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Study DesignRetrospective review of a patient cohort through a prospective study.PurposeTo determine whether there are correlations between radiographic measurements, including sacral slope (SS) and pelvic incidence (PI), and self-reported clinical outcomes among single-level L5/S1 ProDisc-L patients.Overview of LiteratureThe lumbosacral juncture presents unique biomechanical challenges with respect to artificial disc replacement (ADR) because of its orientation and consequential shear loading. Reports of inferior outcomes at L5/S1 compared to those of the outcomes at the levels above, including increased facet joint pain, suggest a relationship with the sacral inclination at L5/S1.MethodsPlain standing lateral radiographs of 71 patients (age, 26–65 years) who underwent ADR at L5/S1 for degenerative disc disease were reviewed. SS and PI were measured based on pretreatment and initial follow-up standing films. Patient's average adjusted self assessments included the Oswestry disability index and visual analog scale for pain 2 years after ADR. Correlation coefficients were computed to evaluate relationships between radiographic parameters and clinical outcomes. Analysis of covariance was used to evaluate multivariate relationships among factors, including radiographic parameters, body mass index (BMI), and clinical outcomes.ResultsSS and PI values were obtained from 71 patients. The average SS was 33.3° and average PI was 39.9°. At the 24-month follow-up, no significant correlations (p≥0.05) were observed between radiographic parameters and clinical outcomes. BMI, age, and sex did not explain any variability in the relationships between clinical outcomes and SS and PI.ConclusionsWe reviewed a large range of SS angles and found no associations between SS, PI, or BMI and clinical outcomes after ADR at L5/S1. These preliminary results demonstrate that ADR provided maintainence of pain relief and functional improvement for a wide range of SS angles, suggesting that steeper angles are not a contraindication for ADR.

One possibility to provide mobile multimedia in domestic multimedia systems is the use of Universal Plug and Play Audio Visual (UPnP-AV) devices. In a standard UPnP-AV scenario, multimedia content provided by a Media Server device is streamed to Media Renderer devices by the initiation of a Control Point. However, there is no provisioning of context-aware multimedia content customization. This paper presents an enhancement of standard UPnP-AV services for home multimedia environments regarding context awareness. It comes up with context profile definitions, shows how this context information can be queried from the Media Renderers, and illustrates how a Control Point can use this information to tailor a media stream from the Media Server to one or more Media Renderers. Moreover, since a standard Control Point implementation only queries one Media Server at a time, there is no global view on the content of all Media Servers in the UPnP-AV network. This paper also presents an approach of multimedia content integration on the Media Server side that provides fast search for content on the network. Finally, a number of performance measurements show the overhead costs of our enhancements to UPnP-AV in order to achieve the benefits.