Vertebral Line Research Articles

THE ASSOCIATION BETWEEN FACET JOINT TROPISM AND LUMBAR DISC HERNIATION

ABSTRACT Background/Aims: Facet joint tropism is thought to be associated with lumbar disc herniation (LDH), but this relationship has not been fully established. The aim of this study was to investigate the relationship between facet joint tropism and LDH in patients (25-30 years old and body-mass index 28-30 kg/m²) using computed tomography (CT) and lumbar magnetic resonance imaging (MRI). Methods: Facet joint angles were measured on lumbar MRI and CT images of 24 male patients with left-sided LDH; 16 patients with right-sided LDH. Facet joint angle was measured by calculating the angle of the facet joints with the vertebral sagittal line in axial sections parallel to the end plate plane. Patients with trauma, rheumatic and oncologic diseases, additional lumbar or spinal and systemic diseases, patients with far lateral, foraminal and central lumbar disc herniations were excluded. Results: The mean left facet joint angle was 44,56º+/-11,29° and the mean right facet joint angle was 41,2º+/-11,27° in 24 patients with left-sided LDH. In 16 patients with right-sided LDH, the mean right facet joint angle was 45,87º +/-16,41°and the mean left facet joint angle was 42,74º+/-12,54°. Conclusions: In the statistical evaluation, no significant correlation was found between LDH and facet joint angle, but in the numerical analysis, it was observed that the left facet joint angle was larger in patients with left-sided LDH and the right facet joint angle was larger in patients with right-sided LDH.

ULTRASOUND MEASUREMENT OF THE VERTEBRAL LEVEL OF TUFFIERS LINE IN ELDERLY WOMEN (A COMPARITIVE CROSS SECTIONAL STUDY)

Background:Sometimes , generalizing the vertebral level which is determined by palpation in patients across all the age groups may be inaccurate. This study has aimed to compare the vertebral level intersected by the Tuffiers line in elderly women versus adult womenutilizing an ultrasound in the left lateral decubitus flexed position, to provide a more precise understanding of the potential age-related differences . Methods:We enrolled 50 female patients over the age of 65 (elderly group) and 50 female patients between ages 20-50 (control group) who had been scheduled to undergo surgeries under spinal Anaesthesia. Using ultrasound, we marked the L2–L5 lumbar spinous processes and intervertebral spaces. The most cephalad part was labeled as 1 and the most caudal part was labeled 11. We then identified to which line of these vertebral levels Tuffiers line crossed using an ultrasound. Results:In the elderly group, the median vertebral level of Tuffiers line was found to be located at L2-L3 (median value = 3), whereas in the control group, it was situated at the lower part of L4 (median value = 8). Moreover, asignificant correlation was found between the vertebral level of Tuffiers line and age, weight and BMI in the elderly group (P < 0.001), indicating a significant association between these factors. Conclusions:The ultrasound measurement in the left lateral decubitus flexed position revealed that the Tuffiers line was situated more cranially (towards the head) in elderly women compared to the control group. This indicates that the needle may inserted at a higher level than anticipated, indicating the importance of careful level determination during spinal Anaesthesia in elderly women to avoidcomplications.

Appropriate pelvic obliquity measurement method in Lenke type 5C adolescent idiopathic scoliosis: a preliminary study.

Although pelvic obliquity (PO) is a risk factor for postoperative coronal decompensation in corrective surgery in adolescent idiopathic scoliosis (AIS), especially Lenke 5C, methods of measuring PO are controversial. This study aimed to establish an appropriate measurement method using multiplanar reconstructed computed tomography (MPR-CT) images instead of standing posteroanterior (PA) whole-spine radiographs to evaluate PO in patients with Lenke 5C AIS. This study was a retrospective cross-sectional study. Twenty-five patients who underwent corrective surgery for AIS in Osaka University Hospital from August 2014 to February 2023 were included. Cobb angle, L5 tilt, C7 plumb line to center sacral vertebral line (C7PL-CSVL), and leg length discrepancy (LLD) were measured on standing PA whole-spine radiographs preoperatively. Sacral obliquity (SO), the slope of the upper endplate of S1, and iliac obliquity (IO), the tilt of the line connecting the iliac crests, were measured on standing PA whole-spine radiographs and MPR-CT (SO/IO-X-ray, SO/IO-CT, respectively). S1 angle and S2 angle were measured on CT. The mean age of the patients was 18.7±3.9 years and all of them were females. SO-X-ray and SO-CT were larger than IO-X-ray and IO-CT, respectively. SO-X-ray was highly correlated with SO-CT (r=0.838, P<0.001). L5 tilt had higher correlation with SO-CT (r=0.884, P<0.001) than with SO-X-ray (r=0.726, P=0.001) and IO-CT (r=0.550, P=0.22). L5 tilt was correlated poorly with IO-X-ray (r=0.104, P=0.69). The S1 angle was 4.5±3.5° meanwhile the S2 angle was 1.2±2.1°, the sacral deformity was mainly due to the S1 vertebral wedging. Given the asymmetric sacral morphology, SO is more appropriate pelvic parameter than IO to represent the sacral tilt of Lenke 5C AIS, especially when measured using CT images to overcome the poor visibility on PA whole-spine radiographs.

