Статті в журналах: "Spine Measurement"

1

Mellin, Guy. "Lumbar Spine Measurement." Physiotherapy 78, no. 3 (March 1992): 201. http://dx.doi.org/10.1016/s0031-9406(10)61398-3.

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2

Okabe, Shigeo. "Recent advances in computational methods for measurement of dendritic spines imaged by light microscopy." Microscopy 69, no. 4 (April 3, 2020): 196–213. http://dx.doi.org/10.1093/jmicro/dfaa016.

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Abstract Dendritic spines are small protrusions that receive most of the excitatory inputs to the pyramidal neurons in the neocortex and the hippocampus. Excitatory neural circuits in the neocortex and hippocampus are important for experience-dependent changes in brain functions, including postnatal sensory refinement and memory formation. Several lines of evidence indicate that synaptic efficacy is correlated with spine size and structure. Hence, precise and accurate measurement of spine morphology is important for evaluation of neural circuit function and plasticity. Recent advances in light microscopy and image analysis techniques have opened the way toward a full description of spine nanostructure. In addition, large datasets of spine nanostructure can be effectively analyzed using machine learning techniques and other mathematical approaches, and recent advances in super-resolution imaging allow researchers to analyze spine structure at an unprecedented level of precision. This review summarizes computational methods that can effectively identify, segment and quantitate dendritic spines in either 2D or 3D imaging. Nanoscale analysis of spine structure and dynamics, combined with new mathematical approaches, will facilitate our understanding of spine functions in physiological and pathological conditions.

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3

Merrill, Robert K., Jun S. Kim, Dante M. Leven, Joshua J. Meaike, Joung Heon Kim, and Samuel K. Cho. "A Preliminary Algorithm Using Spine Measurement Software to Predict Sagittal Alignment Following Pedicle Subtraction Osteotomy." Global Spine Journal 7, no. 6 (April 11, 2017): 543–51. http://dx.doi.org/10.1177/2192568217700098.

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Study Design: Retrospective case series. Objective: To evaluate if spine measurement software can simulate sagittal alignment following pedicle subtraction osteotomy (PSO). Methods: We retrospectively reviewed consecutive adult spinal deformity patients who underwent lumbar PSO. Sagittal measurements were performed on preoperative lateral, standing radiographs. Sagittal measurements after simulated PSO were compared to actual postoperative measurements. A regression equation was developed using cases 1-7 to determine the amount of manual rotation required of each film to match the simulated sagittal vertical axis (SVA) to the actual postoperative SVA. The equation was then applied to cases 8-13. Results: For all 13 cases, the spine software accurately simulated lumbar lordosis, pelvic incidence lumbar lordosis mismatch, and T1 pelvic angle, with no significant differences between actual and simulated measurements. The pelvic tilt (PT), sacral slope (SS), thoracolumbar alignment (TL), thoracic kyphosis (TK), T9 spino-pelvic inclination (T9SPi), T1 spino-pelvic inclination (T1SPi), and SVA were inaccurately simulated. The PT, SS, T9SPi, T1SPi, and SVA all change with manual rotation of the film, and by using the regression equation developed with cases 1-7, we were able to improve the accuracy and decrease the variability of the simulated PT, SS, T9SPi, T1SPi, and SVA for cases 8-13. Conclusions: Dedicated spine measurement software can accurately simulate certain sagittal measurements, such as LL, PI-LL, and TPA, following PSO. A number of measurements, including PT, SS, TL, TK, T9SPi, T1SPi, and SVA were inaccurately simulated. Our preliminary algorithm improved the accuracy and decreased the variability of certain measurements, but requires future prospective studies for further validation.

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4

Tatavarty, Vedakumar, Sulagna Das, and Ji Yu. "Polarization of actin cytoskeleton is reduced in dendritic protrusions during early spine development in hippocampal neuron." Molecular Biology of the Cell 23, no. 16 (August 15, 2012): 3167–77. http://dx.doi.org/10.1091/mbc.e12-02-0165.

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Dendritic spines are small protrusions that receive synaptic signals in neuronal networks. The actin cytoskeleton plays a key role in regulating spine morphogenesis, as well as in the function of synapses. Here we report the first quantitative measurement of F-actin retrograde flow rate in dendritic filopodia, the precursor of dendritic spines, and in newly formed spines, using a technique based on photoactivation localization microscopy. We found a fast F-actin retrograde flow in the dendritic filopodia but not in the spine necks. The quantification of F-actin flow rates, combined with fluorescence recovery after photobleaching measurements, allowed for a full quantification of spatially resolved kinetic rates of actin turnover, which was not previously feasible. Furthermore we provide evidences that myosin II regulates the actin flow in dendritic filopodia and translocates from the base to the tip of the protrusion upon spine formation. Rac1 inhibition led to mislocalization of myosin II, as well as to disruption of the F-actin flow. These results provide advances in the quantitative understanding of F-actin remodeling during spine formation.

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5

Koh, Ingrid Y. Y., W. Brent Lindquist, Karen Zito, Esther A. Nimchinsky, and Karel Svoboda. "An Image Analysis Algorithm for Dendritic Spines." Neural Computation 14, no. 6 (June 1, 2002): 1283–310. http://dx.doi.org/10.1162/089976602753712945.

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The structure of neuronal dendrites and their spines underlie the connectivity of neural networks. Dendrites, spines, and their dynamics are shaped by genetic programs as well as sensory experience. Dendritic structures and dynamics may therefore be important predictors of the function of neural networks. Based on new imaging approaches and increases in the speed of computation, it has become possible to acquire large sets of high-resolution optical micrographs of neuron structure at length scales small enough to resolve spines. This advance in data acquisition has not been accompanied by comparable advances in data analysis techniques; the analysis of dendritic and spine morphology is still accomplished largely manually. In addition to being extremely time intensive, manual analysis also introduces systematic and hard-to-characterize biases. We present a geometric approach for automatically detecting and quantifying the three-dimensional structure of dendritic spines from stacks of image data acquired using laser scanning microscopy. We present results on the measurement of dendritic spine length, volume, density, and shape classification for both static and timelapse images of dendrites of hippocampal pyramidal neurons. For spine length and density, the automated measurements in static images are compared with manual measurements. Comparisons are also made between automated and manual spine length measurements for a time-series data set. The algorithm performs well compared to a human analyzer, especially on time-series data. Automated analysis of dendritic spine morphology will enable objective analysis of large morphological data sets. The approaches presented here are generalizable to other aspects of neuronal morphology.

