Science.gov

Sample records for fusion techniques transforaminal

  1. Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF).

    PubMed

    Ozgur, Burak M; Yoo, Kevin; Rodriguez, Gerardo; Taylor, William R

    2005-11-01

    Minimal access surgical techniques have been described for diskectomy and laminectomy procedures performed through tubular exposures. Tubular exposures, however, restrain visibility to a fixed diameter and require co-axial instrument manipulation. An independent blade retractor system has been developed to overcome the obstacles of working through a tube. Decompression and circumferential fusion can be accomplished through this minimal access exposure via a combination of laminectomy and transforaminal lumbar interbody fusion (TLIF) coupled with minimally invasive pedicle screw fixation. Herein, we describe a minimally-invasive technique for TLIF exposure. Illustrations, intraoperative photographs, and fluoroscopic images supplement this technique. We found that the described minimally-invasive system provides comparable exposure to the traditional-open techniques with the benefits of minimally-invasive techniques. Additionally, it does not have the added constraints of a tubular system. We were able to perform TLIFs without any additional complications. Minimal access decompression and TLIF can be performed safely and effectively using this minimally-invasive system. Besides the retractor system, no additional specialized instruments are required. An operative microscope is not required, in fact, all our cases were performed using operative loupes. The light attachment provides superb visbility without the discomfort of having to wear a headlight. Thus far we have found no added risks or complications using this system. We are currently working on long-term analysis and follow-up to further evaluate this system's efficacy.

  2. Learning curve of a complex surgical technique: minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

    PubMed

    Lee, Kong Hwee; Yeo, William; Soeharno, Henry; Yue, Wai Mun

    2014-10-01

    Prospective cohort study. This study aimed to evaluate the learning curve of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Very few studies have evaluated the learning curve of this technically demanding surgery. We intend to evaluate the learning curve of MIS TLIF with a larger sample size and assess surgical competence based not only on operative time but with perioperative variables, clinical and radiologic outcomes, incidence of complications, and patient satisfaction. From 2005 to 2009, the first 90 single-level MIS TLIF, which utilized a consistent technique and spinal instrumentation, performed by a single surgeon at our tertiary institution were studied. Variables studied included operative time, perioperative variables, clinical (Visual Analogue Scores for back and leg pain, Oswestry Disability Index, North American Spine Society Scores for neurogenic symptoms) and radiologic outcomes, incidence of complications and patient rating of expectation met, and the overall result of surgery. The asymptote of the surgeon's learning curve for MIS TLIF was achieved at the 44th case. Comparing the early group of 44 patients to the latter 46, the demographics were similar. For operative parameters, only 3 variables showed differences between the 2 groups: mean operative duration, fluoroscopy duration, and usage of patient-controlled analgesia. At the final follow-up, for clinical outcome parameters, the 2 groups were different in 3 parameters: VAS scores for back, leg pain, and neurogenic symptom scores. For radiologic outcome, both groups showed similar good fusion rates. For complications, none of the MIS TLIF cases were converted to open TLIF intraoperatively. In the early group, there were 3 complications: 1 incidental durotomy and 2 asymptomatic cage migrations; and in the latter group, there was 1 asymptomatic cage migration. In our study, technical proficiency in MIS TLIF was achieved after 44 surgeries, and the latter patients benefited

  3. Transforaminal lumbar interbody fusion.

    PubMed

    Moskowitz, Alan

    2002-04-01

    Indication and technique of TLIF procedure are described. TLIF provides for anterior column support and posterior tension band. It is a unilateral approach to the spine, and there is no need to expose or manipulate the dura. It provides the benefits of a 360 degrees fusion without performing an anterior approach. It restores the normal anatomy of the motion segment and maintains normal lumbar lordosis. Patients are mobilized quickly and resume activities early.

  4. Transforaminal Approach in Thoracal Disc Pathologies: Transforaminal Microdiscectomy Technique

    PubMed Central

    Dalbayrak, Sedat; Öztürk, Kadir; Yılmaz, Mesut; Gökdağ, Mahmut; Ayten, Murat

    2014-01-01

    Objective. Many surgical approaches have been defined and implemented in the last few decades for thoracic disc herniations. The endoscopic foraminal approach in foraminal, lateral, and far lateral disc hernias is a contemporary minimal invasive approach. This study was performed to show that the approach is possible using the microscope without an endoscope, and even the intervention on the discs within the spinal canal is possible by having access through the foramen. Methods. Forty-two cases with disc hernias in the medial of the pedicle were included in this study; surgeries were performed with transforaminal approach and microsurgically. Extraforaminal disc hernias were not included in the study. Access was made through the Kambin triangle, foramen was enlarged, and spinal canal was entered. Results. The procedure took 65 minutes in the average, and the mean bleeding amount was about 100cc. They were mobilized within the same day postoperatively. No complications were seen. Follow-up periods range between 5 and 84 months, and the mean follow-up period is 30.2 months. Conclusion. Transforaminal microdiscectomy is a method that can be performed in any clinic with standard spinal surgery equipment. It does not require additional equipment or high costs. PMID:24839557

  5. Modified Mini-open Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Pakzaban, Peyman

    2016-01-01

    Study Design. Retrospective case series. Objective. To describe a modified technique for mini-open transforaminal lumbar interbody fusion (TLIF) that improves visualization for decompression, fusion, and freehand pedicle screw insertion. Accuracy of freehand pedicle screw placement with this technique was assessed. Summary of Background Data. Mini-open TLIF is a minimally invasive technique that allows limited visualization of the bone and neural anatomy via an expandable tubular retractor inserted through the Wiltse plane. No significant modification that of this technique has been described in detail. Methods. In this study, 92 consecutive patients underwent one-level modified mini-open TLIF (MOTLIF). MOTLIF modifications consisted of (i) transmuscular dissection through the multifidus muscle rather than intermuscular dissection in the Wiltse plane; (ii) microsurgical detachment of multifidus from the facet rather than muscle dilation; (iii) en bloc total facetectomy (unilateral or bilateral, as needed for decompression); (iv) facet autograft used for interbody fusion; and (v) solid pedicle screws placed bilaterally by a freehand technique under direct vision. Results. The mean age was 53 years. Mean follow-up was 35 months (minimum 2 yrs). By 6 months, mean Visual Analog Scale for back and leg pain had improved from 51 to 19 and from 58 to 17, respectively, and mean Oswestry Disability Index (ODI) improved from 53 to 16. These improvements persisted at 2 years. Solid fusion, defined by computed tomography at 1 year, was achieved in 88.1%, whereas satisfactory fusion was achieved in 95.2% of patients. Pedicle screws were accurately placed in 335 of 336 imaged pedicles (pedicle breach grades: 91.1% grade 1; 8.6% grade 2; and 0.3% grade 3). Mean fluoroscopy time was 29.3 seconds. Conclusion. MOTLIF is a safe and effective minimally invasive technique with a high fusion rate. It allows accurate pedicle screw placement by a freehand technique. By eliminating bi

  6. Minimally invasive versus open transforaminal lumbar interbody fusion

    PubMed Central

    Villavicencio, Alan T.; Roeca, Cassandra M.; Nelson, E. Lee; Mason, Alexander

    2010-01-01

    Background Available clinical data are insufficient for comparing minimally invasive (MI) and open approaches for transforaminal lumbar interbody fusion (TLIF). To date, a paucity of literature exists directly comparing minimally invasive (MI) and open approaches for transforaminal lumbar interbody fusion (TLIF). The purpose of this study was to directly compare safety and effectiveness for these two surgical approaches. Materials and Methods Open or minimally invasive TLIF was performed in 63 and 76 patients, respectively. All consecutive minimally invasive TLIF cases were matched with a comparable cohort of open TLIF cases using three variables: diagnosis, number of spinal levels, and history of previous lumbar surgery. Patients were treated for painful degenerative disc disease with or without disc herniation, spondylolisthesis, and/or stenosis at one or two spinal levels. Clinical outcome (self-report measures, e.g., visual analog scale (VAS), patient satisfaction, and MacNab's criteria), operative data (operative time, estimated blood loss), length of hospitalization, and complications were assessed. Average follow-up for patients was 37.5 months. Results: The mean change in VAS scores postoperatively was greater (5.2 vs. 4.1) in theopen TLIF patient group (P = 0.3). MacNab's criteria score was excellent/good in 67% and 70% (P = 0.8) of patients in open and minimally invasive TLIF groups, respectively. The overall patient satisfaction was 72.1% and 64.5% (P = 0.4) in open and minimally invasive TLIF groups, respectively. The total mean operative time was 214.9 min for open and 222.5 min for minimally invasive TLIF procedures (P = 0.5). The mean estimated blood loss for minimally invasive TLIF (163.0 ml) was significantly lower (P < 0.0001) than the open approach (366.8 ml). The mean duration of hospitalization in the minimally invasive TLIF (3 days) was significantly shorter (P = 0.02) than the open group (4.2 days). The total rate of neurological deficit was

  7. [Posterior interbody fusion versus improved transforaminal lumbar interbody fusion in segmental spinal fixation for aged spondylolisthesis with lumbar spinal canal stenosis].

    PubMed

    Ma, Chao; Wu, Ji-bin; Zhao, Meng; Dai, Wei-xiang; Wu, De-hui; Wang, Zhao-hong; Feng, Jie; Liu, Chao; Zhao, Qing-hua; Tian, Ji-wei

    2012-03-06

    To assess the clinical and radiographic outcomes of posterior lumbar fixation and posterior interbody fusion or improved transforaminal lumbar interbody fusion for Meyerding grade II/III spondylolisthesis so as to address the suitability of a dynamic stabilization. A total of 28 consecutive patients underwent posterior lumbar fixation and posterior interbody fusion or improved transforaminal lumbar interbody fusion for Meyerding grade II/III spondylolisthesis. Among them, 13 patients underwent posterior interface fusion (PLIF) and pedicle screw fixation. And improved transforaminal lumbar interbody fusion (ITLIF) and placement of the same system were performed in 15 patients. Their clinical, economic, functional, and radiographic data were recorded both pre- and postoperatively. The average changes of economic and functional scores on the Prolo scale were 1.36 and 1.48 respectively. In patients with posterior interbody fusion; the average preoperative vertebral slippage was 46.9% (range: 25 - 75%) versus 14.6% (range: 15 - 25%) postoperatively. In patients with ITLIF, the average changes in economic and functional scores were 1.75 and 1.63 respectively. And the average preoperative vertebral slippage was 45.2% (range: 28 - 78%) compared with 26.3% (range: 14 - 28%) postoperatively. When two fusion techniques were compared, an overall superior reliability and resistance of systems was associated with the ITLIF procedure. But their clinical outcomes did not differ greatly (P > 0.05). The application of a segmental pedicle screw fixation is both feasible and efficacious.

  8. Safety and Efficacy of Mini Open Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Eissa, Ehab M.; Elmorsy, Haitham M.

    2016-01-01

    Objective Mini-transforaminal lumbar interbody fusion (Mini-TLIF) and other minimally invasive approaches introduced for the purpose of treating lumbar degenerative disc disease and instability are achieving high success and safety rates as the conventional approaches. Moreover, it has less soft tissue damage, minimal blood loss, and less hospital stay. Methods A prospective study was conducted from 2012 to 2014 on 28 patients who were subjected to Mini-open TLIF combined with transpedicular screw fixation for spondylolisthesis and degenerative disc disease. Two paramedian approaches were done, 4 cm for each, to insert the pedicular screws, along with inserting unilateral TLIF cage with autologous bone graft. Decompression was done either unilateral or bilateral according to the patient side of radiculopathy. Sixteen patients (57.2%) were diagnosed with degenerative spondylolisthesis, 7 patients (25%) were diagnosed with isthmic type spondylolisthesis, and 5 patients (17.8%) were diagnosed with degenerative disc disease, 2 of them(7.1%) had previous operations at the same level. Twenty patients (71.4%) were operated at the L4/5 level, and 8 patients (28.6%) at the L5/S1 level. Results All patients were able to ambulate the next day of surgery. The mean estimated blood loss was 251.79mL. The average hospital stay was 4.14 days. The average follow-up was 9 months. The mean visual analog scale was 1.86 at discharge, 1.68 after 3 months, and 1.38 after 6 months. After 6 months of the operation, MacNab's criteria were good in 23 patients and excellent in 5 patients. We had one case with transient weakness, 2 cases of screw malposition without clinical manifestations, and one case of infection. Conclusion Mini-TLIF approach is an efficient and safe approach for treating instability and degenerative diseases of the lumbar spine. The clinical outcome is encouraging and it may be an operation of choice for lumbar spinal fusion in selected patients. PMID:28127376

  9. Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal Lumbar Interbody Fusion: An Updated Meta-analysis

    PubMed Central

    Xie, Lei; Wu, Wen-Jian; Liang, Yu

    2016-01-01

    Background: The previous studies agree that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures. Methods: Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database (the literature search comprised Medical Subject Heading terms and key words or Emtree term). The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals were calculated for the clinical outcomes and perioperative data. Results: Twenty-four studies (n = 1967 patients) were included in this review (n = 951, open-TLIF, n = 1016, MIS-TLIF). MIS-TLIF was associated with a significant decrease in the visual analog score (VAS)-back pain score (WMD = −0.44; P = 0.001), Oswestry Disabilities Index (WMD = −1.57; P = 0.005), early ambulation (WMD = −1.77; P = 0.0001), less blood loss (WMD = −265.59; P < 0.00001), and a shorter hospital stay (WMD = −1.89; P < 0.0001). However, there were no significant differences in the fusion rate (RR = 0.99; P = 0.34), VAS-leg pain (WMD = −0.10; P = 0.26), complication rate (RR = 0.84; P = 0.35), operation time (WMD = −5.23; P = 0.82), or reoperation rate (RR = 0.73; P = 0.32). Conclusions: MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or

  10. Transforaminal lumbar interbody fusion versus instrumented posterolateral fusion in Grade I/II spondylolisthesis

    PubMed Central

    Pooswamy, Shanmugasundaram; Muralidharagopalan, Niranjanan Raghavn; Subbaiah, Sivasubramaniam

    2017-01-01

    Background: Spondylolisthesis refers to slippage of one vertebra over the other, which may be caused by a variety of reasons such as degenerative, trauma, and isthmic. Surgical management forms the mainstay of treatment to prevent further slip and worsening. However, there is no consensus regarding the best surgical option to treat these patients. This study compares TLIF and instrumented PLF in patients with Grade I and II spondylolisthesis and analysis the outcome with respect to functional outcome, pain, fusion rate, adequacy of medial facetectomy for decompression, and complications. Materials and Methods: Forty patients operated for spondylolisthesis by instrumented posterolateral or transforaminal fusion between January 1, 2010, and June 30, 2012 were included in this retrospective study. They were followed up for 3 years. Twenty one cases were of instrumented posterolateral fusion (PLF) and 19 cases were of transforaminal lumbar interbody fusion (TLIF). The patients were asked to fill up the Oswestry disability index (ODI), Dallas Pain Questionnaire (DPQ), and low back pain rating scale (LBPRS) preoperatively, at 1-month postoperatively, and at 6, 12, 24, and 36 months postoperatively. Radiological parameters were assessed using radiographs. Results: No significant differences were found in DPQ, LBPRS, or ODI scores preoperative, 1-month postoperative, and at 6, 12, 24 and 36 months followup. No significant difference was found between the two groups in blood loss. The only significant difference between the two groups was in the operative time, in which the instrumented PLF group had a mean of 50 min lesser than the TLIF group (P = 0.02). Conclusions: TLIF and instrumented PLF are equally efficacious options in the treatment of Grade I and II spondylolisthesis, except lytic type. PMID:28400657

  11. Transforaminal lumbar interbody fusion versus instrumented posterolateral fusion in Grade I/II spondylolisthesis.

    PubMed

    Pooswamy, Shanmugasundaram; Muralidharagopalan, Niranjanan Raghavn; Subbaiah, Sivasubramaniam

    2017-01-01

    Spondylolisthesis refers to slippage of one vertebra over the other, which may be caused by a variety of reasons such as degenerative, trauma, and isthmic. Surgical management forms the mainstay of treatment to prevent further slip and worsening. However, there is no consensus regarding the best surgical option to treat these patients. This study compares TLIF and instrumented PLF in patients with Grade I and II spondylolisthesis and analysis the outcome with respect to functional outcome, pain, fusion rate, adequacy of medial facetectomy for decompression, and complications. Forty patients operated for spondylolisthesis by instrumented posterolateral or transforaminal fusion between January 1, 2010, and June 30, 2012 were included in this retrospective study. They were followed up for 3 years. Twenty one cases were of instrumented posterolateral fusion (PLF) and 19 cases were of transforaminal lumbar interbody fusion (TLIF). The patients were asked to fill up the Oswestry disability index (ODI), Dallas Pain Questionnaire (DPQ), and low back pain rating scale (LBPRS) preoperatively, at 1-month postoperatively, and at 6, 12, 24, and 36 months postoperatively. Radiological parameters were assessed using radiographs. No significant differences were found in DPQ, LBPRS, or ODI scores preoperative, 1-month postoperative, and at 6, 12, 24 and 36 months followup. No significant difference was found between the two groups in blood loss. The only significant difference between the two groups was in the operative time, in which the instrumented PLF group had a mean of 50 min lesser than the TLIF group (P = 0.02). TLIF and instrumented PLF are equally efficacious options in the treatment of Grade I and II spondylolisthesis, except lytic type.

  12. Failure of a carbon fiber-reinforced polymer implant used for transforaminal lumbar interbody fusion.

    PubMed

    Sardar, Zeeshan; Jarzem, Peter

    2013-12-01

    Lumbar interbody fusion is a common procedure owing to the high prevalence of degenerative spinal disorders. During such procedures, carbon fiber-reinforced polymer (CFRP) cages are frequently utilized to fill the void created between adjacent vertebral bodies, to provide mechanical stability, and to carry graft material. Failure of such implants can lead to significant morbidity. We discuss the possible causes leading to the failure of a CFRP cage in a patient with rheumatoid arthritis. Review of a 49-year-old woman who underwent revision anterior lumbar interbody fusion 2 years after posterior instrumentation and transforaminal lumbar interbody fusion at L4-L5 and L5-S1. The patient developed pseudarthrosis at the two previously fused levels with failure of the posterior instrumentation. Revision surgery reveled failure with fragmentation of the CFRP cage at the L5-S1 level. CFRP implants can break if mechanical instability or nonunion occurs in the spinal segments, thus emphasizing the need for optimizing medical management and meticulous surgical technique in achieving stability.

  13. Failure of a Carbon Fiber–Reinforced Polymer Implant Used for Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Sardar, Zeeshan; Jarzem, Peter

    2013-01-01

    Lumbar interbody fusion is a common procedure owing to the high prevalence of degenerative spinal disorders. During such procedures, carbon fiber–reinforced polymer (CFRP) cages are frequently utilized to fill the void created between adjacent vertebral bodies, to provide mechanical stability, and to carry graft material. Failure of such implants can lead to significant morbidity. We discuss the possible causes leading to the failure of a CFRP cage in a patient with rheumatoid arthritis. Review of a 49-year-old woman who underwent revision anterior lumbar interbody fusion 2 years after posterior instrumentation and transforaminal lumbar interbody fusion at L4–L5 and L5–S1. The patient developed pseudarthrosis at the two previously fused levels with failure of the posterior instrumentation. Revision surgery reveled failure with fragmentation of the CFRP cage at the L5–S1 level. CFRP implants can break if mechanical instability or nonunion occurs in the spinal segments, thus emphasizing the need for optimizing medical management and meticulous surgical technique in achieving stability. PMID:24436878

  14. Transforaminal Endoscopic Decompression for Displaced End Plate Fracture After Lateral Lumbar Interbody Fusion: Technical Note.

    PubMed

    Wagner, Ralf; Telfeian, Albert E; Krzok, Guntram; Iprenburg, Menno

    2017-10-01

    Lateral lumbar interbody fusion is a minimally invasive approach to anterior spinal column fusion, deformity correction, and indirect decompression of the lumbar spine. A rarely reported possible complication of the procedure is end plate fracture, which has the potential for nerve root compression. Here we present a case of end plate fracture and nerve compression after stand-alone lateral lumbar interbody fusion, its diagnosis, and its subsequent successful treatment with transforaminal endoscopic spine surgery. The case highlights the possible role for minimally invasive endoscopic surgery as a rescue procedure after fusion complication. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Bone Morphogenic Protein Is a Viable Adjunct for Fusion in Minimally Invasive Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Siddiqui, M Mashfiqul Arafin; Sta.Ana, Ana Rosario P.; Yeo, William

    2016-01-01

    Study Design Comparison of prospectively collected data of patients undergoing minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) with and without recombinant human bone morphogenic protein 2 (BMP). Purpose To compare the clinical, radiological outcome and complications of patients undergoing MIS-TLIF with and without BMP. Overview of Literature BMP is an effective fusion enhancer with potential complications. Direct comparison of MIS-TLIF with and without BMP is limited to retrospective studies with short follow-up. Methods From June 2005 to February 2011, consecutive cases of MIS-TLIF performed by a single surgeon were included. North American Spine Society (NASS) score, Oswestry disability index (ODI), Short Form-36 (SF-36), and visual analogue score (VAS) were assessed preoperatively and at 6 and 24 months postoperatively. Fusion rates and complications were noted. Results The 252 cases comprised 104 non-BMP and 148 BMP cases. The BMP group was significantly older (mean age, 60.2 vs. 53.9; p<0.01). Preoperative scores were similar. Immediate postoperative morphine usage was significantly lower in the BMP group (12.4 mg vs. 20.1 mg, p<0.01). At 6 months, the BMP group had lower VAS back and leg pain scores (p<0.01). At 2 years, the BMP group had better leg pain scores (p<0.01), ODI (15.4 vs. 20.3, p=0.04) and NASS scores (8.8 vs. 15.8, p<0.01). Both groups showed significant clinical improvement compared to their preoperative levels. The BMP group attained a significantly higher rate of fusion at 6 months follow-up (88.4% vs. 76.8%, p=0.016) with no difference at 2 years. The non-BMP and BMP group had 12 (11.5%) and 9 (6.1%) complications and 5 (4.8%) and 2 (1.4%) reoperations, respectively. Conclusions The use of BMP to augment fusion in MIS-TLIF is an acceptable alternative that has potential benefits of less pain in early and intermediate postoperative follow-up. PMID:27994786

  16. Effect of steerable cage placement during minimally invasive transforaminal lumbar interbody fusion on lumbar lordosis.

    PubMed

    Lindley, Timothy E; Viljoen, Stephanus V; Dahdaleh, Nader S

    2014-03-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is commonly used for the treatment of a variety of degenerative spine disorders. Recently, steerable interbody cages have been developed which potentially allow for greater restoration of lumbar lordosis. Here we describe a technique and radiographic results following minimally invasive placement of steerable cages through a bilateral approach. A retrospective review was conducted of the charts and radiographs of 15 consecutive patients who underwent 19 levels of bilateral MIS-TLIF with the placement of steerable cages. These were compared to 10 patients who underwent 16 levels of unilateral MIS-TLIF with the placement of bullet cages. The average age, body mass index, distribution of the levels operated and follow-up were similar in both groups. The average height of the steerable cage placed was 10.9 mm compared to 8.5mm for bullet cages. The preoperative focal Cobb's angle per level was similar between both groups with a mean of -5.3 degrees for the steerable cage group and -4.8 degrees for the bullet cage group. There was a significant improvement in postoperative Cobb's angle after placement of a steerable cage with a mean of -13.7 (p<0.01) and this persisted at the last follow-up with -13 degrees (p<0.01). There was no significant change in Cobb's angle after bullet cage placement with -5.7 degrees postoperatively and a return to the baseline preoperative Cobb's angle of -4.8 at the last follow-up. Steerable cage placement for MIS-TLIF improves focal lordosis compared to bullet cage placement.

  17. Minimally Invasive Transforaminal Lumbar Interbody Fusion and Unilateral Fixation for Degenerative Lumbar Disease.

    PubMed

    Wang, Hui-Wang; Hu, Yong-Cheng; Wu, Zhan-Yong; Wu, Hua-Rong; Wu, Chun-Fu; Zhang, Lian-Suo; Xu, Wei-Kun; Fan, Hui-Long; Cai, Jin-Sheng; Ma, Jian-Qing

    2017-08-01

    To evaluate the clinical effect of the minimally invasive transforaminal lumbar interbody fusion combined with posterolateral fusion and unilateral fixation using a tubular retractor in the management of degenerative lumbar disease. A retrospective analysis was conducted to analyze the clinical outcome of 58 degenerative lumbar disease patients who were treated with minimally invasive transforaminal lumbar interbody fusion combined with posterolateral fusion and unilateral fixation during December 2012 to January 2015. The spine was unilaterally approached through a 3.0-cm skin incision centered on the disc space, located 2.5 cm lateral to the midline, and the multifidus muscles and longissimus dorsi were stripped off. After transforaminal lumbar interbody fusion and posterolateral fusion the unilateral pedicle screw fixation was performed. The visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI), and the MacNab score were applied to evaluate clinical effects. The operation time, peri-operative bleeding, postoperative time in bed, hospitalization costs, and the change in the intervertebral height were analyzed. Radiological fusion based on the Bridwell grading system was also assessed at the last follow-up. The quality of life of the patients before and after the operation was assessed using the short form-36 scale (SF-36). Fifty-eight operations were successfully performed, and no nerve root injury or dural tear occurred. The average operation time was 138 ± 33 min, intraoperative blood loss was 126 ± 50 mL, the duration from surgery to getting out of bed was 46 ± 8 h, and hospitalization cost was 1.6 ± 0.2 ten thousand yuan. All of the 58 patients were followed up for 7-31 months, with an average of 14.6 months. The postoperative VAS scores and ODI score were significantly improved compared with preoperative data (P < 0.05). The evaluation of the MacNab score was excellent in 41 patients, good

  18. A Biomechanical Comparison of Shape Design and Positioning of Transforaminal Lumbar Interbody Fusion Cages.

    PubMed

    Comer, Garet C; Behn, Anthony; Ravi, Shashank; Cheng, Ivan

    2016-08-01

    Cadaveric biomechanical analysis. The aim of this study was to compare three interbody cage shapes and their position within the interbody space with regards to construct stability for transforaminal lumbar interbody fusion. Twenty L2-L3 and L4-L5 lumbar motion segments from fresh cadavers were potted in polymethyl methacrylate and subjected to testing with a materials testing machine before and after unilateral facetectomy, diskectomy, and interbody cage insertion. The three cage types were kidney-shaped, articulated, and straight bullet-shaped. Each cage type was placed in a common anatomic area within the interbody space before testing: kidney, center; kidney, anterior; articulated, center; articulated, anterior; bullet, center; bullet, lateral. Load-deformation curves were generated for axial compression, flexion, extension, right bending, left bending, right torsion, and left torsion. Finally, load to failure was tested. For all applied loads, there was a statistically significant decrease in the slope of the load-displacement curves for instrumented specimens compared with the intact state (p < 0.05) with the exception of right axial torsion (p = 0.062). Among all instrumented groups, there was no statistically significant difference in stiffness for any of the loading conditions or load to failure. Our results failed to show a clearly superior cage shape design or location within the interbody space for use in transforaminal lumbar interbody fusion.

  19. A Biomechanical Comparison of Shape Design and Positioning of Transforaminal Lumbar Interbody Fusion Cages

    PubMed Central

    Comer, Garet C.; Behn, Anthony; Ravi, Shashank; Cheng, Ivan

    2015-01-01

    Study Design  Cadaveric biomechanical analysis. Objective  The aim of this study was to compare three interbody cage shapes and their position within the interbody space with regards to construct stability for transforaminal lumbar interbody fusion. Methods  Twenty L2–L3 and L4–L5 lumbar motion segments from fresh cadavers were potted in polymethyl methacrylate and subjected to testing with a materials testing machine before and after unilateral facetectomy, diskectomy, and interbody cage insertion. The three cage types were kidney-shaped, articulated, and straight bullet-shaped. Each cage type was placed in a common anatomic area within the interbody space before testing: kidney, center; kidney, anterior; articulated, center; articulated, anterior; bullet, center; bullet, lateral. Load-deformation curves were generated for axial compression, flexion, extension, right bending, left bending, right torsion, and left torsion. Finally, load to failure was tested. Results  For all applied loads, there was a statistically significant decrease in the slope of the load-displacement curves for instrumented specimens compared with the intact state (p < 0.05) with the exception of right axial torsion (p = 0.062). Among all instrumented groups, there was no statistically significant difference in stiffness for any of the loading conditions or load to failure. Conclusions  Our results failed to show a clearly superior cage shape design or location within the interbody space for use in transforaminal lumbar interbody fusion. PMID:27433426

  20. Comparison of the efficacy of transforaminal and interlaminar radicular block techniques for treating lumbar disk hernia☆

    PubMed Central

    Rezende, Rodrigo; Jacob Júnior, Charbel; da Silva, Camila Kill; de Barcellos Zanon, Igor; Cardoso, Igor Machado; Batista Júnior, José Lucas

    2015-01-01

    Objective To compare the interlaminar and transforaminal block techniques with regard to the state of pain and presence or absence of complications. Method This was a randomized double-blind prospective study of descriptive and comparative nature, on 40 patients of both sexes who presented lumbar sciatic pain due to central-lateral or foraminal disk hernias. The patients had failed to respond to 20 physiotherapy sessions, but did not present instability, as diagnosed in dynamic radiographic examinations. The type of block to be used was determined by means of a draw: transforaminal (group 1; 20 patients) or interlaminar (group 2; 20 patients). Results Forty patients were evaluated (17 males), with a mean age of 49 years. There was a significant improvement in the state of pain in all patients who underwent radicular block using both techniques, although the transforaminal technique presented better results than the interlaminar technique. Conclusion Both techniques were effective for pain relief and presented low complication rates, but the transforaminal technique was more effective than the interlaminar technique. PMID:26229920

  1. BMP-2-induced Neuroforaminal Bone Growth in the Setting of a Minimally Invasive Transforaminal Lumbar Interbody Fusion.

    PubMed

    Ahn, Junyoung; Tabaraee, Ehsan; Singh, Kern

    2015-06-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has become a popular alternative to traditional methods of lumbar decompression and fusion. When compared with the open technique, the minimally invasive approach can result in decreased pain and blood loss as well as a shorter length of hospitalization. However, the narrower working channel through the tubular retractor increases the difficulty of decortication and bone grafting. Therefore, recombinant human bone morphogenetic proteins (rhBMP-2) is often utilized (although this is off-label) to create a more favorable interbody fusion environment. Recently, the use of rhBMP-2 has been associated with excessive bone growth in an MIS-TLIF. If this bone growth compresses the neighboring neural structures, patients may present with either new or recurrent radicular pain. Computed tomographic (CT) imaging can demonstrate heterotopic bone growth extending from the disk space into either the ipsilateral neuroforamen or lateral recess, which may result in the compression of the exiting or traversing root, respectively. The purpose of this article and the accompanying video is to demonstrate a technique for defining and resecting rhBMP-2-induced heterotopic bone growth following a previous MIS-TLIF.

  2. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation: comparison between primary and revision surgery.

    PubMed

    Kang, Moo Sung; Park, Jeong Yoon; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2014-01-01

    Minimally invasive surgery with a transforaminal lumbar interbody fusion (MIS TLIF) is an important minimally invasive fusion technique for the lumbar spine. Lumbar spine reoperation is challenging and is thought to have greater complication risks. The purpose of this study was to compare MIS TLIF with unilateral screw fixation perioperative results between primary and revision surgeries. This was a prospective study that included 46 patients who underwent MIS TLIF with unilateral pedicle screw. The patients were divided into two groups, primary and revision MIS TLIF, to compare perioperative results and complications. The two groups were similar in age, sex, and level of operation, and were not significantly different in the length of follow-up or clinical results. Although dural tears were more common with the revision group (primary 1; revision 4), operation time, blood loss, total perioperative complication, and fusion rates were not significantly different between the two groups. Both groups showed substantial improvements in VAS and ODI scores one year after surgical treatment. Revision MIS TLIF performed by an experienced surgeon does not necessarily increase the risk of perioperative complication compared with primary surgery. MIS TLIF with unilateral pedicle screw fixation is a valuable option for revision lumbar surgery.

  3. Computerized tomography evaluation of a resorbable implant after transforaminal lumbar interbody fusion.

    PubMed

    Kuklo, Timothy R; Rosner, Michael K; Polly, David W

    2004-03-15

    Synthetic bioabsorbable implants have recently been introduced in spinal surgery; consequently, the indications, applications, and results are still evolving. The authors used absorbable interbody spacers (Medtronic Sofamor Danek, Memphis, TN) packed with recombinant bone morphogenetic protein (Infuse; Medtronic Sofamor Danek) for single- and multiple-level transforaminal lumbar interbody fusion (TLIF) procedures over a period of 18 months. This is a consecutive case series in which postoperative computerized tomography (CT) scanning was used to assess fusion status. There were 22 patients (17 men, five women; 39 fusion levels) whose mean age was 41.6 years (range 23-70 years) and in whom the mean follow-up duration was 12.4 months (range 6-18 months). Bridging bone was noted as early as the 3-month postoperative CT scan when obtained; solid arthrodesis was routinely noted between 6 and 12 months in 38 (97.4%) of 39 fusion levels. In patients who underwent repeated CT scanning, the fusion mass appeared to increase with time, whereas the disc space height remained stable. Although the results are early (mean 12-month follow-up duration), there was only one noted asymptomatic delayed union/nonunion at L5-S1 in a two-level TLIF with associated screw breakage. There were no infections or complications related to the cages. The bioabsorbable cages appear to be a viable alternative to metal interbody spacers, and may be ideally suited to spinal interbody applications because of their progressive load-bearing properties.

  4. Percutaneous Transforaminal Endoscopic Lumbar Interbody Fusion: Clinical and Radiological Results of Mean 46-Month Follow-Up

    PubMed Central

    Lee, Sang-Ho; Erken, H. Yener

    2017-01-01

    Background. Spinal fusion has been shown to be the preferred surgical option to reduce pain, recover function, and increase quality of life in the treatment of a variety of lumbar spinal disorders. The main goal of the present study is to report our clinical experience and results of percutaneous transforaminal endoscopic lumbar interbody fusion (PELIF) applications using the expandable spacer in a single institution. Methods. We performed a retrospective review of 18 patients with >12-month follow-up who had been operated on PELIF using expandable spacer from 2001 to 2007. Their clinical and radiological data were collected and analyzed. Results. The mean follow-up period was 46 months. The mean DH before the surgery was 8.3 mm which improved to 11.4 mm at the early postoperative period and regressed to 9.3 mm at the last follow-up visit. The VAS-B, VAS-L, and ODI scores at the last follow-up showed a 54%, 72%, and 69% improvement from the preoperative period, respectively. Conclusions. The presented PELIF technique with the expandable spacer seems to be a promising surgical technique for the treatment of a variety of lumbar spinal disorders. Conversely, radiological results including disc space subsidence make the stand-alone application of the expandable spacer debatable. PMID:28337448

  5. Percutaneous Transforaminal Endoscopic Lumbar Interbody Fusion: Clinical and Radiological Results of Mean 46-Month Follow-Up.

    PubMed

    Lee, Sang-Ho; Erken, H Yener; Bae, Junseok

    2017-01-01

    Background. Spinal fusion has been shown to be the preferred surgical option to reduce pain, recover function, and increase quality of life in the treatment of a variety of lumbar spinal disorders. The main goal of the present study is to report our clinical experience and results of percutaneous transforaminal endoscopic lumbar interbody fusion (PELIF) applications using the expandable spacer in a single institution. Methods. We performed a retrospective review of 18 patients with >12-month follow-up who had been operated on PELIF using expandable spacer from 2001 to 2007. Their clinical and radiological data were collected and analyzed. Results. The mean follow-up period was 46 months. The mean DH before the surgery was 8.3 mm which improved to 11.4 mm at the early postoperative period and regressed to 9.3 mm at the last follow-up visit. The VAS-B, VAS-L, and ODI scores at the last follow-up showed a 54%, 72%, and 69% improvement from the preoperative period, respectively. Conclusions. The presented PELIF technique with the expandable spacer seems to be a promising surgical technique for the treatment of a variety of lumbar spinal disorders. Conversely, radiological results including disc space subsidence make the stand-alone application of the expandable spacer debatable.

  6. A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion.

    PubMed

    Singh, Kern; Nandyala, Sreeharsha V; Marquez-Lara, Alejandro; Fineberg, Steven J; Oglesby, Mathew; Pelton, Miguel A; Andersson, Gunnar B; Isayeva, Darya; Jegier, Briana J; Phillips, Frank M

    2014-08-01

    Emerging literature suggests superior clinical short- and long-term outcomes of MIS (minimally invasive surgery) TLIFs (transforaminal lumbar interbody fusion) versus open fusions. Few studies to date have analyzed the cost differences between the two techniques and their relationship to acute clinical outcomes. The purpose of the study was to determine the differences in hospitalization costs and payments for patients treated with primary single-level MIS versus open TLIF. The impact of clinical outcomes and their contribution to financial differences was explored as well. This study was a nonrandomized, nonblinded prospective review. Sixty-six consecutive patients undergoing a single-level TLIF (open/MIS) were analyzed (33 open, 33 MIS). Patients in either cohort (MIS/open) were matched based on race, sex, age, smoking status, medical comorbidities (Charlson Comorbidity index), payer, and diagnosis. Every patient in the study had a diagnosis of either degenerative disc disease or spondylolisthesis and stenosis. Operative time (minutes), length of stay (LOS, days), estimated blood loss (EBL, mL), anesthesia time (minutes), Visual Analog Scale (VAS) scores, and hospital cost/payment amount were assessed. The MIS and open TLIF groups were compared based on clinical outcomes measures and hospital cost/payment data using SPSS version 20.0 for statistical analysis. The two groups were compared using bivariate chi-squared analysis. Mann-Whitney tests were used for non-normal distributed data. Effect size estimate was calculated with the Cohen d statistic and the r statistic with a 95% confidence interval. Average surgical time was shorter for the MIS than the open TLIF group (115.8 minutes vs. 186.0 minutes respectively; p=.001). Length of stay was also reduced for the MIS versus the open group (2.3 days vs. 2.9 days, respectively; p=.018). Average anesthesia time and EBL were also lower in the MIS group (p<.001). VAS scores decreased for both groups, although these

  7. Miniopen Transforaminal Lumbar Interbody Fusion with Unilateral Fixation: A Comparison between Ipsilateral and Contralateral Reherniation

    PubMed Central

    Liu, Fubing; Jiang, Chun

    2016-01-01

    The aim of this study was to evaluate the risk factors between ipsilateral and contralateral reherniation and to compare the effectiveness of miniopen transforaminal lumbar interbody fusion (TLIF) with unilateral fixation for each group. From November 2007 to December 2014, clinical and radiographic data of each group (ipsilateral or contralateral reherniation) were collected and compared. Functional assessment (Visual Analog Scale (VAS) score and Japanese Orthopaedic Association (JOA)) and radiographic evaluation (fusion status, disc height, lumbar lordosis (LL), and functional spine unit (FSU) angle) were applied to compare surgical effect for each group preoperatively and at final followup. MacNab questionnaire was applied to further evaluate the satisfactory rate after the discectomy and fusion. No difference except pain-free interval was found between ipsilateral and contralateral groups. There was a significant difference in operative time between two groups. No differences were found in clinical and radiographic data for assessment of surgical effect between two groups. The satisfactory rate was decreasing in both groups with time passing after discectomy. Difference in pain-free interval may be a distinction for ipsilateral and contralateral reherniation. Miniopen TLIF with unilateral pedicle screw fixation can be a recommendable way for single level reherniation regardless of ipsilateral or contralateral reherniation. PMID:27885358

  8. The Multiple Benefits of Minimally Invasive Spinal Surgery: Results Comparing Transforaminal Lumbar Interbody Fusion and Posterior Lumbar Fusion

    PubMed Central

    Starkweather, Angela R.; Witek-Janusek, Linda; Nockels, Russ P.; Peterson, Jonna; Mathews, Herb L.

    2013-01-01

    Minimally invasive transforaminal lumbar interbody fusion (TLIF) offers equivalent postoperative fusion rates compared to posterior lumbar fusion (PLF) and minimizes the amount of iatrogenic injury to the spinal muscles. The objective of this study was to examine the difference in pain perception, stress, mood disturbance, quality of life, and immunological indices throughout the perioperative course among patients undergoing TLIF and PLF. A prospective, nonrandomized descriptive design was used to evaluate these measures among patients undergoing TLIF (n = 17) or PLF (n = 18) at 1 week prior to surgery (T1), the day of surgery (T2), 24 hours postoperatively (T3), and 6 weeks postoperatively (T4). Among TLIF patients, pain, stress, fatigue, and mood disturbance were significantly decreased at the 6-week follow-up visit (T4) compared to patients who underwent PLF. The TLIF group also demonstrated significantly higher levels (near baseline) of CD8 cells atT4 than the PLF group. Interleukin-6 levels were significantly higher in the TLIF group as well, which may be an indicator of ongoing nerve regeneration and healing. Knowledge concerning the effect of pain and the psychological experience on immunity among individuals undergoing spinal fusion can help nurses tailor interventions to improve outcomes, regardless of the approach used. PMID:18330408

  9. Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

    PubMed Central

    Schwender, James D.; Safriel, Yair; Gilbert, Thomas J.; Mehbod, Amir A.; Denis, Francis; Transfeldt, Ensor E.; Wroblewski, Jill M.

    2009-01-01

    Abundant data are available for direct anterior/posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre- and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups. PMID:19125304

  10. Radiographic results of single level transforaminal lumbar interbody fusion in degenerative lumbar spine disease: focusing on changes of segmental lordosis in fusion segment.

    PubMed

    Kim, Sang-Bum; Jeon, Taek-Soo; Heo, Youn-Moo; Lee, Woo-Suk; Yi, Jin-Woong; Kim, Tae-Kyun; Hwang, Cheol-Mog

    2009-12-01

    To assess the radiographic results in patients who underwent transforaminal lumbar interbody fusion (TLIF), particularly the changes in segmental lordosis in the fusion segment, whole lumbar lordosis and disc height. Twenty six cases of single-level TLIF in degenerative lumbar diseases were analyzed. The changes in segmental lordosis, whole lumbar lordosis, and disc height were evaluated before surgery, after surgery and at the final follow-up. The segmental lordosis increased significantly after surgery but decreased at the final follow-up. Compared to the preoperative values, the segmental lordosis did not change significantly at the final follow-up. Whole lumbar lordosis at the final follow-up was significantly higher than the preoperative values. The disc height was significantly higher in after surgery than before surgery (p = 0.000) and the disc height alter surgery and at the final follow-up was similar. When performing TLIF, careful surgical techniques and attention are needed to restore and maintain the segmental lordosis at the fusion level.

  11. Modeled cost-effectiveness of transforaminal lumbar interbody fusion compared with posterolateral fusion for spondylolisthesis using N(2)QOD data.

    PubMed

    Carreon, Leah Y; Glassman, Steven D; Ghogawala, Zoher; Mummaneni, Praveen V; McGirt, Matthew J; Asher, Anthony L

    2016-06-01

    OBJECTIVE Transforaminal lumbar interbody fusion (TLIF) has become the most commonly used fusion technique for lumbar degenerative disorders. This suggests an expectation of better clinical outcomes with this technique, but this has not been validated consistently. How surgical variables and choice of health utility measures drive the cost-effectiveness of TLIF relative to posterolateral fusion (PSF) has not been established. The authors used health utility values derived from Short Form-6D (SF-6D) and EQ-5D and different cost-effectiveness thresholds to evaluate the relative cost-effectiveness of TLIF compared with PSF. METHODS From the National Neurosurgery Quality and Outcomes Database (N(2)QOD), 101 patients with spondylolisthesis who underwent PSF were propensity matched to patients who underwent TLIF. Health-related quality of life measures and perioperative parameters were compared. Because health utility values derived from the SF-6D and EQ-5D questionnaires have been shown to vary in patients with low-back pain, quality-adjusted life years (QALYs) were derived from both measures. On the basis of these matched cases, a sensitivity analysis for the relative cost per QALY of TLIF versus PSF was performed in a series of cost-assumption models. RESULTS Operative time, blood loss, hospital stay, and 30-day and 90-day readmission rates were similar for the TLIF and PSF groups. Both TLIF and PSF significantly improved back and leg pain, Oswestry Disability Index (ODI) scores, and EQ-5D and SF-6D scores at 3 and 12 months postoperatively. At 12 months postoperatively, patients who had undergone TLIF had greater improvements in mean ODI scores (30.4 vs 21.1, p = 0.001) and mean SF-6D scores (0.16 vs 0.11, p = 0.001) but similar improvements in mean EQ-5D scores (0.25 vs 0.22, p = 0.415) as patients treated with PSF. At a cost per QALY threshold of $100,000 and using SF-6D-based QALYs, the authors found that TLIF would be cost-prohibitive compared with PSF at a

  12. Application of a narrow-surface cage in full endoscopic minimally invasive transforaminal lumbar interbody fusion.

    PubMed

    He, Er-Xing; Guo, Jing; Ling, Qin-Jie; Yin, Zhi-Xun; Wang, Ying; Li, Ming

    2017-06-01

    Spinal endoscopy has been widely applied in lumbar discectomy and decompression. However, endoscopic lumbar interbody fusion still remains a technical challenge due to the limited space within the working trocar for cage implantation. The purpose of this study was to investigate the feasibility and effectiveness of using a narrow-surface fusion cage in full endoscopic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar degenerative disease. From Jun 2013 to Dec 2014, a total of 42 patients (23 males, 19 females) underwent full endoscopic MIS-TLIF at our hospital was recruited. An 8-mm-wide narrow-surface fusion cage was selected for all cases. Perioperative parameters and complications were recorded. Comparisons on visual analog scale (VAS) and oswestry disability index (ODI) scores before and after surgery were performed. At the last follow-up, Nakai grading system was applied to assess patients' satisfaction; meanwhile, interbody fusion was evaluated by computed tomography. Mean operation time was 233.1 ± 69.5 min, and mean blood loss during surgery was 221.8 ± 98.5 ml. Two patients (4.8%) developed neurological complications. Postoperative follow-up ranged from 24 to 36 months (mean 27.6 ± 3.8 months). VAS and ODI scores were significantly improved 3 months after surgery and at the final follow-up, respectively (P < 0.05). Outcome of surgery was graded as excellent for 32 patients, good for 8 patients, and acceptable for 2 patients, corresponding to a success rate ("good" and "excellent") of 95.2%. Thirty-nine of the 42 patients demonstrated solid interbody fusion at the last follow-up, indicating a fusion rate of 92.9%. Application of a narrow-surface fusion cage in full endoscopic MIS-TLIF for the treatment of lumbar degenerative disease is feasible and effective. The clinical outcome and fusion success of this procedure were acceptable and promising. Copyright © 2017 IJS Publishing Group Ltd

  13. Subsidence of polyetheretherketone cage after minimally invasive transforaminal lumbar interbody fusion.

    PubMed

    Kim, Moon-Chan; Chung, Hung-Tae; Cho, Jae-Lim; Kim, Dong-Jun; Chung, Nam-Su

    2013-04-01

    A retrospective case series. The aim of this study was to determine the rate of cage subsidence after minimally invasive transforaminal lumbar interbody fusion (MITLIF) conducted using a polyetheretherketone (PEEK) cage, and to identify associated risk factors. Although various rates of cage subsidence after lumbar interbody fusion have been reported, few studies have addressed subsidence rate after MITLIF using PEEK cage. A total of 104 consecutive patients who had undergone MITLIF using a PEEK cage with a minimum follow-up of 2 years were included in this study. Cage subsidence was defined to have occurred when a cage was observed to sink into an adjacent vertebral body by ≥2 mm on the postoperative or serial follow-up lateral radiographs. The demographic variables considered to affect cage subsidence were the following: age, sex, body mass index, bone mineral density, diagnosis, number of fusion segment, and the quality/quantity of back muscle, and the cage-related variables considered were: level of fusion, intervertebral angle, cage size, cage position, and postoperative distraction of disc height. Logistic regression analysis was conducted to explore relations between these variables and cage subsidence. : For the 122 cages inserted, the rate of cage subsidence was 14.8% (18 cages), and cage subsidence occurred within 7.2±8.5 (1-25) months of surgery. The odds ratios for factors found to significantly increase the risk of cage subsidence were; 1.950 (95% confidence interval, 1.002-4.224) for L5-S1 level, and 1.018 (95% confidence interval, 1.000-1.066) for anterior cage position. The rate of PEEK cage subsidence after MITLIF was relatively low. End-plate manipulation and cage insertion during MITLIF were not influenced by a small operation window.

  14. Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up.

    PubMed

    Høy, Kristian; Bünger, Cody; Niederman, Bent; Helmig, Peter; Hansen, Ebbe Stender; Li, Haisheng; Andersen, Thomas

    2013-09-01

    The aim of the present study was to analyze outcome, with respect to functional disability, pain, fusion rate, and complications of patients treated with transforaminal lumbar interbody fusion (TLIF) in compared to instrumented poserolateral fusion (PLF) alone, in low back pain. Spinal fusion has become a major procedure worldwide. However, conflicting results exist. Theoretical circumferential fusion could improve functional outcome. However, the theoretical advantages lack scientific documentation. Prospective randomized clinical study with a 2-year follow-up period. From November 2003 to November 2008 100 patients with severe low back pain and radicular pain were randomly selected for either posterolateral lumbar fusion [titanium TSRH (Medtronic)] or transforaminal lumbar interbody fusion [titanium TSRH (Medtronic)] with anterior intervertebral support by tantalum cage (Implex/Zimmer). The primary outcome scores were obtained using Dallas Pain Questionnaire (DPQ), Oswestry disability Index, SF-36, and low back pain Rating Scale. All measures assessed the endpoints at 2-year follow-up after surgery. The overall follow-up rate was 94 %. Sex ratio was 40/58. 51 patients had TLIF, 47 PLF. Mean age 49(TLIF)/45(PLF). No statistic difference in outcome between groups could be detected concerning daily activity, work leisure, anxiety/depression or social interest. We found no statistic difference concerning back pain or leg pain. In both the TLIF and the PLF groups the patients had significant improvement in functional outcome, back pain, and leg pain compared to preoperatively. Operation time and blood loss in the TLIF group were significantly higher than in the PLF group (p < 0.001). No statistic difference in fusion rates was detected. Transforaminal interbody fusion did not improve functional outcome in patients compared to posterolateral fusion. Both groups improved significantly in all categories compared to preoperatively. Operation time and blood loss were

  15. Restoration of lordosis and disk height after single-level transforaminal lumbar interbody fusion.

    PubMed

    Kepler, Christopher K; Rihn, Jeffrey A; Radcliff, Kristen E; Patel, Amar A; Anderson, D Greg; Vaccaro, Alexander R; Hilibrand, Alan S; Albert, Todd J

    2012-02-01

    To study radiographic and clinical outcomes after transforaminal lumbar interbody fusion (TLIF) in order to determine the impact of TLIF on lumbar lordosis, intervertebral height and improvement in clinical outcome measures. Forty-five patients who had undergone a single-level TLIF procedure for a single-level degenerative condition were retrospectively reviewed and their clinical histories, degree of pre- and post-operative lumbar lordosis, intervertebral height, and cage position recorded. Clinical assessment included use of modified Odom's criteria and a visual analog scale (VAS) for back and leg pain. At 21 months, the patients had gained an average of 3.6° of lumbar lordosis and 4.5 mm disc height. Change in disc height was significantly associated with an anterior cage position while lumbar lordosis was unaffected by cage position. A spondylolisthesis subgroup demonstrated 31% reduction in the magnitude of anterior slip. Less lordosis was associated with worse back and leg pain as assessed by VAS and greater disk heights were associated with higher Odom's criteria scores. Patients with persistent leg pain at final follow-up had less lumbar lordosis and intervertebral height than patients without leg pain. Intervertebral height and lumbar lordosis reconstruction are important for achieving good surgical results; guidance regarding the likely changes in lumbar lordosis and disk height after TLIF is provided by our findings. © 2012 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

  16. Total 3D Airo® Navigation for Minimally Invasive Transforaminal Lumbar Interbody Fusion

    PubMed Central

    Lian, Xiaofeng; Berlin, Connor; Moriguchi, Yu; Zhang, Qiwei; Härtl, Roger

    2016-01-01

    Introduction. A new generation of iCT scanner, Airo®, has been introduced. The purpose of this study is to describe how Airo facilitates minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Method. We used the latest generation of portable iCT in all cases without the assistance of K-wires. We recorded the operation time, number of scans, and pedicle screw accuracy. Results. From January 2015 to December 2015, 33 consecutive patients consisting of 17 men and 16 women underwent single-level or two-level MIS-TLIF operations in our institution. The ages ranged from 23 years to 86 years (mean, 66.6 years). We treated all the cases in MIS fashion. In four cases, a tubular laminectomy at L1/2 was performed at the same time. The average operation time was 192.8 minutes and average time of placement per screw was 2.6 minutes. No additional fluoroscopy was used. Our screw accuracy rate was 98.6%. No complications were encountered. Conclusions. Airo iCT MIS-TLIF can be used for initial planning of the skin incision, precise screw, and cage placement, without the need for fluoroscopy. “Total navigation” (complete intraoperative 3D navigation without fluoroscopy) can be achieved by combining Airo navigation with navigated guide tubes for screw placement. PMID:27529069

  17. Total 3D Airo® Navigation for Minimally Invasive Transforaminal Lumbar Interbody Fusion.

    PubMed

    Lian, Xiaofeng; Navarro-Ramirez, Rodrigo; Berlin, Connor; Jada, Ajit; Moriguchi, Yu; Zhang, Qiwei; Härtl, Roger

    2016-01-01

    Introduction. A new generation of iCT scanner, Airo®, has been introduced. The purpose of this study is to describe how Airo facilitates minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Method. We used the latest generation of portable iCT in all cases without the assistance of K-wires. We recorded the operation time, number of scans, and pedicle screw accuracy. Results. From January 2015 to December 2015, 33 consecutive patients consisting of 17 men and 16 women underwent single-level or two-level MIS-TLIF operations in our institution. The ages ranged from 23 years to 86 years (mean, 66.6 years). We treated all the cases in MIS fashion. In four cases, a tubular laminectomy at L1/2 was performed at the same time. The average operation time was 192.8 minutes and average time of placement per screw was 2.6 minutes. No additional fluoroscopy was used. Our screw accuracy rate was 98.6%. No complications were encountered. Conclusions. Airo iCT MIS-TLIF can be used for initial planning of the skin incision, precise screw, and cage placement, without the need for fluoroscopy. "Total navigation" (complete intraoperative 3D navigation without fluoroscopy) can be achieved by combining Airo navigation with navigated guide tubes for screw placement.

  18. Comparison of Outcomes of Anterior, Posterior, and Transforaminal Lumbar Interbody Fusion Surgery at a Single Lumbar Level with Degenerative Spinal Disease.

    PubMed

    Lee, Nam; Kim, Keung Nyun; Yi, Seong; Ha, Yoon; Shin, Dong Ah; Yoon, Do Heum; Kim, Keun Su

    2017-05-01

    The fusion rate in spinal surgery may vary in relation to the technique, and it remains unknown which surgical technique provides the best fusion rate and surgical outcome. We aimed to compare radiologic and surgical results between 3 surgical techniques used for lumbar interbody fusion. Participants included 77 patients diagnosed with degenerative spinal stenosis including spondylolytic spondylolisthesis. Patients were divided into 3 groups according to surgical technique: anterior lumbar interbody fusion (ALIF, n = 26), transforaminal lumbar interbody fusion (TLIF, n = 21), and posterior lumbar interbody fusion (PLIF, n = 30). Various radiologic parameters were measured, including fusion rates. Significant changes after surgery were observed in the ALIF group for the percentage of vertebral body slippage, anterior disk height, posterior disk height, and segmental range of movement (ROM). The fusion rate on computed tomography (CT) scan at the final follow-up was 69.2% in the ALIF group, 72.7% in the TLIF group, and 64.3% in the PLIF group. The cage subsidence rate 2 years after surgery was 15.4% in the ALIF group, 38.1% in the TLIF group, and 10% in the PLIF group. ALIF was associated with better restoration of segmental lordosis. The fusion rate on CT scan and with segmental ROM did not differ between the 3 groups. TLIF was associated with a better postoperative visual analog scale. PLIF showed the lowest cage subsidence rate. Therefore, it is difficult to know which surgical technique is better among the 3 groups because each surgical method has its own advantages. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Open and Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Intermediate Results and Complications

    PubMed Central

    Hee, Hwan Tak

    2015-01-01

    Study Design Prospective study. Purpose To compare clinical and radiological outcomes of open vs. minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Overview of Literature MI-TLIF promises smaller incisions and less soft tissue dissection resulting in lower morbidity and faster recovery; however, it is technically challenging. Methods Twenty-five patients with MI-TLIF were compared with 25 matched open TLIF controls. A minimum 2 year follow-up and a statistical analysis of perioperative and long-term outcomes were performed. Potential complications were recorded. Results The mean ages for the open and MI-TLIF cases were 44.4 years (range, 19-69 years) and 43.6 years (range, 20-69 years), respectively. The male:female ratio was 13:12 for both groups. Average follow-up was 26.9 months for the MI-TLIF group and 29.3 months for the open group. Operative duration was significantly longer in the MI-TLIF group than that in the open group (p<0.05). No differences in estimated blood loss, duration to ambulation, or length of stay were found. Significant improvements in the Oswestry disability index and EQ-5D functional scores were observed at 6-, 12-, and 24-months in both groups, but no significant difference was detected between the groups. Fusion rates were comparable. Cage sizes were significantly smaller in the MI-TLIF group at the L5/S1 level (p<0.05). One patient had residual spinal stenosis at the MI-TLIF level, and one patient who underwent two-level MI-TLIF developed a deep vein thrombosis resulting in a pulmonary embolism. Conclusions MI-TLIF and open TLIF had comparable long-term benefits. Due to technical constraints, patients should be advised on the longer operative time and potential undersizing of cages at the L5S1 level. PMID:25901228

  20. Results of lumbar spondylodeses using different bone grafting materials after transforaminal lumbar interbody fusion (TLIF).

    PubMed

    vonderHoeh, Nicolas Heinz; Voelker, Anna; Heyde, Christoph-Eckhard

    2017-05-25

    Can a mixture of hydroxyapatite (HA) and autologous bone from decompression sites produce similar results when used for transforaminal lumbar interbody fusion (TLIF)? In the current literature, autologous iliac crest bone grafts (ICBGs) have been reported the gold standard for this procedure. Indeed, to date, no clinical data have confirmed that a mixture of equal volumes of HA and local autologous bone produce similar results in term of fusion as the same volume of autologous ICBG alone. Study design/setting This study was approved by the local ethics committee and completed in a prospective, randomized, single-blinded manner. The results of lumbar fusion using TLIF and different bone grafting materials were compared. Patient sample The patient sample included patients with spinal lumbar degenerative disease. Outcome measures The clinical outcome was determined using the Oswestry Low Back Pain Disability Questionnaire (ODI) and Visual Analog Scale (VAS). The radiological outcomes and fusion rates were determined with radiographs evaluated using the McAfee criteria and computed tomography (CT) data evaluated by the Williams criteria. Three blinded investigators (one radiologist and two orthopedic surgeons) assessed the data. The secondary variables included donor site morbidity. Methods The patients were admitted to our department for orthopedic surgery with degenerative lumbar pathologies (L2-S1) that required stabilization in one or two segments using a TLIF procedure. The patients were 18-80 years old. Only those patients who had degenerative lumbar pathologies and agreed to be educated about the study were included. The patients were divided into the following two randomized groups: group A: TLIF procedure using autologous ICBGs alone; and group B: TLIF procedure using local bone from decompression site mixed with hydroxyapatite. Each group received equal graft volumes. The mixture in group B consisted of equal volumes of local autograft (5 cc) and synthetic

  1. Vertebral Body Hounsfield Units are Associated With Cage Subsidence After Transforaminal Lumbar Interbody Fusion With Unilateral Pedicle Screw Fixation.

    PubMed

    Mi, Jie; Li, Kang; Zhao, Xin; Zhao, Chang-Qing; Li, Hua; Zhao, Jie

    2017-10-01

    To assess the association between Hounsfield units (HU) measurement and cage subsidence after lumbar interbody fusion. Transforaminal lumbar interbody fusion (TLIF) with unilateral fixation becomes a popular treatment modality for lumbar degenerative disease. Cage subsidence is a potentially devastating complication after lumbar interbody fusion with unilateral fixation. Recently, a new technique for assessing bone mineral density using HU values from computed tomography has been proposed. Bone quality is believed to be one of the important factors that cause cage subsidence after TLIF. Cage subsidence after single-level (L4/5) TLIF with unilateral fixation was prospectively documented at a single institution between 2013 and 2014. Patients with cage subsidence were matched 1:1 to a control cohort without cage subsidence on the basis of age and sex. HU values were measured from the preoperative computed tomography. All patients received computed tomographic scans at a minimum of 6 months postoperatively. Sagittal images were evaluated for evidence of cage subsidence. Eighteen patients with cage subsidence were well matched 1:1 to a cohort without cage subsidence and had complete imaging data. The global lumbar HU values were significantly lower in patients with cage subsidence than in the controls (112.4±10.08 vs. 140.2±10.17; P=0.0015). Similarly, a regional assessment of HU across the fusion levels was significantly lower in patients with cage subsidence (113.4±10.47 vs. 127.9±8.13; P=0.0075). The areas under the receiver operating characteristic cure were 0.715 and 0.636 for global and regional assessment, respectively. The best cut-offs for global and regional assessment were 132 (sensitivity: 83.3%; specificity: 61.1%) and 122 (sensitivity: 72.2%; specificity: 55.6%), respectively. Lower preoperative HU values is associated with cage subsidence after TLIF with unilateral fixation. HU measurement may be used as a predictor of cage subsidence after

  2. Circumferential Fusion: A Comparative Analysis Between Anterior Lumbar Interbody Fusion with Posterior Pedicle Screw Fixation and Transforaminal Lumbar Interbody Fusion for L5-S1 Isthmic Spondylolisthesis.

    PubMed

    Tye, Erik Y; Tanenbaum, Joseph E; Alonso, Andrea S; Xiao, Roy; Steinmetz, Michael P; Mroz, Thomas E; Savage, Jason W

    2017-08-15

    Transforaminal lumbar interbody fusion (TLIF) or anterior lumbar interbody fusion with percutaneous pedicle screws (ALIFPS) offer significantly higher radiographic fusion rates than other fusion techniques for L5-S1 isthmic spondylolisthesis (IS). As it stands, there is a relative paucity of comparative data of the two techniques. To define the clinical, radiographic, and financial differences between TLIF and ALIFPS for L5-S1 IS. A retrospective cohort study conducted at a single-tertiary care center. 66 patients who underwent either TLIF or ALIPFS for L5-S1 IS at a single-tertiary care center between 2009-2014. Self-reported health status measures, including the EuroQol-5 Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9). Radiographic parameters including pelvic incidence, pelvic tilt, sacral slope, segmental lordosis, total lordosis, degree of slip, disc height, and L1-Axis S1 Distance (LASD). Cost measures included in-hospital charges, hospital length of stay (LOS), and post-admission costs out to 1 year. Quality of life (QoL) outcome scores, radiographic data, and financial data were collected with a minimum of 1-year follow up. Clinical results were investigated using the Pain Disability Questionnaire (PDQ), Patient Health Questionnaire-9 (PHQ-9), and EuroQol-5 Dimension Health State (EQ-5D). Radiographic measurements included lumbar lordosis, segmental lordosis, pelvic tilt, pelvic incidence, height of disc, L-1 axis S-1 distance (LASD), and the degree of slip. Cost data were generated based on patient-level resource utilization. Comparative data were presented as median with interquartile range (IQR). Continuous variables were compared using either independent student t-tests assuming unequal variance or Whitney-Mann U tests for parametric and non-parametric variables, respectively. The minimally clinical important difference (MCID) used for each questionnaire was as follows: PDQ (26), PHQ-9 (5), and EQ-5D

  3. Evaluation of a novel tool for bone graft delivery in minimally invasive transforaminal lumbar interbody fusion

    PubMed Central

    Kleiner, Jeffrey B; Kleiner, Hannah M; Grimberg, E John; Throlson, Stefanie J

    2016-01-01

    Study design Disk material removed (DMR) during L4-5 and L5-S1 transforaminal lumbar interbody fusion (T-LIF) surgery was compared to the corresponding bone graft (BG) volumes inserted at the time of fusion. A novel BG delivery tool (BGDT) was used to apply the BG. In order to establish the percentage of DMR during T-LIF, it was compared to DMR during anterior diskectomy (AD). This study was performed prospectively. Summary of background data Minimal information is available as to the volume of DMR during a T-LIF procedure, and the relationship between DMR and BG delivered is unknown. BG insertion has been empiric and technically challenging. Since the volume of BG applied to the prepared disk space likely impacts the probability of arthrodesis, an investigation is justified. Methods A total of 65 patients with pathology at L4-5 and/or L5-S1 necessitating fusion were treated with a minimally invasive T-LIF procedure. DMR was volumetrically measured during disk space preparation. BG material consisting of local autograft, BG extender, and bone marrow aspirate were mixed to form a slurry. BG slurry was injected into the disk space using a novel BGDT and measured volumetrically. An additional 29 patients who were treated with L5-S1 AD were compared to L5-S1 T-LIF DMR to determine the percent of T-LIF DMR relative to AD. Results DMR volumes averaged 3.6±2.2 mL. This represented 34% of the disk space relative to AD. The amount of BG delivered to the disk spaces was 9.3±3.2 mL, which is 2.6±2.2 times the amount of DMR. The BGDT allowed uncomplicated filling of the disk space in <1 minute. Conclusion The volume of DMR during T-LIF allows for a predictable volume of BG delivery. The BGDT allowed complete filling of the entire prepared disk space. The T-LIF diskectomy debrides 34% of the disk relative to AD. PMID:27274320

  4. Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases.

    PubMed

    Lee, Jae Chul; Jang, Hae-Dong; Shin, Byung-Joon

    2012-08-15

    Consecutive case series with prospective data collection. To define and analyze the learning curve for minimally invasive transforaminal lumbar interbody fusion (TLIF). Minimally invasive TLIF using a unilateral approach has recently been gaining popularity because of its potential for minimizing soft-tissue damage and reducing recovery time. However, a steep learning curve has been described for surgeons first performing this technique. Eighty-six consecutive patients with degenerative lumbar diseases who were treated by TLIF were included in the study. Surgeries were performed using a tubular retractor, and a cage was inserted using a unilateral transforaminal approach by a single surgeon. The corresponding segments were fixed with percutaneous pedicle screws. Eighty-three patients were followed up for more than 1 year, and the average follow-up period was 25 months. Single-level TLIF was performed in 60 cases, single-level TLIF plus adjacent-level decompression was performed in 13 cases, and double-level TLIF was performed in 13 cases. Corrected operative time per level, operative blood loss, postoperative blood drainage, total blood loss, and ambulation recovery time were measured. Transfusion rates and complication incidence were also identified. Clinical results were assessed using the Oswestry Disability Index (ODI) and a visual analogue scale (VAS). The learning curve was assessed using a logarithmic curve-fit regression analysis. In the single-level TLIF group (n = 60), 22 patients were defined as the "early" group (among the first 30 cases of the series), and the subsequent 38 cases were defined as the "late" group for comparison. Corrected operative time gradually decreased as the series progressed, and an asymptote was reached after about 30 cases. ODI significantly decreased from an average of 24 at the preoperative stage to 10 at the final follow-up. Average VAS scores for lower back pain and radiating pain also significantly decreased from an average

  5. Posterolateral instrumented fusion with and without transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis: A randomized clinical trial with 2-year follow-up

    PubMed Central

    Etemadifar, Mohammad Reza; Hadi, Abdollah; Masouleh, Mehran Feizi

    2016-01-01

    Background: Spondylolisthesis is a common cause of surgery in patients with lower back pain. Although posterolateral fusion and pedicle screw fixation are a relatively common treatment method for the treatment of spondylolisthesis, controversy exists about the necessity of adding interbody fusion to posterolateral fusion. The aim of our study was to assess the functional disability, pain, and complications in patients with spondylolisthesis treated by posterolateral instrumented fusion (PLF) with and without transforaminal lumbar interbody fusion (TLIF) in a randomized clinical trial. Materials and Methods: From February 2007 to February 2011, 50 adult patients with spondylolisthesis were randomly assigned to be treated with PLF or PLF+TLIF techniques (25 patients in each group) by a single surgeon. Back pain, leg pain, and disability were assessed before treatment and until 2 years after surgical treatment using visual analog scale (VAS) and oswestry disability index (ODI). Patients were also evaluated for postoperative complications such as infection, neurological complications, and instrument failure. Results: All patients completed the 24 months of follow-up. Twenty patients were females and 30 were males. Average age of the patients was 53 ± 11 years for the PLF group and 51 ± 13 for the PLF + TLIF group. Back pain, leg pain, and disability score were significantly improved postoperatively compared to preoperative scores (P < 0.001). At 3 months of follow-up, there was no statistically significant difference in VAS score for back pain and leg pain in both groups; however, after 6 months and 1 year and 2 years follow-up, the reported scores for back pain and leg pain were significantly lower in the PLF+TLIF group (P < 0.05). The ODI score was also significantly lower in the PLF+TLIF group at 1 year and 2 years of follow-up (P < 0.05). One screw breakage and one superficial infection occurred in the PLF+TLIF group, which had no statistical significance (P = 0

  6. Long-Term Objective Physical Activity Measurements using a Wireless Accelerometer Following Minimally Invasive Transforaminal Interbody Fusion Surgery.

    PubMed

    Phan, Kevin; Mobbs, Ralph J

    2016-04-01

    We report on a case of a patient who underwent minimally invasive transforaminal lumbar interbody fusion (mi-TLIF) with objective physical activity measurements performed preoperatively and postoperatively at up to 12-months using wireless accelerometer technology. In the first postoperative month following surgery, the patient had reduced mobility, taking 2,397 steps over a distance of 1.8 km per day. However, the number of steps taken and distance travelled per day had returned to baseline levels by the second postoperative month. At one-year follow-up, the patient averaged 5,095 steps per day in the month over a distance of 3.8 km; this was a 60% improvement in both steps taken and distance travelled compared to the preoperative status. The use of wireless accelerometers is feasible in obtaining objective physical activity measurements before and after lumbar interbody fusion and may be applicable to other related spinal surgeries as well.

  7. Outcome Measures of an Intracanal, Endoscopic Transforaminal Decompression Technique: Initial Findings from the MIS Prospective Registry

    PubMed Central

    Sclafani, Joseph A.; Raiszadeh, Kamshad; Laich, Dan; Shen, Jian; Bennett, Matthew; Blok, Robert; Liang, Kevin

    2015-01-01

    Background Minimally invasive transforaminal endoscopic procedures can achieve spinal decompression through either direct or indirect techniques. Subtle variations in trajectory of the surgical corridor can dictate access to the pathologic tissue. Two general strategies exist: the intradiscal “inside-out” technique and the extradiscal, intracanal (IC) technique. The IC technique utilizes a more lateral transforaminal approach than the intradiscal technique, which allows for a more direct decompression of the spinal canal. Objective This study is an assessment of IC patient outcome data obtained through analysis of a previously validated MIS Prospective Registry. Methods Post-hoc analysis was performed on the MIS Prospective Registry database containing 1032 patients. A subgroup of patients treated with the endoscopic IC technique was identified. Patient outcome measures after treatment of symptomatic disk herniation and neuroforaminal stenosis were evaluated. Results A total of 86 IC patients were analyzed. Overall, there was significant improvement in employment and walking tolerance as soon as 6 weeks post-op as well as significant one year VAS and ODI score improvement. Subanalysis of IC patients with two distinct primary diagnoses was performed. Group IC-1 (disc herniation) showed improvement in ODI and VAS back and leg outcomes at 1 year post-op. Group IC-2 (foraminal stenosis) showed VAS back and leg score improvement at one year post-op but did not demonstrate significant improvement in overall ODI outcome at any time point. The one year re-operation rate was 2% (1/40) for group IC-1 and 28% (5/18) for group IC-2. Conclusions The initial results of the MIS Registry IC subgroup show a significant clinical improvement when the technique is employed to treat patients with lumbar disc herniation. The treatment of foraminal stenosis can lead to improved short-term clinical outcome but is associated with a high re-operation rate at 1 year post-op. PMID

  8. Outcome Measures of an Intracanal, Endoscopic Transforaminal Decompression Technique: Initial Findings from the MIS Prospective Registry.

    PubMed

    Sclafani, Joseph A; Raiszadeh, Kamshad; Laich, Dan; Shen, Jian; Bennett, Matthew; Blok, Robert; Liang, Kevin; Kim, Choll W

    2015-01-01

    Minimally invasive transforaminal endoscopic procedures can achieve spinal decompression through either direct or indirect techniques. Subtle variations in trajectory of the surgical corridor can dictate access to the pathologic tissue. Two general strategies exist: the intradiscal "inside-out" technique and the extradiscal, intracanal (IC) technique. The IC technique utilizes a more lateral transforaminal approach than the intradiscal technique, which allows for a more direct decompression of the spinal canal. This study is an assessment of IC patient outcome data obtained through analysis of a previously validated MIS Prospective Registry. Post-hoc analysis was performed on the MIS Prospective Registry database containing 1032 patients. A subgroup of patients treated with the endoscopic IC technique was identified. Patient outcome measures after treatment of symptomatic disk herniation and neuroforaminal stenosis were evaluated. A total of 86 IC patients were analyzed. Overall, there was significant improvement in employment and walking tolerance as soon as 6 weeks post-op as well as significant one year VAS and ODI score improvement. Subanalysis of IC patients with two distinct primary diagnoses was performed. Group IC-1 (disc herniation) showed improvement in ODI and VAS back and leg outcomes at 1 year post-op. Group IC-2 (foraminal stenosis) showed VAS back and leg score improvement at one year post-op but did not demonstrate significant improvement in overall ODI outcome at any time point. The one year re-operation rate was 2% (1/40) for group IC-1 and 28% (5/18) for group IC-2. The initial results of the MIS Registry IC subgroup show a significant clinical improvement when the technique is employed to treat patients with lumbar disc herniation. The treatment of foraminal stenosis can lead to improved short-term clinical outcome but is associated with a high re-operation rate at 1 year post-op.

  9. Transforaminal Lumbar Interbody Fusion with Rigid Interspinous Process Fixation: A Learning Curve Analysis of a Surgeon Team's First 74 Cases.

