RESUMO
ABSTRACT Objective: With the increasing number and youth of patients with cervical spondylosis, people pay more and more attention to the cervical spine. Early diagnosis, intervention and treatment play an important role in the recovery of cervical spondylosis. With the continuous development of computer technology, the improvement of various modeling theories, and the application of image processing methods in orthopedics, new ideas are opened to observe cervical vertebra motion health. Methods: In this paper, the measurement of cervical motion is achieved by machine vision. A method of parameter measurement based on the constraint relationship of lower cervical motion is proposed. Based on image preprocessing, the left edge of the cervical vertebra was extracted and analyzed. Results: With the horizontal coordinate of registration point as the reference line, the changing trend of the angle between the left edge curve and the reference line of C4 and C5 vertebrae in the process of spontaneous flexion and extension of the cervical vertebrae was observed, and the movement rate of the cervical vertebrae was analyzed. Conclusions: It was found that the speed of the cervical vertebrae in the process of movement of the patients with cervical spondylosis showed jumping changes. Level of evidence II; Therapeutic studies - investigation of treatment results.
RESUMO Objetivo: Com o aumento do número e da juventude dos pacientes com espondilose cervical, as pessoas prestam cada vez mais atenção à coluna cervical. O diagnóstico, intervenção e tratamento precoces desempenham um papel importante na recuperação da espondilose cervical. Com o desenvolvimento contínuo da tecnologia computacional, o aprimoramento de várias teorias de modelagem e a aplicação de métodos de processamento de imagens na ortopedia, novas ideias se abrem para observar a saúde do movimento das vértebras cervicais. Métodos: Neste trabalho, a mensuração do movimento cervical é realizada por meio de visão artificial. É proposto um método de medição de parâmetro baseado na taxa de restrição de movimento cervical inferior. Com base no pré-processamento da imagem, a borda esquerda da vértebra cervical foi extraída e analisada. Resultados: Com a coordenada horizontal do ponto de registro como linha de referência, a tendência de mudança do ângulo entre a curva da borda esquerda e a linha de referência das vértebras C4 e C5 foi observada no processo de flexão espontânea e extensão do vértebras, vértebras cervicais e a taxa de movimento das vértebras cervicais. Conclusões: Verificou-se que a velocidade das vértebras cervicais no processo de movimentação de pacientes com espondilose cervical apresentou alterações de salto. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.
RESUMEN Objetivo: Con el número creciente y la juventud de pacientes con espondilosis cervical, las personas prestan cada vez más atención a la columna cervical. El diagnóstico, la intervención y el tratamiento tempranos juegan un papel importante en la recuperación de la espondilosis cervical. Con el desarrollo continuo de la tecnología informática, la mejora de varias teorías de modelado y la aplicación de métodos de procesamiento de imágenes en ortopedia, se abren nuevas ideas para observar la salud del movimiento de las vértebras cervicales. Métodos: En este trabajo, la medición del movimiento cervical se logra mediante visión artificial. Se propone un método de medición de parámetros basado en la relación de restricción del movimiento cervical inferior. Sobre la base del preprocesamiento de imágenes, se extrajo y analizó el borde izquierdo de la vértebra cervical. Resultados: Con la coordenada horizontal del punto de registro como línea de referencia, se observó la tendencia cambiante del ángulo entre la curva del borde izquierdo y la línea de referencia de las vértebras C4 y C5 en el proceso de flexión y extensión espontánea de las vértebras cervicales, y Se analizó la tasa de movimiento de las vértebras cervicales. Conclusiones: Se encontró que la velocidad de las vértebras cervicales en el proceso de movimiento de los pacientes con espondilosis cervical mostró cambios de salto. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.
