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Intraoperative Cone-Beam Computed Tomography Navigation Versus 2-Dimensional Fluoroscopy in Single-Level Lumbar Spinal Fusion: A Comparative Analysis 单层腰椎融合术术中锥形束计算机断层扫描导航与二维透视:比较分析
IF 3.2 2区 医学 Q1 Medicine Pub Date : 2024-03-01 DOI: 10.14245/ns.2347106.553
G. Vadalà, G. Papalia, F. Russo, P. Brigato, L. Ambrosio, R. Papalia, Vincenzo Denaro
Objective Several studies have advocated for the higher accuracy of transpedicular screw placement under cone-beam computed tomography (CBCT) compared to conventional 2-dimensional (2D) fluoroscopy. The superiority of navigation systems in perioperative and postoperative outcomes remains a topic of debate. This study aimed to compare operative time, screw placement time and accuracy, total radiation dose, perioperative and postoperative outcomes in patients who underwent transpedicular screw fixation for degenerative lumbar spondylolisthesis (DLS) using intraoperative CBCT navigation versus 2D fluoroscopy. Methods A retrospective analysis was conducted on patients affected by single-level DLS who underwent posterior lumbar instrumentation with transpedicular screw fixation using surgical CBCT navigation (NV group) or 2D fluoroscopy-assisted freehand technique (FH group). Demographics, screw placement time and accuracy, operative time, total radiation dose, intraoperative blood loss, screw revision rate, complications, and length of stay (LOS) were assessed. Results The study included a total of 30 patients (NV group: n = 15; FH group: n = 15). The mean screw placement time, operative time, and LOS were significantly reduced in the NV group compared to the FH group (p < 0.05). The total radiation dose was significantly higher in the NV group (p < 0.0001). No significant difference was found in terms of blood loss and postoperative complications. Conclusion This study suggests that intraoperative CBCT-navigated single-level lumbar transpedicular screw fixation is superior in terms of mean screw placement time, operative time, and LOS compared to 2D fluoroscopy, despite a higher intraoperative radiation exposure.
一些研究认为,与传统的二维(2D)透视相比,锥形束计算机断层扫描(CBCT)下经椎螺钉置入的准确性更高。导航系统在围手术期和术后效果方面的优越性仍是一个争论的话题。本研究旨在比较使用术中 CBCT 导航和二维透视对退行性腰椎滑脱症(DLS)进行经椎螺钉固定术的患者的手术时间、螺钉置入时间和准确性、总辐射剂量、围术期和术后效果。方法 对使用 CBCT 手术导航(NV 组)或二维透视辅助徒手技术(FH 组)接受经关节螺钉固定的腰椎后路器械治疗的单水平 DLS 患者进行了回顾性分析。研究评估了人口统计学、螺钉置入时间和准确性、手术时间、总辐射剂量、术中失血量、螺钉翻修率、并发症和住院时间(LOS)。结果 研究共纳入 30 名患者(NV 组:n = 15;FH 组:n = 15)。与 FH 组相比,NV 组的平均螺钉置入时间、手术时间和住院时间明显缩短(P < 0.05)。NV组的总辐射剂量明显高于FH组(P < 0.0001)。在失血量和术后并发症方面没有发现明显差异。结论 本研究表明,与二维透视相比,术中 CBCT 导航单水平腰椎经关节螺钉固定术在平均螺钉置入时间、手术时间和 LOS 方面更胜一筹,尽管术中辐射量更高。
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引用次数: 0
Performance of a Large Language Model in the Generation of Clinical Guidelines for Antibiotic Prophylaxis in Spine Surgery 大语言模型在生成脊柱手术抗生素预防临床指南中的表现
IF 3.2 2区 医学 Q1 Medicine Pub Date : 2024-03-01 DOI: 10.14245/ns.2347310.655