    PubMed

    Doherty, Patrick; Welch, Arthur; Tharpe, Jason; Moore, Camille; Ferry, Chris

    2017-05-30

    Studies have shown that a significant learning curve may be associated with adopting minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with bilateral pedicle screw fixation (BPSF). Accordingly, several hybrid TLIF techniques have been proposed as surrogates to the accepted BPSF technique, asserting that less/fewer fixation(s) or less disruptive fixation may decrease the learning curve while still maintaining the minimally disruptive benefits. TLIF with interspinous process fixation (ISPF) is one such surrogate procedure. However, despite perceived ease of adaptability given the favorable proximity of the spinous processes, no evidence exists demonstrating whether or not the technique may possess its own inherent learning curve. The purpose of this study was to determine whether an intraoperative learning curve for one- and two-level TLIF + ISPF may exist for a single lead surgeon. Seventy-four consecutive patients who received one- or two-Level TLIF with rigid ISPF by a single lead surgeon were retrospectively reviewed. It was the first TLIF + ISPF case series for the lead surgeon. Intraoperative blood loss (EBL), hospitalization length-of-stay (LOS), fluoroscopy time, and postoperative complications were collected. EBL, LOS, and fluoroscopy time were modeled as a function of case number using multiple linear regression methods. A change point was included in each model to allow the trajectory of the outcomes to change during the duration of the case series. These change points were determined using profile likelihood methods. Models were fit using the maximum likelihood estimates for the change points. Age, sex, body mass index (BMI), and the number of treated levels were included as covariates. EBL, LOS, and fluoroscopy time did not significantly differ by age, sex, or BMI (p ≥ 0.12). Only EBL differed significantly by the number of levels (p = 0.026). The case number was not a significant predictor of EBL, LOS, or fluoroscopy time (p ≥ 0

  10. Eccentric technique for foraminoplasty in percutaneous endoscopic transforaminal procedure: A technical note.

    PubMed

    Ba, Zhaoyu; Li, Zhiqiang; Liu, Zhonghan; Li, Haoxi; Wu, Desheng; Zhu, Jianguang

    2017-09-04

    To describe a modified technique usied for foraminoplasty in percutaneous endoscopic transforaminal procedure. 58 patients (20 males and 38 females, average age 52.5 years) underwent percutaneous endoscopic transforaminal procedure by using our modified technique. Under the guidance of C-arm fluoroscopy, a kirschner wire was inserted into targeted superior articular process. After expanding the soft tissues, a trepan with the largest diameter was located through the kirschner wire and the angle of trepan was flexible enough to adjust to different operative conditions. This technique could help to avoided using step-by-step larger diameters of trepans without slippage during foraminoplasty. With our modified technique, the mean operation time was 65 min (range 50-80 min) and mean estimated blood loss was 12 ml (range 10-30 ml). Fluoroscopy was less (the mean duration of fluoroscopy was 20.4 ± 9.2 s and the mean radiation dose was 0.9 ± 0.2 mSv) and no complications occurred. All foraminoplasties were excellent via CT scans after surgery and all patients were discharged on 2nd day after operation. The results of 58 patients with an average follow-up of 18 (6-36) months demonstrated our eccentric technique to be effective. Our eccentric technique could help to avoid step-by-step larger diameters of trepans during foraminoplasty to shorten operation time and reduced the number of fluoroscopy intraoperative. Copyright © 2017. Published by Elsevier Ltd.

  11. Minimally invasive transforaminal lumbar interbody fusion with expandable versus static interbody devices: radiographic assessment of sagittal segmental and pelvic parameters.

    PubMed

    Hawasli, Ammar H; Khalifeh, Jawad M; Chatrath, Ajay; Yarbrough, Chester K; Ray, Wilson Z

    2017-08-01

    OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has been adopted as an alternative technique to hasten recovery and minimize postoperative morbidity. Advances in instrumentation technologies and operative techniques have evolved to maximize patient outcomes as well as radiographic results. The development of expandable interbody devices allows a surgeon to perform MIS-TLIF with minimal tissue disruption. However, sagittal segmental and pelvic radiographic outcomes after MIS-TLIF with expandable interbody devices are not well characterized. The object of this study is to evaluate the radiographic sagittal lumbar segmental and pelvic parameter outcomes of MIS-TLIF performed using an expandable interbody device. METHODS A retrospective review of MIS-TLIFs performed between 2014 and 2016 at a high-volume center was performed. Radiographic measurements were performed on lateral radiographs before and after MIS-TLIF with static or expandable interbody devices. Radiographic measurements included disc height, foraminal height, fused disc angle, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. Mismatch between pelvic incidence and lumbar lordosis were calculated for each radiograph. RESULTS A total of 48 MIS-TLIFs were performed, predominantly at the L4-5 level, in 44 patients. MIS-TLIF with an expandable interbody device led to a greater and more sustained increase in disc height when compared with static interbody devices. Foraminal height increased after MIS-TLIF with expandable but not with static interbody devices. MIS-TLIF with expandable interbody devices increased index-level segmental lordosis more than with static interbody devices. The increase in segmental lordosis was sustained in the patients with expandable interbody devices but not in patients with static interbody devices. For patients with a collapsed disc space, MIS-TLIF with an expandable interbody device provided superior and longer-lasting increases in

  12. Minimally Invasive Transforaminal Lumbar Interbody Fusion with Percutaneous Bilateral Pedicle Screw Fixation for Lumbosacral Spine Degenerative Diseases. A retrospective database of 40 consecutive treated cases and literature review.

    PubMed

    Millimaggi, Daniele Francesco; DI Norcia, Valerio; Luzzi, Sabino; Alfiero, Tommaso; Galzio, Renato Juan; Ricci, Alessandro

    2017-04-12

    To report our results about minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with bilateral pedicle screw fixation, in patients with degenerative lumbosacral spine disease. To describe the indications, surgical technique and results of a consecutive series of 40 patients undergone MI-TLIF. Despite the limited number of clinical studies, published data suggest tremendous potential advantages of this technique. Forty patients with radiological findings of degenerative lumbosacral spine disease were undergone MI-TLIF between July 2012 and January 2015. Clinical outcomes were assessed by means of Oswestry Disability Index (ODI) and Health Survey Scoring (SF36) before surgery and at first year follow-up. Furthermore, the following parameters were retrospectively reviewed: age, sex, working activity, body mass index (BMI), type of degenerative disease, number of levels of fusion, operative time, blood loss, length of hospital stay. Average operative time was of 230 minutes, mean estimated blood loss 170 mL, average length of hospital stay 5 days. The ODI improved from a score of 59, preoperatively, to post-operative score of 20 at first year follow-up. Average SF36 score increased from 36 to 54 (Physical Health) and from 29 to 50 (Mental Health) at first year outcome evaluation. MI-TLIF with bilateral pedicle screw fixation is an excellent choice for selected patients suffering from symptomatic degenerative lumbosacral spine disease, especially secondary to recurrent disk herniations.

  13. Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation in surgical treatment for single-segment lumbar spinal tuberculosis.

    PubMed

    Zeng, Hao; Wang, Xiyang; Zhang, Penghui; Peng, Wei; Liu, Zheng; Zhang, Yupeng

    2015-01-01

    The aim of this study is to determine the feasibility and efficacy of surgical management of single-segment lumbar spinal tuberculosis (TB) by using single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. The mean follow-up was 36.9 months (range: 24-62 months). The kyphotic angle ranged from 15.2-35.1° preoperatively, with an average measurement of 27.8°. The American Spinal Injury Association (ASIA) score system was used to evaluate the neurological deficits and erythrocyte sedimentation rate (ESR) used to judge the activity of TB. Spinal TB was completely cured in all 17 patients. There was no recurrent TB infection. The postoperative kyphotic angle was 6.6-10.2°, 8.1° in average, and there was no significant loss of the correction at final follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation can be a feasible and effective method the in treatment of single-segment lumbar spinal TB.

  14. Minimally Invasive Transforaminal Lumbar Interbody Fusion at L5-S1 through a Unilateral Approach: Technical Feasibility and Outcomes

    PubMed Central

    Choi, Won-Suh; Kim, Jin-Sung; Ryu, Kyeong-Sik; Hur, Jung-Woo; Seong, Ji-Hoon

    2016-01-01

    Background. Minimally invasive spinal transforaminal lumbar interbody fusion (MIS-TLIF) at L5-S1 is technically more demanding than it is at other levels because of the anatomical and biomechanical traits. Objective. To determine the clinical and radiological outcomes of MIS-TLIF for treatment of single-level spinal stenosis low-grade isthmic or degenerative spondylolisthesis at L5-S1. Methods. Radiological data and electronic medical records of patients who underwent MIS-TLIF between May 2012 and December 2014 were reviewed. Fusion rate, cage position, disc height (DH), disc angle (DA), disc slope angle, segmental lordotic angle (SLA), lumbar lordotic angle (LLA), and pelvic parameters were assessed. For functional assessment, the visual analogue scale (VAS), Oswestry disability index (ODI), and patient satisfaction rate (PSR) were utilized. Results. A total of 21 levels in 21 patients were studied. DH, DA, SLA, and LLA had increased from their preoperative measures at the final follow-up. Fusion rate was 86.7% (18/21) at 12 months' follow-up. The most common cage position was anteromedial (15/21). The mean VAS scores for back and leg pain mean ODI scores improved significantly at the final follow-up. PSR was 88%. Cage subsidence was observed in 33.3% (7/21). Conclusions. The clinical and radiologic outcomes after MIS-TLIF at L5-S1 in patients with spinal stenosis or spondylolisthesis are generally favorable. PMID:27433472

  15. Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature.

    PubMed

    Joseph, Jacob R; Smith, Brandon W; La Marca, Frank; Park, Paul

    2015-10-01

    OBJECT Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and lateral lumbar interbody fusion (LLIF) are 2 currently popular techniques for lumbar arthrodesis. The authors compare the total risk of each procedure, along with other important complication outcomes. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies (up to May 2015) that reported complications of either MI-TLIF or LLIF were identified from a search in the PubMed database. The primary outcome was overall risk of complication per patient. Secondary outcomes included risks of sensory deficits, temporary neurological deficit, permanent neurological deficit, intraoperative complications, medical complications, wound complications, hardware failure, subsidence, and reoperation. RESULTS Fifty-four studies were included for analysis of MI-TLIF, and 42 studies were included for analysis of LLIF. Overall, there were 9714 patients (5454 in the MI-TLIF group and 4260 in the LLIF group) with 13,230 levels fused (6040 in the MI-TLIF group and 7190 in the LLIF group). A total of 1045 complications in the MI-TLIF group and 1339 complications in the LLIF group were reported. The total complication rate per patient was 19.2% in the MI-TLIF group and 31.4% in the LLIF group (p < 0.0001). The rate of sensory deficits and temporary neurological deficits, and permanent neurological deficits was 20.16%, 2.22%, and 1.01% for MI-TLIF versus 27.08%, 9.40%, and 2.46% for LLIF, respectively (p < 0.0001, p < 0.0001, p = 0.002, respectively). Rates of intraoperative and wound complications were 3.57% and 1.63% for MI-TLIF compared with 1.93% and 0.80% for LLIF, respectively (p = 0.0003 and p = 0.034, respectively). No significant differences were noted for medical complications or reoperation. CONCLUSIONS While there was a higher overall complication rate with LLIF, MI-TLIF and LLIF both have

  16. Unilateral Versus Bilateral Pedicle Screw Fixation in Transforaminal Lumbar Interbody Fusion: A Monocentric Study of 215 Patients With a Minimum of 4-Year Follow-up.

    PubMed

    Liu, Fubing; Feng, Zhenzhou; Zhou, Xiaogang; Liang, Yun; Jiang, Chun; Li, Xilei; Li, Zheng; Jiang, Xiaoxing; Dong, Jian

    2017-07-01

    A retrospective clinical study. This study sought to retrospectively compare the mid-term to long-term outcomes between unilateral pedicle screw (UPS) and bilateral pedicle screw (BPS) augmented transforaminal lumbar interbody fusion (TLIF) in lumbar degenerative diseases. Recently, UPS fixation has been applied in TLIF, for its satisfactory clinical outcome, less implants and less invasiveness. However, only short-term outcome has been reported, the mid-term to long-term outcome has not been well characterized. From June 2007 to February 2011, 215 of 348 consecutive patients suffering from lumbar degenerative diseases were operated in our hospital and accomplished a minimum of 4-year follow-up. These patients were divided into 2 groups according to the operative techniques: UPS group (n=109), and bilateral pedicle screw group (n=106). Operative time, blood loss, length of hospital stay, hospital bill, fusion status, and complications were recorded and analyzed statistically. Visual analog scale, Oswestry disability index, and Japanese Orthopaedic Association scores were used to assess the preoperative and postoperative pain and functional outcome. The mean follow-up duration was 52.2 months. A significant decrease occurred in operative time, blood loss, and hospital bill in unilateral group, compared with bilateral group (P<0.05). The average postoperative visual analog scale, Oswestry disability index, and Japanese Orthopaedic Association scores improved significantly in each group than the preoperative counterparts (P<0.05); however, there were no significant difference between groups at any follow-up time point (P>0.05). No statistically difference was detected regarding fusion rate and complication rate between the 2 groups (P>0.05), except the cage migration rate (P<0.05). UPS fixation could achieve satisfactory clinical outcome similar to bilateral fixation in TLIF at a mid-term to long-term follow-up. To avoid cage migration, bullet-shaped cages should not

  17. An Outcome and Cost Analysis Comparing Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Intraoperative Fluoroscopy versus Computed Tomography-Guided Navigation.

    PubMed

    Khanna, Ryan; McDevitt, Joseph L; Abecassis, Zachary A; Smith, Zachary A; Koski, Tyler R; Fessler, Richard G; Dahdaleh, Nader S

    2016-10-01

    Minimally invasive transforaminal lumbar interbody fusion (TLIF) has undergone significant evolution since its conception as a fusion technique to treat lumbar spondylosis. Minimally invasive TLIF is commonly performed using intraoperative two-dimensional fluoroscopic x-rays. However, intraoperative computed tomography (CT)-based navigation during minimally invasive TLIF is gaining popularity for improvements in visualizing anatomy and reducing intraoperative radiation to surgeons and operating room staff. This is the first study to compare clinical outcomes and cost between these 2 imaging techniques during minimally invasive TILF. For comparison, 28 patients who underwent single-level minimally invasive TLIF using fluoroscopy were matched to 28 patients undergoing single-level minimally invasive TLIF using CT navigation based on race, sex, age, smoking status, payer type, and medical comorbidities (Charlson Comorbidity Index). The minimum follow-up time was 6 months. The 2 groups were compared in regard to clinical outcomes and hospital reimbursement from the payer perspective. Average surgery time, anesthesia time, and hospital length of stay were similar for both groups, but average estimated blood loss was lower in the fluoroscopy group compared with the CT navigation group (154 mL vs. 262 mL; P = 0.016). Oswestry Disability Index, back visual analog scale, and leg visual analog scale scores similarly improved in both groups (P > 0.05) at 6-month follow-up. Cost analysis showed that average hospital payments were similar in the fluoroscopy versus the CT navigation groups ($32,347 vs. $32,656; P = 0.925) as well as payments for the operating room (P = 0.868). Single minimally invasive TLIF performed with fluoroscopy versus CT navigation showed similar clinical outcomes and cost at 6 months. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Clinical Outcomes of Posterior Lumbar Interbody Fusion versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in Three-Level Degenerative Lumbar Spinal Stenosis

    PubMed Central

    Fan, Guoxin; Wu, Xinbo; Yu, Shunzhi; Sun, Qi; Zhang, Hailong; Gu, Xin

    2016-01-01

    The aim of this study was to directly compare the clinical outcomes of posterior lumbar interbody fusion (PLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in three-level lumbar spinal stenosis. This retrospective study involved a total of 60 patients with three-level degenerative lumbar spinal stenosis who underwent MIS-TLIF or PLIF from January 2010 to February 2012. Back and leg visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) scale were used to assess the pain, disability, and health status before surgery and postoperatively. In addition, the operating time, estimated blood loss, and hospital stay were also recorded. There were no significant differences in back VAS, leg VAS, ODI, SF-36, fusion condition, and complications at 12-month follow-up between the two groups (P > 0.05). However, significantly less blood loss and shorter hospital stay were observed in MIS-TLIF group (P < 0.05). Moreover, patients undergoing MIS-TLIF had significantly lower back VAS than those in PLIF group at 6-month follow-up (P < 0.05). Compared with PLIF, MIS-TLIF might be a prior option because of noninferior efficacy as well as merits of less blood loss and quicker recovery in treating three-level lumbar spinal stenosis. PMID:27747244

  19. Biomechanical Analysis of a Newly Developed Shape Memory Alloy Hook in a Transforaminal Lumbar Interbody Fusion (TLIF) In Vitro Model

    PubMed Central

    Wang, Xi; Xu, Jing; Zhu, Yuexing; Li, Jiukun; Zhou, Si; Tian, Shunliang; Xiang, Yucheng; Liu, Xingmo; Zheng, Ying; Pan, Tao

    2014-01-01

    Objective The objective of this biomechanical study was to evaluate the stability provided by a newly developed shape memory alloy hook (SMAH) in a cadaveric transforaminal lumbar interbody fusion (TLIF) model. Methods Six human cadaveric spines (L1-S2) were tested in an in vitro flexibility experiment by applying pure moments of ±8 Nm in flexion/extension, left/right lateral bending, and left/right axial rotation. After intact testing, a TLIF was performed at L4-5. Each specimen was tested for the following constructs: unilateral SMAH (USMAH); bilateral SMAH (BSMAH); unilateral pedicle screws and rods (UPS); and bilateral pedicle screws and rods (BPS). The L3–L4, L4–L5, and L5-S1 range of motion (ROM) were recorded by a Motion Analysis System. Results Compared to the other constructs, the BPS provided the most stability. The UPS significantly reduced the ROM in extension/flexion and lateral bending; the BSMAH significantly reduced the ROM in extension/flexion, lateral bending, and axial rotation; and the USMAH significantly reduced the ROM in flexion and left lateral bending compared with the intact spine (p<0.05). The USMAH slightly reduced the ROM in extension, right lateral bending and axial rotation (p>0.05). Stability provided by the USMAH compared with the UPS was not significantly different. ROMs of adjacent segments increased in all fixed constructs (p>0.05). Conclusions Bilateral SMAH fixation can achieve immediate stability after L4–5 TLIF in vitro. Further studies are required to determine whether the SMAH can achieve fusion in vivo and alleviate adjacent segment degeneration. PMID:25474112

  20. Biomechanical analysis of a newly developed shape memory alloy hook in a transforaminal lumbar interbody fusion (TLIF) in vitro model.

    PubMed

    Wang, Xi; Xu, Jing; Zhu, Yuexing; Li, Jiukun; Zhou, Si; Tian, Shunliang; Xiang, Yucheng; Liu, Xingmo; Zheng, Ying; Pan, Tao

    2014-01-01

    The objective of this biomechanical study was to evaluate the stability provided by a newly developed shape memory alloy hook (SMAH) in a cadaveric transforaminal lumbar interbody fusion (TLIF) model. Six human cadaveric spines (L1-S2) were tested in an in vitro flexibility experiment by applying pure moments of ±8 Nm in flexion/extension, left/right lateral bending, and left/right axial rotation. After intact testing, a TLIF was performed at L4-5. Each specimen was tested for the following constructs: unilateral SMAH (USMAH); bilateral SMAH (BSMAH); unilateral pedicle screws and rods (UPS); and bilateral pedicle screws and rods (BPS). The L3-L4, L4-L5, and L5-S1 range of motion (ROM) were recorded by a Motion Analysis System. Compared to the other constructs, the BPS provided the most stability. The UPS significantly reduced the ROM in extension/flexion and lateral bending; the BSMAH significantly reduced the ROM in extension/flexion, lateral bending, and axial rotation; and the USMAH significantly reduced the ROM in flexion and left lateral bending compared with the intact spine (p<0.05). The USMAH slightly reduced the ROM in extension, right lateral bending and axial rotation (p>0.05). Stability provided by the USMAH compared with the UPS was not significantly different. ROMs of adjacent segments increased in all fixed constructs (p>0.05). Bilateral SMAH fixation can achieve immediate stability after L4-5 TLIF in vitro. Further studies are required to determine whether the SMAH can achieve fusion in vivo and alleviate adjacent segment degeneration.

  1. Short-Term Results of Transforaminal Lumbar Interbody Fusion Using Pedicle Screw with Cortical Bone Trajectory Compared with Conventional Trajectory

    PubMed Central

    Miyakoshi, Naohisa; Hongo, Michio; Ishikawa, Yoshinori; Kudo, Daisuke; Shimada, Yoichi

    2015-01-01

    Study Design Case-control study. Purpose To evaluate clinical and radiological results of transforaminal lumbar interbody fusion (TLIF) performed with cortical bone trajectory (CBT) pedicle screw insertion with those of TLIF using 'conventional' or percutaneous pedicle screw insertion. Overview of Literature CBT is a new trajectory for pedicle screw insertion in the lumbar spine; clinical and radiological results of TLIF using pedicle screws inserted with CBT are unclear. Methods In total, 26 patients (11 males, 15 females) were enrolled in this retrospective study and divided into three groups: TLIF with pedicle screw insertion by conventional minimally invasive methods via the Wiltse approach (M-TLIF, n=10), TLIF with percutaneous pedicle screw insertion (P-TLIF, n=6), and TLIF with pedicle screw insertion with CBT (CBT-TLIF, n=10). Surgical results and preand postoperative radiological findings were evaluated and compared. Results Intraoperative blood loss was significantly less with CBT-TLIF (p=0.03) than with M-TLIF. Postoperative lordotic angles did not differ significantly among the three groups. Complete fusions were obtained in 10 of 12 levels (83%) with M-TLIF, in seven levels (100%) with P-TLIF, and in 10 of 11 levels (91%) with CBT-TLIF. On postoperative computed tomography, correct positioning was seen in 84.1% of M-TLIF screws, 88.5% of P-TLIF screws, and 90% of CBT-TLIF screws. Conclusions CBT-TLIF resulted in less blood loss and a shorter operative duration than M-TLIF or P-TLIF. Postoperative rates of bone union, maintenance of lordotic angles, and accuracy of pedicle screw positions were similar among the three groups. PMID:26097661

  2. Lumbar retrodiscal transforaminal injection.

    PubMed

    Jasper, Joseph F

    2007-05-01

    Spinal injections are commonly used to treat lumbar radiculitis and back pain. Delivery of medication to specific targeted pathology is considered important for a successful therapeutic outcome. A variety of routes of injection have been devised for epidural injection of corticosteroid. The author demonstrates a variation of the transforaminal injection technique. The radiographic spread of contrast is described using a more oblique and ventral caudad approach in the epidural space "retrodiscal." It is suggested that the radiographic findings of this technique for discogenic causes of induced radiculitis and/or back pain may yield more precise targeting of putative pathologic sources of radiculopathy and back pain in selected patients. In patients with disc pathology and radiculitis, the anatomy of the lumbar epidural space is reviewed for its potential effect on the flow of injectate. Contrast spread was documented for lumbar transforaminal injection using a needle placement more oblique and behind the disc rather than in the cranial portion. Comparison is made to a typical contrast spread of an infra-pedicular placed transforaminal injection. Retrodiscal contrast injection results in reliable coverage of the retrodiscal region, the exiting nerve at that foraminal level and the proximal portion of the transiting segmental neural sleeve. The radiographic findings demonstrate a difference between classic infra-pedicular versus retrodiscal transforaminal epidural contrast injection patterns, particularly at relatively low volumes. The clinical advantage of one technique versus the other should be established in randomized prospective studies.

  3. Comparison of outcomes between minimally invasive transforaminal lumbar interbody fusion and traditional posterior lumbar intervertebral fusion in obese patients with lumbar disk prolapse

    PubMed Central

    Wang, Ya-Peng; An, Ji-Long; Sun, Ya-Peng; Ding, Wen-Yuan; Shen, Yong; Zhang, Wei

    2017-01-01

    Objective The aim of this study was to compare the curative effect between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and the posterior lumbar interbody fusion (PLIF) in obese patients with lumbar disk prolapse. Patients and methods In this study, 72 patients who underwent lumbar disk prolapse therapy in the Third Hospital of Hebei Medical University between March 2011 and 2015 were retrospectively analyzed and were divided into two groups, MIS-TLIF group (n=35) and PLIF group (n=37), according to different surgical procedures. Several clinical parameters were compared between these two groups. Results Compared with PLIF, MIS-TLIF was associated with longer operative time, less blood loss, less postoperative drainage and shorter postoperative time in bed; moreover, patients in the MIS-TLIF group had lower levels of serum creatine kinase on 1, 3 and 5 postoperative days. At the 3- and 6-month follow-up, Visual Analog Scale (VAS) scores of low back pain of patients in the MIS-TLIF group were significantly reduced and Japanese Orthopaedic Association (JOA) scores were increased, whereas the Oswestry Disability Index (ODI) showed no significant difference between the two groups. Conclusion Obese patients can achieve good efficacy with MIS-TLIF or PLIF treatment, but MIS-TLIF surgery showed longer operative time, fewer traumas and bleeding volume, less incidence of short-term pain, low complication rate and faster postoperative recovery. PMID:28176906

  4. The Use of Bone Morphogenetic Protein in Spinal Transforaminal Lumbar Interbody Fusion: Our Experience.

    PubMed

    Colom-Beauchamp, Eduardo; Beaton-Comulada, David; Rodriguez, Julio A; Pérez-López, José C; Montañez-Huertas, José; Escobar-Medina, Enrique; Massanet-Vollrath, José

    2017-09-01

    Since its introduction and FDA approval, rhBMP-2 has been adopted by spine surgeons as a substitute for ICBG in numerous spinal fusion techniques. As broad clinical use increased, reports on potential complications associated with rhBMP-2 also increased. We provide our experience with TLIF using rhBMP-2 or ICBG in an entirely Hispanic population. This was a 2-year retrospective study of 67 patients, with 26 in the rhBMP-2 group and 41 in the ICBG group, who underwent TLIF. Pertinent information was obtained through review of the medical records documenting complications, intraoperative times, and EBL, among other things. There were 28 post-operative complications with 15 (53.6%) in the ICBG group and 13 (46.4%) in the rhBMP-2 group. The average EBL was 572.3 mL (SD: 411.8) in the ICBG group and 397.9 mL (SD: 312.2) in the rhBMP-2 group. The average intraoperative time was 243.1 minutes (SD: 79.5) in the ICBG group and 226.5 minutes (SD: 64.7) in the rhBMP-2 group. Fifty-two patients underwent open TLIF and 15 patients underwent MI TLIF. The average EBL was 571.2 mL (SD: 375.3) in the open TLIF group and 228.3 mL (SD: 299.3) in the MI-TLIF group. The average intraoperative time was 241.0 minutes (SD: 76.0) for patients in the open TLIF group and 218.8 minutes (SD: 65.0) for those in the MI-TLIF group. There were no new cancer events at any of the 2-year follow-up visits. Our results suggest that the safety profile of rhBMP-2 may be inferior to that of ICBG, rejecting the possibility of ICBG being replaced by rhBMP-2 as the gold standard for spinal fusion.

  5. Elderly Patients Achieving Clinical and Radiological Outcomes Comparable with Those of Younger Patients Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.

    PubMed

    Nikhil N, Joshi; Lim, Joel Wei-An; Yeo, William; Yue, Wai-Mun

    2017-04-01

    Retrospective analysis of prospective database. To compare 2-year clinical and radiological outcomes after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) among "middle-age" (50-64.99 years), "young-old" (65-74.99 years), and "old-old" (>75 years) patients. Owing to higher perioperative morbidity and mortality rates, elderly patients with degenerative lumbar conditions are occasionally denied surgical care, even after conservative treatment failure. MIS-TLIF advantages include reduced blood loss, reduced analgesia requirements, early mobilization, and shorter hospital stays. Between 2007 and 2012, 22 patients (age >75 years) treated with 1-2 level MIS-TLIF were matched with "young-old" and "middle-age" patients (22 each) based on race, body mass index (BMI), diagnosis, spinal level, number of spinal levels operated upon, and bone graft type. Clinical outcomes included the Oswestry disability index (ODI), neurogenic symptom score (NSS), 36-item short form health survey (SF-36), and visual analogue scale (VAS) for back and leg pain. Radiological assessment included plain radiographs and preoperative magnetic resonance imaging (MRI) and plain radiographs at 1, 3, 6, and 24 months postoperatively. Fusion grade, loosening, cage migration, and adjacent segment degeneration were assessed. The groups had similar fluoroscopy time, operation duration, and postoperative analgesia type used. "Old-old" patients took longer to ambulate (1.6 days) and had longer hospital stays (6 days). All patients showed significant improvement in clinical outcome scores at all time-points compared with the preoperative status. "Middle-age" patients showed better ODI and SF-36 physical function scores than "old-old" patients preoperatively and 2 years post surgery. NSS, VAS (back and leg), and SF-36 mental function scores were similar between groups preoperatively and at every time-point postoperatively. Minimal clinical important differences (63.6%-95.5% at 2 years) were

  6. The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion: a clinical and radiographic analysis

    PubMed Central

    Makda, Junaid; Hong, Joseph; Patel, Ravi; Hilibrand, Alan S.; Anderson, David G.; Vaccaro, Alexander R.; Albert, Todd J.

    2009-01-01

    The “off label” use of rhBMP-2 in the transforaminal lumbar interbody fusion (TLIF) procedure has become increasingly popular. Although several studies have demonstrated the successful use of rhBMP-2 for this indication, uncertainties remain regarding its safety and efficacy. The purpose of this study is to evaluate the clinical and radiographic outcomes of the single-level TLIF procedure using rhBMP-2. Patients who underwent a single-level TLIF between January 2004 and May 2006 with rhBMP-2 were identified. A retrospective evaluation of these patients included operative report(s), pre- and postoperative medical records, and dynamic and static lumbar radiographs. Patient-reported clinical outcome measures were obtained from a telephone questionnaire and included a modification of the Odom’s criteria, a patient satisfaction score, and back and leg pain numeric rating scale scores. Forty-eight patients met the study criteria and were available for follow-up (avg. radiographic and clinical follow-up of 19.4 and 27.4 months, respectively). Radiographic fusion was achieved in 95.8% of patients. Good to excellent results were achieved in 71% of patients. On most recent clinical follow-up, 83% of patients reported improvement in their symptoms and 84% reported satisfaction with their surgery. Twenty-nine patients (60.4%) reported that they still had some back pain, with an average back pain numeric rating score of 2.8. Twenty patients (41.7%) reported that they still had some leg pain, with an average leg pain numeric rating score was 2.4. Thirteen patients (27.1%) had one or more complications, including transient postoperative radiculitis (8/48), vertebral osteolysis (3/48), nonunion (2/48), and symptomatic ectopic bone formation (1/48). The use of rhBMP-2 in the TLIF procedure produces a high rate of fusion, symptomatic improvement and patient satisfaction. Although its use eliminates the risk of harvesting autograft, rhBMP-2 is associated with other

  7. Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis: comparative effectiveness and cost-utility analysis.

    PubMed

    Parker, Scott L; Mendenhall, Stephen K; Shau, David N; Zuckerman, Scott L; Godil, Saniya S; Cheng, Joseph S; McGirt, Matthew J

    2014-01-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for lumbar spondylolisthesis allows for the surgical treatment of back/leg pain while minimizing tissue injury and accelerating the patient's recovery. Although previous results have shown shorter hospital stays and decreased intraoperative blood loss for MIS versus open TLIF, short- and long-term outcomes have been similar. Therefore, we performed comparative effectiveness and cost-utility analysis for MIS versus open TLIF. A total of 100 patients (50 MIS, 50 open) undergoing TLIF for lumbar spondylolisthesis were prospectively studied. Back-related medical resource use, missed work, and quality-adjusted life years were assessed. Cost of in-patient care, direct cost (2-year resource use × unit costs based on Medicare national allowable payment amounts), and indirect cost (work-day losses × self-reported gross-of-tax wage rate) were recorded, and the incremental cost-effectiveness ratio was calculated. Length of hospitalization and time to return to work were less for MIS versus open TLIF (P = 0.006 and P = 0.03, respectively). MIS versus open TLIF demonstrated similar improvement in patient-reported outcomes assessed. MIS versus open TLIF was associated with a reduction in mean hospital cost of $1758, indirect cost of $8474, and total 2-year societal cost of $9295 (P = 0.03) but similar 2-year direct health care cost and quality-adjusted life years gained. MIS TLIF resulted in reduced operative blood loss, hospital stay and 2-year cost, and accelerated return to work. Surgical morbidity, hospital readmission, and short- and long-term clinical effectiveness were similar between MIS and open TLIF. MIS TLIF may represent a valuable and cost-saving advancement from a societal and hospital perspective. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients.

    PubMed

    McGirt, Matthew J; Parker, Scott L; Lerner, Jason; Engelhart, Luella; Knight, Tyler; Wang, Michael Y

    2011-06-01

    Surgical site infection (SSI) after lumbar fusion results in significant patient morbidity and associated medical resource utilization. Minimally invasive (MI) techniques for posterior/transforaminal lumbar interbody fusion (P/TLIF) were introduced with the goals of smaller wounds, less tissue trauma, reduced blood loss, and quicker postoperative recovery, while maintaining comparable surgical results. Studies with sufficient power to directly compare the incidence of SSI following MI versus open P/TLIF procedures have been lacking. Furthermore, the direct medical cost associated with the treatment of SSI following the P/TLIF procedure is poorly understood and has not been adequately assessed. Thus, the aim in the present study was to determine the incidence of perioperative SSI in patients undergoing MI versus open P/TLIF and the direct hospital cost associated with the diagnosis and management of SSI after P/TLIF as reported in a large administrative database. The authors retrospectively reviewed hospital discharge and billing records from the Premier Perspective Database for 2003 to 2009 to identify patients undergoing 1- or 2-level MI or open P/TLIF for lumbar spondylotic disease, disc degeneration, or spondylolisthesis. The ICD-9-CM procedure codes were used to identify patients undergoing P/TLIF and those experiencing SSI. Infection-related costs were obtained from the total costs incurred by the hospital for SSI-related care provided during inpatient or hospital outpatient encounters. Five thousand one hundred seventy patients undergoing P/TLIF were identified. Demographic profiles, including the Charlson Comorbidity Index, were similar between MI and open cohorts. Overall, 292 patients (5.6%) experienced an SSI with a mean direct cost of $15,817 per SSI. For 1-level MI versus open P/TLIF, the incidence of SSI (38 [4.5%] vs 77 [4.8%], p = 0.77) and the mean SSI-associated cost per P/TLIF ($684 vs $724, p = 0.680) were similar. For 2-level MI versus open P

  9. Transforaminal Lumbar Interbody Fusion with Rigid Interspinous Process Fixation: A Learning Curve Analysis of a Surgeon Team’s First 74 Cases

    PubMed Central

    Doherty, Patrick; Welch, Arthur; Tharpe, Jason; Moore, Camille

    2017-01-01

    Background Studies have shown that a significant learning curve may be associated with adopting minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with bilateral pedicle screw fixation (BPSF). Accordingly, several hybrid TLIF techniques have been proposed as surrogates to the accepted BPSF technique, asserting that less/fewer fixation(s) or less disruptive fixation may decrease the learning curve while still maintaining the minimally disruptive benefits. TLIF with interspinous process fixation (ISPF) is one such surrogate procedure. However, despite perceived ease of adaptability given the favorable proximity of the spinous processes, no evidence exists demonstrating whether or not the technique may possess its own inherent learning curve. The purpose of this study was to determine whether an intraoperative learning curve for one- and two-level TLIF + ISPF may exist for a single lead surgeon. Methods Seventy-four consecutive patients who received one- or two-Level TLIF with rigid ISPF by a single lead surgeon were retrospectively reviewed. It was the first TLIF + ISPF case series for the lead surgeon. Intraoperative blood loss (EBL), hospitalization length-of-stay (LOS), fluoroscopy time, and postoperative complications were collected. EBL, LOS, and fluoroscopy time were modeled as a function of case number using multiple linear regression methods. A change point was included in each model to allow the trajectory of the outcomes to change during the duration of the case series. These change points were determined using profile likelihood methods. Models were fit using the maximum likelihood estimates for the change points. Age, sex, body mass index (BMI), and the number of treated levels were included as covariates. Results EBL, LOS, and fluoroscopy time did not significantly differ by age, sex, or BMI (p ≥ 0.12). Only EBL differed significantly by the number of levels (p = 0.026). The case number was not a significant predictor of EBL, LOS

  10. Percutaneous Transforaminal Lumbar Interbody Fusion (pTLIF) with a Posterolateral Approach for the Treatment of Degenerative Disk Disease: Feasibility and Preliminary Results

    PubMed Central

    Morgenstern, Christian

    2015-01-01

    Background Interbody fusion by open discectomy is the usual treatment for degenerative disk disease but requires a relatively long recovery period. The transforaminal posterolateral approach is a well-known standard in endoscopic spine surgery that allows direct access to the disk with progressive tissue dilation. The aim of this study was to assess the feasibility of percutaneous transforaminal interbody fusion (pTLIF) with percutaneous insertion of an expandable or a standard rigid interbody implant for patients with degenerative disk disease with or without spondylolisthesis and for revision surgery with the endoscopic posterolateral approach. Methods Between 2009 and 2014, the pTLIF procedure was performed in 30 patients. Ten patients underwent insertion of a rigid implant (group A) and the remaining 20 underwent insertion of an expandable titanium interbody implant as the initial procedure (n = 10) (group B) or after failed back surgery (n = 10) (group C). Patient outcomes were scored with visual analogic scale (VAS), Oswestry disability index (ODI) and modified Macnab criteria. Results The mean follow-up period was 38 (17) (range 11 to 67) months. The outcome was excellent in 18, good in 10 and fair in 2. No poor results and no major complications were reported. No significant (p<0.05) differences in VAS and ODI scores according to the study group were found. Median postoperative time until hospital discharge was 26 hours (20 to 68 hours). Postoperative values for VAS and ODI scores improved significantly (p<0.05) compared to preoperative data in all study groups. Conclusions These preliminary results have shown the feasibility and efficacy of the pTLIF procedure using a percutaneous posterolateral approach for the treatment of degenerative disk disease with or without spondylolisthesis up to grade 2 and in revision surgery. No significant differences in outcome were observed between an expandable and a rigid cage. Median postoperative time until hospital

  11. Posterior corrective surgery with a multilevel transforaminal lumbar interbody fusion and a rod rotation maneuver for patients with degenerative lumbar kyphoscoliosis.

    PubMed

    Matsumura, Akira; Namikawa, Takashi; Kato, Minori; Ozaki, Tomonori; Hori, Yusuke; Hidaka, Noriaki; Nakamura, Hiroaki

    2017-02-01

    The purpose of this study was to assess the clinical results of posterior corrective surgery using a multilevel transforaminal lumbar interbody fusion (TLIF) with a rod rotation (RR) and to evaluate the segmental corrective effect of a TLIF using CT imaging. The medical records of 15 consecutive patients with degenerative lumbar kyphoscoliosis (DLKS) who had undergone posterior spinal corrective surgery using a multilevel TLIF with an RR technique and who had a minimum follow-up of 2 years were retrospectively reviewed. Radiographic parameters were evaluated using plain radiographs, and segmental correction was evaluated using CT imaging. Clinical outcomes were evaluated with the Scoliosis Research Society Patient Questionnaire-22 (SRS-22) and the SF-36. The mean follow-up period was 46.7 months, and the mean age at the time of surgery was 60.7 years. The mean total SRS-22 score was 2.9 before surgery and significantly improved to 4.0 at the latest follow-up. The physical functioning, role functioning (physical), and social functioning subcategories of the SF-36 were generally improved at the latest follow-up, although the changes in these scores were not statistically significant. The bodily pain, vitality, and mental health subcategories were significantly improved at the latest follow-up (p < 0.05). Three complications occurred in 3 patients (20%). The Cobb angle of the lumbar curve was reduced to 20.3° after surgery. The overall correction rate was 66.4%. The pelvic incidence-lumbar lordosis (preoperative/postoperative = 31.5°/4.3°), pelvic tilt (29.2°/18.9°), and sagittal vertical axis (78.3/27.6 mm) were improved after surgery and remained so throughout the follow-up. Computed tomography image analysis suggested that a 1-level TLIF can result in 10.9° of scoliosis correction and 6.8° of lordosis. Posterior corrective surgery using a multilevel TLIF with an RR on patients with DLKS can provide effective correction in the coronal plane but allows only

  12. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF

    PubMed Central

    Phan, Kevin; Malham, Greg; Seex, Kevin; Rao, Prashanth J.

    2015-01-01

    Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life. Surgical interbody fusion of degenerative levels is an effective treatment option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity. The surgical options for interbody fusion of the lumbar spine include: posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF). The indications may include: discogenic/facetogenic low back pain, neurogenic claudication, radiculopathy due to foraminal stenosis, lumbar degenerative spinal deformity including symptomatic spondylolisthesis and degenerative scoliosis. In general, traditional posterior approaches are frequently used with acceptable fusion rates and low complication rates, however they are limited by thecal sac and nerve root retraction, along with iatrogenic injury to the paraspinal musculature and disruption of the posterior tension band. Minimally invasive (MIS) posterior approaches have evolved in an attempt to reduce approach related complications. Anterior approaches avoid the spinal canal, cauda equina and nerve roots, however have issues with approach related abdominal and vascular complications. In addition, lateral and OLIF techniques have potential risks to the lumbar plexus and psoas muscle. The present study aims firstly to comprehensively review the available literature and evidence for different lumbar interbody fusion (LIF) techniques. Secondly, we propose a set of recommendations and guidelines

  13. Efficacy of Transforaminal Endoscopic Spine System (TESSYS) Technique in Treating Lumbar Disc Herniation.

    PubMed

    Pan, Zhimin; Ha, Yoon; Yi, Seong; Cao, Kai

    2016-02-18

    BACKGROUND To compare efficacy and safety of percutaneous transforaminal endoscopic spine system (TESSYS) and traditional fenestration discectomy (FD) in treatment of lumbar disc herniation (LDH). MATERIAL AND METHODS A total of 106 LDH patients were divided into TESSYS group (n=48) and FD group (n=58). Visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and modified MacNab criteria were used for efficacy evaluation. Post-operative responses were compared by enzyme-linked immunosorbent assay (ELISA) based on detection of serum IL-6, CRP, and CPK levels. RESULTS In the TESSYS group, compared with the FD group, we observed, shorter incision length, less blood loss, shorter hospital stay, lower hospitalization cost, shorter recovery time, lower complication rate (all P<0.001), and lower VAS scores of lumbago and skelalgia at 3 days and 1, 3, and 6 months postoperatively (all P<0.05). At 24 and 48 h postoperatively, CRP level was remarkably higher in the FD group compared to the TESSYS group (P<0.001). Further, comparison of IL-6 levels at 6, 12, 24, and 48 h postoperatively revealed significantly higher levels in the FD group than in the FESSYS group (all P<0.001). CONCLUSIONS TESSYS had clinical advantages over FD and entails less trauma and quicker postoperative recovery, suggesting that TESSYS is well tolerated by patients and is a better approach than FD in surgical treatment of LDH.

  14. Quality-of-Life Outcomes With Minimally Invasive Transforaminal Lumbar Interbody Fusion Based on Long-Term Analysis of 304 Consecutive Patients

    PubMed Central

    Hussain, Namath S.; White, G. Zachary; Begun, Evan M.; Collins, Robert A.; Fahim, Daniel K.; Hiremath, Girish K.; Adbi, Fadumo M.; Yacob, Sammy A.

    2014-01-01

    Study Design. This was a prospective clinical study that took place in an outpatient spine clinic. Objective. To demonstrate the short-/long-term outcomes from a large cohort of patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF). Summary of Background Data. Long-term prospective outcomes in patients undergoing minimally invasive spinal fusion for debilitating back pain has not been well studied. Methods. Presenting diagnosis was determined from clinical findings and radiographical (radiograph, magnetic resonance image, computed tomographic scan) evaluations preoperatively. Patients were assessed with outcome measures preoperatively, and postoperatively at 2 weeks, 3 months, 6 months, 12 months, 24 months, and annually 2 to 7 years (mean follow-up: 47 mo) final follow-up. The rate of postoperative complications and reoperations at the initial level of MITLIF and adjacent level(s) were followed. Fusion rates were assessed blinded and independently by radiograph. Results. Visual analogue scale scores decreased significantly from 7.0 preoperatively to 3.5 at mean 47-month follow-up. Oswestry Disability Index scores declined from 43.1 preoperatively to 28.2 at mean 47-month follow-up. Short-Form 36 mental component scores increased from 43.8 preoperatively to 49.7 at 47-month follow-up. Short-Form 36 physical component scores increased from 30.6 preoperatively to 39.6 at 47-month follow-up (P < 0.05). Conclusion. This prospectively collected outcomes study shows long-term statistically significant clinical outcomes improvement after MITLIF in patients with clinically symptomatic spondylolisthesis and degenerative disc disease with or without stenosis. MITLIF resulted in a high rate of spinal fusion and very low rate of interbody fusion failure and/or adjacent segment disease requiring reoperation while reducing postoperative complications. Level of Evidence: 3 PMID:24150437

  15. Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis.

    PubMed

    Madhavan, Karthik; Chieng, Lee Onn; Hofstetter, Christoph P; Wang, Michael Y

    2016-02-01

    Isthmic spondylolisthesis due to pars defects resulting from trauma or spondylolysis is not uncommon. Symptomatic patients with such pars defects are traditionally treated with a variety of fusion surgeries. The authors present a unique case in which such a patient was successfully treated with endoscopic discectomy without iatrogenic destabilization. A 31-year-old man presented with a history of left radicular leg pain along the distribution of the sciatic nerve. He had a disc herniation at L5/S1 and bilateral pars defects with a Grade I spondylolisthesis. Dynamic radiographic studies did not show significant movement of L-5 over S-1. The patient did not desire to have a fusion. After induction of local anesthesia, the patient underwent an awake transforaminal endoscopic discectomy via the extraforaminal approach, with decompression of the L-5 and S-1 nerve roots. His preoperative pain resolved immediately, and he was discharged home the same day. His preoperative Oswestry Disability Index score was 74, and postoperatively it was noted to be 8. At 2-year follow-up he continued to be symptom free, and no radiographic progression of the listhesis was noted. In this case preservation of stabilizing structures, including the supraspinous and interspinous ligaments and the facet capsule, may have reduced the likelihood of iatrogenic instability while at the same time achieving symptom control. This may be a reasonable option for select patient symptoms confined to lumbosacral radiculopathy.

  16. Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparison Study Based on Endplate Subsidence and Cystic Change in Individuals Above and Below the Age of 65.

    PubMed

    Lin, Guang-Xun; Quillo-Olvera, Javier; Jo, Hyun-Jin; Lee, Hyeong-Jin; Covarrubias-Rosas, Claudia Angelica; Jin, Chengzhen; Kim, Jin-Sung

    2017-06-29

    To compare the outcomes between patients older and younger than 65 who underwent single-level minimally invasive transforaminal interbody fusion (MI-TLIF) surgery. This study is a retrospective analysis of 76 patients who underwent MI-TLIF between April 2012 and June 2016. Group A consisted of 35 patients (< 65 years) while Group B consisted of 41 patients (≥ 65 years). Intraoperative data were recorded. The evaluation of clinical outcomes was based on the Visual Analog Scale for back and leg pain and the Oswestry Disability Index. Radiological outcomes including cage subsidence, endplate cyst formation, and fusion rate were assessed. The mean age of the study subjects was 65.3 years, and the mean duration of follow-up was 18.98 months. Group B had a higher rate of comorbidities when compared to Group A 90.24% vs. 57.14%, respectively (P < 0.05). There was no statistically significant difference in the rate of complications between the groups: Group A with 14.29% and Group B with 17.07%. Clinical outcomes significantly improved in both groups postoperatively (P < 0.05). Although bony fusion in Group A was slightly higher than that in Group B, the fusion rate was not statistically different according to age. There were no statistically significant differences in the rates of cage subsidence or positive cyst sign between the groups. MI-TLIF presented similar safeness and acceptable outcomes and complication rate in both groups. Cyst formation may be aggravated by cage subsidence, as cage subsidence was a useful potential predictor of cyst formation. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. [Comparison of clinical efficacies of single segment transforaminal lumbar interbody fusion with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis: a prospective randomized controlled study].

    PubMed

    Liu, Peisheng; Liu, Xiaozhen; Qiao, Xuejing; Du, Wennan; Luo, Dawei; Zheng, Xiujun

    2014-09-23

    To compare the clinical efficacies of single segment transforaminal lumbar interbody fusion (TLIF) with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis. A total of 87 patients undergoing single segment TLIF were randomly divided into 2 groups. A cage was implanted into intervertebral space in group A patients while autogenous morselized bone in group B patients. Operative duration, blood loss, length of stay and cost of hospitalization of two groups were recorded. They were followed up at 1 week, 12, 24 months post-operation. Oswestry disability index (ODI), visual analogue scale (VAS) fusion rates, intervertebral space and foramen height restoration, lumbar lordosis and postoperative complications were compared between two groups. No significant inter-group difference existed in operative duration, blood loss or length of stay. However, the average hospitalization cost in group A were 18% higher than that of group B (P < 0.05). Both groups achieved excellent clinical outcomes within 2 years. ODI, VAS score improvement rates and postoperative complication rates were not statistically different. Lumbar fusion rate was 86.7% in group A versus 85.7% in group B after 2 years. And there was no significant difference (P > 0.05). The heights of intervertebral space and foramen in group A achieved a better recovery than those of group B. Both groups had similar improvements of lumbar lordosis. For degenerative lumbar spinal stenosis, usage of interbody cage is more effective in terms of recovery of intervertebral space and foraminal height compared with usage of bone graft. However it brings no better clinical efficacy while the usage of autogenous morselized bone is more cost-effective. Two grafting methods yield similar overall clinical outcomes.

  18. Unilateral versus bilateral pedicle screw fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF): a meta-analysis of randomized controlled trials.

    PubMed

    Wang, Liang; Wang, Yipeng; Li, Zhengyao; Yu, Bin; Li, Ye

    2014-11-06

    A few studies focused on unilateral or bilateral pedicle screw (PS) fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) to treat lumbar degenerative diseases have been published. There is still debate over whether one method is superior to another. A systematic review and meta-analysis of randomized controlled trials (RCT) was performed to compare the efficacy of the two methods. We searched the established electronic literature databases of MEDLINE, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials databases for RCTs comparing the unilateral with bilateral pedicle screw fixation of MIS-TLIF. Pooled mean differences (MD) and odds ratios (OR) and with 95% CIs were calculated for the outcomes. Three RCTs were identified and analyzed. The results showed that there is no significant difference between the two methods in terms of postoperative VAS-BP score (WMD = -0.09; 95% CI: -0.69 to 0.51; P =0.78), ODI (WMD, -0.09; 95% CI -5.85 to 5.67; P =0.98), fusion rate (OR = 2.99; 95% CI 0.55 to 16.38; P = 0.21) or complication rate (OR = 1.61, 95% CI: 0.49 to 5.37; P =0.43). Unilateral pedicle screw fixation was associated with less blood loss (WMD = -87.83; 95% CI: -160.70 to -14.96; P =0.02). The existing evidence indicate that no superiority exists between the two fixation methods of MIS-TLIF in terms of functional outcome, fusion rate and complication rate, in spite of that unilateral pedicle screw fixation can achieve less blood loss than bilateral fixation.

  19. Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: short-term and medium-term outcomes

    PubMed Central

    Yang, Yang; Liu, Bin; Rong, Li-Min; Chen, Rui-Qiang; Dong, Jian-Wen; Xie, Pei-Gen; Zhang, Liang-Ming; Feng, Feng

    2015-01-01

    Objective: To evaluate short-term and medium-term outcomes of microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF for lumbar degenerative disease. Methods: In this prospective, randomized control study, 50 cases received microendoscopy-assisted MIS-TLIF (MIS group), while another well-matched 50 cases accepted open TLIF (open group). Parameters between both groups, including surgical duration, intraoperative blood loss and radiologic exposure, postoperative analgesic usage and ambulatory time, visual analogue scale (VAS) for back and leg, functional scores, self-evaluation of surgical outcome (modified MacNab criteria), interbody fusion rate, adjacent segment degeneration (ASD) rate, as well as complication incidence were compared at 1 month and 24 months postoperatively. Results: Intraoperative blood loss and postoperative analgesic usage were significantly reduced in MIS group (P<0.05). Patients undergoing microendoscopy-assisted MIS-TLIF were able to ambulate earlier postoperatively than those receiving open TLIF (P<0.05). However, it showed prolonged surgical duration and enhanced radiologic exposure in MIS group (P<0.05). At 1 month postoperatively, MIS group was associated with more improvement of VAS and functional scores compared with open group (P<0.05). While at 24 months postoperatively, both groups revealed similar VAS and functional scores (P>0.05). Excellent and perfect scale rating by modified MacNab criteria, interbody fusion rate, ASD rate and complication incidence between both groups were nearly the same (P>0.05). Conclusions: Microendoscopy-assisted MIS-TLIF owns advantages of less iatrogenic injury, decreased blood loss, reduced analgesic usage and earlier rehabilitation, while it has drawbacks of more surgical duration and radiologic exposure. It is superior than open TLIF in terms of short-term clinical outcomes and has similar medium-term clinical outcomes. PMID:26885072

  20. Can cantilever transforaminal lumbar interbody fusion (C-TLIF) maintain segmental lordosis for degenerative spondylolisthesis on a long-term basis?

    PubMed

    Kida, Kazunobu; Tadokoro, Nobuaki; Kumon, Masashi; Ikeuchi, Masahiko; Kawazoe, Tateo; Tani, Toshikazu

    2014-03-01

    To determine if cantilever transforaminal lumbar interbody fusion (C-TLIF) using the crescent-shaped titanium interbody spacer (IBS) favors acquisition of segmental and lumbar lordosis even for degenerative spondylolisthesis (DS) on a long-term basis. We analyzed 23 consecutive patients who underwent C-TLIF with pedicle screw instrumentations fixed with compression for a single-level DS. Measurements on the lateral radiographs taken preoperatively, 2 weeks postoperatively and at final follow-up included disc angle (DA), segmental angle (SA), lumbar lordosis (LL), disc height (%DH) and slip rate (%slip). There was a good functional recovery with 100 % fusion rate at the mean follow-up of 62 months. Segmental lordosis (DA and SA) and %DH initially increased, but subsequently decreased with the subsidence of the interbody spacer, resulting in a significant increase (p = 0.046) only in SA from 13.2° ± 5.5° preoperatively to 14.7° ± 6.4° at the final follow-up. Changes of LL and %slip were more consistent without correction loss finally showing an increase of LL by 3.6° (p = 0.005) and a slip reduction by 6.7 % (p < 0.001). Despite the inherent limitation of placing the IBS against the anterior endplate of the upper vertebra in the presence of DS, the C-TLIF helped significantly restore segmental as well as lumbar lordosis on a long-term basis, which would be of benefit in preventing hypolordosis-induced back pain and the adjacent level disc disease.

  1. Two-Year Comparative Outcomes of MIS Lateral and MIS Transforaminal Interbody Fusion in the Treatment of Degenerative Spondylolisthesis: Part II: Radiographic Findings.

    PubMed

    Isaacs, Robert E; Sembrano, Jonathan N; Tohmeh, Antoine G

    2016-04-01

    Prospective, multicenter, institutional review board approved study with randomized and observational study arms. The purpose of this study was to compare radiographic outcomes between minimally invasive transforaminal (MIS TLIF) or MIS lateral interbody fusion (XLIF) in the treatment of patients with low-grade degenerative spondylolisthesis with stenosis through 2-year postoperative. Few reports exist comparing different MIS approaches directly in the treatment of similar pathology, as most studies report differences between MIS and open procedures. A total of 55 patients undergoing surgical treatment for degenerative spondylolisthesis with spinal stenosis at one or two contiguous levels between L1 and L5 were enrolled. Twenty-nine patients were treated with XLIF and 26 patients were treated with MIS TLIF. Disc height was significantly improved from preoperative at all postoperative time points in both groups, though the XLIF group experienced less subsidence and resultant loss of disc height than the MIS TLIF group by 24-month postoperative (P = 0.002). Postoperative change in central canal area was statistically greater in the MIS TLIF compared with the XLIF group (43.1 mmvs. 4.1 mm, P = 0.028). At several postoperative time points, foraminal height and area on the ipsilateral side and foraminal height on the contralateral side to the approach were significantly increased postoperatively in the XLIF group, and the magnitude of ipsilateral height increase was greater than in the MIS TLIF cohort (P < 0.05).Using fusion criteria of <3° range of motion and <3 mm translation on plain radiographs, 100% of patients in both groups were solidly fused at 24-month postoperative. Using computed tomography fusion criteria of presence of intervertebral bridging bone, 100% (32/32) of XLIF levels and 96% (25/26) of MIS TLIF levels were solidly bridged (P = 0.448). Different mechanisms of stenosis correction (direct vs. indirect) between the MIS TLIF and

  2. Vertebral osteolysis originating from subchondral cyst end plate defects in transforaminal lumbar interbody fusion using rhBMP-2. Report of two cases.

    PubMed

    Balseiro, Sarah; Nottmeier, Eric W

    2010-07-01

    Vertebral osteolysis has been reported as a complication of off-label recombinant human bone morphogenetic protein-2 (rhBMP-2) use in transforaminal lumbar interbody fusion (TLIF). It has been postulated that end plate violation during disc space preparation, rhBMP-2 overdosing, or a combination thereof can contribute to the development of vertebral osteolysis when rhBMP-2 is used in the lumbar interspace. To present two cases of vertebral osteolysis that occurred after TLIF in which rhBMP-2 was used. In each case, the osteolysis originated from subchondral cysts that were present on preoperative computed tomographic (CT) scans. Case report. Two patients underwent instrumented TLIF using INFUSE (Medtronic, Inc., Littleton, MA, USA) on an absorbable collagen sponge carrier. In each patient, approximately 4 mg of rhBMP-2 was placed anteriorly in the disc space with 0.1 mg of rhBMP-2 being placed inside a polyetheretherketone interbody cage. Morcellized allograft bone mixed with demineralized bone matrix was also placed in the disc space and cage. The remaining rhBMP-2 was placed posterolaterally on the contralateral side. Each patient presented with worsening back pain approximately 3 to 4 months postoperatively and CT scans revealed osteolysis affecting the L4 and L5 vertebral bodies. The osteolysis appeared to originate from preoperative vertebral defects caused by subchondral cysts. One patient underwent removal of the interbody cage at the L4-L5 level and revision of the fusion with iliac crest autograft. At 15-month follow-up, he had no complaints of back pain, and CT scanning revealed solid fusion across the L4-L5 disc space. The other patient was offered revision of his fusion but declined any further surgery. At 2-year follow-up, that patient had persistent back pain but still declined any further surgery. A CT scan revealed unchanged osteolysis at the L4 and L5 levels. It has been proposed that rhBMP-2-induced vertebral osteolysis occurring in TLIF

  3. [A feasibility research of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation for recurrent lumbar disc herniation].

    PubMed

    Mao, Ke-ya; Wang, Yan; Xiao, Song-hua; Zhang, Yong-gang; Liu, Bao-wei; Wang, Zheng; Zhang, Xi-Feng; Cui, Geng; Zhang, Xue-song; Li, Peng; Mao, Ke-zheng

    2013-08-01

    To investigate the feasibility of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation of pedicle screws and a translaminar facet screw for recurrent lumbar disc herniation. From January 2010 to December 2011, 16 recurrent lumbar disc herniation patients, 10 male and 6 female patients with an average age of 45 years (35-68 years) were treated with unilateral incision MIS-TLIF through working channel. After decompression, interbody fusion and fixation using unilateral pedicle screws, a translaminar facet screw was inserted from the same incision through spinous process and laminar to the other side facet joint. The results of perioperative parameters, radiographic images and clinical outcomes were assessed. The repeated measure analysis of variance was applied in the scores of visual analogue scale (VAS) and Oswestry disablity index (ODI). All patients MIS-TLIF were accomplished under working channel including decompression, interbody fusion and hybrid fixation without any neural complication. The average operative time was (148 ± 75) minutes, the average operative blood loss was (186 ± 226) ml, the average postoperative ambulation time was (32 ± 15) hours, and the average hospitalization time was (6 ± 4) days. The average length of incision was (29 ± 4) mm, and the average length of translaminar facets screw was (52 ± 6) mm. The mean follow-up was 16.5 months with a range of 12-24 months. The postoperative X-ray and CT images showed good position of the hybrid internal fixation, and all facets screws penetrate through facets joint. The significant improvement could be found in back pain VAS, leg pain VAS and ODI scores between preoperative 1 day and postoperative follow-up at all time-points (back pain VAS:F = 52.845, P = 0.000;leg pain VAS:F = 113.480, P = 0.000;ODI:F = 36.665, P = 0.000). Recurrent lumbar disc herniation could be treated with MIS-TLIF using hybrid fixation through unilateral incision, and the

  4. The accuracy of 3D image navigation with a cutaneously fixed dynamic reference frame in minimally invasive transforaminal lumbar interbody fusion.

    PubMed

    Cho, Ji Young; Chan, Chee Keong; Lee, Sang-Ho; Lee, Ho-Yeon

    2012-01-01

    In contrast to preoperative image-based 3D navigation systems, which require surgeon-dependent registration, an intraoperative cone-beam computed tomography (cb-CT) image-based 3D navigation system allows automatic registration during the acquisition of 3D images intraoperatively. Thus, the need for spinal exposure for point matching is obviated, making a cb-CT image-based navigation system ideal for use in minimally invasive spinal procedures. Conventionally, the dynamic reference frame (DRF) is mounted to an adjacent spinous process or iliac bone through a separate incision. However, the close proximity of the DRF to the surgical area may result in its interfering with the surgical procedure or causing streak artifacts on the navigation images. Cutaneous placement of the DRF overlying the sacral hiatus is one possible solution to these problems, but such a placement does not provide a solid bony fixation point and is distant from the surgical area, both of which factors may hinder the accuracy of the navigation. The purpose of this study was to evaluate the accuracy of a novel idea for DRF placement in a series of mini-open transforaminal lumbar interbody fusion (TLIF) procedures performed with intraoperative cb-CT image-based 3D navigation. From June 2009 to December 2009, 20 patients underwent mini-open TLIF for a total 82 pedicle screws placed in the lumbar spine with cutaneous placement of the DRF overlying the sacral hiatus. The pedicle screws were inserted under navigational guidance using cb-CT data acquired intraoperatively with a Medtronic O-arm. Screw positions were subsequently checked with a final intraoperative cb-CT scan. Nineteen patients underwent single-level fusion (8 at L4-5, 6 at L5-S1, 4 at L3-4, and 1 at L2-3) and one patient underwent two-level fusion (from L3-5). There were 4 (4.9%) pedicle perforations greater than 2 mm out of the 82 pedicle screw insertions in the 20 patients. Two of these breached screws were repositioned and

  5. Clinical outcomes of minimally invasive versus open approach for one-level transforaminal lumbar interbody fusion at the 3- to 4-year follow-up.

    PubMed

    Rodríguez-Vela, Javier; Lobo-Escolar, Antonio; Joven, Eduardo; Muñoz-Marín, Javier; Herrera, Antonio; Velilla, José

    2013-12-01

    Supporters of minimally invasive approaches for transforaminal lumbar interbody fusion (TLIF) have reported short-term advantages associated with a reduced soft tissue trauma. Nevertheless, mid- and long-term outcomes and specifically those involving physical activities have not been adequately studied. The aim of this study was to compare the clinical outcomes of mini-open versus classic open surgery for one-level TLIF, with an individualized evaluation of the variables used for the clinical assessment. A prospective cohort study was conducted of 41 individuals with degenerative disc disease who underwent a one-level TLIF from January 2007 to June 2008. Patients were randomized into two groups depending on the type of surgery performed: classic open (CL-TLIF) group and mini-open approach (MO-TLIF) group. The visual analog scale (VAS), North American Spine Society (NASS) Low Back Pain Outcome instrument, Oswestry Disability Index (ODI) and the Short Form 36 Health Survey (SF-36) were used for clinical assessment in a minimum 3-year follow-up (36-54 months). Patients of the MO-TLIF group presented lower rates of lumbar (p = 0.194) and sciatic pain (p = 0.427) and performed better in daily life activities, especially in those requiring mild efforts: lifting slight weights (p = 0.081), standing (p = 0.097), carrying groceries (p = 0.033), walking (p = 0.069) and dressing (p = 0.074). Nevertheless, the global scores of the clinical questionnaires showed no statistical differences between the CL-TLIF and the MO-TLIF groups. Despite an improved functional status of MO-TLIF patients in the short term, the clinical outcomes of mini-open TLIF at the 3- to 4-year follow-up showed no clinically relevant differences to those obtained with open TLIF.

  6. Dynamic stabilization for L4-5 spondylolisthesis: comparison with minimally invasive transforaminal lumbar interbody fusion with more than 2 years of follow-up.

    PubMed

    Kuo, Chao-Hung; Chang, Peng-Yuan; Wu, Jau-Ching; Chang, Hsuan-Kan; Fay, Li-Yu; Tu, Tsung-Hsi; Cheng, Henrich; Huang, Wen-Cheng

    2016-01-01

    OBJECTIVE In the past decade, dynamic stabilization has been an emerging option of surgical treatment for lumbar spondylosis. However, the application of this dynamic construct for mild spondylolisthesis and its clinical outcomes remain uncertain. This study aimed to compare the outcomes of Dynesys dynamic stabilization (DDS) with minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the management of single-level spondylolisthesis at L4-5. METHODS This study retrospectively reviewed 91 consecutive patients with Meyerding Grade I spondylolisthesis at L4-5 who were managed with surgery. Patients were divided into 2 groups: DDS and MI-TLIF. The DDS group was composed of patients who underwent standard laminectomy and the DDS system. The MI-TLIF group was composed of patients who underwent MI-TLIF. Clinical outcomes were evaluated by visual analog scale for back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores at each time point of evaluation. Evaluations included radiographs and CT scans for every patient for 2 years after surgery. RESULTS A total of 86 patients with L4-5 spondylolisthesis completed the follow-up of more than 2 years and were included in the analysis (follow-up rate of 94.5%). There were 64 patients in the DDS group and 22 patients in the MI-TLIF group, and the overall mean follow-up was 32.7 months. Between the 2 groups, there were no differences in demographic data (e.g., age, sex, and body mass index) or preoperative clinical evaluations (e.g., visual analog scale back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores). The mean estimated blood loss of the MI-TLIF group was lower, whereas the operation time was longer compared with the DDS group (both p < 0.001). For both groups, clinical outcomes were significantly improved at 6, 12, 18, and 24 months after surgery compared with preoperative clinical status. Moreover, there were no differences between the 2

  7. Comparison of open and minimally invasive techniques for posterior lumbar instrumentation and fusion after open anterior lumbar interbody fusion.

    PubMed

    Kepler, Christopher K; Yu, Anthony L; Gruskay, Jordan A; Delasotta, Lawrence A; Radcliff, Kristen E; Rihn, Jeffrey A; Hilibrand, Alan S; Anderson, D Greg; Vaccaro, Alexander R

    2013-05-01

    Minimally invasive techniques for spinal fusion have theoretical advantages for the reduction of iatrogenic injury. Although this topic has been investigated previously for posterior-only interbody surgery, such as transforaminal lumbar interbody fusion, similar studies have not evaluated these techniques after anteroposterior spinal fusion, a study design that can more accurately determine the effect of pedicle screw placement and decompression via a minimally invasive technique without the confounding effect of simultaneous interbody cage placement. To compare process measures that provide insight into the morbidity of surgery, such as surgical time and the length of postoperative hospital stay between open and minimally invasive anteroposterior lumbar fusion; and to compare the complications during the intraoperative and early postoperative period between open and minimally invasive anteroposterior lumbar fusion. Retrospective case-control study. One hundred sixty-two patients. Estimated blood loss, length of surgery, intraoperative fluoroscopy time, length of postoperative hospital stay, malpositioned instrumentation on postoperative imaging, and postoperative complications, including pulmonary embolus and surgical site infection. Patients who underwent open anterior lumbar interbody fusion followed by either traditional open posterior fusion (Open group) or minimally invasive posterior fusion (minimally invasive surgery [MIS] group) were matched by the number of surgical levels. A chart review was performed to document the intraoperative and postoperative process measures and associated complications in the two groups. Secondary analyses were performed to compare the subgroups of patients, who did and did not undergo a posterior decompression at the time of posterior instrumentation to determine the effect of decompression. Baseline characteristics were similar between the Open and MIS groups. Estimated blood loss and postoperative transfusion rate were

  8. “Outside-in” Technique, Clinical Results, and Indications with Transforaminal Lumbar Endoscopic Surgery: a Retrospective Study on 220 Patients on Applied Radiographic Classification of Foraminal Spinal Stenosis

    PubMed Central

    2014-01-01

    Objective To analyze and describe appropriate surgical indications for endoscopically performed transforaminal decompression with the outside-in technique with foraminoplasty in patients with lateral stenosis with and without herniated disc. Background and Significance Endoscopic microdiscectomy is growing in popularity for the removal of lumbar disc herniations. Recent advances in surgical techniques allow for percutaneous endoscopically assisted bony decompression as well. Materials and Methods A retrospective study of 220 consecutive patients undergoing percutaneous endoscopic transforaminal foraminoplasty and microdiscectomy at 228 levels was conducted with intent of identifying appropriate surgical indications in patients with monoradiculopathy. The mean follow up was 46 months ranging from 26 to 54 months. Preoperatively, foraminal and lateral recess stenosis was graded on preoperative MRI and CT scans by dividing the lumbar neuroforamen into three zones: a) entry zone, b) middle zone, and c) exit zone. In addition, the presence of disc herniation causing neural element compression in the lateral recess and neuroforamen was noted. Disc herniations, if present, were recorded as either extruded and contained disc herniations. Surgical outcomes were classified according to the Macnab criteria. In addition, reductions in VAS scores were assessed. Results According to the Macnab criteria, excellent and good results were obtained in 85% (186/220) of patients with monoradiculopathy. The mean VAS score decreased from 7.5 ± 1.5 preoperatively to 2.8 ± 1.9 at the final follow-up (P < 0.01). Concomitant extruded disc herniations and contained disc bulges were recorded in 24 and 82 patients, respectively. There were no approach-related complications. Clinical failures occurred in patients with bony stenosis in the lateral recess and entry zone of the neuroforamen. Less favorable outcomes were observed in patients with concomitant contained disc herniations when

  9. Screw Placement Accuracy for Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery: A Study on 3-D Neuronavigation-Guided Surgery

    PubMed Central

    Torres, Jorge; James, Andrew R.; Alimi, Marjan; Tsiouris, Apostolos John; Geannette, Christian; Härtl, Roger

    2012-01-01

    Purpose The aim of this study was to assess the impact of 3-D navigation for pedicle screw placement accuracy in minimally invasive transverse lumbar interbody fusion (MIS-TLIF). Methods A retrospective review of 52 patients who had MIS-TLIF assisted with 3D navigation is presented. Clinical outcomes were assessed with the Oswestry Disability Index (ODI), Visual Analog Scales (VAS), and MacNab scores. Radiographic outcomes were assessed using X-rays and thin-slice computed tomography. Result The mean age was 56.5 years, and 172 screws were implanted with 16 pedicle breaches (91.0% accuracy rate). Radiographic fusion rate at a mean follow-up of 15.6 months was 87.23%. No revision surgeries were required. The mean improvement in the VAS back pain, VAS leg pain, and ODI at 11.3 months follow-up was 4.3, 4.5, and 26.8 points, respectively. At last follow-up the mean postoperative disc height gain was 4.92 mm and the mean postoperative disc angle gain was 2.79 degrees. At L5–S1 level, there was a significant correlation between a greater disc space height gain and a lower VAS leg score. Conclusion Our data support that application of 3-D navigation in MIS-TLIF is associated with a high level of accuracy in the pedicle screw placement. PMID:24353961

  10. Two-year Comparative Outcomes of MIS Lateral and MIS Transforaminal Interbody Fusion in the Treatment of Degenerative Spondylolisthesis: Part I: Clinical Findings.

    PubMed

    Sembrano, Jonathan N; Tohmeh, Antoine; Isaacs, Robert

    2016-04-01

    A prospective, multicenter, institutional review board (IRB) approved study with randomized and observational study arms. The purpose of this study was to compare clinical outcomes between minimally invasive transforaminal (MIS TLIF) and MIS lateral interbody fusion (XLIF) in the treatment of patients with low-grade degenerative spondylolisthesis with stenosis through two years postoperative. Few reports exist comparing different MIS approaches directly in the treatment of similar pathology, as most studies report differences between MIS and open procedures. A total of 55 patients undergoing surgical treatment for degenerative spondylolisthesis with spinal stenosis at one or two contiguous levels between L1 and L5 were enrolled. Twenty-nine patients were treated with XLIF and 26 patients were treated with MIS TLIF. Operative time and length of stay were similar between the XLIF and MIS TLIF groups (171 vs 186 minutes; two days for each group). Blood loss was significantly lower in the XLIF group, with 79% of XLIF cases and 27% of MIS TLIF cases resulting in <100 mL of blood loss, P < 0.001. Hip flexion weakness was more common in the XLIF group (31%) than in the MIS TLIF group (0%). One patient in the XLIF group had a new distal motor weakness and three patients in the XLIF group and two patients in the MIS TLIF group had new sensory changes postoperatively, all of which resolved by 12 months postoperative. Back and leg pain for both XLIF and MIS TLIF groups improved significantly from baseline to 24 months postoperative, with 73% improvement in the XLIF and 64% in the MIS TLIF group. Worst leg pain showed similar improvements through two years postoperative, with a 79% decrease seen in the XLIF group and 74% in the MIS TLIF group. Disability (ODI) improved 53% in the XLIF group and 57% in the MIS TLIF group. Despite different mechanisms of action (indirect vs direct decompression), mid-term clinical outcomes between XLIF and MIS TLIF were similar. These

  11. Cost-effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years.

    PubMed

    Parker, Scott L; Adogwa, Owoicho; Bydon, Ali; Cheng, Joseph; McGirt, Matthew J

    2012-07-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar spondylolisthesis allows for surgical treatment of back and leg pain while theoretically minimizing tissue injury and accelerating overall recovery. Although the authors of previous studies have demonstrated shorter length of hospital stay and reduced blood loss with MIS versus open-TLIF, short- and long-term outcomes have been similar. No studies to date have evaluated the comprehensive health care costs associated with TLIF procedures or assessed the cost-utility of MIS- versus open-TLIF. As such, we set out to assess previously unstudied end points of health care cost and cost-utility associated with MIS- versus open-TLIF. Thirty patients undergoing MIS-TLIF (n=15) or open-TLIF (n=15) for grade I degenerative spondylolisthesis associated back and leg pain were prospectively studied. Total back-related medical resource use, missed work, and health-state values (quality-adjusted life years [QALYs], calculated from EQ-5D with U.S. valuation) were assessed after two-year follow-up. Two-year resource use was multiplied by unit costs on the basis of Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS- versus open-TLIF was assessed as incremental cost-effectiveness ratio (ICER: COSTmis-COSTopen/QALYmis-QALYopen). MIS versus open-TLIF cohorts were similar at baseline. By two years postoperatively, patients undergoing MIS- versus open-TLIF reported similar mean QALYs gained (0.50 vs. 0.41, P=0.17). Mean total two-year cost of MIS- and open-TLIF was $35,996 and $44,727, respectively. The $8,731 two-year cost savings of MIS- versus open-TLIF did not reach statistical significance (P=0.18) for this sample size. Although our limited sample size prevented statistical significance, MIS- versus open-TLIF was associated with reduced costs over

  12. A novel minimally invasive presacral approach and instrumentation technique for anterior L5-S1 intervertebral discectomy and fusion: technical description and case presentations.

