Analysis of Adjacent Fractures after Two-Level Percutaneous Vertebroplasty: Is the Intervening Vertebral Body Prone to Re-fracture?

Study Design Retrospective study. Purpose This retrospective study aimed to determine the incidence of adjacent level new fractures in a sandwich constellation (one or two untreated vertebrae between two cemented vertebrae) compared with that in other constellations formed by two-level percutaneous vertebroplasty (PVP). It also aimed to investigate the potential factors contributing to adjacent new fractures in a sandwich constellation. Overview of Literature There are few studies regarding the intervening intact vertebral body between two cemented vertebrae. Clinical data from previous studies investigation this sandwich situation, too, have been vague. Methods Clinical data were obtained from 132 patients who had two cemented vertebral bodies, irrespective of whether they had undergone one or two PVP sessions between January 2013 and June 2016 at a single institution. Cases with one or two intact vertebral levels between the two cemented vertebrae were classified into group 1 (n=47), and cases with two consecutive cemented bodies or more than three levels of intervening configurations were classified into group 2 (n=85). Demographic data and radiological parameters for new fractures after PVP were compared between the two groups, and the rates of subsequent adjacent fractures were investigated. Results The incidence of single-level sandwich constellations was quite uncommon (7.7%). The overall incidences of adjacent fracture were 29.8% (14/47) in group 1 and 14.1% (12/85) in group 2. This difference was statistically significant (p =0.03). Approximately 80% (11/14) of the adjacent new fractures in group 1 developed at an intervening level. The patient demographics and radiological parameters for subsequent fractures after PVP did not statistically correlate with the risk of adjacent new fractures in group 1. Conclusions Because they were subjected to double-load shifts, sandwich constellations were prone to re-fractures after PVP. These vertebral configurations required more aggressive management for osteoporosis

A Study on the Manufacturing of Large Size Hollow Shape Parts for Prototype-Car Using Rapid Prototyping Technology and Vacuum Molding

Rapid Prototyping(RP) techniques have revolutionized traditional manufacturing methods. These techniques allow the user to fabricate a part directly from a conceptual model before investing in production tooling and help develop new models with significant short time. This paper suggests the new process to manufacture large size hollow shape parts for prototype-car using Rapid Prototyping technology and Vacuum Molding with the reduction of delivery time. In addition, this paper introduces the dividing and combining method to make large size RP master model in spite of the limit of the build chamber dimensions of commercialized RP systems and post-processing method to achieve sufficient surface quality.Mechanical Engineerin

Effects of Particle Size and Cement Replacement of LCD Glass Powder in Concrete

The high quality liquid crystal display (LCD) processing waste glass (LPWG) generated from the manufacturing process of Korea’s LCD industries, having the world’s highest technological level and production, was finely ground into particles smaller than cement particles (higher fineness than OPC) to verify their applicability and performance as a replacement for cement. For a concrete mix having a W/B ratio of 0.44, cement was replaced with LPWG glass powder (LGP) at ratios of 5, 10, 15, and 20% (LGP12) and 5 and 10% (LGP5) according to the particle size to prepare test cylinder specimens, which were tested with respect to air contents, slump in fresh concrete, and compressive strength and splitting tensile strength of hardened concrete. The microstructure of the concrete specimens was analyzed through Scanning Electron Microscopy (SEM), Energy Dispersive X-ray (EDX), and a Mercury Intrusion Porosimetry (MIP). Replacement of cement with LGP for cement could effectively decrease the quantity of cement used due to the excellent performance of LGP. It may positively contribute to the sustainable development of the cement industry as well as waste recycling and environment conservation on a national scale

Rationale of Endoscopic Spine Surgery: A New Paradigm Shift In Spine Surgery From Patient’s benefits to Public Interest In This New Era of Pandemic

