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OBJECTIVE To demonstrate the significance of the double line appearance of the septi pellucidi laminae (SPL) on fetal ultrasound. METHOD A total of 522 uncomplicated singleton pregnancies (15 to 39 weeks' gestational age) with fetal ultrasounds were enrolled. The presence of a single versus double line SP as well as measurement of the cavum septi pellucidi (CSP) was determined retrospectively. Ultrasound settings from the CSP images were recorded. Thickness of the SPL was measured in 20 ultrasound and 14 MRI cases; histology was reviewed from one neonate. Maternal BMI and gestational age were also recorded. RESULTS The presence of double line SPL is a normal sonographic finding, seen in 47% (188/403) of normal fetuses. Thickness of the SPL in 10 cases with double line averaged 1.4 mm and in 10 cases with single line averaged 0.8 mm; MRI measurements were within 0.1 mm of the corresponding ultrasound measurements. Double line cavum was more often seen with mid-dynamic contrast range settings (5, 6) rather than high range settings (7-10) (P value

BACKGROUND To investigate the roles of the lysyl oxidase-like 1 (loxl1) gene in zebrafish eye development and the potency of loxl1 deficiency in mimicking the ocular manifestations of exfoliation syndrome (XFS). METHODS CRISPR/Cas9 technology was used to generate a frameshift coding deletion in zebrafish loxl1. Expression profiles and ocular manifestations of the wildtype, heterozygous mutant (loxl1+/- ) and homozygous mutant (loxl1-/- ) zebrafish were analysed in a range of developmental stages from zebrafish larvae to dissected adult zebrafish eyes. RESULTS The loxl1 deficiency caused zonular bundling disorders in juvenile zebrafish and accumulation of pearl-like particles adhering to the adult zebrafish zonule. The bundles appeared to lack form and were thinner in both loxl1+/- and loxl1-/- zebrafish compared with the wildtype (p

Lamina cribrosa morphology is ever changing in health and disease, and its changes might cause primary optic nerve damage and secondary damage due to the decrease of blood supply and axoplasmic transport. There is no information in literature about the peculiarities of lamina cribrosa thickness in patients with diabetic optic neuropathy (DON) in vivo.The objective was to study the morphometric changes of the lamina cribrosa and changes of its scleral canal in patients with diabetes mellitus (DM) depending on the type and stage of the diabetic optic neuropathy, and to establish the clinicopathogenetic role of lamina cribrosa morphometric changes in the development of DON.Materials and methods. 575 patients (1150 eyes) with type II DM were examined. In addition to standard ophthalmologic methods optical coherent tomography (OCT) of the retina and optic nerve was performed. Lamina cribrosa thickness was measured with the help of SD OCT using LC_Thickness_programm.m and main_low_ noise_fi lters_programm.m, based on the adaptive compensation algorithm for eliminating a high-level noise in the deep layers of the optic nerve and improving the visualization of the posterior border of the lamina cribrosa, as well as for processing B-scan with a set of 3 digital fi lters: Butterworth Low-pass Filter inverion image, Wavelet Low-pass Filter Analysis Daubechies original and inversion image. The area of lamina cribrosa scleral canal was measured with the help of SD OCT using the LC_cut_position_programm.m for choosing the depth of measurement and LC_diameter_calculation_programm.m for improvement of the selected image by the main digital fi lters.Results. Analyzing the results of examination, the correlation between the type and stage of DON and scleral lamina cribrosa thickness in patients with DM was revealed. An average index of lamina cribrosa thickness in patients with DM without diabetic optic neuropathy was 1.4 times higher than that of the control group; in subclinical stage of axial DON – 1.9 times higher, in initial stage – 2.1 times higher, in severe stage of axial DON and diabetic papillopathy – 2.6 times higher, in anterior ischemic DON – 2.7 times higher, in dystrophic stage – 3.1 times higher than that of the control group (303±56 μm) (р

Objective To analyze correlations between the selection of microtitanium plates with different specifications for use in a cervical vertebral dome expansion laminoplasty. Methods Sixteen patients that underwent the cervical vertebral dome expansion laminoplasty with a cervical spinal stenosis angioplasty procedure for treatment of their cervical spinal cords were recruited at our hospital. From February 2017 to September 2018, medical records confirmed that all patients underwent cervical CT and MRI tests pre‐ and postsurgery. The anteroposterior diameter of the spinal canal, changes in the cross‐sectional area of the spinal canal, and the pre‐ and postsurgery distance of the cervical spinal cord after applying microtitanium plates with different lengths were measured by Mimics version 17.0 software (Materialise NV, Leuven, Belgium). A statistical regression and correlation analysis of relevant specification parameters of the microtitanium plate was then studied. Results As the size of the microtitanium plate increased, we found that the cross‐sectional area of cervical spinal canal and distance between the descendants of the lamina and the distance of cervical spinal cord concordantly increased, and these data changes linearly. The regression equation associated with sagittal diameter, cross‐sectional area, and posterior movement distance of the cervical spinal cord was obtained. Conclusion According to the correlation analysis of imaging data changes, the regression equation was obtained to guide the selection of microtitanium plates with appropriate specifications in a cervical vertebral dome expansion laminoplasty., This type of surgery involves lavage of the lamina at the junction of the C3‐C7 bilateral lamina and the facet joint and requires the lamina to be completely moved backward. In this process, we attempted to protect and retain the relevant tissue structures attached to the spinous process, such as the supraspinous ligament and interspinous ligament, while keeping the spinous process in the original center position and enlarging the spinal canal. This procedure permits the spinal cord to drift backward, thus reducing the pressure on the cervical spinal cord. Then, we used our own microtitanium plate to fix the two sides of the lamina to form a strong structure. As the size of the microtitanium plate increased, we found that the cross‐sectional area of cervical spinal canal and distance between the descendants of the lamina and the distance of cervical spinal cord concordantly increased. The regression equation associated with sagittal diameter, cross‐sectional area, and posterior movement distance of the cervical spinal cord was obtained. The use of the corresponding regression equations enabled the prediction of the cervical spinal canal parameters and posterior movement distance of the cervical spinal cord when adopting different specifications of the microtitanium plate for different segments of the cervical vertebrae.

Vascular calcification is a common phenomenon in the elderly, predominantly appearing in the basal ganglia and in the lamina circumvoluta medullaris of the hippocampus. Calcifications are not an inherent feature of Alzheimer's disease. On the other hand, a rare presenile type of dementia with symmetrical Fahr-type calcifications and numerous neurofibrillary tangles without senile plaques has been described by Kosaka in 1994 and was termed "diffuse neurofibrillary tangles with calcification" (DNTC). We here report a case of Alzheimer's disease with calcifications both in the basal ganglia and in the lamina circumvoluta medullaris of the hippocampus, differing from DNTC by the presence of senile plaques. The calcifications in the hippocampus were not only vascular in nature but also covered amyloid-β- and phosphorylated tau-positive plaque-like structures that were linearly arranged along the dentate fascia in the CA1 sector, an unusual finding of pathogenetic interest.

Knowledge of interlaminar space is important for undertaking percutaneous endoscopic discectomy via an interlaminar approach (PED-IL). However, dynamic changes in the lumbar interlaminar space and the spatial relationship between the interlaminar space and intervertebral disc space (IDS) are not clear. The aim of this study was to anatomically clarify the changes in interlaminar space height (ILH) and variation in distance between the two spaces during flexion–extension of the lumbar spine in vitro. First, we used a validated custom-made loading equipment to obtain neutral, flexion, and extension 3D models of eight lumbar specimens through 3D reconstruction software. Changes in ILH (ILH, IL-yH, IL-zH) and distances between the horizontal plane passing through the lowest edge of the lamina of the superior lumbar vertebrae and the horizontal plane passing through the lowest position of the trailing edge of the same-level IDS (DpLID) at L3/4, L4/5 and L5/S1 were examined on 3D lumbar models. We found that ILH was greater at L4/5 than at L3/4 and L5/S1 in the neutral position, but the difference was not significant. In the flexion position, ILH was significantly more than that in neutral and extension positions at L3/4, L4/5, and L5/S1. There were significantly more DpLID changes from neutral to flexion than that from neutral to extension at all levels (L3/4, L4/5, L5/S1). These findings demonstrated level-specific changes in ILH and DpLID during flexion–extension. The data may provide a better understanding of the spatial relationship between lumbar interlaminar space and IDS, and aid the development of segment-specific treatment for PED-IL.

