Sagittal Computed Tomography Scans Research Articles

Treatment of posttraumatic thoracolumbar fractures using SpineJack for vertebral body augmentation, a single-center retrospective, and observational cohort study of 226 cases

Context: Thoracolumbar spine fractures are frequent and the treatments are debatable because of the lack of randomized control studies and of low number of patient series. Percutaneous Vertebral Body Augmentation using SpineJack prosthesis (SJPVBA) followed by bracing is an available mini-invasive technique. The aim of the study was to assess the imaging and functional results of the largest homogeneous cohort of SJPVBA. Materials and Methods: Every patient who sustained a posttraumatic thoracolumbar vertebral fractures treated by SJPVBA from the January 6, 2012, to January 6, 2020, was retrosepctively included. The main outcome measure was the height of the vertebral body (anterior/middle/posterior parts) on the sagittal computed tomography scan. The secondary outcome measures were a 11-point Likert scale for the pain and the Oswestry Disability Questionnaire for the quality of life. All the data were compared at different times: preoperative versus day after the procedure versus at least 3 months versus (if disposable) a long-term special consultation just before the publication. Results: SPJVBA is a simple, quick (52-min-long on average) reliable, efficacious method to significantly improve the vertebral height (+3.5 mm and 4.3 mm of the anterior and middle vertebral heights, P < 10−5), to correct kyphosis and relieve pain (−6.5/10 on the Likert scale for pain). We also showed that there is a significant vertebral height decrease between day 1 (−2.1 mm and − 0.7 mm of the anterior and middle vertebral heights, P < 10−5 and 0.005, respectively) and 3 months but not between 3 months and the last consultation with a mean follow-up of 37 months (−0.1 mm and − 0.2 mm of the anterior and middle vertebral heights, P = 0.277 and 0.4289, respectively). Conclusions: SPJVBA is a simple, quick, reliable, efficacious method to improve the vertebral height, to correct kyphosis and relieve pain.

Use of Cystourethroscopy to Define the Gross Tumour Volume in Radiation Treatment Planning for Canine Genitourinary Carcinomas.

Radiotherapy (RT) is increasingly utilised for definitive-intent treatment of canine genitourinary carcinomas (CGUC). At our institution, the standard approach is to irradiate tomographically abnormal tissues gross tumour volume (GTV) plus a clinical target volume (CTV) expansion of 2 cm. Cystourethroscopy is often incorporated into the treatment planning workflow, though an optimal approach has yet to be defined. This observational study evaluated cystourethroscopy as a tool for identifying gross lesions that can be targeted with RT. We hypothesised that in most cases, addition of cystourethroscopy would result in a larger GTV than would be drawn with computed tomography (CT) alone. Medical records from 54 dogs diagnosed with CGUC between 2013 and 2023 were reviewed; each had been evaluated before RT using CT and cystourethroscopy. The GTV was initially defined as the tomographically evident disease on a post-contrast sagittal plane CT scan, and then lesions visualised with cystourethroscopy (suspected or confirmed to be tumour) were added. Beyond what was visible on CT, cystourethroscopy extended the GTV by a median of 6.5 cm distally into the urethra (range: 1.5-31.8 cm) and therefore resulted in GTV enlargement in 26 of 54 (48%) cases. Addition of our standard 2 cm CTV expansion to a CT-defined GTV (without use of data from cystourethroscopy) would have underestimated the extent of grossly abnormal tissue in 35% (19/54) of cases. These results suggest that incorporating cystourethroscopy into treatment planning workflows may improve local tumour control by reducing the risk of a geographic miss.

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 > 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< 0.001) and PROMIS Global Mental Health (12.2 + 4.82 vs. 5.59 + 6.76, p< 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).