Bashar Zaidat, Nancy Shrestha, Ashley M. Rosenberg, Wasil Ahmed, Rami Rajjoub, Timothy Hoang, Mateo Restrepo Mejia, A. Duey, Justin E. Tang, Jun S. Kim, Samuel K. Cho
Objective Large language models, such as chat generative pre-trained transformer (ChatGPT), have great potential for streamlining medical processes and assisting physicians in clinical decision-making. This study aimed to assess the potential of ChatGPT’s 2 models (GPT-3.5 and GPT-4.0) to support clinical decision-making by comparing its responses for antibiotic prophylaxis in spine surgery to accepted clinical guidelines. Methods ChatGPT models were prompted with questions from the North American Spine Society (NASS) Evidence-based Clinical Guidelines for Multidisciplinary Spine Care for Antibiotic Prophylaxis in Spine Surgery (2013). Its responses were then compared and assessed for accuracy. Results Of the 16 NASS guideline questions concerning antibiotic prophylaxis, 10 responses (62.5%) were accurate in ChatGPT’s GPT-3.5 model and 13 (81%) were accurate in GPT-4.0. Twenty-five percent of GPT-3.5 answers were deemed as overly confident while 62.5% of GPT-4.0 answers directly used the NASS guideline as evidence for its response. Conclusion ChatGPT demonstrated an impressive ability to accurately answer clinical questions. GPT-3.5 model’s performance was limited by its tendency to give overly confident responses and its inability to identify the most significant elements in its responses. GPT-4.0 model’s responses had higher accuracy and cited the NASS guideline as direct evidence many times. While GPT-4.0 is still far from perfect, it has shown an exceptional ability to extract the most relevant research available compared to GPT-3.5. Thus, while ChatGPT has shown far-reaching potential, scrutiny should still be exercised regarding its clinical use at this time.
目的 大型语言模型,如聊天生成预训练转换器(ChatGPT),在简化医疗流程和辅助医生临床决策方面具有巨大潜力。本研究旨在通过比较 ChatGPT 对脊柱手术中抗生素预防的反应与公认的临床指南,评估 ChatGPT 的两个模型(GPT-3.5 和 GPT-4.0)在支持临床决策方面的潜力。方法 根据北美脊柱学会(NASS)《脊柱手术抗生素预防的多学科脊柱护理循证临床指南》(2013 年)中的问题对 ChatGPT 模型进行提示。然后对其回答进行比较并评估其准确性。结果 在 16 个有关抗生素预防的 NASS 指南问题中,ChatGPT 的 GPT-3.5 模型中有 10 个回答(62.5%)是准确的,GPT-4.0 模型中有 13 个回答(81%)是准确的。25% 的 GPT-3.5 答案被认为过于自信,而 62.5% 的 GPT-4.0 答案直接使用 NASS 指南作为其回答的证据。结论 ChatGPT 在准确回答临床问题方面表现出了令人印象深刻的能力。GPT-3.5 模型的性能受到了限制,因为它倾向于给出过于自信的回答,而且无法识别其回答中最重要的内容。GPT-4.0 模型的回答具有更高的准确性,并多次引用 NASS 指南作为直接证据。虽然 GPT-4.0 还远不够完美,但与 GPT-3.5 相比,它在提取最相关的研究成果方面表现出了非凡的能力。因此,虽然 ChatGPT 已显示出深远的潜力,但目前仍应对其临床使用进行严格审查。
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引用次数: 1
Surgeon Preference Regarding Wound Dressing Management in Lumbar Fusion Surgery: An AO Spine Global Cross-Sectional Study 外科医生对腰椎融合手术伤口敷料管理的偏好:AO 脊柱全球横断面研究
IF 3.2 2区 医学 Q1 Medicine Pub Date : 2024-03-01 DOI: 10.14245/ns.2347168.584
L. Ambrosio, G. Vadalà, Javad Tavakoli, L. Scaramuzzo, G. B. Brodano, Stephen J Lewis, So Kato, Samuel K. Cho, S. T. Yoon, Ho-Joong Kim, Matthew F. Gary, Vincenzo Denaro
