Biomedical subjects

Francis W Smith

Publications and source records attributed to Francis W Smith.

9 recordsLinked to original sources

PubMed2006

Influence of X Stop on neural foramina and spinal canal area in spinal stenosis.

STUDY DESIGN: Measurements of cross sections of exit foramen and spinal canal were performed before and after placement of X Stop in physiologic postures using positional MR scanner at the stenosed level in patients with lumbar spinal stenosis. OBJECTIVE: To quantify the effect of the implant in vivo on the lumbar spine at the instrumented levels in various postures. SUMMARY OF BACKGROUND DATA: Dimensions of the spinal canal and neural foramen decrease from flexion to extension. Symptoms of spinal stenosis occur typically in standing or extension. The X Stop device is designed to distract the posterior elements of the stenotic segment and place it in flexion to treat neurogenic claudication. We think that the device will improve the dimension of the canal in standing and extension. METHODS: Twenty-six patients with lumbar spine stenosis underwent a one- or two-level X Stop procedure. All had preoperative and postoperative positional MRI in standing, supine, and sitting flexion and extension. Measurements were carried out on the images acquired. RESULTS: Significant increase in the dimensions of the neural foramen and canal area were demonstrated after surgery. CONCLUSIONS: The X Stop device improves the degree of central and foraminal stenosis in vivo.

Aged↗

PubMed2006

Cluster analysis as a method for determining size ranges for spinal implants: disc lumbar replacement prosthesis dimensions from magnetic resonance images.

STUDY DESIGN: Statistical analysis of clinical radiologic data. OBJECTIVE: To develop an objective method for finding the number of sizes for a lumbar disc replacement. SUMMARY OF BACKGROUND DATA: Cluster analysis is a well-established technique for sorting observations into clusters so that the "similarity level" is maximal if they belong to the same cluster and minimal otherwise. METHODS: Magnetic resonance scans from 69 patients, with no abnormal discs, yielded 206 sagittal and transverse images of 206 discs (levels L3-L4-L5-S1). Anteroposterior and lateral dimensions were measured from vertebral margins on transverse images; disc heights were measured from sagittal images. Hierarchical cluster analysis was performed to determine the number of clusters followed by nonhierarchical (K-means) cluster analysis. Discriminant analysis was used to determine how well the clusters could be used to classify an observation. RESULTS: The most successful method of clustering the data involved the following parameters: anteroposterior dimension; lateral dimension (both were the mean of results from the superior and inferior margins of a vertebral body, measured on transverse images); and maximum disc height (from a midsagittal image). These were grouped into 7 clusters so that a discriminant analysis was capable of correctly classifying 97.1% of the observations. The mean and standard deviations for the parameter values in each cluster were determined. CONCLUSIONS: Cluster analysis has been successfully used to find the dimensions of the minimum number of prosthesis sizes required to replace L3-L4 to L5-S1 discs; the range of sizes would enable them to be used at higher lumbar levels in some patients.

Adult↗

PubMed2006

The length of the cervical cord: effects of postural changes in healthy volunteers using positional magnetic resonance imaging.

STUDY DESIGN: The length of the cervical cord in healthy volunteers was measured in the supine and erect position using positional magnetic resonance imaging (MRI). OBJECTIVE: To assess the relationship between the length of the cervical cord and cervical posture in healthy volunteers. SUMMARY OF BACKGROUND DATA: A number of detailed descriptions of the normal morphologic features of the cervical cord have been published. However, to our knowledge, there is no report to compare the relationship between the length of the cervical cord and cervical posture in healthy volunteers using positional MRI. METHODS: This study was performed on 20 healthy volunteers using positional MRI. The subjects were studied in the supine and erect positions. The recumbent series consisted of 3 positions: neutral, flexion, and extension. The erect series consisted of 3 positions: neutral, flexion, and extension. On the midsagittal image, the length of the cervical cord from C1 to C7 was measured at the anterior, middle, and posterior line. The angle of the lower-endplate of C2 and C7 was measured. The results were compared with each series. RESULTS: In the recumbent and erect series, the mean length of the cervical cord in flexion was longer than in neutral and extension at the anterior, middle, and posterior line. There were significant differences between the length of the cervical cord in flexion, neutral, and extension. The mean length of the cervical cord in extension was shorter than in neutral and flexion at the anterior, middle, and posterior line. There were significant differences between length of the cervical cord in extension, neutral, and flexion. CONCLUSIONS: We found posture-dependent differences of the length of the cervical cord in the recumbent and erect series. These results may be important when assessing the dynamic factor in cervical spondylotic myelopathy.

