Fusionless Correction of Moderate Adolescent Idiopathic Scoliosis with a New Minimally Invasive Dynamic Implant (ApiFix®) and Postoperative Schroth Scoliosis Specific Exercises-Case Series

The standard surgical management of AIS is spinal fusion. Nonfusion solutions for addressing moderate AIS curves are desirable. ApiFix® is a new posterior dynamic device consisting of an expandable ratcheting rod anchored by two pedicle screws to the concave side of the scoliotic spine. It was designed to address single, moderate Lenke type 1 or 5 curves. Surgery is performed without the addition of spine fusion of the instrumented segments. The surgical procedure is short with negligible blood loss and rapid recovery. Deformity correction is achieved by distraction leading to rod elongation. Curve correction is achieved not only during surgery but also after the surgical procedure by performing scoliosis specific exercises. These exercises activate the ratchet with further rod expansion and curve reduction. The reported cases demonstrate the efficacy of the combined approach of surgery and exercises in controlling moderate AIS. This clinical experience with the ratchet device shows consistent curve improvement and stabilization. It lends support to the concept that surgery with this new posterior dynamic device may be a viable alternative to fusion and or as an internal brace in non-compliant brace users for managing moderate AIS curves

Solid state mass memories in the world of internet of things

The thesis is written as a consulting assignment to Helsinki Memory Technologies Oy. The motivation for this assignment was to learn more about mass memories as a part of Internet of Things ecosystem. Additionally, the thesis seeks if there could be the potentially new business opportunities at the target field. The thesis describes core technologies related to the solid state mass memories in the world of Internet of Things (IoT) at Chapter 2 to 4. Standards chapter covers the benefits of the standardization and the most important corresponding IoT forums. That chapter also summarizes IoT development activities of the key companies. At the end of the thesis there is an analysis of the new business opportunities found during the consulting period, which are grouped into two subsets: the extensions of existing solutions and the new IoT usage models with memory focus. Conclusion chapter states that the architecture of managed NAND holds a strong position, which is foreseen to remain. This enables the development of IoT support to the mass memories. An additional conclusion is that IoT has reached the critical mass, but its final implementation is not defined yet. The business potential of IoT is estimated to be significant. These conclusions lead to recommendation for continuing studying the role of the mass memories in the IoT ecosystem. The final conclusion is that organizations, which study the implementation of IoT to the mass memory in details, will be well prepared and have an adaptable technical offer

Surgical management of moderate adolescent idiopathic scoliosis with ApiFix® : a short peri- apical fixation followed by post-operative curve reduction with exercises

Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 vertebrae are instrumented and fused. A smaller motion preserving surgery would be more desirable for these otherwise healthy adolescents. The ApiFix® system is a novel less invasive short segment pedicle screw based instrumentation inserted around the apex of the main curve. The system has a ratchet mechanism that enables gradual postoperative device elongation and curve correction. The ratchet is activated by performing specific spinal exercises. The unique features of the device allow curve correction without fusion. The system which has a CE approval was employed in adolescents with main thoracic curves. More than a dozen of ApiFix surgeries have been performed so far. The preoperative Cobb angle was 45° ± 8, and 25° ± 8 at final follow up. The following is a report on three adolescent females aged 13–16 years with curves between 43°-53° and Risser sign of 1-4 who underwent surgery with ApiFix®. Two pedicle screws were inserted around the curve apex and the ratchet based device with polyaxial ring connectors was attached to the screws. No fusion attempt was made. Operative time was around one hour. Two weeks after surgery the patients were instructed to perform Schroth like daily exercises with the aim of rod elongation and gradual curve correction. Patients were followed between 6 months to 2 years. Curves were reduced and maintained between 22- 33°. Patients were pain free and were able to perform their spinal exercises. Postoperative gradual elongation of the device was observed. No screw loosening or rod breakage were observed. No adding on or curve progression was seen. Three factors may contribute to the ApiFix® success: polyaxial connections that prevent mechanical failure, gradual curve correction by spinal motion and spinal growth modulation. The ApiFix® system allows managing moderate AIS with a simple and minor surgical intervention. Recovery is rapid with negligible motion loss. It allows gradual and safe curve correction with high patient satisfaction. It may also serve as an internal brace for AIS

