Spine Radiographs In Patients Research Articles

Thoracic spine deformation may predict prosthetic rehabilitation outcome.

A considerable number of patients require prosthetic ambulation, which necessitates improvements in the success rate of prosthetics. This study aimed to determine the association between the presence of thoracic spinal osteophyte on imaging and the patient's ability to walk with lower leg prosthetics. Retrospective cohort study. This study included 15 patients with lower leg amputations who underwent prosthetic rehabilitation. Medical records and spine radiographs of patients with lower leg amputations between 2013 and 2019 at a private rehabilitation hospital were reviewed. The primary outcome was achieving prosthetic ambulation with a single T-cane or without a walking aid. Poor outcomes were associated with the presence of thoracic spinal deformation (P = 0.007) and the lower Berg Balance Scale score at admission (P = .067) and discharge (P = .033) groups. Monte Carlo simulation results showed a ≥33% difference in walking achieving rate between patients with and without thoracic spinal deformity. In addition, an 18% probability was found for randomly selected persons with an amputation to show a difference of ≥1 point in Berg Balance Scale scores. Thoracic spinal deformity on radiography and Berg Balance Scale score at admission are potentially associated with successful prosthetic rehabilitation. These findings potentially affect the indications for prosthetic limbs.

Cervical spine radiographs in patients with vertigo and dizziness.

The purpose of this study is to investigate the role of cervical radiography in the study of patients with vertigo and dizziness. This is a retrospective single-institution case series study of 493 patients suffering from vertigo and dizziness who were referred (from January 2011 to December 2012) to the hospital to study those symptoms. We studied cervical radiographies, CT and MRI of the cervical spine made in the sample and the radiological findings. We analyzed demographic characteristics, presence of psychiatric pathology and emergency assistance due to vertigo in patients who have undergone cervical study. A total of 57% of patients had cervical radiography made; this was more frequent in women, Spanish people, with psychiatric pathology and who have gone to the emergency department for vertigo (p < 0.05). Degenerative changes were found in 74.1% of the patients with radiography made, more frequently at an older age, osteophytes in 49.5% and abnormal cervical lordosis in 37.1%. There are sociodemographic factors that influence in the request for cervical radiographs in patients with vertigo and dizziness. Given the suspicion of cervical vertigo, we do not consider that the findings in the radiographs help in the diagnosis. In our opinion, an excessive use of cervical radiography is made in patients with vertigo and dizziness.

Conversion coefficients for determining organ doses in paediatric spine radiography

Knowledge of organ and effective doses achieved during paediatric x-ray examinations is an important prerequisite for assessment of radiation burden to the patient. Conversion coefficients for reconstruction of organ and effective doses from entrance doses for segmental spine radiographs of 0-, 1-, 5-, 10-, 15- and 30-year-old patients are provided regarding the Guidelines of Good Radiographic Technique of the European Commission. Using the personal computer program PCXMC developed by the Finnish Centre for Radiation and Nuclear Safety (Säteilyturvakeskus STUK), conversion coefficients for conventional segmental spine radiographs were calculated performing Monte Carlo simulations in mathematical hermaphrodite phantom models describing patients of different ages. The clinical variation of beam collimation was taken into consideration by defining optimal and suboptimal radiation field settings. Conversion coefficients for the reconstruction of organ doses in about 40 organs and tissues from measured entrance doses during cervical, thoracic and lumbar spine radiographs of 0-, 1-, 5-, 10-, 15- and 30-year-old patients were calculated for the standard sagittal and lateral beam projections and the standard focus detector distance of 115 cm. The conversion coefficients presented may be used for organ dose assessments from entrance doses measured during spine radiographs of patients of all age groups and all field settings within the optimal and suboptimal standard field settings.

