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Sample records for stand-alone interbody fusion

  1. Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion.

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    Marchi, Luis; Abdala, Nitamar; Oliveira, Leonardo; Amaral, Rodrigo; Coutinho, Etevaldo; Pimenta, Luiz

    2013-07-01

    Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. The influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. The authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale. The study was performed as an institutional review board-approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%-24% loss of postoperative disc height; Grade I, 25%-49%; Grade II, 50%-74%; and Grade III, 75%-100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded. Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group

  2. Graft subsidence as a predictor of revision surgery following stand-alone lateral lumbar interbody fusion.

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    Tempel, Zachary J; McDowell, Michael M; Panczykowski, David M; Gandhoke, Gurpreet S; Hamilton, D Kojo; Okonkwo, David O; Kanter, Adam S

    2018-01-01

    OBJECTIVE Lateral lumbar interbody fusion (LLIF) is a less invasive surgical option commonly used for a variety of spinal conditions, including in high-risk patient populations. LLIF is often performed as a stand-alone procedure, and may be complicated by graft subsidence, the clinical ramifications of which remain unclear. The aim of this study was to characterize further the sequelae of graft subsidence following stand-alone LLIF. METHODS A retrospective review of prospectively collected data was conducted on consecutive patients who underwent stand-alone LLIF between July 2008 and June 2015; 297 patients (623 levels) met inclusion criteria. Imaging studies were examined to grade graft subsidence according to Marchi criteria, and compared between those who required revision surgery and those who did not. Additional variables recorded included levels fused, DEXA (dual-energy x-ray absorptiometry) T-score, body mass index, and routine demographic information. The data were analyzed using the Student t-test, chi-square analysis, and logistic regression analysis to identify potential confounding factors. RESULTS Of 297 patients, 34 (11.4%) had radiographic evidence of subsidence and 18 (6.1%) required revision surgery. The median subsidence grade for patients requiring revision surgery was 2.5, compared with 1 for those who did not. Chi-square analysis revealed a significantly higher incidence of revision surgery in patients with high-grade subsidence compared with those with low-grade subsidence. Seven of 18 patients (38.9%) requiring revision surgery suffered a vertebral body fracture. High-grade subsidence was a significant predictor of the need for revision surgery (p subsidence following stand-alone LLIF required revision surgery. When evaluating patients for LLIF, supplemental instrumentation should be considered during the index surgery in patients with a significant risk of graft subsidence.

  3. Stand-alone anterior lumbar interbody fusion for treatment of degenerative spondylolisthesis.

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    Rao, Prashanth J; Ghent, Finn; Phan, Kevin; Lee, Keegan; Reddy, Rajesh; Mobbs, Ralph J

    2015-10-01

    We sought to evaluate the clinical and radiologic efficacy of stand-alone anterior lumbar interbody fusion (ALIF) for low grade degenerative spondylolisthesis, the favoured surgical management approach at our institution. The optimal approach for surgical management of spondylolisthesis remains contentious. We performed a prospective analysis of all consecutive patients with low grade lumbar spondylolisthesis who underwent ALIF between 2009 and 2013 by a single surgeon (n=27). The mean age was 64.9 years with a male to female ratio of 14:13. There were 32 levels operated and the average preoperative spondylolisthesis was 14.8%, which reduced to 6.4% postoperatively and 9.4% at the latest follow-up (p=0001). Postoperative disc height was increased to 175% of preoperative values and was statistically significant (pspondylolisthesis reduction (p=0.04) and the only clinical factor affecting reduction was body mass index (p=0.04). The present study provides encouraging short term results for stand-alone ALIF as a procedure for low grade lumbar degenerative spondylolisthesis. Future studies should include adequately powered, prospective, multicentre registry studies with long term follow-up to allow a better assessment of the relative benefits and risks. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Incidence and impact of implant subsidence after stand-alone lateral lumbar interbody fusion.

    Science.gov (United States)

    Bocahut, N; Audureau, E; Poignard, A; Delambre, J; Queinnec, S; Flouzat Lachaniette, C-H; Allain, J

    2017-12-30

    Few data are available on the occurrence after stand-alone lateral lumbar interbody fusion (LLIF) of implant subsidence, whose definition and incidence vary across studies. The primary objective of this work was to determine the incidence of subsidence 1 year postoperatively, using an original measurement method, whose validity was first assessed. The secondary objective was to assess the clinical impact of subsidence. Implant subsidence after stand-alone LLIF is a common complication that can adversely affect clinical outcomes. Of 69 included patients who underwent stand-alone LLIF, 67 (97%) were re-evaluated at least 1 year later. Furthermore, 63 (91%) patients had two available computed tomography (CT) scans for assessing subsidence, one performed immediately after surgery and the other 1 year later. Reproducibility of the original measurement method was assessed in a preliminary study. Subsidence was defined as at least 4mm loss of fused space height. The incidence of subsidence was 32% (20 patients). Subsidence was global in 7 (11%) patients and partial in 13 (21%) patients. Mean loss of height was 5.5±1.5mm. Subsidence predominated anteriorly in 50% of cases. The lordotic curvature of the fused segment was altered in 50% of patients, by a mean of 8°±3°. Fusion was achieved in 67/69 (97%) patients. The Oswestry score and visual analogue scale scores for low-back and nerve-root pain were significantly improved after 1 year in the overall population and in the groups with and without subsidence. Reproducibility of our measurement method was found to be excellent. Subsidence was common but without significant clinical effects after 1 year. Nevertheless, subsidence can be associated with pain and can result in loss of lumbar lordosis, which is a potential risk factor for degenerative disease of the adjacent segments. A score for predicting the risk of subsidence will now be developed by our group as a tool for improving patient selection to stand-alone LLIF

  5. Stand-Alone Lateral Interbody Fusion for the Treatment of Low-Grade Degenerative Spondylolisthesis

    Directory of Open Access Journals (Sweden)

    Luis Marchi

    2012-01-01

    Full Text Available The purpose of this paper was to investigate the stand-alone lateral interbody fusion as a minimally invasive option for the treatment of low-grade degenerative spondylolisthesis with a minimum 24-month followup. Prospective nonrandomized observational single-center study. 52 consecutive patients (67.6±10 y/o; 73.1% female; 27.4±3.4 BMI with single-level grade I/II single-level degenerative spondylolisthesis without significant spine instability were included. Fusion procedures were performed as retroperitoneal lateral transpsoas interbody fusions without screw supplementation. The procedures were performed in average 73.2 minutes and with less than 50cc blood loss. VAS and Oswestry scores showed lasting improvements in clinical outcomes (60% and 54.5% change, resp.. The vertebral slippage was reduced in 90.4% of cases from mean values of 15.1% preoperatively to 7.4% at 6-week followup (P<0.001 and was maintained through 24 months (7.1%, P<0.001. Segmental lordosis (P<0.001 and disc height (P<0.001 were improved in postop evaluations. Cage subsidence occurred in 9/52 cases (17% and 7/52 cases (13% spine levels needed revision surgery. At the 24-month evaluation, solid fusion was observed in 86.5% of the levels treated. The minimally invasive lateral approach has been shown to be a safe and reproducible technique to treat low-grade degenerative spondylolisthesis.

  6. Subsidence and nonunion after anterior cervical interbody fusion using a stand-alone polyetheretherketone (PEEK) cage.

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    Yang, Jae Jun; Yu, Chang Hun; Chang, Bong-Soon; Yeom, Jin Sup; Lee, Jae Hyup; Lee, Choon-Ki

    2011-03-01

    The purposes of the present study are to evaluate the subsidence and nonunion that occurred after anterior cervical discectomy and fusion using a stand-alone intervertebral cage and to analyze the risk factors for the complications. Thirty-eight patients (47 segments) who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage and an autologous cancellous iliac bone graft from June 2003 to August 2008 were enrolled in this study. The anterior and posterior segmental heights and the distance from the anterior edge of the upper vertebra to the anterior margin of the cage were measured on the plain radiographs. Subsidence was defined as ≥ a 2 mm (minor) or 3 mm (major) decrease of the segmental height at the final follow-up compared to that measured at the immediate postoperative period. Nonunion was evaluated according to the instability being ≥ 2 mm in the interspinous distance on the flexion-extension lateral radiographs. The anterior and posterior segmental heights decreased from the immediate postoperative period to the final follow-up at 1.33 ± 1.46 mm and 0.81 ± 1.27 mm, respectively. Subsidence ≥ 2 mm and 3 mm were observed in 12 segments (25.5%) and 7 segments (14.9%), respectively. Among the expected risk factors for subsidence, a smaller anteroposterior (AP) diameter (14 mm vs. 12 mm) of cages (p = 0.034; odds ratio [OR], 0.017) and larger intraoperative distraction (p = 0.041; OR, 3.988) had a significantly higher risk of subsidence. Intervertebral nonunion was observed in 7 segments (7/47, 14.9%). Compared with the union group, the nonunion group had a significantly higher ratio of two-level fusion to one-level fusions (p = 0.001). Anterior cervical fusion using a stand-alone cage with a large AP diameter while preventing anterior intraoperative over-distraction will be helpful to prevent the subsidence of cages. Two-level cervical fusion might require more careful attention for avoiding nonunion.

  7. Is Stand-Alone Anterior Lumbar Interbody Fusion a Safe and Efficacious Treatment for Isthmic Spondylolisthesis of L5-S1?

    OpenAIRE

    Viglione, Luke L.; Chamoli, Uphar; Diwan, Ashish D.

    2017-01-01

    Study Design: A systematic review. Objective: The objective of this study was to determine the safety and efficacy of stand-alone anterior lumbar interbody fusion (sa-ALIF) for the treatment of symptomatic isthmic spondylolisthesis of L5-S1 by assessing the level of available clinical and radiographic evidence. Methods: A systematic review utilizing Medline, Embase, and Scopus online databases was undertaken. Clinical, radiographic, and adverse outcome data were extracted for the relevant ist...

  8. Fusion and subsidence rate of stand alone anterior lumbar interbody fusion using PEEK cage with recombinant human bone morphogenetic protein-2.

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    Behrbalk, Eyal; Uri, Ofir; Parks, Ruth M; Musson, Rachel; Soh, Reuben Chee Cheong; Boszczyk, Bronek Maximilian

    2013-12-01

    Anterior lumbar interbody fusion (ALIF) is an established treatment for structural instability associated with symptomatic disk degeneration (SDD). Stand-alone ALIF offers many advantages, however, it may increase the risk of non-union. Recombinant human bone morphogenetic protein-2 (BMP-2) may enhance fusion rate but is associated with postoperative complication. The optimal dose of BMP-2 remains unclear. This study assessed the fusion and subsidence rates of stand-alone ALIF using the SynFix-LR interbody cage with 6 ml/level of BMP-2. Thirty-two ALIF procedures were performed by a single surgeon in 25 patients. Twenty-five procedures were performed for SDD without spondylolisthesis (SDD group) and seven procedures were performed for SDD with grade-I olisthesis (SDD-olisthesis group). Patients were followed-up for a mean of 17 ± 6 months. Solid fusion was achieved in 29 cases (90.6 %) within 6 months postoperatively. Five cases of implant subsidence were observed (16 %). Four of these occurred in the SDD-olisthesis group and one occurred in the SDD group (57 % vs. 4 % respectively; p = 0.004). Three cases of subsidence failed to fuse and required revision. The body mass index of patients with olisthesis who developed subsidence was higher than those who did not develop subsidence (29 ± 2.6 vs. 22 ± 6.5 respectively; p = 0.04). No BMP-2 related complications occurred. The overall fusion rate of stand-alone ALIF using the SynFix-LR system with BMP-2 was 90.6 %, comparable with other published series. No BMP-2 related complication occurred at a dose of 6 mg/level. Degenerative spondylolisthesis and obesity seemed to increase the rate of implant subsidence, and thus we believe that adding posterior fusion for these cases should be considered.

  9. Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3-4 fixation.

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    Kwon, Yoon-Kwang; Jang, Ju-Hee; Lee, Choon-Dae; Lee, Sang-Ho

    2014-06-01

    Many studies attest to the excellent results achieved using anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. The purpose of this report is to document a rare instance of L-4 vertebral body fracture following use of a stand-alone interbody fusion device for L3-4 ALIF. The patient, a 55-year-old man, had suffered intractable pain of the back, right buttock, and left leg for several weeks. Initial radiographs showed Grade I degenerative spondylolisthesis, with instability in the sagittal plane (upon 15° rotation) and stenosis of central and both lateral recesses at the L3-4 level. Anterior lumbar interbody fusion of the affected vertebrae was subsequently conducted using a stand-alone cage/plate system. Postoperatively, the severity of spondylolisthesis diminished, with resolution of symptoms. However, the patient returned 2 months later with both leg weakness and back pain. Plain radiographs and CT indicated device failure due to anterior fracture of the L-4 vertebral body, and the spondylolisthesis had recurred. At this point, bilateral facetectomies were performed, with reduction/fixation of L3-4 by pedicle screws. Again, degenerative spondylolisthesis improved postsurgically and symptoms eased, with eventual healing of the vertebral body fracture. This report documents a rare instance of L-4 vertebral body fracture following use of a stand-alone device for ALIF at L3-4, likely as a consequence of angular instability in degenerative spondylolisthesis. Under such conditions, additional pedicle screw fixation is advised.

  10. [Biomechanicsl evaluation of a stand-alone interbody fusion cage based on porous TiO2/glass-ceramic on the human cervical spine].

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    Korinth, M C; Moersch, S; Ragoss, C; Schopphoff, E

    2003-12-01

    Recently, there has been a rapid increase in the use of cervical spine interbody fusion cages, differing in design and biomaterial used, in competition to autologous iliac bone graft and bone cement (PMMA). Limited biomechanical differences in primary stability, as well as advantages and disadvantages of each cage or material have been investigated in studies, using an in vitro human cervical spine model. 20 human cervical spine specimens were tested after fusion with either a cubical stand-alone interbody fusion cage manufactured from a new porous TiO2/glass composite (Ecopore) or PMMA after discectomy. Non-destructive biomechanical testing was performed, including flexion/extension and lateral bending using a spine testing apparatus. Three-dimensional segmental range of motion (ROM) was evaluated using an ultrasound measurement system. ROM increased more in flexion/extension and lateral bending after PMMA fusion (26.5%/36.1%), then after implantation of the Ecopore-cage (8.1%/7.8%). In this first biomechanical in vitro examination of a new porous ceramic bone replacement material a) the feasibility and reproducibility of biomechanical cadaveric cervical examination and its applicability was demonstrated, b) the stability of the ceramic cage as a stand alone interbody cage was confirmed in vitro, and c) basic information and knowledge for our intended biomechanical and histological in vivo testing, after implantation of Ecopore in cervical sheep spines, were obtained.

  11. Minimally invasive lateral transpsoas interbody fusion using a stand-alone construct for the treatment of adjacent segment disease of the lumbar spine: review of the literature and report of three cases.

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    Palejwala, Sheri K; Sheen, Whitney A; Walter, Christina M; Dunn, Jack H; Baaj, Ali A

    2014-09-01

    We describe 3 patients who presented with radiographic signs and clinical symptoms of adjacent segment disease several years after undergoing L4-S1 posterior pedicle screw fusion. All patients underwent successful lateral lumbar interbody fusion (LLIF) at 1-2 levels above their previous constructs, using stand-alone cages, with complete resolution of radiculopathy and a significant improvement in low-back pain. In addition to a thorough analysis of these cases, we review the pertinent literature regarding treatment options for adjacent segment disease and the applications of the lateral lumbar interbody technique. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Segmental kyphosis after cervical interbody fusion with stand-alone polyetheretherketone (PEEK) cages: a comparative study on 2 different PEEK cages.

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    Kim, Chi Heon; Chung, Chun Kee; Jahng, Tae-Ahn; Park, Sung Bae; Sohn, Seil; Lee, Sungjoon

    2015-02-01

    Retrospective comparative study. Two polyetheretherketone (PEEK) cages of different designs were compared in terms of the postoperative segmental kyphosis after anterior cervical discectomy and fusion. Segmental kyphosis occasionally occurs after the use of a stand-alone cage for anterior cervical discectomy and fusion. Although PEEK material seems to have less risk of segmental kyphosis compared with other materials, the occurrence of segmental kyphosis for PEEK cages has been reported to be from 0% to 29%. There have been a few reports that addressed the issue of PEEK cage design. A total of 41 consecutive patients who underwent single-level anterior discectomy and fusion with a stand-alone cage were included. Either a round tube-type (Solis; 18 patients, S-group) or a trapezoidal tube-type (MC+; 23 patients, M-group) cage was used. The contact area between the cage and the vertebral body is larger in MC+ than in Solis, and anchoring pins were present in the Solis cage. The effect of the cage type on the segmental angle (SA) (lordosis vs. kyphosis) at postoperative month 24 was analyzed. Preoperatively, segmental lordosis was present in 12/18 S-group and 16/23 M-group patients (P=0.84). The SA was more lordotic than the preoperative angle in both groups just after surgery, with no difference between groups (P=0.39). At 24 months, segmental lordosis was observed in 9/18 S-group and 20/23 M-group patients (P=0.01). The patients in M-group were 7.83 times more likely than patients in S-group (P=0.04; odds ratio, 7.83; 95% confidence interval, 1.09-56.28) not to develop segmental kyphosis. The design of the PEEK cage used may influence the SA, and this association needs to be considered when using stand-alone PEEK cages.

  13. Subsidence after single-level anterior cervical fusion with a stand-alone cage.

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    Park, Jae-Young; Choi, Ki-Young; Moon, Bong Ju; Hur, Hyuk; Jang, Jae-Won; Lee, Jung-Kil

    2016-11-01

    To investigate the risk factors for subsidence in patients treated with stand-alone anterior cervical discectomy and fusion (ACDF) using polyetheretherketone (PEEK) cages for single-level degenerative cervical disease. Seventy-seven consecutive patients who underwent single-level stand-alone ACDF with a PEEK cage between 2005 and 2012 were included. Subsidence was defined as a decrease in the interbody height of more than 3mm on radiographs at the 1-year follow-up compared with that in the immediate post-operative image. Patients were divided into the subsidence and non-subsidence groups. The following factors were investigated in relation to the occurrence of subsidence: age, pre-operative overall cervical sagittal angle, segmental angle of the operated level, interbody height, cage height, cage devices and cage location (distance between anterior margin of the body endplate and that of the cage). The clinical outcomes were assessed with visual analog scale, modified Japanese Orthopedic Association score and neck disability index. Twenty-six out of the 77 (33.8%) patients had radiological signs of cage subsidence. Solid fusion was achieved in 25 out of the 26 patients (96.2%) in the subsidence group and in 47 out of the 51 patients (92.2%) in the non-subsidence group. More than 3mm distance between anterior margin of the vertebral body and that of the cage was significantly associated with subsidence (psubsidence did not correlate with fusion rate or clinical outcomes. Cage location was the only significant risk factor. Therefore, cage location should be taken into consideration during stand-alone ACDF using PEEK cages. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Anterior cervical discectomy and fusion using a stand-alone polyetheretherketone cage packed with local autobone : assessment of bone fusion and subsidence.

    Science.gov (United States)

    Park, Jeong-Ill; Cho, Dae-Chul; Kim, Kyoung-Tae; Sung, Joo-Kyung

    2013-09-01

    It remains debatable whether cervical spine fusion cages should be filled with any kind of bone or bone substitute. Cortical and subcortical bone from the anterior and posterior osteophytes of the segment could be used to fill the cage. The purposes of the present study are to evaluate the clinical outcomes and radiological outcomes including bone fusion and subsidence that occurred after anterior cervical discectomy and fusion using a stand-alone cage packed with local autobone graft. Thirty-one patients who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage packed with local autobone graft from July 2009 to december 2011 were enrolled in this study. Bone fusion was assessed by cervical plain radiographs and computed tomographic scan. Nonunion was evaluated according to the absence of bony bridge on computed tomographic scan. Subsidence was defined as a ≥2 mm decrease of the interbody height at the final follow-up compared to that measured at the immediate postoperative period. Subsidence was observed in 7 patients (22.6%). Of 7 patients with subsidence greater 2 mm, nonunion was developed in 3. Three patients with subsidence greater 2 mm were related with endplate damage during intraoperative endplate preparation. Solid bone fusion was achieved in 28 out of 31 patients (90.3%). With proper patient selection and careful endplate preparation, anterior cervical discectomy and fusion (ACDF) using a stand-alone PEEK cage packed with local autobone graft could be a good alternative to the standard ACDF techniques with plating.

  15. Segmental stability and compressive strength of posterior lumbar interbody fusion implants.

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    Tsantrizos, A; Baramki, H G; Zeidman, S; Steffen, T

    2000-08-01

    Human cadaveric study on initial segmental stability and compressive strength of posterior lumbar interbody fusion implants. To compare the initial segmental stability and compressive strength of a posterior lumbar interbody fusion construct using a new cortical bone spacer machined from allograft to that of titanium threaded and nonthreaded posterior lumbar interbody fusion cages, tested as stand-alone and with supplemental pedicle screw fixation. Cages were introduced to overcome the limitations of conventional allografts. Radiodense cage materials impede radiographic assessment of the fusion, however, and may cause stress shielding of the graft. Multisegmental specimens were tested intact, with posterior lumbar interbody fusion implants inserted into the L4/L5 interbody space and with supplemental pedicle screw fixation. Three posterior lumbar interbody fusion implant constructs (Ray Threaded Fusion Cage, Contact Fusion Cage, and PLIF Allograft Spacer) were tested nondestructively in axial rotation, flexion-extension, and lateral bending. The implant-specimen constructs then were isolated and compressed to failure. Changes in the neutral zone, range of motion, yield strength, and ultimate compressive strength were analyzed. None of the stand-alone implant constructs reduced the neutral zone. Supplemental pedicle screw fixation decreased the neutral zone in flexion-extension and lateral bending. Stand-alone implant constructs decreased the range of motion in flexion and lateral bending. Differences in the range of motion between stand-alone cage constructs were found in flexion and extension (marginally significant). Supplemental posterior fixation further decreased the range of motion in all loading directions with no differences between implant constructs. The Contact Fusion Cage and PLIF Allograft Spacer constructs had a higher ultimate compressive strength than the Ray Threaded Fusion Cage. The biomechanical data did not suggest any implant construct to

  16. Clinical and radiological outcome after anterior cervical discectomy and fusion with stand-alone empty polyetheretherketone (PEEK) cages.

    Science.gov (United States)

    Shiban, Ehab; Gapon, Karina; Wostrack, Maria; Meyer, Bernhard; Lehmberg, Jens

    2016-02-01

    To evaluate long-term results after one-, two-, and three-level anterior cervical discectomy and fusion (ACDF) with stand-alone empty polyetheretherketone (PEEK) cages. We performed a retrospective review of a consecutive patient cohort that underwent ACDF with stand-alone empty PEEK cages between 2007 and 2010 with a minimum follow-up of 12 months. Radiographic follow-up included static and flexion/extension radiographs. Changes in the operated segments were measured and compared to radiographs directly after surgery. Clinical outcome was evaluated by a physical examination, pain visual analog scale (VAS), and health-related quality of life (HRQL) using the EuroQOL questionnaire (EQ-5D). Analysis of associations between fusion, subsidence, cervical alignment, and clinical outcome parameters were performed. Of 407 consecutive cases, 318 met all inclusion criteria. Follow-up data were obtained from 265 (83 %) cases. The mean age at presentation was 55 years and 139 patients were male (52 %). In the sample, 127, 125, and 13 patients had one-, two-, and three-level surgeries, respectively; 132 (49 %) presented with spondylotic cervical myelopathy and 133 (50 %) with cervical radiculopathy. Fusion was achieved in 85, 95, and 94 % of segments in one-, two-, and three-level surgeries, respectively. Non-fusion was associated with higher VAS pain levels. Radiographic adjacent segment disease (ASD) was observed in 20, 29, and 15 % in one-, two-, and three-level surgeries, respectively. ASD was associated with lower HRQL. Subsidence was observed in 25, 27, and 15 % of segments in one-, two-, and three-level surgeries, respectively. However, this had no influence on clinical outcome. Follow-up operations for symptomatic adjacent disc disease and implant failure at index level were needed in 16 (6 %) and four (1.5 %) cases, respectively. Younger age was associated with better clinical outcome. Multilevel surgery favored better myelopathy outcomes and fusion reduced overall

  17. Stand-alone XLIF

    DEFF Research Database (Denmark)

    Hansen, E. J.; Simony, A.; Hummel, Stefan

    2015-01-01

    and clinical/radiological results in 22 patients treated with XLIF procedure for DS or degenerative disc disease (DDD). Material and methods: 22 consecutive patients with DS underwent surgery with the XLIF stand-alone procedure, with follow-up of 24 months. Clinical outcome scores were collected. Complications......Introduction: Adult thoracolumbar degeneration is an increasing challenge in the aging population. With age the progressive degeneration of the discs leads to an asymmetric collapse and a thoracolumbar coronal plane deformity, a degenerative scoliosis (DS). Aim: To evaluate the complication rate......-year follow-up, with a 31.8% revision rate. Due to the high revision rate we recommend supplementary posterior instrumentation, to achieve a higher fusion rate. When considering XLIF-stand-alone procedure for DS or DDD without supplemental posterior instrumentation, only single-level disease should...

  18. Lumbar sagittal contour after posterior interbody fusion: threaded devices alone versus vertical cages plus posterior instrumentation.

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    Klemme, W R; Owens, B D; Dhawan, A; Zeidman, S; Polly, D W

    2001-03-01

    An observational radiographic study examining lumbar sagittal contour of patients undergoing posterior interbody arthrodesis. To compare operative alterations of lumbar sagittal contour after posterior interbody fusion using threaded interbody devices alone versus vertical cages combined with posterior compression instrumentation. Technique-related alterations of lumbar sagittal contour during interbody arthrodesis have received little attention in the spinal literature. Standing lumbar radiographs were measured for preoperative and postoperative segmental lordosis at levels undergoing posterior interbody arthrodesis using either stand-alone side-by-side threaded devices or vertical cages combined with posterior transpedicular compression instrumentation. Sagittal plane segmental correction (or loss of correction) was calculated and statistically compared. The radiographs of 30 patients (34 spinal segments) undergoing lumbar or lumbosacral arthrodesis were compared. Seventeen patients (18 segments) had undergone interbody fusion using threaded cages,whereas 13 patients (16 segments) underwent fusion using vertically oriented mesh cages combined with posterior compression instrumentation. Preoperative segmental lordosis averaged 8 degrees for both groups. For patients undergoing fusion with threaded cages, there was a mean lordotic loss of 3 degrees/segment. For patients undergoing fusion with vertically oriented mesh cages combined with posterior compression instrumentation,there was a mean lordotic gain of 5 degrees/segment. This difference in segmental sagittal plane contour was highly significant (P = 0.00). Threaded fusion devices placed under interbody distraction with the endplates parallel fail to preserve or reestablish segmental lordosis. Vertical cages, however, when combined with posterior compression instrumentation, not only maintain segmental lordosis, but also can correct sagittal plane deformity.

  19. Mini-open transforaminal lumbar interbody fusion.

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    Tangviriyapaiboon, Teera

    2008-09-01

    To demonstrate the surgical technique and advantages of the mini-open transforaminal approach for lumbar interbody fusion (TLIF) combined with transpedicular screw fixation. Clinical and radiographic results were assessed to determine the clinical outcomes in twelve consecutive patients selected for minimally invasive access (mini-open technique) for TLIF in Prasat Neurological Institute. A retrospective analysis was performed on 12 patients (age range, 38-74 yr; mean, 54. 8 yr) who underwent mini-open transforaminal approach for lumbar interbody fusion (TLIF) combined with transpedicular screw fixation between September 2006 and June 2008. The titanium pedicle screws were introduced bilaterally through the 3.5 cm length, skin incisions with Spine Classics MLD- system retractor, autologous bone graft were inserted to perform TLIF in all patients. Eight patients were augmented anterior column support with titanium interbody cage, unilateral cage insertion in four patients and the others were inserted bilaterally interbody cages. Six patients presented with low back pain and associated radiculopathy, and six presented with low back pain only. Transforaminal lumbar interbody fusion was performed at L3-L4 in two patients, L4-L5 in four patients, L5-S1 in five patients, and two levels fusion in one patient. All patients were able to ambulate after spinal fusion. The patients were able to walk within 1.4 days (range 1-2 days). The hospital stay averaged 4.4 days (range 3-7 days). Periodic follow-up took place 1 to 21 months after surgery (mean, 7.4 months). The radiological fusion was archived in all nine patients who were operated on more than two months age. The other three patients who had been follow-up less than two months were probably fusion on the 1-month followed-up radiological examination. The use of mini-open technique for pedicle screw instrumentation with spinal fusion procedure provides excellent clinical results and may be an operation of choice for

  20. Outcomes of contemporary use of rectangular titanium stand-alone cages in anterior cervical discectomy and fusion: cage subsidence and cervical alignment.

    Science.gov (United States)

    Yamagata, Toru; Takami, Toshihiro; Uda, Takehiro; Ikeda, Hidetoshi; Nagata, Takashi; Sakamoto, Shinichi; Tsuyuguchi, Naohiro; Ohata, Kenji

    2012-12-01

    Cervical intervertebral disc replacement using a rectangular titanium stand-alone cage has become a standard procedure for anterior cervical discectomy and fusion (ACDF). We examined outcomes resulting from the contemporary use of rectangular titanium stand-alone cages for ACDF, particularly focusing on cage subsidence and subsequent kyphotic malalignment. Patient data were collected prospectively, and a total of 47 consecutive patients who underwent periodic follow-up of at least 1 year's duration after ACDF were studied retrospectively. Sixty-three rectangular titanium cages were implanted during 31 1-level and 16 2-level procedures. None of the patients developed surgery-related complications (including cage displacement or extrusion). Mean Neurosurgical Cervical Spine Scale scores were significantly improved at 1 year after surgery. Twelve of the 63 inserted cages (19.0%) were found to have cage subsidence, occurring in 11 of 47 patients (23.4%). There was no significant difference in functional recovery between patients with and without cage subsidence. Logistic regression analysis indicated that fusion level, cage size and cage position were significantly related to cage subsidence. The distraction ratio among patients with cage subsidence was significantly higher than that among patients without cage subsidence. Cage subsidence resulted in early deterioration of local angle and total alignment of the cervical spine. Although a longer follow-up is warranted, a good surgical outcome with negligible complications appears to justify the use of rectangular titanium stand-alone cages in 1- and 2-level ACDF. Excessive distraction at the fusion level should be avoided, and cage position should be adjusted to the anterior vertical line. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life.

    Science.gov (United States)

    Kapetanakis, Stylianos; Thomaidis, Tryfon; Charitoudis, George; Pavlidis, Pavlos; Theodosiadis, Panagiotis; Gkasdaris, Grigorios

    2017-09-01

    Anterior cervical discectomy and fusion (ACDF) constitutes the conventional treatment of cervical disc herniation due to degenerative disc disease (DDD). ACDF with plating presents a variety of complications postoperatively and stand-alone cages are thought to be a promising alternative. The aim of this study was firstly, to analyze prospectively collected data from a sample of patients treated with single ACDF using C-Plus self-locking stand-alone PEEK cage system, without the use of plates or screws, in order to evaluate pain levels of patients, utilizing Neck and Arm Pain scale as an expression of visual analogue scale (VAS). Secondly, we aimed to evaluate health-related quality of life, via the short-form 36 (SF-36) and Neck Disability Index (NDI). Thirty-six patients (19 male and 17 female) with mean age 49.6±7 years old who underwent successful single ACDF using self-locking stand-alone PEEK cage for symptomatic cervical DDD were selected for the study. Neck and Arm pain, as well as SF-36 and NDI were estimated preoperatively and 1, 3, 6, and 12 months postoperatively. Patients underwent preoperative and postoperative clinical, neurological and radiological evaluation. The clinical and radiological outcomes were satisfactory after a minimum 1-year follow-up. All results were statistically important (P<0.05), excluding improvement in NDI measured between 6 and 12 months. SF-36, Neck Pain, as well as Arm Pain featured gradual and constant improvement during follow-up, with best scores presenting at 12 months after surgery, while NDI reached its best at 6 months postoperatively. Generally, all scores showed improvement postoperatively during the different phases of the follow-up. Subsequently, ACDF using C-Plus cervical cage constitutes an effective method for cervical disc herniation treatment, in terms of postoperative improvement on pain levels and health-related quality of life and a safe alternative to the conventional method of treatment for cervical DDD.

  2. Risk factors for subsidence in anterior cervical fusion with stand-alone polyetheretherketone (PEEK) cages: a review of 82 cases and 182 levels.

    Science.gov (United States)

    Kao, Ting-Hsien; Wu, Chen-Hao; Chou, Yu-Ching; Chen, Hsien-Te; Chen, Wen-Hsien; Tsou, Hsi-Kai

    2014-10-01

    To determine risk factors for subsidence in patients treated with anterior cervical discectomy and fusion (ACDF) and stand-alone polyetheretherketone (PEEK) cages. Records of patients with degenerative spondylosis or traumatic disc herniation resulting in radiculopathy or myelopathy between C2 and C7 who underwent ACDF with stand-alone PEEK cages were retrospectively reviewed. Cages were filled with autogenous cancellous bone harvested from iliac crest or hydroxyapatite. Subsidence was defined as a decrease of 3 mm or more of anterior or posterior disc height from that measured on the postoperative radiograph. Eighty-two patients (32 males, 50 females; 182 treatment levels) were included in the analysis. Most patients had 1-2 treatment levels (62.2 %), and 37.8 % had 3-4 treatment levels. Treatment levels were from C2-7. Of the 82 patients, cage subsidence occurred in 31 patients, and at 39 treatment levels. Multivariable analysis showed that subsidence was more likely to occur in patients with more than two treatment levels, and more likely to occur at treatment levels C5-7 than at levels C2-5. Subsidence was not associated with postoperative alignment change but associated with more disc height change (relatively oversized cage). Subsidence is associated with a greater number of treatment levels, treatment at C5-7 and relatively oversized cage use.

  3. Degenerative spondylolisthesis: contemporary review of the role of interbody fusion.

    Science.gov (United States)

    Baker, Joseph F; Errico, Thomas J; Kim, Yong; Razi, Afshin

    2017-02-01

    Degenerative spondylolisthesis is a common presentation, yet the best surgical treatment continues to be a matter of debate. Interbody fusion is one of a number of options, but its exact role remains ill defined. The aim of this study was to provide a contemporary review of the literature to help determine the role, if any, of interbody fusion in the surgical treatment of degenerative spondylolisthesis. A systematic review of the literature since 2005 was performed. Details on study size, patient age, surgical treatments, levels of slip, patient reported outcome measures, radiographic outcomes, complications and selected utility measures were recorded. Studies that compared a cohort treated with interbody fusion and at least one other surgical intervention for comparison were included for review. Only studies examining the effect in degenerative spondylolisthesis were included. Two authors independently reviewed the manuscripts and extracted key data. Thirteen studies were included in the final analysis. A total of 565 underwent interbody fusion and 761 underwent other procedures including decompression alone, interspinous stabilisation and posterolateral fusion with or without instrumentation. Most studies were graded Level III evidence. Heterogeneous reporting of outcomes prevented formal statistical analysis. However, in general, studies reviewed concluded no significant clinical or radiographic difference in outcome between interbody fusion and other treatments. Two small studies suggested interbody fusion is a better option in cases of definite instability. Interbody fusion only provided outcomes as good as instrumented posterolateral fusion. However, most studies were Level III, and hence, we remain limited in defining the exact role of interbody fusion-cases with clear instability appear to be most appropriate. Future work should use agreed-upon common outcome measures and definitions.

  4. Influence of cervical bone mineral density on cage subsidence in patients following stand-alone anterior cervical discectomy and fusion.

    Science.gov (United States)

    Brenke, Christopher; Dostal, Martin; Scharf, Johann; Weiß, Christel; Schmieder, Kirsten; Barth, Martin

    2015-12-01

    Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical degenerative diseases. However, cage subsidence remains a frequent problem. We therefore investigated if cage design and site-specific bone mineral density (BMD) contribute to the rate and direction of subsidence following ACDF. Patients were prospectively included and received two different cages (groups 1 and 2) using minimization randomization. The degree and direction of cage subsidence were determined using plain radiographs. Neck pain intensity on the visual analogue scale (VAS), the neck disability index (NDI), and the patient satisfaction index were recorded up to 12 months after surgery. 88 patients were analysed with a mean age of 53.7 ± 11.8 years. BMD values decreased in craniocaudal direction from 302.0 ± 62.2 to 235.5 ± 38.9 mg/cm(3). Both groups showed significant height gain after the operation (both p  0.05). Both groups showed improvement of VAS neck pain intensity (both p subsidence was similar, no correlations were found between cage subsidence and BMD or various clinical parameters. Implant geometry of both cages and variations of the operative procedure promoted a relatively high degree of cage subsidence. Further studies are necessary to identify a relation of BMD and subsidence using optimized implant geometry and by controlling additional intraoperative variables.

  5. Comparing minimally invasive transforaminal lumbar interbody fusion and posterior lumbar interbody fusion for spondylolisthesis

    Science.gov (United States)

    Zhang, Dapeng; Mao, Keya; Qiang, Xiaojun

    2017-01-01

    Abstract Although spondylolisthesis was traditionally treated with posterior lumbar interbody fusion (PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) was recently proposed as an alternative treatment for spondylolisthesis. However, no studies have focused on the comparison of these 2 techniques’ outcome on spondylolisthesis. The operative reports and perioperative data of patients who underwent single-level primary open PLIF (n = 29) and MIS-TLIF (n = 26) for I/II spondylolisthesis were retrospectively evaluated. Patients’ demographics, operative blood loss, hospital length of stay, creatine kinase (CK) level, radiographic fusion, complications, and patient-reported outcomes were evaluated. Radiographic fusion was assessed using the Bridwell grading criteria. Preoperative and postoperative patient-reported outcomes included the visual analog scale (VAS) and Oswestry Disability Index (ODI). Average follow-up was 28 ± 3.6 months (range 24–32 months). Bed rest time, hospital stay, estimated blood loss, and operative time in the MIS-TLIF group were significantly lower than those in the PLIF group (P  .05). Compared with PLIF, MIS-TLIF for grade I/II spondylolisthesis can achieve similar reduction and fusion results with better short-term quality of life, shorter hospital stays, less estimated blood loss, and shorter operative times. PMID:28906383

  6. Posterior lumbar interbody fusion with stand-alone Trabecular Metal cages for repeatedly recurrent lumbar disc herniation and back pain

    NARCIS (Netherlands)

    Lequin, Michiel B.; Verbaan, Dagmar; Bouma, Gerrit J.

    2014-01-01

    Patients with recurrent sciatica due to repeated reherniation of the intervertebral disc carry a poor prognosis for recovery and create a large burden on society. There is no consensus about the best treatment for this patient group. The goal of this study was to evaluate the 12-month results of the

  7. A Lower T1 Slope as a Predictor of Subsidence in Anterior Cervical Discectomy and Fusion with Stand-Alone Cages.

    Science.gov (United States)

    Lee, Su Hun; Lee, Jun Seok; Sung, Soon Ki; Son, Dong Wuk; Lee, Sang Weon; Song, Geun Sung

    2017-09-01

    Preoperative parameters including the T1 slope (T1S) and C2-C7 sagittal vertical axis (SVA) have been recognized as predictors of kyphosis after laminoplasty, which is accompanied by posterior neck muscle damage. The importance of preoperative parameters has been under-estimated in anterior cervical discectomy and fusion (ACDF) because there is no posterior neck muscle damage. We aimed to determine whether postoperative subsidence and pseudarthrosis could be predicted according to specific parameters on preoperative plain radiographs. We retrospectively analyzed 41 consecutive patients (male: female, 22: 19; mean age, 51.15±9.25 years) who underwent ACDF with a stand-alone polyether-ether-ketone (PEEK) cage (>1 year follow-up). Parameters including SVA, T1S, segmental angle and range of motion (ROM), C2-C7 cervical angle and ROM, and segmental inter-spinous distance were measured on preoperative plain radiographs. Risk factors of subsidence and pseudarthrosis were determined using multivariate logistic regression. Fifty-five segments (27 single-segment and 14 two-segment fusions) were included. The subsidence and pseudarthrosis rates based on the number of segments were 36.4% and 29.1%, respectively. Demographic data and fusion level were unrelated to subsidence. A greater T1S was associated with a lower risk of subsidence (p=0.017, odds ratio=0.206). A cutoff value of T1Ssubsidence (sensitivity: 70%, specificity: 68.6%). There were no preoperative predictors of pseudarthrosis except old age. A lower T1S (T1Ssubsidence following ACDF. Surgeons need to be aware of this risk factor and should consider various supportive procedures to reduce the subsidence rates for such cases.

  8. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease

    NARCIS (Netherlands)

    Jacobs, Wilco; Willems, Paul C.; van Limbeek, Jacques; Bartels, Ronald; Pavlov, Paul; Anderson, Patricia G.; Oner, Cumhur

    2011-01-01

    Background The number of surgical techniques for decompression and solid interbody fusion as treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques remains unclear. Objectives To determine which technique of anterior interbody fusion

  9. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease

    NARCIS (Netherlands)

    Jacobs, W.; Willems, P.C.P.H.; Limbeek, J. van; Bartels, R.H.M.A.; Pavlov, P.; Anderson, P.G.; Oner, C.

    2011-01-01

    BACKGROUND: The number of surgical techniques for decompression and solid interbody fusion as treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques remains unclear. OBJECTIVES: To determine which technique of anterior interbody fusion

  10. Intraoperative antepulsion of a posterior lumbar interbody fusion ...

    African Journals Online (AJOL)

    Spinal fusion surgery techniques develop together with technologic advancements. New complications are seen as the result of new techniques and these may be very severe due to spinal cord and vascular structures in the lumbar region. The posterior lumbar interbody fusion cage (PLIFC) was shown to enhance spinal ...

  11. CHANGES IN RADIOGRAPHIC PARAMETERS AFTER MINIMALLY INVASIVE LUMBAR INTERBODY FUSION

    Directory of Open Access Journals (Sweden)

    Emiliano Vialle

    2015-12-01

    Full Text Available Objective : This study aims to evaluate changes in lumbosacral parameters after minimally invasive lumbar interbody fusion. The secondary aim was to evaluate whether interbody cage shape (crescent shaped or rectangular would influence the results. Method : Retrospective analysis of 70 patients who underwent one or two level lumbar interbody fusion through a minimally invasive posterolateral approach. This included midline preservation and unilateral facetectomy. Pre- and postoperative (three to six months postoperative radiographs were used for measuring lumbar lordosis (LL, segmental lordosis (SL at the level of interbody fusion, and sacral slope (SS. Further analyses divided the patients into Roussouly lumbar subgroups. Results : LL was significantly reduced after surgery (59o:39o, p=0.001 as well as the SS (33.8o:31.2o, p=0.05. SL did not change significantly (11.4:11.06, p=0.85. There were no significant differences when comparing patients who received crescent shaped cage (n=27 and rectangular cage (n=43. Hypolordotic patients (Roussouly types 1 and 2 had radiographic improvement in comparison to normolordotic and hyperlordotic groups (types 3 and 4. Conclusion : Minimally invasive lumbar interbody fusion caused reduction in lumbosacral parameters. Cage shape had no influence on the results.

  12. Prospective Study of Posterior Lumbar Interbody Fusion With Either Interbody Graft or Interbody Cage in the Treatment of Degenerative Spondylolisthesis.

    Science.gov (United States)

    Sivaraman, A; Altaf, Farhaan; Jalgaonkar, Azal; Kakkar, Rahul; Sirigiri, P B R; Howieson, A; Crawford, Robert J

    2015-10-01

    A prospective study of 2 different fusion techniques for the treatment of single-level degenerative spondylolisthesis. To determine whether the addition of an intervertebral cage improves the clinical outcome and fusion rate of patients undergoing posterior lumbar interbody fusion (PLIF) after decompression for degenerative spondylolisthesis. The surgical approach that should be used for degenerative spondylolisthesis is a controversial issue. Decompression and PLIF with an interbody cage is widely used. Theoretical advantages in favor of PLIF include anterior column support, indirect foraminal decompression, restoration of lordosis, and reduction of the slip via ligamentotaxis. Despite numerous publications, the scientific support for the PLIF method is, however, weak. A prospective study was carried out including 59 patients with degenerative spondylolisthesis. Average age of patients was 66 years: 34 males and 25 females. Patients were divided into 2 treatment groups: group 1-32 patients with PLIF with interbody graft and group 2-27 patients with PLIF with cage. Minimum 2-year follow-up. Outcomes were assessed by measuring preoperative and postoperative lordotic angles. SF-12 physical and mental health scores were recorded along with visual analogue scores for pain. Complications were also recorded. No significant difference in the postoperative lordotic angles was achieved between the 2 techniques. Nonsignificant difference in the clinical outcomes between both the techniques. We have found the use of a cage to achieve lumbar interbody fusion in the treatment of degenerative lumbar spondylolisthesis does not confer any significant advantages in terms of restoration of lumbar lordosis, improvement in clinical symptoms, or relief of pain postoperatively.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  15. Anterior Lumbar Interbody Fusion Integrated Screw Cages: Intrinsic Load Generation, Subsidence, and Torsional Stability.

    Science.gov (United States)

    Assem, Yusuf; Pelletier, Matthew H; Mobbs, Ralph J; Phan, Kevin; Walsh, William R

    2017-05-01

    To perform a repeatable idealized in vitro model to evaluate the effects of key design features and integrated screw fixation on unloaded surface engagement, subsidence, and torsional stability. We evaluated four different stand-alone anterior lumbar interbody fusion (ALIF) cages with two, three, and four screw designs. Polyurethane (saw-bone) foam blocks were used to simulate the vertebral bone. Fuji Film was used to measure the contact footprint, average pressure, and load generated by fixating the cages with screws. Subsidence was tested by axially loading the constructs at 10 N/s to 400 N and torsional load was applied +/-1 Nm for 10 cycles to assess stability. Outcome measures included total subsidence and maximal torsional angle range. Cages 1, 2, and 4 were symmetrical and produced similar results in terms of contact footprint, average pressure, and load. The addition of integrated screws into the cage-bone block construct demonstrated a clear trend towards decreased subsidence. Cage 2 with surface titanium angled ridges and a keel produced the greatest subsidence with and without screws, significantly more than all other cages ( P < 0.05). Angular rotation was not significantly affected by the addition of screws ( P < 0.066). A statistically significant correlation existed between subsidence and reduced angular rotation across all cage constructs ( P = 0.018). Each stand-alone cage featured unique surface characteristics, which resulted in differing cage-foam interface engagement, influencing the subsidence and torsional angle. Increased subsidence significantly reduced the torsional angle across all cage constructs. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  16. Extreme lateral interbody fusion with posterior instrumentation for spondylodiscitis.

    Science.gov (United States)

    Blizzard, Daniel J; Hills, Christopher P; Isaacs, Robert E; Brown, Christopher R

    2015-11-01

    The purpose of this study was to evaluate our initial experience utilizing extreme lateral interbody fusion (XLIF; NuVasive, San Diego, CA, USA) with percutaneous posterior instrumentation to treat 11 spondylodiscitis patients between January 2011 and February 2014. Although medical management is the first line treatment for spondylodiscitis, many patients fail antibiotic therapy and bracing, or present with instability, neurologic deficits, or sepsis, requiring operative debridement and stabilization. High rates of fusion and infection clearance have been reported with anterior lumbar interbody fusion (ALIF), but this approach requires a morbid exposure, associated with non-trivial rates of vascular and peritoneal complications. XLIF is an increasingly popular interbody fusion technique which utilizes a fast and minimally invasive approach, sparing the anterior longitudinal ligament, and allowing sufficient visualization of the intervertebral discs and bodies to debride and place a large, lordotic cage. The outcome measures for this study included lumbar lordosis, sagittal balance, subsidence, fusion, pain, neurological deficit, and microbiology/laboratory evidence of infection. The mean follow-up time was 9.3 months. All patients had improvements in pain and neurological symptoms. The mean lordosis change was 11.0°, from 23.1° preoperatively to 34.0° postoperatively. Fusion was confirmed with CT scans in five of six patients. At the last follow-up, all patients had normalization of inflammatory markers, no symptoms of infection, and none required repeat surgical treatment for spondylodiscitis. XLIF with percutaneous posterior instrumentation is a minimally invasive technique with reduced morbidity for lumbar spine fusion which affords adequate exposure to the vertebral bodies and discs to aggressively debride necrotic and infected tissue. This study suggests that XLIF may be a safe and effective alternative to ALIF for the treatment of spondylodiscitis

  17. Comparison of rigid and semi-rigid instrumentation under acute load on vertebrae treated with posterior lumbar interbody fusion/transforaminal lumbar interbody fusion procedures: An experimental study.

    Science.gov (United States)

    Önen, Mehmet Reşid; Başgül, Cemile; Yılmaz, İlhan; Özkaya, Mustafa; Demir, Teyfik; Naderi, Sait

    2018-04-01

    Rigid and semi-rigid fixations are investigated several times in order to compare their biomechanical stability. Interbody fusion techniques are also preferable for maintaining the sagittal balance by protecting the disk height. In this study, the biomechanical comparison of semi-rigid and rigid fixations with posterior lumbar interbody fusion or transforaminal lumbar interbody fusion procedures is conducted under trauma. There were four different test groups to analyze the effect of acute load on treated ovine vertebrae. First and second groups were fixed with polyetheretherketone rods and transforaminal lumbar interbody fusion and posterior lumbar interbody fusion cages, respectively. Third and fourth groups were fixed with titanium rods and posterior lumbar interbody fusion and transforaminal lumbar interbody fusion cages, respectively. The drop tests were conducted with 7 kg weight. There were six samples in each group so the drop test repeated 24 times in total. The test samples were photographed and X-rayed (laterally and anteroposteriorly) before and after drop test. Two fractures were observed on group 1. Conversely, there were no fractures observed for group 2. There were no anterior element fractures for both groups 1 and 2. However, one fracture seen on group 3 was anterior element fracture, whereas the other three were posterior element fractures. All three fractures were anterior element fractures for group 4. Treated vertebrae with polyetheretherketone rods and posterior lumbar interbody fusion cages showed the best durability to the drop tests among the groups. Semi-rigid fixation gave better results than rigid fixation according to failed segments. Posterior lumbar interbody fusion cages seem to be better option for semi-rigid fixation, however mentioned surgical disadvantages must be considered.

  18. Double-segment Wilhelm Tell technique for anterior lumbar interbody fusion in unstable isthmic spondylolisthesis and adjacent segment discopathy.

    Science.gov (United States)

    Wenger, Markus; Vogt, Emanuel; Markwalder, Thomas-Marc

    2006-02-01

    The Wilhelm Tell technique is a novel instrumented anterior lumbar interbody fusion (ALIF) procedure using a specially designed composite carbon fibre cage and a single short-threaded cancellous screw that obliquely passes through the upper adjacent vertebral body, the interbody cage itself and through the lower adjacent vertebral body. This single-stage fusion method, which is in principle a combination of the Louis technique and modern cage surgery, is reported to have a lower rate of pseudoarthrosis formation than stand-alone cage techniques. In addition, it eliminates both the surgical trauma of paravertebral muscle retraction and the risk of neural damage by poorly located pedicular screws. This anterior approach allows decompression of neural structures within the anterior part of the spinal canal and the foraminal region. It is the purpose of this case report, to present the successful application of this novel technique in a 32-year-old woman who concurrently suffered from severe instability-related back pain from L4/5 isthmic spondylolisthesis and marked L5/S1 degenerative disc disease.

  19. Current Status of Lumbar Interbody Fusion for Degenerative Spondylolisthesis

    Science.gov (United States)

    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

  20. POSTERIOR LUMBAR INTERBODY FUSION AND INSTRUMENTED POSTEROLATERAL FUSION IN ADULT SPONDYLOLISTHESIS: ASSESSMENT AND CLINICAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Rajarajan

    2015-11-01

    Full Text Available OBJECTIVE: Aim of this study is to assess and compare the outcomes of posterior lumbar interbody fusion (PLIF and posterolateral fusion (PLF in adult isthmic spondylosthesis. BACKGROUND: Posterolateral fusion has been considered the best method and widely been used for surgical treatment of adult spondylolisthesis.Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation MATERIALS AND METHODS: Thirty six patients with isthmic spondylolisthesis were operated. One group (20 patients had decompression and posterolateral fusion (PLF with a pedicle screw system; other group (16 patients was treated by decompression, posterior lumbar interbody fusion (PLIF and a Pedicle screw system. In both groups adequate decompression was done RESULTS: Seventy seven percent of the patients had a good result with (PLIF and 68 percent with posterolateral fusion (PLF. However there was no statistical difference in cases with low grade slipping, whereas the difference was significant for cases with high grade slipping. Fusion rate was 93% with (PLIF and 68% with (PLF, but without any significant incidence in the functional outcome. 78% has relief of sciatica and neurogenic claudication. CONCLUSION: Based on these findings we found that for high grade spondylolisthesis which requires reduction or if the disc space is still high posterior lumbar inter body fusion is preferable. For low grade spondylolisthesis or if the disc space is narrow posterolateral fusion is preferable. A successful result of fusion operation depends on adequate decompression which relieves radicular symptoms.

  1. Comparing minimally invasive transforaminal lumbar interbody fusion and posterior lumbar interbody fusion for spondylolisthesis: A STROBE-compliant observational study.

    Science.gov (United States)

    Zhang, Dapeng; Mao, Keya; Qiang, Xiaojun

    2017-09-01

    Although spondylolisthesis was traditionally treated with posterior lumbar interbody fusion (PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) was recently proposed as an alternative treatment for spondylolisthesis. However, no studies have focused on the comparison of these 2 techniques' outcome on spondylolisthesis.The operative reports and perioperative data of patients who underwent single-level primary open PLIF (n = 29) and MIS-TLIF (n = 26) for I/II spondylolisthesis were retrospectively evaluated. Patients' demographics, operative blood loss, hospital length of stay, creatine kinase (CK) level, radiographic fusion, complications, and patient-reported outcomes were evaluated. Radiographic fusion was assessed using the Bridwell grading criteria. Preoperative and postoperative patient-reported outcomes included the visual analog scale (VAS) and Oswestry Disability Index (ODI).Average follow-up was 28 ± 3.6 months (range 24-32 months). Bed rest time, hospital stay, estimated blood loss, and operative time in the MIS-TLIF group were significantly lower than those in the PLIF group (P  .05).Compared with PLIF, MIS-TLIF for grade I/II spondylolisthesis can achieve similar reduction and fusion results with better short-term quality of life, shorter hospital stays, less estimated blood loss, and shorter operative times.

  2. [Costotransversectomy and interbody fusion for treatment of thoracic dyscopathy].

    Science.gov (United States)

    Sagan, Leszek M; Madany, Lukasz; Lickendorf, Marek

    2007-01-01

    Surgical treatment of a thoracic discopathy comprises 4% of all surgeries performed for discopathy. Therefore, analysis of efficacy of particular operative methods used in that scope is limited. We present our analyze modification of costotransversectomy with policarbone cage interbody fusion as the contribution to discussion on optimal operative treatment of thoracic discopathy. Results of the operative treatment of 14 cases of a thoracic discopathy are analyzed. In 12 cases neurological examination revealed radiculopathy and in 2 cases upper motor neuron involvement. All patients underwent MRI for estimation of level and morphology of discopathy. In one case there was two-level dyscopathy and in the other cases there was one-level discopathy localized in the region between fifth and twelve thoracic vertebrae. The follow up period was of 10 months to 6 years (mean 2 years and four months). During the surgery lateral upper aspect of the intervertebral disc on a one side was exposed. It was accomplished by removal of the head of the rib and the upper aspect of the pedicle located caudally to the intervertebral disc. The policarbone cage was introduced into the intervertebral space after discectomy. In the case with sudden preoperative deterioration of the lower extremities strength there was further postoperative deterioration. During follow up, continuous improvement was observed. In the 12th postoperative month the weakness was minimal. In the other cases immediate postoperative resolution of the pain syndrome and neurological deficits was observed. Postoperative imaging studies reveled appropriate decompression of the spinal canal and localization interbody implant. 1. Costotransversectomy approach leads to sufficient exposition of the anterior aspect of the spinal canal. 2. Our modification of interbody fusion with policarbone cage gives good results in fusion of compromised motion unit. It makes the approach more attractive in the light of remote surgery

  3. The Stand-alone Heliostat

    International Nuclear Information System (INIS)

    Garcia Navajas, G. I.; Egea Gea, A.

    2000-01-01

    The first Autonomous Heliostat has been developed by CIEMAT at PSA facilities in Almeria. This heliostat is an innovative approach to reducing the civil engineering work costs in heliostat fields of central tower plants. Channels, cables and other electric elements have been eliminated in the new heliostat. Thus, one 70-nr, classical T glass/metal heliostat has been adapted to include all the new stand-alone concept components. A PV system is able to drive two sun-tracking DC motors between 5 and 24Vdc, 0 and 15A. The heliostat communicates with the control room 400-m away by using a radio-modem working at 9600 baud. An anemometer, a wind switcher, light and ambient temperature sensors have been installed on the heliostat for self-protection decision-making. A PV panel integrated into the heliostat reflecting surface, eliminates cabling and other elements required for a conventional power supply. Communication lines between master control and local control have been replaced by radio-modem. Testing has validated the technical feasibility of the prototype and quantified the real consumption and efficiencies of new elements. The extra costs produced.by the autonomous concepts are compared with the cost of civil work in conventional heliostat field. (Author) 8 refs

  4. Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study.

    Science.gov (United States)

    Wu, Wen-Jian; Jiang, Lei-Sheng; Liang, Yu; Dai, Li-Yang

    2012-07-01

    Clinical outcomes of the stand-alone cage have been encouraging when used in anterior cervical discectomy and fusion (ACDF), but concerns remain regarding its complications, especially cage subsidence. This retrospective study was undertaken to investigate the long-term radiological and clinical outcomes of the stand-alone titanium cage and to evaluate the incidence of cage subsidence in relation to the clinical outcome in the surgical treatment of degenerative cervical disc disease. A total of 57 consecutive patients (68 levels) who underwent ACDF using a titanium box cage for the treatment of cervical radiculopathy and/or myelopathy were reviewed for the radiological and clinical outcomes. They were followed for at least 5 years. Radiographs were obtained before and after surgery, 3 months postoperatively, and at the final follow-up to determine the presence of fusion and cage subsidence. The Cobb angle of C2-C7 and the vertebral bodies adjacent to the treated disc were measured to evaluate the cervical sagittal alignment and local lordosis. The disc height was measured as well. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score for cervical myelopathy, before and after surgery, and at the final follow-up. The recovery rate of JOA score was also calculated. The Visual Analogue Scale (VAS) score of neck and radicular pain were evaluated as well. The fusion rate was 95.6% (65/68) 3 months after surgery. Successful bone fusion was achieved in all patients at the final follow-up. Cage subsidence occurred in 13 cages (19.1%) at 3-month follow-up; however, there was no relation between fusion and cage subsidence. Cervical and local lordosis improved after surgery, with the improvement preserved at the final follow-up. The preoperative disc height of both subsidence and non-subsidence patients was similar; however, postoperative posterior disc height (PDH) of subsidence group was significantly greater than of non-subsidence group

  5. Is the radiographic subsidence of stand-alone cages associated with adverse clinical outcomes after cervical spine fusion? An observational cohort study with 2-year follow-up outcome scoring.

    Science.gov (United States)

    Zajonz, Dirk; Franke, Anne-Catherine; von der Höh, Nicolas; Voelker, Anna; Moche, Michael; Gulow, Jens; Heyde, Christoph-Eckhard

    2014-01-01

    The stand-alone treatment of degenerative cervical spine pathologies is a proven method in clinical practice. However, its impact on subsidence, the resulting changes to the profile of the cervical spine and the possible influence of clinical results compared to treatment with additive plate osteosynthesis remain under discussion until present. This study was designed as a retrospective observational cohort study to test the hypothesis that radiographic subsidence of cervical cages is not associated with adverse clinical outcomes. 33 cervical segments were treated surgically by ACDF with stand-alone cage in 17 patients (11 female, 6 male), mean age 56 years (33-82 years), and re-examined after eight and twenty-six months (mean) by means of radiology and score assessment (Medical Outcomes Study Short Form (MOS-SF 36), Oswestry Neck Disability Index (ONDI), painDETECT questionnaire and the visual analogue scale (VAS)). Subsidence was observed in 50.5% of segments (18/33) and 70.6% of patients (12/17). 36.3% of cases of subsidence (12/33) were observed after eight months during mean time of follow-up 1. After 26 months during mean time of follow-up 2, full radiographic fusion was seen in 100%. MOS-SF 36, ONDI and VAS did not show any significant difference between cases with and without subsidence in the two-sample t-test. Only in one type of scoring (painDETECT questionnaire) did a statistically significant difference in t-Test emerge between the two groups (p = 0.03; α = 0.05). However, preoperative painDETECT score differ significantly between patients with subsidence (13.3 falling to 12.6) and patients without subsidence (7.8 dropped to 6.3). The radiological findings indicated 100% healing after stand-alone treatment with ACDF. Subsidence occurred in 50% of the segments treated. No impact on the clinical results was detected in the medium-term study period.

