Conjoined nerve roots of the lumbar spine

Background contextConjoined nerve roots are a relatively uncommon finding but are frequently undiagnosed on preoperative imaging studies. The presence of a conjoined root anomaly represents a significant potential for neurologic injury when nerve root mobilization is necessary during spinal procedures.PurposeThis comprehensive review of conjoined lumbar nerve roots encompasses preoperative diagnosis by physical examination and radiographic imaging studies, as well as the intraoperative management of conjoined nerve roots.Study designSystematic review of existing literature.ResultsFindings have been described on standard magnetic resonance imaging (MRI) and computed tomography imaging to increase preoperative diagnosis rates. The literature lacks concrete recommendations regarding intraoperative techniques for conjoined root identification and management.ConclusionsPreoperative recognition and diagnosis of this anomaly has proven to be the best way to improve the chances of a successful procedure and avoid inadvertently damaging the nerve roots intraoperatively. Several radiographic signs of conjoined lumbar nerve roots have been described using standard MRI techniques including coronal T1- and T2-weighted sequences. Intraoperative management of conjoined nerve roots has not changed significantly since they were first identified, although diagnostic accuracy has improved with advanced MRI techniques.     

伴有马尾神经松弛影像学改变的腰椎椎管狭窄症患者手术疗效

目的探讨伴马尾神经松弛影像学改变的腰椎椎管狭窄症患者的临床特征及手术效果。方法收集2016年9月—2017年9月接受手术治疗的16例影像学上存在马尾神经松弛改变的腰椎椎管狭窄症患者的临床及影像学资料。16例患者腰椎MRI均可见狭窄节段上方马尾神经迂曲成团,均行常规腰椎后路椎板减压椎间植骨融合内固定术治疗,其中3例患者因术中硬膜撕裂行硬膜内探查。记录所有患者术前与术后3个月的日本骨科学会(JOA)评分评估手术疗效。结果所有患者术后腰痛及下肢放射痛等症状均缓解,无并发症发生。3例患者硬膜内探查可见马尾神经迂曲成团,无粘连及占位。16例患者术后3个月JOA评分为9～14(12.56±0.75)分,较术前4～9(7.44±0.73)分明显改善,差异有统计学意义(P 0.05)。其中6例患者术后3个月复查腰椎MRI,显示马尾神经迂曲成团现象消失。结论马尾神经松弛是腰椎椎管狭窄症发展进程的一部分,椎管内马尾神经迂曲成团是导致其影像学改变的原因。治疗腰椎原发病可以获得较好的治疗效果,不需要松解马尾神经,也不必担心马尾神经松弛现象。     

The diameters and number of nerve fibers in spinal nerve roots

Abstract

Objective

To investigate the anatomical and histological features of spinal nerve roots and provide base data for neuroanastomosis therapy for paraplegia.

Methods

Spinal nerve roots from C1 to S5 were exposed on six adult cadavers. The diameter and the number of nerve fibers of each nerve root were measured, respectively, with a caliper and image analysis software.

Results

As for ventral roots, the diameter of C5 (2.50 ± 0.55 mm) was the largest in cervical segments. In thoracic and lumbosacral segments, the diameter gradually increased from T11 to S1 and then decreased from S1 to S5 except L3. S1 (1.43 ± 0.16 mm) was the thickest root and S5 (0.14 ± 0.02 mm) was the thinnest one. As for dorsal roots, the diameter of C7 (4.61 ± 0.87 mm) was the largest in cervical segments. From T11 to S1, the diameter increased and then decreased gradually from S1 to S5. The diameter of dorsal roots from T1 to S5 was largest at S1 (2.95 ± 0.57 mm) and smallest at S5 (0.27 ± 0.13 mm), respectively. C7 (8467 ± 1019), T12 (6538 ± 892), L3 (9169 ± 1160), and S1 (8253 ± 1419) ventral roots contained the most nerve fibers in cervical, thoracic, lumbar, and sacral segments, respectively. Similarly, C7 (39 653 ± 8458), T1 (26 507 ± 7617), L5 (34 455 ± 2740), and S1 (41 543 ± 3036) dorsal roots, respectively, contained the most nerve fibers in their corresponding segments.

