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Objective: To compare the clinical and radiographic outcomes of single-segment posterior decompression combined with two different non-fusion dynamic stabilization systems, Isobar EVO and Isobar TTL, in the context of facet joint degeneration and segmental mobility. Method: A retrospective study was conducted on 47 patients who underwent single-segment surgery at the L4/5 level using either the Isobar EVO (n = 23) or Isobar TTL (n = 24) systems. We assessed facet joint degeneration on both sides of the fixed (L3/4, L4/5) and superior adjacent (L2/3) segments using the Fujiwara MRI grading system. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain at baseline, 12 months, and 24 months postoperatively. Result: Both groups exhibited significant facet joint degeneration at the fixed segments (L3/4 and L4/5) at 24 months. The TTL group also showed significant degeneration at the superior adjacent segment (L2/3), whereas the EVO group did not. Restoration of lumbar lordosis was significantly better in the EVO group. Pain and disability scores improved more in the EVO group than in the TTL group at both 12 and 24 months postoperatively. Conclusion: The Isobar EVO system, with its enhanced mobility, may delay facet joint degeneration in the superior adjacent segment compared to the Isobar TTL system. However, both systems result in degeneration at the fixed segment, indicating a need for further improvements to mimic the natural biomechanics of the spine more closely. [ABSTRACT FROM AUTHOR]

Abstract Objective To compare the clinical and radiographic outcomes of single-segment posterior decompression combined with two different non-fusion dynamic stabilization systems, Isobar EVO and Isobar TTL, in the context of facet joint degeneration and segmental mobility. Method A retrospective study was conducted on 47 patients who underwent single-segment surgery at the L4/5 level using either the Isobar EVO (n = 23) or Isobar TTL (n = 24) systems. We assessed facet joint degeneration on both sides of the fixed (L3/4, L4/5) and superior adjacent (L2/3) segments using the Fujiwara MRI grading system. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain at baseline, 12 months, and 24 months postoperatively. Result Both groups exhibited significant facet joint degeneration at the fixed segments (L3/4 and L4/5) at 24 months. The TTL group also showed significant degeneration at the superior adjacent segment (L2/3), whereas the EVO group did not. Restoration of lumbar lordosis was significantly better in the EVO group. Pain and disability scores improved more in the EVO group than in the TTL group at both 12 and 24 months postoperatively. Conclusion The Isobar EVO system, with its enhanced mobility, may delay facet joint degeneration in the superior adjacent segment compared to the Isobar TTL system. However, both systems result in degeneration at the fixed segment, indicating a need for further improvements to mimic the natural biomechanics of the spine more closely.

In this essay we put forward a critique of the prevailing orthodoxy of creativity and innovation which are rarely fundamentally questioned neither in science nor in public discourse. We urge to reconsider contemporary purposes and consequences of what we call instrumental and humanist conceptions of creativity and innovation. Based on our critique we speak out to transcend reified notions of creativity and innovation by engaging in disciplined imagination of desirable alternative futures using the example of craft as a timeless form of work. Craft, we argue, prefigures a type of creativity and innovation that addresses the social and ecological challenges of contemporary economy and society and may thus serve as a source for inspiration to radically re-think current, ingrained notions of creativity and innovation. [ABSTRACT FROM AUTHOR]

Background: Adult spinal deformities (ASD) present complex challenges in spine surgery. The diverse nature of these deformities requires a comprehensive understanding of their classification and treatment options. Traditional approaches, such as fusion and rigid stabilization are associated with complications, including screw loosening, breakage, proximal junctional kyphosis (PJK), and pseudoarthrosis. Dynamic stabilization techniques have emerged as promising alternatives, to reduce these complications and preserve spinal motion. Objective: This study investigated the effectiveness of dynamic stabilization using the Dynesys system in the surgical treatment of adult degenerative spinal deformities, with a particular emphasis on their classification. Methods: ASDs were classified according to the Berjano–Lamartina (BL) and Silva–Lenke (SL) classifications. We analyzed the efficacy of the Dynesys system in enhancing sagittal balance, radiological parameters, and clinical outcomes in this context. Results: Dynamic stabilization of patients with ASDs using the Dynesys system significantly improved the visual analog scale and Oswestry Disability Index scores and decreased the complication rates. Patients with BL types 2, 3, and 4 experienced a significant improvement in sagittal balance followed by sagittal vertical axis measurements (p = 0.045, p = 0.015, and p < 0.0001, respectively). Conclusion: The SL and BL classifications, which were originally developed for rigid spinal stabilization, can be applied in dynamic stabilization. Furthermore, dynamic stabilization using the Dynesys system can be used as an alternative to rigid stabilization in SL levels 2 and 3, and BL types 1, 2, and 3, and in some patients with type 4 ASDs. [ABSTRACT FROM AUTHOR]

IntroductionPolyetheretherketone (PEEK) lumbar fusion rods have been successfully used in short-segment posterior instrumentation to prevent adjacent segment degeneration. However, limited studies have reported their application in lumbar long-segment instrumentation. This study aimed to compare the biomechanical performances of PEEK rods and titanium rods in lumbar long-segment instrumentation using finite element (FE) models, with the expectation of providing clinical guidance.MethodsA lumbar FE model (A) and four lumbar fixation FE models (BI, CI, BII, CII) of the L1–S1 vertebral body were developed using CT image segmentation (A: intact model; BI: intact model with L2–S1 PEEK rod internal fixation; CI: intact model with L2–S1 titanium rod internal fixation; BII: intact model with L3–S1 PEEK rod internal fixation; CII: intact model with L3–S1 titanium rod internal fixation). A 150-N preload was applied to the top surface of L1, similar to the intact model. The stresses on the lumbar intervertebral disc, facet joint, pedicle screws, and rods were calculated to evaluate the biomechanical effect of the different fixation procedures in lumbar long-segment instrumented surgery.ResultsUnder the four physiological motion states, the average stresses on the adjacent segment intervertebral disc and facet joint in all fixation models were greater than those in the intact model. Furthermore, the average stresses on the adjacent segment intervertebral disc and facet joint were greater in models CI and CII than in models BI and BII, respectively. The average stresses on the pedicle screws and rods were decreased in models BI and BII compared with models CI and CII under the four physiological motion states, respectively.DiscussionThe PEEK rod internal fixation system may have better biomechanical properties than the titanium rod internal fixation system in delaying adjacent segment degeneration, improving the lumbar function of postoperative patients, and reducing the risk of screw loosening and breakage in lumbar long-segment instrumentation.

The aim. To study the frequency and treatment options for dysfunction of the dynamic stabilization system of the lumbar spine. Materials and methods. We carried out a retrospective analysis of the treatment of 58 patients with degenerative pathology of the lumbar spine and instability of the spinal motion segments, who were treated at the neurosurgical unit of the Irkutsk Scientific Centre of Surgery and Traumatology in 2011–2020. The stability of spinal motion segment was assessed using X-ray imaging, magnetic resonance imaging and multi-layer spiral computed tomography of the lumbar spine. Revision surgery was performed in 7 out of 58 previously operated patients using the dynamic fixation system of spinal motion segments “Coflex” (Paradigm Spine LLC, Germany). Results. Revision surgery was performed in 7 out of 58 patients with dynamic fixation of the spinal motion segments with an interosseous implant due to an increase in pain syndrome. In 1 patient, the reason for repeated surgery was primary instability of the hardware caused by a fracture of the spinous process. In the delayed period, 4 patients had an X-ray picture with heterotopic ossification of the implant and instability of PDS. In two observations, a recurrence of intervertebral hernia was diagnosed at the level of the operated spinal motion segment. During revision surgery, a facetectomy was performed with stabilization by a peek cage, followed by pain management and clinical manifestation regression. Conclusion. The conducted study shows that a number of patients after discectomy and dynamic stabilization of the spine using “Coflex” system have inconsistency and heterotypic ossification of the implant and neoarthrosis. Implantation of a lumbar peek cage while maintaining the “Coflex” device makes it possible to form a rigid interbody fusion, which means it is sufficient and justified surgical technology for treating the failure of the dynamic stabilization system.

