Alignment Of Segments Research Articles

Segmental Sagittal Alignment in Lumbar Spinal Fusion: A Review of Evidence-Based Evaluation of Preoperative Measurement, Surgical Planning, Intraoperative Execution, and Postoperative Evaluation.

Maintaining and restoring global and regional sagittal alignment is a well-established priority that improves patient outcomes in patients with adult spinal deformity. However, the benefit of restoring segmental (level-by-level) alignment in lumbar fusion for degenerative conditions is not widely agreed on. The purpose of this review was to summarize intraoperative techniques to achieve segmental fixation and the impact of segmental lordosis on patient-reported and surgical outcomes. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed, Embase, Cochrane, and Web of Science databases were queried for the literature reporting lumbar alignment for degenerative lumbar spinal pathology. Reports were assessed for data regarding the impact of intraoperative surgical factors on postoperative segmental sagittal alignment and patient-reported outcome measures. Included studies were further categorized into groups related to patient positioning, fusion and fixation, and interbody device (technique, material, angle, and augmentation). A total of 885 studies were screened, of which 43 met inclusion criteria examining segmental rather than regional or global alignment. Of these, 3 examined patient positioning, 8 examined fusion and fixation, 3 examined case parameters, 26 examined or compared different interbody fusion techniques, 5 examined postoperative patient-reported outcomes, and 3 examined the occurrence of adjacent segment disease. The data support a link between segmental alignment and patient positioning, surgical technique, and adjacent segment disease but have insufficient evidence to support a relationship with patient-reported outcomes, cage subsidence, or pseudoarthrosis. This review explores segmental correction's impact on short-segment lumbar fusion outcomes, finding the extent of correction to depend on patient positioning and choice of interbody cage. Notably, inadequate restoration of lumbar lordosis is associated with adjacent segment degeneration. Nevertheless, conclusive evidence linking segmental alignment to patient-reported outcomes, cage subsidence, or pseudoarthrosis remains limited, underscoring the need for future research.

RELATIONSHIP BETWEEN SHOULDER FLEXIBILITY AND HANDSTAND ALIGNMENT IN DIFFERENT FEMALE ARTISTIC GYMNASTICS APPARATUS

A study was performed with the objective of analyzing the relationship between shoulder flexibility and handstand performance across three female artistic gymnastics apparatuses: floor exercise (FX), balance beam (BB), and uneven bars (UB). Twenty-one gymnasts participated and were divided into two groups: “G1”, consisting of twelve child gymnasts, and “G2”, consisting of nine adolescent gymnasts, aged 9 and 14 respectively. The study aimed to consider the sensitive phases for the development of flexibility. Using the Kinovea program, the shoulder angle (°H) in the handstand and the alignment of the joint segments (AJS) involved were analyzed. Participants underwent two different active shoulder flexibility tests (GFMT and FIG), and results were compared between the groups. Significant differences were found between groups in the GFMT test (p = 0.018), the FIG test (p = 0.026), and AJS in the BB handstand (p = 0.043). Significant relationships were also observed between the GFMT test and °H in UB (p = 0.021); and between the FIG test and °H in BB (p = 0.006), both withing the cild gymnast group. Overall, the adolescent group presented better scores, supporting the notion of greater body awareness and technical mastery of the handstand across the different female artistic gymnastics apparatuses.

Nasoalveolar Molding in Lately Presented Moderate to Severe Unilateral Cleft Lip and Palate Infants: Does it Add?

Alignment of the alveolar segments with early nasal cartilage tackling is the foundation upon which excellent surgical results are dependent. The purpose is to evaluate the short-term effect of triple combination of passive alveolar molding with early nasal molding augmented by controlled corrective power of lip tapping in lately presented moderate to severe unilateral complete cleft lip and palate infants. A prospective case series study was conducted in Plastic and Maxillofacial Surgery Department, Ain Shams University in collaboration with Orthodontics Department, from January 2021 till June 2023, 15 infants elder than 2 months till 6 months were enrolled in the study. Eight nasal anthropometric measurements ratios through 2-dimension assessment and 4 maxillary arch measurements ratios through 3-dimension assessment were recorded. Extraoral results revealed clinically and statistically decrease of nasal width, alar base width, alar base height ratios, and columellar angle, while increase of nasal height, nasal dome height, columellar length, and alar projection length ratios. Intraoral results revealed clinically and statistically decrease in cleft width with maintained posterior arch width and intercanine width. In conclusion, this triple combination helped in presurgical lessening the alveolar and nasal deformity of such elder infants in a shorter time in comparison with other conventional methods with lesser number of appointments decreasing burden of care to their families improving their compliance.

