Biomedical subjects

Harvey E Smith

Publications and source records attributed to Harvey E Smith.

7 recordsLinked to original sources

PubMed2006

An evaluation of image-guided technologies in the placement of percutaneous iliosacral screws.

STUDY DESIGN: A surgical simulation study in human cadaver spine specimens was conducted to evaluate the accuracy of 3 different surgical navigation systems compared to standard fluoroscopy in the percutaneous placement of iliosacral screws. OBJECTIVES: To compare the accuracy of percutaneous iliosacral screw placement using standard fluoroscopy, computer-assisted fluoroscopic image guidance, Iso-C3D image guidance (Medtronic Surgical Navigation Technologies, Louisville, CO), and electromagnetic fluoroscopic image guidance. SUMMARY OF BACKGROUND DATA: Conventional percutaneous sacroiliac screw placement has a malposition rate as high as 15%, as reported in the English-speaking literature (Hinsche et al [Clin Orthop Relat Res 2002;395:135-44] and Templeman et al [Clin Orthop Relat Res 1996;329:194-8]). Iso-C3D and computer-assisted image guidance technologies have been proposed to increase this accuracy rate. METHODS: Two iliosacral screws were placed bilaterally (4 screws) in each of 4 cadavers using standard fluoroscopy, computer-assisted fluoroscopic image guidance, Iso-C3D image guidance, and electromagnetic fluoroscopic image guidance. Screw positions were analyzed by computerized tomography after instrumentation and assigned a score based on deviation from ideal screw position. RESULTS: The StealthStation with FluoroNav (Medtronic Surgical Navigation Technologies) appeared to provide the highest accuracy of all guidance techniques. This result was more accurate than standard fluoroscopy. CONCLUSIONS: Computer-assisted fluoroscopy based image navigation appears to be more accurate than standard fluoroscopy in placing these screws. However, errors may occur with all techniques. Further refinement in registration procedures may highly improve the accuracy of percutaneous screw placement in a variety of spinopelvic procedures.

Aged↗

PubMed2006

The use of computerized image guidance in lumbar disk arthroplasty.

OBJECTIVES: Surgical navigation systems have been increasingly studied and applied in the application of spinal instrumentation. Successful disk arthroplasty requires accurate midline and rotational positioning for optimal function and longevity. A surgical simulation study in human cadaver specimens was done to evaluate and compare the accuracy of standard fluoroscopy, computer-assisted fluoroscopic image guidance, and Iso-C3D image guidance in the placement of lumbar intervertebral disk replacements. METHODS: Lumbar intervertebral disk prostheses were placed using three different image guidance techniques in three human cadaver spine specimens at multiple levels. Postinstrumentation accuracy was assessed with thin-cut computed tomography scans. RESULTS: Intervertebral disk replacements placed using the StealthStation with Iso-C3D were more accurately centered than those placed using the StealthStation with FluoroNav and standard fluoroscopy. Intervertebral disk replacements placed with Iso-C3D and FluoroNav had improved rotational divergence compared with standard fluoroscopy. Iso-C3D and FluoroNav had a smaller interprocedure variance than standard fluoroscopy. These results did not approach statistical significance. Relative to both virtual and standard fluoroscopy, use of the StealthStation with Iso-C3D resulted in improved accuracy in centering the lumbar disk prosthesis in the coronal midline. CONCLUSIONS: The StealthStation with FluoroNav appears to be at least equivalent to standard fluoroscopy and may offer improved accuracy with rotational alignment while minimizing radiation exposure to the surgeon. Surgical guidance systems may offer improved accuracy and less interprocedure variation in the placement of intervertebral disk replacements than standard fluoroscopy. Further study regarding surgical navigation systems for intervertebral disk replacement is warranted.

Aged↗

PubMed2005

An evaluation of image-guided technologies in the placement of anterior thoracic vertebral body screws in spinal trauma: a cadaver study.