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6

SARASTE, HELENA, BROSTRÖM, TOMAS APARISI, and GABRIELLA AXDORPH. "Radiographic Measurement of the Lumbar Spine." Spine 10, no. 3 (April 1985): 236–41. http://dx.doi.org/10.1097/00007632-198504000-00008.

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7

Horng, Ming-Huwi, Chan-Pang Kuok, Min-Jun Fu, Chii-Jen Lin, and Yung-Nien Sun. "Cobb Angle Measurement of Spine from X-Ray Images Using Convolutional Neural Network." Computational and Mathematical Methods in Medicine 2019 (February 19, 2019): 1–18. http://dx.doi.org/10.1155/2019/6357171.

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Scoliosis is a common spinal condition where the spine curves to the side and thus deforms the spine. Curvature estimation provides a powerful index to evaluate the deformation severity of scoliosis. In current clinical diagnosis, the standard curvature estimation method for assessing the curvature quantitatively is done by measuring the Cobb angle, which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermost vertebra involved and the lower endplate of the lowest vertebra involved. However, manual measurement of spine curvature requires considerable time and effort, along with associated problems such as interobserver and intraobserver variations. In this article, we propose an automatic system for measuring spine curvature using the anterior-posterior (AP) view spinal X-ray images. Due to the characteristic of AP view images, we first reduced the image size and then used horizontal and vertical intensity projection histograms to define the region of interest of the spine which is then cropped for sequential processing. Next, the boundaries of the spine, the central spinal curve line, and the spine foreground are detected by using intensity and gradient information of the region of interest, and a progressive thresholding approach is then employed to detect the locations of the vertebrae. In order to reduce the influences of inconsistent intensity distribution of vertebrae in the spine AP image, we applied the deep learning convolutional neural network (CNN) approaches which include the U-Net, the Dense U-Net, and Residual U-Net, to segment the vertebrae. Finally, the segmentation results of the vertebrae are reconstructed into a complete segmented spine image, and the spine curvature is calculated based on the Cobb angle criterion. In the experiments, we showed the results for spine segmentation and spine curvature; the results were then compared to manual measurements by specialists. The segmentation results of the Residual U-Net were superior to the other two convolutional neural networks. The one-way ANOVA test also demonstrated that the three measurements including the manual records of two different physicians and our proposed measured record were not significantly different in terms of spine curvature measurement. Looking forward, the proposed system can be applied in clinical diagnosis to assist doctors for a better understanding of scoliosis severity and for clinical treatments.

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8

Quint, Douglas J., Gerald F. Tuite, Joseph D. Stern, Steven E. Doran, Stephen M. Papadopoulos, John E. McGillicuddy, and Craig A. Lundquist. "Computer-assisted measurement of lumbar spine radiographs." Academic Radiology 4, no. 11 (November 1997): 742–52. http://dx.doi.org/10.1016/s1076-6332(97)80078-5.

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9

Lam, Wendy W. M., Victor Ai, Virginia Wong, Wai-man Lui, Fu-luk Chan, and Lilian Leong. "Ultrasound measurement of lumbosacral spine in children." Pediatric Neurology 30, no. 2 (February 2004): 115–21. http://dx.doi.org/10.1016/j.pediatrneurol.2003.07.002.

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10

Lee, Raymond. "Measurement of movements of the lumbar spine." Physiotherapy Theory and Practice 18, no. 4 (January 2002): 159–64. http://dx.doi.org/10.1080/09593980290058562.

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11

Bono, Christopher M., Alexander R. Vaccaro, Michael Fehlings, Charles Fisher, Marcel Dvorak, Steven Ludwig, and James Harrop. "Measurement Techniques for Lower Cervical Spine Injuries." Spine 31, no. 5 (March 2006): 603–9. http://dx.doi.org/10.1097/01.brs.0000201273.39058.dd.

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12

Bono, Christopher M., Alexander R. Vaccaro, Michael Fehlings, Charles Fisher, Marcel Dvorak, Steven Ludwig, and James Harrop. "Measurement Techniques for Upper Cervical Spine Injuries." Spine 32, no. 5 (March 2007): 593–600. http://dx.doi.org/10.1097/01.brs.0000257345.21075.a7.

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13

Vanneuville, Guy, Georges Poumarat, Jean-Jacques Vacheron, and Béatrice Ferry. "Measurement of spine movement from external markers." Journal of Biomechanics 27, no. 6 (January 1994): 818. http://dx.doi.org/10.1016/0021-9290(94)91382-x.

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14

Posłuszny, A., A. Myśliwiec, E. Saulicz, G. Mikołajowski, P. Linek, M. Saulicz, and Myśliwiec Andrzej. "Validation of the device for evaluation of muscular strength in the cervical spine region." Physiotherapy and Health Activity 23, no. 1 (December 1, 2015): 1–9. http://dx.doi.org/10.1515/pha-2015-0008.

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Abstract Background: In the physiotherapeutic practice, the need for measurements of e.g. range of motion or strength of the cervical spine muscles results from a variety of degenerative processes in the area of the head, cervical spine and shoulder girdle. In Poland, we designed a measurement stand based on the equipment described in foreign literature. Validation of the measurement stand was performed in order to determine the usefulness of this stand for measurements of maximal strength and muscle torques for the isometric contraction of the cervical spine muscles.Material/Methods: A group of 13 women was examined to validate the device. The criteria for inclusion into the study group were adult age, no back pain and head pain syndromes. Validation of the equipment consisted in the calculation of the intraclass correlation coefficient (ICC). Three measurements were performed for each movement in three planes: initial measurement (I), second measurement after 15 minutes (II) and the third measurement after a week (III). The ICC coefficient was calculated based on the methodology discussed in the study by Shrout and Fleiss (1979).Results: The results of the measurements reached the "excellent" level of the ICC coefficient between the first and the second test. In the case of the first and the third tests, the ICC coefficient reached the "good" level for the movements in the sagittal and transverse planes and the "excellent" level for the movements in the frontal plane. Conclusions: The measurement system used in the measurement stand designed by the authors of the present study can be successfully used for comparative studies of several groups or repeated examinations of the same study group after application of a specific therapeutic procedure.The stand cannot be used for evaluation whether the results obtained are consistent with the standards for specific populations or for comparison with the results obtained from other devices.

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15

Stothart, J. Peter, and Stuart M. McGill. "Stadiometry: on measurement technique to reduce variability in spine shrinkage measurement." Clinical Biomechanics 15, no. 7 (August 2000): 546–48. http://dx.doi.org/10.1016/s0268-0033(00)00003-6.