We report a rare case of congenital cervical anomaly in a 32 yr old female, who was referred in our department for the complaints of chronic cervical and shoulder pain with a hard cervical mass. Antero-posterior and lateral radiographs of the cervical spine were performed, which show a rib like bony projection, in the left side of neck and on the lateral radiograph, it was corresponding to a hypertrophied C6 spinous process. CT study was done for better delineation of this congenital anomaly, which showed hypertrophied left lamina of C6 and spinous process, crossing midline and towards the left side, extending inferiorly up to the level of thoracic inlet. There was associated fusion of C3 and C4 vertebrae, resulting in block vertebra (Klippel- Feil syndrome Type 1) and unfused spinous process of C6 vertebra.This case report is the first case, where hypertrophied lamina and spinous process of C6 with unfused spinous processes and block vertebra, congenital cervical anomalies were seen in the same patient. Keywords : Spine, Congenital abnormality, Computed tomography, Vertebral schisis.

Background: Laryngeal cancer comprises 2 to 5% of all malignant diseases diagnosed annually worldwide. Cartilage invasion by the laryngeal cancer is of great importance through the staging of laryngeal carcinoma according to TNM classi-fication and has a great impact on management plan. There is a scarcity in the published literature regarding the comparison between MRI and CT for assessment of cartilage involvement. Aim of Study: To assess the validity of MRI and to compare this with CT findings in predicting inner and outer thyroid cartilage laminae invasion in patients with laryngeal carcinoma. Patients and Methods: The present study was an obser-vational analytical study that was carried out from January 2018 to June 2019 at the Radiology Department of Faculty of Medicine, Cairo University. A total of 30 patients with laryngeal carcinoma were included. CT and MRI was done for all patients. Results: There was a good agreement between readers in CT interpretation in term of inner lamina involvement (K=0.78) and very good agreement in term of outer lamina involvement (K=0.87). While in MRI interpretation, there was a very good agreement between readers in term of inner lamina involvement (K=0.83) and outer lamina involvement (K=0.92). However higher accuracy & confidence levels were found on interpre-tation of both CT and MRI together. We found a higher interobserver agreement between interpretation of CT and MRI together (K=1.00). Conclusion: MRI showed high validity and precision in detecting inner and outer thyroid lamina invasion by laryngeal caner than CT scan. We found that the combination of CT and MRI together was associated with more accuracy and confidence level for the readers.

PRECIS The development of beta-zone peripapillary atrophy (β-PPA) and focal lamina cribrosa defect (FLD) was significantly associated with decreased peripapillary optical coherence tomography angiography (OCTA) vessel parameters in young myopic eyes. PURPOSE The purpose of this study was to investigate whether β-PPA and FLD affect peripapillary vessel density (VD) or perfusion density (PD) from OCTA in young myopic eyes. MATERIALS AND METHODS In a cross-sectional study, 330 eyes of 165 healthy volunteers with myopia were involved. Eyes underwent OCTA to measure peripapillary PD and VD. Eyes were grouped according to the presence of β-PPA or FLD: eyes without β-PPA or FLD (group A), eyes with β-PPA but without FLD (group B), and eyes with both β-PPA and FLD (group C). PD and VD were compared among 3 groups, and linear mixed-effect regression model was used to investigate the determinants of PD. RESULTS β-PPA was found in 219 eyes (66.4%), and FLD was detected in 27 eyes (8.2%). The average VD and PD were greatest in group A (19.13±2.04 mm-1 and 0.375±0.038), followed by group B (18.34±2.26 mm-1 and 0.363±0.042) and group C (16.71±2.81 mm-1 and 0.330±0.052) (P

Purpose To provide imaging evidence of the feasibility and clinical efficacy of a new full lamina back shift spinal canal enlargement technique. Methods A retrospective analysis was conducted on 64 patients with multisegment cervical spondylotic myelopathy caused by cervical stenosis. Of these, 32 patients underwent the new full lamina back shift spinal canal enlargement technique (as observation group) and 32 patients underwent single open‐door miniature titanium plate internal fixation (as control group). The computed tomography (CT) data of both groups were imported into Mimics 17.0 software to measure the median sagittal diameter and cross‐sectional area of the spinal canal. Photoshop CS5 was employed to measure the drift distance of the spinal cord on MR images to perform a comparative study of the imaging parameters from the two groups. Results The T2‐weighted MR images in both groups showed continuous recovery of the cerebrospinal fluid signal in the C3–C7 range. The enlarged spinal canal cross‐sectional area (mm2) of each segment after the new full lamina back shift spinal canal enlargement technique was 130.90 ± 20.52 (C3), 180.81 ± 18.86 (C4), 240.48 ± 35.43 (C5), 145.93 ± 36.94 (C6), and 153.16 ± 36.28 (C7), and the enlarged median sagittal diameter (mm) was 5.31 ± 1.13 (C3), 8.8 ± 1.28 (C4), 10.28 ± 1.68 (C5), 9.46 ± 1.48 (C6), and 9.22 ± 1.12 (C7). Both parameters were significantly superior to single open‐door miniature titanium plate internal fixation (P 0.05). Conclusion The new full lamina back shift spinal canal enlargement technique achieved a thorough spinal canal decompression effect on imaging while ensuring a reasonable spinal drift distance and few surgical complications. The clinical curative effect of the new technique was precise., The imaging parameters of the new operation and single‐door laminoplasty were compared, and the new operation was found to reduce the incidence of related surgical complications while achieving complete decompression and obtaining the satisfactory clinical efficacy. Thus, the method could be promoted.

The present study attempted to validate the “Burcev freehand method” based on anatomical observations in Indian cadavers. The study was conducted on 32 cervical pedicle screws (CPSs) that were placed in four cadavers by the authors according to the “freehand technique,” described by Burcev et al, without the aid of fluoroscopy and the trajectory verified by computed tomography scans. The screws were designated as satisfactory, permissible, or unacceptable. Descriptive variables were represented in number and percentages, continuous variables were represented as mean ± standard deviation (SD). Of the 32 CPSs placed, 24 (75%) exhibited a satisfactory position, 1 (3%) exhibited a permissible position, and 7 (22%) exhibited an unacceptable position. Of the seven CPSs in the unacceptable group, four exhibited a lateral breach and three exhibited a medial breach, whereas the CPS in the permissible group exhibited a medial breach. The overall angle with contralateral lamina in the horizontal plane in terms of mean ± SD was 175.43 ± 2.82, 169.49, and 169.65 ± 6.46 degrees in the satisfactory, permissible, and unacceptable groups, respectively. In the sagittal plane, the screws exhibited an angle of 88.15 ± 3.56 degrees. No breach was observed superiorly or inferiorly. The “Burcev technique” is replicable with similar results in cadavers. Further studies must be conducted in a clinical setting to ensure its safety.

Chondromyxoid fibroma; a rarely found tumor, contributing

Summary Background Hand rejuvenation has become increasingly popular in esthetic medicine. Hand rejuvenation with injectables remains challenging, and there are no established practice guidelines. The calcium hydroxylapatite (CaHA) filler injection is currently one of the most common procedures. This study aimed to identify the layer of the hand dorsum that is lifted by skin pinching and to identify the layer where an injectable filler would be placed based on the anatomical study and ultrasound findings. Methods The anatomic layers of the cadaveric hands were examined using the skin pinching method. Anatomic dissections and histological examinations were performed on four fixed and five fresh cadaveric hands to reveal the anatomical layers in which the CaHA filler was administered. Furthermore, 20 patients were treated with the CaHA filler, and the Doppler ultrasound was used to reveal the proper anatomical layers for filler placement. Results The study of the cadaveric hands showed that skin pinching can ensure safe entry points and can guide the cannula into safe planes without compromising the large superficial veins. A filler injection with skin pinching in cadaveric hands demonstrated that the filler was introduced primarily in the dorsal intermediate lamina where the veins are present. This was further confirmed by ultrasound findings. Conclusion The dorsal intermediate lamina, which has the veins is a relatively loose structure, and the cannula was moved along this space. When the layer is stretched by skin pinching, the veins run underneath. The dorsal intermediate lamina is the appropriate layer to inject the filler.