Description of a new karst-adapted species of the subgenus Japonigekko (Squamata: Gekkonidae: Gekko) from Guangxi, southern China

Abstract A new species of the genus Gekko Laurenti, 1768, Gekko paucituberculatussp. nov., is described here, based on two specimens from Tianyang District, Baise City, Guangxi Zhuang Autonomous Region, China. It was placed in subgenus Japonigekko on the basis of morphological and molecular phylogenetic analysis and can be distinguished from all congeners in this subgenus by significant divergences in the mitochondrial 16S and ND2 genes and by a combination of the following morphological characters: Moderate body size, SVL 77.2 mm in the adult male and SVL 85.9 mm in the adult female; tubercles only present along dorsolateral trunk and absent on other regions; fingers and toes with weak webbing; continuous precloacal pores 12 in the male, absent in the female; a single postcloacal tubercle on each side; a light-coloured vertebral line from nape to tip of tail; dorsum greyish-brown, with 7–8 dirty-white bands between nape and sacrum. Meanwhile, the distribution of G. palmatus in China has been confirmed as occurring in Guangxi and Guangdong Provinces. This study brings the total species of the subgenus Japonigekko in China to 19.

A Dual Coordinate System Vertebra Landmark Detection Network with Sparse-to-Dense Vertebral Line Interpolation.

Precise surveillance and assessment of spinal disorders are important for improving health care and patient survival rates. The assessment of spinal disorders, such as scoliosis assessment, depends heavily on precise vertebra landmark localization. However, existing methods usually search for only a handful of keypoints in a high-resolution image. In this paper, we propose the S2D-VLI VLDet network, a unified end-to-end vertebra landmark detection network for the assessment of scoliosis. The proposed network considers the spatially relevant information both from inside and between vertebrae. The new vertebral line interpolation method converts the training labels from sparse to dense, which can improve the network learning process and method performance. In addition, through the combined use of the Cartesian and polar coordinate systems in our method, the symmetric mean absolute percentage error (SMAPE) in scoliosis assessment can be reduced substantially. Specifically, as shown in the experiments, the SMAPE value decreases from 9.82 to 8.28. The experimental results indicate that our proposed approach is beneficial for estimating the Cobb angle and identifying landmarks in X-ray scans with low contrast.

A new bullfrog from southern Africa (Pyxicephalidae, Pyxicephalus Tschudi, 1838)

ABSTRACT Four species of African bullfrogs are currently recognised. We describe a new species from southern Africa, which can be distinguished on the basis of morphology, advertisement call and DNA sequences. Morphologically it differs from other bullfrogs by a combination of characteristics including a tympanum that is smaller or equal in size to the eye, and smaller in diameter than the space between eye and tympanum, presence of a white dot on the tympanum, longitudinal skin ridges with speckling between dorsal mottles, pale vertebral line usually present, absence of cream coloured lateral stripes, absence of a pale interorbital-bar, upper jaw-barring absent or faint. It has been confirmed from north-eastern Namibia, southern Angola and north-western Botswana. Three further undescribed species are recognised but not formally named, pending further investigation. We confirm the genetic distinctiveness of P. angusticeps.

Specifying the Starting Point for S1 Iliosacral Screw Placement in the Dysmorphic Sacrum.