Heart ventricles of the dromedary camel (Camelus dromedarius): new insights from sectional anatomy, 3D computed tomography, and morphometry

BackgroundDromedary camel heart morphology is a crucial research topic with clinical applications. The study aims to understand the dromedary camel anatomy, morphology, and architecture of the ventricular mass. Results: Sagittal and transverse gross sections were compared to sagittal, transverse, and 3D render volume reconstruction computed tomography (CT) scans. The subepicardial fat, which covered the heart base, the coronary groove (sulcus coronarius), the left longitudinal interventricular groove (sulcus interventricularis paraconalis), and the right longitudinal interventricular groove (sulcus interventricularis subsinuosus), had a relatively low density with a homogeneous appearance in the 3D render volume CT. The pericardium in the color cardiac window was identified better than the black and white window (ghost). Transverse and sagittal CT scans demonstrated the internal structures of the heart, including the right atrioventricular orifice (ostium atrioventriculare dextrum), right atrioventricular orifice (ostium atrioventriculare sinistrum), and aortic orifice (ostium aortae), chordae tendineae, the cusps of the valves (cuspis valvae), and the papillary muscles (musculi papillares). The papillary muscle (musculi papillares) was presented with a more moderate density than the rest of the heart, and the cusps of the valves (cuspis valvae) had a lower density. The ventricular wall (margo ventricularis) exhibited different densities: the outer part was hyperdense, while the inner part was hypodense. The thicknesses of the ventricular mural wall and the interventricular septum (septum atrioventriculare) were highest at the midpoint of the ventricular mass, and the lowest value was present toward the apical part. The coronary groove (sulcus coronarius) circumference measured 51.14 ± 0.72 cm, and the fat in the coronary groove (sulcus coronarius) (56 ± 6.55 cm2) represented 28.7% of the total cross-sectional area. Conclusion: The current study provided more information about ventricular mass measurements by gross and CT analysis on the heart, which provides a valuable guide for future cardiac CT investigations in camels in vivo.

Risk Factors for Cage Subsidence in Minimally Invasive Lateral Corpectomy for Osteoporotic Vertebral Fractures.

This study aims to investigate risk factors for cage subsidence following minimally invasive lateral corpectomy for osteoporotic vertebral fractures. Eight males and 13 females (77.2±6.0 years old) with osteoporotic vertebral fractures who underwent single corpectomy using a wide-footprint expandable cage with at least a 1-year follow-up were retrospectively included. The endplate cage (EC) angle was defined as the angle between the vertebral body's endplate and the cage's base on the cranial and caudal sides. A sagittal computed tomography scan was performed immediately after surgery and at the final follow-up, with cage subsidence defined as subsidence of ≥2 mm on the cranial or caudal side. Risk factors were analyzed by dividing cases into groups with (n=6) and without (n=15) cage subsidence. No significant differences were noted in age, bone mineral density, number of fixed vertebrae, sagittal parameters, preoperative and final kyphosis angle, amount of kyphosis angle correction, bone union, screw loosening, and number of other vertebral fractures preoperatively and 1-year postoperatively between the two groups. No difference was noted in cranial EC angle, but a significant difference was noted in caudal EC angle in the group with (10.7±4.1°) and without (4.7±4.2°) subsidence (P=0.008). Logistic regression analysis with the dependent variable as presence or absence of subsidence showed that caudal EC angle (>7.5°) was a significant factor (odds ratio: 20, 95% confidence interval: 1.655-241.7, P=0.018). In minimally invasive lateral corpectomy for osteoporotic vertebral fractures, a cage tilted more than 7.5° to the caudal vertebral endplate is a risk factor for cage subsidence. The cage should be placed as perpendicular to the endplate as possible, especially to the caudal vertebral body, to avoid cage subsidence.

Chronically misdiagnosed Eagle's syndrome, treated through transoral styloidectomy: a rare case report.

A 39-year-old man who is a farmer and a driver was presented with complaints of ongoing, excruciating discomfort in the back of his left ear. Before the exam, he took a variety of drugs, various drugs 2 years without receiving a definitive diagnosis. Axial, coronal, and sagittal computed tomography scans of both petrous bones were analyzed, and the results showed aberrant styloid process elongation and calcification of the stylohyoid ligament. ES, shares many symptoms with other regional illnesses. Physicians frequently misdiagnose cases of ES and treat them without providing a conclusive diagnosis or treatment. ES diagnosis can be difficult for otolaryngologists and primary care providers due to its similarity with other regional illnesses. However, surgical intervention can result in consistent and significant symptomatic improvement when correctly diagnosed. The case presented in the report was successfully diagnosed as ES and treated surgically through transoral approach styloidectomy.