    PubMed

    Marotta, Nicola; Cosar, Murat; Pimenta, Luiz; Khoo, Larry T

    2006-01-15

    The authors describe a new paracoccygeal approach to the L5-S1 junction for interbody fusion with transsacral instrumentation. The purpose of this technical note is to demonstrate a novel surgical approach, technique, and instrumentation system for the treatment of L5-S1 instability in degenerative disc disease and spondylolisthesis. This technical note highlights the AxiaLif (TranS1) transsacral system as an alternative method to transforaminal lumbar interbody fusion or posterior lumbar interbody fusion. Via a novel presacral approach corridor, a truly percutaneous L5-S1 discectomy, interbody distraction, and fixation are achieved, and retroperitoneal viscera and dorsal neural elements are avoided. Percutaneous pedicle screw fixation is then used to provide additional stabilization at the treated level. This novel technique of interbody distraction and fusion via a truly percutaneous approach corridor allows for circumferential treatment of the lower lumbar segments with minimal risk to the anterior organs and dorsal neural elements.

  13. Structural damage detection using information fusion technique

    NASA Astrophysics Data System (ADS)

    Guo, H. Y.

    2006-07-01

    In order to precisely identify the multiple damage locations of a structure, an information fusion technique is proposed in this paper. First, the frequency data and the mode shape data are regarded as two different information sources, and local decisions can be obtained using the multiple damage location assurance criterion (MDLAC) method and the frequency change damage detection method (FCDDM), respectively. Then, the local decisions are sent to a fusion centre. In the fusion centre, three main fusion approaches are applied to integrate all the local decisions. Finally, a global decision is acquired. The measurement errors are also taken into account in the fusion process. The numerical example and analysis demonstrate that the identification results of the three information fusion methods are better than those of the MDLAC method and the frequency change damage detection method.

  14. Associated lumbar scoliosis does not affect outcomes in patients undergoing focal minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF) for neurogenic symptoms-a minimum 2-year follow-up study.

    PubMed

    Tay, Kae Sian; Bassi, Anupreet; Yeo, William; Yue, Wai Mun

    2017-01-01

    There is no current literature comparing outcomes of patients with and without lumbar scoliosis having neurologic symptoms undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF) technique. This study aimed to determine whether associated lumbar scoliosis will result in different clinical, radiological, and operative outcomes in patients undergoing focal MISTLIF for neurogenic symptoms, without specific correction of the scoliosis. A retrospective case comparison study from prospectively collected hospital registry data was carried out. Two hundred and thirty eligible patients were evaluated and divided into two groups: Scoliosis Group (SG; n=57) with Cobb angle >10 degrees on anterioposterior (AP) plain lumbar spine radiographs and Non-Scoliosis Group (NSG; n=173) consisting of the remaining patients. Clinical outcomes were assessed using the Oswestry Disability Index, the North American Spine Society (NASS) Neurogenic Symptom Score, the NASS Satisfaction with Surgery Rating, the 36-Item Short-Form Health Survey (SF-36), and the Numerical Pain Rating Scale for back and leg pain. Radiological findings included Cobb angle, fusion, implant failure or loosening, and adjacent segment degeneration (ASD). Both groups were compared for demographics, perioperative parameters, complications, clinical, and radiological outcomes. Interobserver agreement (kappa statistics) for measurement of Cobb angle was calculated on all cases of both groups by two authors. Patients were evaluated preoperatively, at 6 months, and 2 years after surgery. The average follow-up was 2.88±1.47 years in the SG and 2.71±1.34 years in the NSG (p=.444). Differences in mean age (SG: 62.9±10.9 years and NSG: 57.6±13.1 years), estimated related risk of death (SG: 3.05±2.13 and NSG: 2.41±1.74), and gender (female=SG: 87.7% and NSG: 64.2%) were statistically significant (p<.05), whereas race distribution, body mass index |(BMI), spinal levels operated, number of levels

  15. Surgical techniques for lumbo-sacral fusion.

    PubMed

    Tropiano, P; Giorgi, H; Faure, A; Blondel, B

    2017-02-01

    Lumbo-sacral (L5-S1) fusion is a widely performed procedure that has become the reference standard treatment for refractory low back pain. L5-S1 is a complex transition zone between the mobile lordotic distal lumbar spine and the fixed sacral region. The goal is to immobilise the lumbo-sacral junction in order to relieve pain originating from this site. Apart from achieving inter-vertebral fusion, the main challenge lies in the preoperative determination of the fixed L5-S1 position that will be optimal for the patient. Many lumbo-sacral fusion techniques are available. Stabilisation can be achieved using various methods. An anterior, posterior, or combined approach may be used. Recently developed minimally invasive techniques are gaining in popularity based on their good clinical outcomes and high fusion rates. The objective of this conference is to resolve the main issues faced by spinal surgeons in their everyday practice.

  16. [Effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion and traditional open surgery in the treatment of lumbar spondylolisthesis].

    PubMed

    Cui, G Y; Tian, W; He, D; Xing, Y G; Liu, B; Yuan, Q; Wang, Y Q; Sun, Y Q

    2017-07-01

    Objective: To compare the clinical effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open TLIF in the treatment of lumbar spondylolisthesis. Methods: A total of 41 patients with lumbar spondylolisthesis accepted surgical treatment in Department of Spinal Surgery of Beijing Jishuitan Hospital From July 2015 to April 2016 were retrospectively analyzed. There were 16 cases accepted robot-assisted minimally invasive TLIF and 25 accepted traditional open TLIF. The operation time, X-ray radiation exposure time, perioperative bleeding, drainage volume, time of hospitalization, time for pain relief, time for ambulatory recovery, visual analogue scale (VAS), Oswestry disability index (ODI) and complications were compared. T test and χ(2) were used to analyze data. Results: There were no significant difference in gender, age, numbers, degrees, pre-operative VAS and ODI in spondylolisthesis (all P>0.05). Compared with traditional open TLIF group, the robot-assisted minimally invasive TLIF group had less perioperative bleeding ((187.5±18.4) ml vs. (332.1±23.5) ml), less drainage volume ((103.1±15.6) ml vs. (261.3±19.8) ml), shorter hospitalization ((7.8±1.9) days vs. (10.0±1.6) days), shorter time for pain relief ((2.8±1.0) days vs. (5.2±1.1) days), shorter time for ambulatory recovery ((1.7±0.9) days vs. (2.9±1.3) days) and less VAS of the third day postoperatively (2.2±0.9 vs. 4.2±2.4) (t=2.762-16.738, all P<0.05), but need more operation time ((151.3±12.3) minutes vs. (102.2±7.1) minutes) and more X-ray radiation exposure ((26.1±3.3) seconds vs. (5.5±2.1) seconds) (t=6.125, 15.168, both P<0.01). In both groups ODI was significantly lower in final follow-up than that of the pre-operation (t=12.215, 14.036, P<0.01). Intervertebral disc height of the final follow-up in both groups were significantly larger than that of the preoperation (robot-assisted minimally invasive TLIF group: (11.8 ± 2.8) mm vs

  17. The SNAP trial: a double blind multi-center randomized controlled trial of a silicon nitride versus a PEEK cage in transforaminal lumbar interbody fusion in patients with symptomatic degenerative lumbar disc disorders: study protocol

    PubMed Central

    2014-01-01

    Background Polyetheretherketone (PEEK) cages have been widely used in the treatment of lumbar degenerative disc disorders, and show good clinical results. Still, complications such as subsidence and migration of the cage are frequently seen. A lack of osteointegration and fibrous tissues surrounding PEEK cages are held responsible. Ceramic implants made of silicon nitride show better biocompatible and osteoconductive qualities, and therefore are expected to lower complication rates and allow for better fusion. Purpose of this study is to show that fusion with the silicon nitride cage produces non-inferior results in outcome of the Roland Morris Disability Questionnaire at all follow-up time points as compared to the same procedure with PEEK cages. Methods/Design This study is designed as a double blind multi-center randomized controlled trial with repeated measures analysis. 100 patients (18–75 years) presenting with symptomatic lumbar degenerative disorders unresponsive to at least 6 months of conservative treatment are included. Patients will be randomly assigned to a PEEK cage or a silicon nitride cage, and will undergo a transforaminal lumbar interbody fusion with pedicle screw fixation. Primary outcome measure is the functional improvement measured by the Roland Morris Disability Questionnaire. Secondary outcome parameters are the VAS leg, VAS back, SF-36, Likert scale, neurological outcome and radiographic assessment of fusion. After 1 year the fusion rate will be measured by radiograms and CT. Follow-up will be continued for 2 years. Patients and clinical observers who will perform the follow-up visits will be blinded for type of cage used during follow-up. Analyses of radiograms and CT will be performed independently by two experienced radiologists. Discussion In this study a PEEK cage will be compared with a silicon nitride cage in the treatment of symptomatic degenerative lumbar disc disorders. To our knowledge, this is the first randomized controlled

  18. [Non fusion techniques in spinal surgery].

    PubMed

    Schizas, C; Duff, J M; Tessitore, E; Faundez, A

    2009-12-16

    In order to prevent adjacent segment degeneration following spinal fusion new techniques are being used. Lumbar disc arthroplasty yields mid term results equivalent to those of spinal fusion. Cervical disc arthroplasty is indicated in the treatment of cervicobrachialgia with encouraging initial results. The ability of arthroplasty to prevent adjacent segment degeneration has yet to be proven. Although dynamic stabilization had not been proven effective in treating chronic low back pain, it might be useful following decompression of lumbar spinal stenosis in degenerative spondylolisthesis. Interspinal devices are useful in mild lumbar spinal stenosis but their efficacy in treating low back pain is yet to be proven. Confronted with a growing number of new technologies clinicians should remain critical while awaiting long term results.

  19. Hybrid ultrasound imaging techniques (fusion imaging).

    PubMed

    Sandulescu, Daniela Larisa; Dumitrescu, Daniela; Rogoveanu, Ion; Saftoiu, Adrian

    2011-01-07

    Visualization of tumor angiogenesis can facilitate non-invasive evaluation of tumor vascular characteristics to supplement the conventional diagnostic imaging goals of depicting tumor location, size, and morphology. Hybrid imaging techniques combine anatomic [ultrasound, computed tomography (CT), and/or magnetic resonance imaging (MRI)] and molecular (single photon emission CT and positron emission tomography) imaging modalities. One example is real-time virtual sonography, which combines ultrasound (grayscale, colour Doppler, or dynamic contrast harmonic imaging) with contrast-enhanced CT/MRI. The benefits of fusion imaging include an increased diagnostic confidence, direct comparison of the lesions using different imaging modalities, more precise monitoring of interventional procedures, and reduced radiation exposure.

  20. Biomechanical effect of transforaminal lumbar interbody fusion and axial interbody threaded rod on range of motion and S1 screw loading in a destabilized L5-S1 spondylolisthesis model.

    PubMed

    Fleischer, Gary D; Hart, David; Ferrara, Lisa A; Freeman, Andrew L; Avidano, Eugene E

    2014-01-15

    A cadaveric lumbosacral spondylolytic spondylolisthesis model was used to evaluate the biomechanical function of 2 different interbody spacers. To analyze and compare the reduction in pedicle screw strain and spine range of motion (ROM) between transforaminal lumbar interbody fusion (TLIF) and an axial interbody threaded rod (AxialITR) in a destabilized L5-S1 spondylolisthesis model. Symptomatic spondylolytic spondylolisthesis is often treated with posterior instrumented fusion augmented by a variety of different interbody devices. Interbody spacers rely primarily on posterior instrumentation to stabilize the spine during fusion, but there may be advantages to the more rigid support offered by an anterior threaded rod. Pure-moment flexibility testing was performed on L3-S1 cadaveric specimens in 4 conditions: (1) Intact, (2) L5-S1 pedicle screws (PS) + L5-S1 disc destabilization (DDS), (3) TLIF at L5-S1 + PS + DDS, and (4) AxialITR at L5-S1 + PS + DDS. Specimens were destabilized by performing a complete denucleation at L5-S1 and sectioning two-thirds of the annulus' width from anterior to posterior. The S1 PSs were instrumented with strain gauges to measure screw-bending moments and ROM was quantified with a noncontact camera system. S1 screw strains were highest with PS but were significantly reduced by 73% in flexion and 31% in extension with TLIF (P ≤ 0.004). AxialITR significantly reduced strain by 78% in flexion and 81% in extension (P ≤ 0.001). ROM was smallest with AxialITR in each test direction at 1.7 ± 1.8° in flexion-extension, 1.6 ± 0.9° in lateral bending and 1.3 ± 0.8° in torsion. This study demonstrated that ROM and S1 screw-bending moments were reduced with the use of AxialITR and TLIF. Although the TLIF and AxialITR both reduced strains and motion, the AxialITR provided a significant reduction in extension strain when compared with TLIF. N/A.

  1. Risk factors for intervertebral instability assessed by temporal evaluation of the radiographs and reconstructed computed tomography images after L5-S1 single-level transforaminal interbody fusion: A retrospective study.

    PubMed

    Kobayashi, Yoshiomi; Shinozaki, Yoshio; Takahashi, Yohei; Takaishi, Hironari; Ogawa, Jun

    2017-01-01

    Intervertebral instability risks following L5-S1 transforaminal lumbar interbody fusion (TLIF) and causes of bony bridge formation on computed tomography (CT) remain largely unknown. We evaluated the temporal changes on plain radiographs and reconstructed CT images from 178 patients who had undergone single-level L5-S1 TLIF between February 2011 and February 2015. We statistically analyzed temporal changes the L5-S1 angle on radiographs and intervertebral stability (IVS) at the last observation. Bony bridge formation between the L5-S1 vertebral bodies and the titanium cage subsidence were analyzed by using reconstructed CT. Preoperative L5-S1 angle in the non-IVS group was significantly greater than that in the IVS group. The cage subsidence was classified as follows: type A, both upper and lower endplates; type B, either endplate; or type C, no subsidence. Types B and C decreased over time, whereas type A increased after surgery. The bony bridges between vertebral bodies were found in 87.2% of patients, and 94.5% of all bony bridges were found only in the cage, not on the contralateral side. Our findings suggested that high preoperative L5-S1 angle increased the risk of intervertebral instability after TLIF. The L5-S1 angle decreased over time with increasing type A subsidence, and almost all bony bridges were found only in the cage. These results suggest that the vertebral bodies were stabilized because of cage subsidence, and final bony bridges were created. Methods to improve bony bridge creation are needed to obtain reliable L5-S1 intervertebral bone union. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Risk factors for intervertebral instability assessed by temporal evaluation of the radiographs and reconstructed computed tomography images after L5-S1 single-level transforaminal interbody fusion: A retrospective study.

    PubMed

    Kobayashi, Yoshiomi; Shinozaki, Yoshio; Takahashi, Yohei; Takaishi, Hironari; Ogawa, Jun

    2016-10-28

    Intervertebral instability risks following L5-S1 transforaminal lumbar interbody fusion (TLIF) and causes of bony bridge formation on computed tomography (CT) remain largely unknown. We evaluated the temporal changes on plain radiographs and reconstructed CT images from 178 patients who had undergone single-level L5-S1 TLIF between February 2011 and February 2015. We statistically analyzed temporal changes the L5-S1 angle on radiographs and intervertebral stability (IVS) at the last observation. Bony bridge formation between the L5-S1 vertebral bodies and the titanium cage subsidence were analyzed by using reconstructed CT. Preoperative L5-S1 angle in the non-IVS group was significantly greater than that in the IVS group. The cage subsidence was classified as follows: type A, both upper and lower endplates; type B, either endplate; or type C, no subsidence. Types B and C decreased over time, whereas type A increased after surgery. The bony bridges between vertebral bodies were found in 87.2% of patients, and 94.5% of all bony bridges were found only in the cage, not on the contralateral side. Our findings suggested that high preoperative L5-S1 angle increased the risk of intervertebral instability after TLIF. The L5-S1 angle decreased over time with increasing type A subsidence, and almost all bony bridges were found only in the cage. These results suggest that the vertebral bodies were stabilized because of cage subsidence, and final bony bridges were created. Methods to improve bony bridge creation are needed to obtain reliable L5-S1 intervertebral bone union. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. A Review of Data Fusion Techniques

    PubMed Central

    2013-01-01

    The integration of data and knowledge from several sources is known as data fusion. This paper summarizes the state of the data fusion field and describes the most relevant studies. We first enumerate and explain different classification schemes for data fusion. Then, the most common algorithms are reviewed. These methods and algorithms are presented using three different categories: (i) data association, (ii) state estimation, and (iii) decision fusion. PMID:24288502

  4. A review of data fusion techniques.

    PubMed

    Castanedo, Federico

    2013-01-01

    The integration of data and knowledge from several sources is known as data fusion. This paper summarizes the state of the data fusion field and describes the most relevant studies. We first enumerate and explain different classification schemes for data fusion. Then, the most common algorithms are reviewed. These methods and algorithms are presented using three different categories: (i) data association, (ii) state estimation, and (iii) decision fusion.

  5. Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Provides Sustained Improvements in Clinical and Radiological Outcomes up to 5 Years Postoperatively in Patients with Neurogenic Symptoms Secondary to Spondylolisthesis.

    PubMed

    Bin Abd Razak, Hamid Rahmatullah; Dhoke, Priyesh; Tay, Kae-Sian; Yeo, William; Yue, Wai-Mun

    2017-04-01

    Retrospective review of prospective registry data. To determine 5-year clinical and radiological outcomes of single-level instrumented minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with neurogenic symptoms secondary to spondylolisthesis. MIS-TLIF and open approaches have been shown to yield comparable outcomes. This is the first study to assess MIS-TLIF outcomes using the minimal clinically important difference (MCID) criterion. The outcomes of 56 patients treated by a single surgeon, including the Oswestry disability index (ODI), neurogenic symptom score, short-form 36 questionnaire (SF-36), and visual analog scale (VAS) scores for back pain (BP), and leg pain (LP), were collected prospectively for up to 5 years postoperatively. Radiological outcomes included adjacent segment degeneration, fusion, cage subsidence, and screw loosening rates. Our patients were predominantly female (71.4%) and had a mean age of 53.7±11.3 years and mean body mass index of 25.7±3.7 kg/m(2). The mean operative time, blood loss, time to ambulation, and hospitalization were 167±49 minutes, 126±107 mL, 1.2±0.4 days, and 2.8±1.1 days, respectively. The mean fluoroscopic time was 58.4±33 seconds, and the mean postoperative intravenous morphine dose was 8±2 mg. Regarding outcomes, postoperative scores improved relative to preoperative scores, and this was sustained across various time points for up to 5 years (p<0.001). Improvements in ODI, SF-36, VAS-BP, and VAS-LP all met the MCID criterion. Notably, 5.4% of our patients developed clinically significant adjacent segment disease during follow-up, and 7 minor complications were reported. Single-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate. Both clinical and radiological outcomes were sustained up to 5 years postoperatively, with many patients achieving an MCID.

  6. Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Provides Sustained Improvements in Clinical and Radiological Outcomes up to 5 Years Postoperatively in Patients with Neurogenic Symptoms Secondary to Spondylolisthesis

    PubMed Central

    Bin Abd Razak, Hamid Rahmatullah; Dhoke, Priyesh; Tay, Kae-Sian; Yeo, William

    2017-01-01

    Study Design Retrospective review of prospective registry data. Purpose To determine 5-year clinical and radiological outcomes of single-level instrumented minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with neurogenic symptoms secondary to spondylolisthesis. Overview of Literature MIS-TLIF and open approaches have been shown to yield comparable outcomes. This is the first study to assess MIS-TLIF outcomes using the minimal clinically important difference (MCID) criterion. Methods The outcomes of 56 patients treated by a single surgeon, including the Oswestry disability index (ODI), neurogenic symptom score, short-form 36 questionnaire (SF-36), and visual analog scale (VAS) scores for back pain (BP), and leg pain (LP), were collected prospectively for up to 5 years postoperatively. Radiological outcomes included adjacent segment degeneration, fusion, cage subsidence, and screw loosening rates. Results Our patients were predominantly female (71.4%) and had a mean age of 53.7±11.3 years and mean body mass index of 25.7±3.7 kg/m2. The mean operative time, blood loss, time to ambulation, and hospitalization were 167±49 minutes, 126±107 mL, 1.2±0.4 days, and 2.8±1.1 days, respectively. The mean fluoroscopic time was 58.4±33 seconds, and the mean postoperative intravenous morphine dose was 8±2 mg. Regarding outcomes, postoperative scores improved relative to preoperative scores, and this was sustained across various time points for up to 5 years (p<0.001). Improvements in ODI, SF-36, VAS-BP, and VAS-LP all met the MCID criterion. Notably, 5.4% of our patients developed clinically significant adjacent segment disease during follow-up, and 7 minor complications were reported. Conclusions Single-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate. Both clinical and radiological outcomes were sustained up to 5 years

  7. Complete anatomic reduction and monosegmental fusion for lumbar spondylolisthesis of Grade II and higher: use of the minimally invasive "rocking" technique.

    PubMed

    Rajakumar, Deshpande V; Hari, Akshay; Krishna, Murali; Sharma, Ankit; Reddy, Manjunatha

    2017-08-01

    OBJECTIVE Different surgical approaches have been described for treatment of spondylolisthesis, including in situ fusions, reductions of various degrees, and inclusion of healthy adjacent segments into the fusion construct. To the authors' knowledge, there are only sparse reports describing consistent complete reduction and monosegmental transforaminal lumbar interbody fusion for spondylolisthesis using a minimally invasive technique. The authors assess the efficacy of this technique in the reduction of local deformity and correction of overall sagittal profile in single-level spondylolisthesis. METHODS This cohort study consists of a total of 36 consecutive patients treated over a period of 6 years. Patients with varying grades of lumbar spondylolisthesis (29 Meyerding Grade II and 7 Meyerding Grade III) were treated with operative reduction via minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in which the "rocking" technique was used. The clinical outcomes were measured using the visual analog scale (VAS) for pain and the Revised Oswestry Disability Index (ODI) for low-back pain/dysfunction. Meyerding grade, pelvic incidence (PI), lumbar lordosis (LL), disc space angle (DSA), pelvic tilt (PT), and sacral slope (SS) were assessed to measure the radiological outcomes. These were reviewed for each patient for a minimum of 2 years. RESULTS At most recent follow-up, 94% of patients were pain free. There were 2 patients (6%) who had moderate pain (which corresponded to higher-grade of listhesis), but all showed an improvement in pain scores (p < 0.05). The mean VAS score improved from 6.5 (SD 1.5) preoperatively to 1.6 (SD 1.3) and the mean ODI score improved from 53.7 (SD 13.1) preoperatively to 22.5 (SD 15.5) at 2-year follow-up. All radiological parameters improved following surgery. Most significant improvement was noted for LL, DSA, and SS. Both LL and SS were found to decrease, while DSA increased postoperatively. PI remained relatively

  8. Pneumocephalus during cervical transforaminal epidural steroid injections: a case report.

    PubMed

    Kim, Won-Joong; Park, Hae-Gyun; Park, Yong-Hee; Shin, Mee-Ran; Koo, Gill-Hoi; Shin, Hwa-Yong

    2015-01-01

    A cervical transforaminal epidural injection of anesthetic and corticosteroids (CTFESI) is a frequently used procedure for cervical radiculopathy. Most cases of pneumocephalus after an epidural block occur when using an interlaminar approach with the loss-of-resistance technique. The authors present the first case of pneumocephalus after cervical transforaminal epidural injection of anesthetic and corticosteroids. A 64-yr-old woman with left C7 radiculopathy was undergoing C6-7 transforaminal epidural injection of anesthetic and corticosteroids. The epidural spread of contrast was checked by fluoroscope, and 5 mg of dexamethasone in 4 ml of 0.1875% ropivacaine was injected. She lost consciousness 5 mins after the procedure and regained awareness after manual ventilation. She subsequently complained of nausea and headache, and a computed tomography brain scan revealed pneumocephalus. After carefully assessing the fluoroscopic images, the authors believe that the needle may have punctured the dura mater of the nerve root sleeve, allowing air to enter the subdural space. Thus, fluoroscopic images should be carefully examined to reduce dural puncture when performing cervical transforaminal epidural injection of anesthetic and corticosteroids, and air should be completely removed from the needle, extension tube, and syringe.

  9. Instrumented Minimally Invasive spinal-Transforaminal Lumbar Interbody Fusion (MIS-TLIF); Minimum 5-years Follow-up With Clinical and Radiologic Outcomes.

    PubMed

    Kim, Jin-Sung; Jung, Byungjoo; Lee, Sang-Ho

    2012-09-28

    STUDY DESIGN:: A retrospective study. OBJECTIVE:: To determine the clinical and radiological outcomes of the long-term results of instrumented MIS-TLIF in unstable, single level, low-grade, isthmic spondylolisthesis (IS) or degenerative spondylosis (DS) including degenerative spondylolisthesis, foraminal stenosis with central stenosis, degenerative disc disease, and recurrent disc herniation. SUMMARY OF BACKGROUND DATA:: MIS-TLIF is a common surgical procedure to treat lumbar spondylolisthesis. However, there are no studies that have documented the long-term results of MIS-TLIF. METHODS:: Forty-four patients who had undergone instrumented MIS-TLIF between July 2003 and January 2005, were retrospectively reviewed. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), patient satisfaction rate (PSR), and the patient's return-to-work status were used to assess clinical and functional outcomes. Radiological follow-up were carried out in patients to check for adjacent segmental degeneration (ASD). The plain radiographs, CT and MRI were used in all patients in last follow-up period. RESULTS:: The mean VAS scores for back and leg pain decreased from 5.8 and 7 to 3.5 and 3.7 respectively in the DS group (n=19) and from 6.8 and 6.9 to 1.8 and 2.0 respectively in the IS group (n=25) (P<0.001). The mean ODI scores improved from 61.7% to 21.5% in the DS group and from 53.9% to 16% in the IS group (P<0.001). PSR was 80% and 81% in the DS and IS groups, respectively. Evidence of fusion was observed radiologically in 24 (96%) and 19 (100%) of the patients in the IS and the DS group respectively, giving an overall fusion rate of 97.7% (43/44). The final ASD rate, observed using radiography, was 68.4% (13/19) in the DS, and 40% (10/25) in the IS group. However, 15.8% (3/19) in the DS and 4% (1/25) in the IS group had symptoms associated with ASD. CONCLUSIONS:: The long-term clinical and radiologic outcomes after instrumented MIS-TLIF in patients with unstable single

  10. The “inside out” transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature

    PubMed Central

    Gore, Satishchandra

    2014-01-01

    Surgical management of back and leg pain is evolving and changing due to a better understanding of the patho-anatomy well correlated with its pathophysiology. Pain is better understood with in vivo visualization and probing of the pain generators using an endoscopic access rather than just relying on symptoms diagram and image correlation. This has resulted in a shared decision making involving patient and surgeon, focused on a broader spectrum of surgical as well as non-surgical treatments, and not just masking the pain generator. It has moved away from decisions based on diagnostic images alone, that, while noting the image alterations, cannot explain the pain experienced by each individual as images do not always show variations in nerve supply and patho-anatomy. The ability to isolate and visualize “pain” generators in the foramen and treating persistent pain by visualizing inflammation and compression of nerves, serves as the basis for transforaminal endoscopic (TFE) surgery. This has also resulted in better pre surgical planning with more specific and defined goals in mind. The “Inside out” philosophy of TFE surgery is safe and precise. It provides basic access to the disc and foramen to cover a large spectrum of painful pathologies. PMID:25694940

  11. The "inside out" transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature.

    PubMed

    Gore, Satishchandra; Yeung, Anthony

    2014-01-01

    Surgical management of back and leg pain is evolving and changing due to a better understanding of the patho-anatomy well correlated with its pathophysiology. Pain is better understood with in vivo visualization and probing of the pain generators using an endoscopic access rather than just relying on symptoms diagram and image correlation. This has resulted in a shared decision making involving patient and surgeon, focused on a broader spectrum of surgical as well as non-surgical treatments, and not just masking the pain generator. It has moved away from decisions based on diagnostic images alone, that, while noting the image alterations, cannot explain the pain experienced by each individual as images do not always show variations in nerve supply and patho-anatomy. The ability to isolate and visualize "pain" generators in the foramen and treating persistent pain by visualizing inflammation and compression of nerves, serves as the basis for transforaminal endoscopic (TFE) surgery. This has also resulted in better pre surgical planning with more specific and defined goals in mind. The "Inside out" philosophy of TFE surgery is safe and precise. It provides basic access to the disc and foramen to cover a large spectrum of painful pathologies.

  12. First fusion proton measurements in TEXTOR plasmas using activation technique

    SciTech Connect

    Bonheure, G.; Wassenhove, G. Van; Mlynar, J.; Hult, M.; Gonzalez de Orduna, R.; Lutter, G.; Vermaercke, P.; Huber, A.; Schweer, B.; Esser, G.; Biel, W.

    2012-10-15

    MeV particle loss measurements from fusion plasmas, in particular alpha particles, remain difficult in large fusion devices and further R and D is needed for ITER. This paper describes the first attempt to measure 3 MeV escaping fusion protons emitted from TEXTOR tokamak plasmas using activation technique. This technique was successfully demonstrated, initially, in 2006 on the JET tokamak. An ion camera equipped with a collimator and several types of activation detectors was installed inside the TEXTOR vacuum vessel to perform these measurements. After irradiation, the detectors were analyzed using ultra low level gamma-ray spectrometry at the HADES underground laboratory. 3 MeV escaping fusion protons were detected in larger number -{approx}6 times more - compared to earlier measurements using this technique on JET. Another major progress was the reduction of the cooling time by a factor of 50, which made possible to detect radionuclides with half-life of less than 90 min.

  13. First fusion proton measurements in TEXTOR plasmas using activation technique.

    PubMed

    Bonheure, G; Mlynar, J; Van Wassenhove, G; Hult, M; González de Orduña, R; Lutter, G; Vermaercke, P; Huber, A; Schweer, B; Esser, G; Biel, W

    2012-10-01

    MeV particle loss measurements from fusion plasmas, in particular alpha particles, remain difficult in large fusion devices and further R&D is needed for ITER. This paper describes the first attempt to measure 3 MeV escaping fusion protons emitted from TEXTOR tokamak plasmas using activation technique. This technique was successfully demonstrated, initially, in 2006 on the JET tokamak. An ion camera equipped with a collimator and several types of activation detectors was installed inside the TEXTOR vacuum vessel to perform these measurements. After irradiation, the detectors were analyzed using ultra low level gamma-ray spectrometry at the HADES underground laboratory. 3 MeV escaping fusion protons were detected in larger number -~6 times more--compared to earlier measurements using this technique on JET. Another major progress was the reduction of the cooling time by a factor of 50, which made possible to detect radionuclides with half-life of less than 90 min.

  14. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections.

    PubMed

    Furman, Michael B; Giovanniello, Michael T; O'Brien, Erin M

    2003-01-01

    STUDY DESIGN A prospective, observational, human, study was conducted. OBJECTIVES To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced transforaminal cervical epidural steroid injections, and to determine whether the observation of blood in the needle hub can be used to predict a vascular injection. SUMMARY OF BACKGROUND DATA Incorrectly placed intravascular cervical spinal injections result in medication flow systemically and not to the desired target. A recently published study demonstrates a high incidence of intravascular injections in transforaminal lumbosacral epidural injections. No studies so far have evaluated the incidence of vascular injections in transforaminal cervical epidural steroid injections, nor have they calculated the ability of observed blood in the needle hub to predict a vascular injection in the cervical spine.METHODS The incidence of fluoroscopically confirmed intravascular uptake of contrast was prospectively observed in 337 patients treated with cervical transforaminal epidural steroid injections. The ability of observed blood in the needle hub to predict intravascular injection was also investigated. For each subject, the injection level was chosen on the basis of the clinical scenario including history, physical examination, and review of imaging studies. Some patients had multilevel injections. Using fluoroscopic guidance, the authors placed a 25-gauge needle into the epidural space using a transforaminal approach according to accepted standard technique. Needle tip location was confirmed with biplanar imaging. The presence or absence of blood in the needle hub spontaneously ("flash") and after attempted aspiration by pulling back on the syringe's plunger was documented. Contrast then was injected under real-time fluoroscopy to determine whether the location of the needle tip was intravascular. The results were recorded in a prospective manner indicating the presence or absence of blood

  15. CT fluoroscopy-assisted cervical transforaminal steroid injection: tips, traps, and use of contrast material.

    PubMed

    Hoang, Jenny K; Apostol, Marc A; Kranz, Peter G; Kilani, Ramsey K; Taylor, Jeffrey N; Gray, Linda; Lascola, Christopher D

    2010-10-01

    CT fluoroscopy-assisted cervical transforaminal steroid injection is an effective therapeutic option for cervical radiculopathy, yet it is approached with trepidation by some interventionalists. CT fluoroscopy is superior to conventional fluoroscopy for delineating complex anatomic relations in the neck but must be combined with careful technique to avoid rare but serious complications. We describe the anatomy of the neural foramen, our technique of CT fluoroscopy-assisted cervical transforaminal steroid injection, and the CT appearance of appropriate and inappropriate needle positions. Understanding anatomy will help to avoid complications and optimize the therapeutic potential of cervical transforaminal steroid injection. Use of contrast material for CT fluoroscopic guidance facilitates appropriate needle positioning and reduces the risk of complications.

  16. Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

    PubMed Central

    Gambhir, Shanu

    2016-01-01

    The incidence of lumbar fusion for the treatment of various degenerative lumbar spine diseases has increased dramatically over the last twenty years. Many lumbar fusion techniques have been developed and popularized, each with its own advantages and disadvantages. Anterior lumbar interbody fusion (ALIF) initially introduced in the 1930’s, has become a common and widely accepted technique for lumbar fusions over the last decade offering several advantages over standard posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). More recently, the lateral trans-psoas approach termed extreme, direct or lateral lumbar interbody fusion (XLIF, DLIF, LLIF) is gaining widespread popularity. The aim of this paper is to compare the approaches, advantages and disadvantages of ALIF and XLIF for L4/5 interbody fusion based on relevant literature. PMID:27683688

  17. Comparison of additive image fusion vs. feature-level image fusion techniques for enhanced night driving

    NASA Astrophysics Data System (ADS)

    Bender, Edward J.; Reese, Colin E.; Van Der Wal, Gooitzen S.

    2003-02-01

    The Night Vision & Electronic Sensors Directorate (NVESD) has conducted a series of image fusion evaluations under the Head-Tracked Vision System (HTVS) program. The HTVS is a driving system for both wheeled and tracked military vehicles, wherein dual-waveband sensors are directed in a more natural head-slewed imaging mode. The HTVS consists of thermal and image-intensified TV sensors, a high-speed gimbal, a head-mounted display, and a head tracker. A series of NVESD field tests over the past two years has investigated the degree to which additive (A+B) image fusion of these sensors enhances overall driving performance. Additive fusion employs a single (but user adjustable) fractional weighting for all the features of each sensor's image. More recently, NVESD and Sarnoff Corporation have begun a cooperative effort to evaluate and refine Sarnoff's "feature-level" multi-resolution (pyramid) algorithms for image fusion. This approach employs digital processing techniques to select at each image point only the sensor with the strongest features, and to utilize only those features to reconstruct the fused video image. This selection process is performed simultaneously at multiple scales of the image, which are combined to form the reconstructed fused image. All image fusion techniques attempt to combine the "best of both sensors" in a single image. Typically, thermal sensors are better for detecting military threats and targets, while image-intensified sensors provide more natural scene cues and detect cultural lighting. This investigation will address the differences between additive fusion and feature-level image fusion techniques for enhancing the driver's overall situational awareness.

  18. A novel technique using hydrophilic polymers to promote axonal fusion.

    PubMed

    Bamba, Ravinder; Riley, D Colton; Kelm, Nathaniel D; Does, Mark D; Dortch, Richard D; Thayer, Wesley P

    2016-04-01

    The management of traumatic peripheral nerve injury remains a considerable concern for clinicians. With minimal innovations in surgical technique and a limited number of specialists trained to treat peripheral nerve injury, outcomes of surgical intervention have been unpredictable. The inability to manipulate the pathophysiology of nerve injury (i.e., Wallerian degeneration) has left scientists and clinicians depending on the slow and lengthy process of axonal regeneration (~1 mm/day). When axons are severed, the endings undergo calcium-mediated plasmalemmal sealing, which limits the ability of the axon to be primarily repaired. Polythethylene glycol (PEG) in combination with a bioengineered process overcomes the inability to fuse axons. The mechanism for PEG axonal fusion is not clearly understood, but multiple studies have shown that a providing a calcium-free environment is essential to the process known as PEG fusion. The proposed mechanism is PEG-induced lipid bilayer fusion by removing the hydration barrier surrounding the axolemma and reducing the activation energy required for membrane fusion to occur. This review highlights PEG fusion, its past and current studies, and future directions in PEG fusion.

  19. Gabor-based fusion technique for Optical Coherence Microscopy.

    PubMed

    Rolland, Jannick P; Meemon, Panomsak; Murali, Supraja; Thompson, Kevin P; Lee, Kye-sung

    2010-02-15

    We recently reported on an Optical Coherence Microscopy technique, whose innovation intrinsically builds on a recently reported - 2 microm invariant lateral resolution by design throughout a 2 mm cubic full-field of view - liquid-lens-based dynamic focusing optical probe [Murali et al., Optics Letters 34, 145-147, 2009]. We shall report in this paper on the image acquisition enabled by this optical probe when combined with an automatic data fusion method developed and described here to produce an in-focus high resolution image throughout the imaging depth of the sample. An African frog tadpole (Xenopus laevis) was imaged with the novel probe and the Gabor-based fusion technique, demonstrating subcellular resolution in a 0.5 mm (lateral) x 0.5 mm (axial) without the need, for the first time, for x-y translation stages, depth scanning, high-cost adaptive optics, or manual intervention. In vivo images of human skin are also presented.

  20. Transforaminal full-endoscopic lumbar discectomy in obese patients

    PubMed Central

    Bae, Jun Seok

    2016-01-01

    Background Obese patients are at risk of complications such as slower wound healing and increased infection rates after spinal surgery. Transforaminal full-endoscopic lumbar discectomy (ELD) has advantages over conventional microdiscectomy because it decreases perioperative complications and increases favorable clinical outcomes. No clinical studies have reported ELD in obese patients. The purpose of this study is to evaluate the clinical outcomes of transforaminal ELD in obese patients Methods Obesity is defined as a body mass index (BMI) of more than 30 kg/m2. Our study included 21 obese patients and 27 normal BMI patients treated by posterolateral transforaminal ELD for radiating pain caused by a single-level lumbar disc herniation with more than 2 years of follow-up. Clinical chart reviews and telephone surveys were conducted. Clinical and functional outcomes using VAS and ODI, perioperative complications, and reherniation were evaluated. Results Overall clinical and functional outcomes were improved during postoperative follow-up evaluation. There were no immediate perioperative complications, such as infection or durotomy in both groups. In obese group, three patients had late reherniations. Of these, 2 patients had tolerable pain and showed good recovery with conservative treatment; 1 patient who had undergone ELD for recurrent disc herniation underwent open microdiscectomy. In control group, two patients had early reherniation and underwent open microdiscectomy and one patient with late reherniation showed good recovery with conservative treatment. Conclusion In select cases, ELD is an effective, safe, and minimally invasive technique for obese patients. It decreases perioperative morbidity and allows for both early mobilization and early return to work. Level of Evidence: level 3b. PMID:27441176

  1. Vegetation change detection based on image fusion technique

    NASA Astrophysics Data System (ADS)

    Jia, Yonghong; Liu, Yueyan; Yu, Hui; Li, Deren

    2005-10-01

    The change detection of land use and land cover has always been the focus of remotely sensed study and application. Based on techniques of image fusion, a new approach of detecting vegetation change according to vector of brightness index (BI) and perpendicular vegetation index (PVI) extracted from multi-temporal remotely sensed imagery is proposed. The procedure is introduced. Firstly, the Landsat eTM+ imagery is geometrically corrected and registered. Secondly, band 2,3,4 and panchromatic images of Landsat eTM+ are fused by a trous wavelet fusion, and bands 1,2,3 of SPOT are registered to the fused images. Thirdly, brightness index and perpendicular vegetation index are respectively extracted from SPOT images and fused images. Finally, change vectors are obtained and used to detect vegetation change. The testing results show that the approach of detecting vegetation change is very efficient.

  2. Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF).

    PubMed

    Phan, Kevin; Maharaj, Monish; Assem, Yusuf; Mobbs, Ralph J

    2016-09-01

    Lumbar interbody fusion represents an effective surgical intervention for patients with lumbar degenerative diseases, spondylolisthesis, disc herniation, pseudoarthrosis and spinal deformities. Traditionally, conventional open anterior lumbar interbody fusion and posterior/transforaminal lumbar interbody fusion techniques have been employed with excellent results, but each with their own advantages and caveats. Most recently, the antero-oblique trajectory has been introduced, providing yet another corridor to access the lumbar spine. Termed the oblique lumbar interbody fusion, this approach accesses the spine between the anterior vessels and psoas muscles, avoiding both sets of structures to allow efficient clearance of the disc space and application of a large interbody device to afford distraction for foraminal decompression and endplate preparation for rapid and thorough fusion. This review aims to summarize the early clinical results and complications of this new technique and discusses potential future directions of research.

  3. The SIGN nail for knee fusion: technique and clinical results

    PubMed Central

    Anderson, Duane Ray; Anderson, Lucas Aaron; Haller, Justin M.; Feyissa, Abebe Chala

    2016-01-01

    Purpose: Evaluate the efficacy of using the SIGN nail for instrumented knee fusion. Methods: Six consecutive patients (seven knees, three males) with an average age of 30.5 years (range, 18–50 years) underwent a knee arthrodesis with SIGN nail (mean follow-up 10.7 months; range, 8–14 months). Diagnoses included tuberculosis (two knees), congenital knee dislocation in two knees (one patient), bacterial septic arthritis (one knee), malunited spontaneous fusion (one knee), and severe gout with 90° flexion contracture (one knee). The nail was inserted through an anteromedial entry point on the femur and full weightbearing was permitted immediately. Results: All knees had clinical and radiographic evidence of fusion at final follow-up and none required further surgery. Four of six patients ambulated without assistive device, and all patients reported improved overall physical function. There were no post-operative complications. Conclusion: The technique described utilizing the SIGN nail is both safe and effective for knee arthrodesis and useful for austere environments with limited fluoroscopy and implant options. PMID:27163095

  4. Verification of Ultrasonic Image Fusion Technique for Laparoscopic Surgery

    NASA Astrophysics Data System (ADS)

    Zenbutsu, Satoki; Igarashi, Tatsuo; Mamou, Jonathan; Yamaguchi, Tadashi

    2012-07-01

    Laparoscopic surgery is one of the most challenging surgical operations, because inside information about the target organ cannot be fully understood from the laparoscopic image. Therefore, a fusion technique of laparoscopic and ultrasonic images is proposed for guidance during laparoscopic surgery. The proposed technique can display the internal organ structure by overlaying a three-dimensional (3D) ultrasonic image over a 3D laparoscopic image, which is acquired using a stereo laparoscope. The registration of the 3D images is performed by registering the surface of the target organ, which is found in the two 3D images without requiring the use of an external position detecting device. The proposed technique was evaluated experimentally using a tissue-mimicking phantom. Results obtained led to registration accuracy better than 2 cm. The total computation time was 3.1 min on a personal computer (Xeon processor, 3 GHz CPU). The structural information permits the visualization of target organs during laparoscopic surgery.

  5. Plasma processing techniques for tritium inventory control in fusion research

    NASA Astrophysics Data System (ADS)

    Tabarés, F. L.; Rohde, V.; ASDEX Upgrade Team

    2004-12-01

    Some techniques with a long tradition in the plasma technology field have already been successfully applied to research in plasma wall interactions of fusion devices. They have produced important advances in the control of particle and energy exhaust. In this paper, the possible application of these techniques to the problem of tritium inventory control in fusion reactors with carbon-based plasma facing materials, as in ITER, is proposed. It is based on a critical analysis of relevant information obtained in the field of hard CN film deposition and consists of the use of chemical scavengers for the inhibition of tritium-rich carbon-film formation in hidden areas of the divertor. The practical implementation of the technique, however, requires a detailed knowledge of the physio-chemical processes involved, and, to date, experiments in cold and divertor plasmas have been performed. Very recent experiments in the ASDEX Upgrade device have shown that the injection of nitrogen in the sub-divertor region can lead to a drastic decrease in the level of deposited material with no significant effects in the performance of the main plasma. This and other findings are interpreted in the light of recent results from laboratory and divertor plasma experiments and the extrapolation to new divertor scenarios is discussed.

  6. Multiexpandable cage for minimally invasive posterior lumbar interbody fusion

    PubMed Central

    Coe, Jeffrey D; Zucherman, James F; Kucharzyk, Donald W; Poelstra, Kornelis A; Miller, Larry E; Kunwar, Sandeep

    2016-01-01

    The increasing adoption of minimally invasive techniques for spine surgery in recent years has led to significant advancements in instrumentation for lumbar interbody fusion. Percutaneous pedicle screw fixation is now a mature technology, but the role of expandable cages is still evolving. The capability to deliver a multiexpandable interbody cage with a large footprint through a narrow surgical cannula represents a significant advancement in spinal surgery technology. The purpose of this report is to describe a multiexpandable lumbar interbody fusion cage, including implant characteristics, intended use, surgical technique, preclinical testing, and early clinical experience. Results to date suggest that the multiexpandable cage allows a less invasive approach to posterior/transforaminal lumbar interbody fusion surgery by minimizing iatrogenic risks associated with static or vertically expanding interbody prostheses while providing immediate vertebral height restoration, restoration of anatomic alignment, and excellent early-term clinical results. PMID:27729817

  7. Effervescence Assisted Fusion Technique to Enhance the Solubility of Drugs.

    PubMed

    Alam, Mohd Aftab; Al-Jenoobi, Fahad I; Al-Mohizea, Abdullah M; Ali, Raisuddin

    2015-12-01

    The solubility of five poorly soluble drugs was enhanced by using an effervescence assisted solid dispersion (EASD) technique. EASDs were prepared by using modified fusion method. Drug and hydrophilic carrier were melted, and in this molten mixture, effervescence was generated by adding effervescence couple comprising organic acid (citric acid) and carbonic base (sodium bicarbonate). Solubility of drug powders, solid dispersions, and EASDs was determined at 25°C using shake flask method. Atorvastatin calcium, cefuroxime axetil, clotrimazole, ketoconazole, and metronidazole benzoate were estimated using a spectrophotometer at 246, 280, 260, 230, and 232 nm (λ max), respectively. Solubility of atorvastatin calcium (from 100 to 345 μg/ml), cefuroxime axetil (from 441 to 1948 μg/ml), clotrimazole (from 63 to 677 μg/ml), ketoconazole (from 16 to 500 μg/ml), and metronidazole benzoate (from 112 to 208 μg/ml) in EASDs was enhanced by 3.45-, 4.4-, 10.7-, 31.2-, and 1.8-fold, respectively. Scanning electron micrographs of drug powder, solid dispersion, and EASDs were compared. Scanning electron micrographs of EASDs showed a uniform distribution of drug particles in the carrier matrix. Morphology (size and shape) of cefuroxime axetil particles was altered in solid dispersion as well as in EASD. EASDs showed better solubility enhancement than conventional solid dispersions. The present technique is better suitable for drugs having a low melting point or melt without charring. Effervescence assisted fusion technique of preparing solid dispersions can be employed for enhancing solubility, dissolution, and bioavailability of poorly soluble drugs.

  8. Anaerobically expressed Escherichia coli genes identified by operon fusion techniques.

    PubMed Central

    Choe, M; Reznikoff, W S

    1991-01-01

    Genes that are expressed under anaerobic conditions were identified by operon fusion techniques with a hybrid bacteriophage of lambda and Mu, lambda placMu53, which creates transcriptional fusions to lacZY. Cells were screened for anaerobic expression on XG medium. Nine strains were selected, and the insertion point of the hybrid phage in each strain was mapped on the Escherichia coli chromosome linkage map. The anaerobic and aerobic expression levels of these genes were measured by beta-galactosidase assays in different medium conditions and in the presence of three regulatory mutations (fnr, narL, and rpoN). The anaerobically expressed genes (aeg) located at minute 99 (aeg-99) and 75 (aeg-75) appeared to be partially regulated by fnr, and aeg-93 is tightly regulated by fnr. aeg-60 requires a functional rpoN gene for its anaerobic expression. aeg-46.5 is repressed by narL. aeg-65A and aeg-65C are partially controlled by fnr but only in media containing nitrate or fumarate. aeg-47.5 and aeg-48.5 were found to be anaerobically induced only in rich media. The effects of a narL mutation on aeg-46.5 expression were observed in all medium conditions regardless of the presence or absence of nitrate. This suggests that narL has a regulatory function in the absence of exogenously added nitrate. PMID:1917846

  9. Intervertebral Fusion with Mobile Microendoscopic Discectomy for Lumbar Degenerative Disc Disease.

    PubMed

    Xu, Bao-Shan; Liu, Yue; Xu, Hai-Wei; Yang, Qiang; Ma, Xin-Long; Hu, Yong-Cheng

    2016-05-01

    The aim of this article is to introduce a technique for lumbar intervertebral fusion that incorporates mobile microendoscopic discectomy (MMED) for lumbar degenerative disc disease. Minimally invasive transforaminal lumbar interbody fusion is frequently performed to treat degenerative diseases of the lumbar spine; however, the scope of such surgery and vision is limited by what the naked eye can see through the expanding channel system. To expand the visual scope and reduce trauma, we perform lumbar intervertebral fusion with the aid of a MMED system that provides a wide field through freely tilting the surgical instrument and canals. We believe that this technique is a good option for treating lumbar degenerative disc disease that requires lumbar intervertebral fusion. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  10. Infrared and color visible image fusion system based on luminance-contrast transfer technique

    NASA Astrophysics Data System (ADS)

    Wang, Bo; Gong, Wenfeng; Wang, Chensheng

    2012-12-01

    In this paper, an infrared and color image fusion algorithm based on luminance-contrast transfer technique is presented. This algorithm shall operate YCbCr transform on color visible image, and obtain the luminance component. Then, the grey-scale image fusion methods are utilized to fuse the luminance component of visible and infrared images to acquire grey-scale fusion image. After that, the grey-scale fusion image and visible image are fused to form color fusion image based on inversed YCbCr transform. To acquire better details appearance, a natural-sense color transfer fusion algorithm based on reference image is proposed. Furthermore, a real-time infrared/visible image fusion system based on FPGA is realized. Finally, this design and achievement is verified experimentally, and the experimental results show that the system can produce a color fusion image with good image quality and real-time performance.

  11. Occipitocervical Fusion Surgery: Review of Operative Techniques and Results

    PubMed Central

    Kukreja, Sunil; Ambekar, Sudheer; Sin, Anthony H.; Nanda, Anil

    2015-01-01

    Objective Varying types of clinicoradiologic presentations at the craniovertebral junction (CVJ) influence the decision process for occipitocervical fusion (OCF) surgery. We discuss the operative techniques and decision-making process in OCF surgery based on our clinical experience and a literature review. Material and Methods A total of 49 consecutive patients who underwent OCF participated in the study. Sagittal computed tomography images were used to illustrate and measure radiologic parameters. We measured Wackenheim clivus baseline (WCB), clivus-canal angle (CCA), atlantodental distance (ADD), and Powers ratio (PR) in all the patients. Results Clinical improvement on Nurick grading was recorded in 36 patients. Patients with better preoperative status (Nurick grades 1–3) had better functional outcomes after the surgery (p = 0.077). Restoration of WCB, CCA, ADD, and PR parameters following the surgery was noted in 39.2%, 34.6%, 77.4%, and 63.3% of the patients, respectively. Complications included deep wound infections (n = 2), pseudoarthrosis (n = 2), and deaths (n = 4). Conclusion Conventional wire-based constructs are superseded by more rigid screw-based designs. Odontoidectomy is associated with a high incidence of perioperative complications. The advent of newer implants and reduction techniques around the CVJ has obviated the need for this procedure in most patients. PMID:26401473

  12. Lumbar lordosis restoration following single-level instrumented fusion comparing 4 commonly used techniques.

    PubMed

    Dimar, John R; Glassman, Steven D; Vemuri, Venu M; Esterberg, Justin L; Howard, Jennifer M; Carreon, Leah Y

    2011-11-09

    A major sequelae of lumbar fusion is acceleration of adjacent-level degeneration due to decreased lumbar lordosis. We evaluated the effectiveness of 4 common fusion techniques in restoring lordosis: instrumented posterolateral fusion, translumbar interbody fusion, anteroposterior fusion with posterior instrumentation, and anterior interbody fusion with lordotic threaded (LT) cages (Medtronic Sofamor Danek, Memphis, Tennessee). Radiographs were measured preoperatively, immediately postoperatively, and a minimum of 6 months postoperatively. Parameters measured included anterior and posterior disk space height, lumbar lordosis from L3 to S1, and surgical level lordosis.No significant difference in demographics existed among the 4 groups. All preoperative parameters were similar among the 4 groups. Lumbar lordosis at final follow-up showed no difference between the anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cage groups, although the posterolateral fusion group showed a significant loss of lordosis (-10°) (P<.001). Immediately postoperatively and at follow-up, the LT cage group had a significantly greater amount of lordosis and showed maintenance of anterior and posterior disk space height postoperatively compared with the other groups. Instrumented posterolateral fusion produces a greater loss of lordosis compared with anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cages. Maintenance of lordosis and anterior and posterior disk space height is significantly better with anterior interbody fusion with LT cages. Copyright 2011, SLACK Incorporated.

  13. Development of preoperative planning software for transforaminal endoscopic surgery and the guidance for clinical applications.

    PubMed

    Chen, Xiaojun; Cheng, Jun; Gu, Xin; Sun, Yi; Politis, Constantinus

    2016-04-01

    Preoperative planning is of great importance for transforaminal endoscopic techniques applied in percutaneous endoscopic lumbar discectomy. In this study, a modular preoperative planning software for transforaminal endoscopic surgery was developed and demonstrated. The path searching method is based on collision detection, and the oriented bounding box was constructed for the anatomical models. Then, image reformatting algorithms were developed for multiplanar reconstruction which provides detailed anatomical information surrounding the virtual planned path. Finally, multithread technique was implemented to realize the steady-state condition of the software. A preoperative planning software for transforaminal endoscopic surgery (TE-Guider) was developed; seven cases of patients with symptomatic lumbar disc herniations were planned preoperatively using TE-Guider. The distances to the midlines and the direction of the optimal paths were exported, and each result was in line with the empirical value. TE-Guider provides an efficient and cost-effective way to search the ideal path and entry point for the puncture. However, more clinical cases will be conducted to demonstrate its feasibility and reliability.

  14. NUMO: A new (D,T) fusion diagnostic technique

    SciTech Connect

    Moran, M.J.

    1989-02-06

    A NeUtron MOnochromator, NUMO, for (D,T) fusion diagnostics is described. The monochromator consists of CH/sub 2/ (n,p) converter foil, a sector-magnet monochromator and Faraday cup detector. This system can be used to study some details of (D,T) fusion reaction history. 6 refs., 5 figs.

  15. Multimodality medical image registration and fusion techniques using mutual information and genetic algorithm-based approaches.

    PubMed

    Bhattacharya, Mahua; Das, Arpita

    2011-01-01

    Medical image fusion has been used to derive the useful complimentary information from multimodal images. The prior step of fusion is registration or proper alignment of test images for accurate extraction of detail information. For this purpose, the images to be fused are geometrically aligned using mutual information (MI) as similarity measuring metric followed by genetic algorithm to maximize MI. The proposed fusion strategy incorporating multi-resolution approach extracts more fine details from the test images and improves the quality of composite fused image. The proposed fusion approach is independent of any manual marking or knowledge of fiducial points and starts the procedure automatically. The performance of proposed genetic-based fusion methodology is compared with fuzzy clustering algorithm-based fusion approach, and the experimental results show that genetic-based fusion technique improves the quality of the fused image significantly over the fuzzy approaches.

  16. Transforaminal endoscopic spinal surgery: the future 'gold standard' for discectomy? - A review.

    PubMed

    Gibson, J N Alastair; Cowie, Jonathan G; Iprenburg, Menno

    2012-10-01

    Lumbar disc prolapse is common and the primary method of care in most centres is still open discectomy facilitated by microscope or loupe magnification and illumination. Hospitalisation may be less than 24 h, but post-operative pain usually requires an overnight stay. This review describes transforaminal endoscopic spinal surgery (TESS) using HD-video technology, that is generally performed as a day case procedure under sedation or light general anaesthesia, and collates the evidence comparing the technique to microdiscectomy. The method of TESS is described and an electronic literature search performed to identify papers reporting clinical outcomes. International data were translated where necessary and proceedings' abstracts included. In addition, papers held by the authors and colleagues in personal libraries were carefully cross-referenced to the obtained database. Analysis of the data supports the use of a transforaminal endoscopic approach to the lumbar intervertebral disc and suggests that outcomes following surgery are at least equivalent to those following microdiscectomy. Significant cost-savings in terms of in-patient stay may be generated. In addition, there is also some evidence supporting endoscopic surgery for relief of foraminal stenosis. Based on current evidence there are good arguments supporting a more wide-spread adoption of transforaminal endoscopic surgery for the treatment of lumbar disc prolapse with or without foraminal stenosis. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  17. Comparison of a Modified Kjeldahl and vacuum Fusion Techniques for Determination of Nitrogen in Tantalum Alloys

    DTIC Science & Technology

    1970-07-01

    A MODIFIED KJELDAHL AND VACUUM FUSION TECHNIQUES FOR DETERMINATION OF NITROGEN IN TANTALUM ALLOYS by Warren F. Davis, Judson W. Graab, and EmeryJ...Abstract This report compares results obtained for the determination of nitrogen in the tantalum- base alloys T-111 and T-222 by Kjeldahl and vacuum fusion...the relative standard deviation was 3 to 9 percent by the Kjeldahl procedure and 4 to 8 percent by vacuum fusion. The agreement of the nitrogen results

  18. Midline Lumbar Fusion with Cortical Bone Trajectory Screw

    PubMed Central

    MIZUNO, Masaki; KURAISHI, Keita; UMEDA, Yasuyuki; SANO, Takanori; TSUJI, Masanori; SUZUKI, Hidenori

    2014-01-01

    A novel cortical bone trajectory (CBT) screw technique provides an alternative fixation technique for lumbar spine. Trajectory of CBT screw creates a caudo-cephalad path in sagittal plane and a medio-lateral path in axial plane, and engages cortical bone in the pedicle. The theoretical advantage is that it provides enhanced screw grip and interface strength. Midline lumbar fusion (MIDLF) is composed of posterior mid-line approach, microsurgical laminectomy, and CBT screw fixation. We adopted the MIDLF technique for lumbar spondylolisthesis. Advantages of this technique include that decompression and fusion are available in the same field, and it minimizes approach-related damages. To determine whether MIDLF with CBT screw is as effective as traditional approach and it is minimum invasive technique, we studied the clinical and radiological outcomes of MIDLF. Our results indicate that MIDLF is effective and minimum invasive technique. Evidence of effectiveness of MIDLF is that patients had good recovery score, and that CBT screw technique was safety in clinical and stable in radiological. MIDLF with CBT screw provides the surgeon with additional options for fixation. This technique is most likely to be useful for treating lumbar spondylolisthesis in combination with midline decompression and insertion of an interbody graft, such as the transforaminal lumbar interbody fusion or posterior lumbar interbody fusion techniques. PMID:25169139

  19. Multimodality Image Fusion-Guided Procedures: Technique, Accuracy, and Applications

    SciTech Connect

    Abi-Jaoudeh, Nadine; Kruecker, Jochen; Kadoury, Samuel; Kobeiter, Hicham; Venkatesan, Aradhana M. Levy, Elliot Wood, Bradford J.

    2012-10-15

    Personalized therapies play an increasingly critical role in cancer care: Image guidance with multimodality image fusion facilitates the targeting of specific tissue for tissue characterization and plays a role in drug discovery and optimization of tailored therapies. Positron-emission tomography (PET), magnetic resonance imaging (MRI), and contrast-enhanced computed tomography (CT) may offer additional information not otherwise available to the operator during minimally invasive image-guided procedures, such as biopsy and ablation. With use of multimodality image fusion for image-guided interventions, navigation with advanced modalities does not require the physical presence of the PET, MRI, or CT imaging system. Several commercially available methods of image-fusion and device navigation are reviewed along with an explanation of common tracking hardware and software. An overview of current clinical applications for multimodality navigation is provided.

  20. Multi-intelligence critical rating assessment of fusion techniques (MiCRAFT)

    NASA Astrophysics Data System (ADS)

    Blasch, Erik

    2015-06-01

    Assessment of multi-intelligence fusion techniques includes credibility of algorithm performance, quality of results against mission needs, and usability in a work-domain context. Situation awareness (SAW) brings together low-level information fusion (tracking and identification), high-level information fusion (threat and scenario-based assessment), and information fusion level 5 user refinement (physical, cognitive, and information tasks). To measure SAW, we discuss the SAGAT (Situational Awareness Global Assessment Technique) technique for a multi-intelligence fusion (MIF) system assessment that focuses on the advantages of MIF against single intelligence sources. Building on the NASA TLX (Task Load Index), SAGAT probes, SART (Situational Awareness Rating Technique) questionnaires, and CDM (Critical Decision Method) decision points; we highlight these tools for use in a Multi-Intelligence Critical Rating Assessment of Fusion Techniques (MiCRAFT). The focus is to measure user refinement of a situation over the information fusion quality of service (QoS) metrics: timeliness, accuracy, confidence, workload (cost), and attention (throughput). A key component of any user analysis includes correlation, association, and summarization of data; so we also seek measures of product quality and QuEST of information. Building a notion of product quality from multi-intelligence tools is typically subjective which needs to be aligned with objective machine metrics.

  1. Navigation in Difficult Environments: Multi-Sensor Fusion Techniques

    DTIC Science & Technology

    2010-03-01

    data are applied to improve the robustness of secondary sensors’ signal processing. Applications of the multi-sensor fusion approach are illustrated...algorithms. 1.0 MOTIVATION Many existing and perspective applications of navigation systems would benefit notably from the ability to navigate...accurately and reliably in difficult environments. Examples of difficult navigation scenarios include urban canyons, indoor applications , radio

  2. Evaluating fusion techniques for multi-sensor satellite image data

    SciTech Connect

    Martin, Benjamin W; Vatsavai, Raju

    2013-01-01

    Satellite image data fusion is a topic of interest in many areas including environmental monitoring, emergency response, and defense. Typically any single satellite sensor cannot provide all of the benefits offered by a combination of different sensors (e.g., high-spatial but low spectral resolution vs. low-spatial but high spectral, optical vs. SAR). Given the respective strengths and weaknesses of the different types of image data, it is beneficial to fuse many types of image data to extract as much information as possible from the data. Our work focuses on the fusion of multi-sensor image data into a unified representation that incorporates the potential strengths of a sensor in order to minimize classification error. Of particular interest is the fusion of optical and synthetic aperture radar (SAR) images into a single, multispectral image of the best possible spatial resolution. We explore various methods to optimally fuse these images and evaluate the quality of the image fusion by using K-means clustering to categorize regions in the fused images and comparing the accuracies of the resulting categorization maps.

  3. Model cell membranes: Techniques to form complex biomimetic supported lipid bilayers via vesicle fusion

    PubMed Central

    Hardy, Gregory J.; Nayak, Rahul

    2013-01-01

    Vesicle fusion has long provided an easy and reliable method to form supported lipid bilayers (SLBs) from simple, zwitterionic vesicles on siliceous substrates. However, for complex compositions, such as vesicles with high cholesterol content and multiple lipid types, the energy barrier for the vesicle-to-bilayer transition is increased or the required vesicle-vesicle and vesicle-substrate interactions are insufficient for vesicle fusion. Thus, for vesicle compositions that more accurately mimic native membranes, vesicle fusion often fails to form SLBs. In this paper, we review three approaches to overcome these barriers to form complex, biomimetic SLBs via vesicle fusion: (i) optimization of experimental conditions (e.g., temperature, buffer ionic strength, osmotic stress, cation valency, and buffer pH), (ii) α-helical (AH) peptide-induced vesicle fusion, and (iii) bilayer edge-induced vesicle fusion. AH peptide-induced vesicle fusion can form complex SLBs on multiple substrate types without the use of additional equipment. Bilayer edge-induced vesicle fusion uses microfluidics to form SLBs from vesicles with complex composition, including vesicles derived from native cell membranes. Collectively, this review introduces vesicle fusion techniques that can be generalized for many biomimetic vesicle compositions and many substrate types, and thus will aid efforts to reliably create complex SLB platforms on a range of substrates. PMID:24031164

  4. A channel-based color fusion technique using multispectral images for night vision enhancement

    NASA Astrophysics Data System (ADS)

    Zheng, Yufeng

    2011-09-01

    A fused image using multispectral images can increase the reliability of interpretation because it combines the complimentary information apparent in multispectral images. While a color image can be easily interpreted by human users (for visual analysis), and thus improves observer performance and reaction times. We propose a fast color fusion method, termed as channel-based color fusion, which is efficient for real time applications. Notice that the term of "color fusion" means combing multispectral images into a color-version image with the purpose of resembling natural scenes. On the other hand, false coloring technique usually has no intention of resembling natural scenery. The framework of channel-based color fusion is as follows, (1) prepare for color fusion by preprocessing, image registration and fusion; (2) form a color fusion image by properly assigning multispectral images to red, green, and blue channels; (3) fuse multispectral images (gray fusion) using a wavelet-based fusion algorithm; and (4) replace the value component of color fusion in HSV color space with the gray-fusion image, and finally transform back to RGB space. In night vision imaging, there may be two or several bands of images available, for example, visible (RGB), image intensified (II), near infrared (NIR), medium wave infrared (MWIR), long wave infrared (LWIR). The proposed channel-wise color fusions were tested with two-band (e.g., NIR + LWIR, II + LWIR, RGB + LWIR) or three-band (e.g., RGB + NIR + LWIR) multispectral images. Experimental results show that the colors in the fused images by the proposed method are vivid and comparable with that of the segmentation-based colorization. The processing speed of new method is much faster than any segmentation-based method.

  5. Fusion Techniques for the Oxidation of Refractory Actinide Oxides

    SciTech Connect

    Rudisill, T.S.

    1999-04-15

    Small-scale experiments were performed to demonstrate the feasibility of fusing refractory actinide oxides with a series of materials commonly used to decompose minerals, glasses, and other refractories as a pretreatment to dissolution and subsequent recovery operations. In these experiments, 1-2 g of plutonium or neptunium oxide (PuO2 or NpO2) were calcined at 900 degrees Celsius, mixed and heated with the fusing reagent(s), and dissolved. For refractory PuO2, the most effective material tested was a lithium carbonate (Li2CO3)/sodium tetraborate (Na2B4O7) mixture which aided in the recovery of 90 percent of the plutonium. The fused product was identified as a lithium plutonate (Li3PuO4) by x-ray diffraction. The use of a Li2CO3/Na2B4O7 mixture to solubilize high-fired NpO2 was not as effective as demonstrated for refractory PuO2. In a small-scale experiment, 25 percent of the NpO2 was oxidized to a neptunium (VI) species that dissolved in nitric acid. The remaining neptunium was then easily recovered from the residue by fusing with sodium peroxide (Na2O2). Approximately 70 percent of the neptunium dissolved in water to yield a basic solution of neptunium (VII). The remainder was recovered as a neptunium (VI) solution by dissolving the residue in 8M nitric acid. In subsequent experiments with Na2O2, the ratio of neptunium (VII) to (VI) was shown to be a function of the fusion temperature, with higher temperatures (greater than approximately 400 degrees C) favoring the formation of neptunium (VII). The fusion of an actual plutonium-containing residue with Na2O2 and subsequent dissolution was performed to demonstrate the feasibility of a pretreatment process on a larger scale. Sodium peroxide was chosen due

  6. Joint interpretation of geophysical data using Image Fusion techniques

    NASA Astrophysics Data System (ADS)

    Karamitrou, A.; Tsokas, G.; Petrou, M.

    2013-12-01

    Joint interpretation of geophysical data produced from different methods is a challenging area of research in a wide range of applications. In this work we apply several image fusion approaches to combine maps of electrical resistivity, electromagnetic conductivity, vertical gradient of the magnetic field, magnetic susceptibility, and ground penetrating radar reflections, in order to detect archaeological relics. We utilize data gathered from Arkansas University, with the support of the U.S. Department of Defense, through the Strategic Environmental Research and Development Program (SERDP-CS1263). The area of investigation is the Army City, situated in Riley Country of Kansas, USA. The depth of the relics is estimated about 30 cm from the surface, yet the surface indications of its existence are limited. We initially register the images from the different methods to correct from random offsets due to the use of hand-held devices during the measurement procedure. Next, we apply four different image fusion approaches to create combined images, using fusion with mean values, wavelet decomposition, curvelet transform, and curvelet transform enhancing the images along specific angles. We create seven combinations of pairs between the available geophysical datasets. The combinations are such that for every pair at least one high-resolution method (resistivity or magnetic gradiometry) is included. Our results indicate that in almost every case the method of mean values produces satisfactory fused images that corporate the majority of the features of the initial images. However, the contrast of the final image is reduced, and in some cases the averaging process nearly eliminated features that are fade in the original images. Wavelet based fusion outputs also good results, providing additional control in selecting the feature wavelength. Curvelet based fusion is proved the most effective method in most of the cases. The ability of curvelet domain to unfold the image in

  7. Analysis of polyethylene glycol (PEG) fusion in cultured neuroblastoma cells via flow cytometry: Techniques & optimization.

    PubMed

    Hoffman, Ashley N; Bamba, Ravinder; Pollins, Alonda C; Thayer, Wesley P

    2017-02-01

    Polyethylene glycol (PEG) has long been used as a membrane fusogen, but recently it has been adopted as a technique for peripheral nerve repair. Vertebrate models using PEG fusion have shown improved outcomes when PEG is applied during repair of severed peripheral nerves. The cellular mechanism of PEG fusion in the peripheral nerve repair model has not previously been assessed via flow cytometry. PEG fusion was assessed in this experiment by dying B35 rat neuroblastoma cells with different color fluorescent labels. The different color cells were combined and PEG was applied in concentrations of 50%, 75% and 100%. The amount of cell fusion was assessed via flow cytometry as the percentage of double positive cells. Results showed increasing fusion and decreasing viability with increasing concentrations of PEG.

  8. Incidence of intravascular penetration in transforaminal lumbosacral epidural steroid injections.

    PubMed

    Furman, M B; O'Brien, E M; Zgleszewski, T M

    2000-10-15

    A prospective, observational, human, in vivo study. To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced, transforaminal lumbar epidural steroid injections (ESIs) and determine whether a "flash" (blood in the needle hub) or aspiration of blood can be used to predict a vascular injection. Incorrectly placed, intravascular lumbosacral spinal injections result in systemic medication flow that misses the desired target. No previous studies evaluate the incidence of vascular injections in transforaminal ESIs, nor the ability of flash to predict a vascular injection. The incidence of flash or positive blood aspiration and the incidence of fluoroscopically confirmed vascular spread were prospectively observed in 670 patients treated with lumbosacral fluoroscopically guided transforaminal ESIs. Presence of a flash or positive aspiration was documented. Contrast was injected to determine whether the needle tip was intravascular. Seven hundred sixty-one transforaminal ESIs were included. The overall rate of intravascular injections was 11.2%. There was a statistically significant higher rate of intravascular injections (21.3%) noted with transforaminal ESIs performed at S1 (n = 178), compared with those at the lumbar levels (8.1%, n = 583). Using flash or positive blood aspirate to predict intravascular injections was 97.9% specific, but only 44.7% sensitive. There is a high incidence of intravascular injections in transforaminal ESIs that is significantly increased at S1. Using a flash or blood aspiration to predict an intravascular injection is not sensitive, and therefore a negative flash or aspiration is not reliable. Fluoroscopically guided procedures without contrast confirmation are instilling medications intravascularly and therefore not into the desired epidural location. This finding confirms the need for not only fluoroscopic guidance but also contrast injection instillation in lumbosacral transforaminal ESIs.

  9. National trends in the use of fusion techniques to treat degenerative spondylolisthesis.

    PubMed

    Kepler, Christopher K; Vaccaro, Alexander R; Hilibrand, Alan S; Anderson, D Greg; Rihn, Jeffrey A; Albert, Todd J; Radcliff, Kristen E

    2014-09-01

    Retrospective review. (1) To describe change in treatment patterns for degenerative spondylolisthesis (DS). (2) To report regional variation in treatment of DS. (3) To describe variation in surgeon-reported outcomes for DS based on treatment. Spinal stenosis associated with DS is commonly treated with decompression and fusion but little is known about the optimal fusion technique. During a 6-month period, American Board of Orthopaedic Surgery step II candidates submit procedure lists; these lists have been stored in an electronic database since 1999. The American Board of Orthopaedic Surgery database was retrospectively queried to identify patients who underwent surgery for DS from 1999 to 2011. Included patients underwent uninstrumented fusion, fusion with posterior instrumentation, fusion using interbody device, or decompression without fusion. Utilization of these procedures was analyzed by year and geographic region. The study period included 5639 cases; the annual number of cases doubled during the study period. The percentage of cases treated with interbody fusion (IF) increased significantly throughout the study period, from 13.6% (1999-2001) to 32% (2009-2011) (P<0.001). The percentage of DS cases treated with posterolateral fusion peaked in 2003 then decreased as the rate of IF increased. In 2011, the rates of posterolateral fusion (40%) and posterolateral fusion with IF (37%) were nearly identical. The Northwest had the highest rate of IF (41%), >10% higher than any other region (P<0.001) and more than 23% higher than the Southeast (P<0.001). Despite little evidence guiding treatment strategy for DS, national treatment patterns have changed dramatically during the past 13 years. The rapid adoption of IF and substantial regional variation in treatment utilization patterns raises questions about drivers of change including perceptions about associated fusion rates, the importance of sagittal balance and differential reimbursement. 4.

  10. Transforaminal endoscopic discectomy with foraminoplasty for the treatment of spondylolisthesis.

    PubMed

    Jasper, Gabriele P; Francisco, Gina M; Telfeian, Albert E

    2014-01-01

    Lumbar degenerative spondylolisthesis is a common entity and occurs mainly in elderly patients. The trend in surgery has been to offer decompression with instrumented fusion based on patient-based outcome data and the inherent instability of the condition. Transforaminal endoscopic discectomy and foraminotomy is an ultra-minimally invasive outpatient surgical option available to patients that does not require general anesthesia and does not involve the same amount of destabilizing facet joint removal as a traditional laminectomy and medial facetectomy. The purpose of this study was to assess the benefit of tranforaminal endoscopic discectomy and foraminotomy in patients with lumbar 4-5 (L4-L5) and lumbar 5-sacral 1 (L5-S1) spondylolisthesis and lumbar radiculopathy. After Institutional Review Board Approval, charts from 21 consecutive patients with L4-L5 or L5-S1 spondylolisthesis and complaints of lower back and radicular pain who underwent endoscopic procedures between 2007 and 2012 were reviewed. The average pain relief one year postoperatively was reported to be 71.9%, good results as defined by MacNab. The average pre-operative VAS score was 8.48, indicated in our questionnaire as severe and constant pain. The average one year postoperative VAS score was 2.30, indicated in our questionnaire as mild and intermittent pain. This is a retrospective study and only offers one year follow-up data for patients with spondylolisthesis undergoing endoscopic spine surgery for treatment of lumbar radiculopathy. Endoscopic discectomy is a safe and effective alternative to open back surgery. The one year follow-up data presented here appears to indicate that an ultra-minimally invasive approach to the treatment of lumbar radiculopathy in the setting of spondylolisthesis that has a low complication rate, avoids general anesthesia, and is outpatient might be worth studying in a prospective, longer term way. IRB approval: Meridian Health: IRB Study # 201206071J.

