The feasibility of transpedicular screw fixation of the subaxial cervical spine in the Arab population: a computed tomography-based morphometric study.

BACKGROUND: Transpedicular screw fixation of the cervical spine provides excellent biomechanical stability. The feasibility of inserting a 3.5-mm screw in the pedicle requires a minimum pedicle diameter of 4.5 mm. This diameter allows at least 0.5 mm bony bridge medially and laterally in order to avoid pedicle violation which can result in neurovascular complications. We aim to evaluate the feasibility of this technique in Arab people since no data are available about this population. MATERIALS AND METHODS: This cross-sectional study involved a retrospective review of computed tomography scans of normal cervical spines of 99 Arab adults. Ten morphometric measurements were obtained. Data were analyzed using a p value of ≤0.05 as the cut-off level of statistical significance. RESULTS: Our sample included 63 (63.6 %) males and 36 (36.4 %) females, with a mean age of 35.5 ± 16.5 years. The morphometric parameters of C3-C7 spine pedicles were larger in males than in females. The outer pedicle width (OPW) was <4.5 mm in >25 % of all subjects at C3-C6 vertebrae. Statistically significant differences in the OPW between males and females were noted at C3 (p = 0.032) and C6 (p = 0.004). CONCLUSIONS: Inserting pedicle screws in the subaxial cervical spine is feasible among the majority of Arab people. LEVEL OF EVIDENCE: Level 3.

The Feasibility of Two Screws Anterior Fixation for Type II Odontoid Fracture Among Arabs.

STUDY DESIGN: Retrospective, cross-sectional study. OBJECTIVE: To evaluate the feasibility of two screws anterior fixation of the odontoid process among Arab adults. SUMMARY OF BACKGROUND DATA: Anterior screw fixation is the treatment of choice for type II odontoid fractures. In order to perform the procedure safely, the diameter of the odontoid process should be wide enough to allow for the placement of one or two screws. METHODS: A retrospective review of 156 computed tomography scans of the cervical spine was done. The included patients were Arabs, adults (at least 18 years old), and had no evidence of upper cervical spine trauma, deformity, infection, tumor, or surgery. The minimum external transverse diameter (METD), minimum internal transverse diameter (MITD), minimum external anteroposterior diameter (MEAD), and minimum internal anteroposterior diameter (MIAD) of the odontoid process were measured. A P value of ≤0.05 was considered as the cutoff level of statistical significance. RESULTS: Our study included 94 (60.3%) males and 62 (39.7%) females. The mean age of the subjects was 37.8 ±â€Š16.9 years (range 18-85). The mean values of the METD, MITD, MEAD, and MIAD were 8.7 ±â€Š1.0 mm, 6.0 ±â€Š1.1 mm, 10.3 ±â€Š1.0 mm, and 7.4 ±â€Š1.1 mm, respectively. Men had larger diameters compared to women. This was statistically significant for METD (P = 0.035) and MEAD (P < 0.001). The METD was <9.0 mm in 95 (60.9%) subjects, while the MITD was <8.0 mm in 153 (98.1%) subjects. These findings were not significantly different between males and females. CONCLUSION: Two screws anterior fixation of type II odontoid fracture is not feasible among the majority of Arabs. LEVEL OF EVIDENCE: 3.

Computed tomography-based morphologic and morphometric features of the coccyx among Arab adults.

STUDY DESIGN: Cross-sectional, retrospective. OBJECTIVE: To identify morphological and morphometric features of the coccyx among adult Arabs. SUMMARY OF BACKGROUND DATA: Different sacrococcygeal morphologic features were found to be associated with coccydynia. METHODS: Review of 202 computed tomographic scans of adult Arab subjects was done (mean age: 47.98 ± 16.46 yr). Sacrococcygeal morphological features including number of coccygeal segments, type of coccyx, joint fusion, joint subluxation, coccygeal spicule, coccygeal sacralization, ventral angulation of the terminal sacral segment (S5), and lateral deviation of coccygeal tip were recorded. Moreover, morphometric measurements including lengths and angles of the sacrococcygeal region were measured. Analysis of data was carried out using P value of less than 0.05 as the cutoff level of significance. RESULTS: Three coccygeal segments were present in 138 (68.3%) of individuals. The majority of the subjects had coccyx type I (96; 47.5%), II (70; 34.7%), or III (31; 15.3%); type I being more common among males (P = 0.004). Bony spicule was present in 109 (54.0%) individuals. Joint fusion, joint subluxation, coccygeal sacralization, ventral angulation of S5, and lateral deviation of coccygeal tip were present in 38.6%, 31.7%, 34.2%, 38.1%, and 38.6% of the subjects, respectively. Joint subluxation and ventral angulation of S5 were more significantly present among females (P = 0.015, P = 0.014, respectively). The mean straight and curved lengths of the coccyx were 3.3 ± 0.7 cm and 3.7 ± 0.8 cm, respectively. The sacrococcygeal structures were longer in males than in females. The mean sacrococcygeal joint angle was 149.2°± 28.1°. Based on the morphometric measurements, the coccyx was more ventrally angulated among females. CONCLUSION: The coccygeal morphology and morphometry of Arab adults share some similarities and differences with individuals of other ethnic backgrounds. Future studies should investigate the relation between these anatomic features with coccydynia among this population. LEVEL OF EVIDENCE: 3.