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16

Leroij, Olivier, Lennart Van der Veeken, Bettina Blaumeiser, and Katrien Janssens. "Pushing the Limits of Prenatal Ultrasound: A Case of Dorsal Dermal Sinus Associated with an Overt Arnold–Chiari Malformation and a 3q Duplication." Reproductive Medicine 2, no. 3 (July 9, 2021): 118–24. http://dx.doi.org/10.3390/reprodmed2030012.

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We present a case of a fetus with cranial abnormalities typical of open spina bifida but with an intact spine shown on both ultrasound and fetal MRI. Expert ultrasound examination revealed a very small tract between the spine and the skin, and a postmortem examination confirmed the diagnosis of a dorsal dermal sinus. Genetic analysis found a mosaic 3q23q27 duplication in the form of a marker chromosome. This case emphasizes that meticulous prenatal ultrasound examination has the potential to diagnose even closed subtypes of neural tube defects. Furthermore, with cerebral anomalies suggesting a spina bifida, other imaging techniques together with genetic tests and measurement of alpha-fetoprotein in the amniotic fluid should be performed.

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17

Spurway, Alan J., Chukwudi K. Chukwunyerenwa, Waleed E. Kishta, Jennifer K. Hurry, and Ron El-Hawary. "Sagittal Spine Length Measurement: A Novel Technique to Assess Growth of the Spine." Spine Deformity 4, no. 5 (September 2016): 331–37. http://dx.doi.org/10.1016/j.jspd.2016.03.002.

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18

Hsu, Chien-Jen, Yi-Wen Chang, Wen-Ying Chou, Chou-Ping Chiou, Wei-Ning Chang, and Chi-Yin Wong. "Measurement of spinal range of motion in healthy individuals using an electromagnetic tracking device." Journal of Neurosurgery: Spine 8, no. 2 (February 2008): 135–42. http://dx.doi.org/10.3171/spi/2008/8/2/135.

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Object The authors measured the range of motion (ROM) of the spine in healthy individuals by using an electromagnetic tracking device to evaluate the functional performance of the spine. Methods The authors used the Flock of Birds electromagnetic tracking device with 4 receiver units attached to C-7, T-12, S-1, and the midthigh region. Forward/backward bending, bilateral side bending, and axial rotation of the trunk were performed in 18 healthy individuals. Results The average ROM was calculated after 3 consecutive measurements. The thoracic spine generated the greatest angle in axial rotation and smallest angle in backward bending. The lumbar spine generated the greatest angle in forward bending and smallest angle in axial rotation. The hip joints generated the greatest angle in forward bending and smallest angle in backward bending. Additionally, 40% of forward-bending motion occurred in the lumbar spine and 40% occurred in the hip joints. Approximately 60% of backward bending occurred in the lumbar spine; 60% of axial rotation occurred in the thoracic spine; and 45% of side bending occurred in the thoracic spine. Conclusions The Flock of Birds electromagnetic tracking device cannot only measure the ROM of spine but also easily differentiate the 6-degree contributions by different segments.

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19

Bifulco, Paolo, Mario Cesarelli, Maria Romano, Antonio Fratini, and Mario Sansone. "Measurement of Intervertebral Cervical Motion by Means of Dynamic X-Ray Image Processing and Data Interpolation." International Journal of Biomedical Imaging 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/152920.

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Accurate measurement of intervertebral kinematics of the cervical spine can support the diagnosis of widespread diseases related to neck pain, such as chronic whiplash dysfunction, arthritis, and segmental degeneration. The natural inaccessibility of the spine, its complex anatomy, and the small range of motion only permit concise measurement in vivo. Low dose X-ray fluoroscopy allows time-continuous screening of cervical spine during patient’s spontaneous motion. To obtain accurate motion measurements, each vertebra was tracked by means of image processing along a sequence of radiographic images. To obtain a time-continuous representation of motion and to reduce noise in the experimental data, smoothing spline interpolation was used. Estimation of intervertebral motion for cervical segments was obtained by processing patient’s fluoroscopic sequence; intervertebral angle and displacement and the instantaneous centre of rotation were computed. The RMS value of fitting errors resulted in about 0.2 degree for rotation and 0.2 mm for displacements.

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20

Ellis, Henry B., Aaron J. Zynda, Aristides I. Cruz, Brant Sachleben, Catherine Sargent, Daniel W. Green, Drew E. Warnick, et al. "RELIABILITY IN RADIOGRAPHIC REVIEW OF TIBIAL SPINE FRACTURES IN A TIBIAL SPINE RESEARCH INTEREST GROUP." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (March 1, 2019): 2325967119S0006. http://dx.doi.org/10.1177/2325967119s00069.

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BACKGROUND: Variability that exists amongst the radiographic measurement parameters associated with tibial spine fractures may have direct consequences when comparing, reporting, or treating these injuries. In developing data collection of tibial spine fractures amongst multiple centers, it is important to establish reliability in radiographic parameters. Therefore, we designed a study to validate the classification and a proposed cohort of measurements of tibial spine fractures amongst multiple institutions to assist with standardizing fracture classification and treatment decisions. METHODS: Radiographic assessment of de-identified acute tibial spine fractures was performed by members of the Pediatric Research in Sports Medicine (PRISM) Tibial Spine Research Interest Group. A descriptive Powerpoint presentation was provided to each reviewer demonstrating specific measurements and classification prior to review. Reviewers were also asked to provide treatment recommendations. DICOM files were provided to the surgeon through a web-based shared drive and reviewers were required to use the same imaging software. There were 40 patients included, determined through power analysis performed based on previous reliability studies and the number of participants. Assuming the intraclass correlation coefficient (ICC) will be .85 and 95% confidence interval to be 0.2, the sample size of 40 will achieve the desired 95% confidence. Data will be reviewed using both kappa and ICC reliability measures due to both categorical and continuous data points. RESULTS: A majority of radiographic measures demonstrated moderate ICC including posterior-proximal displacement (0.378), length and height of tibial spine fracture (0.466 and 0.535, respectively), and superior displacement of medial fragment (0.420). Good ICC was seen with superior displacement of the anterior tibial spine fragment (0.734). Poor correlation was seen with the measurements for anterior displacement, posterior sagittal displacement, and roof inclination angle. Classifying tibial spine fractures according to the historical Meyer & McKeever Classification demonstrated fair agreement (kappa = 0.347). 18 of 40 (45%) fracture patterns were classified by reviewers in three or more different classifications types while only 1 fracture pattern (Type 1) was agreed upon by all reviewers. A majority of reviewers recommended arthroscopic treatment with suture for more fracture patterns. However, there was fair agreement with the initial treatment regarding operative versus closed reduction (kappa = 0.328). CONCLUSION: Measurement of superior displacement of anterior tibial spine fracture on the lateral images is the only radiographic assessment with good correlation or agreement amongst a group of surgeons in a Tibial Spine Research Group. Classification of tibial spine fractures did not demonstrate acceptable agreement. Further studies and classification methodology is needed to standardize fracture patterns and thereby study outcomes based on pattern and treatment.