Conclusion

The findings in the current study provided the imperative data and may be valuable for spinal nerve root microanastomosis surgery in the paraplegic patients.     

Diagnostic value of 3D fast imaging employing steady-state acquisition MR imaging for lumbar foraminal nerve root entrapment

Background and purpose

Conventional magnetic resonance imaging (MRI) may fail to diagnose lumbar foraminal nerve root entrapment (LFNRE). Recently, it has been reported that three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) is useful for demonstrating the cranial nerves and spinal cord. However, its application to lumbar nerve root has not been investigated. The purpose of this study was to evaluate the usefulness of 3D FIESTA in the diagnosis of LFNRE.

Subjects and methods

We retrospectively selected 33 male patients, with an average age of 51.6 years, who met the following criteria: (1) single L4 or L5 radiculopathy, (2) pain reproduction during provocative radiculography, and (3) improvement of symptoms after surgery. In all patients, LFNRE was observed at surgery. There were 15 cases with lumbar foraminal stenosis (LFS), 12 cases with lateral disc herniation (LDH), and 6 cases with spondylolytic listhesis (SL). We compared the symptomatic nerve root to the asymptomatic nerve roots on conventional two-dimensional MRI and 3D FIESTA images.

Results

In the symptomatic nerve roots, visualization of entrapment by conventional MRI was demonstrated in 60, 92, and 33 % of the cases with LFS, LDH, and SL, respectively. In contrast, 3D FIESTA clearly visualized the entrapment in all cases.

Conclusions

3D FIESTA imaging revealed an excellent view of the lumbar nerve roots, compared with conventional MRI. Therefore, we suggest that 3D FIESTA adds additional and more specific information for the investigation of LFNRE.     

Intraoperative electromyographic techniques for the decision-making of tumor-involved nerve root resection for treating spinal schwannomas

BACKGROUND CONTEXTTotal removal of spinal schwannomas is ideal but it sometimes requires tumor-involved root resection, which increases the risk of postoperative motor deterioration (PMD). Therefore, it is important for clinicians to predict the impact of tumor-involved root resection on motor function in spinal schwannomas.PURPOSETo investigate the role of intraoperative electromyographic (EMG) techniques in decision-making of tumor-involved root resection for treating spinal schwannomas.STUDY DESIGNA retrospective analysisPATIENT SAMPLESixty-eight patients with spinal schwannomas arising from C5-T1 or L3-S1 roots underwent total resection of schwannoma, including tumoral root.OUTCOME MEASURESNerve root activation threshold, free-running EMG signals, visual analogue scale, and American Spinal Injury Association scale.METHODSDuring evoked EMG, nerve root activation threshold for tumoral root stimulation was recorded from muscles anatomically corresponding to tumoral root. During free-running EMG, abnormal EMG signals were identified as irregularly recurrent, monomorphic signals, low frequency (<5 Hz) or absent discharges recorded from muscles innervated by tumoral root. Clinical assessments were performed before, 3 to 5 day's and six months’ after operation.RESULTSSixteen (16 of 68, 23.5%) patients showed PMD, and muscle strength improved or was not affected in the other 52 patients. Absent myogenic responses were observed in 19 patients with non–PMD, and nerve root activation threshold in non–PMD group was higher than that in PMD group (p<.05). Receiver operating characteristic curve revealed that cut-off value of nerve root activation threshold for distinguishing functional and nonfunctional roots was 11.8 mA. A larger number of patients without PMD than with PMD showed abnormal free-running EMG signals (p<.05). At postoperative 6-months’ follow-up, ten patients with muscle weakness after tumor-involved root resection showed functional recovery (full vs. partial recovery: 5 vs. 5), and intraoperative nerve root activation threshold in these patients was higher than that in the other patients without functional recovery (p<.05). Furthermore, there is negative relationship between the duration for full recovery and nerve root activation threshold (p<.05).CONCLUSIONSBoth evoked and free-running EMG can be used as supplementary tests for differentiating functional and nonfunctional tumoral roots in spinal schwannomas, and nerve root activation threshold may be also related to prognosis of patients with muscle weakness caused by tumor-involved root resection. Therefore, intraoperative EMG techniques may provide additional references in decision-making of tumor-involved root resection.     

