Asian Spine Journal最新文献

{"title":"The potential role of synthetic computed tomography in spinal surgery: generation, applications, and implications for future clinical practice.","authors":"Shreya Sankar, Jake Michael McDonnell, Stacey Darwish, Joseph Simon Butler","doi":"10.31616/asj.2024.0197","DOIUrl":"10.31616/asj.2024.0197","url":null,"abstract":"<p><p>Computed tomography (CT) is widely used for the diagnosis and surgical treatment of spinal pathologies, particularly for pedicle screw placement. However, CT's limitations, notably radiation exposure, necessitate the development of alternative imaging techniques. Synthetic CT (sCT), which generates CT-like images from existing magnetic resonance imaging (MRI) scans, offers a promising alternative to reduce radiation exposure. This study examines the emerging role of sCT in spinal surgery, focusing on usability, efficiency, and potential impact on surgical outcomes. This qualitative literature review evaluated various sCT generation methods, encompassing traditional atlas-based and bulk-density models, as well as advanced convolutional neural network (CNN) architectures, including U-net, V-net, and generative adversarial network models. The review assessed sCT accuracy and clinical feasibility across different medical disciplines, particularly oncology and surgery, with potential applications in orthopedic, neurosurgical, and spinal surgery. sCT has shown significant promise across various medical disciplines. CNN-based techniques enable rapid and accurate generation of sCT from MRI scans, rendering clinical use feasible. sCT has been used to identify pathologies and monitor disease progression, suggesting that MRI alone may suffice for diagnosis and planning in the future. In spinal surgery, sCTs are particularly useful in visualizing key anatomical features like vertebral dimensions and spinal canal diameter. However, challenges persist, especially in visualizing complex structures and larger spinal regions, like the lumbar spine. Additional limitations include inaccuracies stemming from surgical implants and image variability. The application of sCT technology in spinal surgery holds great promise, improving diagnostics, planning, and treatment outcomes. Although further research is required to improve its precision, it offers a viable alternative to traditional CT in many clinical contexts, with the potential for broader application as the technology matures.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"18 6","pages":"913-922"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: enhancing perioperative care for elderly spinal surgery patients.","authors":"Hina Vaish","doi":"10.31616/asj.2024.0500.r1","DOIUrl":"https://doi.org/10.31616/asj.2024.0500.r1","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"18 6","pages":"925-926"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative complications in patients aged ≥85 years undergoing spinal surgery: a retrospective comparative study of pre-old and old patients in Japan.","authors":"Takahiro Mui, Hideki Shigematsu, Masaki Ikejiri, Sachiko Kawasaki, Yasuhito Tanaka","doi":"10.31616/asj.2024.0215","DOIUrl":"10.31616/asj.2024.0215","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective comparative study.</p><p><strong>Purpose: </strong>To compare the characteristics of perioperative complications in patients aged ≥85 years with those of younger patients undergoing similar spine surgery and examine factors associated with perioperative complications and clinical outcomes among patients aged ≥85 years.</p><p><strong>Overview of literature: </strong>The risk factors for perioperative complications and their effect on outcomes in patients aged ≥85 years remain unclear. Furthermore, no study has compared younger patients with similar surgeries and condition with those aged ≥85 years.</p><p><strong>Methods: </strong>The study included patients aged ≥65 years who underwent spinal surgeries. The patients aged ≥85, 75-84, and 65-74 years were categorized into the super-old, old, and pre-old groups, respectively. The differences in perioperative age-related complications were compared among the three groups while matching for surgical procedures and general conditions (study 1). Furthermore, preoperative and intraoperative factors were examined for perioperative complications in the super-old group (study 2). Complications were categorized into surgical site and systemic complications.</p><p><strong>Results: </strong>The analysis included 44 patients from each group. In study 1, the total complication rates were 40.9%, 25%, and 18.2% of the super-old, old, and pre-old groups, respectively. Differences in complication rates were observed between the super-old and pre-old groups (p=0.011). In study 2, 58 patients from the super-old group were analyzed. Surgical site complications were significantly associated with longer surgical duration (p=0.02) and more estimated blood loss (p=0.003). Systemic complications were significantly associated with previous cerebrovascular disease (p=0.014), preoperative motor deficit (p=0.023), and emergency case (p=0.006) and negatively associated with diabetes mellitus (p=0.048).