Abstract:Scoliosis is a 3-D deformity of spinal column, characterized by both lateral curvature and vertebral rotation. The disease can be caused by congenital, developmental, or degenerative problems; but most cases of scoliosis actually have no known cause, and this is known as idiopathic scoliosis. Vertebral rotation has become increasingly prominent in the study of scoliosis and the most deformed vertebra is named as apical vertebra. Apical vertebral deformity demonstrates significance in both preoperative and post… Show more
“…This gives raise to undesired inter-observer and intra-observer variability. So, building an accurate computer based automated measurement is essential and it is challenging for the reliable and robust assessment of scoliosis 3 , 4 . Figure 1 Scoliosis views: ( a ) normal versus scoliotic spine.…”
Analysis of scoliosis requires thorough radiographic evaluation by spinal curvature estimation to completely assess the spinal deformity. Spinal curvature estimation gives orthopaedic surgeons an idea of severity of spinal deformity for therapeutic purposes. Manual intervention has always been an issue to ensure accuracy and repeatability. Computer assisted systems are semi-automatic and is still influenced by surgeon’s expertise. Spinal curvature estimation completely relies on accurate identification of required end vertebrae like superior end-vertebra, inferior end-vertebra and apical vertebra. In the present work, automatic extraction of spinal information central sacral line and medial axis by computerized image understanding system has been proposed. The inter-observer variability in the anatomical landmark identification is quantified using Kappa statistic. The resultant Kappa value computed between proposed algorithm and observer lies in the range 0.7 and 0.9, which shows good accuracy. Identification of the required end vertebra is automated by the extracted spinal information. Difference in inter and intra-observer variability for the state of the art computer assisted and proposed system are quantified in terms of mean absolute difference for the various types (Type-I, Type-II, Type-III, Type-IV, and Type-V) of scoliosis.
“…This gives raise to undesired inter-observer and intra-observer variability. So, building an accurate computer based automated measurement is essential and it is challenging for the reliable and robust assessment of scoliosis 3 , 4 . Figure 1 Scoliosis views: ( a ) normal versus scoliotic spine.…”
Analysis of scoliosis requires thorough radiographic evaluation by spinal curvature estimation to completely assess the spinal deformity. Spinal curvature estimation gives orthopaedic surgeons an idea of severity of spinal deformity for therapeutic purposes. Manual intervention has always been an issue to ensure accuracy and repeatability. Computer assisted systems are semi-automatic and is still influenced by surgeon’s expertise. Spinal curvature estimation completely relies on accurate identification of required end vertebrae like superior end-vertebra, inferior end-vertebra and apical vertebra. In the present work, automatic extraction of spinal information central sacral line and medial axis by computerized image understanding system has been proposed. The inter-observer variability in the anatomical landmark identification is quantified using Kappa statistic. The resultant Kappa value computed between proposed algorithm and observer lies in the range 0.7 and 0.9, which shows good accuracy. Identification of the required end vertebra is automated by the extracted spinal information. Difference in inter and intra-observer variability for the state of the art computer assisted and proposed system are quantified in terms of mean absolute difference for the various types (Type-I, Type-II, Type-III, Type-IV, and Type-V) of scoliosis.
