Method of evaluating deficit of spinal canal lumen

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be used in traumatology, orthopedics, neurosurgery, vertebrology and radiology for evaluating deficit of spinal canal lumen. From a series of images two images of axial section in uninjured zone and zone with the most expressed deficit of spinal canal lumen are selected. On each of said images additional plotting is carried out, on axis of vertebra symmetry and further, at equal distance from each other. Straight lines, parallel to axis of vertebra symmetry, are drawn, crossing with these lines contour of spinal canal from each side. On each of two selected images determined are lengths of segments of drawn straight lines, limited by spinal canal contour. After that deficit of spinal canal lumen is determined.

EFFECT: method allows to determine deficit of spinal canal lumen and volume of surgical intervention.

2 cl, 3 dwg, 1 ex

 

The invention relates to medicine and can be used in traumatology, orthopedics, neurosurgery, vertebrology and radiology to assess deficiency lumen of the spinal canal.

There is a method of evaluation space of the spinal canal, which define the area of the intervertebral holes and the area of the corresponding spinal nerve root, calculate the ratio of the area of the intervertebral holes to the area of the spinal cord root - index of backup space by magnetic resonance tomography study [RU patent for the invention №2177348 "Method for diagnosis of stenosis of the lumbar intervertebral hole"].

The disadvantage of this method is that when expressed degenerative and scar-adhesive processes not always possible to differentiate the tissue of the nerve root and, as a consequence, the calculation of the index backup space is impossible.

There is also known a method of assessing the degree of pathology of the spinal canal [Yahooplay et al. Impeller corporal indexes and stenosis of the spinal canal. Congress of neurologists USSR, proc. report. - Kharkov, 1976], which is determined at the level of the 3rd lumbar vertebra front-impeller radical index is the ratio of the frontal diameter of the channel to the sum of the frontal dimensions of the roots of the right and left sides of the vertebra, is also the sagittal impeller corporeal index the ratio of the sagittal diameter of the spinal canal to the sagittal size of the vertebral body.

The disadvantage of this method is that in this case is determined only indirect signs of compression syndrome, on the basis of which it is impossible to determine the tactics of surgical treatment of the patient.

There is also known a method of assessing spinal canal, in which, after clinical examination of the patient, make x-ray picture of the spine. Direct shot carry out additional construction and determining the magnitude of the Delta, which is the length between the calculated center of gravity of the body and the projection of the center of the vertebra to the main horizontal plane of the body. On the obtained values of Delta judge available compression syndrome [RU patent for the invention № 2152754 "Method for radiographic examination of the spine"].

Known methods for assessing the significant parameters of the spine, based on the processing of (resourcevalue) x-ray and measuring related parameters of the spine in a neutral position and in the position of maximum flexion and extension [RU patent for the invention № 2243721; and work Iseman representative of the applicant organization for this application - Sarnico, published in 1969, with the experience of the applicant organization on this issue on the from period and to which reference see in patent No. 2243721, paragraph 2].

The disadvantage of this method is that this method allows to estimate only the functional condition of the spine, but does not evaluate the parameters space of the spinal canal.

It is also known that in most cases, the narrowing of the spinal canal is determined by the degree of deformation of the dural SAC when performing myelography, magnetic resonance imaging, computed tomography. Important the value of the sagittal size of the spinal canal and dural SAC [article "Surgery for stenosis of the lumbar spine", published on the website

http://www.spine.kiev.ua/ru/specialist_b08.html].

From the point of view of the authors of this article has a value of reducing not only the size but also the area of the spinal canal. The area of the spinal canal are calculated according to the formula: S=A×B/2, where a is the frontal size of the spinal canal (the smallest distance between the inner edges of the base of the arches of the vertebra); sagittal size of the spinal canal (the distance between the rear surface of the vertebral body and a line drawn through the vertices of the vertebral joints).

The disadvantage of this method is that this method is suitable for calculating the degree of spinal canal stenosis with circular stenosis of the spinal canal and in front of the forms of deformation of the spinal canal with the introduction of bone fragments into the spinal canal or Grajewo the protrusion of the accuracy of calculations used in this method is high.

There is also known a method for the diagnosis of stenosis of the lumbar intervertebral holes [application EN for the invention №93025260]. The novelty of this method is the measurement of the linear parameters of the vertebral motor segment and intervertebral openings in patients with lumbar osteochondrosis and the definition of the developed coefficients intervertebral holes to obtain information about the degree of narrowing of the intervertebral holes and define the indications for surgical correction of the latter.

