Surgical Management of Lumbar Spinal Canal Stenosis with Instrumentation at the Yaounde Central Hospital: Comparison of Unilateral versus Bilateral Pedicle Screw Fixation Combined with Transforaminal Lumbar Interbody Fusion

Introduction: The choice of adopting unilateral pedicle screw fixation or using bilateral pedicle screw fixation in lumbar spinal stenosis remains controversial. In our context, very few studies have been performed comparing the clinical effectiveness of unilateral versus bilateral fixation in the surgical management of lumbar spinal canal stenosis. Objective: Evaluate the impact on quality of life and clinical efficacy of unilateral spondylodesis compared to bilateral spondylodesis in the surgical management of lumbar spinal canal stenosis at the Yaounde Central Hospital. Methods: This was a retrospective descriptive cross-sectional study for a period of 4 years, from June 2015 to June 2019. It involved all patients operated for lumbar canal stenosis and who underwent spondylodesis or spinal fusion at the neurosurgery department of the Yaounde Central Hospital. Results: A total of 68 participants were recruited during our study period. 32 (47%) of the study population were in the 50 - 60 age group, with a mean age of 56.98 years ranging from 41 to 75 years. Females, housewives and farmers were the most affected. In our study, 72% of patients had unilateral spondylodesis and 28% had bilateral fusion. Preoperatively, 71% of patients had insurmountable pain, refractory to medical treatment. At 3 months postoperatively, 73.7% of patients with bilateral setup had moderate pain compared to 69% of those with unilateral setup. At 6 months postoperatively, 79% of patients with bilateral fusion had mild pain compared to 82% of patients with unilateral setup. At 1 year postoperatively, all patients had mild pain. Preoperatively, 66.2% of patients were unable to walk and 19.1% of patients were bedridden according to the Oswestry score. At 3 months postoperatively, 10.2% of patients with unilateral setup were unable to walk compared to 10.5% of patients with bilateral fixation, while 67.3% of patients with unilateral fixation had moderate disability compared to 52.6% of patients with bilateral fixation. At 6 months postoperatively, 51% of patients with unilateral setup had moderate disability compared to 47.4% of patients with bilateral fixation, while 42.9% of patients with unilateral fixation had mild disability compared to 42.1% of patients with bilateral fixation. At 1 year postoperatively, 81.6% of patients who underwent unilateral fixation had only mild disability compared to 73.7% of patients with bilateral fixation. Conclusion: The assessment of quality of life according to the set-up used shows similar results at 3 months, 6 months and 1 year, with no statistically significant differences. Single-sided pedicle screw fixation combined with transforaminal lumbar interbody fusion or mounting has the advantage of being faster, with less bleeding and is less expensive compared to bilateral fixation.

Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty:A systematic review and meta-analysis

BACKGROUND Over the past years,patient specific instrumentation(PSI)for total knee arthroplasty(TKA)has been implemented and routinely used.No clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation(CI)for TKA.AIM To compare the cost and cost-effectiveness of PSI TKA compared to CI TKA.METHODS A literature search was performed in healthcare,economical healthcare,and medical databases(MEDLINE,EMBASE,CINAHL,Web of Science,Cochrane Library,EconLit).It was conducted in April 2021 and again in January 2022.Relevant literature included randomised controlled trials,retrospective studies,prospective studies,observational studies,and case control studies.All studies were assessed on methodological quality.Relevant outcomes included incremental cost-effectiveness ratio,quality-adjusted life years,total costs,imaging costs,production costs,sterilization associated costs,surgery duration costs and readmission rate costs.All eligible studies were assessed for risk of bias.Meta-analysis was performed for outcomes with sufficient data.RESULTS Thirty-two studies were included into the systematic review.Two were included in the metaanalysis.3994 PSI TKAs and 13267 CI TKAs were included in the sample size.The methodological quality of the included studies,based on Consensus on Health Economic Criteria-scores and risk of bias,ranged from average to good.PSI TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient case.PSI TKA costs more compared to CI TKA when considering imaging and production costs.Considering total costs per patient case,PSI TKA is more expensive in comparison to CI TKA.Meta-analysis comparing total costs for PSI TKA,and CI TKA showed a significant higher cost for PSI TKA.CONCLUSION Cost for PSI and CI TKA can differ when considering distinct aspects of their implementation.Total costs per patient case are increased for PSI TKA when compared to CI TKA.