Sacral dysmorphism is not uncommon and complicates S1 iliosacral screw placement partially because of the difficulty of determining the starting point accurately on the sacral lateral view. We propose a method of specifying the starting point. The starting point for the S1 iliosacral screw into the dysmorphic sacrum was specifically set at a point where the ossification of the S1/S2 intervertebral disc (OSID) intersected the posterior vertebral cortical line (PVCL) on the sacral lateral view, followed by guidewire manipulation and screw placement on the pelvic outlet and inlet views. Computer-simulated virtual surgical procedures based on pelvic computed tomography (CT) data on 95 dysmorphic sacra were performed to determine whether the starting point was below the iliac cortical density (ICD) and in the S1 oblique osseous corridor and to evaluate the accuracy of screw placement (with 1 screw being used, in the left hemipelvis). Surgical procedures on 17 patients were performed to verify the visibility of the OSID and PVCL, to check the location of the starting point relative to the ICD, and to validate the screw placement safety as demonstrated with postoperative CT scans. In the virtual surgical procedures, the starting point was consistently below the ICD and in the oblique osseous corridor in all patients and all screws were Grade 1. In the clinical surgical procedures, the OSID and PVCL were consistently visible and the starting point was always below the ICD in all patients; overall, 21 S1 iliosacral screws were placed in these 17 patients without malpositioning or iatrogenic injury. On the lateral view of the dysmorphic sacrum, the OSID and PVCL are visible and intersect at a point that is consistently below the ICD and in the oblique osseous corridor, and thus they can be used to identify the starting point. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Discovery of a new cryptic Achalinus Peters, 1869 (Serpentes, Xenodermidae) species from Hunan Province, China.

A new species, Achalinusshenisp. nov., from central Hunan Province is described, based on the results of molecular systematics and morphological characters according to five specimens. Our molecular phylogeny inferred from the mitochondrial CO1 gene fragment revealed that this new species is most closely related to A.yunkaiensis, but a considerable amount of genetic divergence exists between them (p-distance ranging from 5.8% to 6.4%) and much distinct genetic divergence exists compared with other known Achalinus species (p-distance ranging from 10.4% to 15.8%), supporting its validity. Morphologically, it can be distinguished from its congeners by: (1) dorsal scales strongly keeled, 23 rows throughout the body, the outmost row smooth and significantly enlarged; (2) tail relatively short, TaL/TL 0.183 ~ 0.224; (3) the suture between internasals subequal to the suture between prefrontals; (4) loreal one, subrectangular, LorH/LorL 0.53 ~ 0.57; (5) ventrals 161-170, anal entire, subcaudals 55-61, not paired; (6) the length of supraocular equal to or longer than the length of upper anterior temporal; and (7) vertebral line inconspicuous and subcaudal streak absent. Currently, 27 species of Achalinus are known in the world, amongst which 20 species are distributed in China. Moreover, a key to species of the genus Achalinus is provided in this study.

Phenotypic variations among Laudakia stellio populations in Anatolia: Colour, colour pattern, and phylogeny (Reptilia: Agamidae)

We examined the phenotypical intra- and inter-populational variation of Laudakia stellio, one of the most-studied agamids, which is widely distributed in Anatolia in order to reveal the qualitative and quantitative aspects of the morphological differences among populations. We used for the quantification of colouration of different body parts colour palettes with the RGB (Red-Green-Blue) colour scale and prepared colour histograms. The populations were compared with Principal Component Analyses (PCA). We found that the 1st dorsal pattern which is the first of 4-5 star-like pattern throughout the vertebral line, provides information about the sex of the individual and the geographic location of the population. PCA graphs revealed the colouration differences between localities of dorsal, lateral, ventral head and dorsal body regions. A phylogenetic analysis of the mitochondrial ND4 marker revealed four different lineages, namely Hatay, Adana-Mersin-Konya, Burdur-Denizli and Manisa-İzmir-Çanakkale. Noting the need for new studies with different genes, our results show that colouration and quantitative morphology are supported by phylogeny in L. stellio populations, especially in terms of subspeciation.

Post-Maturity Progression in Adolescent Idiopathic Scoliosis Curves of 40° to 50°.

