Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture

The aim of the current study was to compare outcomes between lateral access vertebral reconstruction (LAVR) using a rectangular footplate cage and the conventional procedure using a cylindrical footplate cage in patients with osteoporotic vertebral fracture (OVF). We included 46 patients who underwent anterior–posterior combined surgery for OVF: 24 patients underwent LAVR (Group L) and 22 underwent the conventional procedure (Group C). Preoperative, postoperative, and 1- and 2-year follow-up X-ray images were used to measure local lordotic angle, correction loss, and cage subsidence (>2 mm in vertebral endplate depression). In anterior surgery, the operation time was significantly shorter (183 vs. 248 min, p < 0.001) and the blood loss was significantly less (148 vs. 406 mL, p = 0.01) in Group L than in Group C. In Group C, two patients had anterior instrumentation failure. Correction loss was significantly smaller in Group L than in Group C (1.9° vs. 4.9° at 1 year, p = 0.02; 2.5° vs. 6.5° at 2 years, p = 0.04, respectively). Cage subsidence was significantly less in Group L than in Group C (29% vs. 80%, p < 0.001). LAVR using a rectangular footplate cage is an effective treatment for OVF to minimize surgical invasiveness and postoperative correction loss.

Late Life Field Management with Instrumentation Failure. Modelling Predictions and Successful Validations of Late Life Subsea Gas Condensate System Using Historical Field Data

Depleting reservoir pressure, increasing water cut and decreasing overall system production leading to increased liquid holdup are among the key challenges for typical late life gas condensate production system. This paper elucidates modelling details of a late life offshore subsea gas condensate system and how the findings are implemented and validated with actual field data for successful outcomes. There is only one subsea well remain in operation with relatively long subsea flowlines. Subsea pressure and temperature transducers are out of service as the asset approaches the end of design life. In this context, flow assurance team has taken the modelling approach in order to minimize cost and to maximize values. Detailed transient multiphase thermohydraulics models are developed and benchmarked against field data. Historical field data over the past two years are utilized in order to predict the trend for key parameters such as well production rates and water to gas ratio (WGR). Matrix of simulation including the predictions of slugging flow regimes are carried out for the entire flow path, from reservoir characteristics descriptions at bottom hole, through flow regimes analysis at topsides slug catcher. Three categories of operation characteristics, namely the low risk, medium risk, and high risk production periods are identified. It is predicted that the system would start to fall into slugging flow regimes from 2 months onwards with final production end date of after 10 months. This is shared with wider team such that operations and base management teams are informed with predicted multiphase flow characteristics for the remaining production life. As such, gas supply succession plan can be executed in time to ensure uninterrupted downstream commercial agreement. Feedbacks from operations team revealed accurate predictions of such analysis, including slugging flow phenomenon which was associated with flow and pressure fluctuations, was observed in field as predicted by the study. More importantly, the production cut-off date is accurately predicted 10 months ahead and within the accuracy of ± 1 week. This study demonstrated how historical field data, coupled with detailed transient multiphase thermohydraulics modelling, can be utilized for offshore gas condensate production predictions during late life. Without transducers and/or virtual metering data feed, production end date can be accurately predicted based on key parameters analysis. This is particularly valuable for supply succession planning and is deemed a successful case study with significant positive outcomes which can be used as reference for other gas condensate assets.