Background: This study evaluates the impact of hybrid dynamic stabilization using the Dynesys-Transition-Optima (DTO) system on adjacent segment disease (ASD) in lumbar spinal stenosis patients with spondylolisthesis. Methods: From 2012 to 2020, 115 patients underwent DTO stabilization at a single center by a single neurosurgeon. After exclusions for lack of specific stabilization and incomplete data, 31 patients were analyzed. Follow-up was conducted at 6, 12, and 24 months postoperatively, assessing disc height, listhesis distance, and angular motion changes at L2–L3, L3–L4, and L5–S1. Results: L3–L4 segment (the index level), demonstrated a delayed increase in listhesis distance, contrasting with earlier changes in other segments. At two years, L3–L4 exhibited less increase in listhesis distance and less disc height reduction compared to L2–L3 and L5–S1. Notably, the L3–L4 segment showed a significant reduction in angular motion change over two years. Conclusions: In conclusion, while ASD was not significantly prevented, the study indicates minor and delayed degeneration at the index level. The L3–L4 segment experienced reduced angular change in motion, suggesting a potential benefit of DTO in stabilizing this specific segment. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the clinical and radiological outcomes of patients undergoing transpedicular screw and polyetheretherketone (PEEK) rod stabilization for the surgical treatment of degenerative diseases of the lumbar spine. Materials and Methods: A retrospective analysis was conducted on 51 patients diagnosed with degenerative spine disease, such as recurrent disc herniation, spinal stenosis, spondylolisthesis, and adjacent segment disease, who underwent bilateral transpedicular screw-PEEK rod stabilization between May 2017 and November 2020. Preoperative and postoperative assessments included lumbar lordosis angles, sacral slope, pelvic incidence, pelvic tilt, visual analog scale (VAS) scores, PROLO economic and social scores, and the presence of adjacent segments and fusion. Results: The study included 51 patients with a mean age of 62.5 years (range: 18-85 years), with 56.8% (29 patients) being female and 43.2% (22 patients) being male. Surgical procedures involved single-level stabilization in 16 patients, two-level stabilization in 21 patients, three-level stabilization in 9 patients, and four-level stabilization in 5 patients. The mean follow-up period was 52.4 months. Postoperatively, there was a significant reduction in VAS scores from a mean of 8.2±1.3 to 3.4±1.7 (p«0.01). No significant changes were observed in the lumbar lordosis angle, sacral slope, pelvic tilt angle, and pelvic incidence angle. The mean PROLO score improved from 3.5±1.2 preoperatively to 7.6±1.5 postoperatively. Fusion was observed in 43 patients during the follow-up period. Conclusion: The use of PEEK rods in the surgical treatment of degenerative lumbar spine diseases may lead to improved postoperative quality of life and reduced implant-related complications. Furthermore, our findings suggest that patients without sagittal balance impairment may benefit from PEEK rod stabilization without significant changes in spinal alignment. However, further comparative and long-term studies are required to better understand the efficacy and outcomes of PEEK rod systems in this treatment approach. [ABSTRACT FROM AUTHOR]

Background: As required in every dynamic stabilization system, the implantation of the BDYNTM device implies a perfect positioning of the screws and rods to benefit from its biomechanical properties. To achieve this goal, intra-operative imaging seems mandatory. Method: Through a case report of a patient with symptomatic grade I lumbar degenerative spondylolisthesis, we present the surgical tips for the implantation of BDYNTM dynamic stabilization system under the assistance of spinal navigation Surgivisio® 2D/3D. Conclusion: The pedicular screw convergence, their placement in the pedicles, and the proper alignment of the BDYNTM system placed in neutral position are important steps of the surgery. Intra-operative spinal navigation helps achieving precise and safe positioning of the dynamic stabilization BDYNTM device taking optimal advantages of its biomechanical characteristics. [ABSTRACT FROM AUTHOR]

Objective Pedicle-based dynamic stabilization (DS) has gained popularity outside of America. Although pedicle screw (PS) loosening has always been a concern, it is reportedly innocuous. Cortical bone trajectory (CBT) screw is an emerging option with less invasiveness and similar effectiveness to PS in short-segment lumbar fusion. This study aimed to verify the use of CBT for DS by comparing the outcomes between pedicle- and CBT-based DS. Methods Consecutive patients with lumbar spondylosis or low-grade spondylolisthesis who underwent 1- or 2-level DS between L3–5 with a minimum follow-up of 24 months were reviewed. Screw loosening was determined by computed tomography and the incidences were compared. Results A total of 291 patients who underwent Dynesys DS (235 pedicle- and 56 CBT-based, respectively) were compared. The demographics and preoperative conditions were similar. All the clinical outcomes improved at 24-month postoperation, while the CBT-based group had less operation time and blood loss than the pedicle-based group. The rates of screw loosening were lower in the CBT-based (5.4% per screw and 12.5% per patient) than the pedicle-based group (9% per screw and 26.4% per patient). Furthermore, there were no differences in the clinical outcomes and complication profiles. Conclusion The CBT-based DS for 1- or 2-level lumbar degeneration demonstrated equivalent clinical improvement as the pedicle-based DS. The adaption of CBT-based screws for DS could be a less invasive approach (shorter operation time and less blood loss), with lower chances of screw loosening than the conventional PS-based DS.

Introduction: Primary dysmenorrhea (PD), painful menstruation in the absence of pelvic pathology, is a common gynecological condition that affects between 45 and 95% of menstruating women.1 Among the parameters as- sociated with PD, body composition, core stability, flexibility, balance and psychological problems are prominent.2,3 The high incidence of PD in female athletes4 has led to the need for more comprehensive investigation of these parameters that may affect PD in these athletes. Objectives: To compare body composition, core stability, flexibility, balance and psychological state in female ath- letes with and without PD. Study design: A case-control study. Methods: Nineteen athletes with PD (PD group, age=20 (19-23) years) and 17 athletes without PD (control group, age=21 (18-24) years) were included. Body composition with Tanita BC601 device, core stability with McGill-trunk endurance tests and Sahrmann test, flexibility with sit-and-reach test, balance with Y-balance test and psychological state with Athletic Psychological Skills Inventory were evaluated on days off menstruation. Results: The branches of athletes in the PD group were volleyball (n=17), rugby (n=1) and swimming (n=1). The branches of athletes in the control group were volleyball (n=11), basketball (n=4) and swimming (n=2). Daily training time of PD and control groups were 60 (30-120) min and 60 (30-120) min, respectively. The pain intensity of PD group was 7.3(4.4- 10) cm. Waist-hip ratio (p=0.06) in PD group were higher than control group. Trunk flexor (p=0.029), extensor (p=0.015), right (p=0.001) and left lateral flexor endurance (p=0.018), Sahrmann (p<0.001) and sit-and-reach scores (p=0.004) were lower in PD group than control group. There were no differences in other parameters between groups (p>0.05). Conclusions: While waist-hip ratio was higher in athletes with PD than athletes without PD; core stability and flexibility were lower. These parameters related to sports performance should be considered in management of female athletes with PD. [ABSTRACT FROM AUTHOR]