  11. Fusion technique for liver transection with Kelly-clysis and harmonic technology.

    PubMed

    Jagannath, P; Chhabra, D G; Sutariya, K R; Shah, R C

    2010-01-01

    Various devices are available for liver transection and comparative data on transection techniques are limited by the diversity of operative procedures. Clamp crushing (Kelly-clysis) with a Cavitron ultrasonic surgical aspirator (CUSA-Integra Radionics) is widely used for splitting the liver parenchyma. Hemostasis is achieved by bipolar coagulation, ligatures, or hemoclips. We introduce a fusion technique (Focus-clysis) for liver transection using a combination of Kelly-clysis and harmonic technology. A fusion technique (FT) was performed using FOCUS, a Kelly clamp like instrument attached to a Harmonic generator. Hepatic resections (nine major, nine minor) were performed with the fusion technique in 18 non-cirrhotic patients. Variables evaluated were blood loss, transection time, biliary leak, postoperative liver function, morbidity, and cost-effectiveness. The results were compared with 18 hepatic resections (nine major, nine minor) that were performed with our earlier technique, i.e., CUSA with bipolar cautery, ligatures, and hemoclips. The mean blood loss was 416 ml in the FT group, compared to 833 ml in the CUSA group. Two patients in the FT group needed blood transfusion in the first 48 h, whereas eight patients in the CUSA group had transfusions. No major postoperative liver dysfunction was noted with the new technique, and postoperative morbidity was lower in the FT group. Liver transection with the fusion technique was faster. The fusion technique (Focus-clysis) using Kelly-clysis and harmonic technology is promising, easy, and effective for liver transection. Our initial results show advantages over the routinely used CUSA/bipolar combination. The fusion technique could be a new option for liver transection, especially in non-cirrhotic patients.

  12. Postoperative seizure following transforaminal percutaneous endoscopic lumbar discectomy

    PubMed Central

    Kertmen, Hayri; Gürer, Bora; Yilmaz, Erdal Resit; Sekerci, Zeki

    2016-01-01

    Endoscopic surgery for lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic lumbar discectomy is a well-known, safe, and effective method used for the treatment of the lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic lumbar discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic lumbar discectomy is an extremely rare complication. A 20-year-old patient applied at our department who had undergone transforaminal percutaneous endoscopic lumbar. During the procedure, while performing the discography, non-ionic contrast media was administered into the thecal sac inadvertently. Two hours after surgery, the patient developed generalized tonic-clonic seizure of 5-min duration. Diagnosis of iohexol-induced seizure was made and the patient was treated supportively without anti-epileptics. Here we present the first case of seizure after transforaminal percutaneous endoscopic lumbar discectomy, which was caused by inadvertent administration of the contrast media into the thecal sac. PMID:27695562

  13. Improving image classification in a complex wetland ecosystem through image fusion techniques

    NASA Astrophysics Data System (ADS)

    Kumar, Lalit; Sinha, Priyakant; Taylor, Subhashni

    2014-01-01

    The aim of this study was to evaluate the impact of image fusion techniques on vegetation classification accuracies in a complex wetland system. Fusion of panchromatic (PAN) and multispectral (MS) Quickbird satellite imagery was undertaken using four image fusion techniques: Brovey, hue-saturation-value (HSV), principal components (PC), and Gram-Schmidt (GS) spectral sharpening. These four fusion techniques were compared in terms of their mapping accuracy to a normal MS image using maximum-likelihood classification (MLC) and support vector machine (SVM) methods. Gram-Schmidt fusion technique yielded the highest overall accuracy and kappa value with both MLC (67.5% and 0.63, respectively) and SVM methods (73.3% and 0.68, respectively). This compared favorably with the accuracies achieved using the MS image. Overall, improvements of 4.1%, 3.6%, 5.8%, 5.4%, and 7.2% in overall accuracies were obtained in case of SVM over MLC for Brovey, HSV, GS, PC, and MS images, respectively. Visual and statistical analyses of the fused images showed that the Gram-Schmidt spectral sharpening technique preserved spectral quality much better than the principal component, Brovey, and HSV fused images. Other factors, such as the growth stage of species and the presence of extensive background water in many parts of the study area, had an impact on classification accuracies.

  14. Fusion

    NASA Astrophysics Data System (ADS)

    Herman, Robin

    1990-10-01

    The book abounds with fascinating anecdotes about fusion's rocky path: the spurious claim by Argentine dictator Juan Peron in 1951 that his country had built a working fusion reactor, the rush by the United States to drop secrecy and publicize its fusion work as a propaganda offensive after the Russian success with Sputnik; the fortune Penthouse magazine publisher Bob Guccione sank into an unconventional fusion device, the skepticism that met an assertion by two University of Utah chemists in 1989 that they had created "cold fusion" in a bottle. Aimed at a general audience, the book describes the scientific basis of controlled fusion--the fusing of atomic nuclei, under conditions hotter than the sun, to release energy. Using personal recollections of scientists involved, it traces the history of this little-known international race that began during the Cold War in secret laboratories in the United States, Great Britain and the Soviet Union, and evolved into an astonishingly open collaboration between East and West.

  15. Optimized swimmer tracking system by a dynamic fusion of correlation and color histogram techniques

    NASA Astrophysics Data System (ADS)

    Benarab, D.; Napoléon, T.; Alfalou, A.; Verney, A.; Hellard, P.

    2015-12-01

    To design a robust swimmer tracking system, we took into account two well-known tracking techniques: the nonlinear joint transform correlation (NL-JTC) and the color histogram. The two techniques perform comparably well, yet they both have substantial limitations. Interestingly, they also seem to show some complementarity. The correlation technique yields accurate detection but is sensitive to rotation, scale and contour deformation, whereas the color histogram technique is robust for rotation and contour deformation but shows low accuracy and is highly sensitive to luminosity and confusing background colors. These observations suggested the possibility of a dynamic fusion of the correlation plane and the color scores map. Before this fusion, two steps are required. First is the extraction of a sub-plane of correlation that describes the similarity between the reference and target images. This sub-plane has the same size as the color scores map but they have different interval values. Thus, the second step is required which is the normalization of the planes in the same interval so they can be fused. In order to determine the benefits of this fusion technique, first, we tested it on a synthetic image containing different forms with different colors. We thus were able to optimize the correlation plane and color histogram techniques before applying our fusion technique to real videos of swimmers in international competitions. Last, a comparative study of the dynamic fusion technique and the two classical techniques was carried out to demonstrate the efficacy of the proposed technique. The criteria of comparison were the tracking percentage, the peak to correlation energy (PCE), which evaluated the sharpness of the peak (accuracy), and the local standard deviation (Local-STD), which assessed the noise in the planes (robustness).

  16. A modified technique for occipitocervical fusion using compressed iliac crest allograft results in a high rate of fusion in the pediatric population.

    PubMed

    Iyer, Rajiv R; Tuite, Gerald F; Meoded, Avner; Carey, Carolyn C; Rodriguez, Luis F

    2017-08-05

    In children, high rates of occipitocervical (OC) fusion have been demonstrated using rigid instrumentation in combination with harvested autograft, with or without bone morphogenetic protein (BMP). Historically, the use of allograft materials demonstrated inferior OC fusion outcomes compared to autograft. However, autograft harvest harbors an increased risk of patient morbidity, and BMP use is costly and controversial in children. Thus, there remains a need for safer, less costly, yet efficacious techniques for OC fusion in the pediatric population. We retrospectively reviewed the charts of patients under 21 years of age who underwent OC fusion with structural allograft placement at our institution from 2010 to 2015. Data collected included age, gender, follow up duration, fusion outcomes and post-operative complications. 19 patients (8 female and 11 male) underwent OC fusion with our surgical technique. Mean age was 8.5 ± 4.3 years. Radiographic follow up data was available for 18/19 patients. One patient was lost to clinical follow up, but had radiographic confirmation of fusion. Thus, 18/18 (100%) of patients with radiographic follow up achieved successful arthrodesis as determined by computed tomography. Median duration to documented fusion was 4.5 months. Clinical follow up was available for 17/19 patients and was on average 18.8 ± 13.5 months. One patient required reoperation for graft fracture 8 months following radiographic confirmation of successful fusion. There were no vertebral artery injuries or other post-operative complications. We demonstrate a modified technique for OC fusion in children with unique structural allograft shaping and affixation, leading to excellent fusion outcomes at follow up. This technique obviates the need for autograft harvest and BMP, and may decrease post-operative morbidity. Copyright © 2017. Published by Elsevier Inc.

  17. Data Fusion for Combining Techniques to Detect and Size Surface and Near-Surface Defects

    SciTech Connect

    Edwards, R. S.; Dixon, S.; Sophian, A.; Tian, G. Y.

    2007-03-21

    In NDT it is important to have a high probability of detection and reliable sizing of defects in a sample. This can be gained by using several techniques, which leads to an increase in cost and time for testing. Another option is to use several techniques combined into a single probe, in which case data fusion for the techniques is possible. We report measurements using a dual probe containing a pair of electro-magnetic acoustic transducers generating and detecting low frequency broadband ultrasonic surface waves, combined with a pulsed eddy current probe. These two techniques are complementary but can be combined to work as competitive or cooperative sensors depending on the type of defect being investigated. Our work gives the depth of surface breaking defects by performing data fusion on certain features of data from each technique in a competitive sense, with data fusion by mathematical algorithm. Further analysis of the results using cooperative data fusion can give details of the depth and type of defect, for example surface breaking or near surface. The dual probe has been demonstrated on several samples, including aluminium and steel samples with several simulated defects on each side.

  18. Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions.

    PubMed

    Troyanovich, Stephan J; Stroink, Ann R; Kattner, Keith A; Dornan, Wayne A; Gubina, Irina

    2002-02-01

    A retrospective review of medical records and radiographs of patients receiving anterior cervical discectomy and fusion (ACDF) without anterior plating and with anterior plating was performed. The objective of the study was to determine whether a difference exists in cervical lordotic alignment between subjects undergoing single-level ACDF with and without anterior cervical plating instrumentation for symptomatic cervical disc disease. Collapse or settling of grafted bone into the vertebral endplates with resulting kyphotic deformity of the cervical spine is a commonly described complication of anterior discectomy and fusion. Despite the increasing use of instrumentation for the treatment of cervical spine injuries and degenerative conditions, little is known regarding lordotic alignment of the cervical spine in patients who receive plating instrumentation compared with conventional fusion without plating. Accumulating evidence suggests that plating is superior to non-plating techniques in patients with multiple level cervical disc lesions in regard to fusion, return to work rates, and complication rates; however, little is known about maintenance of lordotic curve alignment in single- and multiple-level procedures. Neutral lateral cervical radiographs of 57 patients who underwent single-level ACDF between 1994 and 1999 with anterior screw plates (n = 26), and conventional single-level fusion without anterior screw plates (n = 21) were retrospectively assessed. Measurements were made on weight-bearing lateral cervical radiographs to assess overall sagittal spinal alignment and intersegmental sagittal alignment at the surgical site before surgery, immediately after surgery, 4 to 12 weeks after surgery, and 12+ months after surgery. The average magnitude of overall lordosis measured between C2 and C7 decreased 4.2 degrees in the non-plated group, while being preserved in the plated group. This finding did not reach statistical significance in the long-term follow

  19. Combined endoscopic transforaminal-transchoroidal approach for the treatment of third ventricle colloid cysts.

    PubMed

    Iacoangeli, Maurizio; di Somma, Lucia Giovanna Maria; Di Rienzo, Alessandro; Alvaro, Lorenzo; Nasi, Davide; Scerrati, Massimo

    2014-06-01

    Colloid cysts are histologically benign lesions whose primary goal of treatment should be complete resection to avoid recurrence and sudden death. Open surgery is traditionally considered the standard approach, but, recently, the endoscopic technique has been recognized as a viable and safe alternative to microsurgery. The endoscopic approach to colloid cysts of the third ventricle is usually performed through the foramen of Monro. However, this route does not provide adequate visualization of the cyst attachment on the tela choroidea. The combined endoscopic transforaminal-transchoroidal approach (ETTA), providing exposure of the entire cyst and a better visualization of the tela choroidea, could increase the chances of achieving a complete cyst resection. Between April 2005 and February 2011, 19 patients with symptomatic colloid cyst of the third ventricle underwent an endoscopic transfrontal-transforaminal approach. Five of these patients, harboring a cyst firmly adherent to the tela choroidea or attached to the middle/posterior roof of the third ventricle, required a combined ETTA. Postoperative MRI documented a gross-total resection in all 5 cases. There were no major complications and only 1 patient experienced a transient worsening of the memory deficit. To date, no cyst recurrence has been observed. An ETTA is a minimally invasive procedure that can allow for a safe and complete resection of third ventricle colloid cysts, even in cases in which the lesions are firmly attached to the tela choroidea or located in the middle/posterior roof of the third ventricle.

  20. Enhanced EDX images by fusion of multimodal SEM images using pansharpening techniques.

    PubMed

    Franchi, G; Angulo, J; Moreaud, M; Sorbier, L

    2017-08-16

    The goal of this paper is to explore the potential interest of image fusion in the context of multimodal scanning electron microscope (SEM) imaging. In particular, we aim at merging the backscattered electron images that usually have a high spatial resolution but do not provide enough discriminative information to physically classify the nature of the sample, with energy-dispersive X-ray spectroscopy (EDX) images that have discriminative information but a lower spatial resolution. The produced images are named enhanced EDX. To achieve this goal, we have compared the results obtained with classical pansharpening techniques for image fusion with an original approach tailored for multimodal SEM fusion of information. Quantitative assessment is obtained by means of two SEM images and a simulated dataset produced by a software based on PENELOPE. © 2017 The Authors Journal of Microscopy © 2017 Royal Microscopical Society.

  1. [Placement of short iliac screw using Galveston technique in lumbosacral fusion].

    PubMed

    Min, Shao-xiong; Jin, An-min; Duan, Yang; Zhang, Li; Cheng, Yuan-ming

    2010-07-01

    To evaluate the effect of placement of short iliac screw using Galveston technique in lumbosacral fusion. From October 2003 to August 2007, 18 consecutive patients (mean age 46 years ranging from 25 to 62 years) received placement of short iliac screw in lumbosacral fusion. The patients were followed up for a mean of 18 months (12-23 months), and the effect of lumbosacral fusion was evaluated according to standing anterior-posterior and lateral plain films taken before and after the operation and at the follow-up and also on the basis of symptom relief. The mean time of surgery was 210 min (180-290 min). No complications occurred during and after the operation. According to the evaluation criteria of surgical treatment of low back pain formulated by the spine group of Chinese Orthopedic Association, excellent clinical outcome was achieved in 12 cases, good outcome in 3 cases, and tolerable outcome in 2 cases, with the excellent and good outcome rate of 83%. The Galveston technique for short iliac screw placement can obtain satisfactory outcome in the lumbosacral fusion.

  2. Technique for image fusion based on nonsubsampled shearlet transform and improved pulse-coupled neural network

    NASA Astrophysics Data System (ADS)

    Kong, Weiwei; Liu, Jianping

    2013-01-01

    A new technique for image fusion based on nonsubsampled shearlet transform (NSST) and improved pulse-coupled neural network (PCNN) is proposed. NSST, as a novel multiscale geometric analysis tool, can be optimally efficient in representing images and capturing the geometric features of multidimensional data. As a result, NSST is introduced into the area of image fusion to complete the decompositions of source images in any scale and any direction. Then the basic PCNN model is improved to be improved PCNN (IPCNN), which is more concise and more effective. IPCNN adopts the contrast of each pixel in images as the linking strength β, and the time matrix T of subimages can be obtained via the synchronous pulse-burst property. By using IPCNN, the fused subimages can be achieved. Finally, the final fused image can be obtained by using inverse NSST. The numerical experiments demonstrate that the new technique presented in this paper is competitive in the field of image fusion in terms of both fusion performance and computational efficiency.

  3. A New Grid based Ionosphere Algorithm for GAGAN using Data Fusion Technique (ISRO GIVE Model-Multi Layer Data Fusion)

    NASA Astrophysics Data System (ADS)

    Srinivasan, Nirmala; Ganeshan, A. S.; Mishra, Saumyaketu

    2012-07-01

    A New Grid based Ionosphere Algorithm for GAGAN using Data Fusion Technique (ISRO GIVE Model-Multi Layer Data Fusion) Saumyaketu Mishra, Nirmala S, A S Ganeshan ISRO Satellite Centre, Bangalore and Timothy Schempp, Gregory Um, Hans Habereder Raytheon Company Development of a region-specific ionosphere model is the key element in providing precision approach services for civil aviation with GAGAN (GPS Aided GEO Augmented Navigation). GAGAN is an Indian SBAS (Space Based Augmentation System) comprising of three segments; space segment (GEO and GPS), ground segment (15 Indian reference stations (INRES), 2 master control centers and 3 ground uplink stations) and user segment. The GAGAN system is intended to provide air navigation services for APV 1/1.5 precision approach over the Indian land mass and RNP 0.1 navigation service over Indian Flight Information Region (FIR), conforming to the standards of GNSS ICAO-SARPS. Ionosphere being largest source of error is of prime concern for a SBAS. India is a low latitude country, posing challenges for grid based ionosphere algorithm development; large spatial and temporal gradients, Equatorial anomaly, Depletions (bubbles), Scintillations etc. To meet the required GAGAN performance, it is necessary to develop and implement a best suitable ionosphere model, applicable for the Indian region as thin shell models like planar does not meet the requirement. ISRO GIVE Model - Multi Layer Data Fusion (IGM-MLDF) employs an innovative approach for computing the ionosphere corrections and confidences at pre-defined grid points at 350 Km shell height. Ionosphere variations over the Geo-magnetic equatorial regions shows peak electron density shell height variations from 200 km to 500 km, so single thin shell assumption at 350 km is not valid over Indian region. Hence IGM-MLDF employs innovative scheme of modeling at two shell heights. Through empirical analysis the shell heights of 250 km and 450 km are chosen. The ionosphere measurement

  4. Plasma diagnostic techniques in thermal-barrier tandem-mirror fusion experiments

    SciTech Connect

    Silver, E.H.; Clauser, J.F.; Carter, M.R.; Failor, B.H.; Foote, J.H.; Hornady, R.S.; James, R.A.; Lasnier, C.J.; Perkins, D.E.

    1986-08-29

    We review two classes of plasma diagnostic techniques used in thermal-barrier tandem-mirror fusion experiments. The emphasis of the first class is to study mirror-trapped electrons at the thermal-barrier location. The focus of the second class is to measure the spatial and temporal behavior of the plasma space potential at various axial locations. The design and operation of the instruments in these two categories are discussed and data that are representative of their performance is presented.

  5. Integration of Narrative Processing, Data Fusion, and Database Updating Techniques in an Automated System.

    DTIC Science & Technology

    1981-10-29

    Station PTAPS Platform-Track Association Production Subsystem Rosie Rule-oriented system for implementing expertise STAMMER System for Tactical Assessment...technique developed under the larger effort is PTAPS , a Platform-Track Association Production Subsystem [21, (3], [4]. PTAPS is a method of extending the...certain kinds of platform identification problems. PTAPS would exist as a subsection of the "Final Fusion" box of Figure 1-1 . 4 1.2 Database The

  6. Speckle noise reduction in ultrasound images using a discrete wavelet transform-based image fusion technique.

    PubMed

    Choi, Hyun Ho; Lee, Ju Hwan; Kim, Sung Min; Park, Sung Yun

    2015-01-01

    Here, the speckle noise in ultrasonic images is removed using an image fusion-based denoising method. To optimize the denoising performance, each discrete wavelet transform (DWT) and filtering technique was analyzed and compared. In addition, the performances were compared in order to derive the optimal input conditions. To evaluate the speckle noise removal performance, an image fusion algorithm was applied to the ultrasound images, and comparatively analyzed with the original image without the algorithm. As a result, applying DWT and filtering techniques caused information loss and noise characteristics, and did not represent the most significant noise reduction performance. Conversely, an image fusion method applying SRAD-original conditions preserved the key information in the original image, and the speckle noise was removed. Based on such characteristics, the input conditions of SRAD-original had the best denoising performance with the ultrasound images. From this study, the best denoising technique proposed based on the results was confirmed to have a high potential for clinical application.

  7. Quality evaluation of different fusion techniques applied on Worldview-2 data

    NASA Astrophysics Data System (ADS)

    Vaiopoulos, Aristides; Nikolakopoulos, Konstantinos G.

    2015-10-01

    In the current study a Worldview-2 image was used for fusion quality assessment. The bundle image was collected on July 2014 over Araxos area in Western Peloponnese. Worldview-2 is the first satellite that collects at the same time a panchromatic (Pan) image and 8 band multispectral (MS) image. The Pan data have a spatial resolution of 0.46m while the MS data have a spatial resolution of 1.84m. In contrary to the respective Pan band of Ikonos and Quickbird that range between 0.45 and 0.90 micrometers the Worldview Pan band is narrower and ranges between 0.45 and 0.8 micrometers. The MS bands include four conventional visible and near-infrared bands common to multispectral satellites like Ikonos Quickbird, Geoeye Landsat-7 etc., and four new bands. Thus, it is quite interesting to investigate the assessment of commonly used fusion algorithms with Worldview-2 data. Twelve fusion techniques and more especially the Ehlers, Gram-Schmidt, Color Normalized, High Pass Filter, Hyperspherical Color Space, Local Mean Matching (LMM), Local Mean and Variance Matching (LMVM), Modified IHS (ModIHS), Pansharp, Pansharp2, PCA and Wavelet were used for the fusion of Worldview-2 panchromatic and multispectral data. The optical result, the statistical parameters and different quality indexes such as ERGAS, Q and entropy difference were examined and the results are presented. The quality control was evaluated both in spectral and spatial domain.

  8. A borax fusion technique for quantitative X-ray fluorescence analysis.

    PubMed

    Van Willigen, J H; Kruidhof, H; Dahmen, E A

    1971-04-01

    A borax fusion technique to cast glass discs for quantitative X-ray analysis is described in detail. The method is based on the "nonwetting" properties of a Pt/Au alloy towards molten borax, on the favourable composition of the flux and finally on the favourable form of the casting mould. The critical points of the technique are stressed, resulting in a method which could be carried out successfully by inexperienced workers. In general the method compares favourably in speed and accuracy with wet-chemical methods.

  9. No additional value of fusion techniques on anterior discectomy for neck pain: a systematic review.

    PubMed

    van Middelkoop, Marienke; Rubinstein, Sidney M; Ostelo, Raymond; van Tulder, Maurits W; Peul, Wilco; Koes, Bart W; Verhagen, Arianne P

    2012-11-01

    We aimed to assess the effects of additional fusion on surgical interventions to the cervical spine for patients with neck pain with or without radiculopathy or myelopathy by performing a systematic review. The search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL and PEDro up to June 2011. Only randomised, controlled trials of adults with neck pain that evaluated at least one clinically relevant primary outcome measure (pain, functional status, recovery) were included. Two authors independently assessed the risk of bias by using the criteria recommended by the CBRG and extracted the data. Data were pooled using a random effects model. The quality of the evidence was rated using the GRADE method. In total, 10 randomised, controlled trials were identified comparing additional fusion upon anterior decompression techniques, including 2 studies with a low risk of bias. Results revealed no clinically relevant differences in recovery: the pooled risk difference in the short-term follow-up was -0.06 (95% confidence interval -0.22 to 0.10) and -0.07 (95% confidence interval -0.14 to 0.00) in the long-term follow-up. Pooled risk differences for pain and return to work all demonstrated no differences. There is no additional benefit of fusion techniques applied within an anterior discectomy procedure on pain, recovery and return to work.

  10. Enamel fusion using a carbon dioxide laser: A technique for sealing pits and fissures

    SciTech Connect

    Walsh, L.J.; Perham, S.J. )

    1991-05-01

    The well-established enhanced resistance of lased enamel to demineralization is the basis for clinical application of the carbon dioxide laser to caries prevention. This in vitro study examined the effect of focused infrared laser radiation on sound enamel and early pit and fissure caries. Low power levels (2-5 W) induced localized melting and resolidification of enamel with little surface destruction. For sound fissures, fusion of enamel from the lateral walls of the fissure eliminated the fissure space, providing a sealant effect; while in carious fissures, carious enamel was vaporized and adjacent sound enamel fused to partially eliminate the defect. The technique for enamel fusion using CO2 lasers has potential application for sealing pits and fissures and producing physicochemical alterations in enamel which may have preventive benefits.

  11. Creating a Strain Relief Loop during S1 Transforaminal Lead Placement for Dorsal Root Ganglion Stimulation for Foot Pain: A Technical Note.

    PubMed

    van Velsen, Valery; van Helmond, Noud; Chapman, Kenneth B

    2017-09-01

    Chronic neuropathic pain is often refractory to conventional medical treatments and leads to significant disability and socio-economic burden. Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for persistent neuropathic pain, but creating a strain relief loop on the S1 level has thus far been a challenging technical component of DRG lead placement. We describe a refined technique for strain relief loop formation on the S1 level using a transforaminal approach that we employed in a 45-year old patient with intractable foot pain. We successfully placed a strain relief loop in the sacral space in a predictable and easily reproducible manner using a transforaminal anchorless approach. The patient experienced a decrease in visual analogue pain score (85%), and improvement in function during the trial period, and proceeded with permanent implantation. The described sacral transforaminal strain relief loop formation technique appears to be a more reliable and predictable technique of DRG lead placement in the sacrum than those previously documented. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  12. Application of data fusion techniques and technologies for wearable health monitoring.

    PubMed

    King, Rachel C; Villeneuve, Emma; White, Ruth J; Sherratt, R Simon; Holderbaum, William; Harwin, William S

    2017-04-01

    Technological advances in sensors and communications have enabled discrete integration into everyday objects, both in the home and about the person. Information gathered by monitoring physiological, behavioural, and social aspects of our lives, can be used to achieve a positive impact on quality of life, health, and well-being. Wearable sensors are at the cusp of becoming truly pervasive, and could be woven into the clothes and accessories that we wear such that they become ubiquitous and transparent. To interpret the complex multidimensional information provided by these sensors, data fusion techniques are employed to provide a meaningful representation of the sensor outputs. This paper is intended to provide a short overview of data fusion techniques and algorithms that can be used to interpret wearable sensor data in the context of health monitoring applications. The application of these techniques are then described in the context of healthcare including activity and ambulatory monitoring, gait analysis, fall detection, and biometric monitoring. A snap-shot of current commercially available sensors is also provided, focusing on their sensing capability, and a commentary on the gaps that need to be bridged to bring research to market.

  13. Fusion of micro-metrology techniques for the flexible inspection of MEMS/MOEMS assembly

    NASA Astrophysics Data System (ADS)

    Schmitt, R.; Pavim, A.

    2008-04-01

    Micro-technology plays an important role in everyday life, without being much perceived. Cell phones, for instance, are daily equipped with small electronic components, which must have their quality level assured. New micro-metrology techniques were developed in the last years for such purposes. They are usually only suited for measuring specific and individual object properties (e.g. geometry, roughness, contours). A multi-sensorial approach is needed to improve the inspection range and flexibility of a micro-production cell, so that the distinct features of different industrial parts may be inspected intelligently and independently of their surface properties. This work provides a basic review on some of the most important "non-contact" micro-metrology techniques (optical and non-optical), performing a comparison of these methods among their distinct capabilities and possible industrial applications/integration scenarios. Based on the already existent sensor fusion principles, the MEOND concept will be introduced to build up flexible inspection systems for small series production by combining sensors and data, focusing possible application scenarios of the micro-world. The fusion of micro-metrology techniques has not yet been far explored and is extremely important to assure flexibility, autonomy, accuracy and robustness for the assembly of MEMS/MOEMS systems.

  14. Preservation or Restoration of Segmental and Regional Spinal Lordosis Using Minimally Invasive Interbody Fusion Techniques in Degenerative Lumbar Conditions: A Literature Review.

    PubMed

    Uribe, Juan S; Myhre, Sue Lynn; Youssef, Jim A

    2016-04-01

    A literature review. The purpose of this study was to review lumbar segmental and regional alignment changes following treatment with a variety of minimally invasive surgery (MIS) interbody fusion procedures for short-segment, degenerative conditions. An increasing number of lumbar fusions are being performed with minimally invasive exposures, despite a perception that minimally invasive lumbar interbody fusion procedures are unable to affect segmental and regional lordosis. Through a MEDLINE and Google Scholar search, a total of 23 articles were identified that reported alignment following minimally invasive lumbar fusion for degenerative (nondeformity) lumbar spinal conditions to examine aggregate changes in postoperative alignment. Of the 23 studies identified, 28 study cohorts were included in the analysis. Procedural cohorts included MIS ALIF (two), extreme lateral interbody fusion (XLIF) (16), and MIS posterior/transforaminal lumbar interbody fusion (P/TLIF) (11). Across 19 study cohorts and 720 patients, weighted average of lumbar lordosis preoperatively for all procedures was 43.5° (range 28.4°-52.5°) and increased 3.4° (9%) (range -2° to 7.4°) postoperatively (P < 0.001). Segmental lordosis increased, on average, by 4° from a weighted average of 8.3° preoperatively (range -0.8° to 15.8°) to 11.2° at postoperative time points (range -0.2° to 22.8°) (P < 0.001) in 1182 patient from 24 study cohorts. Simple linear regression revealed a significant relationship between preoperative lumbar lordosis and change in lumbar lordosis (r = 0.413; P = 0.003), wherein lower preoperative lumbar lordosis predicted a greater increase in postoperative lumbar lordosis. Significant gains in both weighted average lumbar lordosis and segmental lordosis were seen following MIS interbody fusion. None of the segmental lordosis cohorts and only two of the 19 lumbar lordosis cohorts showed decreases in lordosis postoperatively. These results suggest that

  15. Olive oil sensory defects classification with data fusion of instrumental techniques and multivariate analysis (PLS-DA).

    PubMed

    Borràs, Eva; Ferré, Joan; Boqué, Ricard; Mestres, Montserrat; Aceña, Laura; Calvo, Angels; Busto, Olga

    2016-07-15

    Three instrumental techniques, headspace-mass spectrometry (HS-MS), mid-infrared spectroscopy (MIR) and UV-visible spectrophotometry (UV-vis), have been combined to classify virgin olive oil samples based on the presence or absence of sensory defects. The reference sensory values were provided by an official taste panel. Different data fusion strategies were studied to improve the discrimination capability compared to using each instrumental technique individually. A general model was applied to discriminate high-quality non-defective olive oils (extra-virgin) and the lowest-quality olive oils considered non-edible (lampante). A specific identification of key off-flavours, such as musty, winey, fusty and rancid, was also studied. The data fusion of the three techniques improved the classification results in most of the cases. Low-level data fusion was the best strategy to discriminate musty, winey and fusty defects, using HS-MS, MIR and UV-vis, and the rancid defect using only HS-MS and MIR. The mid-level data fusion approach using partial least squares-discriminant analysis (PLS-DA) scores was found to be the best strategy for defective vs non-defective and edible vs non-edible oil discrimination. However, the data fusion did not sufficiently improve the results obtained by a single technique (HS-MS) to classify non-defective classes. These results indicate that instrumental data fusion can be useful for the identification of sensory defects in virgin olive oils.

  16. Computed tomography-ultrasound fusion brachytherapy: description and evolution of the technique.

    PubMed

    Fuller, Donald B; Jin, Haoran

    2007-01-01

    In this manuscript, we describe our computed tomography (CT)-ultrasound (US) fusion prostate brachytherapy method and report the updated dosimetry result and trend. This cohort of 132 consecutive patients received CT-US fusion prostate brachytherapy from the first author (DBF) from December 2002 to August 2006. The technique consists of a hybrid preplanned and intraoperative dynamic dosimetry method, which initially delivers a standard preplanned source distribution, and then uses interval CT-based source identification dosimetry, fused to an identically spaced intraoperative US volume study series, to direct remedial sources that correct initial dosimetry deficiencies. The median and minimum prostate Day 0 prostate volume of interest receiving 100% of prescribed dose (V(100)) results in this patient cohort measured 98.26% and 92.61%, respectively, with all Day 0 prostate dose received by 90% of the volume of interest (D(90)) results exceeding 100% of the prescribed dose, and the maximum Day 0 prostate D(90) value measuring 128% of the prescribed dose. During the period of this analysis, a trend to the decreased quantity of dynamic remedial millicuries per case was identified, with the total sources decreasing from 116% to 106% of the preplanned level, resulting in minimal V(100) and D(90) decreases, while continuing to exceed the minimum Day 0 dosimetry requirements. CT-US fusion dynamic prostate brachytherapy represents a consistent prostate brachytherapy dosimetry delivery mechanism, creating a tight lower and upper bound to the final Day 0 prostate V(100) and D(90) parameters. The practice and pitfalls of this technique are discussed in detail.

  17. An accurate automated technique for quasi-optics measurement of the microwave diagnostics for fusion plasma

    NASA Astrophysics Data System (ADS)

    Hu, Jianqiang; Liu, Ahdi; Zhou, Chu; Zhang, Xiaohui; Wang, Mingyuan; Zhang, Jin; Feng, Xi; Li, Hong; Xie, Jinlin; Liu, Wandong; Yu, Changxuan

    2017-08-01

    A new integrated technique for fast and accurate measurement of the quasi-optics, especially for the microwave/millimeter wave diagnostic systems of fusion plasma, has been developed. Using the LabVIEW-based comprehensive scanning system, we can realize not only automatic but also fast and accurate measurement, which will help to eliminate the effects of temperature drift and standing wave/multi-reflection. With the Matlab-based asymmetric two-dimensional Gaussian fitting method, all the desired parameters of the microwave beam can be obtained. This technique can be used in the design and testing of microwave diagnostic systems such as reflectometers and the electron cyclotron emission imaging diagnostic systems of the Experimental Advanced Superconducting Tokamak.

  18. Transforaminal 5% phenol neurolysis for the treatment of intractable cancer pain.

    PubMed

    Candido, Kenneth D; Philip, Cyril N; Ghaly, Ramsis F; Knezevic, Nebojsa Nick

    2010-01-01

    This is the first case report of using a transforaminal approach for phenol administration. A 76-yr-old patient with a history of leiomyosarcoma and multiple metastatic lesions had unremitting pain in the right thoracic and lumbar regions and had prohibitive opioid-induced side effects. The patient underwent phenol neurolysis using a transforaminal approach in 2 stages at 3 levels (L3-4, L1-2, and T12-L1). The patient had complete resolution of pain, without any complications, and opioid treatment was nearly discontinued. Transforaminal phenol neurolysis is a reasonable treatment option for patients suffering from intractable pain for whom conventional therapies have proven ineffective.

  19. Encoding technique for high data compaction in data bases of fusion devices

    SciTech Connect

    Vega, J.; Cremy, C.; Sanchez, E.; Portas, A.

    1996-12-01

    At present, data requirements of hundreds of Mbytes/discharge are typical in devices such as JET, TFTR, DIII-D, etc., and these requirements continue to increase. With these rates, the amount of storage required to maintain discharge information is enormous. Compaction techniques are now essential to reduce storage. However, general compression techniques may distort signals, but this is undesirable for fusion diagnostics. We have developed a general technique for data compression which is described here. The technique, which is based on delta compression, does not require an examination of the data as in delayed methods. Delta values are compacted according to general encoding forms which satisfy a prefix code property and which are defined prior to data capture. Several prefix codes, which are bit oriented and which have variable code lengths, have been developed. These encoding methods are independent of the signal analog characteristics and enable one to store undistorted signals. The technique has been applied to databases of the TJ-I tokamak and the TJ-IU torsatron. Compaction rates of over 80{percent} with negligible computational effort were achieved. Computer programs were written in ANSI C, thus ensuring portability and easy maintenance. We also present an interpretation, based on information theory, of the high compression rates achieved without signal distortion. {copyright} {ital 1996 American Institute of Physics.}

  20. Application of Frechet and other random-set averaging techniques to fusion of information

    NASA Astrophysics Data System (ADS)

    Goodman, I. R.

    1998-07-01

    An obviously important aspect of target tracking, and more generally, data fusion, is the combination of those pieces of multi-source information deemed to belong together. Recently, it has been pointed out that a random set approach to target tracking and data fusion may be more appropriate rather than the standard point-vector estimate approach -- especially in the case of large inherent parameter errors. In addition, since many data fusion problems involve non-numerical linguistic descriptions, in the same spirit it is also desirable to be able to have a method which averages in some qualitative sense random sets which are non-numerically- valued, i.e., which take on propositions or events, such as 'the target appears in area A or C, given the weather conditions of yesterday and source 1' and 'the target appears in area A or B, given the weather conditions of today and source 2.' This leads to the fundamental problem of how best to define the expectation of a random set. To date, this open issue has only been considered for numerically-based random sets. This paper addresses this issue in part by proposing an approach which is actually algebraically-based, but also applicable to numerical-based random sets, and directly related to both the Frechet and the Aumann-Artstein-Vitale random set averaging procedures. The technique employs the concept of 'constant probability events,' which has also played a key role in the recent development of 'relational event algebra,' a new mathematical tool for representing various models in the form of various functions of probabilities.

  1. Applying data fusion techniques for benthic habitat mapping and monitoring in a coral reef ecosystem

    NASA Astrophysics Data System (ADS)

    Zhang, Caiyun

    2015-06-01

    Accurate mapping and effective monitoring of benthic habitat in the Florida Keys are critical in developing management strategies for this valuable coral reef ecosystem. For this study, a framework was designed for automated benthic habitat mapping by combining multiple data sources (hyperspectral, aerial photography, and bathymetry data) and four contemporary imagery processing techniques (data fusion, Object-based Image Analysis (OBIA), machine learning, and ensemble analysis). In the framework, 1-m digital aerial photograph was first merged with 17-m hyperspectral imagery and 10-m bathymetry data using a pixel/feature-level fusion strategy. The fused dataset was then preclassified by three machine learning algorithms (Random Forest, Support Vector Machines, and k-Nearest Neighbor). Final object-based habitat maps were produced through ensemble analysis of outcomes from three classifiers. The framework was tested for classifying a group-level (3-class) and code-level (9-class) habitats in a portion of the Florida Keys. Informative and accurate habitat maps were achieved with an overall accuracy of 88.5% and 83.5% for the group-level and code-level classifications, respectively.

  2. Phase-shifted fiber Bragg grating inscription by fusion splicing technique and femtosecond laser

    NASA Astrophysics Data System (ADS)

    Jiang, Yajun; Yuan, Yuan; Xu, Jian; Yang, Dexing; Li, Dong; Wang, Meirong; Zhao, Jianlin

    2016-11-01

    A new method for phase-shifted fiber Bragg grating (PS-FBG) inscription in single mode fiber by fusion splicing technique and femtosecond laser is presented. The PS-FBG is produced by exposing the fusion spliced fiber with femtosecond laser through a uniform phase mask. The transmission spectrum of the PS-FBG shows a nonlinear red shift during the inscription process, and two or three main dips can be observed due to the formation of one or two FBG-based Fabry-Pérot structures by controlling the exposure intensity and time of the laser. For a peak power density of 4.8×1013 W/cm2, the induced refractive index modulation can reach to 6.3×10-4 in the fiber without sensitization. The PS-FBG's temperature, strain and pressure characteristics are also experimentally studied. These PS-FBGs can be potentially used for multiple wavelength fiber lasers, filters and optical fiber sensors.

  3. Radioscapholunate Fusions

    PubMed Central

    McGuire, Duncan Thomas; Bain, Gregory Ian

    2012-01-01

    Radiocarpal fusions are performed for a variety of indications, most commonly for debilitating painful arthritis. The goal of a wrist fusion is to fuse the painful, diseased joints and to preserve motion through the healthy joints. Depending on the extent of the disease process, radiocarpal fusions may take the form of radiolunate, radioscapholunate, or total wrist fusions. Surgical techniques and instrumentation have advanced over the last few decades, and consequently the functional outcomes have improved and complications decreased. Techniques for partial carpal fusions have improved and now include distal scaphoid and triquetrum excision, which improves range of motion and fusion rates. In this article we discuss the various surgical techniques and fixation methods available and review the corresponding evidence in the literature. The authors' preferred surgical technique of radioscapholunate fusion with distal scaphoid and triquetrum excision is outlined. New implants and new concepts are also discussed. PMID:24179717

  4. A technique for thick polymer coating of inertial-confinement-fusion targets

    NASA Technical Reports Server (NTRS)

    Lee, M. C.; Feng, I.-A.; Wang, T. G.; Kim, H.-G.

    1983-01-01

    A technique to coat a stalk-mounted inertial-confinement fusion (ICF) target with a thick polymer layer has been successfully demonstrated. The polymer solution is first atomized, allowed to coalesce into a droplet, and positioned in a stable acoustic levitating field. The stalk-mounted ICF target is then moved into the acoustic field by manipulating a 3-D positioner to penetrate the surface membrane of the droplet, thus immersing the target in the levitated coating solution. The target inside the droplet is maintained at the center of the levitated liquid using the 3-D positional information provided by two orthogonally placed TV cameras until the drying process is completed. The basic components of the experimental apparatus, including an acoustic levitator, liquid sample deployment device, image acquisition instrumentation, and 3-D positioner, are briefly described.

  5. A technique for thick polymer coating of inertial-confinement-fusion targets

    NASA Technical Reports Server (NTRS)

    Lee, M. C.; Feng, I.-A.; Wang, T. G.; Kim, H.-G.

    1983-01-01

    A technique to coat a stalk-mounted inertial-confinement fusion (ICF) target with a thick polymer layer has been successfully demonstrated. The polymer solution is first atomized, allowed to coalesce into a droplet, and positioned in a stable acoustic levitating field. The stalk-mounted ICF target is then moved into the acoustic field by manipulating a 3-D positioner to penetrate the surface membrane of the droplet, thus immersing the target in the levitated coating solution. The target inside the droplet is maintained at the center of the levitated liquid using the 3-D positional information provided by two orthogonally placed TV cameras until the drying process is completed. The basic components of the experimental apparatus, including an acoustic levitator, liquid sample deployment device, image acquisition instrumentation, and 3-D positioner, are briefly described.

  6. Fusion techniques using distributed Kalman filtering for detecting changes in systems

    NASA Technical Reports Server (NTRS)

    Belcastro, Celeste M.; Fischl, Robert; Kam, Moshe

    1991-01-01

    A comparison is made of the performances of two detection strategies that are based on different data fusion techniques. The strategies detect changes in a linear system. One detection strategy involves combining the estimates and error covariance matrices of distributed Kalman filters, generating a residual from the used estimates, comparing this residual to a threshold, and making a decision. The other detection strategy involves a distributed decision process in which estimates from distributed Kalman filters are used to generate distributed residuals which are compared locally to a threshold. Local decisions are made and these decisions are then fused into a global decision. The performances of each of these detection schemes are compared, and it is concluded that better performance is achieved when local decisions are made and then fused into a global decision.

  7. Non-neurological major complications of extreme lateral and related lumbar interbody fusion techniques

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: Complications exclusive of new neurological deficits/injuries that follow extreme lateral interbody fusion (XLIF) and related lateral lumbar interbody techniques should be better recognized to determine the safety of these procedures. Unfortunately, a review of the XLIF literature did not accurately reflect the frequency of these “other complications” as few US surgeons publish such adverse events that may lead to medicolegal suits. Methods: Major complications occurring with XLIF included sympathectomy, major vascular injuries, bowel perforations, sterile seromas, and instrumentation failures. Results: The frequency of sympathectomy was 4% for XLIF vs. 15% for anterior lumbar interbody fusion (ALIF). There were three major vascular injuries for XLIF; one fatal intraoperative event, one life-threatening retroperitoneal hematoma, and one iatrogenic lumbar artery pseudoaneurysm that was successfully embolized. Two bowel perforations were reported, whereas a third was a “direct communication.” One patient developed a sterile recurrent seroma due to vancomycin powder utilized for an XLIF. One study cited malpositioning of an XLIF cage resulting in a lateral L3–L4 extrusion, whereas the second series looked at the 45% risk of cage-overhang when XLIF devices were placed in the anterior one-third of the vertebral body. Conclusion: Excluding new neurological deficits, XLIF techniques resulted in multiple other major complications. However, these small numbers likely reflect just the tip of the iceberg (e.g., 10%) and the remaining 90% may never be known as many US-based spine surgeons fail to publish such adverse events as they are discoverable in a court of law and may lead to medicolegal suits. PMID:27843680

  8. Technique for gray-scale visual light and infrared image fusion based on non-subsampled shearlet transform

    NASA Astrophysics Data System (ADS)

    Kong, Weiwei

    2014-03-01

    A novel image fusion technique based on NSST (non-subsampled shearlet transform) is presented, aiming at resolving the fusion problem of spatially gray-scale visual light and infrared images. NSST, as a new member of MGA (multi-scale geometric analysis) tools, possesses not only flexible direction features and optimal shift-invariance, but much better fusion performance and lower computational costs compared with several current popular MGA tools such as NSCT (non-subsampled contourlet transform). We specifically propose new rules for the fusion of low and high frequency sub-band coefficients of source images in the second step of the NSST-based image fusion algorithm. First, the source images are decomposed into different scales and directions using NSST. Then, the model of region average energy (RAE) is proposed and adopted to fuse the low frequency sub-band coefficients of the gray-scale visual light and infrared images. Third, the model of local directional contrast (LDC) is given and utilized to fuse the corresponding high frequency sub-band coefficients. Finally, the final fused image is obtained by using inverse NSST to all fused sub-images. In order to verify the effectiveness of the proposed technique, several current popular ones are compared over three different publicly available image sets using four evaluation metrics, and the experimental results demonstrate that the proposed technique performs better in both subjective and objective qualities.

  9. Green and Fast Laser Fusion Technique for Bulk Silicate Rock Analysis by Laser Ablation-Inductively Coupled Plasma Mass Spectrometry.

    PubMed

    Zhang, Chenxi; Hu, Zhaochu; Zhang, Wen; Liu, Yongsheng; Zong, Keqing; Li, Ming; Chen, Haihong; Hu, Shenghong

    2016-10-18

    Sample preparation of whole-rock powders is the major limitation for their accurate and precise elemental analysis by laser ablation inductively-coupled plasma mass spectrometry (ICPMS). In this study, a green, efficient, and simplified fusion technique using a high energy infrared laser was developed for major and trace elemental analysis. Fusion takes only tens of milliseconds for each sample. Compared to the pressed pellet sample preparation, the analytical precision of the developed laser fusion technique is higher by an order of magnitude for most elements in granodiorite GSP-2. Analytical results obtained for five USGS reference materials (ranging from mafic to intermediate to felsic) using the laser fusion technique generally agree with recommended values with discrepancies of less than 10% for most elements. However, high losses (20-70%) of highly volatile elements (Zn and Pb) and the transition metal Cu are observed. The achieved precision is within 5% for major elements and within 15% for most trace elements. Direct laser fusion of rock powders is a green and notably simple method to obtain homogeneous samples, which will significantly accelerate the application of laser ablation ICPMS for whole-rock sample analysis.

  10. Design of 3D measurement system based on multi-sensor data fusion technique

    NASA Astrophysics Data System (ADS)

    Zhang, Weiguang; Han, Jun; Yu, Xun

    2009-05-01

    With the rapid development of shape measurement technique, multi-sensor approach becomes one of valid way to improve the accuracy, to expend measuring range, to reduce occlusion, to realize multi-resolution measurement, and to increase measuring speed simultaneously. Sensors in multi-sensor system can have different system parameters, and they may have different measuring range and different precision. Light sectioning method is one of useful measurement technique for 3D profile measurement. It is insensitive to the surface optical property of 3D object, has scarcely any demand on surrounding. A multi-sensor system scheme, which uses light sectioning method and multi-sensor data fusion techniques, is presented for blade of aviation engine and spiral bevel gear measurement. The system model is developed to build the relationship between measuring range & precision and system parameters. The system parameters were set according to system error analysis, measuring range and precision. The result shows that the system is more universal than it's ancestor, and that the accuracy of the system is about 0.05mm for the 60× 60mm2 measuring range, and that the system is successful for the aero-dynamical data curve of blade of aviation engine and tooth profile of spiral bevel gear measurement with 3600 multi-resolution measuring character.

  11. Efficacy of transforaminal versus interspinous corticosteroid injectionin discal radiculalgia - a prospective, randomised, double-blind study.

    PubMed

    Thomas, E; Cyteval, C; Abiad, L; Picot, M C; Taourel, P; Blotman, F

    2003-10-01

    A prospective, randomised, double-blind study was carried out to compare the respective efficacies of transforaminal and interspinous epidural corticosteroid injections in discal radiculalgia. Thirty-one patients (18 females, 13 males) with discal radicular pain of less than 3 months' duration were consecutively randomised to receive either radio-guided transforaminal or blindly performed interspinous epidural corticosteroid injections. Post-treatment outcome was evaluated clinically at 6 and 30 days, and then at 6 months, but only by mailed questionnaire. At day 6, the between-group difference was significantly in favour of the transforaminal group with respect to Schober's index, finger-to-floor distance, daily activities, and work and leisure activities on the Dallas pain scale. At day 30, pain relief was significantly better in the transforaminal group. At month 6, answers to the mailed questionnaire still showed significantly better results for transforaminal injection concerning pain, daily activities, work and leisure activities and anxiety and depression, with a decline in the Roland-Morris score. In recent discal radiculalgia, the efficacy of radio-guided transforaminal epidural corticosteroid injections was higher than that obtained with blindly-performed interspinous injections.

  12. Treatment of neuromuscular scoliosis with posterior spinal fusion using the Galveston technique: a retrospective review and results of 62 patients.

    PubMed

    Edwards, Bryan T; Zura, Robert; Bertrand, Styles; Leonard, Sharon; Pellett, Jonathan

    2003-01-01

    Historically, the operative treatment of neuromuscular scoliosis has been associated with a high rate of complication. Recent literature has shown a decreased rate of complication (less 50%) in the management of neuromuscular scoliosis with spinal arthrodesis techniques. A retrospective chart and radiographic review of 62 spinal fusions for neuromuscular scoliosis was performed. There were 53 posterior spinal fusions and 9 anteroposterior spinal fusions. The Galveston technique was used in all patients. The average age at surgery was 13 years 7 months, with an average follow-up of 23 months (minimum 10 months). The mean preoperative and postoperative curve magnitudes were 66 degree and 31 degree, respectively. There were 20 minor complications and 5 major complications in 20 patients. There were no neurologic complications or deaths.

  13. Myoarchitectonic advancement of the C2 spinous process for C1-C2 posterior fusion: A novel technique.

    PubMed

    Sinha, Ajit Kumar; Goyal, Sumit

    2015-01-01

    Retrospective descriptive study of an innovative surgical technique. To assess the feasibility of using a large C2 spinous process as a vascularized bone graft donor with muscles attached to it in C1-C2 posterior fusion with evaluation of post operative fusion and pain in these cases. C1-C2 posterior fusion essentially requires a bone graft and for this a separate incision is needed at the donor site with its associated morbidity. The procedure also entails detachment of muscles attached to the C2 spinous process. Due to the detachment of these muscles with important functions, postoperative nuchal pain is common in these patients. We developed a novel technique of harvesting the vascularized C2 spinous process as a bone graft to minimize the above-mentioned complications. Five patients with atlanto-axial dislocation due to various pathologies underwent C1-C2 posterior arthrodesis with the present technique. They were followed up for 6 to 18 months and were evaluated for feasibility of procedure, post operative fusion and post operative complications, especially pain. The procedure was accomplished successfully in all patients without any perioperative complications. All patients were pain free 3 months after surgery-mean Visual Analogue Scale (VAS) was 0.4. Fusion (confirmed by plain radiography in three and by CT scan in two patients) was achieved in all five patients (100%). Myoarchitectonic advancement of C2 spinous process is a novel technique of C1-C2 posterior fusion in which a local vascularized bone graft is used avoiding donor site morbidity and at the same time preservation of dynamic function of muscles attached reduces the post operative pain.

  14. Myoarchitectonic advancement of the C2 spinous process for C1-C2 posterior fusion: A novel technique

    PubMed Central

    Sinha, Ajit Kumar; Goyal, Sumit

    2015-01-01

    Study Design: Retrospective descriptive study of an innovative surgical technique. Objective: To assess the feasibility of using a large C2 spinous process as a vascularized bone graft donor with muscles attached to it in C1-C2 posterior fusion with evaluation of post operative fusion and pain in these cases. Summary of Background Data: C1-C2 posterior fusion essentially requires a bone graft and for this a separate incision is needed at the donor site with its associated morbidity. The procedure also entails detachment of muscles attached to the C2 spinous process. Due to the detachment of these muscles with important functions, postoperative nuchal pain is common in these patients. We developed a novel technique of harvesting the vascularized C2 spinous process as a bone graft to minimize the above-mentioned complications. Materials and Methods: Five patients with atlanto-axial dislocation due to various pathologies underwent C1-C2 posterior arthrodesis with the present technique. They were followed up for 6 to 18 months and were evaluated for feasibility of procedure, post operative fusion and post operative complications, especially pain. Results: The procedure was accomplished successfully in all patients without any perioperative complications. All patients were pain free 3 months after surgery—mean Visual Analogue Scale (VAS) was 0.4. Fusion (confirmed by plain radiography in three and by CT scan in two patients) was achieved in all five patients (100%). Conclusion: Myoarchitectonic advancement of C2 spinous process is a novel technique of C1-C2 posterior fusion in which a local vascularized bone graft is used avoiding donor site morbidity and at the same time preservation of dynamic function of muscles attached reduces the post operative pain. PMID:25883500

  15. Minimally Invasive Extraforaminal Lumbar Interbody Fusion for Revision Surgery: A Technique through Kambin's Triangle

    PubMed Central

    Lee, Jun Gue; Kim, Hyeun Sung

    2015-01-01

    Objective The purpose of this study was to evaluate the clinical outcomes of minimally invasive extraforaminal lumbar interbody fusion (ELIF) for revision surgery. Methods From January 2011 to December 2012, 12 patients who underwent minimally invasive ELIF through the Kambin's triangle for revision surgery were included in this study. All patients underwent the surgical procedure in the following sequence: (1) epidural anesthesia, (2) exposing the Kambin's triangle toward the lateral part of the dura (partial resection of the superior articular process), (3) bilateral cage insertion for reinforcement of stabilization and fusion, and (4) percutaneous transpedicular screwing. Clinical outcomes were assessed using the visual analogue scale (VAS), and Oswestry disability index (ODI). Imaging and clinical findings including surgical techniques, clinical outcomes, and related complications were depicted and analyzed. Results The mean age of the patients (5 men, 7 women) was 60.7±13.4 years, and the mean follow-up period was 27.1±4.9 months. The mean VAS (back and leg) score improved significantly at final follow-up. The mean ODI score decreased as follows: preoperative, 76.78±6.08; 3 months after the surgery, 37.74±6.67; and at final follow-up, 29.91±2.98. Two patients presented with transient nerve root irritation, but there were no cases of incidental dural tear or serious infection. No significant neurological deterioration or major complication was noted in any of the patients. Conclusion Minimally invasive ELIF for revision surgery is an effective surgical option with a low complication rate. PMID:26834815

  16. Computational comparison of three posterior lumbar interbody fusion techniques by using porous titanium interbody cages with 50% porosity.

    PubMed

    Lee, Yung-Heng; Chung, Chi-Jen; Wang, Chih-Wei; Peng, Yao-Te; Chang, Chih-Han; Chen, Chih-Hsien; Chen, Yen-Nien; Li, Chun-Ting

    2016-04-01

    This study investigated the biomechanical response of porous cages and lumbar spine segments immediately after surgery and after bone fusion, in addition to the long-term effects of various posterior lumbar interbody fusion (PLIF) techniques, by using the finite element method. Lumbar L3-L4 models based on three PLIF techniques (a single cage at the center of the intervertebral space, a single cage half-anterior to the intervertebral space, and two cages bilateral to the intervertebral space) with and without bone ingrowth were used to determine the biomechanical response of porous cages and lumbar segments instrumented with porous titanium cages (cage porosity=50%, pore diameter=1mm). The results indicated that bone fusion enhanced the stability of the lumbar segments with porous cages without any posterior instrumentation and reduced the peak von Mises stress in the cortical bones and porous cages. Two cages placed bilateral to the intervertebral space achieved the highest structural stability in the lumbar segment and lowest von Mises stress in the cages under both bone fusion conditions. Under identical loading (2-Nm), the range of motion in the single cage at the center of the intervertebral space with bone fusion decreased by 11% (from 1.18° to 1.05°) during flexion and by 66.5% (from 4.46° to 1.5°) during extension in the single cage half-anterior to the intervertebral space with bone fusion compared with no-fusion models. Thus, two porous titanium cages with 50% porosity can achieve high stability of a lumbar segment with PLIF. If only one cage is available, placing the cage half-anterior to the intervertebral space is recommended for managing degenerated lumbar segments. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Multi-sensor fusion techniques for state estimation of micro air vehicles

    NASA Astrophysics Data System (ADS)

    Donavanik, Daniel; Hardt-Stremayr, Alexander; Gremillion, Gregory; Weiss, Stephan; Nothwang, William

    2016-05-01

    Aggressive flight of micro air vehicles (MAVs) in unstructured, GPS-denied environments poses unique challenges for estimation of vehicle pose and velocity due to the noise, delay, and drift in individual sensor measurements. Maneuvering flight at speeds in excess of 5 m/s poses additional challenges even for active range sensors; in the case of LIDAR, an assembled scan of the vehicles environment will in most cases be obsolete by the time it is processed. Multi-sensor fusion techniques which combine inertial measurements with passive vision techniques and/or LIDAR have achieved breakthroughs in the ability to maintain accurate state estimates without the use of external positioning sensors. In this paper, we survey algorithmic approaches to exploiting sensors with a wide range of nonlinear dynamics using filter and bundle-adjustment based approaches for state estimation and optimal control. From this foundation, we propose a biologically-inspired framework for incorporating the human operator in the loop as a privileged sensor in a combined human/autonomy paradigm.

  18. Treatment of congenital thoracic scoliosis with associated rib fusions using VEPTR expansion thoracostomy: a surgical technique.

    PubMed

    Dayer, Romain; Ceroni, Dimitri; Lascombes, Pierre

    2014-07-01

    Untreated growing patients with congenital scoliosis and fused ribs will develop finally thoracic insufficiency syndrome. The technique of expansion thoracoplasty with implantation of a vertical expandable prosthetic titanium rib (VEPTR) was introduced initially to treat these children. This article attempts to provide an overview of the surgical technique of opening-wedge thoracostomy and VEPTR instrumentation in children with congenital thoracic scoliosis and fused ribs. Our modification of the surgical approach using a posterior midline incision rather than the modified thoracotomy incision initially described could potentially help to diminish wound dehiscence and secondary infection, while preserving a more acceptable esthetic appearance of the back. Vertical expandable prosthetic titanium rib-based treatments should be undertaken only with a good knowledge of its numerous specific complications. Every aspect of the treatment should be oriented to minimize these complications. At the same time it should be kept in mind that the ultimate step of this long-term fusionless treatment strategy will be a technically demanding spine fusion.

  19. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results.

    PubMed

    Heo, Dong Hwa; Son, Sang Kyu; Eum, Jin Hwa; Park, Choon Keun

    2017-08-01

    OBJECTIVE Minimally invasive spine surgery can minimize damage to normal anatomical structures. Recently, fully endoscopic spine surgeries have been attempted for lumbar fusion surgery. In this study, the authors performed a percutaneous unilateral biportal endoscopic (UBE) technique as a minimally invasive surgery for lumbar fusion. The purpose of this study is to present the UBE technique of fully endoscopic lumbar interbody fusion (LIF) and to analyze the clinical results. METHODS Patients who were to undergo single-level fusion surgery from L3-4 to L5-S1 were enrolled. Two channels (endoscopic portal and working portal) were used for endoscopic lumbar fusion surgery. All patients underwent follow-up for more than 12 months. Demographic characteristics, diagnosis, operative time, and estimated blood loss were evaluated. MRI was performed on postoperative Day 2. Clinical evaluations (visual analog scale [VAS] for the leg and Oswestry Disability Index [ODI] scores) were performed preoperatively and during the follow-up period. RESULTS A total of 69 patients (24 men and 45 women) were enrolled in this study. The mean follow-up period was 13.5 months. Postoperative MRI revealed optimal direct neural decompression after fully endoscopic fusion surgery. VAS and ODI scores significantly improved after the surgery. There was no postoperative neurological deterioration. CONCLUSIONS Fully endoscopic LIF using the UBE technique may represent an alternative minimally invasive LIF surgery for the treatment of degenerative lumbar disease. Long-term follow-up and larger clinical studies are needed to validate the clinical and radiological results of this surgery.

  20. More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion: A review

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: In the lumbar spine, do more nerve root injuries occur utilizing minimally invasive surgery (MIS) techniques versus open lumbar procedures? To answer this question, we compared the frequency of nerve root injuries for multiple open versus MIS operations including diskectomy, laminectomy with/without fusion addressing degenerative disc disease, stenosis, and/or degenerative spondylolisthesis. Methods: Several of Desai et al. large Spine Patient Outcomes Research Trial studies showed the frequency for nerve root injury following an open diskectomy ranged from 0.13% to 0.25%, for open laminectomy/stenosis with/without fusion it was 0%, and for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion it was 2%. Results: Alternatively, one study compared the incidence of root injuries utilizing MIS transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) techniques; 7.8% of PLIF versus 2% of TLIF patients sustained root injuries. Furthermore, even higher frequencies of radiculitis and nerve root injuries occurred during anterior lumbar interbody fusions (ALIFs) versus extreme lateral interbody fusions (XLIFs). These high frequencies were far from acceptable; 15.8% following ALIF experienced postoperative radiculitis, while 23.8% undergoing XLIF sustained root/plexus deficits. Conclusions: This review indicates that MIS (TLIF/PLIF/ALIF/XLIF) lumbar surgery resulted in a higher incidence of root injuries, radiculitis, or plexopathy versus open lumbar surgical techniques. Furthermore, even a cursory look at the XLIF data demonstrated the greater danger posed to neural tissue by this newest addition to the MIS lumbar surgical armamentariu. The latter should prompt us as spine surgeons to question why the XLIF procedure is still being offered to our patients? PMID:26904372

  1. The applicability of holography in forensic identification: a fusion of the traditional optical technique and digital technique.

    PubMed

    Biwasaka, Hitoshi; Saigusa, Kiyoshi; Aoki, Yasuhiro

    2005-03-01

    In this study, the applicability of holography in the 3-dimensional recording of forensic objects such as skulls and mandibulae, and the accuracy of the reconstructed 3-D images, were examined. The virtual holographic image, which records the 3-dimensional data of the original object, is visually observed on the other side of the holographic plate, and reproduces the 3-dimensional shape of the object well. Another type of holographic image, the real image, is focused on a frosted glass screen, and cross-sectional images of the object can be observed. When measuring the distances between anatomical reference points using an image-processing software, the average deviations in the holographic images as compared to the actual objects were less than 0.1 mm. Therefore, holography could be useful as a 3-dimensional recording method of forensic objects. Two superimposition systems using holographic images were examined. In the 2D-3D system, the transparent virtual holographic image of an object is directly superimposed onto the digitized photograph of the same object on the LCD monitor. On the other hand, in the video system, the holographic image captured by the CCD camera is superimposed onto the digitized photographic image using a personal computer. We found that the discrepancy between the outlines of the superimposed holographic and photographic dental images using the video system was smaller than that using the 2D-3D system. Holography seemed to perform comparably to the computer graphic system; however, a fusion with the digital technique would expand the utility of holography in superimposition.

  2. Comparison of inert-gas-fusion and modified Kjeldahl techniques for determination of nitrogen in niobium alloys

    NASA Technical Reports Server (NTRS)

    Merkle, E. J.; Graab, J. W.; Davis, W. F.

    1974-01-01

    This report compares results obtained for the determination of nitrogen in a selected group of niobium-base alloys by the inert-gas-fusion and the Kjeldahl procedures. In the inert-gas-fusion procedure the sample is heated to approximately 2700 C in a helium atmosphere in a single-use graphite crucible. A platinum flux is used to facilitate melting of the sample. The Kjeldahl method consisted of a rapid decomposition with a mixture of hydrofluoric acid, phosphoric acid, and potassium chromate; distillation in the presence of sodium hydroxide; and highly sensitive spectrophotometry with nitroprusside-catalyzed indophenol. In the 30- to 80-ppm range, the relative standard deviation was 5 to 7 percent for the inert-gas-fusion procedure and 2 to 8 percent for the Kjeldahl procedure. The agreement of the nitrogen results obtained by the two techniques is considered satisfactory.

  3. Technique for infrared and visible image fusion based on non-subsampled shearlet transform and spiking cortical model

    NASA Astrophysics Data System (ADS)

    Kong, Weiwei; Wang, Binghe; Lei, Yang

    2015-07-01

    Fusion of infrared and visible images is an active research area in image processing, and a variety of relevant algorithms have been developed. However, the existing techniques commonly cannot gain good fusion performance and acceptable computational complexity simultaneously. This paper proposes a novel image fusion approach that integrates the non-subsampled shearlet transform (NSST) with spiking cortical model (SCM) to overcome the above drawbacks. On the one hand, using NSST to conduct the decompositions and reconstruction not only consists with human vision characteristics, but also effectively decreases the computational complexity compared with the current popular multi-resolution analysis tools such as non-subsampled contourlet transform (NSCT). On the other hand, SCM, which has been considered to be an optimal neuron network model recently, is responsible for the fusion of sub-images from different scales and directions. Experimental results indicate that the proposed method is promising, and it does significantly improve the fusion quality in both aspects of subjective visual performance and objective comparisons compared with other current popular ones.

  4. Evaluation techniques and metrics for assessment of pan+MSI fusion (pansharpening)

    NASA Astrophysics Data System (ADS)

    Mercovich, Ryan A.

    2015-05-01

    Fusion of broadband panchromatic data with narrow band multispectral data - pansharpening - is a common and often studied problem in remote sensing. Many methods exist to produce data fusion results with the best possible spatial and spectral characteristics, and a number have been commercially implemented. This study examines the output products of 4 commercial implementations with regard to their relative strengths and weaknesses for a set of defined image characteristics and analyst use-cases. Image characteristics used are spatial detail, spatial quality, spectral integrity, and composite color quality (hue and saturation), and analyst use-cases included a variety of object detection and identification tasks. The imagery comes courtesy of the RIT SHARE 2012 collect. Two approaches are used to evaluate the pansharpening methods, analyst evaluation or qualitative measure and image quality metrics or quantitative measures. Visual analyst evaluation results are compared with metric results to determine which metrics best measure the defined image characteristics and product use-cases and to support future rigorous characterization the metrics' correlation with the analyst results. Because pansharpening represents a trade between adding spatial information from the panchromatic image, and retaining spectral information from the MSI channels, the metrics examined are grouped into spatial improvement metrics and spectral preservation metrics. A single metric to quantify the quality of a pansharpening method would necessarily be a combination of weighted spatial and spectral metrics based on the importance of various spatial and spectral characteristics for the primary task of interest. Appropriate metrics and weights for such a combined metric are proposed here, based on the conducted analyst evaluation. Additionally, during this work, a metric was developed specifically focused on assessment of spatial structure improvement relative to a reference image and

  5. Endoscopic transchoroidal and transforaminal approaches for resection of third ventricular colloid cysts.

    PubMed

    Ibáñez-Botella, G; Domínguez, M; Ros, B; De Miguel, L; Márquez, B; Arráez, M A

    2014-04-01

    To review our experience over 10 years in endoscopic resection of third ventricular colloid cysts, describing the details of the transventricular-transchoroidal approach used in selected patients. This series included 24 patients with colloid cysts of the third ventricle treated in our department between October 2001 and January 2013 using an endoscopic approach. Clinical presentation, preoperative radiological findings, endoscopic technique employed, and complications were assessed in all patients. The mean length of patient follow-up was 5.16 years. The most common symptom was headache (75%). The average size of the resected colloid cysts was 16.25 mm, the maximum diameter measured in cranial magnetic resonance imaging. Resection was transforaminal in 16 cases (66.7%), transchoroidal in 7 (29.17%), and transseptal in 1; macroscopically complete resection was achieved in 23 of 24 procedures (95.8%). Complications included three intraventricular hemorrhages, four memory deficits (two of them transient), one case of temporary potomania, two soft tissue infections, and one meningitis. There were no statistically significant differences between the route of resection and number of complications. The Glasgow Outcome Scale at 1 year after surgery was 5 in 82.6% of the patients. A transventricular endoscopic approach allows macroscopically complete resection of third ventricle colloid cysts in most cases. The option of opening the choroidal fissure (transventricular-transchoroidal approach) during the procedure can address third ventricle colloid cysts that do not emerge sufficiently through the foramen of Monro without increasing procedure-related morbidity.

  6. The Effects of a Forceful Transforaminal Epidural Steroid Injection on Radicular Pain: A Preliminary Study

    PubMed Central

    Byun, Jong Min; Woo, Jae Hee; Kim, Jin

    2014-01-01

    Background Lumbar transforaminal epidural steroid injections (TFESIs) are performed to provide symptom relief in patients with radicular pain. Recent articles suggested that injected volume itself have analgesic effects and higher volumes are associated with better outcomes. To date, few studies have been conducted to investigate the effects of volume. Therefore, well-designed controlled studies were necessary to confirm the effect of volume itself on pain relief. The purpose of this study was to examine the effectiveness of a forceful saline injection on lumbar TFESI using non-particulate steroids. Methods Fifty consecutive patients with lumbar radicular pain were enrolled. The participants were allocated into one of two groups: dexamethasone with volume (Group DV) and dexamethasone alone (Group DO). The volume was delivered by a forceful injection of 5ml of normal saline. The primary end-point for this study was a VAS pain score and modified MacNab score indicating the rate of effectiveness at the four-week follow-up. Results There were no significant post-procedural VAS differences between two groups (P = .252). The effectiveness rate among the patients was 47.8% in DV group, 34.8% in DO group, measured by modified MacNab score. The difference was not statistically significant (P = .117). Conclusions A forceful saline injection did not have a significant effect during the treatment of radicular pain. Further studies with greater volumes and with additional techniques would offer a more conclusive perspective. PMID:25317282

  7. Extreme lateral lumbar interbody fusion: Do the cons outweigh the pros?

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: Major factors prompted the development of minimally invasive (MIS) extreme lateral interbody fusion (XLIF; NuVasive Inc., San Diego, CA, USE) for the thoracic/lumbar spine. These include providing interbody stabilization and indirect neural decompression while avoiding major visceral/vessel injury as seen with anterior lumbar interbody fusion (ALIF), and to avert trauma to paraspinal muscles/facet joints found with transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and posterior-lateral fusion techniques (PLF). Although anticipated pros of MIS XLIF included reduced blood loss, operative time, and length of stay (LOS), they also included, higher fusion, and lower infection rates. Unanticipated cons, however, included increased morbidity/mortality rates. Methods: We assessed the pros and cons (e.g., risks, complications, comparable value/superiority/inferiority, morbidity/mortality) of MIS XLIF vs. ALIF, TLIF, PLIF, and PLF. Results: Pros of XLIF included various biomechanical and technical surgical advantages, along with multiple cons vs. ALIF, TLIF, PLIF, and PLF. For example, XLIF correlated with a considerably higher frequency of major neurological deficits vs. other constructs; plexus injuries 13.28%, sensory deficits 0–75% (permanent in 62.5%), motor deficits 0.7–33.6%, and anterior thigh pain 12.5–25%. XLIF also disproportionately contributed to other major morbidity/mortality; sympathectomy, major vascular injuries (some life-ending others life-threatening), bowel perforations, and seromas. Furthermore, multiple studies documented no superiority, and the potential inferiority of XLIF vs. ALIF, TLIF, PLIF, and PLF. Conclusion: Reviewing the pros of XLIF (e.g. radiographic, technical, biomechanical) vs. the cons (inferiority, increased morbidity/mortality) vs. ALIF, TLIF, PLIF, and PLF, we question whether XLIF should remain part of the lumbar spinal surgical armamentarium. PMID:27843688

  8. The cost-effectiveness of interbody fusions versus posterolateral fusions in 137 patients with lumbar spondylolisthesis.

    PubMed

    Bydon, Mohamad; Macki, Mohamed; Abt, Nicholas B; Witham, Timothy F; Wolinsky, Jean-Paul; Gokaslan, Ziya L; Bydon, Ali; Sciubba, Daniel M

    2015-03-01

    Reimbursements for interbody fusions have declined recently because of their questionable cost-effectiveness. A Markov model was adopted to compare the cost-effectiveness of posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (/TLIF) versus noninterbody fusion and posterolateral fusion (PLF) in patients with lumbar spondylolisthesis. Decision model analysis based on retrospective data from a single institutional series. One hundred thirty-seven patients underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Quality of life adjustments and expenditures were assigned to each short-term complication (durotomy, surgical site infection, and medical complication) and long-term outcome (bowel/bladder dysfunction and paraplegia, neurologic deficit, and chronic back pain). Patients were divided into a PLF cohort and a PLF plus PLIF/TLIF cohort. Anterior techniques and multilevel interbody fusions were excluded. Each short-term complication and long-term outcome was assigned a numerical quality-adjusted life-year (QALY), based on time trade-off values in the Beaver Dam Health Outcomes Study. The cost data for short-term complications were calculated from charges accrued by the institution's finance sector, and the cost data for long-term outcomes were estimated from the literature. The difference in cost of PLF plus PLIF/TLIF from the cost of PLF alone divided by the difference in QALY equals the cost-effectiveness ratio (CER). We do not report any study funding sources or any study-specific appraisal of potential conflict of interest-associated biases in this article. Of 137 first-time lumbar fusions for spondylolisthesis, 83 patients underwent PLF and 54 underwent PLIF/TLIF. The average time to reoperation was 3.5 years. The mean QALY over 3.5 years was 2.81 in the PLF cohort versus 2.66 in the PLIFo/TLIF cohort (p=.110). The mean 3.5-year costs of $54,827.05 after index interbody fusion were

  9. Removal of discal cyst using percutaneous working channel endoscope via transforaminal route

    PubMed Central

    Kim, Jin-Sung; Choi, Gun; Lee, Choon Dae

    2008-01-01

    Discal cyst is a very rare lesion that can cause refractory low back pain and radiating leg pain. Although there are some reports to remove this lesion, there has been no report of discal cyst removed by percutaneous endoscopic transforaminal approach. Two young patients manifested left gluteal and leg pain due to a discal cyst at L5–S1 level and L4–5 level, respectively. Percutaneous endoscopic transforaminal approach was performed to remove the discal cyst, achieving complete decompression of the nerve root. The symptom was relieved and the patient was discharged the next day. Percutaneous endoscopic transforaminal approach could be a good alternative option in selected cases for the treatment of lumbar discal cyst. PMID:19034535

  10. One-stage posterior osteotomy with short segmental fusion and dual growing rod technique for severe rigid congenital scoliosis: the preliminary clinical outcomes of a hybrid technique.