  6. Artrodese cervical anterior em três e quatro níveis com dispositivo intersomático não associado à placa cervical Artrodesis cervical anterior en tres y cuatro niveles con dispositivo intersomático no asociado a placa cervical Anterior cervical arthrodesis for three and four levels using stand-alone interbody cages without cervical plates

    Directory of Open Access Journals (Sweden)

    Marcel Luiz Benato

    2009-06-01

    en tercer y cuarto niveles; dolor axial y/o irradiada; con mínimo seis meses de postoperatorio. El criterio de exclusión fue la presencia de inestabilidad cervical traumática. Fueron evaluadas las tasas de consolidación, la presencia de síntomas, la tasa de complicaciones y la posición de los dispositivos intersomáticos (subsidente después de seis meses. RESULTADOS: todos los pacientes obtuvieron consolidación en tres meses, sin embargo, dos pacientes presentaron el fenómeno de subsidente, o sea, migración con consolidación en cifosis, sin alterar los resultados clínicos y la consolidación de la artrodesis a los seis meses de postoperatorio. Los pacientes presentaron mejoría del dolor preoperatorio y solo tres (15% presentaron dolor residual. No hubo complicaciones mayores. El tiempo de hospitalización fue de dos días. No fue utilizada inmovilización rígida en el postoperatorio. CONCLUSIÓN: fue obtenida consolidación con esta técnica en todos los casos. La técnica se mostró segura y promovió buenos resultados radiológicos y clínicos.evaluate the rates of fusion of the anterior cervical discectomy and arthrodesis for three and four levels using interbody cages (stand-alone without cervical plates six months after post-operative. METHODS: from November 2005 to July 2008, 20 patients were treated as proposed. The inclusion criteria were: cervical degenerative disease of three and four levels; axial and/or irradiated pain at least six months of follow-up. The exclusion criteria were: cervical traumatic instability. The fusion rate, clinical symptoms, rate of complications and the implant position were evaluated six months after post-operative. RESULTS: results were favorable in 100% of the patients, with residual pain in two cases. Fusion was found in 100% of the patients, except for two cases with minimum subsidence and fusion in a slight kyphotic position. There were not significant complications. The discharge of the hospital was performed

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

    Science.gov (United States)

    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 (Spine. The addition of a lateral interbody device superadjacent to a two-level fusion significantly reduced motion in flexion, extension, and lateral bending (pfusion construct, demonstrating ROM comparable with a traditional three-level TLIF. The data presented suggest that a lateral-based interbody fusion supplemented with additional minimally invasive instrumentation may provide comparable stability with a traditional posterior revision approach

  8. Radiographic and Clinical Outcomes of Anterior and Transforaminal Lumbar Interbody Fusions: A Systematic Review and Meta-analysis of Comparative Studies.

    Science.gov (United States)

    Ajiboye, Remi M; Alas, Haddy; Mosich, Gina M; Sharma, Akshay; Pourtaheri, Sina

    2017-06-15

    Systematic review and meta-analysis. Compare the radiographic and clinical outcomes of anterior lumbar interbody fusion (ALIF) to transforaminal lumbar interbody fusion (TLIF). ALIF and TLIF are 2 methods of achieving spinal arthrodesis. There are conflicting reports with no consensus on the optimal interbody technique to achieve successful radiographic and clinical outcomes. The goal of this systematic review and meta-analysis was to compare the radiographic and clinical outcomes of ALIF to TLIF. A systematic search of multiple medical reference databases was conducted for studies comparing ALIF to TLIF. Studies that included stand-alone ALIFs were excluded. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcome measures included segmental and overall lumbar lordosis, and fusion rates. Clinical outcomes measures included Oswestry disability index (ODI) and visual analog scale (VAS) score for back pain. The search yielded 7 studies totaling 811 patients (ALIF=448, TLIF=363). ALIF was superior to TLIF in restoring segmental lumbar lordosis at L4-L5 and L5-S1 (L4-L5; P=0.013, L5-S1; P<0.001). ALIF was also superior to TLIF in restoring overall lumbar lordosis (P<0.001). However, no significant differences in fusion rates were noted between both techniques [odds ratio=0.905; 95% confidence interval, 0.458-1.789; P=0.775]. In addition, ALIF and TLIF were comparable with regards to ODI and VAS scores (ODI; P=0.184, VAS; P=0.983). For the restoration of lumbar lordosis, ALIF is superior to TLIF. However, TLIF is comparable to ALIF with regards to fusion rate and clinical outcomes.

  9. Analysis of Internet Information on Lateral Lumbar Interbody Fusion.

    Science.gov (United States)

    Belayneh, Rebekah; Mesfin, Addisu

    2016-07-01

    Lateral lumbar interbody fusion (LLIF) is a surgical technique that is being increasingly used. The authors' objective was to examine information on the Internet pertaining to the LLIF technique. An analysis was conducted of publicly accessible websites pertaining to LLIF. The following search engines were used: Google (www.google.com), Bing (www.bing.com), and Yahoo (www.yahoo.com). DuckDuckGo (www.duckduckgo.com) was an additional search engine used due to its emphasis on generating accurate and consistent results while protecting searchers' privacy and reducing advertisements. The top 35 websites providing information on LLIF from the 4 search engines were identified. A total of 140 websites were evaluated. Each web-site was categorized based on authorship (academic, private, medical industry, insurance company, other) and content of information. Using the search term lateral lumbar interbody fusion, 174,000 Google results, 112,000 Yahoo results, and 112,000 Bing results were obtained. DuckDuckGo does not display the number of results found for a search. From the top 140 websites collected from each website, 78 unique websites were identified. Websites were authored by a private medical group in 46.2% of the cases, an academic medical group in 26.9% of the cases, and the biomedical industry in 5.1% of the cases. Sixty-eight percent of websites reported indications, and 24.4% reported contraindications. Benefits of LLIF were reported by 69.2% of websites. Thirty-six percent of websites reported complications of LLIF. Overall, the quality of information regarding LLIF on the Internet is poor. Spine surgeons and spine societies can assist in improving the quality of the information on the Internet regarding LLIF. [Orthopedics. 2016; 39(4):e701-e707.]. Copyright 2016, SLACK Incorporated.

  10. Evaluation of hip flexion strength following lateral lumbar interbody fusion.

    Science.gov (United States)

    Lee, Yu-Po; Regev, Gilad J; Chan, Justin; Zhang, Bing; Taylor, William; Kim, Choll W; Garfin, Steven R

    2013-10-01

    Lateral interbody fusion (LIF) is a minimally invasive procedure that is designed to achieve a solid interbody fusion while minimizing the damage to the surrounding soft tissue. Although short-term results have been promising, few data have been published to date regarding its risks and complication rate. The aim was to evaluate the extent of injury to the psoas muscle after the LIF procedure by measuring hip flexion strength. A prospective case series was used in the study. Hip flexion strength was measured using a handheld digital dynamometer while the patient was seated on a chair; the examiner held the device against the patient's attempt to flex the hip. Both sides were measured to compare the operated and nonoperated psoas muscles. Each side was measured three times and the average amount (in pounds) was recorded. Measurements were done before and after surgery on Day 2-3, at 2 weeks, 6 weeks, and at 3 and 6 months. Thirty-three patients were recruited for this study. Mean preoperative hip flexion strength values were 20.7±3.47 lb and 21.3±4.31 lb for operated and nonoperated legs, respectively, with no significant difference (p=.85). With a mean of 11.2±2.24 lb postoperative measurements on Day 2, the operated side showed statistically significant reduction of strength (p=.0001). The nonoperated side was also weaker postoperatively, but not significantly (mean=19.12±1.74 lb; p=.097). From the first follow-up visit at 2 weeks, the values on the operated leg had returned to baseline values (20.6, p=.97) and were not significantly different from preoperative values on either side. Hip flexion was weakened immediately after the LIF procedure, which may be attributed to psoas muscle injury during the procedure. However, this damage was temporary, with almost complete return to baseline values by 2 weeks. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Efficacy of Platelet-Rich Plasma for Bone Fusion in Transforaminal Lumbar Interbody Fusion.

    Science.gov (United States)

    Kubota, Go; Kamoda, Hiroto; Orita, Sumihisa; Inage, Kazuhidee; Ito, Michihiro; Yamashita, Masaomi; Furuya, Takeo; Akazawa, Tsutomu; Shiga, Yasuhiro; Ohtori, Seiji

    2018-02-01

    Retrospective case series. To examine the efficacy of platelet-rich plasma (PRP) for bone fusion in transforaminal lumbar interbody fusion (TLIF) using local bone grafting. Several authors have reported the efficacy of PRP for bone union in animal models. However, the use of PRP for bone fusion in TLIF surgery has not been fully explored. Twenty patients underwent single-level TLIF surgery because of L4 spondylolisthesis. An interbody fusion cage and local bone were used in nine patients (control group) and an interbody fusion cage, local bone, and PRP were used in 11 patients (PRP group). PRP was prepared from the patients' blood samples (400 mL) immediately before surgery. The duration of bone union and postoperative bone fusion rate were assessed using plain radiography at every 3 months postoperatively and computed tomography at 12 or 24 months postoperatively, respectively. Lower back pain, leg pain, and leg numbness were evaluated using the visual analog scale preoperatively and at 3, 6, 12, and 24 months postoperatively. The platelet count was 8.7 times higher in PRP than in blood. The bone union rate was significantly superior in the PRP group than in the control group (91% and 77%, respectively; p =0.035), whereas the average duration of bone union was not significantly different between the groups (7.7±0.74 and 10.0±2.00 months, respectively; p =0.131). There was no significant difference in lower back pain, leg pain, and leg numbness in both groups during follow-up ( p >0.05). Our study suggests that the use of PRP in TLIF surgery increases bone fusion rate.

  12. Basic Stand Alone Medicare Outpatient Procedures PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Outpatient Procedures Public Use Files (PUF) with information from Medicare outpatient claims. The CMS BSA...

  13. Basic Stand Alone Medicare Hospice Beneficiary PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Hospice Beneficiary Public Use Files (PUF) with information from Medicare hospice claims. The CMS BSA Hospice...

  14. Basic Stand Alone Carrier Line Items PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Carrier Line Items Public Use Files (PUF) with information from Medicare Carrier claims. The CMS BSA Carrier Line...

  15. Basic Stand Alone Medicare Inpatient Claims PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Inpatient Public Use Files (PUF) named CMS 2008 BSA Inpatient Claims PUF with information from 2008 Medicare...

  16. Posterolateral fusion with interbody for lumbar spondylolisthesis is associated with less repeat surgery than posterolateral fusion alone.

    Science.gov (United States)

    Macki, Mohamed; Bydon, Mohamad; Weingart, Robby; Sciubba, Daniel; Wolinsky, Jean-Paul; Gokaslan, Ziya L; Bydon, Ali; Witham, Timothy

    2015-11-01

    Posterior or transforaminal lumbar interbody fusions (PLIF/TLIF) may improve the outcomes in patients with lumbar spondylolisthesis. This study aims to compare outcomes after posterolateral fusion (PLF) only versus PLF with interbody fusion (PLF+PLIF/TLIF) in patients with spondylolisthesis. We retrospectively reviewed103 patients who underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Anterior techniques and multilevel interbody fusions were excluded. All patients were followed for at least 2 years postoperatively. Clinical outcomes including back pain, radiculopathy, weakness, sensory deficits, and loss of bowel/bladder function were ascertained from clinic notes. Radiographic measures were calculated with Tillard percentage of spondylolisthesis. Reoperation for progression of degenerative disease, a primary endpoint, was indicated for all patients with (1) persistent or new-onset neurological symptoms; and (2) radiographic imaging that correlated with clinical presentation. Of the 103 patients, 56.31% were managed with PLF and 43.69% with PLF+PLIF/TLIF. On radiographic studies, spondylolisthesis improved by a mean of 13.06% after PLF+PLIF/TLIF versus 5.67% after PLF (pspondylolisthesis. Patients with interbody fusions were less likely to undergo reoperation for degenerative disease progression compared to non-interbody fusions. However, greater listhesis correction and decreased reoperation in the PLF+PLIF/TLIF cohort should be weighed with favorable clinical outcomes in the PLF cohort. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Effects of Strontium Ranelate on Spinal Interbody Fusion Surgery in an Osteoporotic Rat Model.

    Directory of Open Access Journals (Sweden)

    Tsung-Ting Tsai

    Full Text Available Osteoporosis is a bone disease that afflicts millions of people around the world, and a variety of spinal integrity issues, such as degenerative spinal stenosis and spondylolisthesis, are frequently concomitant with osteoporosis and are sometimes treated with spinal interbody fusion surgery. Previous studies have demonstrated the efficacy of strontium ranelate (SrR treatment of osteoporosis in improving bone strength, promoting bone remodeling, and reducing the risk of fractures, but its effects on interbody fusion surgery have not been adequately investigated. SrR-treated rats subjected to interbody fusion surgery exhibited significantly higher lumbar vertebral bone mineral density after 12 weeks of treatment than rats subjected to the same surgery but not treated with SrR. Furthermore, histological and radiographic assessments showed that a greater amount of newly formed bone tissue was present and that better fusion union occurred in the SrR-treated rats than in the untreated rats. Taken together, these results show significant differences in bone mineral density, PINP level, histological score, SrR content and mechanical testing, which demonstrate a relatively moderate effect of SrR treatment on bone strength and remodeling in the specific context of recovery after an interbody fusion surgery, and suggest the potential of SrR treatment as an effective adjunct to spinal interbody fusion surgery for human patients.

  18. Cervical disc prosthesis replacement and interbody fusion — a comparative study

    Science.gov (United States)

    Yu–Hua, Jia

    2006-01-01

    The purpose of this paper is to compare the new functional intervertebral cervical disc prosthesis replacement and the classical interbody fusion operation, including the clinical effect and maintenance of the stability and segmental motion of cervical vertebrae. Twenty-four patients with single C5-6 intervertebral disk hernias were specifically selected and divided randomly into two groups: One group underwent artificial cervical disc replacement and the other group received interbody fusion. All patients were followed up and evaluated. The operation time for the single disc replacement was (130 ± 50) minutes and interbody fusion was (105 ± 53) minutes. Neurological or vascular complications were not observed during or after operation. There was no prosthesis subsidence or extrusion. The JOA score of the group with prosthesis replacement increased from an average of 8.6 to 15.8. The JOA score of the group with interbody fusion increased from an average of 9 to 16.2. The clinical effect and the ROM of the adjacent space of the two groups showed no statistical difference. The short follow-up time does not support the advantage of the cervical disc prosthesis. The clinical effect and the maintenance of the function of the motion of the intervertebral space are no better than the interbody fusion. At least 5 years of follow-up is needed to assess the long-term functionality of the prosthesis and the influence on adjacent levels. PMID:17180356

  19. Repeated adjacent-segment degeneration after posterior lumbar interbody fusion.

    Science.gov (United States)

    Okuda, Shinya; Oda, Takenori; Yamasaki, Ryoji; Maeno, Takafumi; Iwasaki, Motoki

    2014-05-01

    One of the most important sequelae affecting long-term results is adjacent-segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF). Although several reports have described the incidence rate, there have been no reports of repeated ASD. The purpose of this report was to describe 1 case of repeated ASD after PLIF. A 62-year-old woman with L-4 degenerative spondylolisthesis underwent PLIF at L4-5. At the second operation, L3-4 PLIF was performed for L-3 degenerative spondylolisthesis 6 years after the primary operation. At the third operation, L2-3 PLIF was performed for L-2 degenerative spondylolisthesis 1.5 years after the primary operation. Vertebral collapse of L-1 was detected 1 year after the third operation, and the collapse had progressed. At the fourth operation, 3 years after the third operation, vertebral column resection of L-1 and replacement of titanium mesh cages with pedicle screw fixation between T-4 and L-5 was performed. Although the patient's symptoms resolved after each operation, the time between surgeries shortened. The sacral slope decreased gradually although each PLIF achieved local lordosis at the fused segment.

  20. Miniopen Oblique Lateral L5-S1 Interbody Fusion: A Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    Keijiro Kanno

    2014-01-01

    Full Text Available Extreme lateral interbody fusion (XLIF has been widely used for minimally invasive anterior lumbar interbody fusion (ALIF, but an approach to L5-S1 is difficult because of the iliac crest. In the current study, we present 2 cases using minimally invasive oblique lateral interbody fusion (OLIF of L5-S1. The patients showed foraminal stenosis between L5 and S1 and severe low back and leg pain. The patients were placed in a lateral decubitus position and underwent OLIF surgery (using a cage and bone graft from the iliac crest without posterior decompression. Posterior screws were used in the patients. Pain scores significantly improved after surgery. There was no spinal nerve, major vessel, peritoneal, or urinary injury. OLIF surgery was minimally invasive and produced good surgical results without complications.

  1. Subsidence following anterior lumbar interbody fusion (ALIF): a prospective study.

    Science.gov (United States)

    Rao, Prashanth J; Phan, Kevin; Giang, Gloria; Maharaj, Monish M; Phan, Steven; Mobbs, Ralph J

    2017-06-01

    Anterior lumbar interbody fusion (ALIF) is a widely used surgical technique for disorders of the lumbar spine. One potential complication is the subsidence of disc height in the post-operative period. Few studies have reported the rate of subsidence in ALIF surgery prospectively. We prospectively evaluated the rate of subsidence in adult patients undergoing ALIF. Results were obtained by reviewing scans of 147 patients. Disc heights were measured on radiographic scans taken pre-operatively in addition to post-operatively immediately, at 6 weeks and at 18 months. The anterior and posterior intervertebral disc heights were measured. Subsidence was defined as greater than or equal to 2 mm loss of height. A total of 15 patients (10.2%) had subsidence, with 7 being male. Each case was of delayed cage subsidence (DCS) >6 weeks postoperatively. The mean subsidence was 4.7 mm (range, 2.4-7.8). Mean anterior disc height was 8.6±0.4 mm preoperatively, which improved to 15.1±0.5 mm at latest follow-up. Mean posterior disc height was 4.7±0.2 mm preoperatively, which improved to 8.7±0.4 mm at latest follow-up. The mean lumbar lordosis (LL) angle was 42.5°±10.8° and the mean local disc angle (LDA) was 6.7°±4.0°. The 91.2% (n=114/125) of patients with appropriate radiological follow-up demonstrated fusion by latest follow-up. There was no correlation between subsidence rate with patient reported outcomes [Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and Short Form 12 Item survey (SF-12)] and fusion rates. There was a significant negative correlation between LL and extent of subsidence (Pearson correlation =-0.754, P=0.012). In conclusion, we found that the subsidence rate at follow-up was generally low following standalone ALIF for this patient series. Patient clinical outcomes and bony fusion rates were not significantly influenced by subsidence.

  2. New cage for posterior minimally invasive lumbar interbody fusion: a study in vitro and in vivo.

    Science.gov (United States)

    Hong, Xin; Wu, Xiao-tao; Zhuang, Su-yang; Bao, Jun-ping; Shi, Rui

    2014-02-01

    To design a new type of interbody fusion device made of nickel titanium NiTi shape memory alloy and to compare segmental stiffness after various posterior lumbar interbody fusion (PLIF) procedures in vitro and in vivo. Twelve sheep lumbar functional spinal units were randomly allocated to four groups. One acted as controls (N); the other three were treated with autogenous iliac crest bone dowel graft (L), a threaded cylindrical titanium (KC) interbody fusion device (TFC) or a new type of interbody fusion device made of NiTi shape memory alloy (NT) containing autogenous iliac crest graft. In addition, 15 sheep were allocated to three groups; one served as controls and the other two underwent TFC (KC) or NiTi-FC (NT). Nondestructive mechanical tests were performed in pure compression, extension, lateral bending and torsion. The operated spines were photographed regularly to assess changes in interbody height and degree of fusion. The animals were killed at 6 months for histologic testing. Biomechanical tests showed both the strength and axial stiffness of the NT and KC groups were significantly higher than those of the control group and L group (P destructive load of the NiTi-TFC was 11 200 N and the safety coefficient was above 1.2. Radiological observations revealed that the bone callus around the interbody fusion device were gradually increased postoperatively (2 months, no obvious; 4 months, poorly define; 6 months, dense). The KC and NT group had lost 16% and 16.5% of their postoperative height but remained well above normal disc height (P < 0.05). Histologic examination showed new trabeculation connected with that of the host. The mechanical characteristics of the NiTi-TFC are excellent and it is safe and reliable. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  3. Clinical outcomes and considerations of the lumbar interbody fusion technique for lumbar disk disease in adolescents.

    Science.gov (United States)

    Kwon, Dae-Woong; Kim, Kyung-Hyun; Park, Jeong-Yoon; Chin, Dong-Kyu; Kim, Keun-Su; Cho, Young-Eun; Kuh, Sung-Uk

    2013-08-01

    The posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) techniques are commonly used surgical methods for wide indications such as degeneration or trauma. Although they are rarely required for lumbar disk disease in younger patients, there are a few children and adolescents who are indicated for PLIF or TLIF for other reasons, such as congenital severe stenosis with or without lumbar instability that requires wide decompression or severe bony spur that need to be removed. In such cases, different pathophysiology and outcomes are expected compared with adult patients. We retrospectively reviewed data of 23 patients who underwent PLIF or TLIF surgery when less than 20 years old. Clinical and radiographic outcomes were assessed during a mean of 36.4 months follow-up period. The indications of lumbar interbody fusion, success of fusion, complications, and visual analog scale (VAS) were analyzed. Radiographs of all patients taken 6 months after the surgery showed fusion. Clinical outcome was also satisfactory, with improvement of VAS score from 7.7 preoperatively to 2.3 at 6 months after surgery. Only one patient had reoperation due to adjacent segment disease. For adolescent patients with severe bony spur, massive central disk rupture, or severe spondylolisthesis, lumbar interbody fusion surgery has good surgical outcome with few complications.

  4. Radiographic evaluation of indirect decompression of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spondylolisthesis.

    Science.gov (United States)

    Sato, Jun; Ohtori, Seiji; Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Ochiai, Nobuyasu; Kuniyoshi, Kazuki; Aoki, Yasuchika; Nakamura, Junichi; Miyagi, Masayuki; Suzuki, Miyako; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Fujimoto, Kazuki; Shiga, Yasuhiro; Abe, Koki; Kanamoto, Hiroto; Inoue, Gen; Takahashi, Kazuhisa

    2017-03-01

    Extreme lateral interbody fusion provides minimally invasive treatment of spinal deformity, but complications including nerve and psoas muscle injury have been noted. To avoid nerve injury, mini-open anterior retroperitoneal lumbar interbody fusion methods using an approach between the aorta and psoas, such as oblique lumbar interbody fusion (OLIF) have been applied. OLIF with percutaneous pedicle screws without posterior decompression can indirectly decompress the spinal canal in lumbar degenerated spondylolisthesis. In the current study, we examined the radiographic and clinical efficacy of OLIF for lumbar degenerated spondylolisthesis. We assessed 20 patients with lumbar degenerated spondylolisthesis who underwent OLIF and percutaneous pedicle screw fixation without posterior laminectomy. MR and CT images and clinical symptoms were evaluated before and 6 months after surgery. Cross sections of the spinal canal were evaluated with MRI, and disk height, cross-sectional areas of intervertebral foramina, and degree of upper vertebral slip were evaluated with CT. Clinical symptoms including low back pain, leg pain, and lower extremity numbness were evaluated using a visual analog scale and the Oswestry Disability Index before and 6 months after surgery. After surgery, significant increases in axial and sagittal spinal canal diameter (12 and 32 %), spinal canal area (19 %), disk height (61 %), and intervertebral foramen areas (21 % on the right side, 39 % on the left), and significant decrease of upper vertebral slip (-9 %) were found (P spondylolisthesis with back and leg symptoms.

  5. Clinical study of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability

    OpenAIRE

    GUO, SHUGUANG; SUN, JUNYING; TANG, GENLIN

    2013-01-01

    The aim of this study was to observe the clinical effects of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability. The 48 patients comprised 27 males and 21 females, aged 47?72 years. Three cases had first and second degree lumbar spondylolisthesis and all received bilateral vertebral lamina fenestration for posterior lumbar interbody fusion (PLIF) using a threaded fusion cage (TFC), which maintains the three-column...

  6. Clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion in primary versus revision surgery

    NARCIS (Netherlands)

    Hentenaar, B.; Spoor, A. B.; Malefijt, J. de Waal; Diekerhof, C. H.; den Oudsten, B. L.

    2016-01-01

    Purpose The aim of this study is to compare the clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion (MI-PLIF) in revision and primary cases. Methods In a retrospective study, we compared the clinical and radiological results of MI-PLIF for lytic

  7. Fusion Rate and Clinical Outcomes in Two-Level Posterior Lumbar Interbody Fusion.

    Science.gov (United States)

    Aono, Hiroyuki; Takenaka, Shota; Nagamoto, Yukitaka; Tobimatsu, Hidekazu; Yamashita, Tomoya; Furuya, Masayuki; Iwasaki, Motoki

    2018-04-01

    Posterior lumbar interbody fusion (PLIF) has become a general surgical method for degenerative lumbar diseases. Although many reports have focused on single-level PLIF, few have focused on 2-level PLIF, and no report has covered the fusion status of 2-level PLIF. The purpose of this study is to investigate clinical outcomes and fusion for 2-level PLIF by using a combination of dynamic radiographs and multiplanar-reconstruction computed tomography scans. This study consisted of 48 consecutive patients who underwent 2-level PLIF for degenerative lumbar diseases. We assessed surgery duration, estimated blood loss, complications, clinical outcomes as measured by the Japanese Orthopaedic Association score, lumbar sagittal alignment as measured on standing lateral radiographs, and fusion status as measured by dynamic radiographs and multiplanar-reconstruction computed tomography. Patients were examined at a follow-up point of 4.8 ± 2.2 years after surgery. Thirty-eight patients who did not undergo lumbosacral fusion comprised the lumbolumbar group, and 10 patients who underwent lumbosacral fusion comprised the lumbosacral group. The mean Japanese Orthopaedic Association score improved from 12.1 to 22.4 points by the final follow-up examination. Sagittal alignment also was improved. All patients had fusion in the cranial level. Seven patients had nonunion in the caudal level, and the lumbosacral group (40%) had a significantly poorer fusion rate than the lumbolumbar group (97%) did. Surgical outcomes of 2-level PLIF were satisfactory. The fusion rate at both levels was 85%. All nonunion was observed at the caudal level and concentrated at L5-S level in L4-5-S PLIF. Copyright © 2018 Elsevier Inc. All rights reserved.

  8. Evaluation of a polyetheretherketone (PEEK) titanium composite interbody spacer in an ovine lumbar interbody fusion model: biomechanical, microcomputed tomographic, and histologic analyses.

    Science.gov (United States)

    McGilvray, Kirk C; Waldorff, Erik I; Easley, Jeremiah; Seim, Howard B; Zhang, Nianli; Linovitz, Raymond J; Ryaby, James T; Puttlitz, Christian M

    2017-12-01

    The most commonly used materials used for interbody cages are titanium metal and polymer polyetheretherketone (PEEK). Both of these materials have demonstrated good biocompatibility. A major disadvantage associated with solid titanium cages is their radiopacity, limiting the postoperative monitoring of spinal fusion via standard imaging modalities. However, PEEK is radiolucent, allowing for a temporal assessment of the fusion mass by clinicians. On the other hand, PEEK is hydrophobic, which can limit bony ingrowth. Although both PEEK and titanium have demonstrated clinical success in obtaining a solid spinal fusion, innovations are being developed to improve fusion rates and to create stronger constructs using hybrid additive manufacturing approaches by incorporating both materials into a single interbody device. The purpose of this study was to examine the interbody fusion characteristic of a PEEK Titanium Composite (PTC) cage for use in lumbar fusion. Thirty-four mature female sheep underwent two-level (L 2 -L 3 and L 4 -L 5 ) interbody fusion using either a PEEK or a PTC cage (one of each per animal). Animals were sacrificed at 0, 8, 12, and 18 weeks post surgery. Post sacrifice, each surgically treated functional spinal unit underwent non-destructive kinematic testing, microcomputed tomography scanning, and histomorphometric analyses. Relative to the standard PEEK cages, the PTC constructs demonstrated significant reductions in ranges of motion and a significant increase in stiffness. These biomechanical findings were reinforced by the presence of significantly more bone at the fusion site as well as ingrowth into the porous end plates. Overall, the results indicate that PTC interbody devices could potentially lead to a more robust intervertebral fusion relative to a standard PEEK device in a clinical setting. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  9. Symptomatic Adjacent Segment Pathology after Posterior Lumbar Interbody Fusion for Adult Low-Grade Isthmic Spondylolisthesis

    OpenAIRE

    Sakaura, Hironobu; Yamashita, Tomoya; Miwa, Toshitada; Ohzono, Kenji; Ohwada, Tetsuo

    2013-01-01

    The incidence of symptomatic adjacent segment pathology (ASP) after fusion surgery for adult low-grade isthmic spondylolisthesis (IS) has been reported to be relatively low compared with other lumbar disease entities. However, there has been no study of symptomatic ASP incidence using posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation. We investigated the incidence of symptomatic ASP after PLIF with pedicle screw instrumentation for adult low-grade IS and identified s...

  10. Outcome in the treatment of discopathy by interbody fusion with the posterior approach using metal cages.

    Science.gov (United States)

    Milecki, Marcin; Lukawski, Stanisław; Rapała, Kazimierz; Białecki, Jerzy

    2004-06-30

    Background. Discopathy most often occurs in persons from 20 to 50 years old, in the period of greatest physical and intellectual capacity, and thus poses a major social problem. The goal of our research was to evaluation the outcome of interbody fusion performed with metal cages. Material and methods. We operated 52 patients ranging in age from 29 to 60, who presented with prolapse of the nucleus pulposus (21 patients), instability (8 patients), lumbar stenosis (11 patients), and recurrent discopathy with spondylolisthesis (12 patients). Interbody fusion was performed on these patients from the posterior approach using metal implants. Results. Applying both subjective and radiological criteria, we obtained good outcome in 36 cases, satisfactory in 12 cases, and unsatisfactory in 4 cases. A follow-up at 4 years after surgery showed that the solution was effective in preventing lumbar stenosis and intervertebral instability. However, there were still difficulties in the assessment of bone union. Conclusions. Maintaining or expanding the height of the interbody space by using implants is indicated by radiography in our material to be the most important surgical intervention justifying the use of this method. Interbody fusion in discopathy using metal implants is a logical solution to prevent secondary stenosis of the vertebral canal and intervertebral instability. The outcomes obtained at 4-year follow-up should be regarded as satisfactory.

  11. Comparison Between Posterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Lan, Tao; Hu, Shi-Yu; Zhang, Yuan-Tao; Zheng, Yu-Chen; Zhang, Rui; Shen, Zhe; Yang, Xin-Jian

    2018-04-01

    To compare the efficacy and safety in the management of lumbar diseases performed by either posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). Interbody fusion is considered the "gold standard" in the treatment of lumbar degenerative diseases. Both PLIF and TLIF have been advocated, and it remains controversial as to the best operative technique. The electronic databases including Embase, PubMed, and Cochrane library were searched to identify relevant studies up to September 2017. The primary outcomes were fusion rate, complications, and clinical satisfaction. The secondary outcomes were length of hospitalization, operation time, blood loss, postoperative visual analog scale, Oswestry Disability Index, and Japanese Orthopaedic Association Score. Data analysis was conducted with RevMan 5.3 software. A total of 16 studies involving 1502 patients (805 patients in PLIF group and 697 in TLIF group) were included in the meta-analysis. The pooled analysis showed that there was no significant difference in terms of fusion rate (P > 0.05) and clinical satisfaction (P > 0.05) between the 2 groups. TLIF was superior to PLIF with significantly lower incidence of nerve root injury (P 0.05) and graft malposition (P > 0.05). PLIF required significant longer operation time (P degenerative lumbar diseases. However, TLIF was superior to PLIF with shorter operation time, less blood loss, and lower incidence of nerve root injury and dural tear. There is no significant difference between both groups regarding wound infection and graft malposition. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Stand-alone photovoltaic applications. Lessons learned

    International Nuclear Information System (INIS)

    Loois, G.; Van Hemert, B.

    1999-02-01

    The IEA Photovoltaic Power Systems Programme (PVPS) is one of the collaborative R and D agreements established within the IEA. The objective of Task III is to promote and facilitate the exchange of information and experiences in the field of PV Systems in Stand-alone and Island Applications (SAPV). The book focuses on the practical experiences gained, and does not aim to provide a complete manual on SAPV. When Task III started its activities in 1993, a collection of 50 'State of the art' projects was published in the book 'Examples of Stand-Alone Photovoltaic Systems'. This publication marked the base line for the work of the task. Now, in 1998, the showcases from each country demonstrate the lessons learned in five years of cooperation. The book consists of two parts. The first part contains eight chapters dealing with a specific aspect of stand-alone PV. The second part introduces 14 national showcase projects in a systematic presentation. Each chapter and showcase can be read independently from the rest of the book. Chapter 2, contributed by The Netherlands, analyses the market for stand-alone PV systems. It gives an overview of the 'traditional' application of stand-alone PV, which is the electrification of remote buildings and which has been addressed in depth in other publications. The focus is on the market niches of service applications that are also interesting for more densely populated areas, e.g. in industrialised countries. The United Kingdom illustrates the economic aspects in Chapter 3. Cost comparisons are made, but more important is the illustration of the non-financial considerations that make PV the preferred choice as a power source for many applications. Switzerland explores in Chapter 4 (financing aspects) different financing mechanisms, and financial policies used to overcome the initial cost barrier. Most of these approaches have been applied in developing countries rather than in the western world. Using various examples from all over the

  13. 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.

    Science.gov (United States)

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

    2018-03-01

    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. Sixty-six patients who underwent either TLIF or ALIPFS for L5-S1 IS at a single tertiary care center between 2009 and 2014. Quality of life outcome scores including the EuroQol-5 Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9). Sagittal balance 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 accrued over 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 PDQ, PHQ-9, and EQ-5D. Radiographic measurements included lumbar lordosis, segmental lordosis, pelvic tilt, pelvic incidence, height of disc, L-1 axis S-1 distance, 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 Mann-Whitney U tests for parametric and nonparametric variables, respectively. The minimally clinical important difference (MCID) used for each questionnaire was as follows: PDQ (26), PHQ-9 (5), and EQ-5D (0.4). A total of 66 patients met inclusion criteria. In the ALIFPS cohort, PDQ scores

  14. Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature.

    Science.gov (United States)

    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. Rate of graft bone filling by transforaminal lumber interbody fusion (TLIF) with mesh cages

    International Nuclear Information System (INIS)

    Miura, Kazuto; Kawaji, Youichi; Matsuba, Atsushi; Kouda, Hisao

    2007-01-01

    Compared to posterior lumber interbody fusion (PLIF), the transforaminal lumber interbody fusion (TLIF) procedure has a latent disadvantage in terms of bone grafting because of being a unilateral approach. We calculated the rate of graft bone filling in TLIF cases by postoperative CT and evaluated the clinical results. The rate of filling in the TLIF cases was not significantly less than in the PLIF cases. The results also showed no significant difference between TLIF and PLIF. An adequate amount of bone were grafted into the intervertebral space even by the unilateral TLIF approach, however the procedure is not easy. An incidental dural tear occurred in 1 case each treated by TLIF and PLIF. The exposure of the dural tube increases the risk of epidural bleeding and neural tissue injury. We recommend TLIF for discopathy, foraminal stenosis, and repeat surgery to avoid latent risk. (author)

  16. EFFICACY OF PLATELET-RICH PLASMA IN EXPERIMENTAL INSTRUMENTED INTERBODY SPINAL FUSION

    Directory of Open Access Journals (Sweden)

    Gianfilippo Caggiari

    2016-04-01

    Full Text Available Introduction. This study aimed to analyze the influence of Platelet-Rich Plasma (PRP on bone growth in experimental instrumented interbody spinal fusion (IISF. Methods. 16 adult sheep underwent IISF at L3–L4 level using a cylindrical threaded expanding titanium cage with morselized iliac crest cancellous autograft. In 8 animals (Group I this was augmented with PRP, in the remaining 8 (Group II, it was not. Radiographs of the spine were taken preoperatively and at 1, 3, and 6 months, moreover autoptic vertebral samples were obtained and evaluated histologically and by CT scan at 8 months. Results. Histological analysis revealed more evident new bone formation with bony bridge into the cages in Group I than Group II. There were relevant differences between the groups with regard to interbody fusion calculated using trabecular bone score (p<0.05.

  17. Anterior lumbar inter-body fusion with instrumentation compared with posterolateral fusion for low grade isthmic-spondylolisthesis.

    Science.gov (United States)

    Chandra, Varun; Singh, Raj Kumar

    2016-03-01

    Spondylolisthesis presenting as low back pain is not an uncommon condition. Many of such patients are treated conservatively. For those that require surgical management, various treatment options are in vogue e.g. Postero-lateral fusion (PLF) with decompression or posterior fusion with instrumentation and anterior lumbar inter-body fusion (ALIF). Each technique has produced satisfactory outcome with benefits and disadvantages. To compare the outcome of surgical management of low grade spondylolisthesis with two treatments modalities--Postero-lateral fusion (PLF) and Anterior lumbar inter-body fusion (ALIF) with posterior instrumentation in similar patient profile. Prospective study to compare the results of two surgical treatment modalities. The selected group of patients for surgery based on definite criteria was operated by the same surgeon by two modalities: Postero-lateral fusion with decompression and Anterior Lumbar Inter-body fusion with posterior instrumentation. The outcomes were compared. Analysis of variance (ANOVA) test. Follow up was done at twelve weekly intervals up to 2 years. Both groups showed good recovery in pain as seen in Visual analogue scale (VAS) and Oswestry low back pain scoring. Intra-operative bleeding was observed to be higher in Postero-lateral fusion group. Average length of hospital stay for the patients of PLF group was 6.6 days (Range: 4-7 days) as compared to 12.5 days (Range: 10-16 days) in case of ALIF group. Treatment cost was found to be higher in patients who undergone ALIF with instrumentation. ALIF with posterior instrumentation in low grade isthmic spondylolisthesis provides satisfactory outcome in patients requiring surgical treatment. The results of pain relief and disability index are comparable to time tested posterolateral fusion. ALIF shows a tendency to faster pain relief and return to activity with less intraoperative blood requirement in low grade isthmic spondylolisthesis.

  18. Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis and degenerative spondylosis: 5-year results.

    Science.gov (United States)

    Park, Yung; Ha, Joong Won; Lee, Yun Tae; Sung, Na Young

    2014-06-01

    Multiple studies have reported favorable short-term results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion. However, to our knowledge, results at a minimum of 5 years have not been reported. We determined (1) changes to the Oswestry Disability Index, (2) frequency of radiographic fusion, (3) complications and reoperations, and (4) the learning curve associated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. We reviewed our first 124 patients who underwent minimally invasive transforaminal lumbar interbody fusion to treat low-grade spondylolisthesis and degenerative lumbar diseases and did not need a major deformity correction. This represented 63% (124 of 198) of the transforaminal lumbar interbody fusion procedures we performed for those indications during the study period (2003-2007). Eighty-three (67%) patients had complete 5-year followup. Plain radiographs and CT scans were evaluated by two reviewers. Trends of surgical time, blood loss, and hospital stay over time were examined by logarithmic curve fit-regression analysis to evaluate the learning curve. At 5 years, mean Oswestry Disability Index improved from 60 points preoperatively to 24 points and 79 of 83 patients (95%) had improvement of greater than 10 points. At 5 years, 67 of 83 (81%) achieved radiographic fusion, including 64 of 72 patients (89%) who had single-level surgery. Perioperative complications occurred in 11 of 124 patients (9%), and another surgical procedure was performed in eight of 124 patients (6.5%) involving the index level and seven of 124 patients (5.6%) at adjacent levels. There were slowly decreasing trends of surgical time and hospital stay only in single-level surgery and almost no change in intraoperative blood loss over time, suggesting a challenging learning curve. Oswestry Disability Index scores improved for patients with spondylolisthesis

  19. A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study with 2-year follow-up.

    Science.gov (United States)

    Chen, Yuqiao; Lü, Guohua; Wang, Bing; Li, Lei; Kuang, Lei

    2016-07-01

    To evaluate the clinical efficacy and radiological outcomes of anterior cervical discectomy and fusion (ACDF) using self-locking polyetheretherketone (PEEK) cages for treatment of three-level cervical degenerative spondylopathy. Twenty-eight patients underwent three-level ACDF using self-locking stand-alone PEEK cages (group A), and 26 patients underwent three-level ACDF using cages and plate fixation (group B) were reviewed retrospectively. Clinical efficacy was evaluated by pre- and post-operative Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI). The operation time, blood loss, surgical results according to Odom's criteria and post-operative dysphagia status were also recorded. Radiological outcomes including fusion, cervical Cobb's lordosis, fused segment angle, disc height, and cage subsidence were assessed. Clinical outcome measures such as dysphagia and fusion rate and the results of surgery evaluated according to Odom's criteria were not statistically significant (P > 0.05) between groups. The operation time was shorter and blood loss was less in group A (P  0.05). Post-operative cage subsidence, the loss of disc height, cervical lordosis and the fused segment angle were relatively higher in group A than group B (P < 0.05). ACDF using self-locking stand-alone cages showed similar clinical results as compared to ACDF using cages and plate fixation for the treatment of three-level cervical degenerative spondylopathy. However, potential long-term problems such as cage subsidence, loss of cervical lordosis and fused segment angle post-operatively were shown to be associated with patients who underwent ACDF using self-locking stand-alone cages.

  20. [Anterior interbody fusion of cervical spine with case-plate PCB].

    Science.gov (United States)

    Radek, M; Radek, A; Zapałowicz, K; Maciejczak, A

    2001-01-01

    Two cases with cervical discopathy and radiculopathy are presented. Discectomy and anterior interbody fusion with cage-plate PCB manufactured by French company Scient'x was performed. Authors present the shape of the implant and technical details of implantation. The paper discusses the advantages of the PCB which simplifies and shortens the operation procedure, minimizes the risk of traditional bone graft harvesting and provides immediate stabilization of the operated segment.

  1. [Treatment of degenerative lumbar spondylolisthesis by transforaminal lumbar interbody fusion with microendoscopic surgery].

    Science.gov (United States)

    Zhou, Wei; Li, Li-Jun; Tan, Jun

    2010-04-01

    To investigate the effect of treating degenerative lumbar spondylolisthesis by transforaminal lumbar interbody fusion with microendoscopic surgery. From Jan. 2006 to Jan. 2009, one hundred fifty patients who underwent transforaminal lumbar interbody fusion with microendoscopic surgery were analyzed retrospectively. The diagnosis was degenerative lumbar spondylolisthesis in 84 cases of grade I, and 66 cases of grade II. There were 88 males and 62 females. Preoperatively, at 1 week and 3 months postoperatively, the pain was evaluated with visual analogue scale (VAS) scoring system and therapeutic effect was observed with modified Prolo scoring system. In complications, dural tear happened in 3 cases, biological glues were used for dural tear sealing and neither cerebrospinal fluid leak was found. One case suffered from intervertebral Infection and muscle weakness of foot was found in one case, either was cured after symptomatic treatment. Operative time averaged 160 minutes (120-280 min). Estimated blood loss averaged 210 ml (100-450 ml). The postoperative follow-up ranged from 6 to 36 months (averaged 15.2 months). Preoperatively,at 1 week and 3 months postoperatively, VAS scores were respectively 7.9 +/- 2.1, 2.2 +/- 0.6, 3.2 +/- 1.1 (P surgery transforaminal lumbar interbody fusion technique is indicated for lumbar vertebral instability, localized intervertebral disc disorder and lumbar spondylolisthesis with stenotic nerve root or tube below grade II. This technique has advantages of minimal invasion and early functional recovery.

  2. Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations

    Directory of Open Access Journals (Sweden)

    Doniel Drazin

    2015-01-01

    Full Text Available Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes; p=0.009 and lower intraoperative blood loss: 108 mL (versus 93 mL; NS. Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS. There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

  3. Load-sharing through elastic micro-motion accelerates bone formation and interbody fusion.

    Science.gov (United States)

    Ledet, Eric H; Sanders, Glenn P; DiRisio, Darryl J; Glennon, Joseph C

    2018-02-13

    Achieving a successful spinal fusion requires the proper biological and biomechanical environment. Optimizing load-sharing in the interbody space can enhance bone formation. For anterior cervical discectomy and fusion (ACDF), loading and motion are largely dictated by the stiffness of the plate, which can facilitate a balance between stability and load-sharing. The advantages of load-sharing may be substantial for patients with comorbidities and in multilevel procedures where pseudarthrosis rates are significant. We aimed to evaluate the efficacy of a novel elastically deformable, continuously load-sharing anterior cervical spinal plate for promotion of bone formation and interbody fusion relative to a translationally dynamic plate. An in vivo animal model was used to evaluate the effects of an elastically deformable spinal plate on bone formation and spine fusion. Fourteen goats underwent an ACDF and received either a translationally dynamic or elastically deformable plate. Animals were followed up until 18 weeks and were evaluated by plain x-ray, computed tomography scan, and undecalcified histology to evaluate the rate and quality of bone formation and interbody fusion. Animals treated with the elastically deformable plate demonstrated statistically significantly superior early bone formation relative to the translationally dynamic plate. Trends in the data from 8 to 18 weeks postoperatively suggest that the elastically deformable implant enhanced bony bridging and fusion, but these enhancements were not statistically significant. Load-sharing through elastic micro-motion accelerates bone formation in the challenging goat ACDF model. The elastically deformable implant used in this study may promote early bony bridging and increased rates of fusion, but future studies will be necessary to comprehensively characterize the advantages of load-sharing through micro-motion. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Anterior lumbar interbody fusion with integrated fixation and adjunctive posterior stabilization: A comparative biomechanical analysis.

    Science.gov (United States)

    Yeager, Matthew S; Dupre, Derrick A; Cook, Daniel J; Oh, Michael Y; Altman, Daniel T; Cheng, Boyle C

    2015-10-01

    Interbody fusion cages with integrated fixation components have become of interest due to their ability to provide enhanced post-operative stability and mitigate device migration. A recently approved anterior lumbar interbody fusion cage with integrated fixation anchors has yet to be compared in vitro to a standard polyetheretherketone cage when used in combination with an interspinous process clamp. Twelve human cadaveric lumbar segments were implanted at L4-L5 with a Solus interbody cage (n=6) or standard polyetheretherketone cage (n=6) following Intact testing and discectomy. Each cage was subsequently evaluated in all primary modes of loading after supplementation with the following posterior constructs: interspinous process clamp, bilateral transfacet screws, unilateral transfacet screw with contralateral pedicle screws, and bilateral pedicle screws. Range of motion results were normalized to Intact, and a two-way mixed analysis of variance was utilized to detect statistical differences. The Solus cage in combination with all posterior constructs provided significant fixation compared to Intact in all loading conditions. The polyetheretherketone cage also provided significant fixation when combined with all screw based treatments, however when used with the interspinous process clamp a significant reduction was not observed in lateral bending or axial torsion. Interbody cages with integrated fixation components enhance post-operative stability within the intervertebral space, thus affording clinicians the potential to utilize less invasive methods of posterior stabilization when seeking circumferential fusion. Interspinous process clamps, in particular, may reduce peri-operative and post-operative comorbidities compared to screw based constructs. Further study is necessary to corroborate their effectiveness in vivo. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. One-Level or Multilevel Interbody Fusion for Multilevel Lumbar Degenerative Diseases: A Prospective Randomized Control Study with a 4-Year Follow-Up.

    Science.gov (United States)

    Li, Tiefeng; Shi, Lei; Luo, Yibin; Chen, Deyu; Chen, Yu

    2018-02-01

    The treatment of multilevel lumbar degenerative disease (LDD) is complicated and challenging, and the optimal surgical strategy remains controversial. To compare the differences in clinical and radiologic outcomes and in complications after 1-level interbody fusion versus multilevel interbody fusion for the treatment of multilevel LDD. A total of 100 patients with multilevel LDD were randomized in a 1:1 ratio into the 1-level interbody fusion group or the multilevel interbody fusion group. Clinical and radiologic results and major complications in the 2 groups were analyzed. Clinical outcomes were assessed using the Visual Analog Scale for radicular and back pain, the Oswestry Disability Index, and the short-form 36 physical score. Clinical status was assessed by the Whitecloud classification. Radiologic evaluation included assessment of lumbar lordosis, pelvic incidence, and sacral slope. There were no significant differences in clinical and radiologic results between the 2 groups. Procedure duration and intraoperative blood loss were significantly greater in the multilevel interbody fusion group than in the 1-level interbody fusion group; the multilevel interbody fusion group also had greater incidences of temporary nerve root palsy, wound infection, and adjacent segment disease. A hybrid technique including 1-level interbody fusion and multilevel posterolateral fusion is recommended for patients with multilevel LDD. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion.

    Science.gov (United States)

    Corniola, Marco V; Jägersberg, Max; Stienen, Martin N; Gautschi, Oliver P

    2015-03-01

    A variety of implant-related short and long-term complications after lumbar fusion surgery are recognized. Mid to long-term complications due to cage migration and/or cage subsidence are less frequently reported. Here, we report a patient with a complete cage migration into the superior adjacent vertebral body almost 20 years after the initial posterior lumbar interbody fusion procedure. In this patient, the cage migration/subsidence was clinically silent, but a selective decompression for adjacent segment degenerative lumbar spinal stenosis was performed. We discuss the risk factors for cage migration/subsidence in view of the current literature. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Perspective on Current Evidence and Clinical Knowledge

    Directory of Open Access Journals (Sweden)

    Ali Habib

    2012-01-01

    Full Text Available This paper reviews the current published data regarding open transforaminal lumbar interbody fusion (TLIF in relation to minimally invasive transforaminal lumbar interbody fusion (MI-TLIF. Introduction. MI-TLIF, a modern method for lumbar interbody arthrodesis, has allowed for a minimally invasive method to treat degenerative spinal pathologies. Currently, there is limited literature that compares TLIF directly to MI-TLIF. Thus, we seek to discuss the current literature on these techniques. Methods. Using a PubMed search, we reviewed recent publications of open and MI-TLIF, dating from 2002 to 2012. We discussed these studies and their findings in this paper, focusing on patient-reported outcomes as well as complications. Results. Data found in 14 articles of the literature was analyzed. Using these reports, we found mean follow-up was 20 months. The mean patient study size was 52. Seven of the articles directly compared outcomes of open TLIF with MI-TLIF, such as mean duration of surgery, length of post-operative stay, blood loss, and complications. Conclusion. Although high-class data comparing these two techniques is lacking, the current evidence supports MI-TLIF with outcomes comparable to that of the traditional, open technique. Further prospective, randomized studies will help to further our understanding of this minimally invasive technique.

  8. Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Perspective on Current Evidence and Clinical Knowledge

    Science.gov (United States)

    Habib, Ali; Smith, Zachary A.; Lawton, Cort D.; Fessler, Richard G.

    2012-01-01

    This paper reviews the current published data regarding open transforaminal lumbar interbody fusion (TLIF) in relation to minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Introduction. MI-TLIF, a modern method for lumbar interbody arthrodesis, has allowed for a minimally invasive method to treat degenerative spinal pathologies. Currently, there is limited literature that compares TLIF directly to MI-TLIF. Thus, we seek to discuss the current literature on these techniques. Methods. Using a PubMed search, we reviewed recent publications of open and MI-TLIF, dating from 2002 to 2012. We discussed these studies and their findings in this paper, focusing on patient-reported outcomes as well as complications. Results. Data found in 14 articles of the literature was analyzed. Using these reports, we found mean follow-up was 20 months. The mean patient study size was 52. Seven of the articles directly compared outcomes of open TLIF with MI-TLIF, such as mean duration of surgery, length of post-operative stay, blood loss, and complications. Conclusion. Although high-class data comparing these two techniques is lacking, the current evidence supports MI-TLIF with outcomes comparable to that of the traditional, open technique. Further prospective, randomized studies will help to further our understanding of this minimally invasive technique. PMID:22928099

  9. Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis.

    Science.gov (United States)

    Abulizi, Yakefu; Liang, Wei-Dong; Muheremu, Aikeremujiang; Maimaiti, Maierdan; Sheng, Wei-Bin

    2017-07-14

    Spinal brucellosis is a less commonly reported infectious spinal pathology. There are few reports regarding the surgical treatment of spinal brucellosis in existing literature. This retrospective study was conducted to determine the effectiveness of single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral spinal brucellosis. From February 2012 to April 2015, 32 consecutive patients (19 males and 13 females, mean age 53.7 ± 8.7) with lumbosacral brucellosis treated by transforaminal decompression, debridement, interbody fusion, and posterior instrumentation were enrolled. Medical records, imaging studies, laboratory data were collected and summarized. Surgical outcomes were evaluated based on visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scale. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms and complications were investigated. Graft fusion was evaluated using Bridwell grading criteria. The mean follow-up period was 24.9 ± 8.2 months. Back pain and radiating leg pain was relieved significantly in all patients after operation. No implant failures were observed in any patients. Wound infection was observed in two patients and sinus formation was observed in one patient. Solid bony fusion was achieved in 30 patients and the fusion rate was 93.8%. The levels of ESR and CRP were returned to normal by the end of three months' follow-up. VAS and ODI scores were significantly improved (P brucellosis.

  10. Pyogenic lumbar spondylodiscitis treated with transforaminal lumbar interbody fusion: safety and outcomes.

    Science.gov (United States)

    Shetty, Ajoy Prasad; Aiyer, Siddharth N; Kanna, Rishi Mugesh; Maheswaran, Anupama; Rajasekaran, Shanmuganathan

    2016-06-01

    Our aim was to study the safety and outcomes of posterior instrumentation and transforaminal lumbar interbody fusion (TLIF) for treating pyogenic lumbar spondylodiscitis. Retrospective analysis was performed on prospectively collected data of 27 consecutive cases of lumbar pyogenic spondylodiscitis treated with posterior instrumentation and TLIF between January 2009 and December 2012. Cases were analysed for safety, radiological and clinical outcomes of transforaminal interbody fusion using bone graft ± titanium cages. Interbody metallic cages with bone graft were used in 17 cases and ten cases used only bone graft. Indications for surgical treatment were failed conservative management in 17, neurodeficit in six and significant bony destruction in four. There were no cases reporting cage migration, loosening, pseudoarthrosis or recurrence of infection at a mean follow-up of 30 months. Clinical outcomes were assessed using Kirkaldy-Willis criteria, which showed 14 excellent, nine good, three fair and one poor result. Mean focal deformity improved with the use of bone graft ± interbody cages, and the deformity correction was maintained at final follow-up. Mean pre-operative focal lordosis for the graft group was 8.5° (2-16.5°), which improved to 10.9 °(3.3-16°); mean pre-operative focal lordosis in the group treated with cages was 6.7 °(0-15°), which improved to 7°(0-15°) . TLIFs with cages in patients with pyogenic lumbar spondylodiscitis allows for acceptable clearance of infection, satisfactory deformity correction with low incidence of cage migration, loosening and infection recurrence.

  11. Subsidence of polyetheretherketone intervertebral cages in minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion.

    Science.gov (United States)

    Le, Tien V; Baaj, Ali A; Dakwar, Elias; Burkett, Clinton J; Murray, Gisela; Smith, Donald A; Uribe, Juan S

    2012-06-15

    A retrospective review. The objective is to evaluate subsidence related to minimally invasive lateral retroperitoneal lumbar interbody fusion by reviewing our experience with this procedure. Polyetheretherketone intervertebral cages of different lengths, widths, and heights filled with various allograft types are commonly used as spacers in lumbar fusions. Subsidence is a potential complication. To date, there are no published reports specifically addressing subsidence, because it relates to a series of patients undergoing minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion. An institutional review board-approved, retrospective review of a prospectively collected database was conducted. One hundred forty consecutive patients who underwent this procedure between L1 and L5 during a 2-year period were included. All patients had T scores of -2.5 or more. Postoperative radiographs during routine follow-ups were reviewed for subsidence, defined as any violation of the vertebral end plate. Radiographical subsidence occurred in 14.3% (20 of 140), whereas clinical subsidence occurred in 2.1%. Subsidence occurred in 8.8% (21 of 238) of levels fused. Construct length had a significant positive correlation with increasing subsidence rates. Subsidence rates decreased progressively with lower levels in the lumbar spine, but had a higher than expected rate at L4-L5. Subsidence rates of 14.1% (19 of 135) and 1.9% (2 of 103) were associated with 18-and 22-mm-wide cages, respectively. No significant trends were observed with cage lengths. Supplemental lateral plates had a higher rate of subsidence than bilateral pedicle screws. Subsidence occurred at the superior end plate 70% of the time. The use of wider intervertebral cages leads to a significantly lower rate of subsidence, but a longer cage does not necessarily offer a similar advantage. Wide cages are protective against subsidence, and the widest cages should be used whenever feasible for interbody

  12. Clinical outcome of stand-alone ALIF compared to posterior instrumentation for degenerative disc disease

    DEFF Research Database (Denmark)

    Udby, Peter M.; Bech-Azeddine, Rachid

    2015-01-01

    low back pain resulting from degenerative disc disease. ALIF surgery has previously been linked with certain high risk complications and unfavorable long term fusion results. Newer studies suggest that stand-alone ALIF can possibly be advantageous compared to other types of posterior instrumented...

  13. Vertebroplasty for adjacent vertebral fracture following lumbar interbody fusion.

    Science.gov (United States)

    Ahn, Yong; Lee, Sang-Ho

    2011-02-01

    Adjacent segment vertebral compression fracture after lumbosacral instrumented fusion has been reported to be a significant complication. Recently, percutaneous vertebroplasty (PVP) has been widely used for the treatment of non-traumatic osteoporotic vertebral fracture. However, the clinical effect of this minimally invasive treatment option to the post-fusion vertebral fracture has rarely been reported. We analysed characteristics of adjacent vertebral fractures following lumbar fusion and evaluated the clinical outcome of PVP. A total of 202 consecutive patients underwent PVP for compression fracture in our institute between January 2007 and December 2008. Among them, nine symptomatic adjacent vertebral fractures following lumbar fusion were identified. We randomly selected 50 control patients undergoing vertebroplasty for osteoporotic compression fracture in single level. We analysed the clinical data according to age, height, body weight, body mass index (BMI), and bone mineral density (BMD). Clinical outcome was assessed by a visual analogue scale (VAS) score and the rate of overall satisfaction. Fractures occurred at the cranial adjacent vertebra after fusion surgery in all cases. The mean BMD score for the spine and femur were significantly higher than the control group (p adjacent segment disease. The increased stress around the fusion segment can cause vertebral fracture even with a relatively higher BMD score. Vertebroplasty for the post-fusion vertebral fracture can be as effective as it is for the usual osteoporotic vertebral fracture.

  14. Combined posteroanterior fusion versus transforaminal lumbar interbody fusion (TLIF) in thoracolumbar burst fractures.

    Science.gov (United States)

    Schmid, Rene; Lindtner, Richard Andreas; Lill, Markus; Blauth, Michael; Krappinger, Dietmar; Kammerlander, Christian

    2012-04-01

    The optimal treatment strategy for burst fractures of the thoracolumbar junction is discussed controversially in the literature. Whilst 360° fusion has shown to result in better radiological outcome, recent studies have failed to show its superiority concerning clinical outcome. The morbidity associated with the additional anterior approach may account for these findings. The aim of this prospective observational study was therefore to compare two different techniques for 360° fusion in thoracolumbar burst fractures using either thoracoscopy or a transforaminal approach (transforaminal lumbar interbody fusion (TLIF)) to support the anterior column. Posterior reduction and short-segmental fixation using angular stable pedicle screw systems were performed in all patients as a first step. Monocortical strut grafts were used for the anterior support in the TLIF group, whilst tricortical grafts or titanium vertebral body replacing implants of adjustable height were used in the combined posteroanterior group. At final follow-up, the radiological outcome was assessed by performing X-rays in a standing position. The clinical outcome was measured using five validated outcome scores. The morbidity associated with the approaches and the donor site was assessed as well. There were 21 patients in the TLIF group and 14 patients in the posteroanterior group included. The postoperative loss of correction was higher in the TLIF group (4.9°±8.3° versus 3.4°±6.4°, p>0.05). There were no significant differences regarding the outcome scores between the two groups. There were no differences in terms of return to employment, leisure activities and back function either. More patients suffered from donor-site morbidity in the TLIF group, whilst the morbidity associated with the surgical approach was higher in the posteroanterior group. The smaller donor-site morbidity in the posteroanterior group is counterbalanced by an additional morbidity associated with the anterior approach

  15. Subsidence as of 12 months after single-level anterior cervical inter-body fusion. Is it related to clinical outcomes?