Should planning of cervical pedicle screws be race specific? Computed tomography–based morphometric analysis

Introduction: The neurovascular surgical structures are protected by quantitative understanding of cervical pedicle morphology and aiding in better surgical outcome. Aim of the study is to do morphometric analysis of subaxial cervical pedicle by noncomputerized computed tomography (CT) scans. Materials and Methods: From 50 volunteers, a total of 500 cervical pedicles were evaluated using axial and sagittal CT scan. Five parameters such as outer pedicle width (OPW), inner pedicle width (IPW), pedicle height (PH), pedicle transverse angle (PTA) and pedicle axis length (PAL) were analyzed. Result: OPW, IPW, PH, and PAL show increase in values from C3 to C7, while PTA shows a decrease in value from C3 to C7. Conclusion: The cervical pedicle dimension of our study population was smaller than other studies carried out on Asian and European population. Hence, the planning for pedicle screw fixation should be race specific.

Simultaneous reduction and fixation of concomitant acetabular fracture and ipsilateral sacroiliac joint injury through the pararectus approach: a technical report and early radiological outcome.

Osteosynthesis for acetabular fractures with ipsilateral sacroiliac joint (SIJ) injuries remains challenging for orthopedic surgeons, despite the evolution of surgical approaches, such as the pararectus approach, and treatment sequences. The study aimed to describe the details of the treatment of acetabular fracture with ipsilateral SIJ injury by the pararectus approach and to report its surgical outcomes. We retrospectively assessed patients with acetabular fractures and ipsilateral SIJ injuries undergoing osteosynthesis by the pararectus approach over a three-year period. Evaluation parameters of the quality of reduction of both acetabulum and pelvis injuries were, among others, Matta's criteria, Lefaivre's criteria, inlet/outlet ratios, and maximal gap measured on computed tomography (CT) scans. Ten patients (seven men and three women) were enrolled. Pelvic ring injuries classified as AO B2.3 and acetabular fractures involving two columns were the most common fractures, accounting for 70% and 60%, respectively. Radiological evaluation for pelvic ring injury revealed three excellent and seven good results according to Matta's criteria, as well as five excellent, three good, and one fair results according to Lefaivre's criteria. Inlet and outlet ratios were between 0.84-1.06 and 0.93-1.60, respectively. The distance of the sacroiliac joints significantly improved postoperatively in both axial and coronal views (P = 0.002). Further, the maximal articular gap and step-off of acetabular fractures on axial, coronal, and sagittal view CT scans showed statistically significant improvements after osteosynthesis. Simultaneous reduction and fixation of acetabular fractures with ipsilateral SIJ injuries using the pararectus approach achieved satisfactory radiological outcomes. IV. Retrospectively registered.

Comparison of Dorsal-to-Ventral Ratios of the Cervical Paraspinal Musculature in French Bulldogs With and Without Cervical Intervertebral Disk Disease and Two Other Breeds Based on CT Scan Measurements

Objective: To objectively assess the cervical paraspinal musculature of French bulldogs (FBs) using computed tomography (CT) scan-based measurements, outline differences in other breeds published in the literature, and investigate the potential influence of its cervical paraspinal musculature on predisposed sites for intervertebral disk disease.Animals: Thirty FBs that underwent CT scans of the cervical spine from the skull to C7/T1 were enrolled. Fifteen dogs were patients suffering from intervertebral disk herniation (IVDH group), and 15 dogs underwent CT scans due to brachycephalic obstructive airway syndrome (BOAS group).Methods: At the level of each cervical intervertebral disk from C2/C3 to C7/T1, measurements were performed and statistically analyzed. On the sagittal CT scan reconstruction, the height ratio of the dorsal to ventral paraspinal musculature and the angle of the disk axis to vertebral body length were assessed. On the transverse plane, the area ratio of the dorsal and ventral paraspinal musculature and the ratio of force moments were determined at each intervertebral disk level. Finally, ratios were compared to the values of Labrador retrievers and dachshunds published by Hartmann et al. (1).Results: Comparing the two FB groups, one significant difference was detected in the mean height ratio of the dorsal to ventral paraspinal musculature at the level of C5/C6 (P = 0.0092) and C6/C7 (P = 0.0076), with IVDH FBs having the more prominent dorsal paraspinal musculature. At the level of C3/C4, a significantly less prominent dorsal paraspinal musculature in FBs than in dachshunds (P = 0.0058) and a significantly steeper disk to vertebral body angulation were observed (P = 0.0005).Conclusion: Although some incidental differences were found, most parameters did not significantly differ between the BOAS and IVDH FBs. Significant conformational differences in the cervical paraspinal musculature and disk to vertebral body length angulation were found between FBs and two other breeds (chondrodystrophic and non-chondrodystrophic). This study's findings suggest that the paraspinal musculature is an additional biomechanical influencing factor on the preferential sites of IVDH in the cervical spine and that other major factors exist in IVDH development, especially in FBs.

