Aesthetic acceptance equals to nature's compensation plus surgical correction.

PubMed

Vadgaonkar, Vaishali; Gangurde, Parag; Karandikar, Anita; Mahajan, Nikhil

2013-07-25

Orthognathic surgery has become an acceptable treatment plan for patients with various maxillofacial deformities. The rehabilitation of severe class III adult patients requires a complex interdisciplinary orthodontic and orthognathic approach. This presentation aims to show a case of combination of camouflage and bilateral sagittal split osteotomy (BSSO).Camouflage in maxillary arch was accepted after analysing visual treatment objective (VTO) and pleasing soft tissue compensation which gave us the clue to go ahead for surgical correction of excess mandibular length to achieve best aesthetic outcome while maintaining nature's compensation in upper arch.

Operative time, blood loss, hemoglobin drop, blood transfusion, and hospital stay in orthognathic surgery.

PubMed

Salma, Ra'ed Ghaleb; Al-Shammari, Fahad Mohammed; Al-Garni, Bishi Abdullah; Al-Qarzaee, Mohammed Abdullah

2017-06-01

This study was conducted to evaluate the operative time, blood loss, hemoglobin drop, blood transfusion, and length of hospital stay in orthognathic surgery. A 10-year retrospective analysis was performed on patients who underwent bilateral sagittal split osteotomy (with or without genioplasty), Le Fort I osteotomy (with or without genioplasty), or any combination of these procedures. A total of 271 patients were included. The age range was 17 to 49 years, with a mean age of 24.13 ± 4.51 years. Approximately 62% of patients underwent double-jaw surgery. The most common procedure was bilateral sagittal split with Le Fort I (37%). The average operative time was 3.96 ± 1.25 h. The mean estimated blood loss was 345.2 ± 149.74 mL. Approximately 9% of patients received intraoperative blood transfusion. The mean hemoglobin drop in the non-transfusion cases was 2.38 ± 0.89 g/dL. The mean postoperative hospital stay was 1.85 ± 0.83 days. Only one patient was admitted to the ICU for one night. In orthognathic surgery, blood loss is relatively minor, blood transfusion is frequent, and ICU admission is unlikely. Operative time, blood loss, blood transfusion, and the complexity of the surgical procedure can significantly increase the length of hospital stay. Males may bleed more than females in orthognathic surgery. Hemoglobin drop can be overestimated due to hemodilution in orthognathic surgery, which may influence the decision to use blood transfusion.

Soft tissue changes and its stability as a sequlae to mandibular advancement.

PubMed

Uppada, Uday Kiran; Sinha, Ramen; Reddy, D Sreenatha; Paul, Dushyanth

2014-01-01

To predict the changes and evaluate the stability that occurs in the soft tissues following the skeletal movement subsequent to surgical advancement of the mandible through bilateral sagittal split osteotomy and to provide the patient reliable information with regard to esthetic changes that can be expected following the treatment. Twenty adult patients diagnosed with skeletal class II malocclusion and underwent bilateral sagittal split osteotomy for mandibular advancement by a mean of 8 mm using rigid fixation were included in the study. Soft tissue changes brought about by the surgical procedure and their stability over a period of time were evaluated prospectively using 12 linear (4 vertical and 8 horizontal) and 4 angular measurements on profile cephalograms which were taken preoperatively after the pre-surgical orthodontics (T1) and postoperatively with duration of 1 month (T2) and 6 months (T3) respectively. It was observed that compared to the linear measurements, the angular measurements showed significant changes. The improvement in the esthetic outcome is a direct reflection of the angular changes whereas the linear changes played a contributing role. Following mandibular advancement surgery the profiles of the patients was perceived to have improved with reduction in the facial convexity, an increase in the lower facial height, decrease in the depth of the mentolabial sulcus and improvement in the lip competency with lengthening, straightening and thinning of the lower lip. The soft tissue response and its stability depends on the stability of the surgical procedure itself, postsurgical growth and remodeling of the hard tissues and soft tissue changes as a result of maturation and aging.

Post-Traumatic Bifrontoparietal Extradural Hematoma with Superior Sagittal Sinus Detachment: A Case Report and Review of the Literature.

PubMed

Giannakaki, Venetia; Triantafyllou, Triantafyllos; Drossos, Dimitrios; Papapetrou, Konstantinos

2016-09-01

To present, to our knowledge, the first case of a single bilateral extradural hematoma due to superior sagittal sinus detachment that was treated conservatively with an excellent outcome. Bilateral extradural hematomas are a rare condition, accounting for only 2%-5% of all extradural hematomas. They can be either 2 distinct hematomas on either side or 1 single bilateral hematoma mostly due to sagittal sinus injury, with the latter being the most rare owing to the firm attachment of the sinus to its subperiosteal loggia. These hematomas usually require immediate surgical evacuation, as patients present with decreased level of consciousness, and have good postoperative outcomes. We present a bilateral extradural hematoma due to superior sagittal sinus injury, which was treated conservatively. The patient had an excellent recovery, with no residual neurological deficits and a Glasgow outcome scale of 5 on discharge. Bilateral extradural hematomas due to superior sagittal sinus injury almost always require surgical intervention. We present a patient who was treated conservatively with an excellent outcome and we also perform a review of the current literature. Copyright © 2016 Elsevier Inc. All rights reserved.

Aesthetic acceptance equals to nature’s compensation plus surgical correction

PubMed Central

Vadgaonkar, Vaishali; Gangurde, Parag; Karandikar, Anita; Mahajan, Nikhil

2013-01-01

Orthognathic surgery has become an acceptable treatment plan for patients with various maxillofacial deformities. The rehabilitation of severe class III adult patients requires a complex interdisciplinary orthodontic and orthognathic approach. This presentation aims to show a case of combination of camouflage and bilateral sagittal split osteotomy (BSSO).Camouflage in maxillary arch was accepted after analysing visual treatment objective (VTO) and pleasing soft tissue compensation which gave us the clue to go ahead for surgical correction of excess mandibular length to achieve best aesthetic outcome while maintaining nature’s compensation in upper arch. PMID:23887991

Piezosurgery for Sagittal Split Osteotomy: Procedure Duration and Postoperative Sensory Perturbation.

PubMed

Köhnke, Robert; Kolk, Andreas; Kluwe, Lan; Ploder, Oliver

2017-09-01

To evaluate piezosurgery for bilateral sagittal split osteotomy (BSSO) for its duration and inferior alveolar nerve (IAN) perturbation. In this prospective randomized study, the authors evaluated 100 BSSO procedures in 50 patients. Piezoelectric (group I) and conventional (group II) osteotomies were carried out on each side of the mandible of a patient by 2 specialists. The surgeons had at least 1 year of experience using piezosurgery. The period from incision to complete splitting of the mandibular bone was recorded (ie, procedure duration). The intraoperative status (visibility and relocation) of the IAN also was recorded. The neurosensory function of the IAN was measured by the 2-point discrimination threshold and static light touch methods before surgery and postoperatively (1, 3, and 6 weeks and 6 and 12 months). Parameters were compared between the test groups by the paired t, nonparametric Wilcoxon, or χ 2 test. Intergroup comparison showed the mean duration of osteotomy was significantly shorter for group I (17 ± 6 vs 25 ± 9 minutes; P < .001). The rate of intraoperative exposures of the IAN was slightly lower for group I (68%) compared with group II (81%). However, the difference was not relevant. Neurosensory disturbance and recovery of the IAN did not differ between groups. Piezoelectric osteotomy requires considerably less time than conventional mechanical approaches, but shows no advantage in preventing neurosensory perturbation. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Soft tissue changes and its stability as a sequlae to mandibular advancement

PubMed Central

Uppada, Uday Kiran; Sinha, Ramen; Reddy, D. Sreenatha; Paul, Dushyanth

2014-01-01

Purpose of the Study: To predict the changes and evaluate the stability that occurs in the soft tissues following the skeletal movement subsequent to surgical advancement of the mandible through bilateral sagittal split osteotomy and to provide the patient reliable information with regard to esthetic changes that can be expected following the treatment. Materials and Methods: Twenty adult patients diagnosed with skeletal class II malocclusion and underwent bilateral sagittal split osteotomy for mandibular advancement by a mean of 8 mm using rigid fixation were included in the study. Soft tissue changes brought about by the surgical procedure and their stability over a period of time were evaluated prospectively using 12 linear (4 vertical and 8 horizontal) and 4 angular measurements on profile cephalograms which were taken preoperatively after the pre-surgical orthodontics (T1) and postoperatively with duration of 1 month (T2) and 6 months (T3) respectively. Results: It was observed that compared to the linear measurements, the angular measurements showed significant changes. The improvement in the esthetic outcome is a direct reflection of the angular changes whereas the linear changes played a contributing role. Following mandibular advancement surgery the profiles of the patients was perceived to have improved with reduction in the facial convexity, an increase in the lower facial height, decrease in the depth of the mentolabial sulcus and improvement in the lip competency with lengthening, straightening and thinning of the lower lip. Conclusion: The soft tissue response and its stability depends on the stability of the surgical procedure itself, postsurgical growth and remodeling of the hard tissues and soft tissue changes as a result of maturation and aging. PMID:25593860

Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular advancement: a systematic review.

PubMed

Joss, Christof Urs; Joss-Vassalli, Isabella Maria; Kiliaridis, Stavros; Kuijpers-Jagtman, Anne Marie

2010-06-01

The purpose of the present systematic review was to evaluate the soft tissue/hard tissue ratio in bilateral sagittal split advancement osteotomy (BSSO) with rigid internal fixation (RIF) or wire fixation (WF). The databases PubMed, Medline, CINAHL, Web of Science, Cochrane Library, and Google Scholar Beta were searched. From the original 711 articles identified, 12 were finally included. Only 3 studies were prospective and 9 were retrospective. The postoperative follow-up ranged from 3 months to 12.7 years for RIF and 6 months to 5 years for WF. The short- and long-term ratios for the lower lip to lower incisor for BSSO with RIF or WF were 50%. No difference between the short- and long-term ratios for the mentolabial-fold to point B and soft tissue pogonion to pogonion could be observed. It was a 1:1 ratio. One exception was seen for the long-term results of the soft tissue pogonion to pogonion in BSSO with RIF; they tended to be greater than a 1:1 ratio. The upper lip mainly showed retrusion but with high variability. Despite a large number of studies on the short- and long-term effects of mandibular advancement by BSSO, the results of the present systematic review have shown that evidence-based conclusions on soft tissue changes are still unknown. This is mostly because of the inherent problems of retrospective studies, inferior study designs, and the lack of standardized outcome measures. Well-designed prospective studies with sufficient sample sizes that have excluded patients undergoing additional surgery (ie, genioplasty or maxillary surgery) are needed. 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Bilateral sagittal split mandibular osteotomies for enhanced exposure of the anterior cervical spine in children: technical note.

PubMed

Karsy, Michael; Moores, Neal; Siddiqi, Faizi; Brockmeyer, Douglas L; Bollo, Robert J

2017-04-01

The bilateral sagittal split mandibular osteotomy (BSSMO), a common maxillofacial technique for expanding the oropharynx during treatment of micrognathia, is a rarely employed but useful adjunct to improve surgical access to the ventral cervical spine in children. Specifically, it provides enhanced exposure of the craniocervical junction in the context of midface hypoplasia, and of the subaxial cervical spine in children with severe kyphosis. The authors describe their technique for BSSMO and evaluate long-term outcomes in patients. The pediatric neurosurgical database at a single center was queried to identify children who underwent BSSMO as an adjunct to cervical spine surgery over a 22-year study period (1993-2015). The authors retrospectively reviewed clinical and radiographic data in all patients. The authors identified 5 children (mean age 5.3 ± 3.1 years, range 2.1-10.0 years) who underwent BSSMO during cervical spine surgery. The mean clinical follow-up was 3.0 ± 1.9 years. In 4 children, BSSMO was used to increase the size of the oropharynx and facilitate transoral resection of the odontoid and anterior decompression of the craniocervical junction. In 1 patient with subaxial kyphosis and chin-on-chest deformity, BSSMO was used to elevate the chin, improve anterior exposure of the subaxial cervical spine, and facilitate cervical corpectomy. Careful attention to neurovascular structures, including the inferior alveolar nerve, lingual nerve, and mental branch of the inferior alveolar artery, as well as minimizing tongue manipulation and compression, are critical to complication avoidance. The BSSMO is a rarely used but extremely versatile technique that significantly enhances anterior exposure of the craniocervical junction and subaxial cervical spine in children in whom adequate visualization of critical structures is not otherwise possible.

Assessment of Soft Tissue Changes by Cephalometry and Two-Dimensional Photogrammetry in Bilateral Sagittal Split Ramus Osteotomy Cases

PubMed Central

Martin, Alice

2011-01-01

ABSTRACT Objectives We aimed to compare the standard methods of cephalometry and two-dimensional photogrammetry, to evaluate the reliability and accuracy of both methods. Material and Methods Twenty-six patients (mean age 25.5, standard deviation (SD) 5.2 years) with Class II relationship and 23 patients with Class III relationship (mean age 26.4, SD 4.7 years) who had undergone bilateral sagittal split ramus osteotomy were selected, with a median follow-up of 8 months between pre- and postsurgical evaluation. Pre- and postsurgical cephalograms and lateral photograms were traced and changes were recorded. Results Pre- and postsurgical measurements of hard tissue angles and distances revealed higher correlations with cephalometrically performed soft tissue measurements of facial convexity (Class II: N-PG, r = - 0.50, P = 0.047; Class III: ANB, r = 0.73, P = 0.005; NaPg , r = 0.71, P = 0.007;) and labiomental angle (Class II: SNB, r = 0.72, P = 0.002; ANB, r = - 0.72, P = 0.002; N-B, r = - 0.68, P = 0.004; ANS-Gn, r = 0.71, P = 0.002; Class III: ANS-Gn, r = 0.65, P = 0.043) compared with two-dimensional photogrammetry. However, two-dimensional photogrammetry revealed higher correlation between lower lip length and cephalometrically assessed angular hard tissue changes (Class II: SNB, r = 0.98, P = 0.007; N-B, r = 0.89, P = 0.037; N-Pg, r = 0.90, P = 0.033; Class III: SNB, r = - 0.54, P = 0.060; NAPg, r = - 0.65, P = 0.041; N-Pg, r = 0.58, P = 0.039). Conclusions Our findings suggest that cephalometry and two-dimensional photogrammetry offer the possibility to complement one another. PMID:24421994

Asymmetric Anterior Distraction for Transversely Distorted Maxilla and Midfacial Anteroposterior Deficiency in a Patient With Cleft Lip/Palate: Two-Stage Surgical Approach.

PubMed

Hirata, Kae; Tanikawa, Chihiro; Aikawa, Tomonao; Ishihama, Kohji; Kogo, Mikihiko; Iida, Seiji; Yamashiro, Takashi

2016-07-01

The present report describes a male patient with a unilateral cleft lip and palate who presented with midfacial anteroposterior and transverse deficiency. Correction involved a two-stage surgical-orthodontic approach: asymmetric anterior distraction of the segmented maxilla followed by two-jaw surgery (LeFort I and bilateral sagittal splitting ramus osteotomies). The present case demonstrates that the asymmetric elongation of the maxilla with anterior distraction is an effective way to correct a transversely distorted alveolar form and midfacial anteroposterior deficiency. Furthermore, successful tooth movement was demonstrated in the new bone created by distraction.

Combined Orthodontic-surgical Treatment for Skeletal Class III Malocclusion with Multiple Impacted Permanent and Supernumerary Teeth: Case Report.

PubMed

Xue, Dai Juan And Feng

2014-01-01

In this report we describe a combined orthodontic and surgical treatment for a 14-year-old boy with severe skeletal class III deformity and dental problem. His upper posterior primary teeth in the left side were over-retained and 6 maxillary teeth (bilateral central incisors and canines, left first and second premolars) were impacted, together with 5 supernumerary teeth in both arches. The treatment protocol involved extraction of all the supernumerary and deciduous teeth, surgical exposure and orthodontic traction of the impacted teeth, a bimaxillary orthognathic approach including Lefort I osteotomy. Bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty was performed to correct skeletal problem. After treatment, all of the impacted teeth were brought to proper alignment in the maxillary arch. A satisfied profile and good posterior occlusion was achieved. Treatment mechanics and consideration during different stages are discussed.

Image-Guided Internal Fixation of an Oblique Sagittal Split Fracture of C1 Lateral Mass with Motion Preservation: A Technical Report.

PubMed

Malcolm, James G; Tan, Lee A; Johnson, Andrew K

2017-07-20

A sagittal split fracture of the C1 lateral mass is an unstable subtype of C1 fractures and has a high propensity for developing late deformities and pain with nonoperative management. A primary internal fixation of this type of fracture has been recently described with good clinical outcomes and preservation of motion. We present a modified technique of primary internal fixation using an obliquely inserted C1 lag screw with imaging guidance. We successfully treated a 55-year-old woman with a unilateral C1 oblique sagittal split fracture who failed nonoperative management. Technical nuances are discussed with a review of pertinent literature.

Maxillary Anterior Segmental Distraction Osteogenesis to Correct Maxillary Deficiencies in a Patient With Cleft Lip and Palate.

PubMed

Kageyama-Iwata, Asuka; Haraguchi, Seiji; Iida, Seiji; Aikawa, Tomonao; Yamashiro, Takashi

2017-07-01

This report describes a case of successful orthodontic treatment using maxillary anterior segmental distraction osteogenesis with an internal maxillary distractor and bilateral sagittal split ramus osteotomy in a girl with cleft lip and palate. A 16-year-old girl with unilateral cleft lip and palate exhibited midface retrusion because of growth inhibition of the maxillary complex and mandibular excess. After the presurgical orthodontic treatment, 6.0-mm advancement of the maxillary anterior segment and 4.0-mm set back of the mandible were performed. After a retention period, the patient's midface convexity was greatly improved and the velopharyngeal competence was preserved without relapse.

Surgical-orthodontic treatment of a skeletal class III malocclusion.

PubMed

Katiyar, Radha; Singh, G K; Mehrotra, Divya; Singh, Alka

2010-07-01

For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment option left. One indication for surgery obviously is a malocclusion too severe for orthodontics alone. It is possible now to be at least semiquantitative about the limits of orthodontic treatment, in the context of producing normal occlusion as the diagrams of the "envelope of discrepancy" indicate. In this case report we present orthognathic treatment plan of an adult female patient with skeletal class III malocclusion. Patient's malocclusion was decompensated by orthodontic treatment just before the surgery and then normal jaw relationship achieved by bilateral sagittal split osteotomy.

Combined orthognathic distraction procedure: Le Fort I maxillary osteotomy and mandibular curvilinear distraction osteogenesis. A new technique for craniofacial management.

PubMed

Schendel, Stephen A; Hazan-Molina, Hagai; Aizenbud, Dror

2014-04-01

Dentofacial deformities are traditionally treated by maxillary and mandibular osteotomies conducted separately or simultaneously. Recently, distraction osteogenesis has become an irreplaceable part of the surgical armamentarium, for its ability to induce new bone formation between the surfaces of bone segments that are gradually separated by incremental traction, along with a simultaneous expansion of the surrounding soft-tissue envelope. The aim of this article is to describe a combined surgical technique consisting of simultaneous maxillary Le Fort I advancement and mandibular surgical repositioning by means of bilateral sagittal split osteotomy with a curvilinear distractor based on a preliminary computerized presurgical prediction.

Image-Guided Internal Fixation of an Oblique Sagittal Split Fracture of C1 Lateral Mass with Motion Preservation: A Technical Report

PubMed Central

Malcolm, James G; Johnson, Andrew K

2017-01-01

A sagittal split fracture of the C1 lateral mass is an unstable subtype of C1 fractures and has a high propensity for developing late deformities and pain with nonoperative management. A primary internal fixation of this type of fracture has been recently described with good clinical outcomes and preservation of motion. We present a modified technique of primary internal fixation using an obliquely inserted C1 lag screw with imaging guidance. We successfully treated a 55-year-old woman with a unilateral C1 oblique sagittal split fracture who failed nonoperative management. Technical nuances are discussed with a review of pertinent literature. PMID:28948116

Masticatory performance is not associated with diet quality in Class II orthognathic surgery patients.

PubMed

Shinkai, R S; Hatch, J P; Sakai, S; Mobley, C C; Rugh, J D

2001-01-01

This study evaluated the association between masticatory function, diet, and digestive system problems in 59 Class II patients 5 years after bilateral sagittal split osteotomy. Dietary intake data were recorded in 4-day diet diaries and analyzed for overall diet quality (Healthy Eating Index) and selected dietary components. Masticatory function was assessed through measurements of masticatory performance, maximum bilateral bite force, and chewing time and number of chewing strokes until the subject felt that the bolus was ready to swallow. Self-reported frequency of digestive system problems was recorded with a 7-point Likert scale questionnaire. Masticatory function was not associated with diet quality or gastrointestinal problems. There was a weak association between intake of foods that require chewing (eg, fiber, protein, meat, and vegetables) and masticatory variables. Fourteen subjects (24%) had a poor diet and 45 subjects (76%) had a diet that needed improvement according to the Healthy Eating Index. Self-reported constipation was the only digestive system problem that was significantly associated with masticatory performance.

Surgical–orthodontic treatment of a skeletal class III malocclusion

PubMed Central

Katiyar, Radha; Singh, G. K.; Mehrotra, Divya; Singh, Alka

2010-01-01

For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment option left. One indication for surgery obviously is a malocclusion too severe for orthodontics alone. It is possible now to be at least semiquantitative about the limits of orthodontic treatment, in the context of producing normal occlusion as the diagrams of the “envelope of discrepancy” indicate. In this case report we present orthognathic treatment plan of an adult female patient with skeletal class III malocclusion. Patient's malocclusion was decompensated by orthodontic treatment just before the surgery and then normal jaw relationship achieved by bilateral sagittal split osteotomy. PMID:22442586

[Osteosynthesis in the Surgical Treatment of Prognathism: State of The Art].

PubMed

Durão, Nuno; Amarante, José

2017-03-31

Prognathism is a common skeletal facial abnormality, associated with class III malocclusion, often with repercussions in quality of life. In addition to orthodontic treatment, sagittal split ramus osteotomy is the most common technique for its correction, and segment osteosynthesis is an important element of the post-surgical outcome. A search for relevant literature was conducted in the PubMed/MEDLINE database and in other relevant sources. The stability of different fixation methods, their repercussions on inferior alveolar nerve lesions, and the type of material are among the most researched subjects. Recent research about the type of osteosynthesis applied in the sagittal split ramus osteotomy for mandibular setback is discussed. Miniplates appear to be the better option for fixation of sagittal split osteotomy for mandibular setback. Bioabsorbable osteosynthesis may be an acceptable alternative to titanium.

Evaluation of Mandibular Anatomy Associated With Bad Splits in Sagittal Split Ramus Osteotomy of Mandible.

PubMed

Wang, Tongyue; Han, Jeong Joon; Oh, Hee-Kyun; Park, Hong-Ju; Jung, Seunggon; Park, Yeong-Joon; Kook, Min-Suk

2016-07-01

This study aimed to identify risk factors associated with bad splits during sagittal split ramus osteotomy by using three-dimensional computed tomography. This study included 8 bad splits and 47 normal patients without bad splits. Mandibular anatomic parameters related to osteotomy line were measured. These included anteroposterior width of the ramus at level of lingula, distance between external oblique ridge and lingula, distance between sigmoid notch and inferior border of mandible, mandibular angle, distance between inferior outer surface of mandibular canal and inferior border of mandible under distal root of second molar (MCEM), buccolingual thickness of the ramus at level of lingula, and buccolingual thickness of the area just distal to first molar (BTM1) and second molar (BTM2). The incidence of bad splits in 625 sagittal split osteotomies was 1.28%. Compared with normal group, bad split group exhibited significantly thinner BTM2 and shorter sigmoid notch and inferior border of mandible (P <0.05). However, for BTM1 and buccolingual thickness of the ramus at level of lingula, there was no statistical difference between the 2 groups. Mandibular angle, anteroposterior width of the ramus at level of lingula, external oblique ridge and lingula, and MCEM were not significantly different between the groups. This study suggests that patients with shorter ramus and low thickness of the buccolingual alveolar region distal to the second molar had a higher risk of bad splits. These anatomic data may help surgeons to choose the safest surgical techniques and best osteotomy sites.

Feasibility of translaminar screw placement in Korean population: morphometric analysis of cervical spine.

PubMed

Ji, Gyu Yeul; Oh, Chang Hyun; Park, Sang Hyuk; Kurniawan, Ferry; Lee, Junho; Jeon, Jae Kyun; Shin, Dong Ah; Kim, Keung Nyun

2015-01-01

To analyze the feasibility of unilateral and bilateral translaminar screw placement in Koran population, and compare the acceptance rate using previously reported data in American population. The translaminar lengths, thickness, heights, and sagittal-diagonal measurements were performed. The feasibility analysis was performed using unilateral and bilateral 3.5 mm cervical screw placement on the CT scans within 0.5 mm of safety margin. We also performed radiographic analysis of the morphometric dimensions and the feasibility of unilateral and bilateral translaminar screw placement at C3-C7. Korean population had similar or significantly shorter translaminar lengths and thickness (lengths and thickness in C7 among males; lengths in C6-C7 and thickness in C4 among females) than American population, but had similar or significantly longer translaminar heights and sagittal-diagonal measurements (heights in C3-C7 and sagittal-diagonal measurements in C3-C6 among males; heights in C7 and sagittal-diagonal measurements in C3-C7 among females). Unilaterally, translaminar screw acceptance rates in C3-C7 were similar between Korean and American male population, but the rates in C4-C6 were significantly smaller between Korean and American female population. Bilaterally, translaminar screw acceptance rates in C3 and C5-C6 were significantly larger between Korean and American male population, but the rates in C3-C7 were similar between Korean and American female population. The feasibility of unilateral and bilateral translaminar screw placement is different depending on different ethnics. Subaxial cervical unilateral translaminar screw placement among Korean male population and bilateral placement at C4-C7 among Korean female population are more acceptable than American population.

Sagittal-lung CT measurements in the evaluation of asthma-COPD overlap syndrome: a distinctive phenotype from COPD alone.

PubMed

Qu, Yanjuan; Cao, Yiyuan; Liao, Meiyan; Lu, Zhiyan

2017-07-01

This study aimed at investigating the capability of sagittal-lung computed tomography (CT) measurements in differentiating chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS). Clinical and high-resolution CT of 229 patients including 123 pure COPD patients and 106 ACOS patients were included. Sagittal-lung CT measurements in terms of bilateral lung height (LH), anterior-posterior lung diameter (APLD), diaphragm height (DH), and anterior sterno-diaphragmatic angle (ASDA), as well as inter-pulmonary septum length (IPSL) on axial images were measured both before and after bronchodilator (BD) administration. Comparisons of clinical characteristics and CT measurements between patient groups were performed. All pre-BD quantitative sagittal features measuring diaphragm flattening and hyperinflation were not significantly different between patients with COPD and patients with ACOS (P values all >0.05). Following BD administration, the ACOS patients exhibited lower left LH, bilateral APLD, and bilateral ASDA, but higher right DH, compared to pure COPD patients (P values all <0.05). Right LH, left DH and IPSL were not significantly different between patient groups. Besides, variations of all sagittal-lung CT measurements were significantly larger in patients with ACOS than in patients with pure COPD (P values all <0.001) and showed high performance in differentiating these two kinds of patient, with diagnostic sensitivities ranging from 76.4 to 97.2%, specificities ranging from 86.2 to 100.0%, and accuracies ranging from 80.9 to 90.7%. Sagittal-lung CT measurements allow for differentiating patients with ACOS from those with pure COPD. The ACOS patients had larger post-BD variations of sagittal-lung CT measurements than patients with pure COPD.

Interdisciplinary treatment for an adult patient with anterior open bite, severe periodontitis, and intellectual disability.

PubMed

Kang, Da-Young; Choi, Sung-Hwan; Jung, Young-Soo; Hwang, Chung-Ju

2015-05-01

This case report describes the beneficial effects of the interdisciplinary treatment of an adult patient with severe skeletal periodontal problems. A 30-year-old female patient presented with anterior open bite, gummy smile, and facial asymmetry. The patient had chronic generalized severe periodontitis with pathologic maxillary anterior teeth migration and mild intellectual disability. Treatment included 6 months of periodontal treatment, followed by presurgical orthodontic treatment, a Le Fort I osteotomy with anterior segmental osteotomy, a bilateral sagittal split ramus osteotomy, and postsurgical orthodontic treatment. After treatment completion, the patient exhibited functional and aesthetic improvements. Her periodontal condition improved and was maintained after the treatment. Here, we demonstrate a successful treatment outcome in a complicated case following a systematic interdisciplinary approach performed with the correct diagnosis and treatment planning.

Orthognathic Surgery in Craniofacial Microsomia: Treatment Algorithm

PubMed Central

Valladares, Salvador; Torrealba, Ramón; Nuñez, Marcelo; Uribe, Francisca

2015-01-01

Summary: Craniofacial microsomia is a broad term that covers a variety of craniofacial malformation conditions that are caused by alterations in the derivatives of the first and second pharyngeal arches. In general terms, diverse therapeutic alternatives are proposed according to the growth stage and the severity of the alteration. When craniofacial growth has concluded, conventional orthognathic surgery (Le Fort I osteotomy, bilateral sagittal split osteotomy, and genioplasty) provides good alternatives for MI and MIIA type cases. Reconstruction of the mandibular ramus and temporomandibular joint before orthognathic surgery is the indicated treatment for cases MIIB and MIII. The goal of this article is to establish a surgical treatment algorithm for orthognathic surgery on patients with craniofacial microsomia, analyzing the points that allow the ideal treatment for each patient to be chosen. PMID:25674375

A prospective study on infectious complications in orthognathic surgery.

PubMed

Spaey, Yannick J E; Bettens, Rolf M A; Mommaerts, Maurice Y; Adriaens, Jo; Van Landuyt, Herman W; Abeloos, Johan V S; De Clercq, Calix A S; Lamoral, Philippe R B; Neyt, Luc F

2005-02-01

According to an earlier study in 2000, 4.7% of patients undergoing corrective facial orthopaedic surgery in this unit suffered a postoperative wound infection. In 1998, the Belgian Government recommended stricter rules for infection prophylaxis and a new antibiotic protocol similar to that proposed by Peterson (1990) was implemented in this unit. The new protocol was to be evaluated. Eight hundred and ten consecutive patients were selected receiving orthognathic surgery (Le Fort I-type osteotomies, sagittal split osteotomies, segmental and chin osteotomies). Cefazolin 1g was administered intravenously on induction of general anaesthesia and repeated at 4h intervals for the duration of surgery. No antibiotics were administered postoperatively. The observation period was 6 weeks. When an infection occurred, appropriate culture specimens were obtained according to a standardized protocol. Fifty-one infections (6.8%) were diagnosed, 33 with purulent exudates occurring spontaneously or after incision and drainage. Ninety-two per cent of these infections occurred in the sagittal split area, 6% in the maxillary region and 2% in the chin region. Infections in the sagittal split area were further analysed. A reduction in infection rate from 6.6 to 2.6% was noted following a change in practice when fibrin glue was used in the wound instead of a drain in the sagittal split wound. Of the 30 aerobic cultures, 12 contained normal mucosal flora, of which 9 were Streptococcus species. In 11 of the 30 anaerobic cultures the identified species belonged to the Bacteroides group. This bacterium is resistant to cefazolin but sensitive to amoxicillin-clavulanate and for a high percentage also to clindamycin. All the other cultures were sterile. The infections occurring almost exclusively in the sagittal split osteotomy site can be partially explained by wound contamination upon removal of the drain. It is suggested that for prophylaxis cefazolin is replaced by amoxicillin-clavulanate.

Hard and Soft Tissue Changes Following Maxillary Distraction Osteogenesis and Mandibular Setback with Bilateral Sagittal Split Osteotomy.

PubMed

Bawane, Shilpa S; Andrade, Neelam N

2016-12-01

(1) To highlight the role of intraoral submerged device in distraction osteogenesis (DO) of patients requiring two jaw surgeries for the correction of severe developmental maxillary hypoplasia (MH) and mandibular prognathism (MP) (2) To analyse the hard and soft tissue changes following maxillary DO and mandibular setback with bilateral sagittal split osteotomy (BSSO) in patients with severe MH and MP requiring two jaw surgeries. During the period Jan 2004 to Dec 2006, five patients with severe developmental MH along with MP were treated. In 1st stage maxillary distraction was done. Distraction started on 6th postoperative day, 1 mm distraction was carried out for 10-15 days on either side. Serial radiographs were taken immediate postoperative period for baseline comparison, post-distraction and at the end of distraction. After a period of 3-4 months of distraction 2nd stage was done. In 2nd stage, mandibular setback was done with BSSO and distractors were removed under general anesthesia. Radiographs were taken immediately and at 4 months post-operatively. Cephalometric tracings were carried out preoperatively, post DO and finally after mandibular setback with BSSO. The mean horizontal movement of maxilla was 11.4 mm at ANS and 9.6 mm at A point. Upper incisor edge was advanced by 8.8 mms. SNA increased by 8.4° and SNB decreased by 4.6°. Nasal projection advanced by 4°. Nasolabial angle normalized in all patients, mean change achieved was 10.8°. Upper lip moved forward by 5.4 mm. Lower lip moved backward by 5.4 mm. Mandible positioned backward by 4 mm at B point. No vertical change occurred in the position of A, ANS and upper incisor edges. Mean increase in skeletal angle of convexity was 26.4°. Concave profile was significantly changed to convex in all patients. Maxillary DO and mandibular setback with BSSO was associated with improved facial balance and esthetics.

Mechanical and photoelastic analysis of conventional screws and cannulated screws for sagittal split osteotomy fixation: a comparative study.

PubMed

Lima, Cristina Jardelino de; Falci, Saulo Gabriel Moreira; Rodrigues, Danillo Costa; Marchiori, Érica Cristina; Moreira, Roger Willian Fernandes

2015-12-01

The aim of the present study was to use mechanical and photoelastic tests to compare the performance of cannulated screws with solid-core screws in sagittal split osteotomy fixation. Ten polyurethane mandibles, with a prefabricated sagittal split ramus osteotomy, were fixed with an L inverted technique and allocated to each group as follows: cannulated screw group (CSG), fixed with three 2.3-cannulated screws; and solid-core screw group (SCSG), fixed with three 2.3-solid-core screws. Vertical linear loading tests were performed. The differences between mean values were analyzed through T test for independent samples. The photoelastic test was carried out using a polariscope. The results revealed differences between the two groups only at 1 mm of displacement, in which the cannulated-screw revealed more resistance. Photoelastic test showed higher stress concentration close to mandibular branch in the solid-core group. Cannulated screws performed better than solid-core ones in a mechanical test at 1-mm displacement and photoelastic tests.

Lower extremity sagittal joint moment production during split-belt treadmill walking

PubMed Central

Roemmich, Ryan T.; Stegemöller, Elizabeth L.; Hass, Chris J.

2012-01-01

The split-belt treadmill (SBT) has recently been used to rehabilitate locomotor asymmetries in clinical populations. However, the joint mechanics produced while walking on a SBT are not well-understood. The purpose of this study was to investigate the lower extremity sagittal joint moments produced by each limb during SBT walking and provide insight as to how these joint moment patterns may be useful in rehabilitating unilateral gait deficits. Thirteen healthy young volunteers walked on the SBT with the belts tied and in a “SPLIT” session in which one belt moved twice as fast as the other. Sagittal lower extremity joint moment and ground reaction force impulses were then calculated over the braking and propulsive phases of the gait cycle. Paired t-tests were performed to analyze magnitude differences between conditions (i.e. the fast and slow limbs during SPLIT vs. the same limb during tied-belt walking) and between the fast and slow limbs during SPLIT. During the SPLIT session, the fast limb produced higher ground reaction force and ankle moment impulses during the propulsive and braking phases, and lower knee moment impulses during the propulsive phase when compared to the slow limb. The knee moment impulse was also significantly higher during braking in the slow limb than in the fast limb. The mechanics of each limb during the SPLIT session also differed from the mechanics observed when the belt speeds were tied. Based on these findings, we suggest that each belt may have intrinsic value in rehabilitating specific unilateral locomotor deficits. PMID:22985473

The accuracy of two-dimensional planning for routine orthognathic surgery.

PubMed

Rustemeyer, Jan; Groddeck, Alexander; Zwerger, Stefan; Bremerich, Andreas

2010-06-01

Two-dimensional cephalometric planning software should be helpful for prediction of hard tissue outcome after bilateral sagittal split ramus osteotomy (BSSRO) or bimaxillary osteotomy, but transferring two-dimensional data to three-dimensions (including mock operation and surgery) may result in errors. The objective of this retrospective study was to analyze deviations between predicted results and postoperative outcome using cephalometric analyses, and to evaluate this procedure for daily use. Fifty-four subjects (mean (SD) age 26 (8) years) had a BSSRO (n=21) alone or in combination with Le Fort I osteotomy (n=33). Predictions were made for each case by cephalometric planning software and mock operations done with study models. Postoperative cephalograms were obtained after 14 days and compared with predicted cephalograms for sagittal (SNA, SNB, ANB,) and vertical (ArMeGo, ML-NSL, NL-NSL) measurements. Mean (SD) differences for all measurements varied between 1.3 degrees (1.1 degrees) and 2.2 degrees (1.6 degrees) for BSSRO; and between 1.1 degrees (1.3 degrees) and 2.2 degrees (1.6 degrees) for bimaxillary osteotomy. There were no significant differences between measurements or operations, indicating that the predictions were accurate. A difference of up to 8.5 degrees could be measured in a single case. Cephalometric prediction therefore remains an accurate tool for planning, particularly maxillary rearrangement in the vertical and sagittal dimension for routine operations. If greater shifts in the transversal dimension are necessary, exact planning should be adapted with three-dimensional planning devices to avoid significant differences. Copyright 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Short Lingual Osteotomy Using a Piezosurgery Ultrasonic Bone-Cutting Device During Sagittal Split Ramus Osteotomy.

PubMed

Kawase-Koga, Yoko; Mori, Yoshiyuki; Kanno, Yuki; Hoshi, Kazuto; Takato, Tsuyoshi

2015-10-01

Short lingual osteotomy is a useful method for the performance of sagittal split ramus osteotomy involving interference between the proximal and distal bone fragments when lateral differences exist in the setback distance. However, this procedure occasionally results in abnormal fracture and nerve injury; expert surgical skill is thus required. We herein describe a novel technique involving the use of an ultrasonic bone-cutting device (Piezosurgery; Mectron Medical Technology, Carasco, Italy) for vertical osteotomy posterior to the mandibular foramen. Successful short lingual osteotomy was performed using this technique with avoidance of abnormal fracture and neurovascular bundle damage.

Reduced somatosensory impairment by piezosurgery during orthognathic surgery of the mandible.

PubMed

Brockmeyer, Phillipp; Hahn, Wolfram; Fenge, Stefan; Moser, Norman; Schliephake, Henning; Gruber, Rudolf Matthias

2015-09-01

This clinical trial aimed to test the hypothesis that piezosurgery causes reduced nerval irritations and, thus, reduced somatosensory impairment when used in orthognathic surgery of the mandible. To this end, 37 consecutive patients with Angle Class II and III malocclusion were treated using bilateral sagittal split osteotomies (BSSO) of the mandible. In a split mouth design, randomized one side of the mandible was operated using a conventional saw, while a piezosurgery device was used on the contralateral side. In order to test the individual qualities of somatosensory function, quantitative sensory testings (QSTs) were performed 1 month, 6 months and 1 year after surgery. A comparison of the data using a two-way analysis of variance (ANOVA) revealed a significant reduction in postoperative impairment in warm detection threshold (WDT) (P = 0.046), a decreased dynamic mechanical allodynia (ALL) (P = 0.002) and a decreased vibration detection threshold (VDT) (P = 0.030) on the piezosurgery side of the mandible as opposed to the conventionally operated control side. In the remaining QSTs, minor deviations from the preoperative baseline conditions and a more rapid regression could be observed. Piezosurgery caused reduced somatosensory impairment and a faster recovery of somatosensory functions in the present investigation.

Surgical Orthodontic Treatment of Severe Skeletal Class II

PubMed Central

Alsulaimani, Fahad F.; Al-Sebaei, Maisa O.; Afify, Ahmed R.

2013-01-01

This paper describes an adult Saudi male patient who presented with a severe skeletal class II deformity. The case was managed with a combination of presurgical orthodontic treatment followed by a double jaw orthognathic surgery and then another phase of orthodontic treatment for final occlusal detailing. Extraction of the four first premolars was done during the presurgical orthodontic phase of treatment to decompensate upper and lower incisors and to give room for surgical setback of the maxillary anterior segment. Double jaw surgery was performed: bilateral sagittal split ramus osteotomy for 8 mm mandibular advancement combined with three-piece Le Fort I maxillary osteotomy, 6 mm setback of the anterior segment, 8 mm impaction of the maxilla, and 5 mm advancement genioplasty. Although the anteroposterior discrepancy and the facial convexity were so severe, highly acceptable results were obtained, both esthetically as well as occlusally. PMID:23573428

Scar due to skin incision for screw fixation through the transbuccal approach after sagittal split ramus osteotomy.

PubMed

Muto, Toshitaka

2012-05-01

Most rigid fixation techniques after sagittal split ramus osteotomies of the mandible involve the transbuccal approach. A skin incision in the cheek carries with it possible undesirable sequelae, such as noticeable scarring. The aim of this study was to investigate whether there is scarring in the face after this technique. For screw insertion, a 5-mm stab incision was performed on 40 Japanese patients (20 men and 20 women) with class III occlusion. After surgery, gross examination (via the naked eyes) of the skin incision was performed monthly for 1 year by the same oral surgeon. In all cases, the skin incision had disappeared by 1 year after the surgery.

Reconstruction of bilateral tibial aplasia and split hand-foot syndrome in a father and daughter.

PubMed

Al Kaissi, Ali; Ganger, Rudolf; Klaushofer, Klaus; Grill, Franz

2014-01-01

Tibial aplasia is of heterogeneous aetiology, the majority of reports are sporadic. We describe the reconstruction procedures in two subjects - a daughter and father manifested autosomal dominant (AD) inheritance of the bilateral tibial aplasia and split hand-foot syndrome. Reconstruction of these patients required multiple surgical procedures and orthoprosthesis was mandatory. The main goal of treatment was to achieve walking. Stabilization of the ankle joint by fibular-talar-chondrodesis on both sides, followed by bilateral Brown-procedure at the knee joint level has been applied accordingly. The outcome was with improved function of the deformed limbs and walking was achieved with simultaneous designation of orthotic fitting. This is the first study encompassing the diagnosis and management of a father and daughter with bilateral tibial aplasia associated with variable split hand/foot deformity without foot ablation. Our patients showed the typical AD pattern of inheritance of split-hand/foot and tibial aplasia.

Computer-assisted orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction to correct facial asymmetry and maxillary defects secondary to maxillectomy in childhood.

PubMed

Zhang, Lei; Sun, Hao; Yu, Hong-bo; Yuan, Hao; Shen, Guo-fang; Wang, Xu-dong

2013-05-01

Maxillectomy in childhood not only causes composite primary defects but also secondary malformation of the middle and lower face. In the case presented, we introduced computer-assisted planning and simulation of orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction to correct complex craniofacial deformities. Virtual orthognathic surgery and maxillary reconstruction surgery were undertaken preoperatively. LeFort I osteotomy, with bilateral sagittal split ramus osteotomy and lower border ostectomy, was performed to correct malocclusion and facial asymmetry. Maxillary reconstruction was accomplished using a fibular osteomyocutaneous flap. The patient recovered uneventfully with an adequate aesthetic appearance on 3D computed tomography. Our experience indicates that orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction can used to correct complex facial asymmetry and maxillary defects secondary to maxillectomy. Computer-assisted simulation enables precise execution of the reconstruction. It shortens the free flap ischemia time and reduces the risks associated with microsurgery.

An in vitro evaluation of rigid internal fixation techniques for sagittal split ramus osteotomies: setback surgery.

PubMed

Brasileiro, Bernardo Ferreira; Grotta-Grempel, Rafael; Ambrosano, Glaucia Maria Bovi; Passeri, Luis Augusto

2012-04-01

The aim of this study was to evaluate the biomechanical features of 3 different methods of rigid internal fixation for sagittal split ramus osteotomy for mandibular setback in vitro. Sixty polyurethane replicas of human hemimandibles were used as substrates, simulating a 5-mm setback surgery by sagittal split ramus osteotomy. These replicas served to reproduce 3 different techniques of fixation, including 1) a 4-hole plate and 4 monocortical screws (miniplate group), 2) a 4-hole plate and 4 monocortical screws with 1 additional bicortical positional screw (hybrid group), and 3) 3 bicortical positional screws in a traditional inverted-L pattern (inverted-L group). After fixation, hemimandibles were adapted to a test support and subjected to lateral torsional forces on the buccal molar surface and vertical cantilever loading on the incisal edge with an Instron 4411 mechanical testing unit. Peak loadings at 1, 3, 5, and 10 mm of displacement were recorded. Means and standard deviation were analyzed using analysis of variance and Tukey test with a 5% level of significance, and failures during tests were recorded. Regardless of the amount of displacement and direction of force, the miniplate group always showed the lowest load peak scores (P < .01) compared with the other fixation techniques. The hybrid group demonstrated behavior similar to the inverted-L group in lateral and vertical forces at any loading displacement (P > .05). Molar load tests required more force than incisal load tests to promote the same displacement in the mandibular setback model (P < .05). For mandibular setback surgery of 5 mm, this study concluded that the fixation technique based on the miniplate group was significantly less rigid than the fixation observed in the hybrid and inverted-L groups. Mechanically, adding 1 bicortical positional screw in the retromolar region in the miniplate technique may achieve the same stabilization offered by inverted-L fixation for mandibular sagittal split ramus osteotomy setback surgery in vitro. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Occurrence of a 'bad' split and success of initial mandibular healing: a review of 524 sagittal ramus osteotomies in 262 patients.

PubMed

Posnick, J C; Choi, E; Liu, S

2016-10-01

The purpose of this study was to assess the prevalence of a 'bad' split after sagittal ramus osteotomies (SRO) and report the results of initial mandibular healing. A retrospective cohort study derived from patients treated by a single surgeon at one institution between 2004 and 2013 was performed. An index group consisting of a series of subjects with a spectrum of bimaxillary dentofacial deformities also involving the chin and symptomatic chronic obstructive nasal breathing was identified. The SRO design, bicortical screw fixation technique, and perioperative management were consistent. Outcome variables included the occurrence of a 'bad' split and the success of initial SRO healing. Two hundred sixty-two subjects undergoing 524 SROs met the inclusion criteria. Their average age was 25 years (range 13-63 years) and 134 were female (51%). Simultaneous removal of a third molar was performed during 209 of the SROs (40%). There were no 'bad' splits. All subjects achieved successful bone union, the planned occlusion, and return to a chewing diet and physical activities by 5 weeks after surgery. The presence of a third molar removed during SRO was not associated with an increased frequency of a 'bad' split or delayed mandibular healing. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Postural orientation and standing postural alignment in ambulant children with bilateral cerebral palsy.

PubMed

Domagalska-Szopa, Małgorzata; Szopa, Andrzej

2017-11-01

Standing postural alignment in children with cerebral palsy is usually altered by central postural control disorders. The primary aim of this study is to describe body alignment in a quiet standing position in ambulatory children with bilateral cerebral palsy compared with children with typical development. Fifty-eight children with bilateral cerebral palsy (aged 7-13years) and 45 age-matched children with typical development underwent a surface topography examination based on Moiré topography and were classified according to their sagittal postural profiles. The following eight grouping variables were extracted using a data reduction technique: angle of trunk inclination, pelvic tilt, and lordosis, the difference between kyphosis and lordosis, angle of vertebral lateral curvature, shoulder inclination, and shoulder and pelvic rotation. According to the cluster analysis results, 25% of the participants were classified into Cluster 1, 9% into Cluster 2, 49% in Cluster 3, and 17% in Cluster 4. Three different postural patterns emerged in accordance with the sagittal postural profiles in children with bilateral cerebral palsy and were defined as follows: 1) a lordotic postural pattern corresponding to forward-leaning posture; 2) a swayback postural pattern corresponding to backward-leaning posture; and 3) a balanced postural pattern corresponding to balanced posture. Copyright © 2017 Elsevier Ltd. All rights reserved.

Relationship between mandibular anatomy and the occurrence of a bad split upon sagittal split osteotomy.

PubMed

Aarabi, Mohammadali; Tabrizi, Reza; Hekmat, Mina; Shahidi, Shoaleh; Puzesh, Ayatollah

2014-12-01

A bad split is a troublesome complication of the sagittal split osteotomy (SSO). The aim of this study was to evaluate the relation between the occurrence of a bad split and mandibular anatomy in SSO using cone-beam computed tomography. The authors designed a cohort retrospective study. Forty-eight patients (96 SSO sites) were studied. The buccolingual thickness of the retromandibular area (BLR), the buccolingual thickness of the ramus at the level of the lingula (BLTR), the height of the mandible from the alveolar crest to the inferior border of the mandible, (ACIB), the distance between the sigmoid notch and the inferior border of the mandible (SIBM), and the anteroposterior width of the ramus (APWR) were measured. The independent t test was applied to compare anatomic measurements between the group with and the group without bad splits. The receiver operating characteristic (ROC) test was used to find a cutoff point in anatomic size for various parts of the mandible related to the occurrence of bad splits. The mean SIBM was 47.05±6.33 mm in group 1 (with bad splits) versus 40.66±2.44 mm in group 2 (without bad splits; P=.01). The mean BLTR was 5.74±1.11 mm in group 1 versus 3.19±0.55 mm in group 2 (P=.04). The mean BLR was 14.98±2.78 mm in group 1 versus 11.21±1.29 mm in group 2 (P=.001). No statistically significant difference was found for APWR and ACIB between the 2 groups. The ROC test showed cutoff points of 10.17 mm for BLR, 36.69 mm for SIBM, and 4.06 mm for BLTR. This study showed that certain mandibular anatomic differences can increase the risk of a bad split during SSO surgery. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Planer orientation of the bilateral semicircular canals in dizzy patients.

PubMed

Aoki, Sachiko; Takei, Yasuhiko; Suzuki, Kazufumi; Masukawa, Ai; Arai, Yasuko

2012-10-01

Recent development of 3-dimensional analysis of eye movement enabled to detect the eye rotation axis, which is used to determine the responsible semicircular canal(s) in dizzy patients. Therefore, the knowledge of anatomical orientation of bilateral semicircular canals is essential, as all 6 canals influence the eye movements. Employing the new head coordinate system suitable for MR imaging, we calculated the angles of semicircular canal planes of both ears in 11 dizzy patients who had normal caloric response in both ears. The angles between adjacent canal pairs were nearly perpendicular in both ears. The angle between the posterior canal planes and head sagittal plane was 51° and significantly larger the angle between the anterior canal planes and head sagittal plane, which was 35°. The angle between the horizontal canal plane and head sagittal plane was almost orthogonal. Pairs of contralateral synergistic canal planes were not parallel, forming 10° between right and left horizontal canal planes, 17° between right anterior and left posterior canal planes and 19° between the right posterior and left anterior canal planes. Our measurement of the angles of adjacent canal pairs and the angle between each semicircular canal and head sagittal plane coincided with those of previous reports obtained from CT images and skull specimens. However, the angles between contralateral synergistic canal planes were more parallel than those of previous reports. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Long Term Stability and Relapse Following Mandibular Advancement and Mandibular Setback Surgeries: A Cephalometric Study

PubMed Central

Darshan, S Vinay; Ronad, Yusuf Ahammed; Kishore, M S V; Shetty, K Sadashiva; Rajesh, M; Suman, S D

2014-01-01

Background: The aim was to evaluate the long-term hard and soft tissue changes following mandibular advancement and setback surgeries. Materials and Methods: A total of 16 subjects each were selected who underwent bilateral sagittal split osteotomy mandibular advancement and mandibular setback groups. Pre-surgical (T1), immediate post-surgical (T2) and long-term post-surgical (T3) cephalograms were compared for hard and soft tissue changes. After cephalometric measurements, the quantity of changes between T1-T2 and T1-T3 were determined for each patient. The mean difference between T1-T2 and T1-T3 was compared with assess the long-term changes and stability. Results: In mandibular advancement the mean difference between immediate post-surgical and long term post-surgical is 7%, which accounts for a relapse of 7%. In mandibular setback, the mean difference between immediate post-surgical and long-term post-surgical is 29%, which accounts for a relapse of 29%. Conclusion: Mandibular advancement remained stable over the long period when compared to mandibular setback. PMID:25395792

Long term stability and relapse following mandibular advancement and mandibular setback surgeries: a cephalometric study.

PubMed

Darshan, S Vinay; Ronad, Yusuf Ahammed; Kishore, M S V; Shetty, K Sadashiva; Rajesh, M; Suman, S D

2014-09-01

The aim was to evaluate the long-term hard and soft tissue changes following mandibular advancement and setback surgeries. A total of 16 subjects each were selected who underwent bilateral sagittal split osteotomy mandibular advancement and mandibular setback groups. Pre-surgical (T1), immediate post-surgical (T2) and long-term post-surgical (T3) cephalograms were compared for hard and soft tissue changes. After cephalometric measurements, the quantity of changes between T1-T2 and T1-T3 were determined for each patient. The mean difference between T1-T2 and T1-T3 was compared with assess the long-term changes and stability. In mandibular advancement the mean difference between immediate post-surgical and long term post-surgical is 7%, which accounts for a relapse of 7%. In mandibular setback, the mean difference between immediate post-surgical and long-term post-surgical is 29%, which accounts for a relapse of 29%. Mandibular advancement remained stable over the long period when compared to mandibular setback.

Bilambdoid and posterior sagittal synostosis: the Mercedes Benz syndrome.

PubMed

Moore, M H; Abbott, A H; Netherway, D J; Menard, R; Hanieh, A

1998-09-01

A consistent pattern of craniosynostosis in the sagittal and bilateral lambdoid sutures is described in three patients. The external cranial ridging associated with fusion of these sutures produces a characteristic triradiate, or "Mercedes Benz," appearance to the posterior skull. Locally marked growth restriction is evident in the posterior fossa with compensatory secondary expansion of the anterior fossa manifesting a degree of frontal bossing which mimics bicoronal synostosis. Although this appearance could lead to inadvertent surgery in the frontal region, attention to the occipital region with wide early suture excision and vault shaping is indicated.

Morphometric study of mandibular ramus related to sagittal ramus split osteotomy and osteosynthesis.

PubMed

Vinicius de Oliveira, Marcelo; de Moraes, Paulo Hemerson; Olate, Sergio; Alonso, Maria Beatriz C; Watanabe, Plauto Christopher Aranha; Haiter-Neto, Francisco; de Albergaria-Barbosa, José Ricardo

2012-09-01

The objective of this study was to quantify the cortical bone thickness of the mandibular ramus to determine conditions related to sagittal split ramus osteotomy and placement of screws. The patient sample comprised 44 subjects of ages ranging from 46 to 52 years (mean age, 49 years). The cone-beam computed tomography was performed and realized 3 cuts in the third molar area (section A), 5 mm posterior (section B), and 5 mm posterior to the latter (section C). Measurement in the cortical areas of the superior and inferior levels related to mandibular canal and measurement related to the total width of the mandible was executed. Intraclass correlation coefficient with P < 0.05 was used. The result showed that the buccal and lingual cortical zone did not present statistical differences, and the minor value was 1.5 mm for each one. There were no differences in the superior and inferior cortical bone, and the total width of the mandible was between 15.9 and 8.5 mm in the anterior area, between 17.4 and 12.8 mm in the middle area, and between 18 and 8.8 mm in the posterior area. The distance superiorly to the mandibular canal presented a minimal SD with a mean of 8.5 mm in the anterior region, 10.6 mm for the middle region, and 12.5 mm in the posterior region. In conclusion, the cortical thickness of the mandibular ramus in the adult population is particularly strong and offers a good anchorage for screw insertion in sagittal split ramus osteotomy.

Pulpal and Periodontal Tissues Changes Associated with Le Fort I and Sagittal Split Ramus Osteotomies: A review

PubMed Central

Lazaridis, Konstantinos; Athanasiou, Athanasios E.

2018-01-01

Introduction: Le Fort I and sagittal split ramus osteotomies are the most commonly performed orthognathic surgery procedures on the maxilla and mandible, respectively. Techniques: Despite progress in the techniques, these procedures may still be associated with morbidity, expressed as inflammation, inadequate bony union, periodontal damages or in extreme cases even total bone loss. Discussion: Through a comprehensive review of the literature, the influences of maxillary and mandibular surgery on Pulpal Blood Flow (PBF), pulp sensitivity and pulp vitality are examined. Moreover, adverse effects of maxillary surgery on tooth color and periodontal tissues are also reported. The effects had a variety of expression. Concerning maxillary surgery, some studies showed an initial increase in PBF followed by a decrease to the baseline or even lower levels after 1-3 months. Other studies found an initial decrease in PBF followed by an increase soon after. There were also studies that showed no significant PBF changes, in contrast. Conclusion: Concerning mandibular surgery, a recent study showed a decrease in PBF immediately after sagittal split ramus osteotomy. Some authors detected tooth discoloration of maxillary teeth after Le Fort I osteotomy. Root resorption and root injury were also detected, but were of minor significance. Usually, these adverse effects derive from injury of the vessels of the palatal pedicle. This pedicle should be maintained intact for the avoidance of blood flow impairments. In addition, the descending palatine artery should be protected during maxillary surgery procedures in order to maintain the highest possible blood flow on the maxillary teeth. PMID:29456771

Preliminary Study on Continuous Recognition of Elbow Flexion/Extension Using sEMG Signals for Bilateral Rehabilitation

PubMed Central

Song, Zhibin; Zhang, Songyuan

2016-01-01

Surface electromyography (sEMG) signals are closely related to the activation of human muscles and the motion of the human body, which can be used to estimate the dynamics of human limbs in the rehabilitation field. They also have the potential to be used in the application of bilateral rehabilitation, where hemiplegic patients can train their affected limbs following the motion of unaffected limbs via some rehabilitation devices. Traditional methods to process the sEMG focused on motion pattern recognition, namely, discrete patterns, which are not satisfactory for use in bilateral rehabilitation. In order to overcome this problem, in this paper, we built a relationship between sEMG signals and human motion in elbow flexion and extension on the sagittal plane. During the conducted experiments, four participants were required to perform elbow flexion and extension on the sagittal plane smoothly with only an inertia sensor in their hands, where forearm dynamics were not considered. In these circumstances, sEMG signals were weak compared to those with heavy loads or high acceleration. The contrastive experimental results show that continuous motion can also be obtained within an acceptable precision range. PMID:27775573

Preliminary Study on Continuous Recognition of Elbow Flexion/Extension Using sEMG Signals for Bilateral Rehabilitation.

PubMed

Song, Zhibin; Zhang, Songyuan

2016-10-19

Surface electromyography (sEMG) signals are closely related to the activation of human muscles and the motion of the human body, which can be used to estimate the dynamics of human limbs in the rehabilitation field. They also have the potential to be used in the application of bilateral rehabilitation, where hemiplegic patients can train their affected limbs following the motion of unaffected limbs via some rehabilitation devices. Traditional methods to process the sEMG focused on motion pattern recognition, namely, discrete patterns, which are not satisfactory for use in bilateral rehabilitation. In order to overcome this problem, in this paper, we built a relationship between sEMG signals and human motion in elbow flexion and extension on the sagittal plane. During the conducted experiments, four participants were required to perform elbow flexion and extension on the sagittal plane smoothly with only an inertia sensor in their hands, where forearm dynamics were not considered. In these circumstances, sEMG signals were weak compared to those with heavy loads or high acceleration. The contrastive experimental results show that continuous motion can also be obtained within an acceptable precision range.

A Bony Landmark 'RAI Triangle' to Prevent 'Misplaced and Misdirected' Medial Cut in SSRO.

PubMed

Rai, Kirthi Kumar; Arakeri, Gururaj; Khaji, Shahanavaj I

2011-03-01

'Rai triangle', a new anatomic landmark on the medial surface of the ramus of the mandible which when identified and taken into consideration, may have a definite advantage. This is especially in terms of performing the medial horizontal cut which is an important and integral part of the sagittal split ramus osteotomy so as to avoid a bad split. The objective of this article is to propose an easily identifiable bony land mark, which is closely related to lingula of mandible that may ease the procedure of osteotomy and avoid bad splits.

Bilateral lambdoid and sagittal synostosis (BLSS): a unique craniosynostosis syndrome or predictable craniofacial phenotype?

PubMed

Hing, Anne V; Click, Eleanor S; Holder, Ursula; Seto, Marianne L; Vessey, Kyle; Gruss, Joseph; Hopper, Richard; Cunningham, Michael L

2009-05-01

Multisutural craniosynostosis that includes bilateral lambdoid and sagittal synostosis (BLSS) results in a very characteristic head shape with frontal bossing, turribrachycephaly, biparietal narrowing, occipital concavity, and inferior displacement of the ears. This entity has been reported both in the genetics literature as craniofacial dyssynostosis and in the surgical literature as "Mercedes Benz" syndrome. Craniofacial dyssynostosis was first described in 1976 by Dr. Neuhauser when he presented a series of seven patients with synostosis of the sagittal and lambdoid sutures, short stature, and developmental delay. Over the past 30 years nine additional patients with craniofacial dyssynostosis have been reported in the literature adding to the growing evidence for a distinct craniosynostosis syndrome. The term "Mercedes Benz" syndrome was coined by Moore et al. in 1998 due to the characteristic appearance of the fused sutures on three-dimensional CT imaging. In contrast to the aforementioned reported cases of craniofacial dyssynostosis, all three patients had normal development. Recently, there have been several case reports of patients with BLSS and distinct chromosomal anomalies. These findings suggest that BLSS is a heterogeneous disorder perhaps with syndromic, chromosomal, and isolated forms. In this manuscript we will present the largest series of patients with BLSS and review clinical, CT, and molecular findings.

Surgical Management of Laterognathia in Orthofacial Surgery.

PubMed

García Y Sánchez, J M; Gómez Rodríguez, C L; Romero Flores, J

2017-09-01

Each year around the world, various surgical procedures are carried out with the goal of correcting laterognathia; both the intraoral vertical ramus osteotomy (IVRO) and bilateral sagittal split ramus osteotomy (OSB) have been the most used techniques in mandibular surgery. These techniques have advantages and disadvantages; for example the advantages of the OSB include: increased coefficient of friction between bony segments, for both the forward and the retroposition, as well as decrease in the time of intermaxillary fixation (IMF). Disadvantages include injury to the inferior alveolar nerve (IAN), hemorrhage, bad split, among others. The advantages of IVRO include decrease of possibility of injury to the IAN, ease of implementation of the technique, a lower incidence of hemorrhage and the short duration of the surgical procedure. Their disadvantages include: lower coefficient of friction between bony segments, requires a relatively long period of IMF. The combination between the techniques of mandibular osteotomy for the correction of minor 10 mm laterognathia is the ideal treatment, since it avoids potential recurrence. We describe two cases of patients with laterognathia greater than 6 mm associated with maxilla deformity, which were treated with combined osteotomies. At Maxillofacial Surgery Service, Specialty Hospital, National Medical Center XXI Century, we describe the advantages and disadvantages, pre and postoperative nosocomial, by comparing them with the reports of the literature. The combination of techniques in the correction of laterognathias greater than 4 mm (smaller than 10 mm) is the ideal treatment, eliminating problems of articular compression, recurrence and damage to the alveolar nerve.

Self-Reinforced Biodegradable Screw Fixation Compared With Titanium Screw Fixation in Mandibular Advancement

PubMed Central

Turvey, Timothy A.; Bell, R. Bryan; Phillips, Ceib; Proffit, William R.

2013-01-01

Purpose This report compares the skeletal stability and treatment outcomes of 2 similar cohorts undergoing bilateral sagittal osteotomies of the mandible for advancement. The study groups included patients stabilized with 2-mm self-reinforced polylactate (PLLDL 70/30), biodegradable screws (group B), and 2-mm titanium screws placed in a positional fashion (group T). Materials and Methods Sixty-nine patients underwent bilateral sagittal osteotomies of the mandibular ramus for advancement utilizing an identical technique. There were 34 patients in group B and 35 patients in group T. Each patient had preoperative, immediate postoperative, splint out, and 1-year postoperative cephalometric radiographs available for analysis. The method of analysis and treatment outcomes parameters are identical to those previously used. Repeated measures analysis of variance was performed with means of fixation as the between-subject factor and time as the within subject factor. The level of significance was set at .01. Results There were no clinical failures in group T and a single failure in group B. The average difference in stability between the groups is small and subtly different at the mandibular angle. The data documented similarity of the postsurgical changes in the 2 groups with the only statistically significant difference being the vertical position of the gonion (P < .001) and the mandibular plane angle (P < .01) with greater upward remodeling at gonion in group T. Conclusions Two-mm self-reinforced PLLDL (70/30) screws can be used as effectively as 2-mm titanium screws to stabilize the mandible after bilateral sagittal osteotomies for mandibular advancement. The difference in 1-year stability and outcome is minimal. PMID:16360855

An interesting radiological picture of post traumatic TMJ ankylosis due to sagittal condylar fracture.

PubMed

Kumar L K, Surej; Manuel, Suvy; Kurien, Nikhil M; Khalam, Sherin A; P Menon, Varun

2015-01-01

In a condylar fracture whether to intervene or to go for conservative management still remains a dilemma. Studies and hypothesis suggests that it's medially dislocated condylar fracture segment that is more likely to ankylose, moreover no consensus have been put forth as to whether to remove the medially displaced fracture segment. The current article describes a case of unilateral temporomandibular joint (TMJ) ankylosis, which resulted as a sequlae from conservative management of a bilateral condylar fracture of which, the ankylosed side had a sagittal fracture of condyle. In our case the post trauma CT shows the lateral segment abutting with the arch and that the area has become ankylotic in a span of 2 years. Here we report a case of posttraumatic unilateral TMJ ankylosis resulting from closed reduction of a bilateral condylar fracture with interesting radiological findings. We have tried to discuss a rather interesting radiological picture of posttraumatic TMJ ankylosis which resulted as a sequlae from conservative management of a bilateral condylar fracture. The dilemma for a clinician as to whether to intervene in a condylar fracture or to go for conservative management still remains at large. As in this case the medial fracture segment was intact and the lateral segment was resulting in ankylosis. Copyright © 2015. Published by Elsevier Ltd.

A comparison of skeletal stability after mandibular advancement and use of two rigid internal fixation techniques.

PubMed

Blomqvist, J E; Ahlborg, G; Isaksson, S; Svartz, K

1997-06-01

Two different methods of rigid fixation were compared for postoperative stability 6 months after mandibular advancement for treatment of Class II malocclusion. Sixty (30 + 30) patients from two different oral and maxillofacial units treated for a Class II malocclusion by bilateral saggital split osteotomy (BSSO), and two different methods of internal rigid fixation were prospectively investigated. Two groups (S1, n = 15; S2, n = 15) had bicortical noncompressive screws inserted in the gonial area through a transcutaneous approach, and the other two groups (P1, n = 15; P2, n = 15) had the bone segments fixed with unicortical screws and miniplates on the lateral surface of the mandibular body. Cephalograms were taken preoperatively, 2 days postoperatively and 6 months after the operation. A computer program was used to superimpose the three cephalograms and to register the mandibular advancement and postoperative change both sagittally and vertically. These were minor differences in the advancement and postoperative changes between the four groups, but statistically no significant difference was shown in either sagittal or vertical directions. However, statistically verified differences proved that increasing age was associated with a smaller amount of postsurgical relapse. Low-angle cases (ML/NSL < 25 degrees) had a bigger amount of surgical (P = .0008) and postsurgical (P = .0195) movement compared with the patients in the high-angle group (ML/NSL < 38 degrees). Using a multiple regression test, a positive correlation was also shown between the amount of surgical advancement and the amount of postsurgical instability (P = .018). This prospective dual-center study indicates that the two different methods of internal rigid fixation after surgical advancement of the mandible by BSSO did not significantly differ from each other, and it is up to the individual operator to choose the method for internal rigid fixation.

Side-to-side asymmetries in landing mechanics from a drop vertical jump test are not related to asymmetries in knee joint laxity following anterior cruciate ligament reconstruction.

PubMed

Meyer, Christophe A G; Gette, Paul; Mouton, Caroline; Seil, Romain; Theisen, Daniel

2018-02-01

Asymmetries in knee joint biomechanics and increased knee joint laxity in patients following anterior cruciate ligament reconstruction (ACLR) are considered risk factors for re-tear or early onset of osteoarthritis. Nevertheless, the relationship between these factors has not been established. The aim of the study was to compare knee mechanics during landing from a bilateral drop vertical jump in patients following ACLR and control participants and to study the relationship between side-to-side asymmetries in landing mechanics and knee joint laxity. Seventeen patients following ACLR were evaluated and compared to 28 healthy controls. Knee sagittal and frontal plane kinematics and kinetics were evaluated using three-dimensional motion capture (200 Hz) and two synchronized force platforms (1000 Hz). Static anterior and internal rotation knee laxities were measured for both groups and legs using dedicated arthrometers. Group and leg differences were investigated using a mixed model analysis of variance. The relationship between side-to-side differences in sagittal knee power/energy absorption and knee joint laxities was evaluated using univariate linear regression. A significant group-by-leg interaction (p = 0.010) was found for knee sagittal plane energy absorption, with patients having 25% lower values in their involved compared to their non-involved leg (1.22 ± 0.39 vs. 1.62 ± 0.40 J kg -1 ). Furthermore, knee sagittal plane energy absorption was 18% lower at their involved leg compared to controls (p = 0.018). Concomitantly, patients demonstrated a 27% higher anterior laxity of the involved knee compared to the non-involved knee, with an average side-to-side difference of 1.2 mm (p < 0.001). Laxity of the involved knee was also 30% higher than that of controls (p < 0.001) (leg-by-group interaction: p = 0.002). No relationship was found between sagittal plane energy absorption and knee laxity. Nine months following surgery, ACLR patients were shown to employ a knee unloading strategy of their involved leg during bilateral landing. However, this strategy was unrelated to their increased anterior knee laxity. Side-to-side asymmetries during simple bilateral landing tasks may put ACLR patients at increased risk of second ACL injury or early-onset osteoarthritis development. Detecting and correcting asymmetric landing strategies is highly relevant in the framework of personalized rehabilitation, which calls for complex biomechanical analyses to be applied in clinical routine. III.

Sagittal imbalance in patients with lumbar spinal stenosis and outcomes after simple decompression surgery.

PubMed

Shin, E Kyung; Kim, Chi Heon; Chung, Chun Kee; Choi, Yunhee; Yim, Dahae; Jung, Whei; Park, Sung Bae; Moon, Jung Hyeon; Heo, Won; Kim, Sung-Mi

2017-02-01

Lumbar spinal stenosis (LSS) is the most common lumbar degenerative disease, and sagittal imbalance is uncommon. Forward-bending posture, which is primarily caused by buckling of the ligamentum flavum, may be improved via simple decompression surgery. The objectives of this study were to identify the risk factors for sagittal imbalance and to describe the outcomes of simple decompression surgery. This is a retrospective nested case-control study PATIENT SAMPLE: This was a retrospective study that included 83 consecutive patients (M:F=46:37; mean age, 68.5±7.7 years) who underwent decompression surgery and a minimum of 12 months of follow-up. The primary end point was normalization of sagittal imbalance after decompression surgery. Sagittal imbalance was defined as a C7 sagittal vertical axis (SVA) ≥40 mm on a 36-inch-long lateral whole spine radiograph. Logistic regression analysis was used to identify the risk factors for sagittal imbalance. Bilateral decompression was performed via a unilateral approach with a tubular retractor. The SVA was measured on serial radiographs performed 1, 3, 6, and 12 months postoperatively. The prognostic factors for sagittal balance recovery were determined based on various clinical and radiological parameters. Sagittal imbalance was observed in 54% (45/83) of patients, and its risk factors were old age and a large mismatch between pelvic incidence and lumbar lordosis. The 1-year normalization rate was 73% after decompression surgery, and the median time to normalization was 1 to 3 months. Patients who did not experience SVA normalization exhibited low thoracic kyphosis (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02-1.10) (p<.01) and spondylolisthesis (HR, 0.33; 95% CI, 0.17-0.61) before surgery. Sagittal imbalance was observed in more than 50% of LSS patients, but this imbalance was correctable via simple decompression surgery in 70% of patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Negative pressure wound therapy, staged excision and definitive closure with split-thickness skin graft for axillary hidradenitis suppurativa: a retrospective study.

PubMed

Pearce, F B; Richardson, K A

2017-01-02

Bilateral axillary hidradenitis is a chronic, suppurative, and scarring disease that is most effectively treated by complete excision of all hair-bearing tissues. We assessed our staged procedure for excision and placement of a split-thickness skin graft for bilateral axillary hidradenitis in terms of costs, outcomes, and timing of excision. An IRB approved retrospective case analysis was performed on patients that underwent bilateral axillary hidradenitis skin excision with eventual placement of split-thickness skin grafting using the current LSUHSC/University Health hidradenitis surgical treatment protocol. Using ICD-9 codes (705.83) and CPT codes (11041, 11042, 11451, 11600, 11601, 11602, 11603, 11604) we reviewed cases performed at our institution from 1 January 2008 to 24 Febuary 2014 and we selected patients based on bilateral axillary involvement (alone) and >1 year history of active disease. Patients were excluded if resection of tissue encompassed regions outside of the immediately adjacent axillary. A total of seven patients matching criteria for bilateral axillary hidradenitis were selected for analysis. Clinical course, cost and surgical techniques were assessed. Of the seven patients, six required admission throughout their treatment due to lack of funding making use of negative pressure wound therapy at home not possible. These patients stayed an average of 10 days with a mean hospital charge of $35,178 and a mean hospital provider charge of $10,019. No recurrence was demonstrated. All patients attained full range of motion, post grafting. No patient required a further operation due to graft failure. Split-thickness skin grafting without use of bilayer dermal regenerative templates yielded definitive results with acceptable cosmesis and functionality, without the added cost of treatments such as a bilayer dermal regenerative template.

Evaluation of different screw fixation techniques and screw diameters in sagittal split ramus osteotomy: finite element analysis method.

PubMed

Sindel, A; Demiralp, S; Colok, G

2014-09-01

Sagittal split ramus osteotomy (SSRO) is used for correction of numerous congenital or acquired deformities in facial region. Several techniques have been developed and used to maintain fixation and stabilisation following SSRO application. In this study, the effects of the insertion formations of the bicortical different sized screws to the stresses generated by forces were studied. Three-dimensional finite elements analysis (FEA) and static linear analysis methods were used to investigate difference which would occur in terms of forces effecting onto the screws and transmitted to bone between different application areas. No significant difference was found between 1·5- and 2-mm screws used in SSRO fixation. Besides, it was found that 'inverted L' application was more successful compared to the others and that was followed by 'L' and 'linear' formations which showed close rates to each other. Few studies have investigated the effect of thickness and application areas of bicortical screws. This study was performed on both advanced and regressed jaws positions. © 2014 John Wiley & Sons Ltd.

INJURIES OF THE SAGITTAL GROOVE OF THE PROXIMAL PHALANX IN WARMBLOOD HORSES DETECTED WITH LOW-FIELD MAGNETIC RESONANCE IMAGING: 19 CASES (2007-2016).

PubMed

Gold, Sarah J; Werpy, Natasha M; Gutierrez-Nibeyro, Santiago D

2017-05-01

Sagittal groove injuries of the proximal phalanx are an important cause of lameness in performance horses. The purpose of this retrospective case series study was to describe standing low-field magnetic resonance imaging (MRI) characteristics of these injuries in a group of Warmblood horses. Horses with an MRI diagnosis of sagittal groove injuries involving the proximal phalanx and that had follow-up MRI and clinical outcome information were included. Findings from clinical examinations, diagnostic tests, and other imaging modalities were recorded. All MRI studies were retrieved for re-evaluation by an experienced, board-certified veterinary radiologist. A total of 19 horses met inclusion criteria. All horses had MRI lesions consistent with unilateral or bilateral sagittal groove injuries of the proximal phalanx and abnormal mineralization of the sagittal ridge of the third metacarpal/metatarsal bone. Fifteen horses (79%) had concurrent osteoarthritis of the affected metacarpophalangeal/metatarsophalangeal joint. Eighteen horses received conservative therapy and all horses still had osseous abnormalities detected at the time of follow-up MRI. Thirteen horses (68.5%) were still lame at the time of follow-up, whereas the other six horses (31.5%) had become sound and returned to the previous level of exercise. Findings indicated that, for mature Warmblood horses, acute or chronic injuries of the sagittal groove of the proximal phalanx may have variable standing low-field MRI characteristics. Based on this sample of 19 horses, findings also indicated that the prognosis for performance soundness in horses diagnosed with sagittal groove injury of the proximal phalanx and concurrent osteoarthritis is poor. © 2017 American College of Veterinary Radiology.

Fracture heuristics: surgical decision for approaches to distal radius fractures. A surgeon's perspective.

PubMed

Wichlas, Florian; Tsitsilonis, Serafim; Kopf, Sebastian; Krapohl, Björn Dirk; Manegold, Sebastian

2017-01-01

Introduction: The aim of the present study is to develop a heuristic that could replace the surgeon's analysis for the decision on the operative approach of distal radius fractures based on simple fracture characteristics. Patients and methods: Five hundred distal radius fractures operated between 2011 and 2014 were analyzed for the surgeon's decision on the approach used. The 500 distal radius fractures were treated with open reduction and internal fixation through palmar, dorsal, and dorsopalmar approaches with 2.4 mm locking plates or underwent percutaneous fixation. The parameters that should replace the surgeon's analysis were the fractured palmar cortex, and the frontal and the sagittal split of the articular surface of the distal radius. Results: The palmar approach was used for 422 (84.4%) fractures, the dorsal approach for 39 (7.8%), and the combined dorsopalmar approach for 30 (6.0%). Nine (1.8%) fractures were treated percutaneously. The correlation between the fractured palmar cortex and the used palmar approach was moderate (r=0.464; p<0.0001). The correlation between the frontal split and the dorsal approach, including the dorsopalmar approach, was strong (r=0.715; p<0.0001). The sagittal split had only a weak correlation for the dorsal and dorsopalmar approach (r=0.300; p<0.0001). Discussion: The study shows that the surgical decision on the preferred approach is dictated through two simple factors, even in the case of complex fractures. Conclusion: When the palmar cortex is displaced in distal radius fractures, a palmar approach should be used. When there is a displaced frontal split of the articular surface, a dorsal approach should be used. When both are present, a dorsopalmar approach should be used. These two simple parameters could replace the surgeon's analysis for the surgical approach.

A new palatal distractor device for bodily movement of maxillary bones by rigid self-locking miniplates and screws system.

PubMed

Cortese, Antonio; Savastano, Mauro; Cantone, Antonio; Claudio, Pier Paolo

2013-07-01

A new palatal distractor device for bodily movement of the maxillary bones after complete segmented Le Fort I osteotomy for 1-stage transversal distraction and tridimensional repositioning on 1 patient is presented. The new distractor has an intrinsic tridimensional rigidity also in the fixation system by self-locking miniplates and screws for better control of the 2 maxillary fragments during distraction. Le Fort I distraction and repositioning procedure in association with a bilateral sagittal split osteotomy were performed on 1 patient with complete solution of the cross-bite and class III malocclusion. Results of dental and cephalometric analysis performed before surgery (T1), after surgery and distraction time (T2), and 18 months after surgery and orthodontic appliance removal (T3) are reported. No complications were encountered using the new distractor device. Advantages of this device and technique are presented including improved rigidity of both distraction (jackscrew) and fixation (4 self-locking miniplates and screws) systems resulting in complete control of the position of the 2 maxillary fragments during distraction and surgery. In addition, this new device allows resuming palatal distraction in the event of cross-bite relapse without causing dental-related problems or the risks of screw slackening.

Orthodontic-surgical retreatment of facial asymmetry with occlusal cant and severe root resorption: A 3-year follow-up.

PubMed

Lisboa, Cinthia de Oliveira; Borges, Marlon Sampaio; Medeiros, Paulo José D'Albuquerque; Motta, Alexandre Trindade; Mucha, José Nelson

2017-08-01

Our objective was to report the orthodontic and surgical retreatment of a patient who had undergone a prolonged orthodontic treatment with extractions, but who had unsatisfactory results and persistent side effects. The man, aged 25 years 3 months, sought treatment with major complaints of facial and smile asymmetries. The clinical examination showed a mandibular deviation to the right and a maxillary occlusal cant. A Class II Division 1 subdivision right was observed. Radiographic examination showed extensive root resorptions in the maxillary second premolars and absence of the 4 first premolars. The maxillary midline was deflected 2 mm to the left, and the mandibular midline was shifted 5 mm to the right. Aligning and leveling were performed with orthodontic fixed appliances, with a standard edgewise system (0.022 × 0.028 in), followed by LeFort I maxillary impaction and bilateral sagittal split osteotomy with asymmetrical advancement. Retreatment showed outstanding results that remained stable after 3 years of follow-up. Root resorption in the second premolars did not seem to increase. Orthodontic-surgical intervention is the main choice for correcting esthetic and functional problems in facial asymmetry, particularly in cases of retreatment. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Electromagnetic navigated condylar positioning after high oblique sagittal split osteotomy of the mandible: a guided method to attain pristine temporomandibular joint conditions.

PubMed

Berger, Moritz; Nova, Igor; Kallus, Sebastian; Ristow, Oliver; Eisenmann, Urs; Dickhaus, Hartmut; Engel, Michael; Freudlsperger, Christian; Hoffmann, Jürgen; Seeberger, Robin

2018-05-01

Reproduction of the exact preoperative proximal-mandible position after osteotomy in orthognathic surgery is difficult to achieve. This clinical pilot study evaluated an electromagnetic (EM) navigation system for condylar positioning after high-oblique sagittal split osteotomy (HSSO). After HSSO as part of 2-jaw surgery, the position of 10 condyles was intraoperatively guided by an EM navigation system. As controls, 10 proximal segments were positioned by standard manual replacement. Accuracy was measured by pre- and postoperative cone beam computed tomography imaging. Overall, EM condyle repositioning was equally accurate compared with manual repositioning (P > .05). Subdivided into 3 axes, significant differences could be identified (P < .05). Nevertheless, no significantly and clinically relevant dislocations of the proximal segment of either the EM or the manual repositioning method could be shown (P > .05). This pilot study introduces a guided method for proximal segment positioning after HSSO by applying the intraoperative EM system. The data demonstrate the high accuracy of EM navigation, although manual replacement of the condyles could not be surpassed. However, EM navigation can avoid clinically hidden, severe malpositioning of the condyles. Copyright © 2017 Elsevier Inc. All rights reserved.

Extended Asymmetrical Pedicle Subtraction Osteotomy for Adult Spinal Deformity: 2-Dimensional Operative Video.

PubMed

Buell, Thomas J; Buchholz, Avery L; Quinn, John C; Mullin, Jeffrey P; Garces, Juanita; Mazur, Marcus D; Shaffrey, Mark E; Yen, Chun-Po; Shaffrey, Christopher I; Smith, Justin S

2018-06-16

Pedicle subtraction osteotomy (PSO) is an effective technique to correct fixed sagittal malalignment. A variation of this technique, the "trans-discal" or "extended" PSO (Schwab grade IV osteotomy), involves extending the posterior wedge resection of the index vertebra to include the superior adjacent disc for radical discectomy. The posterior wedge may be resected in asymmetric fashion to correct concurrent global coronal malalignment.This video illustrates the technical nuances of an extended asymmetrical lumbar PSO for adult spinal deformity. A 62-yr-old female with multiple prior lumbar fusions presented with worsening back pain and posture. Preoperative scoliosis X-rays demonstrated severe global sagittal and coronal malalignment (sagittal vertical axis [SVA, C7-plumbline] of 13.5 cm, pelvic incidence [PI] of 60°, lumbar lordosis [LL] of 14° [in kyphosis], pelvic tilt [PT] of 61°, thoracic kyphosis [TK] of 18°, and rightward coronal shift of 9.3 cm). The patient gave informed consent to surgery and for use of her imaging for medical publication. Briefly, surgery first involved transpedicular instrumentation from T10 to S1 with bilateral iliac screw fixation, and then T11-12 and T12-L1 Smith-Petersen osteotomies were performed. Next, an extended asymmetrical L4 PSO was performed and a 12° lordotic cage (9 × 14 × 40 mm) was placed at the PSO defect. Rods were placed from T10 to iliac bilaterally, and accessory supplemental rods spanning the PSO were attached. Postoperative scoliosis X-rays demonstrated improved alignment: SVA 5.5 cm, PI 60°, LL 55°, PT 36°, TK 37°, and 3.7 cm of rightward coronal shift. The patient had uneventful recovery.

Three-dimensional changes in nose and upper lip volume after orthognathic surgery.

PubMed

van Loon, B; van Heerbeek, N; Bierenbroodspot, F; Verhamme, L; Xi, T; de Koning, M J J; Ingels, K J A O; Bergé, S J; Maal, T J J

2015-01-01

Orthognathic surgery aims to improve both the function and facial appearance of the patient. Translation of the maxillomandibular complex for correction of malocclusion is always followed by changes to the covering soft tissues, especially the nose and lips. The purpose of this study was to evaluate the changes in the nasal region and upper lip due to orthognathic surgery using combined cone beam computed tomography (CBCT) and three-dimensional (3D) stereophotogrammetry datasets. Patients who underwent a Le Fort I osteotomy, with or without a bilateral sagittal split osteotomy, were included in this study. Pre- and postoperative documentation consisted of 3D stereophotogrammetry and CBCT scans. 3D measurements were performed on the combined datasets and analyzed. Anterior translation and clockwise pitching of the maxilla led to a significant volume increase in the lip. Cranial translation of the maxilla led to an increase in the alar width. The combination of CBCT DICOM data and 3D stereophotogrammetry proved to be useful in the 3D analysis of the maxillary hard tissue changes, as well as changes in the soft tissues. Measurements could be acquired and compared to investigate the influence of maxillary movement on the soft tissues of the nose and the upper lip. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparison of the long-term clinical performance of a biodegradable and a titanium fixation system in maxillofacial surgery: A multicenter randomized controlled trial.

PubMed

Gareb, B; van Bakelen, N B; Buijs, G J; Jansma, J; de Visscher, J G A M; Hoppenreijs, Th J M; Bergsma, J E; van Minnen, B; Stegenga, B; Bos, R R M

2017-01-01

Biodegradable fixation systems could reduce or eliminate problems associated with titanium removal of implants in a second operation. The aim of this study was to compare the long-term (i.e. >5 years postoperatively) clinical performance of a titanium and a biodegradable system in oral and maxillofacial surgery. The present multicenter Randomized Controlled Trial (RCT) was performed in four hospitals in the Netherlands. Patients treated with a bilateral sagittal split osteotomy (BSSO) and/or a Le Fort-I osteotomy, and those treated for fractures of the mandible, maxilla, or zygoma were included from December 2006 to July 2009. The patients were randomly assigned to either a titanium (KLS Martin) or a biodegradable group (Inion CPS). After >5 years postoperatively, plate removal was performed in 22 of the 134 (16.4%) patients treated with titanium and in 23 of the 87 (26.4%) patients treated with the biodegradable system (P = 0.036, hazard ratio (HR) biodegradable (95% CI) = 2.0 (1.05-3.8), HR titanium = 1). Occlusion, VAS pain scores, and MFIQ showed good and (almost) pain free mandibular function in both groups. In conclusion, the performance of the Inion CPS biodegradable system was inferior compared to the KLS Martin titanium system regarding plate/screws removal in the abovementioned surgical procedures. http://controlled-trials.com ISRCTN44212338.

Voice characteristics before versus after mandibular setback surgery in patients with mandibular prognathism using nonlinear dynamics and conventional acoustic analyses.

PubMed

Mishima, Katsuaki; Moritani, Norifumi; Nakano, Hiroyuki; Matsushita, Asuka; Iida, Seiji; Ueyama, Yoshiya

2013-12-01

The purpose of this study was to explore the voice characteristics of patients with mandibular prognathism, and to investigate the effects of mandibular setback surgery on these characteristics using nonlinear dynamics and conventional acoustic analyses. Sixteen patients (8 males and 8 females) who had skeletal 3, class III malocclusion without cleft palate, and who underwent a bilateral sagittal split ramus osteotomy (BSSRO), were enrolled. As controls, 50 healthy adults (25 males and 25 females) were enrolled. The mean first LEs (mLE1) computed for each one-second interval, and the fundamental frequency (F0) and frequencies of the first and second formant (F1, F2) were calculated for each Japanese vowel. The mLE1s for /u/ in males, and /o/ in females and the F2s for /i/ and /u/ in males, changed significantly after BSSRO. Class III voice characteristics were observed in the mLE1s for /i/ in both males and females, in the F0 for /a/, /i/, /u/ and /o/ in females, and in the F1 and F2 for /a/ in males, and the F1 for /u/ and the F2 for /i/ in females. Most of these characteristics were preserved after BSSRO. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Differences in three-dimensional soft tissue changes after upper, lower, or both jaw orthognathic surgery in skeletal class III patients.

PubMed

Verdenik, M; Ihan Hren, N

2014-11-01

The decision is not always straightforward as to which orthognathic procedure is best for a good aesthetic result; three-dimensional imaging has brought new insight into this topic. The aim of this prospective study was to verify objectively whether postoperative changes occur within those regions not directly affected by surgical movements of the underlying jaw bones. The study included 83 young adults with skeletal class III deformities. They were classified into three groups according to the type of surgery: bilateral sagittal split osteotomy set-back of the mandible (BSSO), Le Fort I advancement of the maxilla, or a combination of both. Pre- and postoperative optical scans were registered as regional best-fits on the areas of the foreheads and both orbits. The shell to shell differences were measured and the average distances between the observed regions were calculated. As expected, changes were greatest in the regions where the underlying bones had been moved, but regardless of the operation performed, changes were found over the whole face. Changes in the nose, cheek, and upper lip regions in the BSSO group and in the lower lip and chin region in the Le Fort I group confirmed the concept of the facial soft tissue mask acting as one unit. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Changes in superior sagittal sinus blood velocities due to postural alterations and pressure on the head of the newborn infant.

PubMed

Cowan, F; Thoresen, M

1985-06-01

A pulsed Doppler bidirectional ultrasound system has been used to measure alterations in the blood velocities in the superior sagittal sinus of the healthy term newborn infant in response to unilateral and bilateral jugular venous occlusion. These maneuvers were performed with the baby lying in different positions: supine, prone, and on the side (both left and right), the neck flexed or extended, and with the head in the midline or turned 90 degrees to the side (both left and right). Transfontanel pressure was also measured in these positions during occlusions. Results show that turning the head effectively occludes the jugular vein on the side to which the head is turned and that occluding the other jugular vein does not force blood through this functional obstruction. The effect of different forms of external pressure to the head on the superior sagittal sinus velocities was also examined. Alterations in velocities were frequently profound although they varied considerably from baby to baby. This work shows how readily large fluctuations in cranial venous velocities and pressures can occur in the course of normal handling of babies.

Position Between Trunk and Pelvis During Gait Depending on the Gross Motor Function Classification System.

PubMed

Sanz-Mengibar, Jose Manuel; Altschuck, Natalie; Sanchez-de-Muniain, Paloma; Bauer, Christian; Santonja-Medina, Fernando

2017-04-01

To understand whether there is a trunk postural control threshold in the sagittal plane for the transition between the Gross Motor Function Classification System (GMFCS) levels measured with 3-dimensional gait analysis. Kinematics from 97 children with spastic bilateral cerebral palsy from spine angles according to Plug-In Gait model (Vicon) were plotted relative to their GMFCS level. Only average and minimum values of the lumbar spine segment correlated with GMFCS levels. Maximal values at loading response correlated independently with age at all functional levels. Average and minimum values were significant when analyzing age in combination with GMFCS level. There are specific postural control patterns in the average and minimum values for the position between trunk and pelvis in the sagittal plane during gait, for the transition among GMFCS I-III levels. Higher classifications of gross motor skills correlate with more extended spine angles.

The Physical Demands of the Tree (Vriksasana) and One-Leg Balance (Utthita Hasta Padangusthasana) Poses Performed by Seniors: A Biomechanical Examination

PubMed Central

Yu, Sean S.-Y.; Wang, Man-Ying; Samarawickrame, Sachithra; Hashish, Rami; Kazadi, Leslie; Greendale, Gail A.; Salem, George J.