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21

Coates, Laura C., and Philip S. Helliwell. "Disease measurement – enthesitis, skin, nails, spine and dactylitis." Best Practice & Research Clinical Rheumatology 24, no. 5 (October 2010): 659–70. http://dx.doi.org/10.1016/j.berh.2010.05.004.

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22

Brown, Mark D., David C. Holmes, and Anneliese D. Heiner. "Measurement of Cadaver Lumbar Spine Motion Segment Stiffness." Spine 27, no. 9 (May 2002): 918–22. http://dx.doi.org/10.1097/00007632-200205010-00006.

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23

Brown, Mark D., David C. Holmes, Anneliese D. Heiner, and Kathleen F. Wehman. "Intraoperative Measurement of Lumbar Spine Motion Segment Stiffness." Spine 27, no. 9 (May 2002): 954–58. http://dx.doi.org/10.1097/00007632-200205010-00014.

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24

Frank, Edmund H., David L. Chamberland, and Brian T. Ragel. "Instrumentation for intraoperative measurement of cervical spine stiffness." Neurological Research 18, no. 3 (June 1996): 217–19. http://dx.doi.org/10.1080/01616412.1996.11740407.

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25

Chong, Albert K., Peter Milburn, Richard Newsham-West, and Marieketer Voert. "High-accuracy photogrammetric technique for human spine measurement." Photogrammetric Record 24, no. 127 (September 2009): 264–79. http://dx.doi.org/10.1111/j.1477-9730.2009.00540.x.

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26

Takahashi, Takashi, David Polly, and Christopher T. Martin. "Three approaches to full-spine radiograph measurement reporting." Skeletal Radiology 48, no. 7 (January 28, 2019): 1103–4. http://dx.doi.org/10.1007/s00256-019-3157-z.

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27

Ma, Xiao-Hui, Wei Zhang, Yan Wang, Peng Xue, and Yu-Kun Li. "Comparison of the Spine and Hip BMD Assessments Derived from Quantitative Computed Tomography." International Journal of Endocrinology 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/675340.

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Quantification of bone mineral density (BMD) is being used as the main method to diagnose osteoporosis. Dual-energy X-ray absorptiometry (DXA) is the most common tools for measuring BMD. Compared to DXA, quantitative computed tomography (QCT) can determine in three dimensions the true volumetric BMD (vBMD) at any skeletal site. In addition to the spine, the hip is an important site for axial BMD measurement. This study examines lumbar spine and hip BMD of Chinese adults by QCT. Age related changes in bone mass derived by QCT measurements were determined. The osteoporosis QCT detection rates at the spine and hip are assessed in both female and male, and agreement of skeletal status category between the spine and hip in older adults is also assessed.

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MacIntyre, Norma J., Lisa Bennett, Alison M. Bonnyman, and Paul W. Stratford. "Optimizing Reliability of Digital Inclinometer and Flexicurve Ruler Measures of Spine Curvatures in Postmenopausal Women with Osteoporosis of the Spine: An Illustration of the Use of Generalizability Theory." ISRN Rheumatology 2011 (February 7, 2011): 1–8. http://dx.doi.org/10.5402/2011/571698.

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The study illustrates the application of generalizability theory (G-theory) to identify measurement protocols that optimize reliability of two clinical methods for assessing spine curvatures in women with osteoporosis. Triplicate measures of spine curvatures were acquired for 9 postmenopausal women with spine osteoporosis by two raters during a single visit using a digital inclinometer and a flexicurve ruler. G-coefficients were estimated using a G-study, and a measurement protocol that optimized inter-rater and inter-trial reliability was identified using follow-up decision studies. The G-theory provides reliability estimates for measurement devices which can be generalized to different clinical contexts and/or measurement designs.

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29

Peel, Nicola. "Measurement of Bone Mineral Density." British Menopause Society Journal 4, no. 2 (June 1998): 73–76. http://dx.doi.org/10.1177/136218079800400210.

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The development of techniques to measure BMD enables individuals at high risk of osteoporotic fracture to be identified, and their response to treatment to be ascertained. Measurement of the spine and proximal femur by DXA is currently the gold standard technique, but peripheral skeletal measurements using QUS and x-ray based techniques are under evaluation. At the present time measurements should be targeted to individuals within high risk categories in whom knowledge of BMD may influence management. Further development of both diagnostic and therapeutic strategies will require modification of current practice in the future.

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30

Digo, Elisa, Giuseppina Pierro, Stefano Pastorelli, and Laura Gastaldi. "Evaluation of spinal posture during gait with inertial measurement units." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 234, no. 10 (July 7, 2020): 1094–105. http://dx.doi.org/10.1177/0954411920940830.

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The increasing number of postural disorders emphasizes the central role of the vertebral spine during gait. Indeed, clinicians need an accurate and non-invasive method to evaluate the effectiveness of a rehabilitation program on spinal kinematics. Accordingly, the aim of this work was the use of inertial sensors for the assessment of angles among vertebral segments during gait. The spine was partitioned into five segments and correspondingly five inertial measurement units were positioned. Articulations between two adjacent spine segments were modeled with spherical joints, and the tilt–twist method was adopted to evaluate flexion–extension, lateral bending and axial rotation. In total, 18 young healthy subjects (9 males and 9 females) walked barefoot in three different conditions. The spinal posture during gait was efficiently evaluated considering the patterns of planar angles of each spine segment. Some statistically significant differences highlighted the influence of gender, speed and imposed cadence. The proposed methodology proved the usability of inertial sensors for the assessment of spinal posture and it is expected to efficiently point out trunk compensatory pattern during gait in a clinical context.

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31

Wong, Christian, Johanna Hall, and Kasper Gosvig. "The effects of rotation on radiological parameters in the spine." Acta Radiologica 60, no. 3 (June 17, 2018): 338–46. http://dx.doi.org/10.1177/0284185118780905.