Intranasal Outer Cortex Splinting With a Kirschner Wire to Immobilize Reduced Buckle-out Segments in Nasal Fractures

High-velocity lateral impacts to the nose sometimes cause nasal buckle-out fractures with a trapdoor buckle-out segment displaced outwards. Prolonged immobilization of a reduced buckle-out segment at risk for outward redisplacement remains challenging. Here we introduce a novel method of intranasal outer cortex splinting with a Kirshner (K)-wire to reinforce the reduced state and prevent outward re-displacement of the buckle-out segment. Eighteen patients with nasal buckle-out fractures underwent outer cortex K-wire splinting to securely immobilize a reduced but unstable buckle-out segment after indirect open reduction through intercartilaginous incisions and inner cortex K-wire splinting. A thin K-wire (diameter 0.8 mm) was inserted at the vestibule, passed above the upper lateral cartilage and the outer cortex of the reduced buckle-out segment, and extended to the cephalic non-fractured bone. The wire served as a crossbeam, effectively supporting the reduced buckle-out segment. All K-wires for inner and outer cortex splinting were removed 10 to 14 days postoperatively. Immediate postoperative computed tomography scans showed successful immobilization of buckle-out segments in 17 patients (94.5%). Postoperative 6-month scans of 7 patients showed excellent maintenance and bony alignment of buckle-out segments in all cases. Sixteen patients (88.9%) were satisfied with the overall external nasal contour at the last follow-up. There were no complications directly related to outer cortex K-wire splinting. One patient complained of a focal lateral protrusion resulting from the under-correction of a buckle-out segment. This technique may be a valuable option for immobilizing and maintaining reduced nasal buckle-out segments until a stable bony union is established.

CAFA: Cross-Modal Attentive Feature Alignment for Cross-Domain Urban Scene Segmentation

CAFA: Cross-Modal Attentive Feature Alignment for Cross-Domain Urban Scene Segmentation

Assessing Abnormal Proximal Junctional Angles in Adult Spinal Deformity: A Normative Data Approach to Define Proximal Junctional Kyphosis.

Multicentric retrospective study of prospectively collected data. Based on normative data from a cohort of asymptomatic volunteers, this study sought to determine the rate of abnormal values of proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, and compare it with PJK rate. Proximal junctional kyphosis (PJK) definition does not take the vertebral level into account. This study included 721 healthy volunteers and 824 ASD surgery patients with 2-year postoperative follow-up. Normative values for each disc and vertebral body between T1 and T12 were analyzed, then normative values for PJA at each thoracic level were defined in the volunteer cohort as the mean±2 standard deviations. PJA abnormal values at the upper instrumented vertebra (UIV) were compared with Glattes' and Lovecchio's definitions for PJK in the ASD population at two years. Mean age was 37.7±16.3 in the volunteer cohort, with 50.5% of females. Mean thoracic kyphosis (TK) was -50.9±10.8°. Corridors of normality included PJA greater than 20° between T3 and T12. Mean age was 60.5±14.0 years in the ASD cohort, with 77.2% of females. Mean baseline TK was -37.4±19.9°, with a significant increase after surgery (-15.6±15.3°, P<0.001). There was 46.2% of PJK according to Glattes' versus 8.7% according to Lovecchio's and 22.9% of kyphotic PJA compared to normative values (P<0.001). This study provides normative values for segmental and regional alignment of thoracic spine, used to describe abnormal values of PJA for each level. Using level-adjusted PJA values allows a more precise assessment of abnormal proximal angles and question the definition for PJK. II.

Impact of Segmental Lordosis Restoration During Degenerative Spinal Fusion on Two-Year Adjacent Segment Disease and Revision Rates.