</p><p><strong>Conclusions: </strong>Perioperative complications increased with advancing age in the super-old, old, and pre-old groups. The complication type is associated with specific background factors; therefore, determining them may help prevent perioperative complications.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"856-866"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonlaminotomy bilateral decompression: a novel approach in biportal endoscopic spine surgery for spinal stenosis.","authors":"Dae-Young Lee, Hee Soo Kim, Si-Young Park, Jun-Bum Lee","doi":"10.31616/asj.2024.0210","DOIUrl":"10.31616/asj.2024.0210","url":null,"abstract":"<p><p>Biportal endoscopic spine surgery (BESS) is an emerging technique for lumbar spinal stenosis. Previous BESS techniques involve partial osteotomy for access to spinal canal such as partial laminotomy, partial facetectomy, and other forms to access the spinal canal for decompression. However, approaches that include osteotomy can cause bone bleeding intraoperatively, leading to obscured vision, and may be at risk of postoperative facet arthritis and segmental instability due to damage to the posterior stability structure. This study aimed to introduce a BESS technique, i.e., nonlaminotomy bilateral decompression (NLBD) that allows for decompression through the interlaminar space without damaging the posterior bony structures. For this, various sizes of curved curettes are mainly used than Kerrison rongeurs. The small tip of the curved curette allows it to reach any part of the spinal canal through the interlaminar space, and its rounded back reduces the risk of nerve damage during decompression. In addition, by changing the portals, decompression through the interlaminar space can be performed without osteotomy. Nine checkpoints were assessed for the complete decompression during surgery. In conclusion, NLBD is an alternative BESS approach that achieves adequate decompression while preserving the posterior structure as much as possible.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"867-874"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: re-evaluating approaches: current issues in the treatment of adolescent idiopathic scoliosis.","authors":"Hina Vaish","doi":"10.31616/asj.2024.0455.r1","DOIUrl":"https://doi.org/10.31616/asj.2024.0455.r1","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"18 6","pages":"923-924"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review.","authors":"Rahmad Mulyadi, Witantra Dhamar Hutami, Kevin Dilian Suganda, Dhiya Farah Khalisha","doi":"10.31616/asj.2024.0325","DOIUrl":"10.31616/asj.2024.0325","url":null,"abstract":"<p><p>Pedicle screws are commonly used for vertebral instrumentation, and a postoperative computed tomography (CT) scan is used to evaluate their position within the pedicle. Medial pedicle screw breaching occurs in 20%-40% of cases. This study investigated the correlation between radiographically evident medial breaching and the incidence of nerve injury, shedding light on the clinical implications. A literature search was conducted on biomedical databases regarding neurologic deficits associated with medially breached pedicle screws with pre-defined inclusion and exclusion criteria. The methodology of the included studies was analyzed, and a systematic review and meta-analysis were performed to investigate the correlation between medial breach on axial CT and clinical neurologic deficits. Our study included thirteen articles. Medial breaches <2 mm caused no neurologic deficit. Medial breaches of 2-4 mm increased the risk of neurologic deficit by 83%, with a risk ratio of 0.17. Breaches exceeding 4 mm increased the risk by 90%, with a risk ratio of 0.1, and were associated with radiculopathy or muscle weakness in 25%-100% of cases. Medial pedicle screw breaches <2 mm are safe, carrying no risk of neurologic injury. Breaches exceeding ≥2 mm significantly increase this risk. For patients experiencing new neurologic deficit (sensory or motor) after pedicle screw instrumentation, particularly in lumbar vertebrae, a postoperative axial CT scan is recommended to identify breaches exceeding 2 mm as the potential cause of neurologic deficit.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"18 6","pages":"903-912"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of en-bloc direct vertebrae rotation and non-direct vertebrae rotation for the correction of adolescent idiopathic scoliosis Lenke 5C: a retrospective study in Changsha, China.","authors":"Emmanuel Alonge, HongQi Zhang, Shaohua Liu, Yuxiang Wang","doi":"10.31616/asj.2024.0318","DOIUrl":"10.31616/asj.2024.0318","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Purpose: </strong>This study aimed to compare the clinical effectiveness of en-bloc direct vertebrae rotation (DVR) to non-DVR for the correction of Lenke 5C.