Background: Adult spinal deformities (ASD) present complex challenges in spine surgery. The diverse nature of these deformities requires a comprehensive understanding of their classification and treatment options. Traditional approaches, such as fusion and rigid stabilization are associated with complications, including screw loosening, breakage, proximal junctional kyphosis (PJK), and pseudoarthrosis. Dynamic stabilization techniques have emerged as promising alternatives, to reduce these complications and preserve spinal motion. Objective: This study investigated the effectiveness of dynamic stabilization using the Dynesys system in the surgical treatment of adult degenerative spinal deformities, with a particular emphasis on their classification. Methods: ASDs were classified according to the Berjano–Lamartina (BL) and Silva–Lenke (SL) classifications. We analyzed the efficacy of the Dynesys system in enhancing sagittal balance, radiological parameters, and clinical outcomes in this context. Results: Dynamic stabilization of patients with ASDs using the Dynesys system significantly improved the visual analog scale and Oswestry Disability Index scores and decreased the complication rates. Patients with BL types 2, 3, and 4 experienced a significant improvement in sagittal balance followed by sagittal vertical axis measurements (p = 0.045, p = 0.015, and p < 0.0001, respectively). Conclusion: The SL and BL classifications, which were originally developed for rigid spinal stabilization, can be applied in dynamic stabilization. Furthermore, dynamic stabilization using the Dynesys system can be used as an alternative to rigid stabilization in SL levels 2 and 3, and BL types 1, 2, and 3, and in some patients with type 4 ASDs.

Context: Patients with anterior cruciate ligament (ACL) tears are likely to have deficient dynamic postural stability compared with healthy sex- and age-matched controls. Objectives: To test the hypothesis that patients undergoing ACL reconstruction have decreased dynamic postural stability compared with matched healthy controls. Design: Prospective case-control study. Setting: Orthopedic sports medicine and physical therapy clinics. Patients or Other Participants: Patients aged 20 years and younger with an ACL tear scheduled for reconstruction were enrolled prospectively. Controls were recruited from local high schools and colleges via flyers. Interventions: Patients underwent double-stance dynamic postural stability testing prior to surgery, recording time to failure and dynamic motion analysis (DMA) scores. Patients were then matched with healthy controls. Main Outcome Measures: Demographics, lime to failure, and DMA scores were compared between groups. Results: A total of 19 females and 12 males with ACL tears were matched with controls. Individuals with ACL tears were more active (Marx activity score: 15.7 [1.0] vs 10.8 [4.9], P < .001); had shorter times until test failure (84.4 [15.8] vs 99.5 [14.5] s, P < .001); and had higher (worse) DMA scores (627 [147] vs 481 [132], P < .001), indicating less dynamic postural stability. Six patients with ACL deficiency (1 male and 5 lemales) demonstrated lower (better) DMA scores than their controls, and another 7 (4 males and 3 females) were within 20% of controls. Conclusions: Patients undergoing ACL reconstruction had worse global dynamic postural stability compared with well-matched controls. This may represent the effect of the ACL injury or preexisting deficits that contributed to the injury itself. These differences should be studied further to evaluate their relevance to ACL injury risk, rehabilitation, and return to play. [ABSTRACT FROM AUTHOR]

• Standard therapy for CMC osteoarthritis with and without a stabilization home exercise program decreases pain and improves function over the course of a year. • Individuals with CMC osteoarthritis may benefit from individualized stabilization, stretching and strengthening exercises. • The role of exercise including optimal exercise selection and dosage is still under investigation. Randomized, interventional trial with 1 year follow-up. Though recommended, evidence is lacking to support specific exercises to stabilize and strengthen the first carpometacarpal (CMC) joint for cases of osteoarthritis (OA). To determine in a naturalistic setting, whether standard treatment plus a home exercise program (ST+HEP) is more effective than standard treatment (ST) alone in improving Quick Disabilities of Arm, Shoulder and Hand (qDASH) scores, and secondarily, in other patient-centered (pain, function) and clinical outcomes (range of motion, strength). A total of 190 patients from a hand therapy practice in northwestern PA were enrolled by informed consent and randomized into ST or ST+HEP groups. Average age was 60 years, most were female (78%) with sedentary occupations most common (36%). ST group received orthotic interventions, modalities, joint protection education and adaptive equipment recommendations, while the ST+HEP group received a home exercise program in addition to ST for 6-12 months. Follow-up occurred at 3, 6, and 12 months. Outcomes included grip strength, pinch strength, range of motion (ROM), qDASH, Patient Specific Functional Scale (PSFS) and pain ratings. At the 6 month mark, all subjects could change groups if desired. Efficacy data analysis included both parametric and non-parametric tests. The threshold for statistical significance was 0.05 and adjusted for multiple comparisons. Repeated measures ANOVA failed to show a statistically significant difference in strength and ROM assessments between treatment groups over the 12 month follow-up (P ≥.398). Differences between groups did not exceed 13%. Both the ST and ST+HEP groups evidenced improvement over time in most patient-focused assessments (P ≤.011), including improvements exceeding reported clinically important differences in pain with activity and PSFS scores. Scores for these measures were similar at each follow-up period (P ≥.080) in each group. The presence of CTS exerted no effect on outcomes; longer treatment time was weakly related to poorer qDASH and PSFS scores initially. Of those enrolled, 48% of subjects completed the study. The addition of a high-frequency home exercise program did not improve clinical or patient-centered outcomes more so than standard care in our sample however, study limitations are numerous. Both groups had decreased pain with activity and improved PSFS scores, meeting the established minimally clinically important difference (MCID) of each at 6 and 12 months. Adherence with the home program was poor and/or unknown. [ABSTRACT FROM AUTHOR]

Abstract Background Dynesys stabilization (DS) is utilized to preserve mobility at the instrumental segments and prevent adjacent segment pathology in clinical practice. However, the advantages of DS method in medium and long-term follow-up remain controversial. Objective To compare the radiographic and clinical outcomes between DS and instrumented fusion in the treatment of degenerative lumbar spine disease with or without grade I spondylolisthesis with a minimum follow-up period of 2 years. Methods We conducted a comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases, Chinese National Knowledge Databases, and Wanfang Database for potentially eligible articles. Clinical outcomes were assessed in terms of VAS and ODI scores, screw loosening and breakage, and surgical revision. Radiographic outcomes were assessed in terms of postoperative range of movement (ROM) and disc heigh. Moreover, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were evaluated. Results Seventeen studies with 1296 patients were included in the meta-analysis. The DS group was associated with significantly lower postoperative VAS scores for low-back and leg pain, and lower rate of surgical revision than the fusion group. Moreover, the Dynesys group showed significantly less ASDeg than the fusion group but showed no significant advantage over the fusion group in terms of preventing ASDis. Additionally, the ROM at the stabilized segments of the fusion group decreased significantly and that at the adjacent segments increased significantly compared with those of the DS group. Conclusion DS showed comparable clinical outcomes and provided benefits in preserving the motion at the stabilized segments, thus limiting the hypermobility at the adjacent segments and preventing ASDeg compared with the fusion method in degenerative disease with or without grade I spondylolisthesis.

