Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management

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MODIS land cover and LAI Collection 4 product quality across nine sites in the western hemisphere

Global maps of land cover and leaf area index (LAI) derived from the Moderate Resolution Imaging Spectrometer (MODIS) reflectance data are an important resource in studies of global change, but errors in these must be characterized and well understood. Product validation requires careful scaling from ground and related measurements to a grain commensurate with MODIS products. We present an updated BigFoot project protocol for developing 25-m validation data layers over 49-km2 study areas. Results from comparisons of MODIS and BigFoot land cover and LAI products at nine contrasting sites are reported. In terms of proportional coverage, MODIS and BigFoot land cover were in close agreement at six sites. The largest differences were at low tree cover evergreen needleleaf sites and at an Arctic tundra site where the MODIS product overestimated woody cover proportions. At low leaf biomass sites there was reasonable agreement between MODIS and BigFoot LAI products, but there was not a particular MODIS LAI algorithm pathway that consistently compared most favorably. At high leaf biomass sites, MODIS LAI was generally overpredicted by a significant amount. For evergreen needleleaf sites, LAI seasonality was exaggerated by MODIS. Our results suggest incremental improvement from Collection 3 to Collection 4 MODIS products, with some remaining problems that need to be addresse

Cyanobacterial Harmful Algal Blooms: Chapter 15: Cyanotoxins Workgroup Report

The Cyanotoxins Workgroup was charged with the identification and prioritization of research needs associated with: the identification of cyanotoxins; toxicokinetics and toxicodynamics of cyanotoxins; human susceptibility to the toxins; cyanobacterial genetics/omics and factors for inclusion in predictive models of toxin production; and risk reduction from an intentional or accidental release of cyanotoxins. Papers presented for the Cyanotoxins Session of the symposium on toxin types, toxicokinetics, and toxicodyamics (See Humpage this volume), cyanobacterial genetics of toxin production (See Neilan this volume), and parameters related to human risks from cyanobacterial exposure (See Love this volume) set the stage for Cyanotoxins Workgroup discussions. A consensus was achieved regarding the need to focus on the major identified classes of cyanotoxins. The group expressed the belief that the most significant toxic components of presently occurring harmful algal blooms have been identified, and the knowledge gaps for these most prevalent toxins are great enough to warrant the attention of most of our future research. This belief does not negate the need to study mixtures of cyanotoxins and toxin precursors, especially those most likely to occur within a given bloom. Moreover, there is also a significant likelihood that novel cyanobacterial blooms and toxins will continue to emerge, and future identification of unknown bloom-forming species and their toxins will require ongoing diligence

A new stand-alone anterior lumbar interbody fusion device: Biomechanical comparison with established fixation techniques

Christopher M. J. Cain, Philip Schleicher, Rene Gerlach, Robert Pflugmacher, Matti Scholz, and Frank Kandzior

Biomechanical comparison of bioabsorbable cervical spine interbody fusion cages

Study Design. In vitro biomechanical study of bioabsorbable cervical spine interbody fusion cages using a sheep model. Objectives: The purpose of this study was to evaluate the segmental stability provided by 2 new developed bioabsorbable cervical spine interbody fusion cages and to compare it with a tricortical iliac crest bone graft and a titanium meshed interbody fusion cage. Further, the biomechanical effect of an additional anterior plate instrumentation was determined. Summary and Background Data. Despite the initial favorable results, the long-term effects of metallic cage devices on spinal motion segments are still unknown. Furthermore, shortcomings of metallic cages like migration, adjacent level degeneration, stenotic myelopathy, and artifacts in postoperative radiologic assessment have already been reported. Bioabsorbable cages have been designed to avoid these complications. Currently, no information is available about the biomechanical properties of bioabsorbable cervical spine interbody fusion cages. Methods. Forty sheep cervical spines (C2-C5) were tested in flexion, extension, axial rotation, and lateral bending with a nondestructive stiffness method using a nonconstrained testing apparatus. First, the motion segment C3-C4 was tested intact. After complete discectomy, the following groups were evaluated: autologous iliac crest bone graft, titanium mesh cylinder (Harms, DePuy AcroMed), bioabsorbable PDLLA-cage (experimental), and bioabsorbable Resorbon cage ( Biomet Merck). Further, all implants were tested with an additional anterior plate instrumentation. The mean apparent stiffness, range of motion, neutral zone, and elastic zone were calculated from the corresponding load-displacement curves. Results. No significant difference in range of motion and segmental stiffness among the tricortical iliac crest bone graft, meshed titanium Harms cage, and PDLLA-cage could be determined. The Resorbon cage significantly (P < 0.05) decreased range of motion and increased stiffness in rotation and flexion in comparison to all tested implants and the intact motion segment. An additional anterior plate significantly (P < 0.05) decreased range of motion and increased stiffness in flexion and extension. Conclusion. In this study, bioabsorbable cages demonstrated biomechanical in vitro properties equal or superior to metallic cages. From the biomechanical point of view, bioabsorbable cages, especially the Resorbon cage, may be a viable alternative to current metallic interbody cage devices. However, animal experimental in vivo evaluation of bioabsorbable cervical spine interbody fusion cages still has to be performed

CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica

BACKGROUND Infiltration procedures are a common treatment of lumbar radiculopathy. There is a wide variety of infiltration techniques without an established gold standard. Therefore, we compared the effectiveness of CT-guided transforaminal infiltrations versus anatomical landmark-guided transforaminal infiltrations at the lower lumbar spine in case of acute sciatica at L3-L5. METHODS A retrospective chart review was conducted of 107 outpatients treated between 2009 and 2011. All patients were diagnosed with lumbar radiculopathic pain secondary to disc herniation in L3-L5. A total of 52 patients received CT-guided transforaminal infiltrations; 55 patients received non-imaging-guided nerve root infiltrations. The therapeutic success was evaluated regarding number of physician contacts, duration of treatment, type of analgesics used and loss of work days. Defined endpoint was surgery at the lower lumbar spine. RESULTS In the CT group, patients needed significantly less oral analgesics (p < 0.001). Overall treatment duration and physician contacts were significantly lower in the CT group (p < 0.001 and 0.002) either. In the CT group, patients lost significant fewer work days due to incapacity (p < 0.001). Surgery had to be performed in 18.2 % of the non-imaging group patients (CT group: 1.9 %; p = 0.008). CONCLUSION This study shows that CT-guided periradicular infiltration in lumbosciatica caused by intervertebral disc herniation is significantly superior to non-imaging, anatomical landmark-guided infiltration, regarding the parameters investigated. The high number of treatment failures in the non-imaging group underlines the inferiority of this treatment concept

Endoscopic facet joint denervation for treatment of chronic lower back pain

Objectives: Percutaneous radiofrequency is an established method for treatment of chronic low back pain of intervertebral facet etiology. Endoscopic techniques have the advantage of visualization of the facet joint and the dorsal medial ramus and thus allow for more accurate denervation. It was thus hypothesized that pain reduction is vaster and longer enduring. Patients and Methods: A total of 98 consecutive patients that underwent endoscopic facet joint denervation (EFJD) were included in this study. Prior to intervention and for follow-up, patients were asked to complete VASpain, ODI, COMI and EQ5D questionnaires. Results: VASpain was reduced significantly (EFJD: p < 0.001) at last follow-up. Values for ODI, COMI and EQ5D showed significant improvements towards subjective well-being at last follow-up. Conclusion: EFJD is a promising technique for the treatment of facet joint syndrome caused CLBP as it contributes to sustaining significant pain reduction and improvement of subjective quality of life parameters