Adult↗

PubMed2006

Biomechanical aspects of the cervical cord: effects of postural changes in healthy volunteers using positional magnetic resonance imaging.

STUDY DESIGN: The area in cross-sectional view of the cervical cord (ACSCC) at each disc levels was measured in supine and erect positions using positional magnetic resonance imaging (pMRI). OBJECTIVES: To assess the relationship between ACSCC and cervical posture in healthy volunteers using pMRI. SUMMARY OF BACKGROUND DATA: There have been few detailed descriptions of the normal morphologic features of the cervical cord. However, there is no report to compare the relationship between ACSCC and cervical posture in healthy volunteers. METHODS: The study was performed on 20 healthy volunteers. The subjects were studied with pMRI in the supine and erect positions. The recumbent series and the erect series consist of 3 positions each: neutral, flexion and extension. On axial images, ACSCC was measured at the C2/3, C3/4, C4/5, C5/6, and C6/7 disc levels. On midsagittal image, the angle of the lower-endplate of C2 and C7 was measured. The results were compared between each series. RESULTS: In the recumbent and erect series, ACSCC was larger in extension than in neutral and flexion at all levels. There were significant differences between ACSCC in extension, neutral and flexion. ACSCC was smaller in flexion than in neutral and extension at all levels. There were significant differences between ACSCC in flexion, neutral and extension. CONCLUSIONS: We found posture-dependent differences of ACSCC in the recumbent and erect series. These results may be valuable for identifying a dynamic factor in patients with cervical spondylotic myelopathy.

Adult↗

PubMed2006

Positional MRI changes in supine versus sitting postures in patients with degenerative lumbar spine.

INTRODUCTION: Back pain is associated with a degree of alteration in the alignment and movement of the lumbar spine. The purpose of this study is to investigate how the degree of lumbar segmental degeneration affects sagittal changes in the lumbar spine as it shifts from the supine to the sitting (load-bearing) posture. MATERIALS AND METHODS: Thirty patients with chronic low back pain were enrolled (14 male and 16 female patients); mean age 44.5 years. Their lumbar spines were initially investigated by conventional supine magnetic resonance imaging (MRI) followed later by positional MRI in the seated posture. Of the 150 discs studied, 87 were classified as healthy grade 1, 16 as grade 2, 34 as grade 3, and 13 as grade 4. RESULTS: As the lumbar spine was loaded from the supine to the sitting position, the end-plate angles were decreased significantly as the degeneration was increased. There were also significant changes in the anterior and middle disc heights between the supine and the sitting postures irrespective of the degree of degeneration. The overall lumbar lordosis did not significantly change between the two postures. CONCLUSIONS: We have found that the changes in the segmental motion were related to the degree of degeneration. With positional MRI, we were able to demonstrate changes in healthy and degenerative discs in the weight-bearing position. More similar studies are needed to understand the complex kinematics of the lumbar spine.

Adult↗

PubMed2006

Effects of X-STOP device on sagittal lumbar spine kinematics in spinal stenosis.

The X-Stop device is designed to distract the posterior elements of the stenotic segment and place it in flexion to treat neurogenic claudication. Previous biomechanical studies on X Stop have been done in vitro on cadavers looking at disc pressures and segmental range of movements. The objective of this study is to understand the sagittal kinematics in vivo of the lumbar spine at the instrumented and adjacent levels. Twenty-six patients with lumbar spine stenosis underwent 1 or 2 level X-Stop procedure. All had pre- and postoperative positional magnetic resonance imaging (MRI) in standing, supine, and sitting in flexion and extension. Measurements of disc heights, endplate angles, segmental and lumbar range of movement were performed after placement of X Stop at the stenosed level in patients with lumbar spinal stenosis. No significant changes were seen in disc heights, segmental and total lumbar spine movements postoperatively. The X-Stop device does not affect the sagittal kinematics of the lumbar spine in vivo.