Digital stitching errors and the scoliosis clinic

Radiographic evaluation of the spine is an essential part of outpatient management of scoliosis. The full-length radiographs are obtained by combining or ‘stitching’ several exposures together. The stitching process can be a source of errors resulting in delays in the outpatient clinic. We describe two cases of stitching errors on full-length spine radiographs of patients seen in the outpatient scoliosis clinic. High-quality reproducible radiographs are necessary to reliably monitor the progression of deformity. Stitching errors cause delays in the scoliosis clinic and may impact the management of patients if not recognised.

Cervical spine radiographs in patients with rheumatoid arthritis undergoing anesthesia.

There is no consensus on the role of preoperative cervical spine radiographs to screen for instability in patients with rheumatoid arthritis (RA). This study aimed to evaluate the preoperative use of cervical spine radiographs in patients with RA undergoing preoperative anesthesia assessment and to determine whether preoperative radiographic findings influenced anesthesia delivery techniques. We reviewed all medical records of RA patients who underwent surgical procedures requiring general anesthesia with airway intubation or monitored anesthesia care without airway intubation. We examined cervical spine radiographs obtained up to 2 years before surgery and determined airway management techniques used during surgery. Overall, 215 patients with RA underwent 217 individual surgeries requiring anesthesia; of these, 176 (82%) underwent general anesthesia with airway management with direct laryngoscopy in 83%, fiber-optic intubation in 10%, and laryngeal mask in 7%. Ninety-two (52%) of the patients receiving airway management had radiographs available for cervical spine evaluation; of these, only 7 (8%) had complete radiographic examinations with which to evaluate possible atlantoaxial subluxation. Eighteen (20%) of the 92 patients receiving airway management had radiographic evidence of cervical spine abnormality. Multiple regression models were conducted to evaluate the association of patient demographics and airway management technique used and showed that the use of fiber-optic intubation or laryngeal mask was not influenced by radiographic results. A difficult oropharyngeal class/glottic visualization grade (3 or 4) as determined by the anesthesiologist was the only statistically significant predictor of fiber-optic intubation or laryngeal mask use. Cervical spine abnormalities were frequently noted in patients who underwent general surgery but did not influence the choice of airway management. Future prospective studies evaluating the utility of cervical spine radiographs in patients with RA and practice guidelines are needed to ensure appropriate and cost-effective perioperative cervical evaluation and management of patients with RA.

Forced Lordosis on the Thoracolumbar Junction Can Correct Coronal Plane Deformity in Adolescents With Double Major Curve Pattern Idiopathic Scoliosis

A prospective radiographic study was conducted. To support our hypothesis that correction of the scoliosis may benefit from a lordotic fulcrum force in the sagittal plane on the thoracolumbar spine. Adolescent idiopathic scoliosis is an important spinal deformity. Correction can be achieved with limited options by current bracing techniques. Lateral bending radiographs are used to assess flexibility and predict treatment outcome. The corrective potential of a lordotic fulcrum force in the sagittal plane has not been addressed. Anterioposterior spine radiographs of patients with a double major curve pattern scoliosis were obtained in 2 groups of patients. In group A radiographs in 3 positions: standing, and supine with and without fulcrum (n = 12), and group B radiographs in 2 positions (n = 28): standing, and supine with lordotic fulcrum. Cobb angles were determined and evaluated statistically. The sagittal contour of the thoracolumbar junction in standing position was measured. In group A with the patients lying supine a correction of the Cobb angle was obtained at the thoracic level of 15.4% and the lumbar level of 27.5% (P < 0.001). Adding in supine position a lordotic fulcrum on the thoracolumbar junction resulted in a coupled further correction at the thoracic level of 15.7% and lumbar 18.1% (P < 0.001). Comparing in group A the thoracic and lumbar curvatures in standing position with that on a lordotic fulcrum in supine position revealed a total reduction of 31% and 45.6%, respectively. For the independent group B this reduction in 1 step is 38% and 44.4%, respectively. Scoliotic deformities are significantly reduced in supine position by a lordotic fulcrum force on the thoracolumbar junction. These findings may have consequences on bracing techniques.