Abstract Objective Posterior instrumented fusion is the most widely accepted surgical treatment for spinal stenosis and disc herniation. However, fusion can affect daily activities due to lumbar stiffness. In recent years, dynamic stabilization has been introduced to overcome the drawbacks of fusion, however, it is inconclusive whether dynamic stabilization requires the maintenance of a level of activity that is closer to the physiological state of activity for better clinical efficacy. The purpose of this study was to compare the effectiveness of dynamic stabilization with different levels of activity (Isobar EVO and TTL) in the treatment of spinal stenosis and disc herniation. Methods This study retrospectively reviewed 80 consecutive patients with lumbar degenerative diseases who were undergoing surgical treatment between March 2014 and July 2018. 41 patients (EVO group) and 39 patients (TTL group) underwent fenestrated decompression with Isobar EVO stabilization and Isobar TTL stabilization, respectively. Clinical outcomes, radiographic data, and postoperative complications were compared between the two groups. Results At an average follow-up of 52.23 ± 2.97 months, there were no significant differences in the oswestry disability index (ODI) (P > 0.05). The visual analog scale for back pain (VASback) and visual analog scale for the leg pain (VASleg) of the EVO group were lower compared with the TTL group (P 0.05). Conclusion Both Isobar EVO dynamic stabilization and TTL dynamic stabilization can improve clinical outcomes of patients with spinal stenosis and disc herniation. Isobar EVO has advantages over Isobar TTL in terms of improving low back and leg pain, maintaining mobility of the operated segment, and preventing further degeneration of the upper adjacent segment.

Study Design Clinical case series. Purpose This study aimed to report dynamization–posterior lumbar interbody fusion (PLIF), our surgical treatment for hemodialysis-related spondyloarthropathy (HSA), and investigate patients’ postoperative course within 2 years. Overview of Literature HSA often requires lumbar fusion surgery. Conventional PLIF for HSA may cause progressive destructive changes in the vertebral endplate, leading to progressive cage subsidence, pedicle screw loosening, and pseudoarthrosis. A dynamic stabilization system might be effective in patients with a poor bone quality. Thus, we performed “dynamization–PLIF” in hemodialysis patients with destructive vertebral endplate changes. Methods We retrospectively examined patients with HSA who underwent dynamization–PLIF at our hospital between April 2010 and March 2018. The radiographic measurements included lumbar lordosis and local lordosis in the fused segment. The evaluation points were before surgery, immediately after surgery, 1 year after surgery, and 2 years after surgery. The preoperative and postoperative radiographic findings were compared using a paired t-test. A p-value of less than 0.05 was considered significant. Results We included 50 patients (28 males, 22 females). Lumbar lordosis and local lordosis were significantly improved through dynamization–PLIF (lumbar lordosis, 28.4°–35.5°; local lordosis, 2.7°–12.8°; p

Abstract Background The spinal hybrid elastic (SHE) rod dynamic stabilization system can provide sufficient spine support and less adjacent segment stress. This study aimed to investigate the biomechanical effects after the internal fracture of SHE rods using finite element analysis. Methods A three-dimensional nonlinear finite element model was developed. The SHE rod comprises an inner nitinol stick (NS) and an outer polycarbonate urethane (PCU) shell (PS). The fracture was set at the caudal third portion of the NS, where the maximum stress occurred. The resultant intervertebral range of motion (ROM), intervertebral disc stress, facet joint contact force, screw stress, NS stress, and PCU stress were analyzed. Results When compared with the intact spine model, the overall trend was that the ROM, intervertebral disc stress, and facet joint force decreased in the implanted level and increased in the adjacent level. When compared with the Ns-I, the trend in the Ns-F decreased and remained nearly half effect. Except for torsion, the PS stress of the Ns-F increased because of the sharing of NS stress after the NS fracture. Conclusions The study concluded the biomechanical effects still afford nearly sufficient spine support and gentle adjacent segment stress after rod fracture in a worst-case scenario of the thinnest PS of the SHE rod system.

Background: Dynesys stabilization (DS) is utilized to preserve mobility at the instrumental segments and prevent adjacent segment pathology in clinical practice. However, the advantages of DS method in medium and long-term follow-up remain controversial. Objective: To compare the radiographic and clinical outcomes between DS and instrumented fusion in the treatment of degenerative lumbar spine disease with or without grade I spondylolisthesis with a minimum follow-up period of 2 years. Methods: We conducted a comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases, Chinese National Knowledge Databases, and Wanfang Database for potentially eligible articles. Clinical outcomes were assessed in terms of VAS and ODI scores, screw loosening and breakage, and surgical revision. Radiographic outcomes were assessed in terms of postoperative range of movement (ROM) and disc heigh. Moreover, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were evaluated. Results: Seventeen studies with 1296 patients were included in the meta-analysis. The DS group was associated with significantly lower postoperative VAS scores for low-back and leg pain, and lower rate of surgical revision than the fusion group. Moreover, the Dynesys group showed significantly less ASDeg than the fusion group but showed no significant advantage over the fusion group in terms of preventing ASDis. Additionally, the ROM at the stabilized segments of the fusion group decreased significantly and that at the adjacent segments increased significantly compared with those of the DS group. Conclusion: DS showed comparable clinical outcomes and provided benefits in preserving the motion at the stabilized segments, thus limiting the hypermobility at the adjacent segments and preventing ASDeg compared with the fusion method in degenerative disease with or without grade I spondylolisthesis. [ABSTRACT FROM AUTHOR]

Dynamic stabilization is an alternative fusion technique that aims to eliminate or at least minimize the possibility of degeneration of adjacent levels. The object of dynamic stabilization systems is to allow limited movement of the spine while maintaining stability. Based on experimental and clinical data, osteoporosis is a contraindication for the application of dynamic spinal fusion systems, due to the fact that the reduced bone density disrupts the osteointegration of the pedicle screws, resulting in an increased chance of loosening, which compromise the success of the operation. For this reason, most clinical trials analyse the effects of dynamic spinal fusion include osteoporosis in the exclusion criteria. [ABSTRACT FROM AUTHOR]

The spinal hybrid elastic (SHE) rod is a semi-rigid pedicle screw-based rod for spinal dynamic stabilization. This study investigated the biomechanical effects of different ratios of SHE rod using finite element analysis (FEA). A three-dimensional nonlinear FEA of an intact lumbar spine model (INT) was constructed. The SHE rod was composed of an inner nitinol stick (NS) and an outer polycarbonate urethane shell (PS). Four groups implanted at L3–L4 had the same outer diameter (5.5 mm) but different NS diameter/PS thickness ratios: Nt45, Nt35, Nt25, and Nt15. The resultant intervertebral range of motion (ROM), disc stress, facet joint contact force, screw stress, NS stress, and PCU stress were analyzed. The results indicated that ROM, disc stress, and facet force decreased moderately in the implanted L3–L4 levels and increased slightly in the adjacent L2–L3 levels. The NS stress and NS diameter trended towards inverse proportionality. Changing the ratio did not markedly influence screw or PS stress. The SHE rod system with elastic NS and insulated PS has a 5.5 mm diameter for universal pedicle screws. The SHE rod system provides sufficient spinal support and increases gentle adjacent segment stress. Considering the durability, the optimal NS diameter/PS thickness ratio of the SHE rod system is 3.5/2.0 mm. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective series., Objective: Screw loosening in the surgical treatment of lumbar spine disease is a major complication of osteopenia or osteoporosis. This study investigated the risk of screw loosening following either MIS-TLIF or pedicle screw-based dynamic stabilization (DS) in patients with osteopenia or osteoporosis., Methods: We retrospectively enrolled patients receiving 1- or 2-level MIS-TLIF or DS in a single institute. All patients were diagnosed as having lumbar spondylosis without concurrent spondylolisthesis and found by dual-energy X-ray absorptiometry to have osteopenia or osteoporosis. Screw loosening was identified by X-ray and CT. Clinical outcomes were also assessed., Results: A total of 103 patients (50 MIS-TLIF and 53 DS) were confirmed to have osteopenia (-2.5

