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The modified Lapidus procedure has emerged as a versatile solution for various pedal pathologies, particularly hallux abducto valgus. There have been numerous modifications over time regarding fixation techniques, joint preparation methods, graft utilization, and weightbearing protocols. However, concerns persist regarding prolonged nonweightbearing postoperatively, prompting the need for alternative approaches. This retrospective descriptive cohort analysis assessed the outcomes of 40 feet from 34 patients who underwent the modified Lapidus procedure with a medial plating system, aimed to evaluate immediate weightbearing outcomes on union rate, fixation-related complications, and functional outcomes. Among the 40 feet, findings showed a 95% (38/40) union rate within 6 months, with 2.5% (1/40) experiencing delayed union and 2.5% (1/40) facing fixation-related complications. There is a single case of malunion in the cohort. Additionally, statistically significant improvements were observed across all domains of the Manchester-Oxford Foot Questionnaire at p <.001. These findings suggest immediate weightbearing as a potential alternative to traditional nonweightbearing protocols. However, the study's retrospective nature and lack of a comparative group warrant cautious interpretation. Further research is essential to validate these findings and refine postoperative care protocols. By challenging conventional practices, this study underscores the complexity of optimizing patient outcomes in modified Lapidus procedure management. Tailored approaches and prospective investigations are imperative for establishing definitive guidelines and enhancing surgical techniques in this domain. [ABSTRACT FROM AUTHOR]

Ankle arthrodesis is an effective surgical intervention for end-stage arthritis or severe ankle joint deformity. Both internal (IF) and external fixation (EF) techniques are valid options, but there is controversy regarding the most effective technique. This study compares the safety and efficacy of EF and IF fixation techniques for ankle arthrodesis. A systematic review and meta-analysis was conducted according to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) Guidelines. A literature search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL), was performed to identify all studies directly comparing the two techniques. Both fixed and random effects models of analysis were used depending on heterogeneity. Odds of union in the EF and IF groups were comparable (OR = 0.60, CI 0.36-1.02, p =.06) however, EF was associated with greater odds of deep hardware infections (OR = 3.67, 1.97-6.83, p <.05) and amputations (OR = 3.17, CI 1.06-9.54, p =.04). Odds of revision surgery and superficial wound complications were similar between groups. EF techniques had significantly longer operation times (MD = 31.23, CI-25.11-37.34, p <.05) and intraoperative blood loss (MD = 44.1, CI 28.77-59.43, p <.05). No significant difference was noted in pain and functionality scores. IF and EF techniques have reasonable union rates with similar postoperative outcomes. [ABSTRACT FROM AUTHOR]

Following the Goldilocks principle, mitochondria size must be "just right." Mitochondria balance division and fusion to avoid becoming too big or too small. Defects in this balance produce dysfunctional mitochondria in human diseases. Mitochondrial safeguard (MitoSafe) is a defense mechanism that protects mitochondria against extreme enlarging by suppressing fusion in mammalian cells. In MitoSafe, hyperfused mitochondria elicit flickering—short pulses of mitochondrial depolarization. Flickering activates an inner membrane protease, Oma1, which in turn proteolytically inactivates a mitochondrial fusion protein, Opa1. The mechanisms underlying flickering are unknown. Using a live-imaging screen, we identified Slc25a3 (a mitochondrial carrier transporting phosphate and copper) as necessary for flickering and Opa1 cleavage. Remarkably, copper, but not phosphate, is critical for flickering. Furthermore, we found that two copper-containing mitochondrial enzymes, superoxide dismutase 1 and cytochrome c oxidase, regulate flickering. Our data identify an unforeseen mechanism linking copper, redox homeostasis, and membrane flickering in mitochondrial defense against deleterious fusion. [Display omitted] • Flickering prevents harmful extreme mitochondrial fusion by inducing Opa1 cleavage • Mitochondrial copper, transported by Slc25a3, regulates flickering • Copper-containing SOD1 suppresses flickering • Copper-containing cytochrome c oxidase promotes flickering Murata et al. report that mitochondrial copper, transported by Slc25a3, regulates the balance between mitochondrial fusion and division by suppressing fusion when mitochondria become hyperfused. This function of copper is mediated by two copper-containing enzymes: superoxide dismutase 1 and cytochrome c oxidase. [ABSTRACT FROM AUTHOR]

To compare the 2-year reoperation rates for adjacent segment disease between patients with pelvic incidence–lumbar lordosis (PI-LL) mismatch postoperatively and patients with normal PI-LL measurements. Patients undergoing elective 1- to 2-level lumbar fusion for degenerative conditions between 2016 and 2018 were retrospectively reviewed. Spinopelvic radiographic parameters immediately postoperation were measured, and PI-LL mismatch was determined using the age-adjusted thresholds defined in Lafage et al. After propensity score matching, early reoperation rates were compared between the PI-LL mismatch and normal PI-LL cohorts. Early reoperation was defined as symptomatic adjacent segment disease (ASD) requiring reoperation within 2 years of the index surgery. A total of 219 patients were identified. The average age was 59 years of age, with 59.8% female. The PI-LL mismatch cohort (n = 148) was younger (57.5 vs. 63.5 years, P < 0.001) and had a higher proportion of Black patients (31.8% vs. 11.3%, P = 0.001) than the normal PI-LL cohort, respectively. A total of 100 patients in the PI-LL mismatch cohort were propensity score matched to 66 patients in the normal PI-LL cohort, resulting in no difference in age (P = 0.177), sex (P = 0.302), race (P = 0.727), or body mass index (P = 0.892). Using these matched cohorts, the rate of early reoperation for ASD was 8.0% in the PI-LL mismatch cohort and 9.1% in the normal PI-LL cohort (P = 0.805), with a mean time to reoperation of 1.28 and 1.33 years, respectively. After propensity score matching, PI-LL mismatch was not associated with early reoperation for ASD in patients undergoing 1- to 2-level lumbar fusions for degenerative conditions. [ABSTRACT FROM AUTHOR]

As value-based health care arrangements gain traction in spine care, understanding the true cost of care becomes critical. Historically, inaccurate cost proxies have been used, including negotiated reimbursement rates or list prices. However, time-driven activity-based costing (TDABC) allows for a more accurate cost assessment, including a better understanding of the primary drivers of cost in 1-level lumbar fusion. To determine the variation of total hospital cost, differences in characteristics between high-cost and nonhigh-cost patients, and to identify the primary drivers of total hospital cost in a sample of patients undergoing 1-level lumbar fusion. Retrospective, multicenter (one academic medical center, one community-based hospital), observational study. A total of 383 patients undergoing elective 1-level lumbar fusion for degenerative spine conditions between November 2, 2021 and December 2, 2022. Total hospital cost of care (normalized); preoperative, intraoperative, and postoperative cost of care (normalized); ratio of most to least expensive 1-level lumbar fusion. Patients undergoing a 1-level lumbar fusion between November 2, 2021 and December 2, 2022 were identified at two hospitals (one quaternary referral academic medical center and one community-based hospital) within our health system. TDABC was used to calculate total hospital cost, which was also broken up into: pre-, intra-, and postoperative timeframes. Operating surgeon and patient characteristics were also collected and compared between high- and nonhigh-cost patients. The correlation of surgical time and cost was determined. Multivariable linear regression was used to determine factors associated with total hospital cost. The most expensive 1-level lumbar fusion was 6.8x more expensive than the least expensive 1-level lumbar fusion, with the intraoperative period accounting for 88% of total cost. On average. the implant cost accounted for 30% of the total, but across the patient sample, the implant cost accounted for a range of 6% to 44% of the total cost. High-cost patients were younger (55 years [SD: 13 years] vs 63 years [SD: 13 years], p=.0002), more likely to have commercial health insurance (24 out of 38 (63%) vs 181 out of 345 (52%), p=.003). There was a poor correlation between time of surgery (ie, incision to close) and total overall cost (ρ:.26, p<.0001). Increase age (RC: -0.003 [95% CI: -0.006 to -0.000007], p=.049) was associated with decreased cost. Surgery by certain surgeons was associated with decreased total cost when accounting for other factors (p<.05). A large variation exists in the total hospital cost for patients undergoing 1-level lumbar fusion, which is primarily driven by surgeon-level decisions and preferences (eg, implant and technology use). Also, being a "fast" surgeon intraoperatively does not mean your total cost is meaningfully lower. As efforts continue to optimize patient value through ensuring appropriate clinical outcomes while also reducing cost, spine surgeons must use this knowledge to lead, or at least be active participants in, any discussions that could impact patient care. [ABSTRACT FROM AUTHOR]