BACKGROUND: Image guidance provides additional anatomic information to the surgeon, which may allow more accurate insertion of spinal implants. Imprecise placement of anterior thoracic screws places the spinal cord and paraspinal structures at risk for injury. Image guidance may afford a safety benefit to patients when anterior thoracic screws are required in the setting of spinal stabilization after trauma. OBJECTIVES: To compare the accuracy of anterior thoracic screw placement using standard fluoroscopy, computer-assisted fluoroscopic image guidance, Iso-C3D image guidance, and electromagnetic fluoroscopic image guidance. STUDY DESIGN: A surgical simulation study in human cadaver spine specimens. METHODS: After an open thoracotomy approach, anterior thoracic screws were placed by experienced spine surgeons using 4 different image-guided techniques in 4 human cadaver thoracic spines. Screws were placed in the 9th, 10th, and 11th thoracic vertebrae of each specimen. The specimens were then examined with thin-cut computed tomography (CT) scans, and with sagittal and coronal reconstructions. Measurements included the distance of the screw from the spinal canal, the angle of the screw path in relation to a perpendicular to a line that bisects the spinous process, and the angle of screw divergence from the superior endplate. RESULTS: There was no evidence of spinal canal penetrance with any of the image-guided techniques used to place anterior thoracic vertebral body screws. Screws inserted with standard fluoroscopy tended to aim anterolaterally by 18 degrees. The image-guidance systems allowed more accurate placement of anterior thoracic screws in the transverse plane compared with standard fluoroscopy. There was no statistically significant difference in coronal plane screw angulation (angle of divergence with the superior endplate) between any of the imaging methods. CONCLUSIONS: Spinal image-guidance systems may allow spine surgeons to place anterior thoracic screws more precisely, particularly in the axial plane. The improved accuracy of spinal implant insertion could ultimately provide a benefit to patient safety, especially in the setting of malaligned vertebral bodies after trauma.

Aged↗

PubMed2004

Change in knee cartilage T2 at MR imaging after running: a feasibility study.

All participants provided informed consent to participate in this study, which was approved by the institutional review board of Milton S. Hershey Medical Center. The purpose of the study was to determine the feasibility of cartilage T2 mapping in the evaluation of response of femoral and tibial cartilage to running exercise. Quantitative magnetic resonance (MR) T2 maps of weight-bearing femoral and tibial articular cartilage were obtained in seven young healthy men before and immediately after 30 minutes of running by using a 3.0-T MR imager. There was no statistically significant change in T2 profiles of tibial cartilage. There was a statistically significant decrease in T2 of the superficial 40% of weight-bearing femoral cartilage after exercise. These in vivo observations agree well with published ex vivo results and support the hypothesis that cartilage compression results in greater anisotropy of superficial collagen fibers.

Adult↗

PubMed2004

Cervical arthroplasty: material properties.

Discectomy, decompression, and fusion are traditionally used to manage cervical disc disease accompanied by neural element compression that is refractory to conservative management. Concerns regarding stress at levels adjacent to fusion and possible adjacent-level degeneration as well as a desire to maintain a more normal biomechanical environment have led to investigation of cervical disc replacement as an alternative to fusion procedures. Cervical disc prostheses currently under investigation are constructed of predominantly metal-on-polyethylene or metal-on-metal bearing surfaces, and use roughened titanium surfaces and osteoconductive coatings to facilitate fixation. The unique anatomy and biomechanics of the cervical spine must be considered when extrapolating from the experience of appendicular arthroplasty and lumbar disc replacement.

Arthroplasty↗

PubMed2004

Interphalangeal joint cartilage: high-spatial-resolution in vivo MR T2 mapping--a feasibility study.

The purpose of this study was to evaluate feasibility of magnetic resonance (MR) T2 mapping of the proximal interphalangeal joint of the index finger. Cartilage T2 maps with an in-plane resolution of 39 microm were obtained from five asymptomatic subjects-four men and one woman, aged 24-45 years-by using a 3.0-T MR imager. Image acquisition time was 9.6 minutes. All cartilage T2 maps demonstrated spatial variation similar to that reported previously for knee cartilage, with T2 values increasing toward the articular surface. These results demonstrate the feasibility of acquiring cartilage T2 maps of small joints in the hand. Application of T2 mapping techniques to non-weight-bearing joints may provide a means for differentiation of local biomechanical and systemic factors that can affect cartilage T2 values.

Adult↗

PubMed2004

Effect of gender on in vivo cartilage magnetic resonance imaging T2 mapping.

PURPOSE: To determine if gender is a significant variable for in vivo magnetic resonance imaging (MRI) T2-mapping of knee articular cartilage in young asymptomatic volunteers. MATERIALS AND METHODS: Cartilage MRI T2 mapping was performed in a young healthy population consisting of seven male and 10 female volunteers, 22 to 29 years of age. High-resolution in vivo T2 maps were obtained of patellar, tibial, and weight-bearing femoral articular cartilage. Spatial dependency of cartilage T2 between groups was evaluated through a comparison of cartilage T2 as a function of normalized distance from bone. RESULTS: Bulk cartilage T2 values were similar at all three anatomic sites, and between male and female volunteers. All volunteers demonstrated similar spatial variation in cartilage MRI T2 values, with a minimum located in the radial zone and increasing T2 values toward the articular surface. There was no difference in spatial dependency of cartilage T2 between males and females. CONCLUSION: In young, healthy volunteers, the magnitude and spatial dependency of cartilage T2 does not differ with gender.

Adult↗