</p><p><strong>Overview of literature: </strong>The primary goal of posterior correction is to preserve the lumbar spine and achieve a well-balanced spine. However, very few studies have examined the effects of en-bloc DVR (ED) on Lenke 5C correction.</p><p><strong>Methods: </strong>A retrospective study was conducted with a minimum follow-up of four years involving 95 patients (ED group, n=45; non-DVR [ND] group, n=50). Radiographic measurements included thoracic kyphosis, lumbar lordosis, sagittal vertical axis, coronal balance, and Cobb angles preoperatively and postoperatively. Flexibility curves and axial vertebral rotation were assessed using computed tomography before and after surgery. Clinical outcomes were evaluated using the Scoliosis Research Society-22 (SRS-22) questionnaire.</p><p><strong>Results: </strong>The preoperative major Cobb angles were comparable between the ED group (52.2°±2°) and the ND group (52.8°±3°), with no significant difference (p=0.327). At the last follow-up, the average Cobb angle was significantly lower in the ED group (4.6°±2°) compared to the ND group (6.1°±3°), indicating a significant difference (p=0.005). The postoperative radiographic shoulder height showed no significant difference at the last follow-up. The axial vertebral rotation was significantly greater in the ED group (8.4°±0°) than in the ND group (11.1°±1°) (p=0.001). Additionally, the ED group demonstrated substantial preservation of fusion levels with an average of 5.6 fused segments compared to 6.3 in the ND group.</p><p><strong>Conclusions: </strong>A significantly higher incidence of satisfactory outcomes was observed at the final follow-up, with the correction rate of the ED group superior to that of the ND group for adolescent idiopathic scoliosis Lenke 5C. Moreover, patients in the ED group reported better outcomes on the SRS-22 questionnaire and had a shorter hospital stay than those in the ND group.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"18 6","pages":"803-812"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors related to surgical site infection in spinal instrumentation surgery: a retrospective study in Japan.","authors":"Kazumasa Konishi, Hideto Sano, Yosuke Kawano, Takehiko Moroi, Takumi Takeuchi, Masahito Takahashi, Naobumi Hosogane","doi":"10.31616/asj.2024.0274","DOIUrl":"10.31616/asj.2024.0274","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Purpose: </strong>To identify factors involved in surgical site infections (SSIs) after spinal instrumentation surgery performed at a single institution.</p><p><strong>Overview of literature: </strong>SSIs after spinal instrumentation surgery are a serious complication. Despite reports on risk factors for SSIs in spine surgery, limited studies are related to spinal instrumentation surgery.</p><p><strong>Methods: </strong>In total, 828 patients (338 males and 490 females; mean age, 65.0 years) who underwent spinal instrumentation surgery from 2013 to 2021 in Kyorin University School of Medicine were retrospectively investigated. Patients were divided into the SSI (group I) and non-SSI (group N) groups. Patient characteristics, comorbidity, laboratory, and surgical factors were investigated. Univariate analysis was performed for each item, and multivariate logistic regression analysis was performed for items with significant differences.</p><p><strong>Results: </strong>Fifteen patients (1.85%) had SSIs. Univariate analysis revealed significant differences between groups I and N in history of steroid use, serum albumin, C-reactive protein, number of fixed vertebrae, and perioperative blood transfusion. Multivariate logistic regression analysis showed that a history of steroid use (odds ratio [OR], 5.38; 95% confidence interval [CI], 1.41-20.49; p=0.014), serum albumin (OR, 0.34; 95% CI, 0.13-0.84; p=0.020), and perioperative blood transfusion (OR, 5.85; 95% CI, 1.46-23.50; p=0.013) were independent risk factors for SSIs.</p><p><strong>Conclusions: </strong>The results of this study indicate that preoperative nutritional intervention, appropriate management of anemia, and intraoperative and postoperative bleeding control may decrease the incidence of SSIs. However, this study has several limitations, including its retrospective design, analysis of a few SSI cases, and inclusion of various surgical approaches and disease types. Future studies that address these limitations are desirable.