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Background Vertebral rotation in straight spines or in spines with small scoliosis may potentially affect measurement of radiological parameters in both the frontal and sagittal plane. This is important, since it could lead to potential misdiagnosis of scoliosis and other clinical consequences, and until now, this has not been examined. Purpose To examine the effect of axial vertebral rotation of the spine on measurement of common radiological parameters. Material and Methods Reconstructions from computed tomography scans of 40 consecutive included and anonymized patients with straight spines or small scoliosis. Fourteen sagittal and coronal reconstructions covering the whole pelvis and spine were executed. Radiographic parameters in both the frontal and sagittal plane were measured blinded and separately by three doctors. These parameters were evaluated for inter-rater reliability using intraclass correlation coefficient and mixed model analysis for the effects of rotation. The parameters were also analyzed sub-stratified according to “Lenke's classification” and 15 sub-categories of thoracic and lumbar Cobb's angle (CA). Results Vertebral rotation in general does not have any significant effects in both the frontal and sagittal plane. However, there are significant effects on CA and spinopelvic radiologic parameters in extreme rotation or for larger scoliosis. Inter-rater reliability was very good to good. Conclusion In conclusion, axial spinal rotation does not influence common radiological parameters in the frontal and sagittal plane, except in cases of extreme rotation or large scoliosis for selected parameters; thus, this does not lead to potential misinterpretation in scoliosis diagnosis, treatment, or research.

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Haws, Brittany E., Benjamin Khechen, Mundeep S. Bawa, Dil V. Patel, Harmeet S. Bawa, Daniel D. Bohl, Adam B. Wiggins, Kaitlyn L. Cardinal, Jordan A. Guntin, and Kern Singh. "The Patient-Reported Outcomes Measurement Information System in spine surgery: a systematic review." Journal of Neurosurgery: Spine 30, no. 3 (March 2019): 405–13. http://dx.doi.org/10.3171/2018.8.spine18608.

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OBJECTIVEThe Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to provide a standardized measure of clinical outcomes that is valid and reliable across a variety of patient populations. PROMIS has exhibited strong correlations with many legacy patient-reported outcome (PRO) measures. However, it is unclear to what extent PROMIS has been used within the spine literature. In this context, the purpose of this systematic review was to provide a comprehensive overview of the PROMIS literature for spine-specific populations that can be used to inform clinicians and guide future work. Specifically, the authors aimed to 1) evaluate publication trends of PROMIS in the spine literature, 2) assess how studies have used PROMIS, and 3) determine the correlations of PROMIS domains with legacy PROs as reported for spine populations.METHODSStudies reporting PROMIS scores among spine populations were identified from PubMed/MEDLINE and a review of reference lists from obtained studies. Articles were excluded if they did not report original results, or if the study population was not evaluated or treated for spine-related complaints. Characteristics of each study and journal in which it was published were recorded. Correlation of PROMIS to legacy PROs was reported with 0.1 ≤ |r| < 0.3, 0.3 ≤ |r| < 0.5, and |r| ≥ 0.5 indicating weak, moderate, and strong correlations, respectively.RESULTSTwenty-one articles were included in this analysis. Twelve studies assessed the validity of PROMIS whereas 9 used PROMIS as an outcome measure. The first study discussing PROMIS in patients with spine disorders was published in 2012, whereas the majority were published in 2017. The most common PROMIS domain used was Pain Interference. Assessments of PROMIS validity were most frequently performed with the Neck Disability Index. PROMIS domains demonstrated moderate to strong correlations with the legacy PROs that were evaluated. Studies assessing the validity of PROMIS exhibited substantial variability in PROMIS domains and legacy PROs used for comparisons.CONCLUSIONSThere has been a recent increase in the use of PROMIS within the spine literature. However, only a minority of studies have incorporated PROMIS for its intended use as an outcomes measure. Overall, PROMIS has exhibited moderate to strong correlations with a majority of legacy PROs used in the spine literature. These results suggest that PROMIS can be effective in the assessment and tracking of PROs among spine populations.

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Pettigrew, David B., Chad J. Morgan, R. Brian Anderson, Philip A. Wilsey, and Charles Kuntz. "Virtual preoperative measurement and surgical manipulation of sagittal spinal alignment using a novel research and educational software program." Neurosurgical Focus 28, no. 3 (March 2010): E2. http://dx.doi.org/10.3171/2009.12.focus09283.

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Understanding regional as well as global spinal alignment is increasingly recognized as important for the spine surgeon. A novel software program for virtual preoperative measurement and surgical manipulation of sagittal spinal alignment was developed to provide a research and educational tool for spine surgeons. This first-generation software program provides tools to measure sagittal spinal alignment from the occiput to the pelvis, and to allow for virtual surgical manipulation of sagittal spinal alignment. The software was developed in conjunction with Clifton Labs, Inc. Photographs and radiographs were imported into the software program, and a 2D virtual spine was constructed from the images. The software then measured regional and global sagittal spinal alignment from the virtual spine construct, showing the user how to perform the measurements. After measuring alignment, the program allowed for virtual surgical manipulation, simulating surgical procedures such as interbody fusion, facet osteotomy, pedicle subtraction osteotomy, and reduction of spondylolisthesis, as well as allowing for rotation of the pelvis on the hip axis. Following virtual manipulation, the program remeasured regional and global sagittal spinal alignment. Computer software can be used to measure and manipulate sagittal spinal alignment virtually, providing a new research and educational tool. In the future, more comprehensive programs may allow for measurement and interaction in the coronal, axial, and sagittal planes.

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Segundo, Saulo de Tarso de Sá Pereira, Edgar Santiago Valesin Filho, Mario Lenza, Durval do Carmo Barros Santos, Laercio Alberto Rosemberg, and Mario Ferretti. "Interobserver reproducibility of radiographic evaluation of lumbar spine instability." Einstein (São Paulo) 14, no. 3 (September 2016): 378–83. http://dx.doi.org/10.1590/s1679-45082016ao3489.

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ABSTRACT Objective: To measure the interobserver reproducibility of the radiographic evaluation of lumbar spine instability. Methods: Measurements of the dynamic radiographs of the lumbar spine in lateral view were performed, evaluating the anterior translation and the angulation among the vertebral bodies. The tests were evaluated at workstations of the organization, through the Carestream Health Vue RIS (PACS), version 11.0.12.14 Inc. 2009© system. Results: Agreement in detecting cases of radiographic instability among the observers varied from 88.1 to 94.4%, and the agreement coefficients AC1 were all above 0.8, indicating excellent agreement. Conclusion: The interobserver analysis performed among orthopedic surgeons with different levels of training in dynamic radiographs of the spine obtained high reproducibility and agreement. However, some factors, such as the manual method of measurement and the presence of vertebral osteophytes, might have generated a few less accurate results in this comparative evaluation of measurements.

