Postoperative Computed Tomography Scans Research Articles

Differential Impact of Subcutaneous and Visceral Fat on Bone Changes after Gastrectomy.

Osteoporosis and fragility fractures are crucial musculoskeletal complications in long-term survivors of gastric cancer. However, the relationship between changes in body composition after gastrectomy and bone loss has not been investigated. Therefore, this study aimed to explore whether computed tomography (CT)-derived body composition parameters are associated with bone loss after gastrectomy in patients with gastric cancer. We retrospectively reviewed medical records and abdomen CT scans of patients who underwent gastrectomy at Yonsei University Severance Hospital between 2009 and 2018. Patients with non-metastatic gastric adenocarcinoma and preoperative and postoperative non-contrast CT scans were analyzed. Section area of skeletal muscle (SMA), visceral fat (VFA), and subcutaneous fat (SFA) were assessed using semi-automatic segmentation software. Changes in trabecular bone attenuation of L1 mid-vertebra level (L1 Hounsfield units [HU]) were measured. Fifty-seven patients (mean age, 65.5±10.6; 70.2% males) were analyzed, and the median duration was 31 months. Fortyseven patients (82.5%) lost weight after gastrectomy. Baseline SMA and VFA did not differ between the bone loss and preserved groups; however, baseline SFA was significantly higher in the bone preserved group than in the bone loss group (P=0.020). In a multivariable linear regression model adjusted for confounding factors, one standard deviation higher VFA at baseline was associated with greater annualized L1 HU loss (%) (P=0.034). However, higher preoperative SFA was associated with protection against bone loss after gastrectomy (P=0.025). Higher preoperative SFA exhibited a protective effect against bone loss after gastrectomy in patients with non-metastatic gastric cancer, whereas VFA exhibited a negative effect.

Progress of Ossification after Mandibular Reconstruction by Free Fibula Flap Depending on Different Timing of Radiotherapy: A Retrospective 3D Analysis by CT Scans

Background: The aim of this study was to evaluate the difference between pre- and post-operative radiotherapy on the progress of ossification after free fibula flap reconstruction of the mandible using three-dimensional (3D) analysis. Methods: A total of 38 free fibula reconstructions of the mandible were evaluated retrospectively for ossification between bone segments by measuring Hounsfield Units (HU) in at least two postoperative computer tomography scans (average of 2.4 scans per patient; around the 5th, 12th, 16th, and 19th month postoperative). Three subgroups were created according to the time of irradiation: preoperative radiotherapy (preORT) (n = 11), postoperative radiotherapy (postORT) (n = 16), and patients without any radiation therapy (n = 11) as the control group (noRT). HU in eight regions of interest (ROI) and overlapping surfaces between segments per contact point, as well as influencing factors, were analyzed. Results: The fastest progress in gain of HU ossification with a difference of 0.30 HU/day was observed in noRT compared to preORT (p = 0.002). postORT was −0.24 HU/day slower than preORT (p = 0.005). Original and grafted bone showed a significantly slower HU uptake than between two graft segments with −84.18 HU/day (p < 0.001). Moreover, a larger initial overlapping surface between the segments in cm2 resulted in a higher rise of HU/day (p < 0.001). Conclusions: 3D analysis of post-reconstructive CT scans shows prolonged ossification of mandible reconstructions by free fibula after head and neck radiation. The effect is distinct in cases with post-operative adjuvant radiotherapy. The effects of radiotherapy on ossification may be minimized by a larger initial contact surface and improved operational techniques. Moreover, HU longitudinal measurements and 3D analysis offer new perspectives for clinical evaluation of successful bony healing.

Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms

Historically, pedicle screw accuracy measurements have relied on CT and expert visual assessment of the position of pedicle screws relative to preoperative plans. Proper pedicle screw placement is necessary to avoid complications, cost and morbidity of revision procedures. The aim of this study was to determine accuracy and precision of pedicle screw insertion via a novel computer vision algorithm using preoperative and postoperative computed tomography (CT) scans. Three cadaveric specimens were utilized. Screw placement planning on preoperative CT was performed according to standard clinical practice. Two experienced surgeons performed bilateral T2–L4 instrumentation using robotic-assisted navigation. Postoperative CT scans of the instrumented levels were obtained. Automated segmentation and computer vision techniques were employed to align each preoperative vertebra with its postoperative counterpart and then compare screw positions along all three axes. Registration accuracy was assessed by preoperatively embedding spherical markers (tantalum beads) to measure discrepancies in landmark alignment. Eighty-eight pedicle screws were placed in 3 cadavers’ spines. Automated registrations between pre- and postoperative CT achieved sub-voxel accuracy. For the screw tip and tail, the mean three-dimensional errors were 1.67 mm and 1.78 mm, respectively. Mean angular deviation of screw axes from plan was 1.58°. For screw mid-pedicular accuracy, mean absolute error in the medial–lateral and superior–inferior directions were 0.75 mm and 0.60 mm, respectively. This study introduces automated algorithms for determining accuracy and precision of planned pedicle screws. Our accuracy outcomes are comparable or superior to recent robotic-assisted in vivo and cadaver studies. This computerized workflow establishes a standardized protocol for assessing pedicle screw placement accuracy and precision and provides detailed 3D translational and angular accuracy and precision for baseline comparison.

Mini-Invasive Endoscope-Assisted Treatment of Metopic Craniosynostosis: 2-Dimensional Operative Video.

The surgical treatment of trigonocephaly has undergone significant evolution, with an increasing use of a minimally invasive technique. The endoscope-assisted metopic suturectomy is currently considered a valid surgical option for the correction of metopic craniosynostosis.1-5 In this video-article, we present our surgical technique performed on a 5-month-old patient with type III (Genitori's classification6) trigonocephaly. The computed tomography (CT) scan showed fusion of the metopic suture with bitemporal narrowing and hypotelorism. The patient underwent endoscope-assisted metopic suturectomy, the width of the suturectomy is 1 cm, and an Esmarch sheet was used to protect the dura mater while drilling. Bridging veins are coagulated under endoscopic vision. The suturectomy is considered complete when the nasal cartilages are exposed, deconnecting thus completely the orbits. The postoperative CT scan showed the extent of the suturectomy. The patient did not present any neurological deficit or complications after surgery and was discharged on postoperative day 2. No helmet was used postoperatively. The patient repeated a head CT at age 11 years after head trauma and was seen at consultation. Interestingly, once the bone gap created after the metopic suturectomy reossifies, the frontal sinus develops normally. The long-term result was quite satisfying. The advantages of the mini-invasive technique consist in a smaller surgical scar, lower blood loss, shorter surgical time, and shorter hospital stay with good long-term results. The parents provided written consent for the publication of the patient's picture, the institutional research board approved the submission of this video article. In the video, the tips, tricks, and pitfalls of the technique are discussed.

Accelerated fusion dynamics by recombinant human bone morphogenetic protein-2 following transforaminal lumbar interbody fusion, particularly in osteoporotic conditions

BACKGROUND CONTEXTEarly fusion is crucial in interbody procedures to minimize mechanical complications resulting from delayed union, especially for patients with osteoporosis. Bone morphogenetic proteins (BMPs) are used in spinal fusion procedures; however, limited evaluation exists regarding time-to-fusion for BMP use, particularly in patients with osteoporosis. PURPOSETo evaluate the difference in time-to-fusion after single-level transforaminal lumbar interbody fusion (TLIF) surgery between recombinant human bone morphogenetic protein-2 (rhBMP-2) usage and nonusage groups according to bone density. STUDY DESIGNRetrospective single-center cohort study. PATIENT SAMPLEThis study enrolled 132 patients (mean age, 65.25±8.66; male patients, 40.9%) who underwent single-level TLIF for degenerative disorders between February 2012 and December 2021, with pre and postoperative computed tomography (CT). OUTCOME MEASUREThe interbody fusion mass and bone graft status on postoperative CT scans was obtained annually, and time-to-fusion was recorded for each patient. METHODSThe patients were divided into 2 groups based on rhBMP-2 use during the interbody fusion procedure. Patients were further divided into osteoporosis, osteopenia, and normal groups based on preoperative L1 vertebral body attenuation values, using cutoffs of 90 and 120 Hounsfield units. It was strictly defined that fusion is considered complete when a trabecular bone bridge was formed, and therefore, the time-to-fusion was measured in years. Time-to-fusion was statistically compared between BMP group and non-BMP groups, followed by further comparison according to bone density. RESULTSThe time-to-fusion differed significantly between BMP and non-BMP groups, with half of the patients achieving fusion within 2.5 years in the BMP group compared with 4 years in the non-BMP group (p<.001). The fusion rate varied based on bone density, with the maximum difference observed in the osteoporosis group, when half of the patients achieved fusion within 3 years in the BMP group compared to 5 years in the non-BMP group (p<.001). Subgroup analysis was conducted, revealing no significant associations between time-to-fusion and factors known to influence the fusion process, including age, gender, medical history, smoking and alcohol use, and medication history, except for rh-BMP2 use and bone density. CONCLUSIONSRhBMP-2 usage significantly reduced time-to-fusion in single-level TLIF, especially in patients with osteoporosis. LEVEL OF EVIDENCELevel III.