2012-01-01

Yoga is considered especially suitable for seniors because poses can be modified to accommodate practitioners' capabilities and limitations. In this study, biomechanical assessments on healthy seniors (n = 20; 70.1 ± 3.8 yr) were used to quantify the physical demands, (net joint moments of force [JMOFs] and muscular activation in the lower extremities) associated with the performance of 3 variations (introductory, intermediate, advanced) of 2 classical Hatha yoga poses – Tree and One-Leg Balance (OLB). ANOVA and Cohen's-d were used to contrast the postural variations statistically. The advanced (single-limb, without additional support) versions were hypothesized to generate the greatest demands, followed by the intermediate (single-limb [Tree] and bilateral-limb [OLB] with support) and introductory (bilateral-limb) versions. Our findings, however, suggest that common, long-held conceptions about pose modifications can be counter-intuitive. There was no difference between the intermediate and advanced Tree variations regarding hip and knee JMOFs in both the sagittal and frontal planes (P = 0.13–0.98). Similarly, OLB introductory and intermediate variations induced sagittal JMOFs that were in the opposite direction of the classic advanced pose version at the hip and knee (P < .001; d = 0.98–2.36). These biomechanical insights provide evidence that may be used by instructors, clinicians and therapists when selecting pose modifications for their yoga participants. PMID:22973410

Simultaneous surgeries in a split forward surgical team: a case study.

PubMed

Vanfosson, Christopher A; Seery, Jason M

2011-12-01

The 541st Forward Surgical Team performed split-based operations, with one site in the city of Pol-e-Khumri. One evening, the 10-person team received two pediatric patients simultaneously and conducted simultaneous surgeries. The 3-year-old female sustained severe injuries to bilateral lower extremities and a puncture wound to her right forearm. The 13-year-old sustained fragmentary wounds to her left hand, left foot, right medial calf, and evisceration to her left lower quadrant. The patients presented in extremis after being taken to a civilian hospital initially, spending approximately 1.5 hours receiving no resuscitative therapy. The 3-year-old underwent amputations of bilateral lower extremities and a fasciotomy of the right forearm. The 13-year-old survived an exploratory laparotomy and irrigation and debridement of intra-abdominal wounds. The successful completion of simultaneous surgeries, by a split forward surgical team at a remote location, for two critically ill patients is possible. It should not become the standard of care. Prior planning made this occurrence feasible and safer, but such situations put the patients at risk for complications.

Treatment of the superior sagittal sinus and transverse sinus thrombosis associated with intracranial hemorrhage with the mechanical thrombectomy and thrombolytics: Case report.

PubMed

Liu, Yuchun; Li, Keqin; Huang, Yi; Sun, Jie; Gao, Xiang

2017-12-01

The superior sagittal sinus (SSS) and transverse sinus are the major dural sinuses that receive a considerable amount of venous drainage. The occlusion of them has been suggested to cause intracranial hypertension, hemorrhage, and lead to potentially fatal consequences. We reported a 35-year-old woman with headache presented to our emergency department with a decreased level of consciousness and epileptic seizures. The examination of speech, higher mental function, and cranial nerve were normal. Computed tomography (CT) demonstrated both subarachnoid and intraparenchymal hemorrhage and brain edema at the right temporal lobe accompanied by high density shadow in the right transverse sinus. Digital subtraction angiography (DSA) revealed extensive thrombosis of the SSS and bilateral transverse sinus. The SSS and transverse sinus thrombosis, accompanied by right temporal lobe hemorrhage, subarachnoid hemorrhage (SAH). An emergent mechanical thrombectomy by placed Solitair AB stent in the SSS, respectively, passed left and right sigmoid sinus-transverse sinus route. We removed the most clots, DSA revealed recanalization of the SSS and left transverse sinus was seen with normalization of the venous outflow, the occlusion of right transverse sinus was still present. There were 4 hours after patient back to neurosurgical intensive care unit (NICU), patient appeared anisocoria (R/L:4.0/2.5 mm), bilateral light reflexes disappeared, then we took a CT reexamination revealed intraparenchymal hemorrhage increased, brain edema was aggravated at the left temporal lobe, and mild midline shift. Subsequently, we performed decompressive hemicraniectomy and puncture the hematoma supplemented by B ultrasonic. Anticoagulation treatment was initiated 24 hours after surgery, and follow-up DSA showed gradually improved patency in the SSS and bilateral transverse sinus. Despite occlusion of the SSS and bilateral transverse sinus, patient's symptoms resolved after the operations and he was discharged without complications. The favorable clinical outcome after complete occlusion of the SSS and transverse sinus, accompanied by right temporal lobe hemorrhage, SAH has rarely been reported and it might be explained by our timely surgical intervention and development of compensatory cerebral collateral circulation.

Bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis.

PubMed

Kocak, Nilufer; Ozturk, Taylan A; Kaynak, Suleyman

2014-04-01

X-linked juvenile retinoschisis is a rare hereditary retinal disease characterized by a tangential splitting of the neurosensory retina which may cause early-onset visual impairment. Existence of the retinal neurosensory layer splitting on cross-sectional images of optical coherance tomography (OCT) and the absence of leakage on fluorescein angiography (FA) help confirming the diagnosis. Such diagnostic tests are also helpful in determining the management of the disease. However, most of the retinoschisis cavities remain stable and rarely extend to the posterior pole, many authors suggest laser prophylaxis to avoid the potential risk of retinal detachment due to holes in the outer retinal layer. Herein, we report a case with bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis who was evaluated with detailed ophthalmologic examination. Visual acuity, fundoscopy, OCT, and FA remained stable in the second year of follow-up after prophylactic argon laser treatment.

Comparison of the long-term clinical performance of a biodegradable and a titanium fixation system in maxillofacial surgery: A multicenter randomized controlled trial

PubMed Central

van Bakelen, N. B.; Buijs, G. J.; Jansma, J.; de Visscher, J. G. A. M.; Hoppenreijs, Th. J. M.; Bergsma, J. E.; van Minnen, B.; Stegenga, B.; Bos, R. R. M.

2017-01-01

Background Biodegradable fixation systems could reduce or eliminate problems associated with titanium removal of implants in a second operation. Aim The aim of this study was to compare the long-term (i.e. >5 years postoperatively) clinical performance of a titanium and a biodegradable system in oral and maxillofacial surgery. Materials and methods The present multicenter Randomized Controlled Trial (RCT) was performed in four hospitals in the Netherlands. Patients treated with a bilateral sagittal split osteotomy (BSSO) and/or a Le Fort-I osteotomy, and those treated for fractures of the mandible, maxilla, or zygoma were included from December 2006 to July 2009. The patients were randomly assigned to either a titanium (KLS Martin) or a biodegradable group (Inion CPS). Results After >5 years postoperatively, plate removal was performed in 22 of the 134 (16.4%) patients treated with titanium and in 23 of the 87 (26.4%) patients treated with the biodegradable system (P = 0.036, hazard ratio (HR) biodegradable (95% CI) = 2.0 (1.05–3.8), HR titanium = 1). Occlusion, VAS pain scores, and MFIQ showed good and (almost) pain free mandibular function in both groups. Conclusion In conclusion, the performance of the Inion CPS biodegradable system was inferior compared to the KLS Martin titanium system regarding plate/screws removal in the abovementioned surgical procedures. Trial registration http://controlled-trials.com ISRCTN44212338. PMID:28493922

Soft tissue outcome after mandibular advancement--an anthropometric evaluation of 171 consecutive patients.

PubMed

Raschke, Gregor F; Rieger, Ulrich M; Bader, Rolf-Dieter; Guentsch, Arndt; Schaefer, Oliver; Schultze-Mosgau, Stefan

2013-06-01

There is an ongoing discussion in the literature about preoperative planning and postoperative evaluation of orthognathic surgery and its impact on facial appearance and aesthetics. We present an anthropometric and cephalometric evaluation of orthognathic surgery results based on reference anthropometric data. In 171 Class II patients, mandibular advancement by bilateral sagittal split osteotomy was performed. Preoperative as well as 3 and 9 months postoperative standardized frontal view and profile photographs and lateral cephalograms were evaluated in a standardized manner by use of 21 anthropometric indices. In cephalograms, SNA and SNB angle as well as Wits appraisal were investigated. Results of anthropometric and cephalometric measurements were correlated. Lower vermilion contour, vermilion and cutaneous total lower lip height, nose-lower face height, nose-face height, upper face-face height, upper lip- and chin-mandible height index showed significant pre- to postoperative changes as well as SNB angle and Wits appraisal. Furthermore, medial-lateral cutaneous upper lip height, vermilion and cutaneous total lower lip height and philtrum-mouth width index presented significant correlations to cephalometric measurements. The investigated anthropometric indices and cephalometric measurements presented reproducible results related to surgery. The correlation of cephalometric to anthropometric measurements has been proven useful for preoperative planning and postoperative evaluation of orthognathic surgery patients. The presented anthropometric measurements and their observed correlation to cephalometric measurements could lead to a better prediction and optimized planning of the soft tissue result in orthognathic surgery patients and thereby improve the aesthetic outcome.

Accuracy of virtual surgical planning in two-jaw orthognathic surgery: comparison of planned and actual results.

PubMed

Zhang, Nan; Liu, Shuguang; Hu, Zhiai; Hu, Jing; Zhu, Songsong; Li, Yunfeng

2016-08-01

This study aims to evaluate the accuracy of virtual surgical planning in two-jaw orthognathic surgery via quantitative comparison of preoperative planned and postoperative actual skull models. Thirty consecutive patients who required two-jaw orthognathic surgery were included. A composite skull model was reconstructed by using Digital Imaging and Communications in Medicine (DICOM) data from spiral computed tomography (CT) and STL (stereolithography) data from surface scanning of the dental arch. LeFort I osteotomy of the maxilla and bilateral sagittal split ramus osteotomy (of the mandible were simulated by using Dolphin Imaging 11.7 Premium (Dolphin Imaging and Management Solutions, Chatsworth, CA). Genioplasty was performed, if indicated. The virtual plan was then transferred to the operation room by using three-dimensional (3-D)-printed surgical templates. Linear and angular differences between virtually simulated and postoperative skull models were evaluated. The virtual surgical planning was successfully transferred to actual surgery with the help of 3-D-printed surgical templates. All patients were satisfied with the postoperative facial profile and occlusion. The overall mean linear difference was 0.81 mm (0.71 mm for the maxilla and 0.91 mm for the mandible); and the overall mean angular difference was 0.95 degrees. Virtual surgical planning and 3-D-printed surgical templates facilitated the diagnosis, treatment planning, and accurate repositioning of bony segments in two-jaw orthognathic surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Changes in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging.

PubMed

Cantarella, Daniele; Dominguez-Mompell, Ramon; Mallya, Sanjay M; Moschik, Christoph; Pan, Hsin Chuan; Miller, Joseph; Moon, Won

2017-11-01

Mini-implant-assisted rapid palatal expansion (MARPE) appliances have been developed with the aim to enhance the orthopedic effect induced by rapid maxillary expansion (RME). Maxillary Skeletal Expander (MSE) is a particular type of MARPE appliance characterized by the presence of four mini-implants positioned in the posterior part of the palate with bi-cortical engagement. The aim of the present study is to evaluate the MSE effects on the midpalatal and pterygopalatine sutures in late adolescents, using high-resolution CBCT. Specific aims are to define the magnitude and sagittal parallelism of midpalatal suture opening, to measure the extent of transverse asymmetry of split, and to illustrate the possibility of splitting the pterygopalatine suture. Fifteen subjects (mean age of 17.2 years; range, 13.9-26.2 years) were treated with MSE. Pre- and post-treatment CBCT exams were taken and superimposed. A novel methodology based on three new reference planes was utilized to analyze the sutural changes. Parameters were compared from pre- to post-treatment and between genders non-parametrically using the Wilcoxon sign rank test. For the frequency of openings in the lower part of the pterygopalatine suture, the Fisher's exact test was used. Regarding the magnitude of midpalatal suture opening, the split at anterior nasal spine (ANS) and at posterior nasal spine (PNS) was 4.8 and 4.3 mm, respectively. The amount of split at PNS was 90% of that at ANS, showing that the opening of the midpalatal suture was almost perfectly parallel antero-posteriorly. On average, one half of the anterior nasal spine (ANS) moved more than the contralateral one by 1.1 mm. Openings between the lateral and medial plates of the pterygoid process were detectable in 53% of the sutures (P < 0.05). No significant differences were found in the magnitude and frequency of suture opening between males and females. Correlation between age and suture opening was negligible (R 2 range, 0.3-4.2%). Midpalatal suture was successfully split by MSE in late adolescents, and the opening was almost perfectly parallel in a sagittal direction. Regarding the extent of transverse asymmetry of the split, on average one half of ANS moved more than the contralateral one by 1.1 mm. Pterygopalatine suture was split in its lower region by MSE, as the pyramidal process was pulled out from the pterygoid process. Patient gender and age had a negligible influence on suture opening for the age group considered in the study.

Instrumentation Strategies to Reduce the Risks of Proximal Junctional Kyphosis in Adult Scoliosis: A Detailed Biomechanical Analysis.

PubMed

Aubin, Carl-Eric; Cammarata, Marco; Wang, Xiaoyu; Mac-Thiong, Jean-Marc

2015-05-01

Biomechanical analysis of proximal junctional kyphosis (PJK) through numerical simulations. Assessment of the effect of sagittal alignment, the upper instrumented vertebral level (UIV), and 4 other surgical variables on biomechanical indices related to the PJK risks. Despite retrospective clinical studies, biomechanical analysis of individual parameters associated with PJK is lacking to support instrumentation strategies to reduce the PJK risks. Instrumentations of 6 adult scoliosis cases with different operative strategies were simulated (1,152 simulations). Proximal junctional (PJ) angle and flexion loads were evaluated against the sagittal alignment and the proximal instrumentation level. Instrumenting 1 more proximal vertebra allowed the PJ angle, proximal moment, and force to be reduced by 18%, 25%, and 16%, respectively. Shifting sagittal alignment by 20 mm posteriorly increased the PJ angle and proximal moment by 16% and 22%, and increased the equivalent posterior extensor force by 37%. Bilateral complete facetectomy, posterior ligaments resection, and the combination of the 2 resulted in an increase of the PJ angle (by 10%, 28%, and 53%, respectively), flexion forces (by 4%, 12%, and 22%, respectively), and proximal moments (by 16%, 44%, and 83%, respectively). Transverse process hooks at UIV compared with pedicle screws allowed 26% lower PJ angle and flexion loads. The use of proximal transition rods with proximal diameter reduced from 5.5 to 4 mm slightly reduced PJ angle, flexion force, and moment (less than 8%). The increase in sagittal rod curvature from 10° to 40° increased the PJ angle (from 6% to 19%), flexion force (from 3% to 10%), and moment (from 9% to 27%). Simulated posteriorly shifted sagittal alignment was associated with higher PJK risks, whereas extending instrumentation proximally allowed a lower mechanical risk of PJK. Preserving PJ intervertebral elements and using a more flexible anchorage at UIV help reduce the biomechanical risks of PJK. Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Onyx removal after embolization of a superior sagittal sinus dural arteriovenous fistula involving scalp artery.

PubMed

Watanabe, Jun; Maruya, Jun; Nishimaki, Keiichi; Ito, Yasushi

2016-01-01

Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. A 59-year-old male presented with involuntary movements of both legs and progressive dementia. Cerebral angiography demonstrated the DAVF in the SSS fed by bilateral superficial temporal, occipital, and middle meningeal arteries. The posterior SSS was thrombosed, and the main drainers were cortical veins. Combined treatment with transarterial embolization using Onyx and transvenous embolization using coils was performed. Although symptoms were improved, a small DAVF remained. Two months later, Onyx cast extrusion through the scalp was observed, requiring removal and debridement because of infection at the extrusion sites. Surgery for the residual DAVF would be difficult because of scalp condition; therefore, an additional endovascular treatment was conducted, completely occluding DAVF. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures.

Bone-anchored maxillary expansion and bilateral interoral mandibular distraction osteogenesis in adult with severe obstructive sleep apnea syndrome.

PubMed

Nie, Ping; Zhu, Min; Lu, Xiao-Feng; Fang, Bing

2013-05-01

Severe obstructive sleep apnea syndrome (OSAS) threatens patients' lives. To solve ventilation problem, snoring, and avoid another orthognathic surgery for mandibular advancement, bone-anchored rapid maxillary expansion and bilateral interoral mandibular distraction osteogenesis were tried on a 20-year-old Chinese male patient with severe skeletal class II malocclusion and OSAS.The patient had polysomnography (apnea-hypopnea index 54.2), body mass index measurement (19.7 kg/m), and cephalometry before the treatment. Bone-anchored rapid maxillary expansion was performed for the correction of maxillary transverse and minor sagittal deficiency and the improvement of nasal airflow by decreasing nasal resistance. Bilateral interoral mandibular distraction osteogenesis was operated to lengthen the small, retruded mandible by 15 mm. Orthodontic treatment after the maxillary expansion and mandibular distraction osteogenesis can help obtain stable occlusion.The Epworth Sleepiness Scale, a questionnaire for temporomandibular joint, cephalometric analysis, polysomnography, acoustic rhinometry, and multislice spiral computed tomography were performed to evaluate changes from the treatment. All the results showed that the patient had a significantly alleviated OSAS. In addition, an acceptable occlusion was also obtained.

Computer assisted positioning of the proximal segment after sagittal split osteotomy of the mandible: Preclinical investigation of a novel electromagnetic navigation system.

PubMed

Nova, Igor; Kallus, Sebastian; Berger, Moritz; Ristow, Oliver; Eisenmann, Urs; Freudlsperger, Christian; Hoffmann, Jürgen; Dickhaus, Hartmut

2017-05-01

Modifications of the temporomandibular joint position after mandible osteotomy are reluctantly accepted in orthognathic surgery. To tackle this problem, we developed a new navigation system using miniaturized electromagnetic sensors. Our imageless navigation approach is therefore optimized to avoid complications of previously proposed optical approaches such as the interference with established surgical procedures and the line of sight problem. High oblique sagittal split osteotomies were performed on 6 plastic skull mandibles in a laboratory under conditions comparable to the operating theatre. The subsequent condyle reposition was guided by an intuitive user interface and performed by electromagnetic navigation. To prove the suitability and accuracy of this novel approach for condyle navigation, the positions of 3 titanium marker screws placed on each of the proximal segments were compared using pre- and postoperative Cone Beam Computed Tomography (CBCT) imaging. Guided by the electromagnetic navigation system, positioning of the condyles was highly accurate in all dimensions. Translational discrepancies up to 0,65 mm and rotations up to 0,38° in mean could be measured postoperatively. There were no statistically significant differences between navigation results and CBCT measurements. The intuitive user interface provides a simple way to precisely restore the initial position and orientation of the proximal mandibular segments. Our electromagnetic navigation system therefore yields a promising approach for orthognathic surgery applications. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Inferior alveolar nerve function after sagittal split osteotomy by reciprocating saw or piezosurgery instrument: prospective double-blinded study.

PubMed

Monnazzi, Marcelo Silva; Real Gabrielli, Mario Francisco; Passeri, Luis Augusto; Cabrini Gabrielli, Marisa Aparecida; Spin-Neto, Rubens; Pereira-Filho, Valfrido Antonio

2014-06-01

The aim of this prospective study was to objectively evaluate inferior alveolar nerve (IAN) sensory disturbances in patients who underwent sagittal split ramus osteotomy (SSRO) by comparing 1 side treated with a reciprocating saw with the other side treated with a piezosurgery device. Clinical evaluation of IAN sensory disturbance was undertaken preoperatively and at 1 week, 4 weeks, 2 months, and 6 months postoperatively in 20 patients who underwent SSRO at the Division of Oral and Maxillofacial Surgery, Araraquara Dental School, São Paulo State University. The 20 patients were examined at all periods for IAN functionality by Semmes-Weinstein testing; neither the patients nor the examiner knew which side was treated using piezosurgery or a reciprocating saw. The mean age of the patients was 28.4 years (range, 20 to 48 yr). Before surgery, no patient had impaired function of the IAN in any of the 8 zones in the mental and inferior lip areas. All patients reported feeling the first monofilament at the time of the preoperative test. Seven days postoperatively, all patients reported some kind of altered sensitivity in at least 1 zone evaluated. The results of this study suggest there was no statistically significant difference in the sensitivity of the labiomental area regarding the instrument used to perform the osteotomy. Future studies will focus on enlarging the sample and evaluating the results. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis

PubMed Central

Kocak, Nilufer; Ozturk, Taylan A; Kaynak, Suleyman

2014-01-01

X-linked juvenile retinoschisis is a rare hereditary retinal disease characterized by a tangential splitting of the neurosensory retina which may cause early-onset visual impairment. Existence of the retinal neurosensory layer splitting on cross-sectional images of optical coherance tomography (OCT) and the absence of leakage on fluorescein angiography (FA) help confirming the diagnosis. Such diagnostic tests are also helpful in determining the management of the disease. However, most of the retinoschisis cavities remain stable and rarely extend to the posterior pole, many authors suggest laser prophylaxis to avoid the potential risk of retinal detachment due to holes in the outer retinal layer. Herein, we report a case with bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis who was evaluated with detailed ophthalmologic examination. Visual acuity, fundoscopy, OCT, and FA remained stable in the second year of follow-up after prophylactic argon laser treatment. PMID:23571248

Comparison of the trunk-pelvis and lower extremities sagittal plane inter-segmental coordination and variability during walking in persons with and without chronic low back pain.

PubMed

Ebrahimi, Samaneh; Kamali, Fahimeh; Razeghi, Mohsen; Haghpanah, Seyyed Arash

2017-04-01

Inter-segmental coordination can be influenced by chronic low back pain (CLBP). The sagittal plane lower extremities inter-segmental coordination pattern and variability, in conjunction with the pelvis and trunk, were assessed in subjects with and without non-specific CLBP during free-speed walking. Kinematic data were collected from 10 non-specific CLBP and 10 non-CLBP control volunteers while the subjects were walking at their preferred speed. Sagittal plane time-normalized segmental angles and velocities were used to calculate continuous relative phase for each data point. Mean absolute relative phase (MARP) and deviation phase (DP) were derived to quantify the trunk-pelvis and bilateral pelvis-thigh, thigh-shank and shank-foot coordination pattern and variability over the stance and swing phases of gait. Mann-Whitney U test was employed to compare the means of DP and MARP values between two groups (same side comparison). Statistical analysis revealed more in-phase/less variable trunk-pelvis coordination in the CLBP group (P<0.05). CLBP group demonstrated less variable right or left pelvis-thigh coordination pattern (P<0.05). Moreover, the left thigh-shank and left shank-foot MARP values in the CLBP group, were more in-phase than left MARP values in the non-CLBP control group during the swing phase (P<0.05). In conclusion, the sagittal plane lower extremities, pelvis and trunk coordination pattern and variability could be generally affected by CLBP during walking. These changes can be possible compensatory strategies of the motor control system which can be considered in the CLBP subjects. Copyright © 2017 Elsevier B.V. All rights reserved.

Coordinative structuring of gait kinematics during adaptation to variable and asymmetric split-belt treadmill walking - A principal component analysis approach.

PubMed

Hinkel-Lipsker, Jacob W; Hahn, Michael E

2018-06-01

Gait adaptation is a task that requires fine-tuned coordination of all degrees of freedom in the lower limbs by the central nervous system. However, when individuals change their gait it is unknown how this coordination is organized, and how it can be influenced by contextual interference during practice. Such knowledge could provide information about measurement of gait adaptation during rehabilitation. Able-bodied individuals completed an acute bout of asymmetric split-belt treadmill walking, where one limb was driven at a constant velocity and the other according to one of three designed practice paradigms: serial practice, where the variable limb belt velocity increased over time; random blocked practice, where every 20 strides the variable limb belt velocity changed randomly; random practice, where every stride the variable limb belt velocity changed randomly. On the second day, subjects completed one of two different transfer tests; one with a belt asymmetry close to that experienced on the acquisition day (transfer 1; 1.5:1), and one with a greater asymmetry (transfer 2; 2:1) . To reduce this inherently high-dimensional dataset, principal component analyses were used for kinematic data collected throughout the acquisition and transfer phases; resulting in extraction of the first two principal components (PCs). For acquisition, PC1 and PC2 were related to sagittal and frontal plane control. For transfer 1, PC1 and PC2 were related to frontal plane control of the base of support and whole-body center of mass. For transfer 2, PC1 did not have any variables with high enough coefficients deemed to be relevant, and PC2 was related to sagittal plane control. Observations of principal component scores indicate that variance structuring differs among practice groups during acquisition and transfer 1, but not transfer 2. These results demonstrate the main kinematic coordinative structures that exist during gait adaptation, and that control of sagittal plane and frontal plane motion are perhaps a trade-off during acquisition of a novel asymmetric gait pattern. Copyright © 2018 Elsevier B.V. All rights reserved.

The variable position of the inferior alveolar nerve (IAN) in the mandibular ramus: a computed tomography (CT) study.

PubMed

Yeh, Andrew Y E; Finn, Brian P; Jones, Robert H B; Goss, Alastair N

2018-06-01

This study was designed to quantify the important anatomical landmarks and the path of the inferior alveolar nerve (IAN) within the human mandibular body and ramus, in particular with reference to the bilateral sagittal split osteotomy (BSSO). Four hundred and eleven CT scans were studied, 299 of these were involved in determining the position of lingula; and 230 were involved in determining the course of IAN in the mandibular molar region, namely from the mesial of the mandibular first molar to the distal of the mandibular second molar; 118 were involved with both measurements. On average, the lingula was located 17.0 ± 2.2 mm from the external oblique ridge; 11.6 ± 2.0 mm from the internal oblique ridge; 17.2 ± 2.7 mm from the sigmoid notch; and 15.6 ± 1.9 mm from the posterior border of the mandible. The course of the IAN in the mandibular molar region was found to descend vertically from the distal of the mandibular second molar (7) to reach its lowest point between the first and second molars (6 and 7), and then ascend towards the mesial of the first molar (6). Horizontally, the IAN was found to traverse medially between the distal of the 7 and the middle of the 7, and then changes its path laterally towards the mesial of the 6. Precise knowledge of the individual's position of the IAN will help surgical planning.

Evaluation of orthognathic surgery on articular disc position and temporomandibular joint symptoms in skeletal class II patients: A Magnetic Resonance Imaging study.

PubMed

Firoozei, Gholamreza; Shahnaseri, Shirin; Momeni, Hasan; Soltani, Parisa

2017-08-01

The purpose of orthognathic surgery is to correct facial deformity and dental malocclusion and to obtain normal orofacial function. However, there are controversies of whether orthognathic surgery might have any negative influence on temporomandibular (TM) joint. The purpose of this study was to evaluate the influence of orthognathic surgery on articular disc position and temporomandibular joint symptoms of skeletal CI II patients by means of magnetic resonance imaging. For this purpose, fifteen patients with skeletal CI II malocclusion, aged 19-32 years (mean 23 years), 10 women and 5 men, from the Isfahan Department of Oral and Maxillofacial Surgery were studied. All received LeFort I and bilateral sagittal split osteotomy (BSSO) osteotomies and all patients received pre- and post-surgical orthodontic treatment. Magnetic resonance imaging was performed 1 day preoperatively and 3 month postoperatively. Descriptive statistics and Wilcoxon and Mc-Nemar tests were used for statistical analysis. P <0.05 was considered significant. Disc position ranged between 4.25 and 8.09 prior to surgery (mean=5.74±1.21). After surgery disc position range was 4.36 to 7.40 (mean=5.65±1.06). Statistical analysis proved that although TM disc tended to move anteriorly after BSSO surgery, this difference was not statistically significant ( p value<0.05). The findings of the present study revealed that orthognathic surgery does not alter the disc and condyle relationship. Therefore, it has minimal effects on intact and functional TM joint. Key words: Orthognathic surgery, skeletal class 2, magnetic resonance imaging, temporomandibular disc.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aburano, T.; Takayama, T.; Nakajima, K.

The three different methods to evaluate the alterations of split renal function following continued captopril treatment were studied in patients with hypertension. Five patients had unilateral and 2 had bilateral renal artery stenosis, and 13 had normal renal arteries. The studies were performed the day prior to receiving captopril (baseline), and 6th or 7th day following continued captorpril treatment (37.5mg or 75mg/day): Split effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) after injections of I-131 iodohippuran and Tc-99m DTPA were measured respectively by the methods using kidney counting corrected for depth and dose, described by Schlegel and Gates.more » And Tc-99m DMSA uptake was also evaluated qualitatively. In most of patients with renal artery stenosis, split GFR and Tc-99m DMSA uptake in the affected kidney were markedly decreased 6th or 7th day following continued captorpril treatment. These findings suggest that the captopril induced alterations of split renal function may be of importance for the diagnosis of renovascular hypertension. For this purpose, split GFR determination and Tc-99m DMSA study are more useful than split ERPF determination.« less

Onyx removal after embolization of a superior sagittal sinus dural arteriovenous fistula involving scalp artery

PubMed Central

Watanabe, Jun; Maruya, Jun; Nishimaki, Keiichi; Ito, Yasushi

2016-01-01

Background: Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Case Description: A 59-year-old male presented with involuntary movements of both legs and progressive dementia. Cerebral angiography demonstrated the DAVF in the SSS fed by bilateral superficial temporal, occipital, and middle meningeal arteries. The posterior SSS was thrombosed, and the main drainers were cortical veins. Combined treatment with transarterial embolization using Onyx and transvenous embolization using coils was performed. Although symptoms were improved, a small DAVF remained. Two months later, Onyx cast extrusion through the scalp was observed, requiring removal and debridement because of infection at the extrusion sites. Surgery for the residual DAVF would be difficult because of scalp condition; therefore, an additional endovascular treatment was conducted, completely occluding DAVF. Conclusion: Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures. PMID:27313969

A Novel Junctional Tether Weave Technique for Adult Spinal Deformity: 2-Dimensional Operative Video.

PubMed

Buell, Thomas J; Mullin, Jeffrey P; Nguyen, James H; Taylor, Davis G; Garces, Juanita; Mazur, Marcus D; Buchholz, Avery L; Shaffrey, Mark E; Yen, Chun-Po; Shaffrey, Christopher I; Smith, Justin S

2018-06-05

Proximal junctional kyphosis (PJK) is a common problem after multilevel spine instrumentation for adult spinal deformity. Various anti-PJK techniques such as junctional tethers for ligamentous augmentation have been proposed. We present an operative video demonstrating technical nuances of junctional tether "weave" application. A 70-yr-old male with prior L2-S1 instrumented fusion presented with worsening back pain and posture. Imaging demonstrated pathological loss of lumbar lordosis (flat back deformity), proximal junctional failure, and pseudarthrosis. The patient had severe global and segmental sagittal malalignment, with sagittal vertical axis (SVA, C7-plumbline) measuring 22.3 cm, pelvic incidence (PI) 55°, lumbar lordosis (LL) 8° in kyphosis, pelvic tilt (PT) 30°, and thoracic kyphosis (TK) 6°. The patient gave informed consent for surgery and use of imaging for medical publication. Briefly, surgery first involved re-instrumentation with bilateral pedicle screws from T10 to S1. After right-sided iliac screw fixation (left-sided iliac screw fixation was not performed due to extensive prior iliac crest bone graft harvesting), we then completed a L2-3 Smith-Petersen osteotomy, extended L4 pedicle subtraction osteotomy, and L3-4 interbody arthrodesis with a 12° lordotic cage (9 × 14 × 40 mm). Cobalt Chromium rods were placed spanning the instrumentation bilaterally, and accessory supplemental rods spanning the PSO were attached. An anti-PJK junctional tether "weave" was then implemented using 4.5 mm polyethylene tape (Mersilene tape [Ethicon, Somerville, New Jersey]). Postoperative imaging demonstrated improved alignment (SVA 2.8 cm, PI 55°, LL 53°, PT 25°, TK 45°) and no significant neurological complications occurred during convalescence or at 6 mo postop.

The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis.

PubMed

Wang, Shengru; Aikenmu, Kahaer; Zhang, Jianguo; Qiu, Guixing; Guo, Jianwei; Zhang, Yanbin; Weng, Xisheng

2017-07-01

The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis. 24 patients with isolated angular congenital kyphosis treated by PVCR in our hospital were retrospectively studied. The patients' radiographs and hospital records were reviewed. Deformity in sagittal planes and global sagittal alignment were analyzed for correction and maintenance of the correction in preoperative, postoperative, and follow-up radiographs. The complications and related risk factors were analyzed. The average age was 13.9 (4-40) years. Three of them were revision surgeries. Two patients have intraspinal anomalies. The mean follow-up is 56.9 (26-129) months. The mean operation time was 293.1 (170-480) min. The averaged blood loss was 993.8 (250-3000) ml. The segmental kyphosis was 87.3° before surgery, 17.6° post surgery and 20.4° at the latest the follow-up. And the sagittal vertical axis was improved from 43.1 mm to 9.2 mm. Mean total score of SRS-22 was 89.3. Complications occurred in 4 patients, including 1 screw pullout due to pseudarthrosis, 1 proximal junctional kyphosis, 1 incomplete spinal cord injury and 1 root injuries. Posterior-only vertebral column resection is an ideal procedure for severe rigid congenital kyphosis. However, it is still a highly technical demanding procedure. Neurological compromises still remain the biggest challenges. Sufficient height of anterior reconstruction, avoidance sacrifice of bilateral roots in the same level in the thoracic spine, avoidance of the sagittal translation of the upper and lower vertebras, intra-operative neuromonitoring, and preoperative surgical release of diastematomyelia and tethered cord may help to improve the safety.

Occlusal plane rotation: aesthetic enhancement in mandibular micrognathia.

PubMed

Rosen, H M

1993-06-01

Patients afflicted with extreme degrees of mandibular micrognathia typically have vertically deficient rami as well as sagittally deficient mandibular bodies. This results in deficient posterior facial height, an obtuse gonial angle, excessively steep occlusal and mandibular planes, and a compensatory increase in anterior facial height. The entire maxillomandibular complex is overrotated in a clockwise direction. Standard orthognathic surgical correction fails to address this rotational deformity. As a consequence, the achieved projection of the lower face is inadequate, posterior facial height is further reduced, and occlusal and mandibular planes remain steep. Eleven patients with severe mandibular micrognathia underwent a surgical correction involving occlusal plane rotation to its normal orientation relative to Frankfort horizontal. This was accomplished by Le Fort I osteotomy to shorten the anterior maxilla (creating open bites in seven patients and making preexisting open bites worse in four patients) and sagittal split ramus osteotomies to advance and rotate the mandibular body counterclockwise, thus closing the surgically produced open bite. Counterclockwise rotation of the mandible afforded significantly greater sagittal displacement at the B point (mean 17 mm) than at the first molar (mean 10 mm) and produced adequate degrees of projection of the lower face when accompanied by a modest sliding genioplasty (mean 6.9 mm). Total advancement at the pogonion was a mean of 25.2 mm. In addition, posterior facial height was preserved, and mandibular and occlusal planes were normalized to mean angles of 27 and 10 degrees, respectively. At follow-up, which ranged from 9 to 24 months with a mean of 14.1 months, the mean sagittal relapse at the B point was 1.9 mm. Although heretofore considered unstable and therefore not clinically accepted, maxillomandibular counterclockwise rotation to normalize the occlusal plane rotational deformity provides stable, aesthetically superior results in patients with extreme degrees of mandibular micrognathia. Extended follow-up will be necessary to document long-term stability.

Dorsal buccal mucosal graft urethroplasty for anterior urethral stricture by Asopa technique.

PubMed

Pisapati, V L N Murthy; Paturi, Srimannarayana; Bethu, Suresh; Jada, Srikanth; Chilumu, Ramreddy; Devraj, Rahul; Reddy, Bhargava; Sriramoju, Vidyasagar

2009-07-01

Buccal mucosal graft (BMG) substitution urethroplasty has become popular in the management of intractable anterior urethral strictures with good results. Excellent long-term results have been reported by both dorsal and ventral onlay techniques. Asopa reported a successful technique for dorsal placement of BMG in long anterior urethral strictures through a ventral sagittal approach. To evaluate prospectively the results and advantages of dorsal BMG urethroplasty for recurrent anterior urethral strictures by a ventral sagittal urethrotomy approach (Asopa technique). From December 2002 to December 2007, a total of 58 men underwent dorsal BMG urethroplasty by a ventral sagittal urethrotomy approach for recurrent urethral strictures. Forty-five of these patients with a follow-up period of 12-60 mo were prospectively evaluated, and the results were analysed. The urethra was split twice at the site of the stricture both ventrally and dorsally without mobilising it from its bed, and the buccal mucosal graft was secured in the dorsal urethral defect. The urethra was then retubularised in one stage. The overall results were good (87%), with a mean follow-up period of 42 mo. Seven patients developed minor wound infection, and five patients developed fistulae. There were six recurrences (6:45, 13%) during the follow-up period of 12-60 mo. Two patients with a panurethral stricture and four with bulbar or penobulbar strictures developed recurrences and were managed by optical urethrotomy and self-dilatation. The medium-term results were as good as those reported with the dorsal urethrotomy approach. Long-term results from this and other series are awaited. More randomised trials and meta-analyses are needed to establish this technique as a procedure of choice in future. The ventral sagittal urethrotomy approach is easier to perform than the dorsal urethrotomy approach, has good results, and is especially useful in long anterior urethral strictures.

[Usefulness of Edoxaban for Deep Cerebral Venous Sinus Thrombosis with Hemorrhagic Infarction:A Case Report].

PubMed

Amemiya, Takeo; Uesaka, Toshio; Kameda, Katsuharu; Uno, Junji; Nagaoka, Shintaro; Ikai, Yoshiaki; Gi, Hidefuku

2017-07-01

We describe a case of deep cerebral venous sinus thrombosis(DCVST)that was successfully treated by oral administration of the Xa inhibitor edoxaban. A 53-year-old man was admitted to our hospital because of a headache and undifferentiated dizziness. Computed tomography(CT)demonstrated a low-density area in the bilateral thalamus and high-density lesions in the internal cerebral veins(ICVs)and vein of Galen. Magnetic resonance imaging with diffusion-weighted images detected areas of hyperintensity in the bilateral thalamus. Additionally, the inferior sagittal sinus, ICV, and vein of Galen were not detected by CT venography or cerebral angiography. We therefore diagnosed DCVST and started anticoagulation therapy with heparin(IV)and warfarin. A week after admission, lesions that showed hypointensity on T2^* images and high density on CT scans were detected in the bilateral thalamus. We thought that hemorrhagic infarction had occurred in association with DCVST, and changed the anticoagulation therapy to oral administration of edoxaban on day 9. The patient's symptoms gradually diminished, and CT venography indicated partial recanalization of the DCV from the ICV to the vein of Galen on day 72. We report our experience, and discuss the safety and usefulness of the Xa inhibitor for treating DCVST with hemorrhagic infarction.

Facial attractiveness of skeletal Class II patients before and after mandibular advancement surgery as perceived by people with different backgrounds.

PubMed

Ng, Doreen; De Silva, Rohana Kumara; Smit, Ryan; De Silva, Harsha; Farella, Mauro

2013-08-01

The purpose of this study was to determine the perceived level of improvement in facial attractiveness as assessed by people with different backgrounds in skeletal Class II patients treated by mandibular advancement with bilateral sagittal split osteotomy (BSSO). The frontal and lateral pre- and post-operative photographs of 10 Caucasian patients were selected. Changes in frontal and profile attractiveness were assessed by 10 orthodontists, 10 art students, and 10 laypersons. Frontal and lateral pre- and post-operative photographs were randomly distributed throughout two surveys. For each photograph, the evaluators ranked the attractiveness of face, chin, and lips on visual analogue scales. A third survey was administered to orthodontists only, by presenting the same pre and post-operative photographs but paired side-by-side with pre- and post-operative status disclosed. Overall, attractiveness scores after BSSO showed an 11.5 per cent improvement (95 per cent confidence intervals: 9.4-13.5 per cent) on the lateral post-operative photographs and a 7.5 per cent improvement (95 per cent confidence intervals: 5.4-9.5 per cent) on the frontal post-operative photographs. Attractiveness scores differed significantly between the groups (P = 0.015), with orthodontists being more generous with their improvement ratings and the art students tending to give a more critical assessment. There were no significant differences between male and female evaluators (P > 0.05). Ratings of before-after attractiveness almost doubled when the pre- and post-operative status was disclosed as compared to blinded evaluations, thus indicating that prior knowledge of pre- and post-treatment status markedly influences aesthetic evaluations, with a bias towards a more favourable outcome.

[Roberts-SC phocomelia syndrome].

PubMed

Musfeld, D A; Bühler, E M; Heinzl, S

2001-01-01

The Roberts-SC phocomelia syndrome is a rare autosomal recessive inherited disorder clinically manifested by tetraphocomelia, pre- and postnatal growth retardation, and craniofacial abnormalities (skull, eyes, lip, and palate), accompanied at times by centromer puffing and splitting, renal abnormalities, heart defect, clitoral or penile enlargement, and bilateral corneal opacities. Mental retardation is common in surviving patients.

Generation of co-speech gestures based on spatial imagery from the right-hemisphere: evidence from split-brain patients.

PubMed

Kita, Sotaro; Lausberg, Hedda

2008-02-01

It has been claimed that the linguistically dominant (left) hemisphere is obligatorily involved in production of spontaneous speech-accompanying gestures (Kimura, 1973a, 1973b; Lavergne and Kimura, 1987). We examined this claim for the gestures that are based on spatial imagery: iconic gestures with observer viewpoint (McNeill, 1992) and abstract deictic gestures (McNeill, et al. 1993). We observed gesture production in three patients with complete section of the corpus callosum in commissurotomy or callosotomy (two with left-hemisphere language, and one with bilaterally represented language) and nine healthy control participants. All three patients produced spatial-imagery gestures with the left-hand as well as with the right-hand. However, unlike healthy controls and the split-brain patient with bilaterally represented language, the two patients with left-hemispheric language dominance coordinated speech and spatial-imagery gestures more poorly in the left-hand than in the right-hand. It is concluded that the linguistically non-dominant (right) hemisphere alone can generate co-speech gestures based on spatial imagery, just as the left-hemisphere can.

Sacroiliac joint luxation after pedicle subtraction osteotomy: report of two cases and analysis of failure mechanism.

PubMed

Charles, Yann Philippe; Yu, Bo; Steib, Jean-Paul

2016-05-01

Sagittal decompensation after pedicle subtraction osteotomy (PSO) is considered as late onset complication. Several mechanisms have been suggested, but little attention has been paid to the caudal end of lumbar instrumented fusion, especially sacral iliac joint (SIJ) deterioration. Clinical histories and radiographic sagittal parameters of two patients with SIJ luxation after PSO are presented. The biomechanical failure mechanism and risk factors are analysed. Two patients underwent correction of fixed anterior sagittal imbalance by PSO, followed by pseudarthrosis revision surgery. Both of them sustained persistent sacroiliac pain, progressive recurrence of anterior imbalance and progressive pelvic incidence (PI) increase around 10°. An acute bilateral SIJ luxation occurred in both patients leading to sharp increase or PI around 20°. One patient was treated by SIJ fusion and the other patient was placed on non-weight-bearing crutch ambulation for 1 year. Both patients had a high preoperative PI (95° and 78°). A theoretical match between lumbar lordosis (LL) and PI was not achieved by PSO. Osteopenia was present in both patients. Computed tomography evidenced L5-S1 pseudarthrosis and sacroiliac joint violation by pelvic or sacral ala screws. Patients with high PI might seek for further compensation at their SIJ when lacking LL after PSO. Chronic anterior imbalance might lead to progressive weakening of sacroiliac ligaments. Initial circumferential lumbosacral fusion and accurate iliac screw fixation might reduce stress on implants, risk for pseudarthrosis, implant failure and finally SIJ deterioration. Bone mineral density should further be investigated preoperatively.

Coordination between pelvis and shoulder girdle during walking in bilateral cerebral palsy.

PubMed

Tavernese, Emanuela; Paoloni, Marco; Mangone, Massimiliano; Castelli, Enrico; Santilli, Valter

2016-02-01

Studies revealed that pelvis and shoulder girdle kinematics is impaired in children with the diplegic form of bilateral cerebral palsy while walking. The features of 3D coordination between these segments, however, have never been evaluated. The gait analyses of 27 children with bilateral cerebral palsy (18 males; mean age 124 months) have been retrospectively reviewed from the database of a Movement Analysis Laboratory. The spatial-temporal parameters and the range-of-motions of the pelvis and of the shoulder girdle on the three planes of motion have been calculated. Continuous relative phase has been calculated for the 3D pelvis-shoulder girdle couplings on the transverse, sagittal and frontal planes of motion to determine coordination between these segments. Data from 10 typically developed children have been used for comparison. Children with bilateral cerebral palsy walk with lower velocity (P=0.01), shorter steps (P<0.0001), larger base of support (P<0.01) and increased duration of the double support phase (P=0.005) when compared to typically developed children. The mean continuous relative phase on the transverse plane has been found lower in the cerebral palsy group throughout the gait cycle (P=0.003), as well as in terminal stance, pre-swing and mid-swing. The age, gait speed and pelvis range-of-motions on the transverse plane have been found correlated to continuous relative phase on the transverse plane. Compared with typically developed children, children with bilateral cerebral palsy show a more in-phase coordination between the pelvis and the shoulder girdle on the transverse plane while walking. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prevalence of Split Nerve Fiber Layer Bundles in Healthy People Imaged with Spectral Domain Optical Coherence Tomography.

PubMed

Gür Güngör, Sirel; Akman, Ahmet; Sarıgül Sezenöz, Almila; Tanrıaşıkı, Gülşah

2016-12-01

The presence of retinal nerve fiber layer (RNFL) split bundles was recently described in normal eyes scanned using scanning laser polarimetry and by histologic studies. Split bundles may resemble RNFL loss in healthy eyes. The aim of our study was to determine the prevalence of nerve fiber layer split bundles in healthy people. We imaged 718 eyes of 359 healthy persons with the spectral domain optical coherence tomography in this cross-sectional study. All eyes had intraocular pressure of 21 mmHg or less, normal appearance of the optic nerve head, and normal visual fields (Humphrey Field Analyzer 24-2 full threshold program). In our study, a bundle was defined as 'split' when there is localized defect not resembling a wedge defect in the RNFL deviation map with a symmetrically divided RNFL appearance on the RNFL thickness map. The classification was performed by two independent observers who used an identical set of reference examples to standardize the classification. Inter-observer consensus was reached in all cases. Bilateral superior split bundles were seen in 19 cases (5.29%) and unilateral superior split was observed in 15 cases (4.16%). In 325 cases (90.52%) there was no split bundle. Split nerve fiber layer bundles, in contrast to single nerve fiber layer bundles, are not common findings in healthy eyes. In eyes with normal optic disc appearance, especially when a superior RNFL defect is observed in RNFL deviation map, the RNLF thickness map and graphs should also be examined for split nerve fiber layer bundles.

Brief Communication: visual-field superiority as a function of stimulus type and content: further evidence.

PubMed

Basu, Anamitra; Mandal, Manas K

2004-07-01

The present study examined visual-field advantage as a function of presentation mode (unilateral, bilateral), stimulus structure (facial, lexical), and stimulus content (emotional, neutral). The experiment was conducted in a split visual-field paradigm using a JAVA-based computer program with recognition accuracy as the dependent measure. Unilaterally, rather than bilaterally, presented stimuli were significantly better recognized. Words were significantly better recognized than faces in the right visual-field; the difference was nonsignificant in the left visual-field. Emotional content elicited left visual-field and neutral content elicited right visual-field advantages. Copyright Taylor and Francis Inc.

Successful Recovery and Transplantation of 11 Organs Including Face, Bilateral Upper Extremities, and Thoracic and Abdominal Organs From a Single Deceased Organ Donor.

PubMed

Tullius, Stefan G; Pomahac, Bohdan; Kim, Heung Bae; Carty, Matthew J; Talbot, Simon G; Nelson, Helen M; Delmonico, Francis L

2016-10-01

We report on the to date largest recovery of 11 organs from a single deceased donor with the transplantation of face, bilateral upper extremities, heart, 1 lung, liver (split for 2 recipients), kidneys, pancreas, and intestine. Although logistically challenging, this case demonstrates the feasibility and safety of the recovery of multiple thoracic and abdominal organs with multiple vascular composite allotransplants and tissues. Our experience of 8 additional successful multiple vascular composite allotransplants, thoracic, and abdominal organ recoveries suggests that such procedures are readily accomplishable from the same deceased donor.

White Matter Changes in Tinnitus: Is It All Age and Hearing Loss?

PubMed

Yoo, Hye Bin; De Ridder, Dirk; Vanneste, Sven

2016-02-01

Tinnitus is a condition characterized by the perception of auditory phantom sounds. It is known as the result of complex interactions between auditory and nonauditory regions. However, previous structural imaging studies on tinnitus patients showed evidence of significant white matter changes caused by hearing loss that are positively correlated with aging. Current study focused on which aspects of tinnitus pathologies affect the white matter integrity the most. We used the diffusion tensor imaging technique to acquire images that have higher contrast in brain white matter to analyze how white matter is influenced by tinnitus-related factors using voxel-based methods, region of interest analysis, and deterministic tractography. As a result, white matter integrity in chronic tinnitus patients was both directly affected by age and also mediated by the hearing loss. The most important changes in white matter regions were found bilaterally in the anterior corona radiata, anterior corpus callosum, and bilateral sagittal strata. In the tractography analysis, the white matter integrity values in tracts of right parahippocampus were correlated with the subjective tinnitus loudness.

Imageological measurement of the sternoclavicular joint and its clinical application.

PubMed

Li, Ming; Wang, Bo; Zhang, Qi; Chen, Wei; Li, Zhi-Yong; Qin, Shi-Ji; Zhang, Ying-Ze

2012-01-01

Dislocation of the sternoclavicular joint is rare. However, posterior dislocation compressing important structures in the mediastinum may be fatal. Early diagnosis and prompt therapy of sternoclavicular joint dislocation are important. Computed tomography (CT) is an optimal means to investigate sternoclavicular joint anatomy; however, there are few reports on the imageological anatomical features of the sternoclavicular joint. The study investigated imageological anatomical features, and a new plate was devised according to these data to treat sternoclavicular joint dislocation. Fifty-three healthy Chinese volunteers examined with chest CT were included in the study. The coronal, sagittal, and axial images of the sternoclavicular region were reconstructed. The sternal head diameter in the inferolateral-to-superomedial direction, length of the clavicular notch, and angle between the clavicular notch and sternum were measured on coronal images. The angle between the presternum and trunk was measured on sagittal images. The following dimensions were measured on axial images: anteroposterior dimensions of the sternal head, clavicular notch, and presternum; width of the sternoclavicular joint; distance between bilateral clavicles; and minimal distance from the presternum to the underlying structures in the thoracic cavity. A new plate was designed according to the above data and was used to repair six sternoclavicular joint dislocations. All cases were followed up with a range of 9 to 12 months. The proximal clavicle is higher than the presternum in a horizontal position. On axial images, the anteroposterior dimension of the sternal head was longer than the presternum, and the center region of the presternum was thinner than the edges. The left sternoclavicular joint space was (0.82 ± 0.21) cm, and the right was (0.87 ± 0.22) cm. Among the structures behind the sternum, the left bilateral innominate vein ran nearest to the presternum. The distance from the anterior cortex of the sterna to the left bilateral innominate vein was (2.38 ± 0.61) cm. The dislocated joints were reduced anatomically and fixed with the new plate. All cases obtained satisfactory outcomes in follow-up visits. Normal sternoclavicular joint parameters were measured on CT images, which can facilitate treatment of sternoclavicular joint dislocation or subluxation. This newly designed plate can be used to treat sternoclavicular joint dislocation effectively and safely.

Midline as a landmark for the position of the superior sagittal sinus on the cranial vault: An anatomical and imaging study.

PubMed

Reis, Cassius Vinicius C; Gusmão, Sebastião N S; Elhadi, Ali M; Dru, Alexander; Tazinaffo, Uédson; Zabramski, Joseph M; Spetzler, Robert F; Preul, Mark C

2015-01-01

Craniotomies involving the midline are regular practice in neurosurgery, during which injury to the superior sagittal sinus (SSS), an uncommon yet devastating event, may occur. The midline tends to be the most common landmark used to identify the position of the SSS. In this study we examined the reliability of the midline as a landmark for the SSS. We performed bilateral craniectomies on eight cadaveric heads, preserving the coronal, sagittal, and lambdoid sutures. The width of the SSS and its displacement from midline were measured on the cadaveric specimens and on 105 normal magnetic resonance images (MRIs) of the head at the following locations: halfway between nasion and bregma (NB), bregma (B), halfway between bregma and lambda (BL), lambda (L), and inion (I). In all cadaveric specimens, the SSS was partially or totally displaced toward one side of midline, usually to the right. It tended to be closer to midline in the frontal region and more displaced posteriorly. The SSS usually drained into the right-side transverse sinus. The mean width of the SSS was 4.3, 5.9, 6.9, 7.9, and 7.8 mm, and the average displacement from midline was 4.3, 6.3, 5.5, 6.9, and 6.0 mm for NB, B, BL, L, and I, respectively. These measurements were then compared with those obtained from the MRIs. The SSS was consistently displaced on either side of midline. Thus, the midline is not reliable for identifying the SSS, and caution should be used within 6-10 mm on either side of midline.

Gender comparisons between unilateral and bilateral landings.

PubMed

Weinhandl, Joshua T; Joshi, Mukta; O'Connor, Kristian M

2010-11-01

The increased number of women participating in sports has led to a higher knee injury rate in women compared with men. Among these injuries, those occurring to the ACL are commonly observed during landing maneuvers. The purpose of this study was to determine gender differences in landing strategies during unilateral and bilateral landings. Sixteen male and 17 female recreational athletes were recruited to perform unilateral and bilateral landings from a raised platform, scaled to match their individual jumping abilities. Three-dimensional kinematics and kinetics of the dominant leg were calculated during the landing phase and reported as initial ground contact angle, ranges of motion (ROM) and peak moments. Lower extremity energy absorption was also calculated for the duration of the landing phase. Results showed that gender differences were only observed in sagittal plane hip and knee ROM, potentially due to the use of a relative drop height versus the commonly used absolute drop height. Unilateral landings were characterized by significant differences in hip and knee kinematics that have been linked to increased injury risk and would best be classified as "stiff" landings. The ankle musculature was used more for impact absorption during unilateral landing, which required increased joint extension at touchdown and may increase injury risk during an unbalanced landing. In addition, there was only an 11% increase in total energy absorption during unilateral landings, suggesting that there was a substantial amount of passive energy transfer during unilateral landings.

Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal: A Retrospective Study.

PubMed

Ge, Jing; Yang, Chi; Zheng, Jiawei; Qian, Wentao

2016-03-01

The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery.Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed.All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment.Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar.

Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal

PubMed Central

Ge, Jing; Yang, Chi; Zheng, Jiawei; Qian, Wentao

2016-01-01

Abstract The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery. Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed. All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment. Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar. PMID:27015214

The Effect of Patellar Taping on Squat Depth and the Perception of Pain in People with Anterior Knee Pain

PubMed Central

Clifford, Amanda M.; Harrington, Elaine

Patellar taping is a treatment adjunct commonly used in the management of anterior knee pain. The aim of this cross sectional study was to investigate the effects of medial glide patellar taping on sagittal plane lower-limb joint kinematics and knee pain during a unilateral squat in a symptomatic population complaining of anterior knee pain. Ten participants with a history of unilateral or bilateral anterior knee pain were included in the study. Subjects were required to squat on the symptomatic leg under three conditions: placebo tape, patellar tape and no tape. Kinematic data was recorded using the CODA mpx64 motion analysis system and subjects’ pain was assessed using the Numerical Rating Scale. Patellar taping resulted in a significantly greater single-legged squat depth compared to placebo tape (p=0.008) and no tape (p=0.001) and a statistically significant reduction in pain during a squat compared to placebo tape (p=0.001) or no tape (p=0.001). Significant differences were not identified for maximum knee flexion in the patella taping compared to the no tape condition. This study may have significant clinical implications as participants reported less pain and alterations in sagittal plane movement following the application of patellar tape. PMID:24146711

Prehospital emergency removal of football helmets using two techniques.

PubMed

Swartz, Erik E; Hernandez, Adam E; Decoster, Laura C; Mihalik, Jason P; Burns, Matthew F; Reynolds, Cathryn

2011-01-01

To compare the Eject Helmet Removal (EHR) System with manual football helmet removal. This quasiexperimental counterbalanced study was conducted in a controlled laboratory setting. Thirty certified athletic trainers (17 men and 13 women; mean ± standard deviation age: 33.03 ± 10.02 years; height: 174.53 ± 12.04 cm; mass: 85.19 ± 19.84 kg) participated after providing informed consent. Participants removed a Riddell Revolution IQ football helmet from a healthy model two times each under two conditions: manual helmet removal (MHR) and removal with the EHR system. A six-camera, three-dimensional motion capture system was used to record range of motion (ROM) of the head. A digital stopwatch was used to time trials and to record a split time associated with EHR system bladder insertion. A modified Borg CR10 scale was used to measure the rating of perceived exertion (RPE). Mean values were created for each variable. Three pairwise t-tests with Bonferroni-corrected alpha levels tested for differences between time for removal, split time, and RPE. A 2 x 3 (condition x plane) totally within-subjects repeated-measures design analysis of variance (ANOVA) tested for differences in head ROM between the sagittal, frontal, and transverse planes. Analyses were performed using SPSS (version 18.0) (alpha = 0.05). There was no statistically significant difference in perceived difficulty between EHR (RPE = 2.73) and MHR (RPE = 2.55) (t(29) = 0.76; p = 0.45; d = 0.20). Manual helmet removal was, on average, 28.95 seconds faster than EHR (t(29) = 11.44; p < 0.001). Head ROM was greater during EHR compared with MHR in the sagittal (t(29) = 4.57; p < 0.001), frontal (t(29) = 5.90; p < 0.001), and transverse (t(29) = 8.34; p < 0.001) planes. Head ROM was also greater during the helmet-removal portion of EHR in the frontal (t(29) = 4.44; p < 0.001) and transverse (t(29) = 5.99; p < 0.001) planes, compared with MHR. Regardless of technique, sagittal-plane head ROM was greater than frontal- and transverse-plane movements (F(2,58) = 241.47; p < 0.001). Removing a helmet manually is faster and creates slightly less motion than removing a helmet using the Eject system. Both techniques were equally easy to use. Future research should analyze the performance of the Eject system in other styles of football helmets and in helmets used in other sports such as lacrosse, motorsports, and ice hockey.

Pain related to robotic cholecystectomy with lower abdominal ports: effect of the bilateral ultrasound-guided split injection technique of rectus sheath block in female patients

PubMed Central

Kim, Jin Soo; Choi, Jong Bum; Lee, Sook Young; Kim, Wook Hwan; Baek, Nam Hyun; Kim, Jayoun; Park, Chu Kyung; Lee, Yeon Ju; Park, Sung Yong

2016-01-01

Abstract Background: Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients. Methods: We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study). Results: Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups. Conclusions: After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB. PMID:27495072

Pain related to robotic cholecystectomy with lower abdominal ports: effect of the bilateral ultrasound-guided split injection technique of rectus sheath block in female patients: A prospective randomised trial.

PubMed

Kim, Jin Soo; Choi, Jong Bum; Lee, Sook Young; Kim, Wook Hwan; Baek, Nam Hyun; Kim, Jayoun; Park, Chu Kyung; Lee, Yeon Ju; Park, Sung Yong

2016-08-01

Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients. We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study). Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups. After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB.

Illusory conjunctions in visual short-term memory: Individual differences in corpus callosum connectivity and splitting attention between the two hemifields.

PubMed

Qin, Shuo; Ray, Nicholas R; Ramakrishnan, Nithya; Nashiro, Kaoru; O'Connell, Margaret A; Basak, Chandramallika

2016-11-01

Overloading the capacity of visual attention can result in mistakenly combining the various features of an object, that is, illusory conjunctions. We hypothesize that if the two hemispheres separately process visual information by splitting attention, connectivity of corpus callosum-a brain structure integrating the two hemispheres-would predict the degree of illusory conjunctions. In the current study, we assessed two types of illusory conjunctions using a memory-scanning paradigm; the features were either presented across the two opposite hemifields or within the same hemifield. Four objects, each with two visual features, were briefly presented together followed by a probe-recognition and a confidence rating for the recognition accuracy. MRI scans were also obtained. Results indicated that successful recollection during probe recognition was better for across hemifields conjunctions compared to within hemifield conjunctions, lending support to the bilateral advantage of the two hemispheres in visual short-term memory. Age-related differences regarding the underlying mechanisms of the bilateral advantage indicated greater reliance on recollection-based processing in young and on familiarity-based processing in old. Moreover, the integrity of the posterior corpus callosum was more predictive of opposite hemifield illusory conjunctions compared to within hemifield illusory conjunctions, even after controlling for age. That is, individuals with lesser posterior corpus callosum connectivity had better recognition for objects when their features were recombined from the opposite hemifields than from the same hemifield. This study is the first to investigate the role of the corpus callosum in splitting attention between versus within hemifields. © 2016 Society for Psychophysiological Research.

Symmetry of priapulids (Priapulida). 1. Symmetry of adults.

PubMed

Adrianov, A V; Malakhov, V V

2001-02-01

Priapulids possess a radial symmetry that is remarkably reflected in both external morphology and internal anatomy. It results in the appearance of 25-radial (a number divisible by five) symmetry summarized as a combination of nonaradial, octaradial, and octaradial (9+8+8) symmetries of scalids. The radial symmetry is a secondary appearance considered as an evolutionary adaptation to a lifestyle within the three-dimensional environment of bottom sediment. The eight anteriormost, or primary, scalids retain their particular position because of their innervation directly from the circumpharyngeal brain. As a result of a combination of the octaradial symmetry of primary scalids, pentaradial symmetry of teeth, and the 25-radial symmetry of scalids, the initial bilateral symmetry remains characterized by the single sagittal plane. Copyright 2001 Wiley-Liss, Inc.

A Split-Mouth Design Comparison for Lateral and Crestal Sinus Lift Techniques with Dental Implants Placements: Short Communication.

PubMed

Al-Almaie, Saad; Kavarodi, Abdul Majeed; Alorf, Ali; Alzahrani, Saeed

2017-01-01

The objective of this study is to compare and evaluate the effectiveness of implant placement and patient appraisal for two sinus lift techniques using both crestal and lateral techniques for bilateral sinus left in a split-mouth design. All implants were successfully osseointegrated without any clinical complications or peri-implant radiolucency during the follow-up period of maximum 3 years. In terms of outcomes postoperative vertigo showed to be a major concern with the crestal approach, this approach is preferred over the lateral technique because of the reduced time required for the procedure and because it is less invasive. Most patients preferred the crestal approach over the lateral approach due to the delay in implant placement.

Microtia Combined With Split Sole of Feet, Deformed Middle Fingers and Café -au-lait Spots on the Trunk: A New Association.

PubMed

Yu, Yan; Hu, Jintian; Liu, Tun; Cao, Yilin; Zhang, Qingguo

2015-11-01

Microtia is a spectrum of congenital deformities. Approximately, half of the patients are associated with hemifacial microtia. The birth rate of microtia ranges from 2 per 10,000 to 17.4 per 10,000. Microtia and limb deformities sometimes occurred simultaneously as described in the literature. In this report, the patient was found to be with unilateral microtia combined with bilateral split sole of feet, deformed middle fingers on both hands, and café-au-lait spots on the trunk. Despite a thorough literature search, the authors could not achieve a satisfactory diagnosis for the current case with respect to the type of anomalies seen in the case.

Outcomes of bilateral sacroiliac joint fusions and the importance of understanding potential coexisting lumbosacral pathology that might also require surgical treatment.

PubMed

Dall, Bruce E; Eden, Sonia V

2015-06-01

Only one study in the literature describes performing a bilateral sacroiliac joint fusion, and the results were poor. Many patients needing a bilateral sacroiliac joint fusion frequently have had previous lumbosacral surgeries and present with lumbosacral pain as well. This study reviews our results in consecutive patients having had a bilateral sacroiliac joint fusion over a five-year period. Fifteen patients had bilateral sacroiliac joint fusions with 13 having concurrent lumbosacral fusions. The modified posterior midline fascial splitting approach, first described by Belanger was utilized. Patients were followed for an average of 30.3 months. There were no infections, neurovascular injuries, lasting morbidity or deaths. One non-union of a sacroiliac joint (7%) occurred, which after revision was satisfactory. There was a statistically significant drop in pain (p=0.01488) using the VAS, and patient satisfaction rates were 86%. With all those patients saying they would have the surgery again for the same result. There was no significant increase in functionality. Patients needing bilateral sacroiliac joint fusions frequently fall into the "failed back" category, and it is important to evaluate both the sacroiliac joints and the lumbosacral spine for potential pain generators. This study shows that by treating all the pain generators in both areas there were significant decreases in pain, low complications, low re-operation rates, and high patient satisfaction scores. Overall functionality, however, was not positively affected.

Rapid orthodontic treatment after the ridge-splitting technique--a combined surgical-orthodontic approach for implant site development: case report.

PubMed

Amato, Francesco; Mirabella, A Davide; Borlizzi, Diego

2012-08-01

This article presents a clinical case of bilateral partial edentulism in the posterior mandible with severe horizontal and moderate vertical bone atrophy. A new technique using rapid orthodontics after ridge splitting is presented. The split-crest technique was carried out using piezosurgical instruments in the first molar and second premolar areas to widen the bone crest and open a channel for tooth movement. Immediately after, orthodontic appliances were used to move the first premolars distally and the second molars mesially into the surgical site. The rationale was to facilitate and accelerate orthodontic movement of the teeth, which is otherwise difficult in a cortical knife-edged ridge. The bone defect was filled with the alveolar bone of the adjacent teeth that were moved into the surgically opened path. Adequate bone volume for implant placement was generated in the first premolar area. Implants were then inserted, and the patient was rehabilitated.

[Characteristics of opening movement in patients with unilateral mastication].

PubMed

Jia, Ling; Wang, Yun; Wang, Mengya

2016-08-01

To analyze characteristics of mandibular movement in patients with unilateral mastication.
 Undergraduate students in oral medicine from Grade 2011 and 2012 in Wannan Medical College were enrolled for this study by cluster sampling method, which include 30 people with unilateral mastication and 30 people with bilateral mastication. The surface electromyogram (sEMG) of masseter muscle and anterovent of digastric muscle were recorded and the trajectory of mandibular incisor point was recorded simultaneously in the maximum opening and closing movement. The results were analyzed by SPSS 19.0 software.
 Average electrical peak of left anterior digastric muscle and right anterior digastric muscle in the unilateral chewing group was lower than that in the bilateral chewing group (P<0.05). The jaw tangent point trajectory was separate in the unilateral chewing group. There were significant differences at the opening type between the 2 groups. The vertical displacement and the sagittal displacement in the unilateral chewing group were significantly lower than those in the bilateral chewing group (P<0.01). There was significant positive correlation between the average peak potential of masseter muscle and displacement on the right side.
 Average electrical peak of left masseter muscle, left anterior digastric muscle, and right anterior digastric muscle decreases in the unilateral chewing group. Jaw tracking in most people deflects to the working side. Opening and closing jaw tracking is separate in 50% unilateral chewing individuals with the decreased opening degree. Unilateral chewing leads to changes in muscle performance accompanied by trajectory anomalies.

Modified Y-splitting Procedure for the Treatment of Duane Retraction Syndrome.

PubMed

Altıntaş, Ayşe Gül; Arifoğlu, Hasan Basri; Köklü, Şükrü Gültekin

2015-08-01

To present the outcomes of modified lateral rectus Y-splitting combined with either unilateral or bilateral horizontal rectus recession in Duane Retraction Syndrome (DRS) with significant upshoot or downshoot. A total of 12 patients including 10 patients with Type I DRS and 2 with Type III DRS underwent modified Y-splitting surgery. Amount of additional recessions varied with the degree of preoperative deviation by intraoperative adjustable suture technique. Preoperatively 3 patients had esotropia (ET), 6 had exotropia (XT), and 3 patients had orthotropia. The mean preoperative deviation was 19.3 prism diopters (PD) (range, 18-20 PD) in ET patients and 19.2 PD (range, 16-20 PD) in XT patients. Postoperatively, all patients had significant correction in horizontal deviation and aligned within 4 PD of orthotropia, and no patients exhibited abnormal head posture. Co-contraction and globe retraction were markedly reduced and abnormal ocular vertical movement disappeared or significantly decreased in all cases. No patients experienced recurrence of ocular motility disorders in the mean 26-month (range, 13-66 months) follow-up period. Modified Y-splitting surgery combined with co-contracting horizontal muscle recession technique seems to be a safe and effective treatment in DRS.

Extreme skeletal open bite correction with vertical elastics.

PubMed

Cruz-Escalante, Marco Antonio; Aliaga-Del Castillo, Aron; Soldevilla, Luciano; Janson, Guilherme; Yatabe, Marilia; Zuazola, Ricardo Voss

2017-11-01

Severe skeletal open bites may be ideally treated with a combined surgical-orthodontic approach. Alternatively, compensations may be planned to camouflage the malocclusion with orthodontics alone. This case report describes the treatment of an 18-year-old man who presented with a severe open bite involving the anterior and posterior teeth up to the first molars, increased vertical dimension, bilateral Class III molar relationship, bilateral posterior crossbite, dental midline deviation, and absence of the maxillary right canine and the mandibular left first premolar. A treatment plan including the extraction of the mandibular right first premolar and based on uprighting and vertical control of the posterior teeth, combined with extrusion of the anterior teeth using multiloop edgewise archwire mechanics and elastics was chosen. After 6 months of alignment and 2 months of multiloop edgewise archwire mechanics, the open bite was significantly reduced. After 24 months of treatment, anterior teeth extrusion, posterior teeth intrusion, and counterclockwise mandibular rotation were accomplished. Satisfactory improvement of the overbite, overjet, sagittal malocclusion, and facial appearance were achieved. The mechanics used in this clinical case demonstrated good and stable results for open-bite correction at the 2-year posttreatment follow-up.

Cost-Effectiveness of a Biodegradable Compared to a Titanium Fixation System in Maxillofacial Surgery: A Multicenter Randomized Controlled Trial

PubMed Central

van Bakelen, N. B.; Vermeulen, K. M.; Buijs, G. J.; Jansma, J.; de Visscher, J. G. A. M.; Hoppenreijs, Th. J. M.; Bergsma, J. E.; Stegenga, B.; Bos, R. R. M.

2015-01-01

Background Biodegradable fixation systems could reduce/delete the problems associated with titanium plate removal. This means less surgical discomfort, and a reduction in costs. Aim The aim of the present study was to compare the cost-effectiveness between a biodegradable and a titanium system in Maxillofacial surgery. Materials and Methods This multicenter RCT was performed in the Netherlands from December 2006 to July 2009. Included were 230 patients who underwent a bilateral sagittal split osteotomy (BSSO), a Le Fort-I osteotomy, or a bi-maxillary osteotomy and those treated for fractures of the mandible, maxilla, or zygoma. The patients were randomly assigned to a titanium group (KLS Martin) or to a biodegradable group (Inion CPS). Costs were assessed from a societal perspective. Health outcomes in the incremental cost-effectiveness ratio (ICER) were bone healing (8 weeks) and plate removal (2 years). Results In 25 out of the 117 patients who were randomized to the biodegradable group, the maxillofacial surgeon made the decision to switch to the titanium system intra-operatively. This resulted in an Intention-To-Treat (ITT-)analysis and a Treatment-Received (TR-) analysis. Both analyses indicated that operations performed with titanium plates and screws had better health outcomes. In the TR-analysis the costs were lower in the biodegradable group, in the ITT-analysis costs were lower in the titanium group. Conclusion and Discussion The difference in costs between the ITT and the TR analyses can be explained by the intra-operative switches: In the TR-analysis the switches were analysed in the titanium group. In the ITT-analysis they were analysed in the biodegradable group. Considering the cost-effectiveness the titanium system is preferable to the biodegradable system in the regular treatment spectrum of mandibular, Le Fort-I, and zygomatic fractures, and BSSO’s, Le Fort-I osteotomies and bimaxillary osteotomies. Trial Registration Controlled-Trials.com ISRCTN 44212338 PMID:26192813

Evaluation of treatment modality for skeletal Class III malocclusion with labioversed upper incisors and/or protrusive maxilla: surgical movement and stability of rotational maxillary setback procedure.

PubMed

Baek, Seung-Hak; Kim, Keunwoo; Choi, Jin-Young

2009-11-01

The purpose of this study was to evaluate the range of surgical movement and stability of rotational maxillary setback (MXS) procedure as treatment modality for skeletal class III malocclusion with labioversed upper incisors and/or protrusive maxilla (CIII/LUI-PM). The samples consisted of 20 adult patients (mean [SD] age, 23.55 [4.30] y) who had CIII/LUI-PM and were treated with rotational MXS and mandibular setback using LeFort I osteotomy and bilateral sagittal split ramus osteotomy. The lateral cephalograms were obtained 1 week before (T0), 1 week after (T1), and 1 year after surgery (T2). The amounts of surgical movement, relapse, and stability rate of the upper central incisor (UIE), upper first molar (U6MBC), point A (A), incisive canal point, and posterior nasal spine (PNS) in relation to the reference planes were statistically analyzed. During T1 - T0, there were backward and downward movements of UIE and A, backward and upward movements of U6MBC, and upward and slight forward movements of PNS due to rotational MXS. The center of rotation of the maxilla was placed between A and the upper premolar area. During T2 - T1, skeletal landmarks showed clinically insignificant counterclockwise rotational relapse (<0.5 mm). The anteroposterior (AP) and vertical positions of skeletal landmarks were more stable than dental landmarks. The U6MBC was more stable in the vertical aspect than UIE (P < 0.01). Posterior nasal spine showed significantly higher stability rate in both vertical and AP aspects (P < 0.01, respectively), whereas UIE showed a lower value in the vertical aspect (P < 0.05). Rotational MXS procedure in cases with CIII/LUI-PM can be regarded as a stable one, especially in the vertical and AP positions of PNS. Vertical relapse in UIE should be managed with postoperative orthodontic treatment.

A Split-Mouth Design Comparison for Lateral and Crestal Sinus Lift Techniques with Dental Implants Placements: Short Communication

PubMed Central

Al-Almaie, Saad; Kavarodi, Abdul Majeed; Alorf, Ali; Alzahrani, Saeed

2017-01-01

Objective: The objective of this study is to compare and evaluate the effectiveness of implant placement and patient appraisal for two sinus lift techniques using both crestal and lateral techniques for bilateral sinus left in a split-mouth design. Introduction: All implants were successfully osseointegrated without any clinical complications or peri-implant radiolucency during the follow-up period of maximum 3 years. Methods: In terms of outcomes postoperative vertigo showed to be a major concern with the crestal approach, this approach is preferred over the lateral technique because of the reduced time required for the procedure and because it is less invasive. Results: Most patients preferred the crestal approach over the lateral approach due to the delay in implant placement. PMID:29290838

Class II treatment in adults: comparing camouflage orthodontics, dentofacial orthopedics and orthognathic surgery--a cephalometric study to evaluate various therapeutic effects.

PubMed

Kinzinger, Gero; Frye, Linda; Diedrich, Peter

2009-01-01

It was the aim of this clinical study to compare the skeletal and dentoalveolar effects as well as those on the profile of three different treatment approaches in Class II patients (camouflage orthodontics, dentofacial orthopedics, and combined orthodontic and surgical treatment). Our study cohort consisted of 60 young adults presenting a skeletal Class II, Division 1 malocclusion: 20 patients whose overjet was reduced by camouflage following premolar extraction, 20 patients whose occlusions were corrected by placement of a fixed functional orthopedic appliance, and 20 who underwent orthognathic surgery (bilateral sagittal split osteotomy of the mandible without genioplasty). We documented the therapeutic progress using cephalometry. Each patient group achieved a reduction in overjet via their respective treatment. While no treatment-related changes in the maxillary area were assessable, the effects on the mandible differed. We observed advancement of the bony chin and an increase in mandibular length in the sagittal-diagonal dimension in the surgical and functional orthopedic groups. However, the extent of the treatment-related changes was significant only in the group of patients that had undergone orthognathic surgery. Only the surgical group presented changes in vertical relationships. Incisor repositioning as an outcome of the respective treatments differed fundamentally, with those in the surgical group revealing significant protrusion of the upper incisors. The maxillary incisors were retruded and mandibular incisors proclined in the functional orthopedic group, whereas the upper and lower incisors both retruded significantly in the extraction group. Soft-tissue remodeling bore no linear relationship to treatment-induced skeletal and dental effects. Still, orthognathic surgery led to the most marked profile changes. Treatment using fixed functional orthopedic appliances reduced the convexity of the soft-tissue profile at least moderately. Camouflage orthodontics, on the other hand, resulted in an increase in the nasolabial angle. In young adults fixed functional appliances are a treatment alternative to extraction therapy but to a lesser extent to orthognathic surgery. Because of their limited skeletal effects and minor changes in the profile they are indicated only in patients with a moderately severe Class II malocclusion. Pre-treatment proclined mandibular incisors limit the scope of indications for fixed functional appliances, as they can cause an increase in lower incisor proclination. Significant reductions in profile convexity are achievable only by combined orthodontic and surgical treatment of the malocclusion. When performing camouflage orthodontics in conjunction with maxillary premolar extractions in adults, an increase in the nasolabial angle, which is often esthetically undesirable, has to be discussed as a potential side effect and has to be taken into account when considering the different therapeutic approaches.

Chronic low back pain after lumbosacral fracture due to sagittal and frontal vertebral imbalance.

PubMed

Boyoud-Garnier, L; Boudissa, M; Ruatti, S; Kerschbaumer, G; Grobost, P; Tonetti, J

2017-06-01

Over time, some patients with unilateral or bilateral lumbosacral injuries experience chronic low back pain. We studied the sagittal and frontal balance in a population with these injuries to determine whether mismatch in the pelvic and lumbar angles are associated with chronic low back pain. Patients with posterior pelvic ring fractures (Tile C1, C2, C3 and A3.3) that had healed were included. Foreign patients and those with an associated spinal or acetabular fracture or nonunion were excluded. The review consisted of subjective questionnaires, a clinical examination, and standing A/P and lateral stereoradiographic views. The pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), measured lumbar lordosis (LLm), T9 sagittal offset, leg discrepancy (LD) and lateral curvature (LC). The expected lumbar lordosis (LLe) was calculated using the formula LLe=PI+9°. We defined lumbopelvic mismatch (LPM) as the difference between LLm and LLe being equal or greater than 25% of LLe. Fifteen patients were reviewed after an average follow-up of 8.8 years [5.4-15]. There were four Tile C1, five Tile C2, five Tile C3 and one Tile A3.3 fracture. Ten of the 15 patients had low back pain. The mean angles were: LLm 49.6° and LLe 71.9° (P=0.002), PT 21.3°, SS 44.1°, PI 62.9° in patients with low back pain and LLm 57.4° and LLe 63.2° (P=0.55), PT 13°, SS 43.1°, PI 54.2° in those without. LPM was present in 9 patients, 8 of who had low back pain (P=0.02). Six patients, all of whom had low back pain, had a mean LC of 7.5° [4.5-23] (P=0.02). The mean LD was 0.77cm. The findings of this small study suggest that patients who experience low back pain after their posterior arch of the pelvic ring fracture has healed, have a lumbopelvic mismatch. Early treatment of these patients should aim to reestablish the anatomy of the pelvic base relative to the frontal and sagittal balance. IV. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Insufficient restoration of lumbar lordosis and FBI index following pedicle subtraction osteotomy is an indicator of likely mechanical complication.

PubMed

Le Huec, J C; Cogniet, A; Demezon, H; Rigal, J; Saddiki, R; Aunoble, S

2015-01-01

Pedicle subtraction osteotomies (PSO) enable correction of spinal deformities but remain difficult and are associated with high complication rates. This study aimed to prospectively review different post-operative complications and mechanical problems in patients who underwent PSO as treatment for sagittal imbalance as sequelae of degenerative disc disease or previous spinal fusion. This was a descriptive prospective single center study of 63 patients who underwent sagittal imbalance correction by PSO. Radiographic analysis of pre- and post-operative pelvic and spinal parameters was completed based on EOS images following 3D modeling. Global and sub-group analyses were completed based on the Roussouly classification. A systematic analysis of post-operative complications was conducted during hospital stay and at follow-up visits. Complications included 15 cases (20.2%) of bilateral leg pain, with transient neurological deficit in 6 cases (9.5%), and 9 cases (12.5%) of early surgical site infections. Intra-operative complications included five tears of the dura mater and two cases of excessive blood loss (>5,000 mL). Two mortalities occurred from major intracerebral bleeds in the early post-operative period. Mechanical complications were principally non-union (9 cases) and junctional kyphosis (3 cases). All 19 post-operative complications (28.1%) were revised at an average of 2 years following surgery. All mechanical complications were found in the patients who had insufficient imbalance correction and this was mainly associated with high PI (>60°) or a moderate PI (45-60º) combined with excess FBI pre-operatively that remained >10° post-operatively. Infection and neurologic complications following PSO are relatively common, and frequently reported in the literature. The principal cause of mechanical complications, such as non-union or junctional kyphosis, was insufficient sagittal correction, characterized by post-operative FBI >10°. The risks of insufficient correction are greater in patients with higher pelvic incidence and those patients who required very high correction.

Biomechanical risk factors for proximal junctional kyphosis: a detailed numerical analysis of surgical instrumentation variables.

PubMed

Cammarata, Marco; Aubin, Carl-Éric; Wang, Xiaoyu; Mac-Thiong, Jean-Marc

2014-04-15

Biomechanical analysis of proximal junctional kyphosis (PJK) through computer simulations and sensitivity analysis. To gain biomechanical knowledge on the risk of PJK and find surgical solutions to reduce the risks. PJK is a pathological kyphotic deformity adjacent to the instrumentation. Clinical studies have documented its risk factors, but still little is known on how it is correlated with various individual instrumentation variables. Biomechanical spine models of 6 patients with adult scoliosis were developed, validated, and then used to perform 576 simulations, varying the proximal dissection procedure, the implant type at the upper instrumented vertebra, the sagittal rod curvature, and the proximal diameter of the proximal transition rods. Four biomechanical indices--the proximal junctional kyphotic angle, thoracic kyphosis, proximal flexion force, and proximal flexion moment--were assessed. The bilateral complete facetectomy, the posterior ligaments resection, and the combination of both increased the proximal junctional kyphotic angle (respectively, by 10%, 28% and 53%) and the proximal flexion force (4%, 12%, and 22%) and moment (16%, 44%, and 83%). Compared with pedicle screws at upper instrumented vertebra, proximal transverse process hooks reduced the 3 biomechanical indices by approximately 26%. The use of proximal transition rods with reduced proximal diameter from 5.5 mm to 4 mm decreased the proximal junctional kyphotic angle (by 6%) and the proximal flexion force (4%) and moment (8%). The increase of the sagittal rod curvature from 10° to 20°, 30°, and 40° increased the proximal junctional kyphotic angle (by 6%, 13%, and 19%) and the proximal flexion force (3%, 7%, and 10%) and moment (9%, 18%, and 27%). Preserving more posterior proximal intervertebral elements, the use of transition rods and transverse process hooks at upper instrumented vertebra, and reducing the global sagittal rod curvature each decreased the 4 biomechanical indices that may be involved in PJK. N/A.

Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry: a case report.

PubMed

Hara, Shingo; Mitsugi, Masaharu; Kanno, Takahiro; Nomachi, Akihiko; Wajima, Takehiko; Tatemoto, Yukihiro

2013-09-01

This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry, by implementing surgical planning with SimPlant OMS. Using this method, we conducted LF1 osteotomy, intraoral vertical ramus osteotomy (IVRO), sagittal split ramus osteotomy (SSRO), mandibular constriction and mandibular border genioplasty. Not only did we obtain a class I occlusal relationship, but the complicated surgery also improved the asymmetry of the frontal view, as well as of the profile view, of the patient. The virtual operation using three-dimensional computed tomography (3D-CT) could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry.

Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry: a case report

PubMed Central

Hara, Shingo; Mitsugi, Masaharu; Kanno, Takahiro; Nomachi, Akihiko; Wajima, Takehiko; Tatemoto, Yukihiro

2013-01-01

This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry, by implementing surgical planning with SimPlant OMS. Using this method, we conducted LF1 osteotomy, intraoral vertical ramus osteotomy (IVRO), sagittal split ramus osteotomy (SSRO), mandibular constriction and mandibular border genioplasty. Not only did we obtain a class I occlusal relationship, but the complicated surgery also improved the asymmetry of the frontal view, as well as of the profile view, of the patient. The virtual operation using three-dimensional computed tomography (3D-CT) could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry. PMID:23907678

Plantar tactile perturbations enhance transfer of split-belt locomotor adaptation

PubMed Central

Mukherjee, Mukul; Eikema, Diderik Jan A.; Chien, Jung Hung; Myers, Sara A.; Scott-Pandorf, Melissa; Bloomberg, Jacob J.; Stergiou, Nicholas

2015-01-01

Patterns of human locomotion are highly adaptive and flexible, and depend on the environmental context. Locomotor adaptation requires the use of multisensory information to perceive altered environmental dynamics and generate an appropriate movement pattern. In this study, we investigated the use of multisensory information during locomotor learning. Proprioceptive perturbations were induced by vibrating tactors, placed bilaterally over the plantar surfaces. Under these altered sensory conditions, participants were asked to perform a split-belt locomotor task representative of motor learning. Twenty healthy young participants were separated into two groups: no-tactors (NT) and tactors (TC). All participants performed an overground walking trial, followed by treadmill walking including 18 minutes of split-belt adaptation and an overground trial to determine transfer effects. Interlimb coordination was quantified by symmetry indices and analyzed using mixed repeated measures ANOVAs. Both groups adapted to the locomotor task, indicated by significant reductions in gait symmetry during the split-belt task. No significant group differences in spatiotemporal and kinetic parameters were observed on the treadmill. However, significant groups differences were observed overground. Step and swing time asymmetries learned on the split belt treadmill, were retained and decayed more slowly overground in the TC group whereas in NT, asymmetries were rapidly lost. These results suggest that tactile stimulation contributed to increased lower limb proprioceptive gain. High proprioceptive gain allows for more persistent overground after-effects, at the cost of reduced adaptability. Such persistence may be utilized in populations displaying pathologic asymmetric gait by retraining a more symmetric pattern. PMID:26169104

Plantar tactile perturbations enhance transfer of split-belt locomotor adaptation.

PubMed

Mukherjee, Mukul; Eikema, Diderik Jan A; Chien, Jung Hung; Myers, Sara A; Scott-Pandorf, Melissa; Bloomberg, Jacob J; Stergiou, Nicholas

2015-10-01

Patterns of human locomotion are highly adaptive and flexible and depend on the environmental context. Locomotor adaptation requires the use of multisensory information to perceive altered environmental dynamics and generate an appropriate movement pattern. In this study, we investigated the use of multisensory information during locomotor learning. Proprioceptive perturbations were induced by vibrating tactors, placed bilaterally over the plantar surfaces. Under these altered sensory conditions, participants were asked to perform a split-belt locomotor task representative of motor learning. Twenty healthy young participants were separated into two groups: no-tactors (NT) and tactors (TC). All participants performed an overground walking trial, followed by treadmill walking including 18 min of split-belt adaptation and an overground trial to determine transfer effects. Interlimb coordination was quantified by symmetry indices and analyzed using mixed repeated-measures ANOVAs. Both groups adapted to the locomotor task, indicated by significant reductions in gait symmetry during the split-belt task. No significant group differences in spatiotemporal and kinetic parameters were observed on the treadmill. However, significant group differences were observed overground. Step and swing time asymmetries learned on the split-belt treadmill were retained and decayed more slowly overground in the TC group whereas in NT, asymmetries were rapidly lost. These results suggest that tactile stimulation contributed to increased lower limb proprioceptive gain. High proprioceptive gain allows for more persistent overground after effects, at the cost of reduced adaptability. Such persistence may be utilized in populations displaying pathologic asymmetric gait by retraining a more symmetric pattern.

Heterotopic Ossification in Combat Amputees from Afghanistan and Iraq wars: Five Case Histories and Results from a Small Series of Patients

DTIC Science & Technology

2011-01-01

symptoms. This patient also had severe soft-tissue injuries to his nonamputated left arm that required a skin graft . Subse- quent to surgery, the...illustrates the use of preventive medi- cation and symptomatic HO following breakdown of a skin graft . This patient had bilateral transfemoral amputa...United States. He was fitted with prostheses and successfully learned to walk. This patient had a split-thickness skin graft on his right residual

Mechanics of jazz shoes and their effect on pointing in child dancers.

PubMed

Fong Yan, Alycia; Smith, Richard; Vanwanseele, Benedicte; Hiller, Claire

2012-07-01

There has been little scientific investigation of the impact of dance shoes on foot motion or dance injuries. The pointed (plantar-flexed) foot is a fundamental component of both the technical requirements and the traditional aesthetic of ballet and jazz dancing. The aims of this study were to quantify the externally observed angle of plantar flexion in various jazz shoes compared with barefoot and to compare the sagittal plane bending stiffness of the various jazz shoes. Sixteen female recreational child dancers were recruited for 3D motion analysis of active plantar flexion. The jazz shoes tested were a split-sole jazz shoe, full-sole jazz shoe, and jazz sneaker. A shoe dynamometer measured the stiffness of the jazz shoes. The shoes had a significant effect on ankle plantar flexion. All jazz shoes significantly restricted the midfoot plantar flexion angle compared with the barefoot condition. The split-sole jazz shoe demonstrated the least restriction, whereas the full-sole jazz shoe the most midfoot restriction. A small restriction in metartarsophalangeal plantar flexion and a greater restriction at the midfoot joint were demonstrated when wearing stiff jazz shoes. These restrictions will decrease the aesthetic of the pointed foot, may encourage incorrect muscle activation, and have an impact on dance performance.

Knee joint changes in patients with neglected developmental hip dysplasia: a prospective case-control study.

PubMed

Li, Qiwei; Kadhim, Muayad; Zhang, Lijun; Cheng, Xiangjun; Zhao, Qun; Li, Lianyong

2014-12-01

Few reports are available describing knee changes in neglected developmental dysplasia of the hip (DDH). The purpose of this study was to assess the radiographic morphology of knee joints in adults with neglected DDH. Thirty-seven patients (35 females and two males) with neglected DDH were prospectively recruited with an average age of 32.6 years. Twenty-three patients had unilateral and 14 patients had bilateral neglected DDH. Thirty-seven healthy individuals were recruited to form a matched control group. Three groups of knee joints were examined: affected knees (on the same side of the neglected DDH), unaffected knees (contralateral to the neglected DDH in patients with unilateral involvement), and control knees. A series of radiographic parameters of the knee joint were measured in the coronal and sagittal plane, and they were compared between patients and normal controls. In the coronal plane, the affected knees had increased valgus angulation related to increased height of the medial femoral condyle, decreased height of the lateral femoral condyle and decreased lateral distal femoral angle compared to control knees. In the sagittal plane, both distal femoral and proximal tibial joints of the affected knees developed a decrease in posterior angles. Additionally, the unaffected knees also developed radiographic changes compared to control knees. Patients with neglected DDH may develop changes in both knee joints. These changes should be considered during surgery to the hip, femur and knee to prevent potential complications. Level 2. Copyright © 2014 Elsevier B.V. All rights reserved.

Quantifying kinematic differences between land and water during squats, split squats, and single-leg squats in a healthy population.

PubMed

Severin, Anna C; Burkett, Brendan J; McKean, Mark R; Wiegand, Aaron N; Sayers, Mark G L

2017-01-01

Aquatic exercises can be used in clinical and sporting disciplines for both rehabilitation and sports training. However, there is limited knowledge on the influence of water immersion on the kinematics of exercises commonly used in rehabilitation and fitness programs. The aim of this study was to use inertial sensors to quantify differences in kinematics and movement variability of bodyweight squats, split squats, and single-leg squats performed on dry land and whilst immersed to the level of the greater trochanter. During two separate testing sessions, 25 active healthy university students (22.3±2.9 yr.) performed ten repetitions of each exercise, whilst tri-axial inertial sensors (100 Hz) recorded their trunk and lower body kinematics. Repeated-measures statistics tested for differences in segment orientation and speed, movement variability, and waveform patterns between environments, while coefficient of variance was used to assess differences in movement variability. Between-environment differences in segment orientation and speed were portrayed by plotting the mean difference ±95% confidence intervals (CI) throughout the tasks. The results showed that the depth of the squat and split squat were unaffected by the changed environment while water immersion allowed for a deeper single leg squat. The different environments had significant effects on the sagittal plane orientations and speeds for all segments. Water immersion increased the degree of movement variability of the segments in all exercises, except for the shank in the frontal plane, which showed more variability on land. Without compromising movement depth, the aquatic environment induces more upright trunk and shank postures during squats and split squats. The aquatic environment allows for increased squat depth during the single-leg squat, and increased shank motions in the frontal plane. Our observations therefore support the use of water-based squat tasks for rehabilitation as they appear to improve the technique without compromising movement depth.