Journal of Measurement Science and Instrumentation

Journal of Measurement Science and Iustrumentation(CN14-1357/TH,ISSN 1674-8042)is published by North University of China.It is a comprehensive academic journal,aiming to present scientifie research papers in the fields of measurement science and instrumentation,ineluding general and instrumentation of measurement and control applied to such academie and industrial fields asprineiples.

Metallosis with spinal implant loosening after spinal instrumentation:A case report

BACKGROUND Spinal metallosis is a rare complication following spinal instrumentation whereby an inflammatory response to the metal implants results in the development of granulomatous tissue.CASE SUMMARY We describe the case of a 78-year-old woman who had recurrence of back pain 5 years after lumbar spine posterior decompression and instrumented fusion.Lumbar spine radiographs showed hardware loosening and magnetic resonance imaging showed adjacent segment disease.Revision surgery revealed evidence of metallosis intraoperatively.CONCLUSION Spinal metallosis can present several years after instrumentation.Radiography and computed tomography may demonstrate hardware loosening secondary to metallosis.Blood metal concentrations associated with spinal metallosis have yet to be established.Hence,metallosis is still an intraoperative and histopathological diagnosis.The presence of metallosis after spinal instrumentation likely indicates a more complex underlying problem:Pseudarthrosis,failure to address sagittal balance,infection,and cross-threading of set screws.Hence,identifying metallosis is important,but initiating treatment promptly for symptomatic implant loosening is of greater paramount.

AVEVA Instrumentation Engineer在仪表系统设计中的应用研究

本文分析AVEVA Instrumentation软件功能模块Engineer在仪表系统设计中的应用。重点探讨借助AVEVA Instrumentation软件实现跨专业、跨软件的数据交互开发及仪表专业清单文件、数据表的模板定制。

Current concepts in total knee arthroplasty: Patient specific instrumentation

Patient specific instrumentation(PSI) in total knee arthroplasty(TKA) promises faster operation time(by using less instruments and individual cutting jigs), less blood loss, faster rehabilitation, better implant sizing and accuracy, superior overall outcome, and at the end- less costs. However, as evident for every new development, its superiority remains to be provenover the conventional systems. Whilst dissatisfaction is reported to be eminent in up to 30% of patients having undergone conventional TKA, it is unclear, whether PSI can address to these patients as a suitable option in the future. The author believes that the current evidence does not support superiority of PSI in TKA over conventional systems. However, future long-term level I and II studies might aid to show its cost-effectiveness stating same results, accuracy, and overall outcome with less operation time.

Computerised tomography vs magnetic resonance imaging for modeling of patient-specific instrumentation in total knee arthroplasty

AIM: To summarise and compare currently available evidence regarding accuracy of pre-operative imaging, which is one of the key choices for surgeons contemplating patient-specific instrumentation(PSI) surgery.METHODS: The MEDLINE and EMBASE medical literature databases were searched, from January 1990 to December 2013, to identify relevant studies. The data from several clinical studies was assimilated to allow appreciation and comparison of the accuracy of each modality. The overall accuracy of each modality was calculated as proportion of outliers > 3% in the coronal plane of both computerised tomography(CT) or magnetic resonance imaging(MRI). RESULTS: Seven clinical studies matched our inclusion criteria for comparison and were included in our study for statistical analysis. Three of these reported series using MRI and four with CT. Overall percentage of outliers > 3% in patients with CT-based PSI systems was 12.5% vs 16.9% for MRI-based systems. These results were not statistically significant. CONCLUSION: Although many studies have been undertaken to determine the ideal pre-operative imaging modality, conclusions remain speculative in the absence of long term data. Ultimately, information regarding accuracy of CT and MRI will be the main determining factor. Increased accuracy of pre-operative imaging could result in longer-term savings, and reduced accumulated dose of radiation by eliminating the need for post-operative imaging and revision surgery.

Evaluation of behaviors of earth and rockfill dams during construction and initial impounding using instrumentation data and numerical modeling

In this study,the behavior of Gavoshan dam was evaluated during construction and the first impounding.A two-dimensional（2D） numerical analysis was conducted based on a finite difference method on the largest cross-section of the dam using the results of instrument measurements and back analysis.These evaluations will be completed in the case that back analysis is carried out in order to control the degree of the accuracy and the level of confidence of the measured behavior since each of the measurements could be controlled by comparing it to the result obtained from the numerical model.Following that,by comparing the results of the numerical analysis with the measured values,it is indicated that there is a proper consistency between these two values.Moreover,it was observed that the dam performance was suitable regarding the induced pore water pressure,the pore water pressure ratio r;,settlement,induced stresses,arching degree,and hydraulic fracturing probability during the construction and initial impounding periods.The results demonstrated that the maximum settlement of the core was 238 cm at the end of construction.In the following 6 years after construction（initial impounding and exploitation period）,the accumulative settlement of the dam was 270 cm.It is clear that 88% of the total settlement of the dam took place during dam construction.The reason is that the clay core was smashed in the wet side,i.e.the optimum moisture content.Whereas the average curving ratio was 0.64 during dam construction; at the end of the initial impounding,the maximum amount of curving ratio in the upstream was 0.81,and the minimum（critical） amount in the downstream was 0.52.It was also concluded that this dam is safe in comparison with the behaviors of other similar dams in the world.