PURPOSE To compare lamina cribrosa curvature (LCC) in pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG) and to elucidate the factors associated with LCC in both groups. DESIGN Retrospective, cross-sectional study. METHOD Forty eyes with PXG and visual field mean deviation-matched 40 eyes with POAG were included. Spectral domain optical coherence tomography enhanced depth imaging was used to acquire LC images. The LCC index (LCCI) was calculated as LCC depth/LCC width × 100. Calculated LCCI values were compared between the PXG and POAG groups. Logistic regression analysis was performed to investigate the factors related to the presence of PXG. Factors associated with LCCI were determined by uni- and multivariable linear regression analyses in both groups. RESULT Visual field mean deviation (-11.7 ± 9.7 dB vs -1.0 ± 8.5 dB, P = .731) and retinal nerve fiber thickness (647.4 ± 22.7 μm vs 68.3 ± 19.9 μm, P = .857) did not differ between the 2 groups. However, the mean (8.8 ± 2.9 in PXG, 6.6 ± 1.9 in POAG) and sectoral LCCIs assessed at 0, 30, 60, 90, and 120° were significantly greater in the PXG than in the POAG group (all, P < .05), but not at 150° (P = .113). Logistic regression analysis revealed that higher average LCCI (odds ratio [OR] = 1.509 [95% confidence interval 1.180-2.047], P = .003) and older age (OR = 1.074 [95% confidence interval 1.017-1.147], P = .019) were associated with the presence of PXG. IOP was associated with mean LCCI only in the POAG group (β = 0.150 [95% confidence interval 0.018-0.281], P = .027) while none of the factors showed association with LCCI in PXG. CONCLUSION PXG eyes had more steeply curved LC than POAG eyes with a similar level of glaucoma severity. The clinical implication(s) of steeper LCC in PXG should be investigated in a forthcoming study.

Study Design: Retrospective radiographic study.Purpose: We hypothesized that the pedicle is almost perpendicular to the interlaminar line in the sagittal plane of the lumbar vertebrae. The current study aimed to define the lumbar lamina–pedicle inclination to verify the right-angle concept and to estimate the safety zones of sagittal inclination during pedicle screw insertion. To the best of our knowledge there are no previous similar studies.Overview of Literature: Based on our observations in different spinal disorders including deformities, we noted that following a sagittal (cranial–caudal) trajectory perpendicular to the interlaminar line joining the two adjacent vertebrae would work well in most of the vertebral levels.Methods: This was a retrospective study on normal lumbar spine lateral radiographs of patients who presented with low back pain and were reviewed by two observers. Different inclination angles were constructed to estimate the safety zones of the pedicle screws’ sagittal inclination.Results: Radiographs of 30 consecutive patients, 25 females and five males, with a mean age of 39.43±11.18 years, were studied. The mean angle of the interlaminar line and the pedicle axis was almost orthogonal at all the levels, with a range of 89.16°–94.63°, which was not affected by the lumbar sagittal profile. The safety zones of the pedicle screws were measured, and they revealed a safe sagittal range of 19.73°–24.40° if the screw was inserted from the pedicle axis, 21.03°–22.59° if inserted from the most cephalic part, and 13.31°–17.03° if inserted from the most caudal part.Conclusions: Our results confirmed the perpendicularity of the interlaminar line with the pedicle axis in the lumbar spine at all the levels. The interlaminar line is a useful guide for pedicle screw sagittal inclination.

Study Design: This is an observational study of computed tomography (CT) data.Purpose: The C1 and C2 laminas in the Malaysian Malay population were analyzed for the feasibility of fitting 3.5-mm laminar screws in a cross configuration.Overview of Literature: Morphometric analysis of the C1 and C2 laminas has been performed for various populations but not for the Malaysian Malay population.Methods: A total of 330 CT cervical images were measured to establish the bicortical diameter of the C1 and C2 laminas as well as their height and length. The C1 posterior tubercle bicortical diameter and height were also determined from these images. All parameters were measured up to 0.1 mm, and statistical analysis was performed using IBM SPSS Statistics ver. 24.0 (IBM Corp., Armonk, NY, USA). An independent t -test and the Pearson chi-square test were used to determine the mean difference and screw acceptance.Results: The means of the C1 lamina measurements were 5.79±1.19 mm in diameter, 9.76±1.51 mm in height, and 20.70±1.86 mm in length. The means of the measurements of the posterior tubercle were 7.20±1.88 mm in diameter and 10.51±1.68 mm in height. The means of the C2 lamina measurements were 5.74±1.31 mm in diameter, 11.76±1.69 mm in height, and 24.96±2.56 mm in length. Overall 65.5% of C1 and 80.3% of C2 laminas are able to accept 3.5-mm screws in a cross configuration. Screw acceptability is similar between the right and left sides (p >0.05). However, males have a higher screw acceptability compared with females (p

PURPOSE To report the 3-year clinical outcomes of corneal stromal cell therapy consisting of the intrastromal implantation with autologous adipose-derived adult stem cells (ADASCs), and decellularized or ADASC-recellularized human donor corneal laminas in advanced keratoconus. METHODS Fourteen patients were enrolled in 3 experimental groups. Group 1 (G-1) patients underwent implantation of ADASCs alone (3 × 10⁶ cells/1 mL) (n = 5). Group 2 (G-2) patients received a 120-μm decellularized corneal stroma lamina (n = 5). Group 3 (G-3) patients received a 120-μm lamina recellularized with ADASCs (1 × 10⁶ cells/1 mL) (n = 4). ADASCs were obtained by elective liposuction. Implantation was performed into a femtosecond pocket under topical anesthesia. RESULTS At 3 years, a significant improvement of 1 to 2 logMAR lines in uncorrected distance visual acuity was observed in all groups. A statistically significant decrease in corrected distance visual acuity was obtained in G-2 and G-3 (P < 0.001) when compared with that of G-1. Rigid contact lens distance visual acuity showed a statistically significant worsening in G-2 (P < 0.001) compared with that of G-1. A statistically significant increase in central corneal thickness was observed in G-2 (P = 0.012) and G-3 (P < 0.001); in the Scheimpflug corneal topography, the thinnest point was observed in G-2 (P = 0.007) and G-3 (P = 0.001) when compared with that of G-1. CONCLUSIONS Intrastromal implantation of ADASCs and decellularized or ADASC-recellularized human corneal stroma laminas did not have complications at 3 years. The technique showed a moderate improvement in (uncorrected distance visual acuity) and (corrected distance visual acuity) in advanced keratoconus.

Boonsong Wanichwecharungruang,1,2 Aungnapa Kongthaworn,1,3 Doreen Wagner,4 Paisan Ruamviboonsuk,1 Kasem Seresirikachorn1 1Department of Ophthalmology, Rajavithi Hospital, Rangsit Medical College, Bangkok, Thailand; 2Department of Ophthalmology, Priest Hospital, Bangkok, Thailand; 3Department of Ophthalmology, Nakorn-Nayok Hospital, Nakorn-nayok, Thailand; 4Senior Clinical Project Manager, Wuppertal, GermanyCorrespondence: Boonsong WanichwecharungruangRajavithi Hospital, 2, Rajavithi Road, Bangkok, 10400, ThailandTel +66 813135040Email boonsongw@yahoo.comPurpose: To compare lamina cribrosa thickness (LCT) of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) using the enhanced depth-imaging mode of the Heidelberg Spectralis spectral-domain optical coherence tomography (EDI-OCT).Patients and Methods: A comparative cross-sectional study was conducted. We enrolled 34 patients with PACG, 38 with POAG, and 62 controls, testing only one eye of each participant. Lamina cribrosa thickness was determined at the center of the optic nerve head using EDI-OCT. Nine points of LCT were measured, and LCT averages were analyzed.Results: Mean age, number of glaucoma medications, current intraocular pressure (IOP), cup to disc ratio, and visual field indices, were not significantly different between PACG and POAG eyes. The maximum IOP (SD) was higher in PACG than in POAG, at 32.5 (10.46) vs 25.05 (6.42) mmHg (p = 0.001), and LCTs were significantly different among the PACG, POAG and control groups. Mean (SD) LCTs were 226.99 (31.08), 257.17 (19.46), and 290.75 (28.02) μm, respectively (p < 0.001). Lamina cribrosa thickness was correlated with mean deviation of the visual field (p = 0.001; correlation coefficient, rs = 0.347), while it was inversely correlated with maximum IOP (p < 0.001; correlation coefficient, rs = − 0.592). Linear regression analysis revealed that LCT was inversely related to age (p = 0.008), female (p = 0.018), and maximum IOP (p = 0.002). LCT was marginally related to visual field MD (p = 0.053).Conclusion: Glaucomatous eyes had thinner LCT than controls, and maximum IOP was inversely correlated to the LCT. PACG eyes had higher maximum IOP and thinner LCT than POAG ones. In living eye, EDI-OCT emphasizes the pressure-dependent mechanism of glaucoma on lamina cribrosa deformation and the higher IOP-loaded stress which leads to a greater lamina cribrosa strain.Keywords: lamina cribrosa thickness, primary angle-closure glaucoma, optical coherence tomography, Asian, intraocular pressure