Quantifying kinematic differences between land and water during squats, split squats, and single-leg squats in a healthy population

PubMed Central

2017-01-01

Aquatic exercises can be used in clinical and sporting disciplines for both rehabilitation and sports training. However, there is limited knowledge on the influence of water immersion on the kinematics of exercises commonly used in rehabilitation and fitness programs. The aim of this study was to use inertial sensors to quantify differences in kinematics and movement variability of bodyweight squats, split squats, and single-leg squats performed on dry land and whilst immersed to the level of the greater trochanter. During two separate testing sessions, 25 active healthy university students (22.3±2.9 yr.) performed ten repetitions of each exercise, whilst tri-axial inertial sensors (100 Hz) recorded their trunk and lower body kinematics. Repeated-measures statistics tested for differences in segment orientation and speed, movement variability, and waveform patterns between environments, while coefficient of variance was used to assess differences in movement variability. Between-environment differences in segment orientation and speed were portrayed by plotting the mean difference ±95% confidence intervals (CI) throughout the tasks. The results showed that the depth of the squat and split squat were unaffected by the changed environment while water immersion allowed for a deeper single leg squat. The different environments had significant effects on the sagittal plane orientations and speeds for all segments. Water immersion increased the degree of movement variability of the segments in all exercises, except for the shank in the frontal plane, which showed more variability on land. Without compromising movement depth, the aquatic environment induces more upright trunk and shank postures during squats and split squats. The aquatic environment allows for increased squat depth during the single-leg squat, and increased shank motions in the frontal plane. Our observations therefore support the use of water-based squat tasks for rehabilitation as they appear to improve the technique without compromising movement depth. PMID:28767683

Split-arm swinging: the effect of arm swinging manipulation on interlimb coordination during walking.

PubMed

Bondi, Moshe; Zeilig, Gabi; Bloch, Ayala; Fasano, Alfonso; Plotnik, Meir

2017-08-01

Human locomotion is defined by bilateral coordination of gait (BCG) and shared features with the fore-hindlimb coordination of quadrupeds. The objective of the present study is to explore the influence of arm swinging (AS) on BCG. Sixteen young, healthy individuals (eight women; eight right motor-dominant, eight left-motor dominant) participated. Participants performed 10 walking trials (2 min). In each of the trials AS was unilaterally manipulated (e.g., arm restriction, weight on the wrist), bilaterally manipulated, or not manipulated. The order of trials was random. Walking trials were performed on a treadmill. Gait kinematics were recorded by a motion capture system. Using feedback-controlled belt speed allowed the participants to walk at a self-determined gait speed. Effects of the manipulations were assessed by AS amplitudes and the phase coordination index (PCI), which quantifies the left-right anti-phased stepping pattern. Most of the AS manipulations caused an increase in PCI values (i.e., reduced lower limb coordination). Unilateral AS manipulation had a reciprocal effect on the AS amplitude of the other arm such that, for example, over-swinging of the right arm led to a decrease in the AS amplitude of the left arm. Side of motor dominance was not found to have a significant impact on PCI and AS amplitude. The present findings suggest that lower limb BCG is markedly influenced by the rhythmic AS during walking. It may thus be important for gait rehabilitation programs targeting BCG to take AS into account. NEW & NOTEWORTHY Control mechanisms for four-limb coordination in human locomotion are not fully known. To study the influence of arm swinging (AS) on bilateral coordination of the lower limbs during walking, we introduced a split-AS paradigm in young, healthy adults. AS manipulations caused deterioration in the anti-phased stepping pattern and impacted the AS amplitudes for the contralateral arm, suggesting that lower limb coordination is markedly influenced by the rhythmic AS during walking. Copyright © 2017 the American Physiological Society.

En face swept-source optical coherence tomographic analysis of X-linked juvenile retinoschisis.

PubMed

Ono, Shinji; Takahashi, Atsushi; Mase, Tomoko; Nagaoka, Taiji; Yoshida, Akitoshi

2016-07-01

To clarify the area of retinoschisis by X-linked juvenile retinoschisis (XLRS) using swept-source optical coherence tomography (SS-OCT) en face images. We report two cases of XLRS in the same family. The patients presented with bilateral blurred vision. The posterior segment examination showed a spoked-wheel pattern in the macula. SS-OCT cross-sectional images revealed widespread retinal splitting at the level of the inner nuclear layer bilaterally. We diagnosed XLRS. To evaluate the area of retinoschisis, we obtained en face SS-OCT images, which clearly visualized the area of retinoschisis seen as a sunflower-like structure in the macula. We report the findings on en face SS-OCT images from patients with XLRS. The en face images using SS-OCT showed the precise area of retinoschisis compared with the SS-OCT thickness map and are useful for managing patients with XLRS.

Distributing coil elements in three dimensions enhances parallel transmission multiband RF performance: A simulation study in the human brain at 7 Tesla.

PubMed

Wu, Xiaoping; Tian, Jinfeng; Schmitter, Sebastian; Vaughan, J Tommy; Uğurbil, Kâmil; Van de Moortele, Pierre-François

2016-06-01

We explore the advantages of using a double-ring radiofrequency (RF) array and slice orientation to design parallel transmission (pTx) multiband (MB) pulses for simultaneous multislice (SMS) imaging with whole-brain coverage at 7 Tesla (T). A double-ring head array with 16 elements split evenly in two rings stacked in the z-direction was modeled and compared with two single-ring arrays consisting of 8 or 16 elements. The array performance was evaluated by designing band-specific pTx MB pulses with local specific absorption rate (SAR) control. The impact of slice orientations was also investigated. The double-ring array consistently and significantly outperformed the other two single-ring arrays, with peak local SAR reduced by up to 40% at a fixed excitation error of 0.024. For all three arrays, exciting sagittal or coronal slices yielded better RF performance than exciting axial or oblique slices. A double-ring RF array can be used to drastically improve SAR versus excitation fidelity tradeoff for pTx MB pulse design for brain imaging at 7 T; therefore, it is preferable against single-ring RF array designs when pursuing various biomedical applications of pTx SMS imaging. In comparing the stripline arrays, coronal and sagittal slices are more advantageous than axial and oblique slices for pTx MB pulses. Magn Reson Med 75:2464-2472, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Sagittal crest formation in great apes and gibbons.

PubMed

Balolia, Katharine L; Soligo, Christophe; Wood, Bernard

2017-06-01

The frequency of sagittal crest expression and patterns of sagittal crest growth and development have been documented in hominoids, including some extinct hominin taxa, and the more frequent expression of the sagittal crest in males has been traditionally linked with the need for larger-bodied individuals to have enough attachment area for the temporalis muscle. In the present study, we investigate sagittal cresting in a dentally mature sample of four hominoid taxa (Pan troglodytes schweinfurthii, Gorilla gorilla gorilla, Pongo pygmaeus pygmaeus and Hylobates lar). We investigate whether sagittal crest size increases with age beyond dental maturity in males and females of G. g. gorilla and Po. pyg. pygmaeus, and whether these taxa show sex differences in the timing of sagittal crest development. We evaluate the hypothesis that the larger sagittal crest of males may not be solely due to the requirement for a larger surface area than the un-crested cranial vault can provide for the attachment of the temporalis muscle, and present data on sex differences in temporalis muscle attachment area and sagittal crest size relative to cranial size. Gorilla g. gorilla and Po. pyg. pygmaeus males show significant relationships between tooth wear rank and sagittal crest size, and they show sagittal crest size differences between age groups that are not found in females. The sagittal crest emerges in early adulthood in the majority of G. g. gorilla males, whereas the percentage of G. g. gorilla females possessing a sagittal crest increases more gradually. Pongo pyg. pygmaeus males experience a three-fold increase in the number of specimens exhibiting a sagittal crest in mid-adulthood, consistent with a secondary growth spurt. Gorilla g. gorilla and Po. pyg. pygmaeus show significant sex differences in the size of the temporalis muscle attachment area, relative to cranial size, with males of both taxa showing positive allometry not shown in females. Gorilla g. gorilla males also show positive allometry for sagittal crest size relative to cranial size. Our results suggest that although patterns of sagittal crest expression have limited utility for taxonomy and phylogeny reconstruction, they could be useful for reconstructing aspects of social behaviour in some extinct hominin taxa. In particular, our results in G. g. gorilla and Po. pyg. pygmaeus, which suggest that the size of sagittal crests in males cannot be solely explained by the surface area required for attachment of the temporalis muscle, offer partial support for the hypothesis that large sagittal crests form in response to sexual selection and may play a role in social signalling. © 2017 Anatomical Society.

The use of mucograft collagen matrix to augment the zone of keratinized tissue around teeth: a pilot study.

PubMed

Nevins, Myron; Nevins, Marc L; Kim, Soo-Woo; Schupbach, Peter; Kim, David M

2011-01-01

This prospective split-mouth pilot case series compared the use of a bilayer collagen matrix (CM) to an autogenous gingival graft (AGG) in the ability to increase the zone of keratinized attached gingiva. Five patients with inadequate amounts of keratinized attached gingiva bilaterally in the posterior mandible were enrolled using a split-mouth design. There were statistically significant increases in attached gingiva at all test (CM) and control (AGG) sites. The CM sites at 12 months blended well with surrounding tissues, while the AGG sites were morphologically dissimilar to the adjacent areas. Biopsy results showed intrapatient histologic similarity between CM and AGG treatments, with all sites exhibiting mature connective tissue covered by keratinized epithelium. Thus, the obtained data support further investigations in evaluating the role of CM as a viable alternative to AGG in augmenting areas deficient in keratinized gingiva.

Oblique Sagittal Images Prevent Underestimation of the Neuroforaminal Stenosis Grade Caused by Disc Herniation in Cervical Spine MRI.

PubMed

Kintzelé, Laurent; Rehnitz, Christoph; Kauczor, Hans-Ulrich; Weber, Marc-André

2018-06-06

 To identify whether standard sagittal MRI images result in underestimation of the neuroforaminal stenosis grade compared to oblique sagittal MRI images in patients with cervical spine disc herniation.  74 patients with a total of 104 cervical disc herniations compromising the corresponding nerve root were evaluated. Neuroforaminal stenosis grades were evaluated in standard and oblique sagittal images by one senior and one resident radiologist experienced in musculoskeletal imaging. Oblique images were angled 30° towards the standard sagittal plane. Neuroforaminal stenosis grades were classified from 0 (no stenosis) to 3 (high grade stenosis).  Average neuroforaminal stenosis grades of both readers were significantly lower in standard compared to oblique sagittal images (p < 0.001). For 47.1 % of the cases, one or both readers reported a stenosis grade, which was at least 1 grade lower in standard compared to oblique sagittal images. There was also a significant difference when looking at patients who had neurological symptoms (p = 0.002) or underwent cervical spine surgery subsequently (p = 0.004). Interreader reliability, as measured by kappa value, and accordance rates were better for oblique sagittal images (0.94 vs. 0.88 and 99 % vs. 93 %).  Standard sagittal images tend to underestimate neuroforaminal stenosis grades compared to oblique sagittal images and are less reliable in the evaluation of disc herniations within the cervical spine MRI. In order to assess the potential therapeutic consequence, oblique images should therefore be considered as a valuable adjunct to the standard MRI protocol for patients with a radiculopathy.   · Neuroforaminal stenosis grades are underestimated in standard compared to oblique sagittal images. · Interreader reliability is higher for oblique sagittal images. · Oblique sagittal images should be performed in patients with a cervical radiculopathy. · Kintzele L, Rehnitz C, Kauczor H et al. Oblique Sagittal Images Prevent Underestimation of the Neuroforaminal Stenosis Grade Caused by Disc Herniation in Cervical Spine MRI. Fortschr Röntgenstr 2018; DOI: 10.1055/a-0612-8205. © Georg Thieme Verlag KG Stuttgart · New York.

Radiographic Evidence of Hip Microinstability in Elite Ballet.

PubMed

Mitchell, Ronald J; Gerrie, Brayden J; McCulloch, Patrick C; Murphy, Andrew J; Varner, Kevin E; Lintner, David M; Harris, Joshua D

2016-06-01

To determine prevalence, magnitude, and predisposing radiographic features of hip subluxation in elite ballet dancers. A cross-sectional investigation of professional male and female ballet dancers was performed using 5 plain radiographs. A "splits" anteroposterior (AP) radiograph was performed with legs abducted parallel to the trunk in the coronal plane (splits position; grand écart facial). Hip center position (HCP) was measured on standing AP pelvis and AP pelvis splits views and the difference calculated (subluxation distance) to determine prevalence and magnitude of femoral head subluxation. Student t test compared HCP on AP pelvis and splits radiographs. Pearson correlations were used to correlate splits HCP with radiographic measures of femoroacetabular impingement and dysplasia. Analyzing 47 dancers (21 men, 26 women; 23.8 ± 5.4 years), mean HCP on standing AP pelvis was 9.39 ± 3.33 mm versus 10.8 ± 2.92 mm on splits radiograph, with mean subluxation distance of 1.41 mm (P = .035). Forty-two dancers' femoral heads translated laterally with splits positioning, and 17 dancers (36%) exhibited a "vacuum sign" (bilateral in 71% of subjects with at least 1 hip vacuum sign). There was strong positive correlation (r = 0.461, P = .001) with splits HCP and alpha angle (Dunn 45°), and moderate negative correlation (r = -0.332, P = .022) with subluxation distance and neck-shaft angle. In men, splits HCP increased as lateral center edge angle (CEA) decreased (r = -0.437, P = .047), as anterior CEA decreased (r = -0.482, P = .027), as Tönnis angle increased (r = 0.656, P = .001), and as femoral head extrusion index increased (r = 0.511, P = .018). In women, there was moderate negative correlation (r = -0.389, P = .049) with subluxation distance and neck-shaft angle. Hip subluxation occurs during splits in most professional ballet dancers, with a significantly greater magnitude of subluxation in women than men. Subluxation magnitude increases with increasing alpha angle and decreasing neck-shaft angle. In men, the magnitude increases with severity of dysplasia. Women had subluxation regardless of acetabular morphology but increased subluxation with decreased neck-shaft angle. This provides radiographic support for hip microinstability in elite ballet. Level IV, diagnostic. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Kabuki make-up (Niikawa-Kuroki) syndrome in five Spanish children

DOE Office of Scientific and Technical Information (OSTI.GOV)

Galan-Gomez, E.; Cardesa-Garcia, J.J. Campo-Sampedro, F.M.

1995-11-20

We describe 5 Spanish children with Kabuki make-up syndrome (KMS) - 3 females and 2 males - identified in Badajoz, Spain, between 1988 and 1990. All had the characteristic clinical and radiological manifestations of the syndrome. Psychomotor/mental retardation, postnatal growth deficiency, distinctive facial appearance, sagittal vertebral clefts, and dermatoglyphic abnormalities were present in all 5. Congenital heart defects were present in 4 patients. In addition, one had myopia, astigmatism, and bilateral paralysis of the VI cranial nerve. Another had apparent fusion of the hamate and capitate. An additional patient, as well as his mother, had an apparently balanced 15/17 translocation.more » The fact that these patients were ascertained in a catchment area of approximately 250,000 inhabitants and in a relatively limited period of time suggests that the prevalence of the KMS may be higher than previously recognized. 30 refs., 6 figs., 2 tabs.« less

Malignant Subdural Hematoma Associated with High-Grade Meningioma

PubMed Central

Teramoto, Shinichiro; Tsunoda, Akira; Kawamura, Kaito; Sugiyama, Natsuki; Saito, Rikizo; Maruki, Chikashi

2018-01-01

A 70-year-old man, who had previously undergone surgical resection of left parasagittal meningioma involving the middle third of the superior sagittal sinus (SSS) two times, presented with recurrence of the tumor. We performed removal of the tumor combined with SSS resection as Simpson grade II. After tumor removal, since a left dominant bilateral chronic subdural hematoma (CSDH) appeared, it was treated by burr hole surgery. However, because the CSDH rapidly and repeatedly recurred and eventually changed to acute subdural hematoma, elimination of the hematoma with craniotomy was accomplished. The patient unfortunately died of worsening of general condition despite aggressive treatment. Histopathology of brain autopsy showed invasion of anaplastic meningioma cells spreading to the whole outer membrane of the subdural hematoma. Subdural hematoma is less commonly associated with meningioma. Our case indicates the possibility that subdural hematoma associated with meningioma is formed by a different mechanism from those reported previously. PMID:29896565

Multi-Detector Row Computed Tomography Findings of Pelvic Congestion Syndrome Caused by Dilated Ovarian Veins

PubMed Central

Eren, Suat

2010-01-01

Objective: To evaluate the efficacy of multi-detector row CT (MDCT) on pelvic congestion syndrome (PCS), which is often overlooked or poorly visualized with routine imaging examination. Materials and Methods: We evaluated the MDCT features of 40 patients with PCS (mean age, 45 years; range, 29–60 years) using axial, coronal, sagittal, 3D volume-rendered, and Maximum Intensity Projection MIP images. Results: MDCT revealed pelvic varices and ovarian vein dilatations in all patients. Bilateral ovarian vein dilatation was present in 25 patients, and 15 patients had unilateral dilatation. While 12 cases of secondary pelvic varices occurred simultaneously with a retroaortic left renal vein, 10 cases were due solely to a mass obstruction or stenosis of venous structures. Conclusion: MDCT is an effective tool in the evaluation of PCS, and it has more advantages than other imaging modalities. PMID:25610142

Temporomandibular joint MR images: Incidental head and neck findings and pathologies.

PubMed

Orhan, Kaan; Avsever, Hakan; Aksoy, Seçil; Seki, Umut; Bozkurt, Poyzan

2017-10-17

To report the number and frequency of incidental findings (IFs) detected during magnetic resonance (MR) imaging screening of the temporomandibular joint (TMJ) and to define related diseases. Bilateral TMJ MR images in the sagittal and coronal sections, from 518 patients with TMJ symptoms were evaluated retrospectively. Patients who were diagnosed with IFs were sent for consultation and clarification of the findings. Patient age, gender, IFs, locations, and diseases were classified and noted.  Results: Seventy-eight (15%) patients were diagnosed with 117 IFs. Of them, 43 were diagnosed with a single IF, and 35 were diagnosed with more than one IF. The most frequent locations were paranasal sinuses and mastoid air cells. The most frequent diseases were inflammatory and cystic lesions.  Discussion: While examining TMJ MR images, it is important to check for evidence of IFs or pathologies that may have mimicked signs and symptoms of TMJ disorders.

[Comparison of treatment results between implant anchorage and traditional intraoral anchorage in patients with maxillary protrusion].

PubMed

Ma, Ning; Li, Wei-Ran; Chen, Xiao-Hong; Zheng, Xu

2016-08-01

To compare the treatment effects in patients with maxillary protrusion between implant anchorage and traditional intraoral anchorage. Thirty patients with maxillary protrusion treated with bilateral maxillary first premolars extractions and high anchorage were selected. They were randomly divided into implant anchorage group and traditional intraoral anchorage group. Each group had 15 cases. The casts and the cephalograms were obtained before treatment (T1) and after treatment (T2). Three-dimensional model analysis was used to compare the teeth movements between the two groups and cephalometric analysis was used to compare the changes of skeletal and soft tissues. The differences were analyzed with SPSS 17.0 software package. In the implant anchorage group, the upper central incisors were retracted by (6.661±1.328) mm and intruded by (0.129±1.815) mm. In the traditional intraoral anchorage group, the upper central incisors were retracted by (5.788±2.009) mm and extruded by (2.623±1.776) mm. There was no significant difference between the two groups in sagittal movement (P>0.05), but there was significant difference in vertical movement (P<0.05). In the implant anchorage group, the upper first molars were protracted by (0.608±1.045) mm, intruded by (0.608±1.045) mm and moved palatally by (0.477±0.904) mm. In the traditional intraoral anchorage group, the upper first molars were protracted by (1.503±0.945) mm, extruded by (0.072±0.690) mm and moved palatally by (0.883±0.752)mm. There was significant difference between the two groups in sagittal movement and vertical movement (P<0.05), but there was no significant difference in horizontal movement(P>0.05). There was no significant difference between the two groups in the changes of cephalometric measurements of skeletal and soft tissues (P>0.05). Implant anchorage may be superior in vertical control of the maxillary incisors and also superior in sagittal and vertical control of the maxillary molars to traditional intraoral anchorage during management of maxillary protrusion.

[Comparison of treatment outcomes in patients with maxillary dentoalveolar protrusion by applying different anchorage methods: a three-dimensional model study].

PubMed

Ning, Ma; Weiran, Li

2015-02-01

This study aims to compare the treatment outcomes in patients with maxillary dentoalveolar protrusion by applying different anchorage methods via three-dimensional model measurement. A total of 46 patients with maxillary dentoalveolar protrusion treated with bilateral maxillary first premolar extractions and high anchorage were selected. The subjects were randomly divided into three groups according to the type of anchorage applied, which included implant, extraoral, and Nance arch anchorages. The maxillary dental models were made before treatment and after space closure of maxilla. The movements of the maxillary central incisors and first molars were measured via a three-dimensional model measurement, and the amounts of movement were compared among the three groups. The sagittal lingual movements of the maxillary central incisors were (-6.661 ± 1.328), (-5.939 ± 1.806), and (-5.788 ± 2.009) mm for the implant, extraoral, and Nance arch anchorage groups, respectively, with no significant difference among the three groups (P = 0.121). The corresponding vertical movements of the maxillary central incisors were (0.129 ± 1.815) mm intrusion, and (-2.162 ± 2.026), (-2.623 ± 1.776) mm extrusion. Significant difference was found between the implant anchorage group and the other groups (P < 0.05). The corresponding sagittal mesial movements of the maxillary first molars were (0.608 ± 1.045), (1.445 ± 1.462), and (1.503 ± 0.945) mm. The corresponding vertical movements of the maxillary first molars were (0.720 ± 0.805) mm intrusion, (0.076 ± 0.986) mm intrusion, and (-0.072 ± 0.690) mm extrusion. Significant difference was found between the implant anchorage group and the other two groups (P < 0.05). In the transverse direction, the first molars all moved lingually with no significant difference among the three groups (P > 0.05). Implant anchorage may be superior in the vertical control of the maxillary incisors and in the sagittal, as well as in the vertical control of the maxillary molars, compared with the traditional anchorages during the treatment of patients with maxillary dentoalveolar protrusion.

In-vitro evaluation of three lasers for the potential treatment of equine pharyngeal lymphoid hyperplasia

NASA Astrophysics Data System (ADS)

Tate, Lloyd P.; Weddle, Diann L.; Correa, Maria T.

1993-07-01

Three medical lasers, Argon, CO2, and Nd:YAG, were studied at power outputs of 5 watts, 5 watts, and 40 watts respectively. Laser irradiation was directed at the pharyngeal mucosa of sagittally split horses heads in a randomized fashion. Areas irradiated were measured immediately using hand held calipers, and after being prepared for microscopic examination to determine width and depth of penetration into the mucosa. The results indicated that tissue destruction produced by the CO2 laser was predictable compared to the Nd:YAG laser. The Argon laser, between 1 and 6 seconds of exposure, produced only superficial photoablation of mucosal tissue which did not extend into the muscular layer. The conclusion of this in vitro investigation was that the Argon laser irradiation applied transendoscopically may be a reasonable substitute for surgery and electrocautery commonly used to treat follicular lymphoid hyperplasia, a respiratory disease of young horses.

Analysis of sagittal spinopelvic parameters in achondroplasia.

PubMed

Hong, Jae-Young; Suh, Seung-Woo; Modi, Hitesh N; Park, Jong-Woong; Park, Jung-Ho

2011-08-15

Prospective radiological analysis of patients with achondroplasia. To analyze sagittal spinal alignment and pelvic orientation in achondroplasia patients. Knowledge of sagittal spinopelvic parameters is important for the treatment of achondroplasia, because they differ from those of the normal population and can induce pain. The study and control groups were composed of 32 achondroplasia patients and 24 healthy volunteers, respectively. All underwent lateral radiography of the whole spine including hip joints. The radiographic parameters examined were sacral slope (SS), pelvic tilt, pelvic incidence (PI), S1 overhang, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis (LL1, LL2), and sagittal balance. Statistical analysis was performed to identify significant differences between the two groups. In addition, correlations between parameters and symptoms were sought. Sagittal spinopelvic parameters, namely, pelvic tilt, pelvic incidence, S1 overhang, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis 1 and sagittal balance were found to be significantly different in the patient and control groups (P < 0.05). In addition, sagittal parameters were found to be related to each other in the patient group (P < 0.05), that is, PI was related to SS and pelvic tilt, and LL was related to thoracic kyphosis. Furthermore, in terms of relations between spinal and pelvic parameters, LL was related to SS and PI, and sagittal balance was related to SS and PI. Furthermore, LL and T10-L2 kyphosis were found to be related to pain (P < 0.05), whereas no other parameter was found to be related to VAS scores. Sagittal parameters and possible relationships between sagittal parameters and symptoms were found to be significantly different in achondroplasia patients and normal healthy controls. The present study shows that sagittal spinal and pelvic parameters can assist the treatment of spinal disorders in achondroplasia patients.

Development of Validated Computer-based Preoperative Predictive Model for Proximal Junction Failure (PJF) or Clinically Significant PJK With 86% Accuracy Based on 510 ASD Patients With 2-year Follow-up.

PubMed

Scheer, Justin K; Osorio, Joseph A; Smith, Justin S; Schwab, Frank; Lafage, Virginie; Hart, Robert A; Bess, Shay; Line, Breton; Diebo, Bassel G; Protopsaltis, Themistocles S; Jain, Amit; Ailon, Tamir; Burton, Douglas C; Shaffrey, Christopher I; Klineberg, Eric; Ames, Christopher P

2016-11-15

A retrospective review of large, multicenter adult spinal deformity (ASD) database. The aim of this study was to build a model based on baseline demographic, radiographic, and surgical factors that can predict clinically significant proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). PJF and PJK are significant complications and it remains unclear what are the specific drivers behind the development of either. There exists no predictive model that could potentially aid in the clinical decision making for adult patients undergoing deformity correction. Inclusion criteria: age ≥18 years, ASD, at least four levels fused. Variables included in the model were demographics, primary/revision, use of three-column osteotomy, upper-most instrumented vertebra (UIV)/lower-most instrumented vertebra (LIV) levels and UIV implant type (screw, hooks), number of levels fused, and baseline sagittal radiographs [pelvic tilt (PT), pelvic incidence and lumbar lordosis (PI-LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA)]. PJK was defined as an increase from baseline of proximal junctional angle ≥20° with concomitant deterioration of at least one SRS-Schwab sagittal modifier grade from 6 weeks postop. PJF was defined as requiring revision for PJK. An ensemble of decision trees were constructed using the C5.0 algorithm with five different bootstrapped models, and internally validated via a 70 : 30 data split for training and testing. Accuracy and the area under a receiver operator characteristic curve (AUC) were calculated. Five hundred ten patients were included, with 357 for model training and 153 as testing targets (PJF: 37, PJK: 102). The overall model accuracy was 86.3% with an AUC of 0.89 indicating a good model fit. The seven strongest (importance ≥0.95) predictors were age, LIV, pre-operative SVA, UIV implant type, UIV, pre-operative PT, and pre-operative PI-LL. A successful model (86% accuracy, 0.89 AUC) was built predicting either PJF or clinically significant PJK. This model can set the groundwork for preop point of care decision making, risk stratification, and need for prophylactic strategies for patients undergoing ASD surgery. 3.

Paraplegic patients: how to measure balance and what is normal or functional?

PubMed

Barkoh, Kaku; Lucas, Joshua W; Lee, Larry; Hsieh, Patrick C; Wang, Jeffrey C; Rolfe, Kevin

2018-02-01

To review the current understanding and data of sagittal balance and alignment considerations in paraplegic patients. A PubMed literature search was conducted to identify all relevant articles relating to sagittal alignment and sagittal balance considerations in paraplegic and spinal cord injury patients. While there are numerous studies and publications on sagittal balance in the ambulatory patient with spinal deformity or complex spine disorders, there is paucity of the literature on "normal" sagittal balance in the paraplegic patients. Studies have reported significantly alterations of the sagittal alignment parameters in the non-ambulatory paraplegic patients compared to ambulatory patients. The variability of the alignment changes is related to the differences in the level of the spinal cord injury and their differences in the activations of truncal muscles to allow functional movements in those patients, particularly in optimizing sitting and transferring. Surgical goal in treating paraplegic patients with complex pathologies should not be solely directed to achieve the "normal" radiographic parameters of sagittal alignment in the ambulatory patients. The goal should be to maintain good coronal balance to allow ideal sitting position and to preserve motion segment to optimize functions of paraplegia patients. Current available literature data have not defined normal sagittal parameters for paraplegic patients. There are significant differences in postural sagittal parameters and muscle activations in paraplegic and non-spinal cord injury patients that can lead to differences in sagittal alignment and balance. Treatment goal in spine surgery for paraplegic patients should address their global function, sitting balance, and ability to perform self-care rather than the accepted radiographic parameters for adult spinal deformity in ambulatory patients.

Usefulness of the dynamic gadolinium-enhanced magnetic resonance imaging with simultaneous acquisition of coronal and sagittal planes for detection of pituitary microadenomas.

PubMed

Lee, Han Bee; Kim, Sung Tae; Kim, Hyung-Jin; Kim, Keon Ha; Jeon, Pyoung; Byun, Hong Sik; Choi, Jin Wook

2012-03-01

Does dynamic gadolinium-enhanced imaging with simultaneous acquisition of coronal and sagittal planes improve diagnostic accuracy of pituitary microadenomas compared with coronal images alone? Fifty-six patients underwent 3-T sella MRI including dynamic simultaneous acquisition of coronal and sagittal planes after gadolinium injection. According to conspicuity, lesions were divided into four scores (0, no; 1, possible; 2, probable; 3, definite delayed enhancing lesion). Additional information on supplementary sagittal images compared with coronal ones was evaluated with a 4-point score (0, no; 1, possible; 2, probable; 3, definite additional information). Accuracy of tumour detection was calculated. Average scores for lesion detection of a combination of two planes, coronal, and sagittal images were 2.59, 2.32, and 2.18. 6/10 lesions negative on coronal images were detected on sagittal ones. Accuracy of a combination of two planes, of coronal and of sagittal images was 92.86%, 82.14% and 75%. Six patients had probable or definite additional information on supplementary sagittal images compared with coronal ones alone (10.71%). Dynamic MRI with combined coronal and sagittal planes was more accurate for detection of pituitary microadenomas than routinely used coronal images. Simultaneous dynamic enhanced acquisition can make study time fast and costs low. We present a new dynamic MRI technique for evaluating pituitary microadenomas • This technique provides simultaneous acquisition of contrast enhanced coronal and sagittal images. • This technique makes the diagnosis more accurate and reduces the examination time. • Such MR imaging only requires one single bolus of contrast agent.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goto, Motoshi; Morita, Shigeru

Emission lines in the visible/UV wavelength ranges are observed with 80 lines of sight which cover an entire poloidal cross section of the plasma in the Large Helical Device. The emitted light is received with optical fibers having 100 {mu}m diameter and is guided into a 1.33 m Czerny-Turner-type spectrometer based on spherical mirrors for collimating and focusing. A charge-coupled device having 13.3x13.3 mm{sup 2} area size is used as the detector and the spectra from all the lines of sight are recorded perpendicularly to the wavelength dispersion. The spectrometer is equipped with optics located in front of the entrancemore » slit to correct the difference between the meridional and sagittal focal points, and thus the astigmatism, which otherwise causes severe cross talk between adjacent optical fiber images on the detector, is corrected. Consequently, simultaneous spectral measurement with 80 lines of sight is realized. The Zeeman splitting of a neutral helium line, {lambda}667.8 nm (2 {sup 1}P-3 {sup 1}D), which is caused by the magnetic field for plasma confinement, is measured with the spectrometer. Though the obtained line profile is in general a superposition of several components on the same line of sight, they can be separated according to their different splitting widths. The two-dimensional poloidal distribution of the helium line intensity is obtained with the help of a tomographic technique.« less

Rod fracture in adult spinal deformity surgery fused to the sacrum: prevalence, risk factors, and impact on health-related quality of life in 526 patients.

PubMed

Lertudomphonwanit, Thamrong; Kelly, Michael P; Bridwell, Keith H; Lenke, Lawrence G; McAnany, Steven J; Punyarat, Prachya; Bryan, Timothy P; Buchowski, Jacob M; Zebala, Lukas P; Sides, Brenda A; Steger-May, Karen; Gupta, Munish C

2018-02-28

Risk factors associated with rod fracture (RF) following adult spinal deformity (ASD) surgery fused to the sacrum remain debatable, and the impact of RF on patient-reported outcomes (PROs) after ASD surgery has not been investigated. We aimed to evaluate the prevalence of and risk factors for RF and determine PROs changes associated with RF after ASD surgery fused to the sacrum. A retrospective single-center cohort study was performed. Patients undergoing long-construct posterior spinal fusions to the sacrum performed at a single institution by two senior spine surgeons from 2004 to 2014 were included. Patient demographics, radiographic parameters, and surgical factors were assessed for risk factors associated with RF. Oswestry Disability Index (ODI) and Scoliosis Research Society-30 (SRS-30) scores were assessed at baseline, 1 year postoperatively, and latest follow-up. Inclusion criteria were ASD patients age >18 who had ≥5 vertebrae instrumented and fused posteriorly to the sacrum and either development of RF or no development of RF with minimum 2-year follow-up. Patient characteristics, operative data, radiographic parameters, and PROs were analyzed at baseline and follow-up. Separate Cox proportional hazard models based on rod material and diameter were used to determine factors associated with RF. Five hundred twenty-six patients (80%) were available for analysis. RF occurred in 97 (18.4%) patients (unilateral RF n=61 [63%]; bilateral RF n=36 [37%]). Risk factors for fracture of 5.5 mm cobalt chromium (CC) instrumentation (CC 5.5 model) included preoperative sagittal vertical axis (hazard ratio [HR] 1.07, 95% confidence interval [95% CI] 1.02-1.14 per 1-cm increase), preoperative thoracolumbar kyphosis (HR 1.02, 95% CI 1.01-1.04 per 1-degree increase), and number of levels fused for patients who received rhBMP-2 <12 mg per level fused (HR 1.48, 95% CI 1.20-1.82 per 1-level increase). Implants that were 5.5-mm CC constructs were at a higher risk for fracture than 6.35-mm stainless steel (SS) constructs (HR 8.49, 95% CI 4.26-16.89). The RF group had less overall improvement in SRS Satisfaction (0.93 vs. 1.32; p=.007) and SRS Self-image domain scores (0.72 vs. 1.02; p=.01). The bilateral RF group had less overall improvement in ODI (8.1 vs. 15.8; p=.02), SRS Subscore (0.51 vs. 0.85; p=.03), and SRS Pain domain scores (0.48 vs. 0.95; p=.02) compared with the non-RF group at final follow-up. The prevalence of all RF after index procedures was 18.4%, 37% for bilateral RF. Greater preoperative sagittal vertical axis, greater preoperative thoracolumbar kyphosis, increased number of vertebrae fused for patients who received rhBMP-2 <12 mg per level fused, and CC 5.5-mm rod were associated with RF. Less improvement in patient satisfaction and self-image was noted in the RF group. Furthermore, bilateral RF significantly affected PROs as measured by ODI and SRS Subscore at final follow-up. Copyright © 2018 Elsevier Inc. All rights reserved.

Sagittal balance and idiopathic scoliosis: does final sagittal alignment influence outcomes, degeneration rate or failure rate?

PubMed

Ilharreborde, Brice

2018-02-01

In the last decade, spine surgeons have been impacted by the "sagittal plane analysis revolution". Significant correlations have been found in adult spinal deformity (ASD) between sagittal lumbo-pelvic parameters and functional outcomes, but most of them do not apply in adolescent idiopathic scoliosis (AIS). Meanwhile, instrumentation and reduction strategies have considerably evolved. This paper aims to describe the preoperative sagittal alignment in AIS, and to report literature evidence regarding the influence of postoperative sagittal balance on complication rates, low back pain incidence and disc degeneration. A bibliographic search in Medline and Google database from 1984 to May 2017 was performed. The keywords included 'adolescent idiopathic scoliosis', 'adult scoliosis', 'sagittal alignment', 'proximal junctional kyphosis', 'distal junctional kyphosis', 'outcomes', 'low back pain' and 'complication', used individually or in combination. Algorithms of sagittal balance analysis and treatment decision have been reported in ASD, but the clinical situation is very different in children. Sagittal alignment greatly varies in AIS among the various Lenke types. Most patients are clinically balanced before surgery, but the spinal harmony is altered, with overgrowth of the anterior column and global sagittal flattening (undersestimated in 2D). The exact role of pelvic incidence and whether or not patients also use pelvic compensation to maintain balance still require further clarification. The incidence of radiological junctional failures remains highly variable, depending on definitions, cohort size and follow-up. Preoperative hyperkyphosis seems to be a consistent and relevant risk factor. Current literature does not support the recent trend to save motion segments (selective fusion), and no significant association was found between the distal level of fusion and the incidence of low back pain. Postoperative sagittal alignment seems to be more important than LIV selection to avoid disc degeneration at mid-term follow-up. It is clear now that sagittal alignment plays a major role in clinical outcomes and should not be neglected in AIS. Seven key guidelines that should be considered for each patient before surgery are reported (Table 2). Personalized planning using 3D technology is gaining popularity and might help in the future reducing complications.

The use of the T1 sagittal angle in predicting overall sagittal balance of the spine.

PubMed

Knott, Patrick T; Mardjetko, Steven M; Techy, Fernando

2010-11-01

A balanced sagittal alignment of the spine has been shown to strongly correlate with less pain, less disability, and greater health status scores. To restore proper sagittal balance, one must assess the position of the occiput relative to the sacrum. The assessment of spinal balance preoperatively can be challenging, whereas predicting postoperative balance is even more difficult. This study was designed to evaluate and quantify multiple factors that influence sagittal balance. Retrospective analysis of existing spinal radiographs. A retrospective review of 52 adult spine patient records was performed. All patients had full-column digital radiographs that showed all the important skeletal landmarks necessary for accurate measurement. The average age of the patient was 53 years. Both genders were equally represented. The radiographs were measured using standard techniques to obtain the following parameters: scoliosis in the coronal plane; lordosis or kyphosis of the cervical, thoracic, and lumbar spine; the T1 sagittal angle (angle between a horizontal line and the superior end plate of T1); the angle of the dens in the sagittal plane; the angle of the dens in relation to the occiput; the sacral slope; the pelvic incidence; the femoral-sacral angle; and finally, the sagittal vertical axis (SVA) measured from both the dens of C2 and from C7. It was found that the SVA when measured from the dens was on average 16 mm farther forward than the SVA measured from C7 (p<.0001). The dens plumb line (SVA(dens)) was then used in the study. An analysis was done to examine the relationship between SVA(dens) and each of the other measurements. The T1 sagittal angle was found to have a moderate positive correlation (r=0.65) with SVA(dens), p<.0001, indicating that the amount of sagittal T1 tilt can be used as a good predictor of overall sagittal balance. When examining the other variables, it was found that cervical lordosis had a weak correlation (r=0.37) with SVA(dens) that was unexpected, given that cervical lordosis determines head position. Thoracic kyphosis also had a weak correlation (r=0.26) with SVA(C1), which was equally surprising. Lumbar lordosis had a slightly higher correlation (r=0.38), p=.006, than the cervical or thoracic spine. A multiple regression was run on the data to examine the relationship that all these independent variables have on SVA(dens). SPSS (SPSS, Inc., Chicago, IL, USA) was used to create a regression equation using the independent variables of T1 sagittal angle, cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and femoral-sacral angle and the dependent variable of SVA(dens). The model had a strong correlation (r=0.80, r(2)=0.64) and was statistically significant (p<.0001). The T1 sagittal angle was the variable that had the strongest correlation with the SVA(dens) Spearman r=0.65, p<.0001, followed by pelvic incidence, p=.002, and lumbar lordosis, p=.006. We also observed that when the T1 tilt was higher than 25°, all patients had at least 10 cm of positive sagittal imbalance. In addition, patients with negative sagittal balance had mostly low T1 tilt values, usually lower than 13°. The other variables were not shown to have a statically significant influence on SVA. This analysis shows that many factors influence the overall sagittal balance of the patient, but it may be the position of the pelvis and lower spine that have a stronger influence than the position of the upper back and neck. Unfortunately, to our knowledge, there are no studies to date that have established a normal sagittal T1 tilt angle. However, our analysis has shown that when the T1 tilt was higher than 25°, all patients had at least 10 cm of positive sagittal imbalance. It also showed that patients with negative sagittal balance had mostly low T1 tilt values, usually below 13° of angulation. The T1 sagittal angle is a measurement that may be very useful in evaluating sagittal balance, as it was the measure that most strongly correlated with SVA(dens). It has its great utility where long films cannot be obtained. Patients whose T1 tilt falls outside the range 13° to 25° should be sent for full-column radiographs for a complete evaluation of their sagittal balance. On the other hand, a T1 tilt within the above range does not guarantee a normal sagittal balance, and further investigation should be performed at the surgeon's discretion. Copyright © 2010 Elsevier Inc. All rights reserved.

Back in time: a new systematic proposal for the Bilateria.

PubMed

Baguñà, Jaume; Martinez, Pere; Paps, Jordi; Riutort, Marta

2008-04-27

Conventional wisdom suggests that bilateral organisms arose from ancestors that were radially, rather than bilaterally, symmetrical and, therefore, had a single body axis and no mesoderm. The two main hypotheses on how this transformation took place consider either a simple organism akin to the planula larva of extant cnidarians or the acoel Platyhelminthes (planuloid-acoeloid theory), or a rather complex organism bearing several or most features of advanced coelomate bilaterians (archicoelomate theory). We report phylogenetic analyses of bilaterian metazoans using quantitative (ribosomal, nuclear and expressed sequence tag sequences) and qualitative (HOX cluster genes and microRNA sets) markers. The phylogenetic trees obtained corroborate the position of acoel and nemertodermatid flatworms as the earliest branching extant members of the Bilateria. Moreover, some acoelomate and pseudocoelomate clades appear as early branching lophotrochozoans and deuterostomes. These results strengthen the view that stem bilaterians were small, acoelomate/pseudocoelomate, benthic organisms derived from planuloid-like organisms. Because morphological and recent gene expression data suggest that cnidarians are actually bilateral, the origin of the last common bilaterian ancestor has to be put back in time earlier than the cnidarian-bilaterian split in the form of a planuloid animal. A new systematic scheme for the Bilateria that includes the Cnidaria is suggested and its main implications discussed.

STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS ACCOMPANIED BY CONTRALATERAL PERIPHERAL RETINOSCHISIS.

PubMed

Ahmed, Daniel; Stattin, Martin; Glittenberg, Carl; Krebs, Ilse; Ansari-Shahrezaei, Siamak

2017-01-16

To present a patient with stellate nonhereditary idiopathic foveomacular retinoschisis on one eye and peripheral retinoschisis without foveal affection on the other eye. A case report with complete workup of family history and clinical examination, including multimodal imaging with optical coherence tomography and angiography, fluorescein angiography, and infrared fundus imaging. Genetic testing for gene mutation XRLS1 was performed. A white woman with unremarkable medical history presented with stellate foveal splitting of the outer plexiform layer on the right eye and peripheral splitting of the outer plexiform layer on both eyes. All known allegeable trigger factors for the existence of a hereditary or acquired foveomacular retinoschisis were ruled out either by clinical presentation or genetic testing. This led to the diagnosis of stellate nonhereditary idiopathic foveomacular retinoschisis with central involvement only present on one eye. Although peripheral schisis of the outer plexiform layer is often concomitant with central splitting in X-linked juvenile retinoschisis, this is the first known report of nonhereditary cleavage of the outer plexiform layer of the peripheral retina without central affection in a patient with documented stellate nonhereditary idiopathic foveomacular retinoschisis on the other eye. These findings suggest an accurate bilateral examination of the peripheral retina while confirming the diagnose of stellate nonhereditary idiopathic foveomacular retinoschisis.

Increase in Periodontal Interleukin-1β Gene Expression Following Osseous Resective Surgery Using Conventional Rotary Instruments Compared with Piezosurgery: A Split-Mouth Randomized Clinical Trial.

PubMed

Aimetti, Mario; Ferrarotti, Francesco; Bergandi, Loredana; Saksing, Laura; Parducci, Francesca; Romano, Federica

2016-01-01

The purpose of this study was to evaluate the early inflammatory response following osseous resective surgery (ORS) with Piezosurgery compared to commonly used diamond burs. A sample was selected of 24 bilateral posterior sextants requiring ORS in 12 chronic periodontitis patients in a split-mouth design. In 12 sextants, bone recontouring was performed using a piezoelectric device. In the contralateral sextants, rotary instruments were used. Sextants treated with Piezosurgery obtained similar 12-month clinical results but lower postsurgical gene expression of interleukin-1β (IL-1β), a well-known proinflammatory cytokine, and lower patient morbidity compared with sextants treated with rotary instruments. In spite of the longer surgical time, the use of Piezosurgery for ORS seems to promote more favorable wound healing compared with rotary instruments, as the lower pain and the low levels of IL-1β mRNA at the surgical sites suggest a milder underlying inflammatory response.

Acute proximal junctional failure in patients with preoperative sagittal imbalance.

PubMed

Smith, Micah W; Annis, Prokopis; Lawrence, Brandon D; Daubs, Michael D; Brodke, Darrel S

2015-10-01

Proximal junctional failure (PJF) is a recognized complication of spinal deformity surgery. Acute PJF (APJF) has recently been demonstrated to be 5.6% in the adult spinal deformity (ASD) population. The incidence and rate of return to the operating room for APJF have not been specifically investigated in individuals with sagittal imbalance. The purpose of this study was to report the incidence of APJF in patients with preoperative sagittal imbalance and the rate of return to the operating room for APJF. This study is based on a retrospective review of prospectively collected database of ASD patients. One hundred seventy-three consecutive patients were included with preoperative sagittal imbalance according to one of the following common parameters: sagittal vertical axis (SVA) greater than 50 mm, global sagittal alignment greater than 45°, or pelvic incidence minus lumbar lordosis greater than 10°. Outcome measure was presence and/or absence of APJF defined as fracture at the upper instrumented vertebra (UIV) or UIV+1, failure of UIV fixation, 15° or more proximal junctional kyphosis, or need for extension of instrumentation within 6 months of surgery. We performed radiographic measurements on X-rays at preoperative, immediate postoperative, and 6-month follow-up visits. The APJF rate was reported for the entire patient population with preoperative sagittal imbalance. Acute PJF incidence was calculated postoperatively for each of the accepted sagittal balance parameters and/or formulas. Patients with persistent postoperative sagittal imbalance were compared with the sagittally balanced group. We also assessed for threshold values. Acute PJF was observed in 60 of 173 patients (35%) and was least common in fusions with the UIV in the upper thoracic (UT) spine (p=.035). Of those who developed APJF, 21.7% required surgery. Proximal junctional kyphosis 15° or more was the most common form of APJF in fusions to the UT spine but least likely to need revision (p=.014). The most common mode of failure in lower thoracic (LT) or lumbar (L) fusions was UIV fracture. Postoperative SVA less than 50 mm was a significant risk factor for APJF (p=.009). Acute PJF is more common in patients with preoperative sagittal imbalance (35%) than the general adult deformity patient population, and 37% of those with APJF require revision. It is least common when the UIV is in the UT spine, compared with the LT or L spine. Sagittal balance correction to an SVA 50 mm or less was a significant risk factor in patients with preoperative sagittal imbalance. Copyright © 2015 Elsevier Inc. All rights reserved.

Training intensity and sagittal curvature of the spine in male and female artistic gymnasts.

PubMed

Sanz-Mengibar, Jose M; Sainz-de-Baranda, Pilar; Santonja-Medina, Fernando

2018-04-01

Specific adaptations of the spine in the sagittal plane have been described according to different sports disciplines. The goal of this study was to describe the integrative diagnosis of the sagittal morphotype of the spine in male and female artistic gymnasts. Forty-eight gymnasts were measured with an inclinometer. Thoracic and lumbar curves were quantified in standing position, in Sit and Reach and Slump Sitting in order to assess the sagittal spine posture and analyze if adaptations were related to training intensity. Correlation values of the sagittal plane spine measurements showed significantly increased thoracic kyphosis in men (-0.445, P<0.001). No significant correlations have been found between training hours per year or training volume and any measurements of the spine on the sagittal plane. When data from the two sitting tests were integrated, 62.5% of gymnasts had a functional thoracic kyphosis and 39.6% had lumbar kyphotic attitude. Our hypothesis has only been partially confirmed, because training intensity did not influence the sagittal curvatures in artistic gymnastics; however, this sport seems to cause specific adaptations in postural hypolordosis, functional thoracic kyphosis and lumbar kyphotic attitude during sitting and trunk flexion. The implications of the functional adaptations observed in our results may require a preventive intervention in male and female artistic gymnasts can be assessed with the integrative diagnosis of the sagittal morphotype of the spine.

The Relationship Between Asymmetry and Athletic Performance: A Critical Review.

PubMed

Maloney, Sean J

2018-05-08

Maloney, SJ. The relationship between asymmetry and athletic performance: A critical review. J Strength Cond Res XX(X): 000-000, 2018-Symmetry may be defined as the quality to demonstrate an exact correspondence of size, shape, and form when split along a given axis. Although it has been widely asserted that the bilateral asymmetries are detrimental to athletic performance, research does not wholly support such an association. Moreover, the research rarely seeks to distinguish between different types of bilateral asymmetry. Fluctuating asymmetries describe bilateral differences in anthropometric attributes, such as nostril width and ear size, and are thought to represent the developmental stability of an organism. There is evidence to suggest that fluctuating asymmetries may be related to impaired athletic performance, although contradictory findings have been reported. Sporting asymmetries is a term that may better describe bilateral differences in parameters, such as force output or jump height. These asymmetries are likely to be a function of limb dominance and magnified by long-standing participation within sport. Sporting asymmetries do not seem to carry a clear influence on athletic performance measures. Given the vast discrepancy in the methodologies used by different investigations, further research is warranted. Recent investigations have demonstrated that training interventions can reduce sporting asymmetries and improve performance. However, studies have not sought to determine whether the influence of sporting asymmetry is independent of improvements in neuromuscular parameters. It may be hypothesized that the deficient (weaker) limb has a greater potential for adaptation in comparison to the strong limb and may demonstrate greater responsiveness to training.

Magnetic resonance features of cerebral malaria.

PubMed

Yadav, P; Sharma, R; Kumar, S; Kumar, U

2008-06-01

Cerebral malaria is a major health hazard, with a high incidence of mortality. The disease is endemic in many developing countries, but with a greater increase in tourism, occasional cases may be detected in countries where the disease in not prevalent. Early diagnosis and evaluation of cerebral involvement in malaria utilizing modern imaging modalities have an impact on the treatment and clinical outcome. To evaluate the magnetic resonance (MR) features of patients with cerebral malaria presenting with altered sensorium. We present the findings in three patients with cerebral malaria presenting with altered sensorium. MR imaging using a 1.5-Tesla unit was carried out. The sequences performed were 5-mm-thick T1-weighted, T2-weighted, fluid-attenuated inversion-recovery (FLAIR), and T2-weighted gradient-echo axial sequences, and sagittal and coronal FLAIR. Diffusion-weighted imaging was performed with b values of 0 and 1000 s/mm(2), and apparent diffusion coefficient (ADC) maps were obtained. Focal hyperintensities in the bilateral periventricular white matter, corpus callosum, occipital subcortex, and bilateral thalami were noticed on T2-weighted and FLAIR sequences. The lesions were more marked in the splenium of the corpus callosum. No enhancement on postcontrast T1-weighted MR images was observed. There was no evidence of restricted diffusion on the diffusion-weighted sequence and ADC map. MR is a sensitive imaging modality, with a role in the assessment of cerebral lesions in malaria. Focal white matter and corpus callosal lesions without any restricted diffusion were the key findings in our patients.

Hunter-McAlpine craniosynostosis phenotype associated with skeletal anomalies and interstitial deletion of chromosome 17q

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomas, J.; Prescott, K.; Milner, R.

1994-09-01

Syndromic craniosynostosis is frequently associated with skeletal abnormalities, but the biological basis for this association is unclear. Molecular genetic studies have the biological basis for this association is unclear. Molecular genetic studies have identified a number of loci and at least one candidate gene, the MSX2 gene. We recently encountered a 9 y.o. boy with moderate mental retardation, congenital craniosynostosis, and multiple skeletal anomalies. Physical features strongly suggested Hunter-McAlpine syndrome (HMS). Specifically, he had triangular facies with a small mouth prominent chin, bulbous nose, thin vermillion border, malaligned and malformed teeth, and low set, rudimentary ears. Skeletal features included: bilambdoidal,more » bicoronal, and sagittal craniosynostosis; right preaxial polydactyly; bilateral talipes; coxa valga; genu valgum; bilateral fusion of the hamate and capitate; scoliosis; and small, irregular middle phalangeal epiphyses. High resolution chromosome analysis revealed an interstitial deletion of G negative material of subbands q23.1{r_arrow}23.3 or q23.3{r_arrow}q24.2 of a No. 17 homologue. HMS, a presumed autosomal dominant disorder associated with characteristic facies, variable degrees of mental retardation, craniosynostosis, and minor acral-skeletal anomalies, proved to be the most likely explanation for this patient`s findings. We propose that our patient has a new mutation for HMS with more severe skeletal involvement than previously reported. Linkage studies are in progress to test the hypothesis that familial HMS may be localized to chromosome 17.« less

'Lumbar Degenerative Kyphosis' Is Not Byword for Degenerative Sagittal Imbalance: Time to Replace a Misconception.

PubMed

Lee, Chang-Hyun; Chung, Chun Kee; Jang, Jee-Soo; Kim, Sung-Min; Chin, Dong-Kyu; Lee, Jung-Kil

2017-03-01

Lumbar degenerative kyphosis (LDK) is a subgroup of the flat-back syndrome and is most commonly caused by unique life styles, such as a prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Unfortunately, LDK has been used as a byword for degenerative sagittal imbalance, and this sometimes causes confusion. The aim of this review was to evaluate the exact territory of LDK, and to introduce another appropriate term for degenerative sagittal deformity. Unlike what its name suggests, LDK does not only include sagittal balance disorder of the lumbar spine and kyphosis, but also sagittal balance disorder of the whole spine and little lordosis of the lumbar spine. Moreover, this disease is closely related to the occupation of female farmers and an outdated Asian life style. These reasons necessitate a change in the nomenclature of this disorder to prevent misunderstanding. We suggest the name "primary degenerative sagittal imbalance" (PDSI), which encompasses degenerative sagittal misalignments of unknown origin in the whole spine in older-age patients, and is associated with back muscle wasting. LDK may be regarded as a subgroup of PDSI related to an occupation in agriculture. Conservative treatments such as exercise and physiotherapy are recommended as first-line treatments for patients with PDSI, and surgical treatment is considered only if conservative treatments failed. The measurement of spinopelvic parameters for sagittal balance is important prior to deformity corrective surgery. LDK can be considered a subtype of PDSI that is more likely to occur in female farmers, and hence the use of LDK as a global term for all degenerative sagittal imbalance disorders is better avoided. To avoid confusion, we recommend PDSI as a newer, more accurate diagnostic term instead of LDK.

‘Lumbar Degenerative Kyphosis’ Is Not Byword for Degenerative Sagittal Imbalance: Time to Replace a Misconception

PubMed Central

Lee, Chang-Hyun; Chung, Chun Kee; Jang, Jee-Soo; Kim, Sung-Min; Chin, Dong-Kyu; Lee, Jung-Kil

2017-01-01

Lumbar degenerative kyphosis (LDK) is a subgroup of the flat-back syndrome and is most commonly caused by unique life styles, such as a prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Unfortunately, LDK has been used as a byword for degenerative sagittal imbalance, and this sometimes causes confusion. The aim of this review was to evaluate the exact territory of LDK, and to introduce another appropriate term for degenerative sagittal deformity. Unlike what its name suggests, LDK does not only include sagittal balance disorder of the lumbar spine and kyphosis, but also sagittal balance disorder of the whole spine and little lordosis of the lumbar spine. Moreover, this disease is closely related to the occupation of female farmers and an outdated Asian life style. These reasons necessitate a change in the nomenclature of this disorder to prevent misunderstanding. We suggest the name “primary degenerative sagittal imbalance” (PDSI), which encompasses degenerative sagittal misalignments of unknown origin in the whole spine in older-age patients, and is associated with back muscle wasting. LDK may be regarded as a subgroup of PDSI related to an occupation in agriculture. Conservative treatments such as exercise and physiotherapy are recommended as first-line treatments for patients with PDSI, and surgical treatment is considered only if conservative treatments failed. The measurement of spinopelvic parameters for sagittal balance is important prior to deformity corrective surgery. LDK can be considered a subtype of PDSI that is more likely to occur in female farmers, and hence the use of LDK as a global term for all degenerative sagittal imbalance disorders is better avoided. To avoid confusion, we recommend PDSI as a newer, more accurate diagnostic term instead of LDK. PMID:28264231

[Analysis of normal pelvis morphometry of modern Chinese southern Han female and its correlation with age].

PubMed

Liu, Ping; Yu, Yan-Hong; Chen, Chun-Lin; Tang, Yi-Xin; Wang, Li; Mao, Dong-Rui; Xu, Yi-Kai; Chen, Lan

2013-07-01

To analyze the normal pelvis morphometry of Chinese southern Han female and its correlation with age. From August 2009 to September 2011, 289 Han nationality females who received pelvis CT scan at Nanfang Hospital of Southern Medical University were eligible for the study. Their mean age was 43.5 years, with normal body development and no pelvic abnormality. The patients were divided into 3 age groups: 25 to 40 (n = 109), 41 to 50 (n = 115), and >50 years (n = 65). After constructing a three-dimensional digital model of the pelvis, the following parameters were measured, including transverse inlet diameter, posterior sagittal diameter of pelvic inlet, sagittal inlet, diagonal conjugate, biischial diameter, posterior sagittal diameter of midpelvis, sagittal midpelvic diameter, intertuberous distance, posterior sagittal diameter of outlet, angle of pubic arch, sagittal outlet, penal height, sacrum length and sacrum curvature. The relationship between all parameters and age was analyzed. (1) The posterior sagittal diameters of pelvic inlet of the 25 to 40 age group, 41 to 50 age group, >50 years age group were (53 ± 8), (51 ± 7), (48 ± 6) mm. The sagittal inlet of the three groups were (122 ± 8), (120 ± 9), (114 ± 8) mm. And the diagonal conjugate of the three groups were (135 ± 10), (132 ± 9), (127 ± 9) mm. All had significant differences among the three groups (P < 0.01) . (2) The posterior sagittal diameter of midpelvis of the three groups were (43 ± 6), (44 ± 6), (43 ± 7) mm, and the sagittal midpelvic diameter of the three groups were (119 ± 8), (120 ± 8), (119 ± 7) mm, with no significant difference among the three groups (P > 0.05). (3) The intertuberous distance of the three groups were (122 ± 11), (121 ± 10), (117 ± 11) mm, and the posterior sagittal diameter of outlet of the three groups were (56 ± 9), (58 ± 8), (57 ± 9) mm. There was no significant difference among the three groups (P > 0.05) .(4) Penal height of three groups were (31 ± 3), (33 ± 3), (34 ± 3) mm, there was with significant differences (P < 0.01) .(5) Pearson correlation analysis showed that penal height was positively correlated with age (r = 0.331, P < 0.05), while sagittal inlet, posterior sagittal diameter of inlet, diagonal conjugate, intertuberous distance, angle of pubic arch, sacrum length and sacrum curvature were negatively correlated with age (r = -0.120 to -0.343, P < 0.05). The shape of the pelvic inlet of Chinese southern Han female changed from sagittal elliptic into transverse elliptic form, and the posterior part of pelvic inlet became larger.Sacral concavity was increased and the pelvis became deeper. Mid pelvis and the pelvic outlet was almost unchanged, and showed no correlation with age.

Position des lignes temporales sur le cranium de «Mrs » Ples (A.africanus) : une attribution sexuelle est-elle possible ?Possible position of the temporal lines on the cranium of 'Mrs' Ples (A. africanus): is sexual determination possible?

NASA Astrophysics Data System (ADS)

Prat, Sandrine; Thackeray, John Francis

2001-03-01

The cranium and associated matrix of Sts 5, a cranium of Australopithecus africanus is re-examined in the context of an unfused sagittal suture and the position of the temporal lines. These lines are not developed as a sagittal crest although they are close to the mid-sagittal line. A comparative study of the presence of sagittal crests in male, female, juvenile and adult specimens of extant great apes ( Gorilla, Pan, Pongo) suggests that the existence of a sagittal crest is influenced to a greater extent by anatomical age rather than by the sex of the individuals.

Dynamic balance deficits in individuals with chronic ankle instability compared to ankle sprain copers 1 year after a first-time lateral ankle sprain injury.

PubMed

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2016-04-01

To quantify the dynamic balance deficits that characterise a group with chronic ankle instability compared to lateral ankle sprain copers and non-injured controls using kinematic and kinetic outcomes. Forty-two participants with chronic ankle instability and twenty-eight lateral ankle sprain copers were initially recruited within 2 weeks of sustaining a first-time, acute lateral ankle sprain and required to attend our laboratory 1 year later to complete the current study protocol. An additional group of non-injured individuals were also recruited to act as a control group. All participants completed the anterior, posterior-lateral and posterior-medial reach directions of the star excursion balance test. Sagittal plane kinematics of the lower extremity and associated fractal dimension of the centre of pressure path were also acquired. Participants with chronic ankle instability displayed poorer performance in the anterior, posterior-medial and posterior-lateral reach directions compared with controls bilaterally, and in the posterior-lateral direction compared with lateral ankle sprain copers on their 'involved' limb only. These performance deficits in the posterior-lateral and posterior-medial directions were associated with reduced flexion and dorsiflexion displacements at the hip, knee and ankle at the point of maximum reach, and coincided with reduced complexity of the centre of pressure path. In comparison with lateral ankle sprain copers and controls, participants with chronic ankle instability were characterised by dynamic balance deficits as measured using the SEBT. This was attested to reduced sagittal plane motions at the hip, knee and ankle joints, and reduced capacity of the stance limb to avail of its supporting base. III.

Normal Development and Measurements of the Occipital Condyle-C1 Interval in Children and Young Adults.

PubMed

Smith, P; Linscott, L L; Vadivelu, S; Zhang, B; Leach, J L

2016-05-01

Widening of the occipital condyle-C1 interval is the most specific and sensitive means of detecting atlanto-occipital dislocation. Recent studies attempting to define normal measurements of the condyle-C1 interval in children have varied substantially. This study was performed to test the null hypothesis that condyle-C1 interval morphology and joint measurements do not change as a function of age. Imaging review of subjects undergoing CT of the upper cervical spine for reasons unrelated to trauma or developmental abnormality was performed. Four equidistant measurements were obtained for each bilateral condyle-C1 interval on sagittal and coronal images. The cohort was divided into 7 age groups to calculate the mean, SD, and 95% CIs for the average condyle-C1 interval in both planes. The prevalence of a medial occipital condyle notch was calculated. Two hundred forty-eight joints were measured in 124 subjects with an age range of 2 days to 22 years. The condyle-C1 interval varies substantially by age. Average coronal measurements are larger and more variable than sagittal measurements. The medial occipital condyle notch is most prevalent from 1 to 12 years and is uncommon in older adolescents and young adults. The condyle-C1 interval increases during the first several years of life, is largest in the 2- to 4-year age range, and then decreases through late childhood and adolescence. A single threshold value to detect atlanto-occipital dissociation may not be sensitive and specific for all age groups. Application of this normative data to documented cases of atlanto-occipital injury is needed to determine clinical utility. © 2016 by American Journal of Neuroradiology.

PubMed Central

DI NARDO, W.; GIANNANTONIO, S.; DI GIUDA, D.; DE CORSO, E.; SCHINAIA, L.; PALUDETTI, G.

2013-01-01

SUMMARY Pre-surgery evaluation, indications for cochlear implantation and expectations in terms of post-operative functional results remain challenging topics in pre-lingually deaf adults. Our study has the purpose of determining the benefits of Single Photon Emission Tomography (SPECT) assessment in pre-surgical evaluation of pre-lingually deaf adults who are candidates for cochlear implantation. In 7 pre-lingually profoundly deaf patients, brain SPECT was performed at baseline conditions and in bilateral simultaneous multi-frequency acoustic stimulation. Six sagittal tomograms of both temporal cortices were used for semi-quantitative analysis in each patient. Percentage increases in cortical perfusion resulting from auditory stimulation were calculated. The results showed an inter-hemispherical asymmetry of the activation extension and intensity in the stimulated temporal areas. Consistent with the obtained brain activation data, patients were implanted preferring the side that showed higher activation after acoustic stimulus. Considering the increment in auditory perception performances, it was possible to point out a relationship between cortical brain activity shown by SPECT and hearing performances, and, even more significant, a correlation between post-operative functional performances and the activation of the most medial part of the sagittal temporal tomograms, corresponding to medium-high frequencies. In light of these findings, we believe that brain SPECT could be considered in the evaluation of deaf patients candidate for cochlear implantation, and that it plays a major role in functional assessment of the auditory cortex of pre-lingually deaf subjects, even if further studies are necessary to conclusively establish its utility. Further developments of this technique are possible by using trans-tympanic electrical stimulation of the cochlear promontory, which could give the opportunity to study completely deaf patients, whose evaluation is objectively difficult with current audiological methods. PMID:23620636

Asymmetric C7 pedicle subtraction osteotomy for correction of rigid cervical coronal imbalance secondary to post-traumatic heterotopic ossification: a case report, description of a novel surgical technique, and literature review.

PubMed

Theologis, Alexander A; Bellevue, Kate D; Qamirani, Erion; Ames, Christopher P; Deviren, Vedat

2017-05-01

Deformities of the cervical spine are uncommon in the coronal plane. In this report, a unique case of a 31-year-old male with a fixed, 30° left coronal deformity due to heterotopic ossification 3 years status post poly-trauma was treated with an asymmetric C7 pedicle subtraction osteotomy (PSO). Case report. Pre-operatively, the patient had a fixed 45-degree left tilt of his neck and radiographs demonstrated a rigid 30° scoliosis, 7 cm coronal imbalance, and 4 cm negative sagittal balance, diffuse bridging bone between the spinous processes and the facet joints of C5 to T1 bilaterally. An asymmetric C7 PSO with C2-T3 posterior spinal fusion was completed without complication. There was residual 9° coronal deformity, 2.9 cm left coronal imbalance, and 2.3 cm sagittal imbalance. He had a marked improvement in his function, as assessed by the SF-36 physical component score (pre-op 31.1; post-op 44.7) and mental component score (pre-op 46.0; post-op 66.8). Post-operatively, neck disability index scores also improved (pre-op 38; post-op 16). Although the patient passed away from a drug overdose 14 months post-operatively, he did not report neck pain, he had not sought evaluation from another physician for his neck, and he had not undergone a subsequent neck operation before his passing. In this one patient, an asymmetric C7 PSO was performed safely. While it was effective in addressing a fixed cervical coronal imbalance, its efficacy and safety profile should be confirmed in larger cohorts.

Morphometric analysis of acetabular dysplasia in cerebral palsy: three-dimensional CT study.

PubMed

Gose, Shinichi; Sakai, Takashi; Shibata, Toru; Murase, Tsuyoshi; Yoshikawa, Hideki; Sugamoto, Kazuomi

2009-12-01

Three-dimensional computed tomography (3D-CT) eliminates the positioning errors and allows the clinician to more accurately assess the radiographic parameters present. To elucidate the 3D geometry of the acetabulum and the extent of hip subluxation/dislocation in patients with cerebral palsy (CP), quantitative morphometric analysis was performed using 3D-CT data. We evaluated 150 hips in 75 patients with bilateral spastic CP. The mean age of the patients was 5.4 years (range: 2.7 to 6.9 y). The fitting plane of the ilium was projected onto the coronal plane and then onto the sagittal plane, and then the angle formed with a horizontal line was defined as CTalpha (the lateral opening angle) and CTbeta (the sagittal inclination angle), respectively. The center of the acetabulum and the femoral head were defined, and the distance between these centers was divided by the femoral head diameter, defined as CT migration percentage (CTMP, %). In 123 (82%) of the 150 hips, the femoral head center was located posteriorly, superiorly, and laterally relative to the acetabular center. Large CTalpha cases tended to show large CTMP. CTalpha and CTMP were significantly larger in the cases with Gross Motor Functional Classification System (GMFCS) level IV/V and spastic quadriplegia, than in the cases with GMFCS level II/III and spastic diplegia. CTbeta showed significant correlation with the acetabular defect on the lateral 3D reconstructed images. Three-dimensional acetabular geometry and migration percentage in CP patients can be analyzed quantitatively using 3D-CT regardless of the abnormal spastic posture. The extent of acetabular dysplasia and subluxation is more severe in patients with GMFCS level IV/V and spastic quadriplesia. Level 4.

Spinal sagittal imbalance in patients with lumbar disc herniation: its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy.

PubMed

Liang, Chen; Sun, Jianmin; Cui, Xingang; Jiang, Zhensong; Zhang, Wen; Li, Tao

2016-07-22

Spinal sagittal imbalance is a widely acknowledged problem, but there is insufficient knowledge regarding its occurrence. In some patients with lumbar disc herniation (LDH), their symptom is similar to spinal sagittal imbalance. The aim of this study is to illustrate the spinopelvic sagittal characteristics and identity the role of spinal musculature in the mechanism of sagittal imbalance in patients with LDH. Twenty-five adults with spinal sagittal imbalance who initially came to our clinic for treatment of LDH, followed by posterior discectomy were reviewed. The horizontal distance between C7 plumb line-sagittal vertical axis (C7PL-SVA) greater than 5 cm anteriorly with forward bending posture is considered as spinal sagittal imbalance. Radiographic parameters including thoracic kyphotic angle (TK), lumbar lordotic angle (LL), pelvic tilting angle (PT), sacral slope angle (SS) and an electromyography(EMG) index 'the largest recruitment order' were recorded and compared. All patients restored coronal and sagittal balance immediately after lumbar discectomy. The mean C7PL-SVA and trunk shift value decreased from (11.6 ± 6.6 cm, and 2.9 ± 6.1 cm) preoperatively to (-0.5 ± 2.6 cm and 0.2 ± 0.5 cm) postoperatively, while preoperative LL and SS increased from (25.3° ± 14.0° and 25.6° ± 9.5°) to (42.4° ± 10.2° and 30.4° ± 8.7°) after surgery (P < 0.05). The preoperative mean TK and PT (24.7° ± 11.3° and 20.7° ± 7.8°) decreased to (22.0° ± 9.8° and 15.8 ± 5.5°) postoperatively (P < 0.05). The largest recruitment order on the level of T7-T8, T12-L1 and the herniated level all improved compared with before and after surgery (P < 0.05). All patients have been followed up for more than 2 years. The mean ODI was 77.8 % before surgery to 4.2 % at the final follow-up. Spinal sagittal imbalance caused by LDH is one type of compensatory sagittal imbalance. Compensatory mechanism of spinal sagittal imbalance mainly includes a loss of lumbar lordosis, an increase of thoracic kyphosis and pelvis tilt. Spinal musculature plays an important role in spinal sagittal imbalance in patients with LDH.

Asymmetrical number-space mapping in the avian brain.

PubMed

Rugani, Rosa; Vallortigara, Giorgio; Vallini, Barbara; Regolin, Lucia

2011-03-01

When trained to peck a selected position in a sagittally-oriented series of identical food containers, and then required to generalize to an identical series rotated by 90°, chicks identify as correct only the target position from the left end, while choosing the right one at chance. Here we show that when accustomed to systematic changes in inter-elements distances during training or faced with similar spatial changes at test, chicks identify as correct both the target positions from left and right ends. However, ordinal position is spontaneously encoded even when inter-element distances are kept fixed during training (in spite of the fact that distances between elements suffice for target identification without any numerical computation). We explain these findings in terms of intra-hemispheric coupling of bilateral numerical (ordinal) representation and unilateral (right hemispheric) spatial representation of the number line, producing differential allocation of attention in the left and right visual hemifields. Copyright © 2010 Elsevier Inc. All rights reserved.

The path of the superior sagittal sinus in unicoronal synostosis.

PubMed

Russell, Aaron J; Patel, Kamlesh B; Skolnick, Gary; Woo, Albert S; Smyth, Matthew D

2014-10-01

This study investigates the anatomic relationship between the superior sagittal sinus (SSS) and the sagittal suture in infants with uncorrected unicoronal synostosis. The morphology of the SSS is also evaluated postoperatively to assess whether normalization of intracranial structures occurs following reconstruction. The study sample consisted of 20 computed tomography scans (10 preoperative, 6 postoperative, and 4 unaffected controls) obtained between 2001 and 2013. The SSS and the sagittal suture were outlined using Analyze imaging software. These data were used to measure the maximum lateral discrepancy between the SSS and the sagittal suture preoperatively and to assess for postoperative changes in the morphology of the SSS. In children with uncorrected unicoronal synostosis, the SSS deviates to the side of the patent coronal suture posteriorly and tends to follow the path of the sagittal and metopic sutures. The lateral discrepancy between the SSS and the sagittal suture ranged from 5.0 to 11.8 mm, with a 99.9 % upper prediction bound of 14.4 mm. Postoperatively, the curvature of the SSS was statistically decreased following surgical intervention, though it remained significantly greater than in unaffected controls. The SSS follows a predictable course relative to surface landmarks in children with unicoronal synostosis. When creating burr holes for craniotomies, the SSS can be avoided in 99.9 % of cases by remaining at least 14.4 mm from the lateral edge of the sagittal suture. Postoperative changes in the path of the SSS provide indirect evidence for normalization of regional brain morphology following fronto-orbital advancement.

Measurement and Finite Element Model Validation of Immature Porcine Brain-Skull Displacement during Rapid Sagittal Head Rotations.

PubMed

Pasquesi, Stephanie A; Margulies, Susan S

2018-01-01

Computational models are valuable tools for studying tissue-level mechanisms of traumatic brain injury, but to produce more accurate estimates of tissue deformation, these models must be validated against experimental data. In this study, we present in situ measurements of brain-skull displacement in the neonatal piglet head ( n  = 3) at the sagittal midline during six rapid non-impact rotations (two rotations per specimen) with peak angular velocities averaging 51.7 ± 1.4 rad/s. Marks on the sagittally cut brain and skull/rigid potting surfaces were tracked, and peak values of relative brain-skull displacement were extracted and found to be significantly less than values extracted from a previous axial plane model. In a finite element model of the sagittally transected neonatal porcine head, the brain-skull boundary condition was matched to the measured physical experiment data. Despite smaller sagittal plane displacements at the brain-skull boundary, the corresponding finite element boundary condition optimized for sagittal plane rotations is far less stiff than its axial counterpart, likely due to the prominent role of the boundary geometry in restricting interface movement. Finally, bridging veins were included in the finite element model. Varying the bridging vein mechanical behavior over a previously reported range had no influence on the brain-skull boundary displacements. This direction-specific sagittal plane boundary condition can be employed in finite element models of rapid sagittal head rotations.

Measurement and Finite Element Model Validation of Immature Porcine Brain–Skull Displacement during Rapid Sagittal Head Rotations

PubMed Central

Pasquesi, Stephanie A.; Margulies, Susan S.

2018-01-01

Computational models are valuable tools for studying tissue-level mechanisms of traumatic brain injury, but to produce more accurate estimates of tissue deformation, these models must be validated against experimental data. In this study, we present in situ measurements of brain–skull displacement in the neonatal piglet head (n = 3) at the sagittal midline during six rapid non-impact rotations (two rotations per specimen) with peak angular velocities averaging 51.7 ± 1.4 rad/s. Marks on the sagittally cut brain and skull/rigid potting surfaces were tracked, and peak values of relative brain–skull displacement were extracted and found to be significantly less than values extracted from a previous axial plane model. In a finite element model of the sagittally transected neonatal porcine head, the brain–skull boundary condition was matched to the measured physical experiment data. Despite smaller sagittal plane displacements at the brain–skull boundary, the corresponding finite element boundary condition optimized for sagittal plane rotations is far less stiff than its axial counterpart, likely due to the prominent role of the boundary geometry in restricting interface movement. Finally, bridging veins were included in the finite element model. Varying the bridging vein mechanical behavior over a previously reported range had no influence on the brain–skull boundary displacements. This direction-specific sagittal plane boundary condition can be employed in finite element models of rapid sagittal head rotations. PMID:29515995

The spectrum of Apert syndrome: phenotype, particularities in orthodontic treatment, and characteristics of orthognathic surgery

PubMed Central

Hohoff, Ariane; Joos, Ulrich; Meyer, Ulrich; Ehmer, Ulrike; Stamm, Thomas

2007-01-01

In the PubMed accessible literature, information on the characteristics of interdisciplinary orthodontic and surgical treatment of patients with Apert syndrome is rare. The aim of the present article is threefold: (1) to show the spectrum of the phenotype, in order (2) to elucidate the scope of hindrances to orthodontic treatment, and (3) to demonstrate the problems of surgery and interdisciplinary approach. Children and adolescents who were born in 1985 or later, who were diagnosed with Apert syndrome, and who sought consultation or treatment at the Departments of Orthodontics or Craniomaxillofacial Surgery at the Dental School of the University Hospital of Münster (n = 22; 9 male, 13 female) were screened. Exemplarily, three of these patients (2 male, 1 female), seeking interdisciplinary (both orthodontic and surgical treatment) are presented. Orthodontic treatment before surgery was performed by one experienced orthodontist (AH), and orthognathic surgery was performed by one experienced surgeon (UJ), who diagnosed the syndrome according to the criteria listed in OMIM™. In the sagittal plane, the patients suffered from a mild to a very severe Angle Class III malocclusion, which was sometimes compensated by the inclination of the lower incisors; in the vertical dimension from an open bite; and transversally from a single tooth in crossbite to a circular crossbite. All patients showed dentitio tarda, some impaction, partial eruption, idopathic root resorption, transposition or other aberrations in the position of the tooth germs, and severe crowding, with sometimes parallel molar tooth buds in each quarter of the upper jaw. Because of the severity of malocclusion, orthodontic treatment needed to be performed with fixed appliances, and mainly with superelastic wires. The therapy was hampered with respect to positioning of bands and brackets because of incomplete tooth eruption, dense gingiva, and mucopolysaccharide ridges. Some teeth did not move, or moved insufficiently (especially with respect to rotations and torque) irrespective of surgical procedures or orthodontic mechanics and materials applied, and without prognostic factors indicating these problems. Establishing occlusal contact of all teeth was difficult. Tooth movement was generally retarded, increasing the duration of orthodontic treatment. Planning of extractions was different from that of patients without this syndrome. In one patient, the sole surgical procedure after orthodontic treatment with fixed appliances in the maxilla and mandible was a genioplasty. Most patients needed two- jaw surgery (bilateral sagittal split osteotomy [BSSO] with mandibular setback and distraction in the maxilla). During the period of distraction, the orthodontist guided the maxilla into final position by means of bite planes and intermaxillary elastics. To our knowledge, this is the first article in the PubMed accessible literature describing the problems with respect to interdisciplinary orthodontic and surgical procedures. Although the treatment results are not perfect, patients undergoing these procedures benefit esthetically to a high degree. Patients need to be informed with respect to the different kinds of extractions that need to be performed, the increased treatment time, and the results, which may be reached using realistic expectations. PMID:17286873

Stability of implants placed in augmented posterior mandible after alveolar osteotomy using resorbable nonceramic hydroxyapatite or intraoral autogenous bone: 12-month follow-up.

PubMed

Dottore, Alexandre M; Kawakami, Paulo Y; Bechara, Karen; Rodrigues, Jose Augusto; Cassoni, Alessandra; Figueiredo, Luciene C; Piattelli, Adriano; Shibli, Jamil Awad

2014-06-01

This prospective, controlled split-mouth study evaluated the stability of dental implants placed in the augmented mandibular areas with alveolar segmental "sandwich" osteotomies using nonceramic hydroxyapatite (ncHA) or autogenous bone. This study included 11 bilaterally partially edentulous mandibular patients in a split-mouth design. Alveolar augmentation osteotomies were performed bilaterally with interpositional ncHA graft (test group) or interpositional intraoral autogenous bone graft (control group). After 6 months of healing, four implants (two implants in each side) were placed in each patient. Forty-four implants were inserted and loaded after 6-month healing period. At 1-year follow-up, radiographic, prosthetic, and resonance frequency analysis parameters were assessed. Success criteria included absence of pain, sensitivity, suppuration, and implant mobility; absence of continuous peri-implant radiolucency; and distance between the implant shoulder and the first visible bone contact (DIB) < 2 mm. After a 1-year loading period, the overall implant survival rate was 95.45%, with two implant losses (one of each group). Among the surviving implants (42 out of 44), two did not fulfill the success criteria; therefore, the implant success was 90.90%. DIB was 0.71 ± 0.70 and 0.84 ± 0.72 mm for ncHA and autogenous bone grafts, respectively (p > .05). Implant stability measurements were similar between the groups during the 12-month follow-up (p > .05). Within the limits of this study, the implants placed either in sites augmented with ncHA or autogenous bone seem to represent a safe and successful procedure, at least, after 12-month follow-up. © 2012 Wiley Periodicals, Inc.

Self-Inflicted Drywall Screws in the Sagittal Sinus.

PubMed

Guppy, Kern H; Ochi, Calvin

2018-02-01

A 30-year-old right-handed man with a history of schizophrenia presented with 2 self-inflicted drywall screws in the skull. The patient was sleepy but easily arousable; blood tests showed he had taken methamphetamines. Computed tomography and computed tomography angiography of the head showed the frontal screw abutted left of the superior sagittal sinus, and the posterior screw went through the superior sagittal sinus with no extravasation of contrast material at either site. Both screws were removed with exposure of the sagittal sinus using U-shaped craniectomies. There was no bleeding on the removal of the screws. It appears the posterior screw entered between the leaflets of the sagittal sinus dura mater. The patient had returned to work without any sequelae 1 month after injury. Copyright © 2017 Elsevier Inc. All rights reserved.

Mid-sagittal plane and mid-sagittal surface optimization in brain MRI using a local symmetry measure

NASA Astrophysics Data System (ADS)

Stegmann, Mikkel B.; Skoglund, Karl; Ryberg, Charlotte

2005-04-01

This paper describes methods for automatic localization of the mid-sagittal plane (MSP) and mid-sagittal surface (MSS). The data used is a subset of the Leukoaraiosis And DISability (LADIS) study consisting of three-dimensional magnetic resonance brain data from 62 elderly subjects (age 66 to 84 years). Traditionally, the mid-sagittal plane is localized by global measures. However, this approach fails when the partitioning plane between the brain hemispheres does not coincide with the symmetry plane of the head. We instead propose to use a sparse set of profiles in the plane normal direction and maximize the local symmetry around these using a general-purpose optimizer. The plane is parameterized by azimuth and elevation angles along with the distance to the origin in the normal direction. This approach leads to solutions confirmed as the optimal MSP in 98 percent of the subjects. Despite the name, the mid-sagittal plane is not always planar, but a curved surface resulting in poor partitioning of the brain hemispheres. To account for this, this paper also investigates an optimization strategy which fits a thin-plate spline surface to the brain data using a robust least median of squares estimator. Albeit computationally more expensive, mid-sagittal surface fitting demonstrated convincingly better partitioning of curved brains into cerebral hemispheres.

Experimentally determining the locations of two astigmatic images for an underwater light source

NASA Astrophysics Data System (ADS)

Yang, Pao-Keng; Liu, Jian-You; Ying, Shang-Ping

2015-05-01

Images formed by an underwater object from light rays refracted in the sagittal and tangential planes are located at different positions for an oblique viewing position. The overlapping of these two images from the observer's perspective will thus prevent the image-splitting astigmatism from being directly observable. In this work, we present a heuristic method to experimentally visualize the astigmatism. A point light source is used as an underwater object and the emerging wave front is recorded using a Shack-Hartmann wave-front sensor. The wave front is found to deform from a circular paraboloid to an elliptic paraboloid as the viewing position changes from normal to oblique. Using geometric optics, we derive an analytical expression for the image position as a function of the rotating angle of an arm used to carry the wave-front sensor in our experimental setup. The measured results are seen to be in good agreement with the theoretical predictions.

Surgical resection of large encephalocele: a report of two cases and consideration of resectability based on developmental morphology.

PubMed

Ohba, Hideo; Yamaguchi, Satoshi; Sadatomo, Takashi; Takeda, Masaaki; Kolakshyapati, Manish; Kurisu, Kaoru

2017-03-01

The first-line treatment of encephalocele is reduction of herniated structures. Large irreducible encephalocele entails resection of the lesion. In such case, it is essential to ascertain preoperatively if the herniated structure encloses critical venous drainage. Two cases of encephalocele presenting with large occipital mass underwent magnetic resonance (MR) imaging. In first case, the skin mass enclosed the broad space containing cerebrospinal fluid and a part of occipital lobe and cerebellum. The second case had occipital mass harboring a large portion of cerebrum enclosing dilated ventricular space. Both cases had common venous anomalies such as split superior sagittal sinus and high-positioned torcular herophili. They underwent resection of encephalocele without subsequent venous congestion. We could explain the pattern of venous anomalies in encephalocele based on normal developmental theory. Developmental theory connotes that major dural sinuses cannot herniate into the sac of encephalocele. Irrespective to its size, encephalocele can be resected safely at the neck without subsequent venous congestion.

Bilateral Simultaneous Ureteroscopic (BS-URS) Approach in the Management of Bilateral Urolithiasis Is a Safe and Effective Strategy in the Contemporary Era-Evidence from a Systematic Review.

PubMed

Geraghty, Robert M; Rai, Bhavan P; Jones, Patrick; Somani, Bhaskar K

2017-02-01

Ureteroscopic treatment of urolithiasis has become safer and more effective in the modern era. With a rise in the incidence of bilateral urolithiasis, management dilemma of staged single-side ureteroscopy versus bilateral simultaneous ureteroscopy (BS-URS) is often debatable. This review evaluates the current evidence base for bilateral simultaneous ureteroscopic approach in the modern era. A systematic review was conducted from 1990 to June 2016 including all English language articles reporting on outcomes of BS-URS for urolithiasis. Data was split into two periods: period 1: 2003-2012 and period 2: 2013-2016, and analysed using SPSS version 21. A total of 11 studies (491 patients) were identified from a literature search of 148 studies with mean age of 45 years and a male: female ratio of 2:1 and a mean operative time of 69 min (SD = ±15). The initial and final stone-free rate (SFR) was 87 and 93%, respectively. Post-operative stents were placed in 89% of patients with a mean hospital stay of 1.6 days (SD = ±0.5). Overall, there was a significant negative association between case volume (procedures per month) and complication rate (p = 0.045). Mean hospital stay was significantly longer in period 1 (1.9 days, SD = ±0.5) than period 2 (1.3 days, SD = ±0.3) and complications were also significantly higher in period 1 (47%) compared to period 2 (12%) (p < 0.001). There were six studies examining holmium laser (HL) lithotripsy and three examining pneumatic lithotripsy (PL). There were significantly more complications after PL than HL; however, their SFR was similar. Our review shows that the complication rates and hospital stay are significantly reduced in the contemporary data suggesting an improving trend in outcomes following BS-URS. Simultaneous bilateral ureteroscopic treatment of urolithiasis is safe and effective in the modern era. Safety is increased in centers with increased number of procedures performed and with laser lithotripsy.

Bilateral native nephrectomy to reduce oxalate stores in children at the time of combined liver-kidney transplantation for primary hyperoxaluria type 1.

PubMed

Lee, Eliza; Ramos-Gonzalez, Gabriel; Rodig, Nancy; Elisofon, Scott; Vakili, Khashayar; Kim, Heung Bae

2018-05-01

Primary hyperoxaluria type-1 (PH-1) is a rare genetic disorder in which normal hepatic metabolism of glyoxylate is disrupted resulting in diffuse oxalate deposition and end-stage renal disease (ESRD). While most centers agree that combined liver-kidney transplant (CLKT) is the appropriate treatment for PH-1, perioperative strategies for minimizing recurrent oxalate-related injury to the transplanted kidney remain unclear. We present our management of children with PH-1 and ESRD on hemodialysis (HD) who underwent CLKT at our institution from 2005 to 2015. On chart review, three patients (2 girls, 1 boy) met study criteria. Two patients received deceased-donor split-liver grafts, while one patient received a whole liver graft. All patients underwent bilateral native nephrectomy at transplant to minimize the total body oxalate load. Median preoperative serum oxalate was 72 μmol/L (range 17.8-100). All patients received HD postoperatively until predialysis serum oxalate levels fell <20 μmol/L. All patients, at a median of 7.5 years of follow-up (range 6.5-8.9), demonstrated stable liver and kidney function. While CLKT remains the definitive treatment for PH-1, bilateral native nephrectomy at the time of transplant reduces postoperative oxalate stores and may mitigate damage to the renal allograft.

Does correction of preoperative coronal imbalance make a difference in outcomes of adult patients with deformity?

PubMed

Daubs, Michael D; Lenke, Lawrence G; Bridwell, Keith H; Kim, Yongjung J; Hung, Man; Cheh, Gene; Koester, Linda A

2013-03-15

Retrospective study with prospectively collected outcomes data. Determine the significance of coronal balance on spinal deformity surgery outcomes. Sagittal balance has been confirmed as an important radiographic parameter correlating with adult deformity treatment outcomes. The significance of coronal balance on functional outcomes is less clear. Eighty-five patients with more than 4 cm of coronal imbalance who underwent reconstructive spinal surgery were evaluated to determine the significance of coronal balance on functional outcomes as measured with the Oswestry Disability Index (ODI) and Scoliosis Research Society outcomes questionnaires. Sixty-two patients had combined coronal (>4 cm) and sagittal imbalance (>5 cm), while 23 patients had coronal imbalance alone. Postoperatively, 85% of patients demonstrated improved coronal balance. The mean improvement in the coronal C7 plumb line was 26 mm for a mean correction of 42%. The mean preoperative sagittal C7 plumb line in patients with combined coronal and sagittal imbalance was 118 mm (range, 50-310 mm) and improved to a mean 49 mm. The mean preoperative and postoperative ODI scores were 42 (range, 0-90) and 27 (range, 0-78), for a mean improvement of 15 (36%) (P = 0.00001; 95% CI, 12-20). The mean Scoliosis Research Society scores improved by 17 points (29%) (P = 0.00). Younger age (P = 0.008) and improvement in sagittal balance (P = 0.014) were positive predictors for improved ODI scores. Improvement in sagittal balance (P = 0.010) was a positive predictor for improved Scoliosis Research Society scores. In patients with combined coronal and sagittal imbalance, improvement in sagittal balance was the most significant predictor for improved ODI scores (P = 0.009). In patients with preoperative coronal imbalance alone, improvement in coronal balance trended toward, but was not a significant predictor for improved ODI (P = 0.092). Sagittal balance improvement is the strongest predictor of improved outcomes in patients with combined coronal and sagittal imbalance. In patients with coronal imbalance alone, improvement in coronal balance was not a factor for predicting improved functional outcomes.

Cervical vertebrae maturation index estimates on cone beam CT: 3D reconstructions vs sagittal sections.

PubMed

Bonfim, Marco A E; Costa, André L F; Fuziy, Acácio; Ximenez, Michel E L; Cotrim-Ferreira, Flávio A; Ferreira-Santos, Rívea I

2016-01-01

The aim of this study was to evaluate the performance of CBCT three-dimensional (3D) reconstructions and sagittal sections for estimates of cervical vertebrae maturation index (CVMI). The sample consisted of 72 CBCT examinations from patients aged 8-16 years (45 females and 27 males) selected from the archives of two private clinics. Two calibrated observers (kappa scores: ≥0.901) interpreted the CBCT settings twice. Intra- and interobserver agreement for both imaging exhibition modes was analyzed by kappa statistics, which was also used to analyze the agreement between 3D reconstructions and sagittal sections. Correlations between cervical vertebrae maturation estimates and chronological age, as well as between the assessments by 3D reconstructions and sagittal sections, were analyzed using gamma Goodman-Kruskal coefficients (α = 0.05). The kappa scores evidenced almost perfect agreement between the first and second assessments of the cervical vertebrae by 3D reconstructions (0.933-0.983) and sagittal sections (0.983-1.000). Similarly, the agreement between 3D reconstructions and sagittal sections was almost perfect (kappa index: 0.983). In most divergent cases, the difference between 3D reconstructions and sagittal sections was one stage of CVMI. Strongly positive correlations (>0.8, p < 0.001) were found not only between chronological age and CVMI but also between the estimates by 3D reconstructions and sagittal sections (p < 0.001). Although CBCT imaging must not be used exclusively for this purpose, it may be suitable for skeletal maturity assessments.

