Posterior Height Research Articles

Posterior fossa morphometry in 170 South Asian children and adults with Chiari malformation and its correlation with tonsillar descent

Aim Patients with Chiari I malformations (CM1) have posterior fossa hypoplasia with crowding of the neural structures. We aimed to study the posterior fossa measurements to analyse the posterior fossa morphology, presence of basilar invagination (BI) and correlated the measurements with the degree of tonsillar descent. Methods We retrospectively reviewed data in170 patients who underwent foramen magnum decompression (FMD) for CM1. The posterior fossa measurements were compared with 30 controls. Patients were divided into those with and without BI. The variables measured included clival length, posterior fossa height, supraocciput length, posterior fossa diameter, foramen magnum width, Boogard’s angle, clival angle, clival slope and the newly introduced foramen magnum (FM) angle. Results The average clivus length and posterior fossa height were significantly shorter with a significant increase in the Boogard’s and FM angle in the patient groups. Tonsillar descent showed a negative correlation with posterior fossa height (r = −0.498, p ≤ 0.001) and clivus length (r = −0.325, p ≤ 0.001) and a positive correlation with Boogard’s angle (r = 0.469, p ≤ 0.001) and FM angle (r = 0.330, p ≤ 0.001). Patients with BI had statistically significant reduced posterior fossa height (p ≤ 0.001) and increased extent of tonsillar herniation (p = 0.001) compared to patients without BI. Conclusion Patients with CM1 have significantly shorter clival length and posterior fossa height with smaller posterior fossa in support of published data. The presence of BI shortens the posterior fossa height and worsens the extent of tonsillar herniation. An increased Boogard’s angle and FM angle result in a more horizontally placed suboccipital bone compared to a slanting bone in normal persons.

Inclusion of the fractured level into the construct of short segment fixation in patients with thoracolumbar fractures: clinical and radiological outcome

BackgroundThoracolumbar fractures represent a widespread injuries that can cause significant disability and strain the healthcare system. Different surgical approaches are described in the literature. This study was conducted to evaluate the fractured level inclusion in short-segment fixation of thoracolumbar junction spine fractures.ResultsPreoperative neurological deficit was reported in seven patients ranging from ASIA grade C to D. All of these patients improved to grade E by the end of the follow-up period, except for one patient who improved from grade C to D. The mean Oswestry Disability Index was 19.87%. The mean postoperative Cobb angle was 11.77° which significantly improved compared to a preoperative value of 19.37°. There was a significant improvement in the postoperative anterior and posterior vertebral body height compared to the preoperative values. The vertebral body compression ratio significantly improved during the postoperative period to a mean of 84% compared to 76% preoperative.ConclusionsThere was significant improvement of the postoperative values of the mean Cobb angle, the anterior and the posterior vertebral body height as well as the vertebral body compression ratio compared to the preoperative values.

A Radiological Evaluation of Lumbar Spinous Processes and Interspinous Spaces, Including Clinical Implications.

Background and objectiveThe aim of this study was the examination of morphometry of the spinous process (SP) and interspinous space (ISS) of the lumbar region to help provide a basis for the design and implantation of interspinous devices.MethodsBetween 2017 and 2019, 215 individuals underwent magnetic resonance imaging of the lumbar region for various reasons. No pathology was detected in these images, and the participants' age, height, and weight information when available were included in the study. From these images, the height and length of the SP and ISS in the lumbar region were noted. The heights of the SP and ISS were measured at three levels as anterior, middle, and posterior (respectively, anterior height of the spinous process [AHSP], middle height of the spinous process [MHSP], as well as posterior height of the spinous process [PHSP] for the height of SP, and anterior ISS, middle ISS and posterior ISS for the height of ISS). All measurements were compared according to the gender, age, weight, height, and body mass index of the individuals.ResultsThe level with the lowest SP height and length was L5 vertebra. The ISS height and length were lowest at L4-L5. In addition, we observed a statistically significant difference at multiple levels with age, weight, height, and body mass index of the reference ranges.ConclusionWe think that these changes should be considered when designing and implanting interspinous devices. Since there are few studies examining all these correlations, we think that the results of this study will make a unique contribution to the literature.