Recent advances in earthquake monitoring I:Ongoing revolution of seismic instrumentation

Seismic networks have significantly improved in the last decade in terms of coverage density,data quality,and instrumental diversity.Moreover,revolutionary advances in ultra-dense seismic instruments,such as nodes and fiber-optic sensing technologies,have recently provided unprecedented high-resolution data for regional and local earthquake monitoring.Nodal arrays have characteristics such as easy installation and flexible apertures,but are limited in power efficiency and data storage and thus most suitable as temporary networks.Fiber-optic sensing techniques,including distributed acoustic sensing,can be operated in real time with an in-house power supply and connected data storage,thereby exhibiting the potential of becoming next-generation permanent networks.Fiber-optic sensing techniques offer a powerful way of filling the observation gap particularly in submarine environments.Despite these technological advancements,various challenges remain.First,the data characteristics of fiber-optic sensing are still unclear.Second,it is challenging to construct software infrastructures to store,transfer,visualize,and process large amount of seismic data.Finally,innovative detection methods are required to exploit the potential of numerous channels.With improved knowledge about data characteristics,enhanced software infrastructures,and suitable data processing techniques,these innovations in seismic instrumentation could profoundly impact observational seismology.

Patient-specific instrumentation in total ankle arthroplasty

The recent increase in the adoption of total ankle arthroplasty(TAA)reflects the improvements in implant designs and surgical techniques,including the use of preoperative navigation system and patient-specific instrumentation(PSI),such as custom-made cutting guides.Cutting guides are customized with respect to each patient's anatomy based on preoperative ankle computed tomography scans,and they drive the saw intra-operatively to improve the accuracy of bone resection and implant positioning.Despite some promising results,the main queries in the literature are whether PSI improves the reliability of achieving neutral ankle alignment and more accurate implant sizing,whether it is actually superior over standard techniques,and whether it is cost effective.Moreover,the advantages of PSI in clinical outcomes are still theoretical because the current literature does not allow to confirm its superiority.The purpose of this review article is therefore to assess the current literature on PSI in TAA with regard to current implants with PSI,templating and preoperative planning strategies,alignment and sizing,clinical outcomes,cost analysis,and comparison with standard techniques.

Intra-operative computed tomography guided navigation for pediatric pelvic instrumentation: A technique guide

Pelvic instrumentation for neuromuscular scoliosis has been part of neuromuscular scoliosis surgery since the era of the Luque Galveston construct. Unit Rod(Medtronic Sofamor-Danek, Nashville, TN) instrumentation brought with it the concept of cantilever correction by placing the implants in the pelvis and then gradually bringing the rod to the spine by sequentially tightening the sublaminar wires, with the goal of creating a level pelvis over a straight spine. More recently surgeons have utilized pedicle screw constructs in which the corrective strategies have varied. Challenges with pelvic fixation using iliac screws linked to the spinal rod have led to the development of the S2-alariliac technique(S2 AI) in which the spinal rod connects to the pelvic screw. The screw is placed in the S2 ala, crosses the sacro-iliac joint and into the ilium through a large column of supra-acetabular bone. This column is the same area used for anterior inferior iliac spine external fixation frames used in trauma surgery. S2 AI screw placement can be technically difficult and can require experienced radiology technologists to provide the appropriate views. Additionally, although the technique was originally described being placed via freehand technique with intra-operative flouroscopy, the freehand technique suffers from the anatomic anomalies present in the pelvis in neuromuscular scoliosis. As such, we prefer to place them using intra-operative navigation for all pediatric spinal deformity cases. Below in detail we report our intra-operative technique and an illustrative case example.