Retrospective cohort study. Assess the impact of inadequate correction of L4-S1 lordosis during transforaminal lumber interbody fusion (TLIF) on adjacent segment disease and revision rates. Restoring alignment is an important consideration in spinal fusions. Failure to correct to level-specific alignment goals could promote the development of adjacent segment disease. As such, it is crucial to investigate the role of sagittal segmental alignment on clinical outcomes following short segment lumbar fusion. Patients who underwent 1- to 3-level transforaminal lumbar interbody fusion (TLIF) and had two-year outcomes data were included in this retrospective cohort study. Segmental lumbar lordosis was assessed in all patients with L3-L4, L4-L5, and L5-S1 constructs. Demographics, radiographic spinopelvic alignment, and complications were compared in a sub-group of patients fused at L4-S1 with adequate (i.e., within 35-45°) and inadequate (i.e., <35°) L4-S1 lordosis. Among the 168 included patients, mean age was 61.7 years, 56.0% were female, and mean follow-up was 32.3 months. Segmental lumbar lordosis did not change significantly after TLIF of L3-L4, L4-L5, or L5-S1 (P>0.05). Two-year postoperatively, 32.7% developed adjacent segment disease and 19.6% underwent revisions. After stratification by adequate (N=15) or inadequate (N=54) restoration of L4-S1 lordosis following initial TLIF surgery, adequately-restored patients had higher preoperative L4-S1 lordosis (Adequately-Restored=39.3° vs Inadequately-Restored=29.5°, P<0.001) and lower two-year postoperative adjacent segment disease (6.7% vs. 33.3%, P=0.032) and revision (5.7% vs. 25.9%, P=0.l33) rates. Adjacent segment disease patients had higher implant-related complications (Adjacent Segment Disease=36.8% vs No Adjacent Segment Disease=8.0%, P=0.008) and subsequent revisions (61.1% vs. 8.7%, P<0.001). Adjacent segment disease and revisions after degenerative lumbar spinal fusion are common. In this cohort, suboptimal restoration of L4-S1 lordosis was associated with higher rates of adjacent segment disease and subsequent revisions, thus highlighting the importance of restoring sagittal alignment in degenerative spine surgery. III.

Learning a Single Network for Robust Medical Image Segmentation With Noisy Labels.

Robust segmenting with noisy labels is an important problem in medical imaging due to the difficulty of acquiring high-quality annotations. Despite the enormous success of recent developments, these developments still require multiple networks to construct their frameworks and focus on limited application scenarios, which leads to inflexibility in practical applications. They also do not explicitly consider the coarse boundary label problem, which results in sub-optimal results. To overcome these challenges, we propose a novel Simultaneous Edge Alignment and Memory-Assisted Learning (SEAMAL) framework for noisy-label robust segmentation. It achieves single-network robust learning, which is applicable for both 2D and 3D segmentation, in both Set-HQ-knowable and Set-HQ-agnostic scenarios. Specifically, to achieve single-model noise robustness, we design a Memory-assisted Selection and Correction module (MSC) that utilizes predictive history consistency from the Prediction Memory Bank to distinguish between reliable and non-reliable labels pixel-wisely, and that updates the reliable ones at the superpixel level. To overcome the coarse boundary label problem, which is common in practice, and to better utilize shape-relevant information at the boundary, we propose an Edge Detection Branch (EDB) that explicitly learns the boundary via an edge detection layer with only slight additional computational cost, and we improve the sharpness and precision of the boundary with a thinning loss. Extensive experiments verify that SEAMAL outperforms previous works significantly.

Tomographic Assessment of Fusion Rate, Implant-Endplate Contact Area, Subsidence, and Alignment With Lumbar Personalized Interbody Implants at 1-Year Follow-Up.