In the interests of more flexible and less stiff bridge constructs to stimulate bone healing, the technique of far cortical locking has been designed to improve locked plating constructs in terms of stress concentration, stress shielding, and inhibition of issues around fracture healing. However, far cortical locking screws currently lack objective designs and anti-fatigue designs. This study investigates an optimization algorithm to form a special locking screw composed of various metals, which can theoretically achieve the maintenance of the excellent mechanical properties of far cortical locking constructs in terms of fracture internal fixation, while maintaining the biomechanical safety and fatigue resistance of the structure. The numerical results of our study indicate that the maximum von Mises stress of the optimized construct is less than the allowable stress of the material under each working condition while still achieving sufficient parallel interfragmentary motion. Numerical analysis of high cycle fatigue indicates that the optimized construct increases the safety factor to five. A high cycle fatigue test and defect analysis indicates that the sandwich locking constructs have better fatigue resistance. We conclude that the sandwich locking construct theoretically maintains its biomechanical safety and fatigue resistance while also maintaining excellent mechanical properties for fracture internal fixation.

Background: The spinal hybrid elastic (SHE) rod dynamic stabilization system can provide sufficient spine support and less adjacent segment stress. This study aimed to investigate the biomechanical effects after the internal fracture of SHE rods using finite element analysis.Methods: A three-dimensional nonlinear finite element model was developed. The SHE rod comprises an inner nitinol stick (NS) and an outer polycarbonate urethane (PCU) shell (PS). The fracture was set at the caudal third portion of the NS, where the maximum stress occurred. The resultant intervertebral range of motion (ROM), intervertebral disc stress, facet joint contact force, screw stress, NS stress, and PCU stress were analyzed.Results: When compared with the intact spine model, the overall trend was that the ROM, intervertebral disc stress, and facet joint force decreased in the implanted level and increased in the adjacent level. When compared with the Ns-I, the trend in the Ns-F decreased and remained nearly half effect. Except for torsion, the PS stress of the Ns-F increased because of the sharing of NS stress after the NS fracture.Conclusions: The study concluded the biomechanical effects still afford nearly sufficient spine support and gentle adjacent segment stress after rod fracture in a worst-case scenario of the thinnest PS of the SHE rod system. [ABSTRACT FROM AUTHOR]

Simple Summary: Tibial tuberosity advancement is a method of surgical treatment of cranial cruciate ligament rupture in animals.. In previous reports, the biomechanical effectiveness of tibial tuberosity advancement surgeries was evaluated by axial pressure on the tibial tuberosity to test the strength and resistance of the fixation or by pulling on the tuberosity. To our knowledge, there are no reports that examined the strength that is needed to pull out an implant from the tibia after tibial advancement. This study is the first report that focuses on pulling out the TTA implant, which corresponds to the biointegrity and ingrowth of the TTA cage with the tibia. Background: Modifications of tibial tuberosity advancement are well accepted for cranial cruciate rupture repair. We compared the loads that were needed to pull the TTA CF cage out in the two groups. The first group consisted of five sheep in which osteotomy and TTA CF cage fixation were performed as assumed preoperatively. The second group consisted of five sheep in which intraoperative or postoperative discrepancies from preoperative planning were found. This is also the first report describing biomechanical testing after tibial tuberosity advancement with cranial implant fixation (TTA CF) surgical procedures. Results: A total of 10 ovine proximal tibiae were tested biomechanically by tearing out TTA CF implants from the bone. The mean maximal loaded forces to pull out the cage in Group 1, in which fixation of the implant was performed as assumed preoperatively, was 878 ± 61 N, and in Group 2, in which discrepancies from preoperative planning were found, was 330 ± 55 N. The mean implant displacement under maximal load to failure was 2.6 mm and 2.2 mm in Groups 1 and 2, respectively. There was a significant difference between Group 1 and Group 2 in the maximal loads-to-failure; however, the difference in the displacement at maximal loaded forces to pull out the cage was not significant between the groups. Conclusions: The mean maximal loaded forces to pull out the cage was significantly lower in Group 2, where discrepancies from preoperative planning were found (878 ± 61 N vs. 330 ± 55 N). The lower forces that were needed to extract the TTA CF implant from the tibia can lead to the conclusion that biointegration of the implant is also weaker. Correct positioning of the osteotomy line and TTA CF implant is essential for good biointegrity and thus for limiting complications in the form of tibial tuberosity avulsion fracture or tibial shaft fracture. [ABSTRACT FROM AUTHOR]

• Randomized trial of efficacy of dynamic stability program for the base of the thumb • Standard conservative therapy vs standard therapy plus dynamic stability exercises • Small improvement in pain and QuickDASH scores for dynamic stability group • Significant reduction in pain and improved QuickDASH scores within each group. Randomized control trial. Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common cause of hand pain and disability. Standard conservative therapy (SCT) for thumb CMC OA includes an orthosis and instruction in joint protection, adaptive equipment, and pain relieving modalities. The dynamic stability home exercise (HE) program is complementary conservative therapy designed to strengthen the stabilizing muscles of the thumb CMC. To investigate whether the addition of HE to SCT (SCT+HE) was more effective at reducing pain and disability in thumb CMC OA compared to SCT alone. The study compared 2 groups: SCT and SCT+HE. The SCT group received SCT with in-home pain management instructions, joint protection strategies with adaptive equipment, and a hand-based thumb-spica orthosis. The SCT+HE group received HE program instructions for adductor stretching and opponens and first dorsal interosseous strengthening in addition to SCT. Our primary outcome measure was the numerical rating scale (NRS) with secondary outcome measures of QuickDASH (shortened Disabilities of the Arm, Shoulder and Hand questionnaire), range of motion, grip strength, and pinch strength. Outcome measurements were assessed at first visit, 6 weeks, and 6 months. There was no statistical difference between the 2 groups for NRS and QuickDASH at 6 weeks (P =. 28 and P =. 36, respectively) or 6 months (P =. 52 and P =. 97, respectively). However, there was a statistically significant decrease in NRS and QuickDASH scores at 6 weeks and 6 months within both groups. Both SCT and SCT+HE are effective at reducing pain and disability in OA of the thumb CMC joint. Neither therapy program was superior to the other at improving NRS or QuickDASH scores at 6-week or 6-month follow-up. [ABSTRACT FROM AUTHOR]