Left-digit bias is a behavioral heuristic or cognitive "shortcut" in which the leftmost digit of a number, such as patient age, disproportionately influences surgical decisions. To determine if left-digit bias in patient age influences the decision to perform arthrodesis with instrumentation vs decompression in lumbar spinal stenosis (LSS). Retrospective cohort. Patients with an ICD-10 diagnosis of lumbar stenosis or spondylolisthesis identified in the 2017-2021 National Surgical Quality Improvement Program (NSQIP) database. The primary outcome was the percent of patients who underwent arthrodesis with instrumentation (AwI). Matched age group comparisons without left-digit differences (ie, 76/77 vs 78/79, 80/81 vs 82/83, etc.) were performed to isolate the effect of the heuristic. Secondary outcomes including peri-operative events and complications were also compared within AwI and decompression cohorts. Using CPT codes, procedures were classified as either AwI or decompression. Patients were grouped into 6 cohorts based on 2-year age windows (74/75, 76/77, 78/79, 80/81, 82/83, 84/85). The cohorts were propensity matched with neighboring age groups based on the presence of spondylolisthesis, demographics, and comorbidities. The primary comparison was between those aged 78/79 vs 80/81. After matching, the primary cohort consisted of two groups of 1,550 patients (aged 78/79 and 80/81). Patients aged 80/81 were less likely to undergo AwI than patients aged 78/79 (23.5% vs 27.2%, p=.021). AwI procedures occurred at similar rates between age groups with the same left digit. Within the decompression and AwI cohorts, there were no differences in secondary outcomes between patients aged 78/79 and 80/81. LSS patients aged 80/81 are less likely to undergo AwI than patients aged 78/79, regardless of comorbidities. This was not seen when comparing patients with similar left digits in age. Until objective measures of physiologic capacity are established, left-digit bias may influence clinical decisions. [ABSTRACT FROM AUTHOR]

The transpsoas lateral lumbar interbody fusion (LLIF) procedure is a minimally invasive lumbar spine approach that provides indirect neural decompression, improved sagittal alignment, and a high fusion rate. Typically accompanied by posterior pedicle screw insertion, there has been interest in performing LLIF in a single position to decrease cost and time under anesthesia. However, there is a paucity of direct comparisons between single-position LLIF via prone versus lateral decubitus positioning. Therefore, this study aims to compare the outcomes of a single surgeon performing prone versus lateral single-position LLIF, inclusive of the L4–L5 level. A retrospective review was performed of a consecutive case series of patients who underwent either prone or lateral, single-position LLIF by a single surgeon. All cases involved the L4–L5 level. Demographic data, perioperative details, clinical outcomes, and preoperative and postoperative lumbar lordosis were recorded. Sixty-three patients underwent lateral and 16 patients underwent prone single-position LLIF. Demographics and average interbody size were similar between groups. Operative time, change in lumbar lordosis, and length of hospital stay did not differ between the 2 positions. Both groups performed similarly in terms of preoperative and postoperative visual analog score pain score and complications. Patients who underwent lateral position LLIF ambulated farther on postoperative day 1 (250 feet vs. 200 feet, P = 0.015). Average time to follow up was 53 weeks. This study demonstrates promising preliminary results indicating that single-position LLIF performs well, even at the L4–L5 level, in both the prone and lateral positions. [ABSTRACT FROM AUTHOR]

To assess the impact of tumor extension into the occipital condyle (OC) in lower clival chordoma management and the need for occipito-cervical fusion (OCF). A retrospective analysis was conducted on 35 patients with lower clival chordoma. The preoperative area of the intact OCs, Hounsfield units, and the integrity of the apical ligament and the tectorial membrane were assessed using preoperative imaging. Seven (20%) patients were in the OCF group. The OCF group exhibited a higher prevalence of preoperative pain in the neck or head (P = 0.006), ligament absence (P = 0.022), and increased propensity for postoperative wound issues (P = 0.022) than the non-OCF group. The OCF group had less intact OCs (P < 0.001) and higher spinal instability neoplastic score (P = 0.002) than the non-OCF group. All patients with intact OCs < 60% underwent OCF, and those with OCs ≥ 70% were treated without OCF. Those with OCs between 60% and 69% underwent OCF if the ligaments were eroded, and did not undergo OCF if the ligaments were intact. Treatment strategies varied, with endoscopic endonasal approach alone being common. Radiation therapy was administered to 89% of patients. All 3 patients treated with OCF after tumor resection had wound issues; none treated with OCF before resection had wound issues. None developed atlanto-occipital instability. Survival rates did not significantly differ between groups. In the absence of mobility-related neck pain, patients with lower clival chordoma and intact OC ≥ 60%, intact apical ligament, and intact tectorial membrane, may not require OCF. [ABSTRACT FROM AUTHOR]

First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly utilised procedure. In this study, the authors aim to explore functional outcomes of patients undergoing nonsynchronous bilateral first MTPJ arthrodesis under the care of a single surgeon using a compression screw/locking plate construct. This is a prospectively collected, retrospectively analysed case series of fifty five patients who underwent bilateral nonsynchronous first MTPJ arthrodesis. Clinical and radiological outcomes were assessed preoperatively and at a minimum of two years postoperatively. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), the Self-Reported Foot and Ankle Score (SEFAS) and the Sports Questionnaire version 1 (SQ). Postoperative radiographs were used to assess evidence of union and compare both hallux valgus and intermetatarsal angles. Removal of hardware, revision surgery and correction of deformities were also recorded. Fifty five patients were included in the study. There was statistically significant improvements in all five facets of the FAOS (p value < 0.05). The mean postoperative SEFAS was 45.1. In total, patients participated in thirteen different sporting activities. This represented 92 patient specific activities preoperatively and 104 postoperatively. The most common activities were walking, cycling and swimming. Overall, 94.5% (N = 52) of the cohort were satisfied with their return to sport while 98.2% (N = 54) would recommend bilateral first MTPJ arthrodesis. Mean reductions in hallux valgus angles and intermetatarsal angles were noted at 18.87 and 4.69 degrees respectively. There was one non-union in the cohort which required revision surgery. One patient required removal of hardware. Bilateral first MTPJ arthrodesis is a safe and effective surgical option for patients with bilateral first MTPJ pathology. It has a high union rate, low complication rate and significantly improves clinical outcomes and allows patients reliably return to physical activities. [ABSTRACT FROM AUTHOR]

Patients undergoing lumbar spine surgery have high rates of preoperative opioid use, which is associated with inferior outcomes and higher risks for opioid dependency postoperatively. Determine whether there are identifiable subgroups of patients that follow distinct patterns in pre- and postoperative opioid dosing. Examine how preoperative patterns in opioid dosing relate to postoperative opioid patterns, opioid cessation, and the risk for adverse events. Retrospective analysis of an administrative claims database (MeritiveTM Marketscan® Research Databases 2007–2015). The 9,768 patients undergoing primary single level lumbar fusion. Primary: daily morphine milligram equivalent (MME) opioid dosing calculated from prescriptions dispensed for 1 year before and after surgery; secondary: 90-day all-cause readmission and complications, 90-day acute postoperative pain, 90-day and 1-year reoperation, surgical costs, length of stay, and discharge disposition. Distinct patient subgroups defined by patterns of daily MME pre- and postoperatively were identified via group-based trajectory modeling. Associations between these groups and outcomes were assessed with multivariable logistic regression with risk adjustment for patient and surgical factors. Among primary single level lumbar fusion patients, 59.5% filled an opioid prescription in the 3 months preceding surgery, whereas 40.5% were opioid naïve (Naïve). Five distinct subgroups of daily MME were identified among those filling opioids preoperatively: (1) Naïve to 3m (21.2% of patients): no opioids until 3 months preoperatively, escalating to 15 MME/day; (2) Low to 3m (11.4%): very low or as needed dose until 3 months preoperatively, escalating to 15 MME/day; (3) 6m Rise (6.9%): no opioids until 6 months preoperatively, escalating to >30 MME/day; (4) Medium (9.8%): increased linearly from 10 to 25 MME/day across the year before surgery; (5) High (10.0%): increased linearly from 60 to >80 MME/day across the year before surgery. These five preoperative opioid groups were related to postoperative opioids filled in a dose-response manner. The two preoperative patient groups with chronic Medium to High -dose opioid dosing were associated with increased adverse events, including all-cause readmission, reoperation, and pneumonia, whereas a low baseline group with a large, earlier preoperative rise in opioid dosing (6m Rise) had increased encounters for acute postoperative pain. Postoperatively, only 9.5% of patients did not fill an opioid prescription. Five distinct postoperative subgroups were identified based on their patterns in daily MME: Two groups ceased filling opioids within the year following surgery (33.6% of patients), and three groups declined in opioid dosage following surgery but plateaued at low (0–5 MME/day, 29.1%), medium (10–15 MME/day, 12.0%), or high (70–75 MME/day), 13.1%) doses by 1 year. Patients within the higher preoperative opioid groups were more likely to belong to the postoperative groups that were unable to cease filling opioids. Identification of a patient's preoperative time trend in daily opioid use may provide significant prognostic value and help guide pain management and risk reduction efforts. III. [ABSTRACT FROM AUTHOR]