    Science.gov (United States)

    Lee, Chang-Hyun; Kim, Ki-Jeong; Hyun, Seung-Jae; Yeom, Jin S; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2015-06-01

    Subsidence is a frequent phenomenon in the interbody fusion process in patients with anterior cervical discectomy and fusion (ACDF). There is little evidence of whether subsidence in the cervical spine has any impact on clinical outcomes. The purpose of this study is to investigate the correlation of subsidence and clinical outcomes after ACDF and to consider reasons subsidence might not cause unfavorable clinical outcomes. A total of 158 consecutive patients who underwent single-level ACDF were included. The patients were divided into a subsidence group (S-group) and a no subsidence group (N-group), with subsidence defined as a decrease by ≥3 mm in total intervertebral height (TIH). We analyzed outcomes resulting from subsidence, particularly focusing on clinical outcomes and subsequent global and segmental kyphosis using a repeated measure analysis of variance (RM-ANOVA). Subsidence occurred in 74 patients (46.8%) as of a 12-month follow-up. The S-group included 58.6% with a stand-alone cage for interbody fusion (p = 0.002). Clinical outcomes improved significantly over time (neck pain, RM-ANOVA: F(1.3, 205) = 125.1, p subsidence and clinical outcomes between the S- and N-group (neck pain, RM-ANOVA: F(2,153) = 1.04, p = 0.356, partial η(2) = 0.229; arm pain, RM-ANOVA: F(2,153) = 0.56, p = 0.571, partial η(2) = 0.142). Segmental angle increased in both groups over time and showed a statistically significant difference between the S- and N-groups (RM-ANOVA: F(3,143) = 6.148, p = 0.001, partial η(2) = 0.959). Although, global cervical angle decreased generally and displayed no statically significant difference between the S- and N-group (RM-ANOVA: F(3,119) = 2.361, p = 0.075, partial η(2) = 0.056). Radiographic subsidence after ACDF occurred in 46.8% patients as of 12 months after the single-level ACDF. The lack of correlation between bad clinical outcome and radiographic subsidence may be due to

  16. 39 CFR 122.2 - Stand-alone special services.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Stand-alone special services. 122.2 Section 122.2 Postal Service UNITED STATES POSTAL SERVICE POST OFFICE SERVICES [DOMESTIC MAIL] SERVICE STANDARDS FOR MARKET-DOMINANT SPECIAL SERVICES PRODUCTS § 122.2 Stand-alone special services. (a) The service standard...

  17. Ampere hour method of sizing a stand alone photovoltaic system ...

    African Journals Online (AJOL)

    Stand-alone photovoltaic power systems are natural options for application in electrification of remote areas which are not served by the grid electricity supply system. An ampere-hour method of sizing a stand-alone PV system for application in any remote location has been presented. The design which is for both ac and dc ...

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

    Science.gov (United States)

    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 degenerative lumbar disease, and the short-term clinical outcome is satisfactory

  19. Investigation of different cage designs and mechano-regulation algorithms in the lumbar interbody fusion process - a finite element analysis.

    Science.gov (United States)

    Postigo, Sergio; Schmidt, Hendrik; Rohlmann, Antonius; Putzier, Michael; Simón, Antonio; Duda, Georg; Checa, Sara

    2014-04-11

    Lumbar interbody fusion cages are commonly used to treat painful spinal degeneration and instability by achieving bony fusion. Many different cage designs exist, however the effect of cage morphology and material properties on the fusion process remains largely unknown. This finite element model study aims to investigate the influence of different cage designs on bone fusion using two mechano-regulation algorithms of tissue formation. It could be observed that different cages play a distinct key role in the mechanical conditions within the fusion region and therefore regulate the time course of the fusion process. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Axial lumbar interbody fusion: a 6-year single-center experience

    Directory of Open Access Journals (Sweden)

    Zeilstra DJ

    2013-08-01

    Full Text Available Dick J Zeilstra,1 Larry E Miller,2,3 Jon E Block3 1Bergman Clinics, Naarden and NedSpine, Ede, The Netherlands; 2Miller Scientific Consulting, Inc, Arden, NC, USA; 3The Jon Block Group, San Francisco, CA, USA Introduction: The aim of this study is to report our 6-year single-center experience with L5–S1 axial lumbar interbody fusion (AxiaLIF. Methods: A total of 131 patients with symptomatic degenerative disc disease refractory to nonsurgical treatment were treated with AxiaLIF at L5–S1, and were followed for a minimum of 1 year (mean: 21 months. Main outcomes included back and leg pain severity, Oswestry Disability Index score, working status, analgesic medication use, patient satisfaction, and complications. Computed tomography was used to determine postoperative fusion status. Results: No intraoperative complications, including vascular, neural, urologic, or bowel injuries, were reported. Back and leg pain severity decreased by 51% and 42%, respectively, during the follow-up period (both P < 0.001. Back function scores improved 50% compared to baseline. Clinical success, defined as improvement ≥30%, was 67% for back pain severity, 65% for leg pain severity, and 71% for back function. The employment rate increased from 47% before surgery to 64% at final follow-up (P < 0.001. Less than one in four patients regularly used analgesic medications postsurgery. Patient satisfaction with the AxiaLIF procedure was 83%. The fusion rate was 87.8% at final follow-up. During follow-up, 17 (13.0% patients underwent 18 reoperations on the lumbar spine, including pedicle screw fixation (n = 10, total disc replacement of an uninvolved level (n = 3, facet screw fixation (n = 3, facet screw removal (n = 1, and interbody fusion at L4–L5 (n = 1. Eight (6.1% reoperations were at the index level. Conclusion: Single-level AxiaLIF is a safe and effective means to achieve lumbosacral fusion in patients with symptomatic degenerative disc disease. Keywords: Axia

  1. AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion

    Directory of Open Access Journals (Sweden)

    Rapp SM

    2011-08-01

    Full Text Available Steven M Rapp1, Larry E Miller2,3, Jon E Block31Michigan Spine Institute, Waterford, MI, USA; 2Miller Scientific Consulting Inc, Biltmore Lake, NC, USA; 3Jon E. Block, Ph.D., Inc., San Francisco, CA, USAAbstract: Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF system is a minimally invasive fusion device that accesses the lumbar (L4–S1 intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date.Keywords: AxiaLIF, fusion, lumbar, minimally invasive, presacral

  2. Clinical Outcomes of Extreme Lateral Interbody Fusion in the Treatment of Adult Degenerative Scoliosis

    Directory of Open Access Journals (Sweden)

    Adam M. Caputo

    2012-01-01

    Full Text Available Introduction. The use of extreme lateral interbody fusion (XLIF and other lateral access surgery is rapidly increasing in popularity. However, limited data is available regarding its use in scoliosis surgery. The objective of this study was to evaluate the clinical outcomes of adults with degenerative lumbar scoliosis treated with XLIF. Methods. Thirty consecutive patients with adult degenerative scoliosis treated by a single surgeon at a major academic institution were followed for an average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Validated clinical outcome scores were obtained on patients preoperatively and at most recent follow-up. Complications were recorded. Results. The study group demonstrated improvement in multiple clinical outcome scores. Oswestry Disability Index scores improved from 24.8 to 19.0 (P < 0.001. Short Form-12 scores improved, although the change was not significant. Visual analog scores for back pain decreased from 6.8 to 4.6 (P < 0.001 while scores for leg pain decreased from 5.4 to 2.8 (P < 0.001. A total of six minor complications (20% were recorded, and two patients (6.7% required additional surgery. Conclusions. Based on the significant improvement in validated clinical outcome scores, XLIF is effective in the treatment of adult degenerative scoliosis.

  3. Clinical and radiological outcomes after stand-alone ALIF for single L5-S1 degenerative discopathy using a PEEK cage filled with hydroxyapatite nanoparticles without bone graft.

    Science.gov (United States)

    Norotte, Gilles; Barrios, Carlos

    2018-05-01

    Recent improvements in cage designs with integral fixation and screw attachments have made stand-alone ALIF a viable option with several possible advantages. The aim of this study was to confirm the efficacy and safety of a PEEK cage filled with hydroxyapatite nanoparticles without adding a bone graft for stand-alone ALIF in the treatment of L5-S1 isolated degenerative disc discopathy (DDD). Sixty-five patients who required surgery for DDD were evaluated. Clinical outcome evaluations included back and leg pain (VAS), disability (Oswestry Disability Index), and patient satisfaction (Macnab's criteria). Radiological outcomes include the assessment of disc height, the L5-S1 intervertebral disc angle, and anterior intervertebral fusion through standard and functional sagittal X-rays of the lumbar spine. Clinical and radiological measurements were assessed 2, 6, 12, and 24 months after surgery. Clinical outcomes improved progressively and stabilized from 12- to 24-month follow-up. Final postoperative ODI scores showed a notable improvement (95%CI = 36.1-48.9 points; p < .001). Similarly, 24-month postoperative VAS scores revealed a significant decrease in pain (95%CI = 5.4-6.2; p < .001). The fusion rate was 95.4%. Anterior disc height was restored from 4.1 ± 3.2 mm at baseline to 9.5 ± 1.6 mm in the immediate postoperative period (p < .001). A small collapse (17.9%) of the disc height was detected from the 2- and 24-month follow-ups. Cage subsidence (more than 3 mm collapse) was detected in 4 cases (6.2%) and was related to cage size (more than 11 mm height; P < .05). There were no serious bone substitute-related adverse events and no revision surgeries. Stand-alone anterior lumbar interbody fusion using hydroxyapatite nanoparticles without an autologous bone graft is an effective and safe treatment option for L5-S1 degenerative pathology. Clinical outcomes were very satisfactory with a high fusion rate. Copyright © 2018

  4. Biomechanical Evaluation of a Novel Apatite-Wollastonite Ceramic Cage Design for Lumbar Interbody Fusion: A Finite Element Model Study.

    Science.gov (United States)

    Bozkurt, Celal; Şenköylü, Alpaslan; Aktaş, Erdem; Sarıkaya, Baran; Sipahioğlu, Serkan; Gürbüz, Rıza; Timuçin, Muharrem

    2018-01-01

    Cage design and material properties play a crucial role in the long-term results, since interbody fusions using intervertebral cages have become one of the basic procedures in spinal surgery. Our aim is to design a novel Apatite-Wollastonite interbody fusion cage and evaluate its biomechanical behavior in silico in a segmental spinal model. Mechanical properties for the Apatite-Wollastonite bioceramic cages were obtained by fitting finite element results to the experimental compression behavior of a cage prototype. The prototype was made from hydroxyapatite, pseudowollastonite, and frit by sintering. The elastic modulus of the material was found to be 32 GPa. Three intact lumbar vertebral segments were modelled with the ANSYS 12.0.1 software and this model was modified to simulate a Posterior Lumbar Interbody Fusion. Four cage designs in different geometries were analyzed in silico under axial loading, flexion, extension, and lateral bending. The K2 design had the best overall biomechanical performance for the loads considered. Maximum cage stress recorded was 36.7 MPa in compression after a flexion load, which was within the biomechanical limits of the cage. Biomechanical analyses suggest that K2 bioceramic cage is an optimal design and reveals essential material properties for a stable interbody fusion.

  5. Primary investigation of clinical application of percutaneous posterior lumbar interbody fusion

    International Nuclear Information System (INIS)

    Guo Jiang; Jiao Wencang; Chen Xiangrong; Li Xiaoyu

    2009-01-01

    Objective: To characterize the feasibility, key technology, indications and clinical outcome of percutaneous lumbar interbody fusion. Methods: Clinical data from 32 cases [16 male, 16 female, age range 31-77 years, average disease duration (5.0±2.0) years] underwent percutaneous nucleotomy and endplate curettage was retrospectively analyzed. After percutaneous nucleotomy and endplate curettage, one expandable spinal spacer B-twin was introduced into the intervertebral space and some allograft cancellous bone implanted around the B-twin. Indications for treatment included degenerative lumbar disc herniation (LDH) with intervertebral distability or I degree spondylolisthesis (21 cases), LDH with intervertebral space collapse (10 cases) and lumbar discogenic pain (1 case). The symptoms and function of all patients were evaluated before, 3 months and 12 months after the operation by clinical outcome judgment criterion of surgical treatment for low back pain formulated by JOA, and the rate of clinical improvement and treatment efficacy were calculated. The JOA scales preoperatively, postoperatively and on the final follow-up was compared using ANOVA in SPSS. The changes before and after surgery with the JOA score and the the rate of clinical improvement between 3 months and 12 months after the operation was also compared using χ 2 test. Results: The average operation time 1 hour and blood loss 0.05). Conclusions: Percutaneous posterior lumbar interbody fusion with B-twin expandable fusion cage could lead to satisfactory outcome in the treatment of degenerative disc disease and intervertebral instability, which minimize surgical soft tissue and trauma spinal damage, does not destroy the structure of spinal stability. The long-term outcome, complications and fusion rate need further observing. (authors)

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

    Science.gov (United States)

    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.

  7. Posterior lumbar interbody fusion for aged patients with degenerative spondylolisthesis: is intentional surgical reduction essential?

    Science.gov (United States)

    Lian, Xiao-Feng; Hou, Tie-Sheng; Xu, Jian-Guang; Zeng, Bing-Fang; Zhao, Jie; Liu, Xiao-Kang; Zhao, Cheng; Li, Hao

    2013-10-01

    Surgical reduction and posterior lumbar interbody fusion (PLIF) is commonly used to recover segmental imbalance in degenerative spondylolisthesis. However, whether intentional reduction of the slipped vertebra during PLIF is essential in aged patients with degenerative spondylolisthesis remains controversial. We compared the outcomes of surgical reduction and fusion in situ among aged patients who underwent PLIF for degenerative spondylolisthesis. A prospective randomized clinical trial on the surgical treatment of degenerative spondylolisthesis patients aged older than 70 years. Between January 2006 and December 2009, 73 patients aged 70 years or older with single-level degenerative spondylolisthesis requiring surgical treatment were included in this study. Clinical outcomes were assessed using the visual analog scale, Oswestry Disability Index, and Japanese Orthopedic Association scores. Radiographic outcomes included percentage of vertebral slippage, focal lordosis, and disc height. The 73 patients were randomly assigned to two groups treated using surgical reduction (Group A, n=36) and fusion in situ (Group B, n=37). Both groups were followed up for an average of 33.2 months (range, 24-54 months). The clinical and radiographic outcomes were compared between the two groups. Surgical complications were similar in the two groups. The average operative time and blood loss during surgery did not insignificantly differ (p>.05) between the two groups. Spondylolisthesis, disc height, and focal lordosis were significantly improved postoperatively in both groups. There was no obvious difference in clinical outcomes, as assessed using the visual analog scale, Oswestry Disability Index, and Japanese Orthopedic Association scores, although the radiographic outcomes were considerably better in Group A than in Group B. Posterior lumbar interbody fusion with pedicle screws fixation, with or without intraoperative reduction, provides good outcomes in the surgical treatment of

  8. Basic Stand Alone Skilled Nursing Facility Beneficiary PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Skilled Nursing Facility (SNF) Beneficiary Public Use Files (PUF) with information from Medicare SNF claims. The...

  9. Basic Stand Alone Medicare Home Health Beneficiary PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Home Health Agency (HHA) Beneficiary Public Use Files (PUF) with information from Medicare HHA claims. The CMS BSA...

  10. Basic Stand Alone Medicare DME Line Items PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Durable Medical Equipment (DME) Line Items Public Use Files (PUF) with information from Medicare DME claims. The...

  11. Symptomatic adjacent segment pathology after posterior lumbar interbody fusion for adult low-grade isthmic spondylolisthesis.

    Science.gov (United States)

    Sakaura, Hironobu; Yamashita, Tomoya; Miwa, Toshitada; Ohzono, Kenji; Ohwada, Tetsuo

    2013-12-01

    The incidence of symptomatic adjacent segment pathology (ASP) after fusion surgery for adult low-grade isthmic spondylolisthesis (IS) has been reported to be relatively low compared with other lumbar disease entities. However, there has been no study of symptomatic ASP incidence using posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation. We investigated the incidence of symptomatic ASP after PLIF with pedicle screw instrumentation for adult low-grade IS and identified significant risk factors for symptomatic ASP. We retrospectively studied records of 40 consecutive patients who underwent PLIF with pedicle screw instrumentation at the Department of Orthopaedic Surgery, Kansai Rosai Hospital, Amagasaki, Japan. The patients were followed for ≥ 4 years. Patients' medical records were retrospectively examined for evidence of symptomatic ASP. Age at time of surgery, sex, fusion level, whole lumbar lordosis, segmental lordosis, preexisting laminar inclination angle, and facet tropism at the cranial fusion segment were analyzed to identify risk factors for symptomatic ASP. Four patients (ASP group) developed symptomatic ASP at the cranial segment adjacent to the fusion. There were no significant differences in age, sex, fusion level, lumbar lordosis, segmental lordosis, or facet tropism at the cranial segment adjacent to the fusion between the ASP and the non-ASP groups. In contrast, laminar inclination angle at the cranial vertebra adjacent to the fusion was significantly higher in the ASP group than in the non-ASP group. Four patients (10%) developed symptomatic ASP after PLIF with transpedicular fixation for adult low-grade IS. Preexisting laminar horizontalization at the cranial vertebra adjacent to the fusion was a significant risk factor for symptomatic ASP.

  12. Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study.

    Science.gov (United States)

    Sakaura, Hironobu; Miwa, Toshitada; Yamashita, Tomoya; Kuroda, Yusuke; Ohwada, Tetsuo

    2016-11-01

    OBJECTIVE Several biomechanical studies have demonstrated the favorable mechanical properties of the cortical bone trajectory (CBT) screw. However, no reports have examined surgical outcomes of posterior lumbar interbody fusion (PLIF) with CBT screw fixation for degenerative spondylolisthesis (DS) compared with those after PLIF using traditional pedicle screw (PS) fixation. The purposes of this study were thus to elucidate surgical outcomes after PLIF with CBT screw fixation for DS and to compare these results with those after PLIF using traditional PS fixation. METHODS Ninety-five consecutive patients underwent PLIF with CBT screw fixation for DS (CBT group; mean followup 35 months). A historical control group consisted of 82 consecutive patients who underwent PLIF with traditional PS fixation (PS group; mean follow-up 40 months). Clinical status was assessed using the Japanese Orthopaedic Association (JOA) scale score. Fusion status was assessed by dynamic plain radiographs and CT. The need for additional surgery and surgery-related complications was also evaluated. RESULTS The mean JOA score improved significantly from 13.7 points before surgery to 23.3 points at the latest follow-up in the CBT group (mean recovery rate 64.4%), compared with 14.4 points preoperatively to 22.7 points at final follow-up in the PS group (mean recovery rate 55.8%; p 0.05). Symptomatic adjacent-segment disease developed in 3 patients from the CBT group (3.2%) compared with 9 patients from the PS group (11.0%, p < 0.05). CONCLUSIONS PLIF with CBT screw fixation for DS provided comparable improvement of clinical symptoms with PLIF using traditional PS fixation. However, the successful fusion rate tended to be lower in the CBT group than in the PS group, although the difference was not statistically significant between the 2 groups.

  13. Minimally Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis: In Situ Versus Reduction.

    Science.gov (United States)

    Fan, Guoxin; Gu, Guangfei; Zhu, Yanjie; Guan, Xiaofei; Hu, Annan; Wu, Xinbo; Zhang, Hailong; He, Shisheng

    2016-06-01

    The study aimed to compare the clinical outcomes of reduction versus in situ fusion with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for isthmic spondylolisthesis. Demographic, preoperative, and postoperative data were collected from the medical records. Radiographic fusion was assessed by use of the grading criteria of Bridwell. Preoperative and postoperative patient-reported outcomes including visual analog scale, Oswestry Disability Index, Japanese Orthopedic Association scale and improvement rate were calculated. Patient satisfaction was assessed with the criteria of Macnab (excellent, good, fair, poor). There were 24 patients (11 male) in the reduction group and 21 patients (10 male) in the in situ fusion group. The average follow-up was 34.75 ± 8.06 months in reduction group and 31.05 ± 6.52 months in the in situ fusion group (P = 0.101). There were no significant differences in hospital stay, estimated blood loss, blood transfusion, operation time, fusion grading, and complications between the 2 groups (P > 0.05). Spinal fusion rate was 91.67% (22/24) in the reduction group and 85.71% (18/21) in the in situ group (P = 0.835). There were no significant differences in Japanese Orthopedic Association scale, visual analog scale, and Oswestry Disability Index score between the 2 groups whenever preoperatively, 3-month postoperatively, or at the last follow-up (P > 0.05). According to the criteria of Macnab, the rate of excellent and good was 83.33% in reduction group and 80.95% in the in situ group (P = 0.899). MIS-TLIF with reduction did not induce significantly better patient-reported outcomes, spinal fusion rate, perioperative outcomes, or fewer complications in isthmic spondylolisthesis. Intentional reduction may not be a requirement in MIS-TLIF for isthmic spondylolisthesis. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Outcomes of autograft alone versus PEEK+ autograft interbody fusion in the treatment of adult lumbar isthmic spondylolisthesis.

    Science.gov (United States)

    Wang, Gang; Han, Dunfu; Cao, Zhenglin; Guan, Honggang; Xuan, Tianhang

    2017-04-01

    Bone resulting from a complete resection of the posterior arch can be cut into an autograft bone that contains the facet joint structure and morselised bone for interbody fusion. However, whether a strut autograft that contains this trimmed facet joint can produce the same clinical and radiographic outcomes as a cage for interbody fusion remains unclear. The aim of this study was to compare the outcomes of a local facet joint autograft alone to those of polyetheretherketone (PEEK)+autograft for posterior lumbar interbody fusion (PLIF) in the treatment of adult isthmic spondylolisthesis. A retrospective analysis was performed on 84 patients with single lumbar isthmic spondylolisthesis who were treated with a local facet joint autograft alone (group A; n=44) or PEEK+autograft (group B; n=40) in PLIF with a minimum follow-up period of 24 months. Pain and disability were assessed using the visual analogue scale, Oswestry disability index and Kirkaldy-Willis criteria. In the radiological evaluation, disc height, slippage reduction, and fusion status were examined. Postoperative complications were also monitored. At the last follow-up examination, 84.1% (37/44) of the patients in group A and 82.5% (33/40) of the patients in group B had a good outcome, and there were no significant differences between the two groups. Boh Methods led to significant improvements in disc height, and while PEEK+autograft produced a smaller loss in disc height, the difference was insignificant. The improvements in slippage and the fusion and complication rates between the two groups were similar. There were no significant differences in the clinical outcomes or radiographic improvements of both fusion methods in the treatment of adult isthmic spondylolisthesis. An autograft excised from a complete posterior arch containing a facet joint for interbody fusion is effective and affordable for treating isthmic spondylolisthesis. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. 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

    OpenAIRE

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

    2015-01-01

    Objective: 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.Methods: Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reco...

  16. Uninstrumented Posterior Lumbar Interbody Fusion: Have Technological Advances in Stabilizing the Lumbar Spine Truly Improved Outcomes?

    Science.gov (United States)

    Prolo, Laura M; Oklund, Sally A; Zawadzki, Nadine; Desai, Manisha; Prolo, Donald J

    2018-04-06

    Since 1980s numerous operations have replaced posterior lumbar interbody fusion (PLIF) with human bone. These often involve expensive implants and complex procedures. Escalating expenditures in lumbar fusion surgery warrant re-evaluation of classical PLIF with allogeneic ilium and without instrumentation. The purpose of this study was to determine the long-term fusion rate and clinical outcomes of allo-PLIF. Between 1981-2006 321 patients ages 12-80, underwent 339 one- or two-level allo-PLIFs for degenerative instability and were followed 1-28 years. Fusion status was determined by radiographs and as available, by CT scans. Clinical outcome was assessed by the Economic/Functional Outcome Scale. 308 of the 321 patients were followed postoperatively (average 6.7 years, range 1-28); 297 (96%) fused. Fusion rates were lower for patients with substance abuse (89%, p=0.007). Clinical outcomes in 87% of patients were excellent (52%) or good (35%). Economic/Functional Outcome Scale scores following initial allo-PLIF on average increased 5.2 points. Successful fusion correlated with nearly a 2-point gain in outcome score (p=0.001). A positive association between a patient characteristic and outcome was observed only with age 65 and greater; whereas negative associations in clinical outcomes were observed with mental illness, substance abuse, heavy stress to low back, or industrial injuries. Total complication rate was 7%. With three decades of follow-up we found successful clinical outcomes are highly correlated with solid fusion using only allogeneic iliac bone. Copyright © 2018. Published by Elsevier Inc.

  17. Spondylectomy and lateral lumbar interbody fusion for thoracolumbar kyphosis in an adult with achondroplasia

    Science.gov (United States)

    Miyazaki, Masashi; Kanezaki, Shozo; Notani, Naoki; Ishihara, Toshinobu; Tsumura, Hiroshi

    2017-01-01

    Abstract Rationale: Fixed thoracolumbar kyphosis with spinal stenosis in adult patients with achondroplasia presents a challenging issue. We describe the first case in which spondylectomy and minimally invasive lateral access interbody arthrodesis were used for the treatment of fixed severe thoracolumbar kyphosis and lumbar spinal canal stenosis in an adult with achondroplasia. Patient concerns: A 61-year-old man with a history of achondroplastic dwarfism presented with low back pain and radiculopathy and neurogenic claudication. Diagnoses: Plain radiographs revealed a high-grade thoracolumbar kyphotic deformity with diffuse degenerative changes in the lumbar spine. The apex was located at L2, the local kyphotic angle from L1 to L3 was 105°, and the anterior area was fused from the L1 to L3 vertebrae. MRI revealed significant canal and lateral recess stenosis secondary to facet hypertrophy. Interventions: We planned a front-back correction of the anterior and posterior spinal elements. We first performed anterior release at the fused part from L1 to L3 and XLIF at L3/4 and L4/5. Next, the patient was placed in the prone position. Spondylectomy at the L2 vertebra and posterior fusion from T10 to L5 were performed. Postoperative radiographs revealed L1 to L3 kyphosis of 32°. Outcomes: No complications occurred during or after surgery. Postoperatively, the patient's low back pain and neurological claudication were resolved. No worsening of kyphosis was observed 24 months postoperatively. Lessons: Circumferential decompression of the spinal cord at the apical vertebral level and decompression of lumbar canal stenosis were necessary. Front-back correction of the anterior and posterior spinal elements via spondylectomy and lateral lumbar interbody fusion is a reasonable surgical option for thoracolumbar kyphosis and developmental canal stenosis in patients with achondroplasia. PMID:29245270

  18. Radiographic Restoration of Sagittal Spinopelvic Alignment After Posterior Lumbar Interbody Fusion in Degenerative Spondylolisthesis.

    Science.gov (United States)

    Kong, Ling-De; Zhang, Ying-Ze; Wang, Feng; Kong, Fan-Long; Ding, Wen-Yuan; Shen, Yong

    2016-03-01

    A retrospective study. This study was aimed to analyze the changes in spinopelvic parameters after surgical correction of degenerative spondylolisthesis and to determine which deformity is most responsible for changes in sagittal spinopelvic alignment. The basic deformities of degenerative spondylolisthesis are forward slippage of the vertebral body, segmental kyphotic angle, and loss of disk height. Correction of those deformities during surgery will subsequently affect the spinopelvic parameters. A few studies have reported the changes of sagittal spinopelvic alignment after surgical treatment of isthmic spondylolisthesis. However, there appears to be relatively little information regarding degenerative spondylolisthesis. Fifty-three patients with L4-L5 degenerative spondylolisthesis were included. All patients underwent posterior lumbar interbody fusion and posterior instrumentation. Back pain, as the clinical outcome, was evaluated by visual analogue scale (VAS). The preoperative and postoperative spinopelvic parameters, including sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), and L1 axis S1 distance were measured, and then the correlations between spinopelvic parameters and local deformity parameters such as slip degree, slip angle (SA), and height of the intervertebral disk were evaluated. After surgical correction of local deformity, all spinopelvic parameters changed subsequently: PT and L1 axis S1 distance had a decrease, SS and LL had an increase. VAS score decreased from 6.1±2.3 before surgery to 2.4±1.7 at the final follow-up assessment. Patients with VAS score changes ≥3 showed significantly higher SS and LL, and lower PT compared with those with VAS score changes spondylolisthesis with posterior lumbar interbody fusion and posterior instrumentation resulted in relief of back pain, which may be associated with improvement of sagittal spinopelvic alignment. Surgeons should consider deformity parameters, especially the SA, in the surgical

  19. Outcomes of anterior lumbar interbody fusion surgery based on indication: a prospective study.

    Science.gov (United States)

    Rao, Prashanth J; Loganathan, Ajanthan; Yeung, Vivian; Mobbs, Ralph J

    2015-01-01

    There is limited information on clinical outcomes after anterior lumbar interbody fusion (ALIF) based on the indications for surgery. To compare the clinical and radiological outcomes of ALIF for each surgical indication. This prospective clinical study included 125 patients who underwent ALIF over a 2-year period. The patients were evaluated preoperatively and postoperatively. Outcome measures included the Short Form-12, Oswestry Disability Index, Visual Analog Scale, and Patient Satisfaction Index. After a mean follow-up of 20 months, the clinical condition of the patients was significantly better than their preoperative status across all indications. A total of 108 patients had a Patient Satisfaction Index score of 1 or 2, indicating a successful clinical outcome in 86%. Patients with degenerative disk disease (with and without radiculopathy), spondylolisthesis, and scoliosis had the best clinical response to ALIF, with statistically significant improvement in the Short Form-12, Oswestry Disability Index, and Visual Analog Scale. Failed posterior fusion and adjacent segment disease showed statistically significant improvement in all of these clinical outcome scores, although the mean changes in the Short Form-12 Mental Component Summary, Oswestry Disability Index, and Visual Analog Scale (back pain) were lower. The overall radiological fusion rate was 94.4%. Superior radiological outcomes (fusion >90%) were observed in patients with degenerative disk disease (with and without radiculopathy), spondylolisthesis, and failed posterior fusion, whereas in adjacent segment disease, it was 80%. ALIF is an effective treatment for degenerative disk disease (with and without radiculopathy) and spondylolisthesis. Although results were promising for scoliosis, failed posterior fusion, and adjacent segment disease, further studies are necessary to establish the effectiveness of ALIF in these conditions.

  20. Anterior Lumbar Interbody Implants: Importance of the Interdevice Distance

    Directory of Open Access Journals (Sweden)

    Brian R. Subach

    2011-01-01

    Full Text Available Object. The implantation of interbody fusion cages allows for the restoration of disc height and the enlargement of the neuroforaminal space. The purpose of this study was to compare the extent of subsidence occurring after conventional cage placement compared to a novel wider cage placement technique. Methods. This study is a retrospective evaluation of radiographs of patients who underwent stand-alone single level anterior lumbar interbody fusion with lordotic titanium cages and rhBMP-2. Fifty-three patients were evaluated: 39 patients had wide cage placement (6 mm interdevice distance and 14 had narrow cage placement (2 mm interdevice distance. Anterior and posterior intervertebral disc space heights were measured post-operatively and at follow-up imaging. Results. The decrease in anterior intervertebral disc space height was 2.05 mm versus 3.92 mm (<.005 and 1.08 mm versus 3.06 mm in posterior disc space height for the wide cage placement and the narrow cage placement respectively. The proportion of patients with subsidence greater than 2 mm was 41.0% in the wide cage patients and 85.7% for the narrow cage patients (<.005. Conclusions. The wider cage placement significantly reduced the amount of subsidence while allowing for a greater exposed surface area for interbody fusion.

  1. Posterior Decompression, Lumber Interbody Fusion and Internal Fixation in the Treatment of Upper Lumbar Intervertebral Disc Herniation

    Directory of Open Access Journals (Sweden)

    DONG Zhan

    2014-12-01

    Full Text Available Objective: To assess the clinical outcomes of posterior decompression, interbody fusion and internal fixationfor the treatment of the upper lumbar intervertebral disc herniation. Methods: Twelve patients with the upper lumbar intervertebral disc herniation were treated by posterior decompression, interbosy fusion and internal fixation. The time of the operation, the amount of bleeding and the clinical efficacy were evaluated. Results: The time of operation was (143±36 min and the amount of bleeding during operation was (331.5±47.9 mL. There was no spinal cord and injuries, nerve injury, epidural damage and leakage of cerebrospinal fluid. All patients were followed up for 10~19 months with the average being 12.6 months. The functional scoring of Japanese Orthopedic Association (JOA before the operation was (11.4±3.3 scores and final score after follow-up was (22.9±3.1 scores and there were statistical difference (P<0.01. Lumber interbody fusion of all patients completed successfully and the good rate after the operation was 91.7%. Conclusion: Posterior decompression, interbody fusion and internal fixation for the treatment of the upper lumbar intervertebral disc herniation was characterized by full exposure, safety and significant efficacy.

  2. Standard versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study

    Directory of Open Access Journals (Sweden)

    Daniel Serban

    2017-01-01

    Full Text Available Symptomatic spondylolisthesis patients may benefit from surgical decompression and stabilization. The standard (S technique is a transforaminal lumbar interbody fusion (TLIF. Newer, minimally invasive (MI techniques seem to provide similar results with less morbidity. We enrolled patients with at least 6 months of symptoms and image-confirmed low-grade spondylolisthesis, at a single academic institution, between 2011 and 2015. The patients were randomized to either S or MI TLIF. The primary outcome measure was the Oswestry Disability Index (ODI improvement at 1 year. Secondary outcome measures included length of operation, estimated blood loss, length of hospitalization, and fusion rates at 1 year. Forty patients were enrolled in each group. The differences in mean operative time and estimated blood loss were not statistically significant between the two groups. The patients were discharged after surgery at 4.12 days for the S TLIF group and 1.92 days for the MI TLIF group. The ODI improvement was similar and statistically significant in both groups. The fusion was considered solid in 36 (90% of patients at 1 year in both groups. In conclusion, the two techniques provided similar clinical and radiological outcomes at 1 year. The patients undergoing MI TLIF had a shorter hospital stay. This trial is registered with NCT03155789.

  3. Digitalized design of extraforaminal lumbar interbody fusion: a computer-based simulation and cadaveric study.

    Directory of Open Access Journals (Sweden)

    Mingjie Yang

    Full Text Available PURPOSE: This study aims to investigate the feasibility of a novel lumbar approach named extraforaminal lumbar interbody fusion (ELIF, a newly emerging minimally invasive technique for treating degenerative lumbar disorders, using a digitalized simulation and a cadaveric study. METHODS: The ELIF surgical procedure was simulated using the Mimics surgical simulator and included dissection of the superior articular process, dilation of the vertebral foramen, and placement of pedicle screws and a cage. ELIF anatomical measures were documented using a digitalized technique and subsequently validated on fresh cadavers. RESULTS: The use of the Mimics allowed for the vivid simulation of ELIF surgical procedures, while the cadaveric study proved the feasibility of this novel approach. ELIF had a relatively lateral access approach that was located 8-9 cm lateral to the median line with an access depth of approximately 9 cm through the intermuscular space. Dissection of the superior articular processes could fully expose the target intervertebral discs and facilitate a more inclined placement of the pedicle screws and cage with robust enhancement. CONCLUSIONS: According to the computer-based simulation and cadaveric study, it is feasible to perform ELIF. Further research including biomechanical study is needed to prove ELIF has a superior ability to preserve the posterior tension bands of the spinal column, with similar effects on spinal decompression, fixation, and fusion, and if it can enhance post-fusion spinal stability and expedites postoperative recovery.

  4. Digitalized design of extraforaminal lumbar interbody fusion: a computer-based simulation and cadaveric study.

    Science.gov (United States)

    Yang, Mingjie; Zeng, Cheng; Guo, Song; Pan, Jie; Han, Yingchao; Li, Zeqing; Li, Lijun; Tan, Jun

    2014-01-01

    This study aims to investigate the feasibility of a novel lumbar approach named extraforaminal lumbar interbody fusion (ELIF), a newly emerging minimally invasive technique for treating degenerative lumbar disorders, using a digitalized simulation and a cadaveric study. The ELIF surgical procedure was simulated using the Mimics surgical simulator and included dissection of the superior articular process, dilation of the vertebral foramen, and placement of pedicle screws and a cage. ELIF anatomical measures were documented using a digitalized technique and subsequently validated on fresh cadavers. The use of the Mimics allowed for the vivid simulation of ELIF surgical procedures, while the cadaveric study proved the feasibility of this novel approach. ELIF had a relatively lateral access approach that was located 8-9 cm lateral to the median line with an access depth of approximately 9 cm through the intermuscular space. Dissection of the superior articular processes could fully expose the target intervertebral discs and facilitate a more inclined placement of the pedicle screws and cage with robust enhancement. According to the computer-based simulation and cadaveric study, it is feasible to perform ELIF. Further research including biomechanical study is needed to prove ELIF has a superior ability to preserve the posterior tension bands of the spinal column, with similar effects on spinal decompression, fixation, and fusion, and if it can enhance post-fusion spinal stability and expedites postoperative recovery.

  5. Models for a stand-alone PV system

    DEFF Research Database (Denmark)

    Hansen, A.D.; Sørensen, Poul Ejnar; Hansen, L.H.

    2001-01-01

    This report presents a number of models for modelling and simulation of a stand-alone photovoltaic (PV) system with a battery bank verified against a system installed at Risø National Laboratory. The work has been supported by the Danish Ministry ofEnergy, as a part of the activities in the Solar...... Energy Centre Denmark. The study is carried out at Risø National Laboratory with the main purpose to establish a library of simple mathematical models for each individual element of a stand-alone PVsystem, namely solar cells, battery, controller, inverter and load. The models for PV module and battery...

  6. Surgical outcome of posterior lumbar interbody fusion with pedicle screw fixation for lumbar spondylolisthesis

    International Nuclear Information System (INIS)

    Shoda, Motoi; Kuno, Shigehiko; Inoue, Tatsushi

    2009-01-01

    Problems of lumbar spondylolisthesis treatment are many surgical tactics, elderly patient, osteoporosis, complications and recurrence of the symptoms. PLIF (posterior lumbar interbody fusion) and PS (pedicle screw) fixation technique for lumbar spondylolisthesis provide good patient satisfaction. Good outcome has been reported by only laminectomy alone, but patient satisfaction becomes worse year after year. The role of instrumentation for lumbar spondylolisthesis is decompression of the nerve root, correction of lumbar pathologies, bony fusion and early mobilization. We show our surgical technique and long term outcome of PLIF with PS for lumbar spondylolisthesis. Three hundred and fifty cases of lumbar spondylolisthesis were operated on in Department of Neurosurgery, Fujita Health University during the period of from December 1992 to August 2008. Patient background: age 16-84 years old (mean 62.5), Gender: male 153, female 197. Follow-up period 1-180 months (mean 61.2). Degenerative: 255, Isthmic: 63, Dysplastic: 10, Fracture: 5 and scoliosis 16 cases. Surgical procedure was PS with interbody fusion cage: 331, Hybrid cage (titanium cage with hydroxyapatite) 314, PS with Cerabone: 2 and PS with autograft: 17. CT was done to evaluate bony fusion postoperatively. Post operative improvements by JOA (Japan Orthopedic Association) score is 11.4 before surgery, 24.1 (post op. within 2 years), 25.4 (post op. 2-5 years), 25.0 (post op. 5-10 years) and 22.4 (post op. 10-15 years). Significant improvements were observed in %Slip and Slip angle but no remarkable change was observed in lumbar lordotic angle by postoperative X-ray evaluation. No root injury, and systemic complication except 4 cases of cerebrospinal fluid (CSF) leakage during surgery. Two cases were reoperated in whom cage with autograft migration due to pseudoarthrosis. Two cases had to undergo screw and cage system removal due to infection. Two cases of adjacent level stenosis had to undergo operation 10

  7. Posterior lumbar interbody fusion and posterolateral fusion: Analogous procedures in decreasing the index of disability in patients with spondylolisthesis.

    Science.gov (United States)

    Alijani, Babak; Emamhadi, Mohamahreza; Behzadnia, Hamid; Aramnia, Ali; Chabok, Shahrokh Yousefzadeh; Ramtinfar, Sara; Leili, Ehsan Kazemnejad; Golmohamadi, Shabnam

    2015-01-01

    The purpose of this study was to evaluate the disability in patients with spondylolisthesis who assigned either to posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF) and to compare it between two groups. In a prospective observational study, 102 surgical candidates with low-grade degenerative and isthmic spondylolisthesis enrolled from 2012 to 2014, and randomly assigned into two groups: PLF and PLIF. Evaluation of disability has been done by a questionnaire using Oswestry Disability Index (ODI). The questionnaire was completed by all patients before the surgery, the day after surgery, after 6 months and after 1-year. There were no statistically significant differences in terms of age and sex distribution and pre-operation ODI between groups (P > 0.05). Comparison of the mean ODI scores of two groups over the whole study period showed no significant statistical difference (P = 0.074). ODIs also showed no significant differences between two groups the day after surgery, 6(th) months and 1-year after surgery (P = 0.385, P = 0.093, P = 0.122 and P = 433) respectively. Analyzing the course of ODI over the study period, showed a significant descending pattern for either of groups (P disability of patients with spondylolisthesis, and none of the fusion techniques were related to a better outcome in terms of disability.

  8. Transforaminal decompression and interbody fusion in the treatment of thoracolumbar fracture and dislocation with spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Ai-Min Wu

    Full Text Available A retrospective clinical study.To evaluate the efficacy and safety of transforaminal decompression and interbody fusion in the treatment of thoracolumbar fracture and dislocation with spinal cord injury.Twenty-six spinal cord injured patients with thoracolumbar fracture and dislocation were treated by transforaminal decompression and interbody fusion. The operation time, intraoperative blood loss, and complications were recorded; the Cobb angle and compressive rate (CR of the anterior height of two adjacent vertebrae were measured; and the nerve injury was assessed according to sensory scores and motor scores of the American Spinal Injury Association (ASIA standards for neurological classification of spinal cord injury.The operative time was 250±57 min, and intraoperative blood loss was 440±168 ml. Cerebrospinal leakage was detected and repaired during the operation in two patients. A total of 24 of 26 patients were followed up for more than 2 years. ASIA sensory scores and motor scores were improved significantly at 3 months and 6 months after operation; the Cobb angle and CR of the anterior height of two adjacent vertebrae were corrected and showed a significant difference at post-operation; and the values were maintained at 3 months after operation and the last follow-up.We showed that transforaminal decompression together with interbody fusion is an alternative method to treat thoracolumbar fracture and dislocation.

  9. Posterior lumber interbody fusion with pedicle screw fixation for the management of spondylolisthesis: An analysis of 40 cases

    Directory of Open Access Journals (Sweden)

    Md. Rezaul Amin

    2017-09-01

    Full Text Available Spondylolisthesis is forward slipping of upper vertebra in relations to its lower one, commonest is L4-L5. The ideal surgical treatment of spondylolisthesis is still controversial. Posterior lumber interbody fusion with pedicle fixation is one of treatment choices for the lumber spondylolisthesis. Forty patients who operated through posterior lumber interbody fusion and pedicle screw fixation by single surgeon was included from January 2012 to March 2015. Periodical follow-up was done both clinically and radiologically up to 6 months. Patient outcome was completed based on pain relief graphic rating scale and Oswestry disability index. In our series, the excellent outcome were 25 patients (62.5%, good were 12 patients (30%, and fair were 3 patients (7.5%. There were no poor outcome and no new neurological deficit. This study concludes that posterior lumber inter-body fusion with pedicle is an effective treatment for the lumber spondylolisthesis. It helps to maintain the biomechanics, associated with less complication and improve the quality of life of patient.

  10. Lateral Lumbar Interbody Fusion for Ossification of the Yellow Ligament in the Lumbar Spine: First Reported Case

    Directory of Open Access Journals (Sweden)

    Kengo Fujii

    2017-01-01

    Full Text Available When ossification of the yellow ligament (OYL occurs in the lumbar spine and extends to the lateral wall of the spinal canal, facetectomy is required to remove all of the ossified lesion and achieve decompression. Subsequent posterior fixation with interbody fusion will then be necessary to prevent postoperative progression of the ossification and intervertebral instability. The technique of lateral lumbar interbody fusion (LLIF has recently been introduced. Using this procedure, surgeons can avoid excess blood loss from the extradural venous plexus and detachment of the ossified lesion and the ventral dura mater is avoidable. We present a 55-year-old male patient with OYL at L3/4 and anterior spondylolisthesis of L4 vertebra, with concomitant ossification of the posterior longitudinal ligament, who presented with a severe gait disturbance. He underwent a 2-stage operation without complications: LLIF for L3/4 and L4/5 was performed at the initial surgery, and posterior decompression fixation using pedicle screws from L3 to L5 was performed at the second surgery. His postoperative progress was favorable, and his interbody fusion was deemed successful. Here, we present the first reported case of LLIF for OYL of the lumbar spine. This procedure can be a good option for OYL of the lumbar spine.

  11. Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review.

    Science.gov (United States)

    Uribe, Juan S; Deukmedjian, Armen R

    2015-04-01

    Minimally invasive lateral interbody fusion (MIS-LIF) has become a popular less invasive treatment option for degenerative spinal disease, deformity, and trauma. While MIS-LIF offers several advantages over traditional anterior and posterior approaches, the procedure is not without risk. The purpose of this study was to evaluate the incidence of visceral, vascular, and wound complications following MIS-LIF performed by experienced surgeons. A survey was conducted by experienced (more than 100 case experience) MIS-LIF surgeons active in the society of lateral access surgery (SOLAS) to collect data on wound infections and visceral and vascular injuries. Of 77 spine surgeons surveyed, 40 (52 %) responded, including 25 (63 %) orthopedic surgeons and 15 (38 %) neurosurgeons, with 20 % practicing at an academic institution and 80 % in community practice. Between 2003 and 2013, 13,004 patients were treated with MIS-LIF by the 40 surgeons who responded to the survey. Of those patients, 0.08 % experienced a visceral complication (bowel injury), 0.10 % experienced a vascular injury, 0.27 % experienced a superficial wound infection, and 0.14 % experienced a deep wound infection. The incidence of surgical site infections and vascular and visceral complications following MIS-LIF in this large series was low and compared favorably with rates for alternative interbody fusion approaches. Although technically demanding, MIS-LIF is a reproducible approach for interbody fusion with a low risk of vascular and visceral complications and infections.

  12. PMBLDCG based stand-alone wind energy conversion system for ...

    African Journals Online (AJOL)

    This paper deals with a permanent magnet brushless DC generator (PMBLDCG) based stand-alone wind energy conversion system (WECS) for small scale power generation. A buck-boost DC-DC converter is used for controlling the PMBLDCG speed to achieve optimum energy output from the wind turbine without sensing ...

  13. The stand-alone test and decreasing serial cost sharing

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Thorlund-Petersen, Lars

    2000-01-01

    The rule of decreasing serial cost sharing defined in de Frutos [1] over the class of concave cost functions may violate the important stand-alone test. Sufficient conditions for the test to be satisfied are given, in terms of individual rationality as well as coalitional stability...

  14. Salvage Percutaneous Vertebral Augmentation Using Polymethyl Methacrylate in Patients with Failed Interbody Fusion.

    Science.gov (United States)

    Yun, Dong-Ju; Hwang, Byeong-Wook; Oh, Hyeong-Seok; Kim, Jin-Sung; Jeon, Sang-Hyeop; Lee, Sang-Ho

    2016-11-01

    Percutaneous vertebral augmentation with cement is used as a salvage procedure for failed instrumentation. Few studies have reported the use of this procedure for failed anterior lumbar fusion in elderly patients with osteoporosis and other complicated diseases who have undergone a previous major operation. Between January 2007 and December 2015, the clinical and radiographic results of 8 patients with osteoporosis who showed subsidence and migration of the implant after an initial operation were examined. After the development of implant failure, the patients underwent vertebral augmentation with polymethyl methacrylate. Mean patient age was 73.4 years (range, 67-78 years), and mean bone mineral density was -2.96 (range, -2.1 to -3.8). The mean radiologic follow-up period between augmentation and the last follow-up examination was 16 months (range, 3-38 months). Although the subjective clinical outcome was not satisfying to the patients, no loss of correction, fractures, or screw loosening occurred during the follow-up period. The injection of cement around the instrument might help to stabilize it by providing strength to the axis and preventing further loosening. This salvage procedure could be an alternative in the management of cases with failed interbody fusion. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Anterior lumbar interbody fusion with percutaneous pedicle screw fixation for multiple-level isthmic spondylolisthesis.

    Science.gov (United States)

    Hsieh, Chang-Sheng; Lee, Hyung Chang; Oh, Hyeong-Seok; Park, Sang-Joon; Hwang, Byeong-Wook; Lee, Sang-Ho

    2017-07-01

    Multiple-level lumbar isthmic spondylolisthesis is rarely reported. Here, we report 23 consecutive patients who underwent anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PPF) for multiple-level isthmic spondylolisthesis. From June 2008 through December 2014, multiple-level lumbar isthmic spondylolisthesis was diagnosed in 23 patients (6 men, 17 women) at Wooridul Spine Hospital (Busan, South Korea). Isthmic spondylolisthesis occurred at three spinal levels in 2 patients and at two levels in 21 patients. All patients underwent ALIF with PPF. We used the Oswestry Disability Index (ODI) and visual analog scale scores to evaluate the preoperative and postoperative functional outcome, low back pain, and radicular pain. We also evaluated segmental lordosis and the fusion status using radiographs and data from computed tomography. Isthmic spondylolisthesis occurred from L3 to S1 and mostly occurred at two consecutive spinal levels (i.e., L4-L5 and L5-S1). Significant improvements in the ODI and visual analog scale were observed in patients at final follow up (pspondylolisthesis. Copyright © 2017. Published by Elsevier B.V.

  16. A STUDY OF POSTERIOR LUMBAR INTERBODY FUSION WITH LOCALLY HARVESTED SPINOLAMINECTOMY BONE GRAFT AND PEDICLE SCREW FIXATION IN SPONDYLOLISTHESIS

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    Pardhasaradhi M

    2017-08-01

    Full Text Available BACKGROUND Posterior Lumbar Interbody Fusion (PLIF and Transforaminal Lumbar Interbody Fusion (TLIF create intervertebral fusion by means of a posterior approach. Successful results have been reported with allograft, various cages (for interbody support, autograft and recombinant human bone morphogenetic protein‐2. Interbody fusion techniques facilitate reduction and enhance fusion. Corticocancellous laminectomy bone chips alone can be used as a means of spinal fusion in patients with single level instrumented PLIF. This has got a good fusion rate. PLIF with cage gives better fusion on radiology than PLIF with iliac bone graft, but no statistical difference in the clinical outcome. Cage use precludes complications associated with iliac bone harvesting. The reported adjacent segment degeneration was 40.5% and reoperation was 8.1% after 10 years of follow up. MATERIALS AND METHODS 30 cases of spondylolisthesis who attended the Orthopaedic Outpatient Department of Andhra Medical College, Visakhapatnam, from 2014 to 2016 were taken up for study. All the cases were examined clinically and confirmed radiologically. The patient’s age, sex, symptoms and duration were noted and were examined clinically for the status of the spine. Straight leg raising test was done and neurological examination of the lower limbs performed. All the patients were subjected to the radiological examination of the lumbosacral spine by taking anteroposterior, lateral (flexion and extension views, oblique views to demonstrate spondylolysis and spondylolisthesis. MRI and x-rays studies were done in all the cases to facilitate evaluation of the root compression disk changes and spinal cord changes. RESULTS In our study, we followed all the 30 patients after the surgery following procedure of removal of loose lamina, spinous process and fibrocartilaginous mass, PLIF with only the laminectomy bone mass and CD screw system fixation up to 2 years. 12 patients (40% had excellent

  17. Impaction durability of porous polyether-ether-ketone (PEEK) and titanium-coated PEEK interbody fusion devices.

    Science.gov (United States)

    Torstrick, F Brennan; Klosterhoff, Brett S; Westerlund, L Erik; Foley, Kevin T; Gochuico, Joanna; Lee, Christopher S D; Gall, Ken; Safranski, David L

    2018-01-31

    Various surface modifications, often incorporating roughened or porous surfaces, have recently been introduced to enhance osseointegration of interbody fusion devices. However, these topographical features can be vulnerable to damage during clinical impaction. Despite the potential negative impact of surface damage on clinical outcomes, current testing standards do not replicate clinically relevant impaction loading conditions. The purpose of this study was to compare the impaction durability of conventional smooth polyether-ether-ketone (PEEK) cervical interbody fusion devices with two surface-modified PEEK devices that feature either a porous structure or plasma-sprayed titanium coating. A recently developed biomechanical test method was adapted to simulate clinically relevant impaction loading conditions during cervical interbody fusion procedures. Three cervical interbody fusion devices were used in this study: smooth PEEK, plasma-sprayed titanium-coated PEEK, and porous PEEK (n=6). Following Kienle et al., devices were impacted between two polyurethane blocks mimicking vertebral bodies under a constant 200 N preload. The posterior tip of the device was placed at the entrance between the polyurethane blocks, and a guided 1-lb weight was impacted upon the anterior face with a maximum speed of 2.6 m/s to represent the strike force of a surgical mallet. Impacts were repeated until the device was fully impacted. Porous PEEK durability was assessed using micro-computed tomography (µCT) pre- and postimpaction. Titanium-coating coverage pre- and postimpaction was assessed using scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy. Changes to the surface roughness of smooth and titanium-coated devices were also evaluated. Porous PEEK and smooth PEEK devices showed minimal macroscopic signs of surface damage, whereas the titanium-coated devices exhibited substantial visible coating loss. Quantification of the porous PEEK deformation

  18. Minimally invasive presacral approach for revision of an Axial Lumbar Interbody Fusion rod due to fall-related lumbosacral instability: a case report

    Directory of Open Access Journals (Sweden)

    Cohen Anders

    2011-09-01

    Full Text Available Abstract Introduction The purpose of this study was to describe procedural details of a minimally invasive presacral approach for revision of an L5-S1 Axial Lumbar Interbody Fusion rod. Case presentation A 70-year-old Caucasian man presented to our facility with marked thoracolumbar scoliosis, osteoarthritic changes characterized by high-grade osteophytes, and significant intervertebral disc collapse and calcification. Our patient required crutches during ambulation and reported intractable axial and radicular pain. Multi-level reconstruction of L1-4 was accomplished with extreme lateral interbody fusion, although focal lumbosacral symptoms persisted due to disc space collapse at L5-S1. Lumbosacral interbody distraction and stabilization was achieved four weeks later with the Axial Lumbar Interbody Fusion System (TranS1 Inc., Wilmington, NC, USA and rod implantation via an axial presacral approach. Despite symptom resolution following this procedure, our patient suffered a fall six weeks postoperatively with direct sacral impaction resulting in symptom recurrence and loss of L5-S1 distraction. Following seven months of unsuccessful conservative care, a revision of the Axial Lumbar Interbody Fusion rod was performed that utilized the same presacral approach and used a larger diameter implant. Minimal adhesions were encountered upon presacral re-entry. A precise operative trajectory to the base of the previously implanted rod was achieved using fluoroscopic guidance. Surgical removal of the implant was successful with minimal bone resection required. A larger diameter Axial Lumbar Interbody Fusion rod was then implanted and joint distraction was re-established. The radicular symptoms resolved following revision surgery and our patient was ambulating without assistance on post-operative day one. No adverse events were reported. Conclusions The Axial Lumbar Interbody Fusion distraction rod may be revised and replaced with a larger diameter rod using

  19. Mini-invasive Transforaminal Lumbar Interbody Fusion through Wiltse Approach to Treating Lumbar Spondylolytic Spondylolisthesis.

    Science.gov (United States)

    Zhou, Chao; Tian, Yong-hao; Zheng, Yan-ping; Liu, Xin-yu; Wang, Hu-hu

    2016-02-01

    To assess the clinical efficacy of mini-invasive transforaminal lumbar interbody fusion (TLIF) through the Wiltse approach for treating lumbar spondylolytic spondylolisthesis. In this retrospective controlled study, 69 cases with lumbar spondylolytic spondylolisthesis treated in Qilu hospital from April to November 2014 were randomly assigned to Wiltse approach (31 cases, 16 male, 15 female; mean age 45.1 years) and traditional approach groups (38 cases, 21 male, 17 female; 47.2 years. In the Wiltse approach group, the affected level was L4, 5 in 19 cases and L5 S1 in 12, 9 of whom had low back pain (LBP) only and 21 both LBP and leg pain. There were 17 cases of I degree and 14 of II degree spondylolisthesis. Pre-operative Japanese Orthopedic Association (JOA) score was 13.1 ± 2.6; visual analog scale (VAS) for LBP 7.4 ± 1.2; VAS for leg pain 6.1 ± 2.0 and Oswestry disability index (ODI) score 42.2% ± 1.2%. In the traditional approach group, the affected level was L4, 5 in 22 cases and L5 S1 in 16, 11 of whom had LBP only and 27 both LBP and leg pain. There were 21 cases of I degree and 17 of II degree spondylolisthesis. Pre-operative JOA score was 12.8 ± 1.2; VAS for LBP 6.9 ± 1.1; VAS for leg pain 7.1 ± 2.0 and ODI score 41.2% ± 2.0%. The JOA score, VAS for LBP and leg pain, ODI dynamic X-rays, CT and/or MR were evaluated 3 and 6 months and 1 year postoperatively. There were no differences in sex, age, affected levels, spondylolisthesis degree, pre-operative JOA score, VAS for LBP or leg pain and ODI score between the two groups (P > 0.05). The incision length, blood loss and time to achieving exposure were better in the Wiltse approach than the traditional approach group (P 0.05). The interbody fusion rate was not significantly different between the groups (P > 0.05). There were no complications of internal fixation in either group. TLIF via both approaches has satisfactory clinical efficacy. TLIF through the Wiltse approach significantly reduces the

  20. Effect of one- or two-level posterior lumbar interbody fusion on global sagittal balance.

    Science.gov (United States)

    Cho, Jae Hwan; Joo, Youn-Suk; Lim, Cheongsu; Hwang, Chang Ju; Lee, Dong-Ho; Lee, Choon Sung

    2017-12-01

    Sagittal imbalance is associated with poor clinical outcomes in patients with degenerative lumbar disease. However, there is no consensus on the impact of posterior lumbar interbody fusion (PLIF) on local and global sagittal balance. To reveal the effect of one- or two-level PLIF on global sagittal balance. A retrospective case-control study. This study included 88 patients who underwent a one- or two-level PLIF for spinal stenosis with spondylolisthesis. Clinical and radiological parameters were measured pre- and postoperatively. All patients were followed up for >2 years. Clinical outcomes included a visual analog scale, Oswestry Disability Index, and EuroQol 5-dimension questionnaire (EQ-5D). Radiological parameters were measured using whole-spine standing lateral radiographs. Fusion, loosening, subsidence rates, and adverse events were also evaluated. Patients were divided into two groups according to their preoperative C7-S1 sagittal vertical axis (SVA): Group N: SVA≤5 cm vs Group I: SVA>5 cm; they were also divided according to postoperative changes in C7-S1 SVA. Clinical and radiological outcomes were compared between the groups. All clinical outcomes and radiological parameters improved postoperatively. C7-S1 SVA improved (-1.6 cm) after L3-L5 fusion, but it was compromised (+3.6 cm) after L4-S1 fusion (p=.001). Preoperative demographic and clinical data showed no difference except in the anxiety or depression domain of EQ-5D. No differences were found in postoperative clinical outcomes. Lumbar lordosis, pelvic tilt, and thoracic kyphosis slightly improved in Group N, whereas C7-S1 SVA decreased from 9.5 cm to 3.8 cm (pfusion (L3-L5 vs L4-S1, p=.033). Global sagittal balance improved after short-level lumbar fusion surgery in patients having spinal stenosis with spondylolisthesis who showed preoperative sagittal imbalance. Restoration of sagittal balance predominantly occurred after L3-L4, L4-L5, or L3-L5 PLIF. However, no such restoration was

  1. Characterization of a novel caudal vertebral interbody fusion in a rat tail model: An implication for future material and mechanical testing

    Directory of Open Access Journals (Sweden)

    Yu-Cheng Yeh

    2017-02-01

    Conclusion: The rat caudal disc interbody fusion model proved to be an efficient, repeatable and easily accessible model. Future research into adjuvant treatments like growth factor injection and alternative fusion materials under conditions of osteoporosis using this model would be worthwhile.

  2. Clinical outcomes of two minimally invasive transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases.

    Science.gov (United States)

    Tian, Yonghao; Liu, Xinyu

    2016-10-01

    There are two modified TLIF, including MIS-TLIF and TLIF through Wiltse approach (W-TLIF). Although both of the two minimally invasive surgical procedures can be effective in the treatment for lumbar degenerative diseases, no comparative analysis has been made so far regarding their clinical outcomes. To compare the clinical outcomes of MIS-TLIF and W-TLIF for the treatment for single-segment degenerative lumbar diseases. Ninety-seven patients with single-segment degenerative lumbar disorders were included in this study. Forty-seven underwent MIS-TLIF surgery (group A). For group B, fifty patients underwent W-TLIF. The Japanese Orthopedic Association (JOA) score, the visual analog scale (VAS) of low back pain (LBP) and leg pain, MRI score and atrophy rate of CSA, interbody fusion rate were assessed during the postoperative follow-up. Incision length, blood loss, operative time, CPK, and postoperative incision pain VAS were better in group A (P degenerative disease. MIS-TLIF has less blood loss, shorter surgical incision, and less lower postoperative back pain, while W-TLIF is less expensive for hospital stay with lower exposure to X-rays.