Effect of vertebral compression fractures on aortic neck angulation after endovascular aneurysm repair

ObjectiveAortic neck angulation (ANA) prior to endovascular aneurysm repair (EVAR) and its changes after EVAR are considered important predictors of postoperative complications. We sought to assess the effects of vertebral body height loss on ANA in patients post-EVAR. MethodsAll patients who had undergone EVAR for infrarenal aortic aneurysms in our institution between August 2010 and December 2018 were assessed. Anterior and posterior vertebral body heights were measured in all patients on preoperative, early postoperative, and follow-up computed tomography scans (T12-L5 vertebral bodies). Patients who had significant height loss in their follow-up period were designated as the Study group. These were matched to a Control group of the same size using propensity-score matching based on age, gender, and duration between follow-up scans. Aortic neck morphology indices including ANA and its changes were measured, and information related to postoperative endoleaks and aneurysm sac size were extracted in the Study and Control groups. ResultsDuring the follow-up period, 10 of 185 patients had a radiologically significant vertebral body compression fracture. There was no significant difference between the Study (n = 10) and Control groups in age (77.6 ± 6.9 vs 77.2 ± 7.5 years; P = .64), gender (seven males and three females in each group; P = 1.0), duration between postoperative scans (1830 ± 665 vs 1800 ± 670 days; P = .25), preoperative ANA (36.0° ± 15.6° vs 42.4° ± 18.6°; P = .41), and early postoperative ANA (21.9° ± 11.7° vs 20.9° ± 16.3°; P = .72). Changes in ANA in the postoperative period (7.2° ± 11.1° vs −4.7° ± 6.7°; P = .009; power = .838) were significantly higher in the Study group. ConclusionsPost-EVAR vertebral body compression fractures exacerbate ANA. Awareness of this can guide both preoperative assessment and postoperative management and follow-up.

MRI-based synthetic CT of the lumbar spine: Geometric measurements for surgery planning in comparison with CT

PurposeMRI is the imaging modality of choice for soft tissue-related spine disease. However, CT is superior to MRI in providing clear visualization of bony morphology. The purpose of this study is to test equivalency of MRI-based synthetic CT to conventional CT in quantitatively assessing bony morphology of the lumbar spine. MethodA prospective study with an equivalency design was performed. Adult patients who had undergone MRI and CT of the lumbar spine were included. Synthetic CT images were generated from MRI using a deep learning-based image synthesis method. Two readers independently measured pedicle width, spinal canal width, neuroforamen length, anterior and posterior vertebral body height, superior and inferior vertebral body length, superior and inferior vertebral body width, maximal disc height, lumbar curvature and spinous process length on synthetic CT and CT. The agreement among CT and synthetic CT was evaluated using equivalency statistical testing. ResultsThirty participants were included (14 men and 16 women, range 20–60 years). The measurements performed on synthetic CT of pedicle width, spinal canal width, vertebral body height, vertebral body width, vertebral body length and spinous process length were statistically equivalent to CT measurements at the considered margins. Excellent inter- and intra-reader reliability was found for both synthetic CT and CT. ConclusionsEquivalency of MRI-based synthetic CT to CT was demonstrated on geometrical measurements in the lumbar spine. In combination with the soft tissue information of the conventional MRI, this provides new possibilities in diagnosis and surgical planning without ionizing radiation.

Changes in Corneal Morphology with Age in Asian Population: A Multicenter Study of 30,618 Cases.

IntroductionTo evaluate normal reference ranges for corneal morphological parameters and investigate age-related changes in these parameters in Asian subjects with healthy eyes in order to provide reference data for preoperative evaluation of corneal refractive surgery and the early differential diagnosis of subclinical and asymptomatic keratoconus.MethodsThis cross-sectional, multicenter, observational study was conducted in five provinces of China, from January 2014 through October 2019. It is a retrospective analysis. Examiner-blinded clinical measurements were performed after stratification of the subjects into the following age groups: < 18, 18–30, 31–40, 41–50. We evaluated 30,618 healthy eyes of Chinese subjects who exhibited a normal corneal morphology, had no history of eye surgery or trauma, stopped wearing soft contact lenses for at least 2 weeks (rigid contact lenses for at least 4 weeks), and underwent topographic studies for both eyes on the same day.ResultsWhile the anterior and posterior corneal curvatures (K1 and K2) increased with age, corneal astigmatism of the anterior and posterior surfaces (ΔK) and central, minimum, and overall corneal thicknesses decreased with age. Age-related decrease of the overall corneal thickness was more obvious toward the periphery. The anterior and posterior corneal surface heights exhibited a decrease and an increase, respectively. Both index of height asymmetry (IHA) and index of vertical asymmetry (IVA) exhibited an increase with age.ConclusionsThe cornea exhibits overall thinning with age and gradually changes from a flat ellipse to an elongated ellipse in Asian individuals with healthy eyes. However, the anterior and posterior surfaces become smoother with age. Owing to the very large number of cases, these small differences are statistically significant. The results obtained are consistent with the hypothesis that a normal cornea seems to withstand quite well the effect of IOP, external pressures, and the natural cross-linking.