Depression and anxiety are common in patients undergoing spinal surgery and might negatively impact outcomes. This study investigates the possible effect of these diagnoses on patient reported outcomes following lumbar fusion. Retrospective review of a registry containing prospectively collected data of lumbar fusion procedures at a single institution was performed from May 23, 2012 to June 15, 2022. Patients with a minimum of two year follow-up were included. Demographic information, diagnoses, medications, patient-reported outcomes measures (PROMs), and complications data at preoperative, three months, six months, 1 year, and two years postoperative were collected. Statistical analysis was performed using Student's t -tests, χ2, binomial correlation, odds ratios, logistic regression, and mean clinically important difference. A total of 156 patients were included (60 males, 96 females) with mean age 62.6 ± 11.1 years at surgery. Thirty-nine (25%) had depression and/or anxiety (DA). Baseline Oswestry Disability Index (ODI) and EuroQol Group 5D questionnaire (EQ5D) scores were significantly worse in the DA cohort compared to controls (ODI 51.1 ± 18.3 vs. 42.9 ± 15.8; P = 0.010, EQ5D 0.46 ± 0.21 vs. 0.57 ± 0.21; P = 0.005). Both cohorts experienced similar relative improvement at two years (delta ODI −18.2 ± 27.9 vs. −17.8 ± 22.1; P = 0.924, EQ5D 6.8 ± 33.8 vs. 8.1 ± 32.9; P = 0.830). Absolute outcome scores were worse in the DA cohort at all intervals. DA were not independently predictive of changes in PROMs (delta ODI mean difference 4.49, r2 = 0.36, P = 0.924). The present study showed similar improvement in PROMs following lumbar fusion for patients with anxiety and depression compared to healthy controls. These data suggest these patients are no less likely to benefit from appropriately planned lumbar fusion. [ABSTRACT FROM AUTHOR]

Tibiotalocalcaneal arthrodesis is frequently performed by foot and ankle surgeons in the management of complex ankle and hindfoot pathology. In this study, the authors describe the clinical and radiological outcomes of tibiotalocalcaneal arthrodesis using a solid posterior offset hindfoot arthrodesis nail. Forty-four consecutive patients underwent tibiotalocalcaneal arthrodesis by a single surgeon operating in two centers. Clinical and radiological outcomes were assessed preoperatively and at 6-month, 12-month and final follow-up (mean 47 months). Clinical outcomes were assessed with VAS, AOFAS and MOXFQ scores. Serial radiographs were used to assess union at each follow-up visit. Forty-four patients attended 12-month and final follow-up (mean 47 months). A total of 44 (100%) ankle joints and 44 (100%) subtalar joints were completely united at 12-month follow-up. The VAS score improved significantly from a mean of 6.5 preoperatively to a mean of 0.98 at final follow-up (P = <0.0001). AOFAS score improved significantly from a mean of 36.4 preoperatively to a mean of 73 at final follow-up (P = <0.0001). MOXFQ score improved significantly from a mean of 44.5 preoperatively to a mean of 12.7 at final follow-up (P = <0.0001). The mean change in frontal plane alignment was 5.7 degrees (P = 0.005). A total of 6 patients (13.6%) had an adverse event during the course of the study. Tibiotalocalcaneal arthrodesis with a solid posterior offset hindfoot arthrodesis nail is a safe and effective surgical option for patients with severe ankle and hindfoot pathology. It has a high union rate, low complication rate and significantly improves clinical outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to systematically review the evidence in the literature to determine the clinical outcomes following glenohumeral arthrodesis. Two independent reviewers performed a literature search in the PubMed database based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if they reported on outcomes following shoulder arthrodesis from the years of 2000-2022. Functional outcomes that were collected included the Subjective Shoulder Value, American Shoulder and Elbow Surgeons shoulder index score, visual analog scale pain score, and Oxford Shoulder Score. Range-of-motion data were also collected. This review included 17 studies, with a total of 316 patients, that met the inclusion criteria. The majority of the patients were male (67.4%), and the average age was 38.4 years (range, 7-82 years). The overall fusion rate was 88.7%, and the time to fusion was on average, 3.9 months (range, 2-8 months). Shoulder arthrodesis resulted in improvement in each of the functional outcomes assessed: Subjective Shoulder Value (preoperatively, 18.8; postoperatively, 43.9; and percent change, 132.8%), American Shoulder and Elbow Surgeons shoulder index score (postoperatively, 62.1), visual analog scale pain score (preoperatively, 8.5; postoperatively, 3.03; and percent change, 62.4%), and Oxford Shoulder Score (preoperatively, 9.4; postoperatively, 30.9; and percent change, 328.7%). The abduction, forward flexion, external rotation, and internal rotation range-of-motion measurements postoperatively were 57°, 64°, 3°, and 48°, respectively. Complications were reported in 33.6% of patients, with fractures (20.9%) and infections (18.6%) being the most common sources of complication. Shoulder arthrodesis provides improvement in functional outcomes for end-stage glenohumeral injuries; however, it is also associated with high rates of complications. [ABSTRACT FROM AUTHOR]

During D-T fusion operations the capture, purification, and recycling of unburned tritium will be crucial, as the formation of tritium containing molecules require additional processing. Removing the tritium can require costly processing to be unbound from the tritium-containing molecules and improvements to these processes will be necessary moving forward. Existing techniques using sorbent material beds to remove tritium-containing molecules from process gas streams undergo repeated high-heat cycling which leads to diminished bed lifespans, necessitating replacement and associated downtime. This work demonstrates the capture and isotopic exchange technique of deuterated ammonia (ND 3), used as a surrogate for tritium, at ambient temperature using a Pt catalyst-loaded 13X molecular sieve. Unmodified 13X molecular sieve is capable of adsorbing and retaining the ND 3 however, incorporation of a catalyst facilitates the isotopic exchange of the hydrogen isotopes. The effluent gas streams were analyzed in conjunction with desorbed ammonia isotopologues post-exchange to verify these results. Isotopically exchanging and removing heavier hydrogen isotopes using this technique provides an alternative to traditional removal methods. • Hydrogen isotopes successfully exchanged at ambient temperature with Pt catalyst present on support material. • Pt-loaded 13X demonstrates higher capacity for ND 3 when compared to 13X • Pt-loaded 13X requires lower temperatures for full desorption of ND 3 when compared to 13X [ABSTRACT FROM AUTHOR]

Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) are well-established procedures for spinal fusion. However, little is known about load sharing between cage, dorsal construct, and biological tissue within the instrumented lumbar spine. The aim of this study was to quantify the forces acting on cages under axial compression force with and without posterior instrumentation. Biomechanical cadaveric study. Ten lumbar spinal segments were tested under uniaxial compression using load cell instrumented intervertebral cages. The force was increased in 100N increments to 1000N or a force greater than 500N on one load cell. Each specimen was tested after unilateral PLIF (uPLIF), bilateral PLIF (bPLIF) and TLIF each with/without posterior instrumentation. Dorsal instrumentation was performed with 55N of compression per side. Cage insertion resulted in median cage preloads of 16N, 29N and 35N for uPLIF, bPLIF, and TLIF. The addition of compressed dorsal instrumentation increased the median preload to 224N, 328N, and 317N, respectively. With posterior instrumentation, the percentage of the external load acting on the intervertebral cage was less than 25% at 100N (uPLIF: 14.2%; bPLIF: 16%; TLIF: 11%), less than 45% at 500N (uPLIF: 31.8%; bPLIF: 41.1%; TLIF: 37.9%) and less than 50% at 1000N (uPLIF: 40.3%; bPLIF: 49.7%; TLIF: 43.4%). Without posterior instrumentation, the percentage of external load on the cages was significantly higher with values above 50% at 100N (uPLIF: 55.6%; bPLIF: 75.5%; TLIF: 66.8%), 500N (uPLIF: 71.7%; bPLIF: 79.2%; TLIF: 65.4%), and 1000N external load (uPLIF: 73%; bPLIF: 80.5%; TLIF: 66.1%). For absolute loads, preloads and external loads must be added together. Without posterior instrumentation, the intervertebral cages absorb more than 50% of the axial load and the load distribution is largely independent of the loading amplitude. With posterior instrumentation, the external load acting on the cages is significantly lower and the load distribution becomes load amplitude dependent, with a higher proportion of the load transferred by the cages at high loads. The bPLIF cages tend to absorb more force than the other two cage configurations. Cage instrumentation allows some of the compression force to be transmitted through the cage to the screws below, better distributing and reducing the overall force on the pedicle screws at the end of the construct and on the rods. [ABSTRACT FROM AUTHOR]

Distal tibial autograft harvesting has been studied in the past, but morbidity at the level of the donor site is unclear. The purpose of this retrospective review is to assess morbidity in distal tibial autograft harvesting associated with foot and ankle arthrodesis procedures. A retrospective analysis was performed utilizing patients treated in the last 13 years at a large, multicenter, academic, tertiary referral, research institution. Included patients were between the ages of 18 and 80 years old. One-hundred and seven patients (39 male; 68 female) underwent ipsilateral distal tibial bone graft (n = 110) harvesting to augment the index procedure. Patients were followed for an average of 11.2 months after surgery (Range: 1-73 months). The incidence rate of distal tibial stress fractures was 4.5%, with an overall postoperative complication rate of 8.2%. Overall, low complication rates associated with distal tibial autograft harvesting were found, supporting the use of the distal tibia as an appropriate site for autograft harvesting in foot and ankle surgery. [ABSTRACT FROM AUTHOR]

Human ear detection is one of the key features in biometric-based identification and person authentication. Detecting ears for position, dimension, and texture is tedious due to the height and movement of humans. The biometric systems based on ear detection are defaced by the height of humans and specific positions. For this purpose, a multi-feature and multi-contour-based assessment for precise detection is required. To address this problem, this article introduces an Enhanced Active Contour Method (EACM) for improving ear detection precision. The proposed method extracts the textural features for differentiating the antitragus and helix of the human ear. The extracted features are fused using a fuzzy threshold for the maximum possibilities of the ear structures. In verifying the maximum possibilities, the helix and antitragus contours are fused by identifying similar features. The features from the existing dataset are used for verifying the similarity; the similarity succeeding contours are used for detecting human ears. The proposed method maximizes accuracy and precision by 12.99% and 12.79% and reduces extraction time by 11.34%. [ABSTRACT FROM AUTHOR]