Cervical vertebrae maturation index estimates on cone beam CT: 3D reconstructions vs sagittal sections

PubMed Central

Bonfim, Marco A E; Costa, André L F; Ximenez, Michel E L; Cotrim-Ferreira, Flávio A; Ferreira-Santos, Rívea I

2016-01-01

Objectives: The aim of this study was to evaluate the performance of CBCT three-dimensional (3D) reconstructions and sagittal sections for estimates of cervical vertebrae maturation index (CVMI). Methods: The sample consisted of 72 CBCT examinations from patients aged 8–16 years (45 females and 27 males) selected from the archives of two private clinics. Two calibrated observers (kappa scores: ≥0.901) interpreted the CBCT settings twice. Intra- and interobserver agreement for both imaging exhibition modes was analyzed by kappa statistics, which was also used to analyze the agreement between 3D reconstructions and sagittal sections. Correlations between cervical vertebrae maturation estimates and chronological age, as well as between the assessments by 3D reconstructions and sagittal sections, were analyzed using gamma Goodman–Kruskal coefficients (α = 0.05). Results: The kappa scores evidenced almost perfect agreement between the first and second assessments of the cervical vertebrae by 3D reconstructions (0.933–0.983) and sagittal sections (0.983–1.000). Similarly, the agreement between 3D reconstructions and sagittal sections was almost perfect (kappa index: 0.983). In most divergent cases, the difference between 3D reconstructions and sagittal sections was one stage of CVMI. Strongly positive correlations (>0.8, p < 0.001) were found not only between chronological age and CVMI but also between the estimates by 3D reconstructions and sagittal sections (p < 0.001). Conclusions: Although CBCT imaging must not be used exclusively for this purpose, it may be suitable for skeletal maturity assessments. PMID:26509559

Conscious and unconscious processing of facial expressions: evidence from two split-brain patients.

PubMed

Prete, Giulia; D'Ascenzo, Stefania; Laeng, Bruno; Fabri, Mara; Foschi, Nicoletta; Tommasi, Luca

2015-03-01

We investigated how the brain's hemispheres process explicit and implicit facial expressions in two 'split-brain' patients (one with a complete and one with a partial anterior resection). Photographs of faces expressing positive, negative or neutral emotions were shown either centrally or bilaterally. The task consisted in judging the friendliness of each person in the photographs. Half of the photograph stimuli were 'hybrid faces', that is an amalgamation of filtered images which contained emotional information only in the low range of spatial frequency, blended to a neutral expression of the same individual in the rest of the spatial frequencies. The other half of the images contained unfiltered faces. With the hybrid faces the patients and a matched control group were more influenced in their social judgements by the emotional expression of the face shown in the left visual field (LVF). When the expressions were shown explicitly, that is without filtering, the control group and the partially callosotomized patient based their judgement on the face shown in the LVF, whereas the complete split-brain patient based his ratings mainly on the face presented in the right visual field. We conclude that the processing of implicit emotions does not require the integrity of callosal fibres and can take place within subcortical routes lateralized in the right hemisphere. © 2013 The British Psychological Society.

Is arch form influenced by sagittal molar relationship or Bolton tooth-size discrepancy?

PubMed

Aldrees, Abdullah M; Al-Shujaa, Abdulmajeed M; Alqahtani, Mohammad A; Aljhani, Ali S

2015-06-26

Orthodontic patients show high prevalence of tooth-size discrepancy. This study investigates the possible association between arch form, clinically significant tooth-size discrepancy, and sagittal molar relationship. Pretreatment orthodontic casts of 230 Saudi patients were classified into one of three arch form types (tapered, ovoid, and square) using digitally scanned images of the mandibular arches. Bolton ratio was calculated, sagittal molar relationship was defined according to Angle classification, and correlations were analyzed using ANOVA, chi-square, and t-tests. No single arch form was significantly more common than the others. Furthermore, no association was observed between the presence of significant Bolton discrepancy and the sagittal molar relationship or arch form. Overall Bolton discrepancy is significantly more prevalent in males. Arch form in a Saudi patient group is independent of gender, sagittal molar relationship, and Bolton discrepancy.

Central obesity is an independent predictor of erectile dysfunction in older men.

PubMed

Riedner, Charles Edison; Rhoden, Ernani Luis; Ribeiro, Eduardo Porto; Fuchs, Sandra Costa

2006-10-01

There is a growing body of evidence in the literature correlating erectile dysfunction to obesity. We investigated the correlation of different anthropometric indexes of central obesity to erectile dysfunction. A cross-sectional study was performed including 256 consecutive men 40 years old or older. All men completed the International Index of Erectile Function, and were evaluated routinely with a clinical history, physical examination and blood analysis for fasting serum glucose, lipid profile and serum testosterone. Anthropometric measures included body mass index, waist circumference, sagittal abdominal diameter, maximal abdominal circumference, and waist-hip, waist-thigh, waist-height, sagittal abdominal diameter-thigh and sagittal abdominal diameter-height indexes. In men 40 to 60 years old the different anthropometric indexes of central obesity were not correlated with the presence of erectile dysfunction (p > 0.05). Men older than 60 years (41%, range 61 to 81) demonstrated an association among erectile dysfunction and waist-hip index (p = 0.04), waist-thigh index (p = 0.02), sagittal abdominal diameter (p = 0.03), sagittal abdominal diameter-height index (p = 0.02) and maximal abdominal circumference (p = 0.04). After logistic regression analysis an independent effect on the presence of erectile dysfunction was observed for waist-hip index (OR 8.56, 95% CI 1.44-50.73), sagittal abdominal diameter (OR 7.87, 95% CI 1.24-49.75), sagittal abdominal diameter-height index (OR 14.21, 95% CI 1.11-182.32), maximum abdominal circumference (OR 11.72, 95% CI 1.73-79.18) and waist circumference (OR 19.37, 95% CI 1.15-326.55). This study suggests that central obesity, assessed by several anthropometric indicators, is associated to the presence of erectile dysfunction in men older than 60 years. Sagittal abdominal diameter, sagittal abdominal diameter-height index, maximum abdominal circumference, waist circumference and waist-hip index were useful indicators to predict the presence of erectile dysfunction.

Anophthalmia-plus syndrome: a clinical report and review of the literature.

PubMed

Makhoul, Imad R; Soudack, Michalle; Kochavi, Orna; Guilburd, Joseph N; Maimon, Shimon; Gershoni-Baruch, Ruth

2007-01-01

We describe a term male infant of healthy non-consanguineous parents, born with congenital malformations, including bilateral cleft palate and lip, mild microphthalmia with iris coloboma and glaucoma of the right eye, and blepharophimosis with severe microphthalmia of the left eye. Spine radiograph and MRI showed first sacral hemivertebra with spina bifida, and agenesis of the 2nd, 3rd, 4th, and 5th sacral vertebrae and coccyx. Spine MRI showed caudal tethering of spinal cord at L(3) level, filum terminalis lipoma and a syringomyelia. Brain ultrasound and MRI showed hypoplasia of corpus callosum with mild dilatation of the lateral ventricles. Orbital MRI showed bilateral microphthalmia-distorted small left eyeball with posteriorly located lens, and a split vitreous body in the right eye, suggestive of primary hyperplastic vitreous. The karyotype was normal. Summary of the findings in nine cases (our case and eight published cases) support the notion that anophthalmia-plus syndrome (APS) is a distinct syndrome. Gene locus of APS is yet to be identified. (c) 2006 Wiley-Liss, Inc.

The longitudinal sagittal growth changes of maxilla and mandible according to quantitative cervical vertebral maturation.

PubMed

Chen, Lili; Lin, Jiuxiang; Xu, Tianmin; Long, Xiaosi

2009-04-01

To investigate the longitudinal sagittal growth changes of maxilla and mandible according to the quantitative cervical vertebral maturation (QCVM) for adolescents with normal occlusion, mixed longitudinal data were used. The samples included 87 adolescents aged from 8 to 18 y old with normal occlusion (32 males, 55 females) selected from 901 candidates. Sequential lateral cephalograms and hand-wrist films were taken once a year, lasting for 6 y. The longitudinal sagittal growth changes of maxilla and mandible according to QCVM were measured. There were some significant differences between maxilla and mandible according to QCVM. The sagittal growth change of maxilla showed a trend towards high velocity-->decelerating velocity-->completing velocity from QCVM stage I to stage IV. The sagittal growth change of mandible showed a trend towards accelerating velocity-->high velocity-->decelerating velocity-->completing velocity from QCVM stage I to stage IV. With sagittal relationship, growth magnitude was almost the same between maxilla and mandible at QCVM stage I. At stage II the growth of mandible exceeded that of maxilla and growth in mandible continued at stages III and IV, while the maxilla ceased to grow. Growth magnitude was greater and the growth duration was longer with male mandible. It is concluded that the longitudinal sagittal growth changes of maxilla and mandible on the basis of QCVM is of value in the orthodontic practice.

Extensor Tendon Instability Due to Sagittal Band Injury in a Martial Arts Athlete: A Case Report.

PubMed

Kochevar, Andrew; Rayan, Ghazi

2017-03-01

A Taekwondo participant sustained a hand injury from punching an opponent that resulted in painful instability of the ring finger extensor digitorum communis tendon due to sagittal band damage. His symptoms resolved after reconstructive surgery on the sagittal band (SB) with stabilization of the extensor tendon over the metacarpophalangeal joint.

A comparative study of surgical drain placement and the use of kinesiologic tape to reduce postoperative morbidity after third molar surgery.

PubMed

Genc, Aysenur; Cakarer, Sirmahan; Yalcin, Basak Keskin; Kilic, Beril Berivan; Isler, Sabri Cemil; Keskin, Cengizhan

2018-04-19

Our aim was to compare the effects of the surgical drain and kinesiotape applications on postoperative morbidity after mandibular third molar surgery in a split-mouth study design. A single-centre, split-mouth study was performed in 23 patients who needed surgical removal of bilateral mandibular third molars. Each patient was treated with a drain tube on one side of the mandible and Kinesio tape (KT) on the contralateral side. Swelling was significantly greater in the KT group than in the drain group throughout the study period. The groups did not differ significantly in the amount of trismus at any time point. The Visual Analogue Scale (VAS)-measured pain intensity was significantly lower in the drainage group. Patients with KT had greater postoperative discomfort than those with a drain tube. All patients were generally satisfied with their treatments. Although both treatments were useful, a surgical drain was significantly more effective at reducing swelling and pain intensity than Kinesio tape. The effects of both on trismus were similar.

Modulation of phase durations, phase variations, and temporal coordination of the four limbs during quadrupedal split-belt locomotion in intact adult cats

PubMed Central

D'Angelo, Giuseppe; Thibaudier, Yann; Telonio, Alessandro; Hurteau, Marie-France; Kuczynski, Victoria; Dambreville, Charline

2014-01-01

Stepping along curvilinear paths produces speed differences between the inner and outer limb(s). This can be reproduced experimentally by independently controlling left and right speeds with split-belt locomotion. Here we provide additional details on the pattern of the four limbs during quadrupedal split-belt locomotion in intact cats. Six cats performed tied-belt locomotion (same speed bilaterally) and split-belt locomotion where one side (constant side) stepped at constant treadmill speed while the other side (varying side) stepped at several speeds. Cycle, stance, and swing durations changed in parallel in homolateral limbs with shorter and longer stance and swing durations on the fast side, respectively, compared with the slow side. Phase variations were quantified in all four limbs by measuring the slopes of the regressions between stance and cycle durations (rSTA) and between swing and cycle durations (rSW). For a given limb, rSTA and rSW were not significantly different from one another on the constant side whereas on the varying side rSTA increased relative to tied-belt locomotion while rSW became more negative. Phase variations were similar for homolateral limbs. Increasing left-right speed differences produced a large increase in homolateral double support on the slow side, while triple-support periods decreased. Increasing left-right speed differences altered homologous coupling, homolateral coupling on the fast side, and coupling between the fast hindlimb and slow forelimb. Results indicate that homolateral limbs share similar control strategies, only certain features of the interlimb pattern adjust, and spinal locomotor networks of the left and right sides are organized symmetrically. PMID:25031257

Influence of implant rod curvature on sagittal correction of scoliosis deformity.

PubMed

Salmingo, Remel Alingalan; Tadano, Shigeru; Abe, Yuichiro; Ito, Manabu

2014-08-01

Deformation of in vivo-implanted rods could alter the scoliosis sagittal correction. To our knowledge, no previous authors have investigated the influence of implanted-rod deformation on the sagittal deformity correction during scoliosis surgery. To analyze the changes of the implant rod's angle of curvature during surgery and establish its influence on sagittal correction of scoliosis deformity. A retrospective analysis of the preoperative and postoperative implant rod geometry and angle of curvature was conducted. Twenty adolescent idiopathic scoliosis patients underwent surgery. Average age at the time of operation was 14 years. The preoperative and postoperative implant rod angle of curvature expressed in degrees was obtained for each patient. Two implant rods were attached to the concave and convex side of the spinal deformity. The preoperative implant rod geometry was measured before surgical implantation. The postoperative implant rod geometry after surgery was measured by computed tomography. The implant rod angle of curvature at the sagittal plane was obtained from the implant rod geometry. The angle of curvature between the implant rod extreme ends was measured before implantation and after surgery. The sagittal curvature between the corresponding spinal levels of healthy adolescents obtained by previous studies was compared with the implant rod angle of curvature to evaluate the sagittal curve correction. The difference between the postoperative implant rod angle of curvature and normal spine sagittal curvature of the corresponding instrumented level was used to evaluate over or under correction of the sagittal deformity. The implant rods at the concave side of deformity of all patients were significantly deformed after surgery. The average degree of rod deformation Δθ at the concave and convex sides was 15.8° and 1.6°, respectively. The average preoperative and postoperative implant rod angle of curvature at the concave side was 33.6° and 17.8°, respectively. The average preoperative and postoperative implant rod angle of curvature at the convex side was 25.5° and 23.9°, respectively. A significant relationship was found between the degree of rod deformation and preoperative implant rod angle of curvature (r=0.60, p<.005). The implant rods at the convex side of all patients did not have significant deformation. The results indicate that the postoperative sagittal outcome could be predicted from the initial rod shape. Changes in implant rod angle of curvature may lead to over- or undercorrection of the sagittal curve. Rod deformation at the concave side suggests that corrective forces acting on that side are greater than the convex side. Copyright © 2014 Elsevier Inc. All rights reserved.

A clinico-radiographic analysis of sagittal condylar guidance determined by protrusive interocclusal registration and panoramic radiographic images in humans

PubMed Central

Prasad, Krishna D.; Shah, Namrata; Hegde, Chethan

2012-01-01

Purpose: To evaluate the correlation between sagittal condylar guidance obtained by protrusive interocclusal records and panoramic radiograph tracing methods in human dentulous subjects. Materials and Methods: The sagittal condylar guidance was determined in 75 dentulous subjects by protrusive interocclusal records using Aluwax through a face bow transfer (HANAU™ Spring Bow, Whip Mix Corporation, USA) to a semi-adjustable articulator (HANAU™ Wide-Vue Articulator, Whip Mix Corporation, USA). In the same subjects, the sagittal outline of the articular eminence and glenoid fossa was traced in panoramic radiographs. The sagittal condylar path inclination was constructed by joining the heights of curvature in the glenoid fossa and the corresponding articular eminence. This was then related to the constructed Frankfurt's horizontal plane to determine the radiographic angle of sagittal condylar guidance. Results: A strong positive correlation existed between right and left condylar guidance by the protrusive interocclusal method (P 0.000) and similarly by the radiographic method (P 0.013). The mean difference between the condylar guidance obtained using both methods were 1.97° for the right side and 3.18° for the left side. This difference between the values by the two methods was found to be highly significant for the right (P 0.003) and left side (P 0.000), respectively. The sagittal condylar guidance obtained from both methods showed a significant positive correlation on right (P 0.000) and left side (P 0.015), respectively. Conclusion: Panoramic radiographic tracings of the sagittal condylar path guidance may be made relative to the Frankfurt's horizontal reference plane and the resulting condylar guidance angles used to set the condylar guide settings of semi-adjustable articulators. PMID:23633793

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ball, J.B. Jr.

Direct oblique sagittal CT was used to evaluate trauma to 77 orbits. Sixty-seven orbital wall fractures with intact orbital rims (36 floor, 22 medial wall, nine roof) were identified in 47 orbits. Since persistent diplopia and/or enophthalmos may warrant surgical repair of orbital floor fractures, optimal imaging should include an evaluation of extraocular muscle status, the nature and amount of displaced orbital contents, and an accurate definition of fracture margins. For orbital floor fractures, a combination of the direct oblique sagittal and direct coronal projections optimally displayed all fracture margins, the fracture's relationship to the inferior orbital rim and medialmore » orbital wall, and the amount of displacement into the maxillary sinus. Inferior rectus muscle status with 36 floor fractures was best seen on the direct oblique sagittal projection in 30 fractures (83.3%) and was equally well seen on sagittal and coronal projections in two fractures (5.5%). Floor fractures were missed on 100% of axial, 5.5% of sagittal, and 0% of coronal projections. Since the direct oblique sagittal projection complements the direct coronal projection in evaluating orbital floor fractures, it should not be performed alone. A technical approach to the CT evaluation or orbital wall fractures is presented.« less

Comparison of prostate contours between conventional stepping transverse imaging and Twister-based sagittal imaging in permanent interstitial prostate brachytherapy.

PubMed

Kawakami, Shogo; Ishiyama, Hiromichi; Satoh, Takefumi; Tsumura, Hideyasu; Sekiguchi, Akane; Takenaka, Kouji; Tabata, Ken-Ichi; Iwamura, Masatsugu; Hayakawa, Kazushige

2017-08-01

To compare prostate contours on conventional stepping transverse image acquisitions with those on twister-based sagittal image acquisitions. Twenty prostate cancer patients who were planned to have permanent interstitial prostate brachytherapy were prospectively accrued. A transrectal ultrasonography probe was inserted, with the patient in lithotomy position. Transverse images were obtained with stepping movement of the transverse transducer. In the same patient, sagittal images were also obtained through rotation of the sagittal transducer using the "Twister" mode. The differences of prostate size among the two types of image acquisitions were compared. The relationships among the difference of the two types of image acquisitions, dose-volume histogram (DVH) parameters on the post-implant computed tomography (CT) analysis, as well as other factors were analyzed. The sagittal image acquisitions showed a larger prostate size compared to the transverse image acquisitions especially in the anterior-posterior (AP) direction ( p < 0.05). Interestingly, relative size of prostate apex in AP direction in sagittal image acquisitions compared to that in transverse image acquisitions was correlated to DVH parameters such as D 90 ( R = 0.518, p = 0.019), and V 100 ( R = 0.598, p = 0.005). There were small but significant differences in the prostate contours between the transverse and the sagittal planning image acquisitions. Furthermore, our study suggested that the differences between the two types of image acquisitions might correlated to dosimetric results on CT analysis.

Reliability of the xipho-pubic angle in patients with sagittal imbalance of the spine.

PubMed

Langella, Francesco; Villafañe, Jorge H; Ismael, Maryem; Buric, Josip; Piazzola, Andrea; Lamartina, Claudio; Berjano, Pedro

2018-04-01

Proximal junctional kyphosis (PJK) is a frequent complication that compromises the outcomes of spinal surgery, especially for adult deformity. To the date no single risk factor or cause has been identified that explains its occurrence. The purpose of this study was to investigate the test-retest reliability of the radiologic measurements using xipho-pubic angle (XPA) for subjects undergoing surgery for sagittal misalignment of the spine. Retrospective observational cross-sectional study of prospectively collected data. Full-spine standing lateral radiographs of 50 patients who underwent surgery for fixed sagittal imbalance (preoperative and postoperative) were evaluated. Internal consistency, reproducibility, concurrent validity, and discriminative ability of the XPA. Two physicians measured XPA on the 100 randomly sorted and anonymized radiographs on two occasions, one week apart (test and retest conditions), were calculated for inter and intraobserver agreement. Test-retest reliability of XPA measurement was excellent for pre- (ICC=0.98; P=0.001) and post-surgical (ICC=0.86; P=0.001) radiographs of subjects with sagittal imbalance of the spine. XPA was able to discriminate between preoperative and postoperative radiographs F=17.924, P<0.001) in patients undergoing surgery for fixed sagittal imbalance for both raters. There were significant differences between pre- vs. postoperative XPA, pelvic tilt, lumbar lordosis and sagittal vertical axis values (all P<0.001). Xipho-pubic angle had fair to excellent test-retest reliability, and it did possess validity to discriminate between preoperative and postoperative radiographs in patients undergoing surgery for fixed sagittal imbalance.

Cephalometric Evaluation of the Hyoid Bone Position in Lebanese Healthy Young Adults.

PubMed

Daraze, Antoine

2018-05-01

The objectives of this study are to assess hyoid sagittal and vertical position, and potential correlations with gender, skeletal class, and anthropometrics. Twenty-seven cephalometric linear, angular, and ratio measurements for the hyoid were recorded on lateral cephalograms obtained from 117 healthy young Lebanese adults. Anthropometric parameters including height, weight, body mass index (BMI), and neck circumference (NC) were measured. Statistically significant gender differences were demonstrated for 21 out of 27 parameters considered. All linear and two out of three angular measurements defining the vertical hyoid position were larger in males compared with females. Five linear, one angular, and two ratio measurements showed differences in the sagittal dimension. Skeletal classes did not influence the sagittal and vertical hyoid position. Anthropometric variables as height were strongly correlated to the vertical hyoid position, while weight correlated more sagittally. Cephalometric norms for hyoid position were established, sexual dimorphism and ethnic differences were demonstrated. Skeletal patterns did not influence the sagittal and vertical hyoid bone position. Anthropometric parameters, such as BMI correlated the least to both vertical and sagittal hyoid position measurements, while the impact of height and weight as separate entities made a paradigm shift providing accurate and strong correlation of the vertical hyoid position to the height, and the sagittal hyoid position to the weight of individuals. The cephalometric norms for the hyoid bone position in the Lebanese population established in the present study are of paramount clinical importance and should be considered in planning combined orthodontic and breathing disorders treatments.

Correlation and Reliability of Cervical Sagittal Alignment Parameters between Lateral Cervical Radiograph and Lateral Whole-Body EOS Stereoradiograph.

PubMed

Singhatanadgige, Weerasak; Kang, Daniel G; Luksanapruksa, Panya; Peters, Colleen; Riew, K Daniel

2016-09-01

Retrospective analysis. To evaluate the correlation and reliability of cervical sagittal alignment parameters obtained from lateral cervical radiographs (XRs) compared with lateral whole-body stereoradiographs (SRs). We evaluated adults with cervical deformity using both lateral XRs and lateral SRs obtained within 1 week of each other between 2010 and 2014. XR and SR images were measured by two independent spine surgeons using the following sagittal alignment parameters: C2-C7 sagittal Cobb angle (SCA), C2-C7 sagittal vertical axis (SVA), C1-C7 translational distance (C1-7), T1 slope (T1-S), neck tilt (NT), and thoracic inlet angle (TIA). Pearson correlation and paired t test were used for statistical analysis, with intra- and interrater reliability analyzed using intraclass correlation coefficient (ICC). A total of 35 patients were included in the study. We found excellent intrarater reliability for all sagittal alignment parameters in both the XR and SR groups with ICC ranging from 0.799 to 0.994 for XR and 0.791 to 0.995 for SR. Interrater reliability was also excellent for all parameters except NT and TIA, which had fair reliability. We also found excellent correlations between XR and SR measurements for most sagittal alignment parameters; SCA, SVA, and C1-C7 had r > 0.90, and only NT had r < 0.70. There was a significant difference between groups, with SR having lower measurements compared with XR for both SVA (0.68 cm lower, p < 0.001) and C1-C7 (1.02 cm lower, p < 0.001). There were no differences between groups for SCA, T1-S, NT, and TIA. Whole-body stereoradiography appears to be a viable alternative for measuring cervical sagittal alignment parameters compared with standard radiography. XR and SR demonstrated excellent correlation for most sagittal alignment parameters except NT. However, SR had significantly lower average SVA and C1-C7 measurements than XR. The lower radiation exposure using single SR has to be weighed against its higher cost compared with XR.

Prevalence of Surgical Site Infections Following Orthognathic Surgery: A Double-Blind, Randomized Controlled Trial on a 3-Day Versus 1-Day Postoperative Antibiotic Regimen.

PubMed

Davis, Clayton M; Gregoire, Curtis E; Davis, Ian; Steeves, Thomas W

2017-04-01

The purpose of this study was to determine the effect of a 3- versus 1-day antibiotic regimen on the rate of surgical site infection (SSI) in patients undergoing orthognathic surgery at a department of oral and maxillofacial surgery in Halifax, Nova Scotia, Canada. A prospective, randomized controlled trial was conducted. All patients received 1 day of intravenous antibiotics after surgery. Then, patients were randomly distributed into groups that received 2 days of additional antibiotics (group A) or placebo (group B). The primary outcome measured was the presence of SSI. The operating surgeon, concomitant extraction of teeth, surgical procedures performed, duration of intermaxillary fixation, and length of hospital stay were analyzed for an effect on SSI. Patients were followed for 1 year after surgery to identify SSIs that might have been diagnosed outside the hospital. The trial started with 288 patients, and 117 patients were lost to follow-up. Statistical analyses were ultimately performed on those 171 patients who were adherent to the study medication regimen. Group A (n = 86) and B (n = 85) SSI rates were 7.0 and 17.6% (number needed to treat = 10; P = .04), respectively. Mandibular bilateral sagittal split osteotomy (BSSO) was involved in 71% of SSIs. Intra- and postoperative surgical variables did not have a relevant effect on the SSI rate. Patients were followed for 1 year after surgery, and group A (n = 46) and group B (n = 44) had SSI rates of 4 and 25% (P < .05), respectively. Three days of postoperative cefazolin and cephalexin markedly decreases SSI rates compared with 1 day. However, the number needed to treat of 10 suggests that the benefits of the extended regimen might not outweigh the risks. The high prevalence of SSIs at the mandibular BSSO incisions might have been caused by contamination, with more saliva and reception of a lower blood supply, than maxillary Le Fort I incisions. Mandibular osteotomies could benefit from an extended antibiotic regimen to minimize SSIs and associated complications. Other surgical variables might not require special consideration for antibiotic therapy. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance.

PubMed

Hikata, Tomohiro; Watanabe, Kota; Fujita, Nobuyuki; Iwanami, Akio; Hosogane, Naobumi; Ishii, Ken; Nakamura, Masaya; Toyama, Yoshiaki; Matsumoto, Morio

2015-10-01

The object of this study was to investigate correlations between sagittal spinopelvic alignment and improvements in clinical and quality-of-life (QOL) outcomes after lumbar decompression surgery for lumbar spinal canal stenosis (LCS) without coronal imbalance. The authors retrospectively reviewed data from consecutive patients treated for LCS with decompression surgery in the period from 2009 through 2011. They examined correlations between preoperative or postoperative sagittal vertical axis (SVA) and radiological parameters, clinical outcomes, and health-related (HR)QOL scores in patients divided according to SVA. Clinical outcomes were assessed according to Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores. Health-related QOL was evaluated using the Roland-Morris Disability Questionnaire (RMDQ) and the JOA Back Pain Evaluation Questionnaire (JOABPEQ). One hundred nine patients were eligible for inclusion in the study. Compared to patients with normal sagittal alignment prior to surgery (Group A: SVA < 50 mm), those with preoperative sagittal imbalance (Group B: SVA ≥ 50 mm) had significantly smaller lumbar lordosis and thoracic kyphosis angles and larger pelvic tilt. In Group B, there was a significant decrease in postoperative SVA compared with the preoperative SVA (76.3 ± 29.7 mm vs. 54.3 ± 39.8 mm, p = 0.004). The patients in Group B with severe preoperative sagittal imbalance (SVA > 80 mm) had residual sagittal imbalance after surgery (82.8 ± 41.6 mm). There were no significant differences in clinical and HRQOL outcomes between Groups A and B. Compared to patients with normal postoperative SVA (Group C: SVA < 50 mm), patients with a postoperative SVA ≥ 50 mm (Group D) had significantly lower JOABPEQ scores, both preoperative and postoperative, for walking ability (preop: 36.6 ± 26.3 vs. 22.7 ± 26.0, p = 0.038, respectively; postop: 71.1 ± 30.4 vs. 42.5 ± 29.6, p < 0.001) and social functioning (preop: 38.7 ± 18.5 vs. 30.2 ± 16.7, p = 0.045; postop: 67.0 ± 25.8 vs. 49.6 ± 20.0, p = 0.001), as well as significantly higher postoperative RMDQ (4.9 ± 5.2 vs. 7.9 ± 5.7, p = 0.015) and VAS scores for low-back pain (2.68 ± 2.69 vs. 3.94 ± 2.59, p = 0.039). Preoperative sagittal balance was not significantly correlated with clinical or HRQOL outcomes after decompression surgery in LCS patients without coronal imbalance. Decompression surgery improved the SVA value in patients with preoperative sagittal imbalance; however, the patients with severe preoperative sagittal imbalance (SVA > 80 mm) had residual imbalance after decompression surgery. Both clinical and HRQOL outcomes were negatively affected by postoperative residual sagittal imbalance.

Effects of frontal and sagittal thorax attitudes in gait on trunk and pelvis three-dimensional kinematics.

PubMed

Begon, Mickaël; Leardini, Alberto; Belvedere, Claudio; Farahpour, Nader; Allard, Paul

2015-10-01

While sagittal trunk inclinations alter upper body biomechanics, little is known about the extent of frontal trunk bending on upper body and pelvis kinematics in adults during gait and its relation to sagittal trunk inclinations. The objective was to determine the effect of the mean lateral trunk attitude on upper body and pelvis three-dimensional kinematics during gait in asymptomatic subjects. Three gait cycles were collected in 30 subjects using a motion analysis system (Vicon 612) and an established protocol. Sub-groups were formed based on the mean thorax lateral bending angle, bending side, and also sagittal tilt. These were compared based on 38 peak angles identified on pelvis, thorax and shoulder kinematics using MANOVAs. A main effect for bending side (p = 0.038) was found, especially for thorax peak angles. Statistics revealed also a significant interaction (p = 0.04993) between bending side and tilt for the thorax sagittal inclination during body-weight transfer. These results reinforce the existence of different gait patterns, which correlate upper body and pelvis motion measures. The results also suggest that frontal and sagittal trunk attitude should be considered carefully when treating a patient with impaired gait. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Sagittal plane tilting deformity of the patellofemoral joint: a new concept in patients with chondromalacia patella.

PubMed

Aksahin, Ertugrul; Aktekin, Cem Nuri; Kocadal, Onur; Duran, Semra; Gunay, Cüneyd; Kaya, Defne; Hapa, Onur; Pepe, Murad

2017-10-01

The aims of this study were to evaluate sagittal plane alignment in patients with chondromalacia patella via magnetic resonance imaging (MRI), analyse the relationships between the location of the patellar cartilaginous lesions and sagittal alignment and finally investigate the relationships between the sagittal plane malalignment and patellofemoral loadings using by finite element analysis. Fifty-one patients who were diagnosed with isolated modified Outerbridge grade 3-4 patellar chondromalacia based on MRI evaluation and 51 control subjects were evaluated. Chondromalacia patella patients were divided into three subgroups according to the chondral lesion location as superior, middle and inferior. The patella-patellar tendon angle (P-PT) was used for evaluation of sagittal alignment of patellofemoral joint. Each subgroup was compared with control group by using P-PT angle. To investigate the biomechanical effects of sagittal plane malpositioning on patellofemoral joint, bone models were created at 30°, 60° and 90° knee flexion by using mean P-PT angles, which obtained from patients with chondromalacia patellae and control subjects. The total loading and contact area values of the patellofemoral joints were investigated by finite element analysis. The mean age of all participants was 52.9 ± 8.2 years. The mean P-PT angle was significantly lower in chondromalacia group (142.1° ± 3.6°) compared to control group (144.5° ± 5.3°) (p = 0.008). Chondral lesions were located in superior, middle and inferior zones in 16, 20 and 15 patients, respectively. The mean P-PT angles in patients with superior (141.8 ± 2.7) and inferior subgroups (139.2 ± 2.3) were significantly lower than the values in the control group (p < 0.05). The contact area values were detected higher in models with chondromalacia than in the control models at the same flexion degrees. There were increased loadings at 30° and 90° flexions in the sagittal patellar tilt models. This study revealed that sagittal plain malpositioning of the patellofemoral joint might be related to chondromalacia, especially in the presence of lesions in the upper and lower part of the patella. This condition leads to supraphysiological loadings on the patellofemoral joint. Sagittal patellar tilt should be considered in the evaluation and management of patellar cartilage defects. Taking sagittal plane malalignment into consideration in patellofemoral joint evaluation will enable us to design new physical and surgical modalities. IV.

Pathology of Minamata disease.

PubMed

Eto, K

1997-01-01

Minamata disease, or methylmercury poisoning, was first discovered in 1956 around Minamata Bay, Kumamoto Prefecture, Japan. A similar epidemic occurred in 1965 along the Agano River, Niigata Prefecture, Japan. The neuropathology of Minamata disease has been well studied; this review focuses on human cases of Minamata disease in Kumamoto Prefecture. Nervous system lesions associated with Minamata disease have a characteristic distribution. In the cerebral cortex, the calcarine cortex was found to be involved in all cases of Minamata disease, particularly along the calcarine fissure. The destruction of nerve tissue was prominent in the anterior portions of the calcarine cortex. Occasionally, the centrifugal route from the visual and visual association areas (internal sagittal stratum) showed secondary degeneration in prolonged cases after acute onset. Postcentral, precentral, and temporal transverse cortices showed similar changes, though they were less severe. Intense lesions in the precentral cortex caused the development of secondary bilateral degeneration of the pyramidal tracts. In the cerebellum, the lesions occurred deeper in the hemisphere. The granule cell population was most affected. In the peripheral nerves, sensory nerves were more affected than motor nerves. Secondary degeneration of Goll's tracts was occasionally seen in prolonged or chronic cases.

Complete duplication of bladder and urethra in a sagittal plane in a male infant: case report and literature review.

PubMed

Coker, Alisa M; Allshouse, Michael J; Koyle, Martin A

2008-08-01

Complete duplication of the bladder and urethra is a rare entity. It may occur in the coronal and sagittal planes, and is often associated with other organ system anomalies, in particular of the gastrointestinal tract. We report an unusual variant of sagittal duplication of the bladder, in a male, associated with rudimentary hindgut duplication, and review the literature pertaining to this unusual anomaly.

Radiographical predictors for postoperative sagittal imbalance in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis after lumbar pedicle subtraction osteotomy.

PubMed

Qian, Bang-ping; Jiang, Jun; Qiu, Yong; Wang, Bin; Yu, Yang; Zhu, Ze-zhang

2013-12-15

A retrospective radiographical study. To identify the radiographical predictors for sagittal imbalance in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis (AS) after 1-level lumbar pedicle subtraction osteotomy (PSO). Few studies had correlated the preoperative sagittal parameters with postoperative sagittal alignments to determine the radiographical predictors for postoperative sagittal imbalance in patients with AS after 1-level lumbar PSO. Thirty-six patients with thoracolumbar kyphosis secondary to AS who underwent 1-level lumbar PSO were recruited with a minimal follow-up of 24 months (mean = 27.4 mo; range, 24-53 mo). Correlation analysis and subsequent stepwise multiple regression analysis were used to evaluate the correlations between preoperative parameters, including global kyphosis, local kyphosis, thoracic kyphosis, thoracolumbar Cobb angle, lumbar lordosis, pelvic incidence (PI), pelvic tilt, sacral slope, and sagittal vertical axis (SVA), as well as SVA at the last follow-up. All these patients were further divided into 2 groups according to the PI value (group A: PI >50°; group B: PI ≤50°). The correction outcomes were compared between these 2 groups. The preoperative SVA was not significantly different between group A and group B (157.6 mm vs. 124.5 mm; P> 0.05), and both groups had similar magnitudes of kyphosis corrections at the last follow-up (global kyphosis: 42.9° vs. 46.1°; local kyphosis: 42.7° vs. 40.5°; lumbar lordosis: 35.7° vs. 43.0°). However, group A patients had significantly larger SVA at the last follow-up (73.2 mm vs. 28.7 mm; P< 0.05) and a higher incidence of postoperative sagittal imbalance (77.8% vs. 25.9%; P< 0.05) than those in group B. The stepwise multiple regression analysis demonstrated that both preoperative SVA and PI were significant independent predictors of postoperative sagittal alignments, which explained 52.0% and 9.7% of the variability of SVA at the last follow-up, respectively. Patients with AS with either larger preoperative SVA or larger PI are more likely to experience failed sagittal realignments after 1-level lumbar PSO. For these patients, additional osteotomies may be recommended for satisfactory correction outcomes. 4.

Graft extrusion in both the coronal and sagittal planes is greater after medial compared with lateral meniscus allograft transplantation but is unrelated to early clinical outcomes.

PubMed

Lee, Dae-Hee; Lee, Chang-Rack; Jeon, Jin-Ho; Kim, Kyung-Ah; Bin, Seong-Il

2015-01-01

Graft extrusion after meniscus allograft transplantation (MAT) may be affected by horn fixation, which differs between medial and lateral MAT. Few studies have compared graft extrusion, especially sagittal extrusion, after medial and lateral MAT. In patients undergoing medial and lateral MAT, graft extrusion is likely similar and not correlated with postoperative Lysholm scores. Cohort study; Level of evidence, 2. Meniscus graft extrusion in the coronal and sagittal planes was compared in 51 knees undergoing medial MAT and 84 undergoing lateral MAT. Distances from the anterior and posterior articular cartilage margins to the anterior (anterior cartilage meniscus distance [ACMD]) and posterior (posterior cartilage meniscus distance [PCMD]) horns, respectively, were assessed on immediate postoperative magnetic resonance imaging and compared in patients undergoing medial and lateral MAT. Correlations between coronal and sagittal graft extrusion and between extrusion and the Lysholm score were compared in the 2 groups. In the coronal plane, mean absolute (4.3 vs 2.7 mm, respectively; P<.001) and relative (39% vs 21%, respectively; P<.001) graft extrusions were significantly greater for medial than lateral MAT. In the sagittal plane, mean absolute and relative ACMD and PCMD values were significantly greater for medial than lateral MAT (P<.001 each). For both medial and lateral MAT, mean absolute and relative ACMDs were significantly larger than PCMDs (P<.001 each). Graft extrusion>3 mm in the coronal plane was significantly more frequent in the medial (78%) than in the lateral (35%) MAT group. In the sagittal plane, the frequencies of ACMDs (72% vs 39%, respectively) and PCMDs (23% vs 4%, respectively) >3 mm were also significantly greater in the medial than in the lateral MAT group. Coronal and sagittal extrusions were not correlated with postoperative Lysholm scores for both medial and lateral MAT. The amount and incidence of graft extrusion were greater after medial than lateral MAT in both the coronal and sagittal planes. In the sagittal plane, graft extrusion was greater and more frequent on the anterior than the posterior horn in both medial and lateral MAT. However, graft extrusion was not correlated with early clinical outcomes after both medial and lateral MAT. © 2014 The Author(s).

Effect of alignment changes on sagittal and coronal socket reaction moment interactions in transtibial prostheses.

PubMed

Kobayashi, Toshiki; Orendurff, Michael S; Zhang, Ming; Boone, David A

2013-04-26

Alignment is important for comfortable and stable gait of lower-limb prosthesis users. The magnitude of socket reaction moments in the multiple planes acting simultaneously upon the residual limb may be related to perception of comfort in individuals using prostheses through socket interface pressures. The aim of this study was to investigate the effect of prosthetic alignment changes on sagittal and coronal socket reaction moment interactions (moment-moment curves) and to characterize the curves in 11 individuals with transtibial amputation using novel moment-moment interaction parameters measured by plotting sagittal socket reaction moments versus coronal ones under various alignment conditions. A custom instrumented prosthesis alignment component was used to measure socket reaction moments during walking. Prosthetic alignment was tuned to a nominally aligned condition by a prosthetist, and from this position, angular (3° and 6° of flexion, extension, abduction or adduction of the socket) and translational (5mm and 10mm of anterior, posterior, medial or lateral translation of the socket) alignment changes were performed in either the sagittal or the coronal plane in a randomized manner. A total of 17 alignment conditions were tested. Coronal angulation and translation alignment changes demonstrated similar consistent changes in the moment-moment curves. Sagittal alignment changes demonstrated more complex changes compared to the coronal alignment changes. Effect of sagittal angulations and translations on the moment-moment curves was different during 2nd rocker (mid-stance) with extension malalignment appearing to cause medio-lateral instability. Presentation of coronal and sagittal socket reaction moment interactions may provide useful visual information for prosthetists to understand the biomechanical effects of malalignment of transtibial prostheses. Copyright © 2013 Elsevier Ltd. All rights reserved.

Cervical spinal stenosis and sports-related cervical cord neurapraxia in children.

PubMed

Boockvar, J A; Durham, S R; Sun, P P

2001-12-15

Congenital spinal stenosis has been demonstrated to contribute to cervical cord neurapraxia after cervical spinal cord injury in adult athletes. A sagittal canal diameter <14 mm and/or a Torg ratio (sagittal diameter of the spinal canal: midcervical sagittal vertebral body diameter) of <0.8 are indicative of significant cervical spinal stenosis. Although sports-related cervical spine injuries are common in children, the role of congenital cervical stenosis in the etiology of these injuries remains unclear. The authors measured the sagittal canal diameter and the Torg ratio in children presenting with cervical cord neurapraxia resulting from sports-related cervical spinal cord injuries to determine the presence of congenital spinal stenosis. A total of 13 children (9 male, 4 female) presented with cervical cord neurapraxia after a sports-related cervical spinal cord injury. Age ranged from 7 to 15 years (mean +/- SD, 11.5 +/- 2.7 years). The sports involved were football (n = 4), wrestling (n = 2), hockey (n = 2), and soccer, gymnastics, baseball, kickball, and pogosticking (n = 1 each). Lateral cervical spine radiographs were used to determine the sagittal canal diameter and the Torg ratio at C4. The sagittal canal diameter (mean +/- SD, 17.58 +/- 1.63 mm) and the Torg ratio (mean +/- SD, 1.20 +/- 0.24) were normal in all of these children. Using the sagittal canal diameter and the Torg ratio as a measurement of congenital spinal stenosis, the authors did not find evidence of congenital cervical spinal stenosis in a group of children with sports-related cervical spinal cord neurapraxia. The occurrence of cervical cord neurapraxia in pediatric patients can be attributed to the mobility of the pediatric spine rather than to congenital cervical spinal stenosis.

Radiographic analysis of the correlation between ossification of the nuchal ligament and sagittal alignment and segmental stability of the cervical spine in patients with cervical spondylotic myelopathy.

PubMed

Ying, Jinwei; Teng, Honglin; Qian, Yunfan; Hu, Yingying; Wen, Tianyong; Ruan, Dike; Zhu, Minyu

2018-01-01

Background Ossification of the nuchal ligament (ONL) caused by chronic injury to the nuchal ligament (NL) is very common in instability-related cervical disorders. Purpose To determine possible correlations between ONL, sagittal alignment, and segmental stability of the cervical spine. Material and Methods Seventy-three patients with cervical spondylotic myelopathy (CSM) and ONL (ONL group) and 118 patients with CSM only (control group) were recruited. Radiographic data included the characteristics of ONL, sagittal alignment and segmental stability, and ossification of the posterior longitudinal ligament (OPLL). We performed comparisons in terms of radiographic parameters between the ONL and control groups. The correlations between ONL size, cervical sagittal alignment, and segmental stability were analyzed. Multivariate logistic regression was used to identify the independent risk factors of the development of ONL. Results C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), T1S minus cervical lordosis (T1S-CL) on the lateral plain, angular displacement (AD), and horizontal displacement (HD) on the dynamic radiograph increased significantly in the ONL group compared with the control group. The size of ONL significantly correlated with C2-C7 SVA, T1S, AD, and HD. The incidence of ONL was higher in patients with OPLL and segmental instability. Cervical instability, sagittal malalignment, and OPLL were independent predictors of the development of ONL through multivariate analysis. Conclusion Patients with ONL are more likely to have abnormal sagittal alignment and instability of the cervical spine. Thus, increased awareness and appreciation of this often-overlooked radiographic finding is warranted during diagnosis and treatment of instability-related cervical pathologies and injuries.

Agreement Between Visual Assessment and 2-Dimensional Analysis During Jump Landing Among Healthy Female Athletes.

PubMed

Rabin, Alon; Einstein, Ofira; Kozol, Zvi

2018-04-01

  Altered movement patterns, including increased frontal-plane knee movement and decreased sagittal-plane hip and knee movement, have been associated with several knee disorders. Nevertheless, the ability of clinicians to visually detect such altered movement patterns during high-speed athletic tasks is relatively unknown.   To explore the association between visual assessment and 2-dimensional (2D) analysis of frontal-plane knee movement and sagittal-plane hip and knee movement during a jump-landing task among healthy female athletes.   Cross-sectional study.   Gymnasiums of participating volleyball teams.   A total of 39 healthy female volleyball players (age = 21.0 ± 5.2 years, height = 172.0 ± 8.6 cm, mass = 64.2 ± 7.2 kg) from Divisions I and II of the Israeli Volleyball Association.   Frontal-plane knee movement and sagittal-plane hip and knee movement during jump landing were visually rated as good, moderate, or poor based on previously established criteria. Frontal-plane knee excursion and sagittal-plane hip and knee excursions were measured using free motion-analysis software and compared among athletes with different visual ratings of the corresponding movements.   Participants with different visual ratings of frontal-plane knee movement displayed differences in 2D frontal-plane knee excursion ( P < .01), whereas participants with different visual ratings of sagittal-plane hip and knee movement displayed differences in 2D sagittal-plane hip and knee excursions ( P < .01).   Visual ratings of frontal-plane knee movement and sagittal-plane hip and knee movement were associated with differences in the corresponding 2D hip and knee excursions. Visual rating of these movements may serve as an initial screening tool for detecting altered movement patterns during jump landings.

The angle of inclination of the native ACL in the coronal and sagittal planes.

PubMed

Reid, Jonathan C; Yonke, Bret; Tompkins, Marc

2017-04-01

The purpose of this cross-sectional study was to evaluate the angle of inclination of the native anterior cruciate ligament (ACL) in both the sagittal and coronal planes and to evaluate these findings based on sex, height, BMI, and skeletal maturity. Inclusion criteria for the study included patients undergoing routine magnetic resonance imaging (MRI) of the knee at a single outpatient orthopedic center who had an intact ACL on MRI. Measurements of the angle of inclination were made on MRIs in both the sagittal and coronal planes. Patients were compared based on sex, height, BMI, and skeletal maturity. One-hundred and eighty-eight patients were included (36 skeletally immature/152 skeletally mature; 98 male/90 female). The overall angle of inclination was 74.3° ± 4.8° in the coronal plane and 46.9° ± 4.9° in the sagittal plane. Skeletally immature patients (coronal: 71.8° ± 6.1°; sagittal: 44.7° ± 5.5°) were significantly different in both coronal and sagittal planes (P = 0.04 and 0.01, respectively) from skeletally mature patients (coronal: 75.3° ± 4.7°; sagittal: 47.4° ± 4.7°). There were no differences based on sex, height, or BMI. There are differences between the angle of inclination findings in this study and other studies, which could be due to MRI and measurement techniques. Clinically, skeletal maturity may be important to account for when using the ACL angle of inclination to evaluate anatomic ACL reconstruction. Prognostic retrospective study, Level of evidence III.

Precision and accuracy of age estimates obtained from anal fin spines, dorsal fin spines, and sagittal otoliths for known-age largemouth bass

USGS Publications Warehouse

Klein, Zachary B.; Bonvechio, Timothy F.; Bowen, Bryant R.; Quist, Michael C.

2017-01-01

Sagittal otoliths are the preferred aging structure for Micropterus spp. (black basses) in North America because of the accurate and precise results produced. Typically, fisheries managers are hesitant to use lethal aging techniques (e.g., otoliths) to age rare species, trophy-size fish, or when sampling in small impoundments where populations are small. Therefore, we sought to evaluate the precision and accuracy of 2 non-lethal aging structures (i.e., anal fin spines, dorsal fin spines) in comparison to that of sagittal otoliths from known-age Micropterus salmoides (Largemouth Bass; n = 87) collected from the Ocmulgee Public Fishing Area, GA. Sagittal otoliths exhibited the highest concordance with true ages of all structures evaluated (coefficient of variation = 1.2; percent agreement = 91.9). Similarly, the low coefficient of variation (0.0) and high between-reader agreement (100%) indicate that age estimates obtained from sagittal otoliths were the most precise. Relatively high agreement between readers for anal fin spines (84%) and dorsal fin spines (81%) suggested the structures were relatively precise. However, age estimates from anal fin spines and dorsal fin spines exhibited low concordance with true ages. Although use of sagittal otoliths is a lethal technique, this method will likely remain the standard for aging Largemouth Bass and other similar black bass species.

Lower extremity joint coupling variability during gait in young adults with and without chronic ankle instability.

PubMed

Lilley, Thomas; Herb, Christopher C; Hart, Joseph; Hertel, Jay

2018-06-01

Chronic ankle instability (CAI) is a condition resulting from a lateral ankle sprain. Shank-rearfoot joint-coupling variability differences have been found in CAI patients; however, joint-coupling variability (VCV) of the ankle and proximal joints has not been explored. Our purpose was to analyse VCV in adults with and without CAI during gait. Four joint-coupling pairs were analysed: knee sagittal-ankle sagittal, knee sagittal-ankle frontal, hip frontal-ankle sagittal and hip frontal-ankle frontal. Twenty-seven adults participated (CAI:n = 13, Control:n = 14). Lower extremity kinematics were collected during walking (4.83 km/h) and jogging (9.66 km/h). Vector-coding was used to assess the stride-to-stride variability of four coupling pairs. During walking, CAI patients exhibited higher VCV than healthy controls for knee sagittal-ankle frontal in latter parts of stance thru mid-swing. When jogging, CAI patients demonstrated lower VCV with specific differences occurring across various intervals of gait. The increased knee sagittal-ankle frontal VCV in CAI patients during walking may indicate an adaptation to deal with the previously identified decrease in variability in transverse plane shank and frontal plane rearfoot coupling during walking; while the decreased ankle-knee and ankle-hip VCV identified in CAI patients during jogging may represent a more rigid, less adaptable sensorimotor system ambulating at a faster speed.

Retromolar foramen and canal: a comprehensive review on its anatomy and clinical applications.

PubMed

Kumar Potu, B; Jagadeesan, S; Bhat, K M R; Rao Sirasanagandla, S

2013-06-01

The retromolar foramen (RMF) and retromolar canal (RMC) are the anatomical structures of the mandible located in retromolar fossa behind the third molar tooth. This foramen and canal contain neurovascular structures which provide accessory/additional innervation to the mandibular molars and the buccal area. These neurovascular contents of the canal gain more importance in medical and dental practice, because these elements are vulnerable to damage during placement of osteointegrated implants, endodontic treatment and sagittal split osteotomy surgeries and a detailed knowledge of this anatomical variation would be vital in understanding failed inferior alveolar nerve blockage, spread of infection and also metastasis. Although few studies have been conducted in the past showing the incidence and types in different population groups, a lacunae in comprehensive review of this structure is lacking. Though this variation posed challenging situations for the practicing surgeons, it has been quite neglected and the incidence of it is not well presented in all the textbooks. Hence, we made an attempt to provide a consolidated review regarding variations and clinical applications of the RMF and RMC. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Incredible negative values of effective electromechanical coupling coefficient for surface acoustic waves in piezoelectrics.

PubMed

Mozhaev, V G; Weihnacht, M

2000-07-01

The extraordinary case of increase in velocity of surface acoustic waves (SAW) caused by electrical shorting of the surface of the superstrong piezoelectric crystal potassium niobate, KNbO3, is numerically found. The explanation of this effect is based on considering SAWs as coupled Rayleigh and Bleustein-Gulyaev modes. A general procedure of approximate decoupling of the modes is suggested for piezoelectric crystals of arbitrary anisotropy. The effect under study takes place when the phase velocity of uncoupled sagittally polarized Rayleigh waves is intermediate between the phase velocities of uncoupled shear-horizontal Bleustein Gulyaev waves at the free and metallized surfaces. In this case, the metallization of the surface by an infinitely thin layer may cause a crossover of the velocity curves of the uncoupled waves. The presence of the mode coupling results in splitting of the curves with transition from one uncoupled branch to the other. This transition is responsible for the increase in SAW velocity, which appears to be greater than its common decrease produced by electrical shorting of the substrate surface.

Endoscopic management of bilateral vocal fold paralysis in newborns and infants.

PubMed

Sedaghat, Sahba; Tapia, Mario; Fredes, Felipe; Rojas, Pablo

2017-06-01

Bilateral vocal cord paralysis in adducted position (BVCPAd) is a severe cause of airway obstruction and usually debuts with stridor and airway distress necessitating immediate intervention. Tracheostomy has long been the gold standard for treating this condition, but has significant associated morbidity and mortality in pediatric patients. New conservative procedures have emerged to treat this condition thus avoiding tracheostomy, like endoscopic anterior and posterior cricoid split (EAPCS). The objective of this paper was to review our experience with EAPCS in newborns and infants. Prospective study involving patients undergoing endoscopic EAPCS for symptomatic BVCPAd. The primary outcomes were tracheostomy avoidance and resolution of airway symptoms. Three patients underwent EAPCS between January 2016 and December 2016. All patients stayed at least 7 days in the Intensive Care Unit (ICU) intubated. All patients presented complete resolution of their symptoms due to airway obstruction, without the need for tracheostomy. EAPCS is a novel and effective alternative to treat BVCPAd in patients under 1 year old. Our study is an initial experience; more cases are required to identify the real impact and benefits of this technique and to determine the proper selection of patients. Copyright © 2017 Elsevier B.V. All rights reserved.

[Plain radiographs of the spine: static and relationships between spine and pelvis].

PubMed

Morvan, G; Wybier, M; Mathieu, P; Vuillemin, V; Guerini, H

2008-05-01

Man, with his erect posture, evolves in a world subject to the laws of gravity. His spine reflects these constraints. The morphology and static of human spine and biomechanical relationships between spine and pelvis are in direct relation with bipedia. Owing to this position the pelvis widened and straightened, characteristic sagittal spinal curves appeared and the perispinal muscles were deeply reorganized. Each pelvis is characterized by an important anatomical landmark: the pelvic incidence that reflects the sagittal morphology of the pelvis. Based on this anatomical characteristic, a chain of reactions determines the more efficient equilibrium of the whole body in the sagittal plane in term of energy consumption. Incidence affects the sacral slope, which determines lumbar lordosis, which itself influences pelvic tilt, thoracic kyphosis, and even hip and knee position. All these landmarks can easily be studied on a sagittal radiograph. Knowledge of these functional relationships is essential to understand the origin of low back pain, sagittal imbalance and above all before surgical treatment of spine disorders especially when arthrodesis is considered.

Stellate nonhereditary idiopathic foveomacular retinoschisis concomitant to exudative maculopathies

PubMed Central

Casalino, G; Upendran, M; Bandello, F; Chakravarthy, U

2016-01-01

Purpose To report the clinical course of patients presenting with stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) concomitant with exudative maculopathies. Methods Retrospective case series. Multimodal imaging findings, including spectral-domain optical coherence tomography (SD-OCT) were reviewed. Genetic testing for the RS1 gene was performed in one patient. Results We identified two female patients who fit the definition of SNIFR and presented with concomitant neovascular age-related macular degeneration (n-AMD). In both the patients, SD-OCT showed exudative macular features and splitting (bilateral in patient 1, unilateral in patient 2) of the outer plexiform layer (OPL) in the macula with no other evidence of hereditary or an acquired predisposing condition. Genetic testing excluded mutation of RS1 gene in patient 1. The fundi of both the patients showed characteristic signs of active choroidal neovascularization (CNV) and following anti-VEGF treatment, visual acuity improved and CNV-related exudative changes resolved. However, the split along the OPL remained unaltered. Conclusions SNIFR may be associated with n-AMD. It is important to recognise the presence of retinoschisis when there is other exudative pathology as the former may be misinterpreted as intraretinal fluid, prompting unnecessary treatment. PMID:26915743

Coexistence of Wormian Bones With Metopism, and Vice Versa, in Adult Skulls.

PubMed

Cirpan, Sibel; Aksu, Funda; Mas, Nuket; Magden, Abdurrahman Orhan

2016-03-01

The aim of the study is to investigate coexistence of Wormian bones with metopism, and vice versa, in adult skulls. A total of 160 dry adult human skulls of unknown sex and ages were randomly selected from the Gross Anatomy Laboratory of Medical School of Dokuz Eylul University. The skulls were examined for presence of metopism, Wormian bones (WB), and coexistence of WBs with metopism and vice versa. Topographic distribution of the WBs was macroscopically evaluated within the skulls including metopism. The photographs were being taken with Canon 400B (55 mm objective). The frequency of metopism and WBs in 160 skulls is 7.50% (12/160) and 59.3% (95/160), respectively, P < 0.05 (). The incidence of coexistence of WBs with metopism was found as 11 of 12 skulls (91.66%), whereas the incidence of coexistence of metopism with WBs was found as 11 of 95 skulls (11.58%), P < 0.05 (). There were totally 23 sutures including WBs in 11 skulls, which had metopism (). The number (%) of metopic skulls for each specific suture including WBs were found as: 11 lamdoid sutures in 7/11 (63.63%) skulls, 4 lambda in 4/11 (36.36%) skulls, 2 asterion in 2/11 (18.18%) skulls, 1 squamous in 1/11 (9.09%) skull, 2 sagittal in 2/11 (18.18%) skulls, and 3 parieromsatoid sutures in 2/11 (18.18%) skulls (). The distribution of these 23 WBs in sutures of 11 skulls including metopisms is determined as follows: 11/23 (47.82%) WBs at lambdoid sutures [5/23 (21.74%) at the right lambdoid sutures and 6/23 (26.08%) at the left lambdoid sutures, and 4 pair of 11 WBs bilaterally located]; 4 (17.39%) WBs at lambda; 2/23 (8.69%) WBs at asterion [1/23 (4.34%) at the right asterion and 1/23 (4.34%) at the left asterion of 2 diverse skulls]; 2/23 (8.69%) WBs at sagittal sutures; 1/23 (4.34%) WBs at the left squamous suture; 3/23 (13.04%) WBs at parietomastoid sutures [2/23 (8.69%) at the right parietomastoid sutures and 1/23 (4.34%) at the left parietomastoid suture and 1 pair of them bilaterally located; , ].(Figure is included in full-text article.)(Table is included in full-text article.)(Table is included in full-text article.) : There was a significant difference in rates between coexistence of WBs with metopism (11/12, 91.66%) and coexistence of metopism with WBs (11/95, 11.58%). The factors leading to metopism may also lead to WBs, whereas that the factors leading to WBs may not lead to metopism.

Graft position in arthroscopic anterior cruciate ligament reconstruction: anteromedial versus transtibial technique.

PubMed

Guler, Olcay; Mahırogulları, Mahir; Mutlu, Serhat; Cercı, Mehmet H; Seker, Ali; Cakmak, Selami

2016-11-01

When treating anterior cruciate ligament (ACL) injuries, the position of the ACL graft plays a key role in regaining postoperative knee function and physiologic kinematics. In this study, we aimed to compare graft angle, graft position in tibial tunnel, and tibial and femoral tunnel positions in patients operated with anteromedial (AM) and transtibial (TT) methods to those of contralateral healthy knees. Forty-eight patients who underwent arthroscopic ACL reconstruction with ipsilateral hamstring tendon autograft were included. Of these, 23 and 25 were treated by AM and TT techniques, respectively. MRI was performed at 18.4 and 19.7 months postoperatively in AM and TT groups. Graft angles, graft positions in the tibial tunnel and alignment of tibial and femoral tunnels were noted and compared in these two groups. The sagittal graft insertion tibia midpoint distance (SGON) has been used for evaluation of graft position in tunnel. Sagittal ACL graft angles in operated and healthy knees of AM patients were 57.78° and 46.80° (p < 0.01). With respect to TT patients, ACL graft angle was 58.87° and 70.04° on sagittal and frontal planes in operated knees versus 47.38° and 61.82° in healthy knees (p < 0.001). ACL graft angle was significantly different between the groups on both sagittal and frontal planes (p < 0.001). Sagittal graft insertion tibia midpoint distance ratio was 0.51 and 0.48 % in the operated and healthy knees of AM group (p < 0.001) and 0.51 and 0.48 % in TT group (p < 0.001). Sagittal tibial tunnel midpoint distance ratio did not differ from sagittal graft insertion tibia midpoint distance of healthy knees in either group. Femoral tunnel clock position was better in AM [right knee 10:19 o'clock-face position (310° ± 4°); left knee 1:40 (50° ± 3°)] compared with TT group [right knee 10:48 (324° ± 5°); left knee 1:04 (32° ± 4°)]. With respect to the sagittal plane, the anterior-posterior position of femoral tunnel was better in AM patients. Lysholm scores and range of motion of operated knees in the AM and TT groups showed no significant difference (p > 0.05). Precise reconstruction on sagittal plane cannot be obtained with either AM or TT technique. However, AM technique is superior to TT technique in terms of anatomical graft positioning. Posterior-placed grafts in tibial tunnel prevent ACL reconstruction, although tibial tunnel is drilled on sagittal plane.

A 2D threshold of the condylar-C1 interval to maximize identification of patients at high risk for atlantooccipital dislocation using computed tomography.

PubMed

Ravindra, Vijay M; Riva-Cambrin, Jay; Horn, Kevin P; Ginos, Jason; Brockmeyer, Russell; Guan, Jian; Rampton, John; Brockmeyer, Douglas L

2017-04-01

OBJECTIVE Measurement of the occipital condyle-C1 interval (CCI) is important in the evaluation of atlantooccipital dislocation (AOD) in pediatric trauma patients. The authors studied a large cohort of children with and without AOD to identify a 2D measurement threshold that maximizes the diagnostic yield of the CCI on cervical spine CT scans obtained in trauma patients. METHODS This retrospective, single-center study included all children who underwent CT of the cervical spine at Primary Children's Hospital from January 1, 2011, through December 31, 2014, for trauma evaluation. Bilateral CCI measurements in the coronal (3 measurements per side) and sagittal (4 measurements per side) planes were recorded. Using an iterative method, the authors determined optimal cutoffs for the maximal CCI in each plane in relation to AOD. The primary outcome was AOD requiring occipitocervical fusion. RESULTS A total of 597 pediatric patients underwent cervical spine CT for trauma evaluation: 578 patients without AOD and 19 patients with AOD requiring occipitocervical fusion. The authors found a statistically significant correlation between CCI and age (p < 0.001), with younger patients having higher CCIs. Using a 2D threshold requiring a sagittal CCI ≥ 2.5 mm and a coronal CCI ≥ 3.5 mm predicted AOD with a sensitivity of 95%, a specificity of 73%, positive predictive value of 10.3%, and negative predictive value of 99%. The accuracy of this 2D threshold was 84%. CONCLUSIONS In the present study population, age-dependent differences in the CCI were found on CT scans of the cervical spine in a large cohort of patients with and without AOD. A 2D CCI threshold as a screening method maximizes identification of patients at high risk for AOD while minimizing unnecessary imaging studies in children being evaluated for trauma.

Reciprocal Changes in Sagittal Alignment in Adolescent Idiopathic Scoliosis Patients Following Strategic Pedicle Screw Fixation.

PubMed

Dumpa, Srikanth Reddy; Shetty, Ajoy Prasad; Aiyer, Siddharth N; Kanna, Rishi Mugesh; Rajasekaran, S

2018-04-01

Retrospective observational study. To analyze the effect of low-density (LD) strategic pedicle screw fixation on the correction of coronal and sagittal parameters in adolescent idiopathic scoliosis (AIS) patients. LD screw fixation achieves favorable coronal correction, but its effect on sagittal parameters is not well established. AIS is often associated with decreased thoracic kyphosis (TK), and the use of multi-level pedicle screws may result in further flattening of the sagittal profile. A retrospective analysis was performed on 92 patients with AIS to compare coronal and sagittal parameters preoperatively and at 2-year follow-up. All patients underwent posterior correction via LD strategic pedicle screw fixation. Radiographs were analyzed for primary Cobb angle (PCA), coronal imbalance, cervical sagittal angle (CSA), TK, lumbar lordosis (LL), pelvic incidence, pelvic tilt (PT), sacral slope (SS), C7 plumb line, spino-sacral angle, curve flexibility, and screw density. PCA changed significantly from 57.6°±13.9° to 19°±8.4° ( p <0.0001) with 67% correction, where the mean curve flexibility was 41% and screw density was 68%. Regional sagittal parameters did not change significantly, including CSA (from 10.76° to 10.56°, p =0.893), TK (from 24.4° to 22.8°, p =0.145), and LL (from 50.3° to 51.1°, p =0.415). However, subgroup analysis of the hypokyphosis group (<10°) and the hyperkyphosis group (>40°) showed significant correction of TK ( p <0.0001 in both). Sacro-pelvic parameters showed a significant decrease of PT and increase of SS, suggesting a reduction in pelvic retroversion SS (from 37° to 40°, p =0.0001) and PT (from 15° to 14°, p =0.025). LD strategic pedicle screw fixation provides favorable coronal correction and improves overall sagittal sacro-pelvic parameters. This technique does not cause significant flattening of TK and results in a favorable restoration of TK in patients with hypokyphosis or hyperkyphosis.

Reciprocal Changes in Sagittal Alignment in Adolescent Idiopathic Scoliosis Patients Following Strategic Pedicle Screw Fixation

PubMed Central

Dumpa, Srikanth Reddy; Aiyer, Siddharth N.; Kanna, Rishi Mugesh; Rajasekaran, S

2018-01-01

Study Design Retrospective observational study. Purpose To analyze the effect of low-density (LD) strategic pedicle screw fixation on the correction of coronal and sagittal parameters in adolescent idiopathic scoliosis (AIS) patients. Overview of Literature LD screw fixation achieves favorable coronal correction, but its effect on sagittal parameters is not well established. AIS is often associated with decreased thoracic kyphosis (TK), and the use of multi-level pedicle screws may result in further flattening of the sagittal profile. Methods A retrospective analysis was performed on 92 patients with AIS to compare coronal and sagittal parameters preoperatively and at 2-year follow-up. All patients underwent posterior correction via LD strategic pedicle screw fixation. Radiographs were analyzed for primary Cobb angle (PCA), coronal imbalance, cervical sagittal angle (CSA), TK, lumbar lordosis (LL), pelvic incidence, pelvic tilt (PT), sacral slope (SS), C7 plumb line, spino-sacral angle, curve flexibility, and screw density. Results PCA changed significantly from 57.6°±13.9° to 19°±8.4° (p <0.0001) with 67% correction, where the mean curve flexibility was 41% and screw density was 68%. Regional sagittal parameters did not change significantly, including CSA (from 10.76° to 10.56°, p =0.893), TK (from 24.4° to 22.8°, p =0.145), and LL (from 50.3° to 51.1°, p =0.415). However, subgroup analysis of the hypokyphosis group (<10°) and the hyperkyphosis group (>40°) showed significant correction of TK (p <0.0001 in both). Sacro-pelvic parameters showed a significant decrease of PT and increase of SS, suggesting a reduction in pelvic retroversion SS (from 37° to 40°, p =0.0001) and PT (from 15° to 14°, p =0.025). Conclusions LD strategic pedicle screw fixation provides favorable coronal correction and improves overall sagittal sacro-pelvic parameters. This technique does not cause significant flattening of TK and results in a favorable restoration of TK in patients with hypokyphosis or hyperkyphosis. PMID:29713412

Sagittal plane analysis of selective posterior thoracic spinal fusion in adolescent idiopathic scoliosis: a comparison study of all pedicle screw and hybrid instrumentation.

PubMed

Liu, Tie; Hai, Yong

2014-07-01

To compare sagittal profiles of selective posterior thoracic instrumentation with segmental pedicle screws instrumentation and hybrid (hook and pedicle screw). Nowadays, thoracic screws are considered more effective than other constructs in spinal deformity correction and have become the treatment in adolescent idiopathic scoliosis surgery. However, recent research found that this enhanced correction ability may sacrifice sagittal balance. As lumbar lordosis is dependent upon thoracic kyphosis (TK), it has been important to maintain TK magnitude in selective thoracic fusions to keep balance. There is no sagittal measurement analysis between the hybrid and all-screw constructs type in cases of selective thoracic fusion. All adolescent idiopathic scoliosis (Lenke1) patients surgically treated in our department between 2003 and 2008 were reviewed. Radiographs of these patients, whose preoperative, immediately postoperative, and minimum 2-year follow-up after selective thoracic fusion (lower instrumented vertebrae not lower than L1, hybrid group the pedicle screw instrumentation not higher than T10) were evaluated, 21 patients underwent posterior hybrid instrumentation and 21 underwent pedicle screw instrumentation. No significant difference in sagittal profiles was observed between the 2 groups. At final follow-up, the proximal junctional measurement has a minor increase in both the groups. TK (T5-T12) also increased (+2.0 degrees of increase in hybrid group vs. +3.9 degrees of increase in the pedicle screw group). The effect of different instrumentation in changing TK at various time points between 2 groups was statistic different (P=0.004). Lumbar lordosis (L1-L5) was increased in both the groups. No significant changes in distal junctional measurement and thoracolumbar junction were noted. The C7 sagittal plumbline remained negative in both the groups at the final follow-up. There was no statistically significant difference comparing the sagittal alignment parameter of pedicle screw and hybrid constructs except for selective TK correction have differences. If used properly, both kinds of instrumentation could result in acceptable sagittal profiles when selective thoracic fusions were performed.

The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain.

PubMed

Kim, J; Hwang, J Y; Oh, J K; Park, M S; Kim, S W; Chang, H; Kim, T-H

2017-05-01

The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls. Patients over 70 years old who visited an outpatient clinic for back pain treatment and underwent a standing whole-body radiograph were enrolled. Falls were prospectively assessed for 12 months using a monthly fall diary, and patients were divided into fallers and non-fallers according to the history of falls. Radiological parameters from whole-body radiographs and clinical data were compared between the two groups. A total of 144 patients (120 female patients and 24 male patients) completed a 12-month follow-up for assessing falls. A total of 31 patients (21.5%) reported at least one fall within the 12-month follow-up. In univariate logistic regression analysis, the risk of falls was significantly increased in older patients and those with more medical comorbidities, decreased lumbar lordosis, increased sagittal vertical axis, and increased horizontal distance between the C7 plumb line and the centre of the ankle (C7A). Increased C7A was significantly associated with increased risk of falls even after multivariate adjustment. Whole body sagittal balance, measured by the horizontal distance between the C7 plumb line and the centre of the ankle, was significantly associated with risk of falls among elderly patients with back pain. Cite this article : J. Kim, J. Y. Hwang, J. K. Oh, M. S. Park, S. W. Kim, H. Chang, T-H. Kim. The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain. Bone Joint Res 2017;6:-344. DOI: 10.1302/2046-3758.65.BJR-2016-0271.R2. © 2017 Kim et al.

Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays.

PubMed

Janssen, Michiel M A; Drevelle, Xavier; Humbert, Ludovic; Skalli, Wafa; Castelein, René M

2009-11-01

A three-dimensional analysis of spino-pelvic alignment in 60 asymptomatic young adult males and females. To analyze the differences in sagittal spino-pelvic alignment in a group of asymptomatic young adult males and females and describe gender specific reference values. Several spinal disorders like idiopathic scoliosis and Scheuermann's disease have a well-known sex-related prevalence ratio. As spino-pelvic alignment plays an important role in spinal biomechanics, it is imperative to analyze possible differences between the male and female spino-pelvic alignment. Furthermore, in spinal fusion surgery, normal sagittal balance should be recreated as closely as possible. An innovative biplanar ultra low-dose radiographic technique was used to obtain three-dimensional reconstructions of the spine (T1-L5), sacrum, and pelvis in a freestanding position of 30 asymptomatic young male and 30 young female adults. Values were calculated for thoracic kyphosis (T4-T12), lumbar lordosis (L1-S1), total and regional lumbopelvic lordosis (PRT12, PRL2, PRL4, and PRL5), sagittal plumb line of T1, T4, and T9 (HAT1, HAT4, and HAT9), T1-L5 sagittal spinal inclination, T9 sagittal offset, and pelvic parameters (pelvic tilt, sacral slope, and pelvic incidence). In addition, vertebral inclination in the sagittal plane of each vertebra was measured. Differences in spino-pelvic alignment between the sexes were analyzed. The female spine was more dorsally inclined (11 degrees vs. 8 degrees ; P = 0.003). High thoracic and thoracolumbar vertebrae were more dorsally inclined in women than in men. Thoracic kyphosis, lumbar lordosis, regional lumbopelvic lordosis, sagittal plumb lines, T9 sagittal offset, and pelvic parameters were not statistically different between the sexes. These results indicate that the female spine is definitely different from the male spine. The spine as whole and individual vertebrae in certain regions of the normal spine is more backwardly inclined in females than in males. Based on our previous research this signifies that these spinal regions are subjected to different biomechanical loading conditions. These vertebral segments are possibly less rotationally stable in females than in males.

Computed tomographic angiography study of the relationship between the lingual artery and lingual markers in patients with obstructive sleep apnoea.

PubMed

Hou, T-N; Zhou, L-N; Hu, H-J

2011-06-01

To determine the relationship between the lingual artery and lingual markers for preoperative evaluation of the lingual artery in patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS). A 16-section computed tomographic angiography (CTA) of the lingual artery was performed in 87 inpatient cases with OSAHS, from December 2007 to May 2009. The course of the lingual artery and the anatomic relationship between the lingual artery and the lingual markers were analyzed using CTA imaging. The course of the lingual artery with the tongue in a resting position was similar to that of the Big Dipper constellation (Plough) in the sagittal view of CTA imaging. The first segment of the lingual artery declined approximately 19.27 ± 5.24 mm, the middle segment of the lingual artery was forward approximately 19.30 ± 6.79 mm, and the ascending segment of the lingual artery rose approximately 52.49 ± 10.98 mm. The entry point where the lingual artery entered into the tongue was adjacent to the tip of the greater horn of the hyoid bone. The relationship between the second segment of the lingual artery and the greater horn of the hyoid bone was relatively steady with the tongue in whatever position. The interval between the bilateral greater horn of the hyoid bone equalled that between the bilateral lingual arteries. Recognizing some lingual markers in the patients with OSAHS, such as the greater horn of the hyoid bone, foramen cecum, circumvallate papilla, lingual vein and tongue midline, may facilitate the surgeon's ability to define the course of the lingual artery accurately in the treatment of OSAHS. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Knee joint motion and muscle activation patterns are altered during gait in individuals with moderate hip osteoarthritis compared to asymptomatic cohort.

PubMed

Rutherford, Derek; Moreside, Janice; Wong, Ivan

2015-07-01

Knee replacements are common after hip replacement for end stage osteoarthritis. Whether abnormal knee mechanics exist in moderate hip osteoarthritis remains undetermined and has implications for understanding early osteoarthritis joint mechanics. The purpose of this study was to determine whether three-dimensional (3D) knee motion and muscle activation patterns in individuals with moderate hip osteoarthritis differ from an asymptomatic cohort and whether these features differ between contra- and ipsilateral knees. 3D motions and medial and lateral quadriceps and hamstring surface electromyography were recorded on 20 asymptomatic individuals and 20 individuals with moderate hip osteoarthritis during treadmill walking, using standardized collection and processing procedures. Principal component analysis was used to derive electromyographic amplitude and temporal waveform features. 3D stance-phase range of motion was calculated. A 2-factor repeated analysis of variance determined significant within-group leg and muscle differences. Student's t-tests identified between group differences, with Bonferroni corrections where applicable (α=0.05). Lower sagittal plane motion between early and mid/late stance (5°, P=0.004, effect size: 0.96) and greater mid-stance quadriceps activity was found in the osteoarthritis group (P=0.01). Compared to the ipsilateral knee, a borderline significant increase in mid-stance hamstring activity was found in the contra-lateral knee of the hip osteoarthritis group (P=0.018). Bilateral knee mechanics were altered, suggesting potentially increased loads and knee muscle fatigue. There was no indication that one knee is more susceptible to osteoarthritis than the other, thus clinicians should include bilateral knee analysis when treating patients with hip osteoarthritis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reduction of hip joint reaction force via medio-lateral foot center of pressure manipulation in bilateral hip osteoarthritis patients.

PubMed

Solomonow-Avnon, Deborah; Haim, Amir; Levin, Daniel; Elboim-Gabyzon, Michal; Rozen, Nimrod; Peled, Eli; Wolf, Alon

2016-10-01

Loading/excessive loading of the hip joint has been linked to onset and progression of hip osteoarthritis. Footwear-generated biomechanical manipulation in the frontal plane has been previously shown in a cohort of healthy subjects to cause a specific gait adaption when the foot center of pressure trajectory was shifted medially, which thereby significantly reduced hip joint reaction force. The objective of the present study was to validate these results in a cohort of female bilateral hip osteoarthritis patients. Sixteen patients underwent gait analysis while using a footworn biomechanical device, allowing controlled foot center of pressure manipulation, in three para-sagittal configurations: medial, lateral, and neutral. Hip osteoarthritis patients exhibited similar results to those observed in healthy subjects in that a medial center of pressure led to an increase in inter-maleolar distance while step width (i.e., distance between right and left foot center of pressure) remained constant. This adaptation, which we speculate subjects adopt to maintain base of support, was associated with significantly greater hip abduction, significantly decreased hip adduction moment, and significantly reduced joint reaction force compared to the neutral and lateral configurations. Recommendations for treatment of hip osteoarthritis emphasize reduction of loads on the pathological joint(s) during daily activities and especially in gait. Our results show that a medially deviated center of pressure causes a reduction in hip joint reaction force. The present study does not prove, but rather suggests, clinical significance, and further investigation is required to assess clinical implications. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1762-1771, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Sagittal plane joint kinetics during stair ascent in patients with peripheral arterial disease and intermittent claudication.

PubMed

King, Stephanie L; Vanicek, Natalie; O'Brien, Thomas D

2017-06-01

Stair negotiation poses a substantial physical demand on the musculoskeletal system and this challenging task can place individuals at risk of falls. Peripheral arterial disease (PAD) can cause intermittent claudication (IC) pain in the calf and results in altered gait mechanics during level walking. However, whether those with PAD-IC adopt alternate strategies to climb stairs is unknown. Twelve participants with PAD-IC (six bilateral and six unilateral) and 10 healthy controls were recruited and instructed to ascend a five-step staircase whilst 3D kinematic data of the lower-limbs were recorded synchronously with kinetic data from force plates embedded into the staircase on steps two and three. Limbs from the unilateral group and both limbs from the bilateral claudicants were categorised as claudicating (N=18), asymptomatic (N=6) and control (N=10). Claudicants walked more slowly than healthy controls (trend; P=<0.066). Both claudicating- and asymptomatic-limb groups had reduced propulsive GRF (P=0.025 and P=0.002, respectively) and vertical GRF (P=0.005 and P=0.001, respectively) compared to controls. The claudicating-limb group had a reduced knee extensor moment during forward continuance (P=0.060), ankle angular velocity at peak moment (P=0.039) and ankle power generation (P=0.055) compared to the controls. The slower gait speed, irrespective of laterality of symptoms, indicates functional capacity was determined by the limitations of the claudicating limb. Reduced ankle power generation and angular velocity (despite adequate plantarflexor moment) implies velocity-dependent limitations existed in the calf. The lack of notable compensatory strategies indicates reliance on an impaired muscle group to accomplish this potentially hazardous task, highlighting the importance of maintaining plantarflexor strength and power in those with PAD-IC. Copyright © 2017 Elsevier B.V. All rights reserved.

Cross-Hemispheric Collaboration and Segregation Associated with Task Difficulty as Revealed by Structural and Functional Connectivity

PubMed Central

Cabeza, Roberto

2015-01-01

Although it is known that brain regions in one hemisphere may interact very closely with their corresponding contralateral regions (collaboration) or operate relatively independent of them (segregation), the specific brain regions (where) and conditions (how) associated with collaboration or segregation are largely unknown. We investigated these issues using a split field-matching task in which participants matched the meaning of words or the visual features of faces presented to the same (unilateral) or to different (bilateral) visual fields. Matching difficulty was manipulated by varying the semantic similarity of words or the visual similarity of faces. We assessed the white matter using the fractional anisotropy (FA) measure provided by diffusion tensor imaging (DTI) and cross-hemispheric communication in terms of fMRI-based connectivity between homotopic pairs of cortical regions. For both perceptual and semantic matching, bilateral trials became faster than unilateral trials as difficulty increased (bilateral processing advantage, BPA). The study yielded three novel findings. First, whereas FA in anterior corpus callosum (genu) correlated with word-matching BPA, FA in posterior corpus callosum (splenium-occipital) correlated with face-matching BPA. Second, as matching difficulty intensified, cross-hemispheric functional connectivity (CFC) increased in domain-general frontopolar cortex (for both word and face matching) but decreased in domain-specific ventral temporal lobe regions (temporal pole for word matching and fusiform gyrus for face matching). Last, a mediation analysis linking DTI and fMRI data showed that CFC mediated the effect of callosal FA on BPA. These findings clarify the mechanisms by which the hemispheres interact to perform complex cognitive tasks. PMID:26019335

Do intraoperative radiographs predict final lumbar sagittal alignment following single-level transforaminal lumbar interbody fusion?

PubMed

Salem, Khalid M I; Eranki, Aditya P; Paquette, Scott; Boyd, Michael; Street, John; Kwon, Brian K; Fisher, Charles G; Dvorak, Marcel F

2018-05-01

OBJECTIVE The study aimed to determine if the intraoperative segmental lordosis (as calculated on a cross-table lateral radiograph following a single-level transforaminal lumbar interbody fusion [TLIF] for degenerative spondylolisthesis/low-grade isthmic spondylolisthesis) is maintained at discharge and at 6 months postsurgery. METHODS The authors reviewed images and medical records of patients ≥ 16 years of age with a diagnosis of an isolated single-level, low-grade spondylolisthesis (degenerative or isthmic) with symptomatic spinal stenosis treated between January 2008 and April 2014. Age, sex, surgical level, surgical approach, and facetectomy (unilateral vs bilateral) were recorded. Upright standardized preoperative, early, and 6-month postoperative radiographs, as well as intraoperative lateral radiographs, were analyzed for the pelvic incidence, segmental lumbar lordosis (SLL) at the TILF level, and total LL (TLL). In addition, the anteroposterior position of the cage in the disc space was documented. Data are presented as the mean ± SD; a p value < 0.05 was considered significant. RESULTS Eighty-four patients were included in the study. The mean age of patients was 56.8 ± 13.7 years, and 46 patients (55%) were men. The mean pelvic incidence was 59.7° ± 11.9°, and a posterior midline approach was used in 47 cases (56%). All TLIF procedures were single level using a bullet-shaped cage. A bilateral facetectomy was performed in 17 patients (20.2%), and 89.3% of procedures were done at the L4-5 and L5-S1 segments. SLL significantly improved intraoperatively from 15.8° ± 7.5° to 20.9° ± 7.7°, but the correction was lost after ambulation. Compared with preoperative values, at 6 months the change in SLL was modest at 1.8° ± 6.7° (p = 0.025), whereas TLL increased by 4.3° ± 9.6° (p < 0.001). The anteroposterior position of the cage, approach, level of surgery, and use of a bilateral facetectomy did not significantly affect postoperative LL. CONCLUSIONS Following a single-level TLIF procedure using a bullet-shaped cage, the intraoperative improvement in SLL is largely lost after ambulation. The improvement in TLL over time is probably due to the decompression part of the procedure. The approach, level of surgery, bilateral facetectomy, and position of the cage do not seem to have a significant effect on LL achieved postoperatively.

Sagittal alignment of the cervical spine after neck injury.

PubMed

Beltsios, Michail; Savvidou, Olga; Mitsiokapa, Evanthia A; Mavrogenis, Andreas F; Kaspiris, Angelos; Efstathopoulos, Nikolaos; Papagelopoulos, Panayiotis J

2013-07-01

The normal sagittal alignment of the cervical spine is lordotic and is affected by the posture of the head and neck. The question of whether loss of cervical lordosis is the result of muscle spasm after injury or a normal variation, and the clinical significance of such changes in sagittal profile of the cervical spine has been an issue of several studies. The purpose of this paper is to study the incidence of normal cervical lordosis and its changes after neck injury compared to the healthy population. We studied the lateral radiographs of the cervical spine of 60 patients with neck injury compared to 100 patients without a neck injury. Lateral radiographs were obtained in the standing or sitting position, and the curvature of the cervical spine was measured using the angle formed between the inferior end plates of the C2 and C7 vertebrae. In the patients without neck injury, lordotic and straight cervical spine sagittal alignment was observed in 36.5% each, double curvature in 17%, and kyphotic in 10%. In the patients with neck injury, lordotic sagittal alignment was observed in 36%, straight in 34%, double curvature in 26% and kyphotic in 4%. No significant difference between the two groups regarding all types of sagittal alignment of the cervical spine was found (p > 0.100). The alterations in normal cervical lordosis in patients with neck injury must be considered coincidental. These alterations should not be associated with muscle spasm caused by neck pain.

Sagittal band, boutonniere, and pulley injuries in the athlete.

PubMed

Grandizio, Louis Christopher; Klena, Joel Christian

2017-03-01

While hand injuries occur frequently in the athletic population, sagittal band ruptures, boutonniere deformities, and pulley ruptures are infrequently encountered. These injuries represent diagnostic challenges and can result in significant impairment. Early recognition with appropriate treatment is necessary to maximize recovery and minimize return to athletic competition. This review will focus on the underlying mechanism, pathophysiology of injury, diagnosis, and treatment of each of these injuries. With respect to sagittal band ruptures, boutonniere deformities, and pulley ruptures, the recent literature has been limited in scope. For sagittal band injuries, current efforts have focused on alternative techniques for sagittal band reconstruction. Little progress has been made in recent years with respect to boutonniere injuries in the athletic population; prevention of fixed deformities remains the backbone of treatment. The exact contribution from individual and combined pulley injuries in the creation of bowstringing remains controversial. Recent anatomical studies have failed to definitively answer the question of what degree of rupture is necessary to create symptomatic bowstringing. Favorable outcomes, with respect to both preventing bowstringing and returning to full athletic participation, have been newly reported following pulley reconstruction in rock climbers. Due to the infrequent nature of sagittal band ruptures, boutonniere deformities, and pulley ruptures, current treatment is mostly guided by historically established methods, limited case series, and case reports. Nonsurgical treatment remains the mainstay for most injuries and, if employed early, often precludes the need for surgery. Further anatomical and clinical research, including outcome studies, is necessary in guiding treatment algorithms.

Effects of ipsilateral anterior thigh soft tissue stretching on passive unilateral straight-leg raise.

PubMed

Clark, S; Christiansen, A; Hellman, D F; Hugunin, J W; Hurst, K M

1999-01-01

Randomized 3-group pretest-posttest with blind assessment of outcome. The purpose of this study was to examine the effect of sagittal plane hold-relax exercise applied to the ipsilateral anterior thigh, and prone positioning on passive unilateral straight-leg raise measurements. Straight-leg raising has been viewed as a measurement for hamstring muscle length, but literature suggests that other structures may affect this measurement. Sixty subjects (45 men, 15 women) qualified for inclusion into the study based on a straight-leg raise measurement of < or = 65 degrees. Subjects were randomly assigned to one of three groups: control, static stretch, or sagittal plane hold-relax exercise. Pretest and posttest straight-leg raise measurements of the right lower extremity were performed for each subject. A 1-way ANOVA of the change scores showed a significant difference between groups. A Tukey post hoc analysis of the change scores showed that both treatment groups' means differed significantly from the control group and from each other, with the sagittal plane hold-relax group exhibiting the largest change (mean of 7.8 degrees +/- 2.8 degrees). The results of this study show that sagittal plane hold-relax exercise and passive prone results of this study show that sagittal plane hold-relax and passive prone positioning can significantly increase straight-leg raise range of motion, however the sagittal plane hold-relax stretching of the anterior thigh is more effective than passive prone positioning.

Staged corrective surgery for complex congenital scoliosis and split cord malformation

PubMed Central

Asad, Ambreen; Pasha, Ibrahim Farooq; Malik, Arslan Sharif; Arlet, Vincent

2009-01-01

Congenital scoliosis associated with split cord malformation raises the issue on how to best manage these patients to avoid neurologic injury while achieving satisfactory correction. We present the case of a 12-year-old girl who first presented when she was 11-year old with such combination but without much physical handicap or neurological deficit. The corrective surgery offered at that time was refused by the family. She again presented after 1 year with documented severe aggravation of the curve resulting in unstable walking and psychological upset. Her imaging studies showed multiple malformations in lower cervical and thoracic spine and a split cord malformation type 2 (fibrous septum with diplomyelia) at the apex of the deformity. A one-stage correction was deemed neurologically too risky. We therefore performed during a first stage a thoracotomy with anterior release. This was followed by skeletal traction with skull tongs and bilateral femoral pins. After gradual increase in traction weights a reasonable correction was achieved without any neurological deficit, over the next 10 days. A second-stage operation was done on the 11th day and a posterior instrumented fusion was performed. Post-operative recovery was uneventful and there were no complications. She was discharged with a Boston Brace to be worn for 3 months. At 2-year follow-up the patient outcome is excellent with excellent balance and correction of the deformity. In this grand round case, we discuss all the different option of treatment of congenital scoliosis associated with split cord malformation. In a medical environment where spinal cord monitoring is lacking, we recommend an initial release followed by skull and bifemoral traction over several days to monitor the neurologic status of the patient. Once optimal correction is achieved with the traction, a posterior instrumentation can be safely done. PMID:19626347

A novel step osteotomy for correction of hemifacial microsomia - A case report.

PubMed

Howlader, Debraj; Bhutia, Dichen P; Vignesh, U; Mehrotra, Divya

2016-01-01

Facial asymmetry is one of the commonest facial anomalies, with reported incidence as high as 34%. Hemifacial microsomia (HFM) has an incidence of 1 in every 4000-5600 children and is one of the commonest causes of facial asymmetry. The standard treatment of HFM is orthognathic surgery by bilateral saggital split osteotomy (BSSO) or distraction osteogenesis (DO) of the mandible, both of which involve prolonged periods of occlusal adjustments by an orthodontist. Here, we present distraction of the mandible by means of a novel modified step osteotomy to correct the facial asymmetry in a case of hemifacial microsomia without disturbing the occlusion. This novel technique can prove to be a new tool in the maxillofacial surgeons armamentarium to treat facial asymmetry.

Laparoscopic extravesical transperitoneal approach following the lich-gregoir procedure in refluxing duplicated collecting systems: initial experience.

PubMed

Lopez, Manuel; Melo, Carlos; François, Michel; Varlet, François

2011-03-01

Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. Nephropathy with renal scarring is still the most concerning issue in VUR. Surgical correction to eliminate VUR is an important part of its management and this need is increasing for duplicated collecting systems (DCS). Laparoscopy may have a place in the treatment of VUR. We report our initial experience in the treatment of refluxing DCS by laparoscopic extravesical transperitoneal approach (LETA) following Lich-Gregoir technique. The aim of this study was to describe the evolution and evaluate the results and benefits of this technique. Between August 2007 and January 2010, 60 renal units in 43 children with VUR and deterioration of renal function on isotope renography were treated with LETA following the Lich-Gregoir procedure. Twelve patients had refluxing DCS in a lower polar system; three of them had bilateral VUR. Three cases of refluxing DCS were associated to obstruction. Two of them presented an ectopic ureterocele with adequate split renal function and another had an ectopic ureterocele with complete deterioration of upper polar renal function. Their mean age was 36 months (range: 15-80 months). The mean surgical time was 90 minutes (38-140 minutes) in unilateral and 144 minutes (120-200 minutes) in bilateral VUR including cystoscopy. All procedures were successfully completed laparoscopically and the reflux was corrected in all patients. One-stage laparoscopic heminephroureterectomy with excision of ureterocele and ureteric reimplantation was done in 1 case, and ureterocele excision and ureteric reimplantation by LETA were done in 2 cases. The mean hospital stay was 27 hours. A cystogram was performed systematically in all patients at 45 days postoperatively; none of them presented recurrence of VUR. The follow-up period was 11 months (range: 2-24 months), without recurrence of VUR. LETA following the Lich-Gregoir procedure in refluxing DCS is a safe and effective approach even in unilateral, bilateral simultaneous, and split renal function in duplicated systems. When refluxing DCS is associated with obstruction and total deterioration of upper polar function, heminephroureterectomy with excision of ureterocele and ureteric reimplantation can be safely and effectively performed in a single-stage laparoscopic procedure, which minimizes the hazards of traditional open surgical reconstruction. A shorter hospital stay, decreased postoperative discomfort, reduced recovery period, and a low morbidity to resolve VUR in DCS are the benefits of this technique, with success rates similar to the open technique.