Determining C2 Pedicle Screw Placement Feasibility in the Pediatric Population: A Computed Tomographic Safe Zone Analysis.

Due to high rates of anatomic variability of the C2 pedicle, thin-sliced pedicular-oriented computed tomography (CT) and 3-dimensional reconstructive CT technologies have been introduced to predict safe C2 pedicle screw placement. However, this technology may not be readily available in all centers. The purpose of this study was to perform a C2 pedicle safe zone analysis using standard sagittal CT scans to predict the feasibility of C2 pedicle screw placement in a pediatric population and to compare the results with our previously obtained safe zone analysis from the adult population. A retrospective analysis was performed at a single level I trauma center of pediatric patients who completed CT scans of the cervical spine. The feasibility of C2 pedicle screw placement was analyzed using our previously described C2 pedicle safe zone analysis technique. The risk profiles were compared with our previously obtained safe zone analysis from the adult population. Thirty-nine consecutive patients with a mean age of 7.8±4.4 years and 78 total pedicles were included in the study. Fourteen pedicles (18%) were considered low risk, 37 (47%) were moderate risk, and 27 (35%) were high risk for vertebral artery injury. Individual patients were found to have a significant amount of side-to-side variability between pedicles with 21 patients (54%) having left and right pedicles with different risk profiles. Four patients (10%) demonstrated low risk profiles in bilateral pedicles. There was no significant difference between the risk profiles of pediatric and adult patients. There is a considerable amount of anatomic variability within the pediatric C2 pedicles. Using this simple and accessible technique during the review of preoperative imaging, C2 pedicle screw placement may be considered in appropriately selected pediatric patients. Level III.

Application and Evaluation of an Independent Robotic Arm System in K-wire Placement for Lumbar Fusion.

A single-center randomized controlled study. The objective of this study was to introduce a novel robotic system with an independent arm ("Orthbot Intelligent Orthopedic Minimally Invasive System"; Xin Junte Surgical Technologies) that has been developed and tested as a surgical assistant for autoplacement of the Kirschner wire (K-wire) in lumbar fusion, and to evaluate its accuracy by comparing it with the conventional free-hand instrumentation. Robotic technology has performed excellently in spine surgeries and has demonstrated high clinical value and potential. Robot-assisted spinal surgery is now being promoted as a paradigm for technology-led advancement. A total of 24 patients were recruited and assigned randomly to the robotic arm group (RG) or the free-hand group (FG). Deviation distance and deviation angle (DA) of K-wire placement were measured and compared between the RG and the FG. The average deviation distance was 0.88±0.08 mm in the RG and 5.13±1.68 mm in the FG (P<0.001). In both coronal and sagittal radiographs, the average DA of K-wire placement was smaller in the RG (P<0.05), and in both axial and sagittal computed tomography scans, the average DA of pedicle screw placement was also lower in the RG (P<0.05), which indicated higher accuracy of the robotic system. The novel robotic system in this study has shown certain advantages over the conventional free-hand approach in K-wire placement for lumbar fusion, including being more accurate in K-wire placement, fully automatic, and more adaptive to preoperative plans. Although the robotic arm proves to be promising in our results, the small sample size in this clinical study necessitates further multicenter, large sample follow-up studies to verify its advantages.

Morphology, ultrasonographic and computed tomography configuration of the dog pelvis and perineum.