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Ritter, Rafael, Yoshinobu Nagasse, Iberê Ribeiro, Clovis Yamazato, Fabio Mastromauro de Oliveira, and René Kusabara. "COMPARISON OF COBB ANGLE MEASUREMENT IN SCOLIOSIS BY RESIDENTS AND SPINE EXPERTS." Coluna/Columna 15, no. 1 (March 2016): 13–16. http://dx.doi.org/10.1590/s1808-185120161501147274.

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ABSTRACT Objective: The adolescent idiopathic scoliosis (AIS) is a spine deformity that occurs in both the coronal plane and the sagittal plane of patients between 10 and 17 years. The Cobb method is the most widely used to determine the angular value of scoliosis and it is defined as the "gold standard". The goal is to verify the reproducibility of the measured angles between orthopedic residents and spinal pathologies specialists, comparing the variability of the angles measured by professionals with greater and lesser experience. Method: A total of 10 radiographs of patients diagnosed with AIS were assessed. Radiographs were handed over to 7 orthopedists specialized in spine and 14 orthopedic residents. The measurement of the angles for each of the examiners was described using means and standard deviations and intraclass correlations were calculated, as well as the measure of repeatability, and Bland-Altman plots were designed with the results of the measurements of each group of examiners, according to experience, to assess the agreement/reproducibility of Cobb angle measurements. Results: Each examiner obtained a resulting average of 10 cases summation. In order to assess trends in variability of the measurements of the angles of each group graphs were plotted based on the arithmetic mean of each of the 10 cases by the total number of participants in the group versus the standard deviation in each case. Conclusion: There was a poor correlation (ICC=0.4) in the measurement of Cobb in both groups, demonstrating difficulties in the method, which cannot be overcome by the expertise.

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Singh, Yashpal, Anchal Brar, Khurshid A. Mattoo, Manas Singh, Puneet Raj Singh Khurana, and Mayank Singh. "Clinical Reliability of Different Facial Measurements in Determining Vertical Dimension of Occlusion in Dentulous and Edentulous Subjects." International Journal of Prosthodontics and Restorative Dentistry 4, no. 3 (2014): 68–77. http://dx.doi.org/10.5005/jp-journals-10019-1110.

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ABSTRACT Purpose To determine the variations in average distances between various facial landmarks used to determine the vertical dimension of rest and occlusion among dentulous and edentulous subjects. Besides determining the reliability of these facial measurements against commonly used Chin-Nose distance, this study would also compare the difference between cephalometric landmarks (anterior nasal Spine-Menton) with the Chin-Nose distance (Niswonger's method). Materials and methods To standardize the measurement and minimize errors associated with observer and subject movement, a novel instrument was designed in the form of an apparatus and was named as subject and device stabilizing apparatus (SDSA). One hundred and twenty subjects, in the age group of 30 to 60 years, were selected and divided into two equal groups which were further subdivided into subgroups. Measurements were recorded with the help of a digital vernier that was attached to the apparatus. The various facial measure- ments studied were Pupil-Stomion, Glabella-Subnasion, Pupil-Pupil and Angle-Angle both at rest and in occlusion. These measurements were then compared with Chin-Nose and anterior nasal Spine-Menton distance. Differences between the dentulous and edentulous subjects at rest and at occlusion were noted and statistically analyzed using unpaired ‘t’ test and Karl Pearson correlation coefficient. Results Among the six measurements Chin-Nose, Glabella- Subnasion, Pupil-Stomion and anterior nasal Spine-Menton were closely associated between dentulous and edentulous subjects both at rest and at occlusion. Among all facial and cephalometric measurement the facial parameter of Pupil- Stomion illustrates the least deviation in edentulous (1.318) and dentulous (1.381) subjects at rest, whereas anterior nasal Spine-Menton displays least deviation in edentulous (2.751) and dentulous (1.224) subjects at occlusion. Conclusion The average facial measurements in dentulous subjects were more than measurements in edentulous subjects and among various facial measurements, Pupil-Stomion and anterior nasal Spine-Menton distance can be used clinically as a guide to verify vertical dimension of occlusion. How to cite this article Brar A, Mattoo KA, Singh Y, Singh M, Khurana PRS, Singh M. Clinical Reliability of Different Facial Measurements in Determining Vertical Dimension of Occlusion in Dentulous and Edentulous Subjects. Int J Prosthodont Restor Dent 2014;4(3):68-77.

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Marques, Catarina, Emma Granström, Anna MacDowall, Nuno Canto Moreira, Martin Skeppholm, and Claes Olerud. "Accuracy and Reliability of X-ray Measurements in the Cervical Spine." Asian Spine Journal 14, no. 2 (April 30, 2020): 169–76. http://dx.doi.org/10.31616/asj.2019.0069.

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Study Design: This study is a post hoc analysis of a multicenter prospective randomized controlled trial which compared artificial disc replacement and anterior cervical discectomy and fusion.Purpose: Useful radiographic parameters for assessing cervical alignment include the Cobb angles, T1 slope (T1S), occipitocervical inclination (OCI), K-line tilt (KLT), and cervical sagittal vertical axis (cSVA). This study aimed to determine measurement accuracy and reliability for these parameters.Overview of Literature: Various authors have assessed repeatability by comparing different methods of measurement, but knowledge of measurement error and minimal detectable change is scarce.Methods: We evaluated 758 lateral cervical radiographs. One medical student and one spine surgeon (i.e., measured ×2 within 4 weeks) independently measured the parameters obtaining 5,850 values. Standard error of measurement (SEm) and minimum detectable change (MDC) were calculated for each parameter. The accuracy and reliability of the Cobb angle measurements were calculated for the different types of angles: cervical lordosis, prosthesis angle, segmental angle with two bone surfaces (SABB), and segmental angle with one bone and one metal surface. Reliability was determined with intraclass correlation coefficient (ICC).Results: SEm was 1.8° and MDC was 5.0° for the Cobb angle, with an intraobserver/interobserver ICC of 0.958/0.886. All the different subtypes of Cobb angles had an ICC higher than 0.950, except SABB (intraobserver/interobserver ICC of 0.922/0.716). The most accurate and reliable measurement was for KLT.Conclusions: This study provides normative data on SEm and MDC for Cobb angles, T1S, KLT, OCI, and cSVA in cervical lateral radiographs. Reliability was excellent for all parameters except SABB (e.g., good).