Objective To evaluate the global practice pattern of wound dressing use after lumbar fusion for degenerative conditions. Methods A survey issued by AO Spine Knowledge Forums Deformity and Degenerative was sent out to AO Spine members. The type of postoperative dressing employed, timing of initial dressing removal, and type of subsequent dressing applied were investigated. Differences in the type of surgery and regional distribution of surgeons’ preferences were analyzed. Results Right following surgery, 60.6% utilized a dry dressing, 23.2% a plastic occlusive dressing, 5.7% glue, 6% a combination of glue and polyester mesh, 2.6% a wound vacuum, and 1.2% other dressings. The initial dressing was removed on postoperative day 1 (11.6%), 2 (39.2%), 3 (20.3%), 4 (1.7%), 5 (4.3%), 6 (0.4%), 7 or later (12.5%), or depending on drain removal (9.9%). Following initial dressing removal, 75.9% applied a dry dressing, 17.7% a plastic occlusive dressing, and 1.3% glue, while 12.1% used no dressing. The use of no additional coverage after initial dressing removal was significantly associated with a later dressing change (p < 0.001). Significant differences emerged after comparing dressing management among different AO Spine regions (p < 0.001). Conclusion Most spine surgeons utilized a dry or plastic occlusive dressing initially applied after surgery. The first dressing was more frequently changed during the first 3 postoperative days and replaced with the same type of dressing. While dressing policies tended not to vary according to the type of surgery, regional differences suggest that actual practice may be based on personal experience rather than available evidence.
目的 评估退行性腰椎融合术后使用伤口敷料的全球实践模式。方法 AO 脊柱知识论坛 "畸形和退行性 "向 AO 脊柱会员发出调查问卷。调查内容包括术后敷料的类型、去除初始敷料的时间以及后续敷料的类型。分析了手术类型的差异和外科医生偏好的地区分布。结果 手术后,60.6%的患者立即使用干性敷料,23.2%使用塑料闭塞性敷料,5.7%使用胶水,6%使用胶水和聚酯网的组合,2.6%使用伤口真空,1.2%使用其他敷料。初始敷料在术后第 1 天(11.6%)、第 2 天(39.2%)、第 3 天(20.3%)、第 4 天(1.7%)、第 5 天(4.3%)、第 6 天(0.4%)、第 7 天或更晚(12.5%)或根据引流管移除情况(9.9%)去除。首次去除敷料后,75.9%的患者使用干性敷料,17.7%的患者使用塑料闭塞性敷料,1.3%的患者使用胶水,12.1%的患者未使用敷料。首次去除敷料后未使用其他覆盖物与后期更换敷料显著相关(p < 0.001)。在比较不同 AO 脊柱区域的敷料管理后,发现存在显著差异(p < 0.001)。结论 大多数脊柱外科医生在术后最初使用干性或塑性闭塞性敷料。术后前三天内,第一种敷料的更换频率较高,并更换为相同类型的敷料。虽然敷料政策并不因手术类型而异,但地区差异表明,实际做法可能是基于个人经验而非现有证据。
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引用次数: 0
Deep Learning-Assisted Quantitative Measurement of Thoracolumbar Fracture Features on Lateral Radiographs 深度学习辅助定量测量侧位片上的胸腰椎骨折特征
IF 3.2 2区 医学 Q1 Medicine Pub Date : 2024-03-01 DOI: 10.14245/ns.2347366.683
W. Yuh, E. Khil, Y. Yoon, Burnyoung Kim, Hongjun Yoon, Jihe Lim, Kyoung Yeon Lee, Yeong Seo Yoo, Kyeong Deuk An
