Patent RU-2732958-C1 (RU)
Title: Spine statics estimation method
Inventor: OREL ALEKSANDR MIKHAJLOVICH
IPC: A61B5/107
Filed: 2019-12-30
Granted: 2020-09-25
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, namely to diagnostics in orthopedics, and can be used for assessment of spine statics. Using a digital X-ray apparatus, radiography of each spine in a sagittal and frontal projection with a vertical patient with a focal distance from the rack of the digital X-ray apparatus to the X-ray tube of not less than 150 cm. On the obtained digital X-ray images of the vertebral column, images of the same vertebrae are found and aligned until complete coincidence of their dimensions and contours, after which two matched digital images are obtained: one in the frontal projection, the second in the sagittal projection. Occipital vertical is determined on a computer monitor on both obtained combined images from the most protruding point of the external occipital protrusion – inion, vertical is performed along all spinal segments. On combined image of spinal column in sagittal projection there is a line connecting two extreme points of lower contour of vertebral body CII, as in fig. 1, this section is measured in millimeters and called "órel". On the combined image in the sagittal projection, perpendicular to the occipital vertical, until the intersection with it, the following horizontal lines are made, which are called "distance" and are measured in units of "órel". Distance of the base of the skull iCr – from the top of tooth CII to the occipital vertical. Distance of the middle portion of the cervical segment iNm (CV) is from the point of the dorsal lower angle of the X-ray image of the CV vertebra to the occipital vertical. Cervical distance iN (CVII) – from dorsal lower angle of image of vertebra CVII to occipital vertical. Distance of the upper thoracic spine of iBup (TII) is from the dorsal lower angle of the TII vertebra image to the occipital vertical. Distance of the middle part of the thoracic spine Bm (TVII) – from the dorsal lower angle of the vertebral image to the occipital vertical. Thoracic portion of the iB (TXII) is from the dorsal lower angle of the TXII vertebra image to the occipital vertical. Distance of the middle part of the lumbar spine iLm (LIII) is from the dorsal lower angle of the vertebral image LIII to the occipital vertical. Lumbar spine of iL (LV or LVI, or LIV) is the distance from the dorsal lower angle of the vertebral image LV or LVI, or LIV to the occipital vertical. Distance of sacral spine iS – from sacrum tip to occipital vertical. Distance of a gastric spine from the top of the lower coccygeal vertebra to the occipital vertical. On the combined image in the sagittal projection, in the occipital vertical in the "órel" units, segments cut off by the above horizontal lines are measured, these sections are called "size". Size of skull base height pCr (C0-CII) – from inion to point of intersection of occipital vertical line with horizontal straight line from top of tooth CII. Cervical pN (CII-CVII) size is between points of occipital vertical intersection with horizontal lines from dorsal lower angles of X-ray image of CII-CVII vertebrae. Size of the upper thoracic pBup (CVII-TVII) is between the points of occipital vertical intersection with the horizontal lines from the dorsal lower angles of the X-ray image of CVII-TVII vertebrae. Thoracic pB (CVII-TXII) size is between points of occipital vertical intersection with horizontal straight lines from dorsal lower angles of X-ray image of vertebral CVII-TXII. Lumbar pL (TXII-LV) size is between points of occipital vertical intersection with horizontal straight lines of dorsal lower corners of X-ray image of TXII-LV vertebras. Thereafter, the total individual size of the movable spine is calculated by the formula P=∑(pN+pB+pL). Vertebrae called key CV, TII, TXII, LV are determined. On the combined image in the sagittal projection on the computer monitor screen the following parameters are determined: 1) through a point located in the middle of the front contour of the image of the body of the key vertebra, and a point on the middle of the back contour of the image of the body of the key vertebra is drawn by a straight line to its intersection with the occipital vertical – "anteroposterior axis of the key vertebra"; 2) to the anteroposterior axis of the key vertebra to the point of its intersection with the occipital vertical, perpendicular is reconstructed, and measuring the acute angle formed by the perpendicular and the occipital vertical – "angle of inclination of the anteroposterior axis of the key vertebra"; 3) measuring distance between points of intersection of anteroposterior axes of key vertebrae with occipital vertical – "size between points of anteroposterior axes of key vertebrae"; 4) the anteroposterior axes of the key vertebrae are continued further anterior and posteriorly to the intersection of: the CV axis with the TII axis, the TII axis with the TXII axis, the TXII axis with the LV axis, the obtained points are referred to as "points of intersection of the anteroposterior axes of the key vertebrae"; 5) measuring distance from intersection of anteroposterior axes of key vertebrae to point of its projection on occipital vertical – "distance of point of intersection of anteroposterior axes of key vertebras". Following lines are drawn on the combined image in a frontal projection: α – a straight line connecting lower contours of mastoid process of temporal bones on both sides, β – a horizontal line passing tangentially to extreme upper point of CII vertebra tooth, γ – straight line passing along lower body contour CVII, λ – straight line passing along lower contour of TXII body, μ – a straight line connecting the right and left protruding upper contours of the sacral base, τ – horizontal passing through the protruding point of the sacral top contour lower contour, δ – a horizontal line passing through the protruding point of the lower outline of the tip of the last of the lateral spines. Derived parameters are used to evaluate spine statics. If on the combined X-ray image of the patient's spine in the sagittal projection, the occipital, starting from the inion, goes parallel to the tooth and body of CII and is left behind, outside X-ray images of the spinal structures, touching