All the above methods require complex radiographic positioning, a large number of images, which greatly increases unreasonable radiation load on the patient.

Known methods for assessing the injuries of the spine and the contents of the spinal canal, based on the classification Denis developed F.Denis (1982-1984) and McAfee et al. (1983). "After 1983, many authors have significantly supplemented and modified this classification that allowed us to successfully apply it in the treatment of various spinal disorders [Louis R., 1977, 1983, 1991; Mc Afee, 1983; Mageri et al., 1994; J. Willen et al., 1992; Wolter D., 1985, 1992; Roy-Camille, 1979]" - [Tendrils E Guide the transpedicular fixation of the spine. Part I. the spinal cord. - SPb.: Hippocrates, 2006. - P.9-11, the information material enclosed].

On mnini the authors called a "Guide" for all its merits, data evaluation methods based on the classification has some disadvantages. This is primarily the determination of the narrowing of the lumen of the spinal canal at the level of injury to the value of 1/3, 2/3 and more. With modern methods of topical diagnosis of spinal cord injuries (x KG, MRI, research methods with contrast) definition of post-traumatic deficit lumen of the spinal canal can be done more accurately [Magnetic resonance imaging of the spine and spinal cord / Choline A.V., Makarov, A., Mazurkiewicz E.A. - SPb., 1995 - 131 C.].

With the accumulation of experience and analysis of the results identified the most important characteristics of cerebrospinal trauma, which served as the basis for the creation of a new classification - [Tendrils E Neuroorthopedics classification closed cerebrospinal trauma / Antennae EAST, Solomatin A.A. // Traumatology and Orthopaedics, Russia. - 1996. No. 4. - P.18-23]. The basis of classification laid neuroactivity principle that defines the mandatory comprehensive assessment of indicators of damage to the bone and ligamentous structures of the spine Denis, and criteria used in the assessment of spinal cord injury and its formations. Own changes and additions in this classification relate to highlight only the main types of spinal cord injuries and precision measuring post-traumatic strain damages the data values and deficit of the lumen of the spinal canal at the level of the injury.

The disadvantage of this method and many others, including previously described, is the lack of sufficient precision and mathematical justification for surgical correction at the level of the damaged spinal segment.

The task of the invention is to improve the accuracy in the estimation space of the spinal canal, namely the deficiency of the lumen, with the simplicity of the method.

The essence of the proposed method estimates the deficit of the lumen of the spinal canal is characterized by the fact that carry out computer-tomographic studies of the damaged segment of the spine, from the obtained tomograms axial slices of the spine choose tomograms with the most pronounced deformation of the spinal canal and without it, hold on the selected tomograms additional construction in the form of parallel lines at equal distances from each other, starting from the line of symmetry of the vertebra on both sides to curve fringing on the tomogram of the vertebral canal in the plane of its axial cross-section on each of the respective tomograms fixed points of intersection of the lines with the contour of the curve and determine the corresponding values of lengths of line segments inside contours, and the number of segments is odd: 5, 7, 9 ..., then summarize the obtained values of protagonist the St segments on each of the selected tomograms - as with the deformation of the biand without ai, - determine the deficiency of the lumen of the spinal canal in percentage based on the formula:

where D is the deficit of the lumen of the spinal canal;

ai- the length of the line segment inside the path on the tomograms without deformation of the spinal canal;

bi- the length of the line segment inside the path on the tomograms with the deformation of the spinal canal;

i - number of the line segment from 1 to n;

n=5, 7, 9 ... - the number of segments;

- the sum of the lengths of the line segments inside the path on the tomograms without deformation of the spinal canal;

- the sum of the lengths of the line segments inside the path on the tomograms with the deformation of the spinal canal.

In addition, in the method of estimating the deficit lumen of the spinal canal with the above signs of multiple injuries of the spine conduct research at the level of each of the damaged segments with subsequent processing of the data at each level, respectively, above.