Advancement of technology and surgical skills act in synergy to lead to exploration of new solutions in spine surgery. One of the key areas of spine innovation is endoscopic spine surgery and its application to a broader spectrum of conditions with the aim of reducing perioperative morbidities, soft tissue and bony conservation and yet achieving long term target outcomes of gold standard traditional open spine surgery. Twenty first century marks the new century of opportunities and challenges, in the face of threat of Coronavirus pandemic and difficult circumstances in hospital bed management and limitation in medical resources, minimally invasiveness is evolving from individual patients’ benefits to public interest

Clinical Results And Review of Techniques of Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression (LE-ULBD) for Lumbar Stenosis

Uniportal Lumbar Endoscopic decompression can be performed through transforaminal and interlaminar route. Interlaminar lumbar endoscopic unilateral laminotomy for bilateral decompression allows good decompression of central and lateral recess of the stenotic lumbar spine region. Both over the top decompression approach and under the ligamentum flavum decompression approach method has been recently described with differing principles and approaches despite achieving the same target in decompression of spinal canal through uniportal interlaminar endoscopic route. The authors aim to share their experience and thoughts on the 2 described approaches. Retrospective clinical cohort evaluation of patients who underwent LEULBD were performed from January 2018 to December 2019 The cohort of 278 cases of LEULBD with mean age of 64 years old were evaluated. Complication rate is 3.6% and reoperation was 3.6%, mean VAS improvement at 1 weeks, 3 months and final follow up were 3.06±0.66, 2.50±0.86 and 2.17±0.91 respectively, p<0.001 and ODI improvement at 1 weeks, 3 months and final follow up were 31.87±5.02, 27.91±6.31 and 25.32±6.44 respectively. Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression could achieve good clinical outcomes and low rate of complications with thorough understanding of endoscopic anatomy

Uniportal Endoscopic Lateral to Medial Direction Transforaminal Lumbar Interbody Fusion: A Case Report and Technical Guide for Navigating Through Landmarks in Left Lumbar 4/5 Post Laminotomy Revision Lumbar Fusion Surgery

Post lumbar laminotomy anatomical changes can be disorienting to uniportal spinal endoscopist. This which led to many open conversionconversion to open surgery to verify landmarks. Isthmus tends not to be violated inis usually preserved in laminotomy and it can be used as a useful landmark for endoscopic fusion surgery. Unlike tubular microscopic surgery, endoscope possess more mobility; conveniently navigating through the identifiable anatomical landmarks in revision surgery with minimal fluroscopy. Uniportal Endoscopic Lateral to Medial Direction Transforaminal Lumbar Interbody Fusion, is a useful revision surgery technique with isthmus as reference point, it had not been described in literature. Case Presentation A 66 years old lady with two previous lumbar decompressive surgery to left L4/5 presented with neurogenic claudication and instability. She was diagnosis was to have L4/5 post-surgical spondylolisthesis with stenosis. She Informed consent was obtained consented for left L4/5 revision uniportal endoscopic lateral to medial direction transforaminal lumbar interbody fusion, Endo (LM)-TLIF. Procedure started with drilling isthmus with from lateral to medial direction using exploratory bone drilling dissection technique to decompress and explore residual bony anatomical landmark. With proper definition of anatomical margins of intervertebral disc space, endoscopic guided discectomy, end plate preparation, cage and percutaneous pedicle screws insertion were done with aid of fluoroscopy and endoscopy to perform spinal fusion. Patient did well post operatively without any intraoperative complication.Conclusion Endo (LM)-TLIF is a viable, safe and efficacious method to explore a potentially challenging post-surgical anatomy around spinal canal in revision lumbar fusio

Percutaneous Full Endoscopic Ligamentum Flavum Splitting Interlaminar Approach for Removal of Dorsally Migrated Lumbar Disc Herniation: A case Report with Technical Note