Diffraction crystal for sagittally focusing x-rays

DOEpatents

Ice, Gene E.; Sparks, Jr., Cullie J.

1984-01-01

The invention is a new type of diffraction crystal designed for sagittally focusing photons of various energies. The invention is based on the discovery that such focusing is not obtainable with conventional crystals because of distortion resulting from anticlastic curvature. The new crystal comprises a monocrystalline base having a front face contoured for sagittally focusing photons and a back face provided with rigid, upstanding, stiffening ribs restricting anticlastic curvature. When mounted in a suitable bending device, the reflecting face of the crystal can be adjusted to focus photons having any one of a range of energies.

Diffraction crystals for sagittally focusing x-rays

DOEpatents

Ice, G.E.; Sparks, C.J. Jr.

1982-06-07

The invention is a new type of diffraction crystal designed for sagittally focusing photons of various energies. The invention is based on the discovery that such focusing is not obtainable with conventional crystals because of distortion resulting from anticlastic curvature. The new crystal comprises a monocrystalline base having a front face contoured for sagittally focusing photons and a back face provided with rigid, upstanding, stiffening ribs restricting anticlastic curvature. When mounted in a suitable bending device, the reflecting face of the crystal can be adjusted to focus photons having any one of a range of energies.

Alphabet Soup: Sagittal Balance Correction Osteotomies of the Spine-What Radiologists Should Know.

PubMed

Takahashi, T; Kainth, D; Marette, S; Polly, D

2018-04-01

Global sagittal malalignment has been demonstrated to have correlation with clinical symptoms and is a key component to be restored in adult spinal deformity. In this article, various types of sagittal balance-correction osteotomies are reviewed primarily on the basis of the 3 most commonly used procedures: Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection. Familiarity with the expected imaging appearance and commonly encountered complications seen on postoperative imaging studies following correction osteotomies is crucial for accurate image interpretation. © 2018 by American Journal of Neuroradiology.

Investigation of sagittal image acquisition for 4D-MRI with body area as respiratory surrogate.

PubMed

Liu, Yilin; Yin, Fang-Fang; Chang, Zheng; Czito, Brian G; Palta, Manisha; Bashir, Mustafa R; Qin, Yujiao; Cai, Jing

2014-10-01

The authors have recently developed a novel 4D-MRI technique for imaging organ respiratory motion employing cine acquisition in the axial plane and using body area (BA) as a respiratory surrogate. A potential disadvantage associated with axial image acquisition is the space-dependent phase shift in the superior-inferior (SI) direction, i.e., different axial slice positions reach the respiratory peak at different respiratory phases. Since respiratory motion occurs mostly in the SI and anterior-posterior (AP) directions, sagittal image acquisition, which embeds motion information in these two directions, is expected to be more robust and less affected by phase-shift than axial image acquisition. This study aims to develop and evaluate a 4D-MRI technique using sagittal image acquisition. The authors evaluated axial BA and sagittal BA using both 4D-CT images (11 cancer patients) and cine MR images (6 healthy volunteers and 1 cancer patient) by comparing their corresponding space-dependent phase-shift in the SI direction (δSPS (SI)) and in the lateral direction (δSPS (LAT)), respectively. To evaluate sagittal BA 4D-MRI method, a motion phantom study and a digital phantom study were performed. Additionally, six patients who had cancer(s) in the liver were prospectively enrolled in this study. For each patient, multislice sagittal MR images were acquired for 4D-MRI reconstruction. 4D retrospective sorting was performed based on respiratory phases. Single-slice cine MRI was also acquired in the axial, coronal, and sagittal planes across the tumor center from which tumor motion trajectories in the SI, AP, and medial-lateral (ML) directions were extracted and used as references from comparison. All MR images were acquired in a 1.5 T scanner using a steady-state precession sequence (frame rate ∼ 3 frames/s). 4D-CT scans showed that δSPS (SI) was significantly greater than δSPS (LAT) (p-value: 0.012); the median phase-shift was 16.9% and 7.7%, respectively. Body surface motion measurement from axial and sagittal MR cines also showed δSPS (SI) was significantly greater than δSPS (LAT). The median δSPS (SI) and δSPS (LAT) was 11.0% and 9.2% (p-value = 0.008), respectively. Tumor motion trajectories from 4D-MRI matched with those from single-slice cine MRI: the mean (±SD) absolute differences in tumor motion amplitude between the two were 1.5 ± 1.6 mm, 2.1 ± 1.9 mm, and 1.1 ± 1.0 mm in the SI, ML, and AP directions from this patient study. Space-dependent phase shift is less problematic for sagittal acquisition than for axial acquisition. 4D-MRI using sagittal acquisition was successfully carried out in patients with hepatic tumors.

Comparing the Effectiveness of Sagittal Balance, Foraminal Stenosis, and Preoperative Cord Rotation in Predicting Postoperative C5 Palsy.

PubMed

Chugh, Arunit J S; Weinberg, Douglas S; Alonso, Fernando; Eubanks, Jason D

2017-11-01

Retrospective cohort review. To determine whether preoperative cord rotation is independently correlated with C5 palsy when analyzed alongside measures of sagittal balance and foraminal stenosis. Postoperative C5 palsy is a well-documented complication of cervical procedures with a prevalence of 4%-8%. Recent studies have shown a correlation with preoperative spinal cord rotation. There have been few studies, however, that have examined the role of sagittal balance and foraminal stenosis in the development of C5 palsy. A total of 77 patients who underwent cervical decompression-10 of whom developed C5 palsy-were reviewed. Sagittal balance was assessed using curvature angle and curvature index on radiographs and magnetic resonance image (MRI). Cord rotation was assessed on axial MRI. C4-C5 foraminal stenosis was assessed on sagittal MRI using area measurements and a grading scale. Demographics and information on surgical approach were gathered from chart review. Correlation with C5 palsy was performed by point-biserial, χ, and regression analyses. Point-biserial analysis indicated that only cord rotation showed significance (P<0.01). There was no statistical significance shown with surgical approach, sex, or age. In addition, changes in sagittal balance did not correlate with presence of C5 palsy. Logistic regression model yielded cord rotation as the only significant independent predictor of C5 palsy. For every degree of axial cord rotation, the likelihood ratio for suffering a C5 palsy was 3.93 (95% confidence interval, 2.01-8.66; P<0.05). This supports the independent capability of preoperative cord rotation to predict postoperative C5 palsy. Lack of correlation with measures of neuroforaminal stenosis potentially points to mechanisms other than direct compression as the etiology. In addition, the lack of correlation with postoperative changes in sagittal balance hints that measures of curvature angle and curvature index may not be appropriate to accurately predict this complication. Level 3.

Classification of high-grade spondylolistheses based on pelvic version and spine balance: possible rationale for reduction.

PubMed

Hresko, Michael T; Labelle, Hubert; Roussouly, Pierre; Berthonnaud, Eric

2007-09-15

Retrospective review of a radiographic database of high-grade spondylolisthesis patients in comparison with asymptomatic controls. To analyze the sagittal spinopelvic alignment in high-grade spondylolisthesis patients and identify subgroups that may require reduction to restore sagittal balance. High-grade spondylolisthesis is associated with an abnormally high pelvic incidence (PI); however, the spatial orientation of the pelvis, determined by sacral slope (SS) and pelvic tilt (PT), is not known. We hypothesized that sagittal spinal alignment would vary with the pelvic orientation. Digitized sagittal radiographs of 133 high-grade spondylolisthesis patients (mean age, 17 years) were measured to determined sagittal alignment. K-means cluster analysis identified 2 groups based on the PT and SS, which were compared by paired t test. Comparisons were made to asymptomatic controls matched for PI. High-grade spondylolisthesis patients had a mean PI of 78.9 degrees +/- 12.1 degrees . Cluster analysis identified a retroverted, unbalanced pelvis group with high PT (36.5 degrees +/- 8.0 degrees )/low SS (40.3 degrees +/- 9.0 degrees ) and a balanced pelvic group with low PT (mean 21.3 degrees +/- 8.2 degrees )/high SS (59.9 degrees +/- 11.2 degrees ). The retroverted pelvis group had significantly greater L5 incidence and lumbosacral angle with less thoracic kyphosis than the balanced pelvic group. A total of 83% of controls had a "balanced pelvis" based on the categorization by SS and PT. Analysis of sagittal alignment of high-grade spondylolisthesis patients revealed distinct groups termed "balanced" and "unbalanced" pelvis. The PT and SS were similar in controls and balanced pelvis patients. Unbalanced pelvis patients had a sagittal spinal alignment that differed from the balanced pelvis and control groups. Treatment strategies for high-grade spondylolisthesis should reflect the different mechanical strain on the spinopelvic junction in each group; reduction techniques might be considered in patients with an unbalanced pelvis high-grade spondylolisthesis.

Transforaminal Anterior Release for the Treatment of Fixed Sagittal Imbalance and Segmental Kyphosis, Minimum 2-Year Follow-Up Study.

PubMed

Sweet, Fred A; Sweet, Andrea

2015-09-01

Retrospective review of prospectively accrued patient cohort. To report minimum 2 years' follow-up after a single-surgeon series of 47 consecutive patients in whom fixed sagittal imbalance or segmental kyphosis was treated with a novel unilateral transforaminal annular release. Fixed sagittal imbalance has been treated most recently with pedicle subtraction osteotomy with great success but is associated with significant blood loss and neurologic risk. Forty-seven consecutive patients with fixed sagittal imbalance (n = 29) or segmental kyphosis (n = 18) were treated by a single surgeon with a single-level transforaminal anterior release (TFAR) to effect an opening wedge correction. Sagittal and coronal correction was performed with in situ rod contouring. An interbody cage was captured in the disc space with rod compression. Radiographic and clinical outcome analysis was performed with a minimum 2-year follow-up (range 2-7.8 years). The average increase in lordosis was 36° (range 24°-56°) in the fixed sagittal deformity group. Coronal corrections averaged 34° (range 18°-48°). The average improvement in plumb line was 13.6 cm. There were four pseudarthroses, one at the TFAR. Average blood loss was 578 mL (range 200-1,200). One patient had a transient grade 4/5 anterior tibialis weakness. There were no vascular injuries or permanent neurologic deficits. There were significant improvements in the Oswestry Disability Index (p < .001) and Scoliosis Research Society Questionnaire scores (p = .003). Eighty-four percent of patients reported improvement in pain, self-image, and satisfaction with the procedure. TFAR is a useful procedure for correcting segmental kyphosis and fixed sagittal imbalance with relatively low blood loss and was found to be neurologically safe in this single-surgeon series. Therapeutic study, Level IV (case series, no control group). Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Relationship between movement time and hip moment impulse in the sagittal plane during sit-to-stand movement: a combined experimental and computer simulation study.

PubMed

Inai, Takuma; Takabayashi, Tomoya; Edama, Mutsuaki; Kubo, Masayoshi

2018-04-27

The association between repetitive hip moment impulse and the progression of hip osteoarthritis is a recently recognized area of study. A sit-to-stand movement is essential for daily life and requires hip extension moment. Although a change in the sit-to-stand movement time may influence the hip moment impulse in the sagittal plane, this effect has not been examined. The purpose of this study was to clarify the relationship between sit-to-stand movement time and hip moment impulse in the sagittal plane. Twenty subjects performed the sit-to-stand movement at a self-selected natural speed. The hip, knee, and ankle joint angles obtained from experimental trials were used to perform two computer simulations. In the first simulation, the actual sit-to-stand movement time obtained from the experiment was entered. In the second simulation, sit-to-stand movement times ranging from 0.5 to 4.0 s at intervals of 0.25 s were entered. Hip joint moments and hip moment impulses in the sagittal plane during sit-to-stand movements were calculated for both computer simulations. The reliability of the simulation model was confirmed, as indicated by the similarities in the hip joint moment waveforms (r = 0.99) and the hip moment impulses in the sagittal plane between the first computer simulation and the experiment. In the second computer simulation, the hip moment impulse in the sagittal plane decreased with a decrease in the sit-to-stand movement time, although the peak hip extension moment increased with a decrease in the movement time. These findings clarify the association between the sit-to-stand movement time and hip moment impulse in the sagittal plane and may contribute to the prevention of the progression of hip osteoarthritis.

Influence of lumbar lordosis restoration on thoracic curve and sagittal position in lumbar degenerative kyphosis patients.

PubMed

Jang, Jee-Soo; Lee, Sang-Ho; Min, Jun-Hong; Maeng, Dae Hyeon

2009-02-01

A retrospective study. To determine postsurgical correlations between thoracic and lumbar sagittal curves in lumbar degenerative kyphosis (LDK) and to determine predictability of spontaneous correction of thoracic curve and sacral angle after surgical restoration of lumbar lordosis and fusion. To our knowledge, there are only a limited number of articles about the relationship between thoracic and lumbar curve in sagittal thoracic compensated LDK. Retrospective review of 53 consecutive patients treated with combined anterior and posterior spinal arthrodesis. We included patients with sagittal thoracic compensated LDK caused by sagittal imbalance in this study. Total lumbar lordosis, thoracic kyphosis, sacral slope, and C7 plumb line were measured on the pre- and postoperative whole spine lateral views. Postoperative changes in thoracic kyphosis, sacral slope, and C7 plumb line according to the surgical lumbar lordosis restoration were measured and evaluated. The mean preoperative sagittal imbalance by plumb line was 78.3 mm (+/-76.5); this improved to 13.6 mm (+/-25) after surgery (P < 0.0001). Mean lumbar lordosis was 9.4 degrees (+/-19.2) before surgery and increased to 38.4 degrees (+/-13.1) at follow-up (P < 0.0001). Mean thoracic kyphosis was 1.1 degrees (+/-12.7) before surgery and increased to 17.6 degrees (+/-12.2) at follow-up (P < 0.0001). Significant preoperative correlations existed between kyphosis and lordosis (r = 0.772, P < 0.0001) and between lordosis and sacral slope (r = 0.785, P < 0.0001). Postoperative lumbar lordosis is correlated to thoracic kyphosis increase (r = 0.620, P < 0.0001). Postoperative lumbar lordosis is correlated to sacral slope increase (r = 0.722, P < 0.0001). Reciprocal relationship exists between lumbar lordosis and thoracic kyphosis in sagittal thoracic compensated LDK. Surgical restoration of lumbar lordosis for LDK brings about high level of statistical correlation to thoracic kyphosis improvement. At the same time, the reciprocal relationship is maintained.

The sagittal stem alignment and the stem version clearly influence the impingement-free range of motion in total hip arthroplasty: a computer model-based analysis.

PubMed

Müller, Michael; Duda, Georg; Perka, Carsten; Tohtz, Stephan

2016-03-01

The component alignment in total hip arthroplasty influences the impingement-free range of motion (ROM). While substantiated data is available for the cup positioning, little is known about the stem alignment. Especially stem rotation and the sagittal alignment influence the position of the cone in relation to the edge of the socket and thus the impingement-free functioning. Hence, the question arises as to what influence do these parameters have on the impingement-free ROM? With the help of a computer model the influence of the sagittal stem alignment and rotation on the impingement-free ROM were investigated. The computer model was based on the CT dataset of a patient with a non-cemented THA. In the model the stem version was set at 10°/0°/-10° and the sagittal alignment at 5°/0°/-5°, which resulted in nine alternative stem positions. For each position, the maximum impingement-free ROM was investigated. Both stem version and sagittal stem alignment have a relevant influence on the impingement-free ROM. In particular, flexion and extension as well as internal and external rotation capability present evident differences. In the position intervals of 10° sagittal stem alignment and 20° stem version a difference was found of about 80° in the flexion and 50° in the extension capability. Likewise, differences were evidenced of up to 72° in the internal and up to 36° in the external rotation. The sagittal stem alignment and the stem torsion have a relevant influence on the impingement-free ROM. To clarify the causes of an impingement or accompanying problems, both parameters should be examined and, if possible, a combined assessment of these factors should be made.

Does Shoe Collar Height Influence Ankle Joint Kinematics and Kinetics in Sagittal Plane Maneuvers?

PubMed Central

Yang, Yang; Fang, Ying; Zhang, Xini; He, Junliang; Fu, Weijie

2017-01-01

The Objective of the study is to investigate the effects of basketball shoes with different collar heights on ankle kinematics and kinetics and athletic performance in different sagittal plane maneuvers. Twelve participants who wore high-top and low-top basketball shoes (hereafter, HS and LS, respectively) performed a weight-bearing dorsiflexion (WB-DF) maneuver, drop jumps (DJs), and lay-up jumps (LJs). Their sagittal plane kinematics and ground reaction forces were recorded using the Vicon motion capture system and Kistler force plates simultaneously. Moreover, ankle dorsiflexion and plantarflexion angles, moment, power, stiffness, and jump height were calculated. In the WB-DF test, the peak ankle dorsiflexion angle (p = 0.041) was significantly smaller in HS than in LS. Additionally, the peak ankle plantarflexion moment (p = 0.028) and power (p = 0.022) were significantly lower in HS than in LS during LJs but not during DJs. In both jumping maneuvers, no significant differences were found in the jump height or ankle kinematics between the two shoe types. According to the WB-DF test, increasing shoe collar height can effectively reduce the ankle range of motion in the sagittal plane. Although the HS did not restrict the flexion–extension performance of the ankle joint during two jumping maneuvers, an increased shoe collar height can reduce peak ankle plantarflexion moment and peak power during the push-off phase in LJs. Therefore, a higher shoe collar height should be used to circumvent effects on the partial kinetics of the ankle joint in the sagittal plane. Key points An increased shoe collar height effectively reduced ankle joint ROM in the sagittal plane in weight-bearing dorsiflexion maneuver. Shoe collar height did not affect sagittal plane ankle kinematics and had no effect on performance during realistic jumping. Shoe collar height can affect the ankle plantarflexion torque and peak power during the push-off phase in lay-up jump. PMID:29238255

Clinical Evaluation of positioning verification using digital tomosynthesis (DTS) based on bony anatomy and soft tissues for prostate image-guided radiation therapy (IGRT)

PubMed Central

Yoo, Sua; Wu, Q. Jackie; Godfrey, Devon; Yan, Hui; Ren, Lei; Das, Shiva; Lee, William R.; Yin, Fang-Fang

2008-01-01

Purpose To evaluate on-board digital tomosynthesis (DTS) for patient positioning in comparison with 2D-radiographs and 3D-CBCT. Methods and Materials A total of 92 image sessions from 9 prostate cancer patients were analyzed. An on-board image set was registered to a corresponding reference image set. Four pairs of image sets were used; DRR vs. on-board orthogonal paired radiograph for the 2D method, coronal-reference-DTS (RDTS) vs. on-board coronal-DTS for the coronal-DTS method, sagittal-RDTS vs. on-board sagittal-DTS for the sagittal-DTS method, and planning CT vs. CBCT for the CBCT method. Registration results were compared. Results The systematic errors in all methods were less than 1 mm/1°. When registering bony anatomy, the mean vector differences were 0.21±0.11 cm between 2D and CBCT, 0.11±0.08 cm between CBCT and coronal-DTS, and 0.14±0.07 cm between CBCT and sagittal-DTS. The correlation of CBCT to DTS was stronger (coefficients=0.92–0.95) than the correlation between 2D and CBCT or DTS (coefficients=0.81–0.83). When registering soft tissue, the mean vector differences were 0.18±0.11 cm between CBCT and coronal-DTS and 0.29±0.17 cm between CBCT and sagittal-DTS. The correlation coefficients of CBCT to sagittal-DTS and to coronal-DTS were 0.84 and 0.92, respectively. Conclusions DTS could provide equivalent results to CBCT when bony anatomy is used as landmarks for prostate IGRT. For soft tissue-based positioning verification, coronal-DTS produced equivalent results to CBCT and sagittal-DTS alone was insufficient. DTS could allow comparable soft tissue-based target localization with faster scanning time and less imaging dose compared to CBCT. PMID:19100923

1975 Memorial Award Paper. Image generation and display techniques for CT scan data. Thin transverse and reconstructed coronal and sagittal planes.

PubMed

Glenn, W V; Johnston, R J; Morton, P E; Dwyer, S J

1975-01-01

The various limitations to computerized axial tomographic (CT) interpretation are due in part to the 8-13 mm standard tissue plane thickness and in part to the absence of alternative planes of view, such as coronal or sagittal images. This paper describes a method for gathering multiple overlapped 8 mm transverse sections, subjecting these data to a deconvolution process, and then displaying thin (1 mm) transverse as well as reconstructed coronal and sagittal CT images. Verification of the deconvolution technique with phantom experiments is described. Application of the phantom results to human post mortem CT scan data illustrates this method's faithful reconstruction of coronal and sagittal tissue densities when correlated with actual specimen photographs of a sectioned brain. A special CT procedure, limited basal overlap scanning, is proposed for use on current first generation CT scanners without hardware modification.

Sagittal plane analysis of the spine and pelvis in degenerative lumbar scoliosis.

PubMed

Han, Fei; Weishi, Li; Zhuoran, Sun; Qingwei, Ma; Zhongqiang, Chen

2017-01-01

Previous studies have reported the normative values of pelvic sagittal parameters, but no study has analyzed the sagittal spino-pelvic alignment in degenerative lumbar scoliosis (DLS) and its role in the pathogenesis. Retrospective analysis was applied to 104 patients with DLS, together with 100 cases of asymptomatic young adults as a control group and another control group consisting of 145 cases with cervical spondylosis. The coronal and sagittal parameters were measured on the anteroposterior and lateral radiograph of the whole spine in the DLS group as well as in the two control groups. Statistical analysis showed that the DLS group had a higher pelvic incidence (PI) value (50.5° ± 10.2°), than the normal control group (with PI 47.2° ± 8.8°) and the cervical spondylosis group (46.9° ± 9.1°). In DLS group, there were 38 cases (36.5%) complicated with degenerative lumbar spondylolisthesis, who had higher PI values than patients without it. Besides, the lumbar lordosis (LL) and sacral slope (SS) of DLS group were lower; the scoliosis Cobb's angle was correlated with pelvic tilt (PT); thoracic kyphosis was correlated with LL, SS, and PT; and LL was correlated with other sagittal parameters. Patients with DLS may have a higher PI, which may impact the pathogenesis of DLS. A high PI value is probably associated with the high prevalence of degenerative lumbar spondylolisthesis among DLS patients. In DLS patients, the lumbar spine maintains the ability of regulating the sagittal balance, and the regulation depends more on thoracic curve.

Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers

PubMed Central

Okada, Eijiro; Ichihara, Daisuke; Chiba, Kazuhiro; Toyama, Yoshiaki; Fujiwara, Hirokazu; Momoshima, Suketaka; Nishiwaki, Yuji; Hashimoto, Takeshi; Ogawa, Jun; Watanabe, Masahiko; Takahata, Takeshi

2009-01-01

There have been few studies that investigated and clarified the relationships between progression of degenerative changes and sagittal alignment of the cervical spine. The objective of the study was to longitudinally evaluate the relationships among progression of degenerative changes of the cervical spine with age, the development of clinical symptoms and sagittal alignment of the cervical spine in healthy subjects. Out of 497 symptom-free volunteers who underwent MRI and plain radiography of the cervical spine between 1994 and 1996, 113 subjects (45 males and 68 females) who responded to our contacts were enrolled. All subjects underwent another MRI at an average of 11.3 years after the initial study. Their mean age at the time of the initial imaging was 36.6 ± 14.5 years (11–65 years). The items evaluated on MRI were (1) decrease in signal intensity of the intervertebral disks, (2) posterior disk protrusion, and (3) disk space narrowing. Each item was evaluated using a numerical grading system. The subjects were divided into four groups according to the age and sagittal alignment of the cervical spine, i.e., subjects under or over the age of 40 years, and subjects with the lordosis or non-lordosis type of sagittal alignment of the cervical spine. During the 10-year period, progression of decrease in signal intensity of the disk, posterior disk protrusion, and disk space narrowing were recognized in 64.6, 65.5, and 28.3% of the subjects, respectively. Progression of posterior disk protrusion was significantly more frequent in subjects over 40 years of age with non-lordosis type of sagittal alignment. Logistic regression analysis revealed that stiff shoulder was closely correlated with females (P = 0.001), and that numbness of the upper extremity was closely correlated with age (P = 0.030) and male (P = 0.038). However, no significant correlation between the sagittal alignment of the cervical spine and clinical symptoms was detected. Sagittal alignment of the cervical spine had some impact on the progression of degenerative changes of the cervical spine with aging; however, it had no correlation with the occurrence of future clinical symptoms. PMID:19609784

Video raster stereography back shape reconstruction: a reliability study for sagittal, frontal, and transversal plane parameters.

PubMed

Schroeder, J; Reer, R; Braumann, K M

2015-02-01

As reliability of raster stereography was proved only for sagittal plane parameters with repeated measures on the same day, the present study was aiming at investigating variability and reliability of back shape reconstruction for all dimensions (sagittal, frontal, transversal) and for different intervals. For a sample of 20 healthy volunteers, intra-individual variability (SEM and CV%) and reliability (ICC ± 95% CI) were proved for sagittal (thoracic kyphosis, lumbar lordosis, pelvis tilt angle, and trunk inclination), frontal (pelvis torsion, pelvis and trunk imbalance, vertebral side deviation, and scoliosis angle), transversal (vertebral rotation), and functional (hyperextension) spine shape reconstruction parameters for different test-retest intervals (on the same day, between-day, between-week) by means of video raster stereography. Reliability was high for the sagittal plane (pelvis tilt, kyphosis and lordosis angle, and trunk inclination: ICC > 0.90), and good to high for lumbar mobility (0.86 < ICC < 0.97). Apart from sagittal plane spinal alignment, there was a lack of certainty for a high reproducibility indicated by wider ICC confidence intervals. So, reliability was fair to high for vertebral side deviation and the scoliosis angle (0.71 < ICC < 0.95), and poor to good for vertebral rotation values as well as for frontal plane upper body and pelvis position parameters (0.65 < ICC < 0.92). Coefficients for the between-day and between-week interval were a little lower than for repeated measures on the same day. Variability (SEM) was less than 1.5° or 1.5 mm, except for trunk inclination. Relative variability (CV) was greater in global trunk position and pelvis parameters (35-98%) than in scoliosis (14-20%) or sagittal sway parameters (4-8 %). Although we found a lower reproducibility for the frontal plane, raster stereography is considered to be a reliable method for the non-invasive, three-dimensional assessment of spinal alignment in normal non-scoliotic individuals in the sagittal plane and partly for scoliosis parameters, which fulfils scientific as well as practical recommendations for spine shape screening and monitoring, but cross-sectional or follow-up effect analyses should take into account the degree of reliability differing in various spine shape parameters. Further investigations should be conducted to analyse reliability in scoliosis patients with differing spinal deformities.

Lower Extremity Energy Absorption and Biomechanics During Landing, Part I: Sagittal-Plane Energy Absorption Analyses

PubMed Central

Norcross, Marc F.; Lewek, Michael D.; Padua, Darin A.; Shultz, Sandra J.; Weinhold, Paul S.; Blackburn, J. Troy

2013-01-01

Context: Eccentric muscle actions of the lower extremity absorb kinetic energy during landing. Greater total sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing has been associated with landing biomechanics considered high risk for anterior cruciate ligament (ACL) injury. We do not know whether groups with different INI EA magnitudes exhibit meaningful differences in ACL-related landing biomechanics and whether INI EA might be useful to identify ACL injury-risk potential. Objective: To compare biomechanical factors associated with noncontact ACL injury among sagittal-plane INI EA groups and to determine whether an association exists between sex and sagittal-plane INI EA group assignment to evaluate the face validity of using sagittal-plane INI EA to identify ACL injury risk. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active individuals volunteered. Intervention(s): We assessed landing biomechanics using an electromagnetic motion-capture system and force plate during a double-legged jump-landing task. Main Outcome Measure(s): Total INI EA was used to group participants into high, moderate, and low tertiles. Sagittal- and frontal-plane knee kinematics; peak vertical and posterior ground reaction forces (GRFs); anterior tibial shear force; and internal hip extension, knee extension, and knee varus moments were identified and compared across groups using 1-way analyses of variance. We used a χ2 analysis to compare male and female representation in the high and low groups. Results: The high group exhibited greater knee-extension moment and posterior GRFs than both the moderate (P < .05) and low (P < .05) groups and greater anterior tibial shear force than the low group (P < .05). No other group differences were noted. Women were not represented more than men in the high group (χ2 = 1.20, P = .27). Conclusions: Greater sagittal-plane INI EA likely indicates greater ACL loading, but it does not appear to influence frontal-plane biomechanics related to ACL injury. Women were not more likely than men to demonstrate greater INI EA, suggesting that quantification of sagittal-plane INI EA alone is not sufficient to infer ACL injury-risk potential. PMID:23944382

Lower extremity energy absorption and biomechanics during landing, part I: sagittal-plane energy absorption analyses.

PubMed

Norcross, Marc F; Lewek, Michael D; Padua, Darin A; Shultz, Sandra J; Weinhold, Paul S; Blackburn, J Troy

2013-01-01

Eccentric muscle actions of the lower extremity absorb kinetic energy during landing. Greater total sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing has been associated with landing biomechanics considered high risk for anterior cruciate ligament (ACL) injury. We do not know whether groups with different INI EA magnitudes exhibit meaningful differences in ACL-related landing biomechanics and whether INI EA might be useful to identify ACL injury-risk potential. To compare biomechanical factors associated with noncontact ACL injury among sagittal-plane INI EA groups and to determine whether an association exists between sex and sagittal-plane INI EA group assignment to evaluate the face validity of using sagittal-plane INI EA to identify ACL injury risk. Descriptive laboratory study. Research laboratory. A total of 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active individuals volunteered. We assessed landing biomechanics using an electromagnetic motion-capture system and force plate during a double-legged jump-landing task. Total INI EA was used to group participants into high, moderate, and low tertiles. Sagittal- and frontal-plane knee kinematics; peak vertical and posterior ground reaction forces (GRFs); anterior tibial shear force; and internal hip extension, knee extension, and knee varus moments were identified and compared across groups using 1-way analyses of variance. We used a χ (2) analysis to compare male and female representation in the high and low groups. The high group exhibited greater knee-extension moment and posterior GRFs than both the moderate (P < .05) and low (P < .05) groups and greater anterior tibial shear force than the low group (P < .05). No other group differences were noted. Women were not represented more than men in the high group (χ(2) = 1.20, P = .27). Greater sagittal-plane INI EA likely indicates greater ACL loading, but it does not appear to influence frontal-plane biomechanics related to ACL injury. Women were not more likely than men to demonstrate greater INI EA, suggesting that quantification of sagittal-plane INI EA alone is not sufficient to infer ACL injury-risk potential.

Measurement of lumbar spine intervertebral motion in the sagittal plane using videofluoroscopy.

PubMed

Harvey, Steven; Hukins, David; Smith, Francis; Wardlaw, Douglas; Kader, Deiary

2016-08-10

Static radiographic techniques are unable to capture the wealth of kinematic information available from lumbar spine sagittal plane motion. Demonstration of a viable non-invasive technique for acquiring and quantifying intervertebral motion of the lumbar spine in the sagittal plane. Videofluoroscopic footage of sagittal plane lumbar spine flexion-extension in seven symptomatic volunteers (mean age = 48 yrs) and one asymptomatic volunteer (age = 54 yrs) was recorded. Vertebral bodies were digitised using customised software employing a novel vertebral digitisation scheme that was minimally affected by out-of-plane motion. Measurement errors in intervertebral rotation (± 1°) and intervertebral displacement (± 0.5 mm) compare favourably with the work of others. Some subjects presenting with an identical condition (disc prolapse) exhibited a similar column vertebral flexion-extension relative to S1 (L3: max. 5.9°, min. 5.6°), while in others (degenerative disc disease) there was paradoxically a significant variation in this measurement (L3: max. 28.1°, min. 0.7°). By means of a novel vertebral digitisation scheme and customised digitisation/analysis software, sagittal plane intervertebral motion data of the lumbar spine data has been successfully extracted from videofluoroscopic image sequences. Whilst the intervertebral motion signatures of subjects in this study differed significantly, the available sample size precluded the inference of any clinical trends.

The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery.

PubMed

Boissière, Louis; Bourghli, Anouar; Vital, Jean-Marc; Gille, Olivier; Obeid, Ibrahim

2013-06-01

Sagittal malalignment is frequently observed in adult scoliosis. C7 plumb line, lumbar lordosis and pelvic tilt are the main factors to evaluate sagittal balance and the need of a vertebral osteotomy to correct it. We described a ratio: the lumbar lordosis index (ratio lumbar lordosis/pelvic incidence) (LLI) and analyzed its relationships with spinal malalignment and vertebral osteotomies. 53 consecutive patients with a surgical adult scoliosis had preoperative and postoperative full spine EOS radiographies to measure spino-pelvic parameters and LLI. The lack of lordosis was calculated after prediction of theoretical lumbar lordosis. Correlation analysis between the different parameters was performed. All parameters were correlated with spinal malalignment but LLI is the most correlated parameter (r = -0.978). It is also the best parameter in this study to predict the need of a spinal osteotomy (r = 1 if LLI <0.5). LLI is a statistically validated parameter for sagittal malalignment analysis. It can be used as a mathematical tool to detect spinal malalignment in adult scoliosis and guides the surgeon decision of realizing a vertebral osteotomy for adult scoliosis sagittal correction. It can be used as well for the interpretation of clinical series in adult scoliosis.

Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis.

PubMed

Clément, Jean-Luc; Geoffray, Anne; Yagoubi, Fatima; Chau, Edouard; Solla, Federico; Oborocianu, Ioana; Rampal, Virginie

2013-11-01

Sagittal spine and pelvic alignment of adolescent idiopathic scoliosis (AIS) is poorly described in the literature. It generally reports the sagittal alignment with regard to the type of curve and never correlated to the thoracic kyphosis. The objective of this study is to investigate the relationship between thoracic kyphosis, lumbar lordosis and sagittal pelvic parameters in thoracic AIS. Spinal and pelvic sagittal parameters were evaluated on lateral radiographs of 86 patients with thoracic AIS; patients were separated into hypokyphosis group (n = 42) and normokyphosis group (n = 44). Results were statistically analyzed. The lumbar lordosis was lower in the hypokyphosis group, due to the low proximal lordosis. The thoracic kyphosis was not correlated with any pelvic parameters but with the proximal lordosis. The pelvic incidence was correlated with sacral slope, pelvic tilt, lumbar lordosis and highly correlated with distal lumbar lordosis in the two groups. There was a significant linear regression between thoracic kyphosis and proximal lordosis and between pelvic incidence and distal lordosis. We can consider that the proximal part of the lordosis depends on the thoracic kyphosis and the distal part depends on the pelvic incidence. The hypokyphosis in AIS is independent of the pelvic parameters and could be described as a structural parameter, characteristic of the scoliotic deformity.

Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee.

PubMed

Obeid, Ibrahim; Hauger, Olivier; Aunoble, Stéphane; Bourghli, Anouar; Pellet, Nicolas; Vital, Jean-Marc

2011-09-01

It has become well recognised that sagittal balance of the spine is the result of an interaction between the spine and the pelvis. Knee flexion is considered to be the last compensatory mechanism in case of sagittal imbalance, but only few studies have insisted on the relationship between spino-pelvic parameters and lower extremity parameters. Correlation between the lack of lumbar lordosis and knee flexion has not yet been established. A retrospective study was carried out on 28 patients with major spinal deformities. The EOS system was used to measure spinal and pelvic parameters and the knee flexion angle; the lack of lumbar lordosis was calculated after prediction of lumbar lordosis with two different formulas. Correlation analysis between the different measured parameters was performed. Lumbar lordosis correlated with sacral slope (r = -0.71) and moderately with knee flexion angle (r = 0.42). Pelvic tilt correlated moderately with knee flexion angle (r = 0.55). Lack of lumbar lordosis correlated best with knee flexion angle (r = 0.72 and r = 0.63 using the two formulas, respectively). Knee flexion as a compensatory mechanism to sagittal imbalance was well correlated to the lack of lordosis and, depending on the importance of the former parameter, the best procedure to correct sagittal imbalance could be chosen.

Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America Myelopathy study.

PubMed

Smith, Justin S; Lafage, Virginie; Ryan, Devon J; Shaffrey, Christopher I; Schwab, Frank J; Patel, Alpesh A; Brodke, Darrel S; Arnold, Paul M; Riew, K Daniel; Traynelis, Vincent C; Radcliff, Kris; Vaccaro, Alexander R; Fehlings, Michael G; Ames, Christopher P

2013-10-15

Post hoc analysis of prospectively collected data. Development of methods to determine in vivo spinal cord dimensions and application to correlate preoperative alignment, myelopathy, and health-related quality-of-life scores in patients with cervical spondylotic myelopathy (CSM). CSM is the leading cause of spinal cord dysfunction. The association between cervical alignment, sagittal balance, and myelopathy has not been well characterized. This was a post hoc analysis of the prospective, multicenter AOSpine North America CSM study. Inclusion criteria for this study required preoperative cervical magnetic resonance imaging (MRI) and neutral sagittal cervical radiography. Techniques for MRI assessment of spinal cord dimensions were developed. Correlations between imaging and health-related quality-of-life scores were assessed. Fifty-six patients met inclusion criteria (mean age = 55.4 yr). The modified Japanese Orthopedic Association (mJOA) scores correlated with C2-C7 sagittal vertical axis (SVA) (r = -0.282, P = 0.035). Spinal cord volume correlated with cord length (r = 0.472, P < 0.001) and cord average cross-sectional area (r = 0.957, P < 0.001). For all patients, no correlations were found between MRI measurements of spinal cord length, volume, mean cross-sectional area or surface area, and outcomes. For patients with cervical lordosis, mJOA scores correlated positively with cord volume (r = 0.366, P = 0.022), external cord area (r = 0.399, P = 0.012), and mean cross-sectional cord area (r = 0.345, P = 0.031). In contrast, for patients with cervical kyphosis, mJOA scores correlated negatively with cord volume (r = -0.496, P = 0.043) and mean cross-sectional cord area (r = -0.535, P = 0.027). This study is the first to correlate cervical sagittal balance (C2-C7 SVA) to myelopathy severity. We found a moderate negative correlation in kyphotic patients of cord volume and cross-sectional area to mJOA scores. The opposite (positive correlation) was found for lordotic patients, suggesting a relationship of cord volume to myelopathy that differs on the basis of sagittal alignment. It is interesting to note that sagittal balance but not kyphosis is tied to myelopathy score. Future work will correlate alignment changes to cord morphology changes and myelopathy outcomes. SUMMARY STATEMENTS: This is the first study to correlate sagittal balance (C2-C7 SVA) to myelopathy severity. We found a moderate negative correlation in kyphotic patients of cord volume and cross-sectional area to mJOA scores. The opposite (positive correlation) was found for lordotic patients, suggesting a relationship of cord volume to myelopathy that differs on the basis of sagittal alignment.

Entrainment to the CIECAM02 and CIELAB colour appearance models in the human cortex.

PubMed

Thwaites, Andrew; Wingfield, Cai; Wieser, Eric; Soltan, Andrew; Marslen-Wilson, William D; Nimmo-Smith, Ian

2018-04-01

In human visual processing, information from the visual field passes through numerous transformations before perceptual attributes such as colour are derived. The sequence of transforms involved in constructing perceptions of colour can be approximated by colour appearance models such as the CIE (2002) colour appearance model, abbreviated as CIECAM02. In this study, we test the plausibility of CIECAM02 as a model of colour processing by looking for evidence of its cortical entrainment. The CIECAM02 model predicts that colour is split in to two opposing chromatic components, red-green and cyan-yellow (termed CIECAM02-a and CIECAM02-b respectively), and an achromatic component (termed CIECAM02-A). Entrainment of cortical activity to the outputs of these components was estimated using measurements of electro- and magnetoencephalographic (EMEG) activity, recorded while healthy subjects watched videos of dots changing colour. We find entrainment to chromatic component CIECAM02-a at approximately 35 ms latency bilaterally in occipital lobe regions, and entrainment to achromatic component CIECAM02-A at approximately 75 ms latency, also bilaterally in occipital regions. For comparison, transforms from a less physiologically plausible model (CIELAB) were also tested, with no significant entrainment found. Copyright © 2018 Elsevier Ltd. All rights reserved.

PubMed Central

BOLZONI, A.; MAPELLI, A.; BAJ, A.; SIDEQUERSKY, F.V; GIANNÌ, A.B.

2015-01-01

SUMMARY Seven patients who underwent mandibular reconstruction with a fibula free flap (one on the midline, six on either right or left side) and were rehabilitated with implant supported prostheses, performed free mandibular border movements (maximal mouth opening and closing, right and left lateral excursions, protrusion) that were recorded by a non-invasive motion analyser. Temporomandibular joint (TMJ) kinematic parameters were compared to those calculated in healthy control subjects using z-scores. Maximum mouth opening was reduced in all patients, with z-scores ranging from -2.742 to -0.106, and performed with a reduced sagittal plane mandibular rotation. Interincisal point forward movement during protrusion was reduced in all but one patient. Lateral mandibular movements (displacement of the interincisal point) and bilateral condylar movements during mouth opening were very variable and sometimes asymmetrical. Mandibular rotation was also variable, with z-scores ranging from -1.265 to 1.388. Together with mandibular range of motion, we investigated biomechanical characteristics of TMJ motion that can provide further information about the joint without submitting the patient to harmful procedures, and that can be followed-up during healing. The investigation indicates those areas that need to be given special attention in preoperative planning, patient information and rehabilitation. PMID:26900241

Effects of orthognathic surgery for class III malocclusion on signs and symptoms of temporomandibular disorders and on pressure pain thresholds of the jaw muscles.

PubMed

Farella, M; Michelotti, A; Bocchino, T; Cimino, R; Laino, A; Steenks, M H

2007-07-01

The aim of this longitudinal study was to determine the effects of orthognathic surgery on signs and symptoms of temporomandibular disorders (TMD) and on pressure pain thresholds (PPTs) of the jaw muscles. Fourteen consecutive class III patients undergoing pre-surgical orthodontic treatment were treated by combined Le Fort I osteotomy and bilateral sagittal ramus osteotomy. The clinical examination included the assessment of signs and symptoms of TMD and the assessment of PPTs of the masseter and temporalis muscles. Anamnestic, clinical and algometric data were collected during five sessions over a 1-year period. Seven out of 14 patients presented with disc displacement with reduction at baseline, whereas four patients (two of them were new cases) did so at the end of follow up (p>0.05). None of the patients were diagnosed with myofascial pain of the jaw muscles at the beginning or end of follow up. PPTs of the masseter and temporalis muscles did not change significantly from baseline values throughout the whole study period. The occurrence of signs and symptoms of TMD fluctuates with an unpredictable pattern after orthognathic surgery for class III malocclusions.

Uncovertebral joint injury in cervical facet dislocation: the headphones sign.

PubMed

Palmieri, Francesco; Cassar-Pullicino, Victor N; Dell'Atti, Claudia; Lalam, Radhesh K; Tins, Bernhard J; Tyrrell, Prudencia N M; McCall, Iain W

2006-06-01

The purpose of our study is to demonstrate the uncovertebral mal-alignment as a reliable indirect sign of cervical facet joint dislocation. We examined the uncovertebral axial plane alignment of 12 patients with unilateral and bilateral cervical facet joint dislocation (UCFJD and BCFJD, respectively), comparing its frequency to the reverse hamburger bun sign on CT and MR axial images. Of the seven cases with BCFJD, five clearly demonstrated the diagnostic reverse facet joint hamburger bun sign on CT and MR images, but in two cases this sign was not detectable. In the five cases with UCFJD, four demonstrated the reverse hamburger bun sign on both CT and MRI. In one case the reverse hamburger bun sign was not seen adequately with either image modality, but the facet dislocation was identified on sagittal imaging. The uncovertebral mal-alignment was detected in all 12 cases. Normally, the two components of the uncovertebral joint enjoy a concentric relationship that in the axial plane is reminiscent of the relationship of headphones with the wearer's head. We name this appearance the 'headphones' sign. Radiologists should be aware of the headphones sign as a reliable indicator of facet joint dislocation on axial imaging used in the assessment of cervical spine injuries.

A systematic review and meta-analysis of tract-based spatial statistics studies regarding attention-deficit/hyperactivity disorder.

PubMed

Chen, Lizhou; Hu, Xinyu; Ouyang, Luo; He, Ning; Liao, Yi; Liu, Qi; Zhou, Ming; Wu, Min; Huang, Xiaoqi; Gong, Qiyong

2016-09-01

Diffusion tensor imaging (DTI) studies that use tract-based spatial statistics (TBSS) have demonstrated the microstructural abnormalities of white matter (WM) in patients with attention-deficit/hyperactivity disorder (ADHD); however, robust conclusions have not yet been drawn. The present study integrated the findings of previous TBSS studies to determine the most consistent WM alterations in ADHD via a narrative review and meta-analysis. The literature search was conducted through October 2015 to identify TBSS studies that compared fractional anisotropy (FA) between ADHD patients and healthy controls. FA reductions were identified in the splenium of the corpus callosum (CC) that extended to the right cingulum, right sagittal stratum, and left tapetum. The first two clusters retained significance in the sensitivity analysis and in all subgroup analyses. The FA reduction in the CC splenium was negatively associated with the mean age of the ADHD group. We hypothesize that, in addition to the fronto-striatal-cerebellar circuit, the disturbed WM matter tracts that integrate the bilateral hemispheres and posterior-brain circuitries play a crucial role in the pathophysiology of ADHD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Sagittal imbalance treated with L5 pedicle subtraction osteotomy with short lumbar fusion from L4 to sacrum using four screws into L4 for enhanced fixation two additional vertebral screws: a technical note.

PubMed

Wangdi, Kuenzang; Otsuki, Bungo; Fujibayashi, Shunsuke; Tanida, Shimei; Masamoto, Kazutaka; Matsuda, Shuichi

2018-02-07

To report on suggested technique with four screws in a single vertebra (two pedicle screws and two direct vertebral body screws) for enhanced fixation with just one level cranially to a pedicle subtraction osteotomy (PSO). A 60-year-old woman underwent L4/5 fusion surgery for degenerative spondylolisthesis. Two years later, she was unable to stand upright even for a short time because of lumbar kyphosis caused by subsidence of the fusion cage and of Baastrup syndrome in the upper lumbar spine [sagittal vertical axis (SVA) of 114 mm, pelvic incidence of 75°, and lumbar lordosis (LL) of 41°]. She underwent short-segment fusion from L4 to the sacrum with L5 pedicle subtraction osteotomy. We reinforced the construct with two vertebral screws at L4 in addition to the conventional L4 pedicle screws. After the surgery, her sagittal parameters were improved (SVA, 36 mm; LL, 54°). Two years after the corrective surgery, she maintained a low sagittal vertical axis though high residual pelvic tilt indicated that the patient was still compensating for residual sagittal misalignment. PSO surgery for sagittal imbalance usually requires a long fusion at least two levels above and below the osteotomy site to achieve adequate stability and better global alignment. However, longer fixation may decrease the patients' quality of life and cause a proximal junctional failure. Our novel technique may shorten the fixation area after osteotomy surgery. These slides can be retrieved under Electronic Supplementary Material.

Association of baseline knee sagittal dynamic joint stiffness during gait and 2-year patellofemoral cartilage damage worsening in knee osteoarthritis.

PubMed

Chang, A H; Chmiel, J S; Almagor, O; Guermazi, A; Prasad, P V; Moisio, K C; Belisle, L; Zhang, Y; Hayes, K; Sharma, L

2017-02-01

Knee sagittal dynamic joint stiffness (DJS) describes the biomechanical interaction between change in external knee flexion moment and flexion angular excursion during gait. In theory, greater DJS may particularly stress the patellofemoral (PF) compartment and thereby contribute to PF osteoarthritis (OA) worsening. We hypothesized that greater baseline knee sagittal DJS is associated with PF cartilage damage worsening 2 years later. Participants all had OA in at least one knee. Knee kinematics and kinetics during gait were recorded using motion capture systems and force plates. Knee sagittal DJS was computed as the slope of the linear regression line for knee flexion moments vs angles during the loading response phase. Knee magnetic resonance imaging (MRI) scans were obtained at baseline and 2 years later. We assessed the association between baseline DJS and baseline-to-2-year PF cartilage damage worsening using logistic regression with generalized estimating equations (GEE). Our sample had 391 knees (204 persons): mean age 64.2 years (SD 10.0); body mass index (BMI) 28.4 kg/m 2 (5.7); 76.5% women. Baseline knee sagittal DJS was associated with baseline-to-2-year cartilage damage worsening in the lateral (OR = 5.35, 95% CI: 2.37-12.05) and any PF (OR = 2.99, 95% CI: 1.27-7.04) compartment. Individual components of baseline DJS (i.e., change in knee moment or angle) were not associated with subsequent PF disease worsening. Capturing the concomitant effect of knee kinetics and kinematics during gait, knee sagittal DJS is a potentially modifiable risk factor for PF disease worsening. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Rotation of intramedullary alignment rods affects distal femoral cutting plane in total knee arthroplasty.

PubMed

Maderbacher, Günther; Matussek, Jan; Keshmiri, Armin; Greimel, Felix; Baier, Clemens; Grifka, Joachim; Maderbacher, Hermann

2018-02-17

Intramedullary rods are widely used to align the distal femoral cut in total knee arthroplasty. We hypothesised that both coronal (varus/valgus) and sagittal (extension/flexion) cutting plane are affected by rotational changes of intramedullary femoral alignment guides. Distal femoral cuts using intramedullary alignment rods were simulated by means of a computer-aided engineering software in 4°, 6°, 8°, 10°, and 12° of valgus in relation to the femoral anatomical axis and 4° extension, neutral, as well as 4°, 8°, and 12° of flexion in relation to the femoral mechanical axis. This reflects the different angles between anatomical and mechanical axis in coronal and sagittal planes. To assess the influence of rotation of the alignment guide on the effective distal femoral cutting plane, all combinations were simulated with the rod gradually aligned from 40° of external to 40° of internal rotation. Rotational changes of the distal femoral alignment guides affect both the coronal and sagittal cutting planes. When alignment rods are intruded neutrally with regards to sagittal alignment, external rotation causes flexion, while internal rotation causes extension of the sagittal cutting plane. Simultaneously the coronal effect (valgus) decreases resulting in an increased varus of the cutting plane. However, when alignment rods are intruded in extension or flexion partly contradictory effects are observed. Generally the effect increases with the degree of valgus preset, rotation and flexion. As incorrect rotation of intramedullary alignment guides for distal femoral cuts causes significant cutting errors, exact rotational alignment is crucial. Coronal cutting errors in the distal femoral plane might result in overall leg malalignment, asymmetric extension gaps and subsequent sagittal cutting errors.

Normal variation in sagittal spinal alignment parameters in adult patients: an EOS study using serial imaging.

PubMed

Hey, Hwee Weng Dennis; Tan, Kian Loong Melvin; Moorthy, Vikaesh; Lau, Eugene Tze-Chun; Lau, Leok-Lim; Liu, Gabriel; Wong, Hee-Kit

2018-03-01

To describe normal variations in sagittal spinal radiographic parameters over an interval period and establish physiological norms and guidelines for which these images should be interpreted. Data were prospectively collected from a continuous series of adult patients with first-episode mild low back pain presenting to a single institution. The sagittal parameters of two serial radiographic images taken 6-months apart were obtained with the EOS ® slot scanner. Measured parameters include CL, TK, TL, LL, PI, PT, SS, and end and apical vertebrae. Chi-squared test and Wilcoxon Signed Rank test were used to compare categorical and continuous variables, respectively. Sixty patients with a total of 120 whole-body sagittal X-rays were analysed. Mean age was 52.1 years (SD 21.2). Mean interval between the first and second X-rays was 126.2 days (SD 47.2). Small variations (< 1°) occur for all except PT (1.2°), CL (1.2°), and SVA (2.9 cm). Pelvic tilt showed significant difference between two images (p = 0.035). Subgroup analysis based on the time interval between X-rays, and between the first and second X-rays, did not show significant differences. Consistent findings were found for end and apical vertebrae of the thoracic and lumbar spine between the first and second X-rays for sagittal curve shapes. Radiographic sagittal parameters vary between serial images and reflect dynamism in spinal balancing. SVA and PT are predisposed to the widest variation. SVA has the largest variation between individuals of low pelvic tilt. Therefore, interpretation of these parameters should be patient specific and relies on trends rather than a one-time assessment.

Radius morphology and its effects on rotation with contoured and noncontoured plating of the proximal radius.

PubMed

Rupasinghe, Shavantha L; Poon, Peter C

2012-05-01

The radius has a sagittal bow and a coronal bow. Fractures are often treated with volar anterior plating. However, the sagittal bow is often overlooked when plating. This study looks at radial morphology and the effect of plating the proximal radius with straight plates and then contoured plates bowed in the sagittal plane. We report our findings and their effect on forearm rotation. Morphology was investigated in 14 radii. Attention was paid to the proximal shaft of the radius and its sagittal bow; from this, 6-, 7-, and 8-hole plates were contoured to fit this bow. A simple transverse fracture was then made at the apex of this bow in 23 cadaver arms. Supination and pronation were compared when plating with a straight plate and a contoured plate. Ten cadavers underwent ulna plating at the same level. The effect on rotation of fractures plated in the distal-third shaft was also measured. A significant reduction in rotation was found when a proximal radius fracture was plated with a straight plate compared with a contoured plate: 10.8°, 12.8°, and 21.7° for 6-, 7-, and 8-hole plates, respectively (P < .05). Forearm rotation was decreased further when a longer plate was used. Ulna or distal shaft plating did not reduce rotation. This study has shown a significant sagittal bow of the proximal shaft of the radius. Plating this with contoured plates in the sagittal plane improves rotation when compared with straight plates. Additional ulna plating is not a source of reduced forearm rotation. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

[Sagittal otolith morphology and the relationship between its mass and the age of Liza haematocheila in the Yangtze Estuary, China].

PubMed

Ji, Yan; Zhao, Feng; Yang, Qin; Ma, Rong Rong; Yang, Gang; Zhang, Tao; Zhuang, Ping

2018-03-01

To examine the relationship of morphological characters of sagittal otolith and the age of Liza haematocheila in the Yangtze Estuary, we analyzed the morphological parameters of 324 pairs of otoliths extracted from 358 L. haematocheila specimens from the Yangtze Estuary in February to June of 2017. The results showed that sagittal otolith had rostrum, antirostrum and obvious central notch. The size and shape of sagittal otolith significantly changed with their growth, from regular melon seeds shape outline to long narrow leaf shape and increasing irregular wavy outline. The average density of sagittal otolith was 1.52 mg·mm -2 . The average rectangularity was 0.68. The length of sagittal otolith was 0.021%-0.047% of entire body length (BL), the width was 0.009%-0.021% of entire BL, and the mass was 0.045‰-0.731‰ of the entire body mass (BM). Otolith length (OL), otolith width (OW) and otolith mass (OM) were all significantly related to the BL, with the determination coefficient for OW and OM model being the highest (R 2 =0.928). The relationship between OM and BL was described best by exponential regression: OM=0.0009BL 1.8737 (R 2 =0.967). The relationships between OM and age (A), BL and A were well fitted by multinomial regressions, respectively: OM=2.9262A 2 +4.8437A+2.1894 (R 2 =0.847), BL=-3.2248A 2 +102.54A+38.373 (R 2 =0.858). In addition, OM was linearly correlated with A. The estimated otolith's ages from the model did not significantly variate from the real ages counting from annulus counts. Therefore, OM could be an effective parameter for the age estimation of L. haematocheila.

Sagittal MRI often overestimates the degree of cerebellar tonsillar ectopia: a potential for misdiagnosis of the Chiari I malformation.

PubMed

Tubbs, R Shane; Yan, Huang; Demerdash, Amin; Chern, Joshua J; Fries, Fabian N; Oskouian, Rod J; Oakes, W Jerry

2016-07-01

We hypothesized that by using coronal MRI, Chiari I malformation could be more precisely diagnosed, would provide simple anatomic landmarks, would provide information regarding asymmetry of hindbrain herniation, and would be a better method for analyzing the tonsillar herniation postoperatively when the opisthion has been removed. Fifty consecutive pediatric patients diagnosed with Chiari I malformation had comparison between the measurements of their caudally descended cerebellar tonsils on midsagittal and coronal MRI images. On MRI coronal imaging, tonsillar asymmetry was found in 48 patients. Maximal left tonsillar descent was 20.9 mm, and maximal right tonsillar descent was 17.4 mm. On MRI sagittal imaging, tonsillar descent ranged from 5 to 27.4 mm. Fifty-eight % of patients had syringomyelia. Five patients (10 %) on coronal MRI were found to have both cerebellar tonsils that were less than 3 mm below the foramen magnum. However, all of these patients had greater than 3 mm of tonsillar ectopia on sagittal imaging. Nineteen patients (38 %) on coronal MRI were found to have one of the cerebellar tonsils that were less than 3 mm below the foramen magnum. Similarly, each of these had greater than 3 mm of tonsillar ecotpia as measured on midsagittal MRI. Also, based on these findings, Chiari I malformation is almost always an asymmetrical tonsillar ectopia. Sagittal MRI overestimates the degree of tonsillar ectopia in patients with Chiari I malformation. Misdiagnosis may occur if sagittal imaging alone is used. The cerebellar tonsils are paramedian structures, and this should be kept in mind when interpreting midline sagittal MRI.

Association of Baseline Knee Sagittal Dynamic Joint Stiffness during Gait and 2-year Patellofemoral Cartilage Damage Worsening in Knee Osteoarthritis

PubMed Central

Chang, Alison H.; Chmiel, Joan S.; Almagor, Orit; Guermazi, Ali; Prasad, Pottumarthi V.; Moisio, Kirsten C.; Belisle, Laura; Zhang, Yunhui; Hayes, Karen; Sharma, Leena

2016-01-01

Objective Knee sagittal dynamic joint stiffness (DJS) describes the biomechanical interaction between change in external knee flexion moment and flexion angular excursion during gait. In theory, greater DJS may particularly stress the patellofemoral (PF) compartment and thereby contribute to PF osteoarthritis (OA) worsening. We hypothesized that greater baseline knee sagittal DJS is associated with PF cartilage damage worsening 2 years later. Methods Participants all had OA in at least one knee. Knee kinematics and kinetics during gait were recorded using motion capture systems and force plates. Knee sagittal DJS was computed as the slope of the linear regression line for knee flexion moments vs. angles during the loading response phase. Knee MRI scans were obtained at baseline and 2 years later. We assessed the association between baseline DJS and baseline-to-2-year PF cartilage damage worsening using logistic regression with generalized estimating equations. Results Our sample had 391 knees (204 persons): mean age 64.2 years (SD 10.0); BMI 28.4 kg/m2 (5.7); 76.5% women. Baseline knee sagittal DJS was associated with baseline-to-2-year cartilage damage worsening in the lateral (OR=5.35, 95% CI: 2.37–12.05) and any PF (OR=2.99, 95% CI: 1.27–7.04) compartment. Individual components of baseline DJS (i.e., change in knee moment or angle) were not associated with subsequent PF disease worsening. Conclusion Capturing the concomitant effect of knee kinetics and kinematics during gait, knee sagittal DJS is a potentially modifiable risk factor for PF disease worsening. PMID:27729289

[Evaluation of the clinical results of non-surgical treatment for pediatric sagittal fracture of mandibular condyle].

PubMed

Liu, Chang-kui; Tan, Xin-ying; Xu, Juan; Liu, Hua-wei; Liu, San-xia; Hu, Min

2013-11-01

To investigate the clinical results of occlusal splint in the treatment of sagittal fracture of mandibular condyle (SFMC) in children. Thirty-nine patients (48 condyles)aged 3-8 years with sagittal fracture of mandibular condyle were included in this study. All the patients were treated by occlusal splint.Slight open occlusion was maintained by occlusal splint for 3-6 months. Clinical and radiological examination was performed six mouths and every year after treatment. Good mandibular function was observed in 39 patients. Maximal mouth opening over 35 mm was achieved at 6 months. But 11 of the 39 patients presented with deviation on mouth opening at 6 months. The radiology showed an complete remodeling in 32 condyles (28 patients) and partial remodeling in 16 condyles (11 patients). Poor remodelling was not observed in any patients. Good clinical results can be obtained by using occlusal splint in the treatment of pediatric sagittal fracture of mandibular condyle.

A comparison of economy and sagittal plane trunk movements among back-, back/front- and head-loading.

PubMed

Hudson, Sean; Cooke, Carlton; Davies, Simeon; West, Sacha; Gamieldien, Raeeq; Low, Chris; Lloyd, Ray

2018-05-14

It has been suggested that freedom of movement in the trunk could influence load carriage economy. This study aimed to compare the economy and sagittal plane trunk movements associated with three load carriage methods that constrain posture differently. Eighteen females walked at 3 km.h -1 with loads of 0, 3, 6, 9, 12, 15 and 20 kg carried on the back, back/front and head. Load carriage economy was assessed using the Extra Load Index (ELI). Change in sagittal plane trunk forward lean and trunk angle excursion from unloaded to loaded walking were assessed. Results show no difference in economy between methods (p = 0.483), despite differences in the change in trunk forward lean (p = 0.001) and trunk angle excursion (p = 0.021) from unloaded to loaded walking. We conclude that economy is not different among the three methods of load carriage, despite significant differences in sagittal plane trunk movements.

Variations of cervical lordosis and head alignment after pedicle subtraction osteotomy surgery for sagittal imbalance.

PubMed

Cecchinato, R; Langella, F; Bassani, R; Sansone, V; Lamartina, C; Berjano, P

2014-10-01

The variations of the cervical lordosis after correction of sagittal imbalance have been poorly studied. The aim of our study is to verify whether the cervical lordosis changes after surgery for sagittal imbalance. Thirty-nine patients were included in the study. Cervical, thoracic and lumbar spine, pelvic and lower-limb sagittal parameters were recorded. The cranial alignment was measured by the newly described Cranial Slope. The global cervical kyphosis (preop -43°, postop -31.5°) and the upper (preop -24.1°, postop -20.2°) and lower cervical kyphosis (preop -18.1°, postop -9.2°) were significantly reduced after surgical realignment of the trunk. A positive linear correlation was observed between the changes in T1 slope and the lower cervical lordosis, and between T1 slope and the global cervical alignment. The cervical lordosis is reduced by surgical correction of malalignment of the trunk, suggesting an adaptive role to maintain the head's neutral position.

A Proposal of New Reference System for the Standard Axial, Sagittal, Coronal Planes of Brain Based on the Serially-Sectioned Images

PubMed Central

Park, Jin Seo; Park, Hyo Seok; Shin, Dong Sun; Har, Dong-Hwan; Cho, Zang-Hee; Kim, Young-Bo; Han, Jae-Yong; Chi, Je-Geun

2010-01-01

Sectional anatomy of human brain is useful to examine the diseased brain as well as normal brain. However, intracerebral reference points for the axial, sagittal, and coronal planes of brain have not been standardized in anatomical sections or radiological images. We made 2,343 serially-sectioned images of a cadaver head with 0.1 mm intervals, 0.1 mm pixel size, and 48 bit color and obtained axial, sagittal, and coronal images based on the proposed reference system. This reference system consists of one principal reference point and two ancillary reference points. The two ancillary reference points are the anterior commissure and the posterior commissure. And the principal reference point is the midpoint of two ancillary reference points. It resides in the center of whole brain. From the principal reference point, Cartesian coordinate of x, y, z could be made to be the standard axial, sagittal, and coronal planes. PMID:20052359

Crossed reciprocal inhibition evoked by electrical stimulation of the lamprey spinal cord.

PubMed

Fagerstedt, P; Zelenin, P V; Deliagina, T G; Orlovsky, G N; Grillner, S

2000-09-01

Activation of a motoneuron pool is often accompanied by inhibition of the antagonistic pool through a system of reciprocal inhibition between the two parts of the neuronal network controlling the antagonistic pools. In the present study, we describe the activity of such a system in the isolated spinal cord of the lamprey, when a tonic motor output is evoked by extracellular stimulation (0.5-1 s train of pulses, 20 Hz) of either end of the spinal cord. With two electrodes symmetrically positioned in relation to the midline, stimulation with either of them separately elicited prolonged (1-5 s) ipsilateral ventral root activity. Activity could be abolished by stronger, simultaneously applied, stimulation of the contralateral side of the cord, suggesting that reciprocal inhibition between hemisegments operates when a tonic motor output is generated. Simultaneous stimulation of both sides of the spinal cord with a single electrode with a large tip (300-400 microm in diameter), positioned over the anatomical midline, elicited inconsistent right-side, leftside, or bilateral ventral root responses. A minor displacement (10-20 microm) to the left or right from the midline resulted in activation of ipsilateral motoneurons, whereas the contralateral motoneurons were silent. These findings indicate that a small asymmetry in the excitatory drive to the left and right spinal hemisegments can be further amplified by reciprocal inhibition between the hemisegments. Longitudinal splitting of the spinal cord along the midline resulted in reduced reciprocal inhibition between the hemisegments separated by the lesion. The reduction was proportional to the extent of the split. The inhibition was abolished when the split reached nine segments in length. From these experiments, the longitudinal distribution of the commissural axons responsible for inhibition of contralateral motor output could be estimated.

The effects of the sagittal plane malpositioning of the patella and concomitant quadriceps hypotrophy on the patellofemoral joint: a finite element analysis.

PubMed

Aksahin, Ertugrul; Kocadal, Onur; Aktekin, Cem N; Kaya, Defne; Pepe, Murad; Yılmaz, Serdar; Yuksel, H Yalcin; Bicimoglu, Ali

2016-03-01

Anterior knee pain is a common symptom after intramedullary nailing in tibia shaft fracture. Moreover, patellofemoral malalignment is also known to be a major reason for anterior knee pain. Patellofemoral malalignment predisposes to increased loading in patellar cartilage. In the previous study, we have demonstrated the quadriceps atrophy and patellofemoral malalignment after intramedullary nailing due to tibia shaft fracture. In this study, our aim was to clarify the effects of quadriceps atrophy and patellofemoral malalignment with the pathologic loading on the joint cartilage. Mesh models of patellofemoral joint were constructed with CT images and integrated with soft tissue components such as menisci and ligaments. Physiological and sagittal tilt models during extension and flexion at 15°, 30° and 60° were created generating eight models. All the models were applied with 137 N force to present the effects of normal loading and 115.7 N force for the simulation of quadriceps atrophy. Different degrees of loading were applied to evaluate the joint contact area and pressure value with the finite element analysis. There was increased patellofemoral contact area in patellar tilt models with respect to normal models. The similar loading patterns were diagnosed in all models at 0° and 15° knee flexion when 137 N force was applied. Higher loading values were obtained at 30° and 60° knee flexions in sagittal tilt models. Furthermore, in the sagittal tilt models, in which the quadriceps atrophy was simulated, the loadings at 30° and 60° knee flexion were higher than in the physiological ones. Sagittal malalignment of the patellofemoral joint is a new concept that results in different loading patterns in the patellofemoral joint biomechanics. This malalignment in sagittal plane leads to increased loading values on the patellofemoral joint at 30° and 60° of the knee flexions. This new concept should be kept in mind during the course of diagnosis and treatment in patients with anterior knee pain. Definition of the exact biomechanical effects of the sagittal tilting will lead to the development of new treatment modalities.

How does sagittal imbalance affect the appropriateness of surgical indications and selection of procedure in the treatment of degenerative scoliosis? Findings from the RAND/UCLA Appropriate Use Criteria study.

PubMed

Daubs, Michael D; Brara, Harsimran S; Raaen, Laura B; Chen, Peggy Guey-Chi; Anderson, Ashaunta T; Asch, Steven M; Nuckols, Teryl K

2018-05-01

Degenerative lumbar scoliosis (DLS) is often associated with sagittal imbalance, which may affect patients' health outcomes before and after surgery. The appropriateness of surgery and preferred operative approaches has not been examined in detail for patients with DLS and sagittal imbalance. The goals of this article were to describe what is currently known about the relationship between sagittal imbalance and health outcomes among patients with DLS and to determine how indications for surgery in patients with DLS differ when sagittal imbalance is present. This study included a literature review and an expert panel using the RAND/University of California at Los Angeles (UCLA) Appropriateness Method. To develop appropriate use criteria for DLS, researchers at the RAND Corporation recently employed the RAND/UCLA Appropriateness Method, which involves a systematic review of the literature and multidisciplinary expert panel process. Experts reviewed a synopsis of published literature and rated the appropriateness of five common operative approaches for 260 different clinical scenarios. In the present work, we updated the literature review and compared panelists' ratings in scenarios where imbalance was present versus absent. This work was funded by the Collaborative Spine Research Foundation, a group of surgical specialty societies and device manufacturers. On the basis of 13 eligible studies that examined sagittal imbalance and outcomes in patients with DLS, imbalance was associated with worse functional status in the absence of surgery and worse symptoms and complications postoperatively. Panelists' ratings demonstrated a consistent pattern across the diverse clinical scenarios. In general, when imbalance was present, surgery was more likely to be appropriate or necessary, including in some situations where surgery would otherwise be inappropriate. For patients with moderate to severe symptoms and imbalance, a deformity correction procedure was usually appropriate and frequently necessary, except in some patients with severe risk factors for complications. Conversely, procedures that did not correct imbalance, when present, were usually inappropriate. Clinical experts agreed that sagittal imbalance is a major factor affecting both when surgery is appropriate and which type of procedure is preferred among patients with DLS. Copyright © 2018 Elsevier Inc. All rights reserved.

Navigated total knee arthroplasty: is it error-free?

PubMed

Chua, Kerk Hsiang Zackary; Chen, Yongsheng; Lingaraj, Krishna

2014-03-01

The aim of this study was to determine whether errors do occur in navigated total knee arthroplasty (TKAs) and to study whether errors in bone resection or implantation contribute to these errors. A series of 20 TKAs was studied using computer navigation. The coronal and sagittal alignments of the femoral and tibial cutting guides, the coronal and sagittal alignments of the final tibial implant and the coronal alignment of the final femoral implant were compared with that of the respective bone resections. To determine the post-implantation mechanical alignment of the limb, the coronal alignment of the femoral and tibial implants was combined. The median deviation between the femoral cutting guide and bone resection was 0° (range -0.5° to +0.5°) in the coronal plane and 1.0° (range -2.0° to +1.0°) in the sagittal plane. The median deviation between the tibial cutting guide and bone resection was 0.5° (range -1.0° to +1.5°) in the coronal plane and 1.0° (range -1.0° to +3.5°) in the sagittal plane. The median deviation between the femoral bone resection and the final implant was 0.25° (range -2.0° to 3.0°) in the coronal plane. The median deviation between the tibial bone resection and the final implant was 0.75° (range -3.0° to +1.5°) in the coronal plane and 1.75° (range -4.0° to +2.0°) in the sagittal plane. The median post-implantation mechanical alignment of the limb was 0.25° (range -3.0° to +2.0°). When navigation is used only to guide the positioning of the cutting jig, errors may arise in the manual, non-navigated steps of the procedure. Our study showed increased cutting errors in the sagittal plane for both the femur and the tibia, and following implantation, the greatest error was seen in the sagittal alignment of the tibial component. Computer navigation should be used not only to guide the positioning of the cutting jig, but also to check the bone resection and implant position during TKA. IV.

Evaluation of recovery in lip closing pressure and occlusal force and contact area after orthognathic surgery.

PubMed

Ueki, Koichiro; Moroi, Akinori; Sotobori, Megumi; Ishihara, Yuri; Marukawa, Kohei; Iguchi, Ran; Kosaka, Akihiko; Ikawa, Hiroumi; Nakazawa, Ryuichi; Higuchi, Masatoshi

2014-10-01

The purpose of this study was to evaluate the relationship between lip closing force, occlusal contact area and occlusal force after orthognathic surgery in skeletal Class III patients. The subjects consisted of 54 patients (28 female and 26 male) diagnosed with mandibular prognathism who underwent sagittal split ramus osteotomy with and without Le Fort I osteotomy. Maximum and minimum lip closing forces, occlusal contact area and occlusal force were measured pre-operatively, 6 months and 1 year post-operative. Maximum and minimum lip closing forces, occlusal contact area and occlusal force increased with time after surgery, however a significant increase was not found in the occlusal contact area in women. In increased ratio (6 months/pre-operative and 1 year/pre-operative), the maximum lip closing force was significantly correlated with the occlusal contact area (P < 0.0001). This study suggested that orthognathic surgery could improve the occlusal force, contact area and lip closing force, and an increase ratio in maximum lip closing force was associated with an increased ratio in occlusal contact area. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Backward distraction osteogenesis in a patient with severe mandibular micrognathia.

PubMed

Mitsukawa, Nobuyuki; Morishita, Tadashi; Saiga, Atsuomi; Akita, Shinsuke; Kubota, Yoshitaka; Satoh, Kaneshige

2013-09-01

Maxillary skeletal prognathism can involve severe mandibular micrognathia with marked mandibular retrognathism or hypoplasia. For patients with such a condition, a conventional treatment is mandibular advancement by sagittal split ramus osteotomy (SSRO). This procedure has problems such as insufficient advancement, instability of jaw position, and postoperative relapse. Thus, in recent years, mandibular distraction osteogenesis has been used in some patients. Mandibular distraction has many advantages, but an ideal occlusion is difficult to achieve using this procedure. That is, 3-dimensional control cannot be attained using an internal device that is unidirectional. This report describes a case of severe mandibular micrognathia in a 14-year-old girl treated using backward distraction osteogenesis. This procedure was first reported by Ishii et al (Jpn J Jaw Deform 2004; 14:49) and involves a combination of SSRO and ramus distraction osteogenesis. In the present study, intermaxillary fixation in centric occlusion was performed after osteotomy, and proximal bone segments were distracted in a posterosuperior direction. This procedure is a superior surgical technique that avoids the drawbacks of SSRO and conventional mandibular distraction. However, it applies a large load to the temporomandibular joints and requires thorough management. Thus, careful evaluation needs to be made of the indication for backward distraction osteogenesis.

Deep learning for brain tumor classification

NASA Astrophysics Data System (ADS)

Paul, Justin S.; Plassard, Andrew J.; Landman, Bennett A.; Fabbri, Daniel

2017-03-01

Recent research has shown that deep learning methods have performed well on supervised machine learning, image classification tasks. The purpose of this study is to apply deep learning methods to classify brain images with different tumor types: meningioma, glioma, and pituitary. A dataset was publicly released containing 3,064 T1-weighted contrast enhanced MRI (CE-MRI) brain images from 233 patients with either meningioma, glioma, or pituitary tumors split across axial, coronal, or sagittal planes. This research focuses on the 989 axial images from 191 patients in order to avoid confusing the neural networks with three different planes containing the same diagnosis. Two types of neural networks were used in classification: fully connected and convolutional neural networks. Within these two categories, further tests were computed via the augmentation of the original 512×512 axial images. Training neural networks over the axial data has proven to be accurate in its classifications with an average five-fold cross validation of 91.43% on the best trained neural network. This result demonstrates that a more general method (i.e. deep learning) can outperform specialized methods that require image dilation and ring-forming subregions on tumors.

X-linked hypophosphatemic rickets and sagittal craniosynostosis: three patients requiring operative cranial expansion: case series and literature review.

PubMed

Jaszczuk, Phillip; Rogers, Gary F; Guzman, Raphael; Proctor, Mark R

2016-05-01

A defect in a phosphate-regulating gene leads to the most common form of rickets: X-linked hypophosphatemic rickets (XLH) or vitamin D-resistant rickets (VDDR). XLH has been associated with craniosynostosis, the sagittal suture being the most commonly involved. We present three patients with rickets and symptomatic sagittal suture craniosynostosis all of whom presented late (>2 years of age). Two had a severe phenotype and papilledema, while the third presented with an osseous bulging near the anterior fontanel and experienced chronic headaches. All underwent successful cranial vault expansion. Rachitic patients with scaphocephaly should be screened for craniosynostosis.

Three dimensional ultrasonography for advanced neurosonography (Neurosofe-3d). Analysis of acquisition-related factors influencing the quality of the brain volumes.

PubMed

Maiz, Nerea; Alonso, Ignacio; Belar, María; Burgos, Jorge; Irasarri, Ana; Molina, Francisca S; de Paco, Catalina; Pijoan, José I; Plasencia, Walter; Rodó, Carlota; Rodríguez, M Angeles; Tajada, Mauricio; Tubau, Albert

2016-11-01

To evaluate the acquisition-related factors influencing the quality of the brain volumes for further study of advanced neurosonography. This was a prospective multicentre study. Five centres were asked to include five cases each, acquiring two volumes per case, at different gestational ages. Ten operators performed an advanced neurosonography per case. The potential influence of the following factors on the number of evaluable structures was assessed: vaginal/ abdominal acquisition, position of the head, gestational age, subjective quality of the volume and the acquiring operator itself. Four hundred and thirty-two evaluations were included in the study. A total of 80% of the structures were evaluated satisfactorily in the axial plane, 67.1% and 55.1% in the coronal and sagittal plane, respectively. Sagittal volumes acquired transvaginally had a better quality than those acquired transabdominally. Gestational age affected the quality of axial and sagittal volumes (p < 0.001), and the best quality was obtained between 20 and 27 weeks. In axial and sagittal volumes, the head position influenced the percentage of structures visualized (p < 0.001, p < 0.001). Factors affecting the quality of the volume for advanced neurosonography are gestational age, fetal head position, transvaginal acquisition in sagittal volumes, the acquiring operator and the subjective quality of the volume. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

Pilot Study for OCT Guided Design and Fit of a Prosthetic Device for Treatment of Corneal Disease.

PubMed

Le, Hong-Gam T; Tang, Maolong; Ridges, Ryan; Huang, David; Jacobs, Deborah S

2012-01-01

Purpose. To assess optical coherence tomography (OCT) for guiding design and fit of a prosthetic device for corneal disease. Methods. A prototype time domain OCT scanner was used to image the anterior segment of patients fitted with large diameter (18.5-20 mm) prosthetic devices for corneal disease. OCT images were processed and analyzed to characterize corneal diameter, corneal sagittal height, scleral sagittal height, scleral toricity, and alignment of device. Within-subject variance of OCT-measured parameters was evaluated. OCT-measured parameters were compared with device parameters for each eye fitted. OCT image correspondence with ocular alignment and clinical fit was assessed. Results. Six eyes in 5 patients were studied. OCT measurement of corneal diameter (coefficient of variation, CV = 0.76%), cornea sagittal height (CV = 2.06%), and scleral sagittal height (CV = 3.39%) is highly repeatable within each subject. OCT image-derived measurements reveal strong correlation between corneal sagittal height and device corneal height (r = 0.975) and modest correlation between scleral and on-eye device toricity (r = 0.581). Qualitative assessment of a fitted device on OCT montages reveals correspondence with slit lamp images and clinical assessment of fit. Conclusions. OCT imaging of the anterior segment is suitable for custom design and fit of large diameter (18.5-20 mm) prosthetic devices used in the treatment of corneal disease.

Increased conformity offers diminishing returns for reducing total knee replacement wear.

PubMed

Fregly, Benjamin J; Marquez-Barrientos, Carlos; Banks, Scott A; DesJardins, John D

2010-02-01

Wear remains a significant problem limiting the lifespan of total knee replacements (TKRs). Though increased conformity between TKR components has the potential to decrease wear, the optimal amount and planes of conformity have not been investigated. Furthermore, differing conformities in the medial and lateral compartments may provide designers the opportunity to address both wear and kinematic design goals simultaneously. This study used a computational model of a Stanmore knee simulator machine and a previously validated wear model to investigate this issue for simulated gait. TKR geometries with different amounts and planes of conformity on the medial and lateral sides were created and tested in two phases. The first phase utilized a wide range of sagittal and coronal conformity combinations to blanket a physically realistic design space. The second phase performed a focused investigation of the conformity conditions from the first phase to which predicted wear volume was sensitive. For the first phase, sagittal but not coronal conformity was found to have a significant effect on predicted wear volume. For the second phase, increased sagittal conformity was found to decrease predicted wear volume in a nonlinear fashion, with reductions gradually diminishing as conformity increased. These results suggest that TKR geometric design efforts aimed at minimizing wear should focus on sagittal rather than coronal conformity and that at least moderate sagittal conformity is desirable in both compartments.

Reproducibility of sagittal radiographic parameters in adolescent idiopathic scoliosis-a guide to reference values using serial imaging.

PubMed

Hey, Hwee Weng Dennis; Wong, Gordon Chengyuan; Chan, Chloe Xiaoyun; Lau, Leok-Lim; Kumar, Naresh; Thambiah, Joseph Shantakumar; Ruiz, John Nathaniel; Liu, Ka-Po Gabriel; Wong, Hee-Kit

2017-06-01

Knowledge of sagittal radiographic parameters in adolescent idiopathic scoliosis (AIS) patients has not yet caught up with our understanding of their roles in patients with adult spinal deformity. It is likely that more emphasis will be placed in restoring sagittal parameters for AIS patients in the future. Therefore, we need to understand how these parameters may vary in AIS to facilitate management plans. This study aimed to determine the reproducibility of sagittal spinal parameters on lateral film radiographs in patients with AIS. This was a retrospective, comparative study conducted in a tertiary health-care institution from January 2013 to February 2016 (3-year period). All AIS patients who underwent deformity correction surgery from January 2013 to February 2016 and had two preoperative serial lateral radiographs taken within the time period of a month were included in the study. Radiographic sagittal spinal parameters including sagittal vertical axis (SVA), cervical lordosis (CL), thoracic kyphosis (TK), thoracolumbar alignment (TL), lumbar lordosis (LL); standard spinopelvic measurements such as pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS); as well as end and apical vertebrae of cervical, thoracic, and lumbar curves were the outcome measures. All patient data were pooled from electronic medical records, and X-ray images were retrieved from Centricity Enterprise Web. Averaged X-ray measurements by two independent assessors were analyzed by comparing two radiographs of the same patients performed within a 1-month time period. Chi-squared and Wilcoxon signed-rank tests were used for categorical and continuous variables. The study cohort comprised 138 patients, 28 men and 110 women, with a mean age of 15 years (range 11-20). Between the two lateral X-rays, there was a mean difference of 0.79 cm in SVA (p<.001), 0.70° in LL (p=.033), and 0.73° in PT (p=.010). In the combined Lenke 1 and 2 subgroup, there was a similar 0.77 cm (p=.002), 0.79° (p=.009), and 1.49° (p=.001) mean difference in SVA, LL, and PT, respectively. Additionally, there was also a 1.85° (p=.009) and 1.76° (p=.006) mean difference seen in TL and SS, respectively. The overall profile of the sagittal curves remained largely similar, with only the lumbar apex shifting from L3 to L4 during the first and the second X-rays, respectively (p<.001). This occurred for the combined Lenke 1 and 2 subgroup as well (p<.001). Most radiographic sagittal spinal parameters in AIS patients are generally reproducible with some variations up to a maximum of 4°. This natural variation should be taken into account when interpreting these radiographic sagittal parameters so as to achieve the most accurate results in surgical planning. Copyright © 2017 Elsevier Inc. All rights reserved.

Three-dimensional growth dynamics of the liver in the human fetus.

PubMed

Szpinda, Michał; Paruszewska-Achtel, Monika; Woźniak, Alina; Badura, Mateusz; Mila-Kierzenkowska, Celestyna; Wiśniewski, Marcin

2015-07-01

The fetal liver is indubitably the earliest and the most severely affected organ by abnormal fetal growth. The size of the fetal liver assessed by three-dimensional ultrasonography is indispensable in determining the status of fetal growth, nutrition and maturity, and in the early recognition and monitoring fetal micro- and macrosomias. The aim of the present study was to measure the human fetal liver length, transverse and sagittal diameters to establish their age-specific reference intervals, the 3rd, 10th, 50th, 90th, and 97th smoothed centile curves, and the relative growth of the liver calculated for the 50th centile. Using anatomical, digital (NIS-Elements AR 3.0, Nikon) and statistical methods (one-way ANOVA test for paired data and post hoc RIR Tukey test, Shapiro-Wilk test, Fisher's test, Student's t test, the Altman-Chitty method), length, transverse and sagittal diameters of the liver for the 3rd, 10th, 50th, 90th, and 97th centiles were assessed in 69 human fetuses of both sexes (32 males and 37 females) aged 18-30 weeks, derived from spontaneous abortions or stillbirths. No male-female differences (P > 0.05) concerning the three parameters studied were found. During the study period, the fetal liver increased tri-dimensionally: in length from 19.51 ± 1.02 to 39.65 ± 7.05 mm, in transverse diameter from 29.44 ± 3.73 to 53.13 ± 5.31 mm, and in sagittal diameter from 22.97 ± 3.79 to 43.22 ± 5.49 mm. The natural logarithmic models were found to fit the data with gestational age (P < 0.001) in the following five cutoff points: 3rd, 10th, 50th, 90th and 97th centiles. The values of liver parameters in relation to gestational age in weeks were calculated by the following logarithmic regressions: y = -82.778 + 35.752 × ln(age) ± Z × (-2.778 + 0.308 × age) for liver length, y = -123.06 + 52.668 × ln(age) ± Z × (3.156 + 0.049 × age) for liver transverse diameter, and y = -108.94 + 46.052 × ln(age) ± Z × (-0.541 + 0.188 × age) for liver sagittal diameter. For the 50th centile, at the range of 18-30 weeks, the growth rates per week were gradually decreasing from 1.93 to 1.21 mm for length, from 2.85 to 1.79 mm for transverse diameter, and from 2.49 to 1.56 mm for sagittal diameter of the liver (P < 0.05). During the study period both the length-to-transverse diameter ratio and the sagittal-to-transverse diameter ratio of the liver changed little, attaining the values of 0.71 ± 0.11 and 0.87 ± 0.12, respectively. The fetal liver does not reveal sex differences in its length, transverse and sagittal diameters. The fetal liver length, transverse and sagittal diameters grow logarithmically. The regression equations for the estimation of the mean and standard deviation of liver length, transverse and sagittal diameters allow for calculating any desired centiles according to gestational age. The three-dimensional evolution of the fetal liver follows proportionately. The age-specific reference intervals for evolving liver length, transverse and sagittal diameters constitute the normative values of potential relevance in monitoring normal fetal development and screening for disturbances in fetal growth.

Are There Age- and Sex-related Differences in Spinal Sagittal Alignment and Balance Among Taiwanese Asymptomatic Adults?

PubMed

Yeh, Kuang-Ting; Lee, Ru-Ping; Chen, Ing-Ho; Yu, Tzai-Chiu; Peng, Cheng-Huan; Liu, Kuan-Lin; Wang, Jen-Hung; Wu, Wen-Tien

2018-05-01

Sagittal spinopelvic balance and proper sagittal alignment are important when planning corrective or reconstructive spinal surgery. Prior research suggests that people from different races and countries have moderate divergence; to the best of our knowledge, the population of Taiwan has not been studied with respect to this parameter. To investigate normal age- and sex-related differences in whole-spine sagittal alignment and balance of asymptomatic adults without spinal disorders. In this prospective study, we used convenience sampling to recruit asymptomatic volunteers who accompanied patients in the outpatient orthopaedic department. One hundred forty males with a mean age of 48 ± 19 years and 252 females with a mean age of 53 ± 17 years underwent standing lateral radiographs of the whole spine. For analysis, participants were divided in three groups by age (20 to 40 years, 41 to 60 years, and 61 to 80 years) and analyzed by sex (male and female). The following eight radiologic parameters were measured: sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, cervical lordosis, C2-C7 sagittal vertical axis, and C7-S1 sagittal vertical axis. Three observers performed estimations of the sagittal parameters twice, and the intraclass correlation coefficients for inter- and intraobserver variability were 0.81 and 0.83. The mean pelvic incidence was 49° ± 12°; lumbar lordosis was smaller in the group that was 61 to 80 years old than in the groups that were 20 to 40 years and 41 to 60 years (95% CI of the difference, 4.50-13.64 and 1.00- 9.60; p < 0.001), while cervical lordosis was greater in the 61 to 80 years age group than the other two groups (95% CI of the difference, -14.64 to -6.57 and -11.57 to -3.45; p < 0.001). The mean C7-S1 sagittal vertical axis was 30 ± 29 mm, and there was no difference among the three groups and between males and females. Pelvic tilt was greater in the group 61 to 80 years old than the 20 to 40 years and 41 to 60 years age groups (95% CI of the difference, -10.81 to -5.42 and -7.15 to -2.08; p < 0.001), while sacral slope was larger in 61 to 80 years age group than in the 41 to 60 years group (95% CI of the difference, 0.79-6.25; p = 0.006). C7 slope was greater in 61 to 80 years age group than in the 20 to 40 years group (95% CI of the difference, -7.49 to -1.26; p = 0.002) and larger in 41 to 60 years age group than in 20 to 40 years group (95% CI of the difference, -6.31 to -0.05; p = 0.045). C2-C7 sagittal vertical axis was greater in males than in females (95% CI of the difference, 2.84-7.74; p < 0.001). C7 slope was negatively correlated with thoracic kyphosis (95% CI of the difference, -0.619 to 0.468; p < 0.001) and lumbar lordosis (95% CI of the difference, -0.356 to -0.223; p < 0.001), and positively correlated with pelvic incidence (95% CI of the difference, 0.058- 0.215; p < 0.001) and cervical lordosis (95% CI of the difference, 0.228 - 0.334; p < 0.001). Normal values of the spinopelvic sagittal parameters vary by age and sex in Taiwanese individuals. Pelvic incidence and sacral slope observed in this population seemed smaller than those reported in other studies of white populations; this seems important when considering spine surgery in Taiwanese patients. Future studies should include collection of whole body sagittal parameters of larger and more-diverse populations, and assessments of patients with symptomatic spinal disorders.

Three dimensional structure of the distal condyles of the third metacarpal bone of the horse.

PubMed

Boyde, A; Haroon, Y; Jones, S J; Riggs, C M

1999-03-01

This study examined the three-dimensional (3D) microarchitecture of regions of the equine third metacarpal bone (McIII) commonly involved in distal condylar fractures. Limbs were obtained from Thoroughbred horses (neonates to age 24 years) destroyed for inoperable fractures and a variety of other conditions. Beams, blocks and sections were cut in the principal axes, some embedded in PMMA and others examined unembedded. Several methods were used to study the 3D structure, including conventional and confocal optical microscopy, scanning electron microscopy (SEM) and radiography. The mineralised articular cartilage tends to cleave in the sagittal plane. Proximal to the subchondral bone, the main trabeculae are robust plates running in the sagittal direction with less significant mediolateral connections. Small blood vessel canals lie inside the sagittal plates. This structure gives maximum strength and protection in the sagittal plane in which the bone rotates, but offers minimal resistance to fracture propagation in this plane. The anatomical course of the common distal condylar fractures of the third metacarpal bones can be explained by underlying anisotropic structural features of the mineralised tissues.

[Extramedullary fixation combined with intramedullary fixation in the surgical reduction of sagittal mandibular condylar fractures].

PubMed

Chuanjun, Chen; Xiaoyang, Chen; Jing, Chen

2016-10-01

This study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures. Twenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination. Postoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening. Extramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.

Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children.

PubMed

Liu, Chang-Kui; Meng, Fan-Wen; Tan, Xin-Ying; Xu, Juan; Liu, Hua-Wei; Liu, San-Xia; Huang, Hai-Tao; Yan, Rong-Zeng; Hu, Min; Hu, Kai-Jin

2014-02-01

This study was designed to investigate the effects of occlusal splints in the treatment of sagittal fractures of the mandibular condyle in children. From January 1995 to December 2011, 37 sagittal fractures of the mandibular condyle in 30 patients aged 4-8 years old were included in this study. All the patients were treated with 1-2mm occlusal splints in the molar region. The mouths of the patients were kept slightly open by the occlusal splints for 3-6 months, and we reviewed the clinical and radiological remodelling of the affected condyles after treatment. Excellent (n=20) and good (n=10) clinical outcomes were achieved with full radiological remodelling seen in 19 and partial remodelling in 11. Treatment with occlusal splints is effective in delivering good results and function with minimal morbidity in children with sagittal fractures of the condyle, while permitting ongoing remodelling and growth in the short term. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Bent Bragg–Laue monochromator for high-energy X-rays

DOE PAGES

Shi, Xianbo; Xu, Wenqian; Yakovenko, Andrey; ...