“…The AV in a scoliotic curvature is defined as the most translated vertebra in the global coordinate system on the frontal radiograph. 3,21 The AV is also the most laterally deviated vertebra from the center sacral vertical line. 15 In order to achieve better surgical outcomes, correction of scoliosis must focus on all 3 planes (frontal, sagittal, and transverse).…”
OBJECTIVEThe aim of this study was to determine if the apical vertebra (AV) in patients with adolescent idiopathic scoliosis (AIS) is the most rotated vertebra in the scoliotic segment.METHODSA total of 158 patients with AIS (Cobb angle range 20°–101°) underwent biplanar radiography with 3D reconstructions of the spine and calculation of vertebral axial rotations. The type of major curvature was recorded (thoracic, thoracolumbar, or lumbar), and both major and minor curvatures were included. The difference of levels (DL) between the level of maximal vertebral rotation (LMVR) and the AV was calculated as follows: DL = 0 if LMVR and AV were the same, DL = 1 if LMVR was directly above or below the AV, and DL = 2 if LMVR was separated by 1 vertebra or more from the AV. To investigate which factors explained the divergence of the LMVR from the AV, multinomial models were computed.RESULTSThe distribution of the DL was as follows: for major curvatures, 143 were DL = 0, 11 were DL = 1, and 4 were DL = 2; and for minor curvatures, 53 were DL = 0, 9 were DL = 1, and 31 were DL = 2. The determinants of a DL = 2 (compared with DL = 0) were lumbar curvature (compared with thoracic; adjusted OR 0.094, p = 0.001), major curvature (compared with minor; adjusted OR 0.116, p = 0.001), and curvatures with increasing apical vertebral rotation (adjusted OR 0.788, p < 0.001).CONCLUSIONSThis study showed that the AV is the most rotated vertebra in the majority of major curvatures, while in minor curvatures, the most rotated vertebra appears to be the junctional vertebra between major and minor curvatures in a significant proportion of cases.
“…* The deformity scale was based on apical vertebral rotation on radiograph. 5 Images were independently reviewed by 2 authors and discrepancies were resolved by consensus.…”
Section: Discussionmentioning
confidence: 99%
“…The degree of each patient's deformity was measured by the apical vertebral rotation method. 5 Images were independently reviewed by 2 authors (F.C.R. and H.H.D.…”
OBJECTIVEMedically refractory spasticity and dystonia are often alleviated with intrathecal baclofen (ITB) administration through an indwelling catheter inserted in the lumbar spine. In patients with cerebral palsy, however, there is a high incidence of concomitant neuromuscular scoliosis. ITB placement may be technically challenging in those who have severe spinal deformity or who have undergone prior instrumented thoracolumbar fusion. Although prior reports have described drilling through the lumbar fusion mass with a high-speed bur, as well as IT catheter implantation at the foramen magnum or cervical spine, these approaches have notable limitations. To the authors' knowledge, this is the first report of ITB placement using cone beam CT (CBCT) image guidance to facilitate percutaneous IT catheterization.METHODSData were prospectively collected on patients treated between November 2012 and June 2014. In the interventional radiology suite, general anesthesia was induced and the patient was positioned prone. Imaging was performed to identify the optimal trajectory. Percutaneous puncture was performed at an entry site with image-guided placement of a sheathed needle. CBCT provided real-time 2D projections and 3D reconstructions for detailed volumetric imaging. A biopsy drill was passed through the sheath, and subsequently a Tuohy needle was advanced intrathecally. The catheter was threaded cephalad under fluoroscopic visualization. After tip localization and CSF flow were confirmed, the stylet was replaced, the external catheter tubing was wrapped sterilely in a dressing, and the patient was transported to the operating room. After lateral decubitus positioning of the patient, the IT catheter was exposed and connected to the distal abdominal tubing with typical pump placement.RESULTSOf 15 patients with Gross Motor Function Classification System Levels IV and V cerebral palsy and instrumented thoracolumbar fusion, 8 had predominantly spasticity, and 7 had mixed spasticity and dystonia. The mean age of patients was 20.1 years (range 13–27 years). Nine patients underwent initial catheter and pump placement, and 6 underwent catheter replacement. The procedure was technically successful, with accurate spinal catheter placement in all patients. The median hospital stay was 4 days (IQR 3–5 days). One patient had an early postoperative urinary tract infection. With a mean follow-up of 25.8 months (median 26, range 18–38 months), no CSF leakage or catheter failure occurred. One late infection due to Pseudomonas aeruginosa (requiring pump explantation) occurred at 4 months, probably secondary to recurrent urinary tract infections.CONCLUSIONSImage-guided CBCT navigation resulted in accurate percutaneous placement of the IT catheter for ITB pumps in patients with prior instrumented thoracolumbar fusion. The multimodality approach is an alternate technique that may be used for IT catheter insertion in patients with complex lumbar spine anatomy, extending the potential to provide safe, durable ITB therapy in this population.
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