Adolescent idiopathic scoliosis (AIS) curves of 50° to 75° are inclined to progress and are thus indicated for surgery. Nevertheless, the natural history of curves of 40° to 50° following skeletal maturity remains uncertain and presents a clinical dilemma. The aim of this study was to determine the prevalence, rate, and prognostic indicators of curve progression within this patient group. This was a retrospective study of 73 skeletally mature patients with AIS. Following yearly or more frequent follow-up, patients were stratified as having no progression (<5° increase) or progression (≥5° increase). Those with progression were further differentiated as having standard progression (<2° increase/year) or fast progression (≥2° increase/year). Radiographic parameters (coronal balance, sagittal balance, truncal shift, apical translation, T1 tilt, apical vertebral wedging) and height were determined on skeletal maturity. Parameters that were significantly associated with progression were subject to receiver operating characteristic (ROC) curve analysis. The average period of post-maturity follow-up was 11.8 years. The prevalence of progression was 61.6%. Among those with progression, the curve increased by a mean of 1.47° ± 1.22° per year, and among those with fast progression, by 3.0° ± 1.2° per year. Thoracic apical vertebral wedging (concave/convex vertebral height × 100) was more apparent in those with progression than in those without progression (84.1 ± 7.5 versus 88.6 ± 3.1; p = 0.003). Increased coronal imbalance (C7 plumb line to central sacral vertebral line) differentiated those with fast progression from others (16.0 ± 11.0 versus 8.7 ± 7.7 mm; p = 0.007). An ROC curve of height-corrected coronal balance demonstrated an area under the curve (AUC) of 0.722, sensitivity of 75.0%, and specificity of 72.5% in identifying fast progression. An ROC curve of height-corrected coronal balance together with apical vertebral wedging to identify those with progression demonstrated an AUC of 0.746, with specificity of 93.7% and sensitivity of 64.5%. While the majority of curves progressed, the average rate of progression was slow, and thus, yearly observation was a reasonable management approach. Upon validation in larger cohorts, apical wedging and coronal imbalance may identity patients suited for closer monitoring and early spinal fusion. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Morphometry of Arch of Aorta and its Branches- A Cadaveric Cross-sectional Study

Introduction: The Arch of Aorta (AA) originates from the ascending aorta in the superior mediastinum, specifically at the level of the right 2nd costal cartilage, behind the lower half of the manubrium sterni. The AA typically gives rise to three major arteries, namely the brachiocephalic trunk, left common carotid, and left subclavian, which is the most common branching pattern. Aim: To investigate the morphometric parameters of the AA and its branches, including the diameters, angles formed by the branches with the AA, and the distance of origin of these branches from the mid vertebral line. Materials and Methods: This descriptive observational cross- sectional study was conducted in the Department of Anatomy at NRI Medical College, Guntur, Andhra Pradesh, India,, from June 2017 to August 2021. A total of 50 aortic arches, along with their branches, were examined from cadavers (45 males, 5 females) assigned to 1st-year MBBS students for regular dissection practicals. Measurements such as the diameter of the arch at its origin and termination, diameter of major vessels at their origin, angles made by major vessels at their origin with the convexity of the arch, and the distance of origin of major branches from the midvertebral line were recorded. Vernier calipers with an accuracy of 0.01 mm were used to measure various parameters, and angles were measured using a Goniometer. Mean and Standard Deviation (SD) were calculated for each parameter using an MS Excel sheet. Results: The distance of origin of the brachiocephalic trunk from the midvertebral line was found to be 1.86±5.13 mm to the right of the midline, while the distance of origin of the Left Common Carotid Artery (LCCA) and Left Subclavian Artery (LSA) from the midvertebral line were +12.68±6.43 mm and +26.31±6.73 mm, respectively. The diameters of the mentioned branches at their origin were 11.22±2.29 mm, 7.39±1.49 mm, and 8.38±2.15 mm, and the angles made by these branches with the aortic arch were 89.10±18.48, 73.52±14.55, and 73.93±16.80 degrees, respectively. Conclusion: The morphometric parameters of the AA and its branches, as observed in the present study, hold significant clinical importance and can be valuable for cardiothoracic and vascular surgeons working in this region.