2017-07-26

A bent Bragg–Laue monochromator (BLM) is proposed for high-energy X-ray (~25–60 keV) beamlines. The BLM has the unique feature of bi-directional focusing. A sagittally bent Laue crystal can focus the large horizontal fan of a bending magnet or wiggler source. A meridionally bent Bragg crystal focuses the beam vertically and corrects for the anticlastic bending effects of the Laue crystal. This monochromator geometry relies on the crystal orientations being optimized. We show that the focusing condition and Rowland condition can be simultaneously satisfied at a given energy. A detailed ray tracings indicate that a BLM can provide similar energy resolutionmore » and higher flux density compared to a sagittally bent double-Laue monochromator configuration. A prototype BLM with a symmetric Bragg crystal and an asymmetric Laue crystal was tested. Matching of the bend radii of the two crystals in the meridional direction was demonstrated. Generally, the horizontal acceptance of the sagittally bent Laue crystal is limited by the large curvature. This horizontal BLM acceptance could be increased by translating the Laue crystal along its sagittal bending axis.« less

Bent Bragg–Laue monochromator for high-energy X-rays

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shi, Xianbo; Xu, Wenqian; Yakovenko, Andrey

A bent Bragg–Laue monochromator (BLM) is proposed for high-energy X-ray (~25–60 keV) beamlines. The BLM has the unique feature of bi-directional focusing. A sagittally bent Laue crystal can focus the large horizontal fan of a bending magnet or wiggler source. A meridionally bent Bragg crystal focuses the beam vertically and corrects for the anticlastic bending effects of the Laue crystal. This monochromator geometry relies on the crystal orientations being optimized. We show that the focusing condition and Rowland condition can be simultaneously satisfied at a given energy. A detailed ray tracings indicate that a BLM can provide similar energy resolutionmore » and higher flux density compared to a sagittally bent double-Laue monochromator configuration. A prototype BLM with a symmetric Bragg crystal and an asymmetric Laue crystal was tested. Matching of the bend radii of the two crystals in the meridional direction was demonstrated. Generally, the horizontal acceptance of the sagittally bent Laue crystal is limited by the large curvature. This horizontal BLM acceptance could be increased by translating the Laue crystal along its sagittal bending axis.« less

Can axial-based nodal size criteria be used in other imaging planes to accurately determine "enlarged" head and neck lymph nodes?

PubMed

Bartlett, Eric S; Walters, Thomas D; Yu, Eugene

2013-01-01

Objective. We evaluate if axial-based lymph node size criteria can be applied to coronal and sagittal planes. Methods. Fifty pretreatment computed tomographic (CT) neck exams were evaluated in patients with head and neck squamous cell carcinoma (SCCa) and neck lymphadenopathy. Axial-based size criteria were applied to all 3 imaging planes, measured, and classified as "enlarged" if equal to or exceeding size criteria. Results. 222 lymph nodes were "enlarged" in one imaging plane; however, 53.2% (118/222) of these were "enlarged" in all 3 planes. Classification concordance between axial versus coronal/sagittal planes was poor (kappa = -0.09 and -0.07, resp., P < 0.05). The McNemar test showed systematic misclassification when comparing axial versus coronal (P < 0.001) and axial versus sagittal (P < 0.001) planes. Conclusion. Classification of "enlarged" lymph nodes differs between axial versus coronal/sagittal imaging planes when axial-based nodal size criteria are applied independently to all three imaging planes, and exclusively used without other morphologic nodal data.

Can Axial-Based Nodal Size Criteria Be Used in Other Imaging Planes to Accurately Determine “Enlarged” Head and Neck Lymph Nodes?

PubMed Central

Bartlett, Eric S.; Walters, Thomas D.; Yu, Eugene

2013-01-01

Objective. We evaluate if axial-based lymph node size criteria can be applied to coronal and sagittal planes. Methods. Fifty pretreatment computed tomographic (CT) neck exams were evaluated in patients with head and neck squamous cell carcinoma (SCCa) and neck lymphadenopathy. Axial-based size criteria were applied to all 3 imaging planes, measured, and classified as “enlarged” if equal to or exceeding size criteria. Results. 222 lymph nodes were “enlarged” in one imaging plane; however, 53.2% (118/222) of these were “enlarged” in all 3 planes. Classification concordance between axial versus coronal/sagittal planes was poor (kappa = −0.09 and −0.07, resp., P < 0.05). The McNemar test showed systematic misclassification when comparing axial versus coronal (P < 0.001) and axial versus sagittal (P < 0.001) planes. Conclusion. Classification of “enlarged” lymph nodes differs between axial versus coronal/sagittal imaging planes when axial-based nodal size criteria are applied independently to all three imaging planes, and exclusively used without other morphologic nodal data. PMID:23984099

A microcontroller-based simulation of dural venous sinus injury for neurosurgical training.

PubMed

Cleary, Daniel R; Siler, Dominic A; Whitney, Nathaniel; Selden, Nathan R

2018-05-01

OBJECTIVE Surgical simulation has the potential to supplement and enhance traditional resident training. However, the high cost of equipment and limited number of available scenarios have inhibited wider integration of simulation in neurosurgical education. In this study the authors provide initial validation of a novel, low-cost simulation platform that recreates the stress of surgery using a combination of hands-on, model-based, and computer elements. Trainee skill was quantified using multiple time and performance measures. The simulation was initially validated using trainees at the start of their intern year. METHODS The simulation recreates intraoperative superior sagittal sinus injury complicated by air embolism. The simulator model consists of 2 components: a reusable base and a disposable craniotomy pack. The simulator software is flexible and modular to allow adjustments in difficulty or the creation of entirely new clinical scenarios. The reusable simulator base incorporates a powerful microcomputer and multiple sensors and actuators to provide continuous feedback to the software controller, which in turn adjusts both the screen output and physical elements of the model. The disposable craniotomy pack incorporates 3D-printed sections of model skull and brain, as well as artificial dura that incorporates a model sagittal sinus. RESULTS Twelve participants at the 2015 Western Region Society of Neurological Surgeons postgraduate year 1 resident course ("boot camp") provided informed consent and enrolled in a study testing the prototype device. Each trainee was required to successfully create a bilateral parasagittal craniotomy, repair a dural sinus tear, and recognize and correct an air embolus. Participant stress was measured using a heart rate wrist monitor. After participation, each resident completed a 13-question categorical survey. CONCLUSIONS All trainee participants experienced tachycardia during the simulation, although the point in the simulation at which they experienced tachycardia varied. Survey results indicated that participants agreed the simulation was realistic, created stress, and was a useful tool in training neurosurgical residents. This simulator represents a novel, low-cost approach for hands-on training that effectively teaches and tests residents without risk of patient injury.

Reliability of Beta angle in assessing true anteroposterior apical base discrepancy in different growth patterns

PubMed Central

Sundareswaran, Shobha; Kumar, Vinay

2015-01-01

Introduction: Beta angle as a skeletal anteroposterior dysplasia indicator is known to be useful in evaluating normodivergent growth patterns. Hence, we compared and verified the accuracy of Beta angle in predicting sagittal jaw discrepancy among subjects with hyperdivergent, hypodivergent and normodivergent growth patterns. Materials and Methods: Lateral cephalometric radiographs of 179 patients belonging to skeletal Classes I, II, and III were further divided into normodivergent, hyperdivergent, and hypodivergent groups based on their vertical growth patterns. Sagittal dysplasia indicators - angle ANB, Wits appraisal, and Beta angle values were measured and tabulated. The perpendicular point of intersection on line CB (Condylion-Point B) in Beta angle was designated as ‘X’ and linear dimension XB was evaluated. Results: Statistically significant increase was observed in the mean values of Beta angle and XB distance in the vertical growth pattern groups of both skeletal Class I and Class II patients thus pushing them toward Class III and Class I, respectively. Conclusions: Beta angle is a reliable indicator of sagittal dysplasia in normal and horizontal patterns of growth. However, vertical growth patterns significantly increased Beta angle values, thus affecting their reliability as a sagittal discrepancy assessment tool. Hence, Beta angle may not be a valid tool for assessment of sagittal jaw discrepancy in patients exhibiting vertical growth patterns with skeletal Class I and Class II malocclusions. Nevertheless, Class III malocclusions having the highest Beta angle values were unaffected. PMID:25810649

An algorithm based on OmniView technology to reconstruct sagittal and coronal planes of the fetal brain from volume datasets acquired by three-dimensional ultrasound.

PubMed

Rizzo, G; Capponi, A; Pietrolucci, M E; Capece, A; Aiello, E; Mammarella, S; Arduini, D

2011-08-01

To describe a novel algorithm, based on the new display technology 'OmniView', developed to visualize diagnostic sagittal and coronal planes of the fetal brain from volumes obtained by three-dimensional (3D) ultrasonography. We developed an algorithm to image standard neurosonographic planes by drawing dissecting lines through the axial transventricular view of 3D volume datasets acquired transabdominally. The algorithm was tested on 106 normal fetuses at 18-24 weeks of gestation and the visualization rates of brain diagnostic planes were evaluated by two independent reviewers. The algorithm was also applied to nine cases with proven brain defects. The two reviewers, using the algorithm on normal fetuses, found satisfactory images with visualization rates ranging between 71.7% and 96.2% for sagittal planes and between 76.4% and 90.6% for coronal planes. The agreement rate between the two reviewers, as expressed by Cohen's kappa coefficient, was > 0.93 for sagittal planes and > 0.89 for coronal planes. All nine abnormal volumes were identified by a single observer from among a series including normal brains, and eight of these nine cases were diagnosed correctly. This novel algorithm can be used to visualize standard sagittal and coronal planes in the fetal brain. This approach may simplify the examination of the fetal brain and reduce dependency of success on operator skill. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Can a Single Sagittal Magnetic Resonance Imaging Slice Represent Whole Fatty Infiltration in Chronic Rotator Cuff Tears at the Supraspinatus?

PubMed

Lee, Yong-Beom; Yang, Cheol-Jung; Li, Cheng Zhen; Zhuan, Zhong; Kwon, Seung-Cheol; Noh, Kyu-Cheol

2018-03-01

This study aimed to investigate whether fatty infiltration (FI) measured on a single sagittal magnetic resonance imaging (MRI) slice can represent FI of the whole supraspinatus muscle. This study retrospectively reviewed the MRIs of 106 patients (age 50-79 years) divided into three rotator cuff tear-size groups: medium, large, and massive. Fat mass and muscle mass on all T1-weighted sagittal MRI scans (FA and MA) were measured. Of the total MRI scans, the Y-view was defined as the most lateral image of the junction of the scapular spine with the scapular body on the oblique sagittal T1-weighted image. Fat mass and muscle mass seen on this Y-view single slice were recorded as F1 and M1, respectively. Fat mass and muscle mass were also assessed on MRI scans lateral and medial to the Y-view. The means of fat mass and muscle mass on these three slices were recorded as F3 and M3, respectively. Average FI ratios (fat mass/muscle mass) of the three assessment methods (F1/M1, FA/MA, and F3/M3) were compared. Intraclass correlation coefficients (ICCs) were calculated for inter- and intraobserver reliability. ICCs showed higher reliability (> 0.8) for all measurements. F1/M1 values were not statistically different from FA/MA and F3/M3 values ( p > 0.05), except in males with medium and large tears. F3/M3 and FA/MA were not statistically different. The difference between F1/M1 and FA/MA did not exceed 2%. A single sagittal MRI slice can represent the whole FI in chronic rotator cuff tears, except in some patient groups. We recommend measurement of FI using a single sagittal MRI slice, given the effort required for repeated measurements.

Can a Single Sagittal Magnetic Resonance Imaging Slice Represent Whole Fatty Infiltration in Chronic Rotator Cuff Tears at the Supraspinatus?

PubMed Central

Lee, Yong-Beom; Yang, Cheol-Jung; Li, Cheng Zhen; Zhuan, Zhong; Kwon, Seung-Cheol

2018-01-01

Background This study aimed to investigate whether fatty infiltration (FI) measured on a single sagittal magnetic resonance imaging (MRI) slice can represent FI of the whole supraspinatus muscle. Methods This study retrospectively reviewed the MRIs of 106 patients (age 50–79 years) divided into three rotator cuff tear-size groups: medium, large, and massive. Fat mass and muscle mass on all T1-weighted sagittal MRI scans (FA and MA) were measured. Of the total MRI scans, the Y-view was defined as the most lateral image of the junction of the scapular spine with the scapular body on the oblique sagittal T1-weighted image. Fat mass and muscle mass seen on this Y-view single slice were recorded as F1 and M1, respectively. Fat mass and muscle mass were also assessed on MRI scans lateral and medial to the Y-view. The means of fat mass and muscle mass on these three slices were recorded as F3 and M3, respectively. Average FI ratios (fat mass/muscle mass) of the three assessment methods (F1/M1, FA/MA, and F3/M3) were compared. Intraclass correlation coefficients (ICCs) were calculated for inter- and intraobserver reliability. Results ICCs showed higher reliability (> 0.8) for all measurements. F1/M1 values were not statistically different from FA/MA and F3/M3 values (p > 0.05), except in males with medium and large tears. F3/M3 and FA/MA were not statistically different. The difference between F1/M1 and FA/MA did not exceed 2%. Conclusions A single sagittal MRI slice can represent the whole FI in chronic rotator cuff tears, except in some patient groups. We recommend measurement of FI using a single sagittal MRI slice, given the effort required for repeated measurements. PMID:29564048

Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis.

PubMed

Iyer, Rajiv R; Wu, Adela; Macmillan, Alexandra; Musavi, Leila; Cho, Regina; Lopez, Joseph; Jallo, George I; Dorafshar, Amir H; Ahn, Edward S

2018-01-01

Cranial vault remodeling surgery for craniosynostosis carries the potential risk of dural venous sinus injury given the extensive bony exposure. Identification of the dural venous sinuses can be challenging in patients with craniosynostosis given the lack of accurate surface-localizing landmarks. Computer-aided design and manufacturing (CAD/CAM) has allowed surgeons to pre-operatively plan these complex procedures in an effort to increase reconstructive efficiency. An added benefit of this technology is the ability to intraoperatively map the dural venous sinuses based on pre-operative imaging. We utilized CAD/CAM technology to intraoperatively map the dural venous sinuses for patients undergoing reconstructive surgery for craniosynostosis in an effort to prevent sinus injury, increase operative efficiency, and enhance patient safety. Here, we describe our experience utilizing this intraoperative technology in pediatric patients with craniosynostosis. We retrospectively reviewed the charts of children undergoing reconstructive surgery for craniosynostosis using CAD/CAM surgical planning guides at our institution between 2012 and 2016. Data collected included the following: age, gender, type of craniosynostosis, estimated blood loss, sagittal sinus deviation from the sagittal suture, peri-operative outcomes, and hospital length of stay. Thirty-two patients underwent reconstructive cranial surgery for craniosynostosis, with a median age of 11 months (range, 7-160). Types of synostosis included metopic (6), unicoronal (6), sagittal (15), lambdoid (1), and multiple suture (4). Sagittal sinus deviation from the sagittal suture was maximal in unicoronal synostosis patients (10.2 ± 0.9 mm). All patients tolerated surgery well, and there were no occurrences of sagittal sinus, transverse sinus, or torcular injury. The use of CAD/CAM technology allows for accurate intraoperative dural venous sinus localization during reconstructive surgery for craniosynostosis and enhances operative efficiency and surgeon confidence while minimizing the risk of patient morbidity.

How to measure kyphosis in everyday clinical practice: a reliability study on different methods.

PubMed

Zaina, Fabio; Donzelli, Sabrina; Lusini, Monia; Negrini, Stefano

2012-01-01

The sagittal plane measures have a relevant role both in Idiopathic Scoliosis (AIS) and in Hyperkyphosis (HK) management. Nevertheless, clinical tools for everyday use are scarce and not adequately studied. To assess the repeatability of different methods for the collection of the sagittal profile of patients with spinal deformities during everyday clinics. We performed 4 different studies in 4 different populations of AIS and HK patients. In the first study we reported the normative data and measurement error of the plumbline measures in a general population of 180 adolescents. In the second study we compared the sagittal distances from the plumbline of C7, T12, L3, and Sagittal Index (SI = C7+L3) with the measures of the Video Rasterstereography at the same levels and the angles of kyphosis and lordosis in 100 AIS patients. In the third study we evaluated the intra and inter-rater repeatability and the measurement error of kyphosis and lordosis angles measured with the Inclimed in 100 AIS patients. In the last study we evaluated the repeatability of the sagittal distances from the plumbline, by using a 1 mm change instead of 5 mm in a population of 40 patients. repeatability has been evaluated according to Bland and Altman, to identify the limits of variation that are clinically significant. Results. Study 1: the normative data were: females: 34 ± 11 mm for C7; 34 ± 15 mm for L3, males: 34 ± 10 mm for C7; 48 ± 10 mm for L3;. Study 2: a coefficient of correlation was calculated in order to compare measures. Study 3: the k value for Inclimed varied from fair to good. Study 4: the repeatability was fair for this measure. Some clinical instruments are now available for sagittal plane assessment in AIS and hyperkyphosis. The results of the present study report the limits during measurements in a clinical setting of parameters that are routinely collected by some clinicians.

Sci-Thur AM: YIS – 03: Combining sagittally-reconstructed 3D and live-2D ultrasound for high-dose-rate prostate brachytherapy needle segmentation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hrinivich, Thomas; Hoover, Douglas; Surry, Kathlee

Ultrasound-guided high-dose-rate prostate brachytherapy (HDR-BT) needle segmentation is performed clinically using live-2D sagittal images. Organ segmentation is then performed using axial images, introducing a source of geometric uncertainty. Sagittally-reconstructed 3D (SR3D) ultrasound enables both needle and organ segmentation, but suffers from shadow artifacts. We present a needle segmentation technique augmenting SR3D with live-2D sagittal images using mechanical probe tracking to mitigate image artifacts and compare it to the clinical standard. Seven prostate cancer patients underwent TRUS-guided HDR-BT during which the clinical and proposed segmentation techniques were completed in parallel using dual ultrasound video outputs. Calibrated needle end-length measurements were usedmore » to calculate insertion depth errors (IDEs), and the dosimetric impact of IDEs was evaluated by perturbing clinical treatment plan source positions. The proposed technique provided smaller IDEs than the clinical approach, with mean±SD of −0.3±2.2 mm and −0.5±3.7mm respectively. The proposed and clinical techniques resulted in 84% and 43% of needles with IDEs within ±3mm, and IDE ranges across all needles of [−7.7mm, 5.9mm] and [−9.3mm, 7.7mm] respectively. The proposed and clinical IDEs lead to mean±SD changes in the volume of the prostate receiving the prescription dose of −0.6±0.9% and −2.0±5.3% respectively. The proposed technique provides improved HDR-BT needle segmentation accuracy over the clinical technique leading to decreased dosimetric uncertainty by eliminating the axial-to-sagittal registration, and mitigates the effect of shadow artifacts by incorporating mechanically registered live-2D sagittal images.« less

How is sagittal balance acquired during bipedal gait acquisition? Comparison of neonatal and adult pelves in three dimensions. Evolutionary implications.

PubMed

Tardieu, Christine; Bonneau, Noémie; Hecquet, Jérôme; Boulay, Christophe; Marty, Catherine; Legaye, Jean; Duval-Beaupère, Geneviève

2013-08-01

We compare adult and intact neonatal pelves, using a pelvic sagittal variable, the angle of sacral incidence, which presents significant correlations with vertebral curvature in adults and plays an important role in sagittal balance of the trunk on the lower limbs. Since the lumbar curvature develops in the child in association with gait acquisition, we expect a change in this angle during growth which could contribute to the acquisition of sagittal balance. To understand the mechanisms underlying the sagittal balance in the evolution of human bipedalism, we also measure the angle of incidence of hominid fossils. Fourty-seven landmarks were digitized on 50 adult and 19 intact neonatal pelves. We used a three-dimensional model of the pelvis (DE-VISU program) which calculates the angle of sacral incidence and related functional variables. Cross-sectional data from newborns and adults show that the angle of sacral incidence increases and becomes negatively correlated with the sacro-acetabular distance. During ontogeny the sacrum becomes curved, tends to sink down between the iliac blades as a wedge and moves backward in the sagittal plane relative to the acetabula, thus contributing to the backwards displacement of the center of gravity of the trunk. A chain of correlations links the degree of the sacral slope and of the angle of incidence, which is tightly linked with the lumbar lordosis. We sketch a model showing the coordinated changes occurring in the pelvis and vertebral column during the acquisition of bipedalism in infancy. In the australopithecine pelves, Sts 14 and AL 288-1, and in the Homo erectus Gona pelvis the angle of sacral incidence reaches the mean values of humans. Discussing the incomplete pelves of Ardipithecus ramidus, Australopithecus sediba and the Nariokotome Boy, we suggest how the functional linkage between pelvis and spine, observed in humans, could have emerged during hominid evolution. Copyright © 2013 Elsevier Ltd. All rights reserved.

Impact of Cervical Sagittal Alignment on Axial Neck Pain and Health-related Quality of Life After Cervical Laminoplasty in Patients With Cervical Spondylotic Myelopathy or Ossification of the Posterior Longitudinal Ligament: A Prospective Comparative Study.

PubMed

Fujiwara, Hiroyasu; Oda, Takenori; Makino, Takahiro; Moriguchi, Yu; Yonenobu, Kazuo; Kaito, Takashi

2018-05-01

This is prospective observational study. To prospectively investigate the correlation among axial neck pain; a newly developed patient-based quality of life outcome measure, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ); and cervical sagittal alignment after open-door laminoplasty for cervical myelopathy. Many studies have focused on postoperative axial neck pain after laminoplasty. However, the correlation among cervical sagittal alignment, neck pain, and JOACMEQ has not been investigated. In total, 57 consecutive patients treated by open-door laminoplasty for cervical myelopathy were included (mean age, 63.7 y; 15 women and 42 men) and divided into 2 groups according to diagnosis [cervical spondylotic myelopathy (CSM) group: 35 patients, and ossification of the posterior longitudinal ligament (OPLL) group: 22 patients]. JOA score, a subdomain of cervical spine function (CSF) in the JOACMEQ, and the visual analog scale for axial neck pain were assessed preoperatively and 12 months postoperatively. Radiographic cervical sagittal parameters were measured by C2 sagittal vertical axis (C2 SVA), C2-C7 lordosis, C7 sagittal slope (C7 slope), and range of motion. C2 SVA values in both groups shifted slightly anteriorly between preoperative and 12-month postoperative measurements (CSM: +19.7±10.9 mm; OPLL: +22.1±13.4 mm vs. CSM: +23.2±16.1 mm; OPLL: +28.7±15.4 mm, respectively). Postoperative axial neck pain in the OPLL group showed strong negative correlations with C2 SVA and C7 slope. Strong negative correlations were found between axial neck pain and CSF in both the preoperative CSM and OPLL groups (CSM: r=-0.45, P=0.01; OPLL: r=-0.61, P<0.01) and between axial neck pain and CSF in the postoperative OPLL group (r=-0.51, P=0.05). This study demonstrated a significant negative correlation between neck pain and CSF in both the CSM and OPLL groups preoperatively and in the OPLL group postoperatively. Radiographic cervical sagittal alignment did not significantly correlate with preoperative or postoperative axial neck pain.

Sagittal Balance in Adolescent Idiopathic Scoliosis

PubMed Central

Xu, Xi-Ming; Wang, Fei; Zhou, Xiao-Yi; Liu, Zi-Xuan; Wei, Xian-Zhao; Bai, Yu-Shu; Li, Ming

2015-01-01

Abstract The relationship between spinal sagittal alignment and pelvic parameters is well known in adolescent idiopathic scoliosis. However, few studies have reported the sagittal spinopelvic relationship after selective posterior fusion of thoracolumbar/lumbar (TL/L) curves. We evaluated the relationship between spinal sagittal alignment and the pelvis, and analyzed how the pelvic sagittal state is adjusted in Lenke type 5C patients. We conducted a retrospective study of 36 patients with Lenke type 5C curves who received selective posterior TL/L curve fusion. Coronal and spinopelvic sagittal parameters were pre and postoperatively compared. Pearson coefficients were used to analyze the correlation between all spinopelvic sagittal parameters before and after surgery. We also evaluated 3 pelvic morphologies (anteverted, normal, and retroverted) before and after surgery. Preoperatively, the mean pelvic incidence was 46.0°, with a pelvic tilt and sacral slope (SS) of 8.2° and 37.8°, respectively, and 25% (9/36) of patients had an anteverted pelvis, whereas the other 75% had a normal pelvis. Postoperatively, 42% (15/36) of patients had a retroverted pelvis, 53% (19/36) had a normal pelvis, and 2 patients had an anteverted pelvis. Logistic regression analyses yielded 2 factors that were significantly associated with the risk for a postoperative unrecovered anteverted pelvis, including increased lumbar lordosis (LL) (odds ratio [OR] 4.8, P = 0.029) and increased SS (OR 5.6, P = 0.018). Four factors were significantly associated with the risk of a postoperative newly anteverted pelvis, including LL at the final follow-up (OR 6.9, P = 0.009), increased LL (OR 8.9, P = 0.003), LL below fusion (OR 9.4, P = 0.002), and increased SS (OR 11.5, P = 0.001). The pelvic state may be adjusted after selective posterior TL/L curve fusion in Lenke 5C adolescent idiopathic scoliosis patients. It is difficult to improve an anteverted pelvis in patients who have an LL that is increased by more than 11.6° or an SS that is increased by more than 4.7° after surgery. The anteverted pelvic state will generally occur with posterior correction surgery for patients with an LL that is greater than 63.7°, or an LL or SS that is respectively increased by more than 17.6° or 9.0° postoperatively. PMID:26559289

Mimics and chameleons in motor neurone disease

PubMed Central

Turner, Martin R; Talbot, Kevin

2013-01-01

The progression of motor neurone disease (MND) is currently irreversible, and the grave implications of diagnosis naturally fuels concern among neurologists over missing a potential mimic disorder. There is no diagnostic test for MND but in reality there are few plausible mimics in routine clinical practice. In the presence of a progressive pure motor disorder, signs such as florid fasciculations, bilateral tongue wasting, the ‘split hand’, head drop, emotionality, and cognitive or behavioural impairment carry high positive predictive value. MND is clinically heterogeneous, however, with some important chameleon-like presentations and considerable variation in clinical course. Lack of confidence about the scope of such variation, or an approach to diagnosis emphasising investigations over clinical common sense, has the potential to exacerbate diagnostic delay in MND and impede timely planning of the care which is essential to maximising quality of life. PMID:23616620

SU-E-J-157: Improving the Quality of T2-Weighted 4D Magnetic Resonance Imaging for Clinical Evaluation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Du, D; Mutic, S; Hu, Y

2014-06-01

Purpose: To develop an imaging technique that enables us to acquire T2- weighted 4D Magnetic Resonance Imaging (4DMRI) with sufficient spatial coverage, temporal resolution and spatial resolution for clinical evaluation. Methods: T2-weighed 4DMRI images were acquired from a healthy volunteer using a respiratory amplitude triggered T2-weighted Turbo Spin Echo sequence. 10 respiratory states were used to equally sample the respiratory range based on amplitude (0%, 20%i, 40%i, 60%i, 80%i, 100%, 80%e, 60%e, 40%e and 20%e). To avoid frequent scanning halts, a methodology was devised that split 10 respiratory states into two packages in an interleaved manner and packages were acquiredmore » separately. Sixty 3mm sagittal slices at 1.5mm in-plane spatial resolution were acquired to offer good spatial coverage and reasonable spatial resolution. The in-plane field of view was 375mm × 260mm with nominal scan time of 3 minutes 42 seconds. Acquired 2D images at the same respiratory state were combined to form the 3D image set corresponding to that respiratory state and reconstructed in the coronal view to evaluate whether all slices were at the same respiratory state. 3D image sets of 10 respiratory states represented a complete 4D MRI image set. Results: T2-weighted 4DMRI image were acquired in 10 minutes which was within clinical acceptable range. Qualitatively, the acquired MRI images had good image quality for delineation purposes. There were no abrupt position changes in reconstructed coronal images which confirmed that all sagittal slices were in the same respiratory state. Conclusion: We demonstrated it was feasible to acquire T2-weighted 4DMRI image set within a practical amount of time (10 minutes) that had good temporal resolution (10 respiratory states), spatial resolution (1.5mm × 1.5mm × 3.0mm) and spatial coverage (60 slices) for future clinical evaluation.« less

Spinal pedicle subtraction osteotomy for fixed sagittal imbalance patients

PubMed Central

Hyun, Seung-Jae; Kim, Yongjung J; Rhim, Seung-Chul

2013-01-01

In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Petersen osteotomy provide the least correction, but can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies; however, they carry increased technical demands, longer operative time, and greater blood loss and associated significant morbidity, including neurological injury. The literature focusing on pedicle subtraction osteotomy for fixed sagittal imbalance patients is reviewed. The long-term overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided. PMID:24340276

Impact of spine alignment on the rotator cuff in long-term wheelchair users.

PubMed

Kentar, Yasser; Brunner, Manuela; Bruckner, Thomas; Hug, Andreas; Raiss, Patric; Zeifang, Felix; Loew, Markus; Almansour, Haidara; Akbar, Michael

2018-06-01

We investigated the impact of poor seated posture on the prevalence of rotator cuff tears (RCTs) among wheelchair-dependent individuals with long-standing paraplegia. The study included 319 patients. Lateral radiographs of the spine were collected from a database and analyzed to assess the global spinopelvic alignment (SPA). Magnetic resonance images of both shoulders were obtained to detect the presence of cuff tears. Patients were divided into 2 groups: Group RCT-I included all patients with cuff tears (right, left, or bilateral), whereas group RCT-II consisted exclusively of patients with bilateral cuff tears. We used the classification systems developed by Kendall et al and Roussouly et al to assess the sagittal spine alignment and SPA, respectively. Univariate and multivariate analyses were performed. To fit both models (groups RCT-I and RCT-II) to the data, the 4 spine curves according to Roussouly et al were subdivided into 2 groups: Group SPA-I included both type 1 and type 2, whereas group SPA-II included both type 3 and type 4. Magnetic resonance images showed a cuff tear in 192 patients (60.19%) (group RCT-I). Among those, 37 patients (11.60%) had tears in both shoulders (group RCT-II). In group RCT-I, 70.31% of the patients had a kyphotic-lordotic posture. The kyphotic-lordotic posture, a longer duration, and a more rostral neurologic level of injury were highly associated with cuff tear prevalence. In group RCT-II, the multivariate analysis showed that only the duration of spinal cord injury was significantly associated with RCTs. Thoracic hyperkyphosis was associated with a markedly high rate of RCTs. The data from this study may provide support for developing preventive strategies. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Aponeurosis of the levator palpebrae superioris in Chinese subjects

PubMed Central

Pan, Er; Nie, Yun-Fei; Wang, Zhen-Jun; Peng, Li-Xia; Wu, Yan-Hong; Li, Qin

2016-01-01

Abstract An accurate understanding of the anatomy of the levator palpebrae superioris aponeurosis (LPSA) is critical for successful blepharoplasty of aponeurotic ptosis. We investigated the macroscopic and microscopic anatomy of the LPSA. This prospective live gross anatomy study enrolled 200 adult Chinese patients with bilateral mild ptosis undergoing elective blepharoplasty. Full-thick eyelid tissues and sagittal sections from the eyelid skin to the conjunctiva were examined with Masson trichrome staining or antismooth muscle actin (SMA) immunohistochemistry. Gross anatomy showed that the space between the superficial and deep layers of the LPSA could be accessed after incising the overlying superficial fascia, by retracting the white line. Adipose layers were clearly observed in 195 out of 200 patients with bilateral mild ptosis, among which 180 cases had the superficial layer connected to the uncoated adipose. Fifteen cases had the superficial layer connected to the smoothly coated layer, and 5 cases had the superficial layer directly connected to the deep loose fiber, almost without adipose. In previously untreated patients, the LPSA space was located beneath the intact orbital septum. In those with previous surgeries, it was beneath the superficial layer of the LPSA, underlying the destructed orbital septum. Cadaveric histology showed that the deep layer of the LPSA extended into the anterior layer of the tarsal plate and the superficial layer reflexed upward in continuity with the vertical orbital septum. An occult space existed between the 2 layers of the LPSA, with a smooth lining on the deep layer. The superficial layer of the LPSA was SMA-immunonegative but the deep layer was slightly immunopositive for SMA. An occult anatomic space exists between the superficial and deep layers of the LPSA, in proximity to the superior tarsal plate margin. Recognition of the more anatomically significant LPSA deep layer may help improve the aesthetic outcome of blepharoplasty. PMID:27495084

Repeat Intracranial Expansion After Skull Regrowth in Hyperostotic Disease: Technical Note.

PubMed

Wong, Timothy; Herschman, Yehuda; Patel, Nitesh V; Patel, Tushar; Hanft, Simon

2017-06-01

Camurati-Engelmann disease (CED) is a rare, autosomal-dominant genetic disorder resulting in hyperostosis of the long bones and skull. Patients often develop cranial nerve dysfunction and increased intracranial pressure secondary to stenosis of nerve foramina and hyperostosis. Surgical decompression may provide symptomatic relief in select patients; however, a small number of reports document the recurrence of symptoms due to bony regrowth. We present a patient who had been treated previously with bilateral frontal and parietal craniotomy who experienced recurrence of symptoms due to reossification of her cranial bones. This report underscores the progressive nature of CED and its influence on surgical management. Furthermore, we propose a novel surgical approach with multiple craniectomies and titanium mesh cranioplasties that could potentially offer long-term symptomatic relief. A 46-year-old female patient with CED who was treated with ventriculoperitoneal shunting, posterior fossa decompression, and multiple craniotomies 2 decades prior presented with signs and symptoms of increased intracranial pressure. Studies of the skull at presentation demonstrated rethickening of cranial bones that resulted in severely decreased intracranial volume. A radical craniectomy, requiring 4 separate bone flaps made up of bilateral frontal and parietal bones, was performed. The remaining coronal and sagittal bony struts were drilled to approximately 1 cm thick. Cranioplasties with 4 separate titanium meshes were performed to preserve the natural contour of the patient's skull. Although surgical decompression could provide some patients with CED symptomatic relief, clinicians should consider managing CED as a chronic condition. To the authors' knowledge, this is one of few case reports documenting the recurrence of symptoms in a patient with CED treated by surgical intervention. Furthermore, we propose that multiple craniectomies with titanium mesh cranioplasties confer more permanent symptomatic control, and, more importantly, lower the risk of recurrence secondary to cranial hyperostosis. Copyright © 2017 Elsevier Inc. All rights reserved.

Which route of antibiotic administration should be used for third molar surgery? A split-mouth study to compare intramuscular and oral intake.

PubMed

Crincoli, V; Di Comite, M; Di Bisceglie, M B; Petruzzi, M; Fatone, L; De Biase, C; Tecco, S; Festa, F

2014-01-01

To compare the effectiveness of two different routes of antibiotic administration in preventing septic complications in patients undergoing third molar extraction. Twenty-four healthy patients requiring bilateral surgical removal of impacted mandibular third molars were successfully enrolled for this study. Depth of impaction, angulation, and relationship of the lower third molars with the mandibular branch had to be overlapping on both sides. A split-mouth design was chosen, so each patient underwent both the first and second surgeries, having for each extraction a different antibiotic route of administration. The second extraction was carried out 1 month later. To compare the effects of the two routes of antibiotic administration, inflammatory parameters, such as edema, trismus, pain, fever, dysphagia and lymphadenopathy were evaluated 2 and 7 days after surgery. Side effects of each therapy were evaluated 48 h after surgery. Oral and intramuscular antibiotic therapies overlap in preventing post-operative complications in dental surgery (p>0.05), even if the oral intake, seems to promote the onset of significant gastrointestinal disorders (p=0.003). This study could help dentists in their ordinary practice to choose the right route of antibiotic administration in the third molar surgery. At the same effectiveness, the higher cost and the minor compliance of the patient seem not to justify a routine antibiotic intramuscular therapy, reserving it for patients with gastrointestinal disorders.

Effect of Preoperative Molding Helmet in Patients With Sagittal Synostosis.

PubMed

Hashmi, Asra; Marupudi, Neena I; Sood, Sandeep; Rozzelle, Arlene

2017-06-01

In our practice, the authors found that molding helmet used for plagiocephaly preoperatively, in patients with sagittal synostosis, decreased bathrocephaly, forehead bossing, and improved posterior vertex, as well as Cephalic Index (CI). This prompted us to investigate the impact of preoperative molding helmet in patients with sagittal synostosis. A prospective study was performed on patients undergoing surgical correction of sagittal synostosis, over a 5-year period. Patients were categorized into 2 groups. "No Helmet group" only had surgical correction, and "Helmet group" had preoperative molding helmet, prior to surgical correction. Cephalic Index for the 2 groups was compared using t-test. There were 40 patients in the No Helmet group and 18 patients in the Helmet group. For No Helmet group, mean CI at presentation, immediately preoperative, and postoperatively was 0.70 (±0.045), 0.70 (±0.020), and 0.80 (±0.030), respectively, and for Helmet group, it was 0.69 (±0.023), 0.73 (±0.036), and 0.83 (±0.036), respectively. There was no statistically significant difference between CI of the 2 groups at presentation (P = 0.45). Comparison of postoperative CI did show a statistically significant difference between the groups (P = 0.01). For Helmet group, on comparison of CI at presentation and preoperative CI (after helmet therapy), a statistically significant improvement in CI was observed (P = 0.0004). Our results suggest that preoperative molding helmet can decrease bathrocephaly, forehead bossing, and improve posterior vertex as well as CI, prior to surgery and thus can be used as a valuable adjunct in patients with sagittal synostosis.

Effect of Cervical Sagittal Balance on Laminoplasty in Patients With Cervical Myelopathy

PubMed Central

Namikawa, Takashi; Matsumura, Akira; Konishi, Sadahiko; Nakamura, Hiroaki

2017-01-01

Study Design: Retrospective clinical study. Objective: We evaluated the relationship between cervical sagittal alignment parameters and clinical status in patients with cervical myelopathy and analyzed the effect of cervical sagittal balance on cervical laminoplasty. Methods: Patients with cervical myelopathy (n = 110) who underwent laminoplasty were included in this study. The relationship between cervical sagittal alignment parameters and clinical status was evaluated. The changes in radiographic cervical sagittal parameters and clinical status 2 years after surgery were compared between patients with preoperative C2-7 SVA ≥35 mm (group A) and those with preoperative C2-7 SVA <35 mm (group B). Results: Preoperatively, C2-7 SVA had no correlation with defined health-related quality of life evaluation scores. At 2-year follow-up, the improvement in SF-36 physical component summary was significantly lower in group A than in group B. The postoperative change of C2-7 SVA did not significantly differ in 2 groups. Patients in group A maintained cervical regional balance after laminoplasty but experienced extensive postoperative neck pain. Conclusions: Our patients with a C2-7 SVA of ≥35 mm maintained cervical regional balance after laminoplasty and their improvement in myelopathy was equivalent to that in patients with a C2-7 SVA of <35 mm. However, the patents with a C2-7 SVA of ≥35 mm experienced severe postoperative neck pain. C2-7 SVA is a parameter worth considering because it can lead to poor QOL and axial neck pain after laminoplasty. PMID:28507885

Radiographic diagnosis of sagittal plane rotational displacement in pelvic fractures: a cadaveric model and clinical case study.

PubMed

Shui, Xiaolong; Ying, Xiaozhou; Kong, Jianzhong; Feng, Yongzeng; Hu, Wei; Guo, Xiaoshan; Wang, Gang

2015-08-01

Our objective was to measure the sagittal plane rotational (flexion and extension) displacement of hemipelvis radiologically and analyze the ratio of flexion and extension displacement of unstable pelvic fractures. We used 8 cadaveric models to study the radiographic evidence of pelvic fractures in the sagittal plane. We performed pelvic osteotomy on 8 cadavers to simulate anterior and posterior pelvic ring injury. Radiological data were measured in the flexion and extension group under different angles (5°, 10°, 15°, 20°, and 25°). We retrospectively reviewed 164 patients who were diagnosed with a unilateral fracture of the pelvis. Pelvic ring displacement was identified and recorded radiographically in cadaveric models. The flexion and extension displacement of pelvic fractures was measured in terms of the vertical distance of fracture from the top of iliac crest to the pubic tubercle (CD) or from the top of iliac crest to the lowest point of ischial tuberosity (AB). Fifty-seven pelves showed flexion displacement and 15 showed extension displacement. Closed reduction including internal fixation and external fixation was successfully used in 141 cases (86.0 %). The success rates of closed reduction in flexion and extension displacement groups were 77 and 73 %, respectively, which were lower than in unstable pelvic ring fractures. The sagittal plane rotation (flexion and extension) displacement of pelvic fractures could be measured by special points and lines on the radiographs. Minimally invasive reduction should be based on clearly identified differences between the sagittal plane rotation and the vertical displacement of pelvic fractures.

Are we simplifying balance evaluation in adolescent idiopathic scoliosis?

PubMed

Pasha, Saba; Baldwin, Keith

2018-01-01

Clinical evaluation of the postural balance in adolescent idiopathic scoliosis has been measured by sagittal vertical axis and frontal balance. The impact of the scoliotic deformity in three planes on balance has not been fully investigated. 47 right thoracic and left lumbar curves adolescent idiopathic scoliosis and 10 non-scoliotic controls were registered prospectively. 13 spinopelvic postural parameters were calculated from the 3-dimantional reconstructions of X-rays. 7 balance variables describing the position and sway of the center of pressure were recorded using a pressure mat. A regression analysis was used to predict sagittal vertical axis and frontal balance from the 7 balance variables. A canonical correlation analysis was performed between all the postural parameters and balance variables and the significant associations between the postural and balance variables were determined. sagittal vertical axis and frontal balance were not significantly associated with the position or sway of the center of pressure (p>0.05). Canonical correlation analysis showed significant associations between the postural variables in the 3 planes and center of pressure position (R 2 =0.81) and sway (R 2 =0.62), p<0.05. Frontal Cobbs, apical rotations, distal kyphosis, pelvic incidence, sacral slope, sagittal vertical axis, and frontal balance contributed to the postural balance in the cohort. The compensatory role of the pelvis and distal kyphosis in sagittal plane was underlined. Multidimensional analyses between the postural and balance variables showed the alignment of the thoracic, lumbar, and pelvis in the 3 planes, in addition to the global head-pelvic position impact on adolescent idiopathic scoliosis balance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Standardized way for imaging of the sagittal spinal balance.

PubMed

Morvan, Gérard; Mathieu, Philippe; Vuillemin, Valérie; Guerini, Henri; Bossard, Philippe; Zeitoun, Frédéric; Wybier, Marc

2011-09-01

Nowadays, conventional or digitalized teleradiography remains the most commonly used tool for the study of the sagittal balance, sometimes with secondary digitalization. The irradiation given by this technique is important and the photographic results are often poor. Some radiographic tables allow the realization of digitalized spinal radiographs by simultaneous translation of X-ray tube and receptor. EOS system is a new, very low dose system which gives good quality images, permits a simultaneous acquisition of upright frontal and sagittal views, is able to cover in the same time the spine and the lower limbs and study the axial plane on 3D envelope reconstructions. In the future, this low dose system should take a great place in the study of the pelvispinal balance. On the lateral view, several pelvic (incidence, pelvic tilt, sacral slope) and spinal (lumbar lordosis, thoracic kyphosis, Th9 sagittal offset, C7 plumb line) parameters are drawn to define the pelvispinal balance. All are interdependent. Pelvic incidence is an individual anatomic characteristic that corresponds to the "thickness" of the pelvis and governs the spinal balance. Pelvis and spine, in a harmonious whole, can be compared to an accordion, more or less compressed or stretched.

Metacarpal geometry changes during Thoroughbred race training are compatible with sagittal-plane cantilever bending.

PubMed

Merritt, J S; Davies, H M S

2010-11-01

Bending of the equine metacarpal bones during locomotion is poorly understood. Cantilever bending, in particular, may influence the loading of the metacarpal bones and surrounding structures in unique ways. We hypothesised that increased amounts of sagittal-plane cantilever bending may govern changes to the shape of the metacarpal bones of Thoroughbred racehorses during training. We hypothesised that this type of bending would require a linear change to occur in the combined second moment of area of the bones for sagittal-plane bending (I) during race training. Six Thoroughbred racehorses were used, who had all completed at least 4 years of race training at a commercial stable. The approximate change in I that had occurred during race training was computed from radiographic measurements at the start and end of training using a simple model of bone shape. A significant (P < 0.001), approximately linear pattern of change in I was observed in each horse, with the maximum change occurring proximally and the minimum change occurring distally. The pattern of change in I was compatible with the hypothesis that sagittal-plane cantilever bending governed changes to the shape of the metacarpal bones during race training. © 2010 EVJ Ltd.

Automatic extraction of the mid-sagittal plane using an ICP variant

NASA Astrophysics Data System (ADS)

Fieten, Lorenz; Eschweiler, Jörg; de la Fuente, Matías; Gravius, Sascha; Radermacher, Klaus

2008-03-01

Precise knowledge of the mid-sagittal plane is important for the assessment and correction of several deformities. Furthermore, the mid-sagittal plane can be used for the definition of standardized coordinate systems such as pelvis or skull coordinate systems. A popular approach for mid-sagittal plane computation is based on the selection of anatomical landmarks located either directly on the plane or symmetrically to it. However, the manual selection of landmarks is a tedious, time-consuming and error-prone task, which requires great care. In order to overcome this drawback, previously it was suggested to use the iterative closest point (ICP) algorithm: After an initial mirroring of the data points on a default mirror plane, the mirrored data points should be registered iteratively to the model points using rigid transforms. Finally, a reflection transform approximating the cumulative transform could be extracted. In this work, we present an ICP variant for the iterative optimization of the reflection parameters. It is based on a closed-form solution to the least-squares problem of matching data points to model points using a reflection. In experiments on CT pelvis and skull datasets our method showed a better ability to match homologous areas.

[Morphometric anatomic study and clinical significance of lunate fossa].

PubMed

Aldemir, Cengiz; Önder, Merve; Doğan, Ali; Duygun, Fatih; Oğuz, Nurettin

2015-01-01

This study aims to investigate the depth, transverse and sagittal diameters of lunate fossa which is a significant structure of the wrist in terms of reducing the risk for volar plate screws, which are administered in distal radius fractures, from penetrating into the joint. Depth, transverse and sagittal diameters of lunate fossa in 50 right and 50 left adult dried radius bones without distal tip damage were measured by using MicroscribeG2X from the MicroScribe G series. Mean lunate fossa depth: left 2.419886±0.51 mm/right 2.543052±0.78 mm, mean lunate fossa sagittal diameter: left 19.656±1.57 mm/right 18.796±1.53 mm, mean lunate fossa transverse diameter: left 11.382±0.65 mm/right 11.106±0.91 mm. There was no statistically significant difference between right and left depth values of lunate fossa (p=0.320), whereas there was statistically significant difference between right and left transverse and sagittal diameters (p=0.006, p=0.048). Measurements involving depth of lunate fossa may guide the development of new anatomic plates and decrease complications like the penetration of screw into joint whilst volar plate administrations.

Avoidance of a moving threat in the common chameleon (Chamaeleo chamaeleon): rapid tracking by body motion and eye use.

PubMed

Lev-Ari, Tidhar; Lustig, Avichai; Ketter-Katz, Hadas; Baydach, Yossi; Katzir, Gadi

2016-08-01

A chameleon (Chamaeleo chamaeleon) on a perch responds to a nearby threat by moving to the side of the perch opposite the threat, while bilaterally compressing its abdomen, thus minimizing its exposure to the threat. If the threat moves, the chameleon pivots around the perch to maintain its hidden position. How precise is the body rotation and what are the patterns of eye movement during avoidance? Just-hatched chameleons, placed on a vertical perch, on the side roughly opposite to a visual threat, adjusted their position to precisely opposite the threat. If the threat were moved on a horizontal arc at angular velocities of up to 85°/s, the chameleons co-rotated smoothly so that (1) the angle of the sagittal plane of the head relative to the threat and (2) the direction of monocular gaze, were positively and significantly correlated with threat angular position. Eye movements were role-dependent: the eye toward which the threat moved maintained a stable gaze on it, while the contralateral eye scanned the surroundings. This is the first description, to our knowledge, of such a response in a non-flying terrestrial vertebrate, and it is discussed in terms of possible underlying control systems.

Maxillary protraction in adult cleft lip and palate by a rigid external distraction device with dentoskeletal anchorage.

PubMed

Akarsu, Bengisu; Taner, Tulin; Tuncbilek, Gokhan; Mavili, M Emin

2012-04-01

The objective is to evaluate the effects of maxillary distraction osteogenesis (DO) in an adult patient with unilateral cleft lip and palate (UCLP) by using a rigid external distraction (RED) device with dentoskeletal anchorage. 31-year-old male patient with UCLP with severe maxillary hypoplasia, dolichofacial growth pattern, negative overjet and 1.5 mm openbite. After pre-surgical orthodontic treatment, an intra-oral appliance was modified to prevent extrusion of the molars and clockwise rotation of the mandible. Stainless steel plates were soldered bilaterally to the intra oral appliance at the level of canines. During surgery, miniplates were inserted in the maxillary segment and fixed to the plates of the intra oral appliance with screws. The mean distraction length was 12 mm immediately after DO. SNA increased from 73o to 82o after distraction. A significant advancement of the maxilla and correction of the sagittal Class III skeletal relationship was achieved. The vertical position of the mandible and the face was kept stable, and the soft tissue profile became more balanced. This intra oral appliance design achieved desired skeletal changes during maxillary protraction with RED device in dolichofacial CLP patient. Occlusion and facial profile changes was found to be stable in 1-year follow-up.

Maxillary protraction in adult cleft lip and palate by a rigid external distraction device with dentoskeletal anchorage

PubMed Central

Akarsu, Bengisu; Taner, Tulin; Tuncbilek, Gokhan; Mavili, M. Emin

2012-01-01

Objective: The objective is to evaluate the effects of maxillary distraction osteogenesis (DO) in an adult patient with unilateral cleft lip and palate (UCLP) by using a rigid external distraction (RED) device with dentoskeletal anchorage. Method: 31-year-old male patient with UCLP with severe maxillary hypoplasia, dolichofacial growth pattern, negative overjet and 1.5 mm openbite. After pre-surgical orthodontic treatment, an intra-oral appliance was modified to prevent extrusion of the molars and clockwise rotation of the mandible. Stainless steel plates were soldered bilaterally to the intra oral appliance at the level of canines. During surgery, miniplates were inserted in the maxillary segment and fixed to the plates of the intra oral appliance with screws. Results: The mean distraction length was 12 mm immediately after DO. SNA increased from 73o to 82o after distraction. A significant advancement of the maxilla and correction of the sagittal Class III skeletal relationship was achieved. The vertical position of the mandible and the face was kept stable, and the soft tissue profile became more balanced. Conclusion: This intra oral appliance design achieved desired skeletal changes during maxillary protraction with RED device in dolichofacial CLP patient. Occlusion and facial profile changes was found to be stable in 1-year follow-up. PMID:22509125

Unstable upper and middle thoracic fractures. Preliminary experience with a posterior transpedicular correction-fixation technique.

PubMed

Payer, M

2005-06-01

A number of conservative and operative approaches have been described for the treatment of unstable traumatic upper and middle thoracic fractures. The advantage of surgical correction and fixation/fusion lies in its potential to restore sagittal and coronal alignment, thereby indirectly decompressing the spinal cord. A consecutive series of 8 patients with unstable traumatic upper and middle thoracic fractures is reviewed. In all patients, polyaxial pedicle screws were inserted bilaterally into the two levels above and below the fracture. Rods that were less contoured ("undercontoured") than the regional hyperkyphosis at the injured level, were anchored to the caudal four screws. The cranial four screws, with the vertebrae to which they were inserted, were then progressively pulled posteriorly onto the undercontoured rods with rod reducers, thus correcting the hyperkyphosis and anterolisthesis. The mean follow-up was 15 months. The mean regional kyphosis was 23 degrees preoperatively, 17 degrees postoperatively and 18 degrees at follow-up. The mean anterolisthesis was 8 mm preoperatively, 1 mm postoperatively and 1 mm at follow-up. No hardware failure occurred. Five patients with complete spinal cord injury at presentation made no neurological recovery, two patients with incomplete spinal cord injury initially (ASIA B), recovered substantially (to ASIA D), and the patients who were neurologically intact at presentation remained so.

Hybrid gait training with an overground robot for people with incomplete spinal cord injury: a pilot study.

PubMed

Del-Ama, Antonio J; Gil-Agudo, Angel; Pons, José L; Moreno, Juan C

2014-01-01

Locomotor training has proved to provide beneficial effect in terms of mobility in incomplete paraplegic patients. Neuroprosthetic technology can contribute to increase the efficacy of a training paradigm in the promotion of a locomotor pattern. Robotic exoskeletons can be used to manage the unavoidable loss of performance of artificially driven muscles. Hybrid exoskeletons blend complementary robotic and neuro-prosthetic technologies. The aim of this pilot study was to determine the effects of hybrid gait training in three case studies with persons with incomplete spinal cord injury (iSCI) in terms of locomotion performance during assisted gait, patient-robot adaptations, impact on ambulation and assessment of lower limb muscle strength and spasticity. Participants with iSCI received interventions with a hybrid bilateral exoskeleton for 4 days. Assessment of gait function revealed that patients improved the 6 min and 10 m walking tests after the intervention, and further improvements were observed 1 week after the intervention. Muscle examination revealed improvements in knee and hip sagittal muscle balance scores and decreased score in ankle extensor balance. It is concluded that improvements in biomechanical function of the knee joint after the tested overground hybrid gait trainer are coherent with improvements in gait performance.

Acupuncture treatment of whiplash injury.

PubMed

Fattori, Bruno; Ursino, Francesco; Cingolani, Cristina; Bruschini, Luca; Dallan, Iacopo; Nacci, Andrea

2004-01-01

We evaluated by computerized static posturography the postural changes after acupuncture treatment in a group of 27 patients (12 men and 15 women; mean age, 35.7+/-6.8 SD) having balance disorders caused by cervical torsion due to whiplash injury. Acupuncture was performed by piercing deeply and bilaterally acupuncture points bladder 10 and gall bladder 20 with steel needles that were twirled manually for 20 seconds. All patients underwent posturographic evaluations before and just after each session of acupuncture. The posturography was performed with open eyes (OE), closed eyes (CE), and closed eyes with retroflexed head (CER). The control group consisted of 25 patients complaining of the same symptoms as those recorded by the study group due to whiplash injury but treated with nonsteroidal anti-inflammatory drugs and myorelaxation or with physiotherapy only. The data presented in this study revealed a considerable difference between the two groups as regards the reduction of the CE and CER length of the statokinesigram just before each session of acupuncture; the frequency oscillation on the sagittal plane in CER was reduced in the study group, whereas we noticed a progressive increase of its values in the control group. The high percentage of positive results in whiplash injury patients leads us to advocate acupuncture for balance disorders due to cervical pathology.

Hybrid gait training with an overground robot for people with incomplete spinal cord injury: a pilot study

PubMed Central

del-Ama, Antonio J.; Gil-Agudo, Ángel; Pons, José L.; Moreno, Juan C.

2014-01-01

Locomotor training has proved to provide beneficial effect in terms of mobility in incomplete paraplegic patients. Neuroprosthetic technology can contribute to increase the efficacy of a training paradigm in the promotion of a locomotor pattern. Robotic exoskeletons can be used to manage the unavoidable loss of performance of artificially driven muscles. Hybrid exoskeletons blend complementary robotic and neuro-prosthetic technologies. The aim of this pilot study was to determine the effects of hybrid gait training in three case studies with persons with incomplete spinal cord injury (iSCI) in terms of locomotion performance during assisted gait, patient-robot adaptations, impact on ambulation and assessment of lower limb muscle strength and spasticity. Participants with iSCI received interventions with a hybrid bilateral exoskeleton for 4 days. Assessment of gait function revealed that patients improved the 6 min and 10 m walking tests after the intervention, and further improvements were observed 1 week after the intervention. Muscle examination revealed improvements in knee and hip sagittal muscle balance scores and decreased score in ankle extensor balance. It is concluded that improvements in biomechanical function of the knee joint after the tested overground hybrid gait trainer are coherent with improvements in gait performance. PMID:24860478

Key-Vertebral Screws Strategy for Main Thoracic Curve Correction in Patients With Adolescent Idiopathic Scoliosis.

PubMed

Li, Jingfeng; Cheung, Kenneth M C; Samartzis, Dino; Ganal-Antonio, Anne K B; Zhu, Xiaodong; Li, Ming; Luk, Keith D K

2016-10-01

The following study was a prospective radiographic and retrospective clinical data assessment of adolescent idiopathic scoliosis (AIS) patients who had undergone a key-vertebral screws strategy (KVSS) at a single institution, with a minimum of 2 years' follow-up. The aim of the study was to introduce the KVSS for the operative treatment of AIS of the main thoracic curve, and to address the role of the fulcrum-bending radiograph (FBR) in predicting the outcome of surgical management by this method. The application of multilevel pedicle screws for the main thoracic curve in AIS patients is popular in an effort to provide spinal stability, enhance fusion outcome, and provide optimal curve correction. However, with the application of pedicle screw also comes a potential risk for soft tissue and neural injury and increased health care costs. It remains unknown whether limited screw placement can provide proper curve correction without compromising patient outcome. A total of 17 consecutive patients with AIS extending to the main thoracic spine, who had undergone posterior fusion and fixation by the KVSS, a procedure in which screws are placed at important strategic points in the spine (ie, bilaterally at the upper and lower end segments of the fusion block, apical vertebra on the convex side, adjacent cephalad, and caudal screw placement on the concave side), at a single institution, with a minimum of 2 year' follow-up, were included. The assessment of preoperative standing posteroanterior and sagittal, FBR, and postoperative standing posteroanterior and sagittal plain radiographs were assessed in all patients. The flexibility of the curve as well as the fulcrum-bending correction index (FBCI) were calculated for all patients. Postoperatively, radiographs were assessed at the immediate (ie, 1 wk) and last follow-up. Clinical assessment entailed evaluation of patient demographics and the presence of any intraoperative or postoperative complications. The mean age at the time of surgery was 15.6 years. The mean follow-up was 39.8 months. The average FBR flexibility was 62.2%. The mean immediate curve correction was 71.2%, which did not differ in comparison with the last follow-up assessment (P>0.05). The mean immediate and last follow-up FBCIs were 119.3% and 112.5%, respectively (P=0.079). A significant negative correlation was found between immediate FBCI to that of the FBR curve flexibility (r=-0.706; P=0.002), which remained similar on the last follow-up (r=-0.681; P=0.003). Sagittal alignment did not significantly change from the immediate to last follow-up (P=0.163) Fusion was achieved in all patients. No instrumentation-related complications were noted. Key-vertebral screws strategy is a safe and cost-effective method for the surgical treatment of the main thoracic curve in AIS patients. Moreover, in the context of this strategy, the FBR may have some predictive utility in the correction of the main thoracic curve in AIS patients.

Gender difference of ankle stability in the sagittal and frontal planes.

PubMed

Hanzlick, Harrison; Hyunglae Lee

2017-07-01

This paper offers quantification of ankle stability in relation to simulated haptic environments of varying stiffness. This study analyzes the stability trends of male and female subjects independently over a wide range of simulated environments after subjects were exposed to vigorous position perturbation. Ankle stability was quantified for both degrees-of-freedom of the ankle in the sagittal and frontal planes. Subjects' stability consistently decreased when exposed to environments of negative simulated stiffness. In the frontal plane, male and female subjects exhibited nearly identical stability levels. In the sagittal plane, however, male subjects demonstrated marginally more stability than female subjects in environments with negative stiffness. Results of this study are beneficial to understanding situations in which the ankle is likely to lose stability, potentially resulting in injury.

Long-term Clinical and Radiographic Outcomes of Pedicle Subtraction Osteotomy for Fixed Sagittal Imbalance: Does Level of Proximal Fusion Affect the Outcome? Minimum 5-Year Follow-up.

PubMed

Yagi, Mitsuru; King, Akilah B; Cunningham, Matthew E; Boachie-Adjei, Oheneba

2013-03-01

Retrospective case series of surgically treated adult patients with fixed sagittal imbalance. To assess clinical and radiographic changes after pedicle subtraction osteotomy (PSO) to treat adult fixed sagittal imbalance. Although recent reports have shown favorable clinical outcomes for PSO, few reports have published long-term follow-up outcomes. It is also unknown whether long-term outcomes are correlated with the level of proximal fusion and the radiographic changes that are observed after PSO. We reviewed the charts, X-rays, and postoperative SRS-22 and Oswestry Disability Index (ODI) scores of 32 adult patients who presented with fixed sagittal imbalance and were treated with lumbar PSO. Long fusions were defined as those proximal to T6, and short fusions were defined as those below T8. Measured radiographic parameters included thoracic kyphosis, lumbar lordosis (LL), sacral slope, pelvic incidence, and sagittal balance (SVA). Statistical analysis included Student t test and chi-square test. A p value of < .05 and a confidence interval of 95% were considered statistically significant. Among the reviewed cases were 23 women and 9 men, with a mean age of 50.9 years (range, 33-76 years) and a mean follow-up 8.6 years (range, 5-16 years). The LL increased from -16.0° preoperatively to -52.1° postoperatively. This metric decreased to -51.0° at final follow-up. The SVA decreased from 10.4 cm preoperatively to 3.6 cm postoperatively. The SVA increased to 5.4 cm at the final follow-up visit. There were 17 long fusions and 15 short fusions. The SRS scores at the final follow-up time point were: total, 3.63; function, 3.59; pain, 3.68; self-image, 3.46; mental health, 3.56; satisfaction, 4.26. A total of 16 patients exhibited minimal disability, 11 exhibited moderate disability, and 2 exhibited severe disability in ODI scores at the final follow-up visit (average, 28.2%). The SRS and ODI scores were not significantly different between groups (p = .64 for SRS; p = .59 for ODI). We observed no significant differences between groups with respect to the LL, sacral slope, or pelvic incidence. The observed increase in SVA at the final follow-up visit was significantly larger in the short fusion group compared with the increase we observed in the long fusion group (p = .03). The thoracic kyphosis (T5-T12) and proximal junctional angle at the final follow-up visit also significantly increased in patients who underwent a short fusion (p < .001). A total of 14 major complications occurred in 12 patients (8 in the short fusion group and 6 in the long fusion group) (p = .43). Eight patients required additional surgery to treat these complications. In a group of adults presenting with fixed sagittal imbalance, PSO provided good sagittal balance and maintained favorable clinical outcomes in both the short and long fusion groups despite a slight decrease in the SVA and a high complication rate. The data suggest that the loss of sagittal balance may be attributed to increase global and junctional kyphosis in short fusion groups, and should be monitored for long-term outcomes. Particular attention should be paid to the long-term deterioration of the SVA in adults who present with fixed sagittal imbalance after PSO. Copyright © 2013 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Gradual training reduces practice difficulty while preserving motor learning of a novel locomotor task.

PubMed

Sawers, Andrew; Hahn, Michael E

2013-08-01

Motor learning strategies that increase practice difficulty and the size of movement errors are thought to facilitate motor learning. In contrast to this, gradual training minimizes movement errors and reduces practice difficulty by incrementally introducing task requirements, yet remains as effective as sudden training and its large movement errors for learning novel reaching tasks. While attractive as a locomotor rehabilitation strategy, it remains unknown whether the efficacy of gradual training extends to learning locomotor tasks and their unique requirements. The influence of gradual vs. sudden training on learning a locomotor task, asymmetric split belt treadmill walking, was examined by assessing whole body sagittal plane kinematics during 24 hour retention and transfer performance following either gradual or sudden training. Despite less difficult and less specific practice for the gradual cohort on day 1, gradual training resulted in equivalent motor learning of the novel locomotor task as sudden training when assessed by retention and transfer a day later. This suggests that large movement errors and increased practice difficulty may not be necessary for learning novel locomotor tasks. Further, gradual training may present a viable locomotor rehabilitation strategy avoiding large movement errors that could limit or impair improvements in locomotor performance. Copyright © 2013 Elsevier B.V. All rights reserved.

Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection.

PubMed

Lee, Jung-Hee; Kim, Ki-Tack; Lee, Sang-Hun; Kang, Kyung-Chung; Oh, Hyun-Seok; Kim, Young-Jun; Jung, Hyuk

2016-08-01

To determine the correlation of the difference between postoperative lumbar lordosis (LL) and ideal LL with the sagittal vertical axis (SVA) at the final follow-up in patients with adult spinal deformity (ASD). Fifty-one patients with degenerative lumbar kyphosis (DLK) (mean age 66.5 years) who underwent surgical correction with a minimum 2-year follow-up were evaluated. Based on the difference between postoperative LL and ideal LL using the Korean version of Legaye's formula, we divided the 51 patients into two groups: overcorrection (degree of postoperative LL > ideal LL) and undercorrection (degree of postoperative LL < ideal LL). Our clinical series of patients comprised 24 in the overcorrection and 27 in the undercorrection group. No significant differences were found in preoperative pelvic incidence (PI 52.6° vs. 57.3°), sacral slope (SS 23.3° vs. 18.3°), LL (-6.9° vs. -2.3°), thoracic kyphosis (TK 4.7° vs. 4.9°) and SVA (140 vs. 139 mm) except pelvic tilt (PT 29.4° vs. 39.0°), between the two groups. All the patients in the overcorrection group and 16 in the undercorrection group achieved postoperative optimal sagittal balance based on SVA ≤ 50 mm. In addition, significant differences in PT (10.5° vs. 26.7°), SS (42.1° vs. 30.6°), LL (-64.3° vs. -37.1°), TK (22.6° vs. 15.8°), and SVA (-1 vs. 41 mm) between the two groups were observed postoperatively. Furthermore, four patients (16.7 %) in the overcorrection group and eight (50 %) in the undercorrection group had sagittal decompensation at the final follow-up. Our results showed that the difference between postoperative LL and ideal LL had a significant correlation with postoperative and final follow-up SVA in our clinical series. Overcorrection of LL is an effective treatment modality to maintain optimal sagittal alignment in patients with DLK; this suggests that it should be considered in preoperative planning for patients with ASD with sagittal imbalance.

[Hidradenitis Suppurativa: Combined Treatment with Dermal Template, Skin Graft and Negative Pressure Wound Therapy, a Case Study].

PubMed

Ribeiro, Luís Mata; Guerra, Ana Silva

2018-01-31

Hidrosadenitis supurativa is a chronic inflammatory disease with great physical and psychological impact. Although conservative treatments may be effective in mild forms of the disease, extensive surgical resection and reconstruction are necessary in more severe forms of the disease. The purpose of this paper is to describe our two-stage reconstructive procedure regarding this kind of disease. We present a clinical case of a patient with severe, bilateral axillary hidrosadenitis. In the first surgical step we excised the lesions and applied the artificial dermis secured with negative pressure wound therapy. In the second step we used a split thickness skin graft to close the wound and again applied negative pressure wound therapy. The graft take was very good, without complications. The cosmetic outcome is acceptable and shoulder mobility was not compromised. No recurrence was detected (nine months follow up).

Orthognathic Surgery for the Correction of Severe Skeletal Class III Malocclusion.

PubMed

Kafle, D; Upadhayaya, C; Chaurasia, N; Agarwal, A

2016-01-01

Skeletal Malocclusions results from the abnormal position of maxilla and mandible in relation with cranial base. These types of malocclusion are commonly treated by orthodontic teeth movement known as camouflage orthodontics. However severe skeletal malocclusions cannot be treated by orthodontics alone. Such cases need surgical intervention to align the position of the jaw along with orthodontic correction. This procedure is commonly known as Orthognathic Surgery. Orthognathic Surgery dates back to early eighteenth century but became popular on mid twentieth century. Though the prevalence of skeletal malocclusion is more than 1% the treatment facility was not available in Nepal till 2012. Here we present a case of Skeletal Class III malocclusion treated at Dhulikhel Hospital, Kathmandu University Hospital. For this case, double jaw surgery was performed by le-Fort I osteotomy and Bilateral Sagital Split Osteotomy. Orthognathic surgery has been routinely performed at this centre since then.

The clinical evaluation of platelet-rich plasma on free gingival graft's donor site wound healing.

PubMed

Samani, Mahmoud Khosravi; Saberi, Bardia Vadiati; Ali Tabatabaei, S M; Moghadam, Mahdjoube Goldani

2017-01-01

It has been proved that platelet-rich plasma (PRP) can promote wound healing. In this way, PRP can be advantageous in periodontal plastic surgeries, free gingival graft (FGG) being one such surgery. In this randomized split-mouth controlled trial, 10 patients who needed bilateral FGG were selected, and two donor sites were randomly assigned to experience either natural healing or healing-assisted with PRP. The outcome was assessed based on the comparison of the extent of wound closure, Manchester scale, Landry healing scale, visual analog scale, and tissue thickness between the study groups at different time intervals. Repeated measurements of analysis of variance and paired t -test were used. Statistical significance was P ≤ 0.05. Significant differences between the study groups and also across different time intervals were seen in all parameters except for the changes in tissue thickness. PRP accelerates the healing process of wounds and reduces the healing time.

Zebrin II Is Expressed in Sagittal Stripes in the Cerebellum of Dragon Lizards (Ctenophorus sp.).

PubMed

Wylie, Douglas R; Hoops, Daniel; Aspden, Joel W; Iwaniuk, Andrew N

2016-01-01

Aldolase C, also known as zebrin II (ZII), is a glycolytic enzyme that is expressed in cerebellar Purkinje cells of the vertebrate cerebellum. In both mammals and birds, ZII is expressed heterogeneously, such that there are sagittal stripes of Purkinje cells with high ZII expression (ZII+) alternating with stripes of Purkinje cells with little or no expression (ZII-). In contrast, in snakes and turtles, ZII is not expressed heterogeneously; rather all Purkinje cells are ZII+. Here, we examined the expression of ZII in the cerebellum of lizards to elucidate the evolutionary origins of ZII stripes in Sauropsida. We focused on the central netted dragon (Ctenophorus nuchalis) but also examined cerebellar ZII expression in 5 other dragon species (Ctenophorus spp.). In contrast to what has been observed in snakes and turtles, we found that in these lizards, ZII is heterogeneously expressed. In the posterior part of the cerebellum, on each side of the midline, there were 3 sagittal stripes consisting of Purkinje cells with high ZII expression (ZII+) alternating with 2 sagittal stripes with weaker ZII expression (ZIIw). More anteriorly, most of the Purkinje cells were ZII+, except laterally, where the Purkinje cells did not express ZII (ZII-). Finally, all Purkinje cells in the auricle (flocculus) were ZII-. Overall, the parasagittal heterogeneous expression of ZII in the cerebellum of lizards is similar to that in mammals and birds, and contrasts with the homogenous ZII+ expression seen in snakes and turtles. We suggest that a sagittal heterogeneous expression of ZII represents the ancestral condition in stem reptiles which was lost in snakes and turtles. © 2017 S. Karger AG, Basel.

Feedforward ankle strategy of balance during quiet stance in adults

PubMed Central

Gatev, Plamen; Thomas, Sherry; Kepple, Thomas; Hallett, Mark

1999-01-01

We studied quiet stance investigating strategies for maintaining balance. Normal subjects stood with natural stance and with feet together, with eyes open or closed. Kinematic, kinetic and EMG data were evaluated and cross-correlated.Cross-correlation analysis revealed a high, positive, zero-phased correlation between anteroposterior motions of the centre of gravity (COG) and centre of pressure (COP), head and COG, and between linear motions of the shoulder and knee in both sagittal and frontal planes. There was a moderate, negative, zero-phased correlation between the anteroposterior motion of COP and ankle angular motion.Narrow stance width increased ankle angular motion, hip angular motion, mediolateral sway of the COG, and the correlation between linear motions of the shoulder and knee in the frontal plane. Correlations between COG and COP and linear motions of the shoulder and knee in the sagittal plane were decreased. The correlation between the hip angular sway in the sagittal and frontal planes was dependent on interaction between support and vision.Low, significant positive correlations with time lags of the maximum of cross-correlation of 250-300 ms were found between the EMG activity of the lateral gastrocnemius muscle and anteroposterior motions of the COG and COP during normal stance. Narrow stance width decreased both correlations whereas absence of vision increased the correlation with COP.Ankle mechanisms dominate during normal stance especially in the sagittal plane. Narrow stance width decreased the role of the ankle and increased the role of hip mechanisms in the sagittal plane, while in the frontal plane both increased.The modulation pattern of the lateral gastrocnemius muscle suggests a central program of control of the ankle joint stiffness working to predict the loading pattern. PMID:9882761

Anterior center-edge angle on sagittal CT: a comparison of normal hips to dysplastic hips.

PubMed

Monazzam, Shafagh; Williams, Karly Ann; Shelton, Trevor J; Calafi, Arash; Haus, Brian M

2018-05-01

The anterior center-edge angle (ACEA) describes anterior acetabular coverage on false profile radiographs. Variability associated with pelvic tilt, radiographic projection, and identifying the true anterior edge, causes discrepancies in measuring an accurate ACEA. Computed tomography (CT) has the potential of improving the accuracy of ACEA. However, because the ACEA on sagittal CT has been shown to not be equivalent to ACEA on false profile radiographs, the normal range of ACEA on CT currently remains unknown and cannot reliably be used to determine over/under coverage. We therefore asked: what is the normal variation of ACEA corrected for pelvic tilt on sagittal CT and how does this compare to dysplastic hips? A retrospective review was conducted on patients 10-35 who underwent CT for non-orthopedic related issues and patients with known hip dysplasia. The ACEA was measured on a sagittal slice corresponding to the center of the femoral head on the axial slice and adjusted for pelvic tilt. A statistical comparison was then performed. A total of 320 normal patients and 22 patients with hip dysplasia were reviewed. The mean ACEA for all ages was 50° ± 8°, (range: 23-81º), with a larger mean ACEA for males (51°) than females (49°). The ACEA mean for dysplastic hips was 30° ± 11° with a statistically significant difference in mean from the normal hip group ( p < 0.0001). The ACEA can be reliably measured on sagittal CT and significantly differs from dysplastic hips. ACEA measurements above 66° or below 34° may represent anterior over and under coverage.

The effect of sagittal rotation of the glenoid on axial glenoid width and glenoid version in computed tomography scan imaging.

PubMed

Gross, Daniel J; Golijanin, Petar; Dumont, Guillaume D; Parada, Stephen A; Vopat, Bryan G; Reinert, Steven E; Romeo, Anthony A; Provencher, C D R Matthew T

2016-01-01

Computed tomography (CT) scans of the shoulder are often not well aligned to the axis of the scapula and glenoid. The purpose of this paper was to determine the effect of sagittal rotation of the glenoid on axial measurements of anterior-posterior (AP) glenoid width and glenoid version attained by standard CT scan. In addition, we sought to define the angle of rotation required to correct the CT scan to optimal positioning. A total of 30 CT scans of the shoulder were reformatted using OsiriX software multiplanar reconstruction. The uncorrected (UNCORR) and corrected (CORR) CT scans were compared for measurements of both (1) axial AP glenoid width and (2) glenoid version at 5 standardized axial cuts. The mean difference in glenoid version was 2.6% (2° ± 0.1°; P = .0222) and the mean difference in AP glenoid width was 5.2% (1.2 ± 0.42 mm; P = .0026) in comparing the CORR and UNCORR scans. The mean angle of correction required to align the sagittal plane was 20.1° of rotation (range, 9°-39°; standard error of mean, 1.2°). These findings demonstrate that UNCORR CT scans of the glenohumeral joint do not correct for the sagittal rotation of the glenoid, and this affects the characteristics of the axial images. Failure to align the sagittal image to the 12-o'clock to 6-o'clock axis results in measurement error in both glenoid version and AP glenoid width. Use of UNCORR CT images may have notable implications for decision-making and surgical treatment. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A modified technique to reduce tibial keel cutting errors during an Oxford unicompartmental knee arthroplasty.

PubMed

Inui, Hiroshi; Taketomi, Shuji; Tahara, Keitarou; Yamagami, Ryota; Sanada, Takaki; Tanaka, Sakae

2017-03-01

Bone cutting errors can cause malalignment of unicompartmental knee arthroplasties (UKA). Although the extent of tibial malalignment due to horizontal cutting errors has been well reported, there is a lack of studies evaluating malalignment as a consequence of keel cutting errors, particularly in the Oxford UKA. The purpose of this study was to examine keel cutting errors during Oxford UKA placement using a navigation system and to clarify whether two different tibial keel cutting techniques would have different error rates. The alignment of the tibial cut surface after a horizontal osteotomy and the surface of the tibial trial component was measured with a navigation system. Cutting error was defined as the angular difference between these measurements. The following two techniques were used: the standard "pushing" technique in 83 patients (group P) and a modified "dolphin" technique in 41 patients (group D). In all 123 patients studied, the mean absolute keel cutting error was 1.7° and 1.4° in the coronal and sagittal planes, respectively. In group P, there were 22 outlier patients (27 %) in the coronal plane and 13 (16 %) in the sagittal plane. Group D had three outlier patients (8 %) in the coronal plane and none (0 %) in the sagittal plane. Significant differences were observed in the outlier ratio of these techniques in both the sagittal (P = 0.014) and coronal (P = 0.008) planes. Our study demonstrated overall keel cutting errors of 1.7° in the coronal plane and 1.4° in the sagittal plane. The "dolphin" technique was found to significantly reduce keel cutting errors on the tibial side. This technique will be useful for accurate component positioning and therefore improve the longevity of Oxford UKAs. Retrospective comparative study, Level III.

Comparison between Awake Endoscopy and Computed Tomography to Define Lingual Tonsil Hypertrophy.

PubMed

Tang, Jessica A; Gorelick, Gleb; Friedman, Michael

2017-11-01

Objectives To analyze correlations between endoscopic lingual tonsil grade (LTG) by the Friedman Lingual Tonsil Hypertrophy grading system and computed tomography (CT) measurements of lingual tonsil thickness (LTT). Study Design Retrospective chart review. Setting Single-center database, September 2016 to April 2017. Subjects and Methods Patients who received CT covering base of tongue and endoscopic LTG were included. LTT was measured on axial and sagittal CT. LTT measurements were compared against endoscopic LTG. One-way analysis of variance with Tukey's post hoc adjustment for multiple comparisons was performed. Results Seventy-five charts were included for a total of 150 LTT measurements. Axial CT measurements of LTG 1 and LTG 2 were each significantly different from LTG 3 ( P < .001 for both), and LTG 1 and LTG 2 also differed significantly ( P = .010). Mean sagittal CT measurements were significantly different between LTG 1 and LTG 3 ( P < .001) and between LTG 2 and LTG 3 ( P = .002) but not between LTG 1 and LTG 2 ( P = .186). Those without lingual tonsil hypertrophy had a mean axial CT thickness of 6.45 ± 1.39 mm and mean sagittal CT thickness of 6.58 ± 1.53 mm, which was significantly different from both the mean axial CT thickness of 8.48 ± 1.52 mm and the mean sagittal CT thickness of 8.07 ± 1.16 mm in the LTG 3 group ( P < .001 for both). Threshold analysis showed a potential cutoff of approximately 7.5 mm on axial and sagittal CT for defining clinically significant lingual tonsil hypertrophy. Conclusion Awake endoscopy grading of lingual tonsil hypertrophy is a subjective measurement that seems to correlate with objective CT measurements. LTT measurements of LTG 1 and LTG 2 on awake endoscopy differed significantly from LTG 3.

Noninvasive Optoelectronic Assessment of Induced Sagittal Imbalance Using the Vicon System.

PubMed

Ould-Slimane, Mourad; Latrobe, Charles; Michelin, Paul; Chastan, Nathalie; Dujardin, Franck; Roussignol, Xavier; Gauthé, Rémi

2017-06-01

Spinal diseases often induce gait disorders with multifactorial origins such as lumbar pain, radicular pain, neurologic complications, or spinal deformities. However, radiography does not permit an analysis of spinal dynamics; therefore, sagittal balance dynamics during gait remain largely unexplored. This prospective and controlled pilot study assessed the Vicon system for detecting sagittal spinopelvic imbalance, to determine the correlations between optoelectronic and radiographic parameters. Reversible anterior sagittal imbalance was induced in 24 healthy men using a thoracolumbar corset. Radiographic, optoelectronic, and comparative analyses were conducted. Corset wearing induced significant variations in radiographic parameters indicative of imbalance; the mean C7-tilt and d/D ratio increased by 15° ± 7.4° and 359%, respectively, whereas the mean spinosacral angle decreased by 16.8° ± 8° (all P < 0.001). The Vicon system detected the imbalance; the mean spinal angle increased by 15.4° ± 5.6° (P < 0.01), the mean floor projection of the C7S1 vector (C7'S1') increased by 126.3 ± 51.9 mm (P < 0.001), and the mean C7-T10-S1 angle decreased by 9.8° ± 3° (P < 0.001). Variations in C7'S1' were significantly correlated with d/D ratio (ρ = 0.58; P < 0.05) and C7-tilt (ρ = 0.636; P < 0.05) variations. Corset wearing induced radiographically confirmed anterior sagittal imbalance detected using the Vicon system. Optoelectronic C7'S1' correlated with radiographic C7-tilt and d/D ratio. Copyright © 2017 Elsevier Inc. All rights reserved.

Three-dimensional reproducibility of natural head position.

PubMed

Weber, Diana W; Fallis, Drew W; Packer, Mark D

2013-05-01

Although natural head position has proven to be reliable in the sagittal plane, with an increasing interest in 3-dimensional craniofacial analysis, a determination of its reproducibility in the coronal and axial planes is essential. This study was designed to evaluate the reproducibility of natural head position over time in the sagittal, coronal, and axial planes of space with 3-dimensional imaging. Three-dimensional photographs were taken of 28 adult volunteers (ages, 18-40 years) in natural head position at 5 times: baseline, 4 hours, 8 hours, 24 hours, and 1 week. Using the true vertical and horizontal laser lines projected in an iCAT cone-beam computed tomography machine (Imaging Sciences International, Hatfield, Pa) for orientation, we recorded references for natural head position on the patient's face with semipermanent markers. By using a 3-dimensional camera system, photographs were taken at each time point to capture the orientation of the reference points. By superimposing each of the 5 photographs on stable anatomic surfaces, changes in the position of the markers were recorded and assessed for parallelism by using 3dMDvultus (3dMD, Atlanta, Ga) and software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). No statistically significant differences were observed between the 5 time points in any of the 3 planes of space. However, a statistically significant difference was observed between the mean angular deviations of 3 reference planes, with a hierarchy of natural head position reproducibility established as coronal > axial > sagittal. Within the parameters of this study, natural head position was found to be reproducible in the sagittal, coronal, and axial planes of space. The coronal plane had the least variation over time, followed by the axial and sagittal planes. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults

PubMed Central

Yin, Jin; Peng, Bao-Gan; Li, Yong-Chao; Zhang, Nai-Yang; Yang, Liang; Li, Duan-Ming

2016-01-01

Background: Recent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of investigation for Han Chinese people concerning the normal range of spinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population. Methods: A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force (Beijing, China) were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A: 36 patients with simple lumbar spondylolysis, and Subgroup B: 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis (slip percentage <30%). Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L5 incidence, L5 slope, and sacral table angle (STA), were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t-test. Results: There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher (P < 0.05) in the spondylolysis group than those in the control group, but STA was lower (P < 0.001) in the spondylolysis group. Conclusions: Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population. PMID:27174324

Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults.

PubMed

Yin, Jin; Peng, Bao-Gan; Li, Yong-Chao; Zhang, Nai-Yang; Yang, Liang; Li, Duan-Ming

2016-05-20

Recent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of investigation for Han Chinese people concerning the normal range of spinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population. A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force (Beijing, China) were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A: 36 patients with simple lumbar spondylolysis, and Subgroup B: 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis (slip percentage <30%). Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L5 incidence, L5 slope, and sacral table angle (STA), were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t- test. There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher (P < 0.05) in the spondylolysis group than those in the control group, but STA was lower (P < 0.001) in the spondylolysis group. Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.

Occlusal traits and orthodontic treatment need in 7‐ to 10‐year‐olds in Estonia

PubMed Central

Saag, Mare; Svedström‐Oristo, Anna‐Liisa; Peltomäki, Timo; Vinkka‐Puhakka, Heli

2017-01-01

Abstract The aim of this study was to evaluate the distribution of occlusal traits and orthodontic treatment need and complexity in Estonian 7‐ to 10‐year‐old children. This data provides solid information for planning of orthodontic care. Data of 392 Estonian children (198 girls and 194 boys, mean age 9.0 years, range 7.1–10.4 years) was analysed in this cross‐sectional study. Assessed traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite, and scissor bite. Orthodontic treatment need and complexity were assessed using the Index of Complexity, Outcome, and Need. Parents' opinion regarding their child's teeth was determined using a questionnaire. The most prevalent occlusal traits were canine class I sagittal relationship (73.7%), midline diastema (73.0%), molar class I sagittal relationship (57.4%), and overbite ≥3.5 mm (51.8%). According to the Index of Complexity, Outcome, and Need, 64.3% of Estonian elementary school children were in need of orthodontic treatment. Treatment complexity was simple in 12.5%, mild in 38.8%, moderate in 22.7%, difficult in 14.0%, and very difficult in 12.0% of the children. Approximately 66.4% of the parents felt that their child needed orthodontic treatment. This study confirms earlier findings indicating that the most frequent sagittal relationship is class I in the first molars and class I in the canines. However, the sagittal relationship was asymmetric in more than half of the children. Correlation between objectively defined treatment need and parents' desire for treatment was high in Estonia. PMID:29744185

Comparing Outcomes and Cost of 3 Surgical Treatments for Sagittal Synostosis: A Retrospective Study Including Procedure-Related Cost Analysis.

PubMed

Garber, Sarah T; Karsy, Michael; Kestle, John R W; Siddiqi, Faizi; Spanos, Stephen P; Riva-Cambrin, Jay

2017-10-01

Neurosurgical techniques for repair of sagittal synostosis include total cranial vault (TCV) reconstruction, open sagittal strip (OSS) craniectomy, and endoscopic strip (ES) craniectomy. To evaluate outcomes and cost associated with these 3 techniques. Via retrospective chart review with waiver of informed consent, the last consecutive 100 patients with sagittal synostosis who underwent each of the 3 surgical correction techniques before June 30, 2013, were identified. Clinical, operative, and process of care variables and their associated specific charges were analyzed along with overall charge. The study included 300 total patients. ES patients had fewer transfusion requirements (13% vs 83%, P < .001) than TCV patients, fewer days in intensive care (0.3 vs 1.3, P < .001), and a shorter overall hospital stay (1.8 vs 4.2 d, P < .001), and they required fewer revisions (1% vs 6%, P = .05). The mean charge for the endoscopic procedure was $21 203, whereas the mean charge for the TCV reconstruction was $45 078 (P < .001). ES patients had more preoperative computed tomography scans (66% vs 44%, P = .003) than OSS patients, shorter operative times (68 vs 111 min, P < .001), and required fewer revision procedures (1% vs 8%, P < .001). The mean charge for the endoscopic procedure was $21 203 vs $20 535 for the OSS procedure (P = .62). The ES craniectomy for sagittal synostosis appeared to have less morbidity and a potential cost savings compared with the TCV reconstruction. The charges were similar to those incurred with OSS craniectomy, but patients had a shorter length of stay and fewer revisions. Copyright © 2017 by the Congress of Neurological Surgeons

5D CNS+ Software for Automatically Imaging Axial, Sagittal, and Coronal Planes of Normal and Abnormal Second-Trimester Fetal Brains.

PubMed

Rizzo, Giuseppe; Capponi, Alessandra; Persico, Nicola; Ghi, Tullio; Nazzaro, Giovanni; Boito, Simona; Pietrolucci, Maria Elena; Arduini, Domenico

2016-10-01

The purpose of this study was to test new 5D CNS+ software (Samsung Medison Co, Ltd, Seoul, Korea), which is designed to image axial, sagittal, and coronal planes of the fetal brain from volumes obtained by 3-dimensional sonography. The study consisted of 2 different steps. First in a prospective study, 3-dimensional fetal brain volumes were acquired in 183 normal consecutive singleton pregnancies undergoing routine sonographic examinations at 18 to 24 weeks' gestation. The 5D CNS+ software was applied, and the percentage of adequate visualization of brain diagnostic planes was evaluated by 2 independent observers. In the second step, the software was also tested in 22 fetuses with cerebral anomalies. In 180 of 183 fetuses (98.4%), 5D CNS+ successfully reconstructed all of the diagnostic planes. Using the software on healthy fetuses, the observers acknowledged the presence of diagnostic images with visualization rates ranging from 97.7% to 99.4% for axial planes, 94.4% to 97.7% for sagittal planes, and 92.2% to 97.2% for coronal planes. The Cohen κ coefficient was analyzed to evaluate the agreement rates between the observers and resulted in values of 0.96 or greater for axial planes, 0.90 or greater for sagittal planes, and 0.89 or greater for coronal planes. All 22 fetuses with brain anomalies were identified among a series that also included healthy fetuses, and in 21 of the 22 cases, a correct diagnosis was made. 5D CNS+ was efficient in successfully imaging standard axial, sagittal, and coronal planes of the fetal brain. This approach may simplify the examination of the fetal central nervous system and reduce operator dependency.

Is Postoperative Intensive Care Unit Care Necessary following Cranial Vault Remodeling for Sagittal Synostosis?

PubMed

Wolfswinkel, Erik M; Howell, Lori K; Fahradyan, Artur; Azadgoli, Beina; McComb, J Gordon; Urata, Mark M

2017-12-01

Of U.S. craniofacial and neurosurgeons, 94 percent routinely admit patients to the intensive care unit following cranial vault remodeling for correction of sagittal synostosis. This study aims to examine the outcomes and cost of direct ward admission following primary cranial vault remodeling for sagittal synostosis. An institutional review board-approved retrospective review was undertaken of the records of all patients who underwent primary cranial vault remodeling for isolated sagittal craniosynostosis from 2009 to 2015 at a single pediatric hospital. Patient demographics, perioperative course, and outcomes were recorded. One hundred ten patients met inclusion criteria with absence of other major medical problems. Average age at operation was 6.7 months, with a mean follow-up of 19.8 months. Ninety-eight patients (89 percent) were admitted to a general ward for postoperative care, whereas the remaining 12 (11 percent) were admitted to the intensive care unit for preoperative or perioperative concerns. Among ward-admitted patients, there were four (3.6 percent) minor complications; however, there were no major adverse events, with none necessitating intensive care unit transfers from the ward and no mortalities. Average hospital stay was 3.7 days. The institution's financial difference in cost of intensive care unit stay versus ward bed was $5520 on average per bed per day. Omitting just one intensive care unit postoperative day stay for this patient cohort would reduce projected health care costs by a total of $540,960 for the study period. Despite the common practice of postoperative admission to the intensive care unit following cranial vault remodeling for sagittal craniosynostosis, the authors suggest that postoperative care be considered on an individual basis, with only a small percentage requiring a higher level of care. Therapeutic, III.

3-D scapular kinematics during arm elevation: effect of motion velocity.

PubMed

Fayad, F; Hoffmann, G; Hanneton, S; Yazbeck, C; Lefevre-Colau, M M; Poiraudeau, S; Revel, M; Roby-Brami, A

2006-11-01

No three-dimensional (3-D) data exist on the influence of motion velocity on scapular kinematics. The effect of arm elevation velocity has been studied only in a two-dimensional setting. Thirty healthy subjects performed dominant (right) arm elevation in two planes, sagittal and frontal, and at slow and fast self-selected arm speed. Scapular orientation and humeral elevation were measured at 30 Hz recording frequency with use of a 6-degree-of-freedom electromagnetic system (Polhemus Fastraka). Motion was computed according to the International Society of Biomechanics standards. Scapular orientation was also determined with the arm held in different static positions. We obtained a full 3-D kinematic description of scapula achieving a reliable, complex 3-D motion during humeral elevation and lowering. The maximal sagittal arm elevation showed a characteristic "M"-shape pattern of protraction/retraction curve. Scapular rotations did not differ significantly between slow and fast movements. Moreover, protraction/retraction and tilt angular values did not differ significantly between static and dynamic tasks. However, scapular lateral rotation values differed between static and dynamic measurements during sagittal and frontal arm elevation. Lateral scapular rotation appears to be less in static than in dynamic measurement, particularly in the sagittal plane. Interpolation of statically recorded positions of the bones cannot reflect the kinematics of the scapula.

A comparison of short term radiological alignment outcomes of the patient specific and standard instrumentation for primary total knee arthroplasty: A systematic review and meta-analysis.

PubMed

Alcelik, Ilhan; Blomfield, Mark; Öztürk, Cenk; Soni, Ashish; Charity, Richard; Acornley, Alex

2017-05-01

The aim of this study was to review the radiological alignment outcomes of patient Specific (PS) cutting blocks and Standard Instrumentation in Primary Total Knee Arthroplasty. We hypothesized that the use of PS techniques would significantly improve sagittal, coronal and rotational alignment of the prosthesis on short term. We performed a systematic review and a meta-analysis including all the randomised controlled trials (RCT) using PS and standard (ST) total knee arthroplasty to date. A total of 538 PS TKA and 549 ST TKA were included in the study. Statistical analysis of the outliers for femoral component sagittal, coronal and rotational positioning, tibial component sagittal and coronal positioning and the overall mechanical axis were assessed. We found that there was no significant benefit from using PS instrumentation in primary knee arthroplasty to aid in the positioning of either the tibial or femoral components. Furthermore sagittal plane tibial component positioning was worse in the PS than the traditional ST group. Our results suggest that at present PS instrumentation is not superior to ST instrumentation in primary total knee arthroplasty. Level 1, Systematic review of therapeutic studies. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

The spatial alignment of time: Differences in alignment of deictic and sequence time along the sagittal and lateral axes.