the skin of the inter-scapula area of the thoracic region, leaving the anatomical structures of the lumbar and pelvic parts anterior to itself, intersection point of anterosuperior axes of TII and TXII vertebrae extends beyond the chest in front not less than by 10 órels, on the combined X-ray image of the patient's spine in the frontal projection, the horizontal lines are parallel to each other or form an angle of not more than 10 degrees with the occipital vertical – absence of spinal statics disorders, norm. I degree of spinal statics disorder is diagnosed, if on a combined X-ray image of a patient's spine in a sagittal projection, the cervical spine is shifted anteriorly, the cervical lordosis is rectified or reinforced, occipital vertical, starting from inion, goes downward, leaving all cervical vertebrae forward, crosses X-ray images of spinous processes of TI-TIII, crosses images of posterior ribs of middle thoracic segment, lower occipital vertical crosses X-ray images of spinous processes of TX, TXI vertebrae, leaving all lumbar vertebrae and sacrum with coccyx, crossing soft tissues of gluteal region, as compared to normal distance of upper thoracic part iBup (TII) and middle part of thoracic spine Bm (TVII), as well as the point of intersection of the anterosuperior axes of TII and TXII vertebrae extends beyond the chest in front by a value of less than 10 órels, but does not reach the boundaries of the chest, on the combined X-ray image of the patient's spine in the frontal projection, the horizontal lines are not parallel and intersect at different angles during their continuation. II degree of spinal statics disorder – compensation, is diagnosed if on combined X-ray image of patient's spine in sagittal projection cervical spine is shifted in front, cervical vertical, starting from inion, goes downward, leaving anterior to itself all structures of neck, including spine, soft tissues, subcutaneous fat and skin, further, the occipital vertical refers to X-ray images of apices of spinous processes CVII and TI, crosses the elements of the arches, including articular processes of TII-TV vertebrae, crosses posterior parts of TVI-TVIII bodies of vertebras, and below it crosses elements of arches and articular processes TIX-TXII, continuing below, occipital vertical crosses X-ray images of spinous processes of LI-LV, crosses the X-ray image of SII and upper coccygeal vertebrae, leaving behind posterior X-ray images of the lower sacral vertebrae, sacral top and upper digestive system vertebrae, in comparison with the norm, the distal distances of the upper thoracic portion of the iBup (TII) and the middle portion of the thoracic spine Bm (TVII) are reduced, wherein the distance Bm (TVII) can acquire a negative value, when the posterior lower point of the X-ray image of the body of the vertebra TVII is differentiated not from the front but from behind the occipital vertical, the distance of the thoracic segment iB (TXII), spinal lumbar spacing lL (LV) is reduced compared to the norm, distances of the sacral spine iS and the coccygeal spine iT acquire negative values, the point of intersection of the axes of TII and TXII of the vertebrae extends beyond the chest from the front by less than 10 órels but does not reach the boundaries of the thoracic cage, on the combined X-ray image of the patient's spine in the frontal projection, the horizontal lines are not parallel and intersect at different angles during the continuation. III degree of spinal statics disorder – subcompensation, diagnosed if on a combined X-ray image of a patient's spine in a sagittal projection, the cervical spine is shifted anteriorly, cervical-thoracic junction area rises, in comparison with norm of vertebra, components of cervical-thoracic junction shift forward and downwards, decreased in comparison with norm, pCr skull base height, cervical pN (CII-CVII) and pectoral upper thoracic pBup (CVII-TVII) section, occipital vertical passes backwards from X-ray images of cervical vertebra spinous processes apexes CII-CV, crosses spinous processes of CVI, CVII and refers to X-ray image of point of dorsal lower angle of body TII or projected in front of this point, in comparison with norm decreases value of distances of middle part of cervical department iNm (CV) and neck department as a whole iN (CVII), distance of upper thoracic spine of iBup (TII) becomes 0 or acquires a negative value, i.e. occipital vertical anterior passage from posterior lower point of vertebral body TII, then occipital vertical crosses X-ray images of bodies of upper thoracic vertebrae and comes anterior from bodies of middle thoracic vertebrae, as a result distance of middle part of thoracic spine Bm (TVII) acquires a negative value, lower occipital vertical crosses X-ray images of bodies of lower thoracic vertebra TVIII-TXI, articular processes TXII, spinous processes LI-LIII, continuing below, occipital vertical crosses the X-ray images of the bodies of the lower lumbar vertebra, the dorsal angle of the body SII of the normally located sacral bone or leaves them behind them, wherein, in comparison with the norm, the distance of the thoracic spine iB (TXII) of the middle part of the lumbar spine iLm (LIII) and the lumbar spine iL (LV) is reduced and / or they acquire a negative value, point of intersection of axes of TII and TXII vertebra is located behind from X-ray image of anterior thoracic wall, approaching spine and occipital vertical, on combined X-ray image of patient's spine in frontal projection horizontal straight lines are not parallel and intersect at different angles during continuation. IV degree of spinal statics disorder – decompensation, diagnosed, when on a combined X-ray image of a patient's spine in a sagittal projection there are signs of spinal statics disorder of I, II or III degree, but unlike them, any spinal area is diagnosed with a pathological fracture in the form of anterior wedge-shaped deformation of the vertebral body, or multiple fractures of vertebral bodies or the vertebral bodies acquire a form of "fish vertebrae". 
     EFFECT: method provides an objective assessment of the spatial position of all parts of the spine on an X-ray image by taking into account a plurality of individual features in the spinal position at a given moment in time. 
     1 cl, 9 tbl, 10 dwg, 5 ex