Incongruity between irregularly shaped vertebral endplates and the uniform surfaces of stock interbody fusion cages has been identified as contributing to cage subsidence, pseudarthrosis, and unpredictable alignment. Advances in manufacturing techniques have driven the development of personalized interbody cages (PICs) that can match individual endplate morphology and provide the exact shape and size needed to fill the disc space and achieve the planned correction. This study used computed tomography (CT) imaging to evaluate the implant-endplate contact area, fusion, subsidence, and achievement of planned alignment correction in patients receiving PIC devices. This retrospective study included patients treated for adult spinal deformity at a single site and implanted with PIC devices at L4 to L5 or L5 to S1 for segmental stabilization and alignment correction, who received 1-year postoperative CT images as part of their standard of care. An evaluation using 3-dimensional thin-section scans was conducted. Implant-endplate contact and signs of fusion were assessed in each CT slice across both endplates. The degree of subsidence as well as measures of segmental and global lumbar alignment were also assessed. Fifteen patients were included in the study, with a mean age of 68.2 years. Follow-up ranged between 9 and 14 months. Twenty-six total lumbar levels were implanted; 20 with PIC devices via the anterior lumbar interbody fusion approach, 2 with stock cages via the anterior lumbar interbody fusion approach, and 4 with PIC devices via the transforaminal lumbar interbody fusion approach. CT analysis of PIC-implanted levels found an overall implant-endplate contact area ratio of 93.9%, a subsidence rate of 4.5%, a fusion rate of 100%, and satisfactory segmental and global lumbar correction compared with the preoperative plan. PIC implants can provide nearly complete contact with endplate surfaces regardless of the individual endplate morphology. Subsidence, fusion, and alignment assessments in this tomographic study illustrated results consistent with the benefits of a personalized interbody implant.

P264. Is manufacturer stated interbody device specifications an accurate predictor of postoperative segmental alignment and disc height?

P264. Is manufacturer stated interbody device specifications an accurate predictor of postoperative segmental alignment and disc height?

Orthodontic treatment protocol versus Peer Assessment Rating: Assessing the quality of orthodontic treatment.

To apply the Peer Assessment Rating (PAR) to cases that have been assessed by the NHS Business Service Authority (NHSBSA) using the orthodontic treatment protocol (OTO), then compare the NHSBSA outcome assessment with weighted (W) and unweighted (U) PAR scores. Cross-sectional study. UK. Anonymised orthodontic cases submitted to the NHSBSA. A sample of 30 reports from 2021/2022 were randomly selected to include different standard of treatment grades. The records were de-identified and the pre- and post-treatment study models were PAR scored by a calibrated assessor. The mean percentage change in PAR was higher in cases from green reports (W: 78%; U: 79%) than amber (W: 68%; U: 67%) and red reports (W: 65%; U: 65%). Alignment and poor buccal segment interdigitation were the most reported concerns for cases included in the red and amber graded reports. A residual increased overjet was the most common occlusal feature leading to PAR scores not being more than 70% improved. Only slight agreement was shown between OTP and PAR using the kappa statistic, and the chi-square statistical test found that outcome measures are statistically significantly different. There are fundamental differences between OTP and PAR, and general agreement between them has not been demonstrated. The NHSBSA Report provides a more critical outcome assessment than PAR, identifying elements that are not assessed or measured by the PAR index.

Enhanced measurement and optimization of railway profile parameters for large tamping machine operations

Abstract In the realm of modern railway maintenance, the employment of large tamping machine for the enhancement of track geometry and elasticity, and the minimization of disturbance to the roadbed, has become a key operational approach. However, factors such as repeated load applications, changes in topography and geology, and ongoing maintenance activities have been known to cause significant deviations of the actual track location from its original design. These deviations present challenges, such as increased construction difficulty and workload, during tamping operations predicated on the original design. Moreover, methods based on manual intervention have rendered large machine maintenance operations inefficient. In this paper, an optimisation method for railway profile parameters suitable for large tamping machine operations is proposed. The method integrates the total least squares method and the direct search method, enabling the accurate fitting of slope segments preceding and following the slope change points and the alignment of circular curve segments to determine the optimal curve radius. Consequently, optimised profile parameters for the continuous track section are obtained. Focusing on the Beijing–Guangzhou line, the operational efficacy of the proposed optimisation method is compared with that of the artificial slope method. The results showed that the proposed optimisation method is not only more accurate and efficient but also adheres to the principle of ‘prefer lifting rather than descending’ of the railways. The method further provides a theoretical basis and practical guidance for the optimisation of railway profile, underscoring the potential for improved maintenance efficiency and enhanced safety in train operations.