Comparison of range of motion between 2-year clinical outcomes and predictions of a static scapula preoperative planning software for reverse shoulder arthroplasty

BackgroundPreoperative planning has gained popularity in the management of reverse shoulder arthroplasty (RSA). Commercially available software provides 3-dimensional segmentation of scapula and humerus, as well as providing arc of motion for the implanted articulation and identifying potential areas of bony impingement. However, these software algorithms use a fixed scapula model, disregarding the preoperative clinical range of motion (C-ROM) of the patient, be it glenohumeral or scapulothoracic, as well as any soft tissue parameters. This study aims to compare the ROM based on preoperative planning software by using the implant position from postoperative computed tomography (CT) images (predicted ROM using preoperative planning software [P-ROM]), with the C-ROM assessed at minimum of 2 years of follow-up. MethodsPreoperative and postoperative CT scans of 46 patients who underwent primary RSA between 2017 and 2021 were analyzed. At the postoperative 2-year review, each patient was assessed for active ROM. Implant size and position based on operative notes and postoperative CT scans were used to replicate the performed surgery in the planning software. Abduction, flexion, and external rotation motion were simulated and recorded. The relationship between C-ROM and P-ROM was investigated using linear regression analysis, Pearson correlation coefficient, and paired t-test. ResultsP-ROM was significantly lower than C-ROM at 2 years postoperatively (P < .001), with an average discrepancy of 78° in abduction, 47° in flexion, and 37° in external rotation (C-ROM: abduction 155° ± 21° [80°-180°]; flexion 160° ± 17° [90°-180°]; external rotation 52° ± 14° [10°-80°] vs. P-ROM: abduction 77° ± 13° [53°-107°]; flexion 112° ± 25° [67°-180°]; external rotation 15° ± 21° [0°-79°]). The linear regression analysis indicated weak agreement between C-ROM and P-ROM (abduction R2 = 0.03; flexion R2 = 0.01; external rotation R2 = 0.04). Pearson’s correlation coefficients revealed weak correlations of −0.18, 0.03, and 0.21 for abduction, flexion, and external rotation, respectively. ConclusionP-ROM based on preoperative software in its current form does not allow the prediction of the C-ROM at 2 years of follow-up for patients undergoing RSA.

Comparative Study for Surgical Treatment of Acute Distal Tibiofibular Syndesmotic Lesions Using the Modified Suture-Button Fixation Versus Static Syndesmotic Screw Fixation.

Several techniques to treat acute distal tibiofibular instability are described consisting in static and dynamic fixation procedures. The aim of our work is to compare the outcomes of acute syndesmotic injury fixation between the modified technique of dynamic fixation using the suture-button principle as an efficient and low-cost method and the classic static fixation. It is a prospective study including patients presenting with acute syndesmotic injury. After fracture fixation, residual syndesmotic instability was managed using syndesmotic screw in group A and dynamic fixation with a double Ethibond suture in group B. Functional results were assessed using the American Orthopaedic Foot and Ankle Society score (AOFAS) score. Radiological evaluation was done by a postoperative computed tomography (CT) scan of both ankles and plain X-rays of the ankle after surgery and at 18 months. Group A included 20 patients meanwhile 35 patients were in group B. The reduction was satisfactory in the 2 groups according to the postoperative CT scan measurements. The mean healing time in group A was 49.65 days and 51.49 days in group B (P = .45). We did not find any significant difference in terms of loss of reduction in the 2 groups. The return to work was faster in group B (P = .04). Patients in group B had better AOFAS score (P = .03) and ankle range of motion than those in group A. The difference was statistically significant (P = .02 for dorsal flexion and P = .001 for plantar flexion). For group A, we did not note any early complications. Meanwhile, 7 patients developed skin complications in group B (P = .03). However, no significant difference was found in terms of late complications. The modified dynamic suture-button fixation remains a therapeutic alternative in low-income countries that could achieve better outcomes than static fixation, with easy postoperative follow-up. Level II.