Assuntos
Humanos , Programas de Rastreamento , Espondilose/diagnóstico por imagem , Atletas , Algoritmos , Diagnóstico PrecoceAssuntos
Alcaptonúria/diagnóstico , Doenças Ósseas Metabólicas/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Ocronose/diagnóstico , Compressão da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Adulto , Alcaptonúria/complicações , Alcaptonúria/urina , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Ácido Homogentísico/urina , Humanos , Deslocamento do Disco Intervertebral/etiologia , Deslocamento do Disco Intervertebral/fisiopatologia , Masculino , Ocronose/complicações , Ocronose/urina , Doenças da Esclera/etiologia , Doenças da Esclera/patologia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Espondilose/etiologia , Espondilose/fisiopatologia , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologiaRESUMO
STUDY DESIGN: Cross-sectional study. OBJECTIVE: To evaluate morphometric variations of the cervical spine in patients with cervical spondylotic myelopathy (CSM) using a standard technique of dynamic magnetic resonance imaging (MRI), to assess the inter- and intraobserver reliability of measurements of morphometric parameters based on this imaging, and to compare the resulting measurements with those previously published. SUMMARY OF BACKGROUND DATA: Because dynamic factors may contribute to the etiology and severity of CSM, dynamic (flexion-extension) MRI may be useful to better evaluate for spinal stenosis and cord compromise. METHODS: Dynamic cervical MRI was obtained using a standard protocol with the neck in neutral, flexion, and extension positions. The morphometric parameters considered were anterior length of the spinal cord (ALSC), posterior length of the spinal cord (PLSC), spinal canal diameter, and spinal cord width. Two observers analyzed the parameters independently, and the inter- and intraobserver reliabilities were assessed by the intraclass correlation coefficient (ICC). RESULTS: A total of 18 patients were included in the study and all completed the dynamic MRI acquisition protocol. The inter- and intraobserver reliabilities demonstrated "almost perfect agreement" (ICC >0.9, Pâ<â0.001) for ALSC and PLSC in all positions. The spinal canal diameter had inter- and intraobserver reliability classified as "almost perfect agreement" (ICC: 0.83-0.98, Pâ<â0.001 and ICC: 0.90-0.99, Pâ<â0.001, respectively) in all positions. The spinal cord width had inter- and intraobserver reliability classified as "substantial agreement" (ICC: 0.73-0.94, Pâ<â0.001 and ICC: 0.79-0.96, Pâ<â0.001, respectively) in all positions. ALSC and PLSC in neutral, flexion, and extension positions from the present study were significantly greater compared to the measurements previously published (Pâ<â0.001). CONCLUSION: The dynamic MRI protocol presented was safe and may allow a more complete evaluation of variations in the cervical spine in patients with CSM than traditional MRI protocols. The morphometric parameters based on this protocol demonstrated excellent inter- and intraobserver reliabilities. LEVEL OF EVIDENCE: 4.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Imageamento por Ressonância Magnética/normas , Espondilose/diagnóstico por imagem , Adulto , Idoso , Vértebras Cervicais/fisiopatologia , Estudos Transversais , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Reprodutibilidade dos Testes , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/fisiopatologia , Estenose Espinal/patologia , Espondilose/fisiopatologiaRESUMO
Relata-se o caso de uma paciente do sexo feminino, 32 anos, comerciante, com manifestações sistêmicas de brucelose, como febre diária contínua, sinal de Faget, lombalgia, cervicalgia, náuseas e cefaleia. Quando questionada, a paciente referiu consumo de leite e queijo não pasteurizados de origem bovina. Nos exames laboratoriais, foram evidenciados leucocitose, linfopenia, proteína C-reativa dentro dos parâmetros da normalidade e ausência de transaminasemia, contrapondo achados clássicos da doença. Os exames de imagem mostraram sinais característicos de sacroileíte. O tratamento foi realizado com doxiciclina 100mg via oral a cada 12 horas e estreptomicina 1g via intramuscular diária. O resultado da titulação para brucelose foi positivo. A paciente teve boa resposta ao tratamento, mantendo-se afebril e em bom estado geral até a alta hospitalar, que ocorreu após 14 dias do início da medicação, tendo sido mantido o tratamento ambulatorialmente. (AU)
A case of a 32-year-old female retailer with systemic manifestations of brucellosis, such as prolonged daily fever, Faget's sign, low back and neck pain, nausea and headache. When questioned, the patient reported consumption of unpasteurized milk and cheese of bovine origin. Laboratory tests revealed leukocytosis, lymphopenia, normal levels of C-reactive protein, and absence of transaminasemia, contrasting classic findings of the disease Imaging evaluation showed characteristic signs of sacroiliitis. The treatment was performed with doxycycline 100mg orally every 12 hours, and streptomycin 1g intramuscularly once daily. The serology for brucellosis was positive. The patient showed good response to the treatment, remaining afebrile and in good general condition until hospital discharge, which took place 14 days after starting the medication; she remained on treatment in an outpatient setting. (AU)
Assuntos
Humanos , Feminino , Adulto , Bradicardia/diagnóstico , Brucelose/diagnóstico , Ceftriaxona/uso terapêutico , Brucelose/imunologia , Espectroscopia de Ressonância Magnética , Estreptomicina/uso terapêutico , Vancomicina/uso terapêutico , Meningites Bacterianas/tratamento farmacológico , Doxiciclina/uso terapêutico , Leite/microbiologia , Espondilose/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Hospitalização , Antibacterianos/uso terapêuticoRESUMO
