Robotic Guided Minimally Invasive Spine Surgery

Minimally invasive spine surgery (MISS) continues to evolve, and the advent of robotic spine technology may play a role in further facilitating MISS techniques, increasing safety, and improving patient outcomes. In this chapter we review early limitations of spinal robotic systems and go over currently available spinal robotic systems. We then summarize the evidence-based advantages of robotic spine surgery, with an emphasis on pedicle screw placement. Additionally, we review some common and expanded clinical applications of robotic spine technology to facilitate MISS. The chapter concludes with a discussion regarding the current limitations and future directions of this relatively novel technology as it applies to MISS

Comparison of Value per Operative Time between Primary and Revision Surgery for Adult Spinal Deformity: A Propensity Score-Matched Analysis

Study Design Retrospective cohort study. Purpose To compare the relative value units (RVUs) per minute of operative time between primary and revision surgery for adult spinal deformity (ASD). Overview of Literature Surgery for ASD is technically demanding and has high risks of complications and revision rates. This common need for additional surgery can increase the overall cost of care for ASD. RVU is used to calculate reimbursement from Medicare and to determine physician payments nationally. In calculating RVUs, the physician’s work, the expenses of the physician’s practice, and professional liability insurance. Cost effectiveness of surgeries for ASD have been evaluated, except for RVUs per minute compared between primary and revision surgery. Methods Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database. Patients aged ≥18 years who underwent surgery for spinal deformity between 2011 and 2019 were identified and included. To ensure a homogenous patient cohort, those who underwent anterior-only and concurrent anterior-posterior fusions were excluded. Propensity score matching analysis was performed, and Mann-Whitney U test, Pearson chi-square test, or Fisher’s exact test were used to compare matched cohorts as appropriate. Results A total of 326 patients who underwent revision surgery were matched with 206 primary surgery patients via propensity score matching. Demographic characteristics, comorbidities, preoperative laboratory values, and readmission and reoperation rates were not significantly different between groups. The revision surgery group had significantly higher mean RVUs per minute than that of the primary surgery group (0.331 vs. 0.249, p<0.001), as well as rates of morbidity and blood transfusion. Conclusions Compared to primary surgery, revision surgery for ASD is associated with significantly higher RVUs per minute and total RVUs and higher rates of 30-day morbidity and blood transfusions. Readmission and reoperation rates are similar between surgeries

Cervical Steroid Injections Are Not Effective for Prevention of Surgical Treatment of Degenerative Cervical Myelopathy.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The objective of this study is to determine how often patients with degenerative cervical myelopathy (DCM) and initially treated with cervical steroid injections (CSI) and to determine whether these injections provide any benefit in delaying ultimate surgical treatment. METHODS: All patients with a new diagnosis of DCM, without previous cervical spine surgery or steroid injections, were identified in PearlDiver, a large insurance database. Steroid injection and surgery timing was identified using Current Procedural Terminology (CPT) codes. Multivariate logistic regression identified associations with surgical treatment. RESULTS: A total of 686 patients with DCM were identified. Pre-surgical cervical spine steroid injections were utilized in 244 patients (35.6%). All patients underwent eventual surgical treatment. Median time from initial DCM diagnosis to surgery was 75.5 days (mean 351.6 days; standard deviation 544.9 days). Cervical steroid injections were associated with higher odds of surgery within 1 year (compared to patients without injections, OR = 1.44, CONCLUSIONS: While cervical steroid injections continue to be commonly performed in patients with DCM, there is an overall increased odds of surgery after any type of cervical injection. Therefore injections should not be used to prevent surgical management of DCM

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

STUDY DESIGN: A multicenter, retrospective review of C5 palsy after cervical spine surgery. OBJECTIVE: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery. METHODS: We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ(2) tests or Fisher exact tests for categorical variables. RESULTS: Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%). CONCLUSION: C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date

Perioperative Anticoagulation Management in Spine Surgery: Initial Findings From the AO Spine Anticoagulation Global Survey.