ANTERIOR SPINAL FUSION WITH TSRH INSTRUMENTATION FOR SCOLIOSIS

Objective. To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.Methods. The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.Results. Preoperatively, the Cobb's angle on the coronal plane was 55. 8° (range 35° - 78°), and 14° postoperatively, with an average correction of 74. 8 %. The average unfused thoracical curve was 35. 9 ° preoperatively (range 26° - 51°) and 21. 8° (10°-42° ) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27. 9° and postoperative 25. 7° respectively. The trunk shift was 13.4 mm (5 - 28mm) preoperatively and 3. 5 mm (0-7 mm) postoperatively. The averaged apic vertebra derivation was 47. 8 mm (21 - 69 mm) before operation and 10. 8 mm (3-20 mm) after operation. The distance of C7 to center sacrum vertical line (CSVL) was 19. 5 mm(16 - 42)preoperatively and 11. 3 mm (0-32 mm) postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively, and were improved to normal in 10 patients, 1 degree in 4 patients, and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side, and the symptom vanished at 3-month followed up.Conclusion. If used appropriately, TSRH anterior spinal system is a good treatment for low thoracic or thoracic lumbar scoliosis.

THREE- DIMENSIONAL CORRECTION OF SCOLIOSIS USING TSRH INSTRUMENTATION

Objective. To evaluate the results of TSRH instrumentation in the correction of coronal, sagittal and rotational deformity of scoliosis. Methods. From January 1998 to December 1999, thirty- two consecutive patients (6 males, 26 females) with scoliosis underwent anterior or posterior spinal instrumentation and fusion using TSRH instrumentation. Of these cases, 21 were idiopathic scoliosis and 11 were congenital scoliosis. The average age at surgery was 16.4 years (range, 11～ 45 years). The mean Cobb angle at surgery was 71 .2 (range, 44～ 125 ) in the coronal plane, and 49.2 ( range, 16～ 67 ) in the sagittal plane. Rotational deformity (Nash- Moe) ranged from I to III degree. Preoperative apical translation averaged 4.8 cm (range, 3～ 9 cm). Results. The average follow- up duration was 13.3 months (range, 10～ 24 months).At the final follow- up, the mean Cobb angle in the coronal plane was 26. 6 (range, 10～ 73 ),with a 63.8％ of improvement. Sagittal alignment was well maintained with a mean Cobb angle of 28 ( range, 10～ 45 ). The average correction of rotation of the apical vertebra was I degree. The average apical translation was 1.6 cm (range, 0.5～ 5.0 cm) representing a correction rate of 66,7％ . Complication was noted in two cases with an incidence of 3.1％ , one case had superficial infection and the other one had lower hook dislocation.There was no neurologic deficit and pseudoarthrodesis in this series. Conclusion. TSRH instrumentation is an effective and convenient three- dimensional correction system with a lower rate of complication, which can not only correct the coronal and rotational deformity, but maintain the sagittal alignment as well.

A Systematic Approach for Instrumentation of a Mechatronic System

This paper deals with instrumenting a mechatronic system,through the incorporation of suitable sensors,actuators,and other required hardware.Sensors(e.g.,semiconductor strain gauges,tachometers,RTD temperature sensors,cameras,piezoelectric accelerometers)are needed to measure(sense)unknown signals and parameters of a system and its environment.The information acquired in this manner is useful in operating or controlling the system,and also in process monitoring;experimental modeling(i.e.,model identification);product testing and qualification;product quality assessment;fault prediction,detection and diagnosis;warning generation;surveillance,and so on.Actuators(e.g.,stepper motors,solenoids,dc motors,hydraulic rams,pumps,heaters/coolers)are needed to"drive"a plant.Control actuators(e.g.,control valves)perform control actions,and in particular they drive control devices.Micro-electromechanical systems(MEMS)use microminiature sensors and actuators.MEMS sensors commonly use piezoelectric,capacitive,electromagnetic and piezoresistive principles.MEMS devices provide the benefits of small size and light weight(negligible loading errors),high speed(high bandwidth),and convenient mass-production(low cost).The process of instrumentation involves the identification of proper sensors,actuators,controllers,signal modification/interface hardware,and software with respect to their functions,operation,parameters,ratings,interaction with each other,so as to achieve the performance requirements of the overall system,and interfacing/integration/tuning of the selected devices into the system,for a given application.This paper presents the key steps of instrumenting a mechatronic system,in a somewhat general and systematic manner.Examples are described to illustrate several key procedures of instrumentation.