Large Amount of Epidural Effusion Outside the Dura After Percutaneous Puncture and Suction Treatment.

Epidural fluid collection is commonly seen as a low-density accumulation beneath the dura on postoperative computed tomography scans. It is discussed less in the literature because, in most cases, the fluid amount is small, self-absorbing, and typically does not cause neurological deficits, so intervention is usually unnecessary. However, when a significant amount of fluid accumulates, patients may experience symptoms such as altered consciousness and even coma. In such cases, treatment is necessary to reduce intracranial pressure, preventing further deterioration of consciousness and potentially life-threatening situations. The authors report a case of a large epidural fluid collection following cranioplasty, resulting in progressive deterioration of consciousness in the patient. Computed tomography scans indicated brain herniation. Subsequently, percutaneous puncture and suction treatment were performed, followed by appropriate pressure dressing. The patient gradually recovered from a shallow coma to clear consciousness and was discharged after rehabilitation.

Ipsilateral pubic ramus fracture during total hip arthroplasty is not rare: does it matter?

Periprosthetic fractures in total hip arthroplasty (THA) have been well described and studied. However, there is a lack of reports on ipsilateral pubic ramus fractures during THA due to the rare occurrence of such fractures and ambiguity of symptoms. With the use of postoperative computed tomography (CT) examinations, we have identified that asymptomatic ipsilateral pubic ramus fractures occur frequently during THA. This study aims to evaluate the incidence, location, clinical outcomes, and risk factors of ipsilateral pubic ramus fractures during THA. From May 2022 to March 2023, a single surgeon performed 203 THAs in 183 patients at a single institution. All patients underwent postoperative CT scans three days after THA. The patients with ipsilateral pubic ramus fractures were followed up for a minimum of six months. Basic demographics, osteoporosis, general conditions of the operations, and outcomes of THA were investigated in all patients. Twenty-two cases (10.8%) of ipsilateral pubic ramus fractures were identified on postoperative CT scans. All fractures were located near the origin of the superior or inferior pubic ramus. Five fractures were detected on simple postoperative radiographs. The fractures did not cause any further complications at a minimum of six-month postoperative follow-up. Univariate and multivariate analyses did not identify any risk factors associated with these fractures. Although the incidence of ipsilateral pubic ramus fractures during THA is high, treatment is not required as they do not cause any significant clinical symptoms or affect the prognosis of THA. However, the possibility of occurrence of these fractures must be explained to the patients before surgery.

Management of Atypical M-Shaped Zygomatic Arch Fractures.

M-shaped zygomatic arch fractures can usually be treated effectively through closed reduction. It consists of 2 fracture segments: the anterior zygomatic segment and the posterior temporal bone segment. In clinical practice, atypical M-shaped fractures are often encountered, in which the anterior and posterior fracture segments are discontinuous and separated. Closed reduction usually cannot achieve the desired anatomic reduction effect for this type of fracture. The preoperative design showed that the anatomic reduction of the posterior zygomatic arch fracture segment was hindered due to bone spurs in the most concave area of the anterior zygomatic bone fracture segment. Open reduction and fixation were performed to achieve anatomic reduction and restore facial symmetry. The fracture sites were exposed through a hemicoronal incision. After the bone spurs are removed, the posterior bone segment can be anatomically reduced. Absorbable plates were used for fixation. The patient's facial appearance was restored after the surgery. The postoperative computed tomography scan showed a good alignment of the fracture. The authors believe that for patients with high requirements for facial symmetry, the presence of atypical M-shaped fractures can indicate open reduction and fixation.

Post-operative MRI synthesis from pre-operative MRI and post-operative CT using conditional GAN for the assessment of degree of resection

BackgroundMagnetic resonance imaging (MRI) is an essential part of assessing the extension of resection after craniotomy, allowing for accurate assessment of the brain. However, the application of MRI within 72 h after surgery is limited, owing to its high cost, long time duration, and patients’ limited mobility. Besides, MRI excludes people with contraindications, in which sceneries computerized tomography (CT) is the only available choice. To overcome these limitations, we investigated the use of a deep learning model for synthesizing post-operative MRI images. MethodsWe employed Cross-domain Correspondence Learning for Exemplar-based Image Translation Network (CoCosNet), an exemplar-based image translation model to synthesize T1 contrast-enhanced (T1ce) MRI images by combining post-operative T1ce and post-operative CT images. 233 cases were retrospectively collected at Sun Yat-sen University Cancer Center and underwent complete MRI and CT scans. ResultsAfter 200 epochs and a batch size of 10, CoCosNet achieved comparable results compared to other existing models, with objective indicators structural similarity index = 0.75, peak signal to noise ratio = 21.68, and mean absolute error = 0.007. Furthermore, assessments of the extension of resection between the true and synthesized T1ce images achieve great consistency. ConclusionsOur study demonstrates the effectiveness of the CoCosNet model in synthesizing post-operative MRI images from pre-operative MRI and post-operative CT scans. Quantitative analysis indicates that the synthesized images have comparable quality to real MRI images and can accurately discriminate the extent of resection. This approach has a promising future by providing a reliable alternative to traditional post-operative MRI.

