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Contains fulltext : 237199.pdf (Publisher’s version ) (Open Access)

Radboud University, 17 april 2018, Promotor : Verdonschot, N.J.J. Co-promotores : Tanck, E.J.M., Linden, Y.M. van der, Contains fulltext : 187343.pdf (publisher's version ) (Open Access)

Here, we describe the development of a Dutch national guideline on metastases and hematological malignancies localized within the spine. The aim was to create a comprehensive guideline focusing on proactive management of these diseases, enabling healthcare professionals to weigh patient perspectives, life expectancy, and expected outcomes to make informed treatment recommendations. A national multidisciplinary panel consisting of clinicians, a nurse, a patient advocate, an epidemiologist, and a methodologist drafted the guideline. The important role of patients in the realization of the guideline enabled us to identify and address perceived shortcomings in patient care. The guideline covers not only metastatic epidural spinal cord compression, but also the treatment of uncomplicated metastases and hematological malignancies localized within the spine. The guideline is applicable in daily practice and provides an up-to-date and concise overview of the diagnostic and treatment possibilities for patients suffering from a disease that can have a serious impact on their quality of life. Suggestions for the practical implementation of patient care in hospitals are also provided, including approaches for pursuing proactive management. The crucial role of the patient in decision making is emphasized in this guideline.

Item does not contain fulltext, We propose an experimental setup and protocol able to induce targeted failure of the middle vertebra in 3-segment spinal units and to capture the specimens' deformation in their post-failure state. Sixteen 3-segment spinal units with and without artificial metastases were destructively tested in axial compression using one of two failure criteria; either: (A) A clear drop in force (>10-15% of peak force) (n=4); or (B) A minimum displacement of 5mm (n=12). Subsequently, the specimens were fully fixated in polymethylmethacrylate (PMMA), thereby preserving their post-failure state. Pre- and post-experiment computed tomography (CT) scans were acquired to determine the occurrence of failure in one of the vertebral bodies. All specimens were successfully fixated in their post-failure state. When applying failure criterion A, two specimens showed signs of failure. When applying failure criterion B, all specimens showed signs of failure; in 9 out of 12 specimens this occurred in the middle vertebrae only. In conclusion, this research provides an experimental setup and protocol able to induce targeted failure of 3-segment spinal units and to capture the specimens' deformation in their post-failure state. Furthermore, this study illustrates the importance of an adequate failure criterion for successful simulation of vertebral fractures in an experimental setup.

Contains fulltext : 195630.pdf (Publisher’s version ) (Open Access), Here, we describe the development of a Dutch national guideline on metastases and hematological malignancies localized within the spine. The aim was to create a comprehensive guideline focusing on proactive management of these diseases, enabling healthcare professionals to weigh patient perspectives, life expectancy, and expected outcomes to make informed treatment recommendations. A national multidisciplinary panel consisting of clinicians, a nurse, a patient advocate, an epidemiologist, and a methodologist drafted the guideline. The important role of patients in the realization of the guideline enabled us to identify and address perceived shortcomings in patient care. The guideline covers not only metastatic epidural spinal cord compression, but also the treatment of uncomplicated metastases and hematological malignancies localized within the spine. The guideline is applicable in daily practice and provides an up-to-date and concise overview of the diagnostic and treatment possibilities for patients suffering from a disease that can have a serious impact on their quality of life. Suggestions for the practical implementation of patient care in hospitals are also provided, including approaches for pursuing proactive management. The crucial role of the patient in decision making is emphasized in this guideline.

Item does not contain fulltext, Musculo-skeletal modeling could play a key role in advancing our understanding of the healthy and pathological spine, but the credibility of such models are strictly dependent on the accuracy of the anatomical data incorporated. In this study, we present a complete and coherent musculo-skeletal dataset for the thoracic and cervical regions of the human spine, obtained through detailed dissection of an embalmed male cadaver. We divided the muscles into a number of muscle-tendon elements, digitized their attachments at the bones, and measured morphological muscle parameters. In total, 225 muscle elements were measured over 39 muscles. For every muscle element, we provide the coordinates of its attachments, fiber length, tendon length, sarcomere length, optimal fiber length, pennation angle, mass, and physiological cross-sectional area together with the skeletal geometry of the cadaver. Results were consistent with similar anatomical studies. Furthermore, we report new data for several muscles such as rotatores, multifidus, levatores costarum, spinalis, semispinalis, subcostales, transversus thoracis, and intercostales muscles. This dataset complements our previous study where we presented a consistent dataset for the lumbar region of the spine (Bayoglu et al., 2017). Therefore, when used together, these datasets enable a complete and coherent dataset for the entire spine. The complete dataset will be used to develop a musculo-skeletal model for the entire human spine to study clinical and ergonomic applications.

Item does not contain fulltext, Musculo-skeletal modeling can greatly help in understanding normal and pathological functioning of the spine. For such models to produce reliable muscle and joint force estimations, an adequate set of musculo-skeletal data is necessary. In this study, we present a complete and coherent dataset for the lumbar spine, based on medical images and dissection measurements from one embalmed human cadaver. We divided muscles into muscle-tendon elements, digitized their attachments at the bones and measured morphological parameters. In total, we measured 11 muscles from one body side, using 96 elements. For every muscle element, we measured three-dimensional coordinates of its attachments, fiber length, tendon length, sarcomere length, optimal fiber length, pennation angle, mass, and physiological cross-sectional area together with the geometry of the lumbar spine. Results were consistent with other anatomical studies and included new data for the serratus posterior inferior muscle. The dataset presented in this paper enables a complete and coherent musculo-skeletal model for the lumbar spine and will improve the current state-of-the art in predicting spinal loading.