SIGNIFICANCE Enhanced depth imaging optical coherence tomography is a useful method to allow for the evaluation of deep ocular structures, such as choroid and lamina cribrosa (LC), which are affected by ocular diseases. We hypothesized that choroidal and optic nerve inflammation in patients with ocular sarcoidosis (OS) might affect the LC structure. PURPOSE This study aimed to evaluate changes in the LC and anterior LC depth (ALCD) in patients with OS. METHODS Forty-eight eyes of 26 patients with OS who received the treatment of panuveitis and were in the quiescent phase for at least 6 months were included in the study. Thirty healthy subjects' randomly selected eyes were selected as a control group. Eyes with OS were divided into two subgroups according to the presence (OS eyes with glaucoma [OSWG], n = 23) or absence of glaucoma (OS eyes without glaucoma [OSWOG], n = 25). The LC thickness, ALCD, and peripapillary choroidal thickness were measured using enhanced depth imaging optical coherence tomography in eyes with OS and in controls. RESULTS The mean LC thickness was found significantly thinner in both OSWG and OSWOG eyes compared with the healthy controls (P < .001 and P = .001, respectively). The mean ALCD was found significantly higher in OSWG eyes (462 ± 65 μm) compared with OSWOG eyes (417 ± 58 μm) and the healthy control eyes (397 ± 59 μm; P = .03 and P = .001, respectively). The average peripapillary choroidal thickness was found to be significantly thinner in OSWG eyes compared with the control eyes (P = .05). CONCLUSIONS The present study revealed that OS is associated with a thinned LC independent of the presence of glaucoma. The degenerative changes in the LC, which is the transition point of the retinal nerve fibers, may cause long-term visual dysfunction in OS. These degenerative changes should be prevented by controlling inflammation with early diagnosis and treatment in patients with OS.

To investigate nasal displacement of central retinal vessel (CRV) on the optic nerve head (ONH) in glaucoma in association with its passage through lamina cribrosa (LC). This cross-sectional study included 113 eyes with glaucoma and 60 normal eyes. Horizontal spectral-domain optical coherence tomography (SD-OCT) scans of the ONH were acquired, and point where CRV emerged on the ONH surface was defined as the position of the CRV. Next, radial scans of the ONH were acquired, and angle of the CRV passing through the LC was measured. These parameters were compared between glaucomatous and normal eyes by t-test, and their relationship with possible confounders was assessed by multiple regression analyses. In glaucoma, CRV was significantly more nasally displaced than it was in normal eyes (66.0 ± 8.6 vs. 54.3 ± 9.5, P P = 0.0004). Greater nasal displacement of the CRV was significantly associated with a more nasally angled path through the LC (rs = 0.569, P

OBJECTIVEComplications after adult spinal deformity surgery are common, with implant-related complications occurring in up to 27.8% of cases. Sublaminar wire fixation strength is less affected by decreasing trabecular bone density in comparison to pedicle screw (PS) fixation due to the predominant cortical bone composition of the lamina. Sublaminar fixation may thus aid in decreasing implant-related complications. The goal of this study was to compare fixation characteristics of titanium sublaminar cables (SCs), ultra–high-molecular-weight polyethylene (UHMWPE) tape, PSs, and PSs augmented with UHMWPE tape in an ex vivo flexion–bending setup.METHODSThirty-six human cadaver vertebrae were stratified into 4 different fixation groups: UHMWPE sublaminar tape (ST), PS, metal SC, and PS augmented with ST (PS + ST). Individual vertebrae were embedded in resin, and a flexion–bending moment was applied that closely resembles the in vivo loading pattern at transitional levels of spinal instrumentation.RESULTSThe failure strength of PS + ST (4522 ± 2314 N) was significantly higher compared to the SC (2931 ± 751 N) and PS (2678 ± 827 N) groups, which had p values of 0.028 and 0.015, respectively (all values expressed as the mean ± SD). Construct stiffness was significantly higher for the PS groups compared to the stand-alone sublaminar wiring groups (p = 0.020). In contrast to SC, ST did not show any case of cortical breach.CONCLUSIONSThe higher failure strength of PS + ST compared to PS indicates that PS augmentation with ST may be an effective measure to reduce the incidence of screw pullout, even in osteoporotic vertebrae. Moreover, the lower stiffness of sublaminar fixation techniques and the absence of damage to the cortices in the ST group suggest that ST as a stand-alone fixation technique in adult spinal deformity surgery may also be clinically feasible and offer clinical benefits.

Purpose: To evaluate the relationship between corneal biomechanical parameters and lamina cribrosa (LC) curvature in normal tension glaucoma (NTG). Methods: 95 eyes of 56 NTG patients were enrolled in this prospective, observational study. Corneal biomechanical parameters, including stiffness parameters at applanation 1 (SP-A1), deformation amplitude ratio (DA ratio), inverse concave radius and biomechanically corrected intraocular pressure estimate (bIOP), were captured using the Corneal Visualization Scheimpflug Technology instrument (Corvis-ST). LC curvature was evaluated by mean adjusted LC curvature index (maLCCI) averaged by the measurements on 12 radial B-scan images obtained using swept-source optical coherence tomography (SS-OCT). Linear mixed models were constructed to assess the relationship between corneal biomechanical parameters and LC curvature. Results: The mean age of participants was 51.04 ± 13.74 years (range, 24–82 years). The SP-A1 and maLCCI were 93.50 ± 13.82 mm Hg/mm and 7.57 ± 1.58, respectively. In univariate and multivariate analysis, SP-A1 ( p Conclusions: The greater posterior LC curvature was associated with lower corneal stiffness parameters and younger eyes in NTG patients. Clinical Trial Registration: Chinese Clinical Trial Registry, ChiCTR1900021465.

Ultrasound spine imaging technique has been applied to the assessment of spine deformity. However, manual measurements of scoliotic angles on ultrasound images are time-consuming and heavily rely on raters experience. The objectives of this study are to construct a fully automatic framework based on Faster R-CNN for detecting vertebral lamina and to measure the fitting spinal curves from the detected lamina pairs. The framework consisted of two closely linked modules: 1) the lamina detector for identifying and locating each lamina pairs on ultrasound coronal images, and 2) the spinal curvature estimator for calculating the scoliotic angles based on the chain of detected lamina. Two hundred ultrasound images obtained from AIS patients were identified and used for the training and evaluation of the proposed method. The experimental results showed the 0.76 AP on the test set, and the Mean Absolute Difference (MAD) between automatic and manual measurement which was within the clinical acceptance error. Meanwhile the correlation between automatic measurement and Cobb angle from radiographs was 0.79. The results revealed that our proposed technique could provide accurate and reliable automatic curvature measurements on ultrasound spine images for spine deformities., Accepted by IUS2021

Cervical dumbbell tumor is usually removed via a posterior approach and may require the spinal fixation sometimes. However, the present surgical methods involved either more trauma or a higher risk of instability of the cervical spine. A new technique of unilateral exposure and stability reconstruction with pedicle and lamina screws fixation for posterior cervical dumbbell tumorectomy was described and compared with conventional techniques. Posterior unilateral exposure, hemi-laminectomy and facetectomy were performed in one patient with the cervical dumbbell tumor between C3 and C4. The stability was reconstructed by the unilateral pedicle and lamina screws fixation (UPLS), and a strip of shaped allograft bone was also implanted between the superior and inferior lateral mass. Biomechanical stability test of this new technique was investigated using seven fresh-frozen human cervical spine specimens (C4–C7) and compared with unilateral pedicle screw (UPS) and bilateral pedicle screw fixation (BPS) techniques. A continuous pure moment of ± 2.0 Nm was applied to the specimen in flexion, extension, lateral bending and axial rotation. The cervical dumbbell tumor was removed completely, and bone fusion with continuous bone trabecula was maintained in the patient on the final follow-up examination at 18 months postoperatively. Biomechanical stability tests revealed that the range of motion of the UPLS fixation plus graft bone implant was the same as the BPS fixation in flexion (1.8°vs. 1.5°, p = 0.58) and extension (2.3°vs. 2.2°, p = 0.73), but significantly bigger in lateral bending (3.9° vs. 1.0°, p