The technical result

Because in today's world, the availability of computer tomography (CT) far does not match the number of medical institutions, on the one hand, on the other hand, existing in AMA medical standard does not include a number of mandatory requirements processing computer tomograms get the value of the size of the deficit of the lumen of the spinal canal, and those institutions, which make computer images to obtain a number of important parameters, the exact size of the deficit lumen of the spinal space is obtained if it is not mandatory for processing tomograms doctors roentgenology on their stage. Spinal patient then gets on the following stages of diagnosis without important indicator. Surgeons involved in the treatment of such patients regardless of the profile of the medical institution, it is necessary to accurately determine these spatial parameters of the spinal canal, as the deficiency of its lumen. In practice it is not always the attending physician to be present during computer tomography (CT) study. Often the patient comes to him already with the finished images. The doctor in the study of these images have to decide in favor of this or that method of treatment. A detailed study of the spatial parameters, as the deficit of the lumen of the spinal canal, to a great extent and sometimes dramatically can affect the choice of the most correct method of treatment. In addition, when performing surgical treatment, the availability of data on the deficit of the lumen of the spinal canal helps to identify the scope of surgical intervention. In such common situations in the presence of CT, but not processed sufficiently for the required the pits today with finding the changed parameter space of the spinal canal, this method with physico-technical appendices of the proposed method will allow for 5-10 minutes to get an important indicator is the size of the deficit lumen of the spinal canal.

The method is illustrated using figures, which presents illustrations assisted builds.

Figure 1 - schematic representation of the results of the subsidiary builds to apply formula (1). (a) for the image of an axial slice of the spine at the level, not susceptible to pathological changes. (b) for the image of an axial slice of the spine at the level of the most pronounced deficit of the lumen of the spinal canal. The circuit noted that the axis of symmetry of the vertebra is a large dash, built pieces of auxiliary lines parallel to the axis of symmetry of the vertebra enclosed within the contour of the spinal canal - small dotted line.

Figure 2 - estimating the area of irregular shapes using the method of rectangles. (a) is entered on the horizontal axis x perpendicular to the symmetry axis vertebra, separating the image of the open portion of the spinal canal at any place in 2 parts, C and D. the symmetry Axis of the vertebra in the drawing, the large dotted line. The area of the whole figure is calculated as the sum of the squares of its parts: C and D. (b) - assessment areamethod of rectangles. The area With razbiva is located on the N rectangles of equal width h height .estimate according to the formula (6). (C) assessment areaproduced similarly by the formula (8).

The method of implementing the claimed invention.

Because often there is no boundary - clear circuit formed between the pathology and the wall of the spinal canal and the border looks overall a blur, it is not possible to determine the size of the defect or the size of the employed pathology space. In such cases it is advisable to resort to indirect measurement is desired, namely, to first determine the percent of significant size is the remaining area not involved in the pathology of space, then subtract this value from 100% (100% correspond to the free space of the spinal canal without pathology) and to get the deficit lumen of the spinal canal in percent:

For the practical implementation of the proposed method for quantitative assessment of deficit lumen of the spinal canal first obtained using computed tomography images of axial sections of the spine choose two, and those images that contain the contour of the spinal canal at the level, not susceptible to pathological changes, and the contour of the spinal canal at the level with the most pronounced for the subjugated patient with deficiency of the lumen of the spinal canal. Then for each of these images carry out additional construction. Along the symmetry axis of the vertebra and then at the same distance h from each other hold direct parallel to the axis of symmetry of the vertebra, crossing those lines, the contour of the spinal canal. The value of h depends on the image scale, it is usually chosen so that the contour of the spinal canal crossed N constructed in this way direct. It is enough to choose N equal to 5, 7, 9 ... etc - the more the selected odd number of divisions, the more accurate the result.

Determine the length of the segments built direct, limited by the contour of the spinal canal for each of the two selected images.

The above build is made for image axial cross-section of the spinal canal at the level, not susceptible to pathological changes, schematically presented in figure 1, where the length of the segment bounded by the contour of the spinal canal is designated as ai. Similar plots made for the image of the spinal canal at the level susceptible to pathological changes shown in Figb, where the length of the segment bounded by the contour of the open part of the spinal canal, designated as bi.

To quantify the ratio of the area of the open part of the spinal canal, imeushih the deficit of the lumen, and the area of the spinal canal, without pathological changes, calculate the sum of the lengths of segments aiand bibuilt direct and evaluate the ratio of the areas as:

For example, for the case presented in figure 1, where N=7 and formula (2) will have the form:

Illustrate the feasibility of applying the proposed formula (2) to quantify the ratio of the area of the open part of the spinal canal with the most pronounced deficit of the lumen and the space channel at a level that is not susceptible to pathological changes.