The feasibility study of extradural nerve anastomosis technique for canine bladder reinnervation after spinal cord injury

Objective: Intradural nerve anastomosis for bladder innervation has been demonstrated to be useful. However, its clinical application remains limited because of the complex surgery, its complications and extensive bony destruction. The purpose of the current study was to demonstrate the feasibility of extradural spinal root anastomosis for bladder innervation in canines.

Methods: Ten beagle dogs were used. The length of the extradural segment of the nerve root, upper nerve root outlet (the point at which it emerges from the spinal dura mater) to S2 (dS2), the S3 (dS3) nerve root outlet distance, and the diameters of the extradural spinal roots were measured. The numbers of nerve fibers from L6 to S3 ventral roots were calculated using immunohistochemical staining.

Results: The extradural spinal roots could be divided into a ventral root (VR) and a dorsal root (DR) before the ganglionic enlargement of the dorsal root, and the extradural motor nerve roots situate ventrally to their corresponding sensory nerve roots. The extradural nerve root lengths of S1 and parts of L7 were longer than the corresponding dS2. The numbers of nerve and motor nerve fibers, and the diameters of extradural nerve roots, were gradually descending from L6 to S3.

Conclusion: The S1 VRs and parts of the L7 VRs can be extradurally anastomosed to the S2 nerves without tension. A nerve graft was needed for extradural anastomosis of L6 VRs and parts of L7 VRs to S2 VRs. This study demonstrated the feasibility of extradural spinal nerve anastomosis for treating neurogenic bladder in canines.     

Costs analysis and comparison of usefulness of acute MRI and 2 weeks of cast immobilization for clinically suspected scaphoid fractures

Background and purpose — Fractures of the scaphoid are often not detected on initial plain radiographs. Conventional management of clinically suspected scaphoid fractures is cast immobilization for 2 weeks and then reassessment. Early MRI is a diagnostic alternative. We compared the cost and usefulness of the early MRI diagnostic strategy with that of conventional management.

Patients and methods — This prospective pseudo-randomized study included patients between 18 and 49 years of age who attended Bergen Accident and Emergency Department, Bergen, Norway during 1 year in 2009–2010, after sustaining an acute wrist trauma in the previous week and with a clinically suspected scaphoid fracture. 61 patients were investigated with acute MRI, while 63 patients received standard treatment as a control group. We used cost-minimization analysis to estimate the cost of the 2 patient groups.

Results — Concerning cost, there were no statistically significant differences in the total direct medical costs or in indirect costs between the groups. Concerning usefulness, patients in the MRI group without a fracture (n = 35) used a cast for fewer days (mean 1 day) than patients in the control group with no fractures (n = 52) (mean 14 days; p < 0.001). They had less than half the number of days on sick leave than patients in the control group (mean 7 days vs. 15 days; p = 0.002).

Interpretation — In a Norwegian setting, an early MRI was of value in patients with clinically suspected scaphoid fracture and normal plain radiographs.     