Rotational vertebrobasilar artery syndrome, or bow hunter syndrome, is a rare yet well-documented pathology. This study presents a surgical approach to a latent manifestation of dynamic, extension-only, bilateral codominant vertebral artery compression in the V3 segment, associated with craniocervical instability and central canal stenosis. The clinical presentation involves the treatment of positional vertigo resulting from left and high-grade right vertebral artery stenosis during neck extension only. Diagnosis was confirmed through a formal angiogram under provocative maneuvers. Surgical intervention, detailed in this section, employed a multidisciplinary approach, including intraoperative angiograms to ensure patent vertebral arteries precraniocervical fusion. The surgical treatment demonstrated success in addressing extension-only vertebrobasilar syndrome and associated complications of C1-2 pannus and craniocervical instability. Intraoperative angiograms confirmed vertebral artery patency pre- and postsurgical positioning, ensuring the effectiveness of the multidisciplinary approach. This study concludes by highlighting the successful multidisciplinary surgical treatment of a patient with nonunion of a C1 Jefferson fracture, leading to extension-only vertebrobasilar syndrome complicated by C1-2 pannus and craniocervical instability. The importance of considering vertebral artery dynamic stenosis in cases of positional vertigo or transient neurological symptoms following an injury is emphasized. Surgical stabilization, particularly when conservative measures prove ineffective, is recommended, with careful attention to pre- and postsurgical positioning to verify vertebral artery patency and posterior vasculature integrity. [ABSTRACT FROM AUTHOR]

Ankle arthrodesis and total ankle arthroplasty are both well-accepted surgical treatment options for end-stage ankle arthrosis. However, total ankle arthroplasty has gained popularity as the survivability of implants is improving. It is understood that there is loss of bone height following tibiotalocalcaneal arthrodesis, but to our knowledge, this has not been investigated in the setting of total ankle arthroplasty. A retrospective radiographic review was conducted over a 5-year period. We investigated all patients who underwent a tibiotalocalcaneal arthrodesis or total ankle arthroplasty for treatment of ankle arthritis by a single fellowship-trained orthopedic surgeon. The anterior and posterior height measurements were measured on preoperative and postoperative lateral radiographs. Differences between preoperative and postoperative heights were analyzed through a series of analyses of covariance. One hundred and thirty-three patients and 143 operative extremities were included: 71 operative extremities in the tibiotalocalcaneal arthrodesis group (mean age 55.5 ± 13.3 years, BMI 32.2 ± 7.9) and 72 in the total ankle arthroplasty group (mean age 65.4 ± 9.5 years, BMI 30.7 ± 6.4). Statistical analysis demonstrated a loss of height in the tibiotalocalcaneal arthrodesis group, and an increased anterior and posterior height in the total ankle arthroplasty group. However, when comparing the arthroplasty group and arthrodesis group only the anterior height measurement reached statistical significance when stratified by gender (p <.001). The potential change in height is an important factor to consider during surgical planning as a limb length discrepancy may result. [ABSTRACT FROM AUTHOR]

Tibiotalocalcaneal arthrodesis has been shown in literature to have good results in regards to low complication rates and deformity correction. While previous studies have investigated functional outcomes and complication rates, no large-scale studies have looked at pain outcomes. The present study performed a retrospective review of 154 extremities to analyze how a patient's comorbidities and characteristics influence pain outcomes following a tibiotalocalcaneal arthrodesis. The present study found an average change of pain from 7.1 to 3.0 in at least a 6 month follow up. We found that a diagnosis of chronic pain and tobacco use had statistically significant less pain improvement compared to patients without chronic pain or current tobacco use. We determined no statistically significant difference in pain outcomes for patients with or without Charcot deformity. Lastly, we found that with older patients there was more pain improvement observed. We physicians can educate current tobacco users of the improved pain outcomes with tobacco cessation prior to surgery. We recommend a multidisciplinary approach for pain in patients with a pre-operative diagnosis of chronic pain and to educate patients on realistic postoperative pain outcomes. [ABSTRACT FROM AUTHOR]

Preoperative anemia is known to be associated with perioperative complications in many surgical interventions. Here, we examine the effects of preoperative anemia on peri-operative complications and postoperative outcomes in pediatric patients undergoing spinal fusion. Retrospective analysis was conducted using the American College of Surgeons Pediatric National Surgery Quality Improvement Program Database between 2012–2020. Current Procedural Terminology codes 22800, 22,802, 22,804, 22,840, 22,842, 22,843, and 22,844 were included to represent all primary spinal fusion procedures performed. Patients without preoperative hematocrit (HCT) levels were excluded. Classification of anemia was determined via age- and sex-adjusted HCT levels. Patient demographics, preoperative comorbidities and risk factors, and 30-day postoperative outcomes were compared between the 2 cohorts using univariate analysis. Multivariate logistic regressions were performed to determine if anemia severity was independently associated with worse postoperative outcomes. A total of 30,243 pediatric patients were included in this study, with 26,621 not having preoperative anemia and 3622 having preoperative anemia. Pediatric patients with anemia have increased length of stay (LOS) (6.7 ± 9.6 vs. 5 ± 6, P < 0.001), 30-day unplanned reoperation rate (4% vs. 2.8%, P < 0.001), and total blood transfused (489.9 ± 497.8 vs. 423.4 ± 452.6, P < 0.001). Multivariate analysis supported anemia and degree of its severity as an independent predictor of increased length of stay (LOS), reoperation rate, and postoperative complications. Preoperative anemia leads to worse outcomes in pediatric spinal fusion procedures. Utilizing HCT recordings could be factored into the equation for optimal patient selection and prevention of post-operative complications. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze the trends in the annual volume and incidence of proximal row carpectomy (PRC), four-corner fusion (4CF), total wrist arthrodesis (TWF), and total wrist arthroplasty (TWA) from 2009 to 2019 in the United States. The IBM Watson Health MarketScan databases were queried to identify annual case volumes for PRC, 4CF, TWF, and TWA from 2009 to 2019. The annual incidence of these procedures was then calculated based on the population estimates from the US Census Bureau. Trends in annual volume and incidence over the study period were evaluated using regression line analysis. Further subgroup analysis was conducted based on age and region. From 2009 to 2019, the total case volumes for the four procedures increased by 3.4%, but the incidence decreased by 2.8%. However, PRC case volume and incidence trends significantly increased (38.2% and 29.7%, respectively), whereas 4CF remained constant. Conversely, the case volume and incidence of TWA significantly decreased (−52.2% and −54.5%, respectively), whereas TWF remained constant. When stratified by age, all four procedures decreased in the <45-year-old cohort (combined −35.1%) significantly for 4CF, TWF, and TWA. TWA decreased significantly in the <45-year-old and 45- to 65-year-old cohorts (53.6% and 63.2%, respectively). For age >65 years, the total case incidence increased by 98.9%, including a significant positive trend in TWF (175%). Surgical management of wrist arthritis remains a controversial issue. However, PRC has gained recent support in the literature, and our results reflect this shift, even for the <45-year-old cohort. Furthermore, TWA declined, despite reports of positive early outcomes for fourth-generation implants. Therapeutic II. [ABSTRACT FROM AUTHOR]

In patients undergoing cervical spine surgery for metastatic spine disease, we sought to 1) compare perioperative and oncologic outcomes among 3 different operative approaches, 2) report fusion rates, and 3) compare different types of anterior vertebral body replacement. A single-center retrospective cohort study of patients undergoing extradural cervical/cervicothoracic spine metastasis surgery between February 2010 and January 2021 was conducted. Operative approaches were anterior-alone, posterior-alone, or combined anterior-posterior, and the grafts/cages used in the anterior fusions were cortical allografts, static cages, or expandable cages. All cages were filled with autograft/allograft. Outcomes included perioperative/postoperative variables, along with fusion rates, functional status, local recurrence (LR), and overall survival (OS). Sixty-one patients underwent cervical spine surgery for metastatic disease, including 11 anterior (18.0%), 28 posterior (45.9%), and 22 combined (36.1%). New postoperative neurologic deficit was the highest in the anterior approach group (P = 0.038), and dysphagia was significantly higher in the combined approach group (P = 0.001). LR (P > 0.999), OS (P = 0.655), and time to both outcomes (log-rank test, OS, P = 0.051, LR, P = 0.187) were not significantly different. Of the 51 patients alive at 3 months, only 19 (37.2%) obtained imaging ≥3 months. Fusion was seen in 11/19 (57.8%) at a median of 8.3 months (interquartile range, 4.6–13.7). Among the anterior corpectomies, the following graft/cage was used: 6 allografts (54.5%), 4 static cages (36.3%), and 1 expandable cage (9.0%), with no difference found in outcomes among the 3 groups. The only discernible differences between operative approaches were that patients undergoing an anterior approach had higher rates of new postoperative neurologic deficit, and the combined approach group had higher rates of postoperative dysphagia. [ABSTRACT FROM AUTHOR]

