Diana Andrei

Utility of the pedicle subtraction osteotomy for the correction of sagittal spine imbalance.

IntroductionPedicle substraction osteotomy (PSO) in the lumbar spine is indicated in the treatment of large sagittal deformities of the lumbar spine. Substantial complications associated with PSOs include pseudarthrosis and mechanical failure. The purpose of the present study was to assess the complications of this procedure and the causes of mechanical complications.Material and methodsFifteen patients aged between 38 and 79 years (mean age 63.8±12.82) were operated on between June 2011 and September 2014 for sagittal imbalance by means of one-level PSO. Pre-operative and post-operative values of radiological spino-pelvic sagittal parameters were measured. Clinical and radiological evaluations were conducted pre-operatively and post-operatively at six months and one year. Clinical evaluation included intra- and post-operative complications.ResultsMean pelvic incidence was 54.86 ± 11.82°. Lumbar lordosis (LL) was measured to be 12.26 ± 18.48° pre-operatively and increased to 42.73 ± 14.05° post-operatively (p< 0.05). Mean gain of lordosis after PSO at index level was calculated to be 28 ± 11° (range, 14–41). SVA decreased post-operatively from 93.46 ± 36.69 mm to 61.73 ±38.68 mm (p< 0.05). Several complications (n = 8), including two minor (one dural tear with no clinical consequences and one transient radicular deficit) and six major with re-intervention, were observed in our series.DiscussionsOptimal post-operative correction in the sagittal plane: SVA <50 mm, LL= –(PI+10°) is an important parameter to reduce the risk of developing sagittal decompensation which is a common condition after PSO. Rate of complications after PSO is not negligible in the literature up to 45%.ConclusionsThe main cause of mechanical complications was insufficient sagittal correction. To limit the risk of mechanical complications and to achieve a good sagittal balance, PSO must be associated with additional SPOs or a second corrective surgery to obtain a solid anterior fusion.

Computer aided scoliosis evaluation and recovery using an intelligent optical 3D sensor

This paper suggests a novel method to evaluate the progress of the scoliotic patients. The scoliosis is an affection that deviates in a three dimensional plan the patients spinal cord. Today the severity of the scoliosis is determined by the Cobb angles on the x-ray. Our method uses the Kinect sensor that can capture in a 3 dimensional plane the joints of the human body. Using the joints position in the 3D plane, the relative angles of key joints to a predetermined point is measured. Using these angles the system calculates the severity of the scoliosis. On the same principle we suggest a system that can monitor the patients exercises during the treatment.

Intraoperative conjoined lumbosacral nerve roots associated with spondylolisthesis

Lumbosacral nerve roots anomalies may produce low back pain. These anomalies are reported to be a cause for failed back surgery. They are usually left undiagnosed, especially in endoscopic discectomy techniques. Any surgery for entrapment disorders, performed on a patient with undiagnosed lumbosacral nerve roots anomaly, may lead to serious neural injuries because of an improper surgical technique or decompression. In this report, we describe our experience with a case of L5–S1 spondylolisthesis and associated congenital lumbosacral nerve root anomalies discovered during the surgical intervention, and the difficulties raised by such a discovery. Careful examination of coronal and axial views obtained through high-quality Magnetic Resonance Imaging may lead to a proper diagnosis of this condition leading to an adequate surgical planning, minimizing the intraoperatory complications.