Aged↗

PubMed2005

Sagittal plane moment arms of the female lumbar region rectus abdominis in an upright neutral torso posture.

BACKGROUND: Prior imaging studies of torso muscle moment arms for use as inputs into biomechanical models have been derived from subjects lying supine. Recent research suggests moment arms of the rectus abdominis are larger when standing versus lying supine. METHODS: Axial MRI images, through and parallel to the intervertebral discs were obtained from five females in a standing upright neutral posture. Digitizing software was utilized to quantify the distance in the sagittal plane between the centroids of the intervertebral disc and the rectus abdominis muscle, and converted to the transverse plane to allow comparisons with studies with subjects in a supine posture. FINDINGS: The mean sagittal plane moment arms in the transverse plane were 9.7, 9.1, 8.5, 8.5 and 9.8 cm at the L(1)/L(2), L(2)/L(3), L(3)/L(4), L(4)/L(5) and L(5)/S(1) intervertebral levels, respectively. Compared with a study on females of a similar age group, the moment arms from this study were larger at each level, increasing from 7.3% larger at L(1)/L(2) to 43.7% larger at L(5)/S(1). INTERPRETATION: Accurate anatomical geometrical representation in biomechanical models is necessary for valid estimates of internal loading. Sagittal plane rectus abdominis moment arms were larger from the upright neutral torso posture in this study compared to studies with subjects lying supine. This suggests the torso internal moment generating capability would be represented differently in biomechanical models that use data from studies where subjects were upright, which is more reflective of the postures biomechanical models are utilized for, than when using anatomical geometry derived from supine postures.

Abdomen↗

PubMed2003

Antenatal factors in the development of the lumbar vertebral canal: a magnetic resonance imaging study.

STUDY DESIGN: The lumbar vertebral canal was measured in two cohorts of 10-year-old children (n = 161) using magnetic resonance imaging (MRI) and compared with obstetric records. OBJECTIVE: To investigate whether there are identifiable obstetric factors that determine the size of the lumbar vertebral canal. SUMMARY OF BACKGROUND DATA: The most rapid period growth for the lumbar vertebral canal is between 12 and 32 weeks in utero, with the midsagittal diameter of L1-L4 already 70% of adult dimension at birth. Therefore, adverse antenatal factors during this critical growth period may be expected to affect the size of the canal. METHODS: The canal size was measured from axial MRI sections taken through each lumbar vertebra (L1-L5) at the pedicular level of 84 children. Relations with obstetric data, prospectively collected in a neonatal database, were sought. The relation of low birthweight and canal size was further investigated in a second cohort of children (n = 77). RESULTS: The canal size, particularly the midsagittal diameter and the cross-sectional area, was found to be significantly reduced by low birthweight (with growth retardation in utero being a more important factor than length of gestation), low placenta weight, and lower socioeconomic class. Smoking during pregnancy significantly reduced the perimeter at L3 (P = 0.032) and L5 (P = 0.031), and also the cross-sectional area at L3 (P = 0.030) and L5 (P = 0.016). CONCLUSIONS: This study showed that, for this group of children, the size of the lumbar vertebral canal was reduced by low birthweight, with maternal smoking as an added adverse factor. Therefore, good antenatal care and maternal education may help to reduce the risk of spinal stenosis in adult life.

Birth Weight↗

PubMed2003

Advanced imaging: Magnetic resonance imaging in implant dentistry.

For accurate and safe placement of dental implants, and planning of associated surgery, a full assessment of the surgical anatomy of the site is necessary. Thus, it is highly desirable to have tomographic, sectional information available, to permit the implant to be aligned correctly. In recent years, X-ray computed tomography (CT) has become accepted as the gold standard in assessment, but the exposure to ionising radiation can be substantial. Artefacts due to dental restorations can also be significant, and some doubts may exist over the accuracy of reformatted CT. Magnetic resonance imaging (MRI) entails no exposure to ionising radiation, and allows direct acquisition of tomographic information in any desired plane. Sequential studies may be safely performed, allowing us a valuable insight into bone graft behaviour. Other than in a small number of cases, MRI may be safely used for presurgical assessments. Artefacts are few and in most cases localised. The surgical confidence from the sectional information gained is a significant step forward in the safe placement of dental implants.

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