Factors Causing Unintended Sagittal and Axial Alignment Changes in High Tibial Osteotomy: Comparative 3-Dimensional Analysis of Simulation and Actual Surgery

Background: Unintended secondary changes in the posterior tibial slope (PTS) and tibial torsion angle (TTA) may occur after medial open-wedge high tibial osteotomy (MOWHTO). In surgical procedures using patient-specific instruments (PSIs), it is essential to reproduce the PTS and TTA that were planned in simulations. Purpose: To analyze the factors causing unintended sagittal and axial alignment changes after MOWHTO. Study Design: Case series; Level of evidence, 4. Methods: Overall, 63 patients (70 knees) who underwent MOWHTO using a PSI between June 2020 and June 2023 were retrospectively reviewed. Preoperative and postoperative computed tomography scans were 3-dimensionally reconstructed. Simulated osteotomy was performed so that the weightbearing line could pass through the target point. A PSI gapper was 3-dimensionally printed to fit the posteromedial corner of the osteotomy gap in the simulated HTO model. After MOWHTO using the PSI gapper, the actual postoperative model was compared with the preoperative or simulation model. This assessment included PTS, TTA, hinge axis, and osteotomy-related parameters. Cortical breakage around the lateral hinge was evaluated to assess stability. Results: The mean PTS and TTA did not change in the simulation. However, significant changes were observed in the actual postoperative PTS and TTA (change, –2.4°± 2.2° and −3.9°± 4.7°, respectively). The PTS was reduced, while the TTA decreased with internal rotation of the distal fragment. The difference in the axial hinge axis angle (AHA) between the simulation and actual surgery was the factor most correlated with the difference in the PTS (r = 0.625; P < .001). In regression analysis, the difference in the AHA was the only factor associated with the difference in the PTS (β = 0.558; P = .001), and there were no factors that showed any significant associations with the difference in the TTA. In subgroup analyses for the change in the TTA, the correction angle and anterior osteotomy angle were significantly higher in the more internal rotation group (P = .023 and P = .010, respectively). The TTA change was significantly higher in the unstable group with lateral cortical breakage (P = .018). The unstable group was more likely to show an internal rotation of ≥5° (odds ratio, 5.0; P = .007). Conclusion: The AHA was associated with a difference in the PTS between the simulation and actual surgery. The change in the TTA was caused by a combination of multiple factors, such as a large correction angle and anterior osteotomy angle, but mainly by instability of the lateral cortical hinge.

Three-dimensional assessment of upper airway changes associated with mandibular positional deviations following fibula free flap reconstruction

ObjectivesFibula free flaps (FFF) are the standard approach to mandibular reconstruction after partial resection, with the goal of restoring aesthetics and masticatory function. The graft position affects both and must be carefully selected. Correlations between sagittal positioning and upper airway anatomy are known from orthognathic surgery. This study aims to evaluate changes in mandibular position and upper airway anatomy after reconstructive surgery with FFF and corresponding correlations.Materials and methodsMandibular position after reconstruction was evaluated using three-dimensional datasets of pre- and postoperative computed tomography scans of patients treated between 2020 and 2022. Three-dimensional measurements were performed on both condyles and the symphyseal region. Changes in upper airway volume and minimum cross-sectional area (minCSA) were analysed. Intra-rater reliability was assessed. Correlations between changes in upper airway anatomy and sagittal mandibular position were tested.ResultsThe analysis included 35 patients. Intra-rater reliability was good to excellent. Condylar deviations and rotations were mostly rated as small. Changes in symphyseal position were considerably greater. Median airway volume decreased in the oropharynx and hypopharynx. Posterior deviation of the symphysis was associated with a decreasing minCSA in the hypopharynx and vice versa.ConclusionsThe overall accuracy of mandibular reconstructions with FFF is high, but there is room for optimization. The focus of research should be extended from masticatory to respiratory rehabilitation.Clinical relevanceEffects on respiratory function should be considered prior to graft positioning. The clinical relevance of upper airway changes within the complex rehabilitation of reconstructive surgery patients needs to be further investigated.