Posterior atlantoaxial fixation with screw rod forms an approximate "II" shape or "H" increasing transverse link for better stability. In order to improve stability and in consideration of difficult placement of transverse connecting rod, possibility of inadequate bone graft, some scholars have preliminarily researched biomechanics of a novel crossed rod as an approximate "X" configuration of screw rod.The aim of this study was to evaluate and compare the biomechanics of the crossed and parallel rod configurations in the screw rod system for posterior atlantoaxial fixation on a cadaveric model.Six fresh cervical specimens were used to complete the range of motion (ROM) testing by applying pure moments of ± 2.0 nm. Following intact state and under destabilization testing, screws were implanted. The specimens were then tested in the following sequence: Group BLS + PR (C2 bilateral laminar screws + parallel rod), Group BLS + CR (C2 bilateral laminar screws + crossed rod), LPRLS + PR (C2 left pedicle screw and right laminar screw + parallel rod), LPRLS + CR (C2 left pedicle screw and right laminar screw + crossed rod), BPS + PR (C2 bilateral pedicle screws + parallel rod) and BPS + CR (C2 bilateral pedicle screws + crossed rod). The ROM of the C1-2 segments was measured in flexion-extension, lateral bending and axial rotation. Six surgical constructs were compared between the groups and with intact condition, respectively.The six fixed modes significantly increased stability compared with both the intact and destabilization group in flexion-extension, lateral bending and axial rotation (p .05). In extension, BPS + CR and BLS + CR showed greater stability than BLS + PR (p .05). During flexion, the six fixation methods showed no statistical significance (p .05). In left lateral bending, stability of the other five screw rod fixation techniques significantly increased when compared with BLS + PR (p .05). In the right lateral bending direction, the stability of BLS + PR was worse than that of BPS + CR and BPS + PR (p .05). In the left axial rotation, stability of BLS + CR, LPRLS + CR and BPS + CR was greater than that of BLS + PR, LPRLS + PR and BPS + PR (p .05). In the right axial rotation, the stability of BPS + CR and BLS + CR was greater than that of BLS + PR (p .05).The six investigated fixation methods provide sufficient biomechanical stability. The crossed rod configuration can further enhance the axial rotation stability of the screw rod system, which consists of C1 bilateral pedicle and C2 pedicle, or C2 lamina screws. The crossed rod can also improve the stability of the screw rod system made up of C1 bilateral pedicle and C2 lamina screws in lateral bending and extension. The crossed rod configuration is reliable and provides superior stability for clinical application.

Introduction: To evaluate the association of focal lamina cribrosa (LC) defect with asymmetric visual field (VF) loss in normal-tension glaucoma (NTG) through intereye comparisons. Methods: Paired eyes were divided into better and worse eyes according to the mean deviation (MD), and ocular parameters were compared between them. Furthermore, patients in the asymmetric group were classified as subgroup A (one eye with LC defect and the fellow one without), subgroup B (both eyes without LC defect), and subgroup C (both eyes with LC defect). Generalized estimation equation approach was used to evaluate the association between ocular parameters and asymmetric VF. Results: A total of 140 eyes of 70 NTG patients were included in the asymmetric group. LC defects were more common in better eyes than that in worse eyes (27/70 [38.57%] vs. 10/70 [14.29%], p = 0.001), and all eyes with LC defect had myopia. Multivariate analysis revealed that the presence of LC defect was significantly associated with better eyes in the asymmetric group (odds ratio, 0.27; p = 0.001). For subgroup A, eyes with LC defects exhibited lower peak IOP (p = 0.011) and lower mean IOP (p = 0.018) than the fellow eyes without. In addition, longer AL (p = 0.025) and larger tilt ratio (p = 0.032) were found in eyes with LC defects. For subgroup B without LC defects, larger tilt ratio was shown to be a risk factor for VF loss (odds ratio, 6.13; p = 0.001). There was no significant difference of binocular parameters except for MD (p < 0.001) in subgroup C. Conclusions: LC defects in myopia were suggested to be associated with better eyes in NTG with asymmetric VF loss. However, in patients without LC defect, larger tilt ratio was a risk factor for VF defect. There might be different pathological mechanisms in asymmetric VF loss for different NTG subtypes.

The purpose of this study is to provide a morphometric description of the bony margins of the interlaminar spaces by level in the cervical spine for guidance of safe posterior cervical surgical dissection and decompression. We also aim to describe the impact of increasing static cervical lordosis on the overlap between the lamina. Morphometric measurements of the interlaminar space were performed on 100 consecutive cervical spine CT scans of patients ranging in age from 18 to 50 years were selected. Three raters performed measurements of the interlaminar height measured using two techniques (true interlaminar height and surgical interlaminar height), and interlaminar width from C2–C3 to C7–T1. In total, 100 patients were included. The true interlaminar height was greatest at C2–3, C3–4, C4–5 (5.2 ± 1.4–1.8 mm) and smallest at C6–7 (4.4 ± 1.3 mm). Surgical interlaminar height was greatest at C3–4 (4.2 ± 1.7) and smallest at C6–7 (3.0 ± 1.3 mm). The widest interlaminar space was observed at C3–4 (27.1 ± 2.1 mm) and most narrow at C7–T1 (20.9 ± 2.4 mm). Following multivariate regression, male gender was associated with greater interlaminar widths at each cervical level between C4 and T1 (Table 2). While greater patient height was associated with larger interlaminar height (true and surgical) and width at C2–3 and C4–5, weight was not independently associated with the interlaminar measurements. Increasing C2–C7 lordosis was significantly associated with decreasing true and surgical interlaminar heights at all levels except C7–T1, but was not associated with differences between interlaminar width. The study provides a morphometric analysis of interlaminar anatomy in the cervical spine. Surgeons can apply this information in their pre-operative plan to safely approach the posterior cervical spine.

Lumbar disc herniation (LDH) comprises one of the most common causes of low back pain. 35%–72% of LDH is associated with disc fragment migration. The migration of the disc fragments can be high-grade up, low-grade up, high-grade down, and low-grade down. Spine surgeons deal with unique challenges during surgical management of migrated discs. Operational challenges with open surgery include extensive lamina excision, pars excision, and potential for iatrogenic instability without fixation. In contrast, rigid instruments and poor visualization are the challenges with transforaminal endoscopic spine surgery (ESS). Hence interlaminar approach with ESS is an excellent choice with these migrated LDH. The creation of a translaminar crater in the cranial lamina without dealing with the interlaminar window or ligamentum flavum could be an excellent option to deal with these herniations face front. The lamina is the only anatomical barrier between the endoscope and the migrated disc fragment. Hence with a translaminar approach, unnecessary flavectomy can be avoided. In this technical report and video, we demonstrate the surgical technique of performing the translaminar ESS for highly upmigrated LDH with the preservation of optimal natural anatomy.

Purpose. To demonstrate the effectiveness of an isolated fixation technique of multilevel spondylosis disorders in young patients.Materials and methods. Two military men were operated for multilevel spondylosis of lumbar vertebra (LII, LIV and LIV, LV).Results and discussion. Patients underwent bone autoplasty and osteosynthesis of vertebral arches using hybrid lamina transpedicular system in a screw-rod-hook form. Good anatomic and functional results were got.Conclusion. Avoidance of fixation of intact functional spinal units allows to achieve good treatment results and classify this operation as organ sparing surgery.

Synopsis Reptiles with continuous tooth replacement, or polyphyodonty, replace their teeth in predictable, well-timed waves in alternating tooth positions around the mouth. This process is thought to occur irrespective of tooth wear or breakage. In this study, we aimed to determine if damage to teeth and premature tooth extraction affects tooth replacement timing long-term in juvenile green iguanas (Iguana iguana). First, we examined normal tooth development histologically using a BrdU pulse-chase analysis to detect label-retaining cells in replacement teeth and dental tissues. Next, we performed tooth extraction experiments for characterization of dental tissues after functional tooth (FT) extraction, including proliferation and β-Catenin expression, for up to 12 weeks. We then compared these results to a newly analyzed historical dataset of X-rays collected up to 7 months after FT damage and extraction in the green iguana. Results show that proliferation in the dental and successional lamina (SL) does not change after extraction of the FT, and proliferation occurs in the SL only when a tooth differentiates. Damage to an FT crown does not affect the timing of the tooth replacement cycle, however, complete extraction shifts the replacement cycle ahead by 4 weeks by removing the need for resorption of the FT. These results suggest that traumatic FT loss affects the timing of the replacement cycle at that one position, which may have implications for tooth replacement patterning around the entire mouth.