To investigate how the expansion trajectory of a lateral expandable cage affects pressure distribution at the cage-endplate interface under well-controlled biomechanical loading conditions. Three unique vertical height expansion trajectories used by clinically relevant lateral expandable cages were evaluated: craniocaudal, fixed-arc, and independently adjustable anterior and posterior height expansion. Two biomechanical loading scenarios were performed. The first scenario used custom bone foam test blocks to assess resultant pressure distribution at varying test block lordotic angles and expansion heights. The second scenario simulated expansion using synthetic spine units and compared the pressure distribution following expansion. For an expandable cage with craniocaudal expansion, the pressure distribution at the cage-endplate interface was found to depend heavily on the lordotic angle of the test block (P < 0.001), but not expansion height (P = 0.634). The greatest maximum pressure occurred at higher test block lordotic angles. For an expandable cage with fixed-arc expansion, the pressure distribution shifted anteriorly throughout expansion. In the simulated expansion trials, an expandable cage with adjustable anterior and posterior height expansion was found to improve the pressure distribution at the cage-endplate interface, reducing the maximum pressure measurements by 22% and 14% in the craniocaudal and fixed-arc expansion, respectively. Of the cage designs evaluated in this study, an expandable cage with independently adjustable anterior and posterior heights lowered the maximum pressure measured at the cage-endplate interface and alleviated the potential of cage edge loading, both of which are important considerations that are fundamental for a successful fusion procedure and the mitigation of implant subsidence risk. [ABSTRACT FROM AUTHOR]

The transforaminal lumbar interbody fusion (TLIF) is among the most utilized methods for the surgical treatment of lumbar degenerative disc disease. The TLIF has advanced significantly with several iterative changes since its inception in the early 1980s, with the advent of several generations of interbody types, shapes, and materials. Steerable curvilinear interbodies are among the most recent innovations in this space and may offer biomechanical advantages, namely in preservation of lumbar and segmental lordosis. While radiographic parameters have been investigated for other cage shapes and lumbar interbody fusion techniques, no study has investigated postoperative radiographic outcomes specific to TLIFs done with curvilinear interbodies. This study is a retrospective review of TLIFs performed with curvilinear interbodies between 2019 and 2022 at a single institution. Upright radiographs were obtained preoperatively and at several timepoints postoperatively. Radiographic variables including interspace height and segmental lordosis were collected. 26 surgeries with 32 curvilinear interbodies were performed across 3 years. There was significant increase in segmental lordosis at the L4-L5 (p = 0.0183) and L5-S1 levels (p = 0.004) as well as interspace height postoperatively at levels L3-L4 (p = 0.011) and L4-L5 (p = 0.002). Pain as measured with the numeric rating scale significantly improved in the overall cohort postoperatively (p<0.001). TLIF with curvilinear interbody placement increases segmental lordosis and interspace height at the L4-L5 and L5-S1 levels, and increased interspace height at the L3-L4 and L4-L5 levels. Further investigation into additional radiographic parameters is warranted and expanded cohort size would benefit deeper analysis of other spinal levels. As an increasing number of cage designs and materials are brought to market, studies such as this allow for better understanding of cage specific outcomes allowing for better informed device selection. [ABSTRACT FROM AUTHOR]

Clear cell sarcoma of soft tissue is a rare aggressive soft tissue malignancy primarily affecting the extremities of young adults and is characterised by an EWSR1 ::ATF1 fusion gene. The tumour has a high rate of local recurrence and metastasis and as such often has a poor prognosis. [ABSTRACT FROM AUTHOR]

Though cage-and-plate constructs are widely used for disk height restoration in surgery for cervical disc disease, concerns over range of motion limitations and adjacent disc space violations have fueled the development of artificial disc and zero-profile constructs. This study investigated the outcomes of patients undergoing two-level cervical interventions via arthroplasty, cage-and-plate, or zero-profile constructs. Patients undergoing two-level anterior cervical procedures between 2010 and 2020 were identified using an all-payer claims database. Logistic regression models were utilized to develop criteria for a 1:1:1-exact match procedure. The primary outcome was the need for additional surgery within 30 months, and the secondary outcomes included medical and surgical complications observed within 30 days of index intervention. P values < 0.05 were considered statistically significant. 133,831 patients were identified as undergoing two-level anterior cervical interventions. Seven thousand three hundred seventy-one records were analyzed through a 1:1:1 match. Patients who received zero-profile versus cage-and-plate constructs had significantly decreased odds of requiring additional surgery within 30 months (Odds Ratio [OR] 0.64; 95% Confidence Interval [CI] 0.51–0.81). However, postoperative medical complications were increased among patients who received zero-profile constructs compared to cage-and-plate (OR 1.59; 95%CI 1.07–2.37). Patients who underwent arthroplasty also had decreased odds for additional surgery versus cage-and-plate (OR 0.75; 95%CI 0.60–0.93). There was no significant difference between arthroplasty and cage-and-plate constructs in developing postoperative surgical or medical complications. Among patients undergoing two-level interventions, cage-and-plate constructs were associated with increased odds of additional surgery within 30 months following index procedures when compared to zero-profile constructs or arthroplasty. [ABSTRACT FROM AUTHOR]

To present a new technique combining anterior release with allograft insertion and lateral fixation at the concave side of the curve, preserving the hemivertebra and posterior bilateral transpedicular fixation in patients with congenital kyphoscoliosis (CKS) who were not operated on until late adolescence, including long-term follow-up of patients, and a discussion of the literature on CKS with hemivertebra. Two patients with CKS concomitant with hemivertebra underwent circumferential (anterior-posterior) instrumentation and fusion using a new technique. Patient 1 underwent a 2-stage operation, first anterior then posterior. Patient 2 was operated on circumferentially in 1 session. Both patients had >10 years of follow-up showing solid fusion of their operated spine segments. The patients were pain-free, and their body heights were comparable to healthy peers. In our circumferential approach, we successfully integrated the hemivertebrae in anterior fusions rather than resecting them in older adolescents with CKS. This technique decreased bleeding, shortened operative time, and promised potential benefits compared with the available techniques in the literature. [ABSTRACT FROM AUTHOR]

Injury to the tarsometatarsal joint (TMT) results in instability throughout the midfoot that does not often improve with conservative management. If instability is identified, surgical intervention is frequently recommended, either open reduction and internal fixation (ORIF) or primary arthrodesis (PA). These 2 treatment options have been compared in the literature multiple times, often reporting similar outcomes. Due to this, as well as the need for subsequent hardware removal after ORIF has led many surgeons towards PA at the index surgery. Concern for nonunion is a leading concern with surgeons who advocate instead for ORIF. The purpose of this study is to review patients who underwent PA and observe nonunion rates. Nonunion at the TMT has been previously studied, but only in the chronic setting. We performed a retrospective study of 34 patients who had PA in the management of an acute Lisfranc injury. The average age in our study was 43.9 years old (range 19-72, SD 17.4) with an average follow-up of 9.4 months (range 4-33, SD 6.2). Radiographs were evaluated for signs of nonunion at regular postoperative intervals. Within the patients included in the study, a total of 71 TMT joints were fused. Overall successful fusion rate was 95.8% at an average of 7.9 weeks (range 6-12, SD 1.4) postoperatively. Individual nonunion rates at the first, second, and third TMT were 0%, 1.4% and 2.8% respectively. Our study demonstrates that primary arthrodesis provides a predictable outcome with low nonunion rates in the management of acute Lisfranc injury. [ABSTRACT FROM AUTHOR]

Preincisional localization has become ubiquitous within spinal neurosurgery and has served as the foundation for modern minimally invasive surgery techniques. Dr. Ralph Bingham Cloward, renowned for his contributions to the field of spinal fusion, was a strong advocate and early adopter of diskography. In fact, Cloward credited cervical diskography for inspiring his anterior approach to the cervical disk. In his landmark 1958 article on what is now known as anterior cervical diskectomy and fusion, Cloward commented on a case of wrong-level surgery that motivated him to implement a standardized technique for spinal level localization with the patient under anesthesia in the operating room before skin incision. We trace the origins of the use of preincisional radiographs to localize the pathologic level at the time of diskectomy and highlight this original contribution by Cloward. [ABSTRACT FROM AUTHOR]

The role of fusion in degenerative spondylolisthesis (DS) is controversial. The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system was developed to assist surgeons in surgical technique selection based on individual patient characteristics. This system has not been clinically validated as a guide to surgical technique selection. The purpose of this study was to determine if outcomes vary with different surgical techniques across the CARDS categories. Prospective cohort study performed at one Swiss and one American spine center. Five hundred eight patients with DS undergoing surgical treatment. Core Outcomes Measure Index (COMI) at 3 months and 12 months postoperatively. Patients undergoing surgery for DS were enrolled at 2 institutions and classified according to the CARDS system using dynamic radiographs. The Core Outcome Measure Index (COMI) was completed preoperatively, and 3 and 12 months postoperatively. Surgical technique was classified as uninstrumented (decompression alone or decompression with uninstrumented fusion) or instrumented (decompression with pedicle screw instrumentation with or without interbody fusion). Unadjusted analyses and mixed effect models compared COMI scores between the two surgery technique groups (uninstrumented vs instrumented), stratified by CARDS category over time. Reoperation rates were also compared between the surgery technique groups stratified by CARDS category. Partial funding was given through NASS grant for clinical research. Five hundred five out of 508 patients enrolled in the study had sufficient data to be classified according to CARDS. Seven percent were classified as CARDS A, 28% as CARDS B, 48% as CARDS C, and 17% as CARDS D (CARDS A most "stable," CARDS D least "stable"). One hundred and thirty-three patients (26%) underwent decompression alone, 30 (6%) underwent decompression and uninstrumented fusion, 42 (8%) underwent decompression and posterolateral instrumented fusion, and 303 (60%) underwent decompression with posterolateral and interbody instrumented fusion. Patients in the least "stable" categories tended to be less likely to be treated with an uninstrumented technique (CARDS D 19% vs 32% for the other categories, p=.10). There were no significant differences in 3 or 12-month COMI scores between surgical technique groups stratified by CARDS category in the unadjusted or adjusted analyses. In the unadjusted analyses, there was a trend towards less improvement in 12-month COMI change score in the CARDS D patients in the uninstrumented group compared to the instrumented group (-2.7 vs -4.1, p=.10). Reoperation rates were not significantly different between the surgical technique groups stratified by CARDS category. In general, outcomes for uninstrumented and instrumented surgical techniques were similar across the CARDS categories. Surgeons likely took factors included in CARDS into account during surgical technique selection. This resulted in a low number of CARDS D (n=15) patients being treated with uninstrumented techniques, which limited the statistical power of this analysis. As such, this study does not validate CARDS as a useful classification system for surgical technique selection in DS. [ABSTRACT FROM AUTHOR]