Fusion Rates in Tibiotalocalcaneal Arthrodesis with Tantalum Coated Metal Cup Augmentation

Introduction/Purpose: Tantalum coated metal spacers (TCMS) have recently been utilized to fill and provide structure to large bony defects in the hindfoot. Tantalum is an appealing material due to its biocompatibility, lack of immune response generation, and structural integrity. Compared to custom printed spacers and bulk allografts, TCMS are readily available off-the-shelf implants with significantly less cost. There is currently a paucity of literature assessing the use and outcomes of TCMS in foot and ankle surgery, specifically in tibiotalocalcaneal (TTC) arthrodesis. This study serves to assess clinical outcomes and fusion rates of patients who underwent TTC arthrodesis utilizing intramedullary nailing with TCMS augmentation for large bony defects. Methods: We retrospectively identified all patients &gt; 18 years of age who underwent TTC arthrodesis with TCMS augmentation at our tertiary care center between 2015-2021. We also identified all patients who underwent TTC arthrodesis without augmentation within that time frame. The computed tomography (CT) scans at the six-month postoperative point were reviewed by one board-certified orthopaedic foot and ankle surgeon to determine fusion status, which was defined as having at least 50% fusion mass. Patient-reported outcomes measures (PROMs) including the modified foot function index (FFI) and PROMIS Global Mental Health Score were collected for patients in both groups. Patient demographics, clinical outcomes, and PROMs were compared between groups. A multivariate logistic regression model measured the effect of TCMS augmentation on the likelihood of achieving fusion. Results: Of the 65 patients included, 21 patients (32.3%) underwent TTC with TCMS augmentation. There were no significant differences in demographics between the two groups. Patients in the TCMS group had significantly higher modified FFI (91.1 + 47.6 vs 26.3 + 48.8, p&lt; 0.001) and PROMIS Global Mental Health (12.2 + 4.82 vs. 5.59 + 6.76, p&lt; 0.001) scores in the postoperative period. Overall, the fusion rate was higher for the TCMS group, however the difference was not significant between groups (90.5% vs. 80.5%, p=0.472). Multivariate logistic regression identified that TCMS augmentation was a nonsignificant predictor of increased odds of fusion at the six-month postoperative point (OR=2.87, p=0.232). Conclusion: This study is the largest to date to present 6-month postoperative CT scans demonstrating successful TTC fusion with TCMS augmentation, contributing to our understanding of its utility. Given the severity of disease and bone loss in the TCMS group, it is not surprising that post-operative patient reported outcome scores differed significantly compared to the control group. TCMS augmentation can be utilized as cost effective spacers to fill large defects in TTC arthrodesis with successful union rates. Further studies are needed to evaluate the efficacy of TCMS augmented fusions as a viable substitute to custom printed cages. Figure 1: Weight-bearing anteroposterior and lateral ankle radiographs of a patient with post-traumatic ankle arthritis and previously treated chronic osteomyelitis with valgus malalignment (A). Anteroposterior and lateral ankle radiographs status post TCMS augmented TTC arthrodesis (B). Coronal and sagittal CT scans demonstrating bony union through the TCMS augment (C).

Tetralogy of Fallot complicated by multiple cerebral abscesses in a child: a case report

IntroductionBrain abscesses are rare but potentially fatal condition and can be associated with cyanotic congenital heart disease of which 5–18.7% of these patients that develop cerebral abscess commonly have tetralogy of Fallot (TOF).Case presentationWe report a case of 3-year-old Muganda male that presented with convulsions, cyanosis and difficulty in breathing. The patient had a combination intervention of medical treatment and surgical drainage of the abscess. Post-operative Computerized tomography scan images and pre-operative brain Computerized tomography scans were compared. The multiple rings enhancing lesions were reduced in number and sizes. The largest measured ring was 44 × 22.5×16mm compared to the previous; 42 × 41×36mm. The mass effect had reduced from 16 mm to 7.5 mm. The periventricular hypodensities persisted. Findings showed radiological improvement with residual abscesses, subacute subdural hematoma and pneumocranium. The patient was treated with intravenous ceftriaxone 1 g OD for six weeks and he showed marked improvement and was discharged home after 3 months.ConclusionA comprehensive strategy involving medications, surgical drainage, and early neurosurgical consultation is vital in treating brain abscesses in uncorrected TOF. Early identification of the pathogen, appropriate antibiotic therapy, and vigilant follow-up through clinical assessments and imaging are crucial, potentially spanning a 4–8-week treatment.