PubMed

Walker, Esther J; Bergen, Benjamin K; Núñez, Rafael

2017-04-01

People use space in a variety of ways to structure their thoughts about time. The present report focuses on the different ways that space is employed when reasoning about deictic (past/future relationships) and sequence (earlier/later relationships) time. In the first study, we show that deictic and sequence time are aligned along the lateral axis in a manner consistent with previous work, with past and earlier events associated with left space and future and later events associated with right space. However, the alignment of time with space is different along the sagittal axis. Participants associated future events and earlier events-not later events-with the space in front of their body and past and later events with the space behind, consistent with the sagittal spatial terms (e.g., ahead, in front of) that we use to talk about deictic and sequence time. In the second study, we show that these associations between sequence time and sagittal space are sensitive to person-perspective. This suggests that the particular space-time associations observed in English speakers are influenced by a variety of different spatial properties, including spatial location and perspective. Copyright © 2016. Published by Elsevier B.V.

Ectrodactyly with aplasia of long bones (OMIM; 119100) in a large inbred Arab family with an apparent autosomal dominant inheritance and reduced penetrance: clinical and genetic analysis.

PubMed

Naveed, Mohammed; Al-Ali, Mahmoud T; Murthy, Sabita K; Al-Hajali, Sarah; Al-Khaja, Najib; Deutsch, Samuel; Bottani, Armand; Antonarakis, Stylianos E; Nath, Swapan K; Radhakrishna, Uppala

2006-07-01

Ectrodactyly with aplasia of long bones syndrome is one of the most recognizable defects involving the extremities. We have studied a very large eight-generation consanguineous Arab family from the United Arab Emirates (UAE) with multiple severe limb anomalies resembling this condition (OMIM; 119100), for which the affected gene is unknown. The pedigree consists of 145 individuals including 23 affected (14 males/9 females) with limb anomalies. Of these, 18 had tibial aplasia (TA) usually on the right side. The expression of the phenotype was variable and ranged from bilateral to unilateral TA with ectrodactyly and other defects of the extremities. The mode of inheritance appears to be autosomal dominant with reduced penetrance. There were 10 consanguineous marriages observed in this pedigree. This could suggest possible pseudodominance due to high frequency of the mutant allele. Candidate loci for the described syndrome include GLI3 (OMIM: 165240) on 7p13, sonic hedgehog; (OMIM: 600725) on 7q36, Langer-Giedion syndrome (OMIM: 150230) on 8q24.1 and split-hand/foot malformation 3 (OMIM: 600095) on 10q24. In addition, bilateral tibial hemimelia and unilateral absence of the ulna was previously observed to co-segregate with deletion of 8q24.1. Two-point linkage and haplotype analyses did not show the involvement of the above regions in this family. (c) 2006 Wiley-Liss, Inc.

[Significance of the sagittal profile and reposition of grade III-V spondylolisthesis].

PubMed

Dick, W; Elke, R

1997-09-01

The deformity in severe spondylolisthesis consists of two components: the parallel anterocaudad slip of the spondylolisthetic vertebra, and its tilt into kyphotic malposition. The influence of the two components is very different: the anterocaudad slippage has not much impact on the sagittal profile of the spine and is easily compensated for by a slight increase in lumbar lordosis. The kyphotic deformity has a high impact on trunk imbalance and the sagittal profile. There are two compensation mechanisms: hyperlordosis of the lumbar spine to its anatomical extremes and-if that is not sufficient-verticalisation of the sacral bone, performed by contracture of the hamstrings and uprighting of the pelvis around the hip joints. The latter mechanism is followed by functional disadvantages. Therefore, correction of the kyphosis of L5 may be considered during operative treatment if the lumbosacral kyphosis (angle delta) is less than 85 degrees and the sacral inclination less than 35 degrees.

Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach.

PubMed

Asopa, H S; Garg, M; Singhal, G G; Singh, L; Asopa, J; Nischal, A

2001-11-01

To explore the feasibility of applying a dorsal free graft to treat urethral stricture by the ventral sagittal urethrotomy approach without mobilizing the urethra. Twelve patients with long or multiple strictures of the anterior urethra were treated by a dorsal free full-thickness preputial or buccal mucosa graft. The urethra was not separated from the corporal bodies and was opened in the midline over the stricture. The floor of the urethra was incised, and an elliptical raw area was created over the tunica on which a free full-thickness graft of preputial or buccal mucosa was secured. The urethra was retubularized in one stage. After a follow-up of 8 to 40 months, one recurrence developed and required dilation. The ventral sagittal urethrotomy approach for dorsal free graft urethroplasty is not only feasible and successful, but is easy to perform.

Lower extremity energy absorption and biomechanics during landing, part II: frontal-plane energy analyses and interplanar relationships.

PubMed

Norcross, Marc F; Lewek, Michael D; Padua, Darin A; Shultz, Sandra J; Weinhold, Paul S; Blackburn, J Troy

2013-01-01

Greater sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing is consistent with sagittal-plane biomechanics that likely increase anterior cruciate ligament (ACL) loading, but it does not appear to influence frontal-plane biomechanics. We do not know whether frontal-plane INI EA is related to high-risk frontal-plane biomechanics. To compare biomechanics among INI EA groups, determine if women are represented more in the high group, and evaluate interplanar INI EA relationships. Descriptive laboratory study. Research laboratory. Participants included 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active volunteers. We assessed landing biomechanics with an electromagnetic motion-capture system and force plate. We calculated frontal- and sagittal-plane total, hip, knee, and ankle INI EA. Total frontal-plane INI EA was used to create high, moderate, and low tertiles. Frontal-plane knee and hip kinematics, peak vertical and posterior ground reaction forces, and peak internal knee-varus moment (pKVM) were identified and compared across groups using 1-way analyses of variance. We used a χ (2) analysis to evaluate male and female allocation to INI EA groups. We used simple, bivariate Pearson product moment correlations to assess interplanar INI EA relationships. The high-INI EA group exhibited greater knee valgus at ground contact, hip adduction at pKVM, and peak hip adduction than the low-INI EA group (P < .05) and greater peak knee valgus, pKVM, and knee valgus at pKVM than the moderate- (P < .05) and low- (P < .05) INI EA groups. Women were more likely than men to be in the high-INI EA group (χ(2) = 4.909, P = .03). Sagittal-plane knee and frontal-plane hip INI EA (r = 0.301, P = .006) and sagittal-plane and frontal-plane ankle INI EA were associated (r = 0.224, P = .04). No other interplanar INI EA relationships were found (P > .05). Greater frontal-plane INI EA was associated with less favorable frontal-plane biomechanics that likely result in greater ACL loading. Women were more likely than men to use greater frontal-plane INI EA. The magnitudes of sagittal- and frontal-plane INI EA were largely independent.

The addition of a sagittal image fusion improves the prostate cancer detection in a sensor-based MRI /ultrasound fusion guided targeted biopsy.

PubMed

Günzel, Karsten; Cash, Hannes; Buckendahl, John; Königbauer, Maximilian; Asbach, Patrick; Haas, Matthias; Neymeyer, Jörg; Hinz, Stefan; Miller, Kurt; Kempkensteffen, Carsten

2017-01-13

To explore the diagnostic benefit of an additional image fusion of the sagittal plane in addition to the standard axial image fusion, using a sensor-based MRI/US fusion platform. During July 2013 and September 2015, 251 patients with at least one suspicious lesion on mpMRI (rated by PI-RADS) were included into the analysis. All patients underwent MRI/US targeted biopsy (TB) in combination with a 10 core systematic prostate biopsy (SB). All biopsies were performed on a sensor-based fusion system. Group A included 162 men who received TB by an axial MRI/US image fusion. Group B comprised 89 men in whom the TB was performed with an additional sagittal image fusion. The median age in group A was 67 years (IQR 61-72) and in group B 68 years (IQR 60-71). The median PSA level in group A was 8.10 ng/ml (IQR 6.05-14) and in group B 8.59 ng/ml (IQR 5.65-12.32). In group A the proportion of patients with a suspicious digital rectal examination (DRE) (14 vs. 29%, p = 0.007) and the proportion of primary biopsies (33 vs 46%, p = 0.046) were significantly lower. The rate of PI-RADS 3 lesions were overrepresented in group A compared to group B (19 vs. 9%; p = 0.044). Classified according to PI-RADS 3, 4 and 5, the detection rates of TB were 42, 48, 75% in group A and 25, 74, 90% in group B. The rate of PCa with a Gleason score ≥7 missed by TB was 33% (18 cases) in group A and 9% (5 cases) in group B; p-value 0.072. An explorative multivariate binary logistic regression analysis revealed that PI-RADS, a suspicious DRE and performing an additional sagittal image fusion were significant predictors for PCa detection in TB. 9 PCa were only detected by TB with sagittal fusion (sTB) and sTB identified 10 additional clinically significant PCa (Gleason ≥7). Performing an additional sagittal image fusion besides the standard axial fusion appears to improve the accuracy of the sensor-based MRI/US fusion platform.

Sagittal Alignment Two Years After Selective and Nonselective Thoracic Fusion for Lenke 1C Adolescent Idiopathic Scoliosis.

PubMed

Celestre, Paul C; Carreon, Leah Y; Lenke, Lawrence G; Sucato, Daniel J; Glassman, Steven D

2015-11-01

Matched cohort. To evaluate thoracic and thoracolumbar sagittal Cobb angles in patients undergoing either selective thoracic fusion (STF) or nonselective thoracic fusion (NSTF) for Lenke 1C adolescent idiopathic scoliosis (AIS). The Lenke classification is used to guide fusion levels in AIS. For some curve types, including 1C, there is a disparity in practice regarding whether the thoracolumbar/lumbar curve should be included in the arthrodesis. The impact of performing an NSTF on sagittal parameters has not been adequately evaluated. A multicenter database of AIS was queried for patients with right-sided 1C curves treated with posterior correction and fusion. A matched cohort for each group was created based on age, gender, preoperative Cobb angles, and Scoliosis Research Society-22R domain scores. Independent t tests for continuous variables and Fisher exact test for categorical variables were used to compare the STF and NSTF groups. Thirty-eight patients who underwent NSTF were matched to 38 patients in the STF. An average of 8.0 levels were fused in the STF group and 11.6 in the NSTF group (p < .001). Preoperative and radiographic variables were similar between the two groups. Postoperatively, there was a statistically significant difference between the STF and NSTF sagittal Cobb in the thoracic spine, 26.9° and 21.7° (p = .013). The greatest difference was in the thoracolumbar sagittal Cobb, which increased to 4.3° kyphosis in the STF group and decreased to 9° of lordosis in the NSTF group (p < .001). Residual thoracolumbar/lumbar scoliosis was 25.5° in the STF group and 14.5° in the NSTF group (p < .001). STF in 1C curves preserves lumbar motion segments but may be associated with an increase in thoracic and thoracolumbar kyphosis compared to NSTF. As expected, residual thoracolumbar/lumbar scoliosis was less in the NSTF group compared to the STF group. Although the long-term implications of these changes are unknown, consideration of sagittal balance is critical. Following these patients in the medium and long term will provide important information to guide fusion levels. II. Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Walking sagittal balance correction by pedicle subtraction osteotomy in adults with fixed sagittal imbalance.

PubMed

Yagi, Mitsuru; Kaneko, Shinjiro; Yato, Yoshiyuki; Asazuma, Takashi; Machida, Masafumi

2016-08-01

Pedicle subtraction osteotomy (PSO) is widely used to treat severe fixed sagittal imbalance. However, the effect of PSO on balance has not been fully documented. The aim of this study was to assess dynamic walking balance after PSO to treat fixed sagittal imbalance. Gait and balance were assessed in 15 consecutive adult female patients who had been treated by PSO for a fixed sagittal imbalance and compare patients' preop and postop dynamic walking balance with that of 15 age- and gender-matched healthy volunteers (HV). Each patient's chart, X-rays, pre and postop SRS22 outcome scores, and ODI were reviewed. Means were compared by Mann-Whitney U test and Chi-square test. The mean age was 66.3 years (51-74 years). The mean follow-up was 2.7 years (2-3.5 years). The C7PL and GL, measured on the force platform, were both improved from 24.2 ± 7.3 cm and 27.6 ± 9.4 to 5.4 ± 2.6 cm and 7.2 ± 3.4 cm, respectively. The baseline hip ROM was significantly smaller in patients compared to HV, whereas no significant difference was observed in the knee or ankle ROM. The pelvic tilt (preop -0.4° ± 1.4°, postop 8.9° ± 1.0°), and maximum hip-extension angle (preop -1.2° ± 14.2°, postop -11.2° ± 7.2°) were also improved after surgery. Cadence (116 s/min), stance-swing ratio (stance 63.2 % vs. swing 36.8 %), and stride (98.0 cm) were all increased after surgery. On the other hand, gait velocity was significantly slower in the PSO group at both pre and postop than in HV (PSO 53.3 m/min at preop and 58.8 m/min at postop vs. HV 71.1 m/min, p = 0.04). Despite a mild residual spinal-pelvic malalignment, PSO restored sagittal alignment and balance satisfactorily and has improved the gait pattern.

Exploiting Inherent Robustness and Natural Dynamics in the Control of Bipedal Walking Robots

DTIC Science & Technology

2000-06-01

physical models of bipedal walking. The insight gained from these models is used in the development of three planar (motion only in the sagittal plane ...ground is implemented and tested in simulation. The dynamics of the sagittal plane are suffciently decoupled from the dynamics of the frontal and...transverse planes such that control of each can be treated separately. We achieve three-dimensional walking by adding lateral balance to the planar algorithms

Quantitative Evaluation of Brain Stem Atrophy Using Magnetic Resonance Imaging in Adult Patients with Alexander Disease.

PubMed

Yoshida, Tomokatsu; Yasuda, Rei; Mizuta, Ikuko; Nakagawa, Masanori; Mizuno, Toshiki

2017-01-01

Brain MRI in adult patients with Alexander disease (AxD) mainly shows atrophy in the medulla oblongata. However, currently there is no quantitative standard for assessing this atrophy. In this study, we quantitatively evaluated the brain stem of AxD patients with glial fibrillary acidic protein (GFAP) mutation using conventional MRI to evaluate its usefulness as an aid to diagnosing AxD in daily clinical practice. Nineteen AxD patients with GFAP mutation were compared with 14 patients negative for GFAP mutation in whom AxD was suspected due to "atrophy of the medulla oblongata." In the GFAP mutation-positive group, the sagittal diameter of the medulla oblongata, the ratio of the diameter of the medulla oblongata to that of the midbrain (MO/MB), and the ratio of the sagittal diameter of the medulla oblongata to that of the pons (MO/Po) were significantly smaller compared to those of the GFAP mutation-negative group (p < 0.01). The sensitivity and specificity of each parameter were 87.5 and 92.3%, 91.7 and 81.3%, and 88.2 and 100% with a sagittal diameter of the medulla oblongata <9.0 mm, MO/MB <0.60, and sagittal MO/Po <0.46, respectively. These parameters can provide very useful information to differentially diagnose AxD from other disorders associated with brain stem atrophy in adult patients. © 2017 S. Karger AG, Basel.

The distance from the extramedullary cutting guide rod to the skin surface as a reference guide for the tibial slope in total knee arthroplasty.

PubMed

Tsukeoka, Tadashi; Tsuneizumi, Yoshikazu

2016-03-01

Although sagittal tibial alignment in total knee arthroplasty (TKA) is important, no landmarks exist to achieve a reproducible slope. The purpose of this study was to evaluate the clinical usefulness of the distance from the guide rod to the skin surface for the tibial slope in TKA. Computer simulation studies were performed on 100 consecutive knees scheduled for TKA. The angle between the line connecting the most anterior point of the predicted tibial cut surface and the skin surface 20 cm distal to the predicted cut surface (Line S) and the mechanical axis (MA) of the tibia in the sagittal plane was measured. The mean (±SD) absolute angle difference between the Line S and the MA was 0.9°±0.7°. The Line S was almost parallel to the MA in the sagittal plane (95% and 99% within two degrees and three degrees of deviation from MA, respectively). The guide rod orientation is a surrogate for the tibial cut slope because the targeted posterior slope is usually built into the cutting block and ensuring the rod is parallel to the MA in the sagittal plane is recommended. Therefore the distance between the skin surface and the rod can be a useful guide for the tibial slope. II. Copyright © 2015 Elsevier B.V. All rights reserved.

Sex differences in lower extremity kinematics and patellofemoral kinetics during running.

PubMed

Almonroeder, Thomas G; Benson, Lauren C

2017-08-01

The incidence of patellofemoral pain (PFP) is 2 times greater in females compared with males of similar activity levels; however, the exact reason for this discrepancy remains unclear. Abnormal mechanics of the hip and knee in the sagittal, frontal, and transverse planes have been associated with an increased risk of PFP. The purpose of this study was to compare the mechanics of the lower extremity in males and females during running in order to better understand the reason(s) behind the sex discrepancy in PFP. Three-dimensional kinematic and kinetic data were collected as male and female participants completed overground running trials at a speed of 4.0 m · s -1 (±5%). Patellofemoral joint stress (PFJS) was estimated using a sagittal plane knee model. The kinematics of the hip and knee in the frontal and transverse planes were also analysed. Male participants demonstrated significantly greater sagittal plane peak PFJS in comparison with the female participants (P < .001, ES = 1.9). However, the female participants demonstrated 3.5° greater peak hip adduction and 3.4° greater peak hip internal rotation (IR). As a result, it appears that the sex discrepancy in PFP is more likely to be related to differences in the kinematics of the hip in the frontal and transverse planes than differences in sagittal plane PFJS.

Movement compatibility for configurations of displays located in three cardinal orientations and ipsilateral, contralateral and overhead controls.

PubMed

Chan, Alan H S; Hoffmann, Errol R

2012-01-01

Stereotype strength and reversibility were determined for displays that were in the Front, Right and Left orientations relative to the operator, along with rotary, horizontally and vertically-moving controls located in the overhead, left-sagittal and right-sagittal planes. In each case, responses were made using the left and right hands. The arrangements used were (i) rotary control with a circular display (ii) horizontal/transverse control moving forward/rearward in the left and right-sagittal planes or transversely in the overhead plane and (iii) vertical/longitudinal control moving vertically in the left and right-sagittal planes and longitudinally in the overhead plane. These are all combinations not previously researched. Stereotype strength varied with display plane, type of control and plane of control. Models for the stereotype strength are developed, showing the contribution of various components to the overall stereotype strength. The major component for horizontally-moving controls comes from the "visual field" model of Worringham and Beringer (1998); for the rotary control important factors are "clockwise-for-clockwise" and the hand/control location effect (Hoffmann, 2009a). Vertically-moving controls are governed by a simple 'up-for-up' relationship between displays and controls. Overall stereotype strength is a maximum when all components add positively. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Ipsilateral wrist-ankle movements in the sagittal plane encoded in extrinsic reference frame.

PubMed

Muraoka, Tetsuro; Ishida, Yuki; Obu, Takashi; Crawshaw, Larry; Kanosue, Kazuyuki

2013-04-01

When performing oscillatory movements of two joints in the sagittal plane, there is a directional constraint for performing such movements. Previous studies could not distinguish whether the directional constraint reflected movement direction encoded in the extrinsic (outside the body) reference frame or in the intrinsic (the participants' torso/head) reference frame since participants performed coordinated movements in a sitting position where the torso/head was stationary relative to the external world. In order to discern the reference frame in the present study, participants performed paced oscillatory movements of the ipsilateral wrist and ankle in the sagittal plane in a standing position so that the torso/head moved relative to the external world. The coordinated movements were performed in one of two modes of coordination, moving the hand upward concomitant with either ankle plantarflexion or ankle dorsiflexion. The same directional mode relative to extrinsic space was more stable and accurate as compared with the opposite directional mode. When forearm position was changed from the pronated position to the supinated position, similar results were obtained, indicating that the results were independent of a particular coupling of muscles. These findings suggest that the directional constraint on ipsilateral joints movements in the sagittal plane reflects movement direction encoded in the extrinsic reference frame. Copyright © 2013 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.

Biomechanical evaluation of sagittal maxillary internal distraction osteogenesis in unilateral cleft lip and palate patient and noncleft patients: a three-dimensional finite element analysis.

PubMed

Olmez, Sultan; Dogan, Servet; Pekedis, Mahmut; Yildiz, Hasan

2014-09-01

To compare the pattern and amount of stress and displacement during maxillary sagittal distraction osteogenesis (DO) between a patient with unilateral cleft lip and palate (UCLP) and a noncleft patient. Three-dimensional finite element models for both skulls were constructed. Displacements of the surface landmarks and stress distributions in the circummaxillary sutures were analyzed after an anterior displacement of 6 mm was loaded to the elements where the inferior plates of the distractor were assumed to be fixed and were below the Le Fort I osteotomy line. In sagittal plane, more forward movement was found on the noncleft side in the UCLP model (-6.401 mm on cleft side and -6.651 mm on noncleft side for the central incisor region). However, similar amounts of forward movement were seen in the control model. In the vertical plane, a clockwise rotation occurred in the UCLP model, whereas a counterclockwise rotation was seen in the control model. The mathematical UCLP model also showed higher stress values on the sutura nasomaxillaris, frontonasalis, and zygomatiomaxillaris on the cleft side than on the normal side. Not only did the sagittal distraction forces produce advancement forces at the intermaxillary sutures, but more stress was also present on the sutura nasomaxillaris, sutura frontonasalis, and sutura zygomaticomaxillaris on the cleft side than on the noncleft side.

Bilateral rib-to-pelvis Eiffel Tower VEPTR construct for children with neuromuscular scoliosis: a preliminary report.

PubMed

Abol Oyoun, Nariman; Stuecker, Ralf

2014-07-01

Neuromuscular scoliosis could develop at a young age and progress beyond skeletal maturity. An early spinal fusion arrests growth of the spine and thorax, risking the development of secondary thoracic insufficiency syndrome. Vertical expandable prosthetic titanium rib (VEPTR) is a fusionless technique aiming at correction of the deformity with preservation of growth potential. To demonstrate the preliminary results of the use of VEPTR in an Eiffel Tower construct in children with neuromuscular scoliosis in regard to coronal and sagittal profiles, space available for the lungs (SAL), and spinal growth. The report lists the complications we faced during the follow-up of 1.33 years after the index procedure. A retrospective analysis of prospectively collected data of a case series. Twenty nonambulatory children (mean 8.9 years) with neuromuscular scoliosis. Their primary diagnoses were myelomeningocele in seven, cerebral palsy in three, spinal muscular atrophy in two, myopathies in three, arthrogryposis in one, and syndromic scoliosis in four patients. All 20 patients received percutaneous rib-to-pelvis VEPTR implantation. Mean operative time was 2 hours, and mean hospital stay was 12 days. None of them needed blood transfusion. They underwent 20 primary implantations and 39 lengthenings. The patients were assessed based on physiologic measures, that is, the radiographic improvement of their scoliosis, SAL, pelvic tilt, spinal height, and sagittal and coronal decompensation. At the latest follow-up, thoracolumbar curvature improved significantly (65.7°±20.5° to 49.9°±15.7°), as did lumbar curvature (61.6°±19.5° to 35°±21.2°), thoracic (17.2±2.3 to 20±2.3 cm) and lumbar spinal height (9.9±1.7 to 11.9±1.8 cm), SAL (86.5±8.9 to 97±10), pelvic obliquity (12.5°±8° to 5.2°± 5.2°), and the iliolumbar angle (15°±8° to 10.06°±7.1°). Nine patients suffered complications in the form of proximal cradle migration (five), implant breakage (five), deep wound infection (three), and dislodged iliac hooks (two). Early results of VEPTR for neuromuscular scoliosis are encouraging. Follow-up till skeletal maturity will best determine future indications. Copyright © 2014 Elsevier Inc. All rights reserved.

Geometrical properties of the human child cervical spine with a focus on the C1 vertebra.

PubMed

Yoganandan, Narayan; Pintar, Frank A; Lew, Sean M; Rao, Raj D

2014-01-01

Child dummies and injury criteria used in automotive crashworthiness environments are based on scaling from the adult and/or between children of different ages. Cartilage-to-bone ossification, spinal canal and joint developments of the spine, and strength attainments do not grow linearly from birth to maturity. Though this is known to medical professionals, age-based quantitative analyses are needed to accurately model the pediatric spine. The objective of this study was to quantify longitudinal growths of various regions of the first cervical vertebrae, responsible for transmitting the axial load from the base of the skull through the condyles to the neck/torso. Computed tomography (CT) images of 54 children from one day to 18 years of age were retrospectively used to determine the following geometrical properties: bilateral neurocentral synchondroses widths, the width of posterior synchondrosis, outer and inner anteroposterior and transverse diameters, spinal canal area, and depths of the anterior and posterior arches of the C1 vertebra. Both axial and sagittal CT images were used in the analysis. Sagittal images were used to quantify data for the anterior and posterior arches and axial images were used for all described cross-sectional parameters. Geometrical properties were extracted and reported for the various parameters at 6 months; one year; 18 months; and 3, 6, and 10 years of age corresponding to the dummy family ages routinely used in motor vehicle crashworthiness research and other applications. The outer transverse diameter ranged from 4.97 to 7.08 cm; outer and inner antero-posterior diameters ranged from 2.99 to 4.18 and 2.19 to 3.03 mm; and spinal canal area ranged from 4.34 to 6.68 mm(2). Other data are given in the body of the article. The growths of the first cervical vertebra quantified in terms of the above variables occurred nonlinearly with age and the degree of nonlinearity depended on the type of the geometrical parameter. Growths did not match with the simple scaling ratios based on the adult spine, used in different studies reported in the current literature. These early nonlinear and nonuniform age- and local geometry-specific variations should be considered in human finite element models for an accurate transfer of the external load from the atlas to the subaxial spine and to improve their fidelity and biomechanical capabilities.

Posterior spinal fusion for adolescent idiopathic scoliosis using a convex pedicle screw technique: a novel concept of deformity correction.

PubMed

Tsirikos, A I; Mataliotakis, G; Bounakis, N

2017-08-01

We present the results of correcting a double or triple curve adolescent idiopathic scoliosis using a convex segmental pedicle screw technique. We reviewed 191 patients with a mean age at surgery of 15 years (11 to 23.3). Pedicle screws were placed at the convexity of each curve. Concave screws were inserted at one or two cephalad levels and two caudal levels. The mean operating time was 183 minutes (132 to 276) and the mean blood loss 0.22% of the total blood volume (0.08% to 0.4%). Multimodal monitoring remained stable throughout the operation. The mean hospital stay was 6.8 days (5 to 15). The mean post-operative follow-up was 5.8 years (2.5 to 9.5). There were no neurological complications, deep wound infection, obvious nonunion or need for revision surgery. Upper thoracic scoliosis was corrected by a mean 68.2% (38% to 48%, p < 0.001). Main thoracic scoliosis was corrected by a mean 71% (43.5% to 8.9%, p < 0.001). Lumbar scoliosis was corrected by a mean 72.3% (41% to 90%, p < 0.001). No patient lost more than 3° of correction at follow-up. The thoracic kyphosis improved by 13.1° (-21° to 49°, p < 0.001); the lumbar lordosis remained unchanged (p = 0.58). Coronal imbalance was corrected by a mean 98% (0% to 100%, p < 0.001). Sagittal imbalance was corrected by a mean 96% (20% to 100%, p < 0.001). The Scoliosis Research Society Outcomes Questionnaire score improved from a mean 3.6 to 4.6 (2.4 to 4, p < 0.001); patient satisfaction was a mean 4.9 (4.8 to 5). This technique carries low neurological and vascular risks because the screws are placed in the pedicles of the convex side of the curve, away from the spinal cord, cauda equina and the aorta. A low implant density (pedicle screw density 1.2, when a density of 2 represents placement of pedicle screws bilaterally at every instrumented segment) achieved satisfactory correction of the scoliosis, an improved thoracic kyphosis and normal global sagittal balance. Both patient satisfaction and functional outcomes were excellent. Cite this article: Bone Joint J 2017;99-B:1080-7. ©2017 The British Editorial Society of Bone & Joint Surgery.

Facet orientation and tropism: Associations with asymmetric lumbar paraspinal and psoas muscle parameters in patients with chronic low back pain.

PubMed

Xu, W B; Chen, S; Fan, S W; Zhao, F D; Yu, X J; Hu, Z J

2016-08-10

Many studies have explored the relationship between facet tropism and facet joint osteoarthritis, disc degeneration and degenerative spondylolisthesis. However, the associations between facet orientation and tropism, and paraspinal muscles have not been studied. To analyze the associations between facet orientation and tropism, and parameters of paraspinal muscles in patients with chronic low back pain. Ninety-five patients with chronic low back pain were consecutively enrolled. Their facet joint angles were measured on computed tomography (CT) while gross cross-sectional area (GCSA), functional cross-sectional area (FCSA) and T2 signal intensity of lumbar paraspinal and psoas muscle were evaluated on magnetic resonance imaging (MRI). The GCSA and FCSA were significantly smaller for multifidus muscle (P< 0.001), but significantly larger for erector spinae and psoas muscles (P< 0.001), in coronally-orientated group than those in sagittally-orientated group. The differences of bilateral GCSA and FCSA of multifidus muscle were significantly larger in facet tropism group than those in no facet tropism group (P= 0.009 and P= 0.019). Muscular asymmetries may develop in the lumbar region of the spine, which are associated with facet asymmetry in patients with chronic low back pain. Longitudinal studies are needed to understand the causal relationship between facet orientation and tropism and muscular asymmetry in future.

Effects of constrained arm swing on vertical center of mass displacement during walking.

PubMed

Yang, Hyung Suk; Atkins, Lee T; Jensen, Daniel B; James, C Roger

2015-10-01

The purpose of this study was to determine the effects of constraining arm swing on the vertical displacement of the body's center of mass (COM) during treadmill walking and examine several common gait variables that may account for or mask differences in the body's COM motion with and without arm swing. Participants included 20 healthy individuals (10 male, 10 female; age: 27.8 ± 6.8 years). The body's COM displacement, first and second peak vertical ground reaction forces (VGRFs), and lowest VGRF during mid-stance, peak summed bilateral VGRF, lower extremity sagittal joint angles, stride length, and foot contact time were measured with and without arm swing during walking at 1.34 m/s. The body's COM displacement was greater with the arms constrained (arm swing: 4.1 ± 1.2 cm, arm constrained: 4.9 ± 1.2 cm, p < 0.001). Ground reaction force data indicated that the COM displacement increased in both double limb and single limb stance. However, kinematic patterns visually appeared similar between conditions. Shortened stride length and foot contact time also were observed, although these do not seem to account for the increased COM displacement. However, a change in arm COM acceleration might have contributed to the difference. These findings indicate that a change in arm swing causes differences in vertical COM displacement, which could increase energy expenditure. Copyright © 2015 Elsevier B.V. All rights reserved.

Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health.

PubMed

Christensen, Sanne Toftgaard; Hartvigsen, Jan

2008-01-01

The purposes of this study were to (1) determine whether sagittal spinal curves are associated with health in epidemiological studies, (2) estimate the strength of such associations, and (3) consider whether these relations are likely to be causal. A systematic critical literature review of epidemiological (cross-sectional, case-control, cohort) studies published before 2008 including studies identified in the CINAHL, EMBASE, Mantis, and Medline databases was performed using a structured checklist and a quality assessment. Level of evidence analysis was performed as outlined by van Tulder et al (Spine. 2003;28:1290-9), and the strength of associations were determined using the procedure outlined by Hemingway and Marmot (BMJ. 1999;318:1460-7). Quality of the included articles were assessed by our own scoring system based on the STrengthening the Reporting of OBservational studies in Epidemiology checklist. Studies scoring maximum points (4/4 or 3/3) were considered to be of higher quality. Fifty-four original studies were included. We found no strong evidence for any association between sagittal spinal curves and any health outcomes including spinal pain. The included studies were generally of low methodological quality. There is moderate evidence for association between sagittal spinal curves and 4 health outcomes as follows: temporomandibular disorders (no odds ratios [ORs] provided), pelvic organ prolapse (OR, 3.18; 95% confidence interval [CI], 1.46-96.93), daily function (OR range, 1.8-3.7; 95% CI range, 1.1-6.3), and death (OR, 1.40; 95% CI, 1.08-1.91). These associations are however unlikely to be causal. Evidence from epidemiological studies does not support an association between sagittal spinal curves and health including spinal pain. Further research of better methodological quality may affect this conclusion, and causal effects cannot be determined in a systematic review.

Three-Dimensional Ankle Moments and Nonlinear Summation of Rat Triceps Surae Muscles

PubMed Central

Tijs, Chris; van Dieën, Jaap H.; Baan, Guus C.; Maas, Huub

2014-01-01

The Achilles tendon and epimuscular connective tissues mechanically link the triceps surae muscles. These pathways may cause joint moments exerted by each muscle individually not to sum linearly, both in magnitude and direction. The aims were (i) to assess effects of sagittal plane ankle angle (varied between 150° and 70°) on isometric ankle moments, in both magnitude and direction, exerted by active rat triceps surae muscles, (ii) to assess ankle moment summation between those muscles for a range of ankle angles and (iii) to assess effects of sagittal plane ankle angle and muscle activation on Achilles tendon length. At each ankle angle, soleus (SO) and gastrocnemius (GA) muscles were first excited separately to assess ankle-angle moment characteristics and subsequently both muscles were excited simultaneously to investigate moment summation. The magnitude of ankle moment exerted by SO and GA, the SO direction in the transverse and sagittal planes, and the GA direction in the transverse plane were significantly affected by ankle angle. SO moment direction in the frontal and sagittal planes were significantly different from that of GA. Nonlinear magnitude summation varied between 0.6±2.9% and −3.6±2.9%, while the nonlinear direction summation varied between 0.3±0.4° and −0.4±0.7° in the transverse plane, between 0.5±0.4° and 0.1±0.4° in the frontal plane, and between 3.0±7.9° and 0.3±2.3° in the sagittal plane. Changes in tendon length caused by SO contraction were significantly lower than those during contraction of GA and GA+SO simultaneously. Thus, moments exerted by GA and SO sum nonlinearly both in the magnitude and direction. The limited degree of nonlinear summation may be explained by different mechanisms acting in opposite directions. PMID:25360524

Biomechanical evaluation of fracture fixation constructs using a variable-angle locked periprosthetic femur plate system.

PubMed

Hoffmann, Martin F; Burgers, Travis A; Mason, James J; Williams, Bart O; Sietsema, Debra L; Jones, Clifford B

2014-07-01

In the United States there are more than 230,000 total hip replacements annually, and periprosthetic femoral fractures occur in 0.1-4.5% of those patients. The majority of these fractures occur at the tip of the stem (Vancouver type B1). The purpose of this study was to compare the biomechanically stability and strength of three fixation constructs and identify the most desirable construct. Fifteen medium adult synthetic femurs were implanted with a hip prosthesis and were osteotomized in an oblique plane at the level of the implant tip to simulate a Vancouver type B1 periprosthetic fracture. Fractures were fixed with a non-contact bridging periprosthetic proximal femur plate (Zimmer Inc., Warsaw, IN). Three proximal fixation methods were used: Group 1, bicortical screws; Group 2, unicortical screws and one cerclage cable; and Group 3, three cerclage cables. Distally, all groups had bicortical screws. Biomechanical testing was performed using an axial-torsional testing machine in three different loading modalities (axial compression, lateral bending, and torsional/sagittal bending), next in axial cyclic loading to 10,000 cycles, again in the three loading modalities, and finally to failure in torsional/sagittal bending. Group 1 had significantly greater load to failure and was significantly stiffer in torsional/sagittal bending than Groups 2 and 3. After cyclic loading, Group 2 had significantly greater axial stiffness than Groups 1 and 3. There was no difference between the three groups in lateral bending stiffness. The average energy absorbed during cyclic loading was significantly lower in Group 2 than in Groups 1 and 3. Bicortical screw placement achieved the highest load to failure and the highest torsional/sagittal bending stiffness. Additional unicortical screws improved axial stiffness when using cable fixation. Lateral bending was not influenced by differences in proximal fixation. To treat periprosthetic fractures, bicortical screw placement should be attempted to maximize load to failure and torsional/sagittal bending stiffness. Copyright © 2014 Elsevier Ltd. All rights reserved.

The effect of age on sagittal plane profile of the lumbar spine according to standing, supine, and various sitting positions

PubMed Central

2014-01-01

Background The sagittal alignment of the spine changes depending on body posture and degenerative changes. This study aimed to observe changes in sagittal alignment of the lumbar spine with different positions (standing, supine, and various sitting postures) and to verify the effect of aging on lumbar sagittal alignment. Methods Whole-spine lateral radiographs were obtained for young volunteers (25.4 ± 2.3 years) and elderly volunteers (66.7 ± 1.7 years). Radiographs were obtained in standing, supine, and sitting (30°, 60°, and 90°) positions respectively. We compared the radiological changes in the lordotic and segmental angles in different body positions and at different ages. Upper and lower lumbar lordosis were defined according to differences in anatomical sagittal mobility and kinematic behavior. Results Lumbar lordosis was greater in a standing position (52.79° and 53.90° in young and old groups, respectively) and tended to decrease as position changed from supine to sitting. Compared with the younger group, the older group showed significantly more lumbar lordosis in supine and 60° and 90° sitting positions (P = 0.043, 0.002, 0.011). Upper lumbar lordosis in the younger group changed dynamically in all changed positions compared with the old group (P = 0.019). Lower lumbar lordosis showed a decreasing pattern in both age groups, significantly changing as position changed from 30° to 60° (P = 0.007, 0.007). Conclusions Lumbar lordosis decreases as position changes from standing to 90°sitting. The upper lumbar spine is more flexible in individuals in their twenties compared to those in their sixties. Changes in lumbar lordosis were concentrated in the lower lumbar region in the older group in sitting positions. PMID:24571953

Sagittal and transversal plane deformity in thoracic scoliosis.

PubMed

Kotwicki, Tomasz

2002-01-01

The aim of the study was to assess the sagittal and transversal plane deformity of the spine in thoracic scoliosis by the mean of 3-D radiographic analysis. 46 patients admitted for surgery for thoracic idiopathic scoliosis underwent preoperative radiographic assessment. All patients presented the same pattern of the coronal plane deformity: single right thoracic curve (Lenke 1, King 3). Neither lumbar nor proximal thoracic structural curve were present. The Cobb angle varied from 41gamma to 77 gamma (mean 55,4 gamma +/- 8,6 gamma). Long cassette standing antero-posterior and lateral radiographs were analysed. Three-dimensional reconstruction with Rachis 91TM software was performed for each pair of radiographs. The following parameters were assessed: sagittal thoracic Cobb angle (Th4-Th12), upper thoracic kyphosis angle (Th5-Th8), lower thoracic kyphosis angle (Th9-Th12), superior and inferior hemi-curve sagittal angles, lumbar lordosis, sacral slope, sacral incidence, vertebral plate index, segmental vertebral axial rotation throughout the thoracic and lumbar spine. Results showed great variability of parameters assessed. The non-harmonious distribution of kyphosis was demonstrated in the thoracic spine. Local Th9-Th12 hypokyphosis and adjacent local Th5-Th8 hyperkyphosis constitute the most typical sagittal pathologies. So called normokyphotic curves were composed of one hyperkyphotic and one hypokyphotic zone. Th1-Th4 segment revealed two patterns of segmental rotation distribution: a purely compensatory curve with no vertebral axial rotation or a rotated curve presenting the morphology intermediate between Lenke 1 and Lenke 2 types (or King 3 and King 5). curves presenting the same coronal plane deformity differ in their morphology assessed in the two other planes; global thoracic kyphosis angle is a misleading parameter because it covers hypo- and hyperkyphotic zones; local distal thoracic (Th9-Th12) hypokyphosis is present in idiopathic thoracic scoliosis.

Imaging and histological features of central subchondral osteophytes in racehorses with metacarpophalangeal joint osteoarthritis.

PubMed

Olive, J; D'Anjou, M A; Girard, C; Laverty, S; Theoret, C L

2009-12-01

Marginal osteophytes represent a well known component of osteoarthritis in man and animals. Conversely, central subchondral osteophytes (COs), which are commonly present in human knees with osteoarthritis, have not been reported in horses. To describe and compare computed radiography (CR), single-slice computed tomography (CT), 1.5 Tesla magnetic resonance imaging (MRI), and histological features of COs in equine metacarpophalangeal joints with macroscopic evidence of naturally-occurring osteoarthritis. MRI sequences (sagittal spoiled gradient recalled echo [SPGR] with fat saturation, sagittal T2-weighted fast spin echo with fat saturation [T2-FS], dorsal and transverse T1-weighted gradient-recalled echo [GRE], and sagittal T2*-weighted gradient echo with fast imaging employing steady state acquisition [FIESTA]), as well as transverse and reformatted sagittal CTI and 4 computed radiographic (CR) views of 20 paired metacarpophalangeal joints were acquired ex vivo. Following macroscopic evaluation, samples were harvested in predetermined sites of the metacarpal condyle for subsequent histology. The prevalence and detection level of COs was determined for each imaging modality. Abnormalities consistent with COs were clearly depicted on MRI, using the SPGR sequence, in 7/20 (35%) joints. They were identified as a focal hypointense protuberance from the subchondral plate into the cartilage, at the palmarodistal aspect (n=7) and/or at the very dorsal aspect (n=2) of the metacarpal condyle. COs were visible but less obvious in 5 of the 7 joints using FIESTA and reformatted sagittal CT, and were not identifiable on T2-FS, T1-GRE or CR. Microscopically, they consisted of dense bone protruding into the calcified cartilage and disrupting the tidemarks, and they were consistently associated with overlying cartilage defects. Subchondral osteophytes are a feature of osteoarthritis of equine metacarpophalangeal joints and they may be diagnosed using 1.5 Tesla MRI and CT. Central subchondral osteophytes on MRI represent indirect evidence of cartilage damage in horses.

An Assessment of Correlation between Dermatoglyphic Patterns and Sagittal Skeletal Discrepancies

PubMed Central

Philip, Biju; Madathody, Deepika; Mathew, Manu; Paul, Jose; Dlima, Johnson Prakash

2017-01-01

Introduction Investigators over years have been fascinated by dermatoglyphic patterns which has led to the development of dermatoglyphics as a science with numerous applications in various fields other than being the best and most widely used method for personal identification. Aim To assess the correlation between dermatoglyphic patterns and sagittal skeletal discrepancies. Materials and Methods A total of 180 patients, aged 18-40 years, were selected from those who attended the outpatient clinic of the Deparment of Orthodontics and Dentofacial Orthopedics, Mar Baselios Dental College, Kothamangalam, Kerala, India. The fingerprints of both hands were taken by ink and stamp method after proper hand washing. The patterns of arches, loops and whorls in fingerprints were assessed. The total ridge count was also evaluated. Data was also sent to the fingerprint experts for expert evaluation. The sagittal jaw relation was determined from the patient’s lateral cephalogram. The collected data was then statistically analyzed using Chi-square tests, ANOVA and Post-hoc tests and a Multinomial regression prediction was also done. Results A significant association was observed between the dermatoglyphic pattern exhibited by eight fingers and the sagittal skeletal discrepancies (p<0.05). An increased distribution of whorl pattern was observed in the skeletal Class II with maxillary excess group and skeletal Class II with mandibular deficiency group while an increased distribution of loop pattern was seen in the skeletal Class III with mandibular excess group and skeletal Class III with maxillary deficiency group. Higher mean of total ridge count was also seen in the groups of skeletal Class II with maxillary excess and skeletal Class II with mandibular deficiency. Multinomial regression predicting skeletal pattern with respect to the fingerprint pattern showed that the left thumb impression fits the best model for predicting the skeletal pattern. Conclusion There was a significant association between dermatoglyphic patterns and sagittal skeletal discrepancies. Dermatoglyphics could serve as a cost effective screening tool of these craniofacial problems. PMID:28511506

Outcome following subluxation of mobile articulating spacers in two-stage revision total knee arthroplasty.

PubMed

Lanting, Brent A; Lau, Adrian; Teeter, Matthew G; Howard, James L

2017-03-01

Infection after total knee arthroplasty (TKA) is a severe complication. It is usually treated with two-stage revision and implantation of a cement spacer. Few studies describe the complications associated with a mobile articulating spacer. This study examined the subluxation of articulating antibiotic spacers in knees and correlated it with prospectively collected early outcome scores after implantation of a revision prosthesis. Staged revisions for 72 infected primary total knee arthroplasties between 2004 and 2012 were examined. The mean age of the patients was 70.2 ± 10.8 years, with 40 right and 32 left knees. Sagittal and coronal subluxation was measured using radiographs prior to second-stage revision and grouped to be within (Group 1) or outside (Group 2) one standard deviation from the mean. Medical Outcomes Study Short Form-12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were obtained via patient-administered questionnaire. Statistical analysis was carried out to look at the correlation between subluxation and outcome. Significant improvements were observed between the interim outcome scores prior to implantation of a revision prosthesis and scores obtained after second-stage revision. Debonding occurred in 5.6%, and one dislocation was found. Mean coronal subluxation was 4.8 ± 5.5% of the tibia width, in the lateral direction. Coronal subluxation did not affect SF12, WOMAC or KSS outcome scores. Mean sagittal subluxation was 6.1 ± 16.4% posteriorly. However, sagittal subluxation had a significant influence on Knee Society Scores, with Group 2 having a lower mean Knee Society Function Score of 39.3 than Group 1 (60.2) (p = 0.045). Sagittal subluxation did not affect SF12 or WOMAC scores. Sagittal subluxation of the knee may influence the early to midterm outcome scores following a staged revision TKA for infection.

Sagittal Thoracic and Lumbar Spine Profiles in Upright Standing and Lying Prone Positions Among Healthy Subjects: Influence of Various Biometric Features.

PubMed

Salem, Walid; Coomans, Ysaline; Brismée, Jean-Michel; Klein, Paul; Sobczak, Stéphane; Dugailly, Pierre-Michel

2015-08-01

A prospective study was performed on the assessment of both thoracic and lumbar spine sagittal profiles (from C7 to S1). To propose a new noninvasive method for measuring the spine curvatures in standing and lying prone positions and to analyze their relationship with various biometric characteristics. Modifications of spine curvatures (i.e. lordosis or kyphosis) are of importance in the development of spinal disorders. Studies have emphasized the development of new devices to measure the spine sagittal profiles using a noninvasive and low-cost method. To date, it has not been applied for analyzing both lumbar and thoracic alterations for various positioning. Seventy-five healthy subjects (mean 22.6 ± 4.3 yr) were recruited to participate in this study. Thoracic and lumbar sagittal profiles were assessed in standing and lying prone positions using a 3D digitizer. In addition, several biometric data were collected including maximal trunk isometric strength for flexion and extension movement. Statistical analysis consisted in data comparisons of spine profiles and a multivariate analysis including biometric features, to classify individuals considering low within- and high between-variability. Kyphosis and lordosis angles decreased significantly from standing to lying prone position by an average of 13.4° and 16.6°, respectively. Multivariate analysis showed a sample clustering of 3 homogenous subgroups. The first group displayed larger lordosis and flexibility, and had low data values for height, weight, and strength. The second group had lower values than the overall trend of the whole sample, whereas the third group had larger score values for the torques, height, weight, waist, body mass index, and kyphosis angle but a reduced flexibility. The present results demonstrate a significant effect of the positioning on both thoracic and lumbar spine sagittal profiles and highlight the use of cluster analysis to categorize subgroups after biometric characteristics including curvature measurement. N/A.

Sagittal balance, a useful tool for neurosurgeons?

PubMed

Villard, Jimmy; Ringel, Florian; Meyer, Bernhard

2014-01-01

New instrumentation techniques have made any correction of the spinal architecture possible. Sagittal balance has been described as an important parameter for assessing spinal deformity in the early 1970s, but over the last decade its importance has grown with the published results in terms of overall quality of life and fusion rate. Up until now, most of the studies have concentrated on spinal deformity surgery, but its use in the daily neurosurgery practice remains uncertain and may warrant further studies.

Kinematic and kinetic analyses of the toes in dance movements.

PubMed

Jarvis, Danielle N; Kulig, Kornelia

2016-09-01

Due to the significant amount of time dancers spend on the forefoot, loads on the metatarsophalangeal joints are likely high, yet vary between dance movements. The purpose of this study was to compare joint motion and net joint moments at the metatarsophalangeal joints during three different dance movements ranging in demands at the foot and ankle joints. Ten healthy, female dancers (27.6 ± 3.2 years; 56.3 ± 6.9 kg; 1.6 ± 0.1 m) with an average 21.7 ± 4.9 years of dance training performed relevés (rising up onto the toes), sautés (vertical bipedal jumps), and saut de chat leaps (split jumps involving both vertical and horizontal components). Metatarsophalangeal joint kinematics and kinetics in the sagittal plane were calculated. Total excursion and peak net joint moments during rising or push-off were compared between the three dance movements. Greater extension of the metatarsophalangeal joints was seen during relevés compared to sautés or saut de chat leaps, and the largest metatarsophalangeal net joint moments were seen during saut de chat leaps. The metatarsophalangeal joints frequently and repetitively manage external loads and substantial metatarsophalangeal extension during these three dance movements, which may contribute to the high rate of foot and ankle injuries in dancers.

Anatomical and embryological considerations in the repair of a large vertex cephalocele. Case report.

PubMed

Hoving, E; Blaser, S; Kelly, E; Rutka, J T

1999-03-01

The case of a neonate with a large vertex cephalocele is presented. The anatomical features of this anomaly were evaluated by means of magnetic resonance imaging and magnetic resonance angiography. Fusion of the thalami, dysgenesis of the corpus callosum, and failure of adequate formation of the interhemispheric fissure were characteristics of the major cerebral anomalies associated with the cephalocele. The absence of a falx in the midline, a split configuration of the superior sagittal sinus, and a dysgenetic tentorium with a concomitant abnormal venous drainage pattern were found in association with a large dorsal cyst. Repair of the anomaly was undertaken on the 3rd postnatal day. A cerebrospinal fluid shunt was required to treat hydrocephalus on Day 30. The child is well at age 3 years, but with significant developmental delay. The pathogenesis of this vertex cephalocele relates to semilobar holoprosencephaly and dorsal cyst formation. In addition, a disturbance in the separation of the diencephalic portion of the neural tube from the surface ectoderm or skin during the final phases of neurulation had occurred to help create the large cephalocele. Detailed preoperative imaging studies and awareness of the embryology and anatomy of this lesion facilitated the repair of the cephalocele. The prognosis of the child is determined not only by the presence of hydrocephalus, but also by the number of associated major cerebral anomalies. Options for treatment are discussed.

Pedicle distraction increases intervertebral and spinal canal area in a cadaver and bone model

PubMed Central

Hughes, Matthew; Papadakos, Nikolaos; Bishop, Tim; Bernard, Jason

2018-01-01

Introduction: Lumbar spinal stenosis is degenerative narrowing of the spinal canal and/or intervertebral foramen causing compression of the spinal cord and nerve roots. Traditional decompression techniques can often cause significant trauma and vertebral instability. This paper evaluates a method of increasing pedicle length to decompress the spinal and intervertebral foramen, which could be done minimally invasive. Methods: Three Sawbone (Sawbones Europe, Sweden) and 1 cadaveric lumbar spine underwent bilateral pedicle distraction at L4. A pedicle channel was drilled between the superior articular process and transverse process into the vertebral body. The pedicles underwent osteotomy at the midpoint. Screws were inserted bilaterally and fixated distraction of 0 mm, 2 mm, 4 mm and 6 mm. CT images were taken at each level of distraction. Foramen area was measured in the sagittal plane at L3/4. Spinal canal area was measured at L4 in the axial images. The cadaver was used to evaluate safety of osteotomy and soft tissue interactions preventing distraction. Statistical analysis was by student paired t-test and Pearson rank test. Results: Increasing distraction led to greater Spinal canal area. From 4.27 cm2 to 5.72 cm2 (p = 0.002) with 6 mm distraction. A Maximal increase of 34.1%. Vertebral foramen area also increased with increasing pedicle distraction. From 2.43 cm2 to 3.22 cm2 (p = 0.022) with 6 mm distraction. A maximal increase of 32.3%. The cadaver spinal canal increased in area by 21.7%. The vertebral foramen increased in area by 36.2% (left) and 22.6% (right). Discussion: For each increase in pedicle distraction the area of the spinal and vertebral foramen increases. Pedicle distraction could potentially be used to alleviate spinal stenosis and root impingement. A potential osteotomy plane could be at the midpoint of the pedicle with minimal risk to nerve roots and soft tissue restrictions to prevent distraction. PMID:29727270

Pedicle distraction increases intervertebral and spinal canal area in a cadaver and bone model.

PubMed

Hughes, Matthew; Papadakos, Nikolaos; Bishop, Tim; Bernard, Jason

2018-01-01

Lumbar spinal stenosis is degenerative narrowing of the spinal canal and/or intervertebral foramen causing compression of the spinal cord and nerve roots. Traditional decompression techniques can often cause significant trauma and vertebral instability. This paper evaluates a method of increasing pedicle length to decompress the spinal and intervertebral foramen, which could be done minimally invasive. Three Sawbone (Sawbones Europe, Sweden) and 1 cadaveric lumbar spine underwent bilateral pedicle distraction at L4. A pedicle channel was drilled between the superior articular process and transverse process into the vertebral body. The pedicles underwent osteotomy at the midpoint. Screws were inserted bilaterally and fixated distraction of 0 mm, 2 mm, 4 mm and 6 mm. CT images were taken at each level of distraction. Foramen area was measured in the sagittal plane at L3/4. Spinal canal area was measured at L4 in the axial images. The cadaver was used to evaluate safety of osteotomy and soft tissue interactions preventing distraction. Statistical analysis was by student paired t-test and Pearson rank test. Increasing distraction led to greater Spinal canal area. From 4.27 cm 2 to 5.72 cm 2 (p = 0.002) with 6 mm distraction. A Maximal increase of 34.1%. Vertebral foramen area also increased with increasing pedicle distraction. From 2.43 cm 2 to 3.22 cm 2 (p = 0.022) with 6 mm distraction. A maximal increase of 32.3%. The cadaver spinal canal increased in area by 21.7%. The vertebral foramen increased in area by 36.2% (left) and 22.6% (right). For each increase in pedicle distraction the area of the spinal and vertebral foramen increases. Pedicle distraction could potentially be used to alleviate spinal stenosis and root impingement. A potential osteotomy plane could be at the midpoint of the pedicle with minimal risk to nerve roots and soft tissue restrictions to prevent distraction. © The Authors, published by EDP Sciences, 2018.

Current concepts on the sagittal balance and classification of spondylolysis and spondylolisthesis☆☆☆

PubMed Central

Tebet, Marcos Antonio

2014-01-01

Treatment of spondylolysis and spondylolisthesis remains a challenge for orthopaedic surgeons, neurosurgeons and paediatrics. In spondylolisthesis, it has been clearly demonstrated over the past decade that spino-pelvic morphology is abnormal and that it can be associated to an abnormal sacro-pelvic orientation as well as to a disturbed global sagittal balance of spine. This article presents the SDSG (Spinal Deformity Study Group) classification of lumbosacral spondylolisthesis. The proper treatment of spondylolisthesis is dependent on recognizing the type of slip, sacro-pelvic balance and overall sagittal balance and its natural history. Although a number of clinical radiographic features have been identified as risk factors, their role as primary causative factors or secondary adaptative changes is not clear. The conservative treatment of adult isthmic spondylolisthesis results in good outcome in the majority of cases. Of those patients who fail conservative treatment, success with surgery is quite good, with significant improvement in neurologic function in those patients with deficits, as well as improvement in patients with back pain. PMID:26229765

Management of a growing Skeletal Class II Patient: A Case Report.

PubMed

Sharma, Narendra Shriram

2013-01-01

Sagittal and transverse discrepancies often coexist in skeletal class II malocclusions. Orthopedic growth modification can work well in such cases, provided that the remaining pubertal growth is adequate and that the clinician can provide timely treatment to coincide with the peak growth period. The transverse discrepancy is generally corrected first, establishing a proper base for the sagittal correction to follow. For example, in a skeletal class II case with a narrow maxillary arch and retrusive mandible, maxillary expansion is performed initially to facilitate functional mandibular advancement. The present article illustrates an exception to this rule, in a case where sagittal correction was undertaken before transverse correction to make optimal use of the patient's pubertal growth spurt in first phase followed by a second phase of fixed appliance therapy during adolescence to achieve optimal results. How to cite this article: Sharma NS. Management of a growing Skeletal Class II Patient: A Case Report. Int J Clin Pediatr Dent 2013;6(1):48-54.

Fluctuating asymmetry and fractal dimension of the sagittal suture as indicators of inbreeding depression in dama and dorcas gazelles

USGS Publications Warehouse

Alados, Concepcion L.; Escos, Juan; Emlen, John M.

1995-01-01

The effects of inbreeding on the developmental instability of skulls of dorcas (Gazella dorcas) and dama (G. dama) gazelles were investigated. In total, 132 dorcas gazelle skulls and 74 dama gazelle skulls from the Estación Experimental de Zonas Aridas in Almera, Spain, were measured. The fluctuating asymmetry of 9 meristic characters, consisting of the numbers of foramina on the two sides of the skull and mandible, was calculated. Although only the foramen infraorbitalis showed a significant increase in asymmetry with inbreeding in dorcas gazelles, the sum of the foramina in 5 of the skull regions clearly indicates an increase in asymmetry with inbreeding in both dorcas and dama gazelles. The fractal dimension of the sagittal suture was calculated by means of the coastline method. A greater effect of inbreeding on the sagittal suture in dama than in dorcas gazelle was observed, in concordance with the more evident deleterious effects of inbreeding depression in dama than in dorcas gazelles.

Inter- and intraobserver repeatability of the Salford Gait Tool: an observation-based clinical gait assessment tool.

PubMed

Toro, Brigitte; Nester, Christopher J; Farren, Pauline C

2007-03-01

To evaluate the inter- and intraobserver repeatability of the Salford Gait Tool (SF-GT), a new observation-based gait assessment tool for evaluating sagittal plane cerebral palsy (CP) gait. Masked comparative evaluation. University in the United Kingdom. A convenience sample of 23 pediatric physical therapists with varying degrees of clinical experience recruited from the Greater Manchester area. Participants viewed videotapes of the sagittal plane gait of 13 children and used the SF-GT to analyze their 13 different gait styles on 2 occasions. Eleven children had hemiplegic, diplegic, or quadriplegic CP and 2 were neurologically intact. Inter- and intraobserver repeatability of hip, knee, and ankle joint positions at 6 different phases of the gait cycle. The SF-GT demonstrated good interobserver (77%) and intraobserver (75%) repeatability. We have established that the SF-GT is a repeatable clinical assessment tool with which to guide the diagnosis, treatment planning, and evaluation of interventions by pediatric physical therapists of sagittal plane gait deviations in CP.

Improved ankle push-off power following cheilectomy for hallux rigidus: a prospective gait analysis study.

PubMed

Smith, Sheryl M; Coleman, Scott C; Bacon, Stacy A; Polo, Fabian E; Brodsky, James W

2012-06-01

There is limited objective scientific information on the functional effects of cheilectomy. The purpose of this study was to test the hypothesis that cheilectomy for hallux rigidus improves gait by increasing ankle push-off power. Seventeen patients with symptomatic Stage 1 or Stage 2 hallux rigidus were studied. Pre- and postoperative first metatarsophalangeal (MTP) range of motion and AOFAS hallux scores were recorded. A gait analysis was performed within 4 weeks prior to surgery and repeated at a minimum of 1 year after surgery. Gait analysis was done using a three-dimensional motion capture system and a force platform embedded in a 10-m walkway. Gait velocity sagittal plane ankle range of motion and peak sagittal plane ankle push-off power were analyzed. Following cheilectomy, significant increases were noted for first MTP range of motion and AOFAS hallux score. First MTP motion improved an average of 16.7 degrees, from means of 33.9 degrees preoperatively to 50.6 degrees postoperatively (p<0.001). AOFAS hallux score increased from 62 to 81 (p<0.007). As demonstrated through gait anaylsis, a significant increase in postoperative peak sagittal plane ankle push-off power from 1.71±0.92 W/kg to 2.05±0.75 W/kg (p<0.04). In addition to clinically increased range of motion and improved AOFAS Hallux score, first MTP joint cheilectomy produced objective improvement in gait, as measured by increased peak sagittal-plane ankle push-off power.

Influence of malalignment on socket reaction moments during gait in amputees with transtibial prostheses.

PubMed

Boone, David A; Kobayashi, Toshiki; Chou, Teri G; Arabian, Adam K; Coleman, Kim L; Orendurff, Michael S; Zhang, Ming

2013-04-01

Alignment - the process and measured orientation of the prosthetic socket relative to the foot - is important for proper function of a transtibial prosthesis. Prosthetic alignment is performed by prosthetists using visual gait observation and amputees' feedback. The aim of this study was to investigate the effect of transtibial prosthesis malalignment on the moments measured at the base of the socket: the socket reaction moments. Eleven subjects with transtibial amputation were recruited from the community. An instrumented prosthesis alignment component was used to measure socket reaction moments during ambulation under 17 alignment conditions, including nominally aligned using conventional clinical methods, and angle perturbations of 3° and 6° (flexion, extension, abduction, and adduction) and translation perturbations of 5mm and 10mm (anterior, posterior, lateral, and medial) referenced from the nominal alignment. Coronal alignment perturbations caused systematic changes in the coronal socket reaction moments. All angle and translation perturbations revealed statistically significant differences on coronal socket reaction moments compared to the nominal alignment at 30% and 75% of stance phase (P<0.05). The effect of sagittal alignment perturbations on sagittal socket reaction moments was not as responsive as that of the coronal perturbations. The sagittal angle and translation perturbations of the socket led to statistically significant changes in minimum moment, maximum moment, and moments at 45% of stance phase in the sagittal plane. Therefore, malalignment affected the socket reaction moments in amputees with transtibial prostheses. Copyright © 2012 Elsevier B.V. All rights reserved.

Peripheral refraction and retinal contour in stable and progressive myopia.

PubMed

Faria-Ribeiro, Miguel; Queirós, António; Lopes-Ferreira, Daniela; Jorge, Jorge; González-Méijome, José Manuel

2013-01-01

To compare the patterns of relative peripheral astigmatic refraction (tangential and sagittal power errors) and eccentric eye length between progressing and stable young-adult myopes. Sixty-two right eyes of 62 white patients participated in the study, of which 30 were nonprogressing myopes (NP group) for the last 2 years and 32 were progressing myopes (P group). Groups were matched for mean spherical refraction, axial length, and age. Peripheral refraction and eye length were measured along the horizontal meridian up to 35 and 30 degrees of eccentricity, respectively. There were statistically significant differences between groups (p < 0.001) in the nasal retina for the astigmatic components of peripheral refraction. The P group presented a hyperopic relative sagittal focus at 35 degrees in the nasal retina of +1.00 ± 0.83 diopters, as per comparison with a myopic relative sagittal focus of -0.10 ± 0.98 diopters observed in the NP group (p < 0.001). Retinal contour in the P group had a steeper shape in the nasal region than that in the NP group (t test, p = 0.001). An inverse correlation was found (r = -0.775; p < 0.001) between retinal contour and peripheral refraction. Thus, steeper retinas presented a more hyperopic trend in the periphery. Stable and progressing myopes of matched age, axial length, and central refraction showed significantly different characteristics in their peripheral retinal shape and astigmatic components of tangential and sagittal power errors. The present findings may help explain the mechanisms that regulate ocular growth in humans.

Correlation between direction and severity of temporomandibular joint disc displacement and reduction ability during mouth opening.

PubMed

Litko, M; Berger, M; Szkutnik, J; Różyło-Kalinowska, I

2017-12-01

The most common temporomandibular joint (TMJ) internal derangement is an abnormal relationship of the disc with respect to the mandibular condyle, articular eminence and glenoid fossa-disc displacement. The aim of our study was to analyse the correlation between partial/complete disc displacement in the intercuspal position (IP) and its reduction in the open-mouth position (OMP) in both oblique sagittal and coronal planes on magnetic resonance imaging (MRI) in patients with temporomandibular disorders. Multisection MRI analysis of 382 TMJs was conducted in 191 patients with disc displacement according to the RDC/TMD criteria (148 women, 43 men; aged 14-60 years). The disc position was evaluated on all oblique sagittal and coronal images in the IP and the OMP. Univariate logistic regression analysis showed that the severity of disc displacement in the sagittal plane is a statistically significant predictor of reduction ability during mouth opening (B = 3.118; P < .001). Moreover, the severity of disc displacement in both planes is also a significant predictor of disc reduction in OMP (B = 2.200; P < .05). In conclusion, reduction ability during mouth opening is associated with the severity of disc displacement in IP, in both sagittal and coronal planes. Multisection analysis of all MR images allows distinguishing the correct disc position from disc displacement and can improve the ability to distinguish between various stages of TMJ internal derangement. © 2017 John Wiley & Sons Ltd.

Morphometric differences of nasopalatine canal based on 3D classifications: descriptive analysis on CBCT.

PubMed

Fernández-Alonso, A; Suárez-Quintanilla, J A; Rapado-González, O; Suárez-Cunqueiro, María Mercedes

2015-09-01

This descriptive retrospective study analyzed differences among sagittal, coronal and axial NC groups based on the dimensions of nasopalatine canal (NC), buccal bone plate (BBP) and palatal bone plate (PBP) to canal. Measurements were made on 224 CBCTs for NC, BBP and PBP on the three anatomic planes at three levels: level 1, when the incisive foramen is completely closed on the axial plane; level 2, at the midpoint of NC length (NCL) on the sagittal plane; and level 3, at the foramina of Stenson on the sagittal plane. ANOVA tests with post hoc tests were used. The intraclass correlation coefficient and Kappa test were used for evaluating the intraobserver agreement. Regarding coronal classification, these significant differences were found: BBP length (BL)level 1 was lower for the two parallel canals group; PBP length (PL)level 1 was lower for single canal group; and NCL was lower for Y-type canal group. Regarding axial classification, these significant differences were found: LPlevel 1 was lower for 3.1-3 group; PBP width (PW)level 3 was the greatest for 3.1-3; and LPlevel 3 was lower for 1.1. Presurgical evaluation with CBCT in premaxillae region should include analysis on coronal and axial planes and not only on sagittal plane seeing as morphometric differences were found on coronal and axial planes. Following the morphological coronal classification, two parallel canals presented a higher NCL, a higher LP and a lower LV at inferior edge of alveolar ridge.

Modic changes of the cervical spine: T1 slope and its impact on axial neck pain.

PubMed

Li, Jia; Qin, Shuhui; Li, Yongqian; Shen, Yong

2017-01-01

The purpose of the research was to evaluate cervical sagittal parameters on magnetic resonance imaging (MRI) in patients with Modic changes and its impact on axial neck pain. This study consisted of 266 consecutive asymptomatic or symptomatic patients with Modic changes, whose average age was 50.9±12.6 years from January 2015 to December 2016. Cervical sagittal parameters included sagittal alignment of the cervical spine (SACS), T1 slope, thoracic inlet angle (TIA), and neck tilt (NT). The Modic changes group was compared with an asymptomatic control group of 338 age- and gender-matched adults. In the Modic changes group, T1 slope was significantly higher (25.8°±6.3°) compared with that in the control group (22.5°±6.8°) ( P =0.000). However, there was no significant difference of the NT, TIA, and SACS between the two groups. Patients in the Modic changes group were more likely to have experienced historical axial neck pain compared with the control group ( P =0.000). With regard to the disc degeneration, it indicated that the disc in the Modic changes group had more severe disc degeneration ( P =0.032). T1 slope in the Modic changes group was significantly higher compared to that of the control group. The findings suggested that a higher T1 slope with broken compensation of cervical sagittal mechanism may be associated with the development of Modic changes in the cervical spine.

Transverse dental compensation in relation to sagittal and transverse skeletal discrepancies in skeletal Class III patients.

PubMed

Ahn, Jaechan; Kim, Sung-Jin; Lee, Ji-Yeon; Chung, Chooryung J; Kim, Kyung-Ho

2017-01-01

The purposes of this study were to compare the buccolingual inclinations of the posterior teeth in skeletal Class III patients with and without facial asymmetry with those of skeletal Class I patients and to investigate their relationships with sagittal and transverse skeletal discrepancies. Sixty-three skeletal Class III adult patients were divided into 2 groups according to the degree of menton deviation: a symmetry group with deviation less than 2 mm (n = 30), and an asymmetry group with deviation greater than 4 mm (n = 33). The control group comprised 25 skeletal Class I patients. The buccolingual inclinations of the posterior teeth measured on cone-beam computed tomography images were compared among the 3 groups, and regression analysis was performed to investigate the relationships between the inclinations and the sagittal and transverse skeletal discrepancies. The symmetry group showed greater buccal inclinations of the maxillary posterior teeth and lingual inclinations of the mandibular second molars than did the control, and this was correlated with the ANB angles. The deviated sides in the asymmetry group showed the greatest transverse dental compensation, which was correlated with menton deviation, whereas the nondeviated sides showed no significant transverse dental compensation. Transverse dental compensation is closely related to sagittal and transverse skeletal discrepancy in skeletal Class III patients. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Isolated sagittal craniosynostosis: definition, classification, and surgical indications.

PubMed

Massimi, Luca; Caldarelli, Massimo; Tamburrini, Gianpiero; Paternoster, Giovanna; Di Rocco, Concezio

2012-09-01

Sagittal craniosynostosis (SC) remains the most common type of synostosis, accounting for about a half of all forms. It would result from a mesenchymal disorder involving the intramembranous ossification of the sagittal suture and leading to its early fusion. No specific data on the etiologic factors are currently available. The premature ossification of the sagittal suture can result in three main types of SC, according to the different segment prevalently involved: anterior, posterior, and complete SC. The diagnosis is easily obtained by clinical examination. However, a radiological work up (3D CT scan) may be necessary to rule out hidden venous or cranial anomalies possibly associated with most severe cases, or for the surgical planning. The most common indication for surgery is the improvement of the cosmetic appearance of the skull, since a cranial deformation may have a significant psychological impact on affected subjects. To relieve from raised intracranial pressure is a further indication to surgery. Although an increased intracranial pressure can be demonstrated in a minority of affected children at diagnosis, indeed, it can present later (usually after the second/third year of life) with chronic symptoms. The role of surgery in the preservation of cognitive functions in scaphocephalic patients does not seem to be relevant, since minor anomalies of the cerebral development associated with SC would occur independently from the cranial shape. On the other hand, the surgical correction may show a protective effect on some visual skills, like the ability to fix and follow, and the fixation shift.

Sagittal and vertical load-deflection and permanent deformation of transpalatal arches connected with palatal implants: an in-vitro study.

PubMed

Crismani, Adriano G; Celar, Ales G; Burstone, Charles J; Bernhart, Thomas G; Bantleon, Hans-Peter; Mittlboeck, Martina

2007-06-01

The purposes of this laboratory investigation were to (1) measure the sagittal and vertical deflection of loaded transpalatal arches (TPAs) connected to a palatal implant, (2) measure the extent of permanent deformation of the connecting TPA in the sagittal and vertical directions, (3) test various wire dimensions in terms of deflection behavior, and (4) evaluate soldering vs laser welding vs adhesive bonding of TPAs in terms of load deflection behavior. Stainless steel wires of 6 dimensions were tested: 0.8 x 0.8, 0.9, 1, 1.1, 1.2, and 1.2 x 1.2 mm. For each dimension, 10 specimens were soldered to the palatal implant abutment, 10 were laser welded, and 10 were adhesively bonded to the implant abutment (total, 180 specimens). The measuring device applied increments of force of 50 cN, from 0 to 500 cN. Then the specimens were unloaded. The values were statistically described and analyzed with ANOVA and Wilcoxon rank sum tests. Absolute orthodontic anchorage without deformation of TPAs was not observed with the wire dimensions tested. To prevent loss of anchorage greater than 370 mum (sagittal deflection of 1.2 x 1.2 mm adhesively bonded TPA at 500 cN force level), wires thicker than 1.2 x 1.2 mm or cast anchorage elements must be considered for clinical practice. However, larger cross sections might cause more patient discomfort, and laboratory procedures increase costs.

Determining the sagittal relationship between the maxilla and the mandible: a cephalometric analysis to clear up the confusion.

PubMed

Davis, Glen S; Cannon, James L; Messersmith, Marion L

2013-01-01

Establishing the sagittal jaw relationship is a key component to developing a diagnosis when treating an orthodontic patient. Several measurements, including the Wits Appraisal, ANB angle and nasion perpendicular have been and are currently used by practitioners to diagnose the sagittal jaw relationship. Unfortunately, all of these measurements have their limitations. The Cannon Analysis was created in an attempt to help overcome these limitations. One hundred untreated patients from the Vanderbilt University Medical Center database were selected, and their initial lateral cephalometric radiographs were digitally traced utilizing the Cannon Cephalometric Analysis. All of these patients had an orthognathic profile, a Class I occlusion and a good skeletal balance as judged by the authors. Normative values were established for the Cannon Analysis and then broken down by sex and age (8-11, 12-18, 19 and over). An example case was analyzed using the Cannon Analysis and several diagnostic scenarios were reviewed. The variance or difference between Porion to A Point (Po-A) and Porion to B Point (Po-B) was found to be 12.6 mm. This value remained relatively constant throughout life, with only slightly higher values for males versus females. The Cannon Analysis is an effective way to accurately establish the sagittal jaw relationship since it is not affected by the anterior / posterior position of nasion, the steepness of the mandibular plane angle, nor an improperly drawn occlusal plane.

Knee joint passive stiffness and moment in sagittal and frontal planes markedly increase with compression.

PubMed

Marouane, H; Shirazi-Adl, A; Adouni, M

2015-01-01

Knee joints are subject to large compression forces in daily activities. Due to artefact moments and instability under large compression loads, biomechanical studies impose additional constraints to circumvent the compression position-dependency in response. To quantify the effect of compression on passive knee moment resistance and stiffness, two validated finite element models of the tibiofemoral (TF) joint, one refined with depth-dependent fibril-reinforced cartilage and the other less refined with homogeneous isotropic cartilage, are used. The unconstrained TF joint response in sagittal and frontal planes is investigated at different flexion angles (0°, 15°, 30° and 45°) up to 1800 N compression preloads. The compression is applied at a novel joint mechanical balance point (MBP) identified as a point at which the compression does not cause any coupled rotations in sagittal and frontal planes. The MBP of the unconstrained joint is located at the lateral plateau in small compressions and shifts medially towards the inter-compartmental area at larger compression forces. The compression force substantially increases the joint moment-bearing capacities and instantaneous angular rigidities in both frontal and sagittal planes. The varus-valgus laxities diminish with compression preloads despite concomitant substantial reductions in collateral ligament forces. While the angular rigidity would enhance the joint stability, the augmented passive moment resistance under compression preloads plays a role in supporting external moments and should as such be considered in the knee joint musculoskeletal models.

The risk of sacrificing the PCL in cruciate retaining total knee arthroplasty and the relationship to the sagittal inclination of the tibial plateau.

PubMed

Sessa, Pasquale; Fioravanti, Giulio; Giannicola, Giuseppe; Cinotti, Gianluca

2015-01-01

In cruciate retaining total knee arthroplasty (TKA), a partial avulsion of PCL may occur when en-bloc tibial osteotomy is performed. We evaluated the effects of a tibial cut performed with different degrees of posterior slope on PCL insertion and whether the results are affected by the sagittal inclination of the patient's tibial plateau. We selected 83 MRIs of knees showing mild or no degenerative changes. The effects of a simulated tibial cut performed with a posterior slope of 0°, 3°, 5° and parallel to the patient's tibial plateau inclination on PCL insertion in the proximal tibia were investigated. The results were correlated with the degree of posterior inclination of the tibial plateau. Every angle we used for the tibial cut caused a PCL avulsion greater than 50%. The percentage of PCL avulsion significantly increased with increasing the posterior slope of the tibial cut. Patients with sagittal tibial plateau inclination <5° showed greater PCL avulsion than those with sagittal inclination >8°. Most of the PCL insertion is likely to be sacrificed when resection of the proximal tibia is performed en-block. The risk of PCL avulsion is reduced in patients showing a marked posterior inclination of the tibial plateau, but even in this group of patients a surgical technique aimed at sparing most of the PCL insertion is necessary. Copyright © 2014 Elsevier B.V. All rights reserved.

Effect of plasma rich in growth factors on alveolar osteitis

PubMed Central

Haraji, Afshin; Lassemi, Eshagh; Motamedi, Mohammad Hosein Kalantar; Alavi, Maryam; Adibnejad, Saman

2012-01-01

Introduction: The high prevalence of dry socket or alveolar osteitis (AO) is of concern in surgical removal of third molars. The aim of the present study was to assess the preventive effect of plasma rich in growth factors (PRGF) on AO and also its effect on pain management and healing acceleration in third molar extraction sockets of high-risk patients. Materials and Methods: This split-mouth, double-blind clinical trial included 40 bilateral third molar extractions (80 sockets) with at least one identified risk factor for AO. PRGF was obtained from patient's own blood, based on manufacturer's instruction, and blindly placed in one of the two bilateral sockets (PRGF group; n = 20) of each patient. The contralateral socket was treated with a placebo (control group; n = 20). Samples were evaluated for AO and pain incidence on days 2, 3 and 4 and healing and infection on days 3 and 7. Data were analyzed in SPSS v16 using Wilcoxon test. Results: There was a significant difference in dry socket and pain incidence and healing rate between the two groups. Intensity of pain and occurrence of dry socket in the study group was lower than the controls. Also the healing rate was higher (P < 0.05) for the PRGF group. No sign of infection was seen in either group. Conclusion: The application of PRGF may significantly reduce the incidence of AO or its associated pain and may accelerate healing. The prophylactic use of PRGF following third molar extraction may be suggested especially in the patients at risk of AO. PMID:23251056

[Influence of disc height on outcome of posterolateral fusion].

PubMed

Drain, O; Lenoir, T; Dauzac, C; Rillardon, L; Guigui, P

2008-09-01

Experimentally, posterolateral fusion only provides incomplete control of flexion-extension, rotation and lateral inclination forces. The stability deficit increases with increasing height of the anterior intervertebral space, which for some warrants the adjunction of an intersomatic arthrodesis in addition to the posterolateral graft. Few studies have been devoted to the impact of disc height on the outcome of posterolateral fusion. The purpose of this work was to investigate the spinal segment immobilized by the posterolateral fusion: height of the anterior intervertebral space, the clinical and radiographic impact of changes in disc height, and the short- and long-term impact of disc height measured preoperatively on clinical and radiographic outcome. In order to obtain a homogeneous group of patients, the series was limited to patients undergoing posterolateral arthrodesis for degenerative spondylolisthesis, in combination with radicular release. This was a retrospective analysis of a consecutive series of 66 patients with mean 52 months follow-up (range 3-63 months). A dedicated self-administered questionnaire was used to collect data on pre- and postoperative function, the SF-36 quality of life score, and patient satisfaction. Pre- and postoperative (early, one year, last follow-up) radiographic data were recorded: olisthesic level, disc height, intervertebral angle, intervertebral mobility (angular, anteroposterior), and global measures of sagittal balance (thoracic kyphosis, lumbar lordosis, T9 sagittal tilt, pelvic version, pelvic incidence, sacral slope). SpineView was used for all measures. Univariate analysis searched for correlations between variation in disc height and early postoperative function and quality of fusion at last follow-up. Multivariate analysis was applied to the following preoperative parameters: intervertebral angle, disc height, intervertebral mobility, sagittal balance parameters, use of osteosynthesis or not. At the olisthesic level, there was a 30% mean decrease in disc height and intervertebral angle. These variations were not correlated with functional outcome or quality of fusion observed at last follow-up. Disc height preoperatively did not affect these variations. The only factor correlated with decreased disc height was T9 sagittal tilt: disc height decreased more when T9 sagittal tilt approached 0 degrees . In this very restricted context (retrospective study, short arthrodesis for degenerative spondylolisthesis), we were unable to find any evidence supporting the notion that high disc height is an argument which should favor complementary intersomatic arthrodesis in combination with posterolateral fusion. Analysis of the spinal balance in the sagittal plane would probably allow a more pertinent assessment of the specific needs of individual patients.

Influence of intentional femoral component flexion in navigated TKA on gap balance and sagittal anatomy.

PubMed

Roßkopf, J; Singh, P K; Wolf, P; Strauch, M; Graichen, H

2014-03-01

Navigation has proven its ability to accurately restore coronal leg axis; however, for a good clinical outcome, other factors such as sagittal anatomy and balanced gaps are at least as important. In a gap-balanced technique, the size of the flexion gap is equalled to that of the extension gap. Flexion of the femoral component has been described as a theoretical possibility to balance flexion and extension gap. Aim of this study was to assess whether intentional femoral component flexion is helpful in balancing TKA gaps and in restoring sagittal anatomy. One hundred and thirty-one patients with TKA were included in this study. Implantation was performed in a navigated, gap-balanced, tibia-first technique. The femoral component flexion needed to equal flexion to extension gap was calculated based upon the navigation data. The sagittal diameter, the anterior and posterior offset were measured pre- and postoperatively based on the lateral radiographs. Medial and lateral gaps in extension and flexion as well as flexion/extension gap differences pre- and postoperatively were analysed. Additionally range of motion (ROM) and patient satisfaction (SF 12) were obtained. To achieve equal flexion and extension gap, the femoral component was flexed in 120 out of 131 patients showing mean flexion of 2.9° (SD 2.2°; navigation data) and 3.1° (SD 2.0°; radiological analysis), respectively. Based on this technique, it was possible to balance the extension gap (<2 mm difference) in 130 out of 131 patients (99%) and the flexion gap in 119 out of 131 (91%). The difference between extension and flexion gap was reduced from 39 to 24 out of 131 patients (81%) on the medial side and from 69 to 28 on the lateral side (79%). The sagittal diameter was restored in 114 out of 131 cases (87%); however, anterior offset was significantly reduced by 1.3 mm (SD 3.9°), and posterior offset was significantly increased by 1.6 mm (SD 3.3°). No correlation between any navigation and radiological parameter was found with ROM and SF 12. The navigation-based, gap-balanced technique allows intentional flexion of the femoral component in order to balance gaps in more than 90% of primary TKA cases. Simultaneously, the sagittal diameter is restored in 87% of patients. However, to achieve equal gaps, the posterior offset is significantly increased by 1.6 mm and the femoral component is flexed by 3°. To evaluate the effect of this technique on the clinical outcome, future studies are needed. II.

Fracture of fusion mass after hardware removal in patients with high sagittal imbalance.

PubMed

Sedney, Cara L; Daffner, Scott D; Stefanko, Jared J; Abdelfattah, Hesham; Emery, Sanford E; France, John C

2016-04-01

As spinal fusions become more common and more complex, so do the sequelae of these procedures, some of which remain poorly understood. The authors report on a series of patients who underwent removal of hardware after CT-proven solid fusion, confirmed by intraoperative findings. These patients later developed a spontaneous fracture of the fusion mass that was not associated with trauma. A series of such patients has not previously been described in the literature. An unfunded, retrospective review of the surgical logs of 3 fellowship-trained spine surgeons yielded 7 patients who suffered a fracture of a fusion mass after hardware removal. Adult patients from the West Virginia University Department of Orthopaedics who underwent hardware removal in the setting of adjacent-segment disease (ASD), and subsequently experienced fracture of the fusion mass through the uninstrumented segment, were studied. The medical records and radiological studies of these patients were examined for patient demographics and comorbidities, initial indication for surgery, total number of surgeries, timeline of fracture occurrence, risk factors for fracture, as well as sagittal imbalance. All 7 patients underwent hardware removal in conjunction with an extension of fusion for ASD. All had CT-proven solid fusion of their previously fused segments, which was confirmed intraoperatively. All patients had previously undergone multiple operations for a variety of indications, 4 patients were smokers, and 3 patients had osteoporosis. Spontaneous fracture of the fusion mass occurred in all patients and was not due to trauma. These fractures occurred 4 months to 4 years after hardware removal. All patients had significant sagittal imbalance of 13-15 cm. The fracture level was L-5 in 6 of the 7 patients, which was the first uninstrumented level caudal to the newly placed hardware in all 6 of these patients. Six patients underwent surgery due to this fracture. The authors present a case series of 7 patients who underwent surgery for ASD after a remote fusion. These patients later developed a fracture of the fusion mass after hardware removal from their previously successfully fused segment. All patients had a high sagittal imbalance and had previously undergone multiple spinal operations. The development of a spontaneous fracture of the fusion mass may be related to sagittal imbalance. Consideration should be given to reimplanting hardware for these patients, even across good fusions, to prevent spontaneous fracture of these areas if the sagittal imbalance is not corrected.

[COMPARISON OF EFFECTIVENESS AND CHANGE OF SAGITTAL SPINO-PELVIC PARAMETERS BETWEEN MINIMALLY INVASIVE TRANSFORAMINAL AND CONVENTIONAL OPEN POSTERIOR LUMBAR INTERBODY FUSIONS IN TREATMENT OF LOW-DEGREE ISTHMIC LUMBAR SPONDYLOLISTHESIS].

PubMed

Sun, Xin; Zeng, Rong; Li, Guangsheng; Wei, Bo; Hu, Zibing; Lin, Hao; Chen, Guanghua; Chen, Siyuan; Sun, Jiecong

2015-12-01

To compare the effectiveness and changes of sagittal spino-pelvic parameters between minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion in treatment of the low-degree isthmic lumbar spondylolisthesis. Between May 2012 and May 2013, 86 patients with single segmental isthmic lumbar spondylolisthesis (Meyerding degree I or II) were treated by minimally invasive transforaminal lumbar interbody fusion (minimally invasive group) in 39 cases, and by open posterior lumbar interbody fusion in 47 cases (open group). There was no significant difference in gender, age, disease duration, degree of lumbar spondylolisthesis, preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between 2 groups (P>0.05). The following sagittal spino-pelvic parameters were compared between 2 groups before and after operation: the percentage of slipping (PS), intervertebral height, angle of slip (AS), thoracolumbar junction (TLJ), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Pearson correlation analysis of the changes between pre- and post-operation was done. Primary healing of incision was obtained in all patients of 2 groups. The postoperative hospital stay of minimally invasive group [(5.1 ± 1.6) days] was significantly shorter than that of open group [(7.2 ± 2.1) days] (t = 2.593, P = 0.017). The patients were followed up 11-20 months (mean, 15 months). The reduction rate was 68.53% ± 20.52% in minimally invasive group, and was 64.21% ± 30.21% in open group, showing no significant difference (t = 0.725, P = 0.093). The back and leg pain VAS scores, and ODI at 3 months after operation were significantly reduced when compared with preoperative ones (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The postoperative other sagittal spino-pelvic parameters were significantly improved (P < 0.05) except PI (P > 0.05), but there was no significant difference between 2 groups (P > 0.05). The correlation analysis showed that ODI value was related to the SVA, SSA, PT, and LL (P < 0.05). Both minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion can significantly improve the sagittal spino-pelvic parameters in the treatment of low-degree isthmic lumbar spondylolisthesis. The reconstruction of SVA, SSA, PT, and LL are related to the quality of life.

Lower Extremity Energy Absorption and Biomechanics During Landing, Part II: Frontal-Plane Energy Analyses and Interplanar Relationships

PubMed Central

Norcross, Marc F.; Lewek, Michael D.; Padua, Darin A.; Shultz, Sandra J.; Weinhold, Paul S.; Blackburn, J. Troy

2013-01-01

Context: Greater sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing is consistent with sagittal-plane biomechanics that likely increase anterior cruciate ligament (ACL) loading, but it does not appear to influence frontal-plane biomechanics. We do not know whether frontal-plane INI EA is related to high-risk frontal-plane biomechanics. Objective: To compare biomechanics among INI EA groups, determine if women are represented more in the high group, and evaluate interplanar INI EA relationships. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: Participants included 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active volunteers. Intervention(s): We assessed landing biomechanics with an electromagnetic motion-capture system and force plate. Main Outcome Measure(s): We calculated frontal- and sagittal-plane total, hip, knee, and ankle INI EA. Total frontal-plane INI EA was used to create high, moderate, and low tertiles. Frontal-plane knee and hip kinematics, peak vertical and posterior ground reaction forces, and peak internal knee-varus moment (pKVM) were identified and compared across groups using 1-way analyses of variance. We used a χ2 analysis to evaluate male and female allocation to INI EA groups. We used simple, bivariate Pearson product moment correlations to assess interplanar INI EA relationships. Results: The high–INI EA group exhibited greater knee valgus at ground contact, hip adduction at pKVM, and peak hip adduction than the low–INI EA group (P < .05) and greater peak knee valgus, pKVM, and knee valgus at pKVM than the moderate– (P < .05) and low– (P < .05) INI EA groups. Women were more likely than men to be in the high–INI EA group (χ2 = 4.909, P = .03). Sagittal-plane knee and frontal-plane hip INI EA (r = 0.301, P = .006) and sagittal-plane and frontal-plane ankle INI EA were associated (r = 0.224, P = .04). No other interplanar INI EA relationships were found (P > .05). Conclusions: Greater frontal-plane INI EA was associated with less favorable frontal-plane biomechanics that likely result in greater ACL loading. Women were more likely than men to use greater frontal-plane INI EA. The magnitudes of sagittal- and frontal-plane INI EA were largely independent. PMID:23944381

PROXIMAL JUNCTIONAL KYPHOSIS IN ADULT RECONSTRUCTIVE SPINE SURGERY RESULTS FROM INCOMPLETE RESTORATION OF THE LUMBAR LORDOSIS RELATIVE TO THE MAGNITUDE OF THE THORACIC KYPHOSIS

PubMed Central

Mendoza-Lattes, Sergio; Ries, Zachary; Gao, Yubo; Weinstein, Stuart L

2011-01-01

Background Proximal junctional kyphosis (PJK) is defined as: 1) Proximal junction sagittal Cobb angle >≥10°, and 2) Proximal junction sagittal Cobb angle of at least 10° greater than the pre-operative measurement PJK is a common complication which develops in 39% of adults following surgery for spinal deformity. The pathogenesis, risk factors and prevention of this complication are unclear. Methods Of 54 consecutive adults treated with spinal deformity surgery (age≥59.3±10.1 years), 19 of 54 (35%) developed PJK. The average follow-up was 26.8months (range 12 - 42). Radiographic parameters were measured at the pre-operative, early postoperative (4-6 weeks), and final follow-up visits. Sagittal alignment was measured by the ratio between the C7-plumbline and the sacral-femoral distance. Binary logistic regression model with predictor variables included: Age, BMI, C7-plumbline, and whether lumbar lordosis, thoracic kyphosis and sacral slope were present Results Patients who developed PJK and those without PJK presented with comparable age, BMI, pelvic incidence and sagittal imbalance before surgery. They also presented with comparable sacral slope and lumbar lordosis. The average magnitude of thoracic kyphosis was significantly larger than the lumbar lordosis in the proximal junctional kyphosis group, both at baseline and in the early postoperative period, as represented by [(-lumbar )lordosis - (thoracic kyphosis)]; no- PJK versus PJK; 6.6°±23.2° versus -6.6°±14.2°; p≥0.012. This was not effectively addressed with surgery in the PJK group [(-LL-TK): 6.2°±13.1° vs. -5.2°±9.6°; p≥0.004]. This group also presented with signs of pelvic retroversion with a sacral slope of 29.3°±8.2° pre-operatively that was unchanged after surgery (30.4°±8.5° postoperatively). Logistic regression determined that the magnitude of thoracic kyphosis and sagittal balance (C7-plumbline) was the most important predictor of proximal junctional kyphosis. Conclusions Proximal junctional kyphosis developed in those patients where the thoracic kyphosis remained greater in magnitude relative to the lumbar lordosis, and where the sagittal balance seemed corrected, but part of thise correction was secondary to pelvic retroversion. Level of Evidence Prognostic case-control study – Level III. PMID:22096442

Comparative Evaluation of Efficacy of Physics Forceps versus Conventional Forceps in Orthodontic Extractions: A Prospective Randomized Split Mouth Study.

PubMed

Patel, Harsh S; Managutti, Anil M; Menat, Shailesh; Agarwal, Arvind; Shah, Dishan; Patel, Jigar

2016-07-01

Tooth extraction is one of the most commonly performed procedures in dentistry. It is usually a traumatic procedure often resulting in immediate destruction and loss of alveolar bone and surrounding soft tissues. Various instruments have been described to perform atraumatic extractions which can prevent damage to the paradental structures. Recently developed physics forceps is one of the instruments which is claimed to perform atraumatic extractions. The aim of the present study was to compare the efficacy of physics forceps with conventional forceps in terms of operating time, prevention of marginal bone loss & soft tissue loss, postoperative pain and postoperative complications following bilateral premolar extractions for orthodontic purpose. In this prospective split-mouth study, outcomes of the 2 groups (n = 42 premolars) requiring extraction of premolars for orthodontic treatment purpose using Physics forceps and Conventional forceps were compared. Clinical outcomes in form of time taken, loss of buccal soft tissue and buccal cortical plate based on extraction defect classification system, postoperative pain and other complication associated with extraction were recorded and compared. Statistically significant reduction in the operating time was noted in physics forceps group. Marginal bone loss and soft tissue loss was also significantly lesser in physics forceps group when compared to conventional forceps group. However, there was no statistically significant difference in severity of postoperative pain between both groups. The results of the present study suggest that physics forceps was more efficient in reducing operating time and prevention of marginal bone loss & soft tissue loss when compared to conventional forceps in orthodontically indicated premolar extractions.