Sixty-four-slice multidetector computerized tomography in the evaluation of transmesenteric internal hernias following Roux-en-Y bariatric surgery.

OBJECTIVE: To evaluate the accuracy of 64-slice multidetector computerized tomography (MDCT) in the detection of transmesenteric internal hernias in patients following Roux-en-Y gastric bypass (RYGB) for bariatric surgery patients. SUBJECTS AND METHODS: This retrospective study was performed on post-bariatric RYGB patients presenting with signs and symptoms suggestive of internal hernias at our institution from the period of April 2010 until March 2012. The patients who had symptoms suggestive of internal hernia had undergone 64-slice MDCT. All the patients who on CT examination were found to have features suggestive of internal hernia were subjected to laparoscopic exploration. RESULTS: Of the 102 patients who had undergone laparoscopic RYGB, 42 (41.2%) were suspected of having internal hernia. Of these, 23 (55%) had CT findings of hernia while the remaining 19 (45%) were considered normal. Of the 23, 21 (91%) patients were confirmed for internal hernia at laparoscopy. The 19 (45%) patients that did not reveal any signs for internal hernia on CT and the 2 patients that were considered normal on laparoscopy were treated conservatively. The sensitivity, specificity and positive and negative predictive values for MDCT in the diagnosis of internal hernias were 100, 90.5, 91 and 91.3% respectively. CONCLUSION: The 64-slice MDCT was accurate in the diagnosis of transmesenteric internal hernias in post-RYGB for bariatric surgery patients. The presence of clustered loops with mesenteric swirl is a reliable indicator of transmesenteric internal hernia.

Sonomammographic characteristics of invasive lobular carcinoma.

OBJECTIVE: The objective of our study was to identify characteristic features of invasive lobular carcinoma on mammography and ultrasound examinations. MATERIALS AND METHODS: This is a retrospective multicenter study of women with biopsy-proven invasive lobular carcinoma. All patients had undergone diagnostic sonomammography. The imaging findings were identified by experienced breast imagers. Final surgical pathology results were used as the reference standard. RESULTS: Thirty-two women ranging in age from 42 to 63 years old (mean age, 53 years), All had biopsy-proven invasive lobular carcinomas. Common features on mammogram included dense mass followed by architectural distortion; three cases showed breast asymmetry and one case was reported as normal. On ultrasound, common features included solid mass with spiculated margins, posterior shadowing, and perpendicular to the skin. CONCLUSION: Although no specific features could be linked to invasive lobular carcinoma, care should be directed to subtle signs such as architectural distortion and breast asymmetry in order not to miss any lesions. The combination of mammographic and sonographic helps to decrease the relatively high false negative diagnosis of this type of breast cancer.

Sixty-four multi-detector computerised tomography in the detection of lower gastrointestinal bleeding: A prospective study.

INTRODUCTION: Acute gastrointestinal bleeding (AGIB) is a serious and life-threatening condition. Many diagnostic procedures and tests are being used to detect the site of bleeding with different success rates. The aim of our study is to prospectively evaluate accuracy of 64-slice multi-detector computerised tomography (MDCT) in the diagnosis of lower AGIB. METHODS: Between September 2007 and January 2009, patients with presumed lower AGIB were referred to the radiology department of our institution for 64-slice MDCT examination as part of the investigation for the lower AGIB. Any abnormalities to account for bleeding, such as tumours, bowel wall enhancement and increased intraluminal density, were recorded. RESULTS: Out of 139 patients with AGIB that were admitted to our casualty department, 27 patients (19 men and 8 women) in the age range of 24-88 years (mean age, 56 years) were suspected to have lower AGIB. Sixty-four-slice MDCT was performed and considered positive for bleeding in 19 (70%) cases, and in all the cases, the bleeding source was indentified in the arterial phase, showing a focal dense wall enhancement in 8 (42%) cases, circumferential wall enhancement in 4 (22%) cases and progressive increasing intraluminal density in 7 (36%) cases. The venous phase scan showed increased dispersion of the contrast within the lumen as an additional clue for active extravasation in 15 (79%) out of the 19 cases. Delayed 5-min scanning showed the same findings as venous phase in all the 19 positive cases and failed to depict any additional findings in the eight cases that were negative on arterial or venous phases. CONCLUSION: The study supports the high accuracy of 64-slice MDCT in locating the site of AGIB in patients thought to have a distal source of bleeding. Its accuracy in clinically proximal bleeding is not clear from this study, but MDCT is capable of showing such sources.