Correlation between objective evaluation and subjective evaluation of facial profile in skeletal Type II females

Objectives: The objective of this study was to find the cephalometric measurements that correlate with the visual perception. Materials and Methods: A total of 250 lateral cephalograms of patients from the year 2016 to 2018 were hand traced and analyzed. Thirty-six hard- and soft-tissue measurements were obtained from the lateral cephalometric analysis. Silhouettes obtained from cephalometric films were rated by 10 orthodontists based on their level of convexity. For each sample, the rating of visual perception was correlated with all the cephalometric (hard and soft) measurements. Results: ANB, AF-BF, L1-NB (mm), overjet, anterior maxillary alveolar height, posterior maxillary alveolar height, lower lip to E plane, and H angle were positively correlated with the visual perception. On the contrary, Pg. to N perpendicular and Pg. to NB (mm) were negatively correlated with the visual perception. However, the measurements in the vertical dimensions did not have any significant correlations with visual perception. H angle showed a higher correlation with visual perception than the nasolabial angle, facial contour angle, and lower lip to E plane. Conclusion: The agreement between objective cephalometric measurements and subjective visual perception was less than expected. In general, only 27% of the cephalometric measurements had a significant correlation with visual perception. Therefore, orthodontic treatment planning based solely on cephalometric analysis can result in unsatisfactory treatment outcomes. An inclusion of subjective measures such as visual perception in orthodontic diagnosis and treatment planning is necessary.

Contribution of postoperative vertebral remodeling to reversal of vertebral wedging and prevention of correction loss in patients with adolescent Scheuermann's kyphosis.

This study aimed to investigate reversal of vertebral wedging and to evaluate the contribution of vertebral remodeling to correction maintenance in patients with adolescent Scheuermann's kyphosis (SK) after posterior-only instrumented correction. A retrospective cohort study of patients with SK was performed. In total, 45 SK patients aged 10-20 years at surgery were included. All patients received at least 24 months of follow-up and had Risser sign greater than grade 4 at latest follow-up. Patients with Risser grade 3 or less at surgery were assigned to the low-Risser group, whereas those with Risser grade 4 or 5 were assigned to the high-Risser group. Radiographic data and patient-reported outcomes were collected preoperatively, immediately postoperatively, and at latest follow-up and compared between the two groups. Remarkable postoperative correction of global kyphosis was observed, with similar correction rates between the two groups (p = 0.380). However, correction loss was slightly but significantly less in the low-Risser group during follow-up (p < 0.001). The ratio between anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH) of deformed vertebrae notably increased in SK patients from postoperation to latest follow-up (p < 0.05). Loss of correction of global kyphosis was significantly and negatively correlated with increased AVBH/PVBH ratio. Compared with the high-Risser group, the low-Risser group had significantly greater increase in AVBH/PVBH ratio during follow-up (p < 0.05). The two groups had similar preoperative and postoperative Scoliosis Research Society-22 questionnaire scores for all domains. Obvious reversal in wedge deformation of vertebrae was observed in adolescent SK patients. Patients with substantial growth potential had greater vertebral remodeling and less correction loss. Structural remodeling of vertebral bodies has a positive effect and protects against correction loss. These results could be help guide treatment decision-making.

Investigation of Preoperative Traction Followed by Percutaneous Kyphoplasty Combined with Percutaneous Cement Discoplasty for the Treatment of Severe Thoracolumbar Osteoporotic Vertebral Compression Fractures.