Cortical bone trajectory (CBT) screws have demonstrated similar biomechanical strength and fusion rates as conventional pedicle screws for short-segment lumbar fusion. However, very few studies have verified the viability of CBT screws in dynamic stabilization. In the present study, we compared the clinical outcomes of CBT-based Dynesys dynamic stabilization (CBT-DDS) with standard minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Consecutive patients who had undergone CBT-DDS or MI-TLIF at L4-L5 or L3–L5 were retrospectively reviewed. All the radiological and clinical outcomes were compared between the 2 groups. The patient-reported outcomes included the visual analog scale scores for back and leg pain, Japanese Orthopaedic Association scores, and Oswestry disability index. The pre- and postoperative radiological evaluations were also reviewed. A total of 60 patients (20 patients in the CBT-DDS and 40 in the MI-TLIF groups) were analyzed. The MI-TLIF group had required a longer operation time (P = 0.010) than the CBT-DDS group but had had a similar estimated blood loss (P = 0.484). The perioperative complications, including screw loosening, wound infection, and radiculopathy, were similar in both groups (P > 0.05 for all). The degree of decreased range of motion after surgery was similar between the 2 groups (P = 0.781), and no pseudarthrosis developed in the MI-TLIF group. Because the clinical and radiological outcomes of CBT-DDS were similar to those of MI-TLIF in patients with L4-L5 or L3–L5 spondylosis and spondylolisthesis, CBT-DDS appears to be a viable and effective alternative to MI-TLIF, with a shorter operation time and similarly limited segmental motility. [ABSTRACT FROM AUTHOR]

Despite the numerous techniques (both arthroscopic and open) for the treatment of acute scapholunate instability, there is no consensus on which one results in better healing of the ligaments. In the present work, we describe a new surgical technique to achieve stability of the scaphoid that enables the reduction inflexion and pronation of this bone when dissociation is produced. Using a high-strength suture wire with double cortical button anchor (Mini TightRope, Arthrex, Naples, FL, US, or MicroLink, Conmed, Largo, FL, US) stabilization of the scaphoid is achieved to protect ligament healing without the need for postoperative immobilization.

BACKGROUND: The treatment of adjacent spondylopathy after lumbar fusion is a research hotspot in spine surgery. Traditional surgery to extend the fusion segment may accelerate the reappearance of adjacent segment disease. The non-fusion pedicle screw system based on pedicle screws has shown excellent short- and mid-term results in the treatment of lumbar degenerative diseases and the prevention of adjacent segment degeneration. However, reports on the use of non-fusion technology to treat adjacent segment disease after lumbar fusion need to be studied urgently. OBJECTIVE: To assess the postoperative outcome of non-fusion dynamic stabilization in situ with the Isobar EVO System for adjacent segment disease. METHODS: Patients with adjacent segment disease who were re-operated at Dongzhimen Hospital from July 2013 to December 2017 due to ineffective conservative treatment were selected. Fifteen patients with adjacent segment disease who received Isobar EVO in situ non-fusion dynamic stabilization treatment were enrolled. Medical records, surgical reports, and X-ray imaging studies were reviewed. The following two groups of indicators were compared before and after operation: low back pain visual analogue scale score and lower limb pain visual analogue scale score, Oswestry Disability Index, SF-36 scale physical health score, range of motion of the operative segment, the motion of the upper adjacent segment, the lordotic angle of the operative segment and the angle of lumbar spine, the disc of height index at surgical segment, and the disc of height index at superior segment. RESULTS AND CONCLUSION: Fifteen patients completed at least 3 years of follow-up. (1) Clinical results: At the last follow-up, the scores were significantly improved compared with those before the operation (P < 0.05), but there was no significant difference between different periods of the follow-up (P > 0.05). (2) Imaging measurement: At the last follow-up, mean range of motion of the segment was significantly reduced compared with that before the operation [(3.16±0.45)° vs. (6.32±1.81)°, P < 0.05]; the average motion range of the superior segment was significantly increased compared with that before the operation [(5.51±1.22)° vs. (4.87±1.47)°, P < 0.05]. The lumbar lordosis angle was significantly increased compared with that before the operation [(30.95±8.96)°vs. (27.12±9.67)°, P < 0.05 ]; the lordosis angle of the operation segment was significantly increased than that before the operation [(11.32±4.86)° vs. (10.14±6.44)°, P < 0.05]. Disc of height index at surgical segment was significantly higher than that before the operation (33.23±3.83 vs. 32.79±4.06, P < 0.05). However, disc of height index at superior segment was not statistically different from preoperatively (P > 0.05). There was no statistically significant difference in above indexes between each period of follow-up after operation (P > 0.05). In all cases, there was no loosening of the internal body during the follow-up period, and no adjacent segment disease occurred again. (3) It is concluded that Isobar EVO non-fusion dynamic fixation is an effective way to treat adjacent segment disease, and the clinical effect is obvious. The follow-up results for more than 3 years after surgery show that this operation can prevent the occurrence of adjacent segment disease after reoperation to a certain extent. The long-term effect needs to be supported by the results of further follow-up and higher-level evidence-based medicine. [ABSTRACT FROM AUTHOR]

BACKGROUND: Enhanced recovery after surgery (ERAS) has been demonstrated to improve early postoperative outcomes and is becoming a crucial component of any perioperative management paradigm. OBJECTIVE: To investigate the effect of an ERAS protocol on lumbar disk herniation (LDH) patients undergoing dynamic stabilization and discectomy. METHODS: A total of 119 lumbar disk herniation (LDH) patients undergoing Dynesys dynamic stabilization and discectomy were divided into the ERAS (n1 = 56) and control group (n2 = 63). ERAS group received an enhanced recovery after surgery (ERAS) protocol, and control group received a traditional care protocol. RESULTS: Both the ERAS and control groups had significantly decreased visual analog scale (VAS) score and Oswestry Disability Index (ODI) and increased Japanese Orthopaedic Association (JOA) score at postoperative 1 week, 1 month and 3 months compared with preoperative scores. Moreover, the ERAS group had lower postoperative VAS score and ODI and higher postoperative JOA score and rate of improved JOA score compared with the control group. Intraoperative blood loss, operation time, ambulation time and length of stay were all lower in the ERAS group than in the control group. CONCLUSIONS: The ERAS protocol designed was feasible for LDH patients undergoing dynamic stabilization and discectomy with significantly improved perioperative outcomes. [ABSTRACT FROM AUTHOR]

In contemporary social and political theory, thinkers from the left as well as those from the right very often start from the basis of an antogistic social ontology. They take it for granted that there are irreconcilable conflicts and divergencies of interest between social groups such that, as Laclau, Rancière and others would have it, eternal struggle is not just unavoidable, but desirable, since its absence signifies nothing but the unchecked hegemony of a particular social faction. This view corresponds to a social reality in which political actors simply perceive of each other as allies or as enemies and obstacles that need to be fought or silenced. Such a reality inevitably produces a growing sense of political alienation. By contrast, this contribution claims that we should start from a relational social ontology which implies that social relations are not a priori given, but are themselves a product of social and political institutions and practices. Hence, relationships between social groups need not be antagonistic, but can take on a wide variety of forms. Critical Theory therefore should focus on the nature and quality of social, physical, temporal and spatial relationships established in social institutions. The paper then goes on to delevop the conceptual framework for such an analysis based on the theory of resonance. [ABSTRACT FROM AUTHOR]

The physics fundamentals and advantages of ring-rolling the products are described. The analysis of production volumes of the products by ring-rolling in Europe is carried out. The definition of rings of low rigidity is given. The problems of using of the ring-rolling for their production, the main errors and deformations arising in the process of manufacturing of rings of low rigidity are considered. The ways of increasing the geometric accuracy of the rings and relieving residual stresses are analyzed. The fundamental advantage of the method of dynamic stabilization of rings of low rigidity to other types of correction is explained. A brief description of the device expanders for dressing rings of low rigidity with a wedge mechanism is presented. The problems of correction with their use are characterized. As a fundamentally new technological operation that increases the accuracy of manufacturing of rings of low rigidity and reduces residual stresses in them, an effective technology of dynamic stabilization, cyclic loading, is proposed. The prospects of using the cyclic loading method to increase geometric accuracy and reduce residual stresses in rings of low rigidity are substantiated. Recommendations are given on the creation of universal installations for the dynamic stabilization of rings of low rigidity in order to eliminate the deformations that have arisen during the production process and relieve residual stresses after the rings are manufactured on ring-rolling complexes. The calculated dependences for the design of installations for the dynamic stabilization of rings with outer diameters up to 3,000 mm and weight up to 1,000 kg are given. The results can be used to increase the accuracy of manufacturing of rings billets of low rigidity during their planned production at the Belarusian Automobile Plant BelAZ and other enterprises.