The current study used topographic anatomy, distribution of arteries and nerves, sectional anatomy of the pelvis, computed tomography (CT) and ultrasonography examination to describe the canine pelvis and its organs. This study was conducted on twenty male and female baladi dogs, weighing 30-35kg and aged between 1.5 and 2years. The pelvis dorsal boundary appeared long and reached to the level of the third caudal vertebra. The vesicogenital pouch in the female extended further caudally than the rectogenital pouch while in the male the two pouches were at the same level and extended to the level of the first sacral vertebra. The plexus lumbosacralis formed from the ventral branches of the last three lumbar nerves and the first three sacral nerves. The obturator nerve arose from the ventral branches of the fifth and sixth lumbar nerves. We developed an anatomical atlas of the pelvis of both sexes of the dog using CT scans compared to anatomical sections. Our study is the first research on the pelvis in both sexes of the dog to compare sagittal CT scan data to sagittal anatomical sections. In the CT slices, the prostate appeared homogenous, relatively hypodense presenting with a soft tissue density. It appeared oval in the longitudinal sections and elliptical to round at the cross sections. It was situated on the floor of the pelvic cavity or the pelvic brim depending on its size. The present study is also the first to describe the fascia diaphragmatic pelvis.

Accuracy and Early Clinical Outcome After 3-Dimensional Correction of Distal Radius Intra-Articular Malunions Using Patient-Specific Instruments

To investigate the residual articular incongruity on computed tomography image data and the early clinical outcome of 3-dimensional planned and navigated intra-articular osteotomies of the distal radius. We conducted a retrospective analysis of intra-articular osteotomies executed between 2008 and 2016. We identified 37 patients (aged 26-73 years) and performed a combined intra-articular and extra-articular osteotomy on 20 patients. A preoperative 3-dimensional plan with the superimposed bone of the contralateral healthy side was performed in each case to analyze and execute the osteotomy by intraoperative navigation. The residual articular incongruity was assessed by quantification of the maximal stepoff in the coronal or sagittal computed tomography scans. Clinical outcome, including range of motion, grip strength, and return to work, was assessed after a minimum follow-up of 12 months and compared with preoperative measurements. On average, the preoperative intra-articular stepoff was 2.5 mm (±0.6 mm; range, 1.4-4.2 mm) and was significantly reduced to 0.8 mm (±0.2 mm) after surgery. After surgery, 30 patients had a stepoff less than 1 mm; in 7, a stepoff of 1.1 to 1.4 mm was measured. After 1 year, 22 had no pain, 9 had slight pain during heavy work, and 5 had moderate pain with no improvement compared with their preoperative status, although wrist strength and range of motion improved in all 37 patients. One patient underwent a secondary radioscapholunate arthrodeses owing to persistent pain despite a congruent joint with a small residual intra-articular stepoff (0.6 mm). Intra-articular osteotomies of the distal radius treated by 3-dimensional preoperative planning and patient-specific guides are an accurate technique to reduce articular incongruity to an average stepoff of 0.8 mm (range, 0.3-1.4 mm). The early clinical outcomes demonstrated overall reduction in pain and improvement of range of motion and grip strength in 36 of 37 patients. Therapeutic IV.

Radiologic Analysis of C2 to Predict Safe Placement of Pedicle Screws.

Preoperative assessment of C2 pedicle morphology is critical to safe pedicle screw placement. To avoid iatrogenic injury, complex digital templating software has been introduced; however, this technology may not be available in many centers. We report a technique for preoperative assessment of C2 pedicle screw placement safety based upon 2-dimensional sagittal computed tomography (CT) scan images and verify its utility in clinical practice. A total of 46 consecutive patients underwent cervical spine CT scans between 2005 and 2011. The C2 pedicle morphology was assessed on sagittal CT imaging by 5 independent reviewers to determine the feasibility and risk associated with pedicle screw placement. Thirty consecutive patients underwent C2 pedicle screw placement and were followed clinically for a minimum of 2 years. The ability to place a screw was noted, and accuracy of screw placement was assessed postoperatively by CT scan. The CT scan analysis demonstrated that 11% (5/46) of patients had sufficient pedicle size bilaterally to allow safe placement of long pedicle screws with a low risk of vertebral artery injury, whereas 15% (7/46) were considered a high risk bilaterally. Screw placement was deemed low risk in 28%, moderate risk in 38%, and high risk in 34%. Excellent intraobserver reliability and good interobserver reliability was observed. Clinically, 18 of 20 (90%) low-risk and 21 of 24 (88%) moderate-risk pedicle screws were placed safely versus 5 of 16 (31%) high-risk pedicle screws (P < .001). Using the described technique for evaluating the C2 pedicle via sagittal CT scan images allows for safe and reliable pedicle screw placement without relying upon complex digital templating software, which may have limited availability. II. This study aids in the surgical decision-making behind the placement of C2 pedicle screws using CT scans without reliance upon complex digital templating software.