超声引导下选择性颈神经根阻滞在肩关节镜术后镇痛中的应用

目的比较超声引导下选择性颈神经根阻滞与传统肌间沟臂丛阻滞在肩关节镜术后镇痛的应用效果。方法择期行肩关节镜手术全麻患者70例,男25例,女45例,年龄18~75岁,随机分为两组,选择性颈神经根阻滞组(S组)和传统肌间沟臂丛阻滞组(ISB组),每组35例。S组在超声引导下分别给予C5、C6神经根0.5%罗哌卡因各5ml;ISB组在超声引导下给予0.5%罗哌卡因10ml。记录神经阻滞起效时间;记录术后4、12、24h的VAS评分和前臂(屈肘、屈腕、屈指)MBS运动评分;记录术后24h曲马多用量,以及患者满意度和不良反应发生情况。结果 S组起效时间明显短于ISB组[(8.24±2.96)min vs(13.85±7.45)min,P0.01];S组术后12h的VAS评分明显低于ISB组[(1.7±0.8)分vs(3.6±0.7)分,P0.05],术后4h前臂(屈肘、屈腕、屈指)MBS运动评分明显高于ISB组[(3.5±0.6)分vs(0.8±0.3)分,(3.4±0.5)分vs(0.9±0.4)分,(3.6±0.6)分vs(0.7±0.4)分,P0.01];术后24h曲马多用量明显少于ISB组[(37.5±35.9)mg vs(112.5±43.5)mg,P0.05],患者满意率明显高于ISB组(88%vs 56%,P0.05),术后不良反应两组差异无统计学意义。结论在肩关节镜手术后镇痛中,超声引导下选择性颈神经根阻滞优于臂丛神经阻滞。     

选择性神经根阻滞术在老年人多节段腰椎椎管狭窄症诊断中的应用

目的 探讨选择性神经根阻滞术对多节段腰椎椎管狭窄症的诊断意义及临床价值.方法 回顾分析2008年5月～2011年2月收治的多节段腰椎椎管狭窄症患者42例,所有患者均采用选择性神经根阻滞术明确责任节段.根据责任节段行相应的选择性椎板开窗减压、椎间盘摘除、椎弓根螺钉内固定、后路腰椎椎体间植骨融合术.随访并比较患者术前及术后3个月、6个月、末次随访时日本骨科学会（Japanese Orthopaedic Association,JOA）及疼痛视觉模拟量表（visual analogue scale,VAS）评分,并依据Nakai分级标准对手术效果进行评价.结果 术后随访12～36个月,平均19个月,选择性神经根阻滞术明确单节段责任节段32例,双节段9例,有1例在神经根阻滞后症状缓解＜30％,未再行手术治疗.41例手术均顺利完成,均未发生神经损伤等并发症.患者术后3个月、术后6个月及末次随访时VAS评分、JOA评分较术前明显改善,差异有统计学意义（P＜0.01）.按照Nakai分级标准评定：本组41患者中,优22例、良14例、可5例,总优良率为87.8％.结论 在多节段腰椎椎管狭窄症的定位诊断中,选择性神经根阻滞术是明确责任节段准确而有效的方法,具有良好的临床应用价值.     

转染NGF基因的Schwann细胞对慢性神经根嵌压伤后神经修复的作用

目的观察转染NGF基因的Schwann细胞（SCs）在慢性神经根嵌压伤后神经修复中的作用。方法建立大鼠腰神经根慢性嵌压伤的动物模型,体外培养、纯化SCs并转染NGF基因,检测基因表达后种植于神经根嵌压伤处,术后2周处死动物切取神经根组织,行western blot、组织形态学及免疫组织化学检测。结果转染NGF的SCs可以在体内长期存活并形成新的髓鞘,较生理盐水对照组及单纯SCs组显著促进慢性神经根嵌压伤后的神经修复。结论转染NGF基因的SCs在慢性神经根嵌压伤后的神经修复中具有显著的促进作用,为慢性神经损伤的基因治疗提供了新的方法。     