Abstract Background The conventional pedicle-screw-based dynamic stabilization process involves dissection of the Wiltse plane to cannulate the pedicles, which cannot be undertaken with minimal surgical invasion. Despite some reports having demonstrated satisfactory outcomes of dynamic stabilization in the management of low-grade spondylolisthesis, the extensive soft tissue dissection involved during pedicle screw insertion substantially compromises the designed rationale of motion (muscular) preservation. The authors report on a novel method for minimally invasive insertion of dynamic screws and a mini case series. Methods The authors describe innovations for inserting dynamic screws via the cortical bone trajectory (CBT) under spinal navigation. All the detailed surgical procedures and clinical data are demonstrated. Results A total of four (2 females) patients (mean age 64.75 years) with spinal stenosis at L4–5 were included. By a combination of microscopic decompression and image-guided CBT screw insertion, laminectomy and dynamic screw stabilization were achieved via one small skin incision (less than 3 cm). These patients’ back and leg pain improved significantly after the surgery. Conclusion This innovative dynamic screw stabilization via the CBT involved no discectomy (or removal of sequestrated fragment only), no interbody fusion, and little muscle dissection (not even of the Wiltse plane). As a minimally invasive surgery, CBT appeared to be a viable alternative to the conventional pedicle-screw-based dynamic stabilization approach.

Background: Dynesys dynamic stabilization (DDS) is an alternative to surgical fusion for the operative management of degenerative lumbar spondylosis. Compared to rigid instrumentation and fusion, DDS is purported to preserve a higher degree of spinal range of motion and reduce the risk of developing adjacent segment disease (ASD)., Observations: A 60-year-old female presented with severe back pain and bilateral leg pain, which had progressed over the prior 4 years. Nine years earlier, she had undergone DDS system implantation at L5-S1 for lumbar stenosis and spondylosis. Repeat imaging revealed an unintended fusion at the index level (L5-S1) and ASD causing severe lateral recess stenosis at L4-5. She underwent DDS system removal, decompression at L4-5, and extension of the fusion to L4., Lessons: Although DDS has been marketed as a motion-preserving system that avoids fusion and reduces the risk of ASD, unintended index-level fusion and ASD can still occur after DDS system surgery. These potential complications should be assessed when determining the optimal primary surgical treatment for patients with lumbar degenerative disc disease. https://thejns.org/doi/10.3171/CASE24179.

Introduction: Polyetheretherketone (PEEK) lumbar fusion rods have been successfully used in short-segment posterior instrumentation to prevent adjacent segment degeneration. However, limited studies have reported their application in lumbar long-segment instrumentation. This study aimed to compare the biomechanical performances of PEEK rods and titanium rods in lumbar long-segment instrumentation using finite element (FE) models, with the expectation of providing clinical guidance., Methods: A lumbar FE model (A) and four lumbar fixation FE models (BI, CI, BII, CII) of the L1-S1 vertebral body were developed using CT image segmentation (A: intact model; BI: intact model with L2-S1 PEEK rod internal fixation; CI: intact model with L2-S1 titanium rod internal fixation; BII: intact model with L3-S1 PEEK rod internal fixation; CII: intact model with L3-S1 titanium rod internal fixation). A 150-N preload was applied to the top surface of L1, similar to the intact model. The stresses on the lumbar intervertebral disc, facet joint, pedicle screws, and rods were calculated to evaluate the biomechanical effect of the different fixation procedures in lumbar long-segment instrumented surgery., Results: Under the four physiological motion states, the average stresses on the adjacent segment intervertebral disc and facet joint in all fixation models were greater than those in the intact model. Furthermore, the average stresses on the adjacent segment intervertebral disc and facet joint were greater in models CI and CII than in models BI and BII, respectively. The average stresses on the pedicle screws and rods were decreased in models BI and BII compared with models CI and CII under the four physiological motion states, respectively., Discussion: The PEEK rod internal fixation system may have better biomechanical properties than the titanium rod internal fixation system in delaying adjacent segment degeneration, improving the lumbar function of postoperative patients, and reducing the risk of screw loosening and breakage in lumbar long-segment instrumentation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Li, Zhao, Qi, Xu, Yue, Zhu and Li.)

Objective To investigate the effect of surgical treatments for delayed ankles fracture combined with distal tibiofibular syndesmosis injuries (AFTSI). Methods A retrospective study the operative effects of 38 cases of delayed AFTSI treated with open reduction and internal fixation (ORIF) + Tightrope fixation (group A, n = 18) or ORIF + screw fixation (group B, n = 20) for syndesmosis injuries. AOFAS (Ankle-Hindfoot Score system), hospital stay, operative time, introperative blood loss, full weightbearing time， difference value between preoperative and postoperative tibiofibular clear space (TFCS) and tibiofibular overlap (TFO) were used to evaluate the postoperative curative effect. All patients were received a follow-up with an average of 18 months, and the syndesmosis screws were removed 2-3 months after operations. Results AOFAS score was higher in group A than in group B, postoperative onset time of full weightbearing was earlier in group A than in group B statistically (P <0. 05), while no statistics difference were found between 2 groups in the factors of hospital stay, operative time, introperative blood loss, and the difference value between preoperative and postoperative time on TFCS together with TFO. Conclusion Tightrope syndesmosis fixation is a better options to enable early weight bearing for the delayed AFTSI compared with the traditional screws fixation. [ABSTRACT FROM AUTHOR]