Morphometry of Arch of Aorta and its Branches- A Cadaveric Cross-sectional Study

Introduction: The Arch of Aorta (AA) originates from the ascending aorta in the superior mediastinum, specifically at the level of the right 2nd costal cartilage, behind the lower half of the manubrium sterni. The AA typically gives rise to three major arteries, namely the brachiocephalic trunk, left common carotid, and left subclavian, which is the most common branching pattern. Aim: To investigate the morphometric parameters of the AA and its branches, including the diameters, angles formed by the branches with the AA, and the distance of origin of these branches from the mid vertebral line. Materials and Methods: This descriptive observational cross- sectional study was conducted in the Department of Anatomy at NRI Medical College, Guntur, Andhra Pradesh, India,, from June 2017 to August 2021. A total of 50 aortic arches, along with their branches, were examined from cadavers (45 males, 5 females) assigned to 1st-year MBBS students for regular dissection practicals. Measurements such as the diameter of the arch at its origin and termination, diameter of major vessels at their origin, angles made by major vessels at their origin with the convexity of the arch, and the distance of origin of major branches from the midvertebral line were recorded. Vernier calipers with an accuracy of 0.01 mm were used to measure various parameters, and angles were measured using a Goniometer. Mean and Standard Deviation (SD) were calculated for each parameter using an MS Excel sheet. Results: The distance of origin of the brachiocephalic trunk from the midvertebral line was found to be 1.86±5.13 mm to the right of the midline, while the distance of origin of the Left Common Carotid Artery (LCCA) and Left Subclavian Artery (LSA) from the midvertebral line were +12.68±6.43 mm and +26.31±6.73 mm, respectively. The diameters of the mentioned branches at their origin were 11.22±2.29 mm, 7.39±1.49 mm, and 8.38±2.15 mm, and the angles made by these branches with the aortic arch were 89.10±18.48, 73.52±14.55, and 73.93±16.80 degrees, respectively. Conclusion: The morphometric parameters of the AA and its branches, as observed in the present study, hold significant clinical importance and can be valuable for cardiothoracic and vascular surgeons working in this region.

Oblique Lateral Lumbar Interbody Fusion at L2-L5: Proposal of a New CT-based Preoperative Assessment to Minimize Risks

Objective: Oblique anterior to psoas (ATP) lumbar fusion is associated with advantages such as sufficient indirect decompression and restoration of lordosis. However, the ATP approach risks damaging the vascular elements anterior to the spine, and it requires a complicated left oblique surgical corridor that puts the contralateral neural elements at risk. Therefore, a thorough preoperative assessment of the location of entry into the disc space, a feasible trajectory to complete the intervertebral space procedure, and the possible retraction of the psoas muscle under these conditions are considered in this article.Methods: From January 2019 to January 2020, 160 lumbar CT scans were evaluated. Only 124 images from the L2-L3, L3-L4, and L4-L5 levels met the inclusion criteria. The length of the anterior vertebral line (AVL) and the middle-third of the disc in the anteroposterior axis were measured to localize the entry point (EP). The distance between the anterior arterial vessel (AV) and the EP was also measured. The trajectory commonly used to set the surgical instruments into the disc space was called α, and a new proposed trajectory termed β was calculated. The psoas cross-sectional area anterior to the β angle trajectory was measured to determine any possible retraction using this parameter. Results: The AVL-EP distances were L2-L3 11.49±0.89 mm, L3-L4 11.54±0.88 mm, and L4-L5 11.57±0.87 mm. The AV-EP lengths were 17.64±5.62 mm, 19.36±5.49 mm, and 16.48±6.47 mm at L2-L3, L3-L4, and L4-L5, respectively. The average α and β trajectory angles reported were 39.91º and 14.48º, respectively. Psoas muscle retraction was primarily noted at the L4-L5 level. Conclusion: This article’s proposed parameters represent a routine preoperative safety assessment in patients previously selected for oblique ATP lumbar fusion.

Effectiveness of nasotracheal intubation in anterior cervical surgery including C3 lesions

Objective Anterior approach cervical surgery is widely used for accessing C3 lesions. When operating with an anterior approach, the surgical field is obstructed by mandible. Neck extension is popular method to secure better surgical field but risk devastating neurological damage. To overcome this limited surgical field without neck extension, we adopted nasotracheal intubation and evaluated its efficiency. Methods We retrospectively analyzed 16 patients who underwent anterior cervical discectomy or corpectomy of C3 lesions via nasotracheal intubation. We enrolled an additional 29 patients who underwent anterior cervical discectomy or corpectomy of C3 lesions via orotracheal intubation as a control group. All patients had been diagnosed with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. We measured the mandibular-cervical angle, which is the angle between the lower mandibular line and anterior vertebral line. Results The mandibular-cervical angle was increased by 7.3 with nasotracheal intubation compared to orotracheal intubation. Conclusions Nasotracheal intubation is an effective surgical option for securing the surgical field without neck extension in anterior cervical surgery including C3 lesions.