选择性神经根阻滞在腰椎有限手术中的应用

目的：总结选择性神经根阻滞在腰椎有限手术中的临床应用结果。方法：2008年1月至2012年10月,对68例多平面腰椎管狭窄症患者采用选择性神经根阻滞,其中男47例,女21例;年龄45～80岁,平均56岁。神经根阻滞后64例为阳性患者进行了腰椎有限手术,另4例封闭后症状减轻不明显为阴性,难以确定手术平面或引起症状的神经根,放弃了手术治疗。术后采用Macnab腰腿痛手术治疗评定标准进行疗效评定。结果：神经根阻滞操作过程顺利,未发生与神经根阻滞相关的并发症,术后无神经损伤并发症。术后随访16～45个月,平均32个月。术后根据Macnab腰腿痛手术治疗评定标准进行疗效评定,优44例,良18例,差2例。结论：对腰椎管狭窄症的手术治疗重点应放在压迫引起症状的部位,而对无症状的部位不做预防性减压操作。应用神经根阻滞能准确判断责任椎与疼痛源,提高腰椎有限手术的疗效。     

A spreading roots sign: Characteristic sign of the preliminary stage of medial meniscus posterior root tear on magnetic resonance imaging

BackgroundMedial meniscus posterior root tears (MMPRTs) can result in the development of osteoarthritis or osteonecrosis. Clinical experience suggests that symptoms such as dull pain or discomfort in the popliteal area or the calf area, which are sometimes misdiagnosed as sciatic nerve pain, may precede impending rupture. We found that bone marrow edema emanating from the meniscal root on magnetic resonance imaging (MRI) scans—spreading roots sign—may indicate the preliminary stage of an MMPRT. The purpose of this study was to evaluate the efficacy of the spreading roots sign as an MMPRT-predictor.MethodsIn a retrospective study, we reviewed the chart data and MRI results of patients who had required surgery for an acute MMPRT. We grouped patients by whether or not they had reported the above-mentioned precursory symptoms prior to acute rupture (precursory symptom group/non-precursor group), and when possible, we examined MRI scans to identify with which events the appearance/disappearance of the spreading roots sign coincided. Sex, age, body mass index, bone mineral density, radiological parameters, and MRI parameters were compared between groups.ResultsData from 24 patients (precursory symptom group, n = 17 [70.8 %]; non-precursor group, n = 7 [29.2 %]) were included; data from 5 patients included MRI scans prior to acute rupture. There were no significant differences between precursory symptom and non-precursor groups, except for the ratio of the presence of the spreading roots sign (p = 0.005). The appearance of the spreading roots sign on MRI scans coincided with the onset of precursory symptoms, and its disappearance coincided with acute rupture and the appearance of other MRI signs typical of MMPRT (white meniscus/truncation/meniscal extrusion/giraffe neck signs).ConclusionsOur findings suggest that the spreading roots sign can be used as a unique precursory sign for MMPRT.     

Implantation of cauda equina nerve roots through a biodegradable scaffold at the conus medullaris in rat

Background contextTraumatic injuries occurring at the conus medullaris of the spinal cord cause permanent damage both to the central nervous system and to the cauda equina nerve roots.PurposeThis proof-of-concept study was to determine whether implanting the nerve roots into a biodegradable scaffold would improve regeneration after injury.MethodsAll experimental works involving rats were performed according to the approved guidelines by the Mayo Clinic Institutional Animal Care and Use Committee. Surgical procedures were performed on 32 Sprague-Dawley rats. Four ventral cauda equina nerve roots were reimplanted either directly into the ventral cord stump or through a poly(lactic-co-glycolic acid) (PLGA) scaffold. These experimental groups were compared with a control group in which the nerves were inserted into a muscle fascia barrier that was placed between the spinal cord and the nerve roots. Animals were sacrificed at 4 weeks.ResultsThere was no difference in motor neuron counts in the spinal cord rostral to the injury in all treatment groups, implying equal potential for the regeneration into implanted nerve roots. One-way analysis of variance testing, with Tukey post hoc test, showed a statistically significant improvement in axon regeneration through the injury in the PLGA scaffold treatment group compared with the control (p<.05, scaffold n=11, control n=11).ConclusionsThis pilot study demonstrated that a PLGA scaffold improved regeneration of axons into peripheral nerve roots. However, the number of regenerating axons observed was limited and did not lead to functional recovery. Future experiments will employ a different scaffold material and possible growth factors or enzymes to increase axon populations.     