Background: One step to create a good image is by doing slice thickness reconstruction. Slice thickness is thick slices or pieces of the object checked out. The examination procedure of MSCT in case of Cervical trauma in Radiology Installation RSUD Tugurejo Semarang using slice thickness 3 mm. This contrasts with Seeram (2016), which explained that the examination of adult MSCT Cervical Spine using slice thickness between 1-2 mm. This research aims to know the difference of anatomic information resulted by 5 slice thickness variation in MSCT Cervical Spine and to find out which slice thickness can provide optimum anatomic information.Methods: The type of this research is quantitative with an experimental approach. Data is performed by reconstructing the 5 images of MSCT cervical of trauma patients using 5 slice thickness variation which is 1 mm, 1.5 mm, 2 mm, 2.5 mm and 3 mm. The final images are evaluated by two Respondents to see the differences in anatomic information and then analyzed by using a different test (Friedman Test) from the SPSS version 24.0.Results: The results showed there is a significant difference in anatomic information on the corpus, lamina, spinous process, transverse process and fragment fracture between variations in slice thickness of 1 mm, 1.5 mm, 2 mm, 2.5 mm, and 3 mm on the MSCT Cervical examination with a significance value of 0,000 or p 0.05.Conclusion: The most optimal slice thickness to provide anatomic information on the cervical MSCT examination is 1 mm slice thickness with a mean rank value of 3.64.

Background Operative procedures to enhance the aesthetic appearance of the feet are associated with risks. Minimally invasive procedures to volumize the dorsum of the foot are to this point not described. The present study investigates the safety and efficacy of such procedures in a retrospective clinical, anatomical, and ultrasound-based study. Methods A total of 106 feet from 53 female patients (mean age, 64.1 ± 8.3 years) were investigated retrospectively after the injection of a commercially available calcium hydroxylapatite product using a single-entry proximal-to-distal fanning injection technique. Anatomical dissections in 20 fresh, nonembalmed feet from 10 human body donors (mean age, 83.1 ± 8.8 years) were dissected, and 20 feet from 10 healthy volunteers (mean age, 26.5 ± 6.2 years) were examined by ultrasound imaging to help guide conclusions. Results Aesthetic outcome after 3 months was graded by the patients as 4, connoting good improvement (range, 3 to 5). No allergic reactions or other types of adverse events were documented. The layered anatomy of the dorsum of the foot was confirmed by anatomical dissections and ultrasound imaging as follows: skin, dorsal superficial fatty layer, dorsal superficial fascia, dorsal intermediate fatty layer, superficial lamina of the dorsal deep fascia, dorsal deep fatty layer, and deep lamina of the dorsal deep fascia. Conclusions Minimally invasive injections of soft-tissue filler in the dorsum of the foot can provide an alternate solution to enhance the aesthetic appearance of feet. The present study provides support for the safety and efficacy of volumizing procedures using a 22-gauge, 50-mm, blunt-tip cannula. Clinical question/level of evidence Therapeutic, IV.

Objective To investigate the incidence of superior facet joint violation (FJV) during percutaneous pedicle screw placement in minimally invasive transforaminal lumbar interbody fusion, and assess the possible risk factors for FJV. Methods An analysis of 91 patients with lumbar degenerative diseases treated with percutaneous pedicle screw placement via minimally invasive transforaminal lumbar interbody fusion from 2012 to 2018 was performed. Superior FJV was evaluated and graded by 3-dimensional lumbar computed tomography reconstruction. Analysis of possible risk factors included general condition of patients, anatomical characteristics of facet joint (FJ; axial, sagittal, and coronal diameters of FJ, facet angle, lumbar lordosis angle, lumbar lordosis index, and depth of lamina), and surgical factors (pedicle screw angle, screw-superior FJ distance, cranial angle, proximal rod length, and rod contouring). Results The overall violation rate of superior FJ was 34.07% (62/182), and high-grade violation rate was 16.06% (27/182). The logistic regression analysis revealed that body mass index ≥30 kg/m2 and pedicle screw placement at L5 were independent risk factors of FJV. Anatomical factors showed that the incidence of FJV was significantly increased when axial, sagittal, and coronal diameters of FJ were all ≥12 mm or FA was ≥40°. Surgical factors showed that the FJV group had a smaller pedicle screw angle and screw-superior FJ distance compared with the non-FJV group (P Conclusions Body mass index ≥30 kg/m2 and pedicle screw placement at L5 were independent risk factors of superior FJV. FJV was more likely to occur in hypertrophic FJ (axial, sagittal, and coronal diameters ≥12 mm) or coronal orientation (FA ≥40°).

OBJECTIVES Application of transcartilage needle electrode for intraoperative neuromonitoring (IONM) during thyroidectomy has been considered an alternative method of electromyography (EMG) tube recording. However, needle electrodes must be inserted into both sides of the thyroid cartilage with exposure of the cartilage lamina. We sought to evaluate the feasibility of applying a single ipsilateral transcartilage needle electrode for IONM during unilateral hemithyroidectomy. METHODS Thirty-four patients underwent IONM during unilateral thyroidectomy. A dual disposable needle electrode was inserted obliquely into the inferior lower third of the ipsilateral lamina of the thyroid cartilage. Patients were classified as deep (≥ 5 mm) or superficial (

Study Design: Retrospective radiographic study.Purpose: The hypothesis of this study was that the pedicle axis (PA) is almost perpendicular to the interlaminar line (ILL) in the sagittal plane of the thoracic vertebrae. The objective of the current study was to define the thoracic lamina–PA inclination in order to verify the right-angle concept and to estimate the safety zones for sagittal inclination during pedicle screw insertion. The authors, to the best of their knowledge, are unaware of previous similar studies.Overview of Literature: Based on the study’s observations of different spinal disorders, including deformities, it was noted that following a sagittal cranial–caudal trajectory perpendicular to the ILL and joining the two adjacent thoracic vertebrae would work well at most vertebral levels.Methods: This was a retrospective study on the computed tomography (CT) chest scans of patients with no spinal pathologies. The ILL–PA, superior and inferior safe angles of the pedicle screw trajectories, and the exit zone of the screw perpendicular to the ILL were reviewed by two observers via three-dimensional multiplanar reconstruction mode of the Horos DICOM software (https:// horosproject.org/).Results: The CT chest images of 30 consecutive patients (20 males and 10 females) with a mean age of 49.87±15.48 years (range, 24–74 years) were evaluated. The mean ILL–PA angle was almost orthogonal for all levels. This angle ranged between 86.21°±3.01° at D5 and 90.59°±2.72° at D10. The safety zones of the sagittal inclination of the pedicle screws were demonstrated. The results revealed that the least safe angle was when the screw was directed cranially along the middle part of the pedicle between 4.43°±0.75° at D8 and 6.94°±1.19° at D11.Conclusions: The results of this study confirmed the ILL–PA angle perpendicularity in the thoracic spine at all levels. The ILL is a useful guide for pedicle screw sagittal inclination.

Purpose: Previous population-based and hospital-based studies have shown an association between high myopia and higher prevalence of glaucomatous or glaucoma-like optic neuropathy (GON). Here we discuss potential factors associated with such a correlation. Design: Review. Methods: Findings from population-based and clinical investigations were combined with observations from light-microscopical examinations of human eyes. GON was defined by an abnormal shape of the neuroretinal rim as shown by a vessel kinking close to optic disc border in the inferior, superior, or nasal optic disc region. Results: The prevalence of GON increased (P 33 mm. It was associated with a larger optic disc and/or larger parapapillary delta zone. Histological factors potentially associated with the myopia-related increased GON prevalence were an elongation and thinning of the lamina cribrosa resulting in intra-lamina changes and a steepening of the translamina cribrosa pressure gradient; a lengthening and thinning of the peripapillary scleral flange which is the ophthalmoscopical equivalent of parapapillary delta zone and acts as the biomechanical anchor of the lamina cribrosa; and an increased distance of the peripapillary arterial circle of Zinn-Haller to the lamina cribrosa, due to the elongation of the peripapillary scleral flange. In addition to GON, a nonglaucomatous optic nerve damage may occur in the papillo-macular region due to a parapapillary gamma zone-associated lengthening of the retinal nerve fibers. Conclusions: In highly myopic eyes, one should be vigilant not to overlook GON.