ObjectiveTo evaluate the feasibility, clinical efficacy and imaging results of preoperative traction (PT) followed by percutaneous kyphoplasty (PKP) combined with percutaneous cement discoplasty (PCD) for treating severe thoracolumbar osteoporotic vertebral compression fractures (OVCFs).MethodsA total of 13 patients with severe thoracolumbar OVCFs treated by PT followed by PKP combined with PCD were enrolled. General information, PT time, operation time, postoperative hospital stay, perioperative complications, visual analog scale (VAS) score, Oswestry disability index (ODI) score, local kyphosis angle, intervertebral angle (IVA), anterior vertebral height (AVH) and posterior vertebral height (PVH) were recorded.ResultsThe average VAS score at admission was 7.4±3.5, decreased to 4.3±1.7 after PT and 2.3±0.7 three days after operation, and 1.5±0.9 at last follow-up. The average ODI score was 73.7±21.4 before operation, decreased to 26.6±9.3 three days after operation and 13.7±7.1 at last follow-up. Compared to VAS and ODI scores at admission, these at the third day after operation and last follow-up were significantly different. At admission, the IVA was 3.4°±6.8°, the disc height was 5.7±1.2mm, the AVH was 10.7±3.2mm, and the PVH was 25.7±4.2 mm, which, after PT, changed to 8.1°±7.3°, 8.6±2.6mm, 18.5±2.8mm, and 26.2±7.1mm, respectively, and the differences were significant. The average kyphotic angle was 43.4°±17.8° at admission, and decreased to 26.3°±6.7° after PT, 17.5°±8.4° three days after operation and 19.1°±10.3° at last follow-up, and the differences were significant.ConclusionPT followed by PKP combined with PCD for the treatment of severe thoracolumbar OVCFs was an effective and simple procedure with satisfactory short-term clinical outcomes by relieving pain and improving kyphosis.

Intelligent quantitative assessment of skeletal maturation based on multi-stage model: a retrospective cone-beam CT study of cervical vertebrae.

To develop new logistic regression estimative models of the cervical vertebral maturation index (CVMI) based on cone-beam CT (CBCT)-derived parameters for intelligent evaluating skeletal maturation. From 231 CBCT volumes (age range 7-17, mean age 11.09years), 154 were randomly selected to produce 2D sagittal projections of the second to fourth cervical vertebrae (C2-C4). From 19 quantitative parameters, significant predictors were deduced to formulate logistic models. Using the CVMI and significant predictors of 77 other subjects, performance of the models was externally examined by direct comparison and the area under the receiver operating characteristic curve (AUC). Models were modified if required, to improve their accuracy. Chronological age, C3 height ([Formula: see text], and ratio of posterior height to lower width of C4 [Formula: see text] were entered as significant predictors. Accuracy of the models was acceptable (total AUC = 0.91) except for 4th and 5th stage (AUC of 0.82 and 0.83, respectively), which were mis-predicted inversely. Adjusted models were generated by bivariate logistic regression analysis and adding significant parameters ([Formula: see text] and [Formula: see text], with odds ratios of 3.308 and 3.38, respectively) from 58 subjects in 4th and 5th stages of CVMI in the model establishment group. The total AUC increased to 0.94, along with an increase in the accuracy of the latter optimized models to 77.9 and 87%, respectively. The new intelligent models reliably estimated skeletal maturation and can be utilized in the clinical field or machine learning-based skeletal maturation assessment.

Is Osteoporotic Thoracolumbar Burst Fracture a Contraindication to Percutaneous Kyphoplasty? A Systematic Review