Functional neuroanatomy of meditation: A review and meta-analysis of 78 functional neuroimaging investigations

Meditation is a family of mental practices that encompasses a wide array of techniques employing distinctive mental strategies. We systematically reviewed 78 functional neuroimaging (fMRI and PET) studies of meditation, and used activation likelihood estimation to meta-analyze 257 peak foci from 31 experiments involving 527 participants. We found reliably dissociable patterns of brain activation and deactivation for four common styles of meditation (focused attention, mantra recitation, open monitoring, and compassion/loving-kindness), and suggestive differences for three others (visualization, sense-withdrawal, and non-dual awareness practices). Overall, dissociable activation patterns are congruent with the psychological and behavioral aims of each practice. Some brain areas are recruited consistently across multiple techniques - including insula, pre/supplementary motor cortices, dorsal anterior cingulate cortex, and frontopolar cortex - but convergence is the exception rather than the rule. A preliminary effect-size meta-analysis found medium effects for both activations (d = .59) and deactivations (d = -.74), suggesting potential practical significance. Our meta-analysis supports the neurophysiological dissociability of meditation practices, but also raises many methodological concerns and suggests avenues for future research

Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction

<p>Abstract</p> <p>Background</p> <p>spondylolisthesis is a condition in which a vertebra slips out of the proper position onto the bone below it as a result of pars interarticularis defect. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column and causes mechanical back pain and neural breach.</p> <p>Materials and methods</p> <p>A randomized and double blinded study consisted of 41 patients aged 36-69 years (18 females and 28 males) treated for symptomatic spondylolisthesis between December,2006 and December, 2009. All patients were randomly distributed into two groups I and II. Twenty patients were in Group I; they underwent reduction of the slipped vertebrae by using Reduction-Screw Technique and posterior lumbar interbody fixation (PLIF). Group II consisted of twenty one patients who underwent only surgical fixation (PLIF) without reduction. All patients in this study had same pre and post operative management.</p> <p>Results</p> <p>only one case had broken rod in group I that required revision. Superficial wound infection was experienced in two patients and one patient, from group II, developed wound hematoma. The outcome in both groups was variable on the short term but was almost the same on the long term follow up.</p> <p>Conclusion</p> <p>surgical management of symptomatic low grade spondylolisthesis should include neural decompression and surgical fixation. Reduction of slipped vertebral bodies is unnecessary as the ultimate outcome will be likely similar.</p

Comparison of effectiveness of Halo-femoral traction after anterior spinal release in severe idiopathic and congenital scoliosis: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Halo-femoral traction could gradually improve the coronal and sagittal deformity and restore the trunk balance through the elongation of the spine. The purpose of this retrospective study was to assess the effectiveness of Halo-femoral traction after anterior spinal release in the management of severe idiopathic and congenital scoliosis.</p> <p>Methods</p> <p>Sixty patients with severe and rigid curve treated with anterior spinal release, Halo-femoral traction, and second stage posterior spinal fusion were recruited for this retrospective study. Idiopathic Scoliosis (IS) group was 30 patients (23 females and 7 males) with mean age of 15.5 years. The average coronal Cobb angle was 91.6° and the mean global thoracic kyphosis was 50.6°. The curve type of these patients were 2 with Lenke 1AN, 4 with Lenke 1A+, 1 with Lenke 1BN, 10 with Lenke 1CN, 3 with Lenke 1C+, 3 with Lenke 3CN, 3 with Lenke 3C+, and 4 with Lenke 5C+. Congenital Scoliosis (CS) group included 30 patients (20 females and 10 males) with average age of 15.2 years. The average coronal Cobb angle of the main curve before operation was 95.7° and the average thoracic kyphosis was 70.2°. All patients had a minimum 12-month follow-up radiograph (range 12–72 months, mean 38 months).</p> <p>Results</p> <p>The average traction time was 23 days and the average traction weight was 16 kg. Four patients experienced brachial plexus palsy and complete nerve functional restoration was achieved at two months follow-up. For the IS group, the post-operative mean Cobb angle of major curve averaged 40.1° with correction rate of 57.5%. For the CS group, the post-operative mean Cobb angle was 56.5° with average correction rate of 45.2%. The difference in curve magnitude between the IS and CS patients after posterior correction was statistically significant (t = 4.15, p < 0.001). The correction rate of kyphosis between IS and CS patients was also statistically significant (t = -2.59, p < 0.016).</p> <p>Conclusion</p> <p>Halo-femoral traction was a safe, well-tolerated and effective method for the treatment of severe and rigid scoliosis patients. The posterior correction rate obtained after anterior release and traction was significant superior than that recorded from side bending film in current study.</p