Prevalence and clinical features of sports-related lumbosacral stress injuries in the young.

Stress injuries (stress fractures and stress reactions) of the lumbosacral region are one of the causes of sports-related lower back pain in young individuals. These injuries can be detected by bone marrow edema lesion on MRI. However, little is known about the prevalence and clinical features of early stage lumbosacral stress injuries. This study aimed to evaluate the epidemiology of lumbosacral stress injuries. A total of 312 patients (under 18 years of age) who complained of sports-related lower back pain that had lasted for ≥7 days underwent magnetic resonance imaging (MRI) scans. We reviewed patients' records retrospectively. MRI showed that 33.0% of the patients had lumbar stress injuries and 1.6% had sacral stress injuries. Lumbar stress injuries were more common in males than in females and were found in 30% of 13- to 18-year-old patients. About 50% of the patients that participated in soccer or track and field were diagnosed with lumbar stress injuries. No clinical patterns in the frequencies of sacral stress injuries were detected due to the low number of patients that suffered this type of injury. Plain radiography is rarely able to detect the early stage lesions associated with lumbosacral stress injuries, but such lesions can be detected in the caudal-ventral region of the pars interarticularis on sagittal computed tomography scans. Thirty-three percent of young patients that complained of sports-related lower back pain for ≥7 days had lumbar stress injuries, while 1.6% of them had sacral stress injuries. Clinicians should be aware of the existence of these injuries. MRI is useful for diagnosing lumbosacral stress injuries.

Facet Joint Orientation and Sagittal Spinopelvic Alignment in Patients with Degenerative Lumbar Scoliosis

The purpose of this study was to evaluate the association between lumbar spine facet joint orientation and tropism, sagittal spinopelvic alignment, and rotational deformity, identified by radiographic and computed tomography (CT) measurements, in degenerative lumbar scoliosis (DLS). Standing whole-spine sagittal radiographs and CT scans, including the pelvis, were performed and analyzed in 60 DLS patients (16 males, 44 females; mean age 65 years). Cobb angle, pelvic incidence (PI) and lumbar lordosis (LL) were measured on standing lumbar radiographs. Facet joint orientation on both sides at L3/4, L4/5, and L5/S1 was determined from transverse-plane CT. Facet joint tropism was defined as a difference in symmetry of more than 10 degrees between the orientations of the facet joints. There were significant differences in the incidence of facet joint tropism between the two groups at L3/4, L4/5, and L5/S1 (P = 0.011, P = 0.043, and P = 0.004, respectively). LL was significantly smaller in type II DLS (P = 0.049). Facet joint orientation, pelvic incidence, and Cobb angle did not differ between groups. No significant correlation between LL and PI was observed in either group. This study provides a reliability analysis of rotational deformity in patients with DLS. In conclusion, we observed a significant relationship between facet joint tropism and rotational deformity in patients with DLS. Furthermore, the different types of DLS demonstrated significant differences in LL that may induce spinal symptoms.