Objective This study aimed to develop and validate a deep learning (DL) algorithm for the quantitative measurement of thoracolumbar (TL) fracture features, and to evaluate its efficacy across varying levels of clinical expertise. Methods Using the pretrained Mask Region-Based Convolutional Neural Networks model, originally developed for vertebral body segmentation and fracture detection, we fine-tuned the model and added a new module for measuring fracture metrics—compression rate (CR), Cobb angle (CA), Gardner angle (GA), and sagittal index (SI)—from lumbar spine lateral radiographs. These metrics were derived from six-point labeling by 3 radiologists, forming the ground truth (GT). Training utilized 1,000 nonfractured and 318 fractured radiographs, while validations employed 213 internal and 200 external fractured radiographs. The accuracy of the DL algorithm in quantifying fracture features was evaluated against GT using the intraclass correlation coefficient. Additionally, 4 readers with varying expertise levels, including trainees and an attending spine surgeon, performed measurements with and without DL assistance, and their results were compared to GT and the DL model. Results The DL algorithm demonstrated good to excellent agreement with GT for CR, CA, GA, and SI in both internal (0.860, 0.944, 0.932, and 0.779, respectively) and external (0.836, 0.940, 0.916, and 0.815, respectively) validations. DL-assisted measurements significantly improved most measurement values, particularly for trainees. Conclusion The DL algorithm was validated as an accurate tool for quantifying TL fracture features using radiographs. DL-assisted measurement is expected to expedite the diagnostic process and enhance reliability, particularly benefiting less experienced clinicians.
目的 本研究旨在开发和验证一种用于定量测量胸腰椎(TL)骨折特征的深度学习(DL)算法,并评估其在不同临床专业知识水平下的功效。方法 利用最初为椎体分割和骨折检测而开发的预训练掩模区域卷积神经网络模型,我们对模型进行了微调,并添加了一个新模块,用于测量腰椎侧位片的骨折指标--压缩率(CR)、科布角(CA)、加德纳角(GA)和矢状位指数(SI)。这些指标是由 3 位放射科医生通过六点标注得出的,形成了地面实况(GT)。训练使用了 1,000 张非骨折和 318 张骨折X光片,验证使用了 213 张内骨折和 200 张外骨折X光片。使用类内相关系数评估了 DL 算法与 GT 在量化骨折特征方面的准确性。此外,4 名具有不同专业水平的读者(包括受训者和一名主治脊柱外科医生)在有 DL 辅助和无 DL 辅助的情况下进行了测量,并将他们的测量结果与 GT 和 DL 模型进行了比较。结果 在内部(分别为 0.860、0.944、0.932 和 0.779)和外部(分别为 0.836、0.940、0.916 和 0.815)验证中,DL 算法在 CR、CA、GA 和 SI 方面与 GT 的一致性良好到极佳。DL 辅助测量显著改善了大多数测量值,尤其是对受训者而言。结论 经验证,DL 算法是使用 X 光片量化 TL 骨折特征的准确工具。DL 辅助测量有望加快诊断过程并提高可靠性,尤其有利于经验不足的临床医生。
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引用次数: 1
Severe Preoperative Disability Is Associated With Greater Mental Health Improvements Following Surgery for Degenerative Spondylolisthesis: A Cohort Matched Analysis. 严重术前残疾与退行性脊椎滑脱症手术后心理健康改善程度相关:队列匹配分析
IF 3.2 2区 医学 Q1 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-31 DOI: 10.14245/ns.2347080.540
Ishan Khosla, Fatima N Anwar, Andrea M Roca, Srinath S Medakkar, Alexandra C Loya, Aayush Kaul, Jacob C Wolf, Vincent P Federico, Arash J Sayari, Gregory D Lopez, Kern Singh

Objective: To evaluate preoperative disability's influence on patient-reported outcomes (PROs) following surgery for degenerative spondylolisthesis (DS).

