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Photoacoustic imaging of a human vertebra: implications for guiding spinal fusion surgeries.

ABSTRACT: It is well known that there are structural differences between cortical and cancellous bone. However, spinal surgeons currently have no reliable method to non-invasively determine these differences in real-time when choosing the optimal starting point and trajectory to insert pedicle screws and avoid surgical complications associated with breached or weakened bone. This paper explores 3D photoacoustic imaging of a human vertebra to noninvasively differentiate cortical from cancellous bone for this surgical task. We observed that signals from the cortical bone tend to appear as compact, high-amplitude signals, while signals from the cancellous bone have lower amplitudes and are more diffuse. In addition, we discovered that the location of the light source for photoacoustic imaging is a critical parameter that can be adjusted to non-invasively determine the optimal entry point into the pedicle. Once inside the pedicle, statistically significant differences in the contrast and SNR of signals originating from the cancellous core of the pedicle (when compared to signals originating from the surrounding cortical bone) were obtained with laser energies of 0.23-2.08 mJ (p??

SUBMITTER: Shubert J

PROVIDER: S-EPMC6097631 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Photoacoustic imaging of a human vertebra: implications for guiding spinal fusion surgeries.

Shubert Joshua J Lediju Bell Muyinatu A MA

Physics in medicine and biology 20180711 14

It is well known that there are structural differences between cortical and cancellous bone. However, spinal surgeons currently have no reliable method to non-invasively determine these differences in real-time when choosing the optimal starting point and trajectory to insert pedicle screws and avoid surgical complications associated with breached or weakened bone. This paper explores 3D photoacoustic imaging of a human vertebra to noninvasively differentiate cortical from cancellous bone for th ...[more]

PMID: 29923832

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Project description:Previous studies to identify risk factors for postoperative deep infection following instrumented spinal fusion surgery for degenerative spinal disease are based on insufficient information and have limited use in clinical practice. This study aims to fill this gap by assessing the risk factors and their adjusted relative risks through a comprehensive analysis, including all core information. In this nationwide, population-based, cohort study, data were obtained from the Korean National Health Insurance claims database between 1 January 2014, and 31 December 2018. This study included a cohort of 194,036 patients older than 19 years, who underwent instrumented spinal fusion surgery for degenerative spinal disease. We divided this population into cases (patients with postoperative deep infection) and controls (patients without postoperative deep infection); risk factors for postoperative deep infection were determined by multivariable analysis. The definition of postoperative deep infection varied, and sensitivity analyses were performed according to each definition. The estimates of all the statistical models were internally validated using bootstrap samples. The study included 767 patients (0.39%) with postoperative deep spinal infections and 193,269 controls. The final multivariable model identified the following variables as significant risk factors for postoperative deep infection: age between 60-69 years (OR = 1.6 [1.1-2.3]); age between 70-79 years (OR = 1.7 [1.2-2.5]); age > 80 years (OR = 2.1 [1.3-3.2]); male sex (OR = 1.7 [1.5-2.0]); rural residence (OR = 1.3 [1.1-1.5]); anterior cervical approach (OR = 0.2 [0.1-0.3]); posterior cervical approach (OR = 0.5 [0.2-1.0]); multiple approaches (OR = 1.4 [1.2-1.6]); cerebrovascular disease (OR = 1.5 [1.2-1.8]); peripheral vascular disease (OR = 1.3 [1.1-1.5]); chronic pulmonary disease (OR = 1.2 [1.0-1.4]); rheumatologic disease (OR = 1.6 [1.3-2.1]); liver disease (OR = 1.4 [1.1-1.7]); diabetes (OR = 1.5 [1.3-1.7]); hemiplegia or paraplegia (OR = 2.2 [1.5-3.3]); allogenous transfusion (OR = 1.6 [1.3-1.8]); and use of systemic steroids over 2 weeks (OR = 1.5 [1.1-2.0]). Our results, which are based on homogenous patient groups, provide clinicians with an acceptable tool for comprehensive risk assessment of postoperative deep infection in patients who will undergo instrumented spinal fusion surgery for degenerative spinal disease.

Project description:ObjectiveCervical remodeling is an important component in determining the pathway of parturition; therefore, assessing changes in cervical tissue composition may provide information about the cervix's status beyond the measurement of cervical length. Photoacoustic imaging is a non-invasive ultrasound-based technology that captures acoustic signals emitted by tissue components in response to laser pulses. This optical information allows for the determination of the collagen-to-water ratio (CWR). The purpose of this study was to compare the CWR evaluated by using spectroscopic photoacoustic (sPA) imaging in cervical samples obtained from pregnant and non-pregnant women.MethodsThis cross-sectional study comprised cervical biopsies obtained at the time of hysterectomy (n = 8) and at the scheduled cesarean delivery in pregnant women at term who were not in labor (n = 8). The cervical CWR was analyzed using a fiber-optic light-delivery system integrated to an ultrasound probe. The photoacoustic signals were acquired within the range of wavelengths that cover the peak absorption of collagen and water. Differences in the CWR between cervical samples from pregnant and non-pregnant women were analyzed. Hematoxylin and eosin and Sirius Red stains were used to compare the collagen content of cervical samples in these two groups.ResultsEight cervix samples were obtained after hysterectomy, four from women ≤41 years of age and four from women ≥43 years of age; all cervical samples (n = 8) from pregnant women were obtained after 37 weeks of gestation at the time of cesarean section. The average CWR in cervical tissue samples from pregnant women was 18.7% (SD 7.5%), while in samples from non-pregnant women, it was 55.0% (SD 20.3%). There was a significantly higher CWR in the non-pregnant group compared to the pregnant group with a p-value <0.001. A subgroup analysis that compared the CWR in cervical samples from pregnant women and non-pregnant women ≤41 years of age (mean 46.3%, SD 23.1%) also showed a significantly higher CWR (p <0.01). Lower collagen content in the pregnancy group was confirmed by histological analysis, which revealed the loss of tissue composition, increased water content, and collagen degradation.ConclusionThe proposed bimodal ultrasound and sPA imaging system can provide information on the biochemical composition of cervical tissue in pregnant and non-pregnant women. Photoacoustic imaging showed a higher collagen content in cervical samples from non-pregnant women as compared to those from pregnant women, which matched with the histological analysis. This novel imaging method envisions a new potential for a sensitive diagnostic tool in the evaluation of cervical tissue composition.

Dataset Information

Photoacoustic imaging of a human vertebra: implications for guiding spinal fusion surgeries.

Publications

Photoacoustic imaging of a human vertebra: implications for guiding spinal fusion surgeries.

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