Clinical outcomes of 20 brachycephalic dogs with thoracolumbar spinal deformities causing neurological signs treated with spinal stabilization using 3D-printed patient-specific drill guides.

To describe the clinical outcomes for pugs and French bulldogs with congenital vertebral malformations, undergoing thoracolumbar spinal stabilization surgery using 3D-printed patient-specific drill guides. To evaluate the accuracy of pedicle screw placement in this group of dogs. Retrospective descriptive study. Twenty dogs (12 pugs and eight French bulldogs). Medical records searched between August 2018 and March 2021 for pugs and French bulldogs diagnosed with congenital vertebral abnormalities via magnetic resonance imaging (MRI) scan and computed tomography (CT) scan causing T3-L3 myelopathy signs that underwent spinal stabilization surgery using 3D-printed patient-specific drill guides followed by a postoperative CT scan. The short-term outcome was based on the neurological grade (modified Frankel score-MFS) on the day after surgery, day of discharge, and at the follow-up examination at 4 to 6 weeks after surgery. The mid-term outcome was obtained via an online questionnaire (or direct examination in one case). Twenty dogs met the inclusion criteria (19/20 grade 2 MFS, 1/20 grade 4 MFS). No complications were reported in the immediate postoperative period and optimal pedicle screw placement was obtained in 169/201 of screws. Twenty-four hours after surgery 16/20 dogs displayed an unchanged neurological grade. Short-term outcomes revealed a static (17/20) or improved (2/20) neurological grade. Ten owners participated in the online questionnaire. All patients were reported to be ambulatory; however, 7/10 dogs displayed abnormal gait. Neurological signs had remained static (6/10) or improved (3/10) in comparison with the dogs' preoperative status at a median of 883.5 days from the surgery. Dogs in this study had a favorable short-term outcome and mid-term outcome evaluation revealed a static/improved neurological status. Thoracolumbar spinal stabilization surgery using 3D-printed patient-specific drill guides showed a favorable outcome in brachycephalic breeds affected by vertebral deformities.

Modified Tap-drilling Technique for Mid-cervical Pedicle Screw Placement: A Case Series of 473 Consecutive Screws.

Retrospective cohort study. To report our modified tap-drilling technique for mid-cervical pedicle screw placement and to evaluate its safety and accuracy. Cervical pedicle screw fixation, which provides a strong stabilization, has been a major concern due to the potential risks to neurovascular structures despite its increasing use. Several insertion techniques have been described so far to improve the cervical pedicle screw placement accuracy. This study retrospectively reviewed patients who underwent mid-cervical (C3-C6) pedicle screw fixation between September 2005 and September 2020. Laminectomy, laminoforaminotomy, or notch-referred anatomic landmark methods were used to adjust the entry point and the direction of the screws. After the cortical bone was removed at the entry point with a diamond burr, the cancellous bone was slowly drilled with a hand drill starting from 8 to 10 millimeters in length. Then, all of the bone walls were checked with a ball-tip probe to determine if there was any breach. The procedure was repeated several times. After completing the drilling, the screw was inserted without tapping. The breach rate of pedicle screws was analyzed on postoperative computed tomography scans. A total of 473 mid-cervical pedicle screws were placed in 122 consecutive patients. No navigation or computer-assisted system was used, and the first 2 authors inserted all of the screws. All patients completed the surgery, and no evident intraoperative complications occurred. Postoperative CT scans were obtained for 405 screws. Although deviation was observed for 131 pedicle screws, a critical deviation was observed for only 25 pedicle screws. Cervical pedicle screw insertion is a risky but applicable technique. Checking all of the bone walls with a ball-tip probe before gradually advancing the hand drill in small amounts, as presented in this article, may lead to the safe and effective placement of cervical pedicle screws.