PARAMETERS ASSOCIATED WITH ERUPTION OUTCOMES AND IMPACTION OF PERMANENT MAXILLARY CANINES AFTER SECONDARY ALVEOLAR BONE GRAFTING IN PATIENTS WITH CLEFT LIP AND PALATE

A cleft lip and palate (CLP) is the most prevalent anomaly affecting craniofacial structures. Alveolar bone grafting is essential for patients with CLP to ensure the proper alignment of the maxillary segments and to create a bony foundation for the permanent maxillary canines (PMC) to erupt. To reduce the risk of PMC impaction, secondary alveolar bone grafting (SABG) is usually performed in patients aged 8–12 years when the development of the canine root is 1/4 to 1/2 the expected length. The aim of this systematic literature review is to access the parameters associated with eruption outcomes and impaction of PMC after SABG in patients with CLP. A comprehensive literature search was carried out following PRISMA guidelines in the MEDLINE (PubMed) and EMBASE (ScienceDirect) electronic databases, using the combinations of the following Medical Subject Heading (MeSH) terms: (impacted canines) AND (alveolar bone grafting) [MeSH term] AND (cleft lip) [MeSH term] AND (cleft palate) [MeSH term]. A total of 276 articles were identified, of which 4 studies met the eligibility criteria. Based on the studies reviewed, the most reliable parameters to determine the risk of canine impaction through the analysis of panoramic radiographs are the angulation and vertical position of PMC. A greater risk of PMC impaction on the cleft side after SABG is associated with an increased canine angulation and a more pronounced displacement in the vertical direction.

Gingival health and relapse tendency: a split mouth randomized controlled trial of two positions of lower fixed retainers.

To compare between lower permanent retainers placed in the middle of the incisal third and retainers placed in the middle of lower incisors in terms of gingival condition, lower incisors stability and retainers' failure rate. This is a split-mouth clinical trial. Fifty patients finished fixed orthodontic treatment and required fixed permanent retainer in the lower arch were recruited. A multistranded (0.0215 inch) retainer, with a vertical step in the midline placing half of the retainer in the incisal third and the other half in the middle of the lower incisors was attached to all the teeth in the lower labial segment. After one year, all the subjects were recalled. The primary outcome was to evaluate the plaque index (PI) and the gingival index (GI) of the lower labial segment teeth. The secondary outcome was to assess retainers' failure rate and the relapse in lower labial segment alignment. The GI and the PI scores were significantly smaller on the side where the retainer was placed incisally (P = 0.004, P < 0.001, respectively). There was no statistical difference in the average Irregularity Index (IRI) and the retainer's failure rate between the two sides (P = 0.52, P = 0.76, respectively). Placing lower fixed retainers in the incisal third will improve the lower labial segment oral hygiene and gingival health in the lingual area without affecting the efficiency or the integrity of the retainers. This trial was not registered Null Hypothesis: Placing the lower permanent retainer in the middle of the lingual surfaces of the lower labial segment' teeth or in the incisal third will not affect the gingival health of the lower incisors.

Charged Gold Nanoparticles for Target Identification-Alignment and Automatic Segmentation of CT Image-Guided Adaptive Radiotherapy in Small Hepatocellular Carcinoma.

Because of the challenges posed by anatomical uncertainties and the low resolution of plain computed tomography (CT) scans, implementing adaptive radiotherapy (ART) for small hepatocellular carcinoma (sHCC) using artificial intelligence (AI) faces obstacles in tumor identification-alignment and automatic segmentation. The current study aims to improve sHCC imaging for ART using a gold nanoparticle (Au NP)-based CT contrast agent to enhance AI-driven automated image processing. The synthesized charged Au NPs demonstrated notable in vitro aggregation, low cytotoxicity, and minimal organ toxicity. Over time, an in situ sHCC mouse model was established for in vivo CT imaging at multiple time points. The enhanced CT images processed using 3D U-Net and 3D Trans U-Net AI models demonstrated high geometric and dosimetric accuracy. Therefore, charged Au NPs enable accurate and automatic sHCC segmentation in CT images using classical AI models, potentially addressing the technical challenges related to tumor identification, alignment, and automatic segmentation in CT-guided online ART.