The management of pain after osteoporotic thoracolumbar burst fracture has not reached a treatment consensus. Percutaneous kyphoplasty has been shown to be efficient in reducing acute pain after burst fracture, although the topic remains highly controversial in this field. This study aimed to conduct a systematic review of the current literature to evaluate the effectiveness and safety of percutaneous kyphoplasty on the treatment of osteoporotic thoracolumbar burst fracture. A systematic review. University hospital. A comprehensive literature search was performed through PubMed, EMBASE, Web of Science, and Cochrane library without time restriction. Among the studies meeting the eligible criteria, any study in which percutaneous kyphoplasty was utilized alone in the treatment of osteoporotic thoracolumbar burst fracture was included in the current review. For radiographic outcome evaluation, vertebral height and kyphotic angle were analyzed. VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) were utilized for clinical outcome evaluation. Complications such as cement leakage and adjacent vertebral fracture or relapse were also analyzed. In total, 289 patients (338 vertebral bodies) were included in the 8 studies. Clinical outcomes indicated that patients achieved pain relief (VAS) from 6.8 preoperatively to 1.1 postoperatively, and improvement of quality of life (ODI) ranged from 87.0 ± 6.0% to 23.9 ± 4.4%. The radiological outcome indicated that anterior vertebral height restoration ranged from 20.1 ± 2.3 to 85.3 ± 10.6, and posterior vertebral height restoration ranged from 27.3 ± 1.7 to 83.3 ± 7.4. Kyphotic angle achieved correction ranged from 21.7 ± 7.8° preoperatively to 3.17° postoperatively. The main complications after PKP were cement leakage and adjacent vertebral fracture or relapse, which had an incidence of 7.7% -45.4% and 4.3% -74.1%, respectively. Due to the good quality of the English publications, only English-language research searches were conducted, but they do not unduly affect our aggregate results impact. More prospective randomized controlled trials are needed to provide higher evidence for clinical practice. To osteoporotic thoracolumbar burst fracture is absolutely not a contraindication to percutaneous kyphoplasty. Percutaneous kyphoplasty can obtain satisfactory effectiveness for the treatment of osteoporotic thoracolumbar burst fractures. Complications can be effectively decreased by meticulous evaluation, careful manipulation, and appropriate precautionary measures.

Effects of age and gender on posterior cranial fossa linear volume and cerebellar tonsil position in normal populations

To investigate the effects of gender and age on the posterior cranial fossa linear volume and cerebellar tonsil position in normal populations. A total of 180 normal adults who underwent cervical MRI examination at the physical examination center were selected, including 90 males and 90 females; the age ranged from 20 to 79 years, with an average of 50.4 years. The posterior cranial fossa linear volume and cerebellar tonsil position were measured by two spine surgeons on the mid-sagittal plane of the cervical MRI T2-weighted image. The posterior cranial fossa linear volume included the length of clivus (AB), anteroposterior diameter of foramen magnum (BC), length of supraocciput (CD), anteroposterior diameter of posterior fossa (DA), posterior fossa height (BE), and clivus angle (∠α). The index of the cerebellar tonsil position was the distance from the lower edge of the cerebellar tonsil to the baseline (MN). The differences of each indicators between males and females were compared, and the correlations between age and each indicators were analyzed. The posterior fossa cranial linear volume AB, BC, CD, BE, and ∠α in males were significantly larger than those in females ( P<0.05); DA in males was larger than that in females, but showing no significant difference ( t=1.978, P=0.050). The cerebellar tonsil position (MN) in females was higher than that in males, but showing no significant difference ( t=0.526, P=0.600). Correlation analysis showed that age was negatively correlated with AB, BC, CD, DA, BE, ∠α, and MN ( r=-0.375, P=0.001; r=-0.417, P=0.001; r=-0.046, P=0.001; r=-0.244, P=0.001; r=-0.326, P=0.001; r=-0.320, P=0.001; r=-0.334, P=0.001). The posterior cranial fossa linear volume of normal adults is significantly larger in males than in females; the posterior cranial fossa linear volume and the cerebellar tonsil position may have a decreasing process of age-related degeneration.

Correlation of skin epidural distance and posterior epidural space depth with age, weight, height, BMI, abdominal girth and position of the patient: A prospective randomised study

Lumbar epidural block is a commonly used procedure for providing anaesthesia, post-operative analgesia in all groups of patients irrespective of age, sex, weight and height of the patients. The knowledge of posterior space is important in view of the fact that this is the space where drugs for epidural anaesthesia/ analgesia are used. The knowledge of variability of this space with physical parameters of the patient, help us in reducing the incidence of total spinal anaesthesia.Two hundred adult patients in the age group of 20-60 years requiring subarachnoid block were chosen for the study. Using 22G Quincke spinal needle, epidural space was identified and skin epidural distance was measured. Proceeding the spinal needle further, causes needle to lie in subarachnoid space. The skin subarachnoid distance was measured. The difference between skin-subarachnoid distance and skin epidural distance denoted the posterior epidural space width. Its correlation with physical parameters was studied.Mean skin epidural distance was 4.30 ±0.57 in lateral position and 4.05 ± 0.57 in sitting position, the difference being statistically significant. (P= 0.002). There was positive correlation between skin epidural distance with weight, BMI and abdominal girth of the patient. Mean posterior epidural space depth was 0.468+14 cm in lateral position and 0.459+0.14 cm in sitting position, the difference being statistically insignificant. There was a positive correlation between posterior epidural space depth and height of the patient.The skin epidural distance varies with weight, BMI, abdominal girth and position of the patient. The posterior epidural space depth varies with the height of the patients.