Percutaneous Transpedicular Vertebroplasty versus Conservative Management in Osteoporotic Vertebral Fractures

Osteoporotic vertebral fractures can lead to late collapse which often cause kyphotic spinal deformity, persistent back pain, decreased lung capacity, increased fracture risk and increased mortality. The purpose of our study is to compare the efficacy and safety of vertebroplasty against conservative management of osteoporotic vertebral fractures without neurologic symptoms. A total of 66 patients with recent OVF on MRI examination were included in the study. All patients were admitted from September 2009 to September 2012. The cohort was divided in two groups: first study group consisted of 33 prospectively followed consecutive patients who suffered 40 vertebral osteoporotic fractures treated by percutaneous vertebroplasty (Group 1), and the control group consisted of 33 patients who suffered 41 vertebral osteoporotic fractures treated conservatory because they reffused vertebroplasty (Group 2). Vertebroplasty with PMMA was performed in 30 patients on 39 VBs, including four thoracic vertebras, 27 vertebras of the thoracolumbar jonction and 8 lumbar vertebras. In the Group 2 were included 30 patients with 39 OVFs (four thoracic vertebras, 23 vertebras of the thoracolumbar junction and 11 lumbar vertebras). In our study on OVF, vertebroplasty delivered superior clinical and radiological outcomes over the first year from intervention when compared to consevative treatment of patients with osteoporotic compression fractures without neurological deficit.

Computer aided patient evaluation in the low back pain pathology

The aim of the paper is to implement an artificially intelligent assessment system that is based on a modified fuzzy inference system. This system reduces the rate of patient complications. This inference system, consisting of 246 rules, avoids the defuzzification process and offers the final result in natural language form. 51 of the rules indicate that appropriate action must be of a lumbar spine surgery, 163 of the rules indicate that the patient should continue medical rehabilitation and 32 of the rules indicate that the patient is medically healthy. Early diagnosis and rapid establishment of a targeted treatment are decisive factors for therapeutic success. The results of this study showed that patients from first lot had better results than patients of the second lot.

Fuzzy Expert System Prediction of Lumbar Spine Subchondral Sclerosis and Lumbar Disk Hernia

One of the first degenerative diseases of the lumbar spine is the subchondral sclerosis from which other degenerative complications can occur. The first symptom of the subchondral sclerosis and herniated disk is the low back pain. The subchondral sclerosis and herniated disk is often associated with obesity, high body fat index, and high stress on the vertebral spine. This paper proposes a fuzzy expert system which predicts that a patient will suffer from subchondral sclerosis. The expert system correlates the body mass index (BMI) with the body fat (BF) percentage and the daily activity expressed by the consumed calories. In total 60 inference rules were created and the first results present a correlation of 0.91 with the results from the control group. Using this system, a compliant patient can avoid serious spinal cord problems.

Process modeling and assisted diagnosis in spinal recovery

The diagnosis and treatment of lumbar spine pathology represents a complex process involving many and diverse parameters that should to be investigated and processed. In order to properly approach the computer assisted treatment and diagnosis this paper presents a model of the process using BPMN and also a UML model for implementation. The data is supplied directly from the keyboard or from the Zebris equipment. The parameters investigated are: demographic data, disability status (4 degrees), daily activity expressed in calories (24 possibilities), Zebris mobility degree (minimum/ maximum-6 values), and Zebris position rate (expressed as an angle). The inference engine of the presented method is created using fuzzy inference system. The data collected from the patients and the Zebris equipment is transformed in linguistic variables and the appropriate fuzzy inference rules are constructed. The consequences of the rules encode the actions that should be taken. Relating the values of the investigated parameters screening values for each measurement can be established. Future work will result in prediction of recovery rate and also developing educational tools related to recovery domain.

Computer assisted osteosclerosis detection using fuzzy inference system

The objective was to find a way for analyzing the medical x-ray images using fuzzy inference systems in order to confirm the presence of osteosclerosis in the bone sections of the joints of the hand and the knee. The medical x-ray is segmented in order to separate the bone sections from the background. The histogram of the bone sections with the metadata extracted from the medical x-ray is analyzed by the fuzzy inference system. The metadata contains the exposure settings of the x-ray image and is used to determine if the x-ray image was under or over exposed. By using of a special program the osteosclerosis could be emphasized earlier if the patient is coming to doctor when the first symptoms occur. The described method has the advantage to decrease the number of clinical errors in imagistic interpretation.