Study Design: This is a retrospective cohort study using data from the adult spinal deformity (ASD) database of a single institution. Purpose: To investigate the incidence of proximal junctional failure and distal jun...Study Design: This is a retrospective cohort study using data from the adult spinal deformity (ASD) database of a single institution. Purpose: To investigate the incidence of proximal junctional failure and distal junctional failure (DJF) after ASD surgery with a lower instrumented vertebra (LIV) at L5. Overview of Literature: Spinopelvic fixation from the lower thoracic vertebra to the pelvis is the current gold standard treatment for ASD. However, the LIV at L5 is acceptable in some cases. Methods: Fifty-six patients who underwent corrective surgery for ASD with LIV at L5 were included. The upper instrumented vertebra (UIV) was T7 in one patient, T9 in 14, T10 in three, T11 in four, T12 in eight, L1 in 10, and L2 in 16. Regarding clinical parameters, age, sex, curve types of Scoliosis Research Society-Schwab classification, number of levels fused, follow-up period, hip bone mallow density, revision surgery rate, and radiographic measurements were compared between the T (UIV: T7 - 10) and TL (UIV: T11 - L2) groups. Results: The revision surgery rate was 19.6% overall. In the T and TL groups, it was 27.8%, and 15.8%, respectively (p = 0.305). The rate of DJF in the T group (33.3%) was significantly higher than in the TL group (5.3%). The rate of proximal junctional kyphosis in the T group (55.6%) was higher than in the TL group (28.9%), with no significant difference. The mean global alignment, sagittal vertical axis, and C7 plumb line-central sacral vertical line were not different between both groups. Conclusions: ASD surgery with LIV set at L5 and UIV set at the thoracic vertebrae (T7 - T10) has a risk of adjacent segment disease.展开更多
Spinal deformities assessment using 3D ultrasound scanning has limitations in fitting onto different back surface contour as well as fitting within the gaps between subject and their spinal brace during bracing assess...Spinal deformities assessment using 3D ultrasound scanning has limitations in fitting onto different back surface contour as well as fitting within the gaps between subject and their spinal brace during bracing assessments.The study proposed a flexible array ultrasound transducer to overcome these limitations.The results demonstrated the feasibility of spinal deformity assessments with a flexible ultrasound array when arranged in four shapes,namely Linear,Concave,Convex,and S-shaped.For comparisons of imaging performance on spinous process using the four shapes,Convex and S-shaped transducer showed a depth dependence and lateral location dependence of the lateral intensity distribution of spinous process,respectively.S-shaped transducer had the least accurate prediction of the location of spinous process,with measurement error of 4.83.2 mm,it also showed poorer prediction on spinal curvature measurements.This is suggested to be due to the asymmetrical distortion to the spinous process due to the lateral location dependence of the image.However,the coronal curve prediction of spine phantom performed well with R-squared values of>0.97 in all transducer shapes.The results of this study paved the way for further investigation on the improvement of image quality and measurement accuracy under different shapes for the flexible array,mechanism of dynamic shape change during the scanning to fit different body contour,as well as extension from 1D to 2D flexible array.展开更多
Tight-skin(TSK) mice are commonly used as an animal model to study the pathogenesis of Marfan syndrome(MFS), but little is known of their skeletal phenotype and in particular of the development of the spinal deformiti...Tight-skin(TSK) mice are commonly used as an animal model to study the pathogenesis of Marfan syndrome(MFS), but little is known of their skeletal phenotype and in particular of the development of the spinal deformities, common in MFS. Here we examined growth of the axial skeletons of TSK and wild-type(B6)mice during their period of rapid growth. The whole bodies of mice, 4–12 weeks of age, were scanned after sacrifice, by micro-computed tomography(micro CT). We reconstructed three-dimensional models of the spine and ribs, and measured vertebral body heights and rib lengths using the Mac-based image-processing software "Osiri X". Although the TSK mice were smaller than the B6 mice at 4 weeks, they experienced an early growth spurt and by 8 weeks the height, but not the width, of the vertebral body was significantly greater in the TSK mice than the B6 mice. Measurement of the angles of scoliotic and kyphotic curves postmortem in the mice was problematic, hence we measured changes that develop in skeletal elements in these disorders. As a marker of kyphosis, we measured anterior wedging of the vertebral bodies; as a marker for scoliosis we measured asymmetries in rib length. We found, unlike in the B6 mice where the pattern was diffuse, wedging in TSK mice was directly related to spinal level and peaked steeply at the thoracolumbar junction. There was also significant asymmetry in length of the ribs in the TSK mice, but not in the B6 mice.The TSK mice thus appear to exhibit spinal deformities seen in MFS and could be a useful model for gaining understanding of the mechanisms of development of scoliosis and kyphosis in this disorder.展开更多