Methods: DS patients who underwent surgical intervention were retrospectively identified from a single-surgeon spine registry. Cohorts based on Oswestry Disability Index (ODI) < 41 (milder disability) and ≥ 41 (severe disability) were created. Demographic differences were accounted for with 1:1 propensity score matching. For the matched sample, perioperative and PRO data were additionally collected. PROs assessed included mental health, physical function, pain, and disability. Pre- and up to 2-year postoperative PROs were utilized. Average time to final follow-up was 15.7 ± 8.8 months. Improvements in PROs and minimal clinically important difference (MCID) rates were calculated. Continuous variables were compared through Student t-test and categorical variables were compared through chi-square tests.

Results: Altogether, 214 patients were included with 77 in the milder disability group. The severe disability group had worse postoperative day (POD) 1 pain scores and longer hospital stays (p ≤ 0.038, both). The severe disability group reported worse outcomes pre- and postoperatively (p < 0.011, all), but had greater average improvement in 12-item Short Form health survey mental composite score (SF-12 MCS), 9-Item Patient Health Questionnaire (PHQ-9), visual analogue scale (VAS)-back, and ODI by 6 weeks (p ≤ 0.037, all) and PHQ-9, VAS-back and ODI by final follow-up (p ≤ 0.015, all). The severe disability cohort was more likely to achieve MCID for SF-12 MCS, PHQ-9, and ODI (p ≤ 0.003, all).

Conclusion: Patients with greater baseline disability report higher POD 1 pain and discharge later than patients with milder disability. While these patients report inferior physical/mental health before and after surgery, they report greater improvements in mental health and disability postoperatively.

目的评估退行性脊柱滑脱症(DS)手术后术前残疾对患者报告结果(PROs)的影响:方法:从单一外科医生脊柱登记处回顾性地识别出接受手术治疗的脊柱退行性关节炎患者。根据奥斯韦特里残疾指数(ODI)进行分组:共纳入 214 名患者,其中轻度残疾组有 77 人。重度残疾组术后第1天疼痛评分更差,住院时间更长(两组P均≤0.038)。重度残疾组的术前和术后效果更差(P结论:与残疾程度较轻的患者相比,基线残疾程度较重的患者报告的 POD 1 疼痛程度较高,出院时间较晚。虽然这些患者在术前和术后的身体/精神健康状况较差,但他们在术后的精神健康和残疾状况却有较大改善。
{"title":"Severe Preoperative Disability Is Associated With Greater Mental Health Improvements Following Surgery for Degenerative Spondylolisthesis: A Cohort Matched Analysis.","authors":"Ishan Khosla, Fatima N Anwar, Andrea M Roca, Srinath S Medakkar, Alexandra C Loya, Aayush Kaul, Jacob C Wolf, Vincent P Federico, Arash J Sayari, Gregory D Lopez, Kern Singh","doi":"10.14245/ns.2347080.540","DOIUrl":"10.14245/ns.2347080.540","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate preoperative disability's influence on patient-reported outcomes (PROs) following surgery for degenerative spondylolisthesis (DS).</p><p><strong>Methods: </strong>DS patients who underwent surgical intervention were retrospectively identified from a single-surgeon spine registry. Cohorts based on Oswestry Disability Index (ODI) < 41 (milder disability) and ≥ 41 (severe disability) were created. Demographic differences were accounted for with 1:1 propensity score matching. For the matched sample, perioperative and PRO data were additionally collected. PROs assessed included mental health, physical function, pain, and disability. Pre- and up to 2-year postoperative PROs were utilized. Average time to final follow-up was 15.7 ± 8.8 months. Improvements in PROs and minimal clinically important difference (MCID) rates were calculated. Continuous variables were compared through Student t-test and categorical variables were compared through chi-square tests.</p><p><strong>Results: </strong>Altogether, 214 patients were included with 77 in the milder disability group. The severe disability group had worse postoperative day (POD) 1 pain scores and longer hospital stays (p ≤ 0.038, both). The severe disability group reported worse outcomes pre- and postoperatively (p < 0.011, all), but had greater average improvement in 12-item Short Form health survey mental composite score (SF-12 MCS), 9-Item Patient Health Questionnaire (PHQ-9), visual analogue scale (VAS)-back, and ODI by 6 weeks (p ≤ 0.037, all) and PHQ-9, VAS-back and ODI by final follow-up (p ≤ 0.015, all). The severe disability cohort was more likely to achieve MCID for SF-12 MCS, PHQ-9, and ODI (p ≤ 0.003, all).