  3. Accidental Durotomy in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Frequency, Risk Factors, and Management

    Directory of Open Access Journals (Sweden)

    Jan-Helge Klingler

    2015-01-01

    Full Text Available Purpose. To assess the frequency, risk factors, and management of accidental durotomy in minimally invasive transforaminal lumbar interbody fusion (MIS TLIF. Methods. This single-center study retrospectively investigates 372 patients who underwent MIS TLIF and were mobilized within 24 hours after surgery. The frequency of accidental durotomies, intraoperative closure technique, body mass index, and history of previous surgery was recorded. Results. We identified 32 accidental durotomies in 514 MIS TLIF levels (6.2%. Analysis showed a statistically significant relation of accidental durotomies to overweight patients (body mass index ≥25 kg/m2; P=0.0493. Patient age older than 65 years tended to be a positive predictor for accidental durotomies (P=0.0657. Mobilizing patients on the first postoperative day, we observed no durotomy-associated complications. Conclusions. The frequency of accidental durotomies in MIS TLIF is low, with overweight being a risk factor for accidental durotomies. The minimally invasive approach seems to minimize durotomy-associated complications (CSF leakage, pseudomeningocele because of the limited dead space in the soft tissue. Patients with accidental durotomy can usually be mobilized within 24 hours after MIS TLIF without increased risk. The minimally invasive TLIF technique might thus be beneficial in the prevention of postoperative immobilization-associated complications such as venous thromboembolism. This trial is registered with DRKS00006135.

  4. Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial.

    Science.gov (United States)

    Kast, Erich; Derakhshani, Sharam; Bothmann, Matthias; Oberle, Joachim

    2009-04-01

    In ventral fusion after anterior cervical discectomy there is still a remarkable number of cage subsidence and segmental kyphosis seen. The aim of the present study is to assess whether the cage design influences the extent of correction loss during follow-up. Sixty patients with single-level cervical disc herniation were randomly treated with two different cervical inter-body cages (group 1: Solis cage, Stryker Company and group 2: Shell cage, AMT Company). Clinical and radiological follow-up was done before and after surgery, 3 and 6 months post-surgery. Clinical follow-up was done with the help of Odom's criteria. Both groups were similar in the baseline parameters (age, sex, treated level). Statistically, the subsidence was significantly higher at 3 and 6-month follow-ups in group 1 than in group 2, however, clinical results showed no significant differences. In 67%, subsidence was seen in the anterior lower aspect of the treated segment. Segmental kyphosis was seen in seven patients of group 1 and two patients of group 2. A significant correlation is found between Odom's criteria and subsidence. Although there was no significant difference in a short-term clinical result between the two treatment groups, we recommend the use of cages which preserve the determined segmental height and lordosis.

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

    Directory of Open Access Journals (Sweden)

    Xiaofeng Lian

    2016-01-01

    Full Text Available 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.

  6. Sagittal Alignment as Predictor of Adjacent Segment Disease After Lumbar Transforaminal Interbody Fusion.

    Science.gov (United States)

    Sun, Jin; Wang, Jun-Jie; Zhang, Li-Wei; Huang, Hui; Fu, Na-Xin

    2018-02-01

    This study was carried out to explore the diagnostic value of sagittal measurements for adjacent segment disease after lumbar transforaminal interbody fusion (TLIF). A total of 163 subjects who underwent TLIF for lumbar disease were initially enrolled in the study from July 2013 to August 2017. Sagittal alignment including thoracic inlet and spinopelvic parameters was measured by using preoperative full-length freestanding radiographs. Multivariate logistic regression analysis was performed to evaluate these parameters as the diagnostic index for adjacent segment disease (ASD). A total of 153 patients completed the final follow-up, and the mean follow-up period was 40.6 months. There were 53 (35.3%) cases with ASD found after the TLIF in the enrolled subjects. Logistic regression analysis and receiver operating characteristic analysis confirmed that preoperative pelvic tilt (PT) of more than 24.1° and thoracic kyphosis (TK) of more than 23.3° were significant risk factors of ASD after TLIF (P < 0.05). We confirmed that PT of more than 24.3° and TK of more than 23.3° could be regarded as predictors of ASD after lumbar TLIF. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Assessment and classification of subsidence after lateral interbody fusion using serial computed tomography.

    Science.gov (United States)

    Malham, Gregory M; Parker, Rhiannon M; Blecher, Carl M; Seex, Kevin A

    2015-07-24

    OBJECT Intervertebral cage settling during bone remodeling after lumbar lateral interbody fusion (LIF) is a common occurrence during the normal healing process. Progression of this settling with endplate collapse is defined as subsidence. The purposes of this study were to 1) assess the rate of subsidence after minimally invasive (MIS) LIF by CT, 2) distinguish between early cage subsidence (ECS) and delayed cage subsidence (DCS), 3) propose a descriptive method for classifying the types of subsidence, and 4) discuss techniques for mitigating the risk of subsidence after MIS LIF. METHODS A total of 128 consecutive patients (with 178 treated levels in total) underwent MIS LIF performed by a single surgeon. The subsidence was deemed to be ECS if it was evident on postoperative Day 2 CT images and was therefore the result of an intraoperative vertebral endplate injury and deemed DCS if it was detected on subsequent CT scans (≥ 6 months postoperatively). Endplate breaches were categorized as caudal (superior endplate) and/or cranial (inferior endplate), and as ipsilateral, contralateral, or bilateral with respect to the side of cage insertion. Subsidence seen in CT images (radiographic subsidence) was measured from the vertebral endplate to the caudal or cranial margin of the cage (in millimeters). Patient-reported outcome measures included visual analog scale, Oswestry Disability Index, and 36-Item Short Form Health Survey physical and mental component summary scores. RESULTS Four patients had ECS in a total of 4 levels. The radiographic subsidence (DCS) rates were 10% (13 of 128 patients) and 8% (14 of 178 levels), with 3% of patients (4 of 128) exhibiting clinical subsidence. In the DCS levels, 3 types of subsidence were evident on coronal and sagittal CT scans: Type 1, caudal contralateral, in 14% (2 of 14), Type 2, caudal bilateral with anterior cage tilt, in 64% (9 of 14), and Type 3, both endplates bilaterally, in 21% (3 of 14). The mean subsidence in the DCS

  8. Endoscope-Assisted Abscess Drainage Secondary to Endoscope-Assisted Transforaminal Lumbar Interbody Fusion: 1-Year Follow-Up.

    Science.gov (United States)

    Madhavan, Karthik; Burks, Steven Shelby; Chieng, Lee Onn; Veeravagu, Anand; Wang, Michael Y

    2017-11-01

    Endoscopic discectomy and fusions have been gaining popularity in the recent past and are noted to be safe for their application in elderly population. The procedure involves ultra-small incision for discectomy followed by placement of percutaneous screws in awake patients. Treatment of advanced spinal pathology with endoscope-assisted techniques is challenging. Although not common with the endoscopic approach, postoperative infection can be problematic, as there are no established guidelines on its management. A 76-year-old female patient underwent lumbar 4-5 endoscopic-assisted transforaminal lumbar interbody fusion for severe degenerative changes leading to back and radicular leg pain. She did well postoperatively and was discharged home the following day. She presented to the outside hospital with new onset of severe back pain, sepsis, and positive methicillin-susceptible Staphylococcus aureus with blood culture and demonstrated no improvement while on antibiotics. Initial magnetic resonance imaging revealed postoperative changes only. With positive blood culture and localized pain, she was then offered to undergo a percutaneous drainage of the abscess. Under local anesthesia and intravenous sedation, a small pocket of collection was found along the endoscopic trajectory from previous surgery. After evacuation of the collection, the interbody device was irrigated with vancomycin through endoscope. Postoperatively, immediate symptomatic improvement was noted in back pain. She was discharged home on oxacillin and continues to do well at 12 months' follow-up with excellent fusion. The present case illustrates the successful treatment of a surgical-site infection after endoscope-assisted transforaminal lumbar interbody fusion via a repeat percutaneous endoscopic approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Lumbar interbody fusion: a parametric investigation of a novel cage design with and without posterior instrumentation.

    Science.gov (United States)

    Galbusera, Fabio; Schmidt, Hendrik; Wilke, Hans-Joachim

    2012-03-01

    A finite element model of the L4-L5 human segment was employed to carry out a parametric biomechanical investigation of lumbar interbody fusion with a novel "sandwich" cage having an inner stiff core and two softer layers in the areas close to the endplates, with and without posterior fixation. Considered cage designs included: (a) cage in a homogeneous material with variable elastic modulus (19-2,000 MPa), (b) "sandwich" cage having an inner core (E=2,000 MPa) and softer layers (E=19 MPa) with variable thickness (1-2.5 mm). The latter cage was also considered in combination with posterior rods made with a material having variable elastic modulus (19-210,000 MPa). All the models were loaded with 500 N compression and moments of 7.5 Nm in flexion, extension, lateral bending and axial rotation. The homogeneous cage stabilized the segment in flexion, lateral bending and axial rotation; in extension there was a destabilization up to 60% and remarkable cage movement (1 mm). The "sandwich" cage limited this phenomenon (cage movement<0.6 mm), effectively stabilized the segment in the other directions and lowered the maximal contact pressure on the endplates, reducing the risk of subsidence. Posterior fixation reduced spinal flexibility and cage movement. The soft layers of the "sandwich" cage had the potential to limit the risk of cage subsidence and to preserve a significant loading of the structure even in combination with flexible posterior instrumentation, which may have a beneficial effect in promoting bony fusion.

  10. Posterolateral fusion (PLF) versus transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis: a systematic review and meta-analysis.

    Science.gov (United States)

    Levin, Jay M; Tanenbaum, Joseph E; Steinmetz, Michael P; Mroz, Thomas E; Overley, Samuel C

    2018-02-13

    Lumbar fusion is an effective and durable treatment for symptomatic lumbar spondylolisthesis; however, the current literature provides insufficient evidence to recommend an optimal surgical fusion strategy. The present study aims to compare the clinical outcomes, fusion rates, blood loss, and operative times between open posterolateral lumbar fusion (PLF) alone and open transforaminal lumbar interbody fusion (TLIF) + posterolateral fusion for spondylolisthesis. This is a systematic literature review and meta-analysis of English language studies for the treatment of spondylolisthesis with PLF versus PLF + TLIF. Data were obtained from published randomized controlled trials (RCTs) and retrospective cohort studies. Clinical outcomes included Oswestry Disability Index (ODI), back pain, leg pain, and health-related quality of life (HRQOL) scores. Fusion rate, operative time, blood loss, and infection rate were also assessed. A literature search of three electronic databases was performed to identify investigations performed comparing PLF alone with PLF + TLIF for treatment of low-grade lumbar spondylolisthesis. The summary effect size was assessed from pooling observational studies for each of the outcome variables, with odds ratios (ORs) used for fusion and infection rate, mean difference used for improvement in ODI and leg pain as well as operative time and blood loss, and standardized mean difference used for improvement in back pain and HRQOL outcomes. Studies were weighed based on the inverse of the variance and heterogeneity. Heterogeneity was assessed using the I 2 -an estimate of the error caused by between-study variation. Effect sizes from the meta-analysis were then compared with data from the RCTs to assess congruence in outcomes. The initial literature search yielded 282 unique, English language studies. Seven were determined to meet our inclusion criteria and were included in our qualitative analysis. Five observational studies were included in

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

    Science.gov (United States)

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

    2017-11-01

    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

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

    Directory of Open Access Journals (Sweden)

    Kleiner JB

    2016-05-01

    Full Text Available Jeffrey B Kleiner, Hannah M Kleiner, E John Grimberg Jr, Stefanie J Throlson The Spine Center of Innovation, The Medical Center of Aurora, Aurora, CO, USA 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

  13. Risk Factors of Adjacent Segment Disease After Transforaminal Inter-Body Fusion for Degenerative Lumbar Disease.

    Science.gov (United States)

    Yamasaki, Koji; Hoshino, Masahiro; Omori, Keita; Igarashi, Hidetoshi; Nemoto, Yasuhiro; Tsuruta, Takashi; Matsumoto, Koji; Iriuchishima, Takanori; Ajiro, Yasumitsu; Matsuzaki, Hiromi

    2017-01-15

    A retrospective study. The purpose of this study was to determine the incidence and risk factors of adjacent segment disease (ASD) after transforaminal inter-body fusion (TLIF) for degenerative lumbar disease. ASD is a major complication after spinal fusion. Many reports have been published concerning the risk factors for ASD after TLIF. A number of quantitative relationships to spino-pelvic parameters have been established. A retrospective cohort study was carried out to investigate spino-pelvic alignment in patients with ASD after TLIF. This study evaluated 263 subjects (150 subjects undergoing floating fusion (FF group), and 113 patients undergoing lumbosacral fusion (LF group)) who underwent TLIF from 2009 to 2012. The mean follow-up period was 37.6 months. Several parameters were measured using pre- and postoperative full-length free-standing radiographs, including lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), and PI-LL. Multivariate logistic regression analysis was performed to evaluate these parameters as potential risk factors of early onset radiographic ASD. Radiographic ASD was found in 65 cases (43.3%) in the FF group, and 49 cases (43.3%) in the LF group. LL improved by 7.5° and 3.9° in each group respectively after TLIF. However, PT worsened by 6.4° in the LF group. When comparing with ASD positive cases and ASD negative cases, a significant difference in preoperative PT was observed in both FF (P = 0.001) and LF groups (P = 0.0001). Logistic regression analysis and receiver operating characteristic analysis revealed that preoperative PT of more than 22.5° was a significant risk factor of the incidence of ASD after TLIF (P = 0.02; odds ratio: 5.1, 95% CI: 1.62-9.03). Patients with preoperative sagittal imbalance have a statistically significant increased risk of ASD. The risk of ASD incidence was 5.1 times greater in subjects with preoperative PT of more than 22.5°.

  14. Transforaminal lumbar interbody fusion vs. posterolateral instrumented fusion: cost-utility evaluation along side an RCT with a 2-year follow-up

    DEFF Research Database (Denmark)

    Christensen, Ann Demant; Hoy, K.; Bunger, C.

    2014-01-01

    -utility of transforaminal lumbar interbody fusion (TLIF) compared to posterolateral instrumented fusion (PLF) from the societal perspective. 100 Patients were randomized to TLIF or PLF (51/49) and followed for 2 years. Cost data were acquired from national registers, and outcomes were measured using the Oswestry Disability...... Index and SF-6D questionnaires. Conventional cost-effectiveness methodology was employed to estimate net benefit and to illustrate cost-effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped confidence intervals. Results showed no statistically significant...

  15. Low incidence of adjacent segment disease after posterior lumbar interbody fusion with minimum disc distraction: A preliminary report.

    Science.gov (United States)

    Makino, Takahiro; Honda, Hirotsugu; Fujiwara, Hiroyasu; Yoshikawa, Hideki; Yonenobu, Kazuo; Kaito, Takashi

    2018-01-01

    A retrospective review of prospectively collected data. To investigate the incidence of radiographic and symptomatic adjacent segment disease (ASD) and identify possible risk factors for ASD after posterior lumbar interbody fusion (PLIF) with minimum disc distraction by selecting low-height interbody cages. Excessive disc space distraction is reportedly 1 of the risk factors for ASD after PLIF; however, the incidence and other risk factors of ASD after PLIF with minimum disc distraction remain unclear. Forty-one consecutive patients who underwent PLIF at L4-L5 and were postoperatively followed up for a minimum of 2 years were included. The height and shape (box or bullet shape) of interbody cages was determined according to the disc height and morphology of the intervertebral space assessed on preoperative computed tomography scans to avoid excessive distraction. The incidence of radiographic and symptomatic ASD was evaluated and all demographic and radiographic parameters were compared between patients with and without ASD. Multivariate logistic regression analysis was performed to identify risk factors for ASD among the variables with P < .20 in univariate analysis. The overall incidence of ASD was 12.2% (5/41 patients): radiographic ASD, 7.3% (3 patients); symptomatic ASD, 4.9% (2 patients). Multivariate analysis revealed preoperative retrolisthesis of L3 on extension as the sole risk factor for ASD after PLIF with minimum disc distraction (odds ratio, 2.13; 95% confidence interval, 1.00-4.05; P = .049). The incidence of ASD in this study was lower than that of ASD in our previous study about PLIF with distraction of disc space (12.2% vs. 31.8%). Minimum disc distraction by selection of low-height interbody cages is a simple and effective method to prevent ASD at the surgeons' discretion, although preexisting retrolisthesis at the adjacent upper segment should be taken into consideration. Copyright © 2017 The Authors. Published by Wolters Kluwer Health

  16. Transforaminal lumbar interbody fusion using one diagonal fusion cage with unilateral pedicle screw fixation for treatment of massive lumbar disc herniation.

    Science.gov (United States)

    Zhao, Chang-Qing; Ding, Wei; Zhang, Kai; Zhao, Jie

    2016-09-01

    Large lumbar or lumbosacral (LS) disc herniations usually expand from the paramedian space to the neuroforamen and compress both the transversing (lower) and the exiting (upper) nerve roots, thus leading to bi-radicular symptoms. Bi-radicular involvement is a statistically significant risk factor for poor outcome in patients presenting with far lateral or foraminal disc herniation after facet preserving microdecompression. There is evidence showing that patients suffering from large lumbar disc herniations treated with interbody fusion have significant superior results in comparison with those who received a simple discectomy. We report our experiences on managing large LS disc herniation with bi-radicular symptoms by transforaminal lumbar interbody fusion (TLIF) using one diagonal fusion cage with unilateral pedicle screw/rod fixation. Twenty-three patients who suffered from single level lumbar or LS disc herniation with bi-radicular symptoms treated with unilateral decompression and TLIF using one diagonal fusion cage with ipsilateral pedicle screw/rod fixation operated between January 2005 and December 2009, were included in this study. Operation time and blood loss were recorded. The pain and disability status were pre- and postoperatively evaluated by the visual analog score (VAS) and Oswestry Disability Index (ODI). Interbody bony fusion was detected by routine radiographs and computed tomography scan. Adjacent segment degeneration was detected by routine radiographs and magnetic resonance imaging examination. Overall outcomes were categorized according to modified Macnab classification. The patients were followed up for an average of 44.7 months. Pain relief in the VAS and improvement of the ODI were significant after surgery and at final followup. No severe complications occurred during hospital stay. Interbody bony fusion was achieved in every case. No cage retropulsion was observed, while 3 cases experienced cage subsidence. Adjacent segment degeneration

  17. Mini-open Anterior Lumbar Interbody Fusion for Recurrent Lumbar Disc Herniation Following Posterior Instrumentation.

    Science.gov (United States)

    Mamuti, Maiwulanjiang; Fan, Shunwu; Liu, Junhui; Shan, Zhi; Wang, Chongyan; Li, Shengyun; Zhao, Fengdong

    2016-09-15

    A retrospective study. The aim of this study is to evaluate, clinically and radiographically, the efficacy of mini-open retroperitoneal anterior lumbar discectomy followed by anterior lumbar interbody fusion (ALIF) for recurrent lumbar disc herniation following primary posterior instrumentation. Recurrent disc herniation following previous disc surgery occurs in 5 to 15% of cases. This is often treated by further surgical intervention where posterior approach is generally preferred. However, posterior surgery may be problematic if the initial surgery involved posterior instrumentation. An anterior approach may be indicated in these patients, and recent findings suggest that a "mini-open" procedure may have some benefits when compared with traditional open techniques and their associated morbidities. A total of 35 recurrent lumbar disc herniation patients (10 male, 25 female) following primary posterior instrumentation with an average age of 52.8 years (range: 34-70 yrs) who underwent the mini-open ALIF procedures between August 2001 and February 2012 were evaluated retrospectively. The ALIF was performed at the levels L4-L5 (n = 14), L5-S1 (n = 15), or both L4-L5 and L5-S1 (n = 6). Visual Analog pain Scale (VAS) and Oswestry Disability Index (ODI) together with radiological results were assessed. The mean operating time, intraoperative estimated blood loss, and hospital stay were 115 minutes, 70 mL, and 6 days, respectively. No blood transfusion was needed. Transient complication was recorded in two patients. Postoperative follow-up was a minimum 24.3 months. VAS score and ODI percentage decreased significantly from 7.9 ± 0.8 and 78.8% ± 12.4% pre-operatively to 1.4 ± 0.6 and 21.7 ± 4.2% at final follow-up, respectively. There was no neurological worsening and radicular pain improved significantly compared with pre-operation in all the patients. Computed tomographic reconstruction 12 and 24 months after surgery showed bony fusion

  18. Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis: Comparison Between Isthmic and Degenerative Spondylolisthesis.

    Science.gov (United States)

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

    2015-11-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is a common surgical option for degenerative spondylolisthesis (DS). However, its effectiveness for isthmic spondylolisthesis (IS) is still controversial. No current studies have directly compared perioperative and postoperative results including various radiological parameters between IS and DS after MIS TLIF. The purpose of this study is to compare the clinical and radiological results between isthmic and degenerative spondylolisthesis after MIS TLIF. This is a retrospective study of 41 patients who underwent MIS TLIF for single-segment, grade 1 or 2 IS (n = 18) and DS (n = 23). The same surgical techniques and procedure were applied to both groups. Perioperative outcomes (operation time, blood loss, hospital stay, complications); clinical outcomes (visual analog scale [VAS], Oswestry Disability Index [ODI]); radiological parameters (disk height, degree of spondylolisthesis, slip angle, lumbar lordosis, segmental lordosis, sacropelvic parameters: pelvic incidence, sacral slope, pelvic tile); and fusion rates using computed tomography scanning were compared between groups at 1 year postoperatively. There were no significantly different perioperative results between groups. Mean VAS and ODI scores improved significantly postoperatively in both groups but were not significantly different between groups at each follow-up point. Radiological parameters were not significantly different between groups except disk height and degree of spondylolisthesis. The disk heights were increased postoperatively (IS: 6.79-9.22 mm; DS: 8.18-8.97 mm) in both groups, and there were significant differences preoperatively. In addition, disk height restoration was greater for IS than DS (2.43 mm vs. 0.79 mm, P = 0.01). However, postoperative disk heights were not significantly different between groups. The degree of spondylolisthesis was significantly different between groups both preoperatively (16.77% vs. 11.33%, P

  19. Radon Monitoring in Army Stand-Alone Housing Units

    Science.gov (United States)

    1990-04-01

    Y cm a cc 0000 0003 000 000 :: - -@-I.00 cmjinu mooc . 0J~CJ~ TTTT J !8 2 T WWWW WW.000 coo 0~~ 80 Im - v ;o e I3 ec ;: C -1,4 04. -c mco : - a c W" 1 .1...Chamber ....................... 25 V U I I I viI Final Report, April 1990 Radon Monitoring in Army Stand-alone Housing Units Summary Argonne National...and analysis. The quality control protocols appli- cable to detector analysis are contained in Chapter V of the procedures manual developed by Tech

  20. Future UK markets for stand-alone renewable energy systems

    International Nuclear Information System (INIS)

    Paish, O.

    1999-01-01

    A study to identify and quantify the market for stand-alone renewable energy supplies of power (photovoltaics, wind and micro-hydro electricity systems) was described. The study focused on small systems, generally less than a few kW installed capacity. It was suggested that in the UK, the emphasis on grid-connected renewable energy technologies (RETs) has blurred the fact that it is 'off-grid' renewable systems that can offer more immediate real commercial markets for the renewables business. With the likelihood of a significant increase in demand for renewables world wide over the next ten years, the UK needs to make a special effort to become involved

  1. Elimination of Subsidence with 26-mm-Wide Cages in Extreme Lateral Interbody Fusion.

    Science.gov (United States)

    Lang, Gernot; Navarro-Ramirez, Rodrigo; Gandevia, Lena; Hussain, Ibrahim; Nakhla, Jonathan; Zubkov, Micaella; Härtl, Roger

    2017-08-01

    Extreme lateral interbody fusion (ELIF) has gained popularity as a minimally invasive technique for indirect decompression. However, graft subsidence potentially threatens long-term success of ELIF. This study evaluated whether 26-mm-wide cages can eliminate subsidence and subsequent loss of decompression in ELIF. Patients undergoing ELIF surgery using a 26-mm-wide cage were analyzed retrospectively. Patient demographics and perioperative data for radiographic and clinical outcomes were recorded. Radiographic parameters included regional sagittal lumbar lordosis and foraminal and disc height. Clinical parameters were evaluated using the Oswestry Disability Index and visual analog scale. Subsidence of 26-mm-wide cages was compared with previous outcomes of patients undergoing ELIF using 18-mm-wide and 22-mm-wide cages. There were 21 patients and 28 spinal segments analyzed. Radiographic outcome measures such as disc and foraminal height revealed significant improvement at follow-up compared with before surgery (P = 0.001). Postoperative to last follow-up cage subsidence translated into 0.34 mm ± 0.26 and -0.55 mm ± 0.64 in disc and foraminal height loss, respectively. Patients with 26-mm-wide cages experienced less subsidence by means of disc (26 mm vs. 18 mm and 22 mm, P ≤ 0.05) and foraminal height (26 mm vs. 18 mm, P = 0.005; 26 mm vs. 22 mm, P = 0.208) loss compared with patients receiving 18-mm-wide and 22-mm-wide cages. The 26-mm-wide cages almost eliminated cage subsidence in ELIF. Compared with 18-mm-wide and 22-mm-wide cages, 26-mm-wide cages significantly reduced cage subsidence in ELIF at midterm follow-up. A 26-mm-wide cage should be used in ELIF to achieve sustained indirect decompression. Copyright © 2017. Published by Elsevier Inc.

  2. The Correlation Between Cage Subsidence, Bone Mineral Density, and Clinical Results in Posterior Lumbar Interbody Fusion.

    Science.gov (United States)

    Oh, Kyu Won; Lee, Jae Hyup; Lee, Ji-Ho; Lee, Do-Yoon; Shim, Hee Jong

    2017-07-01

    A retrospective review of prospectively collected radiographic and clinical data. This study aims to investigate the relationship between cage subsidence and bone mineral density (BMD), and to reveal the clinical implications of cage subsidence. Posterior lumbar interbody fusion (PLIF) has become one of the standard treatment modality for lumbar degenerative disease. However, cage subsidence might result in recurrent foraminal stenosis and deteriorate the clinical results. Furthermore, numbers of osteoporosis patients who underwent PLIF are increasing. Therefore, the information on the correlations between cage subsidence, BMD, and clinical results will be of great significance. A total 139 segments was included in this retrospective study. We examined functional rating index (Visual Analogue Scale for pain, Oswestry Disability Index, Short Form-36 score) preoperatively, and investigated their changes after postoperative 1 year. Correlation between cage subsidence and clinical scores was investigated. Plain anteroposterior and lateral radiograph were taken preoperatively and postoperatively and during follow-up. Preoperative BMD and subsidence measured by postoperative 1 year 3-dimensional computed tomography were achieved and their correlation was assessed. All postoperative clinical scores improved significantly compared with preoperative ones (pain Visual Analogue Scale: 7.34-2.89, Oswestry Disability Index: 25.34-15.86, Short Form-36: 26.45-16.46, all Psubsidence (r=-0.285, Psubsidence (>3 mm) compared with the segments in which T score were higher than -3.0 (P=0.012), and its odds ratio was 8.44. Subsidence had no significant correlation with all clinical scores. This study revealed that cage subsidence is relevant to BMD. However, it was demonstrated that subsidence is not related to the clinical deterioration. Therefore, PLIF procedure which is conducted carefully can be a good surgical option to treat lumbar degenerative disease for osteoporotic patients.

  3. Cost-effectiveness of posterior lumbar interbody fusion in the Japanese universal health insurance system.

    Science.gov (United States)

    Fujimori, Takahito; Miwa, Toshitada; Iwasaki, Motoki; Oda, Takenori

    2018-03-01

    Globally, the cost-effectiveness of spinal surgery is becoming increasingly important. However, these data are limited to a few countries. The purpose of our study was to examine the cost/quality adjusted life year (cost/QALY) gained for posterior lumbar interbody fusion (PLIF) in the Japanese universal health insurance system. Fifty five patients underwent PLIF for lumbar degenerative spinal canal stenosis between July 2013 and September 2015 was included. Effectiveness was measured using Euro QOL 5-dimension (EQ-5D), Short-Form 8 physical component summary (PCS), and visual analog scale (VAS). The cost was calculated from the perspective of the public healthcare payer. Effectiveness and cost were measured one year after surgery. QALYs were calculated by multiplying the utility value (EQ-5D) and life years. Only direct costs were included on the basis of actual reimbursements. Cost/QALY at a 5-year time horizon with a 2% discount rate was estimated. Sensitivity analysis was performed by varying the time horizon (2 years or 10 years). The exchange rate was defined as US $1 to Japanese 100 yen. Mean total cost one year after surgery was ¥2,802,900 ($28029). Operative cost was ¥1,779,700 ($17797). Mean gained score was 0.22 in EQ-5D, 10.3 in PCS, and -44 in VAS. Cost/QALY was ¥2,697,500 ($26975). Sensitivity analysis demonstrated that cost/QALY at a 10-year time horizon was ¥1,428,300 ($14283) and that cost/QALY at a 2-year time horizon was ¥6,435,400 ($64354). Clinical outcomes after PLIF improved beyond minimum clinical improvement difference. Cost/QALY was below the widely-accepted benchmark (cost/QALY < $50000). PLIF could be regarded as cost-effective interventions. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  4. Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion: Single Incision Versus Double Incision

    Directory of Open Access Journals (Sweden)

    Xin-Lei Xia

    2015-01-01

    Full Text Available Background: The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF with a small single posterior median incision. Methods: During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision (single incision group. The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index (ODI scores, Visual Analog Scale (VAS scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results: A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group (P < 0.01. The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups (P ≥ 0.05. Conclusions: Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

  5. Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion: comparison of posterior lumbar interbody fusion and posterolateral fusion.

    Science.gov (United States)

    Lee, Jae Chul; Kim, Yongdai; Soh, Jae-Wan; Shin, Byung-Joon

    2014-03-01

    A retrospective study. To determine the incidence and risk factors of adjacent segment disease (ASD) requiring surgery among patients previously treated with spinal fusion for degenerative lumbar disease and to compare the survivorship of adjacent segment according to various risk factors including comparison of fusion methods: posterior lumbar interbody fusion (PLIF) versus posterolateral fusion (PLF). One of the major issues after lumbar spinal fusion is the development of adjacent segment disease. Biomechanically, PLIF has been reported to be more rigid than PLF, and therefore, patients who undergo PLIF are suspected to experience a higher incidence of ASD than those who underwent PLF. There have been many studies analyzing the risk factors of ASD, but we are not aware of any study comparing PLIF with PLF in incidence of ASD requiring surgery. A consecutive series of 490 patients who had undergone lumbar spinal fusion of 3 or fewer segments to treat degenerative lumbar disease was identified. The mean age at index operation was 53 years, and the mean follow-up period was 51 months (12-236 mo). The number of patients treated by PLF and PLIF were 103 and 387, respectively. The incidence and prevalence of revision surgery for ASD were calculated by Kaplan-Meier method. For risk factor analysis, we used log-rank test and Cox regression analysis with fusion methods, sex, age, number of fused segments, and presence of laminectomy adjacent to index fusion. After index spinal fusion, 23 patients (4.7%) had undergone additional surgery for ASD. Kaplan-Meier analysis predicted a disease-free survival rate of adjacent segments in 94.2% of patients at 5 years and 89.6% at 10 years after the index operation. In the analysis of risk factors, PLIF was associated with 3.4 times higher incidence of ASD requiring surgery than PLF (P = 0.037). Patients older than 60 years at the time of index operation were 2.5 times more likely to undergo revision operation than those younger

  6. Impaired bone mineral density as a predictor of graft subsidence following minimally invasive transpsoas lateral lumbar interbody fusion.

    Science.gov (United States)

    Tempel, Zachary J; Gandhoke, Gurpreet S; Okonkwo, David O; Kanter, Adam S

    2015-04-01

    The LLIF procedure is a useful stand-alone and adjunct surgical approach for many spinal conditions. One complication of LLIF is subsidence of the interbody graft into the vertebral bodies, resulting in severe pain, impaired arthrodesis and potentially fracture of the body. Low bone density, as measured by T score on DEXA scanning, has also been postulated to increase the risk of subsidence. A retrospective review of prospectively collected data was performed on all patients who underwent LLIF at this institution consisting of 712 levels in 335 patients. Patients with subsidence following LLIF were recorded. We utilized the T score obtained from the femoral neck DEXA scans, which is used to determine overall fracture risk. The T score of patients with subsidence was compared to those without subsidence. 20 of 57 (35 %) patients without subsidence had a DEXA T score between -1.0 and -2.4 consistent osteopenia, one patient (1.8 %) exhibited a T score less than -2.5, consistent with osteoporosis. 13 patients of 23 (57 %) with subsidence exhibited a T score between -1.0 and -2.4, consistent with osteopenia, five (22 %) exhibited a T score of -2.5 or less, consistent with osteoporosis. The mean DEXA T score in patients with subsidence was -1.65 (SD 1.04) compared to -0.45 (SD 0.97) in patients without subsidence (p subsidence. Further, they are at an increased risk of requiring additional surgery. In patients with poor bone quality, consideration could be made to supplement the LLIF cage with posterior instrumentation.

  7. Preventive Effect of Dynamic Stabilization Against Adjacent Segment Degeneration After Posterior Lumbar Interbody Fusion.

    Science.gov (United States)

    Tachibana, Naohiro; Kawamura, Naohiro; Kobayashi, Daiki; Shimizu, Takaki; Sasagawa, Takeshi; Masuyama, Shigeru; Hirao, Yujiro; Kunogi, Junichi

    2017-01-01

    Retrospective cohort study. To investigate the effects of dynamic stabilization with sublaminar taping (ST) on the upper segment adjacent to posterior lumbar interbody fusion (PLIF). Hybrid procedures such as dynamic stabilization for adjacent segment in addition to spinal fusion have been developed for reduction of the mechanical stress and prevention of adjacent segment pathology (ASP). However, a few reports are available on hybrid procedures and their efficacy is still controversial. Of the 116 patients who underwent L4/5 PLIF between August 2006 and September 2012, 76 patients with minimum 2-year follow up were included in this study. Fifty three patients underwent L4/5 PLIF with hybrid procedure using ST on L3 lamina (group U), and 23 patients underwent conventional L4/5 PLIF (group C). The adjacent segment degeneration (ASDeg) was determined by measurements of radiograph, computed tomography, and magnetic resonance imaging; the adjacent segment disease (ASDis) was evaluated on medical records. The incidence of ASDeg at L3/4 segment of group U (3.7%) was significantly less than that of group C (30.4%) (P = 0.003), although there were no significant differences at L2/3 (group U, 7.5%; group C, 13%) or L5/S1 segment (group U, 5.7%; group C, 8.7%). On the other hand, no significant difference was found between two groups in the incidence of ASDis in L2/3 to L5/S1 levels, and no patient underwent reoperation. Bivariable and multivariable logistic regression analyses for L3/4 segment ASDeg revealed that the difference of surgical procedure was the only significant factor. The current study showed that L4/5 PLIF with hybrid procedure using ST on L3 lamina significantly reduced the incidence of L3/4 ASDeg as compared with the conventional L4/5 PLIF without compromising L2/3 or L5/S1 segment. Although further studies and longer follow up are necessary, the hybrid procedure is expected to be effective for preventing ASP. 4.

  8. Effects of Addition of Preoperative Intravenous Ibuprofen to Pregabalin on Postoperative Pain in Posterior Lumbar Interbody Fusion Surgery

    Directory of Open Access Journals (Sweden)

    Hüseyin Ulaş Pınar

    2017-01-01

    Full Text Available Objective. Ibuprofen and pregabalin both have independent positive effects on postoperative pain. The aim of the study is researching effect of 800 mg i.v. ibuprofen in addition to preoperative single dose pregabalin on postoperative analgesia and morphine consumption in posterior lumbar interbody fusion surgery. Materials and Methods. 42 adult ASA I-II physical status patients received 150 mg oral pregabalin 1 hour before surgery. Patients received either 250 ml saline with 800 mg i.v. ibuprofen or saline without ibuprofen 30 minutes prior to the surgery. Postoperative analgesia was obtained by morphine patient controlled analgesia (PCA and 1 g i.v. paracetamol every six hours. PCA morphine consumption was recorded and postoperative pain was evaluated by Visual Analog Scale (VAS in postoperative recovery room, at the 1st, 2nd, 4th, 8th, 12th, 24th, 36th, and 48th hours. Results. Postoperative pain was significantly lower in ibuprofen group in recovery room, at the 1st, 2nd, 36th, and 48th hours. Total morphine consumption was lower in ibuprofen group at the 2nd, 4th, 8th, 12th, and 48th hours. Conclusions. Multimodal analgesia with preoperative ibuprofen added to preoperative pregabalin safely decreases postoperative pain and total morphine consumption in patients having posterior lumbar interbody fusion surgery, without increasing incidences of bleeding or other side effects.

  9. Lateral Lumbar Interbody Fusion andin SituScrew Fixation for Rostral Adjacent Segment Stenosis of the Lumbar Spine.

    Science.gov (United States)

    Choi, Young Hoon; Kwon, Shin Won; Moon, Jung Hyeon; Kim, Chi Heon; Chung, Chun Kee; Park, Sung Bae; Heo, Won

    2017-11-01

    The purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease. The medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. The median follow-up period was 13 months (range, 3-48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved ( p fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients. This study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.

  10. 49 CFR 1111.8 - Procedural schedule in stand-alone cost cases.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Procedural schedule in stand-alone cost cases... § 1111.8 Procedural schedule in stand-alone cost cases. (a) Procedural schedule. Absent a specific order by the Board, the following general procedural schedule will apply in stand-alone cost cases: Day 0...

  11. Restoration of the spinopelvic sagittal balance in isthmic spondylolisthesis: posterior lumbar interbody fusion may be better than posterolateral fusion.

    Science.gov (United States)

    Feng, Yu; Chen, Liang; Gu, Yong; Zhang, Zhi-Ming; Yang, Hui-Lin; Tang, Tian-Si

    2015-07-01

    More and more orthopedic surgeons recognize the importance of the sagittal balance of the spine. To analyze the pre- and postoperative sagittal and deformity parameters of low-grade isthmic spondylolisthesis and evaluate the effect of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) on spinopelvic sagittal balance. Nonrandomized controlled prospective study with a historical control. A total of 99 patients with low-grade L5-S1 isthmic spondylolisthesis were treated surgically; 36 patients (mean age, 60.2±5.2 years) received the PLF operation, and 63 patients (mean age, 57.1±6.9 years) chose the PLIF operation. The healthy control group was composed of 60 volunteers (mean age, 44.5±8.4 years). The pre- and postoperative spinopelvic and deformity parameters. All patients had radiographs that allowed measurement of spinopelvic parameters before and after the operation. All the spinopelvic and deformity parameters were measured. Two radiologists measured the parameters with the Cobb method. All of the preoperative spinopelvic parameters showed no difference between the PLIF and PLF groups in this study (p>.05). In both of the operation groups, the preoperative pelvic incidence, pelvic tilt (PT), sacral slope, lumbar lordosis (LL), and L5 incidence (L5I) were significantly higher than in the control group (p.05). LL increased in the PLIF group and decreased in the PLF group. The slip degree (SD) and L5I were restored significantly in both groups. The HOD of the PLIF group increased 5.04 mm, the postoperative HOD of the PLF group had no significant change. In both PLIF and PLF groups, the correction of SD was correlated with the change of LL (r=-0.398, p=.007; r=0.365, p=.022). The restoration of HOD in the PLIF group correlated with the change of LL (r=0.334, p=.011). No significant differences could be found between the short-term clinical outcomes of the PLF and PLIF. Either PLF or PLIF would lead a great change in spinopelvic parameters and

  12. Hydrogen Gas Production in a Stand-Alone Wind Farm

    Directory of Open Access Journals (Sweden)

    M. Naziry Kordkandy

    2017-04-01

    Full Text Available This paper is analyzing the operation of a stand-alone wind farm with variable speed turbines, permanent magnet synchronous generators (PMSG and a system for converting wind energy during wind speed variations. On this paper, the design and modeling of a wind system which uses PMSG’s to provide the required power of a hydrogen gas electrolyzer system, is discussed. This wind farm consists of three wind turbines, boost DC-DC converters, diode full bridge rectifiers, permanent magnet synchronous generators, MPPT control and a hydrogen gas electrolyzer system. The MPPT controller based on fuzzy logic is designed to adjust the duty ratio of the boost DC-DC converters to absorb maximum power. The proposed fuzzy logic controller assimilates, with (PSF MPPT algorithm which generally used to absorb maximum power from paralleled wind turbines and stores it in form of hydrogen gas. The system is modeled and its behavior is studied using the MATLAB software.

  13. DOE and AID stand-alone photovoltaic activities

    Science.gov (United States)

    Bifano, W. J.; Ratajczak, A. F.

    The NASA Lewis Research Center (LeRC) is managing stand-alone photovoltaic (PV) system activities sponsored by the U.S. Department of Energy (DOE) and the U.S. Agency for International Development (AID). The DOE project includes village PV power demonstration projects in Gabon (four sites) and the Marshall Islands, PV-powered medical refrigerators in six countries, PV system microprocessor control development activities and PV-hybrid system assessments. The AID project includes a large village system in Tunisia, a water pumping/grain grinding project in Upper Volta, five medical clinics in four countries, PV-powered remote earth station application. These PV activities and summarizes significant findings to data are reviewed.

  14. Integral type small PWR with stand-alone safety

    International Nuclear Information System (INIS)

    Makihara, Yoshiaki

    2001-01-01

    A feasibility study is achieved on an integral type small PWR with stand-alone safety. It is designed to have the following features. (1) The coolant does not leak out at any accidental condition. (2) The fuel failure does never occur while it is supposed on the large scale PWR at the design base accident. (3) At any accidental condition the safety is secured without any support from the outside (stand-alone safety secure). (4) It has self-regulating characteristics and easy controllability. The above features can be satisfied by integrate the steam generator and CRDM in the reactor vessel while the pipe line break has to be considered on the conventional PWR. Several counter measures are planned to satisfy the above features. The economy feature is also attained by several simplifications such as (1) elimination of main coolant piping and pressurizer by the integration of primary cooling system and self-pressurizing, (2) elimination of RCP by application of natural circulating system, (3) elimination of ECCS and accumulator by application of static safety system, (4) large scale volume reduction of the container vessel by application of integrated primary cooling system, (5) elimination of boric acid treatment by deletion of chemical shim. The long operation period such as 10 years can be attained by the application of Gd fuel in one batch refueling. The construction period can be shortened by the standardizing the design and the introduction of modular component system. Furthermore the applicability of the reduced modulation core is also considered. (K. Tsuchihashi)

  15. Posterior lumbar interbody fusion (PLIF) with cages and local bone graft in the treatment of spinal stenosis.

    Science.gov (United States)

    Trouillier, Hans; Birkenmaier, Christof; Rauch, Alexander; Weiler, Christoph; Kauschke, Thomas; Refior, Hans Jürgen

    2006-08-01

    Posterior lumbar interbody fusion (PLIF) implants are increasingly being used for 360 degrees fusion after decompression of lumbar spinal stenosis combined with degenerative instability. Both titanium and PEEK (PolyEtherEtherKetone) implants are commonly used. Assessing the clinical and radiological results as well as typical complications, such as migration of the cages, is important. In addition, questions such as which radiological parameters can be used to assess successful fusion, and whether the exclusive use of local bone graft is sufficient, are frequently debated. We prospectively evaluated 30 patients after PLIF instrumentation for degenerative lumbar spinal canal stenosis, over a course of 42 months. In all cases, titanium cages and local bone graft were used for spondylodesis. The follow-up protocol of these 30 cases included standardised clinical and radiological evaluation at 3, 6, 12 and 42 months after surgery. Overall satisfactory results were achieved. With one exception, a stable result was achieved with restoration of the intervertebral space in the anterior column. After 42 months of follow-up in most cases, a radiologically visible loss of disc space height can be demonstrated. Clinically relevant migration of the cage in the dorsal direction was detected in one case. Based on our experience, posterior lumbar interbody fusion (PLIF) can be recommended for the treatment of monosegmental and bisegmental spinal stenosis, with or without segmental instability. Postoperative evaluation is mainly based on clinical parameters since the titanium implant affects the diagnostic value of imaging studies and is responsible for artefacts. The results observed in our group of patients suggest that local autologous bone graft procured from the posterior elements after decompression is an adequate material for bone grafting in this procedure.

  16. Bony ingrowth potential of 3D printed porous titanium alloy: a direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model.

    Science.gov (United States)

    McGilvray, Kirk; Easley, Jeremiah; Seim, Howard B; Regan, Daniel; Berven, Sigurd H; Hsu, Wellington K; Mroz, Thomas E; Puttlitz, Christian M

    2018-02-26

    There is significant variability in the materials commonly used for interbody cages in spine surgery. It is theorized that 3-D printed interbody cages utilizing porous titanium material can provide more consistent bone ingrowth and biological fixation. The purpose of this study was to provide an evidence-based approach to decision making regarding interbody materials for spinal fusion. Comparative animal study. A skeletally mature ovine lumbar fusion model was utilized for this study. Interbody fusions were performed at (L2-L3 and L4-L5) in 27 mature sheep using three different interbody cages (i.e., polyetheretherketone [PEEK], plasma sprayed porous titanium coated PEEK [PSP], and 3-D printed porous titanium alloy cage [PTA]). Non-destructive kinematic testing was performed in the three primary directions of motion. The specimens were then analyzed using micro-computed tomography (µCT); quantitative measures of the bony fusion were performed. Histomorphometric analyses were also performed in the sagittal plane through the interbody device. Outcome parameters were compared between cage designs and time-points. Flexion-extension range of motion (ROM) was statistically reduced for the PTA group as compared to the PEEK cages at 16 weeks (p-value = 0.02). Only the PTA cages demonstrated a statistically significant decrease in ROM and increase in stiffness across all three loading directions between the 8-week and 16-week sacrifice time-points (p-value ≤ 0.01). Micro-CT data demonstrated significantly greater total bone volume within the graft window for the PTA cages at both 8-weeks and 16-weeks compared to the PEEK cages (p-value < 0.01). A direct comparison of interbody implants demonstrates significant and measurable differences in biomechanical, µCT, and histologic performance in an ovine model. The 3-D printed porous titanium interbody cage resulted in statistically significant reductions in ROM, increases in the bone ingrowth profile, as well as average

  17. Kinematic efficacy of supplemental anterior lumbar interbody fusion at lumbosacral levels in thoracolumbosacral deformity correction with and without pedicle subtraction osteotomy at L3

    DEFF Research Database (Denmark)

    Dahl, Benny T; Harris, Jonathan A; Gudipally, Manasa

    2017-01-01

    of operative construction (p ≤ 0.05). Across L4-S1 and L2-S1, all instrumented constructs significantly reduced motion, in both PSO- and non-PSO groups, during all loading modes (p ≤ 0.05). CONCLUSIONS: These findings suggest anterior interbody fusion minimally immobilizes motion segments, and interbody...... devices may primarily act to maintain disc height. Additionally, lumbar osteotomy destabilizes axial rotational stability at the osteotomy site, potentially further increasing mechanical demand on posterior instrumentation. Clinical studies are needed to assess the impact of this treatment strategy....

  18. Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients.

    Science.gov (United States)

    Wang, Michael Y; Lerner, Jason; Lesko, James; McGirt, Matthew J

    2012-08-01

    Retrospective multi-institutional database review. To determine if minimally invasive interbody fusion is associated with cost savings when compared with open surgery. Minimally invasive spine (MIS) surgeries are increasingly recognized as equivalent to open procedures. Although these techniques have been advocated for reducing pain, disability, and length of hospitalization, to date there has been little data demonstrating these benefits. This study analyzed inpatient hospital records from the Premier Perspective database (2002 to 2009), including patients who underwent a posterior lumbar fusion with interbody cage placement by ICD-9 code, and had implant charge codes that allowed determination if MIS pedicle screws were utilized. Exclusion criteria included a refusion surgery, deformity, >2 levels, and anterior fusion. Total costs were adjusted for covariates (age, sex, race, hospital geography and setting, payor, and comorbidities) using an analysis of covariance model. A total of 6106 patients were identified (1667 MIS and 4439 open). Length of stay (LOS) for 1-level MIS surgery averaged of 3.35 days versus 3.6 days for open surgery (P≤0.006). For 2-level MIS surgery LOS averaged of 3.4 days versus 4.03 days for open surgery (P≤0.001). Total inflation-adjusted acute hospitalization cost averaged $29,187 for 1-level MIS procedures versus $29,947 for open surgery, a nonsignificant difference (P=0.55). Total inflation-adjusted acute hospitalization cost averaged $2106 lower for 2-level MIS surgery (total costs of $33,879 for MIS vs. $35,984 for open surgery, P=0.0023). Cost savings were attributable primarily to lower room and board ($857), operating room ($359), pharmacy ($304), and laboratory ($166) costs in the MIS group. High variances in the 2-level open surgery with prolonged hospital stay also accounted for overall cost differences. This data from a large nationwide sample of hospitalizations demonstrates that MIS lumbar interbody fusion results in a

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

    Science.gov (United States)

    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

  20. Minimally invasive lateral lumbar interbody fusion and transpsoas approach-related morbidity.

    Science.gov (United States)

    Moller, David J; Slimack, Nicholas P; Acosta, Frank L; Koski, Tyler R; Fessler, Richard G; Liu, John C

    2011-10-01

    Recently, the minimally invasive, lateral retroperitoneal, transpsoas approach to the thoracolumbar spinal column has been described by various authors. This is known as the minimally invasive lateral lumbar interbody fusion. The purpose of this study is to elucidate the approach-related morbidity associated with the minimally invasive transpsoas approach to the lumbar spine. To date, there have been only a couple of reports regarding the morbidity of the transpsoas muscle approach. A nonrandomized, prospective study utilizing a self-reported patient questionnaire was conducted between January 2006 and June 2008 at Northwestern University. Data were collected in 53 patients with a follow-up period ranging from 6 months to 3.5 years. Only 2 patients were lost to follow-up. Thirty-six percent (19 of 53) of patients reported subjective hip flexor weakness, 25% (13 of 53) anterior thigh numbness, and 23% (12 of 53) anterior thigh pain. However, 84% of the 19 patients reported complete resolution of their subjective hip flexor weakness by 6 months, and most experienced improved strength by 8 weeks. Of those reporting anterior thigh numbness and pain, 69% and 75% improved to their baseline function by the 6-month follow-up evaluations, respectively. All patients with self-reported subjective hip flexor weakness underwent examinations during subsequent clinic visits after surgery; however, these examinations did not confirm a motor deficit less than Grade 5. Subset analysis showed that the L3-4 and L4-5 levels were most often affected. The minimally invasive, transpsoas muscle approach to the lumbar spine has a number of advantages. The data show that a percentage of the patients undergoing the transpsoas approach will have temporary sensory and motor symptoms related to this approach. The majority of the symptoms are thought to be related to psoas muscle inflammation and/or stretch injury to the genitofemoral nerve due to the surgical corridor traversed during the

  1. Do intraoperative radiographs predict final lumbar sagittal alignment following single-level transforaminal lumbar interbody fusion?

    Science.gov (United States)

    Salem, Khalid M I; Eranki, Aditya P; Paquette, Scott; Boyd, Michael; Street, John; Kwon, Brian K; Fisher, Charles G; Dvorak, Marcel F

    2018-02-16

    OBJECTIVE The study aimed to determine if the intraoperative segmental lordosis (as calculated on a cross-table lateral radiograph following a single-level transforaminal lumbar interbody fusion [TLIF] for degenerative spondylolisthesis/low-grade isthmic spondylolisthesis) is maintained at discharge and at 6 months postsurgery. METHODS The authors reviewed images and medical records of patients ≥ 16 years of age with a diagnosis of an isolated single-level, low-grade spondylolisthesis (degenerative or isthmic) with symptomatic spinal stenosis treated between January 2008 and April 2014. Age, sex, surgical level, surgical approach, and facetectomy (unilateral vs bilateral) were recorded. Upright standardized preoperative, early, and 6-month postoperative radiographs, as well as intraoperative lateral radiographs, were analyzed for the pelvic incidence, segmental lumbar lordosis (SLL) at the TILF level, and total LL (TLL). In addition, the anteroposterior position of the cage in the disc space was documented. Data are presented as the mean ± SD; a p value level using a bullet-shaped cage. A bilateral facetectomy was performed in 17 patients (20.2%), and 89.3% of procedures were done at the L4-5 and L5-S1 segments. SLL significantly improved intraoperatively from 15.8° ± 7.5° to 20.9° ± 7.7°, but the correction was lost after ambulation. Compared with preoperative values, at 6 months the change in SLL was modest at 1.8° ± 6.7° (p = 0.025), whereas TLL increased by 4.3° ± 9.6° (p level of surgery, and use of a bilateral facetectomy did not significantly affect postoperative LL. CONCLUSIONS Following a single-level TLIF procedure using a bullet-shaped cage, the intraoperative improvement in SLL is largely lost after ambulation. The improvement in TLL over time is probably due to the decompression part of the procedure. The approach, level of surgery, bilateral facetectomy, and position of the cage do not seem to have a significant effect on LL achieved

  2. Ceramic granules enhanced with B2A peptide for lumbar interbody spine fusion: an experimental study using an instrumented model in sheep.

    Science.gov (United States)

    Cunningham, Bryan W; Atkinson, Brent L; Hu, Nianbin; Kikkawa, Jun; Jenis, Louis; Bryant, Joseph; Zamora, Paul O; McAfee, Paul C

    2009-04-01

    New generations of devices for spinal interbody fusion are expected to arise from the combined use of bioactive peptides and porous implants. The purpose of this dose-ranging study was to evaluate the fusion characteristics of porous ceramic granules (CGs) coated with the bioactive peptide B2A2-K-NS (B2A) by using a model of instrumented lumbar interbody spinal fusion in sheep. Instrumented spinal arthrodesis was performed in 40 operative sites in 20 adult sheep. In each animal, posterior instrumentation (pedicle screw and rod) and a polyetheretherketone cage were placed in 2 single-level procedures (L2-3 and L4-5). All cages were packed with graft material prior to implantation. The graft materials were prepared by mixing (1:1 vol/vol) CGs with or without a B2A coating and morselized autograft. Ceramic granules were coated with B2A at 50, 100, 300, and 600 microg/ml granules (50-B2A/CG, 100-B2A/CG, 300-B2A/CG, and 600-B2A/CG, respectively), resulting in 4 B2A-coated groups plus a control group (uncoated CGs). Graft material from each of these groups was implanted in 8 operative sites. Four months after arthrodesis, interbody fusion status was assessed with CT, and the interbody site was further evaluated with quantitative histomorphometry. All B2A/CG groups had higher CT-confirmed interbody fusion rates compared with those in controls (CGs only). Seven of 8 sites were fused in the 50-B2A/CG, 100-B2A/CG, and 300-B2A/CG groups, whereas 5 of 8 sites were fused in the group that had received uncoated CGs. New woven and lamellar bone spanned the fusion sites with excellent osseointegration. There was no heterotopic ossification or other untoward events attributed to the use of B2A/CG in any group. Each B2A/CG treatment produced more new bone than that in the CG group. Bioactive treatment with B2A effectively enhanced the fusion capacity of porous CGs. These findings suggest that B2A/CG may well represent a new generation of biomaterials for lumbar interbody fusion and

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

    Science.gov (United States)

    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 (pFinancial analysis demonstrated lower total hospital direct

  4. The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; A double-blind randomised multicenter study

    NARCIS (Netherlands)

    M.P. Arts (Mark); R. Brand (René); B.W. Koes (Bart); W.C. Peul (Wilco); M.E. van den Akker-van Marle (Elske)

    2010-01-01

    textabstractBackground. Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is

  5. The Stand-alone Heliostat; El Heliostato Autonomo

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Navajas, G.; Egea Gea, A. [Ciemat. Madrid (Spain)

    2000-07-01

    The first Autonomous Heliostat has been developed by CIEMAT at PSA facilities in Almeria. This heliostat is an innovative approach to reducing the civil engineering work costs in heliostat fields of central tower plants. Channels, cables and other electric elements have been eliminated in the new heliostat. Thus, one 70-m''2, classical T glass/metal heliostat has been adapted to include all the new stand-alone concept components. A PV system is able to drive two sun-tracking DC motors between 5 and 24 Vdc, 0 and 15A. The heliostat communicates with the control room 400-m away by using a radio-modern working at 9600 baud. An anemometer, a wind switcher, light and ambient temperature sensors have been installed on the heliostat for self-protection decision-making. A PV panel integrated into the heliostat reflecting surface, eliminates cabling and other elements required for a conventional power supply. Communication lines between master control and local control have been replaced by radio-modern. Testing has validated the technical feasibility of the prototype and quantified the real consumption and efficiencies of new elements. The extra costs produced by the autonomous concepts are compared with the cost of civil work in conventional heliostat field. (Author) 8 refs.

  6. Improving efficiency of a regional stand alone bone bank.

    Science.gov (United States)

    Warnock, Jonathan M; Rowan, Clare H; Davidson, Helen; Millar, Ciara; McAlinden, M Gavan

    2016-03-01

    The introduction of a stand-alone Bone Bank in our Regional Orthopaedic Hospital has improved the availability of femoral head allograft. Benninger et al. (Bone Joint J 96-B:1307-1311, 2014), demonstrated their institutions bank to be cost effective despite a 30 % discard rate for harvested allograft. We sought to audit our own discard rates and subsequent cost-effectiveness of our bone bank. Donor recruitment. Before approaching a potential donor, our establishment's nurse specialists review their clinical notes and biochemical laboratory results, available on a regional Electronic Care Records. They view femoral head architecture on radiographs against set criteria, Patient Archive and Communication system (SECTRA, Sweden). In total 1383 femoral heads were harvested, 247 were discarded giving an overall rate of 17.9 %. The most common reasons for discard of harvested graft was a positive microbiology/bacteriology result, n = 96 (38.9 %). After a rise in discard rates in 2007, we have steadily reduced our discard rates since 2006/2007 (28.2 %), 2008/2009 (17 %), 2010/2011 (14.8 %), and finally to 10.3 % in 2012/2013. In the current financial year, our cost to harvest, test, store and release a femoral head is £ 610. With a structured donor recruitment process and unique pre-operative radiographic analysis we have successfully reduced our discard rates bi-annually making our bone bank increasingly cost-effective.

  7. A control strategy for PV stand-alone applications

    Science.gov (United States)

    Slouma, S.; Baccar, H.

    2015-04-01

    This paper proposes a stand-alone photovoltaic (PV) system study in domestic applications. Because of the decrease in power of photovoltaic module as a consequence of changes in solar radiation and temperature which affect the photovoltaic module performance, the design and control of DC-DC buck converter was proposed for providing power to the load from a photovoltaic source.In fact, the control of this converter is carried out with integrated MPPT (Maximum Power Point Tracking) algorithm which ensures a maximum energy generated by the PV arrays. Moreover, the output stage is composed by a battery energy storage system, dc-ac inverter, LCL filter which enables higher efficiency, low distortion ac waveforms and low leakage currents. The control strategy adopted is cascade control composed by two regulation loops.Simulations performed with PSIM software were able to validate the control system.The realization and testing of the photovoltaic system were achieved in the Photovoltaic laboratory of the Centre for Research and Energy Technologies at the Technopark Borj Cedria. Experimental results verify the effeciency of the proposed system.

  8. Overpowering posterior lumbar instrumentation and fusion with hyperlordotic anterior lumbar interbody cages followed by posterior revision: a preliminary feasibility study.

    Science.gov (United States)

    Kadam, Abhijeet; Wigner, Nathan; Saville, Philip; Arlet, Vincent

    2017-12-01

    OBJECTIVE The authors' aim in this study was to evaluate whether sagittal plane correction can be obtained from the front by overpowering previous posterior instrumentation and/or fusion with hyperlordotic anterior lumbar interbody fusion (ALIF) cages in patients undergoing revision surgery for degenerative spinal conditions and/or spinal deformities. METHODS The authors report their experience with the application of hyperlordotic cages at 36 lumbar levels for ALIFs in a series of 20 patients who underwent revision spinal surgery at a single institution. Included patients underwent staged front-back procedures: ALIFs with hyperlordotic cages (12°, 20°, and 30°) followed by removal of posterior instrumentation and reinstrumentation from the back. Patients were divided into the following 2 groups depending on the extent of posterior instrumentation and fusion during the second stage: long constructs (≥ 6 levels with extension into thoracic spine and/or pelvis) and short constructs (lumbar lordosis increased from 44.3° to 59.8° (p lumbar levels that have pseudarthrosis from the previous posterior spinal fusion. Meticulous selection of levels for ALIF is crucial for safely and effectively performing this technique.