文摘Study Design: This is a retrospective cohort study using data from the adult spinal deformity (ASD) database of a single institution. Purpose: To investigate the incidence of proximal junctional failure and distal junctional failure (DJF) after ASD surgery with a lower instrumented vertebra (LIV) at L5. Overview of Literature: Spinopelvic fixation from the lower thoracic vertebra to the pelvis is the current gold standard treatment for ASD. However, the LIV at L5 is acceptable in some cases. Methods: Fifty-six patients who underwent corrective surgery for ASD with LIV at L5 were included. The upper instrumented vertebra (UIV) was T7 in one patient, T9 in 14, T10 in three, T11 in four, T12 in eight, L1 in 10, and L2 in 16. Regarding clinical parameters, age, sex, curve types of Scoliosis Research Society-Schwab classification, number of levels fused, follow-up period, hip bone mallow density, revision surgery rate, and radiographic measurements were compared between the T (UIV: T7 - 10) and TL (UIV: T11 - L2) groups. Results: The revision surgery rate was 19.6% overall. In the T and TL groups, it was 27.8%, and 15.8%, respectively (p = 0.305). The rate of DJF in the T group (33.3%) was significantly higher than in the TL group (5.3%). The rate of proximal junctional kyphosis in the T group (55.6%) was higher than in the TL group (28.9%), with no significant difference. The mean global alignment, sagittal vertical axis, and C7 plumb line-central sacral vertical line were not different between both groups. Conclusions: ASD surgery with LIV set at L5 and UIV set at the thoracic vertebrae (T7 - T10) has a risk of adjacent segment disease.
基金This work was supported by Hong Kong Research Grant Council(152220/14E,R5017-18),Hong Kong PhD Fellowship Scheme,and the Hong Kong Polytechnic University.
文摘Spinal deformities assessment using 3D ultrasound scanning has limitations in fitting onto different back surface contour as well as fitting within the gaps between subject and their spinal brace during bracing assessments.The study proposed a flexible array ultrasound transducer to overcome these limitations.The results demonstrated the feasibility of spinal deformity assessments with a flexible ultrasound array when arranged in four shapes,namely Linear,Concave,Convex,and S-shaped.For comparisons of imaging performance on spinous process using the four shapes,Convex and S-shaped transducer showed a depth dependence and lateral location dependence of the lateral intensity distribution of spinous process,respectively.S-shaped transducer had the least accurate prediction of the location of spinous process,with measurement error of 4.83.2 mm,it also showed poorer prediction on spinal curvature measurements.This is suggested to be due to the asymmetrical distortion to the spinous process due to the lateral location dependence of the image.However,the coronal curve prediction of spine phantom performed well with R-squared values of>0.97 in all transducer shapes.The results of this study paved the way for further investigation on the improvement of image quality and measurement accuracy under different shapes for the flexible array,mechanism of dynamic shape change during the scanning to fit different body contour,as well as extension from 1D to 2D flexible array.
基金funding for support of this research from the British Scoliosis Research Foundation (JU, JY)the China Postdoctoral Science Foundation (2012M520584)Tianjin Postdoctoral Science Foundation (BL)
文摘Tight-skin(TSK) mice are commonly used as an animal model to study the pathogenesis of Marfan syndrome(MFS), but little is known of their skeletal phenotype and in particular of the development of the spinal deformities, common in MFS. Here we examined growth of the axial skeletons of TSK and wild-type(B6)mice during their period of rapid growth. The whole bodies of mice, 4–12 weeks of age, were scanned after sacrifice, by micro-computed tomography(micro CT). We reconstructed three-dimensional models of the spine and ribs, and measured vertebral body heights and rib lengths using the Mac-based image-processing software "Osiri X". Although the TSK mice were smaller than the B6 mice at 4 weeks, they experienced an early growth spurt and by 8 weeks the height, but not the width, of the vertebral body was significantly greater in the TSK mice than the B6 mice. Measurement of the angles of scoliotic and kyphotic curves postmortem in the mice was problematic, hence we measured changes that develop in skeletal elements in these disorders. As a marker of kyphosis, we measured anterior wedging of the vertebral bodies; as a marker for scoliosis we measured asymmetries in rib length. We found, unlike in the B6 mice where the pattern was diffuse, wedging in TSK mice was directly related to spinal level and peaked steeply at the thoracolumbar junction. There was also significant asymmetry in length of the ribs in the TSK mice, but not in the B6 mice.The TSK mice thus appear to exhibit spinal deformities seen in MFS and could be a useful model for gaining understanding of the mechanisms of development of scoliosis and kyphosis in this disorder.