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Ishii, S., S. Kawabata, K. Sakaki, S. Tomizawa, K. Shinomiya, A. Okawa, Y. Adachi, et al. "P33-26 Neuromagnetic field measurement in the lumbar spine." Clinical Neurophysiology 121 (October 2010): S305. http://dx.doi.org/10.1016/s1388-2457(10)61245-x.

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Vogt, L., and W. Banzer. "Measurement of lumbar spine kinematics in incline treadmill walking." Gait & Posture 9, no. 1 (March 1999): 18–23. http://dx.doi.org/10.1016/s0966-6362(98)00038-1.

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Ungi, Tamas, Hastings Greer, Kyle R. Sunderland, Victoria Wu, Zachary M. C. Baum, Christopher Schlenger, Matthew Oetgen, Kevin Cleary, Stephen R. Aylward, and Gabor Fichtinger. "Automatic Spine Ultrasound Segmentation for Scoliosis Visualization and Measurement." IEEE Transactions on Biomedical Engineering 67, no. 11 (November 2020): 3234–41. http://dx.doi.org/10.1109/tbme.2020.2980540.

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Moffett, Jennifer A. Klaber, Iona Hughes, and Paul Griffiths. "Measurement of Cervical Spine Movements Using a Simple Inclinometer." Physiotherapy 75, no. 6 (June 1989): 309–12. http://dx.doi.org/10.1016/s0031-9406(10)62543-6.

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Raynak, G. C., D. J. Nuckley, A. F. Tencer, and R. P. Ching. "Transducers for Dynamic Measurement of Spine Neural-Space Occlusions." Journal of Biomechanical Engineering 120, no. 6 (December 1, 1998): 787–91. http://dx.doi.org/10.1115/1.2834895.

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De Biasio, P., G. Ginocchio, M. Vignolo, G. Ravera, P. L. Venturini, and G. Aicardi. "Spine length measurement in the first trimester of pregnancy." Prenatal Diagnosis 22, no. 9 (2002): 818–22. http://dx.doi.org/10.1002/pd.428.

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Banta, Charles J., Andrew G. King, Eugene J. Dabezies, and Robert L. Liljeberg. "Measurement of Effective Pedicle Diameter in the Human Spine." Orthopedics 12, no. 7 (July 1989): 939–42. http://dx.doi.org/10.3928/0147-7447-19890701-06.

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Choi, Hyehoon, So-youn Chang, Jaewan Yoo, Seong Hoon Lim, Bo Young Hong, and Joon Sung Kim. "Correlation Between Duration From Injury and Bone Mineral Density in Individuals With Spinal Cord Injury." Annals of Rehabilitation Medicine 45, no. 1 (February 28, 2021): 1–6. http://dx.doi.org/10.5535/arm.20169.

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Objective To investigate the correlation between bone mineral density (BMD) and duration of injury in individuals with spinal cord injury (SCI).Methods Patients with SCI who visited the outpatient department between January 2009 and January 2019 were enrolled. Patients’ most recent dual energy X-ray absorptiometry images were reviewed. According to the 2007 International Society for Clinical Densitometry guidelines, vertebrae with a local structural change were excluded when deriving spine BMD. If one or no vertebra is suitable for evaluation, spine BMD was judged as “improper for assessment”. Correlation analysis was performed between duration from injury and BMD Z-scores of the hip and spine.Results Among 83 individuals with SCI, the spines of 44 were judged as improper for assessment. The correlation analysis showed a significant negative relationship between the duration from injury and femur neck BMD (r=-0.40, p<0.01) and total proximal femur BMD (r=-0.39, p<0.01). However, no significant correlation was found between the duration from injury and spine BMD Z-score.Conclusion The duration of SCI correlated with hip BMD, but not with spine BMD. Further, more than half of the individuals with SCI could not undergo spinal assessment due to local structural changes. Therefore, spine BMD measurement is not an appropriate method for predicting future fracture risk in those with SCI.

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Ravindra, Vijay M., Jay Riva-Cambrin, Kevin P. Horn, Jason Ginos, Russell Brockmeyer, Jian Guan, John Rampton, and Douglas L. Brockmeyer. "A 2D threshold of the condylar–C1 interval to maximize identification of patients at high risk for atlantooccipital dislocation using computed tomography." Journal of Neurosurgery: Pediatrics 19, no. 4 (April 2017): 458–63. http://dx.doi.org/10.3171/2016.10.peds16459.

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OBJECTIVE Measurement of the occipital condyle–C1 interval (CCI) is important in the evaluation of atlantooccipital dislocation (AOD) in pediatric trauma patients. The authors studied a large cohort of children with and without AOD to identify a 2D measurement threshold that maximizes the diagnostic yield of the CCI on cervical spine CT scans obtained in trauma patients. METHODS This retrospective, single-center study included all children who underwent CT of the cervical spine at Primary Children's Hospital from January 1, 2011, through December 31, 2014, for trauma evaluation. Bilateral CCI measurements in the coronal (3 measurements per side) and sagittal (4 measurements per side) planes were recorded. Using an iterative method, the authors determined optimal cutoffs for the maximal CCI in each plane in relation to AOD. The primary outcome was AOD requiring occipitocervical fusion. RESULTS A total of 597 pediatric patients underwent cervical spine CT for trauma evaluation: 578 patients without AOD and 19 patients with AOD requiring occipitocervical fusion. The authors found a statistically significant correlation between CCI and age (p < 0.001), with younger patients having higher CCIs. Using a 2D threshold requiring a sagittal CCI ≥ 2.5 mm and a coronal CCI ≥ 3.5 mm predicted AOD with a sensitivity of 95%, a specificity of 73%, positive predictive value of 10.3%, and negative predictive value of 99%. The accuracy of this 2D threshold was 84%. CONCLUSIONS In the present study population, age-dependent differences in the CCI were found on CT scans of the cervical spine in a large cohort of patients with and without AOD. A 2D CCI threshold as a screening method maximizes identification of patients at high risk for AOD while minimizing unnecessary imaging studies in children being evaluated for trauma.

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Eriksson, S., B. Isberg, and U. Lindgren. "Vertebral Bone Mineral Measurement Using Dual Photon Absorptiometry and Computed Tomography." Acta Radiologica 29, no. 1 (January 1988): 89–94. http://dx.doi.org/10.1177/028418518802900118.

