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Imaging Assessment of the Postoperative Spine: An Updated Pictorial Review of Selected Complications. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9940001. [PMID: 34113681 PMCID: PMC8154286 DOI: 10.1155/2021/9940001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 02/05/2023]
Abstract
Imaging of the postoperative spine requires the identification of several critical points by the radiologist to be written in the medical report: condition of the underlying cortical and cancellous bone, intervertebral disc, and musculoskeletal tissues; location and integrity of surgical implants; evaluation of the success of decompression procedures; delineation of fusion status; and identification of complications. This article presents a pictorial narrative review of the most common findings observed in noninstrumented and instrumented postoperative spines. Complications in the noninstrumented spine were grouped in early (hematomas, pseudomeningocele, and postoperative spine infection) and late findings (arachnoiditis, radiculitis, recurrent disc herniation, spinal stenosis, and textiloma). Complications in the instrumented spine were also sorted in early (hardware fractures) and late findings (adjacent segment disease, hardware loosening, and implant migration). This review also includes a short description of the most used diagnostic techniques in postoperative spine imaging: plain radiography, ultrasound (US), computed tomography (CT), magnetic resonance (MR), and nuclear medicine. Imaging of the postoperative spine remained a challenging task in the early identification of complications and abnormal healing process. It is crucial to consider the advantages and disadvantages of the imaging modalities to choose those that provide more accurate spinal status information during the follow-up. Our review is directed to all health professionals dealing with the assessment and care of the postoperative spine.
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O'donoghue FJ, Meaklim H, Bilston L, Hatt A, Connelly A, Jackson G, Farquharson S, Sutherland K, Cistulli PA, Brown DJ, Berlowitz DJ. Magnetic resonance imaging of the upper airway in patients with quadriplegia and obstructive sleep apnea. J Sleep Res 2017; 27:e12616. [PMID: 29082563 DOI: 10.1111/jsr.12616] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 08/24/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate upper airway anatomy in quadriplegics with obstructive sleep apnea. Fifty subjects were recruited from three hospitals in Australia: people with quadriplegia due to spinal cord injury and obstructive sleep apnea (n = 11), able-bodied people with obstructive sleep apnea (n = 18), and healthy, able-bodied controls (n = 19). All underwent 3-Tesla magnetic resonance imaging of their upper airway. A subgroup (n = 34) received a topical vasoconstrictor, phenylephrine and post-phenylephrine magnetic resonance imaging. Mixed-model analysis indicated no significant differences in total airway lumen volume between the three groups (P = 0.086). Spinal cord injury-obstructive sleep apnea subjects had a significantly larger volume of soft palate (P = 0.020) and retroglossal lateral pharyngeal walls (P = 0.043) than able-bodied controls. Able-bodied-obstructive sleep apnea subjects had a smaller mandible volume than spinal cord injury-obstructive sleep apnea subjects and able-bodied control subjects (P = 0.036). No differences were seen in airway length between groups when controlling for height (P = 0.055). There was a marginal increase in velopharyngeal volume across groups post-phenylephrine (P = 0.050), and post hoc testing indicated the difference was confined to the able-bodied-obstructive sleep apnea group (P < 0.001). No other upper airway structures showed significant changes with phenylephrine administration. In conclusion, people with obstructive sleep apnea and quadriplegia do not have a structurally smaller airway than able-bodied subjects. They did, however, have greater volumes of soft palate and lateral pharyngeal walls, possibly due to greater neck fat deposition. The acute response to upper airway topical vasoconstriction was not enhanced in those with obstructive sleep apnea and quadriplegia. Changes in upper airway anatomy likely contribute to the high incidence in obstructive sleep apnea in quadriplegic subjects.
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Affiliation(s)
- Fergal J O'donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Vic, Australia.,Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic, Australia.,Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Vic, Australia
| | - Hailey Meaklim
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Vic, Australia.,Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic, Australia
| | - Lynne Bilston
- Neuroscience Research Australia, Randwick, NSW, Australia.,University of New South Wales, Randwick, NSW, Australia
| | - Alice Hatt
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Alan Connelly
- Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic, Australia
| | - Graeme Jackson
- Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic, Australia.,Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Vic, Australia
| | - Shawna Farquharson
- Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic, Australia
| | - Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Douglas J Brown
- Spinal Research Institute, Austin Health, Heidelberg, Vic, Australia
| | - David J Berlowitz
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Vic, Australia.,Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Vic, Australia.,Spinal Research Institute, Austin Health, Heidelberg, Vic, Australia
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Wang Z, Zhen X, Tay K, Osman S, Romano W, Li S. Regression Segmentation for M³ Spinal Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:1640-1648. [PMID: 25361503 DOI: 10.1109/tmi.2014.2365746] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Clinical routine often requires to analyze spinal images of multiple anatomic structures in multiple anatomic planes from multiple imaging modalities (M(3)). Unfortunately, existing methods for segmenting spinal images are still limited to one specific structure, in one specific plane or from one specific modality (S(3)). In this paper, we propose a novel approach, Regression Segmentation, that is for the first time able to segment M(3) spinal images in one single unified framework. This approach formulates the segmentation task innovatively as a boundary regression problem: modeling a highly nonlinear mapping function from substantially diverse M(3) images directly to desired object boundaries. Leveraging the advancement of sparse kernel machines, regression segmentation is fulfilled by a multi-dimensional support vector regressor (MSVR) which operates in an implicit, high dimensional feature space where M(3) diversity and specificity can be systematically categorized, extracted, and handled. The proposed regression segmentation approach was thoroughly tested on images from 113 clinical subjects including both disc and vertebral structures, in both sagittal and axial planes, and from both MRI and CT modalities. The overall result reaches a high dice similarity index (DSI) 0.912 and a low boundary distance (BD) 0.928 mm. With our unified and expendable framework, an efficient clinical tool for M(3) spinal image segmentation can be easily achieved, and will substantially benefit the diagnosis and treatment of spinal diseases.
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Abstract
This article reviews the imaging of lumbar spinal fusion and its major indications. The most common procedures are described for the purpose of allowing understanding of postoperative imaging. Imaging options are reviewed for preoperative workup, intraoperative guidance, and postoperative purposes. Examples of hardware integrity, fusion, and loosening are provided.
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Affiliation(s)
- Richard Zampolin
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Amichai Erdfarb
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Todd Miller
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
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