Background: Laminectomy and decompression is a common procedure for treating spine diseases. However, due to the lack of a posterior, bony braced structure, the dural sac and nerve roots can adhere to the surrounding tissues, and scar formation can occur in muscle and soft tissues. This can cause new compression post surgery, and failure of the operation. Objective: This study aimed to produce an individualized titanium alloy spine lamina using 3D printing technology, and to evaluate its effectiveness by implantation in human cadaveric spines. Methods: Six adult lumbar cadaver specimens were used, and computed tomography (CT) was used to obtain DICOM medical digital image standard data. The lumbar vertebrae structure was reconstructed by three-dimensional (3D) modeling software, and then simulated lumbar laminectomy was performed. Based on the characteristics of the original lamina, an artificial spine lamina was designed, including suture holes at the posterior ligament attachment point and a locking screw hole for fixation. A titanium alloy spine lamina was fabricated by 3D printing, and a guide plate to assist artificial lamina implantation was designed. Using the guide plated, L4 lumbar vertebrae segment laminectomy was performed on the 6 lumbar spine specimens, titanium alloy spine lamina were implanted and fixed with cortical bone trajectory screws. After implantation, CT was performed to record the length of the screw, the trajectory of the screw in the pedicle, and changes of bony spinal canal volume and anteroposterior diameter of the spinal canal. Results: The morphology of artificial spine lamina matched that of the original lamina. The artificial lamina was easy to implant, and matched the original lamina. The laminas were fixed by 12 cortical screws (diameter, 4.5 mm; median length, 34.67 ± 1.97 mm). CT scan indicated that all screws passed through the pedicle cortex by < 2 mm (2 screws penetrated the inner wall). The bony canal volume of the L4 vertebral pedicle was 311.23 ± 38.17 mm2 before operation and 356.17 ± 43.11 mm2 after operation, and there was statistical difference (P < 0.001). The anteroposterior diameter of spinal canal was 17.82 ± 2.03 mm before surgery and 20.67 ± 2.38 mm after surgery, and they were statistically different (P < 0.001). Conclusion: An individualized artificial titanium alloy spine lamina designed and produced with 3D printing technology can be used to reconstruct the structure of the posterior spine complex after lumbar laminectomy. The artificial lamina can increase the volume of the spinal canal and provide a posterior ligament reconstruction attachment point.

Purpose To study the mucosal complications of osteo-odonto-keratoprosthesis (OOKP) surgery from the UK national keratoprosthesis cohort. Methods A retrospective study was conducted at the Sussex Eye Hospital, Brighton, UK. The case records of patients who underwent OOKP surgery were reviewed and analysed. Results The cohort contained 64 patients, among which 25 were females and 39 were males. Eyelid and adnexal abnormalities were treated in 69% of the cases prior to OOKP surgery. Mucosal graft complications after OOKP affected 46% of the cases after stage 1 and 22% after stage 2. Most of the complications were observed in cases with autoimmune conditions like Stevens-Johnson syndrome (43% post-stage 1, 59% post-stage 2) and cicatrising conjunctivitis (31% post-stage 1, 20% post-stage 2). On the contrary, mucosal overgrowth covering the anterior surface of the optic, which was noted in 28% of the cases, was a common complication after stage 2. Thinning and ulceration of the mucosa was noted in 22% of cases after stage 2. Laminar exposure due to mucosal ulcers was identified in 11 cases. The central part of the mucosa was frequently affected by thinning and ulceration after stage 1. The mucosa overlying the supero-nasal corner of the lamina was eroded commonly after stage 2 leading to exposure of the lamina. Mucosal thinning after stage 1 was treated with conservative measures such as observation and increased lubrication in 15 cases, and with surgical procedures in 7 cases. Post-stage 1 mucosal ulcers were mostly treated by surgery (7 out of 8 cases). Following stage 2, minor cases of mucosal ulcers and thinning and three cases of overgrowth were conservatively treated with lubrication and observation. However, 18 cases of overgrowth required surgical excision. All cases of lamina exposing ulcers were surgically treated. Surgical treatment of mucosal defects included mucosal grafts, flaps and eyelid corrections. Fusion of the eyelids and conversion to a trans-palpebral OOKP were performed in two cases to treat resistant mucosal ulcers. Two eyes lost lamina as a consequence of lamina exposing ulcers. One lamina was explanted due to severe resorption and one due to infection. Conclusion The majority of surgical revisions following OOKP surgery are due to mucosal problems, such as mucosal thinning and ulcerations. These may be treated with increased lubrication of the mucosa or surgical closure of the defects. Mucosal defects resulting in laminar exposure can be a serious threat to laminal viability, and must be treated promptly and aggressively.

PurposeTo investigate the relationship between corneal hysteresis (CH) and anterior lamina cribrosa surface (ALCS) displacement over time in a cohort of patients with glaucoma.DesignProspective observational case series.MethodsIn this study, 147 eyes from 96 glaucoma or glaucoma suspect patients were followed for a mean of 3.5 years and 7.9 visits. Baseline CH measurements were obtained using the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments Inc, Depew, New York, USA). The mean anterior lamina cribrosa surface depth (ALCSD) and choroidal thickness were by automated segmentation of spectral-domain optical coherence tomography (SD-OCT) scans. The rate of change of ALCSD was calculated using linear mixed effects models. Relationship between baseline CH and follow-up ALCSD rate of change was adjusted for confounding factors, including age, intraocular pressure (IOP), and choroidal thickness.ResultsThe mean baseline CH was 9.4mm Hg (95% confidence interval [CI] 9.1-9.7). Overall, the ALCS was displaced posteriorly at a rate of 0.78μm/y (95% CI-1.82, 0.26). Seventeen eyes (11.5%) showed a significant posterior displacement of ALCS, whereas 22 eyes (15.0%) showed a significant anterior displacement of ALCS. The choroidal thickness thinned at a rate of-1.09μm/y during the follow-up (P= .001). Multivariable mixed modeling showed that choroidal thinning, lower IOP change, and lower corneal hysteresis were significantly associated with posterior ALCS displacement over time (P= .034, P= .037, and P= .048). Each 1mm lower CH was associated with 0.66μm/y posterior displacement of the ALCS.ConclusionsLower corneal hysteresis was significantly associated with posterior displacement of the anterior lamina cribrosa over time. These data provide additional support for lower corneal hysteresis being a risk factor for glaucoma progression.

Background: Traumatic upper cervical spine leads to instability and neurological deficit. At present, C2 (axis) pedicle or lamina screws for fixation are popular because further external immobilization is not needed. However, these techniques demand experience inserting the screws and carry the risk of vertebral artery or spinal cord injury. In some patients, the C2 screws cannot be inserted because of limited C2 size. Objective: To determine the width, length, height, and angle in the C2 pedicle and lamina in the Thai population. Materials and Methods: Patient data were collected from the Picture Archiving and Communication System at the Faculty of Medicine, Prince of Songkla University from January 2016 to December 2017. The C2 parameters, i.e., width, length, height, and angle of the pedicle and lamina were recorded. Results: The CT C-spine scans of 270 patients were enrolled. The mean Thai C2 pedicle dimensions were width 5.51 mm, length 23.78 mm, angle 39.04°, and height 8.64 mm. The mean C2 lamina dimensions were width 5.88 mm, length 32.17 mm, angle 49.46°, and height 12.27 mm. Twenty-four patients from the 270 patients (8.8%) had a pedicle width

We investigated the relationship between microstructure of β-parapapillary atrophy (β-PPA) and morphologic features of optic nerve head (ONH) and posterior pole in highly myopic eyes. Eighty-nine highly myopic eyes were included in this study. Bruch’s membrane opening (BMO) area, lamina cribrosa (LC) thickness, anterior laminar depth, peripapillary and subfoveal choroidal thickness (CT), macular Bruch’s membrane (BM) length, and width of β-PPA with and without Bruch’s membrane (PPA+BM and PPA−BM) were evaluated. The mean age and axial length of the included subjects were 26.88 ± 2.44 years and 27.03 ± 0.88 mm, respectively. The width of PPA−BM was larger with increasing BMO area (P = 0.001), whereas the BMO area was not associated with the width of PPA+BM. The large PPA+BM was significantly related to a thinner LC (P = 0.003), deeper anterior lamina surface (P P = 0.008), and thinner temporal peripapillary CT (P = 0.034). We found that the morphologic features of the ONH and posterior pole in highly myopic eyes were different based on the microstructure of β-PPA. Whether these features are linked to the development of glaucoma in myopic eyes should be investigated in future studies.