</p><p><strong>Conclusion: </strong>Patients with greater baseline disability report higher POD 1 pain and discharge later than patients with milder disability. While these patients report inferior physical/mental health before and after surgery, they report greater improvements in mental health and disability postoperatively.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10992647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139692548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Safety and Complications Related to Emerging Technologies 与新兴技术有关的安全性和并发症
IF 3.2 2区 医学 Q1 Medicine Pub Date : 2024-03-01 DOI: 10.14245/ns.2448162.081
G. Vadalà, L. Ambrosio, Vincenzo Denaro
{"title":"Safety and Complications Related to Emerging Technologies","authors":"G. Vadalà, L. Ambrosio, Vincenzo Denaro","doi":"10.14245/ns.2448162.081","DOIUrl":"https://doi.org/10.14245/ns.2448162.081","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140358890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Artificial Intelligence (AI)-Robotics Started When Human Capability Reached Limit, Human Creativity Begin Again When the Capability of AI-Robotics Reaches a Plateau 人工智能(AI)--机器人技术始于人类能力达到极限之时,而当人工智能--机器人技术的能力达到顶峰时,人类的创造力将重新开始
IF 3.2 2区 医学 Q1 Medicine Pub Date : 2024-03-01 DOI: 10.14245/ns.2448234.117
Seong Yi
{"title":"Artificial Intelligence (AI)-Robotics Started When Human Capability Reached Limit, Human Creativity Begin Again When the Capability of AI-Robotics Reaches a Plateau","authors":"Seong Yi","doi":"10.14245/ns.2448234.117","DOIUrl":"https://doi.org/10.14245/ns.2448234.117","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140360899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Whole Spine Segmentation Using Object Detection and Semantic Segmentation. 利用对象检测和语义分割进行全脊柱分割
IF 3.2 2区 医学 Q1 Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-01 DOI: 10.14245/ns.2347178.589
Raffaele Da Mutten, Olivier Zanier, Sven Theiler, Seung-Jun Ryu, Luca Regli, Carlo Serra, Victor E Staartjes

Objective: Virtual and augmented reality have enjoyed increased attention in spine surgery. Preoperative planning, pedicle screw placement, and surgical training are among the most studied use cases. Identifying osseous structures is a key aspect of navigating a 3-dimensional virtual reconstruction. To automate the otherwise time-consuming process of labeling vertebrae on each slice individually, we propose a fully automated pipeline that automates segmentation on computed tomography (CT) and which can form the basis for further virtual or augmented reality application and radiomic analysis.

Methods: Based on a large public dataset of annotated vertebral CT scans, we first trained a YOLOv8m (You-Only-Look-Once algorithm, Version 8 and size medium) to detect each vertebra individually. On the then cropped images, a 2D-U-Net was developed and externally validated on 2 different public datasets.

Results: Two hundred fourteen CT scans (cervical, thoracic, or lumbar spine) were used for model training, and 40 scans were used for external validation. Vertebra recognition achieved a mAP50 (mean average precision with Jaccard threshold of 0.5) of over 0.84, and the segmentation algorithm attained a mean Dice score of 0.75 ± 0.14 at internal, 0.77 ± 0.12 and 0.82 ± 0.14 at external validation, respectively.

Conclusion: We propose a 2-stage approach consisting of single vertebra labeling by an object detection algorithm followed by semantic segmentation. In our externally validated pilot study, we demonstrate robust performance for our object detection network in identifying individual vertebrae, as well as for our segmentation model in precisely delineating the bony structures.