Role of motor-evoked potential monitoring in conjunction with temporary clipping of spinal nerve roots in posterior thoracic spine tumor surgery

Background contextThe vascular supply of the thoracic spinal cord depends on the thoracolumbar segmental arteries. Because of the small size and ventral course of these arteries in relation to the dorsal root ganglion and ventral root, they cannot be reliably identified during surgery by anatomic or morphologic criteria. Sacrificing them will most likely result in paraplegia.PurposeThe goal of this study was to evaluate a novel method of intraoperative testing of a nerve root's contribution to the blood supply of the thoracic spinal cord.Study design/settingThis is a clinical retrospective study of 49 patients diagnosed with thoracic spine tumors. Temporary nerve root clipping combined with motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring was performed; additionally, postoperative clinical evaluation was done and reported in all cases.MethodsAll cases were monitored by SSEP and MEPs. The nerve root to be sacrificed was temporarily clipped using standard aneurysm clips, and SSEP/MEP were assessed before and after clipping. Four nerve roots were sacrificed in four cases, three nerve roots in eight cases, and two nerve roots in 22 cases. Nerve roots were sacrificed bilaterally in 12 cases.ResultsMost patients (47/49) had no changes in MEP/SSEP and had no neurological deficit postoperatively. One case of a spinal sarcoma demonstrated changes in MEP after temporary clipping of the left T11 nerve root. The nerve was not sacrificed, and the patient was neurologically intact after surgery. In another case of a sarcoma, MEPs changed in the lower limbs after ligation of left T9 nerve root. It was felt that it was a global event because of anesthesia. Postoperatively, the patient had complete paraplegia but recovered almost completely after 6 months.ConclusionsTemporary nerve root clipping combined with MEP and SSEP monitoring may enhance the impact of neuromonitoring in the intraoperative management of patients with thoracic spine tumors and favorably influence neurological outcome.     

三维真稳态进动快速成像序列联合扩散张量神经纤维束示踪成像在腰椎间盘突出症中的应用

目的探讨三维真稳态进动快速成像(3D-Ture FISP)序列联合扩散张量神经纤维束示踪成像(DTT)判定腰椎间盘突症(LDH)所致坐骨神经痛责任神经根的价值。方法分别对40例单侧坐骨神经痛LDH患者(病变组)及40名健康志愿者(对照组)行腰骶部MR检查。将3D-Ture FISP序列与DTT图像融合,于L4～S1椎体水平测量双侧神经根FA及ADC值,结合融合图像所示神经根形态、走行及FA、ADC值判定LDH患者坐骨神经痛责任神经根,并进行统计学分析。结果 3D-True FISP序列与DTT融合图像可清晰显示神经根形态及走行。病变组40例(受累神经根51条,未受累神经根189条)中,37例影像学检查判定的责任神经根与临床症状相符,3例不符。对照组(240条神经根)左侧与右侧神经根FA及ADC值差异均无统计学意义(P均0.05),双侧神经根平均FA值为0.346±0.042,ADC值为(1.296±0.080)mm~2/s。病变组患侧神经根FA值为0.253±0.021,ADC值为(1.743±0.089)mm~2/s;对侧神经根FA值为0.339±0.013,ADC值为(1.297±0.075)mm~2/s。病变组患侧神经根FA值明显低于自身同层面对侧神经根(t=0.806,P=0.038)及对照组神经根(t=0.963,P=0.043),ADC值明显高于自身同层面对侧神经根(t=0.866,P=0.040)及对照组神经根(t=0.921,P=0.042)。病变组对侧神经根FA及ADC值与对照组间差异均无统计学意义(P均0.05)。结论 3D-Ture FLSP序列联合DTT技术可清楚显示神经根解剖形态及走行,结合量化分析判定LDH患者坐骨神经痛责任神经根,为临床提供更多诊疗信息。     