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The lumbar spine of 14 cadavers was studied both by 153Gd dual photon absorptiometry (DPA) and quantitative computed tomography (QCT) at 96 and 125 kVp. The intact spine and the individual vertebrae were analyzed. After these measurements the ash content of the vertebral body, the posterior elements, and the transverse processes was determined. The fat content of the vertebral body as well as its volume was also measured. With DPA, the bone mineral content (BMC) determined in situ as well as on excised spine specimens correlated highly with the amount of total vertebral ash (r>0.92, SEE<3.2 g). The bone mineral density (BMD, area density) of 3 lumbar vertebrae correlated accurately with the mean ash density of the vertebral body (r>0.81, SEE<0.015 g/cm3). The so-called corpus density and central density determinations were less accurate. No difference in accuracy was found between measurements when using 3 mm and 4.5 mm step intervals. Variations in the distribution of mineral between the vertebral body and the posterior elements contribute to the error in predicting vertebral body mineral with DPA. QCT gave a smaller error when a cylindric portion of the vertebral body with a 20 mm diameter was measured compared with one with a 9 mm diameter, when the dual energy technique was used (p<0.01). With dual energy QCT a correlation was found between a center segment of 3 vertebrae in the lumbar spine and the mean ash density of the vertebral body of r=0.92 (SEE=0.010 g/cm3). Single energy QCT was insignificantly less accurate than dual energy QCT. Only small differences were found between vertebrae with high fat density of the vertebral body when single or dual QCT was used. QCT was more accurate than DPA in the prediction of the mineral density of individual vertebral bodies (p<0.05) but no difference was found when the average values for the lumbar spine were calculated.

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Scott, JK, and SM Morrison. "Variation in Populations of Tribulus terrestris (Zygophyllaceae) .1. Burr Morphology." Australian Journal of Botany 44, no. 2 (1996): 175. http://dx.doi.org/10.1071/bt9960175.

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Variation in bun morphology was investigated as part of a study to identify the origins of the widespread weed and potential biological control target Tribulus terrestris L. s.1. (Zygophyllaceae). Measurements were made of four size variables, four spine angles and the number of seeds in each bun from 31 Australian and overseas collection sites. Cluster analysis using all variables (valid for 26 collection sites) identified four groups of burrs, one of which contained a single site from Israel that differed due to the angle of the spines. All 31 sites were included by removing the measurement of the basal spine, which is sometimes absent from burrs. Four clusters were found on reanalysis. The minimum number of variables that produced the four clusters were length and width of burrs and abaxial spine length. Most southern Australian sites were grouped with southern African, Indian and Israeli sites. Three Western Australian sites formed one group, as did Northern Territory and Queensland sites. A fourth group included one site each from Australia, Iran, Israel and USA. The relationship between base length and width of the bun distinguished the probably native northern Australian collections, which have either more squat or more elongate burrs, from the probably introduced populations of T. terrestris in southern Australia. However, analysis of morphological variation only approximately detected groupings within the southern Australian and overseas collections that were subsequently identified by isozyme and cytogenetic studies.

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Mason, Catherine, and Matt Greig. "Lumbar Spine Loading During Dressage Riding." Journal of Sport Rehabilitation 29, no. 3 (March 1, 2020): 315–19. http://dx.doi.org/10.1123/jsr.2019-0266.

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Context: Lower back pain is prevalent in horse riders as a result of the absorption of repetitive and multiplanar propulsive forces from the horse. Global positioning system technology provides potential for in vivo measurement of planar loading during riding. Objective: To quantify the uniaxial loading at the lumbar and cervicothoracic spine during dressage elements. Design: Repeated measures, randomized order. Setting: Equestrian arena. Patients (or Other Participants): Twenty-one female dressage riders. Intervention(s): Each rider completed walk, rising trot, sitting trot, and canter trials in a randomized order. A global positioning system unit was placed within customized garments at C7 and L5, collecting triaxial accelerometry data at 100 Hz. Outcome Measures: PlayerLoad based on the rate of change of acceleration and calculated in the anteroposterior (AP), mediolateral, and vertical planes during each trial. Results: There was no significant main effect for global positioning system location in the AP (P = .76), mediolateral (P = .88), or vertical (P = .76) planes. There was a significant main effect for pace in all trials (P < .001), with successive elements eliciting significantly greater loading (P ≤ .03) in all planes in the order walk < rising trot < canter < sitting trot. There was a significant placement × element interaction only in the AP plane (P = .03) with AP loading greater at L5 during walk, rising trot, and canter trials, but greater at C7 during sitting trot. Conclusions: The significant main effect for dressage element was indicative of greater pace of the horse, with faster pace activities eliciting greater loading in all planes. In vivo measurement of spinal accelerometry has application in the objective measurement and subsequent management of lumbar load for riders.

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Ellis, Henry B., Aaron J. Zynda, Aristides Cruz, Brant Sachleben, Catherine Sargent, Daniel Green, Drew Warnick, et al. "RE-TRAINING IS INEFFECTIVE IN IMPROVING RELIABILITY OF TIBIAL SPINE MEASUREMENTS AND CLASSIFICATION." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0019. http://dx.doi.org/10.1177/2325967120s00192.

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Background: Treatment decisions for patients with tibial spine fractures heavily rely on radiographic measurements. Therefore, it is important to establish reliability of these parameters to assist with standardizing classification and subsequent treatment decisions. Purpose: To improve upon and subsequently validate a proposed measurement system following a live, in-person case review, re-training, and implementation of a new classification of tibial spine fractures. Methods: Following unacceptable classification reliability amongst the tibial spine research interest group when using the original Meyers & McKeever (M&M) classification, a one-hour, live, in-person case review (n=10) of tibial spine fractures with collective agreement on measurements and classification was performed. Based on discussion, a modification of the original M&M classification was developed to specifically define verbiage that lead to unacceptable variance in the original reliability testing. These included a quantitative definition of posterior hinge and the presence of comminution (Figure 1). New reference guidelines were provided to each reviewer demonstrating specific measurements and modified M&M classification prior to subsequent case review along with a new set of randomized, de-identified images. Forty subjects were included, determined as a precedent based on previous reliability studies. Data were analyzed using kappa and ICC for categorical and continuous variables, respectively. Results: Overall, data from 6 surgeon raters were included on a total of 40 cases. Amongst these raters, all variables demonstrated poor interobserver reliability: maximal posterior displacement (ICC=0.23, 95% CI=0.11-0.38), modified M&M classification (Cohen’s Kappa=0.25), amount of comminution (Cohen’s Kappa=0.27), and recommended treatment (Cohen’s Kappa=0.19). Conclusion: Reliability of radiographic measurements and a modified classification for tibial spine fractures remains unacceptable even amongst a group of surgeon experts. A new classification schema may be needed to help reliably guide treatment decisions for patients with tibial spine fractures. [Figure: see text]

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