Equivalent values between anterior vertebral height, wedge ratio, and wedge angle in osteoporotic vertebral fractures.

Vertebral mobility (V-mobility) has been used to diagnose fresh osteoporotic vertebral fractures (OVFs), and determine or predict bone union by setting cutoff values for these purposes. V-mobility is defined as the difference in shape of vertebral bodies between lateral radiographs taken in weight-bearing and non-weight-bearing positions. The parameters for V-mobility have varied in previous reports among anterior vertebral height (Ha, mm), wedge ratio (WR, %), and wedge angle (WA, degrees). The present study aimed to clarify WR and WA equivalent to Ha of 1.0mm, and to compare the reported cutoff values for V-mobility presented as Ha, WR, or WA. Lateral radiographs of 446 normal vertebrae (grade 0) and 146 deformed vertebrae (grade 1-3) from T11 to L2 were obtained from 183 female patients aged > 60years. WR (%) values equivalent to Ha of 1.0mm were calculated by Ha (1.0mm)/Hp × 100 (Hp: posterior vertebral height). Corresponding WA values were calculated by trigonometric function using vertebral dimensions. The mean WR values equivalent to Ha of 1.0mm in the vertebrae from T11 to L2 were 3.2%, 3.2%, 3.5%, and 3.7% for grades 0, 1, 2, and 3, respectively, and the corresponding WA values were 1.6°, 1.6°, 1.5°, and 1.4°. The equivalent values for V-mobility presented as Ha, WR, and WA were obtained. The mean WR and WA values equivalent to Ha of 1.0mm in grade 1-3 vertebrae were 3.5% and 1.5°, respectively.

Is there a difference in the outcomes of anterior cervical discectomy and fusion among female patients with different menopausal statuses?

BackgroundThe surgical outcomes of anterior cervical discectomy and fusion (ACDF) in female patients according to menopausal status remain unclear. The objective of this study was to investigate the differences in these outcomes among female patients with different menopausal statuses.MethodsNinety-one patients undergoing single-level or consecutive two-level ACDF with a minimum 12-month postoperative follow-up were included in this study. There were 38 patients in the premenopausal group, 28 patients in the early postmenopausal group, and 25 patients in the late postmenopausal group. The clinical outcomes were evaluated by means of the neck disability index (NDI) scores, Japanese Orthopedic Association (JOA) scores, and visual analog scale (VAS) scores. Radiological parameters included cervical lordosis (CL), the functional spinal unit (FSU) angle, range of motion (ROM) of the total cervical spine, ROM of the FSU, anterior and posterior FSU height, implant subsidence, adjacent segment degeneration (ASD), and Hounsfield unit (HU) values.ResultsAll groups showed significant improvements in their JOA, VAS, and NDI scores (P < 0.05). The differences in preoperative and final follow-up CL, ROM of C2-7, FSU angle, and ROM of FSU were not statistically significant among the three groups (P > 0.05). The anterior FSU height loss rate showed a significant difference (P = 0.043), while there was no difference in the posterior FSU height loss rate (P = 0.072). The fusion rates in the early and late postmenopausal groups were consistently lower than those in the premenopausal group during the follow-up period. All patients had satisfactory outcomes at the final follow-up.ConclusionThere were no significant differences in clinical or other related outcomes of single-level or consecutive two-level ACDF in the long term among female patients with different menopausal statuses. However, the early bony fusion rates and anterior FSU height loss rates were poorer in late postmenopausal patients than in premenopausal or early postmenopausal patients. Hence, importance should be attached to the protection of late postmenopausal patients in the early postoperative period to guarantee solid bony fusion.

Differences in mitral valve geometry between atrial and ventricular functional mitral regurgitation in patients with atrial fibrillation: a 3D transoesophageal echocardiography study.