Assessing extra-prostatic extension for surgical guidance in prostate cancer: Comparing two PSMA-PET tracers with the standard-of-care

BackgroundIncontinence and impotence occur following radical prostatectomy due to injury to nerves and sphincter muscle. Preserving nerves and muscle adjacent to prostate cancer risks positive surgical margins. Advanced imaging with MRI has improved cancer localization but limitations exist.ObjectiveTo measure the accuracy for assessing extra-prostatic extension at nerve bundles for 2 PSMA-PET tracers and to compare the PET accuracy to standard-of-care predictors including MRI and biopsy results.Materials and MethodsWe studied men with PSMA-targeted PET imaging, performed prior to prostatectomy in men largely with intermediate to high-risk prostate cancer, and retrospectively evaluated for assessment of extra-prostatic extension with whole-mount analysis as reference standard. Two different PSMA-PET tracers were included: ⁶⁸Ga-PSMA-11 and ⁶⁸Ga-P16-093. Blinded reviews of the PET and MRI scans were performed to assess extra-prostatic extension (EPE). Sensitivity and specificity for extra-prostatic extension were compared using McNemar's Chi².ResultsPre-operative PSMA-PET imaging was available for 71 patients with either ⁶⁸Ga-P16-093 (n = 25) or ⁶⁸Ga-PSMA-11 (n = 46). There were 24 (34%) with pT3a (EPE) and 16 (23%) with pT3b (SVI). EPE Sensitivity (87% vs. 92%), Specificity (77% vs. 76%), and ROC area (0.82 vs. 0.84) were similar between P16-093 and PSMA-11, respectively (P = 0.87). MRI (available in only 45) found high specificity (83%) but low sensitivity (60%) for EPE when using a published grading system. MRI sensitivity was significantly lower than the PSMA-PET (60% vs. 90%, P = 0.02), but similar to PET when using a >5 mm capsular contact (76% vs. 90%, P = 0.38). A treatment change to “nerve sparing” was recommended in 21 of 71 (30%) patients based on PSMA-PET imaging.ConclusionsPresurgical PSMA-PET appeared useful as a tool for surgical planning, changing treatment plans in men with ≥4+3 or multi-core 3+4 prostate cancer resulting in preservation of nerve-bundles.     

Diagnostic value of nerve growth factor in detrusor overactivity: a study on women with mixed urinary incontinence

Objective

Urinary incontinence has a profound impact on women’s quality of life. Studies have shown that changes in urinary protein levels could be a potential diagnostic biomarker in some urological diseases. The aim of present study is to determine the diagnostic value of nerve growth factor (NGF) in women with mixed urinary incontinence (MUI) as a diagnostic biomarkers of detrusor overactivity (DO).

Methods

Seventy women aged between 20 and 75 years with MUI were enrolled in this prospective study. All participants underwent urodynamic study. Urine NGF levels were measured using an ELISA method. NGF level was compared between groups using Mann–Whitney U test. Receiver Operator Characteristic (ROC) analysis was employed to evaluate the diagnostic performance of urinary NGF.

Results

The results showed that the median (min, max) of NGF in patients with DO was significantly higher in comparing to its level in women without DO [184.10 (31, 346.60) pg/ml vs. 151.80 (21, 210.70)], respectively (P?=?0.035). Using receiver-operator characteristics analysis, the threshold urinary NGF value of 102.00 pg/ml provided a sensitivity of 88% and specificity of 40% in diagnosing DO, PPV of 39.1%, and NPV of 88.2%, positive likelihood ratio 2.18 and negative likelihood ratio of 0.45 (P?=?0.02).

Conclusion

Based on high sensitivity and low specificity, we can conclude that NGF can be a good tool for ruling out the OAB when the test is negative. However, the future investigations are needed to expand the observed correlation in larger groups of women with DO.