    PubMed

    Wang, Shengru; Zhang, Jianguo; Qiu, Guixing; Wang, Yipeng; Weng, Xisheng; Guo, Jianwei

    2014-02-15

    Retrospective study. To evaluate the clinical outcomes of the hybrid technique of 1-stage posterior osteotomy with short segmental fusion and dual growing rod (GR) technique for severe rigid congenital scoliosis. As some types of congenital scoliosis consist of long curve including sharp deformities producing enormous asymmetric growth at apex, they cannot be well corrected with osteotomy and short segmental fusion. GR technique may be the best option. However, enormous asymmetric growth potential due to the sharp deformities at the apex will increase risk of complications, especially implant failures. Seven patients (2 males, 5 females) undergoing this hybrid technique for severe rigid congenital scoliosis were retrospectively reviewed. The patients' charts were reviewed. The analysis included age at initial surgery and the latest follow-up, number and frequency of lengthening, and complications. Radiographical evaluation included measured changes in scoliosis Cobb angle, thoracic kyphosis, lumbar lordosis, trunk shift, length of T1-S1, and instrumentation. The mean follow-up was 53.3 (30-77) months. The mean age at the initial surgery is 5.9 (2-10) years. The averaged lengthenings were of 5.3 per patient. The mean scoliosis improved from 81.4° to 40.1° after initial surgery and was 41.0° at the latest follow-up. The average T1-S1 length was of 1.23 cm per year. The space available for lung ratio increased from 0.86 to 0.96. Osteotomy with short fusion could help to improve the correction of the GR and eliminate the large asymmetric growth potential around the apex, with little influence to the length of the spine. Dual GR technique could maintain correction achieved at initial surgery while allowing spinal growth to continue. This hybrid technique may be an option for young patients who present sharp deformities with large asymmetric growth potential in a long congenital spinal deformity. 4.

  11. Fluoroscopy guided transforaminal epidural anesthesia in ankylosing spondylitis.

    PubMed

    Channabasappa, S M; Dharmappa, S; Pandurangi, R

    2016-01-01

    A 48-year-old male patient with a long-standing history of ankylosing spondylitis (AS) presented for ureteroscopic stone removal. On preoperative assessment, tracheal intubation was likely to be difficult due to decreased cervical spine mobility. Traditional neuraxial block was impossible due to the fusion of vertebral bodies. AS patients present the most serious array of intubation, which is secondary to decrease in cervical spine mobility and possible temporomandibular joint disease. Management of a case of AS can be very challenging when the airway and the central neuraxial blockade, both are difficult. Fluoroscopic assisted central neuraxial blockade may lead to predictable success in AS. We present a case report with severe AS where conventional techniques failed and C-arm assisted helped in successful epidural anesthesia for ureteroscopic stone removal.

  12. Nonintrusive multibiometrics on a mobile device: a comparison of fusion techniques

    NASA Astrophysics Data System (ADS)

    Allano, Lorene; Morris, Andrew C.; Sellahewa, Harin; Garcia-Salicetti, Sonia; Koreman, Jacques; Jassim, Sabah; Ly-Van, Bao; Wu, Dalei; Dorizzi, Bernadette

    2006-04-01

    In this article we test a number of score fusion methods for the purpose of multimodal biometric authentication. These tests were made for the SecurePhone project, whose aim is to develop a prototype mobile communication system enabling biometrically authenticated users to deal legally binding m-contracts during a mobile phone call on a PDA. The three biometrics of voice, face and signature were selected because they are all traditional non-intrusive and easy to use means of authentication which can readily be captured on a PDA. By combining multiple biometrics of relatively low security it may be possible to obtain a combined level of security which is at least as high as that provided by a PIN or handwritten signature, traditionally used for user authentication. As the relative success of different fusion methods depends on the database used and tests made, the database we used was recorded on a suitable PDA (the Qtek2020) and the test protocol was designed to reflect the intended application scenario, which is expected to use short text prompts. Not all of the fusion methods tested are original. They were selected for their suitability for implementation within the constraints imposed by the application. All of the methods tested are based on fusion of the match scores output by each modality. Though computationally simple, the methods tested have shown very promising results. All of the 4 fusion methods tested obtain a significant performance increase.

  13. Fusion of 3D models derived from TLS and image-based techniques for CH enhanced documentation

    NASA Astrophysics Data System (ADS)

    Bastonero, P.; Donadio, E.; Chiabrando, F.; Spanò, A.

    2014-05-01

    Recognizing the various advantages offered by 3D new metric survey technologies in the Cultural Heritage documentation phase, this paper presents some tests of 3D model generation, using different methods, and their possible fusion. With the aim to define potentialities and problems deriving from integration or fusion of metric data acquired with different survey techniques, the elected test case is an outstanding Cultural Heritage item, presenting both widespread and specific complexities connected to the conservation of historical buildings. The site is the Staffarda Abbey, the most relevant evidence of medieval architecture in Piedmont. This application faced one of the most topical architectural issues consisting in the opportunity to study and analyze an object as a whole, from twice location of acquisition sensors, both the terrestrial and the aerial one. In particular, the work consists in the evaluation of chances deriving from a simple union or from the fusion of different 3D cloudmodels of the abbey, achieved by multi-sensor techniques. The aerial survey is based on a photogrammetric RPAS (Remotely piloted aircraft system) flight while the terrestrial acquisition have been fulfilled by laser scanning survey. Both techniques allowed to extract and process different point clouds and to generate consequent 3D continuous models which are characterized by different scale, that is to say different resolutions and diverse contents of details and precisions. Starting from these models, the proposed process, applied to a sample area of the building, aimed to test the generation of a unique 3Dmodel thorough a fusion of different sensor point clouds. Surely, the describing potential and the metric and thematic gains feasible by the final model exceeded those offered by the two detached models.

  14. Clear Zone Formation around Screws in the Early Postoperative Stages after Posterior Lumbar Fusion Using the Cortical Bone Trajectory Technique

    PubMed Central

    Iwatsuki, Koichi; Ohnishi, Yu-Ichiro; Ohkawa, Toshika; Yoshimine, Toshiki

    2015-01-01

    Study Design Retrospective study. Purpose To evaluate the initial fixation using the cortical bone trajectory (CBT) technique for posterior lumbar fusion through assessment of the clear zones around the screws and the risk factors involved. Overview of Literature Postoperative radiolucent zones (clear zones) are an indicator of poor conventional pedicle screw fixation. Methods Between January 2013 and April 2014, 19 patients (8 men and 11 women) underwent posterior lumbar interbody fusion or posterior lumbar fusion using the CBT technique. A total of 109 screws were used for evaluation with measurement of the maximum insertional torque of last two screw rotations. Clear zone-positivity on plain radiographs was investigated 6 months after surgery. The relation between intraoperative insertional torque and clear zone-positivity was investigated by one-way analysis of variance. In addition, the correlation between clear zone-positivity and gender, age (<75 years old or >75 years old), or operative stabilization level (<2 or >3 vertebral levels) was evaluated using the chi-square test. Results Clear zones were observed around six screws (5.50%) in five patients (26.3%). The mean insertional torque (4.00±2.09 inlbs) of clear zone-positive screws was lower than that of clear zone-negative screws (8.12±0.50 in-lbs), but the difference was not significant. There was a significant correlation between clear zone-positivity and operative level of stabilization. Conclusions The low incidence of clear zone-positive screws indicates good initial fixation using the CBT technique. Multilevel fusions may be risk factors for clear zone generation. PMID:26713120

  15. Incidence of intradiscal injection during lumbar fluoroscopically guided transforaminal and interlaminar epidural steroid injections.

    PubMed

    Candido, Kenneth D; Katz, Jeffrey A; Chinthagada, Mariadas; McCarthy, Robert A; Knezevic, Nebojsa Nick

    2010-05-01

    Intradiscal injections during transforaminal epidural steroid injections and interlaminar lumbar epidural steroid injections have been reported rarely. In that regard, this retrospective observational report is the first attempt to quantify the overall rate of this complication. A retrospective analysis of 3 years of accrued data (2004-2007) showed that 2412 transforaminal epidural steroid injections were performed at the 2 training institutions (Loyola University Medical Center and Northwestern University/Feinberg School of Medicine). There were 6 intradiscal (annular) injections of contrast, for a rate of 1:402. Over the same interval, 4723 lumbar epidural steroid injections were performed, with 1 intradiscal injection, for a rate of 1:4723.

  16. An investigation of density measurement method for yarn-dyed woven fabrics based on dual-side fusion technique

    NASA Astrophysics Data System (ADS)

    Zhang, Rui; Xin, Binjie

    2016-08-01

    Yarn density is always considered as the fundamental structural parameter used for the quality evaluation of woven fabrics. The conventional yarn density measurement method is based on one-side analysis. In this paper, a novel density measurement method is developed for yarn-dyed woven fabrics based on a dual-side fusion technique. Firstly, a lab-used dual-side imaging system is established to acquire both face-side and back-side images of woven fabric and the affine transform is used for the alignment and fusion of the dual-side images. Then, the color images of the woven fabrics are transferred from the RGB to the CIE-Lab color space, and the intensity information of the image extracted from the L component is used for texture fusion and analysis. Subsequently, three image fusion methods are developed and utilized to merge the dual-side images: the weighted average method, wavelet transform method and Laplacian pyramid blending method. The fusion efficacy of each method is evaluated by three evaluation indicators and the best of them is selected to do the reconstruction of the complete fabric texture. Finally, the yarn density of the fused image is measured based on the fast Fourier transform, and the yarn alignment image could be reconstructed using the inverse fast Fourier transform. Our experimental results show that the accuracy of density measurement by using the proposed method is close to 99.44% compared with the traditional method and the robustness of this new proposed method is better than that of conventional analysis methods.

  17. A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy.

    PubMed

    Gibson, J N Alaistair; Subramanian, Ashok S; Scott, Chloe E H

    2017-03-01

    Transforaminal endoscopic discectomy (TED) minimises paraspinal muscle damage. The aim of this trial was to compare clinical outcomes of TED to Microdiscectomy (Micro). 143 patients, age 25-70 years and <115 kg, with single level lumbar prolapse and radiculopathy, were recruited and randomised. 70 received TED under conscious sedation and 70 Micro under general anaesthesia. Oswestry Disability Index (ODI), visual analogue scores (VAS) of back and leg pain, and Short Form Health Survey indices (SF-36) were measured preoperatively and at 3, 12 and 24 months. All outcome measures improved significantly in both groups (p < 0.001). Affected side leg pain was lower in the TED group at 2 years (1.9 ± 2.6 vs 3.5 ± 3.1, p = 0.002). Hospital stay was shorter following TED (0.7 ± 0.7 vs 1.4 ± 1.3 days, p < 0.001). Two Micro patients and five TED patients required revision giving a relative risk of revision for TED of 2.62 (95% CI 0.49-14.0). Functional improvements were maintained at 2 years in both groups with less ongoing sciatica after TED. A greater revision rate after TED was offset by a more rapid recovery.

  18. Magnetic Resonance Imaging-Ultrasound Fusion-Guided Prostate Biopsy: Review of Technology, Techniques, and Outcomes.

    PubMed

    Kongnyuy, Michael; George, Arvin K; Rastinehad, Ardeshir R; Pinto, Peter A

    2016-04-01

    Transrectal ultrasound (TRUS)-guided (12-14 core) systematic biopsy of the prostate is the recommended standard for patients with suspicion of prostate cancer (PCa). Advances in imaging have led to the application of magnetic resonance imaging (MRI) for the detection of PCa with subsequent development of software-based co-registration allowing for the integration of MRI with real-time TRUS during prostate biopsy. A number of fusion-guided methods and platforms are now commercially available with common elements in image and analysis and planning. Implementation of fusion-guided prostate biopsy has now been proven to improve the detection of clinically significant PCa in appropriately selected patients.

  19. Full-endoscopic technique for anterior cervical discectomy and interbody fusion: 5-year follow-up results of 67 cases.

    PubMed

    Yao, Nuzhao; Wang, Cheng; Wang, Wenjun; Wang, Lushan

    2011-06-01

    With minimally invasive technique becoming more popular, endoscopic operations such as arthroscopy or laparoscopy have become the standard of care in several other areas. In this study, we evaluated the 5-year follow-up outcomes of anterior cervical (Ahn et al. in Photomed Laser Surg 23:362-368, 2005) discectomy and interbody fusion (ACDF) performed via endoscopic approach. Sixty-seven patients who underwent anterior cervical discectomy and cage fusion performed using endoscopic technique were followed for at least 5 years. We reviewed the clinical and radiographic records of these patients. The postoperative radiographic measures accessed were the anterior intervertebral height (AIH) and the lordosis angle (LDA). Clinical outcomes were determined using the previously validated Japanese Orthopaedic Association (JOA) and the pain visual analog scale (VAS). Patients included had a minimal follow-up period of 5 years and based on the outcomes criteria (JOA, VAS), 86.6% of patients reported excellent or good results. The AIH increased on average 18.7% of the original height (p < 0.01), and the LDA were more physiologic at final follow-up. Of the 67 cases, there was no segmental instability, and the bone fusion rate was 100%. One patient required revision open ACDF due to adjacent segment disc herniation 6 years postoperatively. There were no intraoperative complications, dysphasia or esophageal injury in this study group. It indicated endoscopic technique for ACDF can obtain satisfactory results in patients with cervical disc herniation, cervical myelopathy, or radiculopathy. Compared with a traditional approach, this technique may be associated with less morbidity while improving cosmesis and postoperative recovery. Prospective randomized control trials are needed to directly compare these two procedures.

  20. A systematic review of minimally invasive sacroiliac joint fusion utilizing a lateral transarticular technique

    PubMed Central

    Heiney, Jake; Cher, Daniel

    2015-01-01

    Background A number of studies have been published regarding minimally invasive surgical (MIS) fusion of the sacroiliac (SI) joint using a lateral transarticular approach. Herein we report a systematic review and meta-analysis to summarize operative measures and clinical outcomes reported in published studies of MIS SI joint fusion. Methods The systematic review was done according to PRISMA standards. PubMed and EMBASE were searched using the terms sacroiliac joint AND fusion. Original peer-reviewed articles in the English language that reported clinical outcomes on at least 5 cases of MIS SI joint fusion using a lateral transarticular approach were included. Random effects meta-analysis (RMA) was performed on selected variables using the DerSimonian and Laird method, including operative measures, VAS SI joint pain ratings (0-10 scale) and Oswestry Disability Index (ODI). Mean and 95% confidence intervals (CI) were calculated and heterogeneity was assessed. Other findings were summarized qualitatively. Results A total of 18 articles met the inclusion criteria. After accounting for overlapping cohorts, 12 unique cohorts from 4 countries were extracted for a total of 432 subjects. The RMA mean (range) was 59 minutes (27-78) for procedure time, 36.9cc (10-70) for estimated blood loss and 1.7 days (range 0-7) for length of stay (LOS). The RMA mean [95% CI] pain score dropped by 5.2 points at 6 months and 5.3 points at 12 months (baseline score of 8.1 [7.8-8.4], 12-month score of 2.7 [2.1-3.3]), and a 24-month score of 2.0(1.4-2.5). ODI decreased by 31 points at 12 months (baseline score of 56.2 [51.0-61.5], 6-month score of 30.7 [21.8-39.6], and 12-month score of 25.1 [12.3-37.9]). Some estimates showed significant variation across studies and between the types of implants used. Other reported outcomes were supportive of the positive effects of SI joint fusion. Conclusion Published studies of MIS SI joint fusion using a lateral transarticular approach confirm its

  1. The Applications of Decision-Level Data Fusion Techniques in the Field of Multiuser Detection for DS-UWB Systems.

    PubMed

    Gu, Yebo; Yang, Minglei; Shi, Zhenguo; Wu, Zhilu

    2015-09-25

    In this paper, the decision-level data fusion techniques are extended to the multiuser detection (MUD) field. Then two novel MUD algorithms, that is the chairman arbitrating decision-level fusion criterion (CA-DFC) based MUD algorithm and the veto logic decision-level fusion criterion (VL-DFC) based MUD algorithm, are proposed for DS-UWB communication systems. In CA-DFC based method, the chairman can make his arbitration among the preliminary decisions from sub-optimal detectors by his own rule. In the VL-DFC based method, the undetermined bits in these preliminary decisions are considered to construct a simplified solution space, and then the chairman can make his final decision within this space. Simulation results demonstrate that the performances of CA-DFC and VL-DFC based MUD algorithms are superior to those of other sub-optimal MUD algorithms, and even close to that of OMD. Moreover, both of these proposed algorithms have lower computational complexity than OMD, which reveals their efficiency. Compared with CA-DFC, VL-DFC based algorithm achieves a little improvement in its performance, at the cost of the increment in its computational complexity. Thus, they can be applied to different practical situations.

  2. The Applications of Decision-Level Data Fusion Techniques in the Field of Multiuser Detection for DS-UWB Systems

    PubMed Central

    Gu, Yebo; Yang, Minglei; Shi, Zhenguo; Wu, Zhilu

    2015-01-01

    In this paper, the decision-level data fusion techniques are extended to the multiuser detection (MUD) field. Then two novel MUD algorithms, that is the chairman arbitrating decision-level fusion criterion (CA-DFC) based MUD algorithm and the veto logic decision-level fusion criterion (VL-DFC) based MUD algorithm, are proposed for DS-UWB communication systems. In CA-DFC based method, the chairman can make his arbitration among the preliminary decisions from sub-optimal detectors by his own rule. In the VL-DFC based method, the undetermined bits in these preliminary decisions are considered to construct a simplified solution space, and then the chairman can make his final decision within this space. Simulation results demonstrate that the performances of CA-DFC and VL-DFC based MUD algorithms are superior to those of other sub-optimal MUD algorithms, and even close to that of OMD. Moreover, both of these proposed algorithms have lower computational complexity than OMD, which reveals their efficiency. Compared with CA-DFC, VL-DFC based algorithm achieves a little improvement in its performance, at the cost of the increment in its computational complexity. Thus, they can be applied to different practical situations. PMID:26404273

  3. Magnetic Resonance Imaging-Ultrasound Fusion-Guided Prostate Biopsy: Review of Technology, Techniques, and Outcomes

    PubMed Central

    Kongnyuy, Michael; George, Arvin K.; Rastinehad, Ardeshir R.; Pinto, Peter A.

    2016-01-01

    Transrectal ultrasound (TRUS)-guided (12–14 core) systematic biopsy of the prostate is the recommended standard for patients with suspicion of prostate cancer (PCa). Advances in imaging have led to the application of magnetic resonance imaging (MRI) for the detection of PCa with subsequent development of software-based co-registration allowing for the integration of MRI with real-time TRUS during prostate biopsy. A number of fusion-guided methods and platforms are now commercially available with common elements in image and analysis and planning. Implementation of fusion-guided prostate biopsy has now been proven to improve the detection of clinically significant PCa in appropriately selected patients. PMID:26902626

  4. Wavelet and pyramid techniques for multisensor data fusion: a performance comparison varying with scale ratios

    NASA Astrophysics Data System (ADS)

    Aiazzi, Bruno; Alparone, Luciano; Argenti, Fabrizio; Baronti, Stefano

    1999-12-01

    Goal of this paper is to provide a quantitative performance evaluation of multiresolution schemes capable to carry out feature-based fusion of data collected by multispectral and panchromatic imaging sensors having different spectral and ground resolutions. To this aim a set of quantitative parameters has been recently proposed. Both visual quality, regarded as contrast, presence of fine details, and absence of impairments and artifacts (e.g., blur, ringing), and spectral fidelity (i.e., preservation of spectral signatures) are concerned and embodied in the measurements. Out of the three methods compared, respectively based on highpass filtering (HPF), wavelet transform (WT), and generalized Laplacian pyramid (GLP), the latter two are far more efficient than the former, thus establishing the advantages for data fusion of a formally multiresolution analysis.

  5. [An alternative dorsal fusion technique after transoral dens resection in basilar impression with atlas assimilation].

    PubMed

    Kaden, B; Schramm, J; Koch, W; Solymosi, L

    1998-01-01

    Current therapy of basilar impression includes transoral dens resection. The essential disadvantage of this procedure is the instability of C1/C2 due to loss of the transverse ligament. We describe two patients in whom this instability was treated by modified screwing. Using MAGERL-screws between C0-C2 an interposition of an iliac graft between the occiput and the arc of C2 was made. Neurological symptoms improved in both patients postoperatively. In both cases stable fusion C0/C2 was achieved with an additional treatment with a HALO-fixateur for eight weeks. In our opinion the combined transoral/dorsal procedure is most suitable and efficient in treatment of basilar impressions. By this approach both, decompression of the myelon as well as stable fusion C0/C2, is achieved.

  6. Advanced data visualization and sensor fusion: Conversion of techniques from medical imaging to Earth science

    NASA Technical Reports Server (NTRS)

    Savage, Richard C.; Chen, Chin-Tu; Pelizzari, Charles; Ramanathan, Veerabhadran

    1993-01-01

    Hughes Aircraft Company and the University of Chicago propose to transfer existing medical imaging registration algorithms to the area of multi-sensor data fusion. The University of Chicago's algorithms have been successfully demonstrated to provide pixel by pixel comparison capability for medical sensors with different characteristics. The research will attempt to fuse GOES (Geostationary Operational Environmental Satellite), AVHRR (Advanced Very High Resolution Radiometer), and SSM/I (Special Sensor Microwave Imager) sensor data which will benefit a wide range of researchers. The algorithms will utilize data visualization and algorithm development tools created by Hughes in its EOSDIS (Earth Observation SystemData/Information System) prototyping. This will maximize the work on the fusion algorithms since support software (e.g. input/output routines) will already exist. The research will produce a portable software library with documentation for use by other researchers.

  7. Advanced data visualization and sensor fusion: Conversion of techniques from medical imaging to Earth science

    NASA Technical Reports Server (NTRS)

    Savage, Richard C.; Chen, Chin-Tu; Pelizzari, Charles; Ramanathan, Veerabhadran

    1992-01-01

    Hughes Aircraft Company and the University of Chicago propose to transfer existing medical imaging registration algorithms to the area of multi-sensor data fusion. The University of Chicago's algorithms have been successfully demonstrated to provide pixel by pixel comparison capability for medical sensors with different characteristics. The research will attempt to fuse GOES, AVHRR, and SSM/I sensor data which will benefit a wide range of researchers. The algorithms will utilize data visualization and algorithm development tools created by Hughes in its EOSDIS prototyping. This will maximize the work on the fusion algorithms since support software (e.g. input/output routines) will already exist. The research will produce a portable software library with documentation for use by other researchers.

  8. Advanced data visualization and sensor fusion: Conversion of techniques from medical imaging to Earth science

    NASA Technical Reports Server (NTRS)

    Savage, Richard C.; Chen, Chin-Tu; Pelizzari, Charles; Ramanathan, Veerabhadran

    1993-01-01

    Hughes Aircraft Company and the University of Chicago propose to transfer existing medical imaging registration algorithms to the area of multi-sensor data fusion. The University of Chicago's algorithms have been successfully demonstrated to provide pixel by pixel comparison capability for medical sensors with different characteristics. The research will attempt to fuse GOES (Geostationary Operational Environmental Satellite), AVHRR (Advanced Very High Resolution Radiometer), and SSM/I (Special Sensor Microwave Imager) sensor data which will benefit a wide range of researchers. The algorithms will utilize data visualization and algorithm development tools created by Hughes in its EOSDIS (Earth Observation SystemData/Information System) prototyping. This will maximize the work on the fusion algorithms since support software (e.g. input/output routines) will already exist. The research will produce a portable software library with documentation for use by other researchers.

  9. Advanced data visualization and sensor fusion: Conversion of techniques from medical imaging to Earth science

    NASA Technical Reports Server (NTRS)

    Savage, Richard C.; Chen, Chin-Tu; Pelizzari, Charles; Ramanathan, Veerabhadran

    1992-01-01

    Hughes Aircraft Company and the University of Chicago propose to transfer existing medical imaging registration algorithms to the area of multi-sensor data fusion. The University of Chicago's algorithms have been successfully demonstrated to provide pixel by pixel comparison capability for medical sensors with different characteristics. The research will attempt to fuse GOES, AVHRR, and SSM/I sensor data which will benefit a wide range of researchers. The algorithms will utilize data visualization and algorithm development tools created by Hughes in its EOSDIS prototyping. This will maximize the work on the fusion algorithms since support software (e.g. input/output routines) will already exist. The research will produce a portable software library with documentation for use by other researchers.

  10. Measuring fusion excitation functions with RIBs: A thorough analysis of the stacked target technique and the related problems

    SciTech Connect

    Fisichella, M. Di Pietro, A.; Figuera, P.; Marchetta, C.; Shotter, A. C.; Lattuada, M.; Torresi, D.; Privitera, V.; Romano, L.; Ruiz, C.; Zadro, M.

    2015-10-15

    The use of the stacked target technique to measure fusion cross-sections of reactions induced by low intensity radioactive beams offers considerable advantages since several reaction energies may be simultaneously measured. The main disadvantage of the method is the degradation of the beam quality as it passes through the stack due to statistical nature of energy loss processes and any non-uniformity of the stacked targets. This degradation can lead to ambiguities of associating effective beam energies to reaction product yields for the targets within the stack. A detailed investigation of these ambiguities has been performed and some of the obtained results are presented.

  11. Fabrication of cryogenic inertial-confinement-fusion targets using target free-fall technique. Report No. 2-82

    SciTech Connect

    Kim, K.; Murphy, M.J.

    1982-04-01

    Techniques for fabricating cryogenic inertial confinement fusion targets (i.e., spherical shells containing a uniform layer of DT ice) are investigated using target free-fall concept. Detection and characterization of the moving targets are effected by optoelectronic means, of which the principal is an RF ac-interferometer. This interferometer system demonstrates, for the first time, the speed capabilities of the phase-modulation ac-interferometry. New techiques developed for handling, holding, launching, and transporting targets are also described. Results obtained at both room and cryogenic temperatures are presented.

  12. Biomechanical analysis of lateral interbody fusion strategies for adjacent segment degeneration in the lumbar spine.

    PubMed

    Metzger, Melodie F; Robinson, Samuel T; Maldonado, Ruben C; Rawlinson, Jeremy; Liu, John; Acosta, Frank L

    2017-07-01

    Surgical treatment of symptomatic adjacent segment disease (ASD) typically involves extension of previous instrumentation to include the newly affected level(s). Disruption of the incision site can present challenges and increases the risk of complication. Lateral-based interbody fusion techniques may provide a viable surgical alternative that avoids these risks. This study is the first to analyze the biomechanical effect of adding a lateral-based construct to an existing fusion. The study aimed to determine whether a minimally invasive lateral interbody device, with and without supplemental instrumentation, can effectively stabilize the rostral segment adjacent to a two-level fusion when compared with a traditional posterior revision approach. This is a cadaveric biomechanical study of lateral-based interbody strategies as add-on techniques to an existing fusion for the treatment of ASD. Twelve lumbosacral specimens were non-destructively loaded in flexion, extension, lateral bending, and torsion. Sequentially, the tested conditions were intact, two-level transforaminal lumbar interbody fusion (TLIF) (L3-L5), followed by lateral lumbar interbody fusion procedures at L2-L3 including interbody alone, a supplemental lateral plate, a supplemental spinous process plate, and then either cortical screw or pedicle screw fixation. A three-level TLIF was the final instrumented condition. In all conditions, three-dimensional kinematics were tracked and range of motion (ROM) was calculated for comparisons. Institutional funds (<$50,000) in support of this work were provided by Medtronic Spine. The addition of a lateral interbody device superadjacent to a two-level fusion significantly reduced motion in flexion, extension, and lateral bending (p<.05). Supplementing with a lateral plate further reduced ROM during lateral bending and torsion, whereas a spinous process plate further reduced ROM during flexion and extension. The addition of posterior cortical screws provided the

  13. Extreme lateral lumbar interbody fusion. Surgical technique, outcomes and complications after a minimum of one year follow-up.

    PubMed

    Domínguez, I; Luque, R; Noriega, M; Rey, J; Alia, J; Marco-Martínez, F

    «Minimally invasive» techniques have been recently been developed in order to achieve good clinical results with a low incidence of complications. The extralateral interbody fusion or direct transpsoas is a minimally invasive anterior arthrodesis. A total of 97 patients with 138 segments received surgery between May 2012 and May 2015. The follow-up was from 12-44 months. The mean age was 68 years (41-86). The most common cause of intervention was the adjacent segment (30%), deformity (22%), and lumbar disc disease (21%). The interbody cage was implanted as: Single (stand-alone) in 33%, and additional fixation was used in the others: Screws, percutaneous unilateral (11%), bilateral (27%), or with a lateral plate (62%). The mean stay was 3.2 days (2-6). The score on a lumbar visual analogue scale decreased from 9 to 4.1, and dropped to 3 after one year. The improvement in disc height was from 8.4mm to 13.8mm, and a larger increase in the foramen diameter from 10.5 to 13.1mm, which were statistically significant. The early major complications recorded were, three motor femoral nerve injuries and retroperitoneal haematoma (4%), and the early minor were: two fractures (2%). As major late complications there was an abdominal hernia, a mobilization of 10mm and three radiculopathy (5%), and as minor late, three fracture, two mobilisations greater than 10mm, four mobilisations of less than 10mm, and one mobilisation of a screw plate (10%). The extralateral interbody fusion technique is a safe and reliable when performing a lumbar fusion by an alternative minimally invasive route.

  14. Single and Dual Drug Release Patterns from Shellac Wax-Lutrol Matrix Tablets Fabricated with Fusion and Molding Techniques

    PubMed Central

    Phaechamud, T.; Choncheewa, C.

    2015-01-01

    The objective of this investigation was to prepare the shellac wax matrix tablets by fusion and molding technique incorporated with Lutrol in different ratios to modify the hydrophobicity of matrix tablet. The matrix tablets with single drug were loaded either with propranolol hydrochloride or hydrochlorothiazide as hydrophilic and hydrophobic model drugs, and a dual drug formula was also prepared. The single and dual drug release patterns were studied in a dissolution apparatus using distilled water as medium. Propranolol hydrochloride released from matrix was easier than hydrochlorothiazide. Drug release from shellac wax matrix could be enhanced by incorporation of Lutrol. However retardation of drug release from some matrix tablets was evident for the systems that could form dispersion in the dissolution medium. The gel network from high content of Lutrol was hexagonal which was a dense and more compact structure than the other structures found when low amounts of Lutrol were present in the formula. Therefore, the formulae with high content of Lutrol could prolong drug release more efficiently than those containing low content of Lutrol. Hence shellac wax matrix could modulate the drug release with the addition of Lutrol. Sustainable dual drug release was also obtained from these developed matrix tablets. Thus shellac wax-Lutrol component could be used as a potential matrix tablet prepared with fusion and molding technique with excellent controlled drug release. PMID:25767320

  15. High neurological complication rates for extreme lateral lumbar interbody fusion and related techniques: A review of safety concerns.

    PubMed

    Epstein, Nancy E

    2016-01-01

    There are frequent reports of lumbosacral plexus and other neurological injuries occurring with extreme lateral interbody fusions (XLIF) and other related lateral lumbar techniques. This review focuses on the new neurological deficits (e.g. lumbosacral plexus, root injuries) that occur following minimally invasive surgery (MIS) XLIF and other related lateral lumbar techniques. A review of multiple articles revealed the following ranges of new postoperative neurological complications for XLIF procedures: plexus injuries 13.28%; sensory deficits 0-75% (permanent in 62.5%); motor deficits 0.7-33.6%; anterior thigh pain 12.5-25%. Of interest, in a study by Lykissas et al., the frequency of long-term neural injury following lateral lumber interbody fusion (LLIF) with BMP-2 (72 patients) was much higher than for LLIF performed with autograft/allograft (72 patients). The addition of bone morphogenetic protein led to persistent sensory deficits in 29 vs. 20 without BMP; persistent motor deficits in 35 with vs. 17 without BMP; and persistent anterior thigh/groin pain in 8 with vs. 0 without BMP. They should also have noted the unacceptably high incidence of neural injury occurring with LLIF alone without BMP. This review highlights the high risk of neural injury (up to 75% for sensory, 33.6% for motor, and an overall plexus injury rate of 13.28%) utilizing the XLIF and other similar lateral lumbar approaches. With such extensive neurological injuries, is the XLIF really safe, and should it still be performed?

  16. Magnetic Resonance and Ultrasound Image Fusion Supported Transperineal Prostate Biopsy Using the Ginsburg Protocol: Technique, Learning Points, and Biopsy Results.

    PubMed

    Hansen, Nienke; Patruno, Giulio; Wadhwa, Karan; Gaziev, Gabriele; Miano, Roberto; Barrett, Tristan; Gnanapragasam, Vincent; Doble, Andrew; Warren, Anne; Bratt, Ola; Kastner, Christof

    2016-08-01

    high, prostate biopsies may not be needed for all men with elevated prostate-specific antigen values and nonsuspicious mpMRI. We present our technique to sample (biopsy) the prostate by the transperineal route (the area between the scrotum and the anus) to detect prostate cancer using a fusion of magnetic resonance and ultrasound images to guide the sampling. Copyright © 2016 European Association of Urology. All rights reserved.

  17. Development of a diagnostic technique based on Cherenkov effect for measurements of fast electrons in fusion devices

    SciTech Connect

    Plyusnin, V. V.; Duarte, P.; Fernandes, H.; Silva, C.

    2012-08-15

    A diagnostic technique based on the Cherenkov effect is proposed for detection and characterization of fast (super-thermal and runaway) electrons in fusion devices. The detectors of Cherenkov radiation have been specially designed for measurements in the ISTTOK tokamak. Properties of several materials have been studied to determine the most appropriate one to be used as a radiator of Cherenkov emission in the detector. This technique has enabled the detection of energetic electrons (70 keV and higher) and the determination of their spatial and temporal variations in the ISTTOK discharges. Measurement of hard x-ray emission has also been carried out in experiments for validation of the measuring capabilities of the Cherenkov-type detector and a high correlation was found between the data of both diagnostics. A reasonable agreement was found between experimental data and the results of numerical modeling of the runaway electron generation in ISTTOK.

  18. Joining techniques for a reduced activation 12Cr steel for inertial fusion energy

    SciTech Connect

    Hunt, R. M.; El-Dasher, B.; Choi, B. W.; Torres, S. G.

    2014-10-01

    At Lawrence Livermore National Laboratory, we are developing a reduced activation ferritic martensitic steel that is based on the ferritic martensitic steel HT-9. As a part of the development of this steel, we tested a series of welding processes for characterization, including conventional welds (electron beam, tungsten inert gas, and laser) as well as solid-state welds (hot isostatic pressing). We also heat treated the joints at various temperatures between 750 °C and 1050 °C to find a suitable normalization scheme. The modified HT-9 reduced activation ferritic martensitic steel appears highly suitable to welding and diffusion bonding. All welds showed good quality fusion zones with insignificant cracking or porosity. Additionally, a heat treatment schedule of 950 °C for one hour caused minimal grain growth while still converging the hardness of the base metal with that of the fusion and heat-affected zones. Also, modified HT-9 diffusion bonds that were created at temperatures of at least 950 °C for two hours at 103 MPa had interface tensile strengths of greater than 600 MPa. The diffusion bonds showed no evidence of increased hardness nor void formation at the diffusion bonded interface.

  19. Decisive factor in increase of loading at adjacent segments after lumbar fusion: operative technique, pedicle screws, or fusion itself: biomechanical analysis using finite element

    NASA Astrophysics Data System (ADS)

    Park, Joon-Hee; Kim, Ho-Joong; Kang, Kyoung-Tak; Kim, Ka-Yeon; Chun, Heoung-Jae; Moon, Seong-Hwan; Lee, Hwan-Mo

    2009-12-01

    The aim of this study is to investigate the change in biomechanical milieu following removal of pedicle screws or removal of spinous process with posterior ligament complex in instrumented single level lumbar arthrodesis. We developed and validated a finite element model (FEM) of the intact lumbar spine (L2-4). Four scenarios of L3-4 lumbar fusion were simulated: posterolateral fusion (PLF) at L3-4 using pedicle screw system with preservation of PLC (Pp WiP), L3-4 lumbar posterolateral fusion state after removal of pedicle screw system with preservation of PLC (Pp WoP), L3-4 using pedicle screw system without preservation PLC (Sp WiP), L3-4 lumbar posterolateral fusion state after removal of pedicle screw system without preservation of PLC (Sp WoP). For these models, we investigated the range of motion and maximal Von mises stress of disc in all segments under various moments. All fusion models demonstrated increase in range of motion at adjacent segments compared to the intact model.For the four fusion models, the WiP model s P had the largest increase in range of motion at each adjacent segment. This study demonstrated that removal of pedicle screw system and preservation of PLC after complete lumbar spinal fusion could reduce the stress of adjacent segments synergistically and might have beneficial effects in preventing ASD.

  20. Decisive factor in increase of loading at adjacent segments after lumbar fusion: operative technique, pedicle screws, or fusion itself: biomechanical analysis using finite element

    NASA Astrophysics Data System (ADS)

    Park, Joon-Hee; Kim, Ho-Joong; Kang, Kyoung-Tak; Kim, Ka-yeon; Chun, Heoung-Jae; Moon, Seong-Hwan; Lee, Hwan-Mo

    2010-03-01

    The aim of this study is to investigate the change in biomechanical milieu following removal of pedicle screws or removal of spinous process with posterior ligament complex in instrumented single level lumbar arthrodesis. We developed and validated a finite element model (FEM) of the intact lumbar spine (L2-4). Four scenarios of L3-4 lumbar fusion were simulated: posterolateral fusion (PLF) at L3-4 using pedicle screw system with preservation of PLC (Pp WiP), L3-4 lumbar posterolateral fusion state after removal of pedicle screw system with preservation of PLC (Pp WoP), L3-4 using pedicle screw system without preservation PLC (Sp WiP), L3-4 lumbar posterolateral fusion state after removal of pedicle screw system without preservation of PLC (Sp WoP). For these models, we investigated the range of motion and maximal Von mises stress of disc in all segments under various moments. All fusion models demonstrated increase in range of motion at adjacent segments compared to the intact model.For the four fusion models, the WiP model s P had the largest increase in range of motion at each adjacent segment. This study demonstrated that removal of pedicle screw system and preservation of PLC after complete lumbar spinal fusion could reduce the stress of adjacent segments synergistically and might have beneficial effects in preventing ASD.

  1. Could the Topping-Off Technique Be the Preventive Strategy against Adjacent Segment Disease after Pedicle Screw-Based Fusion in Lumbar Degenerative Diseases? A Systematic Review

    PubMed Central

    Chou, Po-Hsin; Lin, Hsi-Hsien; An, Howard S.; Liu, Kang-Ying

    2017-01-01

    The “topping-off” technique is a new concept applying dynamic or less rigid fixation such as hybrid stabilization device (HSD) or interspinous process device (IPD) for the purpose of avoiding adjacent segment disease (ASD) proximal to the fusion construct. A systematic review of the literature was performed on the effect of topping-off techniques to prevent or decrease the occurrence of ASD after lumbar fusion surgery. We searched through major online databases, PubMed and MEDLINE, using key words related to “topping-off” technique. We reviewed the surgical results of “topping-off” techniques with either HSD or IPD, including the incidence of ASD at two proximal adjacent levels (index and supra-adjacent level) as compared to the fusion alone group. The results showed that the fusion alone group had statistically higher incidence of radiographic (52.6%) and symptomatic (11.6%) ASD at the index level as well as higher incidence (8.1%) of revision surgery. Besides, the HSD (10.5%) and fusion groups (24.7%) had statistically higher incidences of radiographic ASD at supra-adjacent level than the IPD (1%). The findings suggest that the “topping-off” technique may potentially decrease the occurrence of ASD at the proximal motion segments. However, higher quality prospective randomized trials are required prior to wide clinical application. PMID:28321409

  2. Precision of MRI/ultrasound-fusion biopsy in prostate cancer diagnosis: an ex vivo comparison of alternative biopsy techniques on prostate phantoms.

    PubMed

    Westhoff, N; Siegel, F P; Hausmann, D; Polednik, M; von Hardenberg, J; Michel, M S; Ritter, M

    2017-07-01

    Comparing the accuracy of MRI/ultrasound-guided target-biopsy by transrectal biopsy (TRB) with elastic versus rigid image fusion versus transperineal biopsy (TPB) with rigid image fusion in a standardized setting. Target-biopsy of six differently sized and located lesions was performed on customized CIRS 070L prostate phantoms. Lesions were only MRI-visible. After prior MRI for lesion location, one targeted biopsy per lesion was obtained by TRB with elastic image fusion with Artemis™ (Eigen, USA), TRB with rigid image fusion with real-time virtual sonography (Hitachi, Japan) and TPB with rigid image fusion with a brachytherapy approach (Elekta, Sweden), each on a phantom of 50, 100 and 150 ml prostate volume. The needle trajectories were marked by contrast agent and detected in a postinterventional MRI. Overall target detection rate was 79.6% with a slight superiority for the TPB (83.3 vs. 77.8 vs. 77.8%). TRB with elastic image fusion showed the highest overall precision [median distance to lesion center 2.37 mm (0.14-4.18 mm)], independent of prostate volume. Anterior lesions were significantly more precisely hit than transitional and basal lesions (p = 0.034; p = 0.015) with comparable accuracy for TRB with elastic image fusion and TPB. In general, TRB with rigid image fusion was inferior [median 3.15 mm (0.37-10.62 mm)], particularly in small lesions. All biopsy techniques allow detection of clinically significant tumors with a median error of 2-3 mm. Elastic image fusion appears to be the most precise technique, independent of prostate volume, target size or location.

  3. A novel technique to evaluate the geometrical accuracy of CT-MR image fusion in Gamma Knife radiosurgery procedures

    NASA Astrophysics Data System (ADS)

    Thomas, Sajeev; Sampath, S.; Indiradevi, B.; Bhanumathy, G.; Supe, Sanjay S.; Musthafa, M. M.

    2010-01-01

    In order to optimize the accuracy of imaging in Gamma Knife radiosurgery using the image fusion options available in the Leksell gamma plan. Phantom images from 1.5 Tesla MRI Scan (Magnetom vision - Siemens) and Computed Tomography images from Philips Brilliance 16 CT scanner were used for image fusion in Gammaplan treatment planning system. The images were fused using co-registration technique using multiview and imagemerge modules. Stereotactic coordinates were then calculated for known targets. Vector distances from the centre of the Leksell coordinate system to five known targets were measured in CT, MR and CT-MR fused images and compared with geometrical measurements. The mean values of maximum absolute errors were 0.34 mm, 0.41 mm.0.38 mm (along x-axis), 0.43 mm, 1.53 mm, 0.62 mm (along y-axis) and 0.75 mm 2.02 mm, 0.93 mm (along z-axis) for CT, MR and CT-MR fused image data respectively. The mean error in calculating the vector distances from the center of the Leksell coordinate system (100, 100, 100) to the known target volumes are 0.22 mm, 0.8 mm and 0.43 mm for CT, MR and CT-MR fused images, respectively. Image fusion functions available in gamma plan are useful for combining the features of CT and MR imaging modalities. These methods are highly useful in clinical situations where the error associated with Magnetic Resonance Imaging is beyond acceptable levels.

  4. Using Geostatistical Data Fusion Techniques and MODIS Data to Upscale Simulated Wheat Yield

    NASA Astrophysics Data System (ADS)

    Castrignano, A.; Buttafuoco, G.; Matese, A.; Toscano, P.

    2014-12-01

    Population growth increases food request. Assessing food demand and predicting the actual supply for a given location are critical components of strategic food security planning at regional scale. Crop yield can be simulated using crop models because is site-specific and determined by weather, management, length of growing season and soil properties. Crop models require reliable location-specific data that are not generally available. Obtaining these data at a large number of locations is time-consuming, costly and sometimes simply not feasible. An upscaling method to extend coverage of sparse estimates of crop yield to an appropriate extrapolation domain is required. This work is aimed to investigate the applicability of a geostatistical data fusion approach for merging remote sensing data with the predictions of a simulation model of wheat growth and production using ground-based data. The study area is Capitanata plain (4000 km2) located in Apulia Region, mostly cropped with durum wheat. The MODIS EVI/NDVI data products for Capitanata plain were downloaded from the Land Processes Distributed Active Archive Center (LPDAAC) remote for the whole crop cycle of durum wheat. Phenological development, biomass growth and grain quantity of durum wheat were simulated by the Delphi system, based on a crop simulation model linked to a database including soil properties, agronomical and meteorological data. Multicollocated cokriging was used to integrate secondary exhaustive information (multi-spectral MODIS data) with primary variable (sparsely distributed biomass/yield model predictions of durum wheat). The model estimates looked strongly spatially correlated with the radiance data (red and NIR bands) and the fusion data approach proved to be quite suitable and flexible to integrate data of different type and support.

  5. In vitro biomechanical evaluation of four surgical techniques for fusion of equine centrodistal and tarsometatarsal joints.

    PubMed

    Biedrzycki, Adam H; Grant, Barrie G; Nemke, Brett; Morello, Samantha L; Markel, Mark D

    2016-10-01

    OBJECTIVE To evaluate the biomechanical properties of 4 methods for fusion of the centrodistal and tarsometatarsal joints in horses and compare them among each other and with control tarsi. SAMPLE 24 sets of paired tarsi without substantial signs of osteoarthritis harvested from equine cadavers. PROCEDURES Test constructs (n = 6/type) were prepared from 1 tarsus from each pair to represent surgical drilling; 2 medially to laterally placed kerf-cut cylinders (MLKCs); a single large, dorsally applied kerf-cut cylinder (DKC); and a dorsomedially applied locking compression plate (DMLCP). Constructs and their contralateral control tarsi were evaluated in 4-point bending in the dorsoplantar, lateromedial, and mediolateral directions; internal and external rotation; and axial compression. Bending, torsional, and axial stiffness values were calculated. RESULTS Mean stiffness values were consistently lower for surgical drilling constructs than for contralateral control tarsi. Over all biomechanical testing, surgical drilling significantly reduced joint stability. The MLKC constructs had superior biomechanical properties to those of control tarsi for 4-point bending but inferior properties for external and internal rotation. The DMLCP and DKC constructs were superior to control tarsi in dorsoplantar, rotational, and axial compression directions only; DMLCP constructs had no superior stiffness in lateromedial or mediolateral directions. Only the DKC constructs had greater stiffness in the mediolateral direction than did control tarsi. Over all biomechanical testing, DMLCP and DKC constructs were superior to the other constructs. CONCLUSIONS AND CLINICAL RELEVANCE These biomechanical results suggested that a surgical drilling approach to joint fusion may reduce tarsal stability in horses without clinical osteoarthritis, compared with stability with no intervention, whereas the DMLCP and DKC approaches may significantly enhance stability.

  6. Inter-Greedy technique for fusion of different carotid segmentation boundaries leading to high-performance IMT measurement.

    PubMed

    Molinari, Filippo; Zeng, Guang; Suri, Jasjit S

    2010-01-01

    User-based estimation of intima-media thickness (IMT) of carotid arteries leads to subjectivity in its decision support systems, while being used as a cardiovascular risk marker. During automated computer-based decision support, we had developed segmentation strategies that follow three main courses of our contributions: (a) signal processing approach combined with snakes and fuzzy K-means (CULEXsa), (b) integrated approach based on seed and line detection followed by probability based connectivity and classification (CALEXsa), and (c) morphological approach with watershed transform and fitting (WS). We have extended this fusion concept by taking merits of these multiple boundaries, so called, Inter-Greedy (IG) approach. Starting from the technique with the overall least system error (the snake-based one), we iteratively swapped the vertices of the lumen-intima/media-adventitia (LI/MA) profiles until we minimized its overall distance with respect to ground truth. The fusion boundary was the IG boundary. The mean error of Inter-Greedy technique (evaluated on 200 images) yielded 0.32 ± 0.44 pixel (20.0 ± 27.5 microm) for the LI boundary (a 33.3% ± 5.6% improvement over initial best performing technique) and 0.21 ± 0.34 pixel (13.1 ± 21.3 microm) for MA boundary (a 32.3% ± 6.7% improvement). IMT measurement error for Greedy method was 0.74 ± 0.75 pixel (46.3 ± 46.9 microm), a 43.5% ± 2.4% improvement.

  7. Multimodality Inferring of Human Cognitive States Based on Integration of Neuro-Fuzzy Network and Information Fusion Techniques

    NASA Astrophysics Data System (ADS)

    Yang, G.; Lin, Y.; Bhattacharya, P.

    2007-12-01

    To achieve an effective and safe operation on the machine system where the human interacts with the machine mutually, there is a need for the machine to understand the human state, especially cognitive state, when the human's operation task demands an intensive cognitive activity. Due to a well-known fact with the human being, a highly uncertain cognitive state and behavior as well as expressions or cues, the recent trend to infer the human state is to consider multimodality features of the human operator. In this paper, we present a method for multimodality inferring of human cognitive states by integrating neuro-fuzzy network and information fusion techniques. To demonstrate the effectiveness of this method, we take the driver fatigue detection as an example. The proposed method has, in particular, the following new features. First, human expressions are classified into four categories: (i) casual or contextual feature, (ii) contact feature, (iii) contactless feature, and (iv) performance feature. Second, the fuzzy neural network technique, in particular Takagi-Sugeno-Kang (TSK) model, is employed to cope with uncertain behaviors. Third, the sensor fusion technique, in particular ordered weighted aggregation (OWA), is integrated with the TSK model in such a way that cues are taken as inputs to the TSK model, and then the outputs of the TSK are fused by the OWA which gives outputs corresponding to particular cognitive states under interest (e.g., fatigue). We call this method TSK-OWA. Validation of the TSK-OWA, performed in the Northeastern University vehicle drive simulator, has shown that the proposed method is promising to be a general tool for human cognitive state inferring and a special tool for the driver fatigue detection.

  8. S3 Dorsal Root Ganglion/Nerve Root Stimulation for Refractory Postsurgical Perineal Pain: Technical Aspects of Anchorless Sacral Transforaminal Lead Placement

    PubMed Central

    Zuidema, X.; Breel, J.; Wille, F.

    2016-01-01

    Chronic perineal pain limits patients in physical and sexual activities, leading to social and psychological distress. In most cases, this pain develops after surgery in the urogenital area or as a consequence of trauma. Neuromodulation is one of the options in chronic postsurgical perineal pain treatment. We present a case of refractory perineal pain after right sided surgical resection of a Bartholin's cyst which was treated with third sacral nerve root/dorsal root ganglion stimulation using the transforaminal approach. We describe a new anchorless lead placement technique using a unique curved lead delivery sheath. We postulate that this new posterior foraminal technique of lead placement is simple, safe, and reversible and may lower the occurrence of lead related complications. PMID:27123351

  9. Minimally Invasive Unilateral vs. Bilateral Pedicle Screw Fixation and Lumbar Interbody Fusion in Treatment of Multi-Segment Lumbar Degenerative Disorders

    PubMed Central

    Liu, Xiaoyang; Li, Guangrun; Wang, Jiefeng; Zhang, Heqing

    2015-01-01

    Background The choice for instrumentation with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in treatment of degenerative lumbar disorders (DLD) remains controversial. The goal of this study was to investigate clinical outcomes in consecutive patients with multi-segment DLD treated with unilateral pedicle screw (UPS) vs. bilateral pedicle screw (BPS) instrumented TLIF. Material/Methods Eighty-four consecutive patients who had multi-level MIS-TLIF were retrospectively reviewed. All data were collected to compare the clinical outcomes between the 2 groups. Results Both groups showed similar clinical function scores in VAS and ODI. The two groups differed significantly in operative time (P<0.001), blood loss (P<0.001), and fusion rate (P=0.043), respectively. Conclusions This study demonstrated similar clinical outcomes between UPS fixation and BPS procedure after MIS-TLIF for multi-level DLD. Moreover, UPS technique was superior in operative time and blood loss, but represented lower fusion rate than the BPS construct did. PMID:26603050

  10. Acquiring the Dialogue: Providing Input by Using a Fusion of Skills Technique.

    ERIC Educational Resources Information Center

    Rawley, Lee Ann; Smith, Alfred N.

    1983-01-01

    A technique for teaching dialog is outlined that provides considerable preproduction input and acquisition experiences through which students create dialog lines. The technique uses these steps: prenarrative activities, narrative, contextual expansion of new vocabulary, reading input, dialog construction from visual cues, dialog recreation, and…

  11. Manual-Protocol Inspired Technique for Improving Automated MR Image Segmentation during Label Fusion

    PubMed Central

    Bhagwat, Nikhil; Pipitone, Jon; Winterburn, Julie L.; Guo, Ting; Duerden, Emma G.; Voineskos, Aristotle N.; Lepage, Martin; Miller, Steven P.; Pruessner, Jens C.; Chakravarty, M. Mallar

    2016-01-01

    Recent advances in multi-atlas based algorithms address many of the previous limitations in model-based and probabilistic segmentation methods. However, at the label fusion stage, a majority of algorithms focus primarily on optimizing weight-maps associated with the atlas library based on a theoretical objective function that approximates the segmentation error. In contrast, we propose a novel method—Autocorrecting Walks over Localized Markov Random Fields (AWoL-MRF)—that aims at mimicking the sequential process of manual segmentation, which is the gold-standard for virtually all the segmentation methods. AWoL-MRF begins with a set of candidate labels generated by a multi-atlas segmentation pipeline as an initial label distribution and refines low confidence regions based on a localized Markov random field (L-MRF) model using a novel sequential inference process (walks). We show that AWoL-MRF produces state-of-the-art results with superior accuracy and robustness with a small atlas library compared to existing methods. We validate the proposed approach by performing hippocampal segmentations on three independent datasets: (1) Alzheimer's Disease Neuroimaging Database (ADNI); (2) First Episode Psychosis patient cohort; and (3) A cohort of preterm neonates scanned early in life and at term-equivalent age. We assess the improvement in the performance qualitatively as well as quantitatively by comparing AWoL-MRF with majority vote, STAPLE, and Joint Label Fusion methods. AWoL-MRF reaches a maximum accuracy of 0.881 (dataset 1), 0.897 (dataset 2), and 0.807 (dataset 3) based on Dice similarity coefficient metric, offering significant performance improvements with a smaller atlas library (< 10) over compared methods. We also evaluate the diagnostic utility of AWoL-MRF by analyzing the volume differences per disease category in the ADNI1: Complete Screening dataset. We have made the source code for AWoL-MRF public at: https://github.com/CobraLab/AWoL-MRF. PMID

  12. New model for cardiomyocyte sheet transplantation using a virus-cell fusion technique

    PubMed Central

    Takahashi, Yuto; Tomotsune, Daihachiro; Takizawa, Sakiko; Yue, Fengming; Nagai, Mika; Yokoyama, Tadayuki; Hirashima, Kanji; Sasaki, Katsunori

    2015-01-01

    AIM: To facilitate close contacts between transplanted cardiomyocytes and host skeletal muscle using cell fusion mediated by hemagglutinating virus of Japan envelope (HVJ-E) and tissue maceration. METHODS: Cardiomyocytes (1.5 × 106) from fetal rats were first cultured. After proliferation, some cells were used for fusion with adult muscle fibers using HVJ-E. Other cells were used to create cardiomyocyte sheets (area: about 3.5 cm2 including 2.1 × 106 cells), which were then treated with Nile blue, separated, and transplanted between the latissimus dorsi and intercostal muscles of adult rats with four combinations of HVJ-E and/or NaOH maceration: G1: HVJ-E(+), NaOH(+), Cardiomyocytes(+); G2: HVJ-E(-), NaOH(+), Cardiomyocytes(+); G3: HVJ-E(+), NaOH(-), Cardiomyocytes(+); G4: HVJ-E(-), NaOH(-), Cardiomyocytes(-). At 1 and 2 wk after transplantation, the four groups were compared by detection of beating domains, motion images using moving target analysis software, action potentials, gene expression of MLC-2v and Mesp1 by reverse transcription-polymerase chain reaction, hematoxylin-eosin staining, and immunostaining for cardiac troponin and skeletal myosin. RESULTS: In vitro cardiomyocytes were fused with skeletal muscle fibers using HVJ-E. Cardiomyocyte sheets remained in the primary transplanted sites for 2 wk. Although beating domains were detected in G1, G2, and G3 rats, G1 rats prevailed in the number, size, motion image amplitudes, and action potential compared with G2 and G3 rats. Close contacts were only found in G1 rats. At 1 wk after transplantation, the cardiomyocyte sheets showed adhesion at various points to the myoblast layer in the latissimus dorsi muscle. At 2 wk after transplantation, close contacts were seen over a broad area. Part of the skeletal muscle sarcoplasma seemed to project into the myocardiocyte plasma and some nuclei appeared to share both sarcoplasmas. CONCLUSION: The present results show that close contacts were acquired and facilitated

  13. Techniques For Injection Of Pre-Charaterized Dust Into The Scrape Off Layer Of Fusion Plasma

    SciTech Connect

    Roquemore, A. L.; John, B.; Friesen, F.; Hartzfeld, K.; Mansfield, D. K.

    2011-07-21

    Introduction of micron-sized dust into the scrape-off layer (SOL) of a plasma has recently found many applications aimed primarily at determining dust behavior in future fusion reactors. The dust particles are typically composed of materials intrinsic to a fusion reactor. On DIII-D and TEXTOR carbon dust has been introduced into the SOL using a probe inserted from below into the divertor region. On NSTX, both Li and tungsten dust have been dropped from the top of the machine into the SOL throughout the duration of a discharge, by utilizing a vibrating piezoelectric based particle dropper. The original particle dropper was developed to inject passivated Li powder {approx} 40 {mu}m in diameter into the SOL to enhance plasma performance. A simplified version of the dropper was developed to introduce trace amounts of tungsten powder for only a few discharges, thus not requiring a large powder reservoir. The particles emit visible light from plasma interactions and can be tracked by either spectroscopic means or by fast frame rate visible cameras. This data can then be compared with dust transport codes such as DUSTT to make predictions of dust behavior in next-step devices such as ITER. For complete modeling results, it is desired to be able to inject pre-characterized dust particles in the SOL at various known poloidal locations, including near the vessel midplane. Purely mechanical methods of injecting particles are presently being studied using a modified piezoelectric-based powder dropper as a particle source and one of several piezo-based transducers to deflect the particles into the SOL. Vibrating piezo fans operating at 60 Hz with a deflection of {+-}2.5 cm can impart a significant horizontal boost in velocity. The highest injection velocities are expected from rotating paddle wheels capable of injecting particles at 10's of meters per second depending primarily on the rotation velocity and diameter of the wheel. Several injection concepts have been tested and

  14. Paleochannel delineation using Landsat 8 OLI and Envisat ASAR image fusion techniques in Cholistan desert, Pakistan

    NASA Astrophysics Data System (ADS)

    Islam, Zaheer Ul; Iqbal, Javed; Khan, Junaid Aziz; Qazi, Waqas A.

    2016-10-01

    Sustainability of desert ecosystem is highly dependent upon water availability from different sources. Paleochannels are important sources of groundwater, and exploiting such resources involves their identification/mapping and subsequent investigation for fresh groundwater. A study in which multisensor (optical/infrared Landsat 8 OLI and active microwave Envisat ASAR) images of the Cholistan desert of Pakistan were processed and analyzed to identify and map Hakra River paleochannels is presented. Radiometrically corrected optical and synthetic aperture radar datasets were fused using principal components image fusion method. The paleochannels were extracted from the analysis of this fused output, and normalized difference vegetative index analysis of Landsat 8 OLI atmospheric corrected images was used as supporting information. Identification and alignment of an identified paleochannel was validated with geophysical ground measurements (electrical resistivity and conductivity surveys) and historical records. The presence of high apparent electrical resistivity with corresponding low soil water conductivity values intersects well with the paleochannels identified from the remote sensing data. The results were also confirmed with historical evidence such as old wells beside forts and proposed ground water harvesting sites. The proposed methodology in this study could be adopted in other parts of the world for mapping of paleochannels.

  15. Analysis of monitoring data from cable-stayed bridge using sensor fusion techniques

    NASA Astrophysics Data System (ADS)

    Zonta, Daniele; Bruschetta, Federico; Zandonini, Riccardo; Pozzi, Matteo; Wang, Ming; Zhao, Yang; Inaudi, Daniele; Posenato, Daniele; Glisic, Branko

    2013-04-01

    This paper illustrates an application of Bayesian logic to monitoring data analysis and structural condition state inference. The case study is a 260 m long cable-stayed bridge spanning the Adige River 10 km north of the town of Trento, Italy. This is a statically indeterminate structure, having a composite steel-concrete deck, supported by 12 stay cables. Structural redundancy, possible relaxation losses and an as-built condition differing from design, suggest that long-term load redistribution between cables can be expected. To monitor load redistribution, the owner decided to install a monitoring system which combines built-on-site elasto-magnetic and fiber-optic sensors. In this note, we discuss a rational way to improve the accuracy of the load estimate from the EM sensors taking advantage of the FOS information. More specifically, we use a multi-sensor Bayesian data fusion approach which combines the information from the two sensing systems with the prior knowledge, including design information and the outcomes of laboratory calibration. Using the data acquired to date, we demonstrate that combining the two measurements allows a more accurate estimate of the cable load, to better than 50 kN.

  16. Improved prediction of drug-target interactions using regularized least squares integrating with kernel fusion technique.

    PubMed

    Hao, Ming; Wang, Yanli; Bryant, Stephen H

    2016-02-25

    Identification of drug-target interactions (DTI) is a central task in drug discovery processes. In this work, a simple but effective regularized least squares integrating with nonlinear kernel fusion (RLS-KF) algorithm is proposed to perform DTI predictions. Using benchmark DTI datasets, our proposed algorithm achieves the state-of-the-art results with area under precision-recall curve (AUPR) of 0.915, 0.925, 0.853 and 0.909 for enzymes, ion channels (IC), G protein-coupled receptors (GPCR) and nuclear receptors (NR) based on 10 fold cross-validation. The performance can further be improved by using a recalculated kernel matrix, especially for the small set of nuclear receptors with AUPR of 0.945. Importantly, most of the top ranked interaction predictions can be validated by experimental data reported in the literature, bioassay results in the PubChem BioAssay database, as well as other previous studies. Our analysis suggests that the proposed RLS-KF is helpful for studying DTI, drug repositioning as well as polypharmacology, and may help to accelerate drug discovery by identifying novel drug targets.

  17. High neurological complication rates for extreme lateral lumbar interbody fusion and related techniques: A review of safety concerns

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: There are frequent reports of lumbosacral plexus and other neurological injuries occurring with extreme lateral interbody fusions (XLIF) and other related lateral lumbar techniques. Methods: This review focuses on the new neurological deficits (e.g. lumbosacral plexus, root injuries) that occur following minimally invasive surgery (MIS) XLIF and other related lateral lumbar techniques. Results: A review of multiple articles revealed the following ranges of new postoperative neurological complications for XLIF procedures: plexus injuries 13.28%; sensory deficits 0–75% (permanent in 62.5%); motor deficits 0.7–33.6%; anterior thigh pain 12.5–25%. Of interest, in a study by Lykissas et al., the frequency of long-term neural injury following lateral lumber interbody fusion (LLIF) with BMP-2 (72 patients) was much higher than for LLIF performed with autograft/allograft (72 patients). The addition of bone morphogenetic protein led to persistent sensory deficits in 29 vs. 20 without BMP; persistent motor deficits in 35 with vs. 17 without BMP; and persistent anterior thigh/groin pain in 8 with vs. 0 without BMP. They should also have noted the unacceptably high incidence of neural injury occurring with LLIF alone without BMP. Conclusion: This review highlights the high risk of neural injury (up to 75% for sensory, 33.6% for motor, and an overall plexus injury rate of 13.28%) utilizing the XLIF and other similar lateral lumbar approaches. With such extensive neurological injuries, is the XLIF really safe, and should it still be performed? PMID:27843679

  18. [Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain].

    PubMed

    Beyaz, Serbülent Gökhan

    A cross-sectional study. We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain. Patients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded. Lumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4-L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12-month period compared to basal scores (p<0.001). Significant differences between the two groups according to verbal numeric rating scale and satisfaction scores were not observed (p>0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications. This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por

  19. A Clinical Investigation of Contralateral Neurological Symptom after Transforaminal Lumbar Interbody Fusion (TLIF)

    PubMed Central

    Bai, Jiayue; Zhang, Wei; Zhang, Xin; Sun, Yapeng; Ding, Wenyuan; Shen, Yong

    2015-01-01

    Background The aim of this study was to analyze treatment outcomes and morbidity of contralateral neurological symptom in patients after TLIF surgery and to explore its possible causes. Material/Methods A retrospective study was conducted involving a total of 476 patients who underwent TILF from 2009 to 2012 in our hospital. These cases were divided into a symptomatic group (Group S) and a non-symptomatic group. The differences in contralateral foramen area and disc-height index(DHI) before and after surgery were compared between Group S and a random sample of 40 cases of non-symptomatic group patients (group N). In addition, according to whether the patient underwent second surgery, Group S patients were further divided into a transient neurologic symptoms group (Group T) and an operations exploration group (Group O). The time of symptom appearance, duration, and symptomatic severity (JOA VAS score) were compared between Group T and O. Results Among the 476 patients, 18 had postoperative contralateral neurological symptoms; thus, the morbidity was 3.7815%. The indicators in Group S were lower than in Group N in the differences in contralateral foramen area and disc-height index(DHI) before and after surgery (p<0.05). Five patients (Group O) in Group S had second surgery because of invalid conservative treatment. The surgical exploration rate was 1.0504%. Compared with Group T, the symptoms of Group O patients appeared earlier, persisted longer, and were more serious (p<0.05). Conclusions Contralateral neurological symptom is a potential complication after TLIF, and its causes are diverse. Surgical explorations should be conducted early for those patients with the complication who present with obvious nerve damage. PMID:26109143

  20. Accuracy of intermittent fluoroscopy to detect intravascular injection during transforaminal epidural injections.

    PubMed

    Smuck, Matthew; Fuller, Brian J; Chiodo, Anthony; Benny, Benoy; Singaracharlu, Balaji; Tong, Henry; Ho, Suehun

    2008-04-01

    Prospective validity study. To determine how accurately intermittent fluoroscopy detects inadvertent intravascular injection during transforaminal epidurals. Serious morbidity caused by transforaminal epidural injections is frequently related to inadvertent vascular injection of corticosteroids. Several methods have been proposed to reduce the risk of vascular injection, but none have demonstrated efficacy. Because of the fleeting appearance of vascular contrast patterns, live fluoroscopy is recommended during contrast injection. Despite this, many practitioners continue to use intermittent fluoroscopy. During 50 epidural injections dynamic contrast flow was observed under live fluoroscopy, and the "dynamic true" image was determined. Two intermittent fluoroscopy images were saved from each injection, the first just before completing the contrast injection ("static C" image), and another 1 second after the contrast injection ceased ("static PC" image). Five physicians with experience performing these injections independently interpreted the 100 randomly ordered static images. Accuracy of intermittent fluoroscopy was determined by comparing the interpretation of the 100 static images with the dynamic true patterns observed under live fluoroscopy. Overall, interpretation of the static images missed 57% of the vascular injections. Timing of the static images influenced accuracy with the static C images missing 50% of vascular injections, and the static PC images missing 68% of vascular injections (P = 0.075). Accuracy was significantly worse when vascular injections occurred simultaneous to the expected epidural injection (P = 0.041), and in lumbar images (P = 0.012). Based on these findings, we recommend use of live fluoroscopy to observe dynamic contrast flow during transforaminal epidural steroid injections.

  1. Alternative hot spot formation techniques using liquid deuterium-tritium layer inertial confinement fusion capsules

    SciTech Connect

    Olson, R. E.; Leeper, R. J.

    2013-09-27

    The baseline DT ice layer inertial confinement fusion (ICF) ignition capsule design requires a hot spot convergence ratio of ~34 with a hot spot that is formed from DT mass originally residing in a very thin layer at the inner DT ice surface. In the present paper, we propose alternative ICF capsule designs in which the hot spot is formed mostly or entirely from mass originating within a spherical volume of DT vapor. Simulations of the implosion and hot spot formation in two DT liquid layer ICF capsule concepts—the DT wetted hydrocarbon (CH) foam concept and the “fast formed liquid” (FFL) concept—are described and compared to simulations of standard DT ice layer capsules. 1D simulations are used to compare the drive requirements, the optimal shock timing, the radial dependence of hot spot specific energy gain, and the hot spot convergence ratio in low vapor pressure (DT ice) and high vapor pressure (DT liquid) capsules. 2D simulations are used to compare the relative sensitivities to low-mode x-ray flux asymmetries in the DT ice and DT liquid capsules. It is found that the overall thermonuclear yields predicted for DT liquid layer capsules are less than yields predicted for DT ice layer capsules in simulations using comparable capsule size and absorbed energy. However, the wetted foam and FFL designs allow for flexibility in hot spot convergence ratio through the adjustment of the initial cryogenic capsule temperature and, hence, DT vapor density, with a potentially improved robustness to low-mode x-ray flux asymmetry.

  2. Alternative hot spot formation techniques using liquid deuterium-tritium layer inertial confinement fusion capsules

    SciTech Connect

    Olson, R. E.; Leeper, R. J.

    2013-09-15

    The baseline DT ice layer inertial confinement fusion (ICF) ignition capsule design requires a hot spot convergence ratio of ∼34 with a hot spot that is formed from DT mass originally residing in a very thin layer at the inner DT ice surface. In the present paper, we propose alternative ICF capsule designs in which the hot spot is formed mostly or entirely from mass originating within a spherical volume of DT vapor. Simulations of the implosion and hot spot formation in two DT liquid layer ICF capsule concepts—the DT wetted hydrocarbon (CH) foam concept and the “fast formed liquid” (FFL) concept—are described and compared to simulations of standard DT ice layer capsules. 1D simulations are used to compare the drive requirements, the optimal shock timing, the radial dependence of hot spot specific energy gain, and the hot spot convergence ratio in low vapor pressure (DT ice) and high vapor pressure (DT liquid) capsules. 2D simulations are used to compare the relative sensitivities to low-mode x-ray flux asymmetries in the DT ice and DT liquid capsules. It is found that the overall thermonuclear yields predicted for DT liquid layer capsules are less than yields predicted for DT ice layer capsules in simulations using comparable capsule size and absorbed energy. However, the wetted foam and FFL designs allow for flexibility in hot spot convergence ratio through the adjustment of the initial cryogenic capsule temperature and, hence, DT vapor density, with a potentially improved robustness to low-mode x-ray flux asymmetry.

  3. Experimental techniques for measuring Rayleigh-Taylor instability in inertial confinement fusion (ICF)

    SciTech Connect

    Smalyuk, V A

    2012-06-07

    Rayleigh-Taylor (RT) instability is one of the major concerns in inertial confinement fusion (ICF) because it amplifies target modulations in both acceleration and deceleration phases of implosion, which leads to shell disruption and performance degradation of imploding targets. This article reviews experimental results of the RT growth experiments performed on OMEGA laser system, where targets were driven directly with laser light. RT instability was studied in the linear and nonlinear regimes. The experiments were performed in acceleration phase, using planar and spherical targets, and in deceleration phase of spherical implosions, using spherical shells. Initial target modulations consisted of 2-D pre-imposed modulations, and 2-D and 3-D modulations imprinted on targets by the non-uniformities in laser drive. In planar geometry, the nonlinear regime was studied using 3-D modulations with broadband spectra near nonlinear saturation levels. In acceleration-phase, the measured modulation Fourier spectra and nonlinear growth velocities are in good agreement with those predicted by Haan's model [Haan S W 1989 Phys. Rev. A 39 5812]. In a real-space analysis, the bubble merger was quantified by a self-similar evolution of bubble size distributions [Oron D et al 2001 Phys. Plasmas 8, 2883]. The 3-D, inner-surface modulations were measured to grow throughout the deceleration phase of spherical implosions. RT growth rates are very sensitive to the drive conditions, therefore they can be used to test and validate drive physics in hydrodynamic codes used to design ICF implosions. Measured growth rates of pre-imposed 2-D target modulations below nonlinear saturation levels were used to validate non-local thermal electron transport model in laser-driven experiments.

  4. Positional effects of transforaminal interbody spacer placement at the L5-S1 intervertebral disc space: a biomechanical study.

    PubMed

    Tallarico, Richard A; Lavelle, William F; J Bianco, Aaron; Taormina, Jennifer L; Ordway, Nathaniel R

    2014-12-01

    Transforaminal lumbar interbody fusion (TLIF) is an increasingly used alternative fusion method over anterior and posterior lumbar interbody fusions. There are conflicting results on the optimal positioning of interbody devices. No study has addressed the lumbosacral segment, L5-S1, where the lordotic configuration presents unique challenges. To determine if there are biomechanical and/or anatomical advantages related to the positioning of an interbody device at L5-S1, either anterior or posterior to the neutral axis. An in vitro biomechanical study using human cadaveric lumbar specimens. Lumbar specimens were biomechanically tested using pure moments with and without compressive axial loading. Testing was performed in intact and after TLIF with the implant posterior (TLIF-post) and anterior (TLIF-ant) to neutral axis. Segmental range of motion (ROM) and stiffness were analyzed at the L5-S1 surgical level and the adjacent L4-L5 level. Neuroforaminal height measurements of L5-S1 were analyzed in neutral and end range positions. Compared with the intact condition, ROM decreased more than 75% at L5-S1 and stiffness increased up to 270% with TLIF. There was no significant difference between anterior or posterior placement for ROM and stiffness. There was a change in L5-S1 neuroforaminal height based on the placement, with posterior placement showing a significant increase compared with anterior placement. There were no relative changes in neuroforaminal height under loading after TLIF. Compressive load did not affect the magnitudes or resulting significance of outcome measures at L5-S1 after either TLIFs. An interbody spacer with the addition of posterior instrumentation significantly enhances the mechanical stability of L5-S1 regardless of interbody position. There were noticeable increases in terms of construct stability and stiffness after both TLIF-ant and TLIF-post in comparison with the intact condition. A posteriorly placed interbody implant did result in the

  5. Evaluation of lumbar transforaminal epidural injections with needle placement and contrast flow patterns: a prospective, descriptive report.

    PubMed

    Manchikanti, Laxmaiah; Cash, Kim A; Pampati, Vidyasagar; Damron, Kim S; McManus, Carla D

    2004-04-01

    Transforaminal epidural steroid injection is one of the commonly employed modalities of treatment in managing nerve root pain. However, there have been no controlled prospective evaluations of epidural and nerve root contrast distribution patterns and other aspects of fluoroscopically directed lumbosacral transforaminal epidural steroid injections. To evaluate contrast flow patterns and intravascular needle placement of fluoroscopically guided lumbosacral transforaminal epidural injections. A prospective, observational study. A total of 100 consecutive patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. The contrast flow patterns, ventral or dorsal epidural filling, nerve root filling, C-arm time, and intravascular needle placement were evaluated. Ventral epidural filling was seen in 88% of the procedures, in contrast to dorsal filling noted in 9% of the procedures. Nerve root filling was seen in 97% of the procedures. Total intravenous placement of the needle was noted in 22% of the procedures, whereas negative flashback and aspiration was noted in 5% of the procedures. Lumbosacral transforaminal epidural injections, performed under fluoroscopic visualization, provide excellent nerve root filling and ventral epidural filling patterns. However, unrecognized intravascular needle placement with negative flashback or aspiration was noted in 5% of the procedures.

  6. Incidence of vascular complications during lateral lumbar interbody fusion: an examination of the mini-open access technique.