The cleaning efficiency of the root canal after different instrumentation technique and irrigation protocol:A SEM analysis

Aim: The objective of this study was to evaluate the effectiveness of manual and ultrasonic instrumentation with varying irrigation protocols on removal of the smear layer from root canal walls. Methods: Forty extracted single rooted human teeth stored in 0.5% saline were used. Periodontal soft tissues were removed followed by crown separation at the CEJ. All the teeth were randomly divided into two groups. Manually Instrumented Group 1 was irrigated with 5.25% NaOCl and 17% EDTA alternately, same as Ultrasonically Instrumented Group 2. The controls for both groups were irrigated with saline solution. Results: Ultrasonic instrumentation and the combined use of two different solutions (5.25% NaOCl and 17% EDTA) yielded better results on smear removal. Conclusions: Irrigation with 17% EDTA followed by 5.25% NaOCl was successful in complete removal of smear layer on cervical and middle thirds of the root canals. Ultrasonic instrumentation was slightly more successful on the apical one third of the root canals.

Intracardiac,pulmonary cement embolism in a 67-year-old female after cement-augmented pedicle screw instrumentation:A case report and review of literature

BACKGROUND We report a case of Intracardiac,pulmonary,and intravenous cement embolism after cement-augmented pedicle screw instrumentation in treating spondylolisthesis underlying osteoporotic bone,which was successfully managed by conservative treatment.We describe the treatment and outcome of the patient,hoping to shed light on the management of bone cement embolism.CASE SUMMARY A 67-year-old female suffered from progressive low back pain and numbness in lower extremities for 30 years.She was diagnosed with L4 and L5 spondylolisthesis,spinal stenosis,and osteoporosis.The patient underwent spinal canal decompression,an interbody fusion of L4/5 and L5/S1,cement-augmented pedicle screw instrumentation in L4-L5 segments,and regular pedicle screw in S1 segments.Three days postoperatively,a sudden drop in oxygen saturation occurred.Computerized tomography scan confirmed Intracardiac,pulmonary,and intravenous embolism.The patient was treated conservatively by continuous low-flow oxygen inhalation,anti-coagulation,and antibiotic therapy for 1 mo and continued anticoagulation treatment for 6 mo.The patient showed no further symptoms in a 30-mo follow-up.CONCLUSION Intracardiac,pulmonary cement embolism after cement-augmented pedicle screw instrumentation is extremely rare.Careful clinical and radiographic evaluation is required in multiple sites of bone cement embolism.Conservative treatment may be a primary consideration in scattered emboli without life-threatening conditions,but a clinical decision should be made on an individualized basis.

SURGICAL TREATMENT OF SPONDYLOLISTHESIS WITH SOCON INSTRUMENTATION

To observe the clinical outcomes of using a new instrumentation SOCON system in the treatment of degenerative spondylolisthesis. Methods. Retrospective clinical and roentgenograph review of 21 patients who suffered from degenerative spondylolisthesis with spinal stenosis treated by decompression, posterolateral intertransverse arthrodesis, and with transpedicle instrumentation of SOCON system. Results.Nineteen of 21 patients were completely recovery from their preoperative symptoms, 17 of 18 cases with grade one slippage reduced to normal spine alignment, 2 cases of grade two slippage fully reduced, and one case of grade two spondylolisthesis got 70% reduction. Post operative satisfactory rate was 90.5%. Pain relief was 90.5%. Neither infection nor neurologic complication occurred in this series. Conclusion. Our short time followup and limited cases showed satisfactory preliminary result of surgical treatment of spondylolisthesis with SOCON instrumentation.

Journal of Measurement Science and Instrumentation

Journal of Measurement Science and Instrumentation(CN14-1357/TH,ISSN 1674-8042)is published by North University of China.It is a comprehensive academic journal,aiming to present scientific research papers in the fields of measurement science and instrumentation,including general principles,technologies and instrumentation of measurement and control applied to such academic and industrial fields as mechanics,electric and electronic engineering,magnetics,optics,chemistry,biology,and so on.

Journal of Measurement Science and Instrumentation

Journal of Measurement Science and Instrumentation(CN 14-1357/TH,ISSN 1674-8042)is published by North University of China.It is a comprehensive academic journal,aiming to present scientific research papers in the fields of measurement science and instrumentation,including general principles,technologies and instrumentation of measurement and control applied to such academic and industrial fields as mechanics,electric and electronic engineering,magnetics,optics,chemistry,biology,and so on.

Journal of Measurement Science and Instrumentation

Journal of Measurement Science and Instrumentation(CN14-1357/TH,ISSN 1674-8042)is published by North University of China.It is a comprehensive academic journal,aiming to present scientific research papers in the fields of measurement science and instrumentation,including general principles,technologies and instrumentation of measurement and control applied to such academic and industrial fields as mechanics,electric and electronic engineering,magnetics,optics,chemistry,biology,and so on.