Morphometric Measurement of the Lumbosacral Spine for Minimally-Invasive Cortical Bone Trajectory Implant Using Computed-Tomography

Introduction The cortical bone trajectory (CBT) is a novel lumbar pedicle screw trajectory. There is a dearth of literature on CBT screw insertion techniques. The aim of this study was to conduct a detailed morphometric measurement of the lumbosacral spine for CBT pedicle screw starting point, trajectory, length and diameter, using the inferior facet of the cephalad level as a bony landmark. Methods The 3-dimensional reconstruction computed tomography (CT) scans of 86 adults who underwent examination of the lumbosacral spine were studied. The junction of the inferior and medial border of the smallest coronal section of the lumbar pedicle was traced in lumbar segments while the junction of the medial border of the sacral 1 (S1) pedicle and the inferior border of the L5 inferior facet was traced in S1 segments. The starting point was defined to be the projective point on the vertebral plate by this junction. The distances from the starting point to the inferior, lateral and medial border of the inferior facet of the cephalad level, and the inferior border of the transverse process were measured. The trajectory of pedicle screws for the lumbar and S1 segments was determined in the axial and sagittal planes. The angle formed between this trajectory and a line from the vertebral midline was defined as the transverse angle (TA). The angle formed between this trajectory and a line from superior margin of the vertebral body was defined as the cephalad angle 1 (CA1). Cephalad angle 2 (CA2) was defined as the angle formed between the same trajectory on the sagittal plane and a line from the posterior margin of the pars interarticularis. The maximum pedicle screw diameter, as well as the maximum pedicle screw length of the lumbosacral segments was measured on axial and sagittal CT scans, respectively. Results The distances from the inferior border of inferior facet to the starting point from L1 to S1 were 8.9, 6.3, 4.1, 2.9, 1.4 and 0 mm, respectively. The distances from the medial border of the inferior facet to the starting point from L1 to S1 were between 3 to 4mm. The percentages of the distance from the starting point to the medial border of the inferior facet from L1 to S1 were 80.5, 70.1, 61.6, 48.6, 40.8 and 29.3%, respectively. TA from L1 to S1 were 9.0, 9.6, 11.3, 13.5, 15.5, and 8.2 degrees, respectively. CA1/CA2 from L1 to S1 were 26.7/38.7, 26.0/38.7, 26.9/38.0, 24.4/37.2, 22.9/35.1 and 18.4/47.8 degrees, respectively. The maximum diameters of the trajectory from L1 to S1 were 4.8, 5.1, 6.1, 6.8, 7.8, and 6.1mm, respectively. Twenty-five mm was a safe border as the maximum length of the pedicle screw from L1 to S1. Conclusions The inferior facet of the cephalad level is an attractive bony landmark for establishing a starting point of CBT for minimally-invasive spine surgery.

Successful combination treatment of a bifocal secretory germinoma with brain stem compression in a 17-year-old girl

A 17-year-old girl, evaluated since 2007 for endocrinological disorders due to secondary amenorrhea and weight loss, was referred to the neurosurgery department in May 2011 due to symptoms of rapidly increasing intracranial pressure. Computed tomography revealed a bifocal, irregular, non-homogeneous tumour localised in pineal and suprasellar regions (Figures 1 A, B). Immediate septostomy, ventriculo-peritoneal valve implantation and suprasellar tumour biopsy were performed. Histopathological examination confirmed the tumour to be a secretory type germinoma (β-HCG = 0.696 mIU/ml; AFP = 79.89 µg/ml in serum). After surgical biopsy (Figure 1 C) the chemotherapy was introduced according to the GCT SIOP96 protocol – which is the standard protocol for children in Poland with this diagnosis. The control magnetic resonance imaging (MRI) confirmed total regression of the suprasellar tumour and a residual pineal mass (Figure 1 D). At the end of July 2011 the patient was transferred to the Radiotherapy Department for treatment planning. Radiation therapy was initiated using both static and dynamic fields, including 3 target volumes (Figure 1 E): brain ventricles (blue) irradiated up to 30.6 Gy, PTV2 (cyan) – both tumour loci – up to 45.0 Gy with dose escalation on the pineal tumour residue up to 52.2 Gy (turquoise). Currently the patient is in 3.5-year follow-up (Figure 1 F) in a good clinical condition, presenting only minor left-sided convergent strabismus, slight deafness for high frequency sounds and requires hormonal supplementation. The last MRI revealed only a residual mass in the pineal region 10 × 7 × 12 mm and a “flat” pituitary gland as deviations from the normal condition. Figure 1 A, B – Transverse and sagittal computed tomography scans before initiation of treatment of pineal (38 × 30 × 30 mm) and suprasellar regions (25 × 20 × 20 mm), C – MRI scan after the surgical procedure, ... Intracranial germ cell tumours (GCTs) account for 1–2% of all primary paediatric central nervous system (CNS) tumours and have a peak incidence at between 10 and 14 years with a male-female ratio of 2 : 1 [1]. Although multiple loci at presentation are associated with poorer prognosis [2], in this relatively unusual case, despite dramatic onset of symptoms, the treatment has proven successful thus far. Up to 20% of intracranial GCTs are multifocal, and they usually involve the suprasellar and pineal gland region. This is typically observed in adolescent males rather than females. Pineal GCTs induce acute symptoms of intracranial pressure which may be manifested by the classic triad of chronic symptoms: diabetes insipidus, visual deficits and precocious or delayed sexual maturity [3]. Evaluation must include MRI of the brain and serum marker levels (AFP, β-HCG) should be obtained. Biopsy sampling is recommended in all cases nowadays. Surgical treatment of intracranial GCTs remains controversial. Limited volume radiation therapy (whole ventricle followed by boost for residual tumour) is an important part of treatment preceded by chemotherapy according to currently used protocols. Endocrinopathies are a common complication of treating brain GCTs [4]. If pituitary gland insufficiency persists, it may however be easily corrected by hormonal treatment. The potential late sequelae due to chemotherapy and radiotherapy do not generally impair future mental and social development in adolescents, which gives a chance for a good quality of life in the future for these patients [5]. However, in younger patients, persistent neurological deficiencies resulting from surgical and radiotherapeutic complications may be a serious issue [4, 5].