    PubMed

    Kueper, Janina; Fantini, Gary A; Walker, Brendon R; Aichmair, Alexander; Hughes, Alexander P

    2015-04-01

    This article examines the incidence and management of vascular injury during Lateral Lumbar Interbody Fusion (LLIF). The details of the mini-open access technique are presented. A total of 900 patients who underwent a LLIF at an average 1.94 levels (range: 1-5 levels) by one of six fellowship trained surgeons on 1,754 levels from 2006 to 2013 were identified. The incidence of intraoperative vascular injury was retrospectively determined from the Operative Records. The management of vascular injury was evaluated. The mini-open access adapted by our institution for LLIF is described. The incidence of major vascular complication in our series was 1/900. The incidence of minor vascular injury was 4/900. The overall incidence of vascular injury was calculated to be 0.056 % per case and 0.029 % per level. All minor vascular injuries were identified to be segmental vessel lacerations, which were readily ligated under direct visualization without further extension of the incision with no clinical sequelae. The laceration of the abdominal aorta, the major vascular complication of this series, was emergently repaired through an exploratory laparotomy. None of the patients suffered long-term sequelae from their intraoperative vascular injuries. The mini-open lateral access technique for LLIF provides for minimal risk of vascular injury to the lumbar spine. In the rare event of minor vascular injury, the mini-open access approach allows for immediate visualization, confirmation and repair of the vessel with no long-term sequelae.

  7. Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis.

    PubMed

    Blizzard, Daniel J; Gallizzi, Michael A; Sheets, Charles; Smith, Benjamin T; Isaacs, Robert E; Eure, Megan; Brown, Christopher R

    2016-01-01

    Sagittal balance restoration has been shown to be an important determinant of outcomes in corrective surgery for degenerative scoliosis. Lateral interbody fusion (LIF) is a less-invasive technique which permits the placement of a high lordosis interbody cage without risks associated with traditional anterior or transforaminal interbody techniques. Studies have shown improvement in lumbar lordosis following LIF, but only one other study has assessed sagittal balance in this population. The objective of this study is to evaluate the ability of LIF to restore sagittal balance in degenerative lumbar scoliosis. Thirty-five patients who underwent LIF for degenerative thoracolumbar scoliosis from July 2013 to March 2014 by a single surgeon were included. Outcome measures included sagittal balance, lumbar lordosis, Cobb Angle, and segmental lordosis. Measures were evaluated pre-operative, immediately post-operatively, and at their last clinical follow-up. Repeated measures ANOVAs were used to assess the differences between pre-operative, first postoperative, and a follow-up visit. The average sagittal balance correction was not significantly different: 1.06cm from 5.79cm to 4.74cm forward. The average Cobb angle correction was 14.1 degrees from 21.6 to 5.5 degrees. The average change in global lumbar lordosis was found to be significantly different: 6.3 degrees from 28.9 to 35.2 degrees. This study demonstrates that LIF reliably restores lordosis, but does not significantly improve sagittal balance. Despite this, patients had reliable improvement in pain and functionality suggesting that sagittal balance correction may not be as critical in scoliosis correction as previous studies have indicated. LIF does not significantly change sagittal balance; however, clinical improvement does not seem to be contingent upon sagittal balance correction in the degenerative scoliosis population. The DUHS IRB has determined this study meets criteria for an IRB waiver.

  8. Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis

    PubMed Central

    Gallizzi, Michael A.; Sheets, Charles; Smith, Benjamin T.; Isaacs, Robert E.; Eure, Megan; Brown, Christopher R.

    2016-01-01

    Background Sagittal balance restoration has been shown to be an important determinant of outcomes in corrective surgery for degenerative scoliosis. Lateral interbody fusion (LIF) is a less-invasive technique which permits the placement of a high lordosis interbody cage without risks associated with traditional anterior or transforaminal interbody techniques. Studies have shown improvement in lumbar lordosis following LIF, but only one other study has assessed sagittal balance in this population. The objective of this study is to evaluate the ability of LIF to restore sagittal balance in degenerative lumbar scoliosis. Methods Thirty-five patients who underwent LIF for degenerative thoracolumbar scoliosis from July 2013 to March 2014 by a single surgeon were included. Outcome measures included sagittal balance, lumbar lordosis, Cobb Angle, and segmental lordosis. Measures were evaluated pre-operative, immediately post-operatively, and at their last clinical follow-up. Repeated measures ANOVAs were used to assess the differences between pre-operative, first postoperative, and a follow-up visit. Results The average sagittal balance correction was not significantly different: 1.06cm from 5.79cm to 4.74cm forward. The average Cobb angle correction was 14.1 degrees from 21.6 to 5.5 degrees. The average change in global lumbar lordosis was found to be significantly different: 6.3 degrees from 28.9 to 35.2 degrees. Conclusions This study demonstrates that LIF reliably restores lordosis, but does not significantly improve sagittal balance. Despite this, patients had reliable improvement in pain and functionality suggesting that sagittal balance correction may not be as critical in scoliosis correction as previous studies have indicated. Clinical Relevance LIF does not significantly change sagittal balance; however, clinical improvement does not seem to be contingent upon sagittal balance correction in the degenerative scoliosis population. The DUHS IRB has determined this

  9. A scale space feature based registration technique for fusion of satellite imagery

    NASA Technical Reports Server (NTRS)

    Raghavan, Srini; Cromp, Robert F.; Campbell, William C.

    1997-01-01

    Feature based registration is one of the most reliable methods to register multi-sensor images (both active and passive imagery) since features are often more reliable than intensity or radiometric values. The only situation where a feature based approach will fail is when the scene is completely homogenous or densely textural in which case a combination of feature and intensity based methods may yield better results. In this paper, we present some preliminary results of testing our scale space feature based registration technique, a modified version of feature based method developed earlier for classification of multi-sensor imagery. The proposed approach removes the sensitivity in parameter selection experienced in the earlier version as explained later.

  10. Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment

    PubMed Central

    Seex, Kevin

    2016-01-01

    Background Lateral interbody cages have been proven useful in spinal fusions. Spanning both lateral cortical rims while sparing the Anterior Longitudinal Ligament, the lateral interbody cages restore and maintain disc height while adding stability prior to supplemental fixation. The standard approach for their insertion is by a 90-degree lateral transpsoas method. This is relatively bloodless compared to other techniques although has its limitations, requiring neuro-monitoring and being, at times, very difficult at L4/5 due to iliac crest obstruction or an anterior plexus position. An oblique approach, with the patient in lateral decubitus, passes anterior to the iliac crest, retroperitoneal, and being anterior to psoas, eliminates the need for neuro-monitoring. Methods Twenty-one consecutive patients underwent surgery for a total of 32 levels instrumented with the ATP technique. Mean age at the time of surgery was 62.4±7.4 years. There was a 6 months minimum clinical follow up, with imaging to assess fusion, at 6 and 12 months. Indications included symptomatic degenerative lumbar spondylosis +/− spondylolisthesis, leg and back pain. All patients were assessed with the Oswestry Disability Index (ODI), Visual Analog Scale 100 mm for back pain (VASb) and for leg pain (VASl) preoperatively, at 3, 6 and 12 months. Last follow-up was at 12 months for 9 patients and the rest had 6 months follow up. Results Statistical analysis showed significance for the results in ODI, VASb and VASl with improvement in all components except for one patient with worsening VASl. Eight patients had complications related to surgery which were still present at last follow-up including moderate weakness of hip flexion and EHL weakness. Lateral cutaneous nerve (LCN) palsy on the side of the approach was also seen as well as sympathectomy effect related to the mobilization of the sympathetic trunk. One patient, who also suffered from multiple sclerosis, experienced psoas abscess 3 months

  11. Estimation of water quality parameters applying satellite data fusion and mining techniques in the lake Albufera de Valencia (Spain)

    NASA Astrophysics Data System (ADS)

    Doña, Carolina; Chang, Ni-Bin; Vannah, Benjamin W.; Sánchez, Juan Manuel; Delegido, Jesús; Camacho, Antonio; Caselles, Vicente

    2014-05-01

    Linked to the enforcement of the European Water Framework Directive (2000) (WFD), which establishes that all countries of the European Union have to avoid deterioration, improve and retrieve the status of the water bodies, and maintain their good ecological status, several remote sensing studies have been carried out to monitor and understand the water quality variables trend. Lake Albufera de Valencia (Spain) is a hypereutrophic system that can present chrorophyll a concentrations over 200 mg·m-3 and transparency (Secchi disk) values below 20 cm, needing to retrieve and improve its water quality. The principal aim of our work was to develop algorithms to estimate water quality parameters such as chlorophyll a concentration and water transparency, which are informative of the eutrophication and ecological status, using remote sensing data. Remote sensing data from Terra/MODIS, Landsat 5-TM and Landsat 7-ETM+ images were used to carry out this study. Landsat images are useful to analyze the spatial variability of the water quality variables, as well as to monitor small to medium size water bodies due to its 30-m spatial resolution. But, the poor temporal resolution of Landsat, with a 16-day revisit time, is an issue. In this work we tried to solve this data gap by applying fusion techniques between Landsat and MODIS images. Although the lower spatial resolution of MODIS is 250/500-m, one image per day is available. Thus, synthetic Landsat images were created using data fusion for no data acquisition dates. Good correlation values were obtained when comparing original and synthetic Landsat images. Genetic programming was used to develop models for predicting water quality. Using the reflectance bands of the synthetic Landsat images as inputs to the model, values of R2 = 0.94 and RMSE = 8 mg·m-3 were obtained when comparing modeled and observed values of chlorophyll a, and values of R2= 0.91 and RMSE = 4 cm for the transparency (Secchi disk). Finally, concentration

  12. Evaluating the role of large earthquakes on aquifer dynamics using data fusion and knowledge discovery techniques

    NASA Astrophysics Data System (ADS)

    Friedel, Michael; Cox, Simon; Williams, Charles; Holden, Caroline

    2016-04-01

    Artificial adaptive systems are evaluated for their usefulness in modeling earthquake hydrology of the Canterbury region, NZ. For example, an unsupervised machine-learning technique, self-organizing map, is used to fuse about 200 disparate and sparse data variables (such as, well pressure response, ground acceleration, intensity, shaking, stress and strain; aquifer and well characteristics) associated with the M7.1 Darfield earthquake in 2010 and the M6.3 Christchurch earthquake in 2011. The strength of correlations, determined using cross-component plots, varied between earthquakes with pressure changes more strongly related to dynamic- than static stress-related variables during the M7.1 earthquake, and vice versa during the M6.3. The method highlights the importance of data distribution and that driving mechanisms of earthquake-induced pressure change in the aquifers are not straight forward to interpret. In many cases, data mining revealed that confusion and reduction in correlations are associated with multiple trends in the same plot: one for confined and one for unconfined earthquake response. The autocontractive map and minimum spanning tree techniques are used for grouping variables of similar influence on earthquake hydrology. K-means clustering of neural information identified 5 primary regions influenced by the two earthquakes. The application of genetic doping to a genetic algorithm is used for identifying optimal subsets of variables in formulating predictions of well pressures. Predictions of well pressure changes are compared and contrasted using machine-learning network and symbolic regression models with prediction uncertainty quantified using a leave-one-out cross-validation strategy. These preliminary results provide impetus for subsequent analysis with information from another 100 earthquakes that occurred across the South Island.

  13. Feasibility of three-dimensional magnetic resonance angiography-fluoroscopy image fusion technique in guiding complex endovascular aortic procedures in patients with renal insufficiency.

    PubMed

    Schwein, Adeline; Chinnadurai, Ponraj; Shah, Dipan J; Lumsden, Alan B; Bechara, Carlos F; Bismuth, Jean

    2017-05-01

    Three-dimensional image fusion of preoperative computed tomography (CT) angiography with fluoroscopy using intraoperative noncontrast cone-beam CT (CBCT) has been shown to improve endovascular procedures by reducing procedure length, radiation dose, and contrast media volume. However, patients with a contraindication to CT angiography (renal insufficiency, iodinated contrast allergy) may not benefit from this image fusion technique. The primary objective of this study was to evaluate the feasibility of magnetic resonance angiography (MRA) and fluoroscopy image fusion using noncontrast CBCT as a guidance tool during complex endovascular aortic procedures, especially in patients with renal insufficiency. All endovascular aortic procedures done under MRA image fusion guidance at a single-center were retrospectively reviewed. The patients had moderate to severe renal insufficiency and underwent diagnostic contrast-enhanced magnetic resonance imaging after gadolinium or ferumoxytol injection. Relevant vascular landmarks electronically marked in MRA images were overlaid on real-time two-dimensional fluoroscopy for image guidance, after image fusion with noncontrast intraoperative CBCT. Technical success, time for image registration, procedure time, fluoroscopy time, number of digital subtraction angiography (DSA) acquisitions before stent deployment or vessel catheterization, and renal function before and after the procedure were recorded. The image fusion accuracy was qualitatively evaluated on a binary scale by three physicians after review of image data showing virtual landmarks from MRA on fluoroscopy. Between November 2012 and March 2016, 10 patients underwent endovascular procedures for aortoiliac aneurysmal disease or aortic dissection using MRA image fusion guidance. All procedures were technically successful. A paired t-test analysis showed no difference between preimaging and postoperative renal function (P = .6). The mean time required for MRA-CBCT image

  14. Wastewater quality monitoring system using sensor fusion and machine learning techniques.

    PubMed

    Qin, Xusong; Gao, Furong; Chen, Guohua

    2012-03-15

    A multi-sensor water quality monitoring system incorporating an UV/Vis spectrometer and a turbidimeter was used to monitor the Chemical Oxygen Demand (COD), Total Suspended Solids (TSS) and Oil & Grease (O&G) concentrations of the effluents from the Chinese restaurant on campus and an electrocoagulation-electroflotation (EC-EF) pilot plant. In order to handle the noise and information unbalance in the fused UV/Vis spectra and turbidity measurements during the calibration model building, an improved boosting method, Boosting-Iterative Predictor Weighting-Partial Least Squares (Boosting-IPW-PLS), was developed in the present study. The Boosting-IPW-PLS method incorporates IPW into boosting scheme to suppress the quality-irrelevant variables by assigning small weights, and builds up the models for the wastewater quality predictions based on the weighted variables. The monitoring system was tested in the field with satisfactory results, underlying the potential of this technique for the online monitoring of water quality. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Multiplexed automated digital quantification of fusion transcripts: comparative study with fluorescent in-situ hybridization (FISH) technique in acute leukemia patients.

    PubMed

    Akhter, Ariz; Mughal, Muhammad Kashif; Elyamany, Ghaleb; Sinclair, Gary; Azma, Raja Zahratul; Masir, Noraidah; Shuib, Salwati; Rashid-Kolvear, Fariborz; Shabani-Rad, Meer-Taher; Stewart, Douglas Allan; Mansoor, Adnan

    2016-09-15

    The World Health Organization (WHO) classification system defines recurrent chromosomal translocations as the sole diagnostic and prognostic criteria for acute leukemia (AL). These fusion transcripts are pivotal in the pathogenesis of AL. Clinical laboratories universally employ conventional karyotype/FISH to detect these chromosomal translocations, which is complex, labour intensive and lacks multiplexing capacity. Hence, it is imperative to explore and evaluate some newer automated, cost-efficient multiplexed technologies to accommodate the expanding genetic landscape in AL. "nCounter® Leukemia fusion gene expression assay" by NanoString was employed to detect various fusion transcripts in a large set samples (n = 94) utilizing RNA from formalin fixed paraffin embedded (FFPE) diagnostic bone marrow biopsy specimens. This series included AL patients with various recurrent translocations (n = 49), normal karyotype (n = 19), or complex karyotype (n = 21), as well as normal bone marrow samples (n = 5). Fusion gene expression data were compared with results obtained by conventional karyotype and FISH technology to determine sensitivity/specificity, as well as positive /negative predictive values. Junction probes for PML/RARA; RUNX1-RUNX1T1; BCR/ABL1 showed 100 % sensitivity/specificity. A high degree of correlation was noted for MLL/AF4 (85 sensitivity/100 specificity) and TCF3-PBX1 (75 % sensitivity/100 % specificity) probes. CBFB-MYH11 fusion probes showed moderate sensitivity (57 %) but high specificity (100 %). ETV6/RUNX1 displayed discordance between fusion transcript assay and FISH results as well as rare non-specific binding in AL samples with normal or complex cytogenetics. Our study presents preliminary data with high correlation between fusion transcript detection by a throughput automated multiplexed platform, compared to conventional karyotype/FISH technique for detection of chromosomal translocations in AL patients. Our

  16. Comparison of the resulting error in data fusion techniques when used with remote sensing, earth observation, and in-situ data sets for water quality applications

    NASA Astrophysics Data System (ADS)

    Ziemba, Alexander; El Serafy, Ghada

    2016-04-01

    Ecological modeling and water quality investigations are complex processes which can require a high level of parameterization and a multitude of varying data sets in order to properly execute the model in question. Since models are generally complex, their calibration and validation can benefit from the application of data and information fusion techniques. The data applied to ecological models comes from a wide range of sources such as remote sensing, earth observation, and in-situ measurements, resulting in a high variability in the temporal and spatial resolution of the various data sets available to water quality investigators. It is proposed that effective fusion into a comprehensive singular set will provide a more complete and robust data resource with which models can be calibrated, validated, and driven by. Each individual product contains a unique valuation of error resulting from the method of measurement and application of pre-processing techniques. The uncertainty and error is further compounded when the data being fused is of varying temporal and spatial resolution. In order to have a reliable fusion based model and data set, the uncertainty of the results and confidence interval of the data being reported must be effectively communicated to those who would utilize the data product or model outputs in a decision making process[2]. Here we review an array of data fusion techniques applied to various remote sensing, earth observation, and in-situ data sets whose domains' are varied in spatial and temporal resolution. The data sets examined are combined in a manner so that the various classifications, complementary, redundant, and cooperative, of data are all assessed to determine classification's impact on the propagation and compounding of error. In order to assess the error of the fused data products, a comparison is conducted with data sets containing a known confidence interval and quality rating. We conclude with a quantification of the performance

  17. Multi-energy soft-x-ray technique for impurity transport measurements in the fusion plasma edge

    NASA Astrophysics Data System (ADS)

    Clayton, D. J.; Tritz, K.; Stutman, D.; Finkenthal, M.; Kaye, S. M.; Kumar, D.; LeBlanc, B. P.; Paul, S.; Sabbagh, S. A.

    2012-10-01

    A new diagnostic technique was developed to produce high-resolution impurity transport measurements of the steep-gradient edge of fusion plasmas. Perturbative impurity transport measurements were performed for the first time in the NSTX plasma edge (r/a ˜ 0.6 to the SOL) with short neon gas puffs, and the resulting line and continuum emission was measured with the new edge multi-energy soft-x-ray (ME-SXR) diagnostic. Neon transport is modeled with the radial impurity transport code STRAHL and the resulting x-ray emission is computed using the ADAS atomic database. The radial transport coefficient profiles D(r) and v(r), and the particle flux from the gas puff Φ(t), are the free parameters in this model and are varied to find the best fit to experimental x-ray emissivity measurements, with bolometry used to constrain the impurity source. Initial experiments were successful and results were consistent with previous measurements of core impurity transport and neoclassical transport calculations. New diagnostic tools will be implemented on NSTX-U to further improve these transport measurements.

  18. Development of design technique for vacuum insulation in large size multi-aperture multi-grid accelerator for nuclear fusion

    SciTech Connect

    Kojima, A. Hanada, M.; Tobari, H.; Nishikiori, R.; Hiratsuka, J.; Kashiwagi, M.; Umeda, N.; Yoshida, M.; Ichikawa, M.; Watanabe, K.; Yamano, Y.; Grisham, L. R.

    2016-02-15

    Design techniques for the vacuum insulation have been developed in order to realize a reliable voltage holding capability of multi-aperture multi-grid (MAMuG) accelerators for fusion application. In this method, the nested multi-stage configuration of the MAMuG accelerator can be uniquely designed to satisfy the target voltage within given boundary conditions. The evaluation of the voltage holding capabilities of each acceleration stages was based on the previous experimental results about the area effect and the multi-aperture effect. Since the multi-grid effect was found to be the extension of the area effect by the total facing area this time, the total voltage holding capability of the multi-stage can be estimated from that per single stage by assuming the stage with the highest electric field, the total facing area, and the total apertures. By applying these consideration, the analysis on the 3-stage MAMuG accelerator for JT-60SA agreed well with the past gap-scan experiments with an accuracy of less than 10% variation, which demonstrated the high reliability to design MAMuG accelerators and also multi-stage high voltage bushings.

  19. Measurement of hydrodynamic growth near peak velocity in an inertial confinement fusion capsule implosion using a self-radiography technique

    SciTech Connect

    Pickworth, L. A.; Hammel, B. A.; Smalyuk, V. A.; MacPhee, A. G.; Scott, H. A.; Robey, H. F.; Landen, O. L.; Barrios, M. A.; Regan, S. P.; Schneider, M. B.; Hoppe, Jr., M.; Kohut, T.; Holunga, D.; Walters, C.; Haid, B.; Dayton, M.

    2016-07-11

    First measurements of hydrodynamic growth near peak implosion velocity in an inertial confinement fusion (ICF) implosion at the National Ignition Facility were obtained using a self-radiographing technique and a preimposed Legendre mode 40, λ = 140 μm, sinusoidal perturbation. These are the first measurements of the total growth at the most unstable mode from acceleration Rayleigh-Taylor achieved in any ICF experiment to date, showing growth of the areal density perturbation of ~7000×. Measurements were made at convergences of ~5 to ~10× at both the waist and pole of the capsule, demonstrating simultaneous measurements of the growth factors from both lines of sight. The areal density growth factors are an order of magnitude larger than prior experimental measurements and differed by ~2× between the waist and the pole, showing asymmetry in the measured growth factors. As a result, these new measurements significantly advance our ability to diagnose perturbations detrimental to ICF implosions, uniquely intersecting the change from an accelerating to decelerating shell, with multiple simultaneous angular views.

  20. Measurement of Hydrodynamic Growth near Peak Velocity in an Inertial Confinement Fusion Capsule Implosion using a Self-Radiography Technique

    NASA Astrophysics Data System (ADS)

    Pickworth, L. A.; Hammel, B. A.; Smalyuk, V. A.; MacPhee, A. G.; Scott, H. A.; Robey, H. F.; Landen, O. L.; Barrios, M. A.; Regan, S. P.; Schneider, M. B.; Hoppe, M.; Kohut, T.; Holunga, D.; Walters, C.; Haid, B.; Dayton, M.

    2016-07-01

    First measurements of hydrodynamic growth near peak implosion velocity in an inertial confinement fusion (ICF) implosion at the National Ignition Facility were obtained using a self-radiographing technique and a preimposed Legendre mode 40, λ =140 μ m , sinusoidal perturbation. These are the first measurements of the total growth at the most unstable mode from acceleration Rayleigh-Taylor achieved in any ICF experiment to date, showing growth of the areal density perturbation of ˜7000 × . Measurements were made at convergences of ˜5 to ˜10 × at both the waist and pole of the capsule, demonstrating simultaneous measurements of the growth factors from both lines of sight. The areal density growth factors are an order of magnitude larger than prior experimental measurements and differed by ˜2 × between the waist and the pole, showing asymmetry in the measured growth factors. These new measurements significantly advance our ability to diagnose perturbations detrimental to ICF implosions, uniquely intersecting the change from an accelerating to decelerating shell, with multiple simultaneous angular views.

  1. Measurement of hydrodynamic growth near peak velocity in an inertial confinement fusion capsule implosion using a self-radiography technique

    DOE PAGES

    Pickworth, L. A.; Hammel, B. A.; Smalyuk, V. A.; ...

    2016-07-11

    First measurements of hydrodynamic growth near peak implosion velocity in an inertial confinement fusion (ICF) implosion at the National Ignition Facility were obtained using a self-radiographing technique and a preimposed Legendre mode 40, λ = 140 μm, sinusoidal perturbation. These are the first measurements of the total growth at the most unstable mode from acceleration Rayleigh-Taylor achieved in any ICF experiment to date, showing growth of the areal density perturbation of ~7000×. Measurements were made at convergences of ~5 to ~10× at both the waist and pole of the capsule, demonstrating simultaneous measurements of the growth factors from both linesmore » of sight. The areal density growth factors are an order of magnitude larger than prior experimental measurements and differed by ~2× between the waist and the pole, showing asymmetry in the measured growth factors. As a result, these new measurements significantly advance our ability to diagnose perturbations detrimental to ICF implosions, uniquely intersecting the change from an accelerating to decelerating shell, with multiple simultaneous angular views.« less

  2. Measurement of hydrodynamic growth near peak velocity in an inertial confinement fusion capsule implosion using a self-radiography technique

    SciTech Connect

    Pickworth, L. A.; Hammel, B. A.; Smalyuk, V. A.; MacPhee, A. G.; Scott, H. A.; Robey, H. F.; Landen, O. L.; Barrios, M. A.; Regan, S. P.; Schneider, M. B.; Hoppe, Jr., M.; Kohut, T.; Holunga, D.; Walters, C.; Haid, B.; Dayton, M.

    2016-07-11

    First measurements of hydrodynamic growth near peak implosion velocity in an inertial confinement fusion (ICF) implosion at the National Ignition Facility were obtained using a self-radiographing technique and a preimposed Legendre mode 40, λ = 140 μm, sinusoidal perturbation. These are the first measurements of the total growth at the most unstable mode from acceleration Rayleigh-Taylor achieved in any ICF experiment to date, showing growth of the areal density perturbation of ~7000×. Measurements were made at convergences of ~5 to ~10× at both the waist and pole of the capsule, demonstrating simultaneous measurements of the growth factors from both lines of sight. The areal density growth factors are an order of magnitude larger than prior experimental measurements and differed by ~2× between the waist and the pole, showing asymmetry in the measured growth factors. As a result, these new measurements significantly advance our ability to diagnose perturbations detrimental to ICF implosions, uniquely intersecting the change from an accelerating to decelerating shell, with multiple simultaneous angular views.

  3. Development of design technique for vacuum insulation in large size multi-aperture multi-grid accelerator for nuclear fusion.

    PubMed

    Kojima, A; Hanada, M; Tobari, H; Nishikiori, R; Hiratsuka, J; Kashiwagi, M; Umeda, N; Yoshida, M; Ichikawa, M; Watanabe, K; Yamano, Y; Grisham, L R

    2016-02-01

    Design techniques for the vacuum insulation have been developed in order to realize a reliable voltage holding capability of multi-aperture multi-grid (MAMuG) accelerators for fusion application. In this method, the nested multi-stage configuration of the MAMuG accelerator can be uniquely designed to satisfy the target voltage within given boundary conditions. The evaluation of the voltage holding capabilities of each acceleration stages was based on the previous experimental results about the area effect and the multi-aperture effect. Since the multi-grid effect was found to be the extension of the area effect by the total facing area this time, the total voltage holding capability of the multi-stage can be estimated from that per single stage by assuming the stage with the highest electric field, the total facing area, and the total apertures. By applying these consideration, the analysis on the 3-stage MAMuG accelerator for JT-60SA agreed well with the past gap-scan experiments with an accuracy of less than 10% variation, which demonstrated the high reliability to design MAMuG accelerators and also multi-stage high voltage bushings.

  4. Development and Application of Non-Linear Image Enhancement and Multi-Sensor Fusion Techniques for Hazy and Dark Imaging

    NASA Technical Reports Server (NTRS)

    Rahman, Zia-ur

    2005-01-01

    The purpose of this research was to develop enhancement and multi-sensor fusion algorithms and techniques to make it safer for the pilot to fly in what would normally be considered Instrument Flight Rules (IFR) conditions, where pilot visibility is severely restricted due to fog, haze or other weather phenomenon. We proposed to use the non-linear Multiscale Retinex (MSR) as the basic driver for developing an integrated enhancement and fusion engine. When we started this research, the MSR was being applied primarily to grayscale imagery such as medical images, or to three-band color imagery, such as that produced in consumer photography: it was not, however, being applied to other imagery such as that produced by infrared image sources. However, we felt that it was possible by using the MSR algorithm in conjunction with multiple imaging modalities such as long-wave infrared (LWIR), short-wave infrared (SWIR), and visible spectrum (VIS), we could substantially improve over the then state-of-the-art enhancement algorithms, especially in poor visibility conditions. We proposed the following tasks: 1) Investigate the effects of applying the MSR to LWIR and SWIR images. This consisted of optimizing the algorithm in terms of surround scales, and weights for these spectral bands; 2) Fusing the LWIR and SWIR images with the VIS images using the MSR framework to determine the best possible representation of the desired features; 3) Evaluating different mixes of LWIR, SWIR and VIS bands for maximum fog and haze reduction, and low light level compensation; 4) Modifying the existing algorithms to work with video sequences. Over the course of the 3 year research period, we were able to accomplish these tasks and report on them at various internal presentations at NASA Langley Research Center, and in presentations and publications elsewhere. A description of the work performed under the tasks is provided in Section 2. The complete list of relevant publications during the research

  5. Comparison of Pain Score Reduction Using Triamcinolone vs. Betamethasone in Transforaminal Epidural Steroid Injections for Lumbosacral Radicular Pain.

    PubMed

    McCormick, Zachary; Kennedy, David J; Garvan, Cynthia; Rivers, Evan; Temme, Kate; Margolis, Shana; Zander, Emily; Rohr, Ashley; Smith, Matthew C; Plastaras, Christopher

    2015-12-01

    Although the comparative efficacy of particulate vs. nonparticulate steroids for the treatment of radicular pain with transforaminal epidural steroid injection has been investigated, there is minimal literature comparing particulate steroids. The authors aimed to determine whether transforaminal epidural steroid injection with triamcinolone or betamethasone, two particulate corticosteroids, more effectively reduces lumbosacral radicular pain. This is a longitudinal cohort study of 1021 patients (1568 transforaminal epidural steroid injections) who received betamethasone or triamcinolone between January 2006 and October 2007 in an academic spine center. The frequency of greater than 50% pain reduction was compared between groups. This study included 42.4% (433) male and 57.6% (588) female patients, with a mean (SD) age of 54.1 (16.7) yrs. Betamethasone and triamcinolone were used in 78.8% (1235) and 21.2% (333) of subjects, respectively. Significantly more patients who received triamcinolone (44.4% [95% confidence interval, 36.2%-52.8%]) experienced greater than 50% pain reduction at short-term follow-up (1-4 wks) compared with patients who received betamethasone (26.8% [95% confidence interval, 22.7%-31.4%]). Patients who received transforaminal epidural steroid injection with triamcinolone reported more frequent pain relief of greater than 50% at short-term follow-up compared with those who received betamethasone. These findings further develop the literature on comparative effectiveness in epidural steroid injections. However, given the exploratory and retrospective nature of this investigation, further study is needed.

  6. Does Electrodiagnostic Confirmation of Radiculopathy Predict Pain Reduction after Transforaminal Epidural Steroid Injection? A Multicenter Study

    PubMed Central

    McCormick, Zachary; Cushman, Daniel; Caldwell, Mary; Marshall, Benjamin; Ghannad, Leda; Eng, Christine; Patel, Jaymin; Makovitch, Steven; Chu, Samuel K; Babu, Ashwin N.; Walega, David R.; Marciniak, Christina; Press, Joel; Kennedy, David J.; Plastaras, Christopher

    2015-01-01

    Objective Minimal definitive literature identifies patients with radicular pain who would benefit most from epidural steroid injection (ESI). This study investigated if electromyographic (EMG) confirmation of radiculopathy with active or chronic denervation predicts a positive treatment outcome following ESI. Design Longitudinal cohort study of adults who underwent EMG and subsequent transforaminal ESI within 6 months. The proportion of individuals who experienced >50% pain relief and mean change in daily morphine equivalents (DME) were calculated. Results 170 individuals with respective mean (Standard Deviation) age and duration of symptoms of 55 (15) years and 36 (56) months were included. Mean time to <30 day and >30 day follow-up post-injection were 18 (6) and 99 (130) days, respectively. At >30 day follow-up, a larger proportion of EMG-confirmed individuals (37.7%) reported >50% pain reduction compared to EMG-negative individuals (17.8%) (p=0.03). This was significant for lumbosacral (40% vs. 15%, p=0.01) but not cervical symptoms (p>0.05). Mean decrease in DME at long-term follow-up in EMG-confirmed compared to EMG-negative individuals trended toward significance (-4 vs. -1, p=0.11). There was no significant relationship between myotomal spontaneous activity and pain or opioid use. Conclusions Needle EMG predicts long-term pain reduction from transforaminal ESI in patients with lumbosacral radiculopathy, regardless of the presence of active denervation. PMID:26251843

  7. The Role of Spectral Tissue Sensing During Lumbar Transforaminal Epidural Injection.

    PubMed

    Balthasar, Andrea J R; Lucassen, Gerald W; Sommer, Micha; van der Voort, Marjolein; Gijsbers, Geert; Arnoldussen, Carsten W K P; Kessel, Alfons; Roggeveen, Stefan; Lataster, Arno; van Kleef, Maarten

    2016-01-01

    Spectral tissue sensing (STS) exploits the scattering and absorption of light by tissue. The main objective of the present study was to determine whether STS can discriminate between correct and incorrect placement of the needle tip during lumbar transforaminal epidural injection. This was a single-blind prospective observational study in 30 patients with lumbar radicular pain scheduled for lumbar transforaminal epidural injection. Spectral tissue sensing data from the needle tip were acquired along the needle trajectory at 4 predefined measurement points and compared with ultrasound, fluoroscopy, and digital subtraction angiography images. Spectral tissue sensing data contained the full spectra. The lipid and hemoglobin content at the different measurement points was also calculated, and partial least-squares discriminant analysis was used to estimate the sensitivity and specificity of STS. Spectral tissue sensing identified correct needle placement with a sensitivity of 57% and a specificity of 82%, and intraforaminal versus extraforaminal locations were identified with a sensitivity of 80% and a specificity of 71%.

  8. Multisensor data fusion algorithm development

    SciTech Connect

    Yocky, D.A.; Chadwick, M.D.; Goudy, S.P.; Johnson, D.K.

    1995-12-01

    This report presents a two-year LDRD research effort into multisensor data fusion. We approached the problem by addressing the available types of data, preprocessing that data, and developing fusion algorithms using that data. The report reflects these three distinct areas. First, the possible data sets for fusion are identified. Second, automated registration techniques for imagery data are analyzed. Third, two fusion techniques are presented. The first fusion algorithm is based on the two-dimensional discrete wavelet transform. Using test images, the wavelet algorithm is compared against intensity modulation and intensity-hue-saturation image fusion algorithms that are available in commercial software. The wavelet approach outperforms the other two fusion techniques by preserving spectral/spatial information more precisely. The wavelet fusion algorithm was also applied to Landsat Thematic Mapper and SPOT panchromatic imagery data. The second algorithm is based on a linear-regression technique. We analyzed the technique using the same Landsat and SPOT data.

  9. Final Report on Development of Optimized Field-Reversed Configuration Plasma Formation Techniques for Magnetized Target Fusion

    SciTech Connect

    Lynn, Alan

    2013-11-01

    The University of New Mexico (UNM) proposed a collaboration with Los Alamos National Laboratory (LANL) to develop and test methods for improved formation of field-reversed configuration (FRC) plasmas relevant to magnetized target fusion (MTF) energy research. MTF is an innovative approach for a relatively fast and cheap path to the production of fusion energy that utilizes magnetic confinement to assist in the compression of a hot plasma to thermonuclear conditions by an external driver. LANL is currently pursing demonstration of the MTF concept via compression of an FRC plasma by a metal liner z-pinch in conjunction with the Air Force Research Laboratory in Albuquerque, NM. A key physics issue for the FRC's ultimate success as an MTF target lies in the initial pre-ionization (PI) stage. The PI plasma sets the initial conditions from which the FRC is created. In particular, the PI formation process determines the amount of magnetic flux that can be trapped to form the FRC. A ringing theta pinch ionization (RTPI) technique, such as currently used by the FRX-L device at LANL, has the advantages of high ionization fraction, simplicity (since no additional coils are required), and does not require internal electrodes which can introduce impurities into the plasma. However RTPI has been shown to only trap 50% of the initial bias flux at best and imposes additional engineering constraints on the capacitor banks. The amount of trapped flux plays an important role in the FRC's final equilibrium, transport, and stability properties, and provides increased ohmic heating of the FRC through induced currents as the magnetic field decays. Increasing the trapped flux also provides the route to greatest potential gains in FRC lifetime, which is essential to provide enough time to translate and compress the FRC effectively. In conjunction with LANL we initially planned to develop and test a microwave break- down system to improve the initial PI plasma formation. The UNM team would

  10. Transforaminal lumbar interbody graft placement using an articulating delivery arm facilitates increased segmental lordosis with superior anterior and midline graft placement.

    PubMed

    Shau, David N; Parker, Scott L; Mendenhall, Stephen K; Zuckerman, Scott L; Godil, Saniya S; Devin, Clinton J; McGirt, Matthew J

    2015-05-01

    Transforaminal lumbar interbody fusion (TLIF) is a frequently performed method of lumbar arthrodesis in patients failing medical management of back and leg pain. Accurate placement of the interbody graft and restoration of lordosis has been shown to be crucial when performing lumbar fusion procedures. We performed a single-surgeon, prospective, randomized study to determine whether a novel articulating versus traditional straight graft delivery arm system allows for superior graft placement and increased lordosis for single-level TLIF. Thirty consecutive patients undergoing single-level TLIF were included and prospectively randomized to one of the 2 groups (articulated vs. straight delivery arm system). Three radiographic characteristics were evaluated at 6-week follow-up: (1) degree of segmental lumbar lordosis at the fused level; (2) the percent anterior location of the interbody graft in disk space; and (3) the distance (mm) off midline of the interbody graft placement. Randomization yielded 16 patients in the articulated delivery arm cohort and 14 in the straight delivery arm cohort. The articulating delivery arm system yielded an average of 14.7-degree segmental lordosis at fused level, 35% anterior location, and 3.6 mm off midline. The straight delivery arm system yielded an average of 10.7-degree segmental lordosis at fused level, 46% anterior location, and 7.0 mm off midline. All 3 comparisons were statistically significant (P<0.05). The study suggests that an articulating delivery arm system facilitates superior anterior and midline TLIF graft placement allowing for increased segmental lordosis compared with a traditional straight delivery arm system.

  11. A decision support system for fusion of hard and soft sensor information based on probabilistic latent semantic analysis technique

    NASA Astrophysics Data System (ADS)

    Shirkhodaie, Amir; Elangovan, Vinayak; Alkilani, Amjad; Habibi, Mohammad

    2013-05-01

    This paper presents an ongoing effort towards development of an intelligent Decision-Support System (iDSS) for fusion of information from multiple sources consisting of data from hard (physical sensors) and soft (textural sources. Primarily, this paper defines taxonomy of decision support systems for latent semantic data mining from heterogeneous data sources. A Probabilistic Latent Semantic Analysis (PLSA) approach is proposed for latent semantic concepts search from heterogeneous data sources. An architectural model for generating semantic annotation of multi-modality sensors in a modified Transducer Markup Language (TML) is described. A method for TML messages fusion is discussed for alignment and integration of spatiotemporally correlated and associated physical sensory observations. Lastly, the experimental results which exploit fusion of soft/hard sensor sources with support of iDSS are discussed.

  12. A new microcolumn-type microchip for examining the expression of chimeric fusion genes using a nucleic acid sandwich hybridization technique.

    PubMed

    Ohnishi, Michihiro; Sasaki, Naoyuki; Kishimoto, Takuya; Watanabe, Hidetoshi; Takagi, Masatoshi; Mizutani, Shuki; Kishii, Noriyuki; Yasuda, Akio

    2014-11-01

    We report a new type of microcolumn installed in a microchip. The architecture allows use of a nucleic acid sandwich hybridization technique to detect a messenger RNA (mRNA) chain as a target. Data are presented that demonstrate that the expression of a chimeric fusion gene can be detected. The microcolumn was filled with semi-transparent microbeads made of agarose gel that acted as carriers, allowing increased efficiency of the optical detection of fluorescence from the microcolumn. The hybrid between the target trapped on the microbeads and a probe DNA labeled with a fluorescent dye was detected by measuring the intensity of the fluorescence from the microcolumn directly. These results demonstrate an easy and simple method for determining the expression of chimeric fusion genes with no preamplification. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. A simple, rapid, low-cost technique for naked-eye detection of urine-isolated TMPRSS2:ERG gene fusion RNA

    PubMed Central

    Koo, Kevin M.; Wee, Eugene J. H.; Mainwaring, Paul N.; Trau, Matt

    2016-01-01

    The TMPRSS2:ERG gene fusion is one of a series of highly promising prostate cancer (PCa) biomarker alternatives to the controversial serum PSA. Current methods for detecting TMPRSS2:ERG are limited in terms of long processing time, high cost and the need for specialized equipment. Thus, there is an unmet need for less complex, faster, and cheaper methods to enable gene fusion detection in the clinic. We describe herein a simple, rapid and inexpensive assay which combines robust isothermal amplification technique with a novel visualization method for evaluating urinary TMPRSS2:ERG status at less than USD 5 and with minimal equipment. The assay is sensitive, and rapidly detects as low as 105 copies of TMPRSS2:ERG transcripts while maintaining high levels of specificity. PMID:27470540

  14. Four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate.

    PubMed

    Hernekamp, J F; Reinecke, A; Neubrech, F; Bickert, B; Kneser, U; Kremer, T

    2016-04-01

    Four-corner fusion is a standard procedure for advanced carpal collapse. Several operative techniques and numerous implants for osseous fixation have been described. Recently, a specially designed locking plate (Aptus©, Medartis, Basel, Switzerland) was introduced. The purpose of this study was to compare functional results after osseous fixation using K-wires (standard of care, SOC) with four-corner fusion and locking plate fixation. 21 patients who underwent four-corner fusion in our institution between 2008 and 2013 were included in a retrospective analysis. In 11 patients, osseous fixation was performed using locking plates whereas ten patients underwent bone fixation with conventional K-wires. Outcome parameters were functional outcome, osseous consolidation, patient satisfaction (DASH- and Krimmer Score), pain and perioperative morbidity and the time until patients returned to daily work. Patients were divided in two groups and paired t-tests were performed for statistical analysis. No implant related complications were observed. Osseous consolidation was achieved in all cases. Differences between groups were not significant regarding active range of motion (AROM), pain and function. Overall patient satisfaction was acceptable in all cases; differences in the DASH questionnaire and the Krimmer questionnaire were not significant. One patient of the plate group required conversion to total wrist arthrodesis without implant-related complications. Both techniques for four-corner fusion have similar healing rates. Using the more expensive locking implant avoids a second operation for K-wire removal, but no statistical differences were detected in functional outcome as well as in patient satisfaction when compared to SOC.

  15. True anteroposterior view pedicle screw insertion technique

    PubMed Central

    Bai, Jia-yue; Zhang, Wei; An, Ji-long; Sun, Ya-peng; Ding, Wen-yuan; Shen, Yong

    2016-01-01

    Background The wide use of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery in the treatment of degenerative disc disease of lumbar spine in spinal surgery highlights the gradual decrease in the use of traditional pedicle screw insertion technology. This study aims to analyze the accuracy of the true anteroposterior view pedicle screw insertion technique in MIS-TLIF surgery, compare it with conventional pedicle screw insertion technology, and discuss its clinical application value. Methods Fifty-two patients undergoing true anteroposterior view (group A) and 87 patients undergoing conventional pedicle screw insertion (group B) were diagnosed with lumbar disc herniation or lumbar spinal stenosis. Time for screw placement, intraoperative irradiation exposure, accuracy rate of pedicle screw insertion, and incidence of neurovascular injury were compared between the two groups. Results The time for screw placement and intraoperative irradiation exposure was significantly less in group A. Penetration rates of the paries lateralis of vertebral pedicle, medial wall of vertebral pedicle, and anterior vertebral wall were 1.44%, 0%, and 2.40%, respectively, all of which were significantly lower than that in group B. No additional serious complications caused by the placement of screw were observed during the follow-up period in patients in group A, but two patients with medial penetration underwent revision for unbearable radicular pain. Conclusion The application of true anteroposterior view pedicle screw insertion technique in MIS-TLIF surgery shortens time for screw placement and reduces the intraoperative irradiation exposure along with a higher accuracy rate of screw placement, which makes it a safe, accurate, and efficient technique. PMID:27418828

  16. Isocentric Navigation of Percutaneous Endoscopic Transforaminal Discectomy at the L5/S1 Level in Difficult Puncture Cases: A Technical Note.

    PubMed

    Fan, Guoxin; Wang, Teng; Hu, Shuo; Guan, Xiaofei; Gu, Xin; He, Shisheng

    2017-05-01

    Accurate puncture during percutaneous transforaminal endoscopic discectomy at the L5/S1 level in cases with high iliac crest and narrow foramen were difficult, even though the difficulties of foraminoplasty could be overcome by advanced instruments like reamers. The report aimed to describe an isocentric navigation technique with a definite pathway in difficult puncture cases at the L5/S1 level. Technical note. Difficult punctures were defined as over 10 punctures of the needle before obtaining an ideal puncture location by senior surgeons with experience of over 500 percutaneous endoscopic transforaminal discectomy (PETD) cases. A total of 124 punctures were recorded in 11 difficult puncture cases at the L5/S1 level. A definite pathway was created by an isocentric navigation theory, which was based on a surface locator and an arch-guided device. The surface locator was used to rapidly and accurately identify the puncture target with the recognition of the surrounding rods under fluoroscopy. The arch-guided device can ensure that the puncture target always remains at the center of a virtual sphere. We recorded the puncture times, fluoroscopy exposure times, radiation exposure time, operative time, visual analog scale (VAS) score, Japanese Orthopeadic Association (JOA) score, and patient satisfaction. The average puncture times were significantly reduced to 1.27 with the arch-guided device compared with conventional puncture methods (P < 0.05). The average operative time was 90.09 ± 11.00 minutes and the fluoroscopy times were 53.36 ± 5.85. The radiation exposure time was 50.91 ± 5.20 seconds. VAS score of leg and back pain, as well as JOA score, were all significantly improved after surgery (P < 0.05). The excellent and good rate of satisfaction was 90.91%. No major complications, including cerebral fluid leakage, surgical infection, and postoperative nerve root injury, were recorded in this small sample. This was a small-sample study with a short follow-up. The

  17. Big fusion, little fusion

    NASA Astrophysics Data System (ADS)

    Chen, Frank; ddtuttle

    2016-08-01

    In reply to correspondence from George Scott and Adam Costley about the Physics World focus issue on nuclear energy, and to news of construction delays at ITER, the fusion reactor being built in France.

  18. Minimally Invasive Anterior Decompression Technique without Instrumented Fusion for Huge Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine: Technical Note And Literature Review.

    PubMed

    Yu, Jae Won; Yun, Sang-O; Hsieh, Chang-Sheng; Lee, Sang-Ho

    2017-09-01

    Several surgical methods have been reported for treatment of ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Despite rapid innovation of instruments and techniques for spinal surgery, the postoperative outcomes are not always favorable. This article reports a minimally invasive anterior decompression technique without instrumented fusion, which was modified from the conventional procedure. The authors present 2 cases of huge beak-type OPLL. Patients underwent minimally invasive anterior decompression without fusion. This method created a space on the ventral side of the OPLL without violating global thoracic spinal stability. Via this space, the OPLL and anterior lateral side of the dural sac can be seen and manipulated directly. Then, total removal of the OPLL was accomplished. No orthosis was needed. In this article, we share our key technique and concepts for treatment of huge thoracic OPLL. Case 1. 51-year-old female was referred to our hospital with right lower limb radiating pain and paresis. Thoracic OPLL at T6-7 had been identified at our hospital, and conservative treatment had been tried without success. Case 2. This 54-year-old female with a 6-month history of progressive gait disturbance and bilateral lower extremity radiating pain (right>left) was admitted to our institute. She also had hypoesthesia in both lower legs. Her symptoms had been gradually progressing. Computed tomography scans showed massive OPLL at the T9-10 level. Magnetic resonance imaging of the thoracolumbar spine demonstrated ventral bony masses with severe anterior compression of the spinal cord at the same level. We used this surgical method in 2 patients with a huge beaked-type OPLL in the thoracic level. Complete removal of the OPLL via anterior decompression without instrumented fusion was accomplished. The 1st case had no intraoperative or postoperative complications, and the 2nd case had 1 intraoperative complication (dural tear) and no

  19. Determination of tungsten in tantalum-tungsten alloy by X-ray fluorescence spectrometry using fusion, thin layer, and pressed powder pellet techniques

    NASA Astrophysics Data System (ADS)

    Tian, Lunfu; Zou, Deshuang; Dai, Yichun; Tang, Guangping

    2015-08-01

    A method is described for the X-ray fluorescence (XRF) determination of tungsten in tantalum-tungsten alloy over the range of 10.5%-13.5%. The sample was prepared by three methods, namely, borate fusion, filter paper disk, and pressed powder pellet, respectively. We compared the feature of the three methods of specimen preparation and found that filter paper disk method was the most suitable technique for specimen preparation. Furthermore, the results were compared with those given by inductively coupled plasma optical emission spectrometry (ICP-OES), and the relative standard deviation was less than 2%, which could meet the requirement of this application.

  20. Percutaneous endoscopic transforaminal lumbar spinal canal decompression for lumbar spinal stenosis

    PubMed Central

    Wen, Bingtao; Zhang, Xifeng; Zhang, Lin; Huang, Peng; Zheng, Guoquan

    2016-01-01

    Abstract This study aimed to evaluate the safety and curative effect of percutaneous endoscopic transforaminal lumbar spinal canal decompression in the treatment of lumbar spinal stenosis. This retrospective study recruited 64 patients with lumbar spinal stenosis who underwent percutaneous endoscopic lumbar spinal canal decompression via surgical approach of posterolateral intervertebral foramen. The postoperation neurological function and pain status were evaluated by the visual analog scale (VAS) score of pain and the Oswestry disability index (ODI), and the patient satisfaction was evaluated according to the MacNab outcome criteria. The data, including preoperative comorbidities, operation time, the quantity of bleeding, bed rest time, and intraoperative and postoperative complications, were recorded. The mean operation time was 78 min, the mean quantity of bleeding was 20 mL and bed rest time was 6 h to 3 days. All patients were followed-up for 4 months to 5 years. The mean preoperative VAS score was 7.7 ± 1.2, while postoperative 3 months, 6 months, and final follow-up VAS scores were 2.8 ± 0.7, 2.1 ± 0.6, and 0.8 ± 0.6, respectively (P < 0.001). The mean preoperative ODI score was 72.4 ± 1.2, while postoperative 3 months, 6 months, and final follow-up ODI scores were 29.7 ± 4.9, 23.9 ± 4.0, and 12.5 ± 3.9, respectively (P < 0.001). The excellent and good rate reached 73.4% at the final follow-up. The percutaneous endoscopic transforaminal lumbar spinal canal decompression is an easy, safe, and effective minimally invasive surgery for patients with lumbar spinal stenosis. PMID:27977571

  1. Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections

    PubMed Central

    Yu, Robinson K.; Ghodadra, Anish; Agarwal, Vikas

    2016-01-01

    Background Lumbar transforaminal epidural steroid injection is a common and effective tool for managing lumbar radicular pain, although accidental intravascular injection can rarely result in paralysis. The purpose of this study is to determine the safest needle tip position for computed tomography (CT)-guided lumbar transforaminal epidural steroid injections as determined by incidence of intravascular injection. Methods Three radiologists, in consensus, reviewed procedural imaging for consecutive CT-fluoroscopic lumbar transforaminal epidural steroid injections performed during a 16-month period. Intravascular injections were identified and categorized by needle tip position, vessel type injected, intravascular injection volume and procedural phase containing the intravascular injection. Pearson chi-square and logistic regression testing were used to assess differences between groups, as appropriate. Results Intravascular injections occurred in 9% (52/606) of injections. The intravascular injection rate was significantly lower (P<0.001) for extraforaminal needle position (0%, 0/109) compared to junctional (8%, 27/319) and foraminal (14%, 25/178) needle tip positions. Of the intravascular injections, 4% (2/52) were likely arterial, 35% (18/52) were likely venous, and 62% (32/52) were indeterminate for vessel type injected. 46% (24/52) of intravascular injections were large volume, 33% (17/52) were small volume, and 21% (11/52) were trace volume. 56% (29/52) of intravascular injections occurred with the contrast trial dose, 29% (15/52) with the steroid/analgesic cocktail, and 15% (8/52) with both. Conclusions An extraforaminal needle position for CT-fluoroscopic lumbar transforaminal epidural steroid injections decreases the risk of intravascular injection and therefore may be safer than other needle tip positions. PMID:28097241

  2. Radiographic Results of Minimally Invasive (MIS) Lumbar Interbody Fusion (LIF) Compared with Conventional Lumbar Interbody Fusion.

    PubMed

    Lim, Jae Kwan; Kim, Sung Min

    2013-06-01

    To evaluate the radiographic results of minimally invasive (MIS) anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF). Twelve and nineteen patients who underwent MIS-ALIF, MIS-TLIF, respectively, from 2006 to 2008 were analyzed with a minimum 24-months' follow-up. Additionally, 18 patients treated with single level open TLIF surgery in 2007 were evaluated as a comparative group. X-rays and CT images were evaluated preoperatively, postoperatively, and at the final follow-up. Fusion and subsidence rates were determined, and radiographic parameters, including lumbar lordosis angle (LLA), fused segment angle (FSA), sacral slope angle (SSA), disc height (DH), and foraminal height (FH), were analyzed. These parameters were also compared between the open and MIS-TLIF groups. In the MIS interbody fusion group, statistically significant increases were observed in LLA, FSA, and DH and FH between preoperative and final values. The changes in LLA, FSA, and DH were significantly increased in the MIS-ALIF group compared with the MIS-TLIF group, but SSA and FH were not significantly different. No significant differences were seen between open and MIS-TLIF except for DH. The interbody subsidence and fusion rates of the MIS groups were 12.0±4% and 96%, respectively. Radiographic results of MIS interbody fusion surgery are as favorable as those with conventional surgery regarding fusion, restoration of disc height, foraminal height, and lumbar lordosis. MIS-ALIF is more effective than MIS-TLIF for intervertebral disc height restoration and lumbar lordosis.

  3. Radiographic Results of Minimally Invasive (MIS) Lumbar Interbody Fusion (LIF) Compared with Conventional Lumbar Interbody Fusion

    PubMed Central

    Lim, Jae Kwan

    2013-01-01

    Objective To evaluate the radiographic results of minimally invasive (MIS) anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF). Methods Twelve and nineteen patients who underwent MIS-ALIF, MIS-TLIF, respectively, from 2006 to 2008 were analyzed with a minimum 24-months' follow-up. Additionally, 18 patients treated with single level open TLIF surgery in 2007 were evaluated as a comparative group. X-rays and CT images were evaluated preoperatively, postoperatively, and at the final follow-up. Fusion and subsidence rates were determined, and radiographic parameters, including lumbar lordosis angle (LLA), fused segment angle (FSA), sacral slope angle (SSA), disc height (DH), and foraminal height (FH), were analyzed. These parameters were also compared between the open and MIS-TLIF groups. Results In the MIS interbody fusion group, statistically significant increases were observed in LLA, FSA, and DH and FH between preoperative and final values. The changes in LLA, FSA, and DH were significantly increased in the MIS-ALIF group compared with the MIS-TLIF group, but SSA and FH were not significantly different. No significant differences were seen between open and MIS-TLIF except for DH. The interbody subsidence and fusion rates of the MIS groups were 12.0±4% and 96%, respectively. Conclusion Radiographic results of MIS interbody fusion surgery are as favorable as those with conventional surgery regarding fusion, restoration of disc height, foraminal height, and lumbar lordosis. MIS-ALIF is more effective than MIS-TLIF for intervertebral disc height restoration and lumbar lordosis. PMID:24757461

  4. Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis: The Insertion Technique, the Fusion Levels and Direct Vertebral Rotation

    PubMed Central

    2011-01-01

    The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved three-dimensional (3D) correction and it is accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complications. Many methods of screw insertion have been reported. The author has been using the K-wire method coupled with the intraoperative single posteroanterior and lateral radiographs, which is the most safe, accurate and fast method. Identification of the curve patterns and determining the fusion levels are very important. The ideal classification of adolescent idiopathic scoliosis should address the all patterns, predict the extent of accurate fusion and have good inter/intraobserver reliability. My classification system matches with the ideal classification system, and it is simple and easy to learn; and my classification system has only 4 structural curve patterns and each curve has 2 types. Scoliosis is a 3D deformity; the coronal and sagittal curves can be corrected with rod rotation, and rotational deformity has to be corrected with direct vertebral rotation (DVR). Rod derotation and DVR are true methods of 3D deformity correction with shorter fusion and improved correction of both the fused and unfused curves, and this is accomplished using pedicle screw fixation. The direction of DVR is very important and it should be opposite to the direction of the rotational deformity of the vertebra. A rigid rod has to be used to prevent rod bend-out during the derotation and DVR. PMID:21629468

  5. Optimization of the Surgical Approach in AVMs Using MRI and 4D DSA Fusion Technique : A technical note.

    PubMed

    Tritt, S; Ommer, B; Gehrisch, S; Klein, S; Seifert, V; Berkefeld, J; Konczalla, J

    2017-03-13

    Previously published data demonstrated the possibility of displaying the angioarchitecture of intracranial vascular malformations using time-resolved 3D imaging (4D digital subtraction angiography [DSA]). The purpose of our study was to prove the technical feasibility of creating fused images of time-resolved 3D reconstructions and MPRAGE MRI data sets and to check the reliability of the correct anatomical display of the angioma nidus and the venous drainage in the fused images of patients with intracranial arteriovenous malformations (AVM). In this study 20 patients with intracranial AVM underwent pretherapeutic DSA and time-resolved 3D DSA in addition to MRI including MPRAGE sequences. The images were post-processed with the fusion software tool on a dedicated research workstation. The fusion of both imaging modalities was done semi-automatically with automatic co-registration software followed by a manual co-registration. Co-registered DSA/MRI data sets of 20 untreated AVMs were evaluated independently by two reviewers. Image fusion was successful in all 20 cases with an acceptable additional set-up time. The fused images were highly scored by the two raters in respect to their congruency of the dedicated regions. Precise anatomical localization of the nidus, the feeding arteries and the draining veins were possible with the merged images. Creating fused images of time-resolved 3D DSA and contrast-enhanced T1-weighted MPRAGE MR images might be beneficial for the preoperative and intrasurgical workflow in patients with AVMs. This new software tool fulfils the required quality and accuracy of the merged images. The clinical validation has to be proven in further studies.

  6. Flow Cytometric Immunobead Assay for Detection of BCR-ABL1 Fusion Proteins in Chronic Myleoid Leukemia: Comparison with FISH and PCR Techniques.

    PubMed

    Recchia, Anna Grazia; Caruso, Nadia; Bossio, Sabrina; Pellicanò, Mariavaleria; De Stefano, Laura; Franzese, Stefania; Palummo, Angela; Abbadessa, Vincenzo; Lucia, Eugenio; Gentile, Massimo; Vigna, Ernesto; Caracciolo, Clementina; Agostino, Antolino; Galimberti, Sara; Levato, Luciano; Stagno, Fabio; Molica, Stefano; Martino, Bruno; Vigneri, Paolo; Di Raimondo, Francesco; Morabito, Fortunato

    2015-01-01

    Chronic Myeloid Leukemia (CML) is characterized by a balanced translocation juxtaposing the Abelson (ABL) and breakpoint cluster region (BCR) genes. The resulting BCR-ABL1 oncogene leads to increased proliferation and survival of leukemic cells. Successful treatment of CML has been accompanied by steady improvements in our capacity to accurately and sensitively monitor therapy response. Currently, measurement of BCR-ABL1 mRNA transcript levels by real-time quantitative PCR (RQ-PCR) defines critical response endpoints. An antibody-based technique for BCR-ABL1 protein recognition could be an attractive alternative to RQ-PCR. To date, there have been no studies evaluating whether flow-cytometry based assays could be of clinical utility in evaluating residual disease in CML patients. Here we describe a flow-cytometry assay that detects the presence of BCR-ABL1 fusion proteins in CML lysates to determine the applicability, reliability, and specificity of this method for both diagnosis and monitoring of CML patients for initial response to therapy. We show that: i) CML can be properly diagnosed at onset, (ii) follow-up assessments show detectable fusion protein (i.e. relative mean fluorescent intensity, rMFI%>1) when BCR-ABL1IS transcripts are between 1-10%, and (iii) rMFI% levels predict CCyR as defined by FISH analysis. Overall, the FCBA assay is a rapid technique, fully translatable to the routine management of CML patients.

  7. Lumbar Scoliosis Combined Lumbar Spinal Stenosis and Herniation Diagnosed Patient Was Treated with “U” Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    Zhang, Shaobo; Lian, Qingquan; Yan, Haibo; Lin, Xianfa

    2017-01-01

    The objective was to report a case of a 63-year-old man with a history of low back pain (LBP) and left leg pain for 2 years, and the symptom became more serious in the past 5 months. The patient was diagnosed with lumbar scoliosis combined with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH) at the level of L4-5 that was confirmed using Computerized Topography and Magnetic Resonance Imaging. The surgical team preformed a novel technique, “U” route transforaminal percutaneous endoscopic lumbar discectomy (PELD), which led to substantial, long-term success in reduction of pain intensity and disability. After removing the osteophyte mass posterior to the thecal sac at L4-5, the working channel direction was changed to the gap between posterior longitudinal ligament and thecal sac, and we also removed the herniation and osteophyte at L3-4 with “U” route PELD. The patient's symptoms were improved immediately after the surgical intervention; low back pain intensity decreased from preoperative 9 to postoperative 2 on a visual analog scale (VAS) recorded at 1 month postoperatively. The success of the intervention suggests that “U” route PELD may be a feasible alternative to treat lumbar scoliosis with LSS and LDH patients. PMID:28203471

  8. A Cost-Effectiveness Analysis of Minimally Invasive versus Open Surgery Techniques for Lumbar Spinal Fusion in Italy and the United Kingdom.

    PubMed

    Vertuani, Simona; Nilsson, Jonas; Borgman, Benny; Buseghin, Giorgio; Leonard, Catherine; Assietti, Roberto; Quraishi, Nasir A

    2015-09-01

    Evaluate the cost-effectiveness of minimally invasive surgery (MIS) compared with open surgery (OS) techniques for one- or two-level lumbar spinal fusion in the treatment of degenerative lumbar spinal conditions in the United Kingdom and Italy. A health economic model was developed on the basis of results from a systematic literature review and meta-analysis to determine the cost-effectiveness of MIS compared with OS for lumbar spinal fusion. The analysis was conducted from a health care payer perspective. Parameters included in the model were surgery, blood loss, duration of hospitalization, postoperative complications, and health-related quality of life (HRQOL). Cost-effectiveness was determined by the incremental cost per quality-adjusted life-year gained. MIS was the dominant strategy compared with OS (i.e., yielding both cost savings and improved HRQOL). Cost savings were driven mainly by shorter length of hospital stay, reduced blood loss, and fewer complications such as surgical site infection. The total cost saving per procedure was €973 for Italy and €1666 for the United Kingdom, with an improvement of 0.04 quality-adjusted life-year over 2 years in HRQOL. One-way sensitivity analyses and predefined scenario(s) analyses confirmed the robustness of the model. MIS is a less expensive and a more effective treatment compared with OS for spinal lumbar fusion in both Italy and the United Kingdom. Lower downstream costs and increased HRQOL in the MIS group compensate for potential higher upfront costs of MIS implants and surgery equipment. Copyright © 2015. Published by Elsevier Inc.

  9. Recent advances in technique and clinical outcomes of minimally invasive spine surgery in adult scoliosis.

    PubMed

    Liu, Gang; Liu, Sen; Zuo, Yu-Zhi; Li, Qi-Yi; Wu, Zhi-Hong; Wu, Nan; Yu, Ke-Yi; Qiu, Gui-Xing

    2017-08-09

    Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis. We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: "minimally invasive," "spine," "surgery," and "scoliosis." The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies. The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3-7, operative time was 2.3-8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications. MISS can provide good radiological and self

  10. Quantitative characterization of pulverized coal and biomass-coal blends in pneumatic conveying pipelines using electrostatic sensor arrays and data fusion techniques

    NASA Astrophysics Data System (ADS)

    Qian, Xiangchen; Yan, Yong; Shao, Jiaqing; Wang, Lijuan; Zhou, Hao; Wang, Chao

    2012-08-01

    Quantitative data about the dynamic behaviour of pulverized coal and biomass-coal blends in fuel injection pipelines allow power plant operators to detect variations in fuel supply and oscillations in the flow at an early stage, enable them to balance fuel distribution between fuel feeding pipes and ultimately to achieve higher combustion efficiency and lower greenhouse gas emissions. Electrostatic sensor arrays and data fusion algorithms are combined to provide a non-intrusive solution to the measurement of fuel particle velocity, relative solid concentration and flow stability under pneumatic conveying conditions. Electrostatic sensor arrays with circular and arc-shaped electrodes are integrated in the same sensing head to measure ‘averaged’ and ‘localized’ characteristics of pulverized fuel flow. Data fusion techniques are applied to optimize and integrate the results from the sensor arrays. Experimental tests were conducted on the horizontal section of a 150 mm bore pneumatic conveyor circulating pulverized coal and sawdust under various flow conditions. Test results suggest that pure coal particles travel faster and carry more electrostatic charge than biomass-coal blends. As more biomass particles are added to the flow, the overall velocity of the flow reduces, the electrostatic charge level on particles decreases and the flow becomes less stable compared to the pure coal flow.

  11. PET-MR image fusion in soft tissue sarcoma: accuracy, reliability and practicality of interactive point-based and automated mutual information techniques.

    PubMed

    Somer, Edward J R; Marsden, Paul K; Benatar, Nigel A; Goodey, Joanne; O'Doherty, Michael J; Smith, Michael A

    2003-01-01

    The fusion of functional positron emission tomography (PET) data with anatomical magnetic resonance (MR) or computed tomography images, using a variety of interactive and automated techniques, is becoming commonplace, with the technique of choice dependent on the specific application. The case of PET-MR image fusion in soft tissue is complicated by a lack of conspicuous anatomical features and deviation from the rigid-body model. Here we compare a point-based external marker technique with an automated mutual information algorithm and discuss the practicality, reliability and accuracy of each when applied to the study of soft tissue sarcoma. Ten subjects with suspected sarcoma in the knee, thigh, groin, flank or back underwent MR and PET scanning after the attachment of nine external fiducial markers. In the assessment of the point-based technique, three error measures were considered: fiducial localisation error (FLE), fiducial registration error (FRE) and target registration error (TRE). FLE, which represents the accuracy with which the fiducial points can be located, is related to the FRE minimised by the registration algorithm. The registration accuracy is best characterised by the TRE, which is the distance between corresponding points in each image space after registration. In the absence of salient features within the target volume, the TRE can be measured at fiducials excluded from the registration process. To assess the mutual information technique, PET data, acquired after physically removing the markers, were reconstructed in a variety of ways and registered with MR. Having applied the transform suggested by the algorithm to the PET scan acquired before the markers were removed, the residual distance between PET and MR marker-pairs could be measured. The manual point-based technique yielded the best results (RMS TRE =8.3 mm, max =22.4 mm, min =1.7 mm), performing better than the automated algorithm (RMS TRE =20.0 mm, max =30.5 mm, min =7.7 mm) when

  12. The fusion of MIR absorbance and NIR Raman spectroscopic techniques for identification of improvised explosive materials in multiple scenarios

    NASA Astrophysics Data System (ADS)

    Stokes, Robert J.; Normand, Erwan L.; Lindley, Ruth; Black, Paul; McCulloch, Michael; Middleton, David N.; Smith, W. Ewen; Foulger, Brian; Lewis, Colin

    2009-09-01

    We demonstrate how molecular spectroscopy methods using NIR and MIR lasers can provide rapid detection and identification of many threat materials. It is increasingly recognised that one spectroscopic method will not be suited to every target in every scenario, both in terms of spectroscopic selectivity and the context e.g. vapour phase or within a sealed container. The orthogonal selection rules and capabilities of IR and Raman in combination allow the identification of a very broad range of targets, both in liquid and vapour phase. Therefore, we introduce the benefits of the combining infra-red absorbance based on Quantum Cascade lasers (QC-IR) and NIR Raman spectroscopy for nitrogenous and peroxide based materials. Rapid scan rates up to 10Hz for QC-IR and Raman and are demonstrated using current technology. However, understanding of the chemistry and spectroscopic signatures behind such materials is necessary for accurate fast fitting algorithms to benefit of the full advantage with advances in hardware. This is especially true as future users requirements move towards rapid multiplexed analysis and data fusion from a variety of sensors.

  13. Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques

    PubMed Central

    Pollock, Raymond; Bhatia, Chandra; Chuter, Graham; Lingutla, Kiran; Budithi, Chakravarty; Krishna, Manoj

    2008-01-01

    We have studied the occurrence of donor site morbidity, cosmesis and overall satisfaction with graft procedure in 76 patients who had undergone iliac crest bone harvesting for anterior cervical discectomy and fusion (ACDF). Totally 24 patients underwent an open procedure and 52 a minimally invasive trephine harvesting method. Although our study demonstrated substantial donor site pain and its effect on ambulation in both groups, this was of limited duration. Two patients, one in each group, suffered long-term pain that was eventually resolved. Totally 8.3% of patients in the open group suffered minor complications and 11.5% in the trephine group. There were two cases of meralgia parasthetica. There were no major complications in either group. There was no statistically significant difference in morbidity between the open and trephine groups. There was a trend towards significance (P = 0.076) for pain at the donor site, with less pain reported by patients who underwent the trephine procedure for harvesting. PMID:18389294

  14. Potential advantage of studying the lymphatic drainage by sentinel node technique and SPECT-CT image fusion for pelvic irradiation of prostate cancer

    SciTech Connect

    Krengli, Marco . E-mail: krengli@med.unipmn.it; Ballare, Andrea; Cannillo, Barbara; Rudoni, Marco; Kocjancic, Ervin; Loi, Gianfranco; Brambilla, Marco; Inglese, Eugenio; Frea, Bruno

    2006-11-15

    Purpose: This study aims to investigate the in vivo drainage of lymphatic spread by using the sentinel node (SN) technique and single-photon emission computed tomography (SPECT)-computed tomography (CT) image fusion, and to analyze the impact of such information on conformal pelvic irradiation. Methods and Materials: Twenty-three prostate cancer patients, candidates for radical prostatectomy already included in a trial studying the SN technique, were enrolled. CT and SPECT images were obtained after intraprostate injection of 115 MBq of {sup 99m}Tc-nanocolloid, allowing identification of SN and other pelvic lymph nodes. Target and nontarget structures, including lymph nodes identified by SPECT, were drawn on SPECT-CT fusion images. A three-dimensional conformal treatment plan was performed for each patient. Results: Single-photon emission computed tomography lymph nodal uptake was detected in 20 of 23 cases (87%). The SN was inside the pelvic clinical target volume (CTV{sub 2}) in 16 of 20 cases (80%) and received no less than the prescribed dose in 17 of 20 cases (85%). The most frequent locations of SN outside the CTV{sub 2} were the common iliac and presacral lymph nodes. Sixteen of the 32 other lymph nodes (50%) identified by SPECT were found outside the CTV{sub 2}. Overall, the SN and other intrapelvic lymph nodes identified by SPECT were not included in the CTV{sub 2} in 5 of 20 (25%) patients. Conclusions: The study of lymphatic drainage can contribute to a better knowledge of the in vivo potential pattern of lymph node metastasis in prostate cancer and can lead to a modification of treatment volume with consequent optimization of pelvic irradiation.

  15. A Biomechanical Stability Study of Extraforaminal Lumbar Interbody Fusion on the Cadaveric Lumbar Spine Specimens

    PubMed Central

    Guo, Song; Yan, Meijun; Han, Yingchao; Xia, Dongdong; Sun, Guixin; Li, Lijun; Tan, Jun

    2016-01-01

    Background Transforaminal lumbar interbody fusion (TLIF) is an effective surgery for lumbar degenerative disease. However, this fusion technique requires resection of inferior facet joint to provide access for superior facet joint resection, which results in reduced lumbar spinal stability and unnecessary trauma. We have previously developed extraforaminal lumbar interbody fusion (ELIF) that can avoid back muscle injury with direct nerve root decompression. This study aims to show that ELIF enhances lumbar spinal stability in comparison to TLIF by comparing lumbar spinal stability of L4–L5 range of motion (ROM) on 12 cadaveric spine specimens after performing TLIF or ELIF. Methods 12 cadaveric spine specimens were randomly divided and treated in accordance with the different internal fixations, including ELIF with a unilateral pedicle screw (ELIF+UPS), TLIF with a unilateral pedicle screw (TLIF+UPS), TLIF with a bilateral pedicle screw (TLIF+BPS), ELIF with a unilateral pedicle screw and translaminar facet screw (ELIF+UPS+TLFS) and ELIF with a bilateral pedicle screw (ELIF+BPS). The treatment groups were exposed to a 400-N load and 6 N·m movement force to calculate the angular displacement of L4-L5 during anterior flexion, posterior extension, lateral flexion and rotation operation conditions. Results The ROM in ELIF+UPS group was smaller than that of TLIF+UPS group under all operating conditions, with the significant differences in left lateral flexion and right rotation by 36.15% and 25.97% respectively. The ROM in ELIF+UPS group was higher than that in TLIF+BPS group. The ROM in the ELIF+UPS+TLFS group was much smaller than that in the ELIF+UPS group, but was not significantly different than that in the TLIF+BPS group. Conclusions Despite that TLIF+BPS has great stability, which can be comparable by that of ELIF+UPS. Additionally, ELIF stability can be further improved by using translaminar facet screws without causing more tissue damage to patient. PMID

  16. Spinal Fusion

    MedlinePlus

    ... concept of fusion is similar to that of welding in industry. Spinal fusion surgery, however, does not ... bone taken from the patient has a long history of use and results in predictable healing. Autograft ...

  17. Spinal Fusion

    MedlinePlus

    ... concept of fusion is similar to that of welding in industry. Spinal fusion surgery, however, does not ... bone taken from the patient has a long history of use and results in predictable healing. Autograft ...

  18. Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

    PubMed Central

    Moon, Jangsup; Kwon, Hyung-Min

    2017-01-01

    Introduction Transforaminal epidural steroid injection (TFESI) is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. Methods We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI. Results After 2 min of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities and within 5 min the patient became quadriplegic. Despite active rehabilitation, the patient remained bed-ridden 4 years after the catastrophic event. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI in Korea. Conclusion Considering the risk of dreadful complications, which appear in an unpredictable manner, TFESI with fluoroscopic guidance should be done only with a nonparticulate steroid. PMID:28203184

  19. CT-guided cervical transforaminal steroid injections: where should the needle tip be located?

    PubMed

    Hoang, J K; Massoglia, D P; Apostol, M A; Lascola, C D; Eastwood, J D; Kranz, P G

    2013-03-01

    The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate. We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution. The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) (P value <.0001). There was no relationship between needle angle and contrast distribution. Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.