STUDY DESIGN: Cross-sectional, international survey. OBJECTIVES: This study addressed the global perspectives concerning perioperative use of pharmacologic thromboprophylaxis during spine surgery along with its risks and benefits. METHODS: A questionnaire was designed and implemented by expert members in the AO Spine community. The survey was distributed to AO Spine\u27s spine surgeon members (N = 3805). Data included surgeon demographic information, type and region of practice, anticoagulation principles, different patient scenarios, and comorbidities. Results: A total of 316 (8.3% response rate) spine surgeons completed the survey, representing 64 different countries. Completed surveys were primarily from Europe (31.7%), South/Latin America (19.9%), and Asia (18.4%). Surgeons tended to be 35 to 44 years old (42.1%), fellowship-trained (74.7%), and orthopedic surgeons (65.5%) from academic institutions (39.6%). Most surgeons (70.3%) used routine anticoagulation risk stratification, irrespective of geographic location. However, significant differences were seen between continents with anticoagulation initiation and cessation methodology. Specifically, the length of a procedure (P = .036) and patient body mass index (P = .008) were perceived differently when deciding to begin anticoagulation, while the importance of medical clearance (P \u3c .001) and reference to literature (P = .035) differed during cessation. For specific techniques, most providers noted use of mobilization, low-molecular-weight heparin, and mechanical prophylaxis beginning on postoperative 0 to 1 days. Conversely, bridging regimens were bimodal in distribution, with providers electing anticoagulant initiation on postoperative 0 to 1 days or days 5-6. CONCLUSION: This survey highlights the heterogeneity of spine care and accentuates geographical variations. Furthermore, it identifies the difficulty in providing consistent perioperative anticoagulation recommendations to patients, as there remains no widely accepted, definitive literature of evidence or guidelines

Node Clustering for Wireless Sensor Networks

Recent years have witnessed considerable growth in the development and deployment of clustering methods which are not only used to maintain network resources but also increases the reliability of the WSNs (Wireless Sensor Network) and the facts manifest by the wide range of clustering solutions. Node clustering by selecting key parameters to tackle the dynamic behaviour of resource constraint WSN is a challenging issue. This paper highlights the recent progress which has been carried out pertaining to the development of clustering solutions for the WSNs. The paper presents classification of node clustering methods and their comparison based on the objectives, clustering criteria and methodology. In addition, the potential open issues which need to be considered for future work are high lighted

Residents’s Subjective Assessment of Walkability Attributes in Objectively Assessed Neighbourhoods

The attributes of the built environment may influence walking in neighbourhood. The objective of this study is to find the association between objectively assessed and perceived built environment attributes. To achieve the objective of the study three neighbourhood of Putrajaya, Malaysia Precinct 8, 9 and 18 were selected. This study used NEWS (Neighbourhood Environment Walkability Scale) abbreviated version for the comparison of the residents’ perceptions regarding attributes of three neighbourhoods of Putrajaya in Malaysia that differ on objective measures derived from a GIS (Geographical Information System) data basis and Putrajaya master plan. High-walkable neighbourhood residents reported built environment attributes ratings persistently higher as compared to the residents of the moderate and lowwalkable neighbourhood. Results from the high walkable neighborhood shows that on a 5-point Likert scale most residents perceived high ratings of within the range of “3” except for residential density as there is a different scoring procedure for it. There are lowest ratings perceived within the range of “1” for the attribute crime and according to the scoring procedure for crime lowest score reflects the highest level of walking.There is no significant difference found in the ratings for traffic hazards. Subjective measures of built environment attributes had moderate to high alpha (α) value. Hence the neighbourhood environment walkability scale can be used for subjective assessment in the tropical context

Gastric schwannoma, a benign neoplasm hiding as gastrointestinal stromal tumour

Gastric Schwannomas are rare, submucosal mesenchymal tumours arising from the nerve plexus of the Gut wall. They have an incidence rate of 0.2% of all Gastric tumours. They are mostly asymptomatic, but can present with vague gastrointestinal symptoms and the fact that histopathologically, they are similar to Gastrointestinal stromal tumours, so they are most often misinterpreted as Gastrointestinal stromal tumours. We present a case, which was also hiding as GIST (Gastrointestinal stromal tumours) preoperatively, on the basis of Endoscopic and Radiological investigations. The diagnosis was then confirmed as Gastric Schwannoma, postoperatively by immunohistochemical analysis. Hence, it is important to diagnose correctly to make appropriate treatment decisions. The findings presented here can may be helpful for a clinician for diagnosing a Gastric Schwannoma. Keywords: Gastrointestinal Stromal Tumours, Endoscopes, Stomach Neoplasms, Immunohistochemistry, Care, Postoperative