Estimate the area of the open part of the spinal canal SDfor the image of an axial cross section of a vertebra, made at the level of the most pronounced deficit of the lumen of the spinal canal. Fit ("tie") to the image coordinate system to the x-axis x was held perpendicular to the symmetry axis vertebra and divided in an arbitrary place the open part of the spinal canal into 2 parts: C and D, with squareandboth build:

Built segments biwill cut the x-axis x into two parts, build:

D. the I each of these two parts, C and D, we introduce the y-axis of bCand bDaccordingly, collinear to the axis of symmetry of the vertebra. Directions put the axes of ordinates is chosen as shown on Figa.

Estimate the area of the shape With- Figb. By definition, the integral of a function integral represents the area under the graph of the function, so:

In practice, this integration can be performed numerically using the method of rectangles, the essence of which consists of dividing the area under the graph integrable functions on rectangles and calculate their total area.

To apply the method of rectangles divide the shape into N rectangles of equal width h as shown in Figb. As can be seen from Figb, in this case, the height of the ith rectangle will be. The value of the integral (6) or, in other words, the area of the shape, according to the method of rectangles can be estimated as the sum of the areas of N rectangles:

The value obtained using the method of rectangles, as with any other numerical integration methods, is an estimate of the square shape.

Carrying out similar calculations to estimate the areafigure D (Pigv), we obtain:

From the formula (4) receive estimating the area of the open part of the spinal canal SDusing (7) and (8), get:

Given (5) from formula (9), get:

Similarly, we can estimate the area of the spinal canal, is not affected by pathology:

Expressed in percentage the ratio of the areas:

Appreciate the deficit lumen of the spinal canal, calculating the percentage area of space occupied by pathology, according to the formula:

Thus, it is shown physico-technical sense, the proposed formula (1). The accuracy of the estimates of the deficit of the lumen of the spinal canal increases with the number N.

Example.

Medical care was delivered urgently ill M 44 years old with a diagnosis of "Closed uncomplicated injury of the lumbar spine with compression-comminuted fracture of the body of LI vertebra with the introduction of the bone fragment into the spinal canal with compression of the dural SAC". The presented CT images evaluation of spatial values of the spinal canal produced was not. Therefore to determine the extent of the surgery on the tomograms were evaluated vertebral ka is Ala in accordance with the proposed method. For this series of images were selected two images in axial cross section in the undamaged zone and in the zone with the most pronounced deficit of the lumen of the spinal canal. Then, on each of these pictures are conducted additional construction. Along the symmetry axis of the vertebra and then, at equal distance from each other (3 mm) made direct parallel to the axis of symmetry of the vertebra, crossing those lines, the contour of the spinal canal 3 on each side. Then on each of the two selected images defined length of segments built direct, limited by the contour of the spinal canal (Figure 3). On offer in this application the final mathematical expression defined deficit of the lumen of the spinal canal:

This deficit lumen of the spinal canal elimination it is only possible to open surgical method, namely the removal of bone fragments from the spinal canal, as recommended in the evaluation result of the deficit of the lumen of the spinal canal.

1. Method of assessment deficiency lumen of the spinal canal, characterized by the fact that carry out computer-tomographic studies of the damaged segment of the spine, from the obtained tomograms axial slices of the spine choose tomograms with the most pronounced deformation of the vertebral what about the channel and without it, spend on selected tomograms additional construction in the form of parallel lines at equal distances from each other, starting from the line of symmetry of the vertebra on both sides to curve fringing on the tomogram of the vertebral canal in the plane of its axial cross-section on each of the respective tomograms fixed points of intersection of the lines with the contour of the curve and determine the corresponding values of lengths of line segments inside the contours, and the number of segments is odd: 5, 7, 9 ..., then summarize the obtained values of lengths of segments on each of the selected tomograms as a deformation of biand without andidetermine the deficiency of the lumen of the spinal canal in percent, based on the formula

where D is the deficit of the lumen of the spinal canal;
ai- the length of the line segment inside the path on the tomograms without deformation of the spinal canal;
bi- the length of the line segment inside the path on the tomograms with the deformation of the spinal canal;
I - number of the line segment from 1 to n;
n=5, 7, 9 ... - the number of segments;
- the sum of the lengths of the line segments inside the path on the tomograms without deformation of the spinal canal;
- the sum of the lengths of the line segments is within the outline on the tomograms with the deformation of the spinal canal.

2. Method of assessment deficiency lumen of the spinal canal according to claim 1, characterized in that when multiple injuries of the spine conduct research at the level of each of the damaged segments with subsequent processing of the data at each level accordingly to claim 1.



 

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