This study investigated geometric differences in mitral valve apparatus between atrial functional mitral regurgitation (A-FMR) and functional mitral regurgitation (FMR) with left ventricular (LV) dysfunction in patients with atrial fibrillation (AF) using 3D transoesophageal echocardiography (TOE). In total, 135 moderate or greater FMR patients with persistent AF or atrial flutter underwent 3D TOE. Fifty-six patients had A-FMR, defined as preserved LV ejection fraction (LVEF) of ≥50% and normal LV wall motion. Seventy-nine patients had ventricular FMR (V-FMR), defined as LV dysfunction (LVEF of <50%) or LV wall motion abnormality. To evaluate mitral leaflet coaptation, the coapted area was calculated as follows: total leaflet area (TLA) in end-diastole - closed leaflet area in mid-systole. Although annular area (AA) did not significantly differ between the two groups, TLA was significantly smaller in A-FMR than in V-FMR (P = 0.005). TLA/AA, indicating the degree of the leaflet remodelling, was significantly smaller in A-FMR than in V-FMR (P < 0.001). A-FMR had significantly smaller posterior mitral leaflet tethering height and angle measured at three anteroposterior planes (lateral, central, and medial) than V-FMR (all P < 0.001). However, vena contracta width (VCW) measured on long-axis view on TOE and coapted area, which correlated with VCW (r = -0.464, P < 0.001), were similar between the two groups. Mitral leaflet remodelling may be less in A-FMR compared with V-FMR. However, leaflet tethering was smaller in A-FMR than in V-FMR, and this may result in a similar degree of mitral leaflet coaptation and mitral regurgitation severity.

Conjunctival flap with auricular cartilage grafting: a modified Hughes procedure for large full thickness upper and lower eyelid defect reconstruction.

To investigate the suitability of a modified Hughes procedure, which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect. Patients with full thickness eyelid carcinoma involving more than 50% margin length who underwent surgical resection were retrospectively reviewed in the study. The defects were reconstructed using conjunctival flap with auricular cartilage grafting, covered with myocutaneous flap above. Followed-up time ranged from 12 to 24mo. Outcomes were classified as "good", "fair", and "poor" by evaluating the margin appearance, eyelid appearance, and complications. A total of 42 patients were enrolled in the study (26 males, 16 females, mean age, 68.6±7.7y, range: 53 to 82y). The mean defect widths measured 23.2±2.9 mm (range, 17 to 28 mm). The mean posterior lamellar defect height was 5.5±1.3 mm (4 to 8 mm). Thirty-seven patients had a "good" outcome (88.1%), 5 patients had a "fair" outcome (11.9%), and no one had a "poor" outcome. Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect. It can not only achieve satisfied reconstruction, but also preserve intact tarsal plate of the opposite eyelid, avoiding retraction or entropion.

Retroversion of the hemipelvis rather than hypoplastic posterior wall decreases acetabular anteversion in hips affected by Perthes disease

The acetabular retroversion has a moderate incidence of 31–60% in all patients of the Perthes disease. It might be caused by posterior wall dysplasia based on recent animal researches. However, some studies support that hemipelvic retroversion is the main factor for the acetabular retroversion. The primary pathological factor of increasing retroversion angle is still controversial anatomically. This study aimed to identify whether there is acetabular retroversion in children with Perthes disease,and to find a method to distinguish version types. Forty children with unilateral Perthes disease who were admitted to our hospital from January 1, 2012 to December 31, 2018 were enrolled, and 40 controls were matched based on sex and age. The acetabular anteversion angle (AAA), internal wall anteversion angle (IWAA), anterior wall height of the acetabulum (A), acetabular posterior wall height (P), and acetabular width (W) were assessed on computed tomography (CT) at the level of the femoral head center. The acetabular wall difference index (AWDI; AWDI = P-A)/W*100) was calculated. The mean AAA was significantly lower in Perthes disease hips (10.59 (8.05–12.46)) than in contralateral hips (12.04 (9.02–13.33)) (p = 0.002) but did not differ from control hips (9.68 ± 3.76) (p = 0.465). The mean IWAA was significantly lower in Perthes hips (9.16 ± 3.89) than in contralateral hips (11.31 ± 4.04) (p = 0.000) but did not differ from control hips (9.43 ± 3.82) (p = 0.753). The mean AWDI did not differ between Perthes hips (0.41 ± 4.94) and contralateral hips (− 1.12 (− 4.50, 2.17)) (p = 0.06) or control hips (− 0.49 ± 5.46) (p = 0.437). The mean W was significantly higher in Perthes hips (44.61 ± 5.06) than in contralateral hips (43.36 ± 4.38) (p = 0.000) but did not differ from control hips (45.02 ± 5.01) (p = 0.719). The mean A and P did not differ between Perthes hips and contralateral hips or control hips. Correlation analysis of all hip joints revealed a significant correlation between AAAs and IWAAs (r = 0.772; r = 0.643; r = 0.608; and r = 0.540). Linear regression analysis revealed that AAAs increased with IWAAs. Multiple linear regression showed that IWAAs and AWDIs have good predictive value for AAAs in both Perthes and control hips (R2 = 0.842, R2 = 0.869). In patients with unilateral Perthes disease, the affected acetabulum is more retroverted than that on the contralateral side, which may be caused by hemipelvic retroversion. The measurements in this study could distinguish the form of acetabular retroversion. IWAAs and AWDIs can be used as new observations in future studies of acetabular version.