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"822-828"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel pedicle screw design to maximize screw-bone interface strength using finite element analysis and design of experiment techniques.","authors":"Arvind Kumar Prajapati, Parimanathukovilakom Ramavarma Harikrishna Varma, Gurunathan Saravana Kumar, Chirathody Vayalappil Muraleedharan, Ganesh Divakar","doi":"10.31616/asj.2024.0220","DOIUrl":"10.31616/asj.2024.0220","url":null,"abstract":"<p><strong>Study design: </strong>Basic study.</p><p><strong>Purpose: </strong>This study aimed to utilize finite element (FE) analysis and design of experiment (DoE) techniques to propose and optimize a novel pedicle screw design and compare its pull-out force with that of a control device.</p><p><strong>Overview of literature: </strong>Pedicle screw-based fixation is the gold-standard treatment for spine diseases, particularly in fusion procedures. However, pedicle screw loosening and breakage still occur in osteoporotic and non-osteoporotic patients. This research investigates screw design modifications to enhance screw-bone interface strength and reduce the likelihood of loosening.</p><p><strong>Methods: </strong>We conceptualized a novel pedicle screw considering vertebral bone morphology and strength differences. A validated FE model was developed and used in conjunction with DoE to determine the screw՚s optimum geometrical parameters. The FE model was validated through simulation and laboratory experiments using the control device. The optimized thread profiles for cortical bone and cancellous bone were determined, with pull-out force as the primary factor for screw design evaluation.</p><p><strong>Results: </strong>FE analysis results for the control device closely matched experimental results, with less than 5% difference. The chosen unique pitch/depth ratio showed maximum pull-out force for cortical bone, while DoE enabled the optimization of design parameters for cancellous bone. The optimized pedicle screw exhibited a 15% increase in pull-out force compared to the control device.</p><p><strong>Conclusions: </strong>The study proposes a novel pedicle screw design with better pull-out strength than the control device. Combining FE analysis with DoE is an effective approach for screw design optimization, reducing the need for extensive prototyping tests. A two-variable analysis suffices for optimizing cortical bone design parameters, while a multi-variable analysis is more effective for optimizing cancellous bone design parameters.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"765-776"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative advantages of activities with lumbosacral preservation for adult spinal deformity surgery: a retrospective Japanese cohort study.","authors":"Yoshinori Ishikawa, Takashi Kobayashi, Eiji Abe, Ryo Shoji, Naohisa Miyakoshi","doi":"10.31616/asj.2024.0217","DOIUrl":"10.31616/asj.2024.0217","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>This study aimed to demonstrate the advantages of preservation of the lumbosacral segment (LSS) in adult spinal deformity (ASD) surgery.</p><p><strong>Overview of literature: </strong>Sacroiliac foundation enables sufficient restoration in ASD surgery; however, it could result in poor mobility. Thus, whether LSS provides better activities is still unknown.</p><p><strong>Methods: </strong>Among 399 patients who underwent ASD surgery, 62 (≥5 levels fused, >2-year follow-up) underwent fusion from T9-10 to L5 (group L, n=21) or to S2-alar-iliac (group S, n=41). Spinal alignments, Scoliosis Research Society (SRS)-22 scores, performance of activities (clipping toenail, wiping buttock, and wearing socks), proximal and distal junctional failure (PJF+DJF), rod fractures (RFs), and overall revision rates (RRs) were compared between the groups.</p><p><strong>Results: </strong>Group L included younger patients and had longer follow-ups when compared with group S. Although the preoperative pelvic incidence and SRS sagittal modifiers were better in group L, postoperative spinal restorations were nonpathological in both groups. Both groups showed similar deformity progression at the 2-year follow-up; however, group L had lower SRS-22 pain scores. Although \"wiping buttocks\" did not differ between the groups, the performance of \"clipping toenails\" and \"wearing socks\" was poorer in group S at 2 years (possible, group S; 40% vs. group L; 85%-90%). The RRs did not differ between the groups; however, the PJF+DJF rate was higher in group L. DJF was not observed in group S, but occurrence of RFs was noted.</p><p><strong>Conclusions: </strong>Although poorer SRS-22 pain scores might be related to lumbosacral mobility, sufficient restoration, equivalent deformity progression, and similar RRs with better activity imply that lumbosacral preservation should be considered in younger patients with moderate deformities.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"699-705"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}