  9. Single-Level Lateral Lumbar Interbody Fusion for the Treatment of Adjacent Segment Disease: A Retrospective Two-Center Study.

    Science.gov (United States)

    Aichmair, Alexander; Alimi, Marjan; Hughes, Alexander P; Sama, Andrew A; Du, Jerry Y; Härtl, Roger; Burket, Jayme C; Lampe, Lukas P; Cammisa, Frank P; Girardi, Federico P

    2017-05-01

    A retrospective case series. The aim of this study was to assess the postoperative outcome after single-level lateral lumbar interbody fusion (LLIF) for adjacent segment disease (ASD). Although there is a plethora of literature on ASD following traditional arthrodesis techniques, literature on ASD following LLIF is limited. Vice versa, the surgical outcome after LLIF for the treatment of ASD remains to be elucidated. Patients who underwent single-level LLIF for ASD at two institutions (March 2006-April 2012) were included, and the medical records, operative reports, radiographic imaging studies, and office records reviewed. Out of 523 LLIF patients, 52 met the inclusion criteria, and were postoperatively followed for 16.1 ± 9.8 months (range: 5-44). When comparing the pre-operative data with both the first and most recent follow-up postoperatively, LLIF resulted in a reduction in back pain (P fusion rate in patients who underwent circumferential fusion than the standalone subgroup (87.5% vs. 53.8%; P = 0.173). LLIF may be an effective surgical treatment option for ASD with regard to both the clinical and radiographic outcome in a large proportion of cases. Although standalone LLIF is associated with a narrower spectrum of adverse effects than circumferential fusion, posterior instrumentation may be necessary to increase segmental stability. 4.

  10. Effect of Smoking Status on Successful Arthrodesis, Clinical Outcome, and Complications After Anterior Lumbar Interbody Fusion (ALIF).

    Science.gov (United States)

    Phan, Kevin; Fadhil, Matthew; Chang, Nicholas; Giang, Gloria; Gragnaniello, Cristian; Mobbs, Ralph J

    2018-02-01

    Anterior lumbar interbody fusion (ALIF) is a surgical technique indicated for the treatment of several lumbar pathologies. Smoking has been suggested as a possible cause of reduced fusion rates after ALIF, although the literature regarding the impact of smoking status on lumbar spine surgery is not well established. This study aims to assess the impact of perioperative smoking status on the rates of perioperative complications, fusion, and adverse clinical outcomes in patients undergoing ALIF surgery. A retrospective analysis was performed on a prospectively maintained database of 137 patients, all of whom underwent ALIF surgery by the same primary spine surgeon. Smoking status was defined by the presence of active smoking in the 2 weeks before the procedure. Outcome measures included fusion rates, surgical complications, Short-Form 12, and Oswestry Disability Index. Patients were separated into nonsmokers (n = 114) and smokers (n = 23). Univariate analysis demonstrated that the percentage of patients with successful fusion differed significantly between the groups (69.6% vs. 85.1%, P = 0.006). Pseudarthrosis rates were shown to be significantly associated with perioperative smoking. Results for other postoperative complications and clinical outcomes were similar for both groups. On multivariate analysis, the rate of failed fusion was significantly greater for smokers than nonsmokers (odds ratio 37.10, P = 0.002). The rate of successful fusion after ALIF surgery was found to be significantly lower for smokers compared with nonsmokers. No significant association was found between smoking status and other perioperative complications or adverse clinical outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. THE LONG-TERM RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH ISTHMIC SPONDYLOLISTHESIS USING ANTERIOR LUMBAR INTERBODY FUSION

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    V. M. Shapovalov

    2012-01-01

    Full Text Available The authors analyzed the long-term results of surgical treatment 47 patients with true spondylolisthesis. The follow up period ranged from 14 to 25 years. All patients underwent an isolated anterior interbody riving allograft fusion. The scales of VAS and ODI were used for subjective assessment of treatment outcomes; objective assessment was based on clinical and radiographic, CT and MRI outcomes. There were 42.6% (20 cases patients with good, 31.9% (15 cases with satisfactory and 25.5% (12 cases unsatisfactory results in the long-term follow-up. The main reasons of poor outcome were: the continued high degree of displacement of the vertebral body (17.6%, instability (38.3% and the disbalance of the lumbosacral spine (63.8%, persistent compression of neural structures (42.6%. Most patients had the combination of these factors that were existed against backdrop of progressive degenerative changes of the spine.

  12. Lateral lumbar interbody fusion for the correction of spondylolisthesis and adult degenerative scoliosis in high-risk patients: early radiographic results and complications.

    Science.gov (United States)

    Waddell, Brad; Briski, David; Qadir, Rabah; Godoy, Gustavo; Houston, Allison Howard; Rudman, Ernest; Zavatsky, Joseph

    2014-01-01

    Lateral lumbar interbody fusion (LLIF) is not associated with many of the complications seen in other interbody fusion techniques. This study used computed tomography (CT) scans, the radiographic gold standard, to assess interbody fusion rates achieved utilizing the LLIF technique in high-risk patients. We performed a retrospective review of patients who underwent LLIF between January 2008 and July 2013. Forty-nine patients underwent nonstaged or staged LLIF on 119 levels with posterior correction and augmentation. Per protocol, patients received CT scans at their 1-year follow-up. Of the 49 patients, 21 patients with LLIF intervention on 54 levels met inclusion criteria. Two board-certified musculoskeletal radiologists and the senior surgeon (JZ) assessed fusion. Of the 21 patients, 6 patients had had previous lumbar surgery, and the cohort's comorbidities included osteoporosis, diabetes, obesity, and smoking, among others. Postoperative complications occurred in 12 (57.1%) patients and included anterior thigh pain and weakness in 6 patients, all of which resolved by 6 months. Two cases of proximal junctional kyphosis occurred, along with 1 case of hardware pullout. Two cases of abdominal atonia occurred. By CT scan assessment, each radiologist found fusion was achieved in 53 of 54 levels (98%). The radiologists' findings were in agreement with the senior surgeon. Several studies have evaluated LLIF fusion and reported fusion rates between 88%-96%. Our results demonstrate high fusion rates using this technique, despite multiple comorbidities in the patient population. Spanning the ring apophysis with large LLIF cages along with supplemental posterior pedicle screw augmentation can enhance stability of the fusion segment and increase fusion rates.

  13. One-Level Lumbar Degenerative Spondylolisthesis and Posterior Approach: Is Transforaminal Lateral Interbody Fusion Mandatory?: A Randomized Controlled Trial With 2-Year Follow-Up.

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    Challier, Vincent; Boissiere, Louis; Obeid, Ibrahim; Vital, Jean-Marc; Castelain, Jean-Etienne; Bénard, Antoine; Ong, Nathalie; Ghailane, Soufiane; Pointillart, Vincent; Mazas, Simon; Mariey, Rémi; Gille, Olivier

    2017-04-15

    A monocentric open-label randomized controlled trial (MRCT). Comparison of clinical and radiological outcomes between isolated instrumented posterior fusion (PLF) and associated instrumented posterior fusion and interbody fusion by transforaminal approach (PLF + TLIF) for patients suffering from one-level lumbar degenerative spondylolisthesis (DS) undergoing surgery. DS is a common cause of symptomatic lumbar stenosis. PLF has shown better clinical outcome than decompression with noninstrumented posterolateral fusion. TLIF with interbody cage showed better fusion rate than PLF. There is a need for randomized controlled trials to compare PLF with and without TLIF as to clinical and radiological outcomes. This is a MRCT comparing PLF and TLIF techniques in surgical treatment of DS. Sixty patients were included in a secured database from 2009 to 2011 and randomized into two groups: 30 PLF with posterior pedicle screws and intertransverse autologuous graft, and 30 TLIF in which an interbody fusion by transforaminal approach was added. Data included clinical (pain and disability), surgical (blood loss and operating time), and radiological (alignment and fusion) parameters at baseline and 2-year follow-up. Comparison was made by Student t test and Chi-square test. There was a significant improvement in each group for pain and disability but no difference between the groups. Radiographic assessment showed better posterolateral fusion rate for TLIF without superiority in segmental lordosis improvement. A case of deformity cascade with spino-pelvic mismatch at baseline was noted in PLF. Posterior decompression and instrumented fusion is an efficient technique that proved its significant clinical benefit in the surgical treatment of DS. TLIF did not show its superiority neither in clinical nor alignment parameters despite a better fusion rate. These results suggest that TLIF is not mandatory in this specific indication. Sagittal alignment analysis by standing full

  14. Spondylectomy and lateral lumbar interbody fusion for thoracolumbar kyphosis in an adult with achondroplasia: A case report.

    Science.gov (United States)

    Miyazaki, Masashi; Kanezaki, Shozo; Notani, Naoki; Ishihara, Toshinobu; Tsumura, Hiroshi

    2017-12-01

    Fixed thoracolumbar kyphosis with spinal stenosis in adult patients with achondroplasia presents a challenging issue. We describe the first case in which spondylectomy and minimally invasive lateral access interbody arthrodesis were used for the treatment of fixed severe thoracolumbar kyphosis and lumbar spinal canal stenosis in an adult with achondroplasia. A 61-year-old man with a history of achondroplastic dwarfism presented with low back pain and radiculopathy and neurogenic claudication. Plain radiographs revealed a high-grade thoracolumbar kyphotic deformity with diffuse degenerative changes in the lumbar spine. The apex was located at L2, the local kyphotic angle from L1 to L3 was 105°, and the anterior area was fused from the L1 to L3 vertebrae. MRI revealed significant canal and lateral recess stenosis secondary to facet hypertrophy. We planned a front-back correction of the anterior and posterior spinal elements. We first performed anterior release at the fused part from L1 to L3 and XLIF at L3/4 and L4/5. Next, the patient was placed in the prone position. Spondylectomy at the L2 vertebra and posterior fusion from T10 to L5 were performed. Postoperative radiographs revealed L1 to L3 kyphosis of 32°. No complications occurred during or after surgery. Postoperatively, the patient's low back pain and neurological claudication were resolved. No worsening of kyphosis was observed 24 months postoperatively. Circumferential decompression of the spinal cord at the apical vertebral level and decompression of lumbar canal stenosis were necessary. Front-back correction of the anterior and posterior spinal elements via spondylectomy and lateral lumbar interbody fusion is a reasonable surgical option for thoracolumbar kyphosis and developmental canal stenosis in patients with achondroplasia.

  15. Preliminary results of anterior lumbar interbody fusion, anterior column realignment for the treatment of sagittal malalignment.

    Science.gov (United States)

    Hosseini, Pooria; Mundis, Gregory M; Eastlack, Robert K; Bagheri, Ramin; Vargas, Enrique; Tran, Stacie; Akbarnia, Behrooz A

    2017-12-01

    OBJECTIVE Sagittal malalignment decreases patients' quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column realignment (ALIF ACR) has been introduced as an alternative for correction of sagittal deformity. The objective of this paper was to report clinical and radiographic results for patients treated using the ALIF-ACR technique. METHODS A retrospective study of 39 patients treated with ALIF ACR was performed. Patient demographics, operative details, radiographic parameters, neurological assessments, outcome measures, and preoperative, postoperative, and mean 1-year follow-up complications were studied. RESULTS The patient population comprised 39 patients (27 females and 12 males) with a mean follow-up of 13.3 ± 4.7 months, mean age of 66.1 ± 11.6 years, and mean body mass index of 27.3 ± 6.2 kg/m 2 . The mean number of ALIF levels treated was 1.5 ± 0.5. Thirty-three (84.6%) of 39 patients underwent posterior spinal fixation and 33 (84.6%) of 39 underwent posterior column osteotomy, of which 20 (60.6%) of 33 procedures were performed at the level of the ALIF ACR. Pelvic tilt, sacral slope, and pelvic incidence were not statistically significantly different between the preoperative and postoperative periods and between the preoperative and 1-year follow-up periods (except for PT between the preoperative and 1-year follow-up, p = 0.018). Sagittal vertical axis, T-1 spinopelvic inclination, lumbar lordosis, pelvic incidence-lumbar lordosis mismatch, intradiscal angle, and motion segment angle all improved from the preoperative to postoperative period and the preoperative to 1-year follow-up (p < 0.05). The changes in motion segment angle and intradiscal angle achieved in the ALIF-ACR group without osteotomy compared with the ALIF-ACR group with osteotomy

  16. Treatment of degenerative lumbar spondylolisthesis by using minimally invasive transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation

    Directory of Open Access Journals (Sweden)

    Hao WU

    2016-04-01

    Full Text Available Objective To discuss clinical therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF combined with percutaneous pedicle screw fixation for degenerative lumbar spondylolisthesis (DLS.  Methods A total of 32 DLS patients treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University were retrospectively reviewed. Visual Analogue Scale (VAS, Oswestry Disability Index (ODI and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36 scores were assessed and compared between preoperation and one week, 3 months after operation and in the last follow-up. Lumbar lordosis angle, coronal Cobb angle, coronal and sagittal body shifting, complication, the degree of spondylolisthesis (Meyerding classification and the rate of spondylolisthesis were measured according to preoperative and postoperative spinal X-ray examination. Fusion rate was evaluated according to X-rays or CT in the last follow-up, and MRI was used to assess the degree of decompression.  Results Thirty-two patients were under test with mean operation time 160 min, intraoperative blood loss 120 ml, postoperative hospital stay 7.22 d and follow-up 10.83 months. Decompression and fusion levels ranged from L2-S1 and interbody fusion was performed in 32 patients and 41 levels were fused. Compared with preoperation, the VAS and ODI scores were significantly increased at one week, 3 months after operation and in the last follow-up (P = 0.000, for all, while SF-36 score (P = 0.002, 0.000, 0.000, lumbar lordotic angle (P = 0.000, for all, coronal Cobb angle (P = 0.000, for all and slippage rate (P = 0.000, for all were significantly decreased. The fusion rate was 92.22%, and the improvement rate of ODI was (80.51 ± 6.02% in the last follow-up. There were 3 cases appeared complications, including one case of infection and 2 cases of cerebrospinal fluid (CSF fistula, and were

  17. 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.

    Science.gov (United States)

    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.

  18. Diffuse idiopathic skeletal hyperostosis (DISH) is a risk factor for further surgery in short-segment lumbar interbody fusion.

    Science.gov (United States)

    Otsuki, Bungo; Fujibayashi, Shunsuke; Takemoto, Mitsuru; Kimura, Hiroaki; Shimizu, Takayoshi; Matsuda, Shuichi

    2015-11-01

    To elucidate the effect of diffuse idiopathic skeletal hyperostosis (DISH) on the clinical results of short-segment lumbar interbody fusion (LIF) for the treatment of degenerative lumbar spinal diseases. The 208 patients who underwent one- or two-level LIF were selected as the subjects of this study. Patients with prior lumbar fusion surgery or follow-up adjacent segment disease (ASD). The Cox proportional-hazards model was used to identify possible risk factors (DISH, age, sex, number of levels fused, level of the lowest instrumented vertebra, and laminectomy adjacent to the index fused levels) for further surgery. Among the 208 patients (39 with DISH), 21 patients required further surgery during follow-up. Cox analysis showed that DISH (hazard ratio = 5.46) and two-level fusion (hazard ratio = 2.83) were significant independent predictors of further surgery. Age, sex, level of the lowest instrumented vertebra, and laminectomy adjacent to the index fused levels were not significant predictors. DISH after short-segment LIF surgery is a significant risk factor for further surgery because of pseudoarthrosis or ASD.

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

    Directory of Open Access Journals (Sweden)

    Won-Suh Choi

    2016-01-01

    Full Text Available 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.

  20. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study

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    Chung Sung-Soo

    2011-04-01

    Full Text Available Abstract Background Comparatively little is known about the relation between the sagittal vertical axis and clinical outcome in cases of degenerative lumbar spondylolisthesis. The objective of this study was to determine whether lumbar sagittal balance affects clinical outcomes after posterior interbody fusion. This series suggests that consideration of sagittal balance during posterior interbody fusion for degenerative spondylolisthesis can yield high levels of patient satisfaction and restore spinal balance Methods A retrospective study of clinical outcomes and a radiological review was performed on 18 patients with one or two level degenerative spondylolisthesis. Patients were divided into two groups: the patients without improvement in pelvic tilt, postoperatively (Group A; n = 10 and the patients with improvement in pelvic tilt postoperatively (Group B; n = 8. Pre- and postoperative clinical outcome surveys were administered to determine Visual Analogue Pain Scores (VAS and Oswestry disability index (ODI. In addition, we evaluated full spine radiographic films for pelvic tilt (PT, sacral slope (SS, pelvic incidence (PI, thoracic kyphosis (TK, lumbar lordosis (LL, sacrofemoral distance (SFD, and sacro C7 plumb line distance (SC7D Results All 18 patients underwent surgery principally for the relief of radicular leg pain and back pain. In groups A and B, mean preoperative VAS were 6.85 and 6.81, respectively, and these improved to 3.20 and 1.63 at last follow-up. Mean preoperative ODI were 43.2 and 50.4, respectively, and these improved to 23.6 and 18.9 at last follow-up. In spinopelvic parameters, no significant difference was found between preoperative and follow up variables except PT in Group A. However, significant difference was found between the preoperative and follows up values of PT, SS, TK, LL, and SFD/SC7D in Group B. Between parameters of group A and B, there is borderline significance on preoperative PT, preoperative LL and last

  1. Clinico-radiological profile of indirect neural decompression using cage or auto graft as interbody construct in posterior lumbar interbody fusion in spondylolisthesis: Which is better?

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    Q R Abdul

    2011-01-01

    Full Text Available Study design: A prospective clinical study of posterior lumbar interbody fusion in grade I and II degenerative spondylolisthesis was conducted between Mar 2007 and Aug 2008. Purpose: The objective was to assess the clinicoradiological profile of structural v/s nonstructural graft on intervertebral disc height and its consequences on the low back pain (LBP assessed by Visual analog score (VAS score and oswestry disability index (ODI . This study involved 28 patients. Inclusion criteria: Age of 30-70 years, symptomatic patient with disturbed Activities of daily living (ADL, single-level L4/L5 or L5/S1 grade I or grade II degenerative spondylolisthesis. Exclusion criteria: Patients with osteoporosis, recent spondylodiscitis, subchondral sclerosis, visual and cognitive impairment and all other types of spondylolisthesis. All the patients underwent short-segment posterior fixation using CD2 or M8 instrumentation, laminectomy discectomy, reduction and distraction of the involved vertebral space. In 53.5% (n = 15 of the patients, snugly fitted local bone chips were used while in 46.4% (n = 13 of the patients, cage was used. Among the cage group, titanium cage was used in nine (32.1% and PEEK cages were used in four (14.2% patients. In one patient, a unilateral PEEK cage was used. The mean follow-up period was 24 months. Among the 28 patients, 67.8% (n = 19 were females and 32.14% (n = 9 were males. 68.24% (n = 18 had L4/L5 and 35.71% (n = 10 had L5/S1 spondylolisthesis. 39.28% (n = 11 were of grade I and 60.71% (n = 17 were of grade II spondylolisthesis. Conclusions: There was a statistically significant correlation (P < 0.012 and P < 0.027 between the change in disc height achieved and the improvement in VAS score in both the graft group and the cage group. The increment in disc height and VAS score was significantly better in the cage group (2 mm ± SD vis-a-vis 7.2 [88%] than the graft group (1.2 mm ± SD vis-a-vis 5 [62 %].

  2. A protocol of a randomized controlled multicenter trial for surgical treatment of lumbar spondylolisthesis: the Lumbar Interbody Fusion Trial (LIFT).

    Science.gov (United States)

    de Kunder, Suzanne L; Rijkers, Kim; van Kuijk, Sander M J; Evers, Silvia M A A; de Bie, Rob A; van Santbrink, Henk

    2016-10-06

    With a steep increase in the number of instrumented spinal fusion procedures, there is a need for comparative data to develop evidence based treatment recommendations. Currently, the available data on cost and clinical effectiveness of the two most frequently performed surgeries for lumbar spondylolisthesis, transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF), are not sufficient. Therefore, current guidelines do not advise which is the most appropriate surgical treatment strategy for these patients. Non-randomized studies comparing TLIF and PLIF moreover suggest that TLIF is associated with fewer complications, less blood loss, shorter surgical time and hospital duration. TLIF may therefore be more cost-effective. The results of this study will provide knowledge on short- and long-term clinical and economical effects of TLIF and PLIF procedures, which will lead to recommendations for treating patients with lumbar spondylolisthesis. Multicenter blinded Randomized Controlled Trial (RCT; blinding for the patient and statistician, not for the clinician and researcher). A total of 144 patients over 18 years old with symptomatic single level lumbar degenerative, isthmic or iatrogenic spondylolisthesis whom are candidates for LIF (lumbar interbody fusion) surgery through a posterior approach will be randomly allocated to TLIF or PLIF. The study will consist of three parts: 1) a clinical effectiveness study, 2) a cost-effectiveness study, and 3) a process evaluation. The primary clinical outcome measures are: change in disability measured with Oswestry Disability Index (ODI) and change in quality adjusted life years (QALY) measured with EQ-5D-5L. Secondary clinical outcome measures are: Short Form (36) Health Survey (SF-36), VAS back pain, VAS leg pain, Hospital Anxiety Depression Scale (HADS), complications, productivity related costs (iPCQ) and medical costs (iMCQ). Measurements will be carried out at five fixed time points (pre

  3. Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF) for Spondylolisthesis in 282 Patients: In Situ Arthrodesis versus Reduction.

    Science.gov (United States)

    Scheer, Justin K; Auffinger, Brenda; Wong, Ricky H; Lam, Sandi K; Lawton, Cort D; Nixon, Alexander T; Dahdaleh, Nader S; Smith, Zachary A; Fessler, Richard G

    2015-07-01

    The benefits of spondylolisthesis reduction via minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) remain poorly understood. The purpose was to compare the complications, perioperative factors, and fusion rates in patients undergoing MI-TLIF for degenerative spondylolisthesis between those in whom reduction was or was not performed. 1) patients who underwent a 1, 2, or 3 level MI-TLIF and 2) had a preoperative diagnosis of degenerative spondylolisthesis (Meyerding grade >0). >10° coronal curves, significant sagittal malalignment, infection, and preoperative hardware failure. Patients were grouped on the basis of those who underwent reduction of the spondylolisthesis by at least 1 Meyerding grade (RED) and those who did not (NORED). A total of 282 patients were included: RED (162, 57.4%) and NORED (120, 42.6%). Mean ages (61.68 ± 10.43 vs. 61.88 ± 11.76 years, respectively, P > 0.05) and operative times (P > 0.05) were statistically similar. RED had a significantly larger EBL (280.2 ± 24.03 vs. 212.61 ± 17.54, P 0.05, for all). RED had a significantly higher percentage of patients with a successful fusion at 1 year than NORED (84.50% vs. 70.83%, P spondylolisthesis was not associated with an increase in operative time, length of stay, and perioperative and postoperative complications compared with fusion in situ. Reduction was associated with higher blood loss but also a higher rate of fusion success at 1 year. Overall, reduction did not incur additional risk and had positive perioperative outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Comparison of Topping-off and posterior lumbar interbody fusion surgery in lumbar degenerative disease: a retrospective study.

    Science.gov (United States)

    Liu, Hai-ying; Zhou, Jian; Wang, Bo; Wang, Hui-min; Jin, Zhao-hui; Zhu, Zhen-qi; Miao, Ke-nan

    2012-11-01

    Topping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration. There are few reports on Topping-off surgery and its rationality and indications remains highly controversial. Our study aims to investigate the short-term and mid-term clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration existed before surgery. The 25 cases that underwent L5-S1 posterior lumbar interbody fusion (PLIF) + L4-L5 interspinous process surgeries between April 2008 and March 2010 formed Topping-off group. The 42 cases undergoing L5-S1 PLIF surgery formed PLIF group. Both groups matched in gender, age, body mass index and Pfirrmann grading (4 to 6). The patients were evaluated with visual analogue scale (VAS) and Japanese orthopaedic association (JOA) scores before surgery and in the last follow-up. Modic changes of endplates were recorded. The follow-up averaged 24.8 and 23.7 months. No symptomatic or radiological adjacent segment degeneration was observed. There was no significant difference in intraoperative blood loss or postoperative drainage. VAS and lumbar JOA scores improved significantly in both groups (t = 12.1 and 13.5, P adjacent segment degeneration, restrict the adjacent segment's ROM in extension and prevent excessive olisthesis of adjacent segment in both extension and flexion.

  5. Stand-alone wind system with Vanadium Redox Battery energy storage

    DEFF Research Database (Denmark)

    Teodorescu, Remus; Barote, L.; Weissbach, R.

    2008-01-01

    Energy storage devices are required for power balance and power quality in stand alone wind energy systems. A Vanadium Redox Flow Battery (VRB) system has many features which make its integration with a stand-alone wind energy system attractive. This paper proposes the integration of a VRB system...

  6. Integrated Three-Port DC-DC Converter for Photovoltaic (PV) Battery Stand-alone Systems

    DEFF Research Database (Denmark)

    Ouyang, Ziwei; Andersen, Michael A. E.

    2016-01-01

    Several power sources such as PV solar arrays and battery are often used to manage the power flow for a photovoltaic (PV) based stand-alone power system due to the fluctuation nature of solar energy resource, and deliver a continuous power to the users in an appropriate form. Traditionally, three...... for PV and battery stand-alone system....

  7. 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

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    Mohammad Reza Etemadifar

    2016-01-01

    Full Text Available 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

  8. Late Results of Anterior Cervical Discectomy and Fusion with Interbody Cages

    OpenAIRE

    Da?l?, Murat; Er, Uygur; ?im?ek, Serkan; Bavbek, Murad

    2013-01-01

    Study Design Retrospective analysis. Purpose To evaluate the effectiveness of anterior cervical discectomy with fusion for degenerative cervical disc disease. Overview of Literature Anterior spinal surgery originated in the mid-1950s and graft for fusion was also employed. Currently anterior cervical microdiscectomy and fusion with an intervertebral cage is a widely accepted procedure for treatment of cervical disc hernia. Artificial grafts and cages for fusion are preferred because of their ...

  9. Influence of Obesity on Complications, Clinical Outcome, and Subsidence After Anterior Lumbar Interbody Fusion (ALIF): Prospective Observational Study.

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    Phan, Kevin; Rogers, Priya; Rao, Prashanth J; Mobbs, Ralph J

    2017-11-01

    The complications associated with obesity have been well described for posterior lumbar spinal surgery. However, the influence of obesity on anterior lumbar interbody fusion (ALIF) is not well established. We aimed to compare complication risks, functional outcomes, and subsidence rates in normal-weight, overweight, and obese patients who underwent ALIF. A total of 137 consecutive patients undergoing ALIF surgery from 2012 to 2014 were followed prospectively. Patients were categorized into 3 groups according to their body mass index (BMI). Patients were evaluated preoperative and postoperatively. Outcome measures included Short Form-12, Oswestry Disability Index, surgical complications, and subsidence. There was no significant difference between the BMI groups in terms of baseline age, proportion of men, levels operated, smoking status, diabetes status, or anterior, posterior, or average disc height. There was no difference in operative duration, blood loss, or hospital stay. At 12-month follow-up, no difference was found in terms of total complications, change in Short Form-12 mental or physical component scores, or Oswestry Disability Index scores. Average disc height was significant lower for the obese group (11.3 mm) compared with the normal-weight (14.4 mm) group. Fusion rate was also significantly lower for patients who were obese (60%) compared with normal-weight (88.2%) and overweight patients (76%) (P = 0.014). Delayed subsidence rates also were similar between normal-weight and overweight patients. There were no differences in functional outcomes or complications in patients with elevated BMI compared with normal-weight patients. Fusion rates were lower for patients were obese. Obesity should not be considered a contraindication to surgery in patients with appropriate indication to undergo ALIF. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Two-level anterior lumbar interbody fusion with percutaneous pedicle screw fixation. A minimum 3-year follow-up study

    International Nuclear Information System (INIS)

    Lee, Dong-Yeob; Lee, Sang-Ho; Maeng, Dae-Hyeon

    2010-01-01

    The clinical and radiological outcomes of two-level anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PSF) were evaluated in 24 consecutive patients who underwent two level ALIF with percutaneous PSF for segmental instability and were followed up for more than 3 years. Clinical outcomes were assessed using a visual analogue scale (VAS) score and the Oswestry Disability Index (ODI). Sagittal alignment, bone union, and adjacent segment degeneration (ASD) were assessed using radiography and magnetic resonance imaging. The mean age of the patients at the time of operation was 56.3 years (range 39-70 years). Minor complications occurred in 2 patients in the perioperative period. At a mean follow-up duration of 39.4 months (range 36-42 months), VAS scores for back pain and leg pain, and ODI score decreased significantly (from 6.5, 6.8, and 46.9% to 3.0, 1.9, and 16.3%, respectively). Clinical success was achieved in 22 of the 24 patients. The mean segmental lordosis, whole lumbar lordosis, and sacral tilt significantly increased after surgery (from 25.1deg, 39.2deg, and 32.6deg to 32.9deg, 44.5deg, and 36.6deg, respectively). Solid fusion was achieved in 21 patients. ASD was found in 8 of the 24 patients. No patient underwent revision surgery due to nonunion or ASD. Two-level ALIF with percutaneous PSF yielded satisfactory clinical and radiological outcomes and could be a useful alternative to posterior fusion surgery. (author)

  11. Percutaneous pedicle screw reduction and axial presacral lumbar interbody fusion for treatment of lumbosacral spondylolisthesis: A case series

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    Miller Larry E

    2011-09-01

    Full Text Available Abstract Introduction Traditional surgical management of lumbosacral spondylolisthesis is technically challenging and is associated with significant complications. The advent of minimally invasive surgical techniques offers patients treatment alternatives with lower operative morbidity risk. The combination of percutaneous pedicle screw reduction and an axial presacral approach for lumbosacral discectomy and fusion offers an alternative procedure for the surgical management of low-grade lumbosacral spondylolisthesis. Case presentation Three patients who had L5-S1 grade 2 spondylolisthesis and who presented with axial pain and lumbar radiculopathy were treated with a minimally invasive surgical technique. The patients-a 51-year-old woman and two men (ages 46 and 50-were Caucasian. Under fluoroscopic guidance, spondylolisthesis was reduced with a percutaneous pedicle screw system, resulting in interspace distraction. Then, an axial presacral approach with the AxiaLIF System (TranS1, Inc., Wilmington, NC, USA was used to perform the discectomy and anterior fixation. Once the axial rod was engaged in the L5 vertebral body, further distraction of the spinal interspace was made possible by partially loosening the pedicle screw caps, advancing the AxiaLIF rod to its final position in the vertebrae, and retightening the screw caps. The operative time ranged from 173 to 323 minutes, and blood loss was minimal (50 mL. Indirect foraminal decompression and adequate fixation were achieved in all cases. All patients were ambulatory after surgery and reported relief from pain and resolution of radicular symptoms. No perioperative complications were reported, and patients were discharged in two to three days. Fusion was demonstrated radiographically in all patients at one-year follow-up. Conclusions Percutaneous pedicle screw reduction combined with axial presacral lumbar interbody fusion offers a promising and minimally invasive alternative for the management

  12. Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion: A finite element analysis.

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    Zhao, Xin; Du, Lin; Xie, Youzhuan; Zhao, Jie

    2018-02-21

    Here we used a finite element (FE) analysis to investigate the biomechanical changes caused by transforaminal lumbar interbody fusion (TLIF) at the L4-L5 level by lumbar lordosis (LL) degree. A lumbar FE model (L1-S5) was constructed based on computed tomography scans of a 30-year-old healthy male volunteer (pelvic incidence = 50°, LL = 52°). We investigated the influence of LL on the biomechanical behavior of the lumbar spine after TLIF in L4-L5 fusion models with 57°, 52°, 47°, and 40° LL. The LL was defined as the angle between the superior endplate of L1 and the superior endplate of S1. A 150-N vertical axial pre-load was imposed on the superior surface of L3. A 10-N·m moment was simultaneously applied on the L3 superior surface along the radial direction to simulate the four basic physiological motions of flexion, extension, lateral bending, and torsion in the numerical simulations. The range of motion (ROM) and intradiscal pressure (IDP) of L3-L4 were evaluated and compared in the simulated cases. In all motion patterns, the ROM and IDP were both increased after TLIF. In addition, the decrease in lordosis generally increased the ROM and IDP in all motion patterns. The current FE analysis indicated that decreased spinal lordosis may evoke overstress of the adjacent segment and increase the risk of the pathological development of adjacent segment degeneration (ASD); thus, ASD should be considered when planning a spinal fusion procedure. Copyright © 2018. Published by Elsevier Inc.

  13. Single-level lumbar pyogenic spondylodiscitis treated with mini-open anterior debridement and fusion in combination with posterior percutaneous fixation via a modified anterior lumbar interbody fusion approach.

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    Lin, Yang; Li, Feng; Chen, Wenjian; Zeng, Heng; Chen, Anmin; Xiong, Wei

    2015-12-01

    This study evaluated the efficacy and safety of mini-open anterior debridement and lumbar interbody fusion in combination with posterior percutaneous fixation for single-level lumbar pyogenic spondylodiscitis. This is a retrospective study. Twenty-two patients with single-level lumbar pyogenic spondylodiscitis underwent mini-open anterior debridement and lumbar interbody fusion in combination with posterior percutaneous fixation via a modified anterior lumbar interbody fusion (ALIF) approach. Patients underwent follow-up for 24 to 38 months. Clinical data, etiological examinations, operative time, intraoperative blood loss, American Spinal Injury Association (ASIA) grade, Japanese Orthopaedic Association (JOA) lumbar function score, visual analog scale (VAS) score, Oswestry Disability Index (ODI), postoperative complications, and the bony fusion rate were recorded. The mean operative time was 181.1 ± 22.6 minutes (range 155-240 minutes). The mean intraoperative blood loss was 173.2 ± 70.1 ml (range 100-400 ml). Infection was found in lumbar vertebrae L2-3, L3-4, and L4-5 in 2, 6, and 14 patients, respectively. Bacterial cultures were positive in 15 patients, including 4 with Staphylococcus aureus, 6 with Staphylococcus epidermidis, 4 with Streptococcus, and 1 with Escherichia coli. Postoperative complications included urinary retention, constipation, and numbness in the thigh in 5, 3, and 2 patients, respectively. Compared with before surgery, the VAS scores and ODI were significantly lower at the final follow-up, the JOA scores were significantly higher, and the ASIA grades had improved. All patients achieved good intervertebral bony fusion. Mini-open anterior debridement and lumbar interbody fusion in combination with posterior percutaneous fixation via a modified ALIF approach results in little surgical trauma and intraoperative blood loss, acceptable postoperative complications, and is effective and safe for the treatment of single-level lumbar pyogenic

  14. Long-term outcomes of transforaminal lumbar interbody fusion in patients with spinal stenosis and degenerative scoliosis.

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    Kurra, Swamy; Lavelle, William F; Silverstein, Michael P; Savage, Jason W; Orr, R Douglas

    2017-11-22

    Patients with spinal deformity may present with complaints related to either the deformity itself or the manifestations of the coexisting spinal stenosis. There are reports of successful management of lumbar pathology in the absence of global sagittal or coronal imbalance, with limited decompression and fusion, addressing only the symptomatic segment. Our study examined the long-term outcomes of transforaminal lumbar interbody fusion (TLIF), a less extensive procedure, based on the experience of the senior author over the past 10 years. This was a retrospective study of symptomatic lumbar spinal stenosis and spinal deformity managed by one surgeon at The Cleveland Clinic since 2003. Forty-one patients were included in the study. The present study measures the long-term clinical functional outcomes of these patients through EQ-5D (EuroQol five dimensions questionnaire), PHQ-9 (Patient Health Questionnaire), and PDQ (Pain Disability Questionnaire) forms, along with documented radiographic parameters and Charlson Comorbidity Index (CCI). There were no funding or potential conflicts of interest associated biases in the present study. Patients with symptomatic lumbar spinal stenosis with neutral global alignment in the sagittal and coronal planes and symptomatic stenosis at the deformity level were treated by limited fusion and TLIF, and had a follow-up period of at least 5 years. Excluded were patients under 18 years of age, had more than three levels of fusion, and had an active spinal malignancy or recent spinal trauma. The grouping variables were curve magnitude, revision surgeries, and TLIF levels. Clinical outcomes were compared in all the grouping variables. Analysis of variance (ANOVA) and chi-square tests were utilized; pfusion, in the setting of modest spinal deformity, is a reasonable and safe option. Further study on the concept of short segment fusions in the growing patient population is required as more comprehensive fusions do have noted complication

  15. Characterization of a novel caudal vertebral interbody fusion in a rat tail model: An implication for future material and mechanical testing.

    Science.gov (United States)

    Yeh, Yu-Cheng; Yang, Cheng-Chun; Tai, Ching-Lung; Tsai, Tsung-Ting; Lai, Po-Liang; Fu, Tsai-Sheng; Niu, Chi-Chien; Chen, Lih-Huei; Chen, Wen-Jer

    2017-02-01

    Of the proposed animal interbody fusion models, rat caudal discs have gained popularity in disc research due to their strong resemblance to human discs with respect to geometry, composition and mechanical properties. The purpose of this study is to demonstrate an efficient, repeatable and easily accessible animal model of interbody fusion for future research into mechanical testing and graft materials. Twelve 12-week-old female Sprague-Dawley (SD) rats underwent caudal interbody fusion of the third and fourth coccygeal vertebrae of the tail. Serial radiological evaluation, and histological evaluation and manual palpation after sacrifice were performed to assess the fusion quality. Mechanical testing of functional units (FUs) of non-operated and operated segments was compared using a three-point bending test. At postoperative 12 weeks, callus formation was observed at the fusion sites in all rats, with the mean radiological evaluations of 2.75/3 according to the Bransford classification. Newly formed bone tissue was also observed in all rats with the mean histological score of 5.85/7, according to the Emery grading system. No palpable gaps and obvious change of bending stiffness was observed in the operated segments. The mean bending stiffness of the FUs was statistically higher than that of the control FUs (26.57 ± 6.71 N/mm vs. 12.45 ± 3.21 N/mm, p materials under conditions of osteoporosis using this model would be worthwhile. Copyright © 2017 Chang Gung University. Published by Elsevier B.V. All rights reserved.

  16. Symptomatic ectopic bone formation after off-label use of recombinant human bone morphogenetic protein-2 in transforaminal lumbar interbody fusion.

    Science.gov (United States)

    Chen, Nan-Fu; Smith, Zachary A; Stiner, Eric; Armin, Sean; Sheikh, Hormoz; Khoo, Larry T

    2010-01-01

    Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been approved for use in the lumbar spine in conjunction with the lumbar tapered cage. However, off-label use of this osteoinductive agent is observed with anterior fusion applications as well as with both posterior lumbar interbody fusion and transforaminal lumbar interbody fusion (TLIF). Complications using rhBMP-2 in the cervical spine have been reported. Although radiographic evidence of ectopic bone in the lumbar spine has been described following rhBMP-2 use, this finding was not previously believed to be of clinical relevance. This study was a retrospective review of 4 patients who underwent minimally invasive spinal TLIF (MIS-TLIF) in which bone fusion was augmented with rhBMP-2 applied to an absorbable collagen sponge. Case presentations, operative findings, imaging data, and follow-up findings were reviewed. Four cases with delayed symptomatic neural compression following the off-label use of rhBMP-2 with MIS-TLIF were identified. Although previously believed to be only a radiographic finding, the development of ectopic bone following rhBMP-2 use in lumbar fusion can be clinically significant. This paper describes 4 cases of delayed neural compression following MIS-TLIF. The reader should be aware of this potential complication following the off-label use of rhBMP-2 in the lumbar spine.

  17. Clinical study on minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis

    Directory of Open Access Journals (Sweden)

    Hao WU

    2016-04-01

    Full Text Available Objective To discuss the operative essentials and therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis (DLS.  Methods A total of 17 DLS patients without prior spinal diseases were treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University. The operation time, intraoperative blood loss, hospital stay, and postoperative complication were recorded in each patient. Visual Analogue Scale (VAS and Oswestry Disability Index (ODI were used to evaluate postoperative improvement of low back and leg pain, and clinical effects were assessed according to Medical Outcome Study 36-Item Short-Form Health Survey (SF-36. Coronal Cobb angle, sagittal lordosis angle and spinal deviation distances on coronal and sagittal plane were measured before operation, one week, 3 months after operation and in the last follow-up in spinal full-length X-ray examination. Fusion rate was calculated according to X-ray or CT scan, and the degree of decompression was evaluated by MRI.  Results Decompression and fusion levels ranged from T12-S1 vertebrae, and interbody fusion was performed in 17 patients and 56 levels were fused. Average operation time was 200 min (180-300 min, intraoperative blood loss was 320 ml (200-1000 ml and hospital stay was 8.21 d (5-12 d. All patients were followed-up for 12.13 months (5-24 months. Compared with preoperation, VAS (P = 0.000, for all and ODI scores (P = 0.000, for all decreased significantly, SF-36 score increased (P = 0.000, for all, coronal Cobb angle (P = 0.000, for all, sagittal lordosis angle (P = 0.000, for all, coronal and sagittal deviation (P = 0.000, for all decreased significantly one week and 3 months after operation and in the last follow-up. The improvement rate of ODI was (86.51 ± 6.02%, fusion rate of vertebral bodies

  18. Use of stand-alone anchored intervertebral cage in the surgical treatment of patients with symptomatic cervical spondylosis

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    Tilen Žele

    2015-03-01

    Full Text Available Background:One of the most common surgical operations for treatment of cervical spondylosis is anterior cervical discectomy with fusion (ACDF. In order to achieve stable fusion after discectomy and avoid dysphagia the artificial stand-alone zero-profile cages with integrated screws were developed and introduced into clinical practice. Outcome and complications after ACDF with such cages were not adequately assessed yet.Methods:We analyzed 20 consecutive patients with cervical spondylosis treated in our institution with ACDF with stand-alone zero-profile cage Zero-P. Before and after surgery and then 6, 12 and 24 months after surgery we assessed the level of pain with VAS scale, severity of myelopathy with mJOA scale and dysphagia with four level scale. Treatment outcome was assessed after 2 years according to Odom's criteria.Results:No complications occurred during surgery or recovery after surgery. The VAS score after surgery and then after 6, 12 and 24 months was statistically significantly lower than before surgery (p<0.05. The mJOA scores were 6, 12 and 24 months after surgery statistically significantly higher than before surgery (p<0.05. Transient and mild dysphagia was present after surgery in 15% (3/20 of patients and 6, 12 or 24 months after surgery in none. Outcome after 2 years was excellent in 9 patients and good in 11 patients.Conclusions:Operative treatment of symptomatic cervical spondylosis with ACDF using stand-alone zero-profile cage with integrated screws is safe and efficient. Incidence of dysphagia after surgery is low and generally transient.

  19. Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases.

    Science.gov (United States)

    Liu, Fubing; Jiang, Chun; Cao, Yuanwu; Jiang, Xiaoxing; Feng, Zhenzhou

    2014-07-01

    Transforaminal lumbar interbody fusion (TLIF) has been used in lumbar degenerative diseases. Some researchers have applied unilateral fixation in TLIF to reduce operational trauma without compromising the clinical outcome, but it is always suspected biomechanically unstable. The supplementary contralateral translaminar facet screw (cTLFS) seemed to be able to overcome the inherent drawbacks of unilateral pedicle screw (uPS) fixation theoretically. This study evaluates the safety, feasibility and efficacy of TLIF using uPS with cTLFS fixation in the treatment of lumbar degenerative diseases (LDD). 50 patients (29 male) underwent the aforementioned surgical technique for their LDD between December 2009 and April 2012. The results were evaluated based on visual analogue scale (VAS) of the leg and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were recorded. The radiographic examinations in form of X-ray, computed tomography (CT) or magnetic resonance imaging was done preoperatively and 1 week, 3 months, 6 months, 12 months and 24 months postoperatively. The student t-test was used for comparison between the preoperative values and postoperative counterparts. P degenerative diseases short termly.

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

    Science.gov (United States)

    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.

  1. Subsidence of Cylindrical Cage (AMSLU™ Cage) : Postoperative 1 Year Follow-up of the Cervical Anterior Interbody Fusion

    Science.gov (United States)

    Joung, Young Il; Ko, Yong; Yi, Hyeong Joong; Lee, Seung Ku

    2007-01-01

    Objective There are numerous reports on the primary stabilizing effects of the different cervical cages for cervical radiculopathy. But, little is known about the subsidence which may be clinical problem postoperatively. The goal of this study is to evaluate subsidence of cage and investigate the correlation between radiologic subsidence and clinical outcome. Methods To assess possible subsidence, the authors investigated clinical and radiological results of the one-hundred patients who underwent anterior cervical fusion by using AMSLU™ cage during the period between January 2003 and June 2005. Preoperative and postoperative lateral radiographs were measured for height of intervertebral disc space where cages were placed. Intervertebral disc space was measured by dividing the sum of anterior, posterior, and midpoint interbody distance by 3. Follow-up time was 6 to 12 months. Subsidence was defined as any change in at least one of our parameters of at least 3 mm. Results Subsidence was found in 22 patients (22%). The mean value of subsidence was 2.21 mm, and mean subsidence rate was 22%. There were no cases of the clinical status deterioration during the follow-up period. No posterior or anterior migration was observed. Conclusion The phenomenon of subsidence is seen in substantial number of patients. Nevertheless, clinical and radiological results of the surgery were favorable. An excessive subsidence may result in hardware failure. Endplate preservation may enables us to control subsidence and reduce the number of complications. PMID:19096571

  2. Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis.

    Science.gov (United States)

    Huang, Yun-Peng; Du, Cheng-Fei; Cheng, Cheng-Kung; Zhong, Zheng-Cheng; Chen, Xuan-Wei; Wu, Gui; Li, Zhe-Cheng; Ye, Jin-Duo; Lin, Jian-Hua; Wang, Li Zhen

    2016-01-01

    To investigate the biomechanical effects of the lumbar posterior complex on the adjacent segments after posterior lumbar interbody fusion (PLIF) surgeries. A finite element model of the L1-S1 segment was modified to simulate PLIF with total laminectomy (PLIF-LAM) and PLIF with hemilaminectomy (PLIF-HEMI) procedures. The models were subjected to a 400N follower load with a 7.5-N.m moment of flexion, extension, torsion, and lateral bending. The range of motion (ROM), intradiscal pressure (IDP), and ligament force were compared. In Flexion, the ROM, IDP and ligament force of posterior longitudinal ligament, intertransverse ligament, and capsular ligament remarkably increased at the proximal adjacent segment in the PLIF-LAM model, and slightly increased in the PLIF-HEMI model. There was almost no difference for the ROM, IDP and ligament force at L5-S1 level between the two PLIF models although the ligament forces of ligamenta flava remarkably increased compared with the intact lumbar spine (INT) model. For the other loading conditions, these two models almost showed no difference in ROM, IDP and ligament force on the adjacent discs. Preserved posterior complex acts as the posterior tension band during PLIF surgery and results in less ROM, IDP and ligament forces on the proximal adjacent segment in flexion. Preserving the posterior complex during decompression can be effective on preventing adjacent segment degeneration (ASD) following PLIF surgeries.

  3. Posterior lumbar interbody fusion with instrumented posterolateral fusion in adult spondylolisthesis: description and association of clinico-surgical variables with prognosis in a series of 36 cases

    Science.gov (United States)

    Gomez-Moreta, Juan A.; Hernandez-Vicente, Javier

    2015-01-01

    Background We present our experience in the treatment of patients with isthmic or degenerative spondylolisthesis, by means of a posterior lumbar interbody fusion (PLIF) and instrumented posterolateral fusion (IPLF), and we compare them with those published in the literature. We analyse whether there exists any statistical association between the clinical characteristics of the patient, radiological characteristics of the disease and our surgical technique, with the complications and the clinical-radiological prognosis of the cases. Method We designed a prospective study. A total of 36 cases were operated. The patients included were 14 men and 22 women, with an average age of 57.17±27.32 years. Our technique consists of PLIF+IPLF, using local bone for the fusion. The clinical results were evaluated with the Visual Analogical Scale (VAS) and the Kirkaldy-Willis criteria. The radiological evaluation followed the Bratingan (PLIF) and Lenke (IPLF) methodology. A total of 42 variables were statistically analysed by means of SPSS18. We used the Paired Student's T-test, logistic regression and Pearson's Chi-square-test. Results The spondylolisthesis was isthmic in 15 cases and degenerative in 21 cases. The postoperative evaluations had excellent or good results in 94.5% (n = 34), with a statistically significant improvement in the back pain and sciatica (p spondylolisthesis, isthmic or degenerative, refractory to conservative treatment, for the obtaining the best clinical results and rates of fusion, with similar risks to those of the other published techniques. Our statistical analysis could contribute to improve outcomes after surgery. PMID:26196029

  4. Outcomes of oblique lateral interbody fusion for degenerative lumbar disease in patients under or over 65 years of age.

    Science.gov (United States)

    Jin, Chengzhen; Jaiswal, Milin S; Jeun, Sin-Soo; Ryu, Kyeong-Sik; Hur, Jung-Woo; Kim, Jin-Sung

    2018-02-20

    Oblique lateral interbody fusion (OLIF) offers the solution to problems of anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF). However, OLIF technique for degenerative spinal diseases of elderly patients has been rarely reported. The objective of this study was to determine the clinical and radiological results of OLIF technique for degenerative spinal diseases in patients under or over 65 years of age. Sixty-three patients who underwent OLIF procedure were enrolled, including 29 patients who were less than 65 years of age and 34 patients who were over 65 years of age. Fusion rate, change of disc height and lumbar lordotic angle, Numeric Rating Scale (NRS), return to daily activity, patient's satisfaction rate (PSR), and Oswestry disability index (ODI) were used to assess clinical and functional outcomes. The mean NRS scores for back and leg pain decreased, respectively, from 4.6 and 5.9 to 2.3 and 1.8 in the group A (less than 65 years) and from 4.5 and 6.8 to 2.6 and 2.2 in the group B (over 65 years) at the final follow-up period. The mean ODI scores improved from 48.4 to 24.0% in the group A and from 46.5 to 25.2% in the group B at the final follow-up period. In both groups, the NRS and ODI scores significantly changed preoperatively to postoperatively (p degenerative lumbar diseases in elderly patients showed favorable clinical and radiological outcomes.

  5. Is Body Mass Index a Risk Factor for Revision Procedures After Minimally Invasive Transforaminal Lumbar Interbody Fusion?

    Science.gov (United States)

    Narain, Ankur S; Hijji, Fady Y; Bohl, Daniel D; Yom, Kelly H; Kudaravalli, Krishna T; Singh, Kern

    2018-02-01

    Retrospective cohort study. To determine if an association exists between body mass index (BMI) and the rate of revision surgery after single-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). MIS TLIF is an effective treatment for lumbar degenerative disease. Previous studies in the orthopedic literature have associated increased BMI with increased postoperative complications and need for revision. Few studies have evaluated the association between BMI and the risk for revision after minimally invasive spinal procedures. A surgical registry of patients who underwent a single-level MIS TLIF for degenerative pathology between 2005 and 2014 was reviewed. Patients were stratified based on BMI category: normal weight (BMIrevision fusion procedure within 2 years after MIS TLIF using multivariate Cox proportional hazards survival analysis modeling. In total, 274 patients were analyzed; of these, 52 (18.98%) were normal weight, 101 (36.86%) were overweight, 62 (22.63%) were obese I, and 59 (21.53%) were obese II-III. On multivariate Cox proportional hazards survival analysis modeling, BMI category was not associated with undergoing a revision procedure within 2 years after MIS TLIF (P=0.599). On multivariate analysis, younger age (P=0.004) was associated with increased risk of undergoing a revision after MIS TLIF. The results of this study suggest that increasing BMI is not a risk factor for undergoing a revision procedure after MIS TLIF. As such, patients with high BMI should be counseled regarding having similar rates of needing a revision procedure after MIS TLIF as those with lower BMI. Level IV.

  6. Lumbar spine stability after combined application of interspinous fastener and modified posterior lumbar interbody fusion: a biomechanical study.

    Science.gov (United States)

    Yu, Xiuchun; Zhu, Lei; Su, Qing

    2014-05-01

    Posterior lumbar interbody fusion (PLIF) and internal fixation are commonly performed for the treatment of lower back pain due to lumbar spinal degeneration. We have developed a novel interspinous fixation device, the interspinous fastener (ISF) for potential use in the surgical management of degenerative spinal disease. The aim of this study was to assess the in vitro biomechanical characteristics of calf lumbar spine specimens after ISF fixation with modified PLIF. Ten lumbar spine (L3-L6) specimens from ten fresh calf cadavers (8-10 weeks of age) were used. Each specimen underwent sequential testing for each of the following four groups: no instrumentation (INTACT); interspinous fusion device fixation + PLIF (ISF); unilateral pedicle screw and titanium rod fixation + PLIF (UPS); bilateral pedicle screw and titanium rod fixation + PLIF (BPS). Outcome measures included angular range of motion (ROM) during unloaded and loaded (8 Nm) flexion, extension, left bending, right bending, left torsion and right torsion. For all unloaded and loaded assessments, ROM was significantly higher in the INTACT group compared with all other groups (P < 0.05). Similarly, ROM was significantly higher in the UPS group (indicating decreased stability) compared with the ISF and BPS groups (P < 0.05). The only significant difference between the ISF and BPS groups was in the ROM with unloaded extension (higher in the BPS group, P = 0.006). We found that ISF fixation with PLIF of the lower lumbar spine provided biomechanical stability that was equivalent to that associated with bilateral pedicle screw/rod fixation with PLIF. The ISF shows potential as an alternative means of fixation in the surgical management of degenerative spinal disease.

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

    Science.gov (United States)

    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 (p0.05). 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

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

    Directory of Open Access Journals (Sweden)

    Xi Wang

    Full Text Available 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 (p0.05. 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.

  9. Trends Analysis of rhBMP Utilization in Single-Level Posterior Lumbar Interbody Fusion in the United States.

    Science.gov (United States)

    Lao, Lifeng; Cohen, Jeremiah R; Buser, Zorica; Brodke, Darrel S; Youssef, Jim A; Park, Jong-Beom; Yoon, S Tim; Wang, Jeffrey C; Meisel, Hans-Joerg

    2017-10-01

    Retrospective study. Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been widely used in spinal fusion surgery, but there is little information on rhBMP-2 utilization in single-level posterior lumbar interbody fusion (PLIF). The purpose of our study was to evaluate the trends and demographics of rhBMP-2 utilization in single-level PLIF. Patients who underwent single-level PLIF from 2005 to 2011 were identified by searching ICD-9 diagnosis and procedure codes in the PearlDiver Patient Records Database, a national database of orthopedic insurance records. The year of procedure, age, gender, and region of the United States were recorded for each patient. Results were reported for each variable as the incidence of procedures identified per 100 000 patients searched in the database. A total of 2735 patients had single-level PLIF. The average rate of single-level PLIF with rhBMP-2 maintained at a relatively stable level (28% to 31%) from 2005 to 2009, but decreased in 2010 (9.9%) and 2011 (11.8%). The overall incidence of single-level PLIF without rhBMP-2 (0.68 cases per 100 000 patients) was statistically higher ( P level PLIF with rhBMP-2 (0.21 cases per 100 000 patients). The average rate of single-level PLIF with rhBMP-2 utilization was the highest in West (30.1%), followed by Midwest (26.9%), South (20.5%), and Northeast (17.8%). The highest incidence of single-level PLIF with rhBMP-2 was observed in the age group level PLIF. There was a 3-fold increase in the rate of PLIF without rhBMP-2 compared to PLIF with rhBMP-2, with both procedures being mainly done in patients less than 65 years of age.

  10. Retrospective Study of Anterior Interbody Fusion Rates and Patient Outcomes of Using Mineralized Collagen and Bone Marrow Aspirate in Multilevel Adult Spinal Deformity Surgery.

    Science.gov (United States)

    Hostin, Richard; O'Brien, Michael; McCarthy, Ian; Bess, Shay; Gupta, Munish; Klineberg, Eric

    2016-10-01

    Retrospective, single-center analysis of multilevel anterior fusion rates and health-related quality-of-life outcomes of mineralized collagen and bone marrow aspirate (BMA) in anterior interbody fusion cages for spine fusion surgery. To determine the ability and effectiveness of mineralized collagen and BMA to achieve multilevel anterior spinal fusion in adult spinal deformity patients when placed in carbon fiber reinforced polymer cages. High rates of postoperative pain and nonunion can result from spine fusion procedures. Factors that affect the success of fusion include patient comorbidities, position of implant, and mechanical and biological deficiencies, as well as the choice of bone graft replacement. Analysis of radiographic images and health-related quality-of-life outcomes was performed for a consecutive series of 22 prospectively enrolled adult spinal deformity patients with 104 total anterior fusion levels. Fusions were graded by 3 blinded surgeons not involved in the operative procedure; each fusion was graded on a 1-4 scale based on fusion mass appearance. Levels with an average fusion grade of 1-2.4 were classified as fused; levels with an average grade >2.5 were classified as not fused. The mean patient age was 51.5 years (range, 38-61) with 21 females. A total of 95% of anterior operative levels were graded as fused based on flexion/extension and full-length biplane radiographs at 1 year. Computed tomography grading showed a reduced fusion rate at 87% overall. There was a statistically significant improvement in the Oswestry Disability Index and Scoliosis Research Society 22-item questionnaire scores at 1 and 2 years after index surgery. Fusion rates in multilevel anterior spinal fusion using mineralized collagen and BMA are relatively low compared with fusion rates of 95% or more reported in the existing literature on long fusions with bone morphogenetic protein.

  11. Radiation exposure during the lateral lumbar interbody fusion procedure and techniques to reduce radiation dosage.

    Science.gov (United States)

    Tatsumi, Robert L

    2012-01-01

    Fluoroscopy is widely used in spine surgery to assist with graft and hardware placement. Previous studies have not measured radiation exposure to a surgeon during minimally invasive lateral lumbar spine surgery for single-level discectomy and interbody cage insertion. This study was performed to model and measure radiation exposure to a surgeon during spine surgery using the direct lateral lumbar procedure. The study was performed using a mannequin substituting for the surgeon and a cadaver substituting for the patient. Radiation was measured with dosimeters attached to 6 locations on the mannequin using a OEC Medical Systems 9800 C-arm fluoroscope (OEC Medical Systems, Salt Lake City, Utah). Three different fluoroscopy setups were tested: a standard imaging setup, a standard setup using pulsed-mode fluoroscopy, and a reversed setup. The experiment was tested 5 times per setup, and the dosimeters' values were recorded. The highest amount of radiation exposure occurred when obtaining an anteroposterior view of the spine in the standard setup. Compared with the standard setup, the pulsed-mode setting decreased the radiation exposure to the mannequin by a factor of 6 times (P exposure to the mannequin by a factor of 6 times (P exposure to the eye level (P exposure. Radiation exposure to the surgeon can be greatly minimized by using either a pulsed imaging mode or the reversed setup. The reversed setup has the lowest amount of radiation exposure to the eye level.

  12. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

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    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.

  13. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

    Directory of Open Access Journals (Sweden)

    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.    

  14. Transforaminal lumbar interbody fusion versus instrumented posterolateral fusion In degenerative spondylolisthesis: An attempt to evaluate the superiority of one method over the other.