Combined double lung-liver transplantation for cystic fibrosis without cardio-pulmonary by-pass.

PubMed

Corno, V; Dezza, M C; Lucianetti, A; Codazzi, D; Carrara, B; Pinelli, D; Parigi, P C; Guizzetti, M; Strazzabosco, M; Melzi, M L; Gaffuri, G; Sonzogni, V; Rossi, A; Fagiuoli, S; Colledan, M

2007-10-01

Sequential bilateral single lung-liver transplantation (SBSL-LTx) is a therapeutic option for patients with end stage lung and liver disease (ESLLD) due to cystic fibrosis (CF). A few cases have been reported, all of them were performed with the use of cardio-pulmonary by-pass (CPB). We performed SBSL-LTx in three young men affected by CF. All the recipients had respiratory failure and portal hypertension with hypersplenism. Along with lung transplants, two patients received a whole liver graft and one an extended right graft from an in situ split liver. During transplantation neither CPB nor veno-venous by-pass (VVB) were employed. Immunosuppression was based on basiliximab, tacrolimus, steroids and azathioprine. The three recipients are alive with a median follow-up of 670 days (range 244-1,533). Combined SBSL-LTx is a complex but effective procedure for the treatment of ESLLD due to CF, not necessarily requiring the use of CPB or VVB.

Cognitive subtypes of dyslexia are characterized by distinct patterns of grey matter volume.

PubMed

Jednoróg, Katarzyna; Gawron, Natalia; Marchewka, Artur; Heim, Stefan; Grabowska, Anna

2014-09-01

The variety of different causal theories together with inconsistencies about the anatomical brain markers emphasize the heterogeneity of developmental dyslexia. Attempts were made to test on a behavioral level the existence of subtypes of dyslexia showing distinguishable cognitive deficits. Importantly, no research was directly devoted to the investigation of structural brain correlates of these subtypes. Here, for the first time, we applied voxel-based morphometry (VBM) to study grey matter volume (GMV) differences in a relatively large sample (n = 46) of dyslexic children split into three subtypes based on the cognitive deficits: phonological, rapid naming, magnocellular/dorsal, and auditory attention shifting. VBM revealed GMV clusters specific for each studied group including areas of left inferior frontal gyrus, cerebellum, right putamen, and bilateral parietal cortex. In addition, using discriminant analysis on these clusters 79% of cross-validated cases were correctly re-classified into four groups (controls vs. three subtypes). Current results indicate that dyslexia may result from distinct cognitive impairments characterized by distinguishable anatomical markers.

Retinoschisis and hyperopia associated with partial monosomy of 6q and partial trisomy of 11q.

PubMed

Bagheri, Nika; Bahl, Reecha S; Singh, Arun D; Rychwalski, Paul J

2014-06-01

Retinoschisis, or retinal lamellar splitting, can occur in a number of hereditary conditions. The most common cause of congenital or childhood onset retinoschisis is the clinical entity known as juvenile retinoschsis, which is caused by mutations in the X-linked retinoschisis 1 gene. Genes other than X-linked retinoschisis 1 gene have rarely been implicated in association with hereditary retinoschisis. We describe a 9-year-old male who presented with several phenotypic features associated with partial monosomy of chromosome 6q and partial trisomy of chromosome 11q, including myelomeningocele, mental and growth retardation, seizures, microcephaly, scoliosis, and facial dysmorphisms, as well as novel ocular findings including bilateral retinoschisis and hyperopia. This case report highlights the necessity for a detailed ophthalmic examination of patients with both 6q deletions as well as 11q duplications to ensure accurate and timely diagnosis and treatment of the complications associated with the described ocular conditions.

Models and Analogues for the Evaluation of Human Biodynamic Response, Performance and Protection

DTIC Science & Technology

1979-06-01

but in a point situated more ventrally . Nid-sagittal sacral curvature, length-width proportions and the height of the mid-sagittal curvature are...principal moments of che new ellipsoid are then calculated. I* , ioV- cm2 275 a:.s 1.981Iola - 82.99 225 175 125 75- 50 75 100 12S , S5 O75 Ix.,, to...along and three angulations about the three axes of the coordinate system. The complete descrip- tion of the behavior of a FSU can be obtained by

Trans-falcine and contralateral sub-frontal electrode placement in pediatric epilepsy surgery: technical note.

PubMed

Pindrik, Jonathan; Hoang, Nguyen; Tubbs, R Shane; Rocque, Brandon J; Rozzelle, Curtis J

2017-08-01

Phase II monitoring with intracranial electroencephalography (ICEEG) occasionally requires bilateral placement of subdural (SD) strips, grids, and/or depth electrodes. While phase I monitoring often demonstrates a preponderance of unilateral findings, individual studies (video EEG, single photon emission computed tomography [SPECT], and positron emission tomography [PET]) can suggest or fail to exclude a contralateral epileptogenic onset zone. This study describes previously unreported techniques of trans-falcine and sub-frontal insertion of contralateral SD grids and depth electrodes for phase II monitoring in pediatric epilepsy surgery patients when concern about bilateral abnormalities has been elicited during phase I monitoring. Pediatric patients with medically refractory epilepsy undergoing stage I surgery for phase II monitoring involving sub-frontal and/or trans-falcine insertion of SD grids and/or depth electrodes at the senior author's institution were retrospectively reviewed. Intra-operative technical details of sub-frontal and trans-falcine approaches were studied, while intra-operative complications or events were noted. Operative techniques included gentle subfrontal retraction and elevation of the olfactory tracts (while preserving the relationship between the olfactory bulb and cribriform plate) to insert SD grids across the midline for coverage of the contralateral orbito-frontal regions. Trans-falcine approaches involved accessing the inter-hemispheric space, bipolar cauterization of the anterior falx cerebri below the superior sagittal sinus, and sharp dissection using a blunt elevator and small blade scalpel. The falcine window allowed contralateral SD strip, grid, and depth electrodes to be inserted for coverage of the contralateral frontal regions. The study cohort included seven patients undergoing sub-frontal and/or trans-falcine insertion of contralateral SD strip, grid, and/or depth electrodes from February 2012 through June 2015. Five patients (71%) experienced no intra-operative events related to contralateral ICEEG electrode insertion. Intra-operative events of frontal territory venous engorgement (1/7, 14%) due to sacrifice of anterior bridging veins draining into the SSS and avulsion of a contralateral bridging vein (1/7, 14%), probably due to prior anterior corpus callosotomy, each occurred in one patient. There were no intra-operative or peri-operative complications in any of the patients studied. Two patients required additional surgery for supplemental SD strip and/or depth electrodes via burr hole craniectomy to enhance phase II monitoring. All patients proceeded to stage II surgery for resection of ipsilateral epileptogenic onset zones without adverse events. Trans-falcine and sub-frontal insertion of contralateral SD strip, grid, and depth electrodes are previously unreported techniques for achieving bilateral frontal coverage in phase II monitoring in pediatric epilepsy surgery. This technique obviates the need for contralateral craniotomy and parenchymal exposure with limited, remediable risks. Larger case series using the method described herein are now necessary.

Novel swing-assist un-motorized exoskeletons for gait training.

PubMed

Mankala, Kalyan K; Banala, Sai K; Agrawal, Sunil K

2009-07-03

Robotics is emerging as a promising tool for functional training of human movement. Much of the research in this area over the last decade has focused on upper extremity orthotic devices. Some recent commercial designs proposed for the lower extremity are powered and expensive - hence, these could have limited affordability by most clinics. In this paper, we present a novel un-motorized bilateral exoskeleton that can be used to assist in treadmill training of motor-impaired patients, such as with motor-incomplete spinal cord injury. The exoskeleton is designed such that the human leg will have a desirable swing motion, once it is strapped to the exoskeleton. Since this exoskeleton is un-motorized, it can potentially be produced cheaply and could reduce the physical demand on therapists during treadmill training. A swing-assist bilateral exoskeleton was designed and fabricated at the University of Delaware having the following salient features: (i) The design uses torsional springs at the hip and the knee joints to assist the swing motion. The springs get charged by the treadmill during stance phase of the leg and provide propulsion forces to the leg during swing. (ii) The design of the exoskeleton uses simple dynamic models of sagittal plane walking, which are used to optimize the parameters of the springs so that the foot can clear the ground and have a desirable forward motion during walking. The bilateral exoskeleton was tested on a healthy subject during treadmill walking for a range of walking speeds between 1.0 mph and 4.0 mph. Joint encoders and interface force-torque sensors mounted on the exoskeleton were used to evaluate the effectiveness of the exoskeleton in terms of the hip and knee joint torques applied by the human during treadmill walking. We compared two different cases. In case 1, we estimated the torque applied by the human joints when walking with the device using the joint kinematic data and interface force-torque sensors. In case 2, we calculated the required torque to perform a similar gait only using the kinematic data collected from joint motion sensors. On analysis, we found that at 2.0 mph, the device was effective in reducing the maximum hip torque requirement and the knee joint torque during the beginning of the swing. These behaviors were retained as the treadmill speed was changed between 1-4 mph. These results were remarkable considering the simplicity of the dynamic model, model uncertainty, non-ideal spring behavior, and friction in the joints. We believe that the results can be further improved in the future. Nevertheless, this promises to provide a useful and effective methodology for design of un-motorized exoskeletons to assist and train swing of motor-impaired patients.

Influence of immediate post-extraction socket irrigation on development of alveolar osteitis after mandibular third molar removal: a prospective split-mouth study, preliminary report.

PubMed

Tolstunov, L

2012-12-01

The aim of this prospective comparative split-mouth study was to evaluate the role of socket irrigation with a normal saline solution routinely used at the end of extraction on the development of alveolar osteitis (AO) after removal of impacted mandibular third molars (MTMs). Thirty-five patients who satisfied the inclusion criteria were involved in the study and underwent extraction of four third-molars. To be included in the study, the mandibular third molars had to be impacted (partial or full bone) and require an osteotomy for extraction with use of a motorised drill. All surgeries were done under local anaesthesia or IV sedation. This was a prospective split-mouth study. The patient's left (assistant) side was a control side; it had a standard extraction technique of an impacted mandibular third molar that required a buccal full-thickness flap, buccal trough (osteotomy) and extraction of the tooth (with or without splitting the tooth into segments), followed by a traditional end-of-surgery debridement protocol consisting of a gentle curettage, bone filing of the socket walls, socket irrigation with approximately 5 ml of sterile normal saline solution and socket suctioning. The patient's right (operator) side was an experimental side; it also had a standard extraction technique of an impacted mandibular third molar at the beginning with a flap and osteotomy, but it was followed by a modified end-of-surgery protocol. It consisted of gentle curettage but the socket was not irrigated and not suctioned. It was simply left to bleed. The gauze was placed on top of the socket for haemostasis on both sides and the patient was asked to bite. On both sides, the buccal flap was positioned back without the suture. All patients were seen for a follow-up appointment four to seven days after the surgery to assess healing and check for symptoms and signs of alveolar osteitis, if present, on both irrigated and non-irrigated sides. This study followed the ethical guidelines of human subjects based on the Helsinki Declaration. Thirty-five patients or 70 sockets were evaluated. Eleven out of 35 patients in the study were subjected to a dry socket syndrome (31.4%). The higher number of AO was likely related to specifics of MTM selection in this study - only impacted (partial and full bone) MTMs were chosen. Among eleven patients with AO, two patients had a bilateral condition. By excluding two patients with bilateral dry sockets from the study, there were nine patients (18 extraction sites) with unilateral AO in the study. Seven out of nine patients (14 extraction sites) developed unilateral dry socket on the control (irrigated) side (77.8%) and only two (four extraction sites) on the experimental (non-irrigated) side (22.2%). Therefore, in this study there were 3.5 times more patients (extraction sites) with dry socket syndrome on the irrigated (control) side than patients (extraction sites) in the non-irrigated (experimental) side. A noticeable difference of dry socket syndromes (77.8% on the irrigated versus 22.2% on non-irrigated side) was demonstrated between the traditional extraction protocol versus modified approach without the end-of-surgery irrigation. The study demonstrated that the post-extraction socket bleeding is very important for the proper uncomplicated socket healing. If it's not washed away with irrigation solution at the end of extraction, the normal blood clot has a higher likelihood to form, and therefore, can potentially lead to an uncomplicated socket healing without development of alveolar osteitis. Socket bleeding at the extraction site creates a favourable environment for the formation of a blood clot - a protective dressing - necessary for a favourable osseous healing of the socket.

A split-mouth randomized clinical trial to evaluate the performance of piezosurgery compared with traditional technique in lower wisdom tooth removal.

PubMed

Mantovani, Edoardo; Arduino, Paolo Giacomo; Schierano, Gianmario; Ferrero, Luca; Gallesio, Giorgia; Mozzati, Marco; Russo, Andrea; Scully, Crispian; Carossa, Stefano

2014-10-01

The surgical removal of mandibular third molars is frequently accompanied by significant postsurgical sequelae, and different protocols have been described to decrease such adverse events. The aim of this study was to investigate the performance of piezosurgery compared with traditional rotating instruments during mandibular third molar removal. A single-center, randomized, split-mouth study was performed using a consecutive series of unrelated healthy patients attending the Oral Surgery Unit of the University of Turin for surgical removal of bilateral mandibular third molar teeth. Each patient was treated, at the same appointment, using bur removal on 1 side of the mandible and a piezoelectric device on the contralateral side. The primary outcomes reported were postoperative pain, objective orofacial swelling, and surgical duration; secondary outcomes were gender, age, and possible adverse events. Analysis of variance or paired t test was used as appropriate to test any significant differences at baseline according to each treatment subgroup, and categorical variables were analyzed by χ(2) test. The study sample consisted of 100 otherwise healthy patients. The mean pain evaluation reported by patients who underwent surgery with piezosurgery was significantly lower than that reported after bur (conventional) removal, reaching statistical difference after 4 days (P = .043). The clinical value of orofacial swelling at day 7, normalized to baseline, was lower in the piezosurgery group (P < .005). The average surgical duration was significantly shorter in the bur group than in the piezosurgery group (P < .05). Three patients having bur removal developed short-term complications (2 dry sockets and 1 temporary paraesthesia), which totally resolved by 4 weeks. To date, this prospective investigation is the largest reported split-mouth study on piezosurgery for lower third molar tooth removal. This study also compared surgeons with different degrees of experience. It is evident that using a piezoelectric device can enhance the patient experience and decrease postoperative pain and swelling. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

MicroSaw and Piezosurgery in Harvesting Mandibular Bone Blocks from the Retromolar Region: A Randomized Split-Mouth Prospective Clinical Trial.

PubMed

Hanser, Thomas; Doliveux, Romain

The aim of this randomized prospective split-mouth clinical trial was to evaluate the outcome of bone block harvesting from the retromolar region using the MicroSaw and Piezosurgery. Fifty-three patients for extensive bilateral bone grafting procedures with or without concomitant implant placement in the maxilla and/or mandible were scheduled. In each patient, bone blocks were harvested in the retromolar area within the external oblique ridge of the mandible. Using a randomized protocol, bone blocks were harvested with the MicroSaw and Piezosurgery either from the right or the left side. Clinical outcome parameters were the comparison of osteotomy time; volume of block graft; and clinical determination of intraoperative complications such as hemorrhage, nerve injury, pain, swelling, and healing of the donor site. The mean osteotomy time for harvesting including luxating a bone block was 5.63 (± 1.37) minutes using the MicroSaw and 16.47 (± 2.74) minutes using Piezosurgery (P < .05). A mean graft volume of 1.62 (± 0.27) cm 3 was measured with the MicroSaw and 1.26 (± 0.27) cm 3 with the piezoelectric surgical device (P < .05). No heavy bleeding at the donor site occurred in any of the cases. Complications due to injury of adjacent teeth or nerve lesion of the mandibular nerve were not observed in any cases. According to a scale, there was little postoperative pain with both instruments, and it decreased within 14 days postoperatively (P > .05). Swelling did not appear significantly different either (P > .05), and none of the donor sites showed primary healing complications. The data described in this randomized prospective split-mouth clinical trial indicate that the MicroSaw and Piezosurgery allowed efficient and safe bone block harvesting from the external oblique ridge. Clinically, concerning harvesting time and volume of the grafts, the MicroSaw performed significantly better, whereas pain, swelling, and healing did not appear to be considerably different. Given the improved visibility, precise cut geometries, and the margin of safety afforded by the MicroSaw and Piezosurgery, they are both instruments of choice when harvesting bone from the retromolar area.

Temporary Percutaneous Instrumentation and Selective Anterior Fusion for Thoracolumbar Fractures.

PubMed

Charles, Yann Philippe; Walter, Axel; Schuller, Sébastien; Steib, Jean-Paul

2017-05-01

Prospective clinical trial in thoracolumbar trauma with 5-year follow-up. To analyze clinical and radiographic outcomes of minimal invasive surgery, and the rational of circumferential fracture treatment with regard to age, degenerative changes, bone mineral density, and global sagittal balance. Non-neurologic fractures with anterior column defect can be treated by posterior percutaneous instrumentation and selective anterior fusion. After consolidation, instrumentation can be removed at 1 year to provide mobility in non-fused segments. Fifty-one patients, 47 (18-75) years, were operated for A2, A3, or B-type fractures. Visual analog scale (VAS) for back pain and Oswestry Disability Index (ODI) were assessed. Radiographic measurements were: sagittal index, regional kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, and T9 tilt. Anterior fusion and facet joints were analyzed on computed tomography (CT) at 1 year. The ODI was 8.8 before accident, 35.4 at 3 months, 17.8 at 2 years, 14.4 at 5 years. The VAS was 2.0 at 3 months and 1.0 at 5 years. The sagittal index was 18.0° preoperatively and 1.0° at 3 months (P < 0.0001). A loss of reduction of 1.1° occurred after implant removal (P = 0.009). Global sagittal balance remained unchanged. Ten patients with osteopenia or osteoporosis had a worse ODI: 24.7 versus 11.9 (P = 0.016), and a greater loss of correction: 4.9° versus 1.3° (P = 0.007). Cages filled with cancellous bone from the fractured vertebra fused regularly. Spontaneous facet joint fusions were observed in two patients at the fracture level in B-type injuries. Percutaneous instrumentation and selective anterior fusion using autologous bone and mesh cages lead to high fusion rates, which provided good long-term clinical results in younger patients with thoracolumbar fractures. Sagittal alignment was maintained after instrumentation removal without damaging paravertebral muscles. Outcomes were worse in elderly patients presenting osteopenia or osteoporosis. 3.

Evaluation of T2-weighted versus short-tau inversion recovery sagittal sequences in the identification and localization of canine intervertebral disc extrusion with low-field magnetic resonance imaging.

PubMed

Housley, Daniel; Caine, Abby; Cherubini, Giunio; Taeymans, Olivier

2017-07-01

Sagittal T2-weighted sequences (T2-SAG) are the foundation of spinal protocols when screening for the presence of intervertebral disc extrusion. We often utilize sagittal short-tau inversion recovery sequences (STIR-SAG) as an adjunctive screening series, and experience suggests that this combined approach provides superior detection rates. We hypothesized that STIR-SAG would provide higher sensitivity than T2-SAG in the identification and localization of intervertebral disc extrusion. We further hypothesized that the parallel evaluation of paired T2-SAG and STIR-SAG series would provide a higher sensitivity than could be achieved with either independent sagittal series when viewed in isolation. This retrospective diagnostic accuracy study blindly reviewed T2-SAG and STIR-SAG sequences from dogs (n = 110) with surgically confirmed intervertebral disc extrusion. A consensus between two radiologists found no significant difference in sensitivity between T2-SAG and STIR-SAG during the identification of intervertebral disc extrusion (T2-SAG: 92.7%, STIR-SAG: 94.5%, P = 0.752). Nevertheless, STIR-SAG accurately identified intervertebral disc extrusion in 66.7% of cases where the evaluation of T2-SAG in isolation had provided a false negative diagnosis. Additionally, one radiologist found that the parallel evaluation of paired T2-SAG and STIR-SAG series provided a significantly higher sensitivity than T2-SAG in isolation, during the identification of intervertebral disc extrusion (T2-SAG: 78.2%, paired T2-SAG, and STIR-SAG: 90.9%, P = 0.017). A similar nonsignificant trend was observed when the consensus of both radiologists was taken into consideration (T2-SAG: 92.7%, paired T2-SAG, and STIR-SAG = 97.3%, P = 0.392). We therefore conclude that STIR-SAG is capable of identifying intervertebral disc extrusion that is inconspicuous in T2-SAG, and that STIR-SAG should be considered a useful adjunctive sequence during preliminary sagittal screening for intervertebral disc extrusion in low-field magnetic resonance. © 2017 American College of Veterinary Radiology.

Analysis of Sagittal Parameters in Patients Undergoing One- or Two-Level Closing Wedge Osteotomy for Correcting Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis.

PubMed

Hua, Wen-Bin; Zhang, Yu-Kun; Gao, Yong; Liu, Xian-Zhe; Yang, Shu-Hua; Wu, Xing-Huo; Wang, Jing; Yang, Cao

2017-07-15

Retrospective analysis of clinical records. To assess and compare the improvement in sagittal balance after one- or two-level closing wedge osteotomy for correcting thoracolumbar kyphosis secondary to ankylosing spondylitis (AS). Closing wedge osteotomy represents a common approach to correct kyphosis in AS. Although several reports have described the outcomes of one- or two-level closing wedge osteotomy in terms of sagittal parameters, data comparing the outcomes of these procedures are scarce. Between January 2010 and December 2014, 22 patients with AS underwent closing wedge osteotomy (one-level, 12 patients; two-level, 10 patients) for correcting thoracolumbar kyphosis (mean follow-up, 24.8 months; range, 12-60 months). Preoperative and postoperative chin-brow vertical angle, and the sagittal parameters of the vertebral osteotomy segment were documented and compared. Perioperative and postoperative complications were also recorded. The chin-brow vertical angle improved significantly, from 55.0° ± 27.3° to 4.7° ± 4.9° and from 38.2° ± 14.9° to 3.2° ± 5.4° in the one-level and two-level groups, respectively. The total correction (thoracic kyphosis and lumbar lordosis) was 32.8° ± 18.2° and 53.7° ± 9.4° in the one-level and two-level groups, respectively. No death, complete paralysis, or vascular complications occurred during the procedure, but cerebrospinal fluid leak was noted in one and two patients from the one-level and two-level groups, respectively. A distal pedicle screw adjacent to the osteotomy segment became loose during surgery in one patient (one-level group). Postoperatively, no transient neurological deficit, infection, delay union, or loosening or breaking of the internal fixation devices was observed. Osteotomy site fusion was achieved in all patients, and the Oswestry Disability Index scores improved significantly. Closing wedge osteotomy is effective and safe for correcting thoracolumbar kyphosis in patients with AS. Significant correction and improvement in all sagittal parameters were noted in both groups, but two-level closing wedge osteotomy provided better correction. 3.

The presence of a negative sacral slope in patients with ankylosing spondylitis with severe thoracolumbar kyphosis.

PubMed

Qian, Bang-Ping; Jiang, Jun; Qiu, Yong; Wang, Bin; Yu, Yang; Zhu, Ze-Zhang

2014-11-19

Pelvic retroversion is one of the mechanisms for regulating sagittal balance in patients with a kyphotic deformity. This retroversion is limited by hip extension, which prevents the pelvis from becoming excessively retroverted, achieving a sacral slope of <0°. However, a negative sacral slope can be found in some patients with ankylosing spondylitis with thoracolumbar kyphosis. The purpose of this study was to analyze this finding. We performed a retrospective review of 106 consecutive Chinese Han patients with ankylosing spondylitis with thoracolumbar kyphosis treated at our center from October 2005 to October 2012. Forty-one patients in whom the upper third of the femur was clearly visualized on lateral radiographs were analyzed. Seventeen had a sacral slope of <0° (group A) and twenty-four had a sacral slope of ≥0° (group B). Eight sagittal parameters were measured and compared between the two groups. Correlations among sacral slope, the femoral obliquity angle, and the other sagittal parameters were analyzed. Mean global kyphosis, lumbar lordosis, pelvic tilt, the sagittal vertical axis, and the femoral obliquity angle were significantly larger in group A than in group B, whereas mean pelvic incidence and sacral slope were significantly smaller in group A (p < 0.05 for all). Global kyphosis, lumbar lordosis, pelvic tilt, and the sagittal vertical axis were significantly negatively associated with sacral slope but positively associated with the femoral obliquity angle, whereas pelvic incidence was significantly positively associated with sacral slope but negatively associated with the femoral obliquity angle (p < 0.05 for all). The femoral obliquity angle was significantly negatively associated with sacral slope (p < 0.05). Negative sacral slope does exist in Chinese Han patients with ankylosing spondylitis with thoracolumbar kyphosis. This appears to be caused by severe kyphosis, an initially small sacral slope, and pronounced tilting of the femoral shaft as a result of knee flexion, resulting in the pelvis becoming further retroverted. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Development of synthetic simulators for endoscope-assisted repair of metopic and sagittal craniosynostosis.

PubMed

Eastwood, Kyle W; Bodani, Vivek P; Haji, Faizal A; Looi, Thomas; Naguib, Hani E; Drake, James M

2018-06-01

OBJECTIVE Endoscope-assisted repair of craniosynostosis is a safe and efficacious alternative to open techniques. However, this procedure is challenging to learn, and there is significant variation in both its execution and outcomes. Surgical simulators may allow trainees to learn and practice this procedure prior to operating on an actual patient. The purpose of this study was to develop a realistic, relatively inexpensive simulator for endoscope-assisted repair of metopic and sagittal craniosynostosis and to evaluate the models' fidelity and teaching content. METHODS Two separate, 3D-printed, plastic powder-based replica skulls exhibiting metopic (age 1 month) and sagittal (age 2 months) craniosynostosis were developed. These models were made into consumable skull "cartridges" that insert into a reusable base resembling an infant's head. Each cartridge consists of a multilayer scalp (skin, subcutaneous fat, galea, and periosteum); cranial bones with accurate landmarks; and the dura mater. Data related to model construction, use, and cost were collected. Eleven novice surgeons (residents), 9 experienced surgeons (fellows), and 5 expert surgeons (attendings) performed a simulated metopic and sagittal craniosynostosis repair using a neuroendoscope, high-speed drill, rongeurs, lighted retractors, and suction/irrigation. All participants completed a 13-item questionnaire (using 5-point Likert scales) to rate the realism and utility of the models for teaching endoscope-assisted strip suturectomy. RESULTS The simulators are compact, robust, and relatively inexpensive. They can be rapidly reset for repeated use and contain a minimal amount of consumable material while providing a realistic simulation experience. More than 80% of participants agreed or strongly agreed that the models' anatomical features, including surface anatomy, subgaleal and subperiosteal tissue planes, anterior fontanelle, and epidural spaces, were realistic and contained appropriate detail. More than 90% of participants indicated that handling the endoscope and the instruments was realistic, and also that the steps required to perform the procedure were representative of the steps required in real life. CONCLUSIONS Both the metopic and sagittal craniosynostosis simulators were developed using low-cost methods and were successfully designed to be reusable. The simulators were found to realistically represent the surgical procedure and can be used to develop the technical skills required for performing an endoscope-assisted craniosynostosis repair.

Clinical outcomes, radiologic kinematics, and effects on sagittal balance of the 6 df LP-ESP lumbar disc prosthesis.

PubMed

Lazennec, Jean-Yves; Even, Julien; Skalli, Wafa; Rakover, Jean-Patrick; Brusson, Adrien; Rousseau, Marc-Antoine

2014-09-01

Surgical treatment of degenerative disc disease remains a controversial subject. Lumbar fusion has been associated with a potential risk of segmental junctional disease and sagittal balance misalignment. Motion preservation devices have been developed as an alternative to fusion. The LP-ESP disc is a one-piece deformable device achieving 6 df, including shock absorption and elastic return. This is the first clinical report on its use. To assess clinical outcomes and radiologic kinematics in the first 2 years after implantation. Prospective cohort of patients with LP-ESP total disc replacement (TDR) at the lumbar spine. Forty-six consecutive patients. Clinical outcomes were the visual analog scale (VAS) for pain, the Oswestry disability index (ODI), and the GHQ28 (General Health Questionnaire) psychological score. Radiologic data were the range of motion (ROM), sagittal balance parameters, and mean center of rotation (MCR). Patients had single-level TDR at L4-L5 or L5-S1. Outcomes were prospectively recorded for 2 years (before and at 3, 6, 12, and 24 months after surgery). The SpineView software was used for computed analysis of the radiographic data. Paired t tests were used for statistical comparisons. No intraoperative complication occurred. All clinical scores improved significantly at 24 months: the back pain VAS scores by a mean of 4.1 points and the ODI by 33 points. The average ROM of the instrumented level was 5.4°±4.8° at 2 years and more than 2° for 76% of prostheses. The MCR was in a physiological area in 73% of cases. The sagittal balance (pelvic tilt, sacral slope, and segmental lordosis) did not change significantly at any point of the follow-up. Results from the 2-year follow-up indicate that LP-ESP prosthesis recreates lumbar spine function similar to that of the healthy disc in terms of ROM, quality of movement, effect on sagittal balance, and absence of modification in the kinematics of the upper adjacent level. Copyright © 2014 Elsevier Inc. All rights reserved.

Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine.

PubMed

Harrison, D E; Harrison, D D; Janik, T J; William Jones, E; Cailliet, R; Normand, M

2001-05-01

To calculate and compare combined axial and flexural stresses in lordosis versus buckled configurations of the sagittal cervical curve. Digitized measurements from lateral cervical radiographs of four different shapes were used to calculate axial loads and bending moments on the vertebral bodies of C2-C7.Background. Osteoarthritis and spinal degeneration are factors in neck and back pain. Calculations of stress in clinically occurring configurations of the sagittal cervical spine are rare. Center of gravity of the head (inferior-posterior sella turcica) and vertebral body margins were digitized on four different lateral cervical radiographs: lordosis, kyphosis, and two "S"-shapes. Polynomials (seventh degree) and stress concentrations on the concave and convex margins were derived for the shape of the sagittal cervical curvatures from C1 to T1. Moments of inertia were determined from digitizing and the use of an elliptical shell model of cross-section. Moment arms from a vertical line through the center of gravity of the head to the atlas and scaled neck extensor moment arms from the literature were used to compute the vertical component of extensor muscle effort. Segmental lever arms were calculated from a vertical line through C1 to each vertebra. In lordosis, anterior and posterior stresses in the vertebral body are nearly uniform and minimal. In kyphotic areas, combined stresses changed from tension to compression at the anterior vertebral margins and were very large (6-10 times as large in magnitude) compared to lordosis. In kyphotic areas at the posterior vertebral body, the combined stresses changed from compression (in lordosis) to tension. The stresses in kyphotic areas are very large and opposite in direction compared to a normal lordosis. This analysis provides the basis for the formation of osteophytes (Wolff's Law) on the anterior margins of vertebrae in kyphotic regions of the sagittal cervical curve. This indicates that any kyphosis is an undesirable configuration in the cervical spine. Relevance. Osteophytes and osteoarthritis are found at areas of altered stress and strain. Axial and flexural stresses at kyphotic areas in the sagittal cervical spine are abnormally high.

Eccentric Capitellar Ossification Limits the Utility of the Radiocapitellar Line in Young Children.

PubMed

Fader, Lauren M; Laor, Tal; Eismann, Emily A; Cornwall, Roger; Little, Kevin J

2016-03-01

The radiocapitellar line (RCL) has long been used for the radiographic evaluation of elbow alignment. In children, the capitellar ossific nucleus serves as a proxy for the entire capitellum, but this substitution has not been verified. Using magnetic resonance imaging (MRI), we sought to understand how maturation of the ossific nucleus of the capitellum affects the utility of RCL throughout skeletal maturation of the elbow. The RCL was drawn on coronal and sagittal MRIs in 82 children (43 boys, 39 girls; age range, 1 to 13 y) with at least 3 patients in each 1-year interval age group. The perpendicular distance of the RCL from the center of both the cartilaginous capitellum and the capitellar ossific nucleus was measured relative to its total width, and a percent offset for each measurement was calculated. Logarithmic regression analysis was performed to analyze the effect of age and sex on percent offset. The RCL reliably intersected with the central third of the cartilaginous capitellum at all ages in both planes. Although the RCL intersected with the ossified capitellum in all but 3 measurements, it intersected with the central third of the ossified capitellum less often in younger children in both sagittal (B=0.47, P<0.001) and coronal (B=0.31, P=0.002) planes. Percent offset decreased significantly with age in a logarithmic manner in both sagittal (r=0.57, P<0.001) and coronal (r=-0.47, P<0.001) planes. 95% confidence intervals predict that the sagittal plane RCL will accurately intersect the central third of the ossified capitellum by age 10 years in girls and age 11 years in boys but not in the coronal plane. Eccentric ossification of the capitellum explains RCL variability in young children. The RCL does not reliably intersect the central third of the ossified capitellum until ages 10 years in girls and 11 years in boys in the sagittal plane. The RCL should be used within its limitations in skeletally immature children and should be combined with advanced imaging if necessary.

Dural venous sinuses distortion and compression with supratentorial mass lesions: a mechanism for refractory intracranial hypertension?

PubMed Central

Qureshi, Adnan I.; Qureshi, Mushtaq H.; Majidi, Shahram; Gilani, Waqas I.; Siddiq, Farhan

2014-01-01

Objective To determine the effect of supratentorial intraparenchymal mass lesions of various volumes on dural venous sinuses structure and transluminal pressures. Methods Three set of preparations were made using adult isolated head derived from fresh human cadaver. A supratentorial intraparenchymal balloon was introduced and inflated at various volumes and effect on dural venous sinuses was assessed by serial intravascular ultrasound, computed tomographic (CT), and magnetic resonance (MR) venograms. Contrast was injected through a catheter placed in sigmoid sinus for both CT and MR venograms. Serial trasluminal pressures were measured from middle part of superior sagittal sinus in another set of experiments. Results At intraparenchymal balloon inflation of 90 cm3, there was attenuation of contrast enhancement of superior sagittal sinus with compression visualized in posterior part of the sinus without any evidence of compression in the remaining sinus. At intraparenchymal balloon inflation of 180 and 210 cm3, there was compression and obliteration of superior sagittal sinus throughout the length of the sinus. In the coronal sections, at intraparenchymal balloon inflations of 90 and 120 cm3, compression and obliteration of the posterior part of superior sagittal sinus were visualized. In the axial images, basal veins were not visualized with intraparenchymal balloon inflation of 90 cm3 or greater although straight sinus was visualized at all levels of inflation. Trasluminal pressure in the middle part of superior sagittal sinus demonstrated a mild increase from 0 cm H2O to 0.4 cm H2O and 0.5 cm H2O with inflation of balloon to volume of 150 and 180 cm3, respectively. There was a rapid increase in transluminal pressure from 6.8 cm H2O to 25.6 cm H2O as the supratentorial mass lesion increased from 180 to 200 cm3. Conclusions Our experiments identified distortion and segmental and global obliteration of dural venous sinuses secondary to supratentorial mass lesion and increase in transluminal pressure with large volume lesions. The secondary involvement of dural venous sinuses may represent a mechanism for refractory intracranial hypertension. PMID:24920987

Postural Consequences of Cervical Sagittal Imbalance: A Novel Laboratory Model.

PubMed

Patwardhan, Avinash G; Havey, Robert M; Khayatzadeh, Saeed; Muriuki, Muturi G; Voronov, Leonard I; Carandang, Gerard; Nguyen, Ngoc-Lam; Ghanayem, Alexander J; Schuit, Dale; Patel, Alpesh A; Smith, Zachary A; Sears, William

2015-06-01

A biomechanical study using human spine specimens. To study postural compensations in lordosis angles that are necessary to maintain horizontal gaze in the presence of forward head posture and increasing T1 sagittal tilt. Forward head posture relative to the shoulders, assessed radiographically using the horizontal offset distance between the C2 and C7 vertebral bodies (C2-C7 [sagittal vertical alignment] SVA), is a measure of global cervical imbalance. This may result from kyphotic alignment of cervical segments, muscle imbalance, as well as malalignment of thoracolumbar spine. Ten cadaveric cervical spines (occiput-T1) were tested. The T1 vertebra was anchored to a tilting and translating base. The occiput was free to move vertically but its angular orientation was constrained to ensure horizontal gaze regardless of sagittal imbalance. A 5-kg mass was attached to the occiput to mimic head weight. Forward head posture magnitude and T1 tilt were varied and motions of individual vertebrae were measured to calculate C2-C7 SVA and lordosis across C0-C2 and C2-C7. Increasing C2-C7 SVA caused flexion of lower cervical (C2-C7) segments and hyperextension of suboccipital (C0-C1-C2) segments to maintain horizontal gaze. Increasing kyphotic T1 tilt primarily increased lordosis across the C2-C7 segments. Regression models were developed to predict the compensatory C0-C2 and C2-C7 angulation needed to maintain horizontal gaze given values of C2-C7 SVA and T1 tilt. This study established predictive relationships between radiographical measures of forward head posture, T1 tilt, and postural compensations in the cervical lordosis angles needed to maintain horizontal gaze. The laboratory model predicted that normalization of C2-C7 SVA will reduce suboccipital (C0-C2) hyperextension, whereas T1 tilt reduction will reduce the hyperextension in the C2-C7 segments. The predictive relationships may help in planning corrective strategy in patients experiencing neck pain, which may be attributed to sagittal malalignment. N/A.

Reproducibility and repeatability of a new computerized software for sagittal spinopelvic and scoliosis curvature radiologic measurements: Keops(®).

PubMed

Maillot, C; Ferrero, E; Fort, D; Heyberger, C; Le Huec, J-C

2015-07-01

The purpose of this study was to evaluate the inter- and intra-observer variability of the computerized radiologic measurements using Keops(®) and to determine the bias between the software and the standard paper measurement. Four individuals measured all frontal and sagittal variables on the 30 X-rays randomly selected on two occasions (test and retest conditions). The Bland-Altman plot was used to determine the degree of agreement between the measurement on paper X-ray and the measurement using Keops(®) for all reviewers and for the two measures; the intraclass correlation coefficient (ICC) was calculated for each pair of analyses to assess interobserver reproducibility among the four reviewers for the same patient using either paper X-ray or Keops(®) measurement and finally, concordance correlation coefficient (rc) was calculated to assess intraobserver repeatability among the same reviewer for one patient between the two measure using the same method (paper or Keops(®)). The mean difference calculated between the two methods was minimal at -0, 4° ± 3.41° [-7.1; 6.4] for frontal measurement and 0.1° ± 3.52° [-6.7; 6.8] for sagittal measurement. Keops(®) has a better interobserver reproducibility than paper measurement for determination of the sagittal pelvic parameter (ICC = 0.9960 vs. 0.9931; p = 0.0001). It has a better intraobserver repeatability than paper for determination of Cobbs angle (rc = 0.9872 vs. 0.9808; p < 0.0001) and for pelvic parameter (rc = 0.9981 vs. 0.9953; p < 0.0001). We conclude that Keops(®) has no bias compared to the traditionally paper measurement, and moreover, the repeatability and the reproducibility of measurements with this method is much better than with similar standard radiologic measures done manually in both frontal and sagittal plane and that the use of this software can be recommended for clinical application. Diagnostic, level III.

[CORRELATION OF LUMBAR FACET JOINT DEGENERATION AND SPINE-PELVIC SAGITTAL BALANCE].

PubMed

Lo, Xin; Zhang, Bin; Liu, Yuan; Dai, Min

2015-08-01

To investigate the relationship between lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. A retrospective analysis was made the clinical data of 120 patients with lumbar degenerative disease, who accorded with the inclusion criteria between June and November 2014. There were 58 males and 62 females with an average age of 53 years (range, 24-77 years). The disease duration ranged from 3 to 96 months (mean, 6.6 months). Affected segments included L3,4 in 32 cases, L4,5 in 47 cases, and L5, S1 in 52 cases. The CT and X-ray films of the lumbar vertebrae were taken. The facet joint degeneration was graded based on the grading system of Pathria. The spine-pelvic sagittal balance parameters were measured, including lumbar lordosis (LL), upper lumbar lordosis (ULL), lower lumbar lordosis (LLL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). According to normal range of PI, the patients were divided into 3 groups: group A (PI was less than normal range), group B (PI was within normal range), and group C (PI was more than normal range). The facet joint degeneration was compared; according to the facet joint degeneration degree, the patients were divided into group N (mild degeneration group) and group M (serious degeneration group) to observe the relationship of lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. At L4,5 and L5, S1, facet joint degeneration showed significant difference among groups A, B, and C (P < 0.05), more serious facet joint degeneration was observed in group C; no significant difference was found in facet joint degeneration at L3,4 (P > 0.05). There was no significant difference in the other spine-pelvic sagittal balance parameters between groups N and M at each segment (P > 0.05) except for PT (P < 0.05). PI of more than normal range may lead to or aggravate lumbar facet joint degeneration at L4,5 and L5, Si; PT and PI are significantly associated with facet joint degeneration at the lower lumbar spine.

Correlation between radiographic parameters and functional scores in degenerative lumbar and thoracolumbar scoliosis.

PubMed

Simon, J; Longis, P-M; Passuti, N

2017-04-01

Adult scoliosis is a condition in which the spinal deformity occurs because of degeneration. Although various studies have agreed on the importance of restoring the sagittal balance, few have evaluated the relationship between functional scores and radiological parameters. The primary objective of this retrospective study was to demonstrate the correlation between radiographic parameters and functional outcomes in adult patients with lumbar or thoracolumbar degenerative scoliosis. The secondary objective was to assess the long-term effects of posterolateral fusion for treating this deformity. This single-centre retrospective study included 47 patients over 50years of age who had degenerative lumbar scoliosis treated with an instrumented posterolateral fusion; the mean follow-up was 6.4years (range 2 to 20). Radiographic analysis of A/P and lateral full spine standing radiographs was carried out with the KEOPS software. Three pelvic parameters (pelvic tilt, pelvic incidence, sacral slope), two spinal parameters (lumbar lordosis and thoracic kyphosis) and three sagittal balance parameters (C7 sagittal tilt, C7 Barrey's ratio and spinosacral angle) were calculated. The functional outcomes were evaluated through three self-assessment questionnaires: Oswestry Disability Index, SRS-30 and SF-36. The correlation between clinical and radiographic parameters was calculated with Spearman's correlation test. There was a significant correlation between the SF-36 (PCS) and the following three sagittal parameters: sacral slope (r=-0.31453; P=0.04), lumbar lordosis (r=-0.30198; P=0.0491) and spinosacral angle (r=-0.311967; P=0.0366). The mean ODI score was 33.61, which corresponds to minimal to moderate disability. The mean physical (PCS) and mental (MCS) component summary scores of the SF-36 were 37.70 and 38.40, respectively. The mean SRS-30 score was 3.07. It is essential that the sagittal balance be restored when treating degenerative lumbar scoliosis to generate better functional outcomes and better quality of life. To achieve this correction, instrumented posterolateral fusion appears to be a very reliable technique that leads to lasting improvement. IV. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections.

PubMed

Kim, Han Jo; Bridwell, Keith H; Lenke, Lawrence G; Park, Moon Soo; Song, Kwang Sup; Piyaskulkaew, Chaiwat; Chuntarapas, Tapanut

2014-04-20

Case control study. To evaluate risk factors in patients in 3 groups: those without proximal junctional kyphosis (PJK) (N), with PJK but not requiring revision (P), and then those with PJK requiring revision surgery (S). It is becoming clear that some patients maintain stable PJK angles, whereas others progress and develop severe PJK necessitating revision surgery. A total of 206 patients at a single institution from 2002 to 2007 with adult scoliosis with 2-year minimum follow-up (average 3.5 yr) were analyzed. Inclusion criteria were age more than 18 years and primary fusions greater than 5 levels from any thoracic upper instrumented vertebra to any lower instrumented vertebrae. Revisions were excluded. Radiographical assessment included Cobb measurements in the coronal/sagittal plane and measurements of the PJK angle at postoperative time points: 1 to 2 months, 2 years, and final follow-up. PJK was defined as an angle greater than 10°. The prevalence of PJK was 34%. The average age in N was 49.9 vs. 51.3 years in P and 60.1 years in S. Sex, body mass index, and smoking status were not significantly different between groups. Fusions extending to the pelvis were 74%, 85%, and 91% of the cases in groups N, P, and S. Instrumentation type was significantly different between groups N and S, with a higher number of upper instrumented vertebra hooks in group N. Radiographical parameters demonstrated a higher postoperative lumbar lordosis and a larger sagittal balance change, with surgery in those with PJK requiring revision surgery. Scoliosis Research Society postoperative pain scores were inferior in group N vs. P and S, and Oswestry Disability Index scores were similar between all groups. Patients with PJK requiring revision were older, had higher postoperative lumbar lordosis, and larger sagittal balance corrections than patients without PJK. Based on these data, it seems as though older patients with large corrections in their lumbar lordosis and sagittal balance were at risk for developing PJK, requiring revision surgery. 3.

Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis.

PubMed

Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

2016-04-01

Retrospective study. To assess the relationship between sagittal alignment of the cervical spine and patient-reported health-related quality-of-life scores following multilevel posterior cervical fusion, and to explore whether an analogous relationship exists in the cervical spine using T1 slope minus C2-C7 lordosis (T1S-CL). A recent study demonstrated that, similar to the thoracolumbar spine, the severity of disability increases with sagittal malalignment following cervical reconstruction surgery. From 2007 to 2013, 38 consecutive patients underwent multilevel posterior cervical fusion for cervical stenosis, myelopathy, and deformities. Radiographic measurements included C0-C2 lordosis, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), T1 slope, and T1S-CL. Pearson correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life. C2-C7 SVA positively correlated with neck disability index (NDI) scores (r = 0.495). C2-C7 lordosis (P = 0.001) and T1S-CL (P = 0.002) changes correlated with NDI score changes after surgery. For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of 50 mm, beyond which correlations were most significant. The T1S-CL also correlated positively with C2-C7 SVA and NDI scores (r = 0.871 and r = 0.470, respectively). Results of the regression analysis indicated that a C2-C7 SVA value of 50 mm corresponded to a T1S-CL value of 26.1°. This study showed that disability of the neck increased with cervical sagittal malalignment following surgical reconstruction and a greater T1S-CL mismatch was associated with a greater degree of cervical malalignment. Specifically, a mismatch greater than 26.1° corresponded to positive cervical sagittal malalignment, defined as C2-C7 SVA greater than 50 mm. 3.

Changing Sagittal-Plane Landing Styles to Modulate Impact and Tibiofemoral Force Magnitude and Directions Relative to the Tibia

PubMed Central

Shimokochi, Yohei; Ambegaonkar, Jatin P.; Meyer, Eric G.

2016-01-01

Context: Ground reaction force (GRF) and tibiofemoral force magnitudes and directions have been shown to affect anterior cruciate ligament loading during landing. However, the kinematic and kinetic factors modifying these 2 forces during landing are unknown. Objective: To clarify the intersegmental kinematic and kinetic links underlying the alteration of the GRF and tibiofemoral force vectors secondary to changes in the sagittal-plane body position during single-legged landing. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Twenty recreationally active participants (age = 23.4 ± 3.6 years, height = 171.0 ± 9.4 cm, mass = 73.3 ± 12.7 kg). Intervention(s): Participants performed single-legged landings using 3 landing styles: self-selected landing (SSL), body leaning forward and landing on the toes (LFL), and body upright with flat-footed landing (URL). Three-dimensional kinetics and kinematics were recorded. Main Outcome Measure(s): Sagittal-plane tibial inclination and knee-flexion angles, GRF magnitude and inclination angles relative to the tibia, and proximal tibial forces at peak tibial axial forces. Results: The URL resulted in less time to peak tibial axial forces, smaller knee-flexion angles, and greater magnitude and a more anteriorly inclined GRF vector relative to the tibia than did the SSL. These changes led to the greatest peak tibial axial and anterior shear forces in the URL among the 3 landing styles. Conversely, the LFL resulted in longer time to peak tibial axial forces, greater knee-flexion angles, and reduced magnitude and a more posteriorly inclined GRF vector relative to the tibia than the SSL. These changes in LFL resulted in the lowest peak tibial axial and largest posterior shear forces among the 3 landing styles. Conclusions: Sagittal-plane intersegmental kinematic and kinetic links strongly affected the magnitude and direction of GRF and tibiofemoral forces during the impact phase of single-legged landing. Therefore, improving sagittal-plane landing mechanics is important in reducing harmful magnitudes and directions of impact forces on the anterior cruciate ligament. PMID:27723362

Effect of coordinate frame compatibility on the transfer of implicit and explicit learning across limbs

PubMed Central

Carroll, Timothy J.

2016-01-01

Insights into the neural representation of motor learning can be obtained by investigating how learning transfers to novel task conditions. We recently demonstrated that visuomotor rotation learning transferred strongly between left and right limbs when the task was performed in a sagittal workspace, which afforded a consistent remapping for the two limbs in both extrinsic and joint-based coordinates. In contrast, transfer was absent when performed in horizontal workspace, where the extrinsically defined perturbation required conflicting joint-based remapping for the left and right limbs. Because visuomotor learning is thought to be supported by both implicit and explicit forms of learning, however, it is unclear to what extent these distinct forms of learning contribute to interlimb transfer. In this study, we assessed the degree to which interlimb transfer, following visuomotor rotation training, reflects explicit vs. implicit learning by obtaining verbal reports of participants' aiming direction before each movement. We also determined the extent to which these distinct components of learning are constrained by the compatibility of coordinate systems by comparing transfer between groups of participants who reached to targets arranged in the horizontal and sagittal planes. Both sagittal and horizontal conditions displayed complete transfer of explicit learning to the untrained limb. In contrast, transfer of implicit learning was incomplete, but the sagittal condition showed greater transfer than the horizontal condition. These findings suggest that explicit strategies developed with one limb can be fully implemented in the opposite limb, whereas implicit transfer depends on the degree to which new sensorimotor maps are spatially compatible for the two limbs. PMID:27334955

Effect of coordinate frame compatibility on the transfer of implicit and explicit learning across limbs.

PubMed

Poh, Eugene; Carroll, Timothy J; Taylor, Jordan A

2016-09-01

Insights into the neural representation of motor learning can be obtained by investigating how learning transfers to novel task conditions. We recently demonstrated that visuomotor rotation learning transferred strongly between left and right limbs when the task was performed in a sagittal workspace, which afforded a consistent remapping for the two limbs in both extrinsic and joint-based coordinates. In contrast, transfer was absent when performed in horizontal workspace, where the extrinsically defined perturbation required conflicting joint-based remapping for the left and right limbs. Because visuomotor learning is thought to be supported by both implicit and explicit forms of learning, however, it is unclear to what extent these distinct forms of learning contribute to interlimb transfer. In this study, we assessed the degree to which interlimb transfer, following visuomotor rotation training, reflects explicit vs. implicit learning by obtaining verbal reports of participants' aiming direction before each movement. We also determined the extent to which these distinct components of learning are constrained by the compatibility of coordinate systems by comparing transfer between groups of participants who reached to targets arranged in the horizontal and sagittal planes. Both sagittal and horizontal conditions displayed complete transfer of explicit learning to the untrained limb. In contrast, transfer of implicit learning was incomplete, but the sagittal condition showed greater transfer than the horizontal condition. These findings suggest that explicit strategies developed with one limb can be fully implemented in the opposite limb, whereas implicit transfer depends on the degree to which new sensorimotor maps are spatially compatible for the two limbs. Copyright © 2016 the American Physiological Society.

Comparison of Multisegmental Foot and Ankle Motion Between Total Ankle Replacement and Ankle Arthrodesis in Adults.

PubMed

Seo, Sang Gyo; Kim, Eo Jin; Lee, Doo Jae; Bae, Kee Jeong; Lee, Kyoung Min; Lee, Dong Yeon

2017-09-01

Total ankle replacement (TAR) and ankle arthrodesis (AA) are usually performed for severe ankle arthritis. We compared postoperative foot segmental motion during gait in patients treated with TAR and AA. Gait analysis was performed in 17 and 7 patients undergoing TAR and AA, respectively. Subjects were evaluated using a 3-dimensional multisegmental foot model with 15 markers. Temporal gait parameters were calculated. The maximum and minimum values and the differences in hallux, forefoot, hindfoot, and arch in 3 planes (sagittal, coronal, transverse) were compared between the 2 groups. One hundred healthy adults were evaluated as a control. Gait speed was faster in the TAR ( P = .028). On analysis of foot and ankle segmental motion, the range of hindfoot sagittal motion was significantly greater in the TAR (15.1 vs 10.2 degrees in AA; P = .004). The main component of motion increase was hindfoot dorsiflexion (12.3 and 8.6 degrees). The range of forefoot sagittal motion was greater in the TAR (9.3 vs 5.8 degrees in AA; P = .004). Maximum ankle power in the TAR (1.16) was significantly higher than 0.32 in AA; P = .008). However, the range of hindfoot and forefoot sagittal motion was decreased in both TAR and AA compared with the control group ( P = .000). Although biomechanical results of TAR and AA were not similar to those in the normal controls, joint motions in the TAR more closely matched normal values. Treatment decision making should involve considerations of the effect of surgery on the adjacent joints. Level III, case-control study.

Computer-assisted shape descriptors for skull morphology in craniosynostosis.

PubMed

Shim, Kyu Won; Lee, Min Jin; Lee, Myung Chul; Park, Eun Kyung; Kim, Dong Seok; Hong, Helen; Kim, Yong Oock

2016-03-01

Our aim was to develop a novel method for characterizing common skull deformities with high sensitivity and specificity, based on two-dimensional (2D) shape descriptors in computed tomography (CT) images. Between 2003 and 2014, 44 normal subjects and 39 infants with craniosynostosis (sagittal, 29; bicoronal, 10) enrolled for analysis. Mean age overall was 16 months (range, 1-120 months), with a male:female ratio of 56:29. Two reference planes, sagittal (S-plane: through top of lateral ventricle) and coronal (C-plane: at maximum dimension of fourth ventricle), were utilized to formulate three 2D shape descriptors (cranial index [CI], cranial radius index [CR], and cranial extreme spot index [CES]), which were then applied to S- and C-plane target images of both groups. In infants with sagittal craniosynostosis, CI in S-plane (S-CI) usually was <1.0 (mean, 0.78; range, 0.67-0.95), with CR consistently at 3 and a characteristic CES pattern of two discrete hot spots oriented diagonally. In the bicoronal craniosynostosis subset, CI was >1.0 (mean 1.11; range, 1.04-1.25), with CR at -3 and a CES pattern of four discrete diagonally oriented hot spots. Scatter plots underscored the highly intuitive joint performance of CI and CES in distinguishing normal and deformed states. Altogether, these novel 2D shape descriptors enabled effective discrimination of sagittal and bicoronal skull deformities. Newly developed 2D shape descriptors for cranial CT imaging enabled recognition of common skull deformities with statistical significance, perhaps providing impetus for automated CT-based diagnosis of craniosynostosis.

A Cadaveric Study on Sacroiliac Joint Injection

PubMed Central

Zou, Yu-Cong; Li, Yi-Kai; Yu, Cheng-Fu; Yang, Xian-Wen; Chen, Run-Qi

2015-01-01

The scope of this study was to explore the possibility as well as the feasibility of sacroiliac joint injection following simple X-ray clip location. For the cadaveric study, 10 fixed sacroiliac joint (SIJ) sectional specimens, 4 dried cadaveric pelvises and 21 embalmed adult cadaveric pelvises were dissected, followed by an injection of contrast agent into the joint. The irrigation of the agent was observed through CT scanning. For the radiologic study, 188 CT scans of ankylosing spondylitis patients (143 male, 45 female) were collected from 2010 to 2012, in Nanfang Hospital. What was measured was (1) Distance between the posterior midline and sagittal synovium; (2) Length of the sagittal synovium; (3) Distance between the midpoint of the sagittal synovium and posterior superior iliac spine; and (4) Distance between the superficial skin vertical to the sagittal synovium point were measured. For the practice-based study: 20 patients (17 males and 3 females) with early ankylosing spondylitis, from Nanfang Hospital affiliated with Southern Medical University were recruited, and sacroiliac joint unguided injections were done on the basis of the cadaveric and radiologic study. Only the inferior 1/3rd portion parallel to the posterior midline could be injected into since the superior 2/3rd portion were filled with interosseous ligaments. Thirteen of the 20 patients received successful injections as identified by CT scan using the contrast agent. Sacroiliac joint injection following simple X-ray clip location is possible and feasible if the operation is performed by trained physicians familiar with the sacroiliac joint and its surrounding anatomic structures. PMID:25692437

Ankle and knee kinetics between strike patterns at common training speeds in competitive male runners.

PubMed

Kuhman, Daniel; Melcher, Daniel; Paquette, Max R

2016-01-01

The purpose of this study was to investigate the interaction of foot strike and common speeds on sagittal plane ankle and knee joint kinetics in competitive rear foot strike (RFS) runners when running with a RFS pattern and an imposed forefoot strike (FFS) pattern. Sixteen competitive habitual male RFS runners ran at two different speeds (i.e. 8 and 6 min mile(-1)) using their habitual RFS and an imposed FFS pattern. A repeated measures analysis of variance was used to assess a potential interaction between strike pattern and speed for selected ground reaction force (GRF) variables and, sagittal plane ankle and knee kinematic and kinetic variables. No foot strike and speed interaction was observed for any of the kinetic variables. Habitual RFS yielded a greater loading rate of the vertical GRF, peak ankle dorsiflexor moment, peak knee extensor moment, peak knee eccentric extensor power, peak dorsiflexion and sagittal plane knee range of motion compared to imposed FFS. Imposed FFS yielded greater maximum vertical GRF, peak ankle plantarflexor moment, peak ankle eccentric plantarflexor power and sagittal plane ankle ROM compared to habitual RFS. Consistent with previous literature, imposed FFS in habitual RFS reduces eccentric knee extensor and ankle dorsiflexor involvement but produce greater eccentric ankle plantarflexor action compared to RFS. These acute differences between strike patterns were independent of running speeds equivalent to typical easy and hard training runs in competitive male runners. Current findings along with previous literature suggest differences in lower extremity kinetics between habitual RFS and imposed FFS running are consistent among a variety of runner populations.

Contribution of calcaneal and leg segment rotations to ankle joint dorsiflexion in a weight-bearing task.

PubMed

Chizewski, Michael G; Chiu, Loren Z F

2012-05-01

Joint angle is the relative rotation between two segments where one is a reference and assumed to be non-moving. However, rotation of the reference segment will influence the system's spatial orientation and joint angle. The purpose of this investigation was to determine the contribution of leg and calcaneal rotations to ankle rotation in a weight-bearing task. Forty-eight individuals performed partial squats recorded using a 3D motion capture system. Markers on the calcaneus and leg were used to model leg and calcaneal segment, and ankle joint rotations. Multiple linear regression was used to determine the contribution of leg and calcaneal segment rotations to ankle joint dorsiflexion. Regression models for left (R(2)=0.97) and right (R(2)=0.97) ankle dorsiflexion were significant. Sagittal plane leg rotation had a positive influence (left: β=1.411; right: β=1.418) while sagittal plane calcaneal rotation had a negative influence (left: β=-0.573; right: β=-0.650) on ankle dorsiflexion. Sagittal plane rotations of the leg and calcaneus were positively correlated (left: r=0.84, P<0.001; right: r=0.80, P<0.001). During a partial squat, the calcaneus rotates forward. Simultaneous forward calcaneal rotation with ankle dorsiflexion reduces total ankle dorsiflexion angle. Rear foot posture is reoriented during a partial squat, allowing greater leg rotation in the sagittal plane. Segment rotations may provide greater insight into movement mechanics that cannot be explained via joint rotations alone. Copyright © 2012 Elsevier B.V. All rights reserved.

Sagittal Distal Tibial Articular Angle and the Relationship to Talar Subluxation in Total Ankle Arthroplasty.

PubMed

Veljkovic, Andrea; Norton, Adam; Salat, Peter; Abbas, Kaniza Zahra; Saltzman, Charles; Femino, John E; Phisitkul, Phinit; Amendola, Annunziato

2016-09-01

Longevity of total ankle replacement (TAR) depends heavily on anatomic alignment. The lateral talar station (LTS) classifies the sagittal position of the talus relative to the tibia. We hypothesized that correcting the sagittal distal tibial articular angle (sDTAA) during TAR would anatomically realign the tibiotalar joint and potentially reduce the risk of prosthesis subluxation. The LTS (millimeters) and sDTAA (degrees) were measured twice by 2 blinded observers using weight-bearing lateral ankle radiographs obtained before (n = 96) and after (n = 94) TAR, with excellent interobserver and intraobserver reliability (correlation coefficient >0.9). Preoperative LTS was as follows: anterior (60.4%), posterior (27.1%), and neutral (12.5%). A strong preoperative correlation was found between LTS and sDTAA (r = 0.81; P < .0001). In ankles that were initially anterior and became less anterior postoperatively (n = 41), LTS decreased from an average 8.1 mm to 6.5 mm and the LTS changed 1.1 mm per degree of sDTAA change. In ankles that were initially posterior (n = 25), LTS increased from an average of -5.1 mm to -2.8 mm and the LTS changed 0.6 mm per degree of sDTAA change. The correlation between LTS and sDTAA was reduced postoperatively (r = 0.62; P < .0001). Our results suggest that rather than following generic recommendations, the surgeon should customize the sagittal distal tibial cut to the individual patient based on the preoperative LTS in order to achieve neutral TAR alignment. Level III, retrospective comparative series. © The Author(s) 2016.

Sagittal plane bending moments acting on the lower leg during running.

PubMed

Haris Phuah, Affendi; Schache, Anthony G; Crossley, Kay M; Wrigley, Tim V; Creaby, Mark W

2010-02-01

Sagittal bending moments acting on the lower leg during running may play a role in tibial stress fracture development. The purpose of this study was to evaluate these moments at nine equidistant points along the length of the lower leg (10% point-90% point) during running. Kinematic and ground reaction force data were collected for 20 male runners, who each performed 10 running trials. Inverse dynamics and musculoskeletal modelling techniques were used to estimate sagittal bending moments due to reaction forces and muscle contraction. The muscle moment was typically positive during stance, except at the most proximal location (10% point) on the lower leg. The reaction moment was predominantly negative throughout stance and greater in magnitude than the muscle moment. Hence, the net sagittal bending moment acting on the lower leg was principally negative (indicating tensile loads on the posterior tibia). Peak moments typically occurred around mid-stance, and were greater in magnitude at the distal, compared with proximal, lower leg. For example, the peak reaction moment at the most distal point was -9.61+ or - 2.07%Bw.Ht., and -2.73 + or - 1.18%Bw.Ht. at the most proximal point. These data suggest that tensile loads on the posterior tibia are likely to be higher toward the distal end of the bone. This finding may explain the higher incidence of stress fracture in the distal aspect of the tibia, observed by some authors. Stress fracture susceptibility will also be influenced by bone strength and this should also be accounted for in future studies. Copyright 2009 Elsevier B.V. All rights reserved.

Microsurgical treatment for central gyrus region meningioma with epilepsy as primary symptom.

PubMed

Deng, Wen-shuai; Zhou, Xiao-yang; Li, Zhao-jian; Xie, Hong-wei; Fan, Ming-chao; Sun, Peng

2014-09-01

The objective of this article was to investigate the operation outcome, complications, and the patient's quality of life after surgical therapy for central gyrus region meningioma with epilepsy as the primary symptom. All patients get at least 6 months of follow-up (range, 6-34 mo) after surgery. They underwent preoperative magnetic resonance imaging and video electroencephalography, and their clinical manifestations, imaging characteristics, microsurgical methods, and prognosis were retrospectively analyzed. The meningioma was located in the front and back of the central sulcus vein in 3 and 2 patients, respectively; in the compressed precentral gyrus and central sulcus vein in 3 patients; and in the precentral gyrus and postcentral gyrus each in 1 patient; beside the right sagittal sinus and invaded a thick draining vein on the brain surface in 1 patient and beside the right sagittal sinus and close to the precentral gyrus in 2 patients; invaded the superior sagittal sinus in 8 patients; crossed the cerebral falx and compressed cortex gyrus veins in 1 patient; invaded duramater and irritated skull hyperplasia in 3 patients; invaded duramater and its midline infiltrated into the superior sagittal sinus, was located behind the precentral gyrus, and enveloped the central sulcus vein. They were resected and classified by Simpson standards: 17 of the 26 patients had grade I, 6 patients had in grade II, and 3 patients had in grade III. Resection of central gyrus region meningioma by microsurgical technique avoids injury to the cerebral cortex, central sulcus vein, and other draining veins. Microsurgery improves the total resection rate, reduces recurrence rate, and lowers disability or death rate.

Cervical spine alignment in the pediatric population: a radiographic normative study of 150 asymptomatic patients.

PubMed

Abelin-Genevois, K; Idjerouidene, A; Roussouly, P; Vital, J M; Garin, C

2014-07-01

To describe the normal cervical sagittal alignment of the pediatric spine in a normal population and to identify the changes during growth period. We randomly selected in PACS database 150 full-spine standing views. Exclusion criteria were: age >18 years, spinal deformity and any disease affecting the spine (medical charts reviewing). For cervical alignment we measured: OC-angle according to Mc Gregor, C1C7 angle, upper cervical angle, inferior cervical angle and C7 tilt. Spino pelvic parameters were analyzed: T1 tilt, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt. We compared two age subgroups (juvenile and adolescent). Differences between age groups and gender were tested using Student's t test. Correlations between sagittal spinal parameters were evaluated using Pearson's test. Cervical spine shape was correlated to cranio cervical orientation to maintain horizontal gaze (r = 0.60) and to thoracic kyphosis (r = -0.46). Cervical spine alignment was significantly different between the two age groups except for the global C1C7 cervical lordosis, which remained stable. A significant gender difference was found for all the cervical sagittal angles (p < 0.01) whereas no differences were demonstrated for the spino pelvic parameters, except the lumbar lordosis (p = 0.047). This study is the first to report the cervical spinal alignment in a normal pediatric Caucasian population. Even though cervical lordosis is the common shape, our results showed variability in cervical sagittal alignment. Cervical spine is a junctional area that adjusts its alignment to the head position and to the underlying spinal alignment.

Direction-Specific Impairments in Cervical Range of Motion in Women with Chronic Neck Pain: Influence of Head Posture and Gravitationally Induced Torque.

PubMed

Rudolfsson, Thomas; Björklund, Martin; Svedmark, Åsa; Srinivasan, Divya; Djupsjöbacka, Mats

2017-01-01

Cervical range of motion (ROM) is commonly assessed in clinical practice and research. In a previous study we decomposed active cervical sagittal ROM into contributions from lower and upper levels of the cervical spine and found level- and direction-specific impairments in women with chronic non-specific neck pain. The present study aimed to validate these results and investigate if the specific impairments can be explained by the neutral posture (defining zero flexion/extension) or a movement strategy to avoid large gravitationally induced torques on the cervical spine. Kinematics of the head and thorax was assessed in sitting during maximal sagittal cervical flexion/extension (high torque condition) and maximal protraction (low torque condition) in 120 women with chronic non-specific neck pain and 40 controls. We derived the lower and upper cervical angles, and the head centre of mass (HCM), from a 3-segment kinematic model. Neutral head posture was assessed using a standardized procedure. Previous findings of level- and direction-specific impairments in neck pain were confirmed. Neutral head posture was equal between groups and did not explain the direction-specific impairments. The relative magnitude of group difference in HCM migration did not differ between high and low torques conditions, lending no support for our hypothesis that impairments in sagittal ROM are due to torque avoidance behaviour. The direction- and level-specific impairments in cervical sagittal ROM can be generalised to the population of women with non-specific neck pain. Further research is necessary to clarify if torque avoidance behaviour can explain the impairments.

Morphological assessment of the stylohyoid complex variations with cone beam computed tomography in a Turkish population.

PubMed

Buyuk, C; Gunduz, K; Avsever, H

2018-01-01

The aim of this investigation was to evaluate the length, thickness, sagittal and transverse angulations and the morphological variations of the stylohyoid complex (SHC), to assess their probable associations with age and gender, and to investigate the prevalence of it in a wide range of a Turkish sub-population by using cone beam computed tomography (CBCT). The CBCT images of the 1000 patients were evaluated retrospectively. The length, thickness, sagittal and transverse angulations, morphological variations and ossification degrees of SHC were evaluated on multiplanar reconstructions (MPR) adnd three-dimensional (3D) volume rendering (3DVR) images. The data were analysed statistically by using nonparametric tests, Pearson's correlation coefficient, Student's t test, c2 test and one-way ANOVA. Statistical significance was considered at p < 0.05. It was determined that 684 (34.2%) of all 2000 SHCs were elongated (> 35 mm). The mean sagittal angle value was measured to be 72.24° and the mean transverse angle value was 70.81°. Scalariform shape, elongated type and nodular calcification pattern have the highest mean age values between the morphological groups, respectively. Calcified outline was the most prevalent calcification pattern in males. There was no correlation between length and the calcification pattern groups while scalariform shape and pseudoarticular type were the longest variations. We observed that as the anterior sagittal angle gets wider, SHC tends to get longer. The most observed morphological variations were linear shape, elongated type and calcified outline pattern. Detailed studies on the classification will contribute to the literature. (Folia Morphol 2018; 77, 1: 79-89).

Optimal sagittal motion axis for trunk extension and flexion tests in chronic low back trouble.

PubMed

Rantanen, P; Nykvist, F

2000-11-01

To find the optimal height for sagittal motion axis for trunk strength test in chronic low back trouble. Cross-sectional study. The strength of trunk muscles of low back pain patients is decreased. The measured strength depends on the height of the sagittal motion axis but the differences between patients and controls are not known. 114 (67 female) patients with chronic low back trouble are classified according to Quebec Task Force, 50 (31 female) patients with rheumatic disorder, but without low back trouble, and 33 (22 female) healthy controls, no appreciable physical differences but clear differences in Oswestry score. Isometric trunk extension-flexion test with different heights for the pelvic fulcrum. Force decreased in extension, increased in flexion, and torque increased both in flexion and extension in every group (P<0.001) as the fulcrum was moved caudally. The male controls were stronger than patients with low back trouble (P<0.01). The female controls were stronger only if the fulcrum was set at the hip joint level (P<0.05). There were no differences between patients with rheumatic disorder and low back trouble, except in extension if the fulcrum was at the hip joint level (P<0.02). The rotation axis in trunk extension-flexion strength test should be set at the level of the hip joint. Trunk muscle weakness is a common sign of different rheumatic disorders. Proper setting of sagittal motion axis and concomitant measurement of trunk and hip extensor or flexor muscles increases the specificity of the strength test for low back trouble.

The triple PCL sign: bucket handle tears of both medial and lateral menisci in a chronically ACL-deficient knee.

PubMed

Kakel, Rafid; Russell, Robert; VanHeerden, Pieter

2010-10-11

Bucket handle tears of both menisci in the setting of acute or chronic anterior cruciate ligament (ACL) tears of the same knee have rarely been reported in the literature. This article presents a case of a bucket handle tear affecting both the medial and lateral menisci in a patient with chronic ACL rupture. Both bucket handle tears were displaced and locked in the intercondylar notch. A new magnetic resonance image (MRI) sign suggested on sagittal view is called the triple PCL sign, comprising the intact posterior cruciate ligament (PCL) and the 2 displaced fragments in the intercondylar notch from the two bucket handle tears. The precise diagnosis of this condition is of obvious importance for optimal operative planning. While finding the displaced fragment from the medial meniscus is expected to cause the double PCL sign, the torn ACL may have made it easier to visualize the bucket handle tear of the lateral meniscus in the same sagittal plane as the PCL. Only 5 other reports mention bimeniscal bucket handle tears of both the medial and lateral menisci in association with an ACL tear. None have shown the suggested triple PCL sign because of lack of overlap between the 2 bucket handle tears in the coronal plane while lying in the intercondylar notch causing them not to fall in the same sagittal plane. Our patient showed some overlap between the 2 meniscal fragments while lying in the notch to create the triple PCL sign on sagittal MRI. Copyright 2010, SLACK Incorporated.

The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis.

PubMed

Hashim, Peter W; Patel, Anup; Yang, Jenny F; Travieso, Roberto; Terner, Jordan; Losee, Joseph E; Pollack, Ian; Jane, John; Jane, John; Kanev, Paul; Mayes, Linda; Duncan, Charles; Bridgett, David J; Persing, John A

2014-09-01

The optimal type of surgical management for isolated sagittal synostosis remains a source of significant debate. There is a paucity of data regarding possible differences in long-term neuropsychological outcomes following treatment with whole-vault cranioplasty or endoscopic strip craniectomy. This study provides the first comparative analysis examining the effects of the two techniques related to long-term intellectual functioning. A total of 70 patients were enrolled in this multicenter study, 29 of whom had previously undergone endoscopic strip craniectomy and 41 of whom had previously undergone whole-vault cranioplasty. All patients completed a battery of neurodevelopmental tests (Beery-Buktenica Developmental Test of Visual-Motor Integration, Wechsler Abbreviated Scale of Intelligence, and Wechsler Fundamentals) to evaluate various domains of neuropsychological function. In a group comparison of those treated before 6 months of age, whole-vault patients obtained higher scores relative to endoscopic strip craniectomy patients on visuomotor integration, full-scale intelligence quotient, verbal intelligence quotient, word reading, and reading comprehension (p < 0.05 for all). When compared against strip craniectomy performed before 3 months of age, the whole-vault group still showed significantly higher scores in verbal intelligence quotient, reading comprehension, and word reading (p < 0.05 for all). The type of surgical intervention for isolated sagittal synostosis impacts long-term neuropsychological outcomes. Patients undergoing early whole-vault cranioplasty attained higher intelligence quotient and achievement scores relative to those undergoing strip craniectomy. Surgical management with whole-vault cranioplasty performed before 6 months of age provides the most favorable long-term intellectual outcomes in patients with isolated sagittal synostosis. Therapeutic, II.

Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment

PubMed Central

Kim, Jang Hoon; Yi, Seong; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

2015-01-01

Purpose Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. Materials and Methods Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. Results Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. Conclusion ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope. PMID:26069131

Is the sagittal postural alignment different in normal and dysphonic adult speakers?

PubMed

Franco, Débora; Martins, Fernando; Andrea, Mário; Fragoso, Isabel; Carrão, Luís; Teles, Júlia

2014-07-01

Clinical research in the field of voice disorders, in particular functional dysphonia, has suggested abnormal laryngeal posture due to muscle adaptive changes, although specific evidence regarding body posture has been lacking. The aim of our study was to verify if there were significant differences in sagittal spine alignment between normal (41 subjects) and dysphonic speakers (33 subjects). Cross-sectional study. Seventy-four adults, 35 males and 39 females, were submitted to sagittal plane photographs so that spine alignment could be analyzed through the Digimizer-MedCalc Software Ltd program. Perceptual and acoustic evaluation and nasoendoscopy were used for dysphonic judgments: normal and dysphonic speakers. For thoracic length curvature (TL) and for the kyphosis index (KI), a significant effect of dysphonia was observed with mean TL and KI significantly higher for the dysphonic speakers than for the normal speakers. Concerning the TL variable, a significant effect of sex was found, in which the mean of the TL was higher for males than females. The interaction between dysphonia and sex did not have a significant effect on TL and KI variables. For the lumbar length curvature variable, a significant main effect of sex was demonstrated; there was no significant main effect of dysphonia or significant sex×dysphonia interaction. Findings indicated significant differences in some sagittal spine posture measures between normal and dysphonic speakers. Postural measures can add useful information to voice assessment protocols and should be taken into account when considering particular treatment strategies. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Influence of a variation in the position of the arms on the sagittal connection of the gravity line with the spinal structures.

PubMed

Legaye, Jean; Duval-Beaupere, Ginette

2017-11-01

To evaluate the influence of the position of the arms on the location of the body's gravity line. The sagittal balance of the pelvi-spinal unit is organized so that the gravity line is localized in a way that limits the mechanical loads and the muscle efforts. This position of the gravity line was analyzed in vivo, in standing position, the arms dangling, by the barycentremeter, a gamma rays scanner. Then, several teams had the same purpose but using a force platform combined with radiographies. Their results differed significantly among themselves and with the data of the barycentremetry. However, in these studies, the positions of the arms varied noticeably, either slightly bent forwards on a support, or the fingers on the clavicles or on the cheeks. We estimated, for each varied posture of the arms, the sagittal coordinates of the masses of the upper limbs and their influence on the anatomical position of the gravity line of the whole body. Using a simple equation and the data of the barycentremeter, we observed that the variations in the location of the gravity line were proportionally connected to the changes of the sagittal position of the mass of the upper limbs induced by the various positions of the arms. We conclude in a validation of the data of the barycentremeter, as well as of the data obtained by the force platforms as long as the artifact of the position of the arms is taken into account.

Three-dimensional shear wave elastography for differentiation of breast lesions: An initial study with quantitative analysis using three orthogonal planes.

PubMed

Wang, Qiao

2018-05-25

To prospectively evaluate the diagnostic performance of three-dimensional (3D) shear wave elastography (SWE) for breast lesions with quantitative stiffness information from transverse, sagittal and coronal planes. Conventional ultrasound (US), two-dimensional (2D)-SWE and 3D-SWE were performed for 122 consecutive patients with 122 breast lesions before biopsy or surgical excision. Maximum elasticity values of Young's modulus (Emax) were recorded on 2D-SWE and three planes of 3D-SWE. Area under the receiver operating characteristic curve (AUC), sensitivity and specificity of US, 2D-SWE and 3D-SWE were evaluated. Two combined sets (i.e., BI-RADS and 2D-SWE; BI-RADS and 3D-SWE) were compared in AUC. Observer consistency was also evaluated. On 3D-SWE, the AUC and sensitivity of sagittal plane were significantly higher than those of transverse and coronal planes (both P < 0.05). Compared with BI-RADS alone, both combined sets had significantly (P < 0.05) higher AUCs and specificities, whereas, the two combined sets showed no significant difference in AUC (P > 0.05). However, the combined set of BI-RADS and sagittal plane of 3D-SWE had significantly higher sensitivity than the combined set of BI-RADS and 2D-SWE. The sagittal plane shows the best diagnostic performance among 3D-SWE. The combination of BI-RADS and 3D-SWE is a useful tool for predicting breast malignant lesions in comparison with BI-RADS alone.

Satisfactory rate of post-processing visualization of fetal cerebral axial, sagittal, and coronal planes from three-dimensional volumes acquired in routine second trimester ultrasound practice by sonographers of peripheral centers.

PubMed

Rizzo, Giuseppe; Pietrolucci, Maria Elena; Capece, Giuseppe; Cimmino, Ernesto; Colosi, Enrico; Ferrentino, Salvatore; Sica, Carmine; Di Meglio, Aniello; Arduini, Domenico

2011-08-01

The aim of this study was to evaluate the feasibility to visualize central nervous system (CNS) diagnostic planes from three-dimensional (3D) brain volumes obtained in ultrasound facilities with no specific experience in fetal neurosonography. Five sonographers prospectively recorded transabdominal 3D CNS volumes starting from an axial approach on 500 consecutive pregnancies at 19-24 weeks of gestation undergoing routine ultrasound examination. Volumes were sent to the referral center (Department of Obstetrics and Gynecology, Università Roma Tor Vergata, Italy) and two independent reviewers with experience in 3D ultrasound assessed their quality in the display of axial, coronal, and sagittal planes. CNS volumes were acquired in 491/500 pregnancies (98.2%). The two reviewers acknowledged the presence of satisfactory images with a visualization rate ranging respectively between 95.1% and 97.14% for axial planes, 73.72% and 87.16% for coronal planes, and 78.41% and 94.29% for sagittal planes. The agreement rate between the two reviewers as expressed by Cohen's kappa coefficient was >0.87 for axial planes, >0.89 for coronal planes, and >0.94 for sagittal planes. The presence of a maternal body mass index >30 alters the probability of achieving satisfactory CNS views, while existence of previous maternal lower abdomen surgery does not affect the quality of the reconstructed planes. CNS volumes acquired by 3D ultrasonography in peripheral centers showed a quality high enough to allow a detailed fetal neurosonogram.

Ambulant adults with spastic cerebral palsy: the validity of lower limb joint angle measurements from sagittal video recordings.

PubMed

Larsen, Kerstin L; Maanum, Grethe; Frøslie, Kathrine F; Jahnsen, Reidun

2012-02-01

In the development of a clinical program for ambulant adults with cerebral palsy (CP), we investigated the validity of joint angles measured from sagittal video recordings and explored if movements in the transversal plane identified with three-dimensional gait analysis (3DGA) affected the validity of sagittal video joint angle measurements. Ten observers, and 10 persons with spastic CP (19-63 years), Gross Motor Function Classification System I-II, participated in the study. Concurrent criterion validity between video joint angle measurements and 3DGA was assessed by Bland-Altman plots with mean differences and 95% limits of agreement (LoA). Pearson's correlation coefficients (r) and scatter plots were used supplementary. Transversal kinematics ≥2 SD from our reference band were defined as increased movement in the transversal plane. The overall mean differences in degrees between joint angles measured by 3DGA and video recordings (3°, 5° and -7° for the hip, knee and ankle respectively) and corresponding LoA (18°, 10° and 15° for the hip, knee and ankle, respectively) demonstrated substantial discrepancies between the two methods. The correlations ranged from low (r=0.39) to moderate (r=0.68). Discrepancy between the two measurements was seen both among persons with and without the presence of deviating transversal kinematics. Quantifying lower limb joint angles from sagittal video recordings in ambulant adults with spastic CP demonstrated low validity, and should be conducted with caution. This gives implications for selecting evaluation method of gait. Copyright © 2011 Elsevier B.V. All rights reserved.

Morphometric study of the lumbar spinal canal in the Korean population.

PubMed

Lee, H M; Kim, N H; Kim, H J; Chung, I H

1995-08-01

The anatomic dimensions of the vertebral body and spinal canal of the lumbar spine were analyzed in Koreans. To determine the normal dimension of the lumbar spinal canal in Koreans, to determine whether there are any racial differences in the morphometry of the lumbar spinal canal, and to provide criteria for diagnosing spinal stenosis in the Far Eastern Asian. Some radiologic and anatomic studies have been conducted regarding the size of the lumbar spinal canal of whites and blacks in western and African countries. One-thousand-eight-hundred measurements were performed on the transverse and sagittal diameters of vertebral bodies and spinal canals using complete sets of 90 lumbar vertebrae. The mean mid-sagittal diameter of the lumbar spinal canal in the Korean population was less than that measured in white and African populations, but there was no significant differences between the Korean, white, and African populations regarding the transverse diameter of the lumbar spinal canal. The mid-sagittal diameter of the lumbar spinal canal is narrowest in the Far Eastern Asian population; the radiologic criteria of spinal stenosis should be reconsidered for these people.

Sagittal fresh blood imaging with interleaved acquisition of systolic and diastolic data for improved robustness to motion.

PubMed

Atanasova, Iliyana P; Kim, Daniel; Storey, Pippa; Rosenkrantz, Andrew B; Lim, Ruth P; Lee, Vivian S

2013-02-01

To improve robustness to patient motion of "fresh blood imaging" (FBI) for lower extremity noncontrast MR angiography. In FBI, two sets of three-dimensional fast spin echo images are acquired at different cardiac phases and subtracted to generate bright-blood angiograms. Routinely performed with a single coronal slab and sequential acquisition of systolic and diastolic data, FBI is prone to subtraction errors due to patient motion. In this preliminary feasibility study, FBI was implemented with two sagittal imaging slabs, and the systolic and diastolic acquisitions were interleaved to minimize sensitivity to motion. The proposed technique was evaluated in volunteers and patients. In 10 volunteers, imaged while performing controlled movements, interleaved FBI demonstrated better tolerance to subject motion than sequential FBI. In one patient with peripheral arterial disease, interleaved FBI offered better depiction of collateral flow by reducing sensitivity to inadvertent motion. FBI with interleaved acquisition of diastolic and systolic data in two sagittal imaging slabs offers improved tolerance to patient motion. Copyright © 2013 Wiley Periodicals, Inc.

Sagittal Fresh Blood Imaging with Interleaved Acquisition of Systolic and Diastolic Data for Improved Robustness to Motion

PubMed Central

Atanasova, Iliyana P.; Kim, Daniel; Storey, Pippa; Rosenkrantz, Andrew B; Lim, Ruth P.; Lee, Vivian S.

2012-01-01

Purpose To improve robustness to patient motion of ‘fresh blood imaging’ (FBI) for lower extremity non-contrast MRA. Methods In FBI, two sets of 3D fast spin echo images are acquired at different cardiac phases and subtracted to generate bright-blood angiograms. Routinely performed with a single coronal slab and sequential acquisition of systolic and diastolic data, FBI is prone to subtraction errors due to patient motion. In this preliminary feasibility study, FBI was implemented with two sagittal imaging slabs, and the systolic and diastolic acquisitions were interleaved to minimize sensitivity to motion. The proposed technique was evaluated in volunteers and patients. Results In ten volunteers, imaged while performing controlled movements, interleaved FBI demonstrated better tolerance to subject motion than sequential FBI. In one patient with peripheral arterial disease, interleaved FBI offered better depiction of collateral flow by reducing sensitivity to inadvertent motion. Conclusions FBI with interleaved acquisition of diastolic and systolic data in two sagittal imaging slabs offers improved tolerance to patient motion. PMID:23300129

Mid-callosal plane determination using preferred directions from diffusion tensor images

NASA Astrophysics Data System (ADS)

Costa, André L.; Rittner, Letícia; Lotufo, Roberto A.; Appenzeller, Simone

2015-03-01

The corpus callosum is the major brain structure responsible for inter{hemispheric communication between neurons. Many studies seek to relate corpus callosum attributes to patient characteristics, cerebral diseases and psychological disorders. Most of those studies rely on 2D analysis of the corpus callosum in the mid-sagittal plane. However, it is common to find conflicting results among studies, once many ignore methodological issues and define the mid-sagittal plane based on precary or invalid criteria with respect to the corpus callosum. In this work we propose a novel method to determine the mid-callosal plane using the corpus callosum internal preferred diffusion directions obtained from diffusion tensor images. This plane is analogous to the mid-sagittal plane, but intended to serve exclusively as the corpus callosum reference. Our method elucidates the great potential the directional information of the corpus callosum fibers have to indicate its own referential. Results from experiments with five image pairs from distinct subjects, obtained under the same conditions, demonstrate the method effectiveness to find the corpus callosum symmetric axis relative to the axial plane.

Skull fracture with effacement of the superior sagittal sinus following drone impact: a case report.

PubMed

Chung, Lawrance K; Cheung, Yuri; Lagman, Carlito; Au Yong, Nicholas; McBride, Duncan Q; Yang, Isaac

2017-09-01

The popularity of unmanned aerial vehicles, or drones, raises safety concerns as they become increasingly common for commercial, personal, and recreational use. Collisions between drones and people may result in serious injuries. A 13-year-old male presented with a comminuted depressed skull fracture causing effacement of the superior sagittal sinus secondary to a racing drone impact. The patient experienced a brief loss of consciousness and reported lower extremity numbness and weakness after the accident. Imaging studies revealed bone fragments crossing the superior sagittal sinus with a short, focal segment of blood flow interruption. Neurosurgical intervention was deferred given the patient's improving neurological deficits, and the patient was treated conservatively. He was discharged home in stable condition. Drones may represent a hazard when operated inappropriately due to their capacity to fly at high speeds and altitudes. Impacts from drones can carry enough force to cause skull fractures and significant head injuries. The rising popularity of drones likely translates to an increased incidence of drone-related injuries. Thus, clinicians should be aware of this growing trend.

A systematic review on soft-to-hard tissue ratios in orthognathic surgery part II: Chin procedures.

PubMed

San Miguel Moragas, Joan; Oth, Olivier; Büttner, Michael; Mommaerts, Maurice Y

2015-10-01

Precise soft-to-hard tissue ratios in orthofacial chin procedures are not well established. The aim of this study was to determine useful soft-to-hard tissue ratios for planning the magnitude of sliding genioplasty (chin osteotomy), osseous chin recontouring and alloplastic chin augmentation. A systematic review of English and non-English articles using PubMed central, ProQuest Dissertations and Theses, Science Citation Index, Elsevier Science Direct Complete, Highwire Press, Springer Standard Collection, SAGE premier 2011, DOAJ Directory of Open Access Journals, Sweetswise, Free E-Journals, Ovid Lippincott Williams & Wilkins total Access Collection, Wiley Online Library Journals, and Cochrane Plus databases from their onset until July 2014. Additional studies were identified by searching the references. Search terms included soft tissue, ratios, genioplasty, mentoplasty, chin, genial AND advancement, augmentation, setback, retrusion, impaction, reduction, vertical deficit, widening, narrowing, and expansion. Study selection criteria were as follows: only academic publications; human patients; no reviews; systematic reviews or meta-analyses; no cadavers; no syndromic patients; no pathology at the chin or mandible region; only articles of level of evidence from I to IV; number of patients must be cited in the articles; hard-to-soft tissue ratios must be cited in the articles or at least are able to be calculated with the quantitative data available in the article; if all patients of one article have had bilateral sagittal split osteotomy (BSSO) performed along with chin osteotomy, there should be an independent group evaluation of the data concerning to the chin; and no restriction regarding the size of the group. Independent extraction of articles by two authors using predefined data fields, including study quality indicators (level of evidence). The search identified 22 articles. Eleven additional articles were found in their reference sections. Of these, two were evidence level IIIb, three were evidence level IIb, and the rest were evidence level IV. Three studies were prospective in nature. A high variability of soft-to-hard tissue ratios regarding genioplasty seemed to disappear if data were stratified according to confounding factors. With the available data, a soft-to-hard pogonion ratio of 0.9:1 and 0.55:1 could be used for chin advancement and chin setback surgery, respectively. Advancement and extrusion movements of the chin segment show respectively a 0.9:1 of sPg:Pg horizontally and 0.95:1 of sMe:Me vertically. Setback and impaction movements show respectively a -0.52:1 of sPg:Pg horizontally and -0.43:1 of sMe:Me vertically. Prospective studies are needed that stratify by confounding factors such as type of osteotomy technique, magnitude of the movement, age, sex, race/ethnicity, and quantity and quality of the soft tissues. More specifically, studies are needed regarding soft-to-hard tissue changes after chin extrusion ("downgrafting"), intrusion ("impaction"), and widening and narrowing surgery. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Papilledema secondary to a superior sagittal sinus thrombosis. Mantle cell lymphoma paraneoplastic syndrome.

PubMed

Platas-Moreno, I; Antón-Benito, A; Pérez-Cid-Rebolleda, M T; Rosado Sierra, M B

2016-01-01

A 46 year old patient presented with visual loss in the left eye during the previous months. Ophthalmoscopic examination and magnetic resonance angiography found the presence of papilledema due to thrombosis in superior sagittal sinus. The examination findings revealed a mantle cell lymphoma. Cerebral venous thrombosis is an unusual cause of papilledema. This type of thrombosis may be secondary to hyper-viscosity within a context of a paraneoplastic syndrome. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Grazing incidence toroidal mirror pairs in imaging and spectroscopic applications.

PubMed

Malvezzi, A M; Tondello, G

1983-08-15

The optical performance of pairs of toroidal mirrors in grazing incidence has been studied analytically and numerically. Two types of toroidal surface are possible: football and bicycle tire. In grazing incidence and for configurations that compensate up to second-order aberrations, there are significant differences in performance between the two types. For football-type tori the best configuration appears to be Z-shaped with tangential and sagittal foci at the middle point between the mirrors. For bicycle tire-type tori the best configuration is U-shaped with the tangential focus at the middle point and the sagittal at infinity.

A Reconstructive Stabilization Technique for Nontraumatic or Chronic Traumatic Extensor Tendon Subluxation.

PubMed

Lee, Jae Hoon; Baek, Jong Hun; Lee, Jung Seok

2017-01-01

Subluxation of the extensor tendon results from a disruption to the sagittal band at the metacarpophalangeal joint. When conservative treatment fails to correct the subluxation, surgical treatment may be necessary. Surgical techniques for chronic cases vary in graft source and graft pathway. We present a surgical technique to recentralize and stabilize the extensor tendon using a residual ruptured sagittal band. This technique is simple and effective without donor site morbidity and seems to provide potential biomechanical advantages by restoring nearly normal anatomy. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.