MRI versus CT: a retrospective investigation of the feasibility and agreeability in post-operative evaluation of screw position after posterior lumbar interbody fusion

PURPOSE

Many patients receive magnetic resonance (MR) and computed tomography (CT) scans post-operatively to review screw placement. Traditionally, CT is diagnostic but as metal artefact reduction sequences are advancing in MR, the necessity for both MR and CT scans is questionable. The objective is to establish the statistical agreeability of MR and CT for evaluation of adequate screw placement in posterior lumbar interbody fusion.

METHODS

This opportunistic retrospective study of 58 patients investigated 297 images of 296 implanted screws. Post-operative MR and CT images were scrutinised for depiction of lumbar pedicle screw position using a 5-point scale. Kappa value for statistical agreeability tested MR against CT.

RESULTS

The 297 images of screws resulted in strong to near-perfect agreement between MR and CT (n = 297 k = 0.8042 p < 0.025). MRI resulted in high sensitivity (88.7%) and positive predictive value (78.3%). MRI demonstrated very high specificity (96.2%) and negative predictive value (98.2%). MR depicted screws (mean 12.6 mm diameter, mean 65.3 mm length) with 50% error in diameter and 30% in length from susceptibility artefact compared to manufacturer dimensions (6.5-7.5 mm diameter, 40-50 mm length). Adequate screw placement was high despite this (85.8%). On MR, the cortex border visibility was 60.7% and the spinal canal visibility was 74.6%.

CONCLUSION

There is strong to near-perfect agreement between MR and CT for evaluating adequate screw position in PLIF surgery. MR alone is useful for analyzing screw placement and should be considered first-line imaging in uncomplicated cases with CT analysis reserved for cases of uncertainty.

LEVEL OF EVIDENCE

Level III retrospective cohort study.

Compression of the dorsalis pedis artery: a novel cause of blue toe syndrome

Blue toe syndrome (BTS) is an important vascular condition characterized by painful blue discoloration of one or more digits. It is frequently due to emboli and is important because of the risk of progressive ischemia and tissue loss. A 53-year-old male presented with recurrent episodes of painful blue discoloration and blistering of the skin of the right hallux. On examination, the patient was found to have a cool, blue-purple great toe; all peripheral pulses were present. The patient was investigated for coagulopathy and potential sources of emboli, but the only abnormality was significant stenosis of the dorsalis pedis artery due to extrinsic compression by the extensor hallucis brevis tendon. In the absence of any other embolic source or abnormality, we believe that this case presents a novel and potentially remediable cause of BTS and indicates the need for a careful search for an underlying lesion when common causes of BTS have been excluded.

Modern spinal instrumentation. Part 2: multimodality imaging approach for assessment of complications

Radiologists frequently encounter studies demonstrating spinal instrumentation, either as part of the patient's postoperative evaluation, or as incidental to a study performed for another purpose. It is important for the reporting radiologist to identify potential complications of commonly used spinal implants. Part 1 of this review examined both the surgical approaches used and the normal appearances of these spinal implants and bone grafting techniques. This second part of the review will focus on the multimodal imaging strategy adopted in the assessment of the instrumented spine and the demonstration of imaging findings of common postoperative complications.

Soft tissue injuries: 7 Shoulder and elbow

A description of soft tissue injuries to the shoulder and elbow, together with assessment, imaging and treatment considerations.

The Great, Late Lesbian and Bisexual Women's Discrimination Survey

SUMMARY This 1992 New Zealand survey of discrimination against 261 lesbian and bisexual women found comparable rates of public abuse and workplace discrimination to those reported by surveys in other developed countries. The women reported higher rates of assault in public places than a random sample of New Zealand women. Indigenous Maori women reported higher rates of assault, threats, verbal abuse, and workplace discrimination than the non-Maori women surveyed. Aggression against the women was often in response to public expression of affection for another woman or to rejection of men's public sexual advances. The respondents reported hostile educational environments that coincided with peer harassment of students attracted to their own gender. Around two-thirds of the women had hidden their sexuality on some occasions at work to avoid discrimination. No significant differences between the discrimination experiences of lesbian and bisexual women emerged, although the bisexual sample was too small for statistical analysis.

Sea urchin egg mitochondrial DNA contains a short displacement loop (D-loop) in the replication origin region

Based on solution hybridization using single-stranded probes, native mitochondrial DNA extracted from sea urchin eggs contains a displacement-loop (D-loop) of approximately 70-80 nt. This maps to the single extended unassigned sequence of the genome, between the genes for tRNA(thr) and tRNA(pro), which also appears to contain the origin of first-strand replication. The D-loop commences at or close to a site of supercoil-dependent S1 nuclease hypersensitivity, adjacent to a run of 20 consecutive C residues, terminates near to the boundary of tRNA(thr), and appears to be composed at least partly of RNA, based on the sensitivity of the assays to RNase H. These experiments imply that the mechanisms of replication initiation in sea urchin and vertebrate mtDNAs are very similar, and suggest that the developmental restriction on mtDNA synthesis in eggs and embryos is maintained at the level of D-loop extension.