    Science.gov (United States)

    Ghasemi, Amir Abbas

    2016-11-01

    Various surgical procedures have been recommended for the treatment of degenerative spondylolisthesis,but Controversy still exists regarding the optimal surgical technique . In this study,we compared the clinical and radiologic outcome of the Transforaminal lumbar interbody fusion(TLIF) method with the Instrumented Posterolateral fusion(PLF) in these patients. The study population in this retrospective study consisted of 145 consecutive patients of degenerative spondylolisthesis who had undergone lumbar fusion in our institute between September 2010 and October 2013. The patients were divided into two treatment groups, where either instrumented PLF with pedicle screw(180° fusion) or TLIF procedure(360° fusion) was done. The follow-up was performed clinically using the Oswestry Disability Index (ODI), visual analogue scale (VAS)and global outcome. Outcome scores were assessed at 3, 6, 12, and 24 months after surgery. Radiographs were obtained postoperatively and at regular intervals for 24 months. Perioperative outcomes such as surgery time, blood loss, length of hospital stay and incidence of surgical complications were also recorded. 80 patients underwent TLIF procedure and 65 patients were included in the instrumented PLF group. There were no significant differences between the groups with respect to age,gender,Body Mass Index,smoking and comorbid conditions(p>0.05). No significant difference existed in Pre-operative VAS for back pain,VAS for leg pain and ODI between the two groups(p>0.05). There were no significant group differences in the operation level,hospital stay and surgical complications(all p>0.05). Blood loss, operation time and fusion success rate were significantly greater in the TLIF group than in the PLF group (all P<0.05). Significant differences between groups concerning VAS for back pain,ODI and Global outcome were present at final follow-up. There was no significant difference between the two groups with respect to VAS for leg pain. Our study

  15. The European multicenter trial on the safety and efficacy of guided oblique lumbar interbody fusion (GO-LIF

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    Birkenmaier Christof

    2010-09-01

    Full Text Available Abstract Background Because of the implant-related problems with pedicle screw-based spinal instrumentations, other types of fixation have been tried in spinal arthrodesis. One such technique is the direct trans-pedicular, trans-discal screw fixation, pioneered by Grob for spondylolisthesis. The newly developed GO-LIF procedure expands the scope of the Grob technique in several important ways and adds security by means of robotic-assisted navigation. This is the first clinical trial on the GO-LIF procedure and it will assess safety and efficacy. Methods/Design Multicentric prospective study with n = 40 patients to undergo single level instrumented spinal arthrodesis of the lumbar or the lumbosacral spine, based on a diagnosis of: painful disc degeneration, painful erosive osteochondrosis, segmental instability, recurrent disc herniation, spinal canal stenosis or foraminal stenosis. The primary target criteria with regards to safety are: The number, severity and cause of intra- and perioperative complications. The number of significant penetrations of the cortical layer of the vertebral body by the implant as recognized on postoperative CT. The primary target parameters with regards to feasibility are: Performance of the procedure according to the preoperative plan. The planned follow-up is 12 months and the following scores will be evaluated as secondary target parameters with regards to clinical improvement: VAS back pain, VAS leg pain, Oswestry Disability Index, short form - 12 health questionnaire and the Swiss spinal stenosis questionnaire for patients with spinal claudication. The secondary parameters with regards to construct stability are visible fusion or lack thereof and signs of implant loosening, implant migration or pseudarthrosis on plain and functional radiographs. Discussion This trial will for the first time assess the safety and efficacy of guided oblique lumbar interbody fusion. There is no control group, but the results, the

  16. Lateral lumbar interbody fusion with unilateral pedicle screw fixation for the treatment of adjacent segment disease: a preliminary report.

    Science.gov (United States)

    Du, Jerry Y; Kiely, Paul D; Al Maaieh, Motasem; Aichmair, Alexander; Huang, Russel C

    2017-09-01

    To assess the clinical outcomes of 20 patients who underwent single level unilateral pedicle screw fixation following lateral lumbar interbody fusion (LLIF) for treatment of lumbar adjacent segment disease (ASD). Demographic, comorbidity, clinical assessment, peri-operative, and complication data were assessed. Visual analog scale (VAS), Oswestry disability index (ODI), and short form-12 (SF-12) were used to assess clinical outcomes. Post-operative radiographs were assessed for subsidence, cage migration, and fusion. Average age of patients was 63.2±13.7 years (range, 41-86 years), with 8 males and 12 females. Recombinant human bone morphogenic protein-2 (rhBMP-2) was utilized in 18 LLIF cages (90%) and 12 posterolateral fusions (60%). Mean operation time was 214.1±47.2 minutes (range, 146-342 minutes), mean estimated blood loss of 187.5±90.1 cc (range, 50-400 cc). No patients received a blood transfusion. There were no intra-operative complications. Mean hospital length of stay was 4.4±1.7 days (range, 2-9 days). At final follow-up (mean: 13.0±12.7 months after surgery), there was significant improvement in post-op VAS (P=0.006) score compared to pre-op, but not ODI (P=0.181), SF-12 PC (P=0.480), and SF-12 MC (P=0.937). Patients with >6 months of post-operative imaging (14/20, 70%) demonstrated successful fusion in 13 out of 14 cases (93%). There was grade 0 subsidence of adjacent cranial vertebra in all cases (100%). There was grade 0 subsidence of the adjacent caudal vertebra in 13 cases (93%) and grade 1 subsidence in 1 case (7%). There was evidence of cage migration in 3 cases (21%). There were 4 patients (20%) who experienced transient neurological deficits that eventually resolved. Two patients required surgery for further ASD. In conclusion, this pilot study suggests that patients who undergo LLIF with unilateral pedicle screw fixation for treatment of ASD may have significantly reduced pain and favorable radiographic results. Further investigation in

  17. Lateral lumbar interbody fusion with unilateral pedicle screw fixation for the treatment of adjacent segment disease: a preliminary report

    Science.gov (United States)

    Kiely, Paul D.; Al Maaieh, Motasem; Aichmair, Alexander; Huang, Russel C.

    2017-01-01

    Background To assess the clinical outcomes of 20 patients who underwent single level unilateral pedicle screw fixation following lateral lumbar interbody fusion (LLIF) for treatment of lumbar adjacent segment disease (ASD). Methods Demographic, comorbidity, clinical assessment, peri-operative, and complication data were assessed. Visual analog scale (VAS), Oswestry disability index (ODI), and short form-12 (SF-12) were used to assess clinical outcomes. Post-operative radiographs were assessed for subsidence, cage migration, and fusion. Results Average age of patients was 63.2±13.7 years (range, 41–86 years), with 8 males and 12 females. Recombinant human bone morphogenic protein-2 (rhBMP-2) was utilized in 18 LLIF cages (90%) and 12 posterolateral fusions (60%). Mean operation time was 214.1±47.2 minutes (range, 146–342 minutes), mean estimated blood loss of 187.5±90.1 cc (range, 50–400 cc). No patients received a blood transfusion. There were no intra-operative complications. Mean hospital length of stay was 4.4±1.7 days (range, 2–9 days). At final follow-up (mean: 13.0±12.7 months after surgery), there was significant improvement in post-op VAS (P=0.006) score compared to pre-op, but not ODI (P=0.181), SF-12 PC (P=0.480), and SF-12 MC (P=0.937). Patients with >6 months of post-operative imaging (14/20, 70%) demonstrated successful fusion in 13 out of 14 cases (93%). There was grade 0 subsidence of adjacent cranial vertebra in all cases (100%). There was grade 0 subsidence of the adjacent caudal vertebra in 13 cases (93%) and grade 1 subsidence in 1 case (7%). There was evidence of cage migration in 3 cases (21%). There were 4 patients (20%) who experienced transient neurological deficits that eventually resolved. Two patients required surgery for further ASD. Conclusions In conclusion, this pilot study suggests that patients who undergo LLIF with unilateral pedicle screw fixation for treatment of ASD may have significantly reduced pain and favorable

  18. Radiologic Assessment of Subsidence in Stand-Alone Cervical Polyetheretherketone (PEEK) Cage.

    Science.gov (United States)

    Ha, Sung-Kon; Park, Jung-Yul; Kim, Se-Hoon; Lim, Dong-Jun; Kim, Sang-Dae; Lee, Sang-Kook

    2008-12-01

    Aim of study was to find a proper method for assessing subsidence using a radiologic measurement following anterior cervical discectomy and fusion (ACDF) with stand-alone polyetheretherketone (PEEK), Solistrade mark cage. Forty-two patients who underwent ACDF with Solistrade mark cage were selected. With a minimum follow-up of 6 months, the retrospective investigation was conducted for 37 levels in 32 patients. Mean follow-up period was 18.9 months. Total intervertebral height (TIH) of two fused vertebral bodies was measured on digital radiographs with built-in software. Degree of subsidence (DeltaTIH) was reflected by the difference between the immediate postoperative and follow-up TIH. Change of postoperative disc space height (CT-MRDeltaTIH) was reflected by the difference between TIH of the preoperative mid-sagittal 2D CT and that of the preoperative mid-sagittal T1-weighted MRI. Compared to preoperative findings, postoperative disc height was increased in all cases and subsidence was observed only in 3 cases. For comparison of subsidence and non-subsidence group, TIH and CT-MRDeltaTIH of each group were analyzed. There was no statistically significant difference in TIH and CT-MRDeltaTIH between each group at 4 and 8 weeks, but a difference was observed at the last follow-up TIH (p=0.0497). ACDF with Solistrade mark cage was associated with relatively good radiologic long-term results. Fusion was achieved in 94.5% and subsidence occurred in 8.1% by the radiologic assessment. Statistical analysis reveals that the subsidence seen later than 8 weeks after surgery and the development of subsidence does not correlate statistically with the change of the postoperative disc space height.

  19. Anterior lumbar interbody fusion using a barbell-shaped cage: a biomechanical comparison.

    Science.gov (United States)

    Murakami, H; Boden, S D; Hutton, W C

    2001-10-01

    There are drawbacks to using threaded cylindrical cages (e.g., limited area for bone ingrowth and metal precluding radiographic visualization of bone healing). To somewhat offset these drawbacks, a barbell-shaped cage has been designed. The central core of the barbell can be wrapped with collagen sheets infiltrated with bone morphogenetic protein. The obvious theoretical advantages of a barbell cage have to be weighed against potential biomechanical disadvantages. Our purpose was to compare the biomechanical properties of an anterior lumbar interbody reconstruction using 18-mm-diameter threaded cylindrical cages, with a reconstruction using barbell cages (18-mm diameter and 6 mm wide at both cylindrical ends, with a round 4-mm-diameter bar joining the two ends). Twelve cadaveric lumbar motion segments were tested. Three L5-S1 segments received two threaded cylindrical cages, and three L5-S1 segments received two barbell cages. Three L3-L4 segments received one threaded cylindrical cage, and three L3-L4 segments received one barbell cage. A series of biomechanical loading sequences were carried out on each motion segment, and stiffness curves were obtained. After the biomechanical testing, an axial compressive load was applied to the motion segments until failure. They were then radiographed and bisected through the disc, and the subsidence (or penetration) of the cage(s) in the cancellous bone of the vertebral bodies was measured. There was no difference in terms of stiffness between the motion segments with the threaded cylindrical cage(s) inserted and those with the barbell cage(s) inserted (p > 0.15). The average values of subsidence was 0.96 mm for the threaded cylindrical cage group and 0.80 mm for the barbell cage group (difference not significant: p = 0.38). The results suggest that a reconstruction using barbell cages is a biomechanically acceptable alternative to one using threaded cylindrical cages.

  20. [Effect evaluation of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for lumbar degenerative diseases].

    Science.gov (United States)

    Wang, Chong; Ying, Jin-He; Xie, Pan-Pan; Wu, Xiao-Guang

    2016-07-25

    To evaluate the clinical effects of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion(TLIF) in treating lumbar degenerative diseases. The clinical data of 24 patients with lumbar degenerative disease underwent unilateral pedicle screw fixation with transforaminal lumbar interbody fusion from March 2007 to October 2009, were retrospectively analyzed. There were 13 males and 11 females, aged from 34 to 68 years old with an average of 52 years. Postoperative pain and functional results were analyzed by the visual analogue scale(VAS) and Oswestry Disability Index(ODI). Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and general complications. All patients were followed up from 5 to 8 years with an average of 6.7 years. VAS scores of low back pain and leg pain decreased from preoperative 7.82±0.71, 8.42±1.24 to postoperative 1.87±0.81, 2.23±1.62, respectively( P degenerative diseases according to over 5 year follow up, however, its indications should be well considered. But the problems such as intervertebral space height of operated side loss and adjacent segment degeneration after unilateral pedicle screw fixation need further clinical study.

  1. [The shor-term clinical outcomes and safety of extreme lateral interbody fusion combined with percutaneous pedicle screw fixation for the treatment of degenerative lumbar disease].

    Science.gov (United States)

    Hu, Xu-Dong; Ma, Wei-Hu; Jiang, Wei-Yu; Ruan, Chao-Yue; Chen, Yun-Lin

    2017-02-25

    To evaluate the early efficacy and safety of extreme lateral interbody fusion (XLIF) combined with percutaneous pedicle screw fixation for lumbar degenerative disease. From January 2013 to June 2014, 13 patients with degenerative lumbar disease were treated with XLIF combined with percutaneous pedicle screw fixation, including 8 cases of lumbar instability, 5 cases of mild to moderate lumbar spondylolisthesis;there were 5 males and 8 females, aged from 56 to 73 years with an average of 62.1 years. All patients were single segment fusion. Operation time, perioperative bleeding and perioperative complications were recorded. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy. Interbody fusion rate was observed and the intervertebral foramen area changes were compared preoperation and postoperation by X-rays and CT scanning. The mean operation time and perioperative bleeding in the patients respectively was(62.8±5.2) min and(82.5±22.6) ml. One case occurred in the numbness of femoribus internus and 1 case occurred in the muscle weakness of hip flexion after operation, both of them recovered within 2 weeks. All the patients were followed up from 12 to 19 months with an average of 15.6 months. VAS was decreased from preoperative 7.31±0.75 to 2.31±0.75 at final follow-up( P degenerative disease.

  2. [Clinical outcomes of single-level lumbar spondylolisthesis by minimally invasive transforaminal lumbar interbody fusion with bilateral tubular channels].

    Science.gov (United States)

    Zeng, Z L; Jia, L; Yu, Y; Xu, W; Hu, X; Zhan, X H; Jia, Y W; Wang, J J; Cheng, L M

    2017-04-01

    Objective: To evaluate the clinical effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-level lumbar spondylolisthesis treatment with bilateral Spotlight tubular channels. Methods: A total of 21 patients with lumbar spondylolisthesis whom underwent MIS-TLIF via bilateral Spotlight tubular channels were retrospectively analyzed from October 2014 to November 2015. The 21 patients included 11 males and 10 females ranged from 35 to 82 years (average aged 60.7 years). In term of spondylolisthesis category, there were 18 cases of degenerative spondylolisthesis and 3 cases of isthmic spondylolisthesis. With respect to spondylolisthesis degree, 17 cases were grade Ⅰ° and 4 cases were grade Ⅱ°. Besides, 17 cases at L(4-5) and 4 cases at L(5)-S(1)were categorized by spondylolisthesis levels. Operation duration, blood loss, postoperative drainage and intraoperative exposure time were recorded, functional improvement was defined as an improvement in the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) was also employed at pre and post-operation (3 months and the last follow-up), to evaluate low back and leg pain. Furthermore, to evaluate the recovery of the intervertebral foramen and of lumbar sagittal curvature, average height of intervertebral space, Cobb angles of lumbar vertebrae and operative segments, spondylolisthesis index were measured. At the last follow-up, intervertebral fusion was assessed using Siepe evaluation criteria and the clinical outcome was assessed using the MacNab scale. Radiographic and functional outcomes were compared pre- and post-operation using the paired T test to determine the effectiveness of MIS-TLIF. Statistical significance was defined as P spondylolisthesis incidence ( t =17.1, P spondylolisthesis incidence ( t =18.6, P spondylolisthesis vertebrae were restored completely. Lastly, at the last follow-up, 12 cases of grade 1 and 7 cases of grade 2 fusion were present as determined

  3. Superior Facet Joint Violations during Single Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Preliminary Retrospective Clinical Study

    Directory of Open Access Journals (Sweden)

    Long Jia

    2018-01-01

    Full Text Available Background. Facet joint violation (FV was reported as variable iatrogenic damage that can be a crucial risk factor leading to the adjacent segment degeneration (ASD. “Blind” screw placement technique in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF contributes to the increasing incidence of FV that can be influenced by several potential factors. Many controversies about these factors and clinical outcomes of different types of FV patients exist, yet they have not been analyzed. Methods. 99 cases undergoing single-segment MIS-TLIF from July 2013 to December 2015 were retrospectively analyzed. Computed tomography (CT was applied to determine the incidence of FV, and then the correlation between FV and relevant factors, including gender, age, body mass index (BMI, top-screw level, and decompression, was analyzed. A total of 53 cases were followed up after one year, 31 cases in noninjury (A group and 22 patients in FV injury (B group. Results. The incidence of FV was 39. 39% (39/99 in the patients and 23.23% (46/198 in the screws. Logistic regression analysis showed that screw at L5 in patients with BMI > 30 kg/m2 was vulnerable to FV (P<0.05. Moreover, postoperative average intervertebral disc height (AIDH of fusion segment, visual analog scale (VAS, and Oswestry disability index (ODI scores improved significantly in group A and B when compared with preoperative data (P<0.05. Adjacent superior average intervertebral disc height (ASAIDH presented decrease, but adjacent superior intervertebral disc Cobb angle (ASIDCA appeared to increase in the two groups at the final follow-up compared with postoperative 3 days (P<0.05. Low back VAS and ODI scores in group A (31 cases were lower than those in group B (22 cases in the final follow-up (P<0.05. Conclusion. MIS-TLIF is an effective treatment for lumbar degenerative disease, but FV occurred at a higher incidence. Facet joints should be protected in MIS-TLIF to avoid FV.

  4. Integrated versus stand-alone second generation ethanol production from sugarcane bagasse and trash.

    Science.gov (United States)

    Dias, Marina O S; Junqueira, Tassia L; Cavalett, Otávio; Cunha, Marcelo P; Jesus, Charles D F; Rossell, Carlos E V; Maciel Filho, Rubens; Bonomi, Antonio

    2012-01-01

    Ethanol production from lignocellulosic materials is often conceived considering independent, stand-alone production plants; in the Brazilian scenario, where part of the potential feedstock (sugarcane bagasse) for second generation ethanol production is already available at conventional first generation production plants, an integrated first and second generation production process seems to be the most obvious option. In this study stand-alone second generation ethanol production from surplus sugarcane bagasse and trash is compared with conventional first generation ethanol production from sugarcane and with integrated first and second generation; simulations were developed to represent the different technological scenarios, which provided data for economic and environmental analysis. Results show that the integrated first and second generation ethanol production process from sugarcane leads to better economic results when compared with the stand-alone plant, especially when advanced hydrolysis technologies and pentoses fermentation are included. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Stand-alone wind system with Vanadium Redox Battery energy storage

    DEFF Research Database (Denmark)

    Teodorescu, Remus; Barote, L.; Weissbach, R.

    2008-01-01

    Energy storage devices are required for power balance and power quality in stand alone wind energy systems. A Vanadium Redox Flow Battery (VRB) system has many features which make its integration with a stand-alone wind energy system attractive. This paper proposes the integration of a VRB system...... with a typical stand-alone wind energy system during wind speed variation as well as transient performance under variable load. The investigated system consists of a variable speed wind turbine with permanent magnet synchronous generator (PMSG), diode rectifier bridge, buck-boost converter, bidirectional charge...... controller, transformer, inverter, ac loads and VRB (to store a surplus of wind energy and to supply power during a wind power shortage). The main purpose is to supply domestic appliances through a single phase 230V, 50Hz inverter. Simulations are accomplished in order to validate the stability of the supply....

  6. Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparison Study Based on End Plate Subsidence and Cystic Change in Individuals Older and Younger than 65 Years.

    Science.gov (United States)

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

    2017-10-01

    To compare the outcomes between patients older and younger than 65 years 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 (subsidence, end plate 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 compared with group A (90.24% vs. 57.14%, respectively; P 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, because cage subsidence was a useful potential predictor of cyst formation. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Sensorless direct voltage control of the stand-alone brushless doubly-fed generator

    DEFF Research Database (Denmark)

    Liu, Yi; Xu, Wei; Xiong, Fei

    2017-01-01

    The conventional stand-alone brushless doubly-fed generator (BDFG) control strategies need the feedback from the rotor position or speed sensors, which can reduce system reliability and increase the cost and axial volume of the machine. In this paper, a sensorless direct voltage control (DVC......) strategy is presented for the stand-alone BDFG. The satisfactory dynamic performance is verified by experimental results under four kinds of typical operation conditions. Besides, the proposed control strategy is robust due to no generator parameters being required....

  8. A Current Sensorless MPPT Control Method for a Stand-Alone-Type PV Generation System

    Science.gov (United States)

    Itako, Kazutaka; Mori, Takeaki

    In this paper, a current sensorless MPPT control method for a stand-alone-type PV generation system is proposed. This control method offers advantages of the simplified hardware configuration and the low cost, by using only one sensor to measure the PV output voltage. In the application to stand-alone-type with a battery load, the experimental results show that the estimated values of PV output current are accurate, and the use of the proposed MPPT control increases the PV generated energy by 16.3% compared to the conventional system. Furthermore, it is clarified that the proposed method has extremely high UUF (Useful utilization factor) of 98.7%.

  9. Photovoltaic Module Simulink Model for a Stand-alone PV System

    Science.gov (United States)

    Qi, Chen; Ming, Zhu

    Photovoltaic(PV) Module is indispensable of a stand-alone PV system. In this paper, a one-diode equivalent circuit-based versatile simulation model in the form of masked block PV module is proposed. By the model, it is allowed to estimate behavior of PV module with respect changes on irradiance intensity, ambient temperature and parameters of the PV module. In addition, the model is capable of function of Maximum Power Point Tracking (MPPT) which can be used in the dynamic simulation of stand-alone PV systems.

  10. A control strategy for stand-alone wound rotor induction machine

    Energy Technology Data Exchange (ETDEWEB)

    Forchetti, D.G.; Garcia, G.O. [Grupo de Electronica Aplicada (GEA), Universidad Nacional de Rio Cuarto, X5804 BYA Rio Cuarto (Argentina); Solsona, J.A. [Instituto de Investigaciones en Ingenieria Electrica?Alfredo Desages?, Departamento de Ingenieria Electrica y de Computadoras, Universidad Nacional del Sur, Bahia Blanca (Argentina); Valla, M.I. [Laboratorio de Electronica Industrial, Control e Instrumentacion (LEICI), Facultad de Ingenieria, Universidad Nacional de La Plata, 1900 La Plata (Argentina)

    2007-02-15

    A control strategy to regulate the frequency and voltage of a stand-alone wound rotor induction machine is presented. This strategy allows the machine to work as a generator in stand-alone systems (without grid connection) with variable rotor speed. A stator flux-oriented control is proposed using the rotor voltages as actuation variables. Two cascade control loops are used to regulate the stator flux and the rotor currents. A closed loop observer is designed to estimate the machine flux which is necessary to implement these control loops. The proposed control strategy is validated through simulations with satisfactory results. (author)

  11. Assessment of Stand-Alone Displays for Time Management in a Creativity-Driven Learning Environment

    DEFF Research Database (Denmark)

    Frimodt-Møller, Søren

    2017-01-01

    This paper considers the pros and cons of stand-alone displays, analog (e.g. billboards, blackboards, whiteboards, large pieces of paper etc.) as well as digital (e.g. large shared screens, digital whiteboards or similar), as tools for time management processes in a creativity-driven learning...... to storing information digitally. The findings could indicate a possible market for stand-alone, interactive digital displays combining the ‘touch and feel’ character of an analog board with the convenience of digital data storage....

  12. Percutaneous transforaminal endoscopic decompression and cageless percutaneous bone graft transforaminal lumbar interbody fusion: A feasibility study

    Directory of Open Access Journals (Sweden)

    Ajay Krishnan

    2018-01-01

    RESULTS: All the outcome measures were significant (P < 0.05 and fusion achieved in all with a mean follow-up period was 39 ± 6.36 months. Operating room time was 250.23 ± 52.90 min (187–327. Postoperative LOH hospital stay was 29.92 ± 4.94 h (24–39. The tolerance score was 2.30 ± 0.85 (1–3. One superficial bone graft site infection resolved with antibiotics. CONCLUSION: It not appealing to be recommendable to general population inspite of it being low cost and with negligible complications. Further research and engineered tools are needed to reduce the operating time.

  13. Comparison of Adjacent Segment Degeneration After Nonrigid Fixation System and Posterior Lumbar Interbody Fusion for Single-Level Lumbar Disc Herniation: A New Method of MRI Analysis of Lumbar Nucleus Pulposus Volume.

    Science.gov (United States)

    Yang, Shaofeng; Liu, Yanan; Bao, Zhaohua; Zou, Jun; Yang, Huilin

    2017-05-19

    To evaluate the influence of a nonrigid fixation system and posterior lumbar interbody fusion on adjacent intervertebral disc degeneration by using MRI analysis of lumbar nucleus pulposus volume for single-level lumbar disc herniation. We selected 112 patients who underwent nonrigid fixation (17 men and 44 women) or posterior lumbar interbody fusion (13 men and 38 women) for this retrospective study. Based on the T2-weighted magnetic resonance imaging (MRI) scans taken preoperatively, and 6, 12, and 24 months after surgery, the nucleus pulposus in the upper segments of the operated level was considered an ellipsoid, and their volumes were measured respectively and then compared between the two groups. The posterior lumbar interbody fusion group had significantly lower lumbar nucleus pulposus volume than the nonrigid fixation group at 12 (4.04 ± 1.42 vs. 5.25 ± 1.47 mm 3 ) and 24 months (4.16 ± 0.89 vs. 5.06 ± 1.23 mm 3 ), and had the highest nucleus pulposus. Meanwhile, the h value in the posterior lumbar interbody fusion group was notably smaller than the preoperative level at 12 (0.46 ± 0.03 vs. 0.55 ± 0.05 mm) and 24 months (0.44 ± 0.03 vs. 0.55 ± 0.05 mm). MRI analysis of lumbar nucleus pulposus volume is a new and quantitative method of analysis, which is a considerable method and contributes to the detection of severe intervertebral disc degeneration. Based on this new method, nonrigid fixation demonstrates excellent outcomes on the adjacent segment in comparison with posterior lumbar interbody fusion.

  14. Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4-5.

    Science.gov (United States)

    Campbell, Peter G; Nunley, Pierce D; Cavanaugh, David; Kerr, Eubulus; Utter, Philip Andrew; Frank, Kelly; Stone, Marcus

    2018-01-01

    OBJECTIVE Recently, authors have called into question the utility and complication index of the lateral lumbar interbody fusion procedure at the L4-5 level. Furthermore, the need for direct decompression has also been debated. Here, the authors report the clinical and radiographic outcomes of transpsoas lumbar interbody fusion, relying only on indirect decompression to treat patients with neurogenic claudication secondary to Grade 1 and 2 spondylolisthesis at the L4-5 level. METHODS The authors conducted a retrospective evaluation of 18 consecutive patients with Grade 1 or 2 spondylolisthesis from a prospectively maintained database. All patients underwent a transpsoas approach, followed by posterior percutaneous instrumentation without decompression. The Oswestry Disability Index (ODI) and SF-12 were administered during the clinical evaluations. Radiographic evaluation was also performed. The mean follow-up was 6.2 months. RESULTS Fifteen patients with Grade 1 and 3 patients with Grade 2 spondylolisthesis were identified and underwent fusion at a total of 20 levels. The mean operative time was 165 minutes for the combined anterior and posterior phases of the operation. The estimated blood loss was 113 ml. The most common cage width in the anteroposterior dimension was 22 mm (78%). Anterior thigh dysesthesia was identified on detailed sensory evaluation in 6 of 18 patients (33%); all patients experienced resolution within 6 months postoperatively. No patient had lasting sensory loss or motor deficit. The average ODI score improved 26 points by the 6-month follow-up. At the 6-month follow-up, the SF-12 mean Physical and Mental Component Summary scores improved by 11.9% and 9.6%, respectively. No patient required additional decompression postoperatively. CONCLUSIONS This study offers clinical results to establish lateral lumbar interbody fusion as an effective technique for the treatment of Grade 1 or 2 degenerative spondylolisthesis at L4-5. The use of this surgical

  15. Does Subcutaneous Infiltration of Liposomal Bupivacaine Following Single-Level Transforaminal Lumbar Interbody Fusion Surgery Improve Immediate Postoperative Pain Control?

    Science.gov (United States)

    Tomov, Marko; Tou, Kevin; Winkel, Rose; Puffer, Ross; Bydon, Mohamad; Nassr, Ahmad; Huddleston, Paul; Yaszemski, Michael; Currier, Bradford; Freedman, Brett

    2018-02-01

    Retrospective case-control study using prospectively collected data. Evaluate the impact of liposomal bupivacaine (LB) on postoperative pain management and narcotic use following standardized single-level low lumbar transforaminal lumbar interbody fusion (TLIF). Poor pain control after surgery has been linked with decreased pain satisfaction and increased economic burden. Unfortunately, opioids have many limitations and side effects despite being the primary treatment of postoperative pain. LB may be a form of pre-emptive analgesia used to reduce the use of postoperative narcotics as evidence in other studies evaluating its use in single-level microdiskectomies. The infiltration of LB subcutaneously during wound closure was performed by a single surgeon beginning in July 2014 for all single-level lumbar TLIF spinal surgeries at Landstuhl Regional Medical Center. This cohort was compared against a control cohort of patients who underwent the same surgery by the same surgeon in the preceding 6 months. Statistical analysis was performed on relevant variables including: morphine equivalents of narcotic medication used (primary outcome), length of hospitalization, Visual Analog Scale pain scores, and total time spent on a patient-controlled analgesia (PCA) pump. A total of 30 patients were included in this study; 16 were in the intervention cohort and 14 were in the control cohort. The morphine equivalents of intravenous narcotic use postoperatively were significantly less in the LB cohort from day of surgery to postoperative day 3. Although the differences lost their statistical significance, the trend remained for total (oral and intravenous) narcotic consumption to be lower in the LB group. The patients who received the study intervention required an acute pain service consult less frequently (62.5% in LB cohort vs. 78.6% in control cohort). The amount of time spent on a PCA pump in the LB group was 31 hours versus 47 hours in the control group ( p =0.1506). Local

  16. Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease.

    Science.gov (United States)

    Wu, Haiting; Pang, Qingjiang; Jiang, Guoqiang

    2017-10-01

    Objective To compare the medium-term clinical and radiographic outcomes of Dynesys dynamic stabilization and posterior lumbar interbody fusion (PLIF) for treatment of multisegmental lumbar degenerative disease. Methods Fifty-seven patients with multisegmental lumbar degenerative disease underwent Dynesys stabilization (n = 26) or PLIF (n = 31) from December 2008 to February 2010. The mean follow-up period was 50.3 (range, 46-65) months. Clinical outcomes were evaluated using a visual analogue scale (VAS) and the Oswestry disability index (ODI). Radiographic evaluations included disc height and range of motion (ROM) of the operative segments and proximal adjacent segment on lumbar flexion-extension X-rays. The intervertebral disc signal change was defined by magnetic resonance imaging, and disc degeneration was classified by the Pfirrmann grade. Results The clinical outcomes including the VAS score and ODI were significantly improved in both groups at 3 months and the final follow-up, but the difference between the two was not significant. At the final follow-up, the disc height of stabilized segments in both groups was significantly increased; the increase was more notable in the Dynesys than PLIF group. The ROM of stabilized segments at the final follow-up decreased from 6.20° to 2.76° and 6.56° to 0.00° in the Dynesys and PLIF groups, respectively. There was no distinct change in the height of the proximal adjacent segment in the two groups. The ROM of the proximal adjacent segment in both groups increased significantly at the final follow-up; the change was significantly greater in the PLIF than Dynesys group. Only one case of adjacent segment degeneration occurred in the PLIF group, and this patient underwent a second operation. Conclusions Both Dynesys stabilization and PLIF can improve the clinical and radiographic outcomes of multisegmental lumbar degenerative disease. Compared with PLIF, Dynesys stabilization can maintain the mobility of the

  17. Comparison of clinical outcomes following minimally invasive lateral interbody fusion stratified by preoperative diagnosis.

    Science.gov (United States)

    Khajavi, Kaveh; Shen, Alessandria; Lagina, Madeline; Hutchison, Anthony

    2015-04-01

    Lumbar fusion has been shown to be effective in treating a variety of degenerative spinal conditions, though significant differences exist in the magnitude of clinical improvement across different surgical diagnoses. With modern, minimally disruptive approaches for fusion, diagnosis-specific differences in clinical improvement may be reduced. The purpose of this study is to report and compare interim clinical improvements in patients treated with XLIF for various degenerative lumbar conditions. 160 patients underwent XLIF for either degenerative spondylolisthesis (n = 68), degenerative disc disease (n = 20), adjacent segment disease (n = 26), or post-laminectomy syndrome (n = 46). Average age was 61 years and 66 % were female. Mean BMI was 28.9 kg/m(2). 37 % were smokers, 23 % had diabetes mellitus, 22 % had depression. Mean age was highest for ASD patients (66 years) and lowest for DDD patients (48 years) (p < 0.001). There were no other baseline demographic differences between groups. Patient-reported clinical outcomes measures were collected at baseline and prospectively at standard intervals. Interim results at an average of 19 months follow-up are reported here. In total, 197 levels were treated with XLIF (mean 1.2 per patient). There were no cases of symptomatic pseudoarthrosis or implant/instrument failure. Overall, 1 patient (0.6 %) had a major complication and 12 % had a minor complication. Approach-related anterolateral thigh/groin sensory changes were present in 14 % and hip flexion weakness in 9 %. At last follow-up, overall ODI decreased 47 % (44.1-23.5), VAS LBP decreased 59 % (6.9-2.8), VAS LP decreased 56 % (7.1-3.1), and SF-36 PCS improved 40 % (30.9-43.2) (all p < 0.001). Baseline ODI was significantly lower for DDD patients (p = 0.052). At last follow-up, mean percent improvements on all outcomes were highest for DSP group, though not all differences were significant. Improvements between diagnostic groups were statistically different for LBP (p

  18. Minimally invasive transaxial lumbosacral interbody fusion: a ten year single-centre experience.

    Science.gov (United States)

    Zeilstra, Dick J; Staartjes, Victor E; Schröder, Marc L

    2017-01-01

    Our aim was to evaluate mid- and long-term results in a cohort of patients who underwent minimally invasive transaxial lumbosacral fixation and to identify clinical and other parameters that can aid in proper patient selection. Over a period of ten years, we assessed 164 patients who had a complete follow-up of a minimum of one year (average 54 months). On follow-up, we recorded clinical status, fusion status, visual analogue scale (VAS), Oswestry Lower Back Pain Disability Index (ODI) scores and patient satisfaction. There were no intra- or peri-operative complications. Overall clinical success rate was 73.8 %. Only sex (female), working status (still working), body mass index (BMI) (lower) and presence of Modic II changes (absent) were correlated with a good result. Transaxial fixation is a safe, minimally invasive technique that can offer good results in patients with single-level degenerative disc disease (DDD) at the lumbosacral level, with minimal operative risk.

  19. Stand alone solar energy harvesting and storage systems in off-grid applications

    Science.gov (United States)

    Alonso-Marroquin, Fernando; Gormly, Justin Blake; Bilbao, Jose

    2017-06-01

    The following is an implementation of a stand-alone system for solar energy harvesting and electrical energy storage systems for use in off-grid housing applications. The principal aim of this project was to construct a compact and affordable system for an off-grid house and to monitor its efficiency along the year.

  20. 11kW stand alone wind turbine based on proven wind turbine

    DEFF Research Database (Denmark)

    Bindner, H.; Wodstrup, J.; Andersen, J.

    2004-01-01

    and enable control of frequency and voltage independently on both the grid side and the generator side. The prototype has been installed at Risø. The paper will present results from test runs of the system both operating stand-alone supplying a single load and in parallel operation with a diesel genset....

  1. Linguistic and Structural Analyses of Stand-Alone Literature Reviews: Seventy-Five Years of Change

    Science.gov (United States)

    Wright, Heidi Rachel

    2016-01-01

    The purpose of this dissertation is to offer a multifaceted overview of stand-alone literature reviews. These texts, literature reviews published unattached to research articles, have existed for centuries but remained largely unstudied by linguists. Thus, the goal of this project is to present these reviews' situational, grammatical, and…

  2. Design and Operation Studies of A Stand-Alone PV Generation System

    DEFF Research Database (Denmark)

    Hu, Yanting; Chen, Zhe; Zhang, Donglai

    2013-01-01

    This paper discusses the modeling, design and operation of a PV powered stand-alone system, which includes a PV array, a battery bank, power electronic converters and the associated control system. The design considerations are analyzed and a design platform is presented. Furthermore the operatio...

  3. Environmental/Climatic Effect on Stand-Alone Solar Energy Supply ...

    African Journals Online (AJOL)

    This paper investigates the climatic eects and environmental variations on the performance of a stand-alone photovoltaic system. The eects of partial shading with dierent climate conditions and load resistance variations were examined. A survey of some of the work done in this eld of environmental eect on solar panel was ...

  4. MOSFET Loss Evaluation for a Low-Power Stand-Alone Photovoltaic-LED System

    DEFF Research Database (Denmark)

    Mira Albert, Maria del Carmen; Knott, Arnold; Andersen, Michael A. E.

    2015-01-01

    This paper presents a performance evaluation and comparison of state-of-the-art low voltage Si MOSFETs for a stand-alone photovoltaic-LED Light to Light (LtL) system. The complete system is formed by two cascaded converters that will be optimized for a determined solar irradiation and LED...

  5. Integrated Three-Port DC-DC Converter for Photovoltaic (PV) Battery Stand-alone Systems

    DEFF Research Database (Denmark)

    Ouyang, Ziwei; Andersen, Michael A. E.

    2016-01-01

    Several power sources such as PV solar arrays and battery are often used to manage the power flow for a photovoltaic (PV) based stand-alone power system due to the fluctuation nature of solar energy resource, and deliver a continuous power to the users in an appropriate form. Traditionally, three...

  6. Stand-alone version of the 11kW Gaia wind turbine

    DEFF Research Database (Denmark)

    Bindner, H.; Rosas, P.A.C.; Teodorescu, R.

    2004-01-01

    This report describes the development of a stand-alone version of the 11kW Gaia wind turbine. Various possible configurations are investigated and a configuration using a back-to-back converter is chosen. A model is developed for controller design of thefast controllers of the unit. Controllers...... assessment and controller design a dynamic performance assessment model has been developed....

  7. A maximum power point tracking scheme for a 1kw stand-alone ...

    African Journals Online (AJOL)

    A maximum power point tracking scheme for a 1kw stand-alone solar energy based power supply. ... This paper elucidates one of the tracking schemes for a photovoltaic (PV) systems using Cuk converter operating in discontinuous inductor current mode (DICM) as an interface. A method for efficiently maximizing the output ...

  8. Analysis and controller design for stand-alone VSIs in synchronous reference frame

    DEFF Research Database (Denmark)

    Ramezani, Malek; Li, Shuhui; Golestan, Saeed

    2017-01-01

    The common practice for controlling the stand-alone voltage source inverters (VSIs) is to transform abc voltage and current signals to DC signals using the dq transformation, which makes it possible to control the new DC voltage and current signals just using simple proportional-integral controll...

  9. A Change in Lumbar Sagittal Alignment After Single-level Anterior Lumbar Interbody Fusion for Lumbar Degenerative Spondylolisthesis With Normal Sagittal Balance.

    Science.gov (United States)

    Kim, Chi Heon; Chung, Chun Kee; Park, Sung Bae; Yang, Seung Heon; Kim, Jung-Hee

    2017-08-01

    Retrospective analysis. The object is to assess the correlation between whole lumbar lordosis (LL) and the segmental angle (SA) after single-level anterior lumbar interbody fusion for degenerative lumbar spondylolisthesis. The restoration of the SA at lower lumbar spine is meaningful, considering it contributes approximately 60% of LL, and revision surgery due to flat back or adjacent segment pathology was necessary decades after the initial surgery. However, little is known about the change of whole lumbar curvature after single-level lower lumbar fusion surgery, especially for balanced spine. We included 41 consecutive patients (M:F=9:32; mean age, 59.8±9.3 y) with a single-level anterior lumbar interbody fusion surgery for low-grade degenerative spinal spondylolisthesis, with C7 plumb line of <5 cm and ≥2-year follow-up period. The operated levels were L4-L5 in 34 patients and L5-S1 in 7 patients. Whole LL, SA, pelvic tilt, and sacral slope were compared. According to the Macnab criteria, a favorable outcome (excellent, 21; good, 15) was achieved in 36/41 (88%; excellent, 21; good, 15) patients. LL and SA were significantly changed from -50.8±9.9 to -54.6±11.1 degrees and -15.6±6.1 to -18.7±5.1 degrees (P<0.01), and a positive correlation (r=0.43, P=0.01) was observed between LL and SA at postoperative month 24. The changes to the pelvic tilt and sacral slope were not significant. Whole lumbar sagittal alignment was influenced by single SA. Therefore, obtaining adequate segmental lordosis is desirable considering the effect on the whole spine for a long time.

  10. Adjacent segment disease after anterior cervical interbody fusion: a multicenter retrospective study of 288 patients with long-term follow-up.

    Science.gov (United States)

    Litrico, S; Lonjon, N; Riouallon, G; Cogniet, A; Launay, O; Beaurain, J; Blamoutier, A; Pascal-Mousselard, H

    2014-10-01

    Cervical discectomy with interbody fusion is a common procedure in spinal surgery. The resultant biomechanical alterations accelerate degeneration of the adjacent segment, but the contribution of natural degeneration to adjacent segment disease is unclear. To assess the long-term rate of surgery to discs adjacent to cervical interbody fusion; and to assess the associated incidence of cervico-brachial neuralgia and radiological degeneration of adjacent discs. A multicenter retrospective study included anterior cervical discectomy patients at a minimum of 10 years' follow-up. Clinical variables comprised pain, use of analgesics and surgical revision. Functional assessment was performed on the Neck Disability Index (NDI). Radiologic degeneration was assessed on the Goffin score based on cervical spine X-ray. Two hundred and eighty-eight patients were contacted and filled out the clinical questionnaire. Among the patients, 153 underwent radiological reassessment. Mean age was 46 years (range, 16-73 years). Mean follow-up was 14.5 years (12-18 years). The rate of surgical revision on a disc adjacent to the primary level was 5.9%. Frequent attacks of cervico-brachial neuralgia were reported in 20.5% of cases. Radiologic adjacent segment degeneration was found in 81.3% of cases over follow-up. There was a significant correlation between degree of radiologic adjacent segment degeneration and NDI (P=0.02). Degeneration adjacent to discectomy/fusion is partly due to aging. The present findings, however, agree with the literature and indicate accelerated degeneration in adjacent segments. These findings should be taken into account in treatment decision-making and suggest a possible interest of more physiological surgery such as arthroplasty. IV - Multicenter retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. Posterior Lumbar Interbody Fusion with 3D-Navigation Guided Cortical Bone Trajectory Screws for L4/5 Degenerative Spondylolisthesis: 1-Year Clinical and Radiographic Outcomes.

    Science.gov (United States)

    Hussain, Ibrahim; Virk, Michael S; Link, Thomas W; Tsiouris, Apostolos J; Elowitz, Eric

    2018-02-01

    We describe our technique and evaluate clinical and radiographic outcomes for patients undergoing L4/5 posterior lumbar interbody fusion with 3D-navigation guided cortical bone trajectory screws (PLIF-CBT) for grade 1 or 2 degenerative spondylolisthesis with a minimum follow-up time of 12 months. A single-institution series of 18 patients was evaluated with data prospectively collected and retrospectively analyzed. Pain and disability scores were collected preoperatively and at a minimum of 12 months postoperatively, including back and bilateral leg pain visual analog scores (VAS) and Oswestry Disability Index (ODI) scores. Radiographic fusion was assessed as complete, partial, or none based on the presence of bridging bones across the disc space, posterior elements, or both. Patients demonstrated statistically significant reductions in back pain VAS (P = 0.0025), leg pain VAS (P fusion at an average of 14.9 months postoperatively was available for 16/18 patients, with 6 patients demonstrating fusion (4/6 with complete fusion; 2/6 with partial fusion). There were no instances of intraoperative complications or delayed complications requiring subsequent interventions. PLIF-CBT can be performed in a safe and reproducible fashion with excellent clinical outcomes at 1 year postoperatively. The outcomes did not correlate with fusion status, which was unexpectedly low at 37.5% without significant hardware abnormalities necessitating reoperations. PLIF-CBT offers several perioperative advantages compared with traditional open PLIF and requires longer-term studies to demonstrate its durability with regard to improvement in clinical pain and radiographic endpoints, including anterior and/or posterior element fusion. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. An effect comparison of teriparatide and bisphosphonate on posterior lumbar interbody fusion in patients with osteoporosis: a prospective cohort study and preliminary data.

    Science.gov (United States)

    Cho, Pyung Goo; Ji, Gyu Yeul; Shin, Dong Ah; Ha, Yoon; Yoon, Do Heum; Kim, Keung Nyun

    2017-03-01

    Our purpose was to evaluate the efficacy of teriparatide for posterior lumbar interbody fusion (PLIF) in osteoporotic women. Forty-seven osteoporotic patients underwent PLIF with pedicle screw fixation for degenerative lumbar stenosis and instability. Patients were divided into two groups. The teriparatide group (n = 23) was injected subcutaneously with teriparatide (20 μg daily) for 3-month cycles alternating with 3-month periods of oral sodium alendronate for 12 months. The bisphosphonate group (n = 24) was administered oral sodium alendronate (91.37 mg/week) for ≥1 year. Serial plain radiography, computed tomography, and bone mineral densitometry (BMD) evaluations were performed. Fusion rate, bony fusion duration, and T score changes were evaluated. Clinical data [pain scores, Prolo's functional scale, and Oswestry disability index (ODI)] were also serially evaluated. The teriparatide group showed earlier fusion than the bisphosphonate group. The average period of bone fusion was 6.0 ± 4.8 months in the teriparatide group but 10.4 ± 7.2 months in the bisphosphonate group. The bone fusion rate in the teriparatide group was higher than that in the bisphosphonate group at 6 months; however, there was no difference 12 and 24 months after surgery. Pain scores and ODI were not significantly different between groups. BMD scores in the teriparatide group were significantly improved compared with the bisphosphonate group 2 years after surgery. There was no significant improvement in overall fusion rate and clinical outcome in our patients after injection of teriparatide, but the teriparatide group showed faster bony union and highly improved BMD scores.

  13. Role of Weekly Teriparatide Administration in Osseous Union Enhancement within Six Months After Posterior or Transforaminal Lumbar Interbody Fusion for Osteoporosis-Associated Lumbar Degenerative Disorders: A Multicenter, Prospective Randomized Study.

    Science.gov (United States)

    Ebata, Shigeto; Takahashi, Jun; Hasegawa, Tomohiko; Mukaiyama, Keijiro; Isogai, Yukihiro; Ohba, Tetsuro; Shibata, Yosuke; Ojima, Toshiyuki; Yamagata, Zentaro; Matsuyama, Yukihiro; Haro, Hirotaka

    2017-03-01

    For elderly patients, posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) is usually performed to treat lumbar degenerative diseases. However, some patients exhibit pseudarthrosis following such procedures. The anabolic agent teriparatide is an approved treatment for promoting bone formation in osteoporotic patients. Our multicenter, prospective randomized study assessed the role of once-weekly teriparatide administration on patient outcomes following interbody fusion. Patients were females who were ≥50 years of age, had a bone mineral density (BMD) of teriparatide, administered subcutaneously starting at week 1, for 6 months postoperatively (the teriparatide arm), or no teriparatide (the control arm). Blinded radiographic evaluations were performed using dynamic radiography and computed tomography (CT) and assessed by modified intention-to-treat analysis and per-protocol analysis. Clinical and neurological symptoms were evaluated using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI). Seventy-five patients were randomized to treatment, and 66 patients completed treatment. At 4 months postoperatively, bone fusion in the 2 center CT slices was significantly higher in the teriparatide arm compared with the control arm in the age-adjusted modified intention-to-treat analysis and was significantly higher at 6 months in the per-protocol analysis. Radiographic examinations showed no disc-space narrowing and no intervertebral disc instability. JOA-BPEQ and ODI results were improved postoperatively in both treatment arms. Weekly administration of teriparatide promoted bone formation at the surgical fusion site and decreased bone resorption, as indicated by bone metabolic marker results, within the early postoperative period. Our findings suggest that combining lumbar interbody fusion and teriparatide treatment may be an effective option for managing lumbar

  14. A Control Method for Maximum Power Point Tracking in Stand-Alone-Type PV Generation Systems

    Science.gov (United States)

    Itako, Kazutaka; Mori, Takeaki

    In this paper, a new control method for maximum power point tracking (MPPT) in stand-alone-type PV generaton systems is proposed. In this control method, the operations detecting the maximum power point and tracking its point are alternately carried out by using a step-up DC—DC converter. This method requires neither the measurement of temperature and insolation level nor PV array model. In a stand-alone-type application with a battery load, the design method for the boost inductance L of the step-up DC—DC converter is described, and the experimental results show that the use of the proposed MPPT control increases the PV generated energy by 14.8% compared to the conventional system.

  15. A Three-Port Topology Comparison for a Low Power Stand-Alone Photovoltaic System

    DEFF Research Database (Denmark)

    Mira Albert, Maria del Carmen; Knott, Arnold; Andersen, Michael A. E.

    2014-01-01

    Three-port converter (TPC) topologies for renewable energy systems aim to provide higher efficiency and power density than conventional cascaded structures. This work proposes an analytical comparison of different TPC topologies for a photovoltaic LED lamp stand-alone system. A comparison using...... component stress factor (CSF) is performed, which gives a quantitative measure of the performance of the converter. The candidate topologies are compared to each other according to a defined LED lighting strategy and a solar irradiation profile....

  16. Secure stand alone positive personnel identity verification system (SSA-PPIV)

    International Nuclear Information System (INIS)

    Merillat, P.D.

    1979-03-01

    The properties of a secure stand-alone positive personnel identity verification system are detailed. The system is designed to operate without the aid of a central computing facility and the verification function is performed in the absence of security personnel. Security is primarily achieved by means of data encryption on a magnetic stripe badge. Several operational configurations are discussed. Advantages and disadvantages of this system compared to a central computer driven system are detailed

  17. The NEtherlands Cervical Kinematics (NECK Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study

    Directory of Open Access Journals (Sweden)

    van den Akker Elske

    2010-06-01

    Full Text Available Abstract Background Patients with cervical radicular syndrome due to disc herniation refractory to conservative treatment are offered surgical treatment. Anterior cervical discectomy is the standard procedure, often in combination with interbody fusion. Accelerated adjacent disc degeneration is a known entity on the long term. Recently, cervical disc prostheses are developed to maintain motion and possibly reduce the incidence of adjacent disc degeneration. A comparative cost-effectiveness study focused on adjacent segment degeneration and functional outcome has not been performed yet. We present the design of the NECK trial, a randomised study on cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in patients with cervical disc herniation. Methods/Design Patients (age 18-65 years presenting with radicular signs due to single level cervical disc herniation lasting more than 8 weeks are included. Patients will be randomised into 3 groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at 2 and 5 years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which 3 surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for 2 years. The follow-up period is 5 years. Discussion Currently, anterior cervical discectomy with fusion is the golden standard in the surgical treatment of cervical disc herniation. Whether additional interbody fusion or disc prothesis is necessary and cost-effective will be determined by this trial

  18. Modeling, Design and Simulation of Stand-Alone Photovoltaic Power Systems with Battery Storage

    Directory of Open Access Journals (Sweden)

    Abd Essalam BADOUD

    2013-06-01

    Full Text Available Stand alone renewable energy based on photovoltaic systems accompanied with battery storage system are beginning to play an important role over the world to supply power to remote areas. The objective of the study reported in this paper is to elaborate and design a bond graphs model for sizing stand-alone domestic solar photovoltaic electricity systems and simulating the performance of the systems in a tropical climate. The systems modelled consist of an array of PV modules, a lead-acid battery, and a number of direct current appliances. This paper proposes the combination of lead acid battery system with a typical stand alone photovoltaic energy system under variable loads. The main activities of this work purpose to establish library graphical models for each individual component of standalone photovoltaic system. Control strategy has been considered to achieve permanent power supply to the load via photovoltaic/battery based on the power available from the sun. The complete model was simulated under two testing including sunny and cloudy conditions. Simulation of the system using Symbols software was performed and the results of simulation show the superior stable control system and high efficiency. These results have been contrasted with real measured data from a measurement campaign plant carried on electrical engineering laboratory of Grenoble using various interconnection schemes are presented.

  19. Effect of soft tissue thickness over the posterior border of the vertebral body and disc space on cage placement during posterior lumbar interbody fusion: a cadaveric study.

    Science.gov (United States)

    Yang, Jae Hyuk; Kasat, Niraj Sharad; Whang, Jin Ho; Kim, Min Keun; Min, Kyueng-Whan; Hong, Jae Young; Modi, Hitesh N; Suh, Seung Woo

    2012-11-01

    In the present study, we investigated whether there is a difference between visual depth (VD) and radiological image depth (RD) of cages (i.e., structural interbody support devices) placed in disc spaces during posterior lumbar interbody fusion and whether soft tissues covering the posterior border of the vertebral body and associated disc space are the cause of any observed differences. Using digital calipers, cages were inserted at a depth of 5 mm from the soft tissues covering the posterior border of the vertebral body and disc space under direct vision; this depth was defined as VD. After insertion, RD was measured in triplicate. The reliability of RD measurements was evaluated using an intraclass coefficient test. To identify the cause of differences between VD and RD, the thicknesses of soft tissues were measured microscopically. A total of 40 lumbar intervertebral disc spaces with cages were evaluated. The mean RD of cages was 3.12 mm, while the mean difference between the VD and RD of cages (DVRD) was 1.91 mm. On histological examination, the mean thickness of the soft tissue was 2.02 mm. Comparative analysis between histological values and DVRD showed no statistical difference (P = 1.14, 1.55, 0.06). There was a significant difference between VD and RD during cage placement, and soft tissue structure appeared to be responsible for the DVRD of inserted cages. Therefore, cages should be inserted deeper to account for differences between visual and radiological image depths. Copyright © 2012 Wiley Periodicals, Inc.

  20. 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.

    Science.gov (United States)

    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.

  1. Patient-reported and radiographic outcomes of minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis with or without reduction: A comparative study.

    Science.gov (United States)

    Fan, Guoxin; Zhang, Hailong; Guan, Xiaofei; Gu, Guangfei; Wu, Xinbo; Hu, Annan; Gu, Xin; He, Shisheng

    2016-11-01

    This retrospective study aimed to compare the patient-reported outcomes and radiographic assessment of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative spondylolisthesis with reduction versus in situ fusion. Patients receiving MI-TLIF with reduction were assigned as Group A, and those without reduction were assigned as Group B. Radiographic fusion was assessed using Bridwell's grading criteria. Preoperative and postoperative patient-reported outcomes including visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) scale and improvement rate were analyzed. There were 41 patients in Group A and 37 patients in Group B. The mean follow-up was 30.78±14.15months in Group A and 28.95±10.75months in Group B (p=0.525). There were no significant differences in hospital stay (p=0.261), estimated blood loss (p=0.639), blood transfusion (p=0.336), operation time (p=0.762) and complications (p=1.00) between the two groups. Radiographic fusion rate was 92.68% (38/41) in Group A, and 81.08% (30/37) in Group B (p=0.110). Significant differences were observed in either 3-month or last follow-up JOA, VAS, and ODI compared with preoperative JOA, VAS, and ODI, respectively (p0.05). According to MacNab criteria, the excellent and good rate was 85.37% in Group A and 86.49% in Group B (p=0.983). MI-TLIF is an effective and satisfactory surgical technique to manage degenerative spondylolisthesis regardless of reduction or not, so routine reduction may not be a requirement in MI-TLIF for degenerative spondylolisthesis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. First Results of a New Vacuum Plasma Sprayed (VPS Titanium-Coated Carbon/PEEK Composite Cage for Lumbar Interbody Fusion

    Directory of Open Access Journals (Sweden)

    Sven Hoppe

    2018-03-01

    Full Text Available The aim of this study was to assess the performance of a new vacuum plasma sprayed (VPS titanium-coated carbon/polyetheretherketone (PEEK cage under first use clinical conditions. Forty-two patients who underwent a one or two segment transforaminal lumbar interbody fusion (TLIF procedure with a new Ca/PEEK composite cage between 2012 and 2016 were retrospectively identified by an electronic patient chart review. Fusion rates (using X-ray, patient’s satisfaction, and complications were followed up for two years. A total of 90.4% of the patients were pain-free and satisfied after a follow up (FU period of 29.1 ± 9 (range 24–39 months. A mean increase of 3° in segmental lordosis in the early period (p = 0.002 returned to preoperative levels at final follow-ups. According to the Bridwell classification, the mean 24-month G1 fusion rate was calculated as 93.6% and the G2 as 6.4%. No radiolucency around the cage (G3 or clear pseudarthrosis could be seen (G4. In conclusion, biological properties of the inert, hydrophobic surface, which is the main disadvantage of PEEK, can be improved with VPS titanium coating, so that the carbon/PEEK composite cage, which has great advantages in respect of biomechanical properties, can be used safely in TLIF surgery. High fusion rates, good clinical outcome, and low implant-related complication rates without the need to use rhBMP or additional iliac bone graft can be achieved.

  3. A Simple Sizing Algorithm for Stand-Alone PV/Wind/Battery Hybrid Microgrids

    Directory of Open Access Journals (Sweden)

    Jing Li

    2012-12-01

    Full Text Available In this paper, we develop a simple algorithm to determine the required number of generating units of wind-turbine generator and photovoltaic array, and the associated storage capacity for stand-alone hybrid microgrid. The algorithm is based on the observation that the state of charge of battery should be periodically invariant. The optimal sizing of hybrid microgrid is given in the sense that the life cycle cost of system is minimized while the given load power demand can be satisfied without load rejection. We also report a case study to show the efficacy of the developed algorithm.

  4. Stand-alone and Interdisciplinary Course Design for Engineering Education for Sustainable Development

    DEFF Research Database (Denmark)

    Arsat, M.; Holgaard, Jette Egelund; de Graaff, Erik

    In order to embed ESD in the EE curriculum, several approaches has been introduced and practiced in higher education institutions. One of the approaches is to introduce a new ESD course as an add-on to the existing curriculum being either compulsory or elective and either designed for a single...... and reported examples of other ESD courses of the same kind. The presented conceptual framework is put to practice, characterising the AAU course as a stand-alone interdisciplinary course with a consensual approach. The conclusion is that the conceptual framework can provide an awareness of the design features...

  5. Information systems for the materials management department: stand-alone and enterprise resource planning systems.

    Science.gov (United States)

    2005-03-01

    Materials management information systems (MMISs) incorporate information tools that hospitals can use to automate certain business processes, increase staff compliance with these processes, and identify opportunities for cost savings. Recently, there has been a push by hospital administration to purchase enterprise resource planning (ERP) systems, information systems that promise to integrate many more facets of healthcare business. We offer this article to help materials managers, administrators, and others involved with information system selection understand the changes that have taken place in materials management information systems, decide whether they need a new system and, if so, whether a stand-alone MMIS or an ERP system will be the best choice.

  6. Solar Photovoltaic Applications Seminar: Design, installation and operation of small, stand-alone photovoltaic power systems

    Science.gov (United States)

    1980-07-01

    An introduction to photoconductivity, semiconductors, and solar photovoltaic cells is included along with a demonstration of specific applications and application identification. Small solar cell power system design engineering is discussed. Solar PV power system applications involve classical direct electrical energy conversion and electric power system analysis and synthesis. Presentations and examples involve a variety of disciplines including structural analysis, electric power and load analysis, reliability, sizing and optimization; and, installation, operation and maintenance. Four specific system designs are demonstrated: water pumping; domestic uses; navigational and aircraft aids; and telecommunications. All of the applications discussed are for small power requirement (under 2 kilowatts), stand alone systems to be used in remote locations.

  7. Boost converter with combined control loop for a stand-alone photovoltaic battery charge system

    DEFF Research Database (Denmark)

    Mira Albert, Maria del Carmen; Knott, Arnold; Thomsen, Ole Cornelius

    2013-01-01

    frequency avoids perturbations in the load being propagated to the photovoltaic panel and thus deviating the operating point. Linearization of the photovoltaic panel and converter state-space modeling is performed. In order to achieve stable operation under all operating conditions, the photovoltaic panel......The converter control scheme plays an important role in the performance of maximum power point tracking (MPPT) algorithms. In this paper, an input voltage control with double loop for a stand-alone photovoltaic system is designed and tested. The inner current control loop with high crossover...

  8. Surgical data and early postoperative outcomes after minimally invasive lumbar interbody fusion: results of a prospective, multicenter, observational data-monitored study.