Analyzing the L4-5 Segmental Alignment Change of Two Minimally Invasive Prone-Based Interbody Fusions.

Retrospective Cohort Study. Restoration of lumbar lordosis (LL) is a principal objective during spinal fusion procedures, traditionally focusing on achieving an LL within 10° of the pelvic incidence (PI). Recent studies have demonstrated a relatively constant L4-S1 alignment of 35-40° at L4-S1 and at least 15° at L4-5, regardless of PI. Based on these results, this study was created to examine the success rate of achieving a minimum of 15° at L4-5 through two differing prone-based techniques: Prone Lateral (pLLIF) and Trans Foraminal Interbody Fusion (TLIF). One hundred patients with a primary single-level L4-5 interbody fusion (50 pLLIF and 50 TLIF) were retrospectively analyzed. Pre and post-operative radiographs were measured to examine the segmental change at each level in the lumbar spine and calculate the success rate for achieving a minimum L4-5 segmental lordosis of 15° at the final follow-up. The overall success rate of achieving an L4-5 segmental alignment >15° at the final follow-up was 70%. Prone LLIF was significantly more likely than TLIF to achieve this goal, achieving L4-5 > 15° 84% of the time vs TLIFs 56% (P = 0.002). Prone LLIF demonstrated an average L4-5 increase of 5.6 ± 5.9° which was larger than the mean increase for TLIF 0.4 ± 3.8° (P < 0.001). In both techniques, there was an inverse correlation between pre-operative L4-5 angle and L4-5 angle change. Prone lateral lumbar interbody fusion demonstrates a high success rate for achieving a post-operative L4-5 angle >15° and achieves this at a higher rate than TLIF.

Efficient Extraction of Horizontal and Vertical Alignment Information for Roadways Using Public Data and Open Application Programming Interfaces

An open-source program was developed to extract horizontal and vertical alignment information from roadways using public data and open application programming interfaces. The program employs unsupervised analysis to detect, segment, classify, and measure curves and tangents along an individual route or a network of connected routes. The algorithms used in the horizontal and vertical alignment analyses were described. For vertical alignment, the route was segmented based on the vertical grade profile using a data structure change method. Erratic vertical grade data points at bridges were detected and replaced with estimated values. Two validation cases are provided to demonstrate the function of the program. The first case is an 11.0 km Interstate highway route. The second case is a network of 13 connected routes at a highway interchange. A visual inspection of the results showed that the program was able to detect and measure horizontal and vertical alignment segments with reasonable accuracy. Occasional inaccuracies in the vertical alignment analysis were observed, mainly at short segments near bridges. The program was developed in the R language. The complete source code of the program is publicly accessible via a dedicated GitHub repository.

Self-assembly of curdlan molecules for the formation of thermally induced gels

The differences in the self-assembly process between cold-set (CCS) and heat-set (CHS) curdlan gels were investigated using micro-differential scanning calorimetry, atomic force microscopy, and small-angle X-ray diffraction. The results indicate that the triple-helix structure of curdlan dissociated into single helices in its suspension state (C-SUS) at 65 °C. Upon cooling to around 38 °C, these single helices assembled into long, thick fibers with a height of up to 11.50 nm, contributing to the gel structure of CCS. Heating C-SUS from 65 °C to 90 °C caused the single helices to transform into triple helices due to hydrophobic interactions. Subsequent cooling to 25 °C, led to the formation of short, thick bundles with a height of up to 8.78 nm, forming the network structure of CHS gel. As a consequence, CHS gels exhibited higher hardness and elasticity but lower fatigue resistance. This is attributed to an increased degree of physical cross-linking, as evidenced by a reduction in the size (Ξ) and spacing (ξ) of high-density domains within the gel structure, and a simpler mechanism of energy dissipation through alignment of the molecular chain segment. These findings are valuable for the design and development of curdlan-based gels with tailored mechanical properties.

