyrannosauridae, and distributed principally among axial elements. Statistical tests on the distribution of injuries in these theropod clades show a strong association between taxa-pathologies, body regions-pathologies, and taxa-body regions, suggesting different life styles and behaviours may underlie the frequency of different injuries among theropod taxa.

Clinical Relevance of Painful Congenital Early-onset Scoliosis: A Magnetic Resonance Image-based Study.

Back pain, as a clinical marker in scoliosis, has been associated with underlying pathology for many years, warranting further magnetic resonance imaging (MRI). Failures of segmentation, mixed defects, female gender, rib anomalies, congenital thoracic anomalies, and neurocutaneous markers are known risk factors for abnormal MRI pathology findings in patients with congenital early-onset scoliosis (Congenital-EOS). Yet, back pain has not been evaluated as a risk factor for underlying MRI pathology in patients with Congenital-EOS. This study aimed to assess back pain as a risk factor for underlying pathology in Congenital-EOS using MRI as a diagnostic tool. A retrospective database review from the Pediatric Spine Study Group (PSSG) of all patients with Congenital-EOS who reported a back pain complaint, and underwent a spinal MRI study before surgical intervention was performed. Patients were divided into those with an underlying MRI pathology and those without. Demographics were compared between groups. From a total of 2355 patients with Congenital-EOS registered in PSSG, 107 patients reported a back pain complaint, with only 42 patients fulfilling the inclusion criteria (being evaluated with an MRI study). Overall group mean age was 8.1±4.5 years, with 25 of the 42 patients (60%) being females. Twenty-four of 42 patients (57%) had a comorbidity reported such as cardiac problems, musculoskeletal complaints, neurological deficits/myelopathy, gastrointestinal symptoms, developmental delay, respiratory problems, craniofacial abnormalities, and chromosomal conditions. An underlying MRI pathology was found in 21 of 42 patients with Congenital-EOS (50%) with back pain. The underlying MRI pathologies found were tethered spinal cord, spinal canal stenosis, syringomyelia, Arnold-Chiari malformation, and arachnoid cyst. Abnormal MRI findings are common in patients with Congenital-EOS who report back pain. Gender, age, major coronal curve angle, thoracic or lumbar predominance deformity, and comorbidities type or amount were not associated with abnormal MRI findings. Level II-Prognostic study.

Talocalcaneal coalition: an easily overlooked abnormality - A case report

Abstract Congenital tarsal coalition involves failure of segmentation between two or more tarsal bones. Although coalition can be asymptomatic, foot or ankle pain occasionally occurs, especially in young patients, and is often overlooked at the first presentation. Radiography can be used to diagnose or indirectly identify tarsal coalition, and computed tomography (CT) or magnetic resonance imaging (MRI) can be used to confirm the diagnosis. Here, we present a case of a patient with a delayed diagnosis of tarsal coalition. In our patient, plain radiography of the left ankle showed the typical C-sign. Moreover, a noncontrast MRI of the left ankle revealed focal bone hypertrophy over the medial aspect of the talus and the sustentaculum tali of the calcaneus separated by a low signal gap. Familiarity with the radiographic features and signs of the tarsal coalition might aid in its diagnosis, and CT or MRI might provide additional information for its clinical management.

Dual Growing Rods and the Apical Control Technique for Treating Congenital Early-Onset Scoliosis: Lessons Learned.

Congenital early-onset scoliosis (CEOS) is characterized by a spectrum of vertebral anomalies, including formation failures and segmentation failures at the apex segment, which makes CEOS different from other etiologies of early-onset scoliosis. To date, studies on patients who have graduated from CEOS treatment using traditional dual growing rods (TDGR) have been scarce, and the preliminary results of TDGR with or without the apical control technique (ACT) have varied. We therefore compared the final outcomes of patients with CEOS who graduated from TDGR with or without the ACT. A retrospective study of patients with CEOS who had graduated from TDGR treatment performed from 2007 to 2020 was conducted. Graduation included final fusion or observation after reaching skeletal maturity. Patients were divided into the ACT-TDGR group (apical vertebrectomy and/or hemivertebrectomy with short fusion and TDGR) and the TDGR-only group. Demographic characteristics, radiographic data, patient-reported clinical outcomes, pulmonary function, and complications were analyzed. A total of 41 patients with CEOS were enrolled: 13 in the ACT-TDGR group and 28 in the TDGR-only group. The lengthening intervals were longer in the ACT-TDGR group (mean [and standard deviation], 1.26 ± 0.66 years) than in the TDGR-only group (0.80 ± 0.27 years). The preoperative main curve was larger in the ACT-TDGR group (80.53° ± 19.50°) than in the TDGR-only group (64.11° ± 17.50°). The residual curve was comparable between groups (26.31° ± 12.82° in the ACT-TDGR group compared with 27.76° ± 15.0° in the TDGR group) at the latest follow-up. The changes in apical vertebral rotation and thoracic rotation were significantly larger in the ACT-TDGR group. Patients had comparable T1-12 and T1-S1 heights, pulmonary function, and 22-item Scoliosis Research Society (SRS-22) scores at the latest follow-up. The mean number of mechanical-related complications per patient was lower in the ACT-TDGR group (0.77 ± 0.73) than in the TDGR-only group (1.54 ± 1.43). Seventeen patients underwent final fusion. In this small-scale study, we observed that both ACT-TDGR and TDGR-only could correct the deformity while allowing for spinal growth in patients with CEOS. ACT-TDGR yielded better correction in severe cases and did not have a deleterious effect on spinal height. A large number of cases will be needed to validate the clinical value of the ACT. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.