On Reliability of М.н. Mehta Prognostic Test

Objective. Validation of the Mehta sign reliability on dynamic spine radiographs of patients with progressive idiopathic scoliosis. Material and Methods. Radiographs of 65 patients with progressive idiopathic right-side thoracic scoliosis examined in dynamics were analyzed. The rib-vertebra angle difference (RVAD) was assessed in accordance with Mehta techniques, and scoliosis evolution was followed up. Results. Initial RVAD in 35 patients was less than 20°. Deformity progressed with time in all patients, and in 71 % of them it evolved into a severe form. Almost half of these patients (43 %) have a curve of 30° to 63° even at initial examination. Equality of rib-vertebra angles (RVA-L and RVA-R) does not indicate the absence of scoliosis. Nine patients (26 %) with equal RVA had the Cobb angle of deformity of 6° to 28°. Conclusion. Our findings raise doubt on reliability of the Mehta sign. Further research is necessary including series of patients with non-progressive forms of idiopathic scoliosis.

Cervical injury in head trauma

Criteria for excluding cervical spine injury in patients who have sustained blunt head or neck trauma were prospectively studied at four hospitals in the Chicago area. The authors attempted to define a subset of these adult patients who, based on clinical criteria, could reliably be excluded from cervical spine radiography, thus avoiding unnecessary radiation and saving considerable time and money in their evaluation. Patients fell into four groups: (1) patients who were awake, alert, and had no complaint of neck pain or tenderness on physical examination: (2) patients who were awake, alert, but had complaint of neck pain or tenderness on physical examination laterally over the trapezius muscle only: (3) patients who were awake, alert, but had complaint of central neck pain or tenderness on physical examination over the cervical spine or center of the neck; and (4) patients who were not fully awake or alert, were clinically intoxicated, had other painful or distracting injuries, or had focal neurologic findings. Patients in group 4 had significantly more fractures (21/387) when compared with all other patients (7/478). Patients with central neck pain or tenderness (group 3) had significantly more fractures ( 7 237 ) than patients without pain or tenderness or with these findings limited to the trapezius area (0/236). It is clear that patients who have altered mental status, abnormal examination findings, distracting injury, or pain or tenderness over the cervical spine must have cervical spine radiographs. In a patient who is awake, alert, has normal physical examination findings, is undistracted by other painful injuries, and has no pain or tenderness in the neck or these findings are limited to the trapezius area, there is less than 1% chance of a cervical spine fracture, with a 90% confidence limit. Our data strongly suggest we can modify our use of cervical spine radiographs in patients sustaining blunt head trauma without subjecting patients to undue risk.

Spine radiographs in patients with low-back pain. An epidemiological study in men.

A cohort of 321 men between the ages of eighteen and fifty-five was randomly selected from a group of 1221 men who had been surveyed by a questionnaire. They then had radiographs made of the lumbar spine. Of the 292 subjects fulfilling the criteria for inclusion in the study, ninety-six (32.9 per cent) had never had low-back pain, 134 (45.9 per cent) had had or were having moderate low-back pain, and sixty-two (21.2 per cent) had had or were having severe low-back pain. In the three groups there was a similar frequency of transitional vertebrae, Schmorl's nodes, the disc vacuum sign, narrowing of the disc space between the third and fourth lumbar and the fifth lumbar and first sacral vertebrae, and claw spurs. When there were traction spurs or disc-space narrowing, or both, between the fourth and fifth lumbar vertebrae, an increased incidence of severe low-back pain was evident. There also was a significant association of these two radiographic findings with symptoms (pain, weakness, and numbness) in the lower limbs. The measured lumbar lordosis, the length of the transverse process of the fourth lumbar vertebra, and the relationship between the fourth and fifth lumbar vertebral bodies with reference to the intercristal line had no association with the low-back pain. Increased lumbar lordosis had a significant association with decreased disc-space height and wedging deformity of the disc between the fourth and fifth lumbar vertebrae.(ABSTRACT TRUNCATED AT 250 WORDS)