Disc Height and Angle Changes on Radiographs and Magnetic Resonance Imaging after Anterior or Posterior Percutaneous Endoscopic Cervical Discectomy.

Objectives: Cervical disc herniation (CDH) leads to pain, numbness, and potential disability. Percutaneous endoscopic cervical discectomy (PECD) offers an anterior or posterior approach. This study aims to compare postoperative disc height and angle changes one year after PECD, considering both approaches. Methods: We retrospectively reviewed the data from patients with CDH who underwent PECD from October 2017 to July 2022. Cervical disc height was measured using the preoperative and one-year postoperative magnetic resonance imaging (MRI) examinations. Lordotic angle (LA), global alignment angle (GAA), segmental alignment angle (SAA), and slippage distance (SD) at the surgical level were measured on radiographs in the neutral, flexion, and extension positions. Results: Thirty-eight patients who underwent posterior PECD (PPECD) and five patients who underwent anterior PECD (APECD) were included in the evaluation. The mean age of the patients was 47.4 years (range: 29-69 years). There was a significant difference in the preoperative and one-year postoperative GAA and SAA in extension in the PPECD group (p = 0.003 and 0.031, respectively). The mean decreased disc height one-year postoperative was 1.30 mm in the APECD group and 0.3 mm in the PPECD group by MRI. A significant disc height decrease was observed in the APECD group (p < 0.001). Conclusions: Treating CDH with PPECD or APECD is feasible, as it can relieve symptoms and reduce disability. Stability remained unaffected during the first year after surgery, even though there was an increase in angulation during extension. Despite a significant decrease in disc space following APECD, patients reported significant symptom improvement and no new symptoms.

An optimized multisource acquisition and registration workflow for imaging guided ventricular tachycardia ablation

Abstract Background Catheter ablation is a cornerstone treatment for scar-related ventricular arrhythmias arising in patients affected by structural heart disease. Imaging integration with electroanatomical mapping (EAM) suites for ventricular tachycardia (VT) ablation procedural guidance is an established step for advanced substrate characterization and treatment. Purpose To compare and validate different approaches for intraprocedural multisource imaging registration and integration with EAM suites for VT ablation guidance. Methods Thirty consecutive patients prospectively enrolled in the ongoing VOYAGE clinical trial for imaging guided/aided VT ablation at our center were retrospectively analyzed. Multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging was performed before procedure. MDCT and LGE-CMR images were both acquired during end-expiratory breath hold. Same cardiac cycle phase images were used. Wide band LGE-CMR was acquired in case of a cardiac implantable electronic device was present to reduce artifacts. Images were imported in ADAS3D software. MDCT and CMR images were manually registered using established anatomical landmarks (left ventricle outflow tract, left ventricle apex, papillary muscles, left and right ventricle junction), were then respectively processed for aortic/ventricular anatomical reconstruction and myocardial characterization and then imported in CARTO3 electroanatomical mapping suite for procedural guidance. Registration between EAM and imaging was either performed with ascending aorta fast anatomical mapping (FAM) and 3D landmark alignment with aortic MDCT or via intracardiac echocardiography (ICE) left ventricle (LV) chamber segmentation and 3D landmark alignment with ventricular MDCT. ICE segmentation was also obtained for every case regardless of aortic FAM. Surface match between ICE and MDCT LV chamber reconstructions was calculated for method comparison. Results All 30 patients had an ICE segmentation of the LV, with a mean of 15,66±4,89 contours. Aortic FAM was obtained and used for aortic MDCT registration in 10 subjects. LV ICE was instead used for imaging alignment in 20 subjects. When compared to aortic FAM, LV ICE to LV MDCT alignment achieved lower average surface distance (3,86±1,41 mm vs 8,884±6,77 mm; p&amp;lt;0,001), lower minimum surface distance (0,002±0,03 vs 0,07±0,06; p= 0,001) and lower maximum surface distance (14,16±4,37 vs 22,93±11,10; p&amp;lt;0,001). Conclusion An optimized workflow consisting of ICE LV chamber segmentation was superior in terms of 3D surface distance to aortic FAM reconstruction to obtain reliable multisource imaging registration for MDCT/CMR guided/aided VT ablation.