• More preoperative leg pain and less comorbidity associated with improved outcome. • Baseline variables did not modify the treatment effect. • Instability criteria cannot be recommended as selection criteria for fusion surgery. Patients with spinal stenosis and degenerative spondylolisthesis are treated surgically with decompression alone or decompression with fusion. However, there is debate regarding which subgroups of patients may benefit from additional fusion. To investigate possible treatment effect modifiers and prognostic variables among patients operated for spinal stenosis and degenerative spondylolisthesis. A secondary exploratory study using data from the Norwegian Degenerative Spondylolisthesis and Spinal Stenosis (NORDSTEN-DS) trial. Patients were randomized to decompression alone or decompression with instrumented fusion. The sample in this study consists of 267 patients from a randomized multicenter trial involving 16 hospitals in Norway. Patients were enrolled from February 12, 2014, to December 18, 2017. The study did not include patients with degenerative scoliosis, severe foraminal stenosis, multilevel spondylolisthesis, or previous surgery. The primary outcome was an improvement of ≥ 30% on the Oswestry Disability Index score (ODI) from baseline to 2-year follow-up. When investigating possible variables that could modify the treatment effect, we analyzed the treatment arms separately. When testing for prognostic factors we analyzed the whole cohort (both treatment groups). We used univariate and multiple regression analyses. The selection of variables was done a priori, according to the published trial protocol. Of the 267 patients included in the trial (183 female [67%]; mean [SD] age, 66 [7.6] years), complete baseline data for the variables required for the present analysis were available for 205 of the 267 individuals. We did not find any clinical or radiological variables at baseline that modified the treatment effect. Thus, none of the commonly used criteria for selecting patients for fusion surgery influenced the chosen primary outcome in the two treatment arms. For the whole cohort, less comorbidity (American Society of Anesthesiologists Classification [ASA], OR = 4.35; 95% confidence interval (CI [1.16–16.67]) and more preoperative leg pain (OR = 1.23; CI [1.02–1.50]) were significantly associated with an improved primary outcome. In this study on patients with degenerative spondylolisthesis, neither previously defined instability criteria nor other pre-specified baseline variables were associated with better clinical outcome if fusion surgery was performed. None of the analyzed variables can be applied to guide the decision for fusion surgery in patients with degenerative spondylolisthesis. For both treatment groups, less comorbidity and more leg pain were associated with improved outcome 2 years after surgery. NORDSTEN-DS ClinicalTrials.gov, NCT02051374. [ABSTRACT FROM AUTHOR]

Charcot neuroarthropathy (CNA) is a progressive disease affecting the bones and joints of the foot that can lead to instability, breakdown, and collapse. Minimally invasive surgery (MIS) techniques are becoming a popular option within musculoskeletal surgery of the foot and ankle and may be an alternative to aggressive dissection seen during corrective surgery. An MIS approach minimizes vascular disruption, provides structural stability at an osteotomy or arthrodesis site, and encourages early mobilization if indicated. This retrospective study compares 17 patients who underwent an open approach for midfoot CNA reconstruction with 17 patients who underwent an MIS approach for midfoot CNA reconstruction. Preoperative and postoperative radiographic parameters were measured: lateral talus-first metatarsal, anteroposterior (AP) talus-first metatarsal, calcaneal pitch, and cuboid height. Difficulties that occurred during treatment were gathered and sorted into postoperative problems (stage I), obstacles (stage II), and complications (stage III). Changes from preoperative to postoperative radiographic lateral talus-first metatarsal and AP talus-first metatarsal angles were statistically significant (p <.001) for both the MIS and open approach. No true postoperative complications (stage III) were observed at last follow-up. The most common difficulty encountered was pin-site infection (stage I; in 23.5% of patients) in the MIS group. In the open group, the most common complications were wound development (stage I; 23.5%) and nonunions (stage II; 23.5%). Our findings suggest that midfoot CNA reconstruction with MIS methods offers similar outcomes to the open approach. [ABSTRACT FROM AUTHOR]

Parkinson disease (PD) is a neurodegenerative disorder that manifests with postural instability and gait imbalance. Correction of spinal deformity in patients with PD presents unique challenges. The PearlDiver database was queried between 2010 and 2020 to identify adult patients with spinal deformity before undergoing deformity correction with posterior spinal fusion. Two cohorts were created representing patients with and without a preoperative diagnosis of PD. Outcome measures included reoperation rates, surgical technique, cost, surgical complications, and medical complications. Multivariable logistic regression adjusting for Charlson Comorbidity Index, age, gender, 3-column osteotomy, pelvic fixation, and number of levels fused was used to assess rates of reoperation and complications. In total, 26,984 patients met the inclusion criteria and were retained for analysis. Of these patients, 725 had a diagnosis of PD before deformity correction. Patients with PD underwent higher rates of pelvic fixation (odds ratio [OR], 1.33; P < 0.001) and 3-column osteotomies (OR, 1.53; P < 0.001). On adjusted regression, patients with PD showed increased rates of reoperation at 1 year (OR, 1.37; P < 0.001), 5 years (OR, 1.32; P < 0.001), and overall (OR, 1.33; P < 0.001). Patients with PD also experienced an increased rate of medical complications within 30 days after deformity correction including deep venous thrombosis (OR, 1.60; P = 0.021), pneumonia (OR, 1.44; P = 0.039), and urinary tract infections (OR, 1.54; P < 0.001). Deformity correction in patients with PD was associated with higher 90-day cost (P = 0.007). Patients with PD undergoing long fusion for deformity correction are at significantly increased risk of 30-day medical complications and revision procedures after 1 year, controlling for comorbidities, age, and invasiveness. Surgeons should consider the risk of complications, subsequent revision procedures, and increased cost. [ABSTRACT FROM AUTHOR]

• Almost all the investigated PCMs are compatible with aluminium, copper, stainless steel, and plastic. • Differences in thermal behaviour were observed despite the same operating conditions were applied. • The thermophysical and transport properties deeply affect the thermal performance of PCMs. • The charging time differs from the discharging one despite the same operating conditions. • The presence of metal lattice structures reduces the charging time more than the discharging one. Refrigeration, air conditioning and heat pump sector represents between 25 and 30% of the global consumption of electricity and this figure is expected to rapidly grow due to the current trend of electrification. To increase the efficiency of these systems or to maximize the use of renewable energy, latent thermal storage systems are being studied and recommended. However, there is a lack of reliable design rules based on trustable data that could help the thermal experts to design efficient and cost-effective latent thermal energy storage. This paper follows a previous work recently published (Longo et al., 2022) where the thermo-physical and transport properties of a few low temperature PCMs (i.e. 2–9 °C of melting temperature) were measured and discussed. In the present work, the attention is focused on two other fundamental aspects: the PCMs' compatibility with the most common construction materials and their thermal behaviour during the solid/liquid phase change. The collected results will contribute to add currently unavailable data in the literature and to highlight interesting insights on the performance of the selected PCMs. [Display omitted] [ABSTRACT FROM AUTHOR]