English

BACKGROUND The intervertebral disc (IVD) is the primary load-bearing structure in the vertebral column. It is avascular, has low metabolic rate and hence most vulnerable to damage. One of the most important causes of low back pain is the disc lesions. Hence, the present study was done to provide morphometric data of lumbar intervertebral discs in central Indians. METHODS Anterior and posterior heights of lumbar intervertebral discs were measured in (a) 10 cadavers by digital vernier calipers; (b) 120 normal, lateral view digital radiographs divided in three age groups in both the sexes, digitally. RESULTS Average heights of lumbar intervertebral discs were recorded as follows: (a) Average anterior height, measured in centimeters, was: In cadavers, L1/2-0.7922, L2/3-0.9139, L3/4-1.0611, L4/5-1.2569, and L5/S1- 1.2565 cms. On digital radiographs, L1/2-1.023, L2/3-1.262, L3/4-1.433, L4/5-1.691, L5/S1- 1.763 cms. (b) Average posterior height, measured in centimeters, was: In cadavers, L1/2-0.4624, L2/3-0.4925, L3/4-0.5872, L4/5-0.6546, and L5/S1- 0.4997cms. On digital radiographs, L1/2-0.78475, L2/3-0.875917, L3/4-0.900083, L4/5- 0.92375, and L5/S1-0.795 cms. CONCLUSIONS Average anterior heights are more than posterior heights. Average anterior and posterior heights increase from L1/2 upto L4/5, then decrease at L5/S1. But in digital radiographs, average anterior height increases from L1/2 to L5/S1. The difference in measurements of average anterior heights of L1/2 disc is found to be statistically significant with respect to age. Gender difference is statistically significant at different disc levels in different age groups. The present study will help to generate baseline data to detect abnormality and to make population specific prosthesis for treatment of disc lesions. KEYWORDS Morphometry, Lumbar Intervertebral Discs

A systematic review on the outcome of distraction osteogenesis in TMJ ankylosis

IntroductionTMJ ankylosis (TMJa) management by arthroplasty alone fails to address the deformity and the compromised airway. Distraction osteogenesis (DO) can offer a pragmatic solution to TMJa. The aim of the study was to generate evidence towards the role of DO in TMJa, evaluate its efficiency and develop an algorithm for use of DO in TMJa. Material and methodsThe research question was formulated using the PICOS statement for reporting guidelines in systematic reviews, where the efficiency of DO was evaluated in terms of mouth opening, correction of facial deformity and asymmetry, airway correction, and its long term effects. Results1130 articles reported DO as a treatment modality for TMJ ankylosis, of which 32 prospective studies, 16 retrospective and 2 RCTs were included in the study. DO was used for mandibular distraction in 45 studies and for simultaneous maxillamandibular distraction in only five studies. An algorithm for use of DO in TMJa was developed. ConclusionAlthough DO has proven its application in TMJ ankylosis cases, its best use is for correction of obstructive sleep apnoea. Relapse causing loss of posterior ramal height is a concern after transport DO. Prearthroplastic DO appears to best correct mandibular deformity. A maxillomandibular deformity requires simultaneous maxillomandibular distraction. However, a metanalysis is still awaited for effectiveness of DO in TMJ ankylosis.