    Directory of Open Access Journals (Sweden)

    Paulo Pereira

    Full Text Available Minimally invasive lumbar interbody fusion (MILIF offers potential for reduced operative morbidity and earlier recovery compared with open procedures for patients with degenerative lumbar disorders (DLD. Firm conclusions about advantages of MILIF over open procedures cannot be made because of limited number of large studies of MILIF in a real-world setting. Clinical effectiveness of MILIF in a large, unselected real-world patient population was assessed in this Prospective, monitored, international, multicenter, observational study.To observe and document short-term recovery after minimally invasive interbody fusion for DLD.In a predefined 4-week analysis from this study, experienced surgeons (≥ 30 MILIF surgeries pre-study treated patients with DLD by one- or two-level MILIF. The primary study objective was to document patients' short-term post-interventional recovery (primary objective including back/leg pain (visual analog scale [VAS], disability (Oswestry Disability Index [ODI], health status (EQ-5D and Patient satisfaction.At 4 weeks, 249 of 252 patients were remaining in the study; the majority received one-level MILIF (83% and TLIF was the preferred approach (94.8%. For one-level (and two-level procedures, surgery duration was 128 (182 min, fluoroscopy time 115 (154 sec, and blood-loss 164 (233 mL. Time to first ambulation was 1.3 days and time to study-defined surgery recovery was 3.2 days. Patients reported significantly (P < 0.0001 reduced back pain (VAS: 2.9 vs 6.2, leg pain (VAS: 2.5 vs 5.9, and disability (ODI: 34.5% vs 45.5%, and a significantly (P < 0.0001 improved health status (EQ-5D index: 0.61 vs 0.34; EQ VAS: 65.4 vs 52.9 4 weeks postoperatively. One adverse event was classified as related to the minimally invasive surgical approach. No deep site infections or deaths were reported.For experienced surgeons, MILIF for DLD demonstrated early benefits (short time to first ambulation, early recovery, high patient satisfaction

  9. Feasibility and Optimal Design of a Stand-Alone Photovoltaic Energy System for the Orphanage

    Directory of Open Access Journals (Sweden)

    Vincent Anayochukwu Ani

    2014-01-01

    Full Text Available Access to electricity can have a positive psychological impact through a lessening of the sense of exclusion, and vulnerability often felt by the orphanages. This paper presented the simulation and optimization study of a stand-alone photovoltaic power system that produced the desired power needs of an orphanage. Solar resources for the design of the system were obtained from the National Aeronautics and Space Administration (NASA Surface Meteorology and Solar Energy website at a location of 6°51′N latitude and 7°35′E longitude, with annual average solar radiation of 4.92 kWh/m2/d. This study is based on modeling, simulation, and optimization of energy system in the orphanage. The patterns of load consumption within the orphanage were studied and suitably modeled for optimization. Hybrid Optimization Model for Electric Renewables (HOMER software was used to analyze and design the proposed stand-alone photovoltaic power system model. The model was designed to provide an optimal system configuration based on an hour-by-hour data for energy availability and demands. A detailed design, description, and expected performance of the system were presented in this paper.

  10. Coordination Control Strategy for AC/DC Hybrid Microgrids in Stand-Alone Mode

    Directory of Open Access Journals (Sweden)

    Dwi Riana Aryani

    2016-06-01

    Full Text Available Interest in DC microgrids is rapidly increasing along with the improvement of DC power technology because of its advantages. To support the integration process of DC microgrids with the existing AC utility grids, the form of hybrid AC/DC microgrids is considered for higher power conversion efficiency, lower component cost and better power quality. In the system, AC and DC portions are connected through interlink bidirectional AC/DC converters (IC with a proper control system and power management. In the stand-alone operation mode of AC/DC hybrid microgrids, the control of power injection through the IC is crucial in order to maintain the system security. This paper mainly deals with a coordination control strategy of IC and a battery energy storage system (BESS converter under stand-alone operation. A coordinated control strategy for the IC, which considers the state of charge (SOC level of BESS and the load shedding scheme as the last resort, is proposed to obtain better power sharing between AC and DC subgrids. The scheme will be tested with a hybrid AC/DC microgrid, using the tool of the PSCAD/EMTDC software.

  11. Fuzzy logic control of stand-alone photovoltaic system with battery storage

    Science.gov (United States)

    Lalouni, S.; Rekioua, D.; Rekioua, T.; Matagne, E.

    Photovoltaic energy has nowadays an increased importance in electrical power applications, since it is considered as an essentially inexhaustible and broadly available energy resource. However, the output power provided via the photovoltaic conversion process depends on solar irradiation and temperature. Therefore, to maximize the efficiency of the photovoltaic energy system, it is necessary to track the maximum power point of the PV array. The present paper proposes a maximum power point tracker (MPPT) method, based on fuzzy logic controller (FLC), applied to a stand-alone photovoltaic system. It uses a sampling measure of the PV array power and voltage then determines an optimal increment required to have the optimal operating voltage which permits maximum power tracking. This method carries high accuracy around the optimum point when compared to the conventional one. The stand-alone photovoltaic system used in this paper includes two bi-directional DC/DC converters and a lead-acid battery bank to overcome the scare periods. One converter works as an MPP tracker, while the other regulates the batteries state of charge and compensates the power deficit to provide a continuous delivery of energy to the load. The Obtained simulation results show the effectiveness of the proposed fuzzy logic controller.

  12. International market assessment of stand-alone photovoltaic power systems for cottage industry applications

    Science.gov (United States)

    Philippi, T. M.

    1981-01-01

    The final result of an international assessment of the market for stand-alone photovoltaic systems in cottage industry applications is reported. Nonindustrialized countries without centrally planned economies were considered. Cottage industries were defined as small rural manufacturers, employing less than 50 people, producing consumer and simple products. The data to support this analysis were obtained from secondary and expert sources in the U.S. and in-country field investigations of the Philippines and Mexico. The near-term market for photovoltaics for rural cottage industry applications appears to be limited to demonstration projects and pilot programs, based on an in-depth study of the nature of cottage industry, its role in the rural economy, the electric energy requirements of cottage industry, and a financial analysis of stand-alone photovoltaic systems as compared to their most viable competitor, diesel driven generators. Photovoltaics are shown to be a better long-term option only for very low power requirements. Some of these uses would include clay mixers, grinders, centrifuges, lathes, power saws and lighting of a workshop.

  13. A sizing method for stand-alone PV installations with variable demand

    Energy Technology Data Exchange (ETDEWEB)

    Posadillo, R. [Grupo de Investigacion en Energias y Recursos Renovables, Dpto. de Fisica Aplicada, E.P.S., Universidad de Cordoba, Avda. Menendez Pidal s/n, 14004 Cordoba (Spain); Lopez Luque, R. [Grupo de Investigacion de Fisica Para las Energias y Recursos Renovables, Dpto. de Fisica Aplicada, Edificio C2 Campus de Rabanales, 14071 Cordoba (Spain)

    2008-05-15

    The practical applicability of the considerations made in a previous paper to characterize energy balances in stand-alone photovoltaic systems (SAPV) is presented. Given that energy balances were characterized based on monthly estimations, the method is appropriate for sizing installations with variable monthly demands and variable monthly panel tilt (for seasonal estimations). The method presented is original in that it is the only method proposed for this type of demand. The method is based on the rational utilization of daily solar radiation distribution functions. When exact mathematical expressions are not available, approximate empirical expressions can be used. The more precise the statistical characterization of the solar radiation on the receiver module, the more precise the sizing method given that the characterization will solely depend on the distribution function of the daily global irradiation on the tilted surface H{sub g{beta}}{sub i}. This method, like previous ones, uses the concept of loss of load probability (LLP) as a parameter to characterize system design and includes information on the standard deviation of this parameter ({sigma}{sub LLP}) as well as two new parameters: annual number of system failures (f) and the standard deviation of annual number of system failures ({sigma}{sub f}). This paper therefore provides an analytical method for evaluating and sizing stand-alone PV systems with variable monthly demand and panel inclination. The sizing method has also been applied in a practical manner. (author)

  14. Method to size photovoltaic arrays for hydrogen-PV stand-alone power stations

    Energy Technology Data Exchange (ETDEWEB)

    Barra, L.; Coiante, D. [ENEA, Casaccia (Italy). Area Energetica

    1993-11-01

    With reference to a stand alone power plant configuration, a photovoltaic (PV) system, integrated with an electrolytic hydrogen production and fuel cell reconversion line, is examined with the aim of checking the possibility of assuring energy supply for a given load with time continuity. In order to size the PV array in function of the annual load diagram, for a given site, a method, which utilizes the monthly average values of sun energy density collected on horizontal surface as input data, is presented. The results demonstrate that a PV-H{sub 2} system is suitable for a modular stand alone solar power station, able to supply continuously each generic load. This technical acquisition has to be considered as the first necessary condition to get photovoltaics to overcome the limit due to working intermittence and become a real energy option. An example of an application for a small Mediterranean island, the Volcano Island, permanently inhabited by 469 people, is also discussed. This typical case can be actually show the technical viability of the PV-H{sub 2} solution in powering a small community with the required reliability.

  15. Robust Power Management Control for Stand-Alone Hybrid Power Generation System

    International Nuclear Information System (INIS)

    Kamal, Elkhatib; Adouane, Lounis; Aitouche, Abdel; Mohammed, Walaa

    2017-01-01

    This paper presents a new robust fuzzy control of energy management strategy for the stand-alone hybrid power systems. It consists of two levels named centralized fuzzy supervisory control which generates the power references for each decentralized robust fuzzy control. Hybrid power systems comprises: a photovoltaic panel and wind turbine as renewable sources, a micro turbine generator and a battery storage system. The proposed control strategy is able to satisfy the load requirements based on a fuzzy supervisor controller and manage power flows between the different energy sources and the storage unit by respecting the state of charge and the variation of wind speed and irradiance. Centralized controller is designed based on If-Then fuzzy rules to manage and optimize the hybrid power system production by generating the reference power for photovoltaic panel and wind turbine. Decentralized controller is based on the Takagi-Sugeno fuzzy model and permits us to stabilize each photovoltaic panel and wind turbine in presence of disturbances and parametric uncertainties and to optimize the tracking reference which is given by the centralized controller level. The sufficient conditions stability are formulated in the format of linear matrix inequalities using the Lyapunov stability theory. The effectiveness of the proposed Strategy is finally demonstrated through a SAHPS (stand-alone hybrid power systems) to illustrate the effectiveness of the overall proposed method. (paper)

  16. Photovoltaic OLED Driver for Low-Power Stand-Alone Light-to-Light Systems

    DEFF Research Database (Denmark)

    Ploug, Rasmus Overgaard; Knott, Arnold

    2016-01-01

    Photovoltaic (PV) stand-alone systems need to achieve multiple energy conversion modes. I.e. the energy conversion from PV to a local energy storage as well as energy conversion from the energy storage to the load. This paper documents the practical design considerations for the development of a ...... conversion from photovoltaic panel to the battery, and 97 % in the area 1.4 W to 2 W for power delivery to the OLED.......Photovoltaic (PV) stand-alone systems need to achieve multiple energy conversion modes. I.e. the energy conversion from PV to a local energy storage as well as energy conversion from the energy storage to the load. This paper documents the practical design considerations for the development...... of a three-port-converter for this purpose optimized for the specifications for driving an Organic Light Emitting Diode (OLED) panel intended for lighting purposes. By using a three-port-converter, featuring shared components for each conversion mode, the converter reaches 97 % efficiency at 1.8 W during...

  17. Modified Chaos Particle Swarm Optimization-Based Optimized Operation Model for Stand-Alone CCHP Microgrid

    Directory of Open Access Journals (Sweden)

    Fei Wang

    2017-07-01

    Full Text Available The optimized dispatch of different distributed generations (DGs in stand-alone microgrid (MG is of great significance to the operation’s reliability and economy, especially for energy crisis and environmental pollution. Based on controllable load (CL and combined cooling-heating-power (CCHP model of micro-gas turbine (MT, a multi-objective optimization model with relevant constraints to optimize the generation cost, load cut compensation and environmental benefit is proposed in this paper. The MG studied in this paper consists of photovoltaic (PV, wind turbine (WT, fuel cell (FC, diesel engine (DE, MT and energy storage (ES. Four typical scenarios were designed according to different day types (work day or weekend and weather conditions (sunny or rainy in view of the uncertainty of renewable energy in variable situations and load fluctuation. A modified dispatch strategy for CCHP is presented to further improve the operation economy without reducing the consumers’ comfort feeling. Chaotic optimization and elite retention strategy are introduced into basic particle swarm optimization (PSO to propose modified chaos particle swarm optimization (MCPSO whose search capability and convergence speed are improved greatly. Simulation results validate the correctness of the proposed model and the effectiveness of MCPSO algorithm in the optimized operation application of stand-alone MG.

  18. International market assessment of stand-alone photovoltaic power systems for cottage industry applications

    Science.gov (United States)

    Philippi, T. M.

    1981-11-01

    The final result of an international assessment of the market for stand-alone photovoltaic systems in cottage industry applications is reported. Nonindustrialized countries without centrally planned economies were considered. Cottage industries were defined as small rural manufacturers, employing less than 50 people, producing consumer and simple products. The data to support this analysis were obtained from secondary and expert sources in the U.S. and in-country field investigations of the Philippines and Mexico. The near-term market for photovoltaics for rural cottage industry applications appears to be limited to demonstration projects and pilot programs, based on an in-depth study of the nature of cottage industry, its role in the rural economy, the electric energy requirements of cottage industry, and a financial analysis of stand-alone photovoltaic systems as compared to their most viable competitor, diesel driven generators. Photovoltaics are shown to be a better long-term option only for very low power requirements. Some of these uses would include clay mixers, grinders, centrifuges, lathes, power saws and lighting of a workshop.

  19. Design of a Stand-Alone Photovoltaic Model for Home Lightings and Clean Environment

    International Nuclear Information System (INIS)

    Ani, Vincent Anayochukwu

    2016-01-01

    This paper gives a well-documented health risk of fuel-based lighting (kerosene lamps and fuel-powered generators) and proposed a design of a stand-alone solar PV system for sustainable home lightings in rural Nigerian area. The design was done in three different patterns of electricity consumptions with energy efficient lightings (EELs) using two different battery types (Rolls Surrette 6CS25PS and Hoppecke 10 OpzS 1000) on; (i) judicious power consumption, (ii) normal power consumption, and (iii) excess power consumption; and compared them with the incandescent light bulb consumption. The stand-alone photovoltaic energy systems were designed to match the rural Nigerian sunlight and weather conditions to meet the required lightings of the household. The objective function and constraints for the design models were formulated and optimization procedures were used to demonstrate the best solution (reliability at the lowest lifecycle cost). Initial capital costs as well as annualized costs over 5, 10, 15, 20, and 25 years were quantified and documented. The design identified the most cost-effective and reliable solar and battery array among the patterns of electricity consumption with EEL options (judicious power consumption, normal power consumption, and excess power consumption).

  20. Simulation of stand alone PV systems; Dokuritsugata taiyoko hatsuden system no simulation

    Energy Technology Data Exchange (ETDEWEB)

    Tsuda, I.; Sakuta, K. [Electrotechnical Laboratory, Tsukuba (Japan); Oshiro, T. [Japan Quality Assurance Organization, Tokyo (Japan); Kurokawa, K. [Tokyo University of Agriculture and Technology, Tokyo (Japan)

    1997-11-25

    Studies are performed to develop a simulation program for a stand-alone photovoltaic power generation system equipped with a lead acid battery. In this stand-alone photovoltaic power generation system, the load is connected in shunt with the solar cell array output through the intermediary of a lead acid battery and inverter. The program is a model in which the solar cell model is built taking parallel resistance into account, and the temperature-dependence of the constants is described using approximations experimentally obtained by Solar Techno Center of JQA (Japan Quality Assurance Organization), Hamamatsu. Insolation data for the model is described using METPV compiled by Japan Weather Association, and load data is described using data actually measured at Shizuoka. This program is compared with the data of operation at Hamamatsu, and the result is almost satisfactory. Simulations are conducted at five typical locations in Japan using this program, and it is found that the array load matching correction factor is dependent on seasonal changes rather than locality, that the battery contribution rate does not change much throughout the year, and that it is not dependent on locality. 5 refs., 7 figs., 3 tabs.

  1. Design of a Stand-Alone Photovoltaic (PV Models for Home Lightings and Clean Environment

    Directory of Open Access Journals (Sweden)

    Vincent Anayochukwu Ani

    2016-01-01

    Full Text Available This paper gives a well-documented health risks of fuel-based lighting (kerosene lamps and fuel-powered generators and proposed a design of a stand-alone solar PV system for sustainable home lightings in rural Nigerian area. The design was done in three different patterns of electricity consumptions with energy efficient lightings (EELs using two different battery types (Rolls Surrette 6CS25PS and hoppecke 10 OpzS 1000 on; i judicious power consumption, ii normal power consumption, iii excess power consumption; and compared them with the incandescent light bulb consumption. The stand-alone photovoltaic energy systems were designed to match the rural Nigerian sunlight and weather conditions to meet the required lightings of the household. The objective function and constraints for the design models were formulated and optimization procedure were used to demonstrate the best solution (reliability at the lowest lifecycle cost. Initial capital costs as well as annualized costs over 5, 10, 15, 20, and 25 years were quantified and documented. The design identified the most cost-effective and reliable solar and battery array among the patterns of electricity consumption with energy efficient lighting options (judicious power consumption, normal power consumption, and excess power consumption.

  2. Design of Stand-Alone Hybrid Power Generation System at Brumbun Beach Tulungagung East Java

    Science.gov (United States)

    Rahmat, A. N.; Hidayat, M. N.; Ronilaya, F.; Setiawan, A.

    2018-04-01

    Indonesian government insists to optimize the use of renewable energy resources in electricity generation. One of the efforts is launching Independent Energy Village plan. This program aims to fulfill the need of electricity for isolated or remote villages in Indonesia. In order to support the penetration of renewable energy resources in electricity generation, a hybrid power generation system is developed. The simulation in this research is based on the availability of renewable energy resources in Brumbun beach, Tulungagung, East Java. Initially, the electricity was supplied through stand-alone electricity generations which are installed at each house. Hence, the use of electricity between 5 p.m. – 9 p.m. requires high operational costs. Based on the problem above, this research is conducted to design a stand-alone hybrid electricity generation system, which may consist of diesel, wind, and photovoltaic. The design is done by using HOMER software to optimize the use of electricity from renewable resources and to reduce the operation of diesel generation. The combination of renewable energy resources in electricity generation resulted in NPC of 44.680, COE of 0,268, and CO2 emissions of 0,038 % much lower than the use of diesel generator only.

  3. Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: Based on Cases With a Minimum of 10 Years of Follow-up.

    Science.gov (United States)

    Nakashima, Hiroaki; Kawakami, Noriaki; Tsuji, Taichi; Ohara, Tetsuya; Suzuki, Yoshitaka; Saito, Toshiki; Nohara, Ayato; Tauchi, Ryoji; Ohta, Kyotaro; Hamajima, Nobuyuki; Imagama, Shiro

    2015-07-15

    Retrospective case-controlled study. To investigate the incidence of adjacent segment degeneration (ASD) and the associated risk factors during a period of at least 10 years after posterior lumbar interbody fusion (PLIF). ASD is a problematic sequelae after spinal fusion surgery. Few long-term follow-up studies have investigated ASD after PLIF; thus, magnetic resonance imaging (MRI) data available for the evaluation of postoperative changes associated with ASD are limited. One hundred one patients were retrospectively enrolled. The minimum follow-up was 10 years after surgery. Preoperative and postoperative (2, 5, and 10 yr after surgery) Radiographs and MRI images were evaluated. Disc height, vertebral slip, and intervertebral angle were examined on radiographical images. Disc degeneration and spinal stenosis on MRI images were evaluated. Risk factors for developing early-onset radiographical ASD were evaluated using a multivariate logistic regression analysis. The degenerative changes in disc height, vertebral slip, and intervertebral angle on radiographs 10 years after surgery were found in 12, 36, and 17 cases, respectively, at the cranial-adjacent level and in 3, 6, and 11 cases, respectively, at the caudal-adjacent level. Increased disc degeneration and spinal stenosis worsening were observed in 62 and 68 cases, respectively, at the cranial-adjacent level and in 25 and 12 cases, respectively, at the caudal-adjacent level on MRI 10 years after surgery. Ten patients (9.9%) required reoperation, and 80% of revision surgeries were performed more than 5 years after the initial surgery. High pelvic incidence was a risk factor for developing early-onset radiographical ASD. The majority of the reoperations for ASD were performed more than 5 years after the initial lumbar fusion surgery, although the progression of radiographical ASD began in the early postoperative period. A high degree of pelvic incidence was a risk factor for developing early-onset radiographical

  4. The significance of removing ruptured intervertebral discs for interbody fusion in treating thoracic or lumbar type B and C spinal injuries through a one-stage posterior approach.

    Directory of Open Access Journals (Sweden)

    Qian-Shi Zhang

    Full Text Available To identify the negative effect on treatment results of reserving damaged intervertebral discs when treating type B and type C spinal fracture-dislocations through a one-stage posterior approach.This is a retrospective review of 53 consecutive patients who were treated in our spine surgery center from January 2005 to May 2012 due to severe thoracolumbar spinal fracture-dislocation. The patients in Group A (24 patients underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression. In Group B (29 patients, the patients underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression evacuating of the ruptured disc and inserting of a bone graft into the evacuated disc space for interbody fusion. The mean time between injury and operation was 4.1 days (range 2-15 days. The clinical, radiologic and complication outcomes were analyzed retrospectively.Periodic follow-ups were carried out until an affirmative union or treatment failure took place. A progressive kyphosis angle larger than 10°, loss of disc height, pseudoarthrosis, recurrence of dislocation or subluxation, or instrument failure before fusion were considered treatment failures. Treatment failures were detected in 13 cases in Group A (failure rate was 54.2%. In Group B, there were 28 cases in which definitive bone fusion was demonstrated on CT scans, and CT scans of the other cases demonstrated undefined pseudoarthrosis without hardware failure. There were statistically significant differences between the two groups (p0.05 Fisher's exact test.Intervertebral disc damage is a common characteristic in type B and C spinal fracture-dislocation injuries. The damaged intervertebral disc should be removed and substituted with a bone graft because reserving the damaged disc in situ increases the risk of treatment failure.

  5. Which Approach Is Advantageous to Preventing Development of Adjacent Segment Disease? Comparative Analysis of 3 Different Lumbar Interbody Fusion Techniques (ALIF, LLIF, and PLIF) in L4-5 Spondylolisthesis.

    Science.gov (United States)

    Lee, Chul-Woo; Yoon, Kang-Jun; Ha, Sang-Soo

    2017-09-01

    The purpose of this study was to compare radiologic and clinical outcomes in patients with L4-5 lumbar spondylolisthesis who have undergone either instrumented anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), or posterior lumbar interbody fusion (PLIF), especially with regard to the development of adjacent segment disease (ASD). Eighty-two patients with preoperative L4-5 spondylolisthesis and minimal ASD who underwent instrumented L4-5 fusion were divided into 3 groups according to the surgical approach used for treatment (ALIF: 27 patients, LLIF: 24 patients, PLIF: 31 patients). Radiographic measurements including preoperative and postoperative foraminal and disk height, segmental and lumbar lordosis, percentage of vertebral slippage, and reduction rate were reviewed. The incidence of ASD and clinical outcomes were evaluated and compared between the 3 groups. ASD was found in 37.0% (10/27), 41.7% (10/24), and 64.5% (20/31) of the patients in the ALIF, LLIF, and PLIF groups, respectively (mean follow-up duration: 35.42 ± 9.35 months). The ALIF and LLIF groups had significantly increased disk and foraminal height compared with the PLIF group. The ALIF group had significantly improved lordosis compared with the PLIF and LLIF groups. There were no statistically significant intergroup differences in clinical outcomes assessed by visual analog scale and Oswestry Disability Index. The 3 different fusion techniques investigated can all produce good outcomes in treating lumbar spondylolisthesis in L4-5, but ALIF and LLIF are more advantageous in preventing the development of ASD. Copyright © 2017. Published by Elsevier Inc.

  6. Charactrization of a Li-ion battery based stand-alone a-Si photovoltaic system

    International Nuclear Information System (INIS)

    Hamid Vishkasougheh, Mehdi; Tunaboylu, Bahadir

    2014-01-01

    Highlights: • An Li-ion battery based stand-alone a-Si PV was designed. The system composed of three a-Si panels with an efficiency of 7% and 40 cells of LFP batteries. • Effects of solar radiation and environmental temperature for three cities, Istanbul, Ankara, and Adana, have been investigated on a-Si panels. • Using transition formulas BSPV outputs are predictable for any location out of standard test condition. - Abstract: The number of photovoltaic (PV) system installations is increasing rapidly. As more people learn about this versatile and often cost-effective power option, this trend will accelerate. This document presents a recommended design for a battery based stand-alone photovoltaic system (BSPV). BSPV system has the ability to be applied in different areas, including warning signals, lighting, refrigeration, communication, residential water pumping, remote sensing, and cathodic protection. The presented calculation method gives a proper idea for a system sizing technique. Based on application load, different scenarios are possible for designing a BSPV system. In this study, a battery based stand-alone system was designed. The electricity generation part is three a-Si panels, which are connected in parallel, and for the storage part LFP (lithium iron phosphate) battery was used. The high power LFP battery packs are 40 cells each 8S5P (configured 8 series 5 parallel). Each individual pack weighs 0.5 kg and is 25.6 V. In order to evaluate the efficiency of a-Si panels with respect to the temperature and the solar irradiation, cities of Istanbul, Ankara and Adana in Turkey were selected. Temperature and solar irradiation were gathered from reliable sources and by using translation equations, current and voltage output of panels were calculated. As a result of these calculations, current and energy outputs were computed by considering an average efficient solar irradiation time value per day in Turkey. The calculated power values were inserted to a

  7. Effect of Mechanical Ventilation Mode Type on Intra- and Postoperative Blood Loss in Patients Undergoing Posterior Lumbar Interbody Fusion Surgery: A Randomized Controlled Trial.

    Science.gov (United States)

    Kang, Woon-Seok; Oh, Chung-Sik; Kwon, Won-Kyoung; Rhee, Ka Young; Lee, Yun Gu; Kim, Tae-Hoon; Lee, Suk Ha; Kim, Seong-Hyop

    2016-07-01

    The aim of study was to evaluate the effect of mechanical ventilation mode type, pressure-controlled ventilation (PCV), or volume-controlled ventilation (VCV) on intra- and postoperative surgical bleeding in patients undergoing posterior lumbar interbody fusion (PLIF) surgery. This was a prospective, randomized, single-blinded, and parallel study that included 56 patients undergoing PLIF and who were mechanically ventilated using PCV or VCV. A permuted block randomization was used with a computer-generated list. The hemodynamic and respiratory parameters were measured after anesthesia induction in supine position, 5 min after patients were changed from supine to prone position, at the time of skin closure, and 5 min after the patients were changed from prone to supine position. The amount of intraoperative surgical bleeding, fluid administration, urine output, and transfusion requirement were measured at the end of surgery. The amount of postoperative bleeding and transfusion requirement were recorded every 24 h for 72 h. The primary outcome was the amount of intraoperative surgical bleeding, and 56 patients were analyzed. The amount of intraoperative surgical bleeding was significantly less in the PCV group than that in the VCV group (median, 253.0 [interquartile range, 179.0 to 316.5] ml in PCV group vs. 382.5 [328.0 to 489.5] ml in VCV group; P patients undergoing PLIF, which may be related to lower intraoperative peak inspiratory pressure.

  8. Effects of Lordotic Angle of a Cage on Sagittal Alignment and Clinical Outcome in One Level Posterior Lumbar Interbody Fusion with Pedicle Screw Fixation

    Directory of Open Access Journals (Sweden)

    Ji-Ho Lee

    2015-01-01

    Full Text Available This study aims to assess the differences in the radiological and clinical results depending on the lordotic angles of the cage in posterior lumbar interbody fusion (PLIF. We reviewed 185 segments which underwent PLIF using two different lordotic angles of 4° and 8° of a polyetheretherketone (PEEK cage. The segmental lordosis and total lumbar lordosis of the 4° and 8° cage groups were compared preoperatively, as well as on the first postoperative day, 6th and 12th months postoperatively. Clinical assessment was performed using the ODI and the VAS of low back pain. The pre- and immediate postoperative segmental lordosis angles were 12.9° and 12.6° in the 4° group and 12° and 12.0° in the 8° group. Both groups exhibited no significant different segmental lordosis angle and total lumbar lordosis over period and time. However, the total lumbar lordosis significantly increased from six months postoperatively compared with the immediate postoperative day in the 8° group. The ODI and the VAS in both groups had no differences. Cages with different lordotic angles of 4° and 8° showed insignificant results clinically and radiologically in short-level PLIF surgery. Clinical improvements and sagittal alignment recovery were significantly observed in both groups.

  9. Stand-alone differential capacitance force sensors with sub-nano-newton sensitivity

    Science.gov (United States)

    Ye, Jilong; Sun, Taotao; Huang, Dong; Li, Zhihong; Lin, Li

    2017-09-01

    This paper presents structure design, microfabrication processes, calibration techniques and experimental results of differential capacitance force sensors with features of sub-nano-newton sensitivity, up to 10 000 Hz sampling rate, and applicability as stand-alone devices. The representative sensor demonstrates a force resolution of 0.11 nN at a 19 Hz sampling rate or 1.47 nN at 10 000 Hz. A novel asymmetric differential capacitance structure proposed results in remarkable increase in the ratio of measurement range to resolution in comparison with traditional symmetric structure. In addition, the stiction between silicon and glass caused by the capillary force during dicing is eliminated by the use of hydrophobization treatment. Such a treatment is essential to successfully fabricate structures with a large ratio of overlapped area to gap in silicon/glass anodic bonding processes.

  10. Lossy Data Aggregation with Network Coding in Stand-Alone Wireless Sensor Networks

    DEFF Research Database (Denmark)

    Madsen, Tatiana Kozlova

    2011-01-01

    This work focuses on a special type of wireless sensor networks (WSNs) that we refer to as a stand alone network. These netwoks operate in harsh and extreme environments where data collection is done only occasionally. Typical examples include habitat monitoring systems, monitoring systems...... in chemical plants, etc. Given resource constrained operation of a sensor network where the nodes are battery powered and buffer sizes are limited, efficient methods for in-network data storage abd it subsequent fast and reliable transmission to a gateway is desirable. To save scarse resources and to prolong...... the lifetime of the whole network, the lossy data grregation method can be applied. It is especially viable in the networks where several sensors are measuring the same physical phenomenum and only average values of sensor readings are of interest. In this paper we present a method for efficient lossy data...

  11. Study of Stand-Alone Microgrid under Condition of Faults on Distribution Line

    Science.gov (United States)

    Malla, S. G.; Bhende, C. N.

    2014-10-01

    The behavior of stand-alone microgrid is analyzed under the condition of faults on distribution feeders. During fault since battery is not able to maintain dc-link voltage within limit, the resistive dump load control is presented to do so. An inverter control is proposed to maintain balanced voltages at PCC under the unbalanced load condition and to reduce voltage unbalance factor (VUF) at load points. The proposed inverter control also has facility to protect itself from high fault current. Existing maximum power point tracker (MPPT) algorithm is modified to limit the speed of generator during fault. Extensive simulation results using MATLAB/SIMULINK established that the performance of the controllers is quite satisfactory under different fault conditions as well as unbalanced load conditions.

  12. Solar pv fed stand-alone excitation system of a synchronous machine for reactive power generation

    Science.gov (United States)

    Sudhakar, N.; Jain, Siddhartha; Jyotheeswara Reddy, K.

    2017-11-01

    This paper presents a model of a stand-alone solar energy conversion system based on synchronous machine working as a synchronous condenser in overexcited state. The proposed model consists of a Synchronous Condenser, a DC/DC boost converter whose output is fed to the field of the SC. The boost converter is supplied by the modelled solar panel and a day time variable irradiance is fed to the panel during the simulation time. The model also has one alternate source of rechargeable batteries for the time when irradiance falls below a threshold value. Also the excess power produced when there is ample irradiance is divided in two parts and one is fed to the boost converter while other is utilized to recharge the batteries. A simulation is done in MATLAB-SIMULINK and the obtained results show the utility of such modelling for supplying reactive power is feasible.

  13. An Analysis of Stand-alone GPS Quality and Simulated GNSS Quality for Road Pricing

    DEFF Research Database (Denmark)

    Zabic, Martina; Nielsen, Otto Anker

    2006-01-01

    Use of GPS for road pricing has often been suggested as the way of creating more efficient charging strategies than existing systems based on cordon lines or time use. In Denmark, Copenhagen participated with the AKTA project in the PRoGRESS programme, sponsored by the EU. The major part...... of the AKTA project was to equip 500 cars with GPS receivers. The paper presents the methods and results from a study of GPS quality in relation to road pricing in a dense urban area. The collected data from 500 cars over a two-year period in the Copenhagen region was analyzed in order to determine whether...... the stand alone GPS quality and reliability is adequate for implementation of an operational road pricing system in Copenhagen. The results from the analysis show that the satellite availability in Copenhagen is not sufficient to form the basis for a reliable operational road pricing system. The narrow...

  14. Electrical integration of renewable energy into stand-alone power supplies incorporating hydrogen storage

    Energy Technology Data Exchange (ETDEWEB)

    Little, Matthew; Thomson, Murray

    2007-07-15

    A stand-alone renewable-energy system employing a hydrogen-based energy store is now being commissioned within the HaRI project at West Beacon Farm, Leicestershire, UK. The interconnection of the various generators, loads and storage system is made through a central DC busbar: an arrangement that is believed to be unique within systems of this type and scale. The rotating generators, such as the wind turbines, are connected through standard industrial drives operating in regenerative mode, while the DC devices - electrolyser, fuel cell and solar photovoltaic array - employ custom DC-DC converters. This paper reviews the design philosophy of the electrical system and the various converters required. Modelling and simulation of the system is discussed along with practical lessons learnt from its implementation and some initial results are presented. (author)

  15. System Simulation by Recursive Feedback: Coupling a Set of Stand-Alone Subsystem Simulations

    Science.gov (United States)

    Nixon, D. D.

    2001-01-01

    Conventional construction of digital dynamic system simulations often involves collecting differential equations that model each subsystem, arran g them to a standard form, and obtaining their numerical gin solution as a single coupled, total-system simultaneous set. Simulation by numerical coupling of independent stand-alone subsimulations is a fundamentally different approach that is attractive because, among other things, the architecture naturally facilitates high fidelity, broad scope, and discipline independence. Recursive feedback is defined and discussed as a candidate approach to multidiscipline dynamic system simulation by numerical coupling of self-contained, single-discipline subsystem simulations. A satellite motion example containing three subsystems (orbit dynamics, attitude dynamics, and aerodynamics) has been defined and constructed using this approach. Conventional solution methods are used in the subsystem simulations. Distributed and centralized implementations of coupling have been considered. Numerical results are evaluated by direct comparison with a standard total-system, simultaneous-solution approach.

  16. Stand-alone version of the 11kW Gaia wind turbine

    Energy Technology Data Exchange (ETDEWEB)

    Bindner, H.; Rosas, P.A.C.; Teodorescu, R.; Blaabjerg, F.

    2004-09-15

    This report describes the development of a stand-alone version of the 11kW Gaia wind turbine. Various possible configurations are investigated and a configuration using a back-to-back converter is chosen. A model is developed for controller design of the fast controllers of the unit. Controllers are designed and a prototype is built for testing. The report documents the performance of the prototype through measurements done on the full scale prototype installed in a test facility where it has been tested both as a standalone unit and in parallel with a diesel genset. For system wide power quality assessment and controller design a dynamic performance assessment model has been developed. (au)

  17. Energy management system for stand-alone diesel-wind-biomass microgrid with energy storage system

    International Nuclear Information System (INIS)

    Wang, Chengshan; Liu, Yixin; Li, Xialin; Guo, Li; Qiao, Lei; Lu, Hai

    2016-01-01

    An energy management system for stand-alone microgrid composed of diesel generators, wind turbine generator, biomass generator and an ESS (energy storage system) is proposed in this paper. Different operation objectives are achieved by a hierarchical control structure with different time scales. Firstly, the optimal schedules of the diesel generators, wind turbine generator, biomass generator and ESS are determined fifteen minutes ahead according to the super short-term forecast of load and wind speed in the optimal scheduling layer. Comprehensive analysis which takes the uncertainty of load and wind speed into account is conducted in this layer to minimize the operation cost of the system and ensure a desirable range of the state of charge of the ESS. Secondly, the operation points of each unit are regulated dynamically to guarantee real-time power balance and safety range of diesel generation in the real-time control layer, based on which the response capability when suffering significant forecast deviation and other emergency issues, e.g. sudden load-up can be improved. Finally, the effectiveness of the proposed energy management strategy is verified on an RT_Lab based real-time simulation platform, and the economic performances with different types of ESS are analyzed as well. - Highlights: • A hierarchical control strategy is proposed for a stand-alone microgrid. • The uncertainties of load and wind speed have been considered. • Better economic performance and high reliability of the system can be achieved. • The influences of different energy storage systems have been analyzed.

  18. Optimal expansion planning of stand-alone systems with stochastic simulations

    Energy Technology Data Exchange (ETDEWEB)

    Hoese, Alejandro [Instituto de Energia Electrica (IEE), Universidad Nacional de San Juan, (Argentina)

    1997-12-31

    Stand-alone systems in the range of 1 kW - 10 MW are taking relevance in the new (global) liberal concept of energy market. State and private investors are becoming increasingly attention on the use of renewable for these systems, but it must be shown that these non-conventional solutions are competitive with the established conventional ones. The high investment costs and the technical and economic uncertainties coupled with the use of time-dependent energy sources are the mainly inhibiting factors for the decision agents to choose these systems instead of conventional ones. In the paper a new model for optimal expansion planning of hybrid stand-alone generating systems under consideration of uncertainties is presented. This model is at present in {sup d}evelopment state{sup .} Results already obtained in the first steps of this research are promising and some of them are here presented. [Espanol] Los sistemas autocontenidos en el rango de 1 Kw a 10 MW estan tomando importancia en el nuevo (global) concepto liberal del mercado de la energia. Inversionistas privados y del Estado estan poniendo mayor atencion en el uso de energias renovables para estos sistemas, pero debe mostrarse que estas soluciones no-convencionales son competitivas con las convencionales establecidas. Los altos costos de inversion y las incertidumbres tecnicas y economicas aunadamente con el uso de fuentes de energia dependientes del tiempo son los principales factores inhibidores de los factores de decision para escoger estos sistemas en lugar de los convencionales. En este articulo se presenta un nuevo modelo de planeacion de expansion optima de sistemas hibridos autocontenidos de generacion electrica bajo la consideracion de incertidumbres. Este modelo esta actualmente en {sup e}stado de desarrollo{sup .} Los resultados ya obtenidos en las primeras etapas de esta investigacion son prometedores y se presentan algunos de ellos.

  19. Diagnostic value of the stand-alone synthetic image in digital breast tomosynthesis examinations.

    Science.gov (United States)

    Garayoa, Julia; Chevalier, Margarita; Castillo, Maria; Mahillo-Fernández, Ignacio; Amallal El Ouahabi, Najim; Estrada, Carmen; Tejerina, Alejandro; Benitez, Olivia; Valverde, Julio

    2018-02-01

    To demonstrate the non-inferiority of synthetic image (SI) mammography versus full-field digital mammography (FFDM) in breast tomosynthesis (DBT) examinations. An observational, retrospective, single-centre, multireader blinded study was performed, using 2384 images to directly compare SI and FFDM based on Breast Imaging Reporting and Data System (BIRADS) categorisation and visibility of radiological findings. Readers had no access to digital breast tomosynthesis slices. Multiple reader, multiple case (MRMC) receiver operating characteristic (ROC) methodology was used to compare the diagnostic performance of SI and FFDM images. The kappa statistic was used to estimate the inter-reader and intra-reader reliability. The area under the ROC curves (AUC) reveals the non-inferiority of SI versus FFDM based on BIRADS categorisation [difference between AUC (ΔAUC), -0.014] and lesion visibility (ΔAUC, -0.001) but the differences were not statistically significant (p=0.282 for BIRADS; p=0.961 for lesion visibility). On average, 77.4% of malignant lesions were detected with SI versus 76.5% with FFDM. Sensitivity and specificity of SI are superior to FFDM for malignant lesions scored as BIRADS 5 and breasts categorised as BIRADS 1. SI is not inferior to FFDM when DBT slices are not available during image reading. SI can replace FFDM, reducing the dose by 45%. • Stand-alone SI demonstrated performance not inferior for lesion visibility as compared to FFDM. • Stand-alone SI demonstrated performance not inferior for lesion BIRADS categorisation as compared to FFDM. • Synthetic images provide important dose savings in breast tomosynthesis examinations.

  20. Imagery rescripting as a stand-alone treatment for patients with social phobia: a case series.

    Science.gov (United States)

    Frets, Petra G; Kevenaar, Ciska; van der Heiden, Colin

    2014-03-01

    The majority of patients with social phobia reports experiencing negative images, usually linked to memories of earlier aversive social experiences. Several studies have indicated that such negative self-imagery appears to have a causal role in maintaining social phobia, which suggests that interventions aimed at dealing with these images could be beneficial in the treatment of social phobia. One potentially powerful approach is imagery rescripting (IR), a clinical intervention that focuses on changing the meaning and impact of unpleasant memories. In the treatment of social phobia IR was only used as part of a broader cognitive-behavioral treatment package. However, we propose that IR alone might also be an effective treatment for this anxiety disorder. The present study reports an initial evaluation of the application of IR as a stand-alone treatment for six adult outpatients presenting with social phobia. A single case series using an A-B replication across patients design was employed. Following a no-treatment baseline period, IR was delivered weekly and patients were followed up for 3 and 6 months. For all patients, substantial reductions were obtained on all outcome measures at post-treatment, and gains were largely maintained at 6-months follow-up. The generalizability of the effects of IR for social phobia is limited by the small number of patients treated by only one therapist. The results of this preliminary case series suggest that IR as a stand alone treatment is an apparently effective intervention in the treatment of patients with social phobia, and indicate that controlled evaluation of its efficacy might be worthwhile. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. A Meta-Analytic Review of Stand-Alone Interventions to Improve Body Image.

    Directory of Open Access Journals (Sweden)

    Jessica M Alleva

    Full Text Available Numerous stand-alone interventions to improve body image have been developed. The present review used meta-analysis to estimate the effectiveness of such interventions, and to identify the specific change techniques that lead to improvement in body image.The inclusion criteria were that (a the intervention was stand-alone (i.e., solely focused on improving body image, (b a control group was used, (c participants were randomly assigned to conditions, and (d at least one pretest and one posttest measure of body image was taken. Effect sizes were meta-analysed and moderator analyses were conducted. A taxonomy of 48 change techniques used in interventions targeted at body image was developed; all interventions were coded using this taxonomy.The literature search identified 62 tests of interventions (N = 3,846. Interventions produced a small-to-medium improvement in body image (d+ = 0.38, a small-to-medium reduction in beauty ideal internalisation (d+ = -0.37, and a large reduction in social comparison tendencies (d+ = -0.72. However, the effect size for body image was inflated by bias both within and across studies, and was reliable but of small magnitude once corrections for bias were applied. Effect sizes for the other outcomes were no longer reliable once corrections for bias were applied. Several features of the sample, intervention, and methodology moderated intervention effects. Twelve change techniques were associated with improvements in body image, and three techniques were contra-indicated.The findings show that interventions engender only small improvements in body image, and underline the need for large-scale, high-quality trials in this area. The review identifies effective techniques that could be deployed in future interventions.

  2. Comparison of posterior lumbar interbody fusion (PLIF) with autogenous bone chips and PLIF with cage for treatment of double-level isthmic spondylolisthesis.

    Science.gov (United States)

    Song, Deyong; Chen, Zhong; Song, Dewei; Li, Zaixue

    2015-11-01

    Spondylolytic defects involving multiple vertebral levels are rare. It is reported that only 1.48% of patients with back pain were diagnosed with multi-level spondylolysis. The incidence of multiple-level spondylolisthesis is even rarer, so far there have been few reports of multi-level isthmic spondylolisthesis in the literature. The aim of this study is to evaluate clinical and radiological outcomes of two different fusion techniques for treatment of double-level isthmic spondylolisthesis. Fifty-four patients who were managed surgically for treatment of double-level symptomatic isthmic spondylolisthesis were included in this study. Between May 2004 and September 2012, 29 consecutive patients underwent posterior lumbar interbody fusion (PLIF) with autogenous bone chips (group I) at Foshan Hospital of Traditional Chinese Medicine, Guangdong, China. Between March 2005 and December 2013, 25 consecutive patients underwent PLIF with cage (group II) at Zhujiang Hospital of Southern Medical University, Guangdong, China. The mean follow-up periods were 27.2 and 26.8 months, respectively. The mean VAS scores of back and leg pain significantly decreased from 7.2 to 2.2 and 5.8 to 2.1 in the group I and from 7.0 to 1.9 and 6.1 to 1.8 in the group II, respectively. In the group I, mean ODI scores improved significantly from 54% to 14.2% and, in the group II, from 60% to 12.6%. In both groups, VAS and ODI scores significantly changed from pre- to postoperatively (p0.05). In both groups, changes in disc height, degree of listhesis, and whole lumbar lordosis between the pre- and postoperative periods were significant. Clinical and functional outcomes demonstrate no significant differences between groups in treating back and leg pain of adult patients with double-level isthmic spondylolisthesis. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. [Risk Factors for Predicting the Need for Additional Surgery for Symptomatic Adjacent Segment Disease after Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion].

    Science.gov (United States)

    Fukaya, Kenji; Hasegawa, Mitsuhiro; Shirato, Mitsuru; Teshima, Takashi

    2017-04-01

    To determine the incidence of and risk factors for symptomatic adjacent segment disease(SASD)requiring additional surgery in patients previously treated with minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF)for degenerative lumbar disease. A series of 467 consecutive patients who had undergone MIS-TLIF of one or two segments to treat degenerative lumbar disease was identified. The mean age of the patients at the time of the index operation was 67.7 years and the mean follow-up period was 33.2 months(range, 6.0-110.1 months). The incidence rate of SASD surgeries was calculated using the Kaplan-Meier method. The log-rank test and Cox regression analysis were used for risk factor analysis based on age, sex, number of fused segments, presence of laminectomy adjacent to index fusion, and L1 plumb line. The overall incidence rate of SASD requiring additional surgery was 2.8%. Kaplan-Meier analysis predicted a disease-free rate of adjacent segments in 94.3% of the patients at 4 years and in 90.8% of the patients at 8 years after the index operation. In the analysis of risk factors, a negative L1 plumb line was associated with a 5.6 times higher incidence of SASD requiring additional surgery than that associated with a positive L1 plumb line(p=0.0096). There was no significant difference in the survival rates based on age, sex, number of fused segments, and concomitant laminectomy to adjacent segment. Approximately 9.2% of the patients were predicted to undergo additional surgery for treating SASD within 8 years of MIS-TLIF. In this study, presence of a negative L1 plumb line indicated higher incidence of additional SASD associated surgeries than that shown by a positive L1 plumb line. Therefore, surgeons should carefully consider this factor while performing MIS-TLIF.

  4. Comparison of fusion rate and clinical results between CaO-SiO2-P2O5-B2O3bioactive glass ceramics spacer with titanium cages in posterior lumbar interbody fusion.

    Science.gov (United States)

    Lee, Jae Hyup; Kong, Chang-Bae; Yang, Jae Jun; Shim, Hee-Jong; Koo, Ki-Hyoung; Kim, Jeehyoung; Lee, Choon-Ki; Chang, Bong-Soon

    2016-11-01

    The CaO-SiO 2 -P 2 O 5 -B 2 O 3 glass ceramics spacer generates chemical bonding to adjacent bones with high mechanical stability to produce a union with the end plate, and ultimately stability. The authors aimed to compare the clinical efficacy and safety of CaO-SiO 2 -P 2 O 5 -B 2 O 3 glass ceramics with a titanium cage that is widely used for posterior lumbar interbody fusion (PLIF) surgery in the clinical field. This is a prospective, stratified randomized, multicenter, single-blinded, comparator-controlled non-inferiority trial. The present study was conducted in four hospitals and enrolled a total of 86 patients between 30 and 80 years of age who required one-level PLIF due to severe spinal stenosis, spondylolisthesis, or huge disc herniation. The Oswestry Disability Index (ODI), Short Form-36 Health Survey (SF-36), and pain visual analog scale (VAS) were assessed before surgery and at 3, 6, and 12 months after surgery. The spinal fusion rate was assessed at 6 and 12 months after surgery. The spinal fusion rate and the area of fusion, subsidence of each CaO-SiO 2 -P 2 O 5 -B 2 O 3 glass ceramics and titanium cage, and the extent of osteolysis were evaluated using a dynamic plain radiography and a three-dimensional computed tomography at 12 months after surgery. The present study was supported by BioAlpha, and some authors (JHL, C-KL, and B-SC) have stock ownership (CaO-SiO 2 -P 2 O 5 -B 2 O 3 glass ceramics spacer showed a similar fusion rates and clinical outcomes compared with titanium cage. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

  5. Key factors for the implementation of successful, stand-alone village electrification schemes in Peru

    Science.gov (United States)

    Sanchez-Campos, Teodoro

    The hypothesis of this work is that there are social, financial, technical, managerial institutional and political key factors that may either support or prevent the success of small stand alone energy systems in rural areas. This research work aims at contributing to the identification of such factors and study their relevance to the performance and sustainability of stand alone energy systems in rural areas; to meet its purpose, a wide range of literature was reviewed including rural electrification programmes and projects, research and development projects on access to electricity in rural areas, impact studies and others, and a field research survey was done the Andes and Upper Jungle regions in Peru. Nineteen possible critical factors were identified, thirteen with relevance at the local context (the community or village), and six with relevance at the national (or wider) context. From literature review it was found that the possible local critical factors were relevant only to four categories of factors instead of the six considered initially (i.e. social, financial, technological and managerial): the other two categories, political and institutional were found to be more relevant to the national context, therefore those were included in the group of possible critical factors of wider context. A series of questionnaires were designed to collect field data information, which was later used to analyse and establish the relation of each identified factor with the success of the systems studied. The survey research was implemented in 14 villages, 7 with small diesel sets and 7 with small hydropower schemes, all spread in the Andes and Upper Jungle of Peru, which were carefully selected to be representative of regions with isolated stand alone systems and with different socioeconomic background. Out of the 13 possible critical factors of local context, it was found that only 3 are really critical, the others are important but not critical; one of them (technical

  6. [COMPARISON OF EFFECTIVENESS AND CHANGE OF SAGITTAL SPINO-PELVIC PARAMETERS BETWEEN MINIMALLY INVASIVE TRANSFORAMINAL AND CONVENTIONAL OPEN POSTERIOR LUMBAR INTERBODY FUSIONS IN TREATMENT OF LOW-DEGREE ISTHMIC LUMBAR SPONDYLOLISTHESIS].

    Science.gov (United States)

    Sun, Xin; Zeng, Rong; Li, Guangsheng; Wei, Bo; Hu, Zibing; Lin, Hao; Chen, Guanghua; Chen, Siyuan; Sun, Jiecong

    2015-12-01

    To compare the effectiveness and changes of sagittal spino-pelvic parameters between minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion in treatment of the low-degree isthmic lumbar spondylolisthesis. Between May 2012 and May 2013, 86 patients with single segmental isthmic lumbar spondylolisthesis (Meyerding degree I or II) were treated by minimally invasive transforaminal lumbar interbody fusion (minimally invasive group) in 39 cases, and by open posterior lumbar interbody fusion in 47 cases (open group). There was no significant difference in gender, age, disease duration, degree of lumbar spondylolisthesis, preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between 2 groups (P>0.05). The following sagittal spino-pelvic parameters were compared between 2 groups before and after operation: the percentage of slipping (PS), intervertebral height, angle of slip (AS), thoracolumbar junction (TLJ), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Pearson correlation analysis of the changes between pre- and post-operation was done. Primary healing of incision was obtained in all patients of 2 groups. The postoperative hospital stay of minimally invasive group [(5.1 ± 1.6) days] was significantly shorter than that of open group [(7.2 ± 2.1) days] (t = 2.593, P = 0.017). The patients were followed up 11-20 months (mean, 15 months). The reduction rate was 68.53% ± 20.52% in minimally invasive group, and was 64.21% ± 30.21% in open group, showing no significant difference (t = 0.725, P = 0.093). The back and leg pain VAS scores, and ODI at 3 months after operation were significantly reduced when compared with preoperative ones (P 0.05). The postoperative other sagittal spino-pelvic parameters were significantly improved (P 0.05), but there was no significant

  7. Five-year durability of stand-alone interspinous process decompression for lumbar spinal stenosis

    Directory of Open Access Journals (Sweden)

    Nunley PD

    2017-09-01

    Full Text Available Pierce D Nunley,1 Vikas V Patel,2 Douglas G Orndorff,3 William F Lavelle,4 Jon E Block,5 Fred H Geisler6 1Spine Institute of Louisiana, Shreveport, LA, 2The Spine Center, University of Colorado Hospital, Denver, CO, 3Spine Colorado, Mercy Regional Hospital, Durango, CO, 4Upstate Bone and Joint Center, East Syracuse, NY, 5Independent Consultant, San Francisco, CA, 6Independent Consultant, Chicago, IL, USA Background: Lumbar spinal stenosis is the most common indication for spine surgery in older adults. Interspinous process decompression (IPD using a stand-alone spacer that functions as an extension blocker offers a minimally invasive treatment option for intermittent neurogenic claudication associated with spinal stenosis.Methods: This study evaluated the 5-year clinical outcomes for IPD (Superion® from a randomized controlled US Food and Drug Administration (FDA noninferiority trial. Outcomes included Zurich Claudication Questionnaire (ZCQ symptom severity (ss, physical function (pf, and patient satisfaction (ps subdomains, leg and back pain visual analog scale (VAS, and Oswestry Disability Index (ODI.Results: At 5 years, 84% of patients (74 of 88 demonstrated clinical success on at least two of three ZCQ domains. Individual ZCQ domain success rates were 75% (66 of 88, 81% (71 of 88, and 90% (79 of 88 for ZCQss, ZCQpf, and ZCQps, respectively. Leg and back pain success rates were 80% (68 of 85 and 65% (55 of 85, respectively, and the success rate for ODI was 65% (57 of 88. Percentage improvements over baseline were 42%, 39%, 75%, 66%, and 58% for ZCQss, ZCQpf, leg and back pain VAS, and ODI, respectively (all P<0.001. Within-group effect sizes were classified as very large for four of five clinical outcomes (ie, >1.0; all P<0.0001. Seventy-five percent of IPD patients were free from reoperation, revision, or supplemental fixation at their index level at 5 years.Conclusion: After 5 years of follow-up, IPD with a stand-alone spacer provides

  8. Charactrization of a Li-ion battery based stand-alone a-Si photovoltaic system

    Science.gov (United States)

    Hamid Vishkasougheh, Mehdi; Tunaboylu, Bahadir

    2014-11-01

    The number of photovoltaic (PV) system installations is increasing rapidly. As more people learn about this versatile and often cost-effective power option, this trend will accelerate. This document presents a recommended design for a battery based stand-alone photovoltaic system (BSPV). BSPV system has the ability to be applied in different areas, including warning signals, lighting, refrigeration, communication, residential water pumping, remote sensing, and cathodic protection. The presented calculation method gives a proper idea for a system sizing technique. Based on application load, different scenarios are possible for designing a BSPV system. In this study, a battery based stand-alone system was designed. The electricity generation part is three a-Si panels, which are connected in parallel, and for the storage part LFP (lithium iron phosphate) battery was used. The high power LFP battery packs are 40 cells each 8S5P (configured 8 series 5 parallel). Each individual pack weighs 0.5 kg and is 25.6 V. In order to evaluate the efficiency of a-Si panels with respect to the temperature and the solar irradiation, cities of Istanbul, Ankara and Adana in Turkey were selected. Temperature and solar irradiation were gathered from reliable sources and by using translation equations, current and voltage output of panels were calculated. As a result of these calculations, current and energy outputs were computed by considering an average efficient solar irradiation time value per day in Turkey. The calculated power values were inserted to a battery cycler system, and the behavior of high power LFP batteries in a time sequence of 7.2 h was evaluated. The charging and discharging cycles were obtained and their behavior was discussed. According to the results, Istanbul has the lowest number of peak month's energy, it followed by Ankara, and ultimately Adana has the highest number of peak months and energy storage. It was observed during the tests that values up to 4 A was

  9. Multi-objective analytical model for optimal sizing of stand-alone photovoltaic water pumping systems

    International Nuclear Information System (INIS)

    Olcan, Ceyda

    2015-01-01

    Highlights: • An analytical optimal sizing model is proposed for PV water pumping systems. • The objectives are chosen as deficiency of power supply and life-cycle costs. • The crop water requirements are estimated for a citrus tree yard in Antalya. • The optimal tilt angles are calculated for fixed, seasonal and monthly changes. • The sizing results showed the validity of the proposed analytical model. - Abstract: Stand-alone photovoltaic (PV) water pumping systems effectively use solar energy for irrigation purposes in remote areas. However the random variability and unpredictability of solar energy makes difficult the penetration of PV implementations and complicate the system design. An optimal sizing of these systems proves to be essential. This paper recommends a techno-economic optimization model to determine optimally the capacity of the components of PV water pumping system using a water storage tank. The proposed model is developed regarding the reliability and cost indicators, which are the deficiency of power supply probability and life-cycle costs, respectively. The novelty is that the proposed optimization model is analytically defined for two-objectives and it is able to find a compromise solution. The sizing of a stand-alone PV water pumping system comprises a detailed analysis of crop water requirements and optimal tilt angles. Besides the necessity of long solar radiation and temperature time series, the accurate forecasts of water supply needs have to be determined. The calculation of the optimal tilt angle for yearly, seasonally and monthly frequencies results in higher system efficiency. It is, therefore, suggested to change regularly the tilt angle in order to maximize solar energy output. The proposed optimal sizing model incorporates all these improvements and can accomplish a comprehensive optimization of PV water pumping systems. A case study is conducted considering the irrigation of citrus trees yard located in Antalya, Turkey

  10. Flexible Control of Small Wind Turbines With Grid Failure Detection Operating in Stand-Alone and Grid-Connected Mode

    DEFF Research Database (Denmark)

    Teodorescu, Remus; Blaabjerg, Frede

    2004-01-01

    This paper presents the development and test of a flexible control strategy for an 11-kw wind turbine with a back-to-back power converter capable of working in both stand-alone and grid-connected mode. The stand-alone control is featured with a complex output voltage controller capable of handling...... nonlinear load and excess or deficit of generated power. Grid-connection mode with current control is also enabled for the case of isolated local grid involving other dispersed power generators such as other wind turbines or diesel generators. A novel automatic mode switch method based on a phase...

  11. Correction of sagittal plane deformity and predictive factors for a favourable radiological outcome following multilevel posterior lumbar interbody fusion for mild degenerative scoliosis.

    Science.gov (United States)

    Sabou, Silviu; Tseng, Tzu-Heng Jason; Stephenson, John; Siddique, Irfan; Verma, Rajat; Mohammad, Saeed

    2016-08-01

    Limited data is available in the literature on the radiographic results of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment of degenerative scoliosis. The objective of our study was to evaluate the segmental and global correction achieved with MPLIF in the treatment of degenerative scoliosis. Between 2009 and 2014, 42 patients underwent correction of degenerative scoliosis with MPLIF. Several radiological parameters were measured pre- and post-operatively by two independent observers. A statistical analysis was performed to assess the inter-observer reliability of the measurements and to determine the degree of segmental correction achieved at each intervertebral disc. Using sagittal vertical axis (SVA) less than 47 mm; lumbar lordosis (LL) within 11° of pelvic incidence (PI); and pelvic tilt (PT) no more than 22° as radiological criteria for procedural acceptability, we determined predictive factors for a favourable radiological outcome. Forty-two patients (34 female) were included in our study. The average amount of correction per segment was 6.2°. The overall correction achieved with MPLIF was 16.6°. Twenty-six of the 42 patients (61.9 %) had post-operative SVA values less than 47 mm. Nineteen of the 42 patients (45.2 %) had average post-operative LL within 11° of the PI. Sixteen of the 42 patients (38.1 %) had PT less than 22°. Younger age, female gender and a low pre-operative PT were significantly associated with the attainment of a satisfactory sagittal alignment. Our results demonstrate that a satisfactory correction can be achieved in degenerative scoliosis with MPLIF. In addition, our results show that it is significantly more likely to achieve a satisfactory radiological outcome in younger, female patients with low pre-operative PT.

  12. Restoration of lumbopelvic sagittal alignment and its maintenance following transforaminal lumbar interbody fusion (TLIF): comparison between straight type versus curvilinear type cage.

    Science.gov (United States)

    Kim, Jong-Tae; Shin, Myung-Hoon; Lee, Ho-Jin; Choi, Du-Yong

    2015-11-01

    To evaluate a radiological and clinical difference between the curvilinear type cages compared to the straight type cages for the restoration of lumbopelvic sagittal alignment and its maintenance after transforaminal lumbar interbody fusion (TLIF) procedure. 68 patients who underwent single-level TLIF using either the straight type or curvilinear type cage were retrospectively reviewed. Assessment of the lumbopelvic parameters and the height of disc space was performed before surgery as well as 2 days, 6 and 12 months after surgery. Clinical outcome was assessed using VAS and ODI. The curvilinear type cages were positioned more anteriorly than the straight type. Restoration of the segmental lordosis (SL) in the curvilinear group was significantly greater than the straight group and at 12 months of follow-up, the straight group showed greater decrease in the disc height than the curvilinear group. The straight group failed to show improvement of lumbar lordosis (LL), while the curvilinear group showed significant restoration of LL and could maintain it to the 6 months of follow-up. In both groups, pelvic tilt was significantly decreased and it lasted to 6 months in the straight group; whereas in the curvilinear group, it was maintained to the last follow-up of 12 months. There were no significant differences between the two groups in mean VAS and ODI score over the follow-up period. This study demonstrates that the curvilinear type cage is superior to the straight type cage in improving the SL and maintaining both the restored lumbopelvic parameters and elevated disc height. These results could be attributable to the anterior position of the curvilinear cage which permits easy restoration of segmental lordosis and less sinking of cages.