  20. Fundus image fusion in EYEPLAN software: An evaluation of a novel technique for ocular melanoma radiation treatment planning

    SciTech Connect

    Daftari, Inder K.; Mishra, Kavita K.; O'Brien, Joan M.; and others

    2010-10-15

    Purpose: The purpose of this study is to evaluate a novel approach for treatment planning using digital fundus image fusion in EYEPLAN for proton beam radiation therapy (PBRT) planning for ocular melanoma. The authors used a prototype version of EYEPLAN software, which allows for digital registration of high-resolution fundus photographs. The authors examined the improvement in tumor localization by replanning with the addition of fundus photo superimposition in patients with macular area tumors. Methods: The new version of EYEPLAN (v3.05) software allows for the registration of fundus photographs as a background image. This is then used in conjunction with clinical examination, tantalum marker clips, surgeon's mapping, and ultrasound to draw the tumor contour accurately. In order to determine if the fundus image superimposition helps in tumor delineation and treatment planning, the authors identified 79 patients with choroidal melanoma in the macular location that were treated with PBRT. All patients were treated to a dose of 56 GyE in four fractions. The authors reviewed and replanned all 79 macular melanoma cases with superimposition of pretreatment and post-treatment fundus imaging in the new EYEPLAN software. For patients with no local failure, the authors analyzed whether fundus photograph fusion accurately depicted and confirmed tumor volumes as outlined in the original treatment plan. For patients with local failure, the authors determined whether the addition of the fundus photograph might have benefited in terms of more accurate tumor volume delineation. Results: The mean follow-up of patients was 33.6{+-}23 months. Tumor growth was seen in six eyes of the 79 macular lesions. All six patients were marginal failures or tumor miss in the region of dose fall-off, including one patient with both in-field recurrence as well as marginal. Among the six recurrences, three were managed by enucleation and one underwent retreatment with proton therapy. Three

  1. Analysis of the sEMG/force relationship using HD-sEMG technique and data fusion: A simulation study.

    PubMed

    Al Harrach, Mariam; Carriou, Vincent; Boudaoud, Sofiane; Laforet, Jeremy; Marin, Frederic

    2017-04-01

    The relationship between the surface Electromyogram (sEMG) signal and the force of an individual muscle is still ambiguous due to the complexity of experimental evaluation. However, understanding this relationship should be useful for the assessment of neuromuscular system in healthy and pathological contexts. In this study, we present a global investigation of the factors governing the shape of this relationship. Accordingly, we conducted a focused sensitivity analysis of the sEMG/force relationship form with respect to neural, functional and physiological parameters variation. For this purpose, we used a fast generation cylindrical model for the simulation of an 8×8 High Density-sEMG (HD-sEMG) grid and a twitch based force model for the muscle force generation. The HD-sEMG signals as well as the corresponding force signals were simulated in isometric non-fatiguing conditions and were based on the Biceps Brachii (BB) muscle properties. A total of 10 isometric constant contractions of 5s were simulated for each configuration of parameters. The Root Mean Squared (RMS) value was computed in order to quantify the sEMG amplitude. Then, an image segmentation method was used for data fusion of the 8×8 RMS maps. In addition, a comparative study between recent modeling propositions and the model proposed in this study is presented. The evaluation was made by computing the Normalized Root Mean Squared Error (NRMSE) of their fitting to the simulated relationship functions. Our results indicated that the relationship between the RMS (mV) and muscle force (N) can be modeled using a 3rd degree polynomial equation. Moreover, it appears that the obtained coefficients are patient-specific and dependent on physiological, anatomical and neural parameters. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. New multispectral MRI data fusion technique for white matter lesion segmentation: method and comparison with thresholding in FLAIR images

    PubMed Central

    Ferguson, Karen J.; Chappell, Francesca M.; Wardlaw, Joanna M.

    2010-01-01

    Objective Brain tissue segmentation by conventional threshold-based techniques may have limited accuracy and repeatability in older subjects. We present a new multispectral magnetic resonance (MR) image analysis approach for segmenting normal and abnormal brain tissue, including white matter lesions (WMLs). Methods We modulated two 1.5T MR sequences in the red/green colour space and calculated the tissue volumes using minimum variance quantisation. We tested it on 14 subjects, mean age 73.3 ± 10 years, representing the full range of WMLs and atrophy. We compared the results of WML segmentation with those using FLAIR-derived thresholds, examined the effect of sampling location, WML amount and field inhomogeneities, and tested observer reliability and accuracy. Results FLAIR-derived thresholds were significantly affected by the location used to derive the threshold (P = 0.0004) and by WML volume (P = 0.0003), and had higher intra-rater variability than the multispectral technique (mean difference ± SD: 759 ± 733 versus 69 ± 326 voxels respectively). The multispectral technique misclassified 16 times fewer WMLs. Conclusion Initial testing suggests that the multispectral technique is highly reproducible and accurate with the potential to be applied to routinely collected clinical MRI data. Electronic supplementary material The online version of this article (doi:10.1007/s00330-010-1718-6) contains supplementary material, which is available to authorized users. PMID:20157814

  3. Effects of transforaminal balloon treatment in patients with lumbar foraminal stenosis: a randomized, controlled, double-blind trial.

    PubMed

    Kim, Sung Hoon; Choi, Woo-Jong; Suh, Jeong Hun; Jeon, Sang-Ryong; Hwang, Chang Ju; Koh, Won Uk; Lee, Chung; Leem, Jeong Gil; Lee, Sang Chul; Shin, Jin-Woo

    2013-01-01

    Lumbar spinal stenosis is a common condition in the elderly. Although balloon treatment is a well-known therapeutic method in specific pain conditions, applying the balloon treatment in patients with lumbar spinal stenosis is not yet well established. We tested the therapeutic effect of transforaminal balloon treatment with a Fogarty balloon catheter on body pain and functional performance in patients with severe lumbar spinal stenosis. Prospective, randomized, double-blinded, active control trial. A tertiary, interventional pain management practice, specialty referral center. Sixty-two patients with refractory unilateral radiculopathy aggravated by walking were enrolled and randomly assigned to receive transforaminal steroid injection after transforaminal balloon treatment using a 3 Fr balloon catheter (n = 32) or the same procedure without balloon treatment (n = 30). The patients were prohibited from making any alterations to their medications during the 12 weeks of their follow-up period. After the first 12 weeks, the patients who had persistent symptoms or unbearable pain were allowed to increase the dose of analgesics or to receive additional interventional treatment. Visual analogue scale (VAS) pain scores for the leg and lower back, Oswestry disability index (ODI), and claudication distance were measured at 2, 4, 8, and 12 weeks post procedure. During the 52 weeks of the overall follow-up period, the patients achieving ≥ 50% leg pain relief without additional treatment or increasing the dose of analgesics were evaluated. Significant improvement occurred compared to baseline in VAS (P < 0.001), ODI (P < 0.001), and claudication distance (P < 0.001) in the balloon group during the overall follow-up period, whereas the improvement in ODI (P < 0.05) and claudication distance (P < 0.05) in the control group persisted for 8 weeks. The balloon group showed better improvement in leg VAS (P < 0.05), ODI (P < 0.05), and claudication distance (P < 0.05) than the

  4. Inertial Confinement fusion targets

    NASA Technical Reports Server (NTRS)

    Hendricks, C. D.

    1982-01-01

    Inertial confinement fusion (ICF) targets are made as simple flat discs, as hollow shells or as complicated multilayer structures. Many techniques were devised for producing the targets. Glass and metal shells are made by using drop and bubble techniques. Solid hydrogen shells are also produced by adapting old methods to the solution of modern problems. Some of these techniques, problems, and solutions are discussed. In addition, the applications of many of the techniques to fabrication of ICF targets is presented.

  5. Image computing techniques to extrapolate data for dust tracking in case of an experimental accident simulation in a nuclear fusion plant

    SciTech Connect

    Camplani, M.; Malizia, A.; Gelfusa, M.; Poggi, L. A.; Ciparisse, J. F.; Richetta, M.; Gaudio, P.; Barbato, F.; Antonelli, L.; Salgado, L.

    2016-01-15

    In this paper, a preliminary shadowgraph-based analysis of dust particles re-suspension due to loss of vacuum accident (LOVA) in ITER-like nuclear fusion reactors has been presented. Dust particles are produced through different mechanisms in nuclear fusion devices, one of the main issues is that dust particles are capable of being re-suspended in case of events such as LOVA. Shadowgraph is based on an expanded collimated beam of light emitted by a laser or a lamp that emits light transversely compared to the flow field direction. In the STARDUST facility, the dust moves in the flow, and it causes variations of refractive index that can be detected by using a CCD camera. The STARDUST fast camera setup allows to detect and to track dust particles moving in the vessel and then to obtain information about the velocity field of dust mobilized. In particular, the acquired images are processed such that per each frame the moving dust particles are detected by applying a background subtraction technique based on the mixture of Gaussian algorithm. The obtained foreground masks are eventually filtered with morphological operations. Finally, a multi-object tracking algorithm is used to track the detected particles along the experiment. For each particle, a Kalman filter-based tracker is applied; the particles dynamic is described by taking into account position, velocity, and acceleration as state variable. The results demonstrate that it is possible to obtain dust particles’ velocity field during LOVA by automatically processing the data obtained with the shadowgraph approach.

  6. Comprehensive glycosylation profiling of IgG and IgG-fusion proteins by top-down MS with multiple fragmentation techniques.

    PubMed

    Tran, Bao Quoc; Barton, Christopher; Feng, Jinhua; Sandjong, Aimee; Yoon, Sung Hwan; Awasthi, Shivangi; Liang, Tao; Khan, Mohd M; Kilgour, David P A; Goodlett, David R; Goo, Young Ah

    2016-02-16

    We employed top- and middle-down analyses with multiple fragmentation techniques including electron transfer dissociation (ETD), electron capture dissociation (ECD), and matrix-assisted laser desorption ionization in-source decay (MALDI-ISD) for characterization of a reference monoclonal antibody (mAb) IgG1 and a fusion IgG protein. Fourier transform ion cyclotron resonance (FT-ICR) or high performance liquid chromatography electrospray ionization (HPLC-ESI) on an Orbitrap was employed. These experiments provided a comprehensive view on the protein species; especially for different glycosylation level in these two proteins, which showed good agreement with oligosaccharide profiling. Top- and middle-down MS provided additional information regarding glycosylation sites and different combinational protein species that were not available from oligosaccharide mapping or conventional bottom-up analysis. Finally, incorporating a limited enzymatic digestion by immunoglobulin G-degrading enzyme of Streptococcus pyogene (IdeS) with MALDI-ISD analysis enabled extended sequence coverage of the internal region of protein without pre-fractionation. Oligosaccharide profiling together with top- and middle-down methods enabled: 1) detection of heterogeneous glycosylated protein species and sites in intact IgG1 and fusion proteins with high mass accuracy, 2) estimation of relative abundance levels of protein species in the sample, 3) confirmation of the protein termini structural information, and 4) improved sequence coverage by MALDI-ISD analysis for the internal regions of the proteins without sample pre-fractionation. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Image computing techniques to extrapolate data for dust tracking in case of an experimental accident simulation in a nuclear fusion plant

    NASA Astrophysics Data System (ADS)

    Camplani, M.; Malizia, A.; Gelfusa, M.; Barbato, F.; Antonelli, L.; Poggi, L. A.; Ciparisse, J. F.; Salgado, L.; Richetta, M.; Gaudio, P.

    2016-01-01

    In this paper, a preliminary shadowgraph-based analysis of dust particles re-suspension due to loss of vacuum accident (LOVA) in ITER-like nuclear fusion reactors has been presented. Dust particles are produced through different mechanisms in nuclear fusion devices, one of the main issues is that dust particles are capable of being re-suspended in case of events such as LOVA. Shadowgraph is based on an expanded collimated beam of light emitted by a laser or a lamp that emits light transversely compared to the flow field direction. In the STARDUST facility, the dust moves in the flow, and it causes variations of refractive index that can be detected by using a CCD camera. The STARDUST fast camera setup allows to detect and to track dust particles moving in the vessel and then to obtain information about the velocity field of dust mobilized. In particular, the acquired images are processed such that per each frame the moving dust particles are detected by applying a background subtraction technique based on the mixture of Gaussian algorithm. The obtained foreground masks are eventually filtered with morphological operations. Finally, a multi-object tracking algorithm is used to track the detected particles along the experiment. For each particle, a Kalman filter-based tracker is applied; the particles dynamic is described by taking into account position, velocity, and acceleration as state variable. The results demonstrate that it is possible to obtain dust particles' velocity field during LOVA by automatically processing the data obtained with the shadowgraph approach.

  8. On different techniques for the calculation of Bouguer gravity anomalies for joint inversion and model fusion of geophysical data in the Rio Grande Rift

    NASA Astrophysics Data System (ADS)

    Zamora, Azucena

    Density variations in the Earth result from different material properties, which reflect the tectonic processes attributed to a region. Density variations can be identified through measurable material properties, such as seismic velocities, gravity field, magnetic field, etc. Gravity anomaly inversions are particularly sensitive to density variations but suffer from significant non-uniqueness. However, using inverse models with gravity Bouguer anomalies and other geophysical data, we can determine three dimensional structural and geological properties of the given area. We explore different techniques for the calculation of Bouguer gravity anomalies for their use in joint inversion of multiple geophysical data sets and a model fusion scheme to integrate complementary geophysical models. Various 2- and 3- dimensional gravity profile forward modeling programs have been developed as variations of existing algorithms in the last decades. The purpose of this study is to determine the most effective gravity forward modeling method that can be used to combine the information provided by complementary datasets, such as gravity and seismic information, to improve the accuracy and resolution of Earth models obtained for the underlying structure of the Rio Grande Rift. In an effort to determine the most appropriate method to use in a joint inversion algorithm and a model fusion approach currently in development, we test each approach by using a model of the Rio Grande Rift obtained from seismic surface wave dispersion and receiver functions. We find that there are different uncertainties associated with each methodology that affect the accuracy achieved by including gravity profile forward modeling. Moreover, there exists an important amount of assumptions about the regions under study that must be taken into account in order to obtain an accurate model of the gravitational acceleration caused by changes in the density of the material in the substructure of the Earth.

  9. Image computing techniques to extrapolate data for dust tracking in case of an experimental accident simulation in a nuclear fusion plant.

    PubMed

    Camplani, M; Malizia, A; Gelfusa, M; Barbato, F; Antonelli, L; Poggi, L A; Ciparisse, J F; Salgado, L; Richetta, M; Gaudio, P

    2016-01-01

    In this paper, a preliminary shadowgraph-based analysis of dust particles re-suspension due to loss of vacuum accident (LOVA) in ITER-like nuclear fusion reactors has been presented. Dust particles are produced through different mechanisms in nuclear fusion devices, one of the main issues is that dust particles are capable of being re-suspended in case of events such as LOVA. Shadowgraph is based on an expanded collimated beam of light emitted by a laser or a lamp that emits light transversely compared to the flow field direction. In the STARDUST facility, the dust moves in the flow, and it causes variations of refractive index that can be detected by using a CCD camera. The STARDUST fast camera setup allows to detect and to track dust particles moving in the vessel and then to obtain information about the velocity field of dust mobilized. In particular, the acquired images are processed such that per each frame the moving dust particles are detected by applying a background subtraction technique based on the mixture of Gaussian algorithm. The obtained foreground masks are eventually filtered with morphological operations. Finally, a multi-object tracking algorithm is used to track the detected particles along the experiment. For each particle, a Kalman filter-based tracker is applied; the particles dynamic is described by taking into account position, velocity, and acceleration as state variable. The results demonstrate that it is possible to obtain dust particles' velocity field during LOVA by automatically processing the data obtained with the shadowgraph approach.

  10. Simultaneous determination of major to ultratrace elements in geological samples by fusion-dissolution and inductively coupled plasma mass spectrometry techniques.

    PubMed

    García de Madinabeitia, S; Sánchez Lorda, M E; Ibarguchi, J I Gil

    2008-09-12

    A method has been developed for the simultaneous quantification of major to ultratrace elements in geological samples using quadrupole ICP-MS techniques. The sample preparation involves fusion with LiBO2 and dilution in HNO3-HF which allows complete decomposition of refractory minerals and quantification of the elements of interest. The effects of high Total Dissolved Solids (TDS) and Li in the solution are minimized using a matrix-tolerant interface and conditioning the instrument with LiBO2 solution. The signal drift is moreover controlled using conventional internal standards and specific Drift Correction Standards (DCS). A key issue of the technique is the external calibration using selected Certified Reference Materials (CRM). Depending on the sample type and analytes of interest three optimized programmable modes are used sequentially: Standard, Collision Cell (CCT) and Kinetic Energy Discrimination (KED) mode. The method allows to quantify more than 40 elements in concentrations from tens-of-percent to <0.1 ppm levels during a single experiment. The method has been validated through the analysis of different CRMs with recovery factors of ca. 100% and typical 2sigma errors of <10%.

  11. Clinical outcomes following spinal fusion using an intraoperative computed tomographic 3D imaging system.

    PubMed

    Xiao, Roy; Miller, Jacob A; Sabharwal, Navin C; Lubelski, Daniel; Alentado, Vincent J; Healy, Andrew T; Mroz, Thomas E; Benzel, Edward C

    2017-05-01

    OBJECTIVE Improvements in imaging technology have steadily advanced surgical approaches. Within the field of spine surgery, assistance from the O-arm Multidimensional Surgical Imaging System has been established to yield superior accuracy of pedicle screw insertion compared with freehand and fluoroscopic approaches. Despite this evidence, no studies have investigated the clinical relevance associated with increased accuracy. Accordingly, the objective of this study was to investigate the clinical outcomes following thoracolumbar spinal fusion associated with O-arm-assisted navigation. The authors hypothesized that increased accuracy achieved with O-arm-assisted navigation decreases the rate of reoperation secondary to reduced hardware failure and screw misplacement. METHODS A consecutive retrospective review of all patients who underwent open thoracolumbar spinal fusion at a single tertiary-care institution between December 2012 and December 2014 was conducted. Outcomes assessed included operative time, length of hospital stay, and rates of readmission and reoperation. Mixed-effects Cox proportional hazards modeling, with surgeon as a random effect, was used to investigate the association between O-arm-assisted navigation and postoperative outcomes. RESULTS Among 1208 procedures, 614 were performed with O-arm-assisted navigation, 356 using freehand techniques, and 238 using fluoroscopic guidance. The most common indication for surgery was spondylolisthesis (56.2%), and most patients underwent a posterolateral fusion only (59.4%). Although O-arm procedures involved more vertebral levels compared with the combined freehand/fluoroscopy cohort (4.79 vs 4.26 vertebral levels; p < 0.01), no significant differences in operative time were observed (4.40 vs 4.30 hours; p = 0.38). Patients who underwent an O-arm procedure experienced shorter hospital stays (4.72 vs 5.43 days; p < 0.01). O-arm-assisted navigation trended toward predicting decreased risk of spine

  12. A Geostatistical Data Fusion Technique for Merging Remote Sensing and Ground-Based Observations of Aerosol Optical Thickness

    NASA Technical Reports Server (NTRS)

    Chatterjee, Abhishek; Michalak, Anna M.; Kahn, Ralph A.; Paradise, Susan R.; Braverman, Amy J.; Miller, Charles E.

    2010-01-01

    Particles in the atmosphere reflect incoming sunlight, tending to cool the Earth below. Some particles, such as soot, also absorb sunlight, which tens to warm the ambient atmosphere. Aerosol optical depth (AOD) is a measure of the amount of particulate matter in the atmosphere, and is a key input to computer models that simulate and predict Earth's changing climate. The global AOD products from the Multi-angle Imaging SpectroRadiometer (MISR) and the MODerate resolution Imaging Spectroradiometer (MODIS), both of which fly on the NASA Earth Observing System's Terra satellite, provide complementary views of the particles in the atmosphere. Whereas MODIS offers global coverage about four times as frequent as MISR, the multi-angle data makes it possible to separate the surface and atmospheric contributions to the observed top-of-atmosphere radiances, and also to more effectively discriminate particle type. Surface-based AERONET sun photometers retrieve AOD with smaller uncertainties than the satellite instruments, but only at a few fixed locations. So there are clear reasons to combine these data sets in a way that takes advantage of their respective strengths. This paper represents an effort at combining MISR, MODIS and AERONET AOD products over the continental US, using a common spatial statistical technique called kriging. The technique uses the correlation between the satellite data and the "ground-truth" sun photometer observations to assign uncertainty to the satellite data on a region-by-region basis. The larger fraction of the sun photometer variance that is duplicated by the satellite data, the higher the confidence assigned to the satellite data in that region. In the Western and Central US, MISR AOD correlation with AERONET are significantly higher than those with MODIS, likely due to bright surfaces in these regions, which pose greater challenges for the single-view MODIS retrievals. In the east, MODIS correlations are higher, due to more frequent sampling

  13. A fusion of top-down and bottom-up modeling techniques to constrain regional scale carbon budgets

    NASA Astrophysics Data System (ADS)

    Goeckede, M.; Turner, D. P.; Michalak, A. M.; Vickers, D.; Law, B. E.

    2009-12-01

    The effort to constrain regional scale carbon budgets benefits from assimilating as many high quality data sources as possible in order to reduce uncertainties. Two of the most common approaches used in this field, bottom-up and top-down techniques, both have their strengths and weaknesses, and partly build on very different sources of information to train, drive, and validate the models. Within the context of the ORCA2 project, we follow both bottom-up and top-down modeling strategies with the ultimate objective of reconciling their surface flux estimates. The ORCA2 top-down component builds on a coupled WRF-STILT transport module that resolves the footprint function of a CO2 concentration measurement in high temporal and spatial resolution. Datasets involved in the current setup comprise GDAS meteorology, remote sensing products, VULCAN fossil fuel inventories, boundary conditions from CarbonTracker, and high-accuracy time series of atmospheric CO2 concentrations. Surface fluxes of CO2 are normally provided through a simple diagnostic model which is optimized against atmospheric observations. For the present study, we replaced the simple model with fluxes generated by an advanced bottom-up process model, Biome-BGC, which uses state-of-the-art algorithms to resolve plant-physiological processes, and 'grow' a biosphere based on biogeochemical conditions and climate history. This approach provides a more realistic description of biomass and nutrient pools than is the case for the simple model. The process model ingests various remote sensing data sources as well as high-resolution reanalysis meteorology, and can be trained against biometric inventories and eddy-covariance data. Linking the bottom-up flux fields to the atmospheric CO2 concentrations through the transport module allows evaluating the spatial representativeness of the BGC flux fields, and in that way assimilates more of the available information than either of the individual modeling techniques alone

  14. [Image fusion in medical radiology].

    PubMed

    Burger, C

    1996-07-20

    Image fusion supports the correlation between images of two or more studies of the same organ. First, the effect of differing geometries during image acquisitions, such as a head tilt, is compensated for. As a consequence, congruent images can easily be obtained. Instead of merely putting them side by side in a static manner and burdening the radiologist with the whole correlation task, image fusion supports him with interactive visualization techniques. This is especially worthwhile for small lesions as they can be more precisely located. Image fusion is feasible today. Easy and robust techniques are readily available, and furthermore DICOM, a rapidly evolving data exchange standard, diminishes the once severe compatibility problems for image data originating from systems of different manufacturers. However, the current solutions for image fusion are not yet established enough for a high throughput of fusion studies. Thus, for the time being image fusion is most appropriately confined to clinical research studies.

  15. Comparison of clinical efficacy in epidural steroid injections through transforaminal or parasagittal approaches.

    PubMed

    Hong, Ji Hee; Park, Eun Kyul; Park, Ki Bum; Park, Ji Hoon; Jung, Sung Won

    2017-07-01

    The transforaminal (TF) epidural steroid injection (ESI) is suggested as more effective than the interlaminar (IL) route due to higher delivery of medication at the anterior epidural space. However, serious complications such as spinal cord injury and permanent neural injury have been reported. The purpose of this study is to evaluate and compare the clinical effectiveness, technical ease, and safety of the TF and parasagittal IL (PIL) ESI. A total of 72 patients were randomized to either the PIL group (n = 41) or the TF group (n = 31) under fluoroscopic guidance. Patients were evaluated for effective pain relief by the numerical rating scale (NRS) and Oswestry Disability Index (ODI) (%) before and 2 weeks after the ESI. The presence of concordant paresthesia, anterior epidural spread, total procedure time, and exposed radiation dose were also evaluated. Both the PIL and TF approach produced similar clinically significant improvements in pain and level of disability. Among the 72 patients, 27 PIL (66%) and 20 TF (64%) patients showed concordant paresthesia while 14 (34%) and 11 (36%) patients in the same respective order showed disconcordant or no paresthesia. Radiation dose and total procedure time required were compared; the PIL group showed a significantly lower radiation dose (30.2 ± 12 vs. 80.8 ± 26.8 [Cgy/cm(2)]) and shorter procedure time (96.2 ± 31 vs. 141.6 ± 30 seconds). ESI under fluoroscopic guidance with PIL or TF approach were effective in reducing the NRS and ODI. PIL ESI was a technically easier and simple method compared to TF ESI.

  16. Comparison of clinical efficacy in epidural steroid injections through transforaminal or parasagittal approaches

    PubMed Central

    Park, Eun Kyul; Park, Ki Bum; Park, Ji Hoon; Jung, Sung Won

    2017-01-01

    Background The transforaminal (TF) epidural steroid injection (ESI) is suggested as more effective than the interlaminar (IL) route due to higher delivery of medication at the anterior epidural space. However, serious complications such as spinal cord injury and permanent neural injury have been reported. The purpose of this study is to evaluate and compare the clinical effectiveness, technical ease, and safety of the TF and parasagittal IL (PIL) ESI. Methods A total of 72 patients were randomized to either the PIL group (n = 41) or the TF group (n = 31) under fluoroscopic guidance. Patients were evaluated for effective pain relief by the numerical rating scale (NRS) and Oswestry Disability Index (ODI) (%) before and 2 weeks after the ESI. The presence of concordant paresthesia, anterior epidural spread, total procedure time, and exposed radiation dose were also evaluated. Results Both the PIL and TF approach produced similar clinically significant improvements in pain and level of disability. Among the 72 patients, 27 PIL (66%) and 20 TF (64%) patients showed concordant paresthesia while 14 (34%) and 11 (36%) patients in the same respective order showed disconcordant or no paresthesia. Radiation dose and total procedure time required were compared; the PIL group showed a significantly lower radiation dose (30.2 ± 12 vs. 80.8 ± 26.8 [Cgy/cm2]) and shorter procedure time (96.2 ± 31 vs. 141.6 ± 30 seconds). Conclusions ESI under fluoroscopic guidance with PIL or TF approach were effective in reducing the NRS and ODI. PIL ESI was a technically easier and simple method compared to TF ESI. PMID:28757923

  17. The role of transforaminal percutaneous endoscopic discectomy in lumbar disc herniations

    PubMed Central

    Gotecha, Sarang; Ranade, Deepak; Patil, Sujay Vikhe; Chugh, Ashish; Kotecha, Megha; Sharma, Shrikant; Punia, Prashant

    2016-01-01

    Objectives: To study 1)the efficacy of transforaminal percutaneous endoscopic lumbar discectomy in lumbar disc herniations.2) limitations and advantages of the surgical procedure. 3)morbidity and complications associated with the procedure. Materials and Methods: This study was carried out on 120 patients who had single level herniated disc Pre-operative assessment of VAS and MSS scoring systems were documented one day prior to surgery. Post operative results were determined by MacNab criteria and by modified Suezawa and Schreiber clinical scoring system (MSS score). Results: Maximum patients were in the age group of 31 to 40 years and 83.43% of the patients were males. 80% patients had lumbar disc herniation at L4-L5 level, The mean operative time of endoscopic discectomy was 52.28 minutes and the mean hospital stay was 2.1days.8 cases of L5-S I were abandoned due to high iliac bone and hence their disc could not be accessed. Out of 112 patients who underwent operation, 2 patients developed discitis and 1 was found to have dysesthesia. Also recurrent prolapsed intervertebral disc was seen in 6 cases The mean preoperative and 6 months follow-up VAS score was 8.4 and 1.89 respectively. Mean preoperative and 6 months follow-up Modified Suezawa And Schreiber Clinical Scoring System(MSS Score) was 3.47 and 7.92 respectively. MSS score showed excellent and good outcome in 82.12% patients and Modified Macnab Criteria showed excellent and good outcome in 89.3% patients at 6months follow-up. Conclusion: TPELD can be a reasonable alternative to conventional microscopic discectomy for the treatment of patients with LDH. We also conclude that TPELD is not an effective procedure for L5-S 1 disc and an open procedure should be opted for better outcomes. PMID:27891030

  18. Fusion breeder

    SciTech Connect

    Moir, R.W.

    1982-04-20

    The fusion breeder is a fusion reactor designed with special blankets to maximize the transmutation by 14 MeV neutrons of uranium-238 to plutonium or thorium to uranium-233 for use as a fuel for fission reactors. Breeding fissile fuels has not been a goal of the US fusion energy program. This paper suggests it is time for a policy change to make the fusion breeder a goal of the US fusion program and the US nuclear energy program. The purpose of this paper is to suggest this policy change be made and tell why it should be made, and to outline specific research and development goals so that the fusion breeder will be developed in time to meet fissile fuel needs.

  19. Fusion breeder

    SciTech Connect

    Moir, R.W.

    1982-02-22

    The fusion breeder is a fusion reactor designed with special blankets to maximize the transmutation by 14 MeV neutrons of uranium-238 to plutonium or thorium to uranium-233 for use as a fuel for fission reactors. Breeding fissile fuels has not been a goal of the US fusion energy program. This paper suggests it is time for a policy change to make the fusion breeder a goal of the US fusion program and the US nuclear energy program. The purpose of this paper is to suggest this policy change be made and tell why it should be made, and to outline specific research and development goals so that the fusion breeder will be developed in time to meet fissile fuel needs.

  20. Microstructural changes in compressed nerve roots treated by percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation

    PubMed Central

    Wu, Weifei; Liang, Jie; Chen, Ying; Chen, Aihua; Wu, Bin; Yang, Zong

    2016-01-01

    Abstract To investigate the microstructural changes in compressed nerves using diffusion tensor imaging (DTI) of herniated disc treated with percutaneous transforaminal endoscopic discectomy. Diffusion tensor imaging has been widely used to visualize peripheral nerves, and the microstructure of compressed nerve roots can be assessed using DTI. However, the microstructural changes after surgery are not well-understood in patients with lumbar disc herniation. Thirty-four consecutive patients with foraminal disc herniation affecting unilateral sacral 1 (S1) nerve roots were enrolled in this study. DTI with tractography was performed on S1 nerve roots before and after surgery. The mean fractional anisotropy (FA) and apparent diffusion coefficient values were calculated from tractography images. In compressed nerve roots, the FA value before surgery was significantly lower than that after surgery (P = 0.000). A significant difference in FA values was found between the compressed and normal sides before surgery (P = 0.000). However, no significant difference was found between the compressed and normal sides after surgery (P = 0.057). A significant difference in apparent diffusion coefficient values was found before and after surgery at the compressed side (P = 0.023). However, no significant difference was found between the compressed and normal sides after surgery (P = 0.203). We show that the diffusion parameters of compressed nerve roots were not significantly different before and after percutaneous transforaminal endoscopic discectomy, indicating that the microstructure of the nerve root recovered after surgery. PMID:27749591

  1. [Evaluation of the efficacy of CT-guided epidural and transforaminal steroid injections in patients with diskogenic radiculopathy].

    PubMed

    Riboud, C; Lerais, J M; Sailley, N; Kastler, B

    2008-06-01

    To evaluate the efficacy of CT-guided epidural and transforaminal steroid injections in patients with diskogenic radiculopathy. Seventy patients underwent CT guided injections after failure of medical management. Only patients with minimal degenerative changes and diskogenic monoradicular symptoms were treated. Only two patients with fibrosis were included. 78.6% of patients experienced persistent symptomatic improvement. No difference was noted between lumbar segments and there was no more failures with epidural injections compared to transforaminal injections. Cervical disk herniations responded better than lumbar disk herniations. Good results were obtained in younger patients (M=46.25 years), symptomatic for 3-4 months or less, and with clear radicular symptoms and clinical neurological deficits (hypoesthesia, absent DTR) without motor deficit. No patient with severe spinal stenosis (S-) was included and the disk herniations were small (b1, b2, c1, c2 or d1, d2). Only a single injection was needed. Cortivazol provided superior results compared to dexamethasone. CT-guided injections should be included in the therapeutic armamentarium after standard medical management, with cure as the goal.

  2. Comparison of Incidences of Intravascular Injection between Medial and Lateral Side Approaches during Traditional S1 Transforaminal Epidural Steroid Injection.

    PubMed

    Park, Sang Jun; Kim, Shin Hyung; Kim, Seon Ju; Yoon, Duck Mi; Yoon, Kyung Bong

    2017-01-01

    Purpose. Intravascular injection rates are higher during traditional S1 transforaminal epidural steroid injection (TFESI) compared with lumbar transforaminal injection. We compared the incidences of intravascular injection between the medial and lateral approaches to the S1 foramen during S1 TFESI. Materials and Methods. A total of 139 patients underwent one or more TFESIs (170 total injections). The patients received S1 TFESI by either medial or lateral side of S1 foramen under fluoroscopic anteroposterior view using digital subtraction method. The intravascular injection rates, epidural spread patterns, and contrast volumes required to reach the superior aspect of the L5-S1 intervertebral disc (SIVD) were compared between groups. Results. Intravascular injection rates during S1 TFESI were significantly lower in the medial approach compared with the lateral approach patients (4.9% versus 38.6%, resp., P < 0.001). The medial approach group had more epidural spread to the L5-S1 SIVD than the lateral group (82.1% versus 58.8%, resp.); lower contrast volume amounts were required to extend the L5-S1 SIVD (1.46 ± 0.48 versus 1.90 ± 0.62, resp.). Conclusion. During S1 TFESI, approaching the needle towards the medial part of the S1 foramen may reduce intravascular injection risk.

  3. Clinical and radiological evaluation of Trabecular Metal and the Smith-Robinson technique in anterior cervical fusion for degenerative disease: a prospective, randomized, controlled study with 2-year follow-up.

    PubMed

    Löfgren, Håkan; Engquist, M; Hoffmann, P; Sigstedt, B; Vavruch, L

    2010-03-01

    ), respectively (P = 0.001). The patients' global assessments of their neck and arm symptoms 2 years postoperatively for the TM group were rated as 79% much better or better after fusion with TM and 75% using autograft. Pain scores and NDI scores were significantly improved in both groups when compared with baseline at all follow-ups, except for neck pain at 1 year for the TM group. There was no statistically significant difference in clinical outcomes between fusion techniques or between patients who appeared radiologically fused or non-fused. There was no difference in pelvic/hip pain between patients operated on with or without autograft. In our study, Trabecular Metal showed a lower fusion rate than the Smith-Robinson technique with autograft after single-level anterior cervical fusion without plating. There was no difference in clinical outcomes between the groups. The operative time was shorter with Trabecular Metal implants.

  4. Posterior spinal fusion for adolescent idiopathic scoliosis using a convex pedicle screw technique: a novel concept of deformity correction.

    PubMed

    Tsirikos, A I; Mataliotakis, G; Bounakis, N

    2017-08-01

    We present the results of correcting a double or triple curve adolescent idiopathic scoliosis using a convex segmental pedicle screw technique. We reviewed 191 patients with a mean age at surgery of 15 years (11 to 23.3). Pedicle screws were placed at the convexity of each curve. Concave screws were inserted at one or two cephalad levels and two caudal levels. The mean operating time was 183 minutes (132 to 276) and the mean blood loss 0.22% of the total blood volume (0.08% to 0.4%). Multimodal monitoring remained stable throughout the operation. The mean hospital stay was 6.8 days (5 to 15). The mean post-operative follow-up was 5.8 years (2.5 to 9.5). There were no neurological complications, deep wound infection, obvious nonunion or need for revision surgery. Upper thoracic scoliosis was corrected by a mean 68.2% (38% to 48%, p < 0.001). Main thoracic scoliosis was corrected by a mean 71% (43.5% to 8.9%, p < 0.001). Lumbar scoliosis was corrected by a mean 72.3% (41% to 90%, p < 0.001). No patient lost more than 3° of correction at follow-up. The thoracic kyphosis improved by 13.1° (-21° to 49°, p < 0.001); the lumbar lordosis remained unchanged (p = 0.58). Coronal imbalance was corrected by a mean 98% (0% to 100%, p < 0.001). Sagittal imbalance was corrected by a mean 96% (20% to 100%, p < 0.001). The Scoliosis Research Society Outcomes Questionnaire score improved from a mean 3.6 to 4.6 (2.4 to 4, p < 0.001); patient satisfaction was a mean 4.9 (4.8 to 5). This technique carries low neurological and vascular risks because the screws are placed in the pedicles of the convex side of the curve, away from the spinal cord, cauda equina and the aorta. A low implant density (pedicle screw density 1.2, when a density of 2 represents placement of pedicle screws bilaterally at every instrumented segment) achieved satisfactory correction of the scoliosis, an improved thoracic kyphosis and normal global sagittal balance. Both patient satisfaction and functional

  5. "Polarized" Fusion

    NASA Astrophysics Data System (ADS)

    Schieck, Hans Paetz Gen.

    Increasing energy demand in view of limited supply, as well as environmental and nuclear-safety concerns leading to increased emphasis on renewable energy sources such as solar or wind energy are expected to focus public and scientific interest increasingly also on fusion energy. With the decision to build ITER (low-density magnetic confinement) and also continuing research on (high-density) inertial-confinement fusion (cf. the inauguration of the laser fusion facility at the Lawrence Livermore National Laboratory) prospects of fusion energy have probably entered a new era.

  6. Cervical anterior hybrid technique with bi-level Bryan artificial disc replacement and adjacent segment fusion for cervical myelopathy over three consecutive segments.

    PubMed

    Chen, Jiang; Xu, Lin; Jia, Yu-Song; Sun, Qi; Li, Jin-Yu; Zheng, Chen-Ying; Bai, Chun-Xiao; Yu, Qin-Sheng

    2016-05-01

    This study aimed to assess the preliminary clinical efficacy and feasibility of the hybrid technique for multilevel cervical myelopathy. Considering the many shortcomings of traditional treatment methods for multilevel cervical degenerative myelopathy, hybrid surgery (bi-level Bryan artificial disc [Medtronic Sofamor Danek, Memphis, TN, USA] replacement and anterior cervical discectomy and fusion) should be considered. Between March 2006 and November 2012, 108 patients (68 men and 40 women, average age 45years) underwent hybrid surgery. Based on the Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Odom's criteria, the clinical symptoms and neurological function before and after surgery were evaluated. Mean surgery duration was 90minutes, with average blood loss of 30mL. Mean follow-up duration was 36months. At the final follow-up, the mean JOA (± standard deviation) scores were significantly higher compared with preoperative values (15.08±1.47 versus 9.18±1.22; P<0.01); meanwhile, NDI values were markedly decreased (12.32±1.03 versus 42.68±1.83; P<0.01). Using Odom's criteria, the clinical outcomes were rated as excellent (76 patients), good (22 patients), fair (six patients), and poor (four patients). These findings indicate that the hybrid method provides an effective treatment for cervical myelopathy over three consecutive segments, ensuring a good clinical outcome. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Plasma fusion and cold fusion

    SciTech Connect

    Hideo, Kozima

    1996-12-31

    Fundamental problems of plasma fusion (controlled thermonuclear fusion) due to the contradicting demands of the magnetic confinement of plasma and suppression of instabilities occurring on and in plasma are surveyed in contrast with problems of cold fusion. Problems in cold fusion due to the complicated constituents and types of force are explained. Typical cold fusion events are explained by a model based on the presence of trapped neutrons in cold fusion materials. The events include Pons-Fleishmann effect, tritium anomaly, helium 4 production, and nuclear transmutation. Fundamental hypothesis of the model is an effectiveness of a new concept--neutron affinity of elements. The neutron affinity is defined and some bases supporting it are explained. Possible justification of the concept by statistical approach is given.

  8. Cellulose binding domain fusion proteins

    DOEpatents

    Shoseyov, O.; Yosef, K.; Shpiegl, I.; Goldstein, M.A.; Doi, R.H.

    1998-02-17

    A cellulose binding domain (CBD) having a high affinity for crystalline cellulose and chitin is disclosed, along with methods for the molecular cloning and recombinant production. Fusion products comprising the CBD and a second protein are likewise described. A wide range of applications are contemplated for both the CBD and the fusion products, including drug delivery, affinity separations, and diagnostic techniques. 16 figs.

  9. Cellulose binding domain fusion proteins

    SciTech Connect

    Shoseyov, Oded; Shpiegl, Itai; Goldstein, Marc A.; Doi, Roy H.

    1998-01-01

    A cellulose binding domain (CBD) having a high affinity for crystalline cellulose and chitin is disclosed, along with methods for the molecular cloning and recombinant production thereof. Fusion products comprising the CBD and a second protein are likewise described. A wide range of applications are contemplated for both the CBD and the fusion products, including drug delivery, affinity separations, and diagnostic techniques.

  10. Image fusion

    NASA Technical Reports Server (NTRS)

    Pavel, M.

    1993-01-01

    The topics covered include the following: a system overview of the basic components of a system designed to improve the ability of a pilot to fly through low-visibility conditions such as fog; the role of visual sciences; fusion issues; sensor characterization; sources of information; image processing; and image fusion.

  11. Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis.

    PubMed

    Schröder, Marc L; Staartjes, Victor E

    2017-05-01

    OBJECTIVE The accuracy of robot-guided pedicle screw placement has been proven to be high, but little is known about the impact of such guidance on clinical outcomes such as the rate of revision surgeries for screw malposition. In addition, there are very few data about the impact of robot-guided fusion on patient-reported outcomes (PROs). Thus, the clinical benefit for the patient is unclear. In this study, the authors analyzed revision rates for screw malposition and changes in PROs following minimally invasive robot-guided pedicle screw fixation. METHODS A retrospective cohort study of patients who had undergone minimally invasive posterior lumbar interbody fusion (MI-PLIF) or minimally invasive transforaminal lumbar interbody fusion was performed. Patients were followed up clinically at 6 weeks, 12 months, and 24 months after treatment and by mailed questionnaire in March 2016 as a final follow-up. Visual analog scale (VAS) scores for back and leg pain severity, Oswestry Disability Index (ODI), screw revisions, and socio-demographic factors were analyzed. A literature review was performed, comparing the incidence of intraoperative screw revisions and revision surgery for screw malposition in robot-guided, navigated, and freehand fusion procedures. RESULTS Seventy-two patients fit the study inclusion criteria and had a mean follow up of 32 ± 17 months. No screws had to be revised intraoperatively, and no revision surgery for screw malposition was needed. In the literature review, the authors found a higher rate of intraoperative screw revisions in the navigated pool than in the robot-guided pool (p < 0.001, OR 9.7). Additionally, a higher incidence of revision surgery for screw malposition was observed for freehand procedures than for the robot-guided procedures (p < 0.001, OR 8.1). The VAS score for back pain improved significantly from 66.9 ± 25.0 preoperatively to 30.1 ± 26.8 at the final follow-up, as did the VAS score for leg pain (from 70.6 ± 22.8 to

  12. Biomechanical advantages of robot-assisted pedicle screw fixation in posterior lumbar interbody fusion compared with freehand technique in a prospective randomized controlled trial-perspective for patient-specific finite element analysis.

    PubMed

    Kim, Ho-Joong; Kang, Kyoung-Tak; Park, Sung-Cheol; Kwon, Oh-Hyo; Son, Juhyun; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S; Lenke, Lawrence G

    2017-05-01

    There have been conflicting results on the surgical outcome of lumbar fusion surgery using two different techniques: robot-assisted pedicle screw fixation and conventional freehand technique. In addition, there have been no studies about the biomechanical issues between both techniques. This study aimed to investigate the biomechanical properties in terms of stress at adjacent segments using robot-assisted pedicle screw insertion technique (robot-assisted, minimally invasive posterior lumbar interbody fusion, Rom-PLIF) and freehand technique (conventional, freehand, open approach, posterior lumbar interbody fusion, Cop-PLIF) for instrumented lumbar fusion surgery. This is an additional post-hoc analysis for patient-specific finite element (FE) model. The sample is composed of patients with degenerative lumbar disease. Intradiscal pressure and facet contact force are the outcome measures. Patients were randomly assigned to undergo an instrumented PLIF procedure using a Rom-PLIF (37 patients) or a Cop-PLIF (41), respectively. Five patients in each group were selected using a simple random sampling method after operation, and 10 preoperative and postoperative lumbar spines were modeled from preoperative high-resolution computed tomography of 10 patients using the same method for a validated lumbar spine model. Under four pure moments of 7.5 Nm, the changes in intradiscal pressure and facet joint contact force at the proximal adjacent segment following fusion surgery were analyzed and compared with preoperative states. The representativeness of random samples was verified. Both groups showed significant increases in postoperative intradiscal pressure at the proximal adjacent segment under four moments, compared with the preoperative state. The Cop-PLIF models demonstrated significantly higher percent increments of intradiscal pressure at proximal adjacent segments under extension, lateral bending, and torsion moments than the Rom-PLIF models (p=.032, p=.008, and p

  13. Puncture Reduction in Percutaneous Transforaminal Endoscopic Discectomy with HE's Lumbar LOcation (HELLO) System: A Cadaver Study.

    PubMed

    Fan, Guoxin; Guan, Xiaofei; Sun, Qi; Hu, Annan; Zhu, Yanjie; Gu, Guangfei; Zhang, Hailong; He, Shisheng

    2015-01-01

    Percutaneous transforaminal endoscopic discectomy (PTED) usually requires numerous punctures under X-ray fluoroscopy. Repeated puncture will lead to more radiation exposure and reduce the beginners' confidence. This cadaver study aimed to investigate the efficacy of HE's Lumbar Location (HELLO) system in puncture reduction of PTED. Cadaver study. Comparative groups. HELLO system consists of self-made surface locator and puncture locator. One senior surgeon conducted the puncture procedure of PTED on the left side of 20 cadavers at L4/L5 and L5/S1 level with the assistance of HELLO system (Group A). Additionally, the senior surgeon conducted the puncture procedure of PTED on the right side of the cadavers at L4/L5 and L5/S1 level with traditional methods (Group B). On the other hand, an inexperienced surgeon conducted the puncture procedure of PTED on the left side of the cadavers at L4/L5 and L5/S1 level with the assistance of our HELLO system (Group C). At L4/L5 level, there was significant difference in puncture times between Group A and Group B (P<0.001), but no significant difference was observed between Group A and Group C (P = 0.811). Similarly at L5/S1 level, there was significant difference in puncture times between Group A and Group B (P<0.001), but no significant difference was observed between Group A and Group C (P = 0.981). At L4/L5 level, there was significant difference in fluoroscopy time between Group A and Group B (P<0.001), but no significant difference was observed between Group A and Group C (P = 0.290). Similarly at L5/S1 level, there was significant difference in fluoroscopy time between Group A and Group B (P<0.001), but no significant difference was observed between Group A and Group C (P = 0.523). As for radiation exposure, HELLO system reduced 39%-45% radiation dosage when comparing Group A and Group B, but there was no significant difference in radiation exposure between Group A and Group C whatever at L4/L5 level or L5/S1 level (P>0

  14. Kinetic advantage of controlled intermediate nuclear fusion

    SciTech Connect

    Guo Xiaoming

    2012-09-26

    The dominated process of controlled fusion is to let nuclei gain enough kinetic energy to overcome Coulomb barrier. As a result, a fusion scheme can consider two factors in its design: to increase kinetic energy of nuclei and to alter the Coulomb barrier. Cold Fusion and Hot fusion are all one-factor schemes while Intermediate Fusion is a twofactors scheme. This made CINF kinetically superior. Cold Fusion reduces deuteron-deuteron distance, addressing Coulomb barrier, and Hot Fusion heat up plasma into extreme high temperature, addressing kinetic energy. Without enough kinetic energy made Cold Fusion skeptical. Extreme high temperature made Hot Fusion very difficult to engineer. Because CIFN addresses both factors, CIFN is a more promising technique to be industrialized.

  15. Kinetic advantage of controlled intermediate nuclear fusion

    NASA Astrophysics Data System (ADS)

    Guo, Xiaoming

    2012-09-01

    The dominated process of controlled fusion is to let nuclei gain enough kinetic energy to overcome Coulomb barrier. As a result, a fusion scheme can consider two factors in its design: to increase kinetic energy of nuclei and to alter the Coulomb barrier. Cold Fusion and Hot fusion are all one-factor schemes while Intermediate Fusion is a twofactors scheme. This made CINF kinetically superior. Cold Fusion reduces deuteron-deuteron distance, addressing Coulomb barrier, and Hot Fusion heat up plasma into extreme high temperature, addressing kinetic energy. Without enough kinetic energy made Cold Fusion skeptical. Extreme high temperature made Hot Fusion very difficult to engineer. Because CIFN addresses both factors, CIFN is a more promising technique to be industrialized.

  16. Ultrastructural Analysis of Myoblast Fusion in Drosophila

    PubMed Central

    Zhang, Shiliang; Chen, Elizabeth H.

    2015-01-01

    Summary Myoblast fusion in Drosophila has become a powerful genetic system with which to unravel the mechanisms underlying cell fusion. The identification of important components of myoblast fusion by genetic analysis has led to a molecular pathway toward our understanding of this cellular process. In addition to the application of immunohistochemistry and live imaging techniques to visualize myoblast fusion at the light microscopic level, ultrastructural analysis using electron microscopy remains an indispensable tool to reveal fusion intermediates and specific membrane events at sites of fusion. In this chapter, we describe conventional chemical fixation and high-pressure freezing/freeze substitution methods for visualizing fusion intermediates during Drosophila myoblast fusion. Furthermore, we describe an immunoelectron microscopic method for localizing specific proteins relative to the fusion apparatus. PMID:18979250

  17. Comparison of 3 fusion techniques in the treatment of the degenerative cervical spine disease. Is stand-alone autograft really the "gold standard?": prospective study with 2-year follow-up.

    PubMed

    Vanek, Petr; Bradac, Ondrej; DeLacy, Patricia; Saur, Karel; Belsan, Tomas; Benes, Vladimir

    2012-09-01

    A prospective study. The aim of this study was to compare the 3 different methods of interbody fusion of the cervical spine-autograft in stand-alone technique, autograft with anterior plate, and polyetheretherketone cage supported by anterior plate. The clinical and radiological data obtained were analyzed and discussed. Although degenerative cervical spine disease has been treated by an anterior approach for more than 50 years, there is not one generally accepted operative approach. There is a very low-quality evidence of little or no difference in pain relief between each of the techniques. Iliac crest autograft still seems to be the "gold standard" for interbody fusion. Prospective study collecting clinical and radiological data of 81 patients undergoing anterior cervical interbody fusion, in which the interbody fusion of 1 or 2 motion segments from C3 to C7 was done by any of the 3 techniques--stand-alone insertion of autograft (group 1: 28 patients), autograft and anterior plate (group 2: 18 patients), and polyetheretherketone cage filled with beta-tricalcium phosphate and plate (group 3: 29 patients). Patients were followed for 2 years after surgery. Significant interaction of relative height in the segment and time was found (P < 0.001). The values of the relative height of stand-alone autograft dropped below 95% of initial height and the values of the other 2 groups remained above 105%. Significant interaction of time and group was found for Cobb S angles (P < 0.001). Values of group 1 decreased substantially and remained significantly lower than values of other 2 groups. Fusion rate was 100% in all groups. Neck Disability Index group and time interaction was found (P = 0.023). During postoperative follow-up, group 1 scored in all controls higher than the other 2 groups, but differences were not significant. Visual analogue scale showed effect of time (P < 0.001). This was due to a smaller improvement of patients in group 1 during the whole follow-up in

  18. Possible in-lattice confinement fusion (LCF)

    SciTech Connect

    Kawarasaki, Y.

    1996-05-01

    New scheme of a nuclear fusion reactor system is proposed, the basic concept of which comes from ingenious combination of hitherto developed techniques and verified facts; (1) so-called cold fusion (CF), (2) plasma of both magnetic confinement fusion (MCF) and inertial confinement fusion (ICF), and (3) accelerator-based D-T (D) neutron source. Through the comparison of the characteristics among ICF, LCF, and MCF, the feasibility of the LCFs is discussed. {copyright} {ital 1996 American Institute of Physics.}

  19. CT navigated lateral interbody fusion.

    PubMed

    Drazin, Doniel; Liu, John C; Acosta, Frank L

    2013-10-01

    Lateral interbody fusion techniques are heavily reliant on fluoroscopy for retractor docking and graft placement, which expose both the patient and surgeon to high doses of radiation. Use of image-guided technologies with CT-based images, however, can eliminate this radiation exposure for the surgeon. We describe the surgical technique of performing lateral lumbar interbody fusion using CT navigation. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Hemorrhagic lumbar synovial facet cyst secondary to transforaminal epidural injection: A case report and review of the literature

    PubMed Central

    Elgafy, Hossein; Peters, Nicholas; Lea, Justin E; Wetzel, Robert M

    2016-01-01

    A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection (ESI). Magnetic resonance imaging revealed left side L5-S1 large extradural heterogeneous mass with layering areas suggesting different stages of hematoma formation. Past medical history was significant for peripheral vascular disease and transient ischemic attacks, for which she took aspirin and clopidogrel (antiplatelet agent). These medications were discontinued one week prior to ESI. Although synovial cysts associated with facet arthropathy are common, hemorrhagic cyst is not. To the best of the authors’ knowledge, this is the first reported case of symptomatic hemorrhagic lumbar facet synovial cyst following ESI on a patient taking anti-platelet medications. PMID:27458557

  1. Fusion Power.

    ERIC Educational Resources Information Center

    Dingee, David A.

    1979-01-01

    Discusses the extraordinary potential, the technical difficulties, and the financial problems that are associated with research and development of fusion power plants as a major source of energy. (GA)

  2. Fusion Power.

    ERIC Educational Resources Information Center

    Dingee, David A.

    1979-01-01

    Discusses the extraordinary potential, the technical difficulties, and the financial problems that are associated with research and development of fusion power plants as a major source of energy. (GA)

  3. Physics of Fusion Welding

    NASA Technical Reports Server (NTRS)

    Nunes, A. C., Jr.

    1986-01-01

    Applicabilities and limitations of three techniques analyzed. NASA technical memorandum discusses physics of electron-beam, gas/ tungsten-arc, and laser-beam welding. From comparison of capabilities and limitations of each technique with regard to various welding conditions and materials, possible to develop criteria for selecting best welding technique in specific application. All three techniques classified as fusion welding; small volume of workpiece melted by intense heat source. Heat source moved along seam, leaving in wake solid metal that joins seam edges together.

  4. Physics of Fusion Welding

    NASA Technical Reports Server (NTRS)

    Nunes, A. C., Jr.

    1986-01-01

    Applicabilities and limitations of three techniques analyzed. NASA technical memorandum discusses physics of electron-beam, gas/ tungsten-arc, and laser-beam welding. From comparison of capabilities and limitations of each technique with regard to various welding conditions and materials, possible to develop criteria for selecting best welding technique in specific application. All three techniques classified as fusion welding; small volume of workpiece melted by intense heat source. Heat source moved along seam, leaving in wake solid metal that joins seam edges together.

  5. A Preliminary Report on the CO2 Laser for Lumbar Fusion: Safety, Efficacy and Technical Considerations.

    PubMed

    Villavicencio, Alan T; Burneikiene, Sigita; Babuska, Jason M; Nelson, Ewell L; Mason, Alexander; Rajpal, Sharad

    2015-04-01

    The purpose of this study was to evaluate potential technical advantages of the CO2 laser technology in mini-open transforaminal lumbar interbody fusion (TLIF) surgeries and report our preliminary clinical data on the safety and clinical outcomes. There is currently no literature discussing the recently redeveloped CO2 laser technology application for lumbar fusion. Safety and clinical outcomes were compared between two groups: 24 patients that underwent CO2 laser-assisted one-level TLIF surgeries and 30 patients that underwent standard one-level TLIF surgeries without the laser. There were no neural thermal injuries or other intraoperative laser-related complications encountered in this cohort of patients. At a mean follow-up of 17.4 months, significantly reduced lower back pain scores (P=0.013) were reported in the laser-assisted patient group compared to a standard fusion patient group. Lower extremity radicular pain intensity scores were similar in both groups. Laser-assisted TLIF surgeries showed a tendency (P = 0.07) of shorter operative times that was not statistically significant. Based on this preliminary clinical report, the safety of the CO2 laser device for lumbar fusion surgeries was assessed. There were no neural thermal injuries or other intraoperative laser-related complications encountered in this cohort of patients. Further investigation of CO2 laser-assisted lumbar fusion procedures is warranted in order to evaluate its effect on clinical outcomes.

  6. Radiologic assessment of spinal fusion.

    PubMed

    Selby, Michael Derrick; Clark, Simon Richard; Hall, David John; Freeman, Brian J C

    2012-11-01

    Since surgical fusion of the spine was first described in 1911, multiple methods have been used to assess it. Although open surgical exploration remains the standard of care for determination of fusion, it is impractical in most clinical situations. Static radiographs have long been used as a practical method of fusion assessment, but they tend to significantly overestimate the presence of a solid fusion. Dynamic radiographs improve accuracy but limitations include measurement reliability, disagreement on allowable motion, and the two-dimensional nature of radiographs. Ultimately, lack of movement at a fused segment does not confirm fusion. Radiostereometric analysis further improves accuracy; however, methodological demands make it largely impractical for routine use. CT is now widely accepted as the standard for noninvasive assessment of spinal fusion. Fine-cut imaging, multiplanar reconstruction, and metal artifact reduction have increased the ability to assess fusion on CT. However, significant concerns remain regarding the effects of high radiation exposure. Although MRI is appealing, its utility in assessing fusion remains unproven. Understanding the limitations of each technique allows judicious use of radiology in the assessment of spinal fusion.

  7. Differential Rates of Inadvertent Intravascular Injection during Lumbar Transforaminal Epidural Injections Using Blunt-Tip, Pencil-Point, and Catheter-Extension Needles.

    PubMed

    Smuck, Matthew; Paulus, Stephen; Patel, Ajay; Demirjian, Ryan; Ith, Ma Agnes; Kennedy, David J

    2015-11-01

    To quantify the incidence of inadvertent vascular penetration during lumbosacral transforaminal epidural injections using blunt-tip, pencil-point, and catheter-extension needles. This is a prospective, observational, consecutive cohort study. Two hundred consecutive patients undergoing lumbosacral transforaminal epidural injections at an academic outpatient spine center. Four hundred seventy-five fluoroscopically guided lumbosacral transforaminal epidural injections were performed on consecutively consenting patients by one interventional spine physician, using three different needle types. The presence or absence of vascular uptake was determined during contrast injection under live fluoroscopy. Vascular uptake of contrast was observed in 58 of the total 475 injections, for an overall incidence of 12.2%. By needle type, the incidence of inadvertent vascular uptake was 16.6% (26/157) in the pencil-point group, 15.6% (24/154) in the blunt-tip group, and 4.9% (8/164) in the catheter-extension group. The difference in rates is statistically significant between the catheter-extension needle group and both the pencil-point group (P = 0.0009) and blunt-tip group (P = 0.0024). A secondary analysis was performed to quantify the incidence of functional pitfalls between needle groups, with a significantly lower incidence in the pencil-point group compared to both the catheter-extension (P = 0.0148) and blunt-tip needle (P = 0.0288) groups. Blunt-tip and pencil-point needles have comparable risk of inadvertent vascular injection during lumbosacral transforaminal injections. Catheter-extension needles demonstrated a reduce incidence of vascular uptake, but also result in a significantly higher rate of functional pitfalls that limits their usefulness in routine practice. Wiley Periodicals, Inc.

  8. Clinical effects of computed tomography-guided lumbosacral facet joint, transforaminal epidural, and translaminar epidural injections of methylprednisolone acetate in healthy dogs.

    PubMed

    Liotta, Annalisa P; Girod, Maud; Peeters, Dominique; Sandersen, Charlotte; Couvreur, Thierry; Bolen, Géraldine

    2016-10-01

    OBJECTIVE To determine clinical effects of CT-guided lumbosacral facet joint, transforaminal epidural, and translaminar epidural injections of methylprednisolone acetate in healthy dogs. ANIMALS 15 healthy Beagles. PROCEDURES Dogs were randomly assigned to 3 groups (5 dogs/group) and received a single CT-guided lumbosacral facet joint, transforaminal epidural, or translaminar epidural injection of methylprednisolone acetate (0.1 mg/kg). Contrast medium was injected prior to injection of methylprednisolone to verify needle placement. Neurologic examinations were performed 1, 3, 7, and 10 days after the injection. In dogs with neurologic abnormalities, a final neurologic examination was performed 24 days after the procedure. RESULTS Methylprednisolone injections were successfully performed in 14 of the 15 dogs. In 1 dog, vascular puncture occurred, and the methylprednisolone injection was not performed. No major or minor complications were identified during or immediately after the procedure, other than mild transient hyperthermia. During follow-up neurologic examinations, no motor, sensory, or postural deficits were identified, other than mild alterations in the patellar, withdrawal, cranial tibial, and perineal reflexes in some dogs. Overall, altered reflexes were observed in 11 of the 14 dogs, during 27 of 65 neurologic examinations. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that CT-guided lumbosacral facet joint, transforaminal epidural, and translaminar epidural injections of methylprednisolone acetate were associated with few complications in healthy dogs. However, the number of dogs evaluated was small, and additional studies are needed to assess clinical efficacy and safety of these procedures.

  9. Factors influencing segmental lumbar lordosis after lateral transpsoas interbody fusion.

    PubMed

    Kepler, Christopher K; Huang, Russel C; Sharma, Amit K; Meredith, Dennis S; Metitiri, Ochuko; Sama, Andrew A; Girardi, Federico P; Cammisa, Frank P

    2012-05-01

    Although contributions to sagittal alignment have been characterized for anterior, posterior and transforaminal lumbar interbody fusion, sagittal alignment after lateral transpsoas interbody fusion (LTIF) has not yet been characterized. This study examined the ability of LTIF to restore lumbar lordosis and identified factors associated with change in sagittal alignment. Twenty-nine patients and 67 levels were studied. Segmental lordosis, anterior-posterior cage position, and cage obliquity were measured on preoperative and postoperative radiographs and CT scans. Change in sagittal alignment was analyzed with respect to demographic information and measures of cage position and obliquity to identify factors associated with segmental alignment change. Mean lordosis increased 3.7° at instrumented segments, increasing from 4.1° preoperatively to 7.8° postoperatively. Although increases at each level were significant, there were no significant differences between levels. Lordosis increase was inversely-associated with preoperative lordosis; levels with the least preoperative lordosis gained the most lordosis. Cage obliquity and height were not significantly associated with lordosis change. Anterior cage placement resulted in the largest lordosis gain (+7.4°/level) while posterior placement was prokyphotic (-1.2°/level). There were no significant associations with age, sex or body mass index. Anteroposterior cage placement is an important intraoperative determinant of postoperative alignment; anterior placement results in greater lordosis while middle/posterior placement has a minimal effect on sagittal alignment. © 2012 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

  10. Observations of membrane fusion in a liposome dispersion: the missing fusion intermediate?

    PubMed Central

    Foldvari, Marianna

    2015-01-01

    Early intermediate structures of liposome-liposome fusion events were captured by freeze-fracture electron microscopic (EM) technique. The images show the morphology of the fusion interface at several different stages of the fusion event. One of the intermediates was captured at a serendipitous stage of two vesicles’ membranes (both leaflets) merging and their contents starting to intermix clearly showing the fusion interface with a previously unseen fusion rim. From the morphological information a hypothetical sequence of the fusion event and corresponding lipid structural arrangements are described. PMID:26069726

  11. Laser fusion

    SciTech Connect

    Smit, W.A.; Boskma, P.

    1980-12-01

    Unrestricted laser fusion offers nations an opportunity to circumvent arms control agreements and develop thermonuclear weapons. Early laser weapons research sought a clean radiation-free bomb to replace the fission bomb, but this was deceptive because a fission bomb was needed to trigger the fusion reaction and additional radioactivity was induced by generating fast neutrons. As laser-implosion experiments focused on weapons physics, simulating weapons effects, and applications for new weapons, the military interest shifted from developing a laser-ignited hydrogen bomb to more sophisticated weapons and civilian applications for power generation. Civilian and military research now overlap, making it possible for several countries to continue weapons activities and permitting proliferation of nuclear weapons. These countries are reluctant to include inertial confinement fusion research in the Non-Proliferation Treaty. 16 references. (DCK)

  12. What is the optimum fusion technique for adult isthmic spondylolisthesis--PLIF or PLF? A long-term prospective cohort comparison study.

    PubMed

    Cunningham, John Edward; Elling, Elizabeth Mary; Milton, Abul Hasnat; Robertson, Peter Alexander

    2013-07-01

    Long-term prospective observational cohort study. The objective of the study was to compare the long-term functional outcomes of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) for the treatment of adult isthmic spondylolisthesis (IS). PLIF has the theoretical advantage of improving sagittal alignment and providing a larger, more consistent fusion mass in patients with IS compared with PLF. Studies to date though have not shown a clinical difference, with follow-up of 2 years. An prospective cohort study was performed of a single surgeon's patients with IS treated surgically over a 10-year period. Average follow-up was 7 years and 10 months. Preoperative patient characteristics between the 2 groups were not significantly different. The return rate of the long-term questionnaires was 83%. Outcome measures were the Roland Morris Disability Questionnaire (RMDQ), Low Back Outcome Score (LBOS), Short Form (SF)-12v2, and SF-6D R2. PLIF provided better short-term and long-term results than PLF. The PLIF group had significantly better LBOS scores in the long term, and nonsignificantly better RMDQ scores. As measured by the RMDQ Minimal Clinically Important Difference set at 4 and 8, the LBOS Minimal Clinically Important Difference set at 7.5 points and by SF-12v2 Physical Component Score, PLIF patients performed better than PLF patients. When analyzing single-level fusions alone, the difference is more pronounced, with Physical Component Score, Mental Component Scores, and SF-6D R2 all being significantly better in the PLIF group rather than the PLF group. This study strongly supports the use of PLIF to obtain equivalent or superior clinical outcomes compared with PLF for spinal fusion for lumbar IS. Although there are considerable issues when commenting on the results of observational studies, the results of this study are the first to report long-term follow-up beyond 2 years, and further larger long-term randomized studies are suggested.

  13. Use of image registration and fusion algorithms and techniques in radiotherapy: Report of the AAPM Radiation Therapy Committee Task Group No. 132.

    PubMed

    Brock, Kristy K; Mutic, Sasa; McNutt, Todd R; Li, Hua; Kessler, Marc L

    2017-07-01

    Image registration and fusion algorithms exist in almost every software system that creates or uses images in radiotherapy. Most treatment planning systems support some form of image registration and fusion to allow the use of multimodality and time-series image data and even anatomical atlases to assist in target volume and normal tissue delineation. Treatment delivery systems perform registration and fusion between the planning images and the in-room images acquired during the treatment to assist patient positioning. Advanced applications are beginning to support daily dose assessment and enable adaptive radiotherapy using image registration and fusion to propagate contours and accumulate dose between image data taken over the course of therapy to provide up-to-date estimates of anatomical changes and delivered dose. This information aids in the detection of anatomical and functional changes that might elicit changes in the treatment plan or prescription. As the output of the image registration process is always used as the input of another process for planning or delivery, it is important to understand and communicate the uncertainty associated with the software in general and the result of a specific registration. Unfortunately, there is no standard mathematical formalism to perform this for real-world situations where noise, distortion, and complex anatomical variations can occur. Validation of the software systems performance is also complicated by the lack of documentation available from commercial systems leading to use of these systems in undesirable 'black-box' fashion. In view of this situation and the central role that image registration and fusion play in treatment planning and delivery, the Therapy Physics Committee of the American Association of Physicists in Medicine commissioned Task Group 132 to review current approaches and solutions for image registration (both rigid and deformable) in radiotherapy and to provide recommendations for quality

  14. Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature.

    PubMed

    Seaman, Scott; Kerezoudis, Panagiotis; Bydon, Mohamad; Torner, James C; Hitchon, Patrick W

    2017-10-01

    Spinal interbody fusion is a standard and accepted method for spinal fusion. Interbody fusion devices include titanium (Ti) and polyetheretherketone (PEEK) cages with distinct biomechanical properties. Titanium and PEEK cages have been evaluated in the cervical and lumbar spine, with conflicting results in bony fusion and subsidence. Using Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, we reviewed the available literature evaluating Ti and PEEK cages to assess subsidence and fusion rates. Six studies were included in the analysis, 3 of which were class IV evidence, 2 were class III, and 1 was class II. A total of 410 patients (Ti-228, PEEK-182) and 587 levels (Ti-327, PEEK-260) were studied. Pooled mean age was 50.8years in the Ti group, and 53.1years in the PEEK group. Anterior cervical discectomy was performed in 4 studies (395 levels) and transforaminal interbody fusion in 2 studies (192 levels). No statistically significant difference was found between groups with fusion (OR 1.16, 95% C.I 0.59-2.89, p=0.686, I(2)=49.7%) but there was a statistically significant the rate of subsidence with titanium (OR 3.59, 95% C.I 1.28-10.07, p=0.015, I(2)=56.9%) at last follow-up. Titanium and PEEK cages are associated with a similar rate of fusion, but there is an increased rate of subsidence with titanium cage. Future prospective randomized controlled trials are needed to further evaluate these cages using surgical and patient-reported outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Generalized Chernoff Fusion Approximation for Practical Distributed Data Fusion

    DTIC Science & Technology

    2009-07-01

    Generalized Chernoff Fusion Approximation for Practical Distributed Data Fusion William J. Farrell III R&D Department Adaptive Methods , Inc...independence or modify legacy systems with pedigree tagging techniques . Leveraging the well- known Covariance Intersection algorithm, its generalization...Adaptive Methods , Inc.,Centreville, VA , , 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR

  16. Fusion rate following extreme lateral lumbar interbody fusion.

    PubMed

    Berjano, Pedro; Langella, Francesco; Damilano, Marco; Pejrona, Matteo; Buric, Josip; Ismael, Maryem; Villafañe, Jorge Hugo; Lamartina, Claudio

    2015-04-01

    Lumbar fusion has been found to be a clinically effective procedure in adult patients. The lateral transpsoas approach allows for direct visualization of the intervertebral space, significant support of the vertebral anterior column, while avoiding the complications associated with the posterior procedures. The aim of this study is to determine the fusion rate of inter body fusion using computed tomography in patients treated by extreme lateral intersomatic fusion (XLIF) technique. All patients intervened by XLIF procedure between 2009 and 2013 by a single operating team at a single institution were recruited for this study. A clinical evaluation and a CT scan of the involved spinal segments were then performed with at least 1-year follow-up following the standard clinical practice in the center. A total of 77 patients met inclusion criteria, of which 53 were available for review with a mean follow-up of 34.5 (12-62) months. A total of 68 (87.1 %) of the 78 operated levels were considered as completely fused, 8 (10.2 %) were considered as stable, probably fused, and 2 (2.6 %) of the operated levels were diagnosed as pseudarthrosis. When stratified by type of graft material complete fusion was obtained in 75 % of patients in which autograft was used to fill the cages, compared to 89 % of patients in which calcium triphosphate was used, and 83 % of patients in which Attrax™ was used. Reports of XLIF fusion rate in the literature vary from 85 to 93 % at 1-year follow-up. Fusion rate in our series corroborates data from previous publications. The results of this series confirm that anterior inter body fusion by means of XLIF approach is a technique that achieves high fusion rate and satisfactory clinical outcomes.

  17. Anterior Fusion Technique for Multilevel Cervical Spondylotic Myelopathy: A Retrospective Analysis of Surgical Outcome of Patients with Different Number of Levels Fused

    PubMed Central

    Yu, Shunzhi; Li, Fengning; Yan, Ning; Yuan, Chaoqun; He, Shisheng; Hou, Tiesheng

    2014-01-01

    Objective The anterior approach for multilevel CSM has been developed and obtained favorable outcomes. However, the operation difficulty, invasiveness and operative risks increase when multi-level involved. This study was to assess surgical parameters, complications, clinical and radiological outcomes in the treatment of 2-, 3- and 4-level CSM. Methods A total of 248 patients with 2-, 3- or 4-level CSM who underwent anterior decompression and fusion procedures between October 2005 and June 2011 were divided into three groups, the 2-level group (106 patients), the 3-level group (98 patients) and the 4-level group (44 patients). The clinical and Radiographic outcomes including Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI) score, Odom's Scale, hospital stay, blood loss, operation time, fusion rate, cervical lordosis, cervical range of motion (ROM), and complications were compared. Results At a minimum of 2-year follow-up, no statistical differences in JOA score, NDI score, Odom's Scale, hospital stay, fusion rate and cervical lordosis were found among the 3 groups. However, the mean postoperative NDI score of the 4-level group was significantly higher than that in the other two groups (P<0.05), and in terms of postoperative total ROM, the 3-level group was superior to the 4-level group and inferior to 2-level group (P<0.05). The decrease rate of ROM in the 3-level group was significantly higher than that in the 2-level group, and lower than that in the 4-level group (P<0.05). Conclusions As the number of involved levels increased, surgical results become worse in terms of operative time, blood loss, NDI score, cervical ROM and complication rates postoperatively. An appropriate surgical procedure for multilevel CSM should be chosen according to comprehensive clinical evaluation before operation, thus reducing fusion and decompression levels if possible. PMID:24618678

  18. Inertial-confinement-fusion targets

    SciTech Connect

    Hendricks, C.D.

    1981-11-16

    Inertial confinement fusion (ICF) targets are made as simple flat discs, as hollow shells or as complicated multilayer structures. Many techniques have been devised for producing the targets. Glass and metal shells are made by using drop and bubble techniques. Solid hydrogen shells are also produced by adapting old methods to the solution of modern problems. Some of these techniques, problems and solutions are discussed. In addition, the applications of many of the techniques to fabrication of ICF targets is presented.

  19. Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery.

    PubMed

    van Helvoirt, Hans; Apeldoorn, Adri T; Knol, Dirk L; Arts, Mark P; Kamper, Steven J; van Tulder, Maurits W; Ostelo, Raymond W

    2016-04-27

    Prospective cohort study. Although lumbar radiculopathy is regarded as a specific diagnosis, the most effective treatment strategy is unclear. Commonly used treatments include transforaminal epidural steroid injections (TESIs) and Mechanical Diagnosis & Therapy (MDT), but no studies have investigated the effectiveness of this combination. MDT differentiates pain centralization (C) from non-centralization (NC), which indicates good vs. poor prognostic validity respectively. The main aims were 1) to determine changes in Mechanical Diagnosis and Therapy (MDT) pain response classifications after transforaminal epidural steroid injections (TESIs) in candidates for lumbar herniated disc surgery and 2) to evaluate differences in short and long term outcomes for patients with different pain response classifications. Candidates for lumbar herniated disc surgery were assessed with a MDT protocol and their pain response classified as centralizing or peripheralizing. For this study,only patients were eligible who showed a peripheralizing pain response at intake. All patients then received TESIs and were reassessed and classified using the MDT protocol, into groups according to pain response (resolved, centralizing, peripheralizing with less pain and peripheralising with severe pain). After receiving targeted treatment based on pain response after TESIs, ranging from advice, MDT or surgery, follow-up assessments were completed at discharge and at 12 months. The primary outcomes were disability (Roland-Morris Disability Questionnaire [RMDQ] for Sciatica), pain severity in leg (visual analogue scale [VAS], 0-100) and global perceived effect (GPE). Linear mixed-models were used to determine between-groups differences in outcome. A total of 77 patients with lumbar disc herniation and peripheralizing symptoms were included. Patients received an average of 2 (SD 0.7) TESIs. After TESIs, 17 patients (22%) were classified as peripheralizing with continuing severe pain.These patients

  20. Cold fusion, Alchemist's dream

    SciTech Connect

    Clayton, E.D.