An unusual body colouration of Ceylon roughside snake (Aspidura ceylonensis)

The small sized, non-venomous, and fossorial colubrid snake genus Aspidura Wagler, 1830 is endemic to Sri Lanka. Aspidura ceylonensis (Günther, 1858) is rare and restricted to mid-elevation to montane and sub-montane forests at elevation of 500–1300 m a.s.l. in the Central Highlands and the Knuckles massif. It is found in cool and well-shaded forest areas, with thick moist leaflitter, woody debris, and loose soil. The usual adult body coloration on dorsum is dark reddish or dark orange, rarely yellowish, with a continuous black vertebral line and two rows of dorsolateral black spots along the body.

Accuracy of vertebral puncture in percutaneous vertebroplasty

PurposeTo clarify the accuracy of vertebral puncture of the vertebral tertile area needling (VETERAN) method puncturing the pedicle superimposed on one-third of the width between the lateral vertebral line to the contralateral medial lamina line compared with Cathelin-needle-assisted puncture (CAP) method puncturing using the Cathelin needle as a guide in percutaneous vertebroplasty.Materials and methods449 punctures by CAP method and 125 punctures by VETERAN method were enrolled. We compared the puncture accuracy of both methods. We estimated a vertebral estimated tilting ratio (VET-ratio) defined as ratio of the distance between the lateral vertebral line and the contralateral medial laminal line to the distance between the vertebral lateral line and the puncture point measured by computed tomography. We also estimated the procedural items and clinical outcomes.ResultsVETERAN method with 100% of punctures within safe zone (cortical breaches within 2 mm) had significantly higher accuracy than CAP method with 97.8% (p < 0.01) for the 2 mm incremental evaluation. No cases with a VET-ratio of 36% or less had cortical breaches. VETERAN method had shorter operative time per puncture (p < 0.01) and exposure time per puncture (p < 0.05).ConclusionVETERAN method reduced the occurrence of the inaccurate puncture, operative times, and exposure times. A VET-ratio with 36% or less is associated with a safe puncture using VETERAN method.

A new species of Homonota (Squamata: Gekkota: Phyllodactylidae) from Paraguay

The 12 recognized species of the genus Homonota are geographically restricted to central and southern South America in Argentina, Brazil, Uruguay, Bolivia, and Paraguay. The phylogenetic relationships within the genus are well known where three groups are identified, each of them containing four species: the whitii group (Homonota darwinii, H. williamsii, H. whitii, and H. andicola), the borellii group (H. borellii, H. taragui, H. rupicola, and H. uruguayensis) and the horrida group (H. horrida, H. underwoodi, H. septentrionalis, and H. marthae). During fieldwork in Paraguay, we found a specimen of Homonota with unique morphological and geographical traits. Thus, we performed a comparative morphological analysis against specimens housed in different Paraguayan collections. Additionally, we performed a DNA analysis of our specimen to assess its relationships within the genus. Results suggest that this specimen represents a new species of the Homonota horrida group based on molecular and morphological evidence. The new species is characterized by a robust body, 10 longitudinal rows of strongly keeled scales separated by one or two granular scales, square-shaped mental scales, small postmental scales, one or two rows of rectangular scales in the upper eye scales, rostral scale divided, edge of auditory meatus serrated posteriorly, and black and brown background coloration with one white vertebral line and seven white transverse bands. The new species is restricted to Paraguarí Department, characterized by herbaceous grasslands with rocky outcrops.

Combining 3D Structured Light Imaging and Spine X-ray Data Improves Visualization of the Spinous Lines in the Scoliotic Spine

Scoliosis is a three-dimensional trunk and spinal deformity. Patient evaluation is essential for the decision-making process and determines the selection of specific and adequate treatment. The diagnosis requires a radiological evaluation that exposes patients to radiation. This exposure reaches hazardous levels when numerous, repetitive radiographic studies are required for diagnostics, monitoring, and treatment. Technological improvements in radiographic devices have significantly reduced radiation exposure, but the risk for patients remains. Optical three-dimensional surface topography (3D ST) measurement systems that use surface topography (ST) to screen, diagnose, and monitor scoliosis are safer alternatives to radiography. The study aimed to show that the combination of plain X-ray and 3D ST scans allows for an approximate presentation of the vertebral column spinous processes line in space to determine the shape of the spine’s deformity in scoliosis patients. Twelve patients diagnosed with scoliosis, aged 13.1 ± 4.5 years (range: 9 to 20 years) (mean: Cobb angle 17.8°, SD: ±9.5°) were enrolled in the study. Patients were diagnosed using full-spine X-ray and whole torso 3D ST. The novel three-dimensional assessment of the spinous process lines by merging 3D ST and X-ray data in patients with scoliosis was implemented. The method’s expected uncertainty is less than 5 mm, which is better than the norm for a standard measurement tool. The presented accuracy level is considered adequate; the proposed solution is accurate enough to monitor the changes in the shape of scoliosis’s spinous processes line. The proposed method allows for a relatively precise calculation of the spinous process lines based on a three-dimensional point cloud obtained with a four-directional, three-dimensional structured light diagnostic system and a single X-ray image. The method may help reduce patients’ total radiation exposure and avoid one X-ray in the sagittal projection if biplanar radiograms are required for reconstructing the three-dimensional line of the spinous processes line.