Arthroscopic Coracoid Transfer in the Lateral Decubitus Position is Safe and Effective at Short-Term Follow-Up

To report on operative and clinical outcomes in a series of shoulders treated with arthroscopic Latarjet performed in the lateral decubitus position. Patients with shoulders that underwent arthroscopic Latarjet in the lateral decubitus position were identified. Data were retrospectively collected, including patient demographics, operative times, intra- and postoperative complications, and clinical and functional outcomes. Descriptive statistics were performed. Eighteen shoulders in 17 patients were included in the study with a mean follow-up of 14 ± 12.1 months (range, 4-39 months). The mean operative time for all procedures was 132.2 ± 18.0 minutes, and the mean operative time for the first half of the cohort was significantly longer than that of the second half (141.6 ± 14.2 minutes vs 122.8 ± 17.0 minutes, P= .02). There were no intraoperative complications, and no patients required a conversion to open surgery. One patient experienced a recurrent dislocation after a traumatic event but was able to be treated nonoperatively. Preoperative and postoperative patient-reported outcome measures (PROMs) were able to be collected on 8 of 18 patients (44.4%). Although all PROMs demonstrated improvements postoperatively, only the Single Assessment Numeric Evaluation score and American Shoulder and Elbow Surgeons Shoulder Index displayed a statistically significant increase (P<.05). Five of 8 (62.5%) shoulders demonstrated bony fusion on postoperative computed tomography scan. Of those eligible, 100% of patients returned to sport or felt that they could return if they wanted to. The arthroscopic Latarjet is an effective procedure for managing glenohumeral instability and can safely be performed in the lateral decubitus position. Level IV, therapeutic case series.

Robot-Assisted Lumbar Pedicle Screw Placement Based on 3D Magnetic Resonance Imaging.

Human Cadaveric Study. This study aims to explore the feasibility of using preoperative magnetic resonance imaging (MRI), zero-time-echo (ZTE) and spoiled gradient echo (SPGR), as source data for robotic-assisted spine surgery and assess the accuracy of pedicle screws. Zero-time-echo and SPGR MRI scans were conducted on a human cadaver. These images were manually post-processed, producing a computed tomography (CT)-like contrast. The Mazor X robot was used for lumbar pedicle screw-place navigating of MRI. The cadaver underwent a postoperative CT scan to determine the actual position of the navigated screws. Ten lumbar pedicle screws were robotically navigated of MRI (4 ZTE; 6 SPGR). All MR-navigated screws were graded A on the Gertzbein-Robbins scale. Comparing preoperative robotic planning to postoperative CT scan trajectories: The screws showed a median deviation of overall 0.25mm (0.0; 1.3), in the axial plane 0.27mm (0.0; 1.3), and in the sagittal plane 0.24mm (0.0; 0.7). This study demonstrates the first successful registration of MRI sequences, ZTE and SPGR, in robotic spine surgery here used for intraoperative navigation of lumbar pedicle screws achieving sufficient accuracy, showcasing potential progress toward radiation-free spine surgery.

Postoperative Computed Tomography Scans of Acetabular Fractures Routinely Identify Indications for Revision Surgery.

To investigate the utility of postoperative computed tomography (CT) scans in identifying indications for revision surgery after surgical fixation of acetabular fractures. Retrospective cohort study. Urban level 1 trauma center. Patients with surgically treated acetabular fractures with surgical fixation (open reduction and internal fixation or percutaneous fixation) with routine postoperative CT scans. Primary outcome-revision surgery based on postoperative imaging, including intra-articular osteochondral fragments, implant complications, and malreductions. Secondary outcome-quality of reduction on radiographs versus CT scans. One hundred forty-eight patients were included. The revision surgery rate was 15.5% (23/148); indications included malpositioned implants (6.7%, n = 10), malreductions (5.4%, n = 8), and intra-articular loose bodies (3.4%, n = 5). Only 8.7% (2/23) of the indications for revision surgery were identified on postoperative radiographs, with the remainder being identified on CT scans. Revision surgeries were found to be associated with male gender (proportional difference: 19.6%, 95% confidence interval [CI]: 3.4%-29.4%; P = 0.04) and T-type fractures (PD 28.7%; CI, 9.0%-48.9%; P = 0.001). Revision surgery was not found to be associated with age, body mass index, posterior wall fractures, concurrent pelvic ring fractures, or surgical approach. On radiographs, 51.3% (n = 76/148) had anatomic reductions (<2 mm) compared with only 10.2% (n = 15/148) on CT scans. Indications for revision of acetabular fixation surgeries and poor reductions were frequently missed on plain radiography and identified on postoperative CT scans. This suggests that the use of advanced imaging such as intraoperative 3D imaging or postoperative CT scans may be beneficial. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.