Degenerative lumbar spondylolisthesis (DLS) is a debilitating condition associated with poor preoperative functional status. Surgical intervention has been shown to improve functional outcomes in this population though the optimal surgical procedure remains controversial. The importance of maintaining and/or improving sagittal and pelvic spinal balance parameters has received increasing interest in the recent DLS literature. However, little is known about the radiographic parameters most associated with improved functional outcomes among patients undergoing surgery for DLS. To identify the effect of postoperative sagittal spinal alignment on functional outcome after DLS surgery. Retrospective cohort study. Two-hundred forty-three patients in the Canadian Spine Outcomes and Research Network (CSORN) prospective DLS study database. Baseline and 1-year postoperative leg and back pain on the 10-point Numeric Rating Scale and baseline and 1-year postoperative disability on the Oswestry Disability Index (ODI). All enrolled study patients had a DLS diagnosis and underwent decompression in isolation or with posterolateral or interbody fusion. Global and regional radiographic alignment parameters were measured at baseline and 1-year postoperatively including sagittal vertical axis (SVA), pelvic incidence and lumbar lordosis (LL). Both univariate and multiple linear regression was used to assess for the association between radiographic parameters and patient-reported functional outcomes with adjustment for possible confounding baseline patient factors. Two-hundred forty-three patients were available for analysis. Among participants, the mean age was 66 with 63% (153/243) female with the primary surgical indication of neurogenic claudication in 197/243 (81%) of patients. Worse pelvic incidence-LL mismatch was correlated with more severe disability [ODI, 0.134, p<.05), worse leg pain (0.143, p<.05) and worse back pain (0.189, p<.001) 1-year postoperatively. These associations were maintained after adjusting for age, BMI, gender, and preoperative presence of depression (ODI, R2 0.179, β, 0.25, 95% CI 0.08, 0.42, p=.004; back pain R2 0.152 (β, 0.05, 95% CI 0.022, 0.07, p<.001; leg pain score R2 0.059, β, 0.04, 95% CI 0.008, 0.07, p=.014). Likewise, reduction of LL was associated with worse disability (ODI, R2 0.168, β, 0.04, 95% CI -0.39, -0.02, p=.027) and worse back pain (R2 0.135, β, -0.04, 95% CI -0.06, -0.01, p=.007). Worsened SVA correlated with worse patient reported functional outcomes (ODI, R2 0.236, β, 0.12, 95% CI 0.05, 0.20, p=.001). Similarly, an increase (worsening) in SVA resulted in a worse NRS back pain (R2 0.136, β, 0.01, 95% CI.001, 0.02, p=.029) and worse NRS leg pain (R2 0.065, β, 0.02, 95% CI 0.002, 0.02, p=.018) scores regardless of surgery type. Preoperative emphasis on regional and global spinal alignment parameters should be considered in order to optimize functional outcome in lumbar degenerative spondylolisthesis treatment. [ABSTRACT FROM AUTHOR]

Eye is the most specialized and sensory body organ and treating eye diseases efficiently is necessary. Despite various attempts, the design of a consummate ophthalmic drug delivery system remains unsolved because of anatomical and physiological barriers that hinder drug transport into the desired ocular tissues. It is important to advance new platforms to manage ocular disorders, whether they exist in the anterior or posterior cavities. Nanotechnology has piqued the interest of formulation scientists because of its capability to augment ocular bioavailability, control drug release, and minimize inefficacious drug absorption, with special attention to lipid-based nanocarriers (LBNs) because of their cellular safety profiles. LBNs have greatly improved medication availability at the targeted ocular site in the required concentration while causing minimal adverse effects on the eye tissues. Nevertheless, the exact mechanisms by which lipid-based nanocarriers can bypass different ocular barriers are still unclear and have not been discussed. Thus, to bridge this gap, the current work aims to highlight the applications of LBNs in the ocular drug delivery exploring the different ocular barriers and the mechanisms viz. adhesion, fusion, endocytosis, and lipid exchange, through which these platforms can overcome the barrier characteristics challenges. [Display omitted] • Ocular drug delivery remains challenging due to various ocular barriers. • Lipid-based nanocarriers (LBNs) overcome ocular barriers via different mechanisms. • LBNs undergo fusion, endocytosis, and lipid exchange with ocular endothelium. • LBNs can improve drug ocular residence time. • Several limitations facing the translation of lipid-based nanocarrier to the clinic. [ABSTRACT FROM AUTHOR]

Since its proposal, the Global Alignment and Proportion (GAP) score has been the topic of several external validation studies, which have yielded conflicting results. Given the lack of consensus regarding this prognostic tool, the authors aim to assess the accuracy of GAP scores for predicting mechanical complications following adult spinal deformity correction surgery. A systematic search was performed using PubMed, Embase, and Cochrane Library for the purpose of identifying all studies evaluating the GAP score as a predictive tool for mechanical complications. GAP scores were pooled using a random-effects model to compare patients reporting mechanical complications after surgery versus those reporting no complications. Where receiver operator curves were provided, the area under the curve (AUC) was pooled. A total of 15 studies featuring 2092 patients were selected for inclusion. Qualitative analysis using Newcastle-Ottawa criteria revealed moderate quality among all included studies (5.99/9). With respect to sex, the cohort was predominantly female (82%). The pooled mean age among all patients in the cohort was 58.55 years, with a mean follow-up of 33.86 months after surgery. Upon pooled analysis, we found that mechanical complications were associated with higher mean GAP scores, albeit minimal (mean difference = 0.571 [ 95% confidence interval: 0.163–0.979]; P = 0.006, n = 864). Additionally, age (P = 0.136, n = 202), fusion levels (P = 0.207, n = 358), and body mass index (P = 0.616, n = 350) were unassociated with mechanical complications. Pooled AUC revealed poor discrimination overall (AUC = 0.69; n = 1206). GAP scores may have a minimal-to-moderate predictive capability for mechanical complications associated with adult spinal deformity correction. [ABSTRACT FROM AUTHOR]

The occurrence of early osteointegration and reduced modulus of elasticity have been proved with 3-dimensinally (3D) printed porous titanium (3DP-titanium) cages used for posterior lumbar interbody fusion (PLIF). The present study was conducted to demonstrate the fusion rate, subsidence, and clinical outcomes for the 3DP-titanium cage in PLIF and to compare its results with those of the polyetheretherketone (PEEK) cage. A total of 150 patients who underwent 1–2-level PLIF and were followed up for >2 years were retrospectively reviewed. The fusion rates, subsidence, segmental lordosis, visual analog scale (VAS) score for back pain, VAS score for leg pain, and Oswestry disability index were assessed. A higher 1-year (3DP-titanium, 86.9%; PEEK, 67.7%; P = 0.002) and 2-year (3DP-titanium, 92.9%; PEEK, 82.3%; P = 0.037) fusion rate could be achieved with 3DP-titanium cages for PLIF than with PEEK cages. The amount of subsidence (3DP-titanium, 1.4 ± 1.6 mm; PEEK, 1.9 ± 1.8 mm; P = 0.092) and incidence of significant subsidence (3DP-titanium, 17.9%; PEEK, 23.4%; P = 0.389) was not significantly different between the 2 materials. Furthermore, the VAS score for back pain and leg pain and Oswestry disability index were not significantly different between the 2 groups. On logistic regression analysis, cage material (P = 0.027) showed a significant association with fusion, and the number of levels fused (P = 0.012) was associated with subsidence. The 3DP-titanium cage resulted in a higher fusion rate than the PEEK cage when used for PLIF. The subsidence rate did not differ significantly between the 2 cage materials. Therefore, the 3DP-titanium cage can be safely used for PLIF, considering its stable construct. [ABSTRACT FROM AUTHOR]

To evaluate the safety and efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) in patients with L4-L5 degenerative lumbar spondylolisthesis (DLS) with instability. The clinical data of 27 patients with L4-L5 DLS who underwent PE-TLIF from September 2019 to April 2022 were retrospectively reviewed. A minimum of 12 months of follow-up visits was provided to all patients. The demographics, perioperative, and clinical outcomes were reviewed based on the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. Brantigan criteria estimated the result of interbody fusion at 12 months. The mean age was 70.70 ± 8.91 (55–83) years. The mean ± standard deviation values of the preoperative visual analog scale for back pain, leg pain, and Oswestry Disability Index were 7.37 ± 1.01, 7.26 ± 0.94, and 66.22 ± 7.49, respectively. The values improved to 1.66 ± 0.62, 1.74 ± 0.52, and 19.55 ± 5.56 at 12 months postoperatively (P ＜ 0.05). The modified MacNab criteria revealed that 88.89% (24/27) of patients achieved good-to-excellent outcomes. The interbody fusion rate was 100% at the final follow-up. In patients with L4-L5 DLS with instability, PE-TLIF under conscious sedation and local anesthesia could be an effective supplement for open decompression and fusion. [ABSTRACT FROM AUTHOR]

Vertebral hemangiomas (VHs), formed from a vascular proliferation in bone marrow spaces limited by bone trabeculae, are the most common benign tumors of the spine. While most VHs remain clinically quiescent and often only require surveillance, rarely they may cause symptoms. They may exhibit active behaviors, including rapid proliferation, extending beyond the vertebral body, and invading the paravertebral and/or epidural space with possible compression of the spinal cord and/or nerve roots ("aggressive" VHs). An extensive list of treatment modalities is currently available, but the role of techniques such as embolization, radiotherapy, and vertebroplasty as adjuvants to surgery has not yet been elucidated. There exists a need to succinctly summarize the treatments and associated outcomes to guide VH treatment plans. In this review article, a single institution's experience in the management of symptomatic VHs is summarized along with a review of the available literature on their clinical presentation and management options, followed by a proposal of a management algorithm. [ABSTRACT FROM AUTHOR]

