Francesco Fabbiano

MRI can assess glenoid bone loss after shoulder luxation: inter- and intra-individual comparison with CT

ObjectiveComputed tomography (CT) is the gold standard for evaluating glenoid bone loss in patients with glenohumeral dislocations. The aim of this study was to verify if magnetic resonance imaging (MRI) can quantify the area of bone loss without any significant difference from CT.Materials and methodsTwenty-three patients, who had experienced one or more post-traumatic unilateral glenohumeral dislocations, underwent MRI and CT. MR and multiplanar reconstruction CT images were acquired in the sagittal plane: the glenoid area and the area of bone loss were calculated using the PICO method. Mean values, percentages, Cohen’s kappa coefficients and Bland-Altman plots were all used to confirm the working hypothesis.ResultsThe mean glenoid surface area was 575.29 mm2 as measured by MRI, and 573.76 mm2 as measured by CT; the calculated mean glenoid bone loss was respectively 4.38% and 4.34%. The interobserver agreement was good (k>0.81), and the coefficient of variance was 5% of the mean value using both methods. The two series of measurements were within two standard deviations of each other.ConclusionsMRI is a valid alternative to CT for measuring glenoid bone loss in patients with glenohumeral dislocation.RiassuntoObiettivoLa tomografia computerizzata (TC) è il gold standard nella valutazione del danno osseo glenoideo in pazienti con lussazione gleno-omerale. Lo scopo dello studio è verificare se la risonanza magnetica (RM) può quantificare l’area di danno osseo senza significative differenze rispetto alla TC.Materiali e metodiVentitre pazienti con uno o più episodi di lussazione traumatica gleno-omerale unilaterale sono stati sottoposti a RM e TC. Sono state acquisite le ricostruzioni MPR in TC e le immagini RM sul piano sagittale: la misura dell’area della glena e la misura del danno osseo sono state effettuate utilizzando il metodo PICO. Medie, percentuali, test di concordanza K di Cohen e Bland-Altman test sono stati elaborati per confermare l’ipotesi di lavoro.RisultatiLa misura dell’area glenoidea risulta di 575,29 mm2 con RM e di 573,76 mm2 con TC e le rispettive misure del deficit glenoideo sono di 4,38% e 4,34%. La concordanza inter-osservatore in TC e RM è risultata buona con k>0,81, il coefficiente di varianza è <5% del valor medio sia in TC che RM. Le due serie di misurazioni sono comprese entro 2 deviazioni standard.ConclusioniLa RM è una valida alternativa alla TC nella misurazione del danno osseo glenoideo in pazienti con dislocazioni gleno-omerali.

Degenerative Cervical Instability Stabilization–Posterior Decompression

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Patient with odontoid traumatic fracture treated by posterior stabilization through screws in C1 lateral process and in C2 isthmus peduncles.

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Patient with herniated disk and canal stenosis treated by diskectomy with posterolateral transpedicular approach and further surgery of laminectomy and pedicular stabilization

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Patient with grade II C5–C6 anterior traumatic listesis treated by stabilization through metallic screws, anterior decompression, diskectomy and intervertebral C5–C6 mesh positioning.

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Patient with L4 traumatic collapse treated by L3–L5 posterior stabilization through transpedicular screws, L3 decompression, L3 prosthesis positioning after 4 months (Obelisc) through anterolateral approach.

Multiple Traumatic Dorsal Collapses Double Stabilization

Patient with D6–D11 traumatic collapses treated by posterior double stabilization through transpedicular screws at D10, D11, and D12. D10–D11 laminectomy.

Lumbar Collapse in Lymphoma Vertebroplasty

Patient 80 y.o. with L5 pathological collapse treated by vertebroplasty through right transpedicular approach

Amyotrophic Lateral Sclerosis Stem Cells Transplant

1 month after transplant: D6–D8 laminotomy and stem cells injection in fluid solution through microinjectors