Spinal Instrumentation Failure from the Perspective of Load Sharing

Background In recent years, pedicle screw (PS) fixation has often been used to stabilize the spine and correct deformities, yielding good clinical results. On the other hand, PS fixation is known to show problems such as instrumentation failure. However, few biomechanical studies have described causes of instrumentation failure. In this study, causes of instrumentation failure in lumbar PS fixation were investigated from the perspective of load sharing by measuring both strains generated in the rod and intradiscal pressure.Methods Four human cadaveric multi-segmental lumbar vertebrae (L2-L5) were used to prepare a control model and a PS fixation model. Next, axial compression tests were performed on each model using a universal material testing machine, and the strains generated in the rods and the intradiscal pressures were measured from strain gauges attached to the rods and a pressure sensor installed between L3-L4.Results Combined compressive and bending stresses were found to be generated in the rod, with bending stress around 10 times higher than compressive stress, and with vast differences in the levels of stress generated between right and left rods. Moreover, the stress shielding by PS fixation was small, and intervertebral discs were still subjected to a large load. Conclusion Preventing instrumentation failure in lumbar spine PS fixation, it seems necessary to strengthen the durability of the rod against bending stress and to ensure the stability of the anterior stabilizing element of the spine.

Atlantoaxial wiring hardware failure resulting in intracranial hemorrhage and hydrocephalus: illustrative case

BACKGROUND Atlantoaxial sublaminar wiring has many known complications related to hardware failure, but intracranial hemorrhage is a rare complication. OBSERVATIONS A 61-year-old female patient with prior atlantoaxial sublaminar wiring for odontoid fracture nonunion experienced decreased level of consciousness due to a subarachnoid and subdural hemorrhage of the posterior fossa with intraventricular extension and hydrocephalus. Rupture of the sublaminar wire with intramedullary protrusion was the cause of the hemorrhage. The patient was treated with ventriculostomy for hydrocephalus and occipital cervical fusion for spinal instability, along with removal of the broken wire and drainage of a hematoma. LESSONS This uncommon cause of intracranial hemorrhage highlights an additional risk of atlantoaxial sublaminar wiring compared with other atlantoaxial fusion techniques. In addition, this case suggests cervical instrumentation failure as a differential diagnosis of subarachnoid and subdural hemorrhage of the posterior fossa when a history of prior instrumentation is known.

Stand-Alone Rod Augmentation for Instrumentation Failure after Pedicle Subtraction Osteotomy: A Case Report with a 2-year Follow-up

Background: Revision surgery of spine can be a complex procedure and has known complications. It involves hardware revision, removal of scar/callus tissue, realignment of sagittal balance, and anterior augmentation. However, through this report, we aim to demonstrate that a stand-alone rod augmentation at the failure site without removal of scar/callus tissue and/or anterior fixation can achieve excellent results in select cases. Case Report: A 66-year-old woman underwent L2 pedicle subtraction osteotomy (PSO) + T9-iliac fixation for fixed sagittal imbalance and osteoporotic collapse of L3. One year later, she developed progressive axial lumbar pain and difficulty in mobilization. The patient was diagnosed with pseudoarthrosis and instrumentation failure and underwent revision spine surgery with stand-alone rod augmentation. She had anuneventful rehabilitation and showed complete radiographic union and excellent clinical outcome in the 2-year follow-up. Conclusion: Stand-alone rod augmentation can provide stable posterior construct to prevent future pseudoarthrosis and/or instrumentation failure after revision spine surgery in selected cases. Anterior augmentation or resection dural scar tissue or dissection through callus tissue is not always necessary.

Surgical results of Hybrid Mita method to idiopathic scoliosis: minimum two years follow-up

Hybrid Mita (Suzuki) method is a newly developed technique of scoliosis surgery. This concept consists of three components: rib mobilization, rod rotation maneuver and hook rotation maneuver, which does not require intra-operative CT scan with lower risk of screw malposition. The aim of this study is to evaluate the efficacies of this method for correction in scoliosis. : This is a retrospective observational study, consist of eighty-nine idiopathic scoliosis patients who underwent this method between 2009 and 2016 with minimum 2-years follow-up. The curve pattern, Cobb angle, hump height and angle, peri-operative events and complications were analyzed. The mean pre- and post-operative Cobb angle was 50.9° and 10.1°, respectively. The average correction rate was 80.5%. Hump height was reduced from 20.2 mm to 9.8 mm and hump angle reduced from 13.1° to 6.1° in average. The correction loss at the final follow-up was 0.3° in average. There were two local superficial infection cases, but there was no instrumentation failure such as malposition or dislodgement, or pseudarthrosis. This novel method is promising to provide excellent clinical correction to idiopathic scoliosis, which is no less than all pedicle screw constructs. The technique of the skillful utilization of hooks in spinal surgery should not perish from the stage.

Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis

OBJECTIVE The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix. METHODS The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel. Pseudarthrosis was determined based on CT or radiographic imaging of the cervical spine. Patients were determined to have radiographic pseudarthrosis if they met any of the following criteria: 1) lack of bridging bone on CT obtained > 300 days postoperatively, 2) evidence of instrumentation failure, or 3) motion across the index level as seen on flexion-extension cervical spine radiographs. Univariate and multivariate analyses were then performed to identify independent preoperative or perioperative predictors of pseudarthrosis in this population. RESULTS A total of 326 patients met the inclusion criteria; 43 (13.2%) patients met criteria for pseudarthrosis, of whom 15 (34.9%) underwent revision surgery. There were no significant differences between patients with and those without pseudarthrosis, respectively, for patient age (54.1 vs 53.8 years), sex (34.9% vs 47.4% male), race, prior cervical spine surgery (37.2% vs 33.6%), tobacco abuse (16.3% vs 14.5%), chronic kidney disease (2.3% vs 2.8%), and diabetes (18.6% vs 14.5%) (p > 0.05). Presence of osteopenia or osteoporosis (16.3% vs 3.5%) was associated with pseudarthrosis (p < 0.001). Implant type was also significantly associated with pseudarthrosis, with a 16.4% rate of pseudarthrosis for patients with polyetherethereketone (PEEK) implants versus 8.4% for patients with allograft implants (p = 0.04). Average lengths of follow-up were 27.6 and 23.8 months for patients with and those without pseudarthrosis, respectively. Multivariate analysis demonstrated osteopenia or osteoporosis (OR 4.97, 95% CI 1.51–16.4, p < 0.01) and usage of PEEK implant (OR 2.24, 95% CI 1.04–4.83, p = 0.04) as independent predictors of pseudarthrosis. CONCLUSIONS In patients who underwent single-level ACDF, rates of pseudarthrosis associated with the use of the osteobiologic agent Osteocel are higher than the literature-reported rates associated with the use of alternative osteobiologics. This is especially true when Osteocel is combined with a PEEK implant.

Bidirectional Modeling of Surface Winds and Significant Wave Heights in the Caribbean Sea

Though the ocean is sparsely populated by buoys that feature co-located instruments to measure surface winds and waves, their data is of vital importance. However, due to either minor instrumentation failure or maintenance, intermittency can be a problem for either variable. This paper attempts to mitigate the loss of valuable data from two opposite but equivalent perspectives: the conventional reconstruction of significant wave height (SWH) from Caribbean Sea buoy-observed surface wind speeds (WSP) and the inverse modeling of WSP from SWH using the long short-term memory (LSTM) network. In either direction, LSTM is strongly able to recreate either variable from its counterpart with the lowest correlation coefficient (r2) measured at 0.95, the highest root mean square error (RMSE) is 0.26 m/s for WSP, and 0.16 m for SWH. The highest mean absolute percentage errors (MAPE) for WSP and SWH are 1.22% and 5%, respectively. Additionally, in the event of complete instrument failure or the absence of a buoy in a specific area, the Simulating WAves Nearshore (SWAN) wave model is first validated and used to simulate mean and extreme SWH before, during, and after the passage of Hurricane Matthew (2016). Synthetic SWH is then fed to LSTM in a joint SWAN—LSTM model, and the corresponding WSP is reconstructed and compared with observations. Although the reconstruction is highly accurate (r2 > 0.9, RMSE < 1.3 m/s, MAPE < 0.8%), there remains great room for improvement in minimizing error and capturing high-frequency events.