Scoliosis and dental occlusion: a review of the literature

<p>Abstract</p> <p>Background</p> <p>Idiopathic scoliosis is a deformity without clear etiology. It is unclear wether there is an association between malocclusion and scoliosis. Several types of occlusion were described in subjects with scoliosis, mostly case-reports.</p> <p>Objectives</p> <p>The aim of this review was to evaluate the type of occluslins more prevalent in subjects with scoliosis</p> <p>Search strategy</p> <p>All randomised and controlled clinical trials identified from the Cochrane Oral Health Group Trials Register, a MEDLINE search using the Mesh term scoliosis, malocclusion, and relevant free text words, and the bibliographies of papers and review articles which reported the outcome of orthodontic treatment in subjects with scoliosis that were published as abstracts or papers between 1970 and 2010.</p> <p>Selection criteria</p> <p>All randomised and controlled clinical trials published as full papers or abstracts which reported quantitative data on the outcomes malocclusion in subjects with scoliosis.</p> <p>Data collection and analysis</p> <p>Data were extracted without blinding to the authors, age of patients or type of occlusion.</p> <p>Main results</p> <p>Using the search strategy eleven observational longitudinal studies were identified. No randomized clinical trials were recorded. Twenty-three cross-sectional studies were recorderd, and the others studies were reviews, editorials, case-reports, or opinions. The clinical trials were often not controlled and were about the cephalometric evaluation after treatment with the modified Milwuakee brace, followed by the orthodontic treatment of the class II relationship with a functional appliance. Clinical trials also included the study of the associations between scoliosis and unilateral crossbite, in children with asymmetry of the upper cervical spine. This association was also investigated in rats, pigs and rabbits in clinical trials. The other associations between scoliosis and occlusion seems to be based only on cross-sectional studies, case-reports, opinions.</p> <p>Authors' conclusions</p> <p>Based on selected studies, this review concludes that there is plausible evidence for an increased prevalence of unilateral Angle Class II malocclusions associated with scoliosis, and an increased risk of lateral crossbite, midline deviation in children affected by scoliosis. Also, documentation of associations between reduced range of lateral movements and scoliosis seem convincing. Data are also mentioned about the association between plagiocephaly and scoliosis.</p

The metabolic basis of adolescent idiopathic scoliosis: 2011 report of the “metabolic” workgroup of the Fondation Yves Cotrel

OBJECTIVE: The purpose of this review is to elucidate the metabolic processes involved in the pathogenesis of adolescent idiopathic scoliosis (AIS) in light of research by the present authors as well as current literature. METHODS: Pathogenetic mechanism

Repair, regenerative and supportive therapies of the annulus fibrosus: achievements and challenges

Lumbar discectomy is a very effective therapy for neurological decompression in patients suffering from sciatica due to hernia nuclei pulposus. However, high recurrence rates and persisting post-operative low back pain in these patients require serious attention. In the past decade, tissue engineering strategies have been developed mainly targeted to the regeneration of the nucleus pulposus (NP) of the intervertebral disc. Accompanying techniques that deal with the damaged annulus fibrous are now increasingly recognised as mandatory in order to prevent re-herniation to increase the potential of NP repair and to confine NP replacement therapies. In the current review, the requirements, achievements and challenges in this quickly emerging field of research are discussed