Of the rhinosinusitis (CRS) patients, half of whom require surgical intervention. Functional endoscopic sinus surgery (FESS) is a standard treatment of CRS and sinonasal polyposis. Orbito-ocular complications can occur during FESS. The lamina papyracea (LP) is the weakest point of the medial wall of the orbit. The variability in the size and shape of the paranasal sinuses is important in the FESS procedure. The ethmoid sinus is the most complex paranasal sinuses. Preoperative evaluation using computed tomography (CT) is mandatory for all patients undergoing FESS. This study aimed to determine the lamina papyracea area and ethmoid sinuses volume in patients who underwent a CT scan of paranasal sinuses. This study was a descriptive study on 103 patients who underwent a CT scan of paranasal sinuses in the Radiology Department of Hasanuddin University General Hospital, Makassar, from January to August 2019. The lamina papyracea area and ethmoid sinus volume were measured based on age and gender. The results showed that the average of lamina papyracea size and ethmoid sinus volume was greater in males than in females. There was a correlation between age and posterior height of left lamina papyracea (p=0.02), but no correlation between ethmoid sinuses volume and age.

Objective to determine the anterior ethmoidal artery (AEA) anatomy and variations by computed tomography (CT) in adult and their relations to and presents new AEA classifications. Methods One hundred and fifty paranasal CT scans (300 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes. Results One hundred and forty-four AEAs canal (48%), 293 AEAs foramen (97.7%), and 229 AEAs sulcus could be detected (76.3%). The mean AEA intranasal length was 6.7 ± 1.27 mm (range: 4.24–10.6 mm). The mean angle between AEA and lamina papyracea was 105.49 ± 9.28 degrees (range: 76.41–129.76 degrees). Of them, 95.8% AEAs had an angle with lamina >90 degrees, while 4.2% had angle 90 degrees and 12.5% had an angle 6 mm; 2.1%). The mean distance between the AEA and frontal sinus ostium was 9.17 ± 4.72 mm (range: 0–25.36 mm). AEA classification according to distance from AEA to frontal sinus ostium was 17.4% type 1 (15 mm). Conclusion Provided AEA details improve surgeons' awareness of AEA variations in the endoscopic field and can help residents in training.

A retrospective study investigated and compared the results of lamina with spinous process (LSP), transverse process strut (TPS) and iliac graft (IG) as bone graft in thoracic single-segment spinal tuberculosis(TB) with the one-stage posterior approach of debridement, fusion and internal instrumentation. 99 patients treated from January 2012 to December 2015 were reviewed. LSP was performed in 35 patients (group A), TPS was undertaken in 33 patients (group B), and IG was carried out in 31 patients (group C). Surgical time, blood loss, hospitalization time, drainage volume, and follow-up (FU) duration were recorded. The visual analog scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, segmental angle, intervertebral height and bone fusion time were compared between preoperative and final FU. All the patients were followed up for a mean 43.90±10.39 months in group A, 45.30±6.20 months in group B, 44.32±7.17 months in group C without difference(P>0.05). The mean age was younger, the blood loss was less, the hospitalization time and the surgical time were shorter in group A than those in group B and C (P0.05). In conclusion, the LSP and TPS as bone graft are reliable, safe, and effective for single-segment stability reconstruction for surgical management of thoracic TB and TPS could be new bone graft methods.

Objective: Synchrotron radiation-based X-ray phase-contrast tomography (XPCT) imaging is an innovative modality for the quantitative analysis of three-dimensional morphology. XPCT has been used in this study to evaluate ascending aorta specimens from patients with acute type A aortic dissection (ATAAD) and to analyze the morphologic structure of the aortic wall in patients with this condition. Methods: Aortic specimens from 12 patients were obtained during repairs for ATAAD and were fixed with formalin. Five patients had Marfan syndrome (MFS), and seven did not. In addition, six normal aortas were obtained from autopsies. Using XPCT (effective pixel size, 12.5 μm; density resolution, 1 mg/cm3), the density of the tunica media (TM) in each sample was measured at eight points. The specimens were subsequently analyzed pathologically. Results: The density of the TM was almost constant within each normal aorta (mean, 1.081 ± 0.001 g/cm3). The mean density was significantly lower in the ATAAD aortas without MFS (1.066 ± 0.003 g/cm3; P < .0001) and differed significantly between the intimal and adventitial sides (1.063 ± 0.003 vs 1.074 ± 0.002 g/cm3, respectively; P < .0001). The overall density of the TM was significantly higher in the ATAAD aortas with MFS than those without MFS (1.079 ± 0.008 g/cm3; P = .0003), and greater variation and markedly different distributions were observed in comparison with the normal aortas. These density variations were consistent with the pathologic findings, including the presence of cystic medial necrosis and malalignment of the elastic lamina in the ATAAD aortas with and without MFS. Conclusions: XPCT exhibited differences in the structure of the aortic wall in aortic dissection specimens with and without MFS and in normal aortas. Medial density was homogeneous in the normal aortas, markedly varied in those with MFS, and was significantly lower and different among those without MFS. These changes may be present in the TM before the onset of aortic dissection.

Purpose The aim of this study was to evaluate the preliminary results of osteo-odonto keratoprosthesis (OOKP) performed in Alexandria Main University Hospital, Alexandria, Egypt in eyes with end-stage cicatrizing conjunctivitis. Patients and methods OOKP surgery was done in two stages. Stage 1 included preparation of the globe, buccal mucous membrane harvesting, and preparation of osteo-odonto alveolar lamina with the cemented optical cylinder. The prepared lamina was then placed in the submuscular space for 2–3 months. In stage 2, the lamina–optical cylinder complex was implanted under the buccal mucous membrane and the posterior part of the optical cylinder was placed in a central corneal opening to act as an artificial cornea, transmitting image to the retina. Results Six eyes with end-stage ocular surface disease were included in this study. Anatomical success, in the form of retention of the prosthesis, was achieved in five eyes. The procedure failed in one eye due to unhealthy canines with a small amount of bone in the lamina. Functional success, defined as restoration of vision, was achieved in four eyes. Visual improvement was not attained in one eye (in addition to the eye with anatomical failure) due to optic atrophy despite good retention of the device. Conclusion OOKP is a promising procedure to regain vision in severe cases of end-stage corneal blindness, unsuitable for cadaveric corneal grafts. Proper selection of cases is crucial to achieve the best anatomical and functional results.

Background The rigid cricoid cartilage is functionally the narrowest portion of the larynx. There is some controversy over the shape of the pediatric cricoid cartilage in the transverse plane. It is important to understand the development of the cricoid cartilage so that endo-traceheal tubes can be used more safely. Aim To determine changes in the internal diameter and shape of the cricoid cartilage during development and explore the implications of those changes for the selection of ETT type and size for children. Methods The cervical computed tomography scans were reviewed in patients aged 1-20 years. After performing the multiplanar reconstruction and correcting the slant, the transverse and anteroposterior internal diameters of the inlet and outlet of the cricoid cartilage were measured, respectively. The angle between the arch and the lamina of the cricoid cartilage in the middle sagittal plane was measured. The ratios of transverse to anteroposterior diameter for the inlet and outlet of the cricoid cartilage were calculated, respectively. Results In females, the internal diameters of the cricoid cartilage increased linearly with age. In males, the internal diameters of the cricoid cartilage exhibited a growth spurt during adolescence. The transverse diameter of the inlet was the smallest diameter of the cricoid cartilage, and the predicting formula of the transverse diameter of the inlet for children aged 1-12 was 0.4 × age (year) + 5.1, R2 = .758. The angle between the arch and lamina of the cricoid cartilage and the ratios of transverse to anteroposterior diameter correlated weakly with age. Conclusion The transverse inner diameter of the inlet is the smallest diameter of the cricoid cartilage. The "funnel shape" of the cricoid cartilage remains unchanged during development. The outer diameter should be considered when selecting an endotracheal tube.