Treatment of dorsally migrated lumbar disc described so far commonly in present literature is removal by open technique through hemi or complete laminectomy or by use of microsurgical technique or by partial use of endoscope without use of irrigation system. We present a case of dorsally migrated disc herniation treated safely with good outcome by Percutaneous Full Endoscopic Ligamentum Flavum Splitting Interlaminar Approach. A 60 years old man presented with subacute onset of back pain and right leg radiating pain with weakness of right great toe dorsiflexion and diagnosed as a case of dorsally migrated L4-5 disc herniation was treated with this technique. He had also subtle instability at that level.His pain resolved immediately after surgery. Weakness of right great toe also resolved gradually in 2 months. Postoperative X-ray showed no further instability. Postoperative MRI revealed complete removal of disc with resolution of cauda equina compression. No complication was noted related to this technique. This new technique ultimately preserves motion segment while simultaneously addressing symptomatic pathology of dorsally migrated HNP with added benefits of minimally invasive spine surgery

Akt regulates the expression of MafK, synaptotagmin I, and syntenin-1, which play roles in neuronal function

<p>Abstract</p> <p>Background</p> <p>Akt regulates various cellular processes, including cell growth, survival, and metabolism. Recently, Akt's role in neurite outgrowth has also emerged. We thus aimed to identify neuronal function-related genes that are regulated by Akt.</p> <p>Methods</p> <p>We performed suppression subtractive hybridization on two previously established PC12 sublines, one of which overexpresses the wild-type (WT) form and the other, the dominant-negative (DN) form of Akt. These sublines respond differently to NGF's neuronal differentiation effect.</p> <p>Results</p> <p>A variety of genes was identified and could be classified into several functional groups, one of which was developmental processes. Two genes involved in neuronal differentiation and function were found in this group. v-Maf musculoaponeurotic fibrosarcoma oncogene homolog K (MafK) induces the neuronal differentiation of PC12 cells and immature telencephalon neurons, and synaptotagmin I (SytI) is essential for neurotransmitter release. Another gene, <it>syntenin-1 </it>(<it>Syn-1</it>) was also recognized in the same functional group into which <it>MafK </it>and <it>SytI </it>were classified. Syn-1 has been reported to promote the formation of membrane varicosities in neurons. Quantitative reverse transcription polymerase chain reaction analyses show that the transcript levels of these three genes were lower in PC12 (WT-Akt) cells than in parental PC12 and PC12 (DN-Akt) cells. Furthermore, treatment of PC12 (WT-Akt) cells with an Akt inhibitor resulted in the increase of the expression of these genes and the improvement of neurite outgrowth. These results indicate that dominant-negative or pharmacological inhibition of Akt increases the expression of <it>MafK</it>, <it>SytI</it>, and <it>Syn-1 </it>genes. Using lentiviral shRNA to knock down endogenous Syn-1 expression, we demonstrated that Syn-1 promotes an increase in the numbers of neurites and branches.</p> <p>Conclusions</p> <p>Taken together, these results indicate that Akt negatively regulates the expression of <it>MafK</it>, <it>SytI</it>, and <it>Syn-1 </it>genes that all participate in regulating neuronal integrity in some way or another.</p

Treatment of Two Level Artificial Disc Replacement for Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy (CSM) is a common spinal disorder caused by compression of the spinal cord, due to degeneration of the cervical spine. We investigated post-operative results and suggest artificial disc replacement (ADR) as an effective surgical method for treating CSM. We present the case of a 36-year-old man, with nuchal pain; severe paresthesia of both upper and lower extremities; and pain, motor weakness, and difficulty in fine motor control of both hands. A cervical X-ray showed spondylotic changes at the C5-6, C6-7 level and MRI revealed cord compression at the C5-6, C6-7 level. ADR was performed at the C5-6, C6-7 level. After the surgery, the motor weakness of both upper extremities and paresthesia of both aspects improved. In addition, the JOA score and Nurick grade improved. A post-operative X-ray showed well positioned instruments, and post- operative MRI displayed no lesions of cord compression. Anterior cervical discectomy and fusion (ACDF) is widely accepted as a leading treatment for CSM, but ACDF may cause adjacent segment disease (ASD). We suggest that ADR also can represent a good surgical procedure for the management of multilevel spinal cord compression, as it can preserve cervical motion while avoiding AS