    1989-09-01

    In this report the following topics relating to cold fusion are discussed: muon catalysed cold fusion; piezonuclear fusion; sundry explanations pertaining to cold fusion; cosmic ray muon catalysed cold fusion; vibrational mechanisms in excited states of D{sub 2} molecules; barrier penetration probabilities within the hydrogenated metal lattice/piezonuclear fusion; branching ratios of D{sub 2} fusion at low energies; fusion of deuterons into {sup 4}He; secondary D+T fusion within the hydrogenated metal lattice; {sup 3}He to {sup 4}He ratio within the metal lattice; shock induced fusion; and anomalously high isotopic ratios of {sup 3}He/{sup 4}He.

  1. Photoinduced Fusion of Lipid Bilayer Membranes.

    PubMed

    Suzuki, Yui; Nagai, Ken H; Zinchenko, Anatoly; Hamada, Tsutomu

    2017-03-14

    We have developed a novel system for photocontrol of the fusion of lipid vesicles through the use of a photosensitive surfactant containing an azobenzene moiety (AzoTAB). Real-time microscopic observations clarified a change in both the surface area and internal volume of vesicles during fusion. We also determined the optimal cholesterol concentrations and temperature for inducing fusion. The mechanism of fusion can be attributed to a change in membrane tension, which is caused by the solubilization of lipids through the isomerization of AzoTAB. We used a micropipet technique to estimate membrane tension and discuss the mechanism of fusion in terms of membrane elastic energy. The obtained results regarding this novel photoinduced fusion could lead to a better understanding of the mechanism of membrane fusion in living cells and may also see wider applications, such as in drug delivery and biomimetic material design.

  2. Clinical Evaluation of Spatial Accuracy of a Fusion Imaging Technique Combining Previously Acquired Computed Tomography and Real-Time Ultrasound for Imaging of Liver Metastases

    SciTech Connect

    Hakime, Antoine Deschamps, Frederic; Garcia Marques de Carvalho, Enio; Teriitehau, Christophe; Auperin, Anne; De Baere, Thierry

    2011-04-15

    Purpose: This study was designed to evaluate the spatial accuracy of matching volumetric computed tomography (CT) data of hepatic metastases with real-time ultrasound (US) using a fusion imaging system (VNav) according to different clinical settings. Methods: Twenty-four patients with one hepatic tumor identified on enhanced CT and US were prospectively enrolled. A set of three landmarks markers was chosen on CT and US for image registration. US and CT images were then superimposed using the fusion imaging display mode. The difference in spatial location between the tumor visible on the CT and the US on the overlay images (reviewer no. 1, comment no. 2) was measured in the lateral, anterior-posterior, and vertical axis. The maximum difference (Dmax) was evaluated for different predictive factors.CT performed 1-30 days before registration versus immediately before. Use of general anesthesia for CT and US versus no anesthesia.Anatomic landmarks versus landmarks that include at least one nonanatomic structure, such as a cyst or a calcificationResultsOverall, Dmax was 11.53 {+-} 8.38 mm. Dmax was 6.55 {+-} 7.31 mm with CT performed immediately before VNav versus 17.4 {+-} 5.18 with CT performed 1-30 days before (p < 0.0001). Dmax was 7.05 {+-} 6.95 under general anesthesia and 16.81 {+-} 6.77 without anesthesia (p < 0.0015). Landmarks including at least one nonanatomic structure increase Dmax of 5.2 mm (p < 0.0001). The lowest Dmax (1.9 {+-} 1.4 mm) was obtained when CT and VNav were performed under general anesthesia, one immediately after the other. Conclusions: VNav is accurate when adequate clinical setup is carefully selected. Only under these conditions (reviewer no. 2), liver tumors not identified on US can be accurately targeted for biopsy or radiofrequency ablation using fusion imaging.

  3. Effect of relative injectate pressures on the efficacy of lumbar transforaminal epidural steroid injection in patients with lumbar foraminal stenosis.

    PubMed

    Park, Chan Hong; Lee, Sang Ho

    2014-03-01

    Transforaminal epidural steroid injections (TFESIs) are often used to treat lumbar foraminal stenosis. Injectate pressure (of contrast) was monitored during fluoroscopically guided TFESI to assess the effect on short-term pain reduction. A total of 40 patients underwent single-level lumbar TFESI for unilateral lumbar radicular pain ascribed to foraminal stenosis. Relative injectate pressure of contrast epidurography during TFESI was recorded and compared with pre- and postprocedural pain levels using the Roland 5-point pain scoring method. Pain relief achieved after TFESI revealed no statistically significant correlation with injectate pressure (mean 13.0 cm H2 O). Mean pressures in patients with and without demonstrable pain reduction were 12.9 and 13.2 cm H2 O, respectively. Secondary outcomes were not measured, and no mid- or long-term follow-up was conducted. In this setting, relative injectate pressures had no significant effect on immediate outcomes of TFESI. © 2013 The Authors Pain Practice © 2013 World Institute of Pain.

  4. A new deflection technique applied to an existing scheme of electrostatic accelerator for high energy neutral beam injection in fusion reactor devices.

    PubMed

    Pilan, N; Antoni, V; De Lorenzi, A; Chitarin, G; Veltri, P; Sartori, E

    2016-02-01

    A scheme of a neutral beam injector (NBI), based on electrostatic acceleration and magneto-static deflection of negative ions, is proposed and analyzed in terms of feasibility and performance. The scheme is based on the deflection of a high energy (2 MeV) and high current (some tens of amperes) negative ion beam by a large magnetic deflector placed between the Beam Source (BS) and the neutralizer. This scheme has the potential of solving two key issues, which at present limit the applicability of a NBI to a fusion reactor: the maximum achievable acceleration voltage and the direct exposure of the BS to the flux of neutrons and radiation coming from the fusion reactor. In order to solve these two issues, a magnetic deflector is proposed to screen the BS from direct exposure to radiation and neutrons so that the voltage insulation between the electrostatic accelerator and the grounded vessel can be enhanced by using compressed SF6 instead of vacuum so that the negative ions can be accelerated at energies higher than 1 MeV. By solving the beam transport with different magnetic deflector properties, an optimum scheme has been found which is shown to be effective to guarantee both the steering effect and the beam aiming.

  5. A novel technique for single-shot energy-resolved 2D x-ray imaging of plasmas relevant for the inertial confinement fusion.

    PubMed

    Labate, L; Köster, P; Levato, T; Gizzi, L A

    2012-10-01

    A novel x-ray diagnostic of laser-fusion plasmas is described, allowing 2D monochromatic images of hot, dense plasmas to be obtained in any x-ray photon energy range, over a large domain, on a single-shot basis. The device (named energy-encoded pinhole camera) is based upon the use of an array of many pinholes coupled to a large area CCD camera operating in the single-photon mode. The available x-ray spectral domain is only limited by the quantum efficiency of scientific-grade x-ray CCD cameras, thus extending from a few keV up to a few tens of keV. Spectral 2D images of the emitting plasma can be obtained at any x-ray photon energy provided that a sufficient number of photons had been collected at the desired energy. Results from recent inertial confinement fusion related experiments will be reported in order to detail the new diagnostic.

  6. A new deflection technique applied to an existing scheme of electrostatic accelerator for high energy neutral beam injection in fusion reactor devices

    SciTech Connect

    Pilan, N. Antoni, V.; De Lorenzi, A.; Chitarin, G.; Veltri, P.; Sartori, E.

    2016-02-15

    A scheme of a neutral beam injector (NBI), based on electrostatic acceleration and magneto-static deflection of negative ions, is proposed and analyzed in terms of feasibility and performance. The scheme is based on the deflection of a high energy (2 MeV) and high current (some tens of amperes) negative ion beam by a large magnetic deflector placed between the Beam Source (BS) and the neutralizer. This scheme has the potential of solving two key issues, which at present limit the applicability of a NBI to a fusion reactor: the maximum achievable acceleration voltage and the direct exposure of the BS to the flux of neutrons and radiation coming from the fusion reactor. In order to solve these two issues, a magnetic deflector is proposed to screen the BS from direct exposure to radiation and neutrons so that the voltage insulation between the electrostatic accelerator and the grounded vessel can be enhanced by using compressed SF{sub 6} instead of vacuum so that the negative ions can be accelerated at energies higher than 1 MeV. By solving the beam transport with different magnetic deflector properties, an optimum scheme has been found which is shown to be effective to guarantee both the steering effect and the beam aiming.

  7. Correlation of the Patient Reported Outcomes Measurement Information System with legacy outcomes measures in assessment of response to lumbar transforaminal epidural steroid injections.

    PubMed

    Shahgholi, L; Yost, K J; Carter, R E; Geske, J R; Hagen, C E; Amrami, K K; Diehn, F E; Kaufmann, T J; Morris, J M; Murthy, N S; Wald, J T; Thielen, K R; Kallmes, D F; Maus, T P

    2015-03-01

    The Patient Reported Outcomes Measurement Information System is a newly developed outcomes measure promulgated by the National Institutes of Health. This study compares changes in pain and physical function-related measures of this system with changes on the Numeric Rating Pain Scale, Roland Morris Disability Index, and the European Quality of Life scale 5D questionnaire in patients undergoing transformational epidural steroid injections for radicular pain. One hundred ninety-nine patients undergoing transforaminal epidural steroid injections for radicular pain were enrolled in the study. Before the procedure, they rated the intensity of their pain by using the 0-10 Numeric Rating Pain Scale, Roland Morris Disability Index, and European Quality of Life scale 5D questionnaire. Patients completed the Patient Reported Outcomes Measurement Information System Physical Function, Pain Behavior, and Pain Interference short forms before transforaminal epidural steroid injections and at 3 and 6 months. Seventy and 43 subjects replied at 3- and 6-month follow-up. Spearman rank correlations were used to assess the correlation between the instruments. The minimally important differences were calculated for each measurement tool as an indicator of meaningful change. All instruments were responsive in detecting changes at 3- and 6-month follow-up (P < .0001). There was significant correlation between changes in Patient Reported Outcomes Measurement Information System scores and legacy questionnaires from baseline to 3 months (P < .05). There were, however, no significant correlations in changes from 3 to 6 months with any of the instruments. The studied Patient Reported Outcomes Measurement Information System domains offered responsive and correlative psychometric properties compared with legacy instruments in a population of patients undergoing transforaminal epidural steroid injections for radicular pain. © 2015 by American Journal of Neuroradiology.

  8. Percutaneous Hindfoot and Midfoot Fusion.

    PubMed

    Bauer, Thomas

    2016-09-01

    Hindfoot and midfoot fusions can be performed with percutaneous techniques. Preliminary results of these procedures are encouraging because they provide similar results than those obtained with open techniques with less morbidity and quick recovery. The best indications are probably fusions for mild-to-moderate reducible hindfoot and midfoot deformities in fragile patients with general or local bad conditions. The main limit is linked to the surgeon's experience in percutaneous foot surgery because a learning curve with the specific tools is necessary before doing these procedures.

  9. An Innovative Use of Cortoss Bone Cement to Stabilize a Nonunion after Interbody Fusion

    PubMed Central

    Jacobson, Robert E

    2017-01-01

    A 65-year-old male originally had surgery for spondylolisthesis at L5-S1 in 2008 and then went on to have an L4-5 transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation from L4 to S1 and interbody graft in 2010. Despite having two surgical procedures, he continued with intractable back pain and was told he had a failed lumbar fusion. When he was evaluated with a computerized tomography (CT) scan from April 2015, it demonstrated an erosive nonunion of the L4-5 interbody fusion without incorporation of the polyetheretherketone (PEEK) cage. In an attempt to perform a minimally invasive stabilization of the L4-5 nonunion, he underwent a percutaneous lateral foraminal approach with an injection of Cortoss® cement (Stryker®, Malvern, PA) into the L4-5 interspace and around the graft. The objective was to stabilize the nonunion, resulting in intermediate relief of pain. PMID:28229033

  10. An Innovative Use of Cortoss Bone Cement to Stabilize a Nonunion after Interbody Fusion.

    PubMed

    Granville, Michelle; Jacobson, Robert E

    2017-01-20

    A 65-year-old male originally had surgery for spondylolisthesis at L5-S1 in 2008 and then went on to have an L4-5 transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation from L4 to S1 and interbody graft in 2010. Despite having two surgical procedures, he continued with intractable back pain and was told he had a failed lumbar fusion. When he was evaluated with a computerized tomography (CT) scan from April 2015, it demonstrated an erosive nonunion of the L4-5 interbody fusion without incorporation of the polyetheretherketone (PEEK) cage. In an attempt to perform a minimally invasive stabilization of the L4-5 nonunion, he underwent a percutaneous lateral foraminal approach with an injection of Cortoss® cement (Stryker®, Malvern, PA) into the L4-5 interspace and around the graft. The objective was to stabilize the nonunion, resulting in intermediate relief of pain.

  11. Mass Producing Targets for Nuclear Fusion

    NASA Technical Reports Server (NTRS)

    Wang, T. G.; Elleman, D. D.; Kendall, J. M.

    1983-01-01

    Metal-encapsulating technique advances prospects of controlling nuclear fusion. Prefilled fusion targets form at nozzle as molten metal such as tin flows through outer channel and pressurized deuterium/tritium gas flows through inner channel. Molten metal completely encloses gas charge as it drops off nozzle.

  12. Mass Producing Targets for Nuclear Fusion

    NASA Technical Reports Server (NTRS)

    Wang, T. G.; Elleman, D. D.; Kendall, J. M.

    1983-01-01

    Metal-encapsulating technique advances prospects of controlling nuclear fusion. Prefilled fusion targets form at nozzle as molten metal such as tin flows through outer channel and pressurized deuterium/tritium gas flows through inner channel. Molten metal completely encloses gas charge as it drops off nozzle.

  13. The Fusion Energy Option

    NASA Astrophysics Data System (ADS)

    Dean, Stephen O.

    2004-06-01

    Presentations from a Fusion Power Associates symposium, The Fusion Energy Option, are summarized. The topics include perspectives on fossil fuel reserves, fusion as a source for hydrogen production, status and plans for the development of inertial fusion, planning for the construction of the International Thermonuclear Experimental Reactor, status and promise of alternate approaches to fusion and the need for R&D now on fusion technologies.

  14. Significant Improvement of Puncture Accuracy and Fluoroscopy Reduction in Percutaneous Transforaminal Endoscopic Discectomy With Novel Lumbar Location System

    PubMed Central

    Fan, Guoxin; Guan, Xiaofei; Zhang, Hailong; Wu, Xinbo; Gu, Xin; Gu, Guangfei; Fan, Yunshan; He, Shisheng

    2015-01-01

    Abstract Prospective nonrandomized control study. The study aimed to investigate the implication of the HE's Lumbar LOcation (HELLO) system in improving the puncture accuracy and reducing fluoroscopy in percutaneous transforaminal endoscopic discectomy (PTED). Percutaneous transforaminal endoscopic discectomy is one of the most popular minimally invasive spine surgeries that heavily depend on repeated fluoroscopy. Increased fluoroscopy will induce higher radiation exposure to surgeons and patients. Accurate puncture in PTED can be achieved by accurate preoperative location and definite trajectory. The HELLO system mainly consists of self-made surface locator and puncture-assisted device. The surface locator was used to identify the exact puncture target and the puncture-assisted device was used to optimize the puncture trajectory. Patients who had single L4/5 or L5/S1 lumbar intervertebral disc herniation and underwent PTED were included the study. Patients receiving the HELLO system were assigned in Group A, and those taking conventional method were assigned in Group B. Study primary endpoint was puncture times and fluoroscopic time, and the secondary endpoint was location time and operation time. A total of 62 patients who received PTED were included in this study. The average age was 45.35 ± 8.70 years in Group A and 46.61 ± 7.84 years in Group B (P = 0.552). There were no significant differences in gender, body mass index, conservative time, and surgical segment between the 2 groups (P > 0.05). The puncture time(s) were 1.19 ± 0.48 in Group A and 6.03 ± 1.87 in Group B (P < 0.001). The fluoroscopic times were 14.03 ± 2.54 in Group A and 25.19 ± 4.28 in Group B (P < 0.001). The preoperative location time was 4.67 ± 1.41 minutes in Group A and 6.98 ± 0.94 minutes in Group B (P < 0.001). The operation time was 79.42 ± 10.15 minutes in Group A and 89.65 ± 14.06 minutes in Group B (P

  15. Revitalizing Fusion via Fission Fusion

    NASA Astrophysics Data System (ADS)

    Manheimer, Wallace

    2001-10-01

    Existing tokamaks could generate significant nuclear fuel. TFTR, operating steady state with DT might generate enough fuel for a 300 MW nuclear reactor. The immediate goals of the magnetic fusion program would necessarily shift from a study of advanced plasma regimes in larger sized devices, to mostly known plasmas regimes, but at steady state or high duty cycle operation in DT plasmas. The science and engineering of breeding blankets would be equally important. Follow on projects could possibly produce nuclear fuel in large quantity at low price. Although today there is strong opposition to nuclear power in the United States, in a 21st century world of 10 billion people, all of whom will demand a middle class life style, nuclear energy will be important. Concern over greenhouse gases will also drive the world toward nuclear power. There are studies indicating that the world will need 10 TW of carbon free energy by 2050. It is difficult to see how this can be achieved without the breeding of nuclear fuel. By using the thorium cycle, proliferation risks are minimized. [1], [2]. 1 W. Manheimer, Fusion Technology, 36, 1, 1999, 2.W. Manheimer, Physics and Society, v 29, #3, p5, July, 2000

  16. Magnetic fusion 1985: what next

    SciTech Connect

    Fowler, T.K.

    1985-03-01

    Recent budget reductions for magnetic fusion have led to a re-examination of program schedules and objectives. Faced with delays and postponement of major facilities as previously planned, some have called for a near-term focus on science, others have stressed technology. This talk will suggest a different focus as the keynote for this conference, namely, the applications of fusion. There is no doubt that plasma science is by now mature and fusion technology is at the forefront. This has and will continue to benefit many fields of endeavor, both in actual new discoveries and techniques and in attracting and training scientists and engineers who move on to make significant contributions in science, defense and industry. Nonetheless, however superb the science or how challenging the technology, these are means, not ends. To maintain its support, the magnetic fusion program must also offer the promise of power reactors that could be competitive in the future. At this conference, several new reactor designs will be described that claim to be smaller and economically competitive with fission reactors while retaining the environmental and safety characteristics that are the hallmark of fusion. The American Nuclear Society is an appropriate forum in which to examine these new designs critically, and to stimulate better ideas and improvements. As a preview, this talk will include brief discussions of new tokamak, tandem mirror and reversed field pinch reactor designs to be presented in later sessions. Finally, as a preview of the session on fusion breeders, the talk will explore once again the economic implications of a new nuclear age, beginning with improved fission reactors fueled by fusion breeders, then ultimately evolving to reactors based solely on fusion.

  17. Health-related quality of life after transforaminal percutaneous endoscopic discectomy: An analysis according to the level of operation

    PubMed Central

    Kapetanakis, Stylianos; Charitoudis, Georgios; Thomaidis, Tryfon; Theodosiadis, Panagiotis; Papathanasiou, Jannis; Giatroudakis, Konstantinos

    2017-01-01

    Background: Many patients suffer from radiculopathy and low back pain due to lumbar disc hernia. Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive method that accesses the disc pathology through the intervertebral foramen. Health-related quality of life (HRQoL) has been previously assessed for this method. However, a possible effect of the level of operation on the postoperative progress of HRQoL remains undefined. Purpose: The purpose of this study was to evaluate the impact of the level of operation on HRQoL, following TPED. Patients and Methods: A total of 76 patients diagnosed with lumbar disc hernia were enrolled in the study. According to the level of operation, they were divided into three groups: Group A (21 patients) for L3–L4, Group B (40 patients) for L4–L5, and Group C (15 patients) for L5–S1 intervertebral level. All patients underwent TPED. Their HRQoL was evaluated by the short-form-36 (SF-36) health survey questionnaire before the operation and at 6 weeks, 3, 6, and 12 months postsurgery. The progress of SF-36 was analyzed in relation to the operated level. Results: All aspects of SF-36 showed statistical significant improvement, at every given time interval (P ≤ 0.05) in the total of patients and in each group separately. Group A had a significantly higher increase in physical functioning (PF) score at 3 and 12 months postsurgery (P = 0.046 and P = 0.056, respectively). On the other hand, Group B had a significant lower increase in mental health (MH) score at 6 months (P = 0.009) postoperatively. Conclusion: Our study concludes that the level of operation in patients who undergo TPED for lumbar disc herniation affects the HRQoL 1 year after surgery, with Group A having a significantly greater improvement of PF in comparison with Groups B and C. PMID:28250636

  18. Transforaminal epidural steroid injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniation.

    PubMed

    van Helvoirt, Hans; Apeldoorn, Adri T; Ostelo, Raymond W; Knol, Dirk L; Arts, Mark P; Kamper, Steven J; van Tulder, Maurits W

    2014-07-01

    Prospective cohort study. To report the clinical course of patients with MRI-confirmed lumbar disc herniation-related radicular noncentralizing pain who received transforaminal epidural steroid injections (TESIs) and mechanical diagnosis and therapy (MDT). Noncentralizing symptoms in patients with lumbar disc herniation are associated with poor outcome. Commonly used treatments for these patients include TESIs and MDT. No study has evaluated the outcome of combining both strategies. Consecutive candidates for herniated lumbar disc surgery with noncentralizing chronic pain were eligible. Patients received TESIs followed by MDT. The primary outcomes were pain severity in the leg, disability (Roland-Morris Disability Questionnaire for Sciatica), and global perceived effect (GPE). Outcomes were measured at baseline, discharge, and 12 months. Linear mixed-models and McNemar's tests were used to analyze outcome data. Sixty-nine patients receive TESIs. After TESIs, symptoms were resolved completely in 11 patients (16%). In these patients, symptom resolution was maintained at 12 months. A second subgroup of 32 patients (46%) reported significantly less pain after TESIs and showed centralization with MDT reassessment (significant reductions in leg pain and disability [P < 0.001]) and a satisfaction rate of 90% at 12 months. A third subgroup of 11 patients (16%) reported significantly less pain after TESIs but still showed noncentralization with MDT reassessment (significant reductions in leg pain and disability [P < 0.05] and a satisfaction rate of 50% at 12 months). A fourth subgroup of 15 patients (22%) did not respond on TESIs and received an operative intervention. The results indicate that a course of TESIs followed by MDT may be able to avoid surgery in a substantial proportion of candidates for herniated lumbar disc surgery. Wiley Periodicals, Inc.

  19. Transforaminal epidural steroid injection in lumbar spinal stenosis: an observational study with two-year follow-up.

    PubMed

    Davis, Niel; Hourigan, Patrick; Clarke, Andrew

    2017-04-01

    Transforaminal epidural steroid injection (TFESI) is recognised as a treatment for symptomatic lumbar disc herniation, whilst surgical decompression is generally thought to be the most effective treatment option for lumbar spinal stenosis. There is little available literature examining the effect of TFESI on symptomatic lumbar spinal stenosis. To evaluate the use of TFESI as an alternative to surgery in patients with symptomatic stenosis. An observational study which took place between May 2010 and July 2013. All patients were seen by the Extended Scope Physiotherapist (ESP) injection service. A total of 68 consecutive patients were included. Thirty-one were male and 37 were female. The average age was 75 years. The primary outcome measure was the avoidance of decompressive surgery. Patients with radicular leg pain were seen by an ESP in an Outpatient setting. Concordant clinical examination and magnetic resonance imaging were required for diagnosis. Peri-radicular bupivacaine hydrochloride 0.25% (3 ml) and triamcinolone (40 mg) were then injected. Outcome measures were recorded at 6 weeks, 1 year and 2 years. Of 68 patients with spinal stenosis, 22 (32%) had opted for surgery at two year follow-up. Thirty (44%) patients were satisfied with non-surgical management at 2 years, required no further treatment, and were discharged. Of the remaining 24%, nine patients were referred for further injection, four declined surgery but were referred to the Pain Relief Clinic, two still had a similar level of pain but declined surgery and one had died. Our study reports a considerably lower percentage patients opting for surgery than previously demonstrated by the available literature. TFESI is a reasonable treatment for lumbar spinal stenosis and can result in long-term relief from symptoms in a high proportion of patients.

  20. Increased dose of betamethasone for transforaminal epidural steroid injections is not associated with superior pain outcomes at 4 weeks.

    PubMed

    Wong, Waylan; Maher, Dermot P; Iyayi, Daniel; Lopez, Raul; Shamloo, Bahman; Rosner, Howard; Yumul, Roya

    2015-01-01

    Fluoroscopically guided transforaminal epidural steroid injections (FG-TFESIs) have been shown to provide both immediate and long-term improvement in patient's self-reported pain. Administration of the lowest possible dose of epidural betamethasone is desired to minimize side effects while maintaining efficacy. We hypothesize that a 3 mg or a 6 mg dose of betamethasone will demonstrate equivalent analgesic properties. To compare the analgesic efficacy of 3 mg and a 6 mg dose of betamethasone for use in FG-TFESI. Retrospective evaluation. Academic outpatient pain center. One hundred fifty-eight patients underwent FG-TFESI for lumbar back pain between 2012 and 2013. Depending on the date of service, a dose of 3 mg or a dose of 6 mg betamethasone was used in the single level unilateral TFESI. Opioid consumption and NRS pain score were analyzed pre-procedurally and at a clinic visit 4 weeks post-procedurally. Changes in numerical rating scale (NRS) pain score (-1.21 +' 2.61 vs. -0.81 +' 2.40 respectively, P = 0.17) and changes in opioid consumption as measured in oral morphine equivalents (-2.94 +' 16.4 mg vs. -2.93 +' 14.8 mg, P = 0.17) were statistically equivalent between both groups. Intergroup sub-analysis of those with > 50% reduction in baseline VRS {sp} pain score was not different (15.2% vs. 34%, P = 0.56), and the proportion with a VRS pain score < 3 were similar (24.5% vs. 23.8%, P = 0.92). Potential selection bias inherent with study design. Reduction in NRS pain scores and narcotic usage at 4 weeks after FG-TFESI were statistically equivalent between patients who received 3 mg or 6 mg of betamethasone, suggesting that a lower steroid dose has similar analgesic efficacy. IRB Number: Cedars Sinai Medical Center Institutional Review Board Pro00031594

  1. The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature

    PubMed Central

    Epstein, Nancy E.

    2013-01-01

    Background: Multiple type of spinal injections, whether epidural/translaminar or transforaminal, facet injections, are offered to patients with/without surgical spinal lesions by pain management specialists (radiologists, physiatrists, and anesthesiologists). Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffective over the longer-term, while exposing patients to major risks/complications. Methods: For many patients with spinal pain alone and no surgical lesions, the “success” of epidural injections may simply reflect the self-limited course of the disease. Alternatively, although those with surgical pathology may experience transient or no pain relief, undergoing these injections (typically administered in a series of three) unnecessarily exposes them to the inherent risks, while also delaying surgery and potentially exposing them to more severe/permanent neurological deficits. Results: Multiple recent reports cite contaminated epidural steroid injections resulting in meningitis, stroke, paralysis, and death. The Center for Disease Control (CDC) specifically identified 25 deaths (many due to Aspergillosis), 337 patients sickened, and 14,000 exposed to contaminated steroids. Nevertheless, many other patients develop other complications that go unreported/underreported: Other life-threatening infections, spinal fluid leaks (0.4-6%), positional headaches (28%), adhesive arachnoiditis (6-16%), hydrocephalus, air embolism, urinary retention, allergic reactions, intravascular injections (7.9-11.6%), stroke, blindness, neurological deficits/paralysis, hematomas, seizures, and death. Conclusions: Although the benefits for epidural steroid injections may include transient pain relief for those with/without surgical disease, the multitude of risks attributed to these injections outweighs the benefits. PMID:23646278

  2. Caudal vs transforaminal epidural steroid injections as short-term (6 months) pain relief in lumbar spinal stenosis patients with sciatica.

    PubMed

    Ploumis, Avraam; Christodoulou, Pavlos; Wood, Kirkham B; Varvarousis, Dimitrios; Sarni, James L; Beris, Alexander

    2014-03-01

    The aim of this study is to evaluate prospectively the efficacy of caudal epidural steroid injection (CESI) and transforaminal epidural steroid injection (TFESI) in lumbar spinal stenosis patients with sciatic pain. Prospective clinical study. Thirty-one patients (average age 62 years) from two hospitals, with single dermotomal distribution of sciatic pain due to spinal stenosis were included in the study. Patients underwent epidural steroid injections done by the same injectionist. Eleven patients from one hospital were included in the CESI group, while the TFESI group consisted of 20 comparable patients from the second site. Primary outcome measure was the complete relief or at least 50% reduction of pain (visual analog scale [VAS]) at 6 months postinjection. Secondary outcome measures were the improvement of function (of at least 15 points of Oswestry Disability Index [ODI]) at 6 months and the changes of VAS and ODI and at 2 weeks, at 3 months, and at 6 months postinjection. A significantly greater number of stenosis patients showed pain relief at 6 months postinjection with TFSI (90%) than with CESI (54.54%). All patients with TFSI showed improvement of function at 6 months while only three (27.27%) patients with caudal epidural improved functionally. Out of the total 31 patients, two patients from group A underwent a second CESI at 15 days postinjection and decompressive spine surgery between 3 and 6 months postinjection. The effectiveness of transforaminal steroid injection for the stenosis patients with sciatica was superior to caudal at 6 months postinjection. Wiley Periodicals, Inc.

  3. Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc herniation: a retrospective case series

    PubMed Central

    Manson, Neil A.; McKeon, Melissa D.; Abraham, Edward P.

    2013-01-01

    Background The median orthopedic surgery wait time in Canada is 33.7 weeks, thus alternative treatments for pathologies such as lumbar disc herniations (LDH) are needed. We sought to determine whether transforaminal epidural steroid injections (TFESIs) alleviate or merely delay the need for surgery. Methods We retrospectively reviewed the charts of patients with LDH who received TFESIs between September 2006 and July 2008. Patient demographics, level and side of pathology, workers’ compensation status, levels injected, treatment outcome and time from referral to treatment were evaluated. The primary outcome measure was the need for versus the avoidance of surgery. Results We included 91 patients in our analysis. Time from family physician referral to injection was 123 (standard deviation [SD] 88) days; no significant differences in wait times were found between TFESI patients and those requiring surgery. In all, 51 patients (22 women, 29 men) with a mean age of 45.8 (SD 10.2) years avoided surgery following TFESI, whereas 40 patients (16 women, 24 mean) with a mean age of 43.1 (SD 12.0) years proceeded to surgery within 189 (SD 125) days postinjection. In all, 15 patients received multiple injections, and of these, 9 did not require surgical intervention. Age, sex and level/side of pathology did not influence the treatment outcome. Workers’ compensation status influenced outcome significantly; these patients demonstrated less benefit from TFESI. Conclusion Transforaminal epidural steroid injections are an important treatment tool, preventing the need for surgery in 56% of patients with LDH. PMID:23351495

  4. Multisensor image fusion guidelines in remote sensing

    NASA Astrophysics Data System (ADS)

    Pohl, C.

    2016-04-01

    Remote sensing delivers multimodal and -temporal data from the Earth's surface. In order to cope with these multidimensional data sources and to make the most of them, image fusion is a valuable tool. It has developed over the past few decades into a usable image processing technique for extracting information of higher quality and reliability. As more sensors and advanced image fusion techniques have become available, researchers have conducted a vast amount of successful studies using image fusion. However, the definition of an appropriate workflow prior to processing the imagery requires knowledge in all related fields - i.e. remote sensing, image fusion and the desired image exploitation processing. From the findings of this research it can be seen that the choice of the appropriate technique, as well as the fine-tuning of the individual parameters of this technique, is crucial. There is still a lack of strategic guidelines due to the complexity and variability of data selection, processing techniques and applications. This paper gives an overview on the state-of-the-art in remote sensing image fusion including sensors and applications. Putting research results in image fusion from the past 15 years into a context provides a new view on the subject and helps other researchers to build their innovation on these findings. Recommendations of experts help to understand further needs to achieve feasible strategies in remote sensing image fusion.

  5. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review.

    PubMed

    Goldstein, Christina L; Macwan, Kevin; Sundararajan, Kala; Rampersaud, Y Raja

    2016-03-01

    The objective of this study was to determine the clinical comparative effectiveness and adverse event rates of posterior minimally invasive surgery (MIS) compared with open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). A systematic review of the Medline, EMBASE, PubMed, Web of Science, and Cochrane databases was performed. A hand search of reference lists was conducted. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) or comparative cohort studies including at least 10 patients undergoing MIS or open TLIF/PLIF for degenerative lumbar spinal disorders and reporting at least 1 of the following: clinical outcome measure, perioperative clinical or process measure, radiographic outcome, or adverse events. Study quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. When appropriate, a meta-analysis of outcomes data was conducted. The systematic review and reference list search identified 3301 articles, with 26 meeting study inclusion criteria. All studies, including 1 RCT, were of low or very low quality. No significant difference regarding age, sex, surgical levels, or diagnosis was identified between the 2 cohorts (856 patients in the MIS cohort, 806 patients in the open cohort). The meta-analysis revealed changes in the perioperative outcomes of mean estimated blood loss, time to ambulation, and length of stay favoring an MIS approach by 260 ml (p < 0.00001), 3.5 days (p = 0.0006), and 2.9 days (p < 0.00001), respectively. Operative time was not significantly different between the surgical techniques (p = 0.78). There was no significant difference in surgical adverse events (p = 0.97), but MIS cases were significantly less likely to experience medical adverse events (risk ratio [MIS vs open] = 0.39, 95% confidence interval 0.23-0.69, p = 0.001). No difference in nonunion (p = 0.97) or reoperation rates (p = 0.97) was observed. Mean Oswestry

  6. ICF research at KMS Fusion

    SciTech Connect

    Glass, A.J.; Henderson, T.M.; Storm, E.K.

    1982-08-01

    The principal accomplishments of the KMS Fusion program over the past year are reviewed. Our activities in the area of target fabrication include both the production of high quality fuel shells, and the development of techniques for the production of special target materials.

  7. Hyperspectral Image Sharpening Based on Ehlers Fusion

    NASA Astrophysics Data System (ADS)

    Xu, S.; Ehlers, M.

    2017-09-01

    As the application of hyperspectral images is increasing, many researchers attempt to extend existing pansharpening techniques to hyperspectral images. This paper focuses on the application of Ehlers fusion to hyperspectral image sharpening. Ehlers fusion involves two crucial algorithms: filter technique in the frequency domain and intensity transform. In this study, different filter types and intensity transform methods were analysed separately. With a combination of filter types and intensity transforms, the fusion procedure was implemented to test data sets. The spectral profiles of the pixels of the images were then used as a tool to control the quality of the fused image. Finally, the performance of Ehlers fusion is compared with Principle Component (PC) analysis, Gram-Schmidt transform (Gram-Schmidt), High-Pass Filtering in the spatial domain (HPF), and Wavelet Principal Component (Wavelet-PC) analysis using the same input data. The comparison shows that Ehlers high-pass filter fusion shows outstanding performance both on spatial enhancement and colour preservation.

  8. Application of Fisher fusion techniques to improve the individual performance of sonar computer-aided detection/computer-aided classification (CAD/CAC) algorithms

    NASA Astrophysics Data System (ADS)

    Ciany, Charles M.; Zurawski, William C.

    2009-05-01

    Raytheon has extensively processed high-resolution sidescan sonar images with its CAD/CAC algorithms to provide classification of targets in a variety of shallow underwater environments. The Raytheon CAD/CAC algorithm is based on non-linear image segmentation into highlight, shadow, and background regions, followed by extraction, association, and scoring of features from candidate highlight and shadow regions of interest (ROIs). The targets are classified by thresholding an overall classification score, which is formed by summing the individual feature scores. The algorithm performance is measured in terms of probability of correct classification as a function of false alarm rate, and is determined by both the choice of classification features and the manner in which the classifier rates and combines these features to form its overall score. In general, the algorithm performs very reliably against targets that exhibit "strong" highlight and shadow regions in the sonar image- i.e., both the highlight echo and its associated shadow region from the target are distinct relative to the ambient background. However, many real-world undersea environments can produce sonar images in which a significant percentage of the targets exhibit either "weak" highlight or shadow regions in the sonar image. The challenge of achieving robust performance in these environments has traditionally been addressed by modifying the individual feature scoring algorithms to optimize the separation between the corresponding highlight or shadow feature scores of targets and non-targets. This study examines an alternate approach that employs principles of Fisher fusion to determine a set of optimal weighting coefficients that are applied to the individual feature scores before summing to form the overall classification score. The results demonstrate improved performance of the CAD/CAC algorithm on at-sea data sets.

  9. Fusion energy

    NASA Astrophysics Data System (ADS)

    1990-09-01

    The main purpose of the International Thermonuclear Experimental Reactor (ITER) is to develop an experimental fusion reactor through the united efforts of many technologically advanced countries. The ITER terms of reference, issued jointly by the European Community, Japan, the USSR, and the United States, call for an integrated international design activity and constitute the basis of current activities. Joint work on ITER is carried out under the auspices of the International Atomic Energy Agency (IAEA), according to the terms of quadripartite agreement reached between the European Community, Japan, the USSR, and the United States. The site for joint technical work sessions is at the Max Planck Institute of Plasma Physics. Garching, Federal Republic of Germany. The ITER activities have two phases: a definition phase performed in 1988 and the present design phase (1989 to 1990). During the definition phase, a set of ITER technical characteristics and supporting research and development (R and D) activities were developed and reported. The present conceptual design phase of ITER lasts until the end of 1990. The objectives of this phase are to develop the design of ITER, perform a safety and environmental analysis, develop site requirements, define future R and D needs, and estimate cost, manpower, and schedule for construction and operation. A final report will be submitted at the end of 1990. This paper summarizes progress in the ITER program during the 1989 design phase.

  10. Fusion energy

    SciTech Connect

    Not Available

    1990-09-01

    The main purpose of the International Thermonuclear Experimental Reactor (ITER) is to develop an experimental fusion reactor through the united efforts of many technologically advanced countries. The ITER terms of reference, issued jointly by the European Community, Japan, the USSR, and the United States, call for an integrated international design activity and constitute the basis of current activities. Joint work on ITER is carried out under the auspices of the International Atomic Energy Agency (IAEA), according to the terms of quadripartite agreement reached between the European Community, Japan, the USSR, and the United States. The site for joint technical work sessions is at the MaxPlanck Institute of Plasma Physics. Garching, Federal Republic of Germany. The ITER activities have two phases: a definition phase performed in 1988 and the present design phase (1989--1990). During the definition phase, a set of ITER technical characteristics and supporting research and development (R D) activities were developed and reported. The present conceptual design phase of ITER lasts until the end of 1990. The objectives of this phase are to develop the design of ITER, perform a safety and environmental analysis, develop site requirements, define future R D needs, and estimate cost, manpower, and schedule for construction and operation. A final report will be submitted at the end of 1990. This paper summarizes progress in the ITER program during the 1989 design phase.

  11. Seismic data fusion anomaly detection

    NASA Astrophysics Data System (ADS)

    Harrity, Kyle; Blasch, Erik; Alford, Mark; Ezekiel, Soundararajan; Ferris, David

    2014-06-01

    Detecting anomalies in non-stationary signals has valuable applications in many fields including medicine and meteorology. These include uses such as identifying possible heart conditions from an Electrocardiography (ECG) signals or predicting earthquakes via seismographic data. Over the many choices of anomaly detection algorithms, it is important to compare possible methods. In this paper, we examine and compare two approaches to anomaly detection and see how data fusion methods may improve performance. The first approach involves using an artificial neural network (ANN) to detect anomalies in a wavelet de-noised signal. The other method uses a perspective neural network (PNN) to analyze an arbitrary number of "perspectives" or transformations of the observed signal for anomalies. Possible perspectives may include wavelet de-noising, Fourier transform, peak-filtering, etc.. In order to evaluate these techniques via signal fusion metrics, we must apply signal preprocessing techniques such as de-noising methods to the original signal and then use a neural network to find anomalies in the generated signal. From this secondary result it is possible to use data fusion techniques that can be evaluated via existing data fusion metrics for single and multiple perspectives. The result will show which anomaly detection method, according to the metrics, is better suited overall for anomaly detection applications. The method used in this study could be applied to compare other signal processing algorithms.

  12. Fusion Plasma Theory project summaries

    SciTech Connect

    Not Available

    1993-10-01

    This Project Summary book is a published compilation consisting of short descriptions of each project supported by the Fusion Plasma Theory and Computing Group of the Advanced Physics and Technology Division of the Department of Energy, Office of Fusion Energy. The summaries contained in this volume were written by the individual contractors with minimal editing by the Office of Fusion Energy. Previous summaries were published in February of 1982 and December of 1987. The Plasma Theory program is responsible for the development of concepts and models that describe and predict the behavior of a magnetically confined plasma. Emphasis is given to the modelling and understanding of the processes controlling transport of energy and particles in a toroidal plasma and supporting the design of the International Thermonuclear Experimental Reactor (ITER). A tokamak transport initiative was begun in 1989 to improve understanding of how energy and particles are lost from the plasma by mechanisms that transport them across field lines. The Plasma Theory program has actively-participated in this initiative. Recently, increased attention has been given to issues of importance to the proposed Tokamak Physics Experiment (TPX). Particular attention has been paid to containment and thermalization of fast alpha particles produced in a burning fusion plasma as well as control of sawteeth, current drive, impurity control, and design of improved auxiliary heating. In addition, general models of plasma behavior are developed from physics features common to different confinement geometries. This work uses both analytical and numerical techniques. The Fusion Theory program supports research projects at US government laboratories, universities and industrial contractors. Its support of theoretical work at universities contributes to the office of Fusion Energy mission of training scientific manpower for the US Fusion Energy Program.

  13. Comparison of Clinical Efficacy Between Interlaminar and Transforaminal Epidural Injection in Patients With Axial Pain due to Cervical Disc Herniation

    PubMed Central

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-01-01

    Abstract Transforaminal (TF) approach is preferred by physician to interlaminar (IL) approach because it can deliver injectates directly around nerve root and dorsal root ganglion, which is regarded as main pain sources. Axial neck pain is originated from sinuvertebral nerve located in ventral epidural spaces, which has been described to be related to central or paramedian disc herniation. It is very questionable that TF injection is also more effective than IL injection in the patients with axial neck or interscapular pain. This study was to evaluate clinical efficacy of cervical epidural injection in patients with axial pain due to cervical disc herniation and to compare the clinical outcomes between TF and IL approaches. Fifty-six and 52 patients who underwent IL and TF epidural injections, respectively, for axial neck/interscapular pain due to central or paramedian cervical disc herniation were included. Numeric Rating Scale (NRS) and Neck Disability Index (NDI) were compared between both groups at 2 and 8 weeks after treatment. Successful pain relief was defined if a 50% or more reduction of NRS score was achieved in comparison with pretreatment one. Successful functional improvement was defined if at least a 40% reduction of NDI was obtained. Overall, 79 (73.1%) and 57 (52.8%) among 108 patients showed successful pain relief at 2 and 8 weeks, respectively. Seventy-six (70.4%) and 52 (48.1%) had successful functional improvement at 2 and 8 weeks, respectively. The IL and TF groups showed no significant difference in proportion of successful results of NRS 2 weeks (73.2% vs 67.3%) and 8 weeks (48.2% vs 48.1%). Also, no significant difference was obtained in proportion of successful NDI between 2 groups at 2 weeks (75.0% vs 71.2%) and 8 weeks (53.6% vs 51.9%). Cervical epidural injection showed favorable results in 2 weeks and moderate results in 8 weeks in patients with axial pain due to cervical disc herniation. IL and TF showed no significant difference in

  14. Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study

    PubMed Central

    Wu, Xin-bo; Fan, Guo-xin; Gu, Xin; Shen, Tu-gang; Guan, Xiao-fei; Hu, An-nan; Zhang, Hai-long; He, Shi-sheng

    2016-01-01

    Objectives: This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy (PELD) in a transforaminal approach at the L4/5 and L5/S1 levels. Methods: We retrospectively reviewed the first 60 cases at the L4/5 level (Group I) and the first 60 cases at the L5/S1 level (Group II) of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C (Group I: A cases 1–20, B cases 21–40, C cases 41–60; Group II: A cases 1–20, B cases 21–40, C cases 41–60). Operation time was thoroughly analyzed. Results: Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were (88.75±17.02), (67.75±6.16), and (64.85±7.82) min, respectively. There was a significant difference between Groups A and B (P<0.05), but no significant difference between Groups B and C (P=0.20). The mean operation times of Groups IIA, IIB, and IIC were (117.25±13.62), (109.50±11.20), and (92.15±11.94) min, respectively. There was no significant difference between Groups A and B (P=0.06), but there was a significant difference between Groups B and C (P<0.05). There were 6 cases of postoperative dysesthesia (POD) in Group I and 2 cases in Group IIA (P=0.27). There were 2 cases of residual disc in Group I, and 4 cases in Group II (P=0.67). There were 3 cases of recurrence in Group I, and 2 cases in Group II (P>0.05). Conclusions: Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training. PMID:27381732

  15. Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study.

    PubMed

    Wu, Xin-Bo; Fan, Guo-Xin; Gu, Xin; Shen, Tu-Gang; Guan, Xiao-Fei; Hu, An-Nan; Zhang, Hai-Long; He, Shi-Sheng

    2016-07-01

    This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy (PELD) in a transforaminal approach at the L4/5 and L5/S1 levels. We retrospectively reviewed the first 60 cases at the L4/5 level (Group I) and the first 60 cases at the L5/S1 level (Group II) of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C (Group I: A cases 1-20, B cases 21-40, C cases 41-60; Group II: A cases 1-20, B cases 21-40, C cases 41-60). Operation time was thoroughly analyzed. Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were (88.75±17.02), (67.75±6.16), and (64.85±7.82) min, respectively. There was a significant difference between Groups A and B (P<0.05), but no significant difference between Groups B and C (P=0.20). The mean operation times of Groups IIA, IIB, and IIC were (117.25±13.62), (109.50±11.20), and (92.15±11.94) min, respectively. There was no significant difference between Groups A and B (P=0.06), but there was a significant difference between Groups B and C (P<0.05). There were 6 cases of postoperative dysesthesia (POD) in Group I and 2 cases in Group IIA (P=0.27). There were 2 cases of residual disc in Group I, and 4 cases in Group II (P=0.67). There were 3 cases of recurrence in Group I, and 2 cases in Group II (P>0.05). Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training.

  16. Assessing the performance of multisensor fusion systems

    NASA Astrophysics Data System (ADS)

    Llinas, James

    1992-04-01

    In recent years, numerous prototypical systems have been developed for multisensor data fusion. A typical data fusion process operates on sensor parametric data (e.g., data related to target position or attribute data) in order to develop an order of battle, provide an evaluation of tactical situations, or assess tactical threats. This model, developed by the Data Fusion Sub- panel (DFS) of the Joint Directors of Laboratories, partitions fusion processing into four conceptual levels. Ancillary functions in a fusion system include the human computer interface, data base management, source-preprocessing functions, and communications. Military applications for data fusion span a broad range including fusion of data on board a single platform for identifying other platforms (e.g., identification--friend or foe--neutral systems), threat warning systems, situation assessment, and threat assessment systems. Large scale systems such as the All-Source Analysis System (ASAS) or the Joint Surveillance, Targeting, and Reconnaissance System (JSTARS) provide for direction, coordination, and fusion of both ground-based and airborne sensors to aid in the effective management of a ground based battlefield environment. Such systems have become ever more sophisticated. Indeed, many of the prototypical systems utilize advanced identification techniques such as knowledge-based or expert systems. Dempster-Shafer interface techniques, adaptive neural networks, and sophisticated tracking algorithms. While much research is being performed to develop and apply new algorithms and techniques, little work has been performed to determine how well such methods work or to compare alternative methods against a common problem. The issues of system performance and system effectiveness are keys to establishing how well an algorithm, technique, or collection of techniques perform, and then the extent to which these techniques may be used to achieve success on an operational mission.

  17. Review of fusion synfuels

    SciTech Connect

    Fillo, J.A.

    1980-01-01

    Thermonuclear fusion offers an inexhaustible source of energy for the production of hydrogen from water. Depending on design, electric generation efficiencies of approx. 40 to 60% and hydrogen production efficiencies by high-temperature electrolysis of approx. 50 to 65% are projected for fusion reactors using high-temperatures blankets. Fusion/coal symbiotic systems appear economically promising for the first generation of commercial fusion synfuels plants. Coal production requirements and the environmental effects of large-scale coal usage would be greatly reduced by a fusion/coal system. In the long term, there could be a gradual transition to an inexhaustible energy system based solely on fusion.

  18. Fudge: a high-bandwidth fusion diagnostic of the NIF

    SciTech Connect

    Moran, M. J., LLNL

    1998-06-02

    Diagnostics for the National Ignition Facility (NIF)/Inertial Confinement Fusion (ICF) program must include good characterization of the fusion source. Ideally, diagnostics would measure the spatially-resolved history of the fusion reaction rate and temperature. Existing diagnostics can satisfy this goal only partially. One class of new techniques that could play a major role in high-yield diagnostics is measurements based on fusion {gamma} rays. The Fusion Diagnostic Gamma Experiment (FUDGE) can be used to perform energy-resolved measurements of (D,T) fusion reaction rates This diagnostic is based on the 16 7-MeV {gamma} rays that are produced by (D,T) fusion. The {gamma} rays are free of spectral dispersion and can be detected with a high bandwidth Cherenkov detector. A simple magnetic monochromator selects signals from the 16 7-MeV {gamma} rays and reduces background signals from non-fusion {gamma} rays.

  19. Data fusion for the detection of buried land mines

    SciTech Connect

    Clark, G.A.; Sengupta, S.K.; Schaich, P.C.; Sherwood, R.J.; Buhl, M.R.; Hernandez, J.E.; Kane, R.J.; Barth, M.J.; Fields, D.J.; Carter, M.R.

    1993-10-01

    The authors conducted experiments to demonstrate the enhanced delectability of buried land mines using sensor fusion techniques. Multiple sensors, including imagery, infrared imagery, and ground penetrating radar, have been used to acquire data on a number of buried mines and mine surrogates. The authors present this data along with a discussion of the application of sensor fusion techniques for this particular detection problem. The authors describe the data fusion architecture and discuss some relevant results of these classification methods.

  20. Comparison of Semidistributed Multinode TOA-DOA Fusion Localization and GPS-Aided TOA (DOA) Fusion Localization for MANETs

    NASA Astrophysics Data System (ADS)

    Wang, Zhonghai; Zekavat, Seyed

    2008-12-01

    This paper evaluates the performance of a semidistributed multinode time-of-arrival (TOA) and direction-of-arrival (DOA) fusion localization technique in terms of localization circular error probability (CEP). The localization technique is applicable in mobile ad hoc networks (MANETs) when global positioning system (GPS) is not available (GPS denied environments). The localization CEP of the technique is derived theoretically and verified via simulations. In addition, we theoretically derive the localization CEP of GPS-aided TOA fusion and GPS-aided DOA fusion techniques, which are also applicable in MANETs. Finally, we compare these three localization techniques theoretically and via simulations. The comparison confirms that in moderate scale MANETs, the multinode TOA-DOA fusion localization technique achieves the best performance; while in large scale MANETs, GPS-aided TOA fusion leads to the best performance.

  1. Viral membrane fusion

    PubMed Central

    Harrison, Stephen C.

    2015-01-01

    Membrane fusion is an essential step when enveloped viruses enter cells. Lipid bilayer fusion requires catalysis to overcome a high kinetic barrier; viral fusion proteins are the agents that fulfill this catalytic function. Despite a variety of molecular architectures, these proteins facilitate fusion by essentially the same generic mechanism. Stimulated by a signal associated with arrival at the cell to be infected (e.g., receptor or co-receptor binding, proton binding in an endosome), they undergo a series of conformational changes. A hydrophobic segment (a “fusion loop” or “fusion peptide”) engages the target-cell membrane and collapse of the bridging intermediate thus formed draws the two membranes (virus and cell) together. We know of three structural classes for viral fusion proteins. Structures for both pre- and postfusion conformations of illustrate the beginning and end points of a process that can be probed by single-virion measurements of fusion kinetics. PMID:25866377

  2. Can fan beam iCT accurately predict indirect decompression in MISS fusion procedures?

    PubMed

    Janssen, Insa; Lang, Gernot; Navarro-Ramirez, Rodrigo; Jada, Ajit; Berlin, Connor; Hilis, Aaron; Zubkov, Micaella; Gandevia, Lena; Härtl, Roger

    2017-08-07

    Recently, a novel mobile intraoperative fan-beam CT (iFBCT) was introduced, allowing for real time navigation and immediate intraoperative evaluation of neural decompression in spine surgery. This study sought to investigate whether intraoperatively assessed neural decompression during minimally invasive spine surgery (MISS) has a predictive value for clinical and radiographic outcome. A retrospective study of patients undergoing iCT-guided extreme lateral interbody fusion (XLIF) or transforaminal lumbar interbody fusion (TLIF) was conducted. Pre- (1) and intraoperative (after cage implantation; 2), postoperative (3), and follow-up (4) radiographic and clinical parameters obtained from X-rays or CT were quantified. 34 patients (41 spinal segments) were analyzed. iCT-based navigation was successfully accomplished in all patients. Radiographic parameters, revealed significant improvement from preoperatively to intraoperatively after cage implantation in both MISS procedures (XLIF/TLIF) (p≤0.05). Radiological parameters for both MISS fusion procedures did not reveal significant differences to the assessed radiographic measures at follow-up (P>0.05). Radiological outcome values did not decrease when compared intraoperatively (after cage implantation) to latest follow-up. Utilization of intraoperative fan-beam CT is capable of assessing neural decompression intraoperatively with high accuracy allowing for precise prediction of radiological outcome and earliest possible feedback during MISS fusion procedures. These findings are highly valuable for routine practice and future investigations towards finding a threshold for neural decompression that translates into clinical improvement. If sufficient neural decompression has been confirmed with iCT imaging studies, additional postoperative and/or follow-up imaging studies might no longer be required if patients remain asymptomatic. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. A novel imaging technique for fusion of high-quality immobilised MR images of the head and neck with CT scans for radiotherapy target delineation.

    PubMed

    Webster, G J; Kilgallon, J E; Ho, K F; Rowbottom, C G; Slevin, N J; Mackay, R I

    2009-06-01

    Uncertainty and inconsistency are observed in target volume delineation in the head and neck for radiotherapy treatment planning based only on CT imaging. Alternative modalities such as MRI have previously been incorporated into the delineation process to provide additional anatomical information. This work aims to improve on previous studies by combining good image quality with precise patient immobilisation in order to maintain patient position between scans. MR images were acquired using quadrature coils placed over the head and neck while the patient was immobilised in the treatment position using a five-point thermoplastic shell. The MR image and CT images were automatically fused in the Pinnacle treatment planning system using Syntegra software. Image quality, distortion and accuracy of the image registration using patient anatomy were evaluated. Image quality was found to be superior to that acquired using the body coil, while distortion was < 1.0 mm to a radius of 8.7 cm from the scan centre. Image registration accuracy was found to be 2.2 mm (+/- 0.9 mm) and < 3.0 degrees (n = 6). A novel MRI technique that combines good image quality with patient immobilization has been developed and is now in clinical use. The scan duration of approximately 15 min has been well tolerated by all patients.

  4. A low-cost, durable, combined ultrasound and fluoroscopic phantom for cervical transforaminal injections.

    PubMed

    Lerman, Imanuel R; Souzdalnitski, Dmitri; Narouze, Samer

    2012-01-01

    This technical report describes a durable, low-cost, anatomically accurate, and easy-to-prepare combined ultrasound (US) and fluoroscopic phantom of the cervical spine. This phantom is meant to augment training in US- and fluoroscopic-guided pain medicine procedures. The combined US and fluoroscopic phantom (CUF-P) is prepared from commercially available liquid plastic that is ordinarily used to prepare synthetic fishing lures. The liquid plastic is heated and then poured into a metal canister that houses an anatomical cervical spine model. Drops of dark purple dye are added to make the phantom opaque. After cooling, tubing is attached to the CUF-P to simulate blood vessels. The CUF-P accurately simulates human tissue by imitating both the tactile texture of skin and the haptic resistance of human tissue as the needle is advanced. This phantom contains simulated fluid-filled vertebral arteries that exhibit pulsed flow under color Doppler US. Under fluoroscopic examination, the CUF-P-simulated vertebral arteries also exhibit uptake of contrast dye if mistakenly injected. The creation of a training phantom allows the pain physician to practice needle positioning technique while simultaneously visualizing both targeted and avoidable vascular structures under US and fluoroscopic guidance. This low-cost CUF-P is easy to prepare and is reusable, making it an attractive alternative to current homemade and commercially available phantom simulators.

  5. Magnetized Target Fusion in Advanced Propulsion Research

    NASA Technical Reports Server (NTRS)

    Cylar, Rashad

    2003-01-01

    The Magnetized Target Fusion (MTF) Propulsion lab at NASA Marshall Space Flight Center in Huntsville, Alabama has a program in place that has adopted to attempt to create a faster, lower cost and more reliable deep space transportation system. In this deep space travel the physics and development of high velocity plasma jets must be understood. The MTF Propulsion lab is also in attempt to open up the solar system for human exploration and commercial use. Fusion, as compared to fission, is just the opposite. Fusion involves the light atomic nuclei combination to produce denser nuclei. In the process, the energy is created by destroying the mass according to the distinguished equation: E = mc2 . Fusion energy development is being pursued worldwide as a very sustainable form of energy that is environmentally friendly. For the purposes of space exploration fusion reactions considered include the isotopes of hydrogen-deuterium (D2) and tritium (T3). Nuclei have an electrostatic repulsion between them and in order for the nuclei to fuse this repulsion must be overcome. One technique to bypass repulsion is to heat the nuclei to very high temperatures. The temperatures vary according to the type of reactions. For D-D reactions, one billion degrees Celsius is required, and for D-T reactions, one hundred million degrees is sufficient. There has to be energy input for useful output to be obtained form the fusion To make fusion propulsion practical, the mass, the volume, and the cost of the equipment to produce the reactions (generally called the reactor) need to be reduced by an order of magnitude or two from the state-of-the-art fusion machines. Innovations in fusion schemes are therefore required, especially for obtaining thrust for propulsive applications. Magnetized target fusion (MTF) is one of the innovative fusion concepts that have emerged over the last several years. MSFC is working with Los Alamos National Laboratory and other research groups in studying the

  6. Magneto-Inertial Fusion

    SciTech Connect

    Wurden, G. A.; Hsu, S. C.; Intrator, T. P.; Grabowski, T. C.; Degnan, J. H.; Domonkos, M.; Turchi, P. J.; Campbell, E. M.; Sinars, D. B.; Herrmann, M. C.; Betti, R.; Bauer, B. S.; Lindemuth, I. R.; Siemon, R. E.; Miller, R. L.; Laberge, M.; Delage, M.

    2015-11-17

    In this community white paper, we describe an approach to achieving fusion which employs a hybrid of elements from the traditional magnetic and inertial fusion concepts, called magneto-inertial fusion (MIF). The status of MIF research in North America at multiple institutions is summarized including recent progress, research opportunities, and future plans.

  7. Cold fusion coatings

    SciTech Connect

    Wachtler, W.R.

    1993-12-31

    Historically, fusion of metals was accomplished through the use of heat. Cold fusion has become a reality with metal to metal fusion occurring at room temperature. The basics of this new technology which can be done in tank, brush or solid form is covered in this paper.

  8. Hot and cold fusion

    SciTech Connect

    Not Available

    1990-08-01

    This article presents an overview of research in cold fusion research and development in cold fusion at the Tokomak Fusion Test Reactor at the Princeton Plasma Physics Lab, and at the inertial containment facility at Lawrence Livermore National Lab. is described.

  9. Magneto-Inertial Fusion

    DOE PAGES

    Wurden, G. A.; Hsu, S. C.; Intrator, T. P.; ...

    2015-11-17

    In this community white paper, we describe an approach to achieving fusion which employs a hybrid of elements from the traditional magnetic and inertial fusion concepts, called magneto-inertial fusion (MIF). Furthermore, the status of MIF research in North America at multiple institutions is summarized including recent progress, research opportunities, and future plans.

  10. Cluster-impact fusion

    SciTech Connect

    Echenique, P.M.; Manson, J.R.; Ritchie, R.H. )

    1990-03-19

    We present a model for the cluster-impact-fusion experiments of Buehler, Friedlander, and Friedman, Calculated fusion rates as a function of bombarding energy for constant cluster size agree well with experiment. The dependence of the fusion rate on cluster size at fixed bombarding energy is explained qualitatively. The role of correlated, coherent collisions in enhanced energy loss by clusters is emphasized.

  11. Cold fusion research

    SciTech Connect

    1989-11-01

    I am pleased to forward to you the Final Report of the Cold Fusion Panel. This report reviews the current status of cold fusion and includes major chapters on Calorimetry and Excess Heat, Fusion Products and Materials Characterization. In addition, the report makes a number of conclusions and recommendations, as requested by the Secretary of Energy.

  12. Magnetized target fusion and fusion propulsion

    NASA Astrophysics Data System (ADS)

    Kirkpatrick, Ronald C.

    2002-01-01

    Magnetized target fusion (MTF) is a thermonuclear fusion concept that is intermediate between the two mainline approaches, magnetic confinement and inertial confinement fusion (MCF and ICF). MTF incorporates some aspects of each and offers advantages over each of the mainline approaches. First, it provides a means of reducing the driver power requirements, thereby admitting a wider range of drivers than ICF. Second, the magnetic field is only used for insulation, not confinement, and the plasma is wall confined, so that plasma instabilities are traded in for hydrodynamic instabilities. However, the degree of compression required to reach fusion condition is lower than for ICF, so that hydrodynamic instabilities are much less threatening. The standoff driver innovation proposes to dynamically form the target plasma and a gaseous shell that compresses and confines the target plasma. Therefore, fusion target fabrication is traded in for a multiplicity of plasma guns, which must work in synchrony. The standoff driver embodiment of MTF leads to a fusion propulsion system concept that is potentially compact and lightweight. We will discuss the underlying physics of MTF and some of the details of the fusion propulsion concept using the standoff driver approach. We discuss here the optimization of an MTF target design for space propulsion. .

  13. Lower Learning Difficulty and Fluoroscopy Reduction of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with an Accurate Preoperative Location Method.

    PubMed

    Fan, Guoxin; Gu, Xin; Liu, Yifan; Wu, Xinbo; Zhang, Hailong; Gu, Guangfei; Guan, Xiaofei; He, Shisheng

    2016-01-01

    Transforaminal percutaneous endoscopic lumbar discectomy (tPELD) poses great challenges for junior surgeons. Beginners often require repeated attempts using fluoroscopy causing more punctures, which may significantly undermine their confidence and increase the radiation exposure to medical staff and patients. Moreover, the impact of an accurate location on the learning curve of tPELD has not been defined. The study aimed to investigate the impact of an accurate preoperative location method on learning difficulty and fluoroscopy time of tPELD. Retrospective evaluation. Patients receiving tPELD by one surgeon with a novel accurate preoperative location method were regarded as Group A, and those receiving tPELD by another surgeon with a conventional fluoroscopy method were regarded as Group B. From January 2012 to August 2014, we retrospectively reviewed the first 80 tPELD cases conducted by 2 junior surgeons. The operation time, fluoroscopy times, preoperative location time, and puncture-channel time were thoroughly analyzed. The operation time of the first 20 patients were 99.75 ± 10.38 minutes in Group A and 115.7 ± 16.46 minutes in Group B, while the operation time of all 80 patients was 88.36 ± 11.56 minutes in Group A and 98.26 ± 14.90 minutes in Group B. Significant differences were detected in operation time between the 2 groups, both for the first 20 patients and total 80 patients (P < 0.05). The fluoroscopy times were 26.78 ± 4.17 in Group A and 33.98 ± 2.69 in Group B (P < 0.001). The preoperative location time was 3.43 ± 0.61 minutes in Group A and 5.59 ± 1.46 minutes in Group B (P < 0.001). The puncture-channel time was 27.20 ± 4.49 minutes in Group A and 34.64 ± 8.35 minutes in Group B (P < 0.001). There was a moderate correlation between preoperative location time and puncture-channel time (r = 0.408, P < 0.001), and a moderate correlation between preoperative location time and fluoroscopy times (r = 0.441, P < 0.001). Mild correlations were

  14. Puncture Reduction in Percutaneous Transforaminal Endoscopic Discectomy with HE’s Lumbar LOcation (HELLO) System: A Cadaver Study

    PubMed Central

    Sun, Qi; Hu, Annan; Zhu, Yanjie; Gu, Guangfei; Zhang, Hailong; He, Shisheng

    2015-01-01

    Background Percutaneous transforaminal endoscopic discectomy (PTED) usually requires numerous punctures under X-ray fluoroscopy. Repeated puncture will lead to more radiation exposure and reduce the beginners' confidence. Objective This cadaver study aimed to investigate the efficacy of HE’s Lumbar Location (HELLO) system in puncture reduction of PTED. Study design Cadaver study. Setting Comparative groups. Methods HELLO system consists of self-made surface locator and puncture locator. One senior surgeon conducted the puncture procedure of PTED on the left side of 20 cadavers at L4/L5 and L5/S1 level with the assistance of HELLO system (Group A). Additionally, the senior surgeon conducted the puncture procedure of PTED on the right side of the cadavers at L4/L5 and L5/S1 level with traditional methods (Group B). On the other hand, an inexperienced surgeon conducted the puncture procedure of PTED on the left side of the cadavers at L4/L5 and L5/S1 level with the assistance of our HELLO system (Group C). Results At L4/L5 level, there was significant difference in puncture times between Group A and Group B (P<0.001), but no significant difference was observed between Group A and Group C (P = 0.811). Similarly at L5/S1 level, there was significant difference in puncture times between Group A and Group B (P<0.001), but no significant difference was observed between Group A and Group C (P = 0.981). At L4/L5 level, there was significant difference in fluoroscopy time between Group A and Group B (P<0.001), but no significant difference was observed between Group A and Group C (P = 0.290). Similarly at L5/S1 level, there was significant difference in fluoroscopy time between Group A and Group B (P<0.001), but no significant difference was observed between Group A and Group C (P = 0.523). As for radiation exposure, HELLO system reduced 39%-45% radiation dosage when comparing Group A and Group B, but there was no significant difference in radiation exposure between Group A

  15. Viral membrane fusion

    SciTech Connect

    Harrison, Stephen C.

    2015-05-15

    Membrane fusion is an essential step when enveloped viruses enter cells. Lipid bilayer fusion requires catalysis to overcome a high kinetic barrier; viral fusion proteins are the agents that fulfill this catalytic function. Despite a variety of molecular architectures, these proteins facilitate fusion by essentially the same generic mechanism. Stimulated by a signal associated with arrival at the cell to be infected (e.g., receptor or co-receptor binding, proton binding in an endosome), they undergo a series of conformational changes. A hydrophobic segment (a “fusion loop” or “fusion peptide”) engages the target-cell membrane and collapse of the bridging intermediate thus formed draws the two membranes (virus and cell) together. We know of three structural classes for viral fusion proteins. Structures for both pre- and postfusion conformations of illustrate the beginning and end points of a process that can be probed by single-virion measurements of fusion kinetics. - Highlights: • Viral fusion proteins overcome the high energy barrier to lipid bilayer merger. • Different molecular structures but the same catalytic mechanism. • Review describes properties of three known fusion-protein structural classes. • Single-virion fusion experiments elucidate mechanism.

  16. Nuclear diagnostics for inertial confinement fusion implosions

    SciTech Connect

    Murphy, T.J.

    1997-11-01

    This abstract contains viewgraphs on nuclear diagnostic techniques for inertial confinement fusion implosions. The viewgraphs contain information on: reactions of interest in ICF; advantages and disadvantages of these methods; the properties nuclear techniques can measure; and some specifics on the detectors used.

  17. A survey of multi-sensor data fusion systems

    NASA Astrophysics Data System (ADS)

    Linn, R. J.; Hall, D. L.; Llinas, J.

    1991-08-01

    Multisensor data fusion integrates data from multiple sensors (and types of sensors) to perform inferences which are more accurate and specific than those from processing single-sensor data. Levels of inference range from target detection and identification to higher level situation assessment and threat assessment. This paper provides a survey of more than 50 data fusion systems and summarizes their application, development environment, system status and key techniques. The techniques are mapped to a taxonomy previously developed by Hall and Linn (1990); these include positional fusion techniques, such as association and estimation, and identity fusion methods, including statistical methods, nonparametric methods, and cognitive techniques (e.g. templating, knowledge-based systems, and fuzzy reasoning). An assessment of the state of fusion system development is provided.

  18. Current Status of Lumbar Interbody Fusion for Degenerative Spondylolisthesis

    PubMed Central

    TAKAHASHI, Toshiyuki; HANAKITA, Junya; OHTAKE, Yasufumi; FUNAKOSHI, Yusuke; OICHI, Yuki; KAWAOKA, Taigo; WATANABE, Mizuki

    2016-01-01

    Instrumented lumbar fusion can provide immediate stability and assist in satisfactory arthrodesis in patients who have pain or instability of the lumbar spine. Lumbar adjunctive fusion with decompression is often a good procedure for surgical management of degenerative spondylolisthesis (DS). Among various lumbar fusion techniques, lumbar interbody fusion (LIF) has an advantage in that it maintains favorable lumbar alignment and provides successful fusion with the added effect of indirect decompression. This technique has been widely used and represents an advancement in spinal instrumentation, although the rationale and optimal type of LIF for DS remains controversial. We evaluated the current status and role of LIF in DS treatment, mainly as a means to augment instrumentation. We addressed the basic concept of LIF, its indications, and various types including minimally invasive techniques. It also has acceptable biomechanical features, and offers reconstruction with ideal lumbar alignment. Postsurgical adverse events related to each LIF technique are also addressed. PMID:27169496

  19. Materials research for fusion

    NASA Astrophysics Data System (ADS)

    Knaster, J.; Moeslang, A.; Muroga, T.

    2016-05-01

    Fusion materials research started in the early 1970s following the observation of the degradation of irradiated materials used in the first commercial fission reactors. The technological challenges of fusion energy are intimately linked with the availability of suitable materials capable of reliably withstanding the extremely severe operational conditions of fusion reactors. Although fission and fusion materials exhibit common features, fusion materials research is broader. The harder mono-energetic spectrum associated with the deuterium-tritium fusion neutrons (14.1 MeV compared to <2 MeV on average for fission neutrons) releases significant amounts of hydrogen and helium as transmutation products that might lead to a (at present undetermined) degradation of structural materials after a few years of operation. Overcoming the historical lack of a fusion-relevant neutron source for materials testing is an essential pending step in fusion roadmaps. Structural materials development, together with research on functional materials capable of sustaining unprecedented power densities during plasma operation in a fusion reactor, have been the subject of decades of worldwide research efforts underpinning the present maturity of the fusion materials research programme.

  20. Establishment of an Institute for Fusion Studies

    SciTech Connect

    Hazeltine, R.D.

    1992-07-01

    The Institute for Fusion Studies is a national center for theoretical fusion plasma physics research. Its purposes are: (1) to conduct research on theoretical questions concerning the achievement of controlled fusion energy by means of magnetic confinement--including both fundamental problems of long-range significance, as well as shorter-term issues; (2) to serve as a center for information exchange, nationally and internationally, by hosting exchange visits, conferences, and workshops; (3) and to train students and postdoctoral research personnel for the fusion energy program and plasma physics research areas. The theoretical research results that are obtained by the Institute contribute mainly to the progress of national and international efforts in nuclear fusion research, whose goal is the development of fusion power.as a basic energy source. In addition to its primary focus on fusion physics, the Institute is also involved with research in related fields, such as advanced computing techniques, nonlinear dynamics, plasma astrophysics, and accelerator physics. The work of EFS scientists continued to receive national and international recognition. Numerous invited papers were given during the past year at workshops, conferences, and scientific meetings. Last year IFS scientists published 95 scientific articles in technical journals and monographs.

  1. Parameterizing loop fusion for automated empirical tuning

    SciTech Connect

    Zhao, Y; Yi, Q; Kennedy, K; Quinlan, D; Vuduc, R

    2005-12-15

    Traditional compilers are limited in their ability to optimize applications for different architectures because statically modeling the effect of specific optimizations on different hardware implementations is difficult. Recent research has been addressing this issue through the use of empirical tuning, which uses trial executions to determine the optimization parameters that are most effective on a particular hardware platform. In this paper, we investigate empirical tuning of loop fusion, an important transformation for optimizing a significant class of real-world applications. In spite of its usefulness, fusion has attracted little attention from previous empirical tuning research, partially because it is much harder to configure than transformations like loop blocking and unrolling. This paper presents novel compiler techniques that extend conventional fusion algorithms to parameterize their output when optimizing a computation, thus allowing the compiler to formulate the entire configuration space for loop fusion using a sequence of integer parameters. The compiler can then employ an external empirical search engine to find the optimal operating point within the space of legal fusion configurations and generate the final optimized code using a simple code transformation system. We have implemented our approach within our compiler infrastructure and conducted preliminary experiments using a simple empirical search strategy. Our results convey new insights on the interaction of loop fusion with limited hardware resources, such as available registers, while confirming conventional wisdom about the effectiveness of loop fusion in improving application performance.

  2. Sensor fusion for mobile robot navigation

    SciTech Connect

    Kam, M.; Zhu, X.; Kalata, P.

    1997-01-01

    The authors review techniques for sensor fusion in robot navigation, emphasizing algorithms for self-location. These find use when the sensor suite of a mobile robot comprises several different sensors, some complementary and some redundant. Integrating the sensor readings, the robot seeks to accomplish tasks such as constructing a map of its environment, locating itself in that map, and recognizing objects that should be avoided or sought. The review describes integration techniques in two categories: low-level fusion is used for direct integration of sensory data, resulting in parameter and state estimates; high-level fusion is used for indirect integration of sensory data in hierarchical architectures, through command arbitration and integration of control signals suggested by different modules. The review provides an arsenal of tools for addressing this (rather ill-posed) problem in machine intelligence, including Kalman filtering, rule-based techniques, behavior based algorithms and approaches that borrow from information theory, Dempster-Shafer reasoning, fuzzy logic and neural networks. It points to several further-research needs, including: robustness of decision rules; simultaneous consideration of self-location, motion planning, motion control and vehicle dynamics; the effect of sensor placement and attention focusing on sensor fusion; and adaptation of techniques from biological sensor fusion.

  3. On the path to fusion energy

    NASA Astrophysics Data System (ADS)

    Tabak, M.

    2006-06-01

    There is a need to develop alternate energy sources in the coming century because fossil fuels will become depleted and their use may lead to global climate change. Inertial fusion can become such an energy source, but significant progress must be made before its promise is realized. The high-density approach to inertial fusion suggested by Nuckolls, et al., leads to reactors compatible with civilian power production. Methods to achieve the good control of hydrodynamic stability (adiabat shaping) and implosion symmetry required to achieve these high fuel densities will be discussed. Examples of symmetry control for targets driven by Z-pinches or heavy ion beams are given. Fast Ignition, a technique that achieves fusion ignition by igniting fusion fuel after it is assembled, will be described along with its gain curves. Fusion costs of energy for conventional hotspot ignition will be compared with those of Fast Ignition and their capital costs compared with advanced fission plants. Finally, techniques that may improve possible Fast Ignition gains by an order of magnitude and reduce driver scales by an order of magnitude below conventional ignition requirements are described. If these innovations are successful, the fusio