目的:虚拟现实和增强现实技术在脊柱手术中受到越来越多的关注。术前规划、椎弓根螺钉置入和手术培训是研究最多的应用案例。识别骨性结构是浏览三维虚拟重建的一个关键方面。为了将在每个切片上单独标注椎骨这一耗时的过程自动化,我们提出了一个全自动管道,它能在计算机断层扫描(CT)上自动分割,并能为进一步的虚拟或增强现实应用和放射学分析奠定基础:方法:我们首先基于注释椎体计算机断层扫描的大型公共数据集,训练 YOLOv8m 对每个椎体进行单独检测。结果:214 个 CT 扫描(颈椎、胸椎或腰椎)用于模型训练,40 个扫描用于外部验证。椎体识别的mAP50超过0.84,分割算法在内部验证中的平均Dice得分分别为0.75±0.14,0.77±0.12和82±0.14:结论:我们提出了一种两阶段方法,包括通过对象检测算法对单个椎体进行标记,然后进行语义分割。在经过外部验证的试验研究中,我们证明了物体检测网络在识别单个椎体方面的强大性能,以及分割模型在精确划分骨骼结构方面的强大性能。
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引用次数: 0
Transoral Robotic-Assisted Neurosurgery for Skull Base and Upper Spine Lesions 经口机器人辅助神经外科手术治疗颅底和上脊椎病变
IF 3.2 2区 医学 Q1 Medicine Pub Date : 2024-03-01 DOI: 10.14245/ns.2448062.031
Jun Muto, Ichiro Tateya, Hirofumi Nakatomi, Ichiro Uyama, Yuichi Hirose
Objective The application of the da Vinci Surgical System in neurosurgery is limited due to technical difficulties requiring precise maneuvers and small instruments. This study details the advantages and disadvantages of robotics in neurosurgery and the reachable range of the transoral approach to lesions of the skull base and upper cervical spine. Methods In a cadaver study, the da Vinci Xi robot, lacking haptic feedback, was utilized for sagittal and coronal approaches on 5 heads, facilitating dura suturing in 3, with a 30°-angled drill for bone removal. Results Perfect exposure of all the nasopharyngeal sites, clivus, sellar, and choana, including the bilateral eustachian tubes, was achieved without any external incisions using this palatal split approach of transoral robotic surgery. The time required to perform a single stitch, knot, and complete single suture in robotic suturing of deep-seated were significantly less compared to manual suturing via the endonasal approach. Conclusion This is the first report to show the feasibility of suturing the dural defect in deep-seated lesions transorally and revealed that the limit of reach in the coronal plane via a transoral approach with incision of the soft palate is the foramen ovale. This preclinical investigation also showed that the transoral robotic approach is feasible for lesions extending from the sellar to the C2 in the sagittal plane. Refinement of robotic instruments for specific anatomic sites and future neurosurgical studies are needed to further demonstrate the feasibility and effectiveness of this system in treating benign and malignant skull base lesions.