"Cup-shaped power reamers" and "flat cuts" (FC) are common joint preparation techniques in first metatarsophalangeal (MTP) joint arthrodesis. However, the third option of an "in situ" (IS) technique has rarely been studied. This study aims to compare the clinical, radiographic, and patient-reported outcomes (PROMs) of the IS technique for various MTP pathologies with other MTP joint preparation techniques. A single-center retrospective review was performed for patients who underwent primary MTP joint arthrodesis between 2015 and 2019. In total, 388 cases were included in the study. We found higher nonunion rates in the IS group (11.1% vs 4.6%, p =.016). However, the revision rates were similar between the groups (7.1% vs 6.5%, p =.809). Multivariate analysis revealed that diabetes mellitus was associated with significantly higher overall complication rates (p <.001). The FC technique was associated with transfer metatarsalgia (p =.015) and a more first ray shortening (p <.001). Visual analog scale, PROMIS-10 physical, and PROMIS-CAT physical scores significantly improved in IS and FC groups (p <.001, p =.002, p =.001, respectively). The improvement was comparable between the joint preparation techniques (p =.806). In conclusion, the IS joint preparation technique is simple and effective for first MTP joint arthrodesis. In our series, the IS technique had a higher radiographic nonunion rate that did not correlate with a higher revision rate, and otherwise similar complication profile to the FC technique while providing similar PROMs. The IS technique resulted in significantly less first ray shortening when compared to the FC technique. [ABSTRACT FROM AUTHOR]

First metatarsal phalangeal (MTP) joint arthrodesis has been employed for decades for pain related to arthritis and other associated abnormalities. Despite the commonality of the procedure there continues to be questions regarding functional expectations following the procedure especially when employed for correction of hallux valgus deformity. We surveyed 60 patients who had a tri plane MTP joint arthrodesis at mean 28.4 months (median 27.8) regarding their activities of daily living and sports activity through a direct conversation. Secondary endpoints assessed were return to activity, deformity correction and arthrodesis healing rate based on chart review and weightbearing radiographs. The primary outcomes showed robust return to all activities of daily living with 96.7% able to walk without restrictions and or pain, 98.3% were able to walk at a normal pace and 95% responded that loss of motion of their big toe did not affect their daily function. Regarding return to sports all patients that participated in sports before surgery resumed participation after with a trend toward increased sports activity. Early return to walking in a fracture boot was noted in this cohort at mean 4.1 days, return to athletic shoe at mean 6.3 weeks and full unrestricted activity at mean 13.3 weeks with no non-unions identified on radiographic or clinical exam. Deformity correction of the typical components of hallux valgus deformity was similar to previously published studies. This data set supports the hypothesis that patients undergoing first MTP joint arthrodesis can expect rapid and full return to activities of daily living and sports with a low complication rate. [ABSTRACT FROM AUTHOR]

In this study, we aimed to retrospectively analyze the effects of the use of univertebral screw plates (USPs) and bivertebral screw plates (BSPs) on fusion in patients who underwent anterior cervical discectomy and fusion (ACDF). Forty-two patients who were treated with USPs or BSPs after 1-level or 2-level ACDF and had a minimum follow-up period of 2 years were included in the study. Fusion and the global cervical lordosis angle were evaluated using direct radiographs and computed tomography images of the patients. The clinical outcomes were assessed using the Neck Disability Index and visual analog scale. Seventeen patients were treated using USPs and 25 patients using BSPs. Fusion was achieved in all patients who underwent BSP fixation (1-level ACDF, 15 patients; 2-level ACDF, 10 patients) and 16 of the 17 patients who underwent USP fixation (1-level ACDF, 11 patients; 2-level ACDF, 6 patients). The plate of the patient with fixation failure had to be removed because it was symptomatic. A statistically significant improvement was observed in the immediate postoperative period and at the last follow-up in terms of global cervical lordosis angle, visual analog scale score, and Neck Disability Index of all patients who underwent 1-level or 2-level ACDF surgery (P < 0.05) Although USPs are less costly and easier to implant, the effect of USPs and BSPs on fusion and clinical outcomes is similar. Thus, surgeons may prefer to use USPs after 1-level or 2-level ACDF. [ABSTRACT FROM AUTHOR]

Type II odontoid fracture is the most common fracture type, and its treatment remains challenging. The objective of this study was to evaluate the results of anterior screw fixation for type II odontoid fractures in patients aged over and below 60 years. A retrospective analysis of consecutive patients diagnosed with type II odontoid fractures who were surgically treated using the anterior approach by a single surgeon was conducted. Demographic characteristics, including age, sex, type of fracture, time from trauma to surgery, length of stay (LoS), fusion rate, complications, and reoperation, were evaluated. Surgical outcomes were compared between patients over and below 60 years of age. Sixty consecutive patients underwent odontoid anterior fixation during the analysis period. The mean age of patients was 49.58 ± 23.22 years. Twenty-three (38.3%) patients were aged over 60 years, and the minimum follow-up period was two years. Of the patients, 93.3% developed bone fusion, which was observed in 86.9% of patients over 60 years. Complications related to hardware failure occurred in six (10%) patients. Transient dysphagia was observed in 10% of the cases. Three (5%) patients required reoperation. Patients over 60 years had a significantly increased risk of dysphagia compared with those below 60 years (P = 0.0248). There was no significant difference between the groups regarding nonfusion rate, reoperation rate, or LoS. Anterior fixation of the odontoid showed high fusion rates with a low rate of complications. It is a technique to be considered for treating type II odontoid fractures in selected cases. [ABSTRACT FROM AUTHOR]

Deepfake is a deep learning technology that replaces source person face photos with the target person face photos in a movie to create a video of the target by executing the actions performed by source person. Due to the limited storage capacity and network bandwidth constraints, compressed media is now commonly employed in social networks. The goal of this research study is to determine whether or not a given compressed video is a deepfake. To do this, both the spatial and temporal components of the video should be considered, and the findings will be integrated by using an appropriate fusion approach. Hence, the deep learning model used in the spatial approach is pruned using the Network Pruning technique to achieve a better performance. The combined prediction of the spatial and temporal approaches indicates whether the given video is deepfake or not. [ABSTRACT FROM AUTHOR]

Image dehazing is always a hot topic in the field of computer vision since haze has significant impact on the imaging quality of camera. Therefore, many image dehazing methods have been proposed for the past decades. To help researchers who are new to this field quickly figure out the development history as well as the current status of image dehazing, this review analyzes some representative dehazing methods, evaluates their advantages and disadvantages, and most importantly, points out the best dehazing method from different viewpoints. A large quantity of experiments show that AECR-Net can be generally considered to be the best dehazing algorithm and Tarel method can be regarded as the best real-time dehazing method. Besides, the mainstream benchmark, metrics, challenges and opportunities for image dehazing are also discussed in this review. [ABSTRACT FROM AUTHOR]

• RSV F protein is most antigenic in its trimeric prefusion conformation. • Like antibody AM14, nanobody F-VHH-L66 binds specifically to prefusion RSV F trimer. • F-VHH-L66 performs similarly to AM14 in ELISA and virus neutralization assays and is a suitable replacement for AM14. In the past decade, camelid nanobodies have been developed for multiple applications, including immuno-imaging, cancer immunotherapy, and antiviral therapeutics. Despite the prevalence of these approaches, nanobodies have rarely been used to assess the potency of vaccine antigen candidates, which are primarily based on mAb binding approaches. In this work, we demonstrate that a nanobody-based ELISA method is suitable for characterization of a leading respiratory syncytial virus (RSV) vaccine candidate, RSVPreF3. This nanobody, F-VHH-L66, compares similarly with AM14, an antibody well-known to be specific for the prefusion form of the RSV surface fusion glycoprotein, RSV F. ELISA assays based on F-VHH-L66 were specific for the trimeric, prefusion form of RSV F, the antigen conformation that best generates neutralizing antibodies. Additionally, the F-VHH-L66-based ELISA proved accurate, linear, and stability-indicating. Statistical analysis of 65 independent F-VHH-L66-based ELISA experiments indicated assay performance similar to that of ELISA assays based on AM14. Moreover, the binding kinetics of F-VHH-L66 to RSVPreF3 are comparable to those of AM14 when measured by surface plasmon resonance (SPR). Finally, F-VHH-L66 neutralized RSV(A) with similar efficacy as AM14; this bioactivity data further supports its use as an alternative to AM14 for pre-fusion specific structural characterization of RSVPreF3. [ABSTRACT FROM AUTHOR]

We assessed whether the insurance type reflects a patient's quality of care after an anterior discectomy and fusion (ACDF) procedure by comparing differences in the postoperative complications, readmission rates, reoperation rates, lengths of hospital stay, and cost of treatment between patients with Medicare versus private insurance. Propensity score matching was used to match patient cohorts insured by Medicare and private insurance in the MarketScan Commercial Claims and Encounters Database (2007–2016). Age, sex, year of operation, geographic region, comorbidities, and operative factors were used to match cohorts of patients who had undergone an ACDF procedure. A total of 110,911 patients met the inclusion criteria. Of these patients, 97,543 patients (87.9%) were privately insured and 13,368 patients (12.1%) were insured by Medicare. The propensity score matching algorithm matched 7026 privately insured patients to 7026 Medicare patients. After matching, no significant differences were found in the 90-day postoperative complication rates, lengths of stay, or reoperation rates between the Medicare and privately insured cohorts. The Medicare group had had lower postoperative readmission rates for all time points: 30 days (1.8% vs. 4.6%; P < 0.001), 60 days (2.5% vs. 6.3%; P < 0.001), and 90 days (4.2% vs. 7.7%; P < 0.001). The median payment to physicians was significantly lower for the Medicare group ($3885 vs. $5601; P < 0.001). In the present study, propensity score matched patients covered by Medicare and private insurance who had undergone an ACDF procedure had had similar treatment outcomes. [ABSTRACT FROM AUTHOR]