Analysis of Sacrococcygeal Morphology in Koreans Using Computed Tomography.

BackgroundThe sacrococcygeal morphology of Arabs and Europeans has been studied using computed tomography (CT) or magnetic resonance imaging to determine the cause of coccydynia. Studies have suggested differences in sacrococcygeal morphology among ethnic groups. However, there are no data on the sacrococcygeal anatomy of Koreans.MethodsWe conducted a retrospective analysis of 606 pelvic CT scans that were taken at Cheju Halla General Hospital between 2008 and 2014. Fractures of the sacrum or coccyx were excluded. Differences in the sacrococcygeal morphology among age groups stratified by decade of life and between genders were analyzed using sagittal plane pelvic CT scans. The morphological parameters studied were the sacral and coccygeal curved indexes, sacrococcygeal angle, intercoccygeal angle, coccygeal type, coccygeal segmental number, and sacrococcygeal fusion.ResultsThe average sacral and coccygeal curved indexes were 6.15 and 7.41, respectively. The average sacrococcygeal and intercoccygeal angles were 110° and 49°, respectively. Type II coccyx was most common, and the rate of sacrococcygeal fusion was 34%. There was a moderate positive correlation between age and the sacral curved index (r = 0.493, p = 0.000) and a weak negative correlation between age and the coccyx curved index (r = −0.257, p = 0.000). There was a weak negative correlation between age and the intercoccygeal angle (r = −0.187, p = 0.000). The average intercoccygeal angle in males and females was 53.9° and 44.7°, respectively.ConclusionsThe sacrum tended to be more curved and the coccyx straighter with age. The coccyx was straighter in females than males. Knowledge of the sacrococcygeal anatomy of Koreans will promote better understanding of anatomical differences among ethnicities and future studies on coccydynia.

Roles of computed tomography in the diagnosis and treatment of complex atlas pillow deformity

To explore the roles of computed tomography (CT) in the diagnosis and treatment of complex atlas pillow deformity. From January 2010 to February 2012, the preoperative and postoperative CT imaging findings were collected from 32 cases of complicated atlas pillow deformity undergoing surgical treatment at Henan Provincial People's Hospital. There were 18 males and 14 females with a mean age of 36.8 years (range: 23 - 65). The average duration of disease was 4.5 years (range: 0.25 - 10). In 32 cases, a definite diagnosis was established preoperatively by coronary sagittal CT scans and 3-dimensional reconstruction. And CT re-examinations were performed to review the postoperative curative efficacies. CT imaging examination is of vital importance in the diagnosis, personalized surgical procedures and prognostic evaluation of complex craniocervical junction deformity.