目的 达芬奇手术系统在神经外科的应用受到限制,原因是需要精确操作和小型器械的技术困难。本研究详细介绍了机器人技术在神经外科手术中的优缺点,以及经口入路治疗颅底和上颈椎病变的可达范围。方法 在一项尸体研究中,使用缺乏触觉反馈的达芬奇Xi机器人对5个头部进行矢状和冠状切口,在3个头部进行硬脑膜缝合,并使用30°角钻头进行骨切除。结果 采用这种经口机器人手术的腭分路方法,在没有任何外部切口的情况下,完美地暴露了所有鼻咽部位、蝶窦、蝶窦和咽鼓管,包括双侧咽鼓管。与通过鼻内入路进行人工缝合相比,机器人深部缝合所需的单针缝合、打结和完整单针缝合时间明显更短。结论 这是第一份显示经口缝合深部病变硬膜缺损可行性的报告,并揭示了经口切口软腭方法在冠状面上到达的极限是卵圆孔。这项临床前研究还表明,在矢状面上,经口机器人方法适用于从蝶骨延伸至 C2 的病变。为进一步证明该系统治疗良性和恶性颅底病变的可行性和有效性,需要针对特定解剖部位对机器人器械进行改进,并在未来开展神经外科研究。
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引用次数: 0
Proteoglycan Dysfunction as a Key Hallmark of Intervertebral Disc Degeneration: Commentary on “Proteoglycan Dysfunction: A Common Link Between Intervertebral Disc Degeneration and Skeletal Dysplasia” 蛋白多糖功能障碍是椎间盘退变的重要标志:关于 "蛋白多糖功能障碍:椎间盘退变与骨骼发育不良之间的共同联系
IF 3.2 2区 医学 Q1 Medicine Pub Date : 2024-03-01 DOI: 10.14245/ns.2448266.133
T. Yurube
Low back pain is a global health problem with a markedly high lifetime prevalence— 70%–85% 1 —and socioeconomic burden—up to $102.0 billion/yr in the United States, 2 which is also the most common reason for the worker’s disability. 3 Although the cause of low back pain is largely nonspecific, a large-scale twin study has found intervertebral disc degeneration as the independent, main risk factor for disabling low back pain. 4 A population study of magnetic resonance imaging has further identified the increase in the prevalence of lumbar disc degeneration with age, based on 42% of 18–30 years and 88% of 50–55 years in age, 5 thereby facilitating impaired daily activities of the elderly. 6 Along with severe low back pain, intervertebral disc degeneration can cause neurological disorders such as ra-diculopathy, myelopathy, paralysis, intermittent claudication, and even bladder and bowel dysfunction. 7 Despite successful conservative treatment for degenerative disc disease, 6 non-responders need surgery. 7 The current primary surgical approach is symptomatic disc excision and/or spinal fusion, which results in the loss of load bearing, shock absorption, and movement. 7 Therefore, the development of new biological therapies for degenerative disc disease is an urgent demand to restore the physiological function. The intervertebral disc is unique, as the largest immune-privileged, low-nutrient, avascular organ in the human body. 8 The disc has a complex structure of the central nucleus pulp-osus (NP) encapsulated by the peripheral annulus fibrosus (AF) and sandwiching cartilage endplates. 7 The collagenous, laminar AF maintains the pressurization of the gelatinous, oval NP
腰背痛是一个全球性的健康问题,终生发病率极高(70%-85%1),在美国的社会经济负担高达每年 1,020 亿美元,2 这也是工人致残的最常见原因。3 虽然腰背痛的病因在很大程度上是非特异性的,但一项大规模的双胞胎研究发现,椎间盘退化是导致致残性腰背痛的主要独立风险因素。4 一项磁共振成像人群研究进一步发现,随着年龄的增长,腰椎间盘退变的患病率也在增加,18-30 岁的患病率为 42%,50-55 岁的患病率为 88%,5 从而导致老年人的日常活动能力受损。6 除了严重的腰背痛,椎间盘退变还会引起神经系统疾病,如脊髓灰质炎、脊髓病、瘫痪、间歇性跛行,甚至膀胱和肠道功能障碍。7 尽管椎间盘退行性病变的保守治疗取得了成功,6 但无应答者仍需手术治疗。7 目前的主要手术方法是无症状椎间盘切除术和/或脊柱融合术,这导致患者失去承重、减震和运动能力。7 因此,开发治疗椎间盘退行性病变的新型生物疗法是恢复其生理功能的迫切需求。椎间盘具有独特性,是人体最大的免疫特权、低营养、无血管器官。8 椎间盘结构复杂,中心髓核(NP)被外周纤维环(AF)包裹,软骨终板夹在其中。7 胶原层状纤维环维持着胶状椭圆形 NP 的压力
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引用次数: 0
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Neurospine
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