What Is the Ideal Entry Point for Transforaminal Endoscopic Lumbar Discectomy?

ObjectiveThe method of approach during transforaminal endoscopic lumbar discectomy (TELD) has been the subject of repeated study. However, the ideal entry point during TELD has not been studied in detail. Therefore, this study investigated the ideal entry point for avoiding complications using computed tomography (CT) scans obtained from patients in the prone position. MethodsUsing CT scans obtained from patients in the prone position, we checked for retroperitoneal or visceral violations and measured the angles of approach with five conventional approach lines drawn on axial CT scans at each disc space level (L2–3, L3–4, and L4–5). We also determined the ideal entry point distance and approach angles for avoiding retroperitoneal or visceral violations. Correlation analysis was performed to identify the patient characteristics related to the ideal entry point properties. ResultsWe found that the far lateral approach at the L2–3 level resulted in high rates of visceral violation. However, rates of visceral violation at the L3–4 and L4–5 levels were remarkably low or absent. The ideal angles of approach decreased moving caudally along the spine, and the ideal entry point distances increased moving caudally along the spine. Weight, body mass index (BMI), and the depth of the posterior vertebral line from the skin were positively associated with the distance of the ideal entry point from the midline. ConclusionWe reviewed the risk of the extreme lateral approach by analyzing rates of retroperitoneal and visceral violations during well-known methods of approach. We suggested an ideal entry point at each level of the lumbar spine and found a positive correlation between the distance of the entry point to the midline and patient characteristics such as BMI, weight, and the depth of the posterior vertebral line from the skin.

It is not just about the frontal plane: sagittal parameters impact curve progression in AIS patients undergoing brace treatment.

Retrospective cohort study. The purpose of this study was to explore the association between pre-brace and in-brace sagittal parameters and curve progression. To date, there has been no published research focused on spinopelvic sagittal parameters and bracing outcomes in AIS. We hypothesize that sagittal spinopelvic parameters are associated with curve progression at 2years. This study included AIS patients with a pre-brace (PB) major curve between 20° and 45°. The outcome was defined as > 10° curve progression or surgery within 2years of brace initiation. Spinopelvic parameters included C7-Central Sacral Vertebral Line shift (C7-CSVL), thoracic trunk shift, lumbar lordosis (LL), pelvic incidence (PI), T2-T12 thoracic kyphosis (TK) pelvic incidence-lumbar lordosis (PI-LL) mismatch, sagittal vertical axis (SVA), and pelvic tilt (PT). Of 50 patients included in this review, [70% Rigo (RCSO) and 30% Boston (BSO)], 16 (32%) patients demonstrated progression (23% of patients with RCSO vs 53% with BSO; p = 0.034). In patients with more than 30% major coronal curve correction (CCC), 23% had progression. 45% of patients progressed when they achieved ≤ 30% correction (p = 0.108). Among PB sagittal parameters and adjusting for coronal curve, patients with an abnormal PB SVA had 3.1 times increased risk of treatment failure compared with patients who had a normal PB SVA. Patients with PB hypo-LL had a 2.8 times increased risk of treatment failure compared with patients who had normal or hyper-LL. Among IB sagittal parameters, patients who had a normal PB PI-LL had a 3.9 times increased risk of treatment failure when they became mismatched in-brace (IB). Patients who had normal pre-brace kyphosis who became hypo-kyphotic IB had an 8.4 times increased risk of treatment failure compared with patients who maintained normal TK or became hyper-kyphotic. These data suggest that we should pay careful attention to sagittal parameters prior to and during brace treatment as braces can control these parameters. Level III.