STUDY DESIGN: A retrospective review of radiographic data and functional outcomes. OBJECTIVE: The aim of this study was to evaluate whether myelopathy symptom severity upon presentation corresponds to sagittal plane alignment or nonmyelopathy symptoms, such as pain, in patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: Cervical sagittal balance is an important parameter in the outcome of surgical reconstruction. However, the effect of sagittal alignment on symptom severity in patients who have not undergone spine surgery is not well defined. METHODS: A consecutive series of CSM patients was identified at an academic institution. Preoperative radiographs were analyzed for sagittal vertical axis (C2SVA), C7 slope (C7S), C2-C7 angle in neutral (C27N), flexion (C27F), and extension (C27E), and range of motion (C27ROM). Neutral alignment was categorized as lordotic, kyphotic, or sigmoid/straight. Outcomes collected were SF-12, neck disability index, arm pain, neck pain, and modified JOA (mJOA). Pearson coefficients determined correlations between radiographic and outcome parameters. Multivariate regression evaluated predictive factors of mJOA. RESULTS: Radiographic parameters did not correlate with pain. Increasing age, smaller C27ROM, and smaller flexion angles correlated to lower (more severe) baseline mJOA scores. ROM (and not static alignment) was the only significant predictor of mJOA in the multivariate regression. Despite significant radiographic differences between lordotic, kyphotic, and sigmoid/straight alignment groups, myelopathy severity did not differ between these groups. CONCLUSION: Static, neutral alignment, including SVA and lordosis, did not correlate with myelopathy or pain symptoms. Greater C27ROM and increased maximal flexion corresponded to milder myelopathy symptoms, suggesting that patients with myelopathy may compensate for cervical stenosis with hyperflexion, similar to that which is observed in the lumbar spine. In a CSM patient population, dynamic motion and compensatory deformities may play a more significant role in myelopathy symptom severity than what can be discerned from standard, neutral position radiographs. LEVEL OF EVIDENCE: 3.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Índice de Gravidade de Doença , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Doenças da Medula Espinal/fisiopatologia , Espondilose/fisiopatologiaRESUMO
The aim of this study was to determine the reliability of magnetic resonance imaging (MRI) in the assessment of facet tropism and facet arthrosis of spondylolisthesis levels in degenerative cervical spondylolisthesis as compared to computed tomography (CT). The discrepancies in the interpretation of CT and MRI data in the evaluation of facet tropism and arthrosis have given rise to questions regarding the reliability of comparisons of the two techniques. Using a 4-point scale, 3 blinded readers independently graded the severity of facet tropism and facet arthrosis of 79 cervical facet joints on axial T2-weighted and sagittal T1 and T2-weighted turbo spin echo images as well as the corresponding axial CT scans. All results were subjected to the kappa coefficient statistic for strength of agreement. In the assessment of the severity of facet arthrosis, intermethod agreement (weighted κ) between CT scanning with a moderate inter-rater reliability (range κ = 0.43-0.57) and MRI with fair inter-rater reliability (range κ = 0.23-0.38) was 0.76 and 0.43 for the severity of facet tropism and facet arthrosis, respectively. Intra-rater reliability for the severity of facet arthrosis was moderate to substantial for CT and was moderate for MRI scans. Intra-rater reliability for the severity of facet tropism was substantial to very good for CT and substantial for MRI scans. MRI can reliably determine the presence or degree of facet tropism but not facet arthrosis. Therefore, for a comprehensive assessment of cervical facet joint degeneration, both a CT and an MRI scan should be performed.
Assuntos
Imageamento por Ressonância Magnética/métodos , Espondilolistese/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Articulação Zigapofisária/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/patologia , Espondilolistese/fisiopatologia , Espondilose/diagnóstico por imagem , Tropismo , Articulação Zigapofisária/patologiaRESUMO
UNLABELLED: The laminoplasty technique was devised by Hirabayashi in 1978 for patients diagnosed with multilevel cervical spondylotic myelopathy. OBJECTIVE: To describe an easy modification of Hirabayashi's method and present the clinical and radiological results from a five-year follow-up study. METHOD AND RESULTS: Eighty patients had 5 levels of decompression (C3-C7), 3 patients had 6 levels of decompression (C2-T1) and 3 patients had 4 levels of decompression (C3-C6). Foraminotomies were performed in 23 cases (27%). Following Nurick`s scale, 76 patients (88%) improved, 9 (11%) had the same Nurick grade, and one patient worsened and was advised to undergo another surgical procedure. No deaths were observed. The mean surgery time was 122 min. Radiographic evaluation showed an increase in the mean sagittal diameter from 11.2 mm at pretreatment to 17.3 mm post surgery. There was no significant difference between pretreatment and post-surgery C2-C7 angles. CONCLUSIONS: This two-open-doors laminoplasty technique is safe, easy and effective and can be used as an alternative treatment for cases of multilevel cervical spondylotic myelopathy without instability.
Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND CONTEXT: Spine fusions can be performed through different techniques and are used to treat a number of vertebral pathologies. However, there seems to be no consensus regarding which technique of fusion is best suited to treat each distinct spinal disease or group of diseases. PURPOSE: To study the effectiveness and complications of the different techniques used for spinal fusion in patients with lumbar spondylosis. STUDY DESIGN: Systematic literature review and meta-analysis. SAMPLE: Randomized clinical studies comparing the most commonly performed surgical techniques for spine fusion in lumbar-sacral spondylosis, as well as those reporting patient outcome were selected. OUTCOME MEASURES: Identify which technique, if any, presents the best clinical, functional, and radiographic outcome. METHODS: Systematic literature review and meta-analysis based on scientific articles published and indexed to the following databases: PubMed (1966-2009), Cochrane Collaboration-CENTRAL, EMBASE (1980-2009), and LILACS (1982-2009). The general search strategy focused on the surgical treatment of patients with lumbar-sacral spondylosis. RESULTS: Eight studies met the inclusion criteria and were selected with a total of 1,136 patients. Meta-analysis showed that patients who underwent interbody fusion presented a significantly smaller blood loss (p=.001) and a greater rate of bone fusion (p=.02). Patients submitted to fusion using the posterolateral approach had a significantly shorter operative time (p=.007) and less perioperative complications (p=.03). No statistically significant difference was found for the other studied variables (pain, functional impairment, and return to work). CONCLUSIONS: The most commonly used techniques for lumbar spine fusion in patients with spondylosis were interbody fusion and posterolateral approach. Both techniques were comparable in final outcome, but the former presented better rates of fusion and the latter the less complications.
Assuntos
Vértebras Lombares/cirurgia , Sacro/cirurgia , Fusão Vertebral/métodos , Espondilose/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Radiografia , Ensaios Clínicos Controlados Aleatórios como Assunto , Sacro/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Resultado do TratamentoRESUMO
STUDY DESIGN: Retrospective analysis of a cohort of patients treated between April 2006 and January 2008, and diagnosed with cervical degenerative disease. OBJECTIVE: To determine the correlation of the clinical findings associated with cervical myelopathy to the presence of spinal cord compression or cord signal abnormalities on magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA: There are numerous reports describing the radiographic features of cervical spondylosis, however, no publication specifically describes the association between the physical signs of cervical myelopathy and the presenting imaging findings. METHODS: Myelopathy was defined as the presence of greater than one long-tract sign localized to the cervical spinal cord (Hoffman or Babinski signs, clonus, hyper-reflexia, crossed abductor sign, and/or gait dysfunction) on physical examination in the absence of other neurologic condition(s). The presence of these signs, MRI imaging features of spinal cord compression and hyperintense T2 intraparenchymal cord signal abnormality, and patient demographics were recorded. RESULTS: One hundred three patients met inclusion criteria (age >18, symptomatic cervical degenerative disease and complete neurologic assessment). Of these, 54 had clinical findings of cervical myelopathy. Radiographic features of cord compression were present in 62% of patients, and 84% had myelopathy on examination. No patients without cord compression presented with myelopathy (P < 0.0001). Thirty-five percent of the patients presented with hyperintense signal on T2 MRI within the spinal cord parenchyma. This finding correlated with the presence of myelopathy (P < 0.0001). Multivariate analysis on the subset with cord compression indicates that the likelihood of myelopathy increased with the presence of cord signal hyperintensity (odds ratio [OR], 11.4), sensory loss (OR, 16.9), and age (OR, 1.10 per year). CONCLUSION: The diagnosis of cervical myelopathy is based on presenting symptoms and physical examination. This analysis illustrates that radiographic cervical spinal cord compression and hyperintense T2 intraparen chymal signal abnormalities correlate with the presence of myelopathic findings on physical examination.