     

Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized double-blind sham-controlled multi-center study

Background

Damaged or degenerated vertebral endplates are a significant cause of vertebrogenic chronic low back pain (CLBP). Modic changes are one objective MRI biomarker for these patients. Prior data from the treatment arm of a sham-controlled, RCT showed maintenance of clinical improvements at 2 years following ablation of the basivertebral nerve (BVN). This study reports 5-year clinical outcomes.

Methods

In total, 117 US patients were treated successfully with BVN ablation. Patient-reported outcomes of ODI, VAS, postablation treatments, and patient satisfaction were collected at a minimum of 5-years following BVN ablation. Primary outcome was mean change in ODI. Comparisons between the postablation and baseline values were made using an analysis of covariance with alpha 0.05.

Results

Of the 117 US treated patients 100 (85%) were available for review with a mean follow-up of 6.4 years (5.4–7.8 years). Mean ODI score improved from 42.81 to 16.86 at 5-year follow-up, a reduction of 25.95 points (p < 0.001). Mean reduction in VAS pain score was 4.38 points (baseline of 6.74, p < 0.001). In total, 66% of patients reported a > 50% reduction in pain, 47% reported a > 75% reduction in pain, and 34% of patients reported complete pain resolution. Composite responder rate using thresholds of ≥ 15-point ODI and ≥ 2-point VAS for function and pain at 5 years was 75%.

Conclusion

CLBP patients treated with BVN ablation exhibit sustained clinical improvements in function and pain with high responder rates at a mean of 6.4 years following treatment. BVN ablation is a durable, minimally invasive treatment for vertebrogenic CLBP.

     

Comparative effectiveness of imaging modalities for preoperative assessment of anorectal malformation in the pediatric population

ObjectiveThe aim of this study was to compare the accuracy of MRI, colostography/fistulography, and X-ray imaging modalities for preoperative diagnosis of anorectal malformations (ARMs) in pediatric patients.MethodsThis retrospective analysis included a total of 84 pediatric patients with ARMs. Preoperative imaging findings were assessed by 2 radiologists and compared to surgical findings.ResultsMRI identified anomalies of the spine in 25 of 84 patients (29.8%), anomalies of the genital system in 7 of 84 patients (8.3%), anomalies of the urinary system in 22 of 84 patients (26.2%), and underdeveloped sphincter muscle complex in 34 of 84 patients (40.5%). In the 44 subjects receiving both MRI and X-ray, MRI was more sensitive in detecting anomalies of spine (18/44 vs. 8/44; P = 0.002), and both correctly identified the distal end of the rectum in 77.3% (34/44) of the cases. In the 24 subjects receiving both MRI and colostography/fistulography, MRI was more accurate in identifying Pena's classification (22/24 vs. 15/24; P = 0.039). Distal end of the rectum was correctly identified in 75.0% (18/24) and 58.3% (14/24) of the cases (P = 0.125).ConclusionsMRI could clearly reveal fistula anatomy and associated anomalies of ARMs and should be routinely used for preoperative evaluation of ARMs.Type of studyStudy of diagnostic test.Level of evidenceLevel II.     

三维颅脑容积成像增强MRI用于病因学诊断动眼神经麻痹

目的 观察三维颅脑容积成像(3D-BRAVO)增强MR用于病因学诊断动眼神经麻痹(ONP)的价值。方法 回顾性分析27例临床诊断为单侧ONP患者的颅脑T1-液体衰减反转恢复(T1-FLAIR)增强及3D-BRAVO增强图像,对比其病因学诊断ONP结果的差异。结果 27例ONP病因包括肿瘤或肿瘤样病变压迫或浸润13例、血管压迫7例、颅脑炎性病变4例及颅脑外伤3例。T1-FLAIR增强图像显示ONP病因包括肿瘤压迫或侵犯10例、血管压迫3例、颅脑炎性病变2例、颅脑外伤3例,正确率66.67%(18/27);3D-BRAVO增强图像显示病因正确率为100%(27/27),二者差异均有统计学意义(P=0.002)。结论 3D-BRAVO增强MRI用于病因学诊断ONP具有高度价值。