Background: Implants for use in disc herniation surgery have been commercially available for some time. Several clinical trials have shown promising results. There are now a wide variety of surgical methods for treating lumbar disc herniation.Purpose: The objective of this systematic review was to compare all current surgical methods for disc herniation, including newer methods with implants for annulus repair and dynamic stabilization.Study Design: Systematic review and network meta-analysis.Methods: PRISMA-P guidelines were followed in this review. Literature search in PubMed, Embase, and Cochrane library databases identified eligible randomized controlled trials (RCT) studies comparing interventions for lumbar disc surgery. The investigated outcomes were: changes in pain score, disability score and reoperation rate with a minimum follow-up of 1 year. Risk of bias was assessed in concordance with Cochrane Neck and Back Review Group recommendation. A network meta-analysis was performed using gemtc and BUGSnet software, and each outcome evaluated using Confidence in Network Meta-Analysis (CINeMA).Results: Thirty-two RCT studies, with 4,877 participants, and eight different interventions were identified. A significant difference was seen in change of pain score, as all treatments were superior to conservative treatment and percutaneous discectomy. This difference was only found to be of clinically importance when comparing conservative treatment and dynamic stabilization. There was no significant difference in reoperation rates or change in disability score, regardless of treatment. However, SUCRA plots showed a trend in ranking annulus repair and dynamic stabilization highest. Risk of bias assessment showed that 15 studies had a high overall risk of bias. Meta-regression with risk of bias as covariate did not indicate any influence in risk of bias on the model. Confidence in Network Meta-Analysis evaluation showed a high level of confidence for all treatment comparisons.Conclusions: With this network meta-analysis, we have aimed to compare all treatments for herniated lumbar disc in one large comprehensive systematic review and network meta-analysis. We have compared across the three main outcomes: disability score, pain score and reoperation rate. We were not able to rank one single treatment as the best. Most of the treatment performed at the same level. However percutaneous discectomy and conservative treatment consistently performed worse than the other treatments. In general, the CINeMA evaluation according to the GRADE recommendations gave a high level of confidence for the study comparisons. [ABSTRACT FROM AUTHOR]

A pipe in an electromagnetic shutoff valve must meet high requirements on its surface roughness Ra (µm) and shape precision (quality classes IT8 and IT9). At the same time, reaming of the product is associated with self-oscillation that impairs the internal surface quality. An antivibrational reaming tool has been developed to address this problem. [ABSTRACT FROM AUTHOR]

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The spinal hybrid elastic (SHE) rod is a semi-rigid pedicle screw-based rod for spinal dynamic stabilization. This study investigated the biomechanical effects of different ratios of SHE rod using finite element analysis (FEA). A three-dimensional nonlinear FEA of an intact lumbar spine model (INT) was constructed. The SHE rod was composed of an inner nitinol stick (NS) and an outer polycarbonate urethane shell (PS). Four groups implanted at L3–L4 had the same outer diameter (5.5 mm) but different NS diameter/PS thickness ratios: Nt45, Nt35, Nt25, and Nt15. The resultant intervertebral range of motion (ROM), disc stress, facet joint contact force, screw stress, NS stress, and PCU stress were analyzed. The results indicated that ROM, disc stress, and facet force decreased moderately in the implanted L3–L4 levels and increased slightly in the adjacent L2–L3 levels. The NS stress and NS diameter trended towards inverse proportionality. Changing the ratio did not markedly influence screw or PS stress. The SHE rod system with elastic NS and insulated PS has a 5.5 mm diameter for universal pedicle screws. The SHE rod system provides sufficient spinal support and increases gentle adjacent segment stress. Considering the durability, the optimal NS diameter/PS thickness ratio of the SHE rod system is 3.5/2.0 mm.

Study Design: Retrospective cohort study.Objectives: The purpose of this study was to analyze the long-term results for patients with lumbar spinal stenosis (LSS) treated with dynamic stabilization (DS) and to consider how we can improve the results.Summary Of Background Data: Few studies have reported long-term outcomes of DS surgery for LSS with or without spondylolisthesis.Methods: A single-center, single-surgeon consecutive series of LSS patients who underwent DS surgery with at least 5 years of follow-up were retrospectively reviewed. Twenty-seven patients were included in the LSS group and 38 patients in the spondylolisthesis group. Patient characteristics, operative data, radiographic parameters, clinical outcomes, and complications were analyzed at baseline and follow-up.Results: In the LSS group, all radiographic parameters (e.g., disc height, segmental lordosis, segmental range of motion [ROM] at the index level and proximal adjacent level, global lordosis, and global ROM) were maintained well until the last follow-up. In the spondylolisthesis group, global lordosis decreased from 36.5° ± 8.2° to 32.6° ± 6.0° at the last follow-up (P = 0.039), and global ROM decreased from 22.1° ± 6.9° to 18.8° ± 7.1° at the last follow-up (P = 0.012). In both groups, back pain, leg pain, and Oswestry Disability Index scores showed significant and sustained improvements. Screw loosening occurred in three patients (11.1%) in the LSS group and five patients (13.2%) in the spondylolisthesis group. Symptomatic adjacent segment degeneration (ASD) occurred in two patients (7.4%) in the LSS group and three patients (7.9%) in the spondylolisthesis group.Conclusion: Decompression and DS surgery for LSS with or without spondylolisthesis showed favorable long-term surgical outcomes with an acceptable rate of complications and ASD. However, an improved physiological DS system should be developed.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Relevance. Surgical decompression and decompression with stabilization are highly effective for treatment of spinal canal stenosis at the level of lumbar spine. However, complications developing after application of rigid fixation systems resulted in active introduction of dynamic implants into clinical practice.Purpose of the study — to compare effectiveness of nitinol and titanium nails for lumbosacral fixation in surgical treatment of degenerative spine diseases.Materials and methods. 220 patients who underwent surgeries in 4 hospitals were randomized into two groups, each consisting of 110 patients (1:1 ratio): a group of patients who underwent stabilization of the vertebral motor segments with rods of nitinol with the required volume of decompression at the operation level and a group of patients who underwent stabilization of the vertebral motor segments with standard rods of titanium with the required volume of decompression at the intervention level. Patients suffered clinically significant spinal canal stenosis in one or two adjacent segments: from L3 to S1. Outcomes were evaluated during three years postoperatively by VAS scale for spine and lower limbs, and by ODI and SF-36 scales.Results. All scales demonstrated better values in both groups of patients, namely, significant decrease of pain syndrome and improvement in mental and physical health. X-ray examination of all patients during the study period demonstrated restoration of lumbar lordosis. Group of patients with dynamic nails featured less complications rate related to metal implants including adjacent segment disease.Conclusion. Transpedicular fixation of lumbosacral spine by nitinol nails is an effective technique allowing to preserve motion along with stable fixation.

Background: Modifications of tibial tuberosity advancement are well accepted for cranial cruciate rupture repair. We compared the loads that were needed to pull the TTA CF cage out in the two groups. The first group consisted of five sheep in which osteotomy and TTA CF cage fixation were performed as assumed preoperatively. The second group consisted of five sheep in which intraoperative or postoperative discrepancies from preoperative planning were found. This is also the first report describing biomechanical testing after tibial tuberosity advancement with cranial implant fixation (TTA CF) surgical procedures. Results: A total of 10 ovine proximal tibiae were tested biomechanically by tearing out TTA CF implants from the bone. The mean maximal loaded forces to pull out the cage in Group 1, in which fixation of the implant was performed as assumed preoperatively, was 878 ± 61 N, and in Group 2, in which discrepancies from preoperative planning were found, was 330 ± 55 N. The mean implant displacement under maximal load to failure was 2.6 mm and 2.2 mm in Groups 1 and 2, respectively. There was a significant difference between Group 1 and Group 2 in the maximal loads-to-failure; however, the difference in the displacement at maximal loaded forces to pull out the cage was not significant between the groups. Conclusions: The mean maximal loaded forces to pull out the cage was significantly lower in Group 2, where discrepancies from preoperative planning were found (878 ± 61 N vs. 330 ± 55 N). The lower forces that were needed to extract the TTA CF implant from the tibia can lead to the conclusion that biointegration of the implant is also weaker. Correct positioning of the osteotomy line and TTA CF implant is essential for good biointegrity and thus for limiting complications in the form of tibial tuberosity avulsion fracture or tibial shaft fracture.