  13. Design of a reliable and low-cost stand-alone micro hydropower station

    Energy Technology Data Exchange (ETDEWEB)

    Kusakana, K.; Munda, J.L. [Tshwane Univ. of Technology, Pretoria (South Africa)

    2008-07-01

    A stand-alone micro-hydropower station was presented. The plant was comprised of a squirrel cage induction machine coupled to a Kaplan water turbine. Power converters were used to control the variable frequency and voltage outputs of the generator caused by variations in water flow. The hydropower plant was installed a farm in the Kwazulu-Natal region of South Africa, and was designed to provide electricity in relation to the low power demand of users in the region as well as according to the site's hydrology and topology. Load forecasts for the 8 houses using the system were conducted. A generator with a higher output than the average power needed to feed the load was selected in order to ensure load supply during peak demand. The system was designed to shore energy generated during off-peak periods in batteries. An AC-DC-AC converter was used as an interface between the generator and the load in order to ensure voltage and frequency stabilization. Simulations of plant components were conducted to demonstrate output power supply during water flow variations. Results of the modelling study indicated that power converters are needed to stabilize generator outputs. The hydropower design is a cost-effective means of supplying power to low-income households. 10 refs., 2 tabs., 7 figs.

  14. Solar photovoltaic applications seminar: design, installation and operation of small, stand-alone photovoltaic power systems

    Energy Technology Data Exchange (ETDEWEB)

    1980-07-01

    This seminar material was developed primarily to provide solar photovoltaic (PV) applied engineering technology to the Federal community. An introduction to photoconductivity, semiconductors, and solar photovoltaic cells is included along with a demonstration of specific applications and application identification. The seminar details general systems design and incorporates most known information from industry, academia, and Government concerning small solar cell power system design engineering, presented in a practical and applied manner. Solar PV power system applications involve classical direct electrical energy conversion and electric power system analysis and synthesis. Presentations and examples involve a variety of disciplines including structural analysis, electric power and load analysis, reliability, sizing and optimization; and, installation, operation and maintenance. Four specific system designs are demonstrated: water pumping, domestic uses, navigational and aircraft aids, and telecommunications. All of the applications discussed are for small power requirement (under 2 kilowatts), stand-alone systems to be used in remote locations. Also presented are practical lessons gained from currently installed and operating systems, problems at sites and their resolution, a logical progression through each major phase of system acquisition, as well as thorough design reviews for each application.

  15. Stand-alone excitation synchronous wind power generators with power flow management strategy

    Directory of Open Access Journals (Sweden)

    Tzuen-Lih Chern

    2014-09-01

    Full Text Available This study presents a stand-alone excitation synchronous wind power generator (SESWPG with power flow management strategy (PFMS. The rotor speed of the excitation synchronous generator tracks the utility grid frequency by using servo motor tracking technologies. The automatic voltage regulator governs the exciting current of generator to achieve the control goals of stable voltage. When wind power is less than the needs of the consumptive loading, the proposed PFMS increases motor torque to provide a positive power output for the loads, while keeping the generator speed constant. Conversely, during the periods of wind power greater than output loads, the redundant power of generator production is charged to the battery pack and the motor speed remains constant with very low power consumption. The advantage of the proposed SESWPG is that the generator can directly output stable alternating current (AC electricity without using additional DC–AC converters. The operation principles with software simulation for the system are described in detail. Experimental results of a laboratory prototype are shown to verify the feasibility of the system.

  16. Simulation of stand alone PV system; Dokuritsugata taiyoko hatsuden system no simulation

    Energy Technology Data Exchange (ETDEWEB)

    Kondo, H.; Ogawa, H.; Sekii, Y. [Chiba Institute of Technology, Chiba (Japan); Tsuda, I.; Nozaki, K. [Electrotechnical Laboratory, Tsukuba (Japan); Kurokawa, K. [Tokyo University of Agriculture and Technology, Tokyo (Japan)

    1996-10-27

    In order to evaluate the simulation results of a photovoltaic power generation system, an operation simulation was carried out using the actual measured data of a stand alone PV system in Miyakojima, Okinawa Prefecture, so as to make a comparison with the actual operation data. The electric power was supplied to 250 houses and primary/junior high schools in the surrounding villages, which had an average demand load of approximately 90kw and the maximum of approximately 200kw. The power was supplied through the PV power generation in the duration of the sunshine, with an excess power charged in storage batteries and then supplied from the batteries at night. The array capacity was made 750kWp, the output current and storage batteries being characteristic type with an actual efficiency curve used for the inverter. The weather data used were the actual inclined insolation quantity and the outside air temperature data for a period of one month of November. The power charged in excess of 100% in the batteries was termed as an overflow power. With the charging condition 30% or less, a diesel generator was run for a rated operation for one hour, the power of which was termed as a backup power. As a result, the simulation was found nearly in agreement with the actual measurements. 5 refs., 7 figs., 2 tabs.

  17. Control of a Stand-Alone Variable Speed Wind Energy Supply System †

    Directory of Open Access Journals (Sweden)

    Mohamed M. Hamada

    2013-04-01

    Full Text Available This paper presents a simple control strategy for the operation of a variable speed stand-alone wind turbine with a permanent magnet synchronous generator (PMSG. The PMSG is connected to a three phase resistive load through a switch mode rectifier and a voltage source inverter. Control of the generator side converter is used to achieve maximum power extraction from the available wind power. Control of the DC-DC bidirectional buck-boost converter, which is connected between batteries bank and DC-link voltage, is used to maintain the DC-link voltage at a constant value. It is also used to make the batteries bank stores the surplus of wind energy and supplies this energy to the load during a wind power shortage. The load side voltage source inverter uses a relatively complex vector control scheme to control the output load voltage in terms of amplitude and frequency. The control strategy works under wind speed variation as well as with variable load. Extensive simulation results have been performed using MATLAB/SIMULINK.

  18. Can aqueous hydrogen peroxide be used as a stand-alone energy source?

    International Nuclear Information System (INIS)

    Disselkamp, Robert S.

    2010-01-01

    A novel electrochemical scheme to convert a stand-alone supply of aqueous hydrogen peroxide into a fuel cell-ready stream of hydrogen gas plus aqueous hydrogen peroxide is described. The electrochemical cell, consisting of a solid base and solid acid electrocatalyst, together with a proton exchange membrane, comprise the system that converts aqueous hydrogen peroxide into separate gas streams of oxygen and hydrogen. Aqueous hydrogen peroxide is contained in the anode compartment only and exists in the region where oxygen gas is formed, whereas the cathode compartment is where hydrogen gas is generated and therefore exists in a reduced state. A near zero theoretical over-potential can be achieved by the choice of basicity and acidity of the electrode materials. The primary cost of the electrochemical cell is electrode construction and the aqueous hydrogen peroxide energy storage compound. Additional research effort is required to experimentally validate the concept and explore the full economic impact should initial studies, based on the design presented here, prove promising. (author)

  19. Comparative analysis of distributed MPPT controllers for partially shaded stand alone photovoltaic systems

    International Nuclear Information System (INIS)

    Muthuramalingam, M.; Manoharan, P.S.

    2014-01-01

    Highlights: • Analyzes the performance of ANN and ANFIS MPPT algorithms by stand alone PV system. • ISSBC with ANFIS can provide the overall efficiency higher than ANN. • CHBMLI integrate with SHE ANN modulation technique improve output voltage quality. • Simulation and hardware results show the ANFIS algorithm efficient than ANN algorithm. - Abstract: This paper presents a unique combination of an interleaved soft switched boost converter (ISSBC) run by a set of two photovoltaic panel (PV) with a distributed MPPT, suitable to guarantee MPPT even under partial shadowed conditions, managed by an adaptive neuro fuzzy inference system trained by the training data derived from a particle swarm optimization (PSO–ANFIS) unit. The ISSBC is followed by a, single phase cascaded H bridge five-level inverter (CHI) driven by the individual DC outputs of the ISSBC, with selective harmonic elimination scheme to eliminate typically the seventh order harmonics. A comparison of different intelligent distributed maximum power point tracking (MPPT) algorithms for photovoltaic (PV) system under partial shadow conditions is carried out. The use of the ISSBC guarantees mitigation of ripple and it is meant to handle higher currents with minimal switching losses. Simulation was carried out in the Matlab Simulink environment and an experimental verification with a scaled down model validated the proposed scheme. It has been thus established, by both simulation and experimental verification, that the PSO–ANFIS model of distributed MPPT scheme of control outperforms other schemes of control for MPPT

  20. Battery Storage Technologies for Electrical Applications: Impact in Stand-Alone Photovoltaic Systems

    Directory of Open Access Journals (Sweden)

    Daniel Akinyele

    2017-11-01

    Full Text Available Batteries are promising storage technologies for stationary applications because of their maturity, and the ease with which they are designed and installed compared to other technologies. However, they pose threats to the environment and human health. Several studies have discussed the various battery technologies and applications, but evaluating the environmental impact of batteries in electrical systems remains a gap that requires concerted research efforts. This study first presents an overview of batteries and compares their technical properties such as the cycle life, power and energy densities, efficiencies and the costs. It proposes an optimal battery technology sizing and selection strategy, and then assesses the environmental impact of batteries in a typical renewable energy application by using a stand-alone photovoltaic (PV system as a case study. The greenhouse gas (GHG impact of the batteries is evaluated based on the life cycle emission rate parameter. Results reveal that the battery has a significant impact in the energy system, with a GHG impact of about 36–68% in a 1.5 kW PV system for different locations. The paper discusses new batteries, strategies to minimize battery impact and provides insights into the selection of batteries with improved cycling capacity, higher lifespan and lower cost that can achieve lower environmental impacts for future applications.

  1. Approaches for developing a sizing method for stand-alone PV systems with variable demand

    Energy Technology Data Exchange (ETDEWEB)

    Posadillo, R. [Grupo de Investigacion en Energias y Recursos Renovables, Dpto. de Fisica Aplicada, E.P.S., Universidad de Cordoba, Avda. Menendez Pidal s/n, 14004 Cordoba (Spain); Lopez Luque, R. [Grupo de Investigacion de Fisica para las Energias y Recursos Renovables, Dpto. de Fisica Aplicada. Edificio C2 Campus de Rabanales, 14071 Cordoba (Spain)

    2008-05-15

    Accurate sizing is one of the most important aspects to take into consideration when designing a stand-alone photovoltaic system (SAPV). Various methods, which differ in terms of their simplicity or reliability, have been developed for this purpose. Analytical methods, which seek functional relationships between variables of interest to the sizing problem, are one of these approaches. A series of rational considerations are presented in this paper with the aim of shedding light upon the basic principles and results of various sizing methods proposed by different authors. These considerations set the basis for a new analytical method that has been designed for systems with variable monthly energy demands. Following previous approaches, the method proposed is based on the concept of loss of load probability (LLP) - a parameter that is used to characterize system design. The method includes information on the standard deviation of loss of load probability ({sigma}{sub LLP}) and on two new parameters: annual number of system failures (f) and standard deviation of annual number of failures ({sigma}{sub f}). The method proves useful for sizing a PV system in a reliable manner and serves to explain the discrepancies found in the research on systems with LLP<10{sup -2}. We demonstrate that reliability depends not only on the sizing variables and on the distribution function of solar radiation, but on the minimum value as well, which in a given location and with a monthly average clearness index, achieves total solar radiation on the receiver surface. (author)

  2. On the economics of stand-alone renewable hybrid power plants in remote regions

    International Nuclear Information System (INIS)

    Petrakopoulou, Fontina

    2016-01-01

    Highlights: • Economic evaluation of three renewable hybrid power plants for off-grid operation. • The high electricity cost of remote regions increases the competitiveness of renewable energy. • The proposed plants are economically viable when compared to the existing situation. • The zero direct emissions of the plants constitute an additional advantage of the plants. - Abstract: In recent years ever more examples of regions that have managed to achieve or orientate themselves toward renewable energy sufficiency are emerging. However, actions to create energy autonomy are mainly the result of isolated activities and they are less driven from fully organized movements. In addition, total energy independence without the support of a centralized electrical grid is yet to be achieved. The objectives of this work are to investigate the associated costs of stand-alone renewable hybrid power plants on a Greek island and compare them to the cost of the currently used fossil-fuel-based conventional plant. The plants examined here are designed to fully cover the electricity needs of the island. Islands may face numerous energy problems and rely heavily on foreign and environmentally-harmful fuels. It is shown that the relatively high cost of electricity of such a remote region can increase the competitiveness and promote the wider incorporation of technologies based on renewable energy sources that may, in other cases, seem economically inferior to business-as-usual energy solutions.

  3. Use of Super-Capacitor to Enhance Charging Performance of Stand-Alone Solar PV System

    KAUST Repository

    Huang, B. J.

    2011-01-01

    Introduction: The battery charging performance in a stand-alone solar PV system affects the PV system efficiency and the load operating time. The New Energy Center of National Taiwan University has been devoted to the development of a PWM charging technique to continue charging the lead-acid battery after the overcharge point to increase the battery storage capacity by more than 10%. The present study intends to use the super-capacitor to further increase the charge capacity before the overcharge point of the battery. The super-capacitor is connected in parallel to the lead-acid battery. This will reduce the overall charging impedance during the charge and increase the charging current, especially in sunny weather. A system dynamics model of the lead-acid battery and super-capacitor was derived and the control system simulation was carried out to predict the charging performance for various weathers. It shows that the overall battery impedance decreases and charging power increases with increasing solar radiation. An outdoor comparative test for two identical PV systems with and without supercapacitor was carried out. The use of super-capacitor is shown to be able to increase the lead-acid charging capacity by more than 25% at sunny weather and 10% in cloudy weather. © Springer-Verlag Berlin Heidelberg 2011.

  4. Short-term alendronate treatment does not maintain a residual effect on spinal fusion with interbody devices and bone graft after treatment withdrawal: an experimental study on spinal fusion in pigs.

    Science.gov (United States)

    Huang, Baoding; Zou, Xuenong; Li, Haisheng; Xue, Qingyun; Bünger, Cody

    2013-02-01

    Whether alendronate treatment has a residual effect on bone ingrowth into porous biomaterial in humans or experimental animals after treatment withdrawal is still unknown. The purpose of this study was to investigate bone ingrowth into porous tantalum and carbon fiber interbody implants after discontinuing alendronate treatment in experimental spinal fusion in pigs. Twenty-four pigs were randomly divided into two groups of each 12 pigs. The pigs underwent anterior intervertebral lumbar arthrodeses at L2-3, L4-5 and L6-7. Each level was randomly allocated to one of the three implants: a porous tantalum ring with pedicle screw fixation, a porous tantalum ring or a carbon fiber cage with anterior staple fixation. The central hole of implants was packed with an autograft. Alendronate was given orally for the first 3 months to one of the two groups. The pigs were observed for 6 months postoperatively. Histology and micro-CT scans were done at the endpoint. The spinal fusion rates of each implant showed no differences between two treatment groups. Furthermore, no differences were found between two groups as for bone ingrowth into the central holes of implants and bone-implant interface in each implant, or as for the pores of tantalum implants. Trabecular bone microarchitecture in the central hole of the carbon fiber cage did not differ between two treatment groups. The application of ALN, with a dose equivalent to that given to humans during the first 3 months after surgery, does not maintain a residual effect on spinal fusion with porous tantalum ring and autograft after treatment withdrawal in a porcine ALIF model.

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

    Science.gov (United States)

    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 spondylolisthesis at L4-5. DDS might be an alternative to standard arthrodesis in mild lumbar spondylolisthesis. However, unlike fusion, dynamic implants have issues of wearing and loosening in the long term

  6. Risk factors for adjacent segment disease after posterior lumbar interbody fusion and efficacy of simultaneous decompression surgery for symptomatic adjacent segment disease.

    Science.gov (United States)

    Hikata, Tomohiro; Kamata, Michihiro; Furukawa, Mitsuru

    2014-04-01

    A retrospective study. Posterior lumbar interbody fusion (PLIF) increases mechanical stress and can cause degenerative changes at the adjacent segment. However, the precise causes of adjacent segment disease (ASD) after PLIF are not known, and it is unclear whether simultaneous decompression surgery for symptomatic ASD is effective. To study, radiographically and symptomatically, the risk factors for adjacent segment disease (ASD) in the lumbar spine after L4/5 PLIF and to examine whether decompression surgery for the adjacent segment (L3/4) reduces the occurrence of symptomatic ASD. Fifty-four patients who underwent L4/5 PLIF for L4 degenerative spondylolisthesis and could be followed up for at least 2 years were included. Of these, 37 were treated simultaneously with decompression surgery at L3/4. We measured radiographic changes and assessed symptoms from the cranial adjacent segment. Thirty-one patients (57.4%) met radiologic criteria for ASD. The length of follow-up (P=0.004) and simultaneous decompression surgery at L3/4 (P=0.009) were statistically significant factors for radiologic diagnosis of ASD. Seven patients (13.0%) had symptomatic ASD: 6 in the decompression group (16.2%) and 1 in the PLIF-only group (5.9%). Simultaneous decompression surgery did not reduce the incidence of symptomatic ASD (P=0.256). Local lordosis at the fused segment (P=0.005) and the sagittal angle of the facet joint at L3/4 (P=0.024) were statistically significant predictors of symptomatic ASD, which was accompanied by postoperative anterior listhesis above the fused segment (S group, 8.4%±8.0%; nonsymptomatic group: -0.7%±5.0%, P=0.024). Patients whose facet joint at the adjacent segment had a more sagittal orientation had postoperative anterior listhesis, which caused symptomatic ASD. Simultaneous decompression surgery without fusion at the adjacent level was not effective for these patients, but rather, there was a possibility that it induced symptomatic ASD.

  7. Motion Sensorless Bidirectional PWM Converter Control with Seamless Switching from Power Grid to Stand Alone and Back

    DEFF Research Database (Denmark)

    Fatu, Marius; Tutelea, Lucian; Teodorescu, Remus

    2007-01-01

    This paper presents concepts and tests results on a flexible sensorless control strategy for a PMSG driven by a small wind turbine with back-to-back power converters capable to function in both stand alone and grid connection mode. A new automatic seamless transfer method, based on phase-locked...

  8. Analyzing grid extension and stand-alone photovoltaic systems for the cost-effective electrification of Kenya

    NARCIS (Netherlands)

    Zeyringer, Marianne; Pachauri, Shonali; Schmid, Erwin; Schmidt, Johannes; Worrell, Ernst; Morawetz, Ulrich B.

    2015-01-01

    The declaration of 2014-2024 as the Decade of Sustainable Energy for All has catalyzed actions towards achieving universal electricity access. The high costs of building electric infrastructure are a major impediment to improved access, making stand-alone photovoltaic (PV) systems an attractive

  9. Stand-Alone Ethics, Social Responsibility, and Sustainability Course Requirements: A Snapshot from Australia and New Zealand

    Science.gov (United States)

    Rundle-Thiele, Sharyn R.; Wymer, Walter

    2010-01-01

    This article analyzes the extent to which Australian and New Zealand marketing educators use dedicated or stand-alone courses to equip students with alternative views of business. A census of marketing programs in degree-granting universities was conducted. Program brochures were obtained via the Internet and were content analyzed. This study…

  10. 49 CFR 1109.4 - Mandatory mediation in rate cases to be considered under the stand-alone cost methodology.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Mandatory mediation in rate cases to be considered... § 1109.4 Mandatory mediation in rate cases to be considered under the stand-alone cost methodology. (a) A... methodology must engage in non-binding mediation of its dispute with the railroad upon filing a formal...

  11. An improved synchronous reference frame phase-locked loop for stand-alone variable speed constant frequency power generation systems

    DEFF Research Database (Denmark)

    Liu, Yi; Xu, Wei; Ke, Longzhang

    2017-01-01

    The phase-locked loop (PLL) based on conventional synchronous reference frame, i.e. dqPLL, is usually employed in grid-connected variable speed constant frequency (VSCF) power generation systems (PGSs). However, the voltage amplitude drop of stand-alone PGSs is often greater than that of the grid...

  12. The eBioKit, a stand-alone educational platform for bioinformatics.

    Science.gov (United States)

    Hernández-de-Diego, Rafael; de Villiers, Etienne P; Klingström, Tomas; Gourlé, Hadrien; Conesa, Ana; Bongcam-Rudloff, Erik

    2017-09-01

    Bioinformatics skills have become essential for many research areas; however, the availability of qualified researchers is usually lower than the demand and training to increase the number of able bioinformaticians is an important task for the bioinformatics community. When conducting training or hands-on tutorials, the lack of control over the analysis tools and repositories often results in undesirable situations during training, as unavailable online tools or version conflicts may delay, complicate, or even prevent the successful completion of a training event. The eBioKit is a stand-alone educational platform that hosts numerous tools and databases for bioinformatics research and allows training to take place in a controlled environment. A key advantage of the eBioKit over other existing teaching solutions is that all the required software and databases are locally installed on the system, significantly reducing the dependence on the internet. Furthermore, the architecture of the eBioKit has demonstrated itself to be an excellent balance between portability and performance, not only making the eBioKit an exceptional educational tool but also providing small research groups with a platform to incorporate bioinformatics analysis in their research. As a result, the eBioKit has formed an integral part of training and research performed by a wide variety of universities and organizations such as the Pan African Bioinformatics Network (H3ABioNet) as part of the initiative Human Heredity and Health in Africa (H3Africa), the Southern Africa Network for Biosciences (SAnBio) initiative, the Biosciences eastern and central Africa (BecA) hub, and the International Glossina Genome Initiative.

  13. Hydrogen-based energy storage unit for stand alone PV systems

    International Nuclear Information System (INIS)

    Labbe, J.

    2006-12-01

    Stand alone systems supplied only by a photovoltaic generator need an energy storage unit to be fully self sufficient. Lead acid batteries are commonly used to store energy because of their low cost, despite several operational constraints. A hydrogen-based energy storage unit (HESU) could be another candidate, including an electrolyser, a fuel cell and a hydrogen tank. However many efforts still need to be carried out for this technology to reach an industrial stage. In particular, market outlets must be clearly identified. The study of small stationary applications (few kW) is performed by numerical simulations. A simulator is developed in the Matlab/Simulink environment. It is mainly composed of a photovoltaic field and a storage unit (lead acid batteries, HESU, or hybrid storage HESU/batteries). The system component sizing is achieved in order to ensure the complete system autonomy over a whole year of operation. The simulator is tested with 160 load profiles (1 kW as a yearly mean value) and three locations (Algeria, France and Norway). Two coefficients are set in order to quantify the correlation between the power consumption of the end user and the renewable resource availability at both daily and yearly scales. Among the tested cases, a limit value of the yearly correlation coefficient came out, enabling to recommend the use of the most adapted storage to a considered case. There are cases for which using HESU instead of lead acid batteries can increase the system efficiency, decrease the size of the photovoltaic field and improve the exploitation of the renewable resource. In addition, hybridization of HESU with batteries always leads to system enhancements regarding its sizing and performance, with an efficiency increase by 10 to 40 % depending on the considered location. The good agreement between the simulation data and field data gathered on real systems enabled the validation of the models used in this study. (author)

  14. Stand-alone rolling circle amplification combined with capillary electrophoresis for specific detection of small RNA.

    Science.gov (United States)

    Li, Ni; Jablonowski, Carolyn; Jin, Hailing; Zhong, Wenwan

    2009-06-15

    Noncoding small RNAs play diverse, important biological roles through gene expression regulation. However, their low expression levels make it difficult to identify new small RNA species and study their functions, calling for the development of detection schemes with higher simplicity, sensitivity, and specificity. Herein, we reported a straightforward assay that combined the stand-alone rolling circle amplification (RCA) with capillary electrophoresis (CE) for specific and sensitive detection of small RNAs in biological samples. In order to enhance the overall reaction efficiency and simplify the procedure, RCA was not preceded with ligation, and a preformed circular probe was employed as the template for the target small RNA-primed isothermal amplification. The long RCA product was digested and analyzed by CE. Two DNA polymerases, the Phi29 and Bst, were compared for their detection performance. Bst is superior in the aspects of specificity, procedure simplicity, and reproducibility, while Phi29 leads to a 5-fold lower detection limit and is able to detect as low as 35 amol of the target small RNA. Coamplification of an internal standard with the target and employment of the RNase A digestion step allow accurate and reproducible quantification of low amounts of small RNA targets spiked into hundreds of nanograms of the plant total RNA extract with a recovery below 110% using either enzyme. Our assay can be adapted to a capillary array system for high-throughput screening of small RNA expression in biological samples. Also, the one-step isothermal process has the potential to conveniently amplify a very limited amount of the RNA samples, e.g., RNA extracted from only a few cells, inside the capillary column or on a microchip.

  15. "Candidatus Fokinia solitaria", a Novel "Stand-Alone" Symbiotic Lineage of Midichloriaceae (Rickettsiales.

    Directory of Open Access Journals (Sweden)

    Franziska Szokoli

    Full Text Available Recently, the family Midichloriaceae has been described within the bacterial order Rickettsiales. It includes a variety of bacterial endosymbionts detected in different metazoan host species belonging to Placozoa, Cnidaria, Arthropoda and Vertebrata. Representatives of Midichloriaceae are also considered possible etiological agents of certain animal diseases. Midichloriaceae have been found also in protists like ciliates and amoebae. The present work describes a new bacterial endosymbiont, "Candidatus Fokinia solitaria", retrieved from three different strains of a novel Paramecium species isolated from a wastewater treatment plant in Rio de Janeiro (Brazil. Symbionts were characterized through the full-cycle rRNA approach: SSU rRNA gene sequencing and fluorescence in situ hybridization (FISH with three species-specific oligonucleotide probes. In electron micrographs, the tiny rod-shaped endosymbionts (1.2 x 0.25-0.35 μm in size were not surrounded by a symbiontophorous vacuole and were located in the peripheral host cytoplasm, stratified in the host cortex in between the trichocysts or just below them. Frequently, they occurred inside autolysosomes. Phylogenetic analyses of Midichloriaceae apparently show different evolutionary pathways within the family. Some genera, such as "Ca. Midichloria" and "Ca. Lariskella", have been retrieved frequently and independently in different hosts and environmental surveys. On the contrary, others, such as Lyticum, "Ca. Anadelfobacter", "Ca. Defluviella" and the presently described "Ca. Fokinia solitaria", have been found only occasionally and associated to specific host species. These last are the only representatives in their own branches thus far. Present data do not allow to infer whether these genera, which we named "stand-alone lineages", are an indication of poorly sampled organisms, thus underrepresented in GenBank, or represent fast evolving, highly adapted evolutionary lineages.

  16. Optimum capacity determination of stand-alone hybrid generation system considering cost and reliability

    International Nuclear Information System (INIS)

    Chen, Hung-Cheng

    2013-01-01

    Highlights: ► This paper presents a methodology for the installation capacity optimization. ► Hybrid generation system is optimized by application of adaptive genetic algorithm. ► A cost investigation is made under various conditions and component characteristics. ► The optimization scheme is validated to meet the annual power load demand. -- Abstract: The aim of this work is to present an optimization methodology for the installation capacity of a stand-alone hybrid generation system, taking into consideration the cost and reliability. Firstly, on the basis of derived steady state models of a wind generator (WG), a photovoltaic array (PV), a battery and an inverter, the hybrid generation system is modeled for the purpose of capacity optimization. Secondly, the power system is analyzed for determining both the system structure and the operation control strategy. Thirdly, according to hourly weather database of wind speed, temperature and solar irradiation, annual power generation capacity is estimated for the system match design in order that an annual power load demand can be met. The capacity determination of a hybrid generation system becomes complicated as a result of the uncertainty in the renewable energy together with load demand and the nonlinearity of system components. Aimed at the power system reliability and the cost minimization, the capacity of a hybrid generation system is optimized by application of an adaptive genetic algorithm (AGA) to individual power generation units. A total cost investigation is made under various conditions, such as wind generator power curves, battery discharge depth and the loss of load probability (LOLP). At the end of this work, the capacity of a hybrid generation system is optimized at two installation sites, namely the offshore Orchid Island and Wuchi in Taiwan. The optimization scheme is validated to optimize power capacities of a photovoltaic array, a battery and a wind turbine generator with a relative

  17. A Low-Power Wearable Stand-Alone Tongue Drive System for People With Severe Disabilities.

    Science.gov (United States)

    Jafari, Ali; Buswell, Nathanael; Ghovanloo, Maysam; Mohsenin, Tinoosh

    2018-02-01

    This paper presents a low-power stand-alone tongue drive system (sTDS) used for individuals with severe disabilities to potentially control their environment such as computer, smartphone, and wheelchair using their voluntary tongue movements. A low-power local processor is proposed, which can perform signal processing to convert raw magnetic sensor signals to user-defined commands, on the sTDS wearable headset, rather than sending all raw data out to a PC or smartphone. The proposed sTDS significantly reduces the transmitter power consumption and subsequently increases the battery life. Assuming the sTDS user issues one command every 20 ms, the proposed local processor reduces the data volume that needs to be wirelessly transmitted by a factor of 64, from 9.6 to 0.15 kb/s. The proposed processor consists of three main blocks: serial peripheral interface bus for receiving raw data from magnetic sensors, external magnetic interference attenuation to attenuate external magnetic field from the raw magnetic signal, and a machine learning classifier for command detection. A proof-of-concept prototype sTDS has been implemented with a low-power IGLOO-nano field programmable gate array (FPGA), bluetooth low energy, battery and magnetic sensors on a headset, and tested. At clock frequency of 20 MHz, the processor takes 6.6 s and consumes 27 nJ for detecting a command with a detection accuracy of 96.9%. To further reduce power consumption, an application-specified integrated circuit processor for the sTDS is implemented at the postlayout level in 65-nm CMOS technology with 1-V power supply, and it consumes 0.43 mW, which is 10 lower than FPGA power consumption and occupies an area of only 0.016 mm.

  18. Stand-Alone Photovoltaic System Assessment in Warmer Urban Areas in Mexico

    Directory of Open Access Journals (Sweden)

    Alberto-Jesus Perea-Moreno

    2018-01-01

    Full Text Available The aim of this study is to examine the possibility of using a stand-alone photovoltaic system (SAPVS for electricity generation in urban areas in Southern Mexico. In Mexico, an urban area is defined as an area where more than 2500 inhabitants live. Due to constant migration from the countryside to the cities, the number of inhabitants of urban localities has been increasing. Global horizontal irradiation (GHI data were recorded every 10 min during 2014–2016 in Coatzacoalcos in the state of Veracruz located on 18°08′09″ N and 94°27′48″ W. In this study, batteries represented 77% of the total cost, 12 PV panels of 310 W could export 5.41 MWh to the grid, and an inverter with an integrated controller and charger was selected, which decreased the initial cost. The city of Coatzacoalcos was chosen because the average annual temperature is 28°, with an average relative humidity of 75% and an average irradiance of 5.3 kWh/m2/day. An emission factor 0.505 tCO2/MWh of greenhouse gases (GHG were obtained, based on the power system, the reduction of net annual GHG would be 11 tCO2 and a financial revenue of 36.951 × 103 $/tCO2 would be obtained. Financial parameters such as a 36.3% Internal Rate Return (IRR and 3.4 years payback show the financial viability of this investment. SAPVSs in urban areas in Mexico could be a benefit as long as housing has a high consumption of electricity.

  19. Brackish water desalination by a stand alone reverse osmosis desalination unit powered by photovoltaic solar energy

    Energy Technology Data Exchange (ETDEWEB)

    Hrayshat, Eyad S. [Tafila Technical University, P.O. Box 66, Tafila 66110 (Jordan)

    2008-08-15

    Desalination of brackish water as a viable option to cope with water scarcity and to overcome water deficit in Jordan is assessed. A stand alone reverse osmosis (RO) desalination unit powered by photovoltaic (PV) solar energy is proposed, and a computer code in C++ was generated in order to simulate the process, and to predict the water production at 10 selected sites based on the available solar radiation data, sunshine hours and salinity of the feed water (TDS of 3000, 5000, 7000, and 10,000 mg/L). It was found that most of the selected sites showed favorable application of the proposed system in Jordan. Tafila, Queira, Ras Muneef, H-4, and H-5 are the most favorable sites. With TDS of 7000 mg/L, the highest annual water production of 1679 m{sup 3}/year was observed in Tafila, followed by Queira with production of 1473 m{sup 3}/year. Ras Muneef, H-4, and H-5 showed close to each other production of 1363, 1345, and 1340 m{sup 3}/year, respectively. Among the most favorable sites (Tafila, Queira, Ras Muneef, H-4, and H-5), Ras Muneef was found to be the best site in terms of the daily amount of water produced during the driest months of the year (May-September). Its production during these months forms about 65% of its total daily water production during a 1-year cycle, while for each of the other most favorable sites namely Tafila, Queira, H-4, and H-5, a 61% of production was observed during the same period. (author)

  20. Stand-Alone Solar Organic Rankine Cycle Water Pumping System and Its Economic Viability in Nepal

    Directory of Open Access Journals (Sweden)

    Suresh Baral

    2015-12-01

    Full Text Available The current study presents the concept of a stand-alone solar organic Rankine cycle (ORC water pumping system for rural Nepalese areas. Experimental results for this technology are presented based on a prototype. The economic viability of the system was assessed based on solar radiation data of different Nepalese geographic locations. The mechanical power produced by the solar ORC is coupled with a water pumping system for various applications, such as drinking and irrigation. The thermal efficiency of the system was found to be 8% with an operating temperature of 120 °C. The hot water produced by the unit has a temperature of 40 °C. Economic assessment was done for 1-kW and 5-kW solar ORC water pumping systems. These systems use different types of solar collectors: a parabolic trough collector (PTC and an evacuated tube collector (ETC. The economic analysis showed that the costs of water are $2.47/m3 (highest and $1.86/m3 (lowest for the 1-kW system and a 150-m pumping head. In addition, the cost of water is reduced when the size of the system is increased and the pumping head is reduced. The minimum volumes of water pumped are 2190 m3 and 11,100 m3 yearly for 1 kW and 5 kW, respectively. The payback period is eight years with a profitability index of 1.6. The system is highly feasible and promising in the context of Nepal.

  1. Feasibility study and energy conversion analysis of stand-alone hybrid renewable energy system

    International Nuclear Information System (INIS)

    Baghdadi, Fazia; Mohammedi, Kamal; Diaf, Said; Behar, Omar

    2015-01-01

    Highlights: • Hybrid stand-alone wind–solar–fossil power system is analyzed. • Measurement data are used to evaluate system performance. • The proposed system can generate about 70% from renewables. • Such a hybrid plant is very promising for remote regions in Algeria. - Abstract: There is a great interest in the development of renewable power technologies in Algeria, and more particularly hybrid concept. The present paper has investigated the performance of hybrid PV–Wind–Diesel–Battery configuration based on hourly measurements of Adrar climate (southern Algeria). Data of global solar radiation, ambient temperature and wind speed for a period of one year have been used. Firstly, the proposed hybrid system has been optimized by means of HOMER software. The optimization process has been carried out taking into account renewable resources potential and energy demand; while maximizing renewable electricity use and fuel saving are the purpose. In the second step, a mathematical model has been developed to ensure efficient energy management on the basis of various operation strategies. The analysis has shown that renewable energy system (PV–Wind) is able to supply about 70% of the demand. Wind power has ranked first with 43% of the annual total electricity production followed by diesel generator (with 31%) while the remaining fraction is being to PV panels. In this context, 69% of the fossil fuel can be saved when using the proposed hybrid configuration instead of the diesel generators that are currently installed in most remote regions in Algeria. Such a concept is very promising to meet the focus of renewable energy program announced in 2011.

  2. Probabilistic modelling and analysis of stand-alone hybrid power systems

    International Nuclear Information System (INIS)

    Lujano-Rojas, Juan M.; Dufo-López, Rodolfo; Bernal-Agustín, José L.

    2013-01-01

    As a part of the Hybrid Intelligent Algorithm, a model based on an ANN (artificial neural network) has been proposed in this paper to represent hybrid system behaviour considering the uncertainty related to wind speed and solar radiation, battery bank lifetime, and fuel prices. The Hybrid Intelligent Algorithm suggests a combination of probabilistic analysis based on a Monte Carlo simulation approach and artificial neural network training embedded in a genetic algorithm optimisation model. The installation of a typical hybrid system was analysed. Probabilistic analysis was used to generate an input–output dataset of 519 samples that was later used to train the ANNs to reduce the computational effort required. The generalisation ability of the ANNs was measured in terms of RMSE (Root Mean Square Error), MBE (Mean Bias Error), MAE (Mean Absolute Error), and R-squared estimators using another data group of 200 samples. The results obtained from the estimation of the expected energy not supplied, the probability of a determined reliability level, and the estimation of expected value of net present cost show that the presented model is able to represent the main characteristics of a typical hybrid power system under uncertain operating conditions. - Highlights: • This paper presents a probabilistic model for stand-alone hybrid power system. • The model considers the main sources of uncertainty related to renewable resources. • The Hybrid Intelligent Algorithm has been applied to represent hybrid system behaviour. • The installation of a typical hybrid system was analysed. • The results obtained from the study case validate the presented model

  3. Unusual back pain caused by intervertebral disc degeneration associated with schmorl node at Th11/12 in a young athlete, successfully treated by anterior interbody fusion: a case report.

    Science.gov (United States)

    Fukuta, Shoji; Miyamoto, Kei; Iwata, Atsushi; Hosoe, Hideo; Iwata, Hisashi; Shirahashi, Koyo; Shimizu, Katsuji

    2009-03-01

    A case report describing thoracic intervertebral disc degeneration and spondylolisthesis associated with a Schmorl node in a young athlete, which was successfully treated by anterior interbody fusion (AIF). To describe a rare pathologic condition with a clinical outcome of a surgical intervention. Intervertebral degeneration and spondylolisthesis of the lower thoracic spine associated with a Schmorl node in a young athlete has not been reported. A 19-year-old male amateur soccer player presented with severe back pain during motion. This pain was associated with intervertebral disc degeneration, spondylolisthesis, and a Schmorl node at the Th11/12 level. He was surgically treated by AIF. The AIF resulted in a solid fusion, an improvement in sagittal alignment, and amelioration of symptoms. The AIF procedure was effective for lower thoracic symptomatic intervertebral disc degeneration and spondylolisthesis associated with a Schmorl node.

  4. TRANSFORAMINAL L U MBAR INTERBODY FUSION IN LOW GRADE COMBINED LYTIC AND DEGENERATIVE SPONDYLOLIDTHESIS : FUNCTIONAL OUTCOME OF 21 CASES

    Directory of Open Access Journals (Sweden)

    Suresh

    2015-10-01

    Full Text Available BACKGROUND: Spondylolisthesis is a heterogenous disorder characterised by subluxation of a vertebral body in sagittal plane occuring frequently at l4 - 5 and l5 - S1commonest being isthmic and degenerative variety. While majority are asymptomatic, a subset do produce pain with neurology. Complete decompression of roots is essential, as is the need for solid stabi lization. Several fusion techniques were reported in literature like PLF, TLIF, PLF, ALIF On theoretical grounds, TLIF has been suggested to be safe and result in an improved outcome compared to other techniques. Data to support this view, are lacking. M ETHODS: A total of 21 patients (age range, 27 - 62 years with adult isthmic and degenerative spondylolisthesis were operated. There were 8 males and 13 females with mean age of 46.8 pre - op and 2 - year follow - up, pain (VAS and functional disability were quan tified by Oswestry Disability Index (ODI.Radiological union assessed with xrays by Brantigen and Steffee criteria. The global outcome was excellent in 90%.and 92% fusion. 2 patients presented motor deficit which did not recover. RESULTS: The follow - up was for 2 years. The mean VAS score for low back pain improved from 7.0 preoperatively to 2.1, as did the mean VAS score for leg pain from 6.7 to 1.4 and the mean ODI from 59.5% to 11.3%. CONCLUSION: TLIF does affect the 2 - year outcome of surgical treatment of spondylolisthesis with decreased back pain and ODI’s, with advantages of minimal thecal retraction, restored segmental lordosis and preserved posterior tension band.

  5. A stand-alone demography and landscape structure module for Earth system models

    Science.gov (United States)

    Nieradzik, L. P.; Haverd, V.; Smith, B.; Cook, G. D.; Briggs, P.; Roxburgh, S.; Liedloff, A.; Meyer, C.; Canadell, J.

    2013-12-01

    component of any LSM, represents a significant advance in our ability to use in-situ and remotely sensed observations of biomass and individual level parameters (e.g. crown-size, tree-height, stem diameter) as constraints on the terrestrial carbon cycle. Haverd, V., B. Smith, G. Cook, P. Briggs, L. Nieradzik, S. Roxburgh, A. Liedloff, C. Meyer, and J. G. Canadell, A stand-alone tree demography and landscape structure module for Earth system models, submitted to Geophys. Res. Let., 2013 Wolf, A., P. Ciais, V. Bellassen, N. Delbart, C.B. Field, and J.A. Berry, Forest biomass allometry in global land surface models, Global Biogeochem. Cycles, 25, GB3015, doi:10.1029/2010GB003917, 2011

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

    Science.gov (United States)

    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). The results of the post-operative CT showed that the pedicle screws in the robot-assisted minimally invasive TLIF group were more precisely placed than traditional open TLIF group (χ(2)=4.247, P =0.039). The mean follow-up time was 8 months (ranging from 3 to 12 months). There were no significant difference in outcomes between the two groups (χ(2)=0.366, P =0.545). Conclusions: In the treatment of lumbar spondylolisthesis, Robot-assisted minimally invasive TLIF can lead to less

  7. Cortical bone trajectory screw fixation versus traditional pedicle screw fixation for 2-level posterior lumbar interbody fusion: comparison of surgical outcomes for 2-level degenerative lumbar spondylolisthesis.

    Science.gov (United States)

    Sakaura, Hironobu; Miwa, Toshitada; Yamashita, Tomoya; Kuroda, Yusuke; Ohwada, Tetsuo

    2018-01-01

    OBJECTIVE The cortical bone trajectory (CBT) screw technique is a new nontraditional pedicle screw (PS) insertion method. However, the biomechanical behavior of multilevel CBT screw/rod fixation remains unclear, and surgical outcomes in patients after 2-level posterior lumbar interbody fusion (PLIF) using CBT screw fixation have not been reported. Thus, the purposes of this study were to examine the clinical and radiological outcomes after 2-level PLIF using CBT screw fixation for 2-level degenerative lumbar spondylolisthesis (DS) and to compare these outcomes with those after 2-level PLIF using traditional PS fixation. METHODS The study included 22 consecutively treated patients who underwent 2-level PLIF with CBT screw fixation for 2-level DS (CBT group, mean follow-up 39 months) and a historical control group of 20 consecutively treated patients who underwent 2-level PLIF using traditional PS fixation for 2-level DS (PS group, mean follow-up 35 months). Clinical symptoms were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Bony union was assessed by dynamic plain radiographs and CT images. Surgery-related complications, including symptomatic adjacent-segment disease (ASD), were examined. RESULTS The mean operative duration and intraoperative blood loss were 192 minutes and 495 ml in the CBT group and 218 minutes and 612 ml in the PS group, respectively (p 0.05, respectively). The mean JOA score improved significantly from 12.3 points before surgery to 21.1 points (mean recovery rate 54.4%) at the latest follow-up in the CBT group and from 12.8 points before surgery to 20.4 points (mean recovery rate 51.8%) at the latest follow-up in the PS group (p > 0.05). Solid bony union was achieved at 90.9% of segments in the CBT group and 95.0% of segments in the PS group (p > 0.05). Symptomatic ASD developed in 2 patients in the CBT group (9.1%) and 4 patients in the PS group (20.0%, p > 0.05). CONCLUSIONS Two-level PLIF with CBT screw fixation

  8. Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages.

    Science.gov (United States)

    Niu, Chi-Chien; Liao, Jen-Chung; Chen, Wen-Jer; Chen, Lih-Huei

    2010-07-01

    A prospective study was performed in case with cervical spondylosis who underwent anterior cervical discectomy and fusion (ACDF) with titanium or polyetheretherketone (PEEK) cages. To find out which fusion cage yielded better clinical and radiographic results. Although use of autogenous iliac-bone grafts in ACDF for cervical disc diseases remain standard surgical procedure, donor site morbidity and graft collapse or breakage are concerns. Cage technology was developed to prevent these complications. However, there is no comparison regarding the efficacy between titanium and PEEK cage. January 2005 to January 2006, 53 patients who had 1 and 2-levels ACDF with titanium or PEEK cages were evaluated. We measured the rate and amount of interspace collapse, segmental sagittal angulations, and the radiographic fusion success rate. Odom criteria were used to assess the clinical results. The fusion rate was higher in the PEEK group (100% vs. 86.5%, P=0.0335). There was no significant difference between both groups in loss of cervical lordosis (3.2 + or - 2.4 vs. 2.8 + or - 3.4, P=0.166). The mean anterior interspace collapse (1.6 + or - 1.0 mm) in the titanium group was significantly higher than the collapse of the PEEK group (0.5 + or - 0.6 mm) (PPEEK group (PPEEK group achieved an 80% rate of successful clinical outcomes, compared with 75% in the titanium group (P=0.6642). The PEEK cage is superior to the titanium cage in maintaining cervical interspace height and radiographic fusion after 1 and 2-levels anterior cervical decompression procedures.

  9. Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain

    Directory of Open Access Journals (Sweden)

    Ara J Deukmedjian

    2015-01-01

    Full Text Available Background: Lumbar fusion is a proven treatment for chronic lower back pain (LBP in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD. Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD. Materials and Methods: Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS, patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS. Results: The average resolution of preoperative back pain per patient was 84% (n = 205 while the average resolution of preoperative leg pain was 90% (n = 190 while a mean follow-up period of 528 days (1.5 years. Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001, a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4. Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11 and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4. Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3; surgical site infection (n = 7; repair of cerebrospinal fluid leak (n = 1, and one patient death at home 3 days after discharge. Conclusion: Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain.

  10. prfectBLAST: a platform-independent portable front end for the command terminal BLAST+ stand-alone suite.

    Science.gov (United States)

    Santiago-Sotelo, Perfecto; Ramirez-Prado, Jorge Humberto

    2012-11-01

    prfectBLAST is a multiplatform graphical user interface (GUI) for the stand-alone BLAST+ suite of applications. It allows researchers to do nucleotide or amino acid sequence similarity searches against public (or user-customized) databases that are locally stored. It does not require any dependencies or installation and can be used from a portable flash drive. prfectBLAST is implemented in Java version 6 (SUN) and runs on all platforms that support Java and for which National Center for Biotechnology Information has made available stand-alone BLAST executables, including MS Windows, Mac OS X, and Linux. It is free and open source software, made available under the GNU General Public License version 3 (GPLv3) and can be downloaded at www.cicy.mx/sitios/jramirez or http://code.google.com/p/prfectblast/.

  11. Flexible Control of Small Wind Turbines With Grid Failure Detection Operating in Stand-Alone and Grid-Connected Mode

    DEFF Research Database (Denmark)

    Teodorescu, Remus; Blaabjerg, Frede

    2004-01-01

    This paper presents the development and test of a flexible control strategy for an 11-kw wind turbine with a back-to-back power converter capable of working in both stand-alone and grid-connected mode. The stand-alone control is featured with a complex output voltage controller capable of handling...... nonlinear load and excess or deficit of generated power. Grid-connection mode with current control is also enabled for the case of isolated local grid involving other dispersed power generators such as other wind turbines or diesel generators. A novel automatic mode switch method based on a phase......-locked loop controller is developed in order to detect the grid failure or recovery and switch the operation mode accordingly. A flexible digital signal processor (DSP) system that allows user-friendly code development and on-line tuning is used to implement and test the different control strategies. The back...

  12. Stand-alone flat-plate photovoltaic power systems: System sizing and life-cycle costing methodology for Federal agencies

    Science.gov (United States)

    Borden, C. S.; Volkmer, K.; Cochrane, E. H.; Lawson, A. C.

    1984-01-01

    A simple methodology to estimate photovoltaic system size and life-cycle costs in stand-alone applications is presented. It is designed to assist engineers at Government agencies in determining the feasibility of using small stand-alone photovoltaic systems to supply ac or dc power to the load. Photovoltaic system design considerations are presented as well as the equations for sizing the flat-plate array and the battery storage to meet the required load. Cost effectiveness of a candidate photovoltaic system is based on comparison with the life-cycle cost of alternative systems. Examples of alternative systems addressed are batteries, diesel generators, the utility grid, and other renewable energy systems.

  13. Radiographic Adjacent Segment Degeneration at 5 Years After L4/5 Posterior Lumbar Interbody Fusion With Pedicle Screw Instrumentation: Evaluation by Computed Tomography and Annual Screening With Magnetic Resonance Imaging.

    Science.gov (United States)

    Imagama, Shiro; Kawakami, Noriaki; Matsubara, Yuji; Tsuji, Taichi; Ohara, Tetsuya; Katayama, Yoshito; Ishiguro, Naoki; Kanemura, Tokumi

    2016-11-01

    Retrospective clinical study. To investigate adjacent segment degeneration (ASD) at 5 years after L4/5 posterior lumbar interbody fusion with pedicle screw instrumentation and L4/5 decompression surgery using plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI), with the evaluation of annual changes on MRI. Methods of evaluation have been inconsistent among studies of ASD. There is no report that ASD in the lumbar spine after posterior lumbar interbody fusion at the same level is thoroughly evaluated on radiographs, CT, annual MRI changes, and the impact of decompression procedures. ASD was evaluated in 52 patients. Disk height, vertebral slip, intervertebral angle, and intervertebral range of motion were examined on plain radiographs. Facet joint degeneration on CT and disk degradation and spinal stenosis on MRI were classified into categories, and facet sagittalization and tropism were measured on CT. The incidence of ASD was compared between the decompression procedures. The radiographic changes observed in the study were defined as radiographic ASD (R-ASD) without reoperation, as no patient required reoperation. R-ASD was rarely detected by radiography. The incidences of facet joint degeneration, MRI-detected disk degeneration, and spinal stenosis at the L3/4 and L5/S1 levels were 21% and 23%, 27% and 17%, and 35% and 4%, respectively. Progressive disk degeneration at L3/4 was found significantly more frequently in patients with aggravation of facet degeneration (Pspine fusion, rather than aging degeneration. Decompression with preservation of posterior connective components is recommended to prevent R-ASD.

  14. Optimum autonomous stand-alone photovoltaic system design on the basis of energy pay-back analysis

    International Nuclear Information System (INIS)

    Kaldellis, J.K.; Zafirakis, D.; Kondili, E.

    2009-01-01

    Stand-alone photovoltaic (PV) systems comprise one of the most promising electrification solutions for covering the demand of remote consumers. However, such systems are strongly questioned due to extreme life-cycle (LC) energy requirements. For similar installations to be considered as environmentally sustainable, their LC energy content must be compensated by the respective useful energy production, i.e. their energy pay-back period (EPBP) should be found less than their service period. In this context, an optimum sizing methodology is currently developed, based on the criterion of minimum embodied energy. Various energy autonomous stand-alone PV-lead-acid battery systems are examined and two different cases are investigated; a high solar potential area and a medium solar potential area. By considering that the PV-battery (PV-Bat) system's useful energy production is equal to the remote consumer's electricity consumption, optimum cadmium telluride (CdTe) based systems yield the minimum EPBP (15 years). If achieving to exploit the net PV energy production however, the EPBP is found less than 20 years for all PV types. Finally, the most interesting finding concerns the fact that in all cases examined the contribution of the battery component exceeds 27% of the system LC energy requirements, reflecting the difference between grid-connected and stand-alone configurations.

  15. Control strategy of wind turbine based on permanent magnet synchronous generator and energy storage for stand-alone systems

    DEFF Research Database (Denmark)

    Deng, Fujin; Liu, Dong; Chen, Zhe

    2017-01-01

    This paper investigates a variable speed wind turbine based on permanent magnet synchronous generator and a full-scale power converter in a stand-alone system. An energy storage system(ESS) including battery and fuel cell-electrolyzer combination is connected to the DC link of the full-scale power...... converter through the power electronics interface. Wind is the primary power source of the system, the battery and FC-electrolyzer combination is used as a backup and a long-term storage system to provide or absorb power in the stand-alone system, respectively. In this paper, a control strategy is proposed...... for the operation of this variable speed wind turbine in a stand-alone system, where the generator-side converter and the ESS operate together to meet the demand of the loads. This control strategy is competent for supporting the variation of the loads or wind speed and limiting the DC-link voltage of the full...

  16. Methanol production via pressurized entrained flow biomass gasification – Techno-economic comparison of integrated vs. stand-alone production

    International Nuclear Information System (INIS)

    Andersson, Jim; Lundgren, Joakim; Marklund, Magnus

    2014-01-01

    The main objective with this work was to investigate techno-economically the opportunity for integrated gasification-based biomass-to-methanol production in an existing chemical pulp and paper mill. Three different system configurations using the pressurized entrained flow biomass gasification (PEBG) technology were studied, one stand-alone plant, one where the bark boiler in the mill was replaced by a PEBG unit and one with a co-integration of a black liquor gasifier operated in parallel with a PEBG unit. The cases were analysed in terms of overall energy efficiency (calculated as electricity-equivalents) and process economics. The economics was assessed under the current as well as possible future energy market conditions. An economic policy support was found to be necessary to make the methanol production competitive under all market scenarios. In a future energy market, integrating a PEBG unit to replace the bark boiler was the most beneficial case from an economic point of view. In this case the methanol production cost was reduced in the range of 11–18 Euro per MWh compared to the stand-alone case. The overall plant efficiency increased approximately 7%-units compared to the original operation of the mill and the non-integrated stand-alone case. In the case with co-integration of the two parallel gasifiers, an equal increase of the system efficiency was achieved, but the economic benefit was not as apparent. Under similar conditions as the current market and when methanol was sold to replace fossil gasoline, co-integration of the two parallel gasifiers was the best alternative based on received IRR. - Highlights: • Techno-economic results regarding integration of methanol synthesis processes in a pulp and paper mill are presented. • The overall energy efficiency increases in integrated methanol production systems compared to stand-alone production units. • The economics of the integrated system improves compared to stand-alone alternatives. • Tax

  17. Stand-Alone Personalized Normative Feedback for College Student Drinkers: A Meta-Analytic Review, 2004 to 2014.

    Directory of Open Access Journals (Sweden)

    Keri B Dotson

    Full Text Available Norms clarification has been identified as an effective component of college student drinking interventions, prompting research on norms clarification as a single-component intervention known as Personalized Normative Feedback (PNF. Previous reviews have examined PNF in combination with other components but not as a stand-alone intervention.To investigate the degree to which computer-delivered stand-alone personalized normative feedback interventions reduce alcohol consumption and alcohol-related harms among college students and to compare gender-neutral and gender-specific PNF.Electronic databases were searched systematically through November 2014. Reference lists were reviewed manually and forward and backward searches were conducted.Outcome studies that compared computer-delivered, stand-alone PNF intervention with an assessment only, attention-matched, or active treatment control and reported alcohol use and harms among college students.Between-group effect sizes were calculated as the standardized mean difference in change scores between treatment and control groups divided by pooled standard deviation. Within-group effect sizes were calculated as the raw mean difference between baseline and follow-up divided by pooled within-groups standard deviation.Eight studies (13 interventions with a total of 2,050 participants were included. Compared to control participants, students who received gender-neutral (dbetween = 0.291, 95% CI [0.159, 0.423] and gender-specific PNF (dbetween = 0.284, 95% CI [0.117, 0.451] reported greater reductions in drinking from baseline to follow-up. Students who received gender-neutral PNF reported 3.027 (95% CI [2.171, 3.882] fewer drinks per week at first follow-up and gender-specific PNF reported 3.089 (95% CI [0.992, 5.186] fewer drinks. Intervention effects were small for harms (dbetween = 0.157, 95% CI [0.037, 0.278].Computer-delivered PNF is an effective stand-alone approach for reducing college student

  18. Stand-Alone Personalized Normative Feedback for College Student Drinkers: A Meta-Analytic Review, 2004 to 2014.

    Science.gov (United States)

    Dotson, Keri B; Dunn, Michael E; Bowers, Clint A

    2015-01-01

    Norms clarification has been identified as an effective component of college student drinking interventions, prompting research on norms clarification as a single-component intervention known as Personalized Normative Feedback (PNF). Previous reviews have examined PNF in combination with other components but not as a stand-alone intervention. To investigate the degree to which computer-delivered stand-alone personalized normative feedback interventions reduce alcohol consumption and alcohol-related harms among college students and to compare gender-neutral and gender-specific PNF. Electronic databases were searched systematically through November 2014. Reference lists were reviewed manually and forward and backward searches were conducted. Outcome studies that compared computer-delivered, stand-alone PNF intervention with an assessment only, attention-matched, or active treatment control and reported alcohol use and harms among college students. Between-group effect sizes were calculated as the standardized mean difference in change scores between treatment and control groups divided by pooled standard deviation. Within-group effect sizes were calculated as the raw mean difference between baseline and follow-up divided by pooled within-groups standard deviation. Eight studies (13 interventions) with a total of 2,050 participants were included. Compared to control participants, students who received gender-neutral (dbetween = 0.291, 95% CI [0.159, 0.423]) and gender-specific PNF (dbetween = 0.284, 95% CI [0.117, 0.451]) reported greater reductions in drinking from baseline to follow-up. Students who received gender-neutral PNF reported 3.027 (95% CI [2.171, 3.882]) fewer drinks per week at first follow-up and gender-specific PNF reported 3.089 (95% CI [0.992, 5.186]) fewer drinks. Intervention effects were small for harms (dbetween = 0.157, 95% CI [0.037, 0.278]). Computer-delivered PNF is an effective stand-alone approach for reducing college student drinking and

  19. 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.

    Science.gov (United States)

    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

  20. Direct lateral approach to lumbar fusion is a biomechanically equivalent alternative to the anterior approach: an in vitro study.

    Science.gov (United States)

    Laws, Cory J; Coughlin, Dezba G; Lotz, Jeffrey C; Serhan, Hassan A; Hu, Serena S

    2012-05-01

    A human cadaveric biomechanical study of lumbar mobility before and after fusion and with or without supplemental instrumentation for 5 instrumentation configurations. To determine the biomechanical differences between anterior lumbar interbody fusion (ALIF) and direct lateral interbody fusion (DLIF) with and without supplementary instrumentation. Some prior studies have compared various surgical approaches using the same interbody device whereas others have investigated the stabilizing effect of supplemental instrumentation. No published studies have performed a side-by-side comparison of standard and minimally invasive techniques with and without supplemental instrumentation. Eight human lumbosacral specimens (16 motion segments) were tested in each of the 5 following configurations: (1) intact, (2) with ALIF or DLIF cage, (3) with cage plus stabilizing plate, (4) with cage plus unilateral pedicle screw fixation (PSF), and (5) with cage plus bilateral PSF. Pure moments were applied to induce specimen flexion, extension, lateral bending, and axial rotation. Three-dimensional kinematic responses were measured and used to calculate range of motion, stiffness, and neutral zone. Compared to the intact state, DLIF significantly reduced range of motion in flexion, extension, and lateral bending (P = 0.0117, P = 0.0015, P = 0.0031). Supplemental instrumentation significantly increased fused-specimen stiffness for both DLIF and ALIF groups. For the ALIF group, bilateral PSF increased stiffness relative to stand-alone cage by 455% in flexion and 317% in lateral bending (P = 0.0009 and P < 0.0001). The plate increased ALIF group stiffness by 211% in extension and 256% in axial rotation (P = 0.0467 and P = 0.0303). For the DLIF group, bilateral PSF increased stiffness by 350% in flexion and 222% in extension (P < 0.0001 and P = 0.0008). No differences were observed between ALIF and DLIF groups supplemented with bilateral PSF. Our data support that the direct lateral approach

  1. Hierarchical energy management system for stand-alone hybrid system based on generation costs and cascade control

    International Nuclear Information System (INIS)

    Torreglosa, J.P.; García, P.; Fernández, L.M.; Jurado, F.

    2014-01-01

    Highlights: • We present an energy management system for a stand-alone WT/PV/hydrogen/battery hybrid system. • Hierarchical control composed by master and slave control strategies. • Control assures reliable electricity support for stand-alone applications subject to technical and economic criteria. - Abstract: This paper presents an energy management system (EMS) for stand-alone hybrid systems composed by photovoltaic (PV) solar panels and a wind turbine (WT) as primary energy sources and two energy storage systems, which are a hydrogen system and a battery. The hydrogen system is composed of fuel cell (FC), electrolyzer and hydrogen storage tank. The EMS is a hierarchical control composed by a master control strategy and a slave control strategy. On the one hand, the master control generates the reference powers to meet several premises (such as to satisfy the load power demand, and to maintain the hydrogen tank level and the state of charge (SOC) of the battery between their target margins), taking also into account economic aspects to discriminate between using the battery or hydrogen system. On the other hand, the slave control modifies the reference powers generated by the master control according to the energy sources dynamic limitations, and maintains the DC bus voltage at its reference value. The models, implemented in MATLAB-Simulink environment, have been developed from commercially available components. To check the viability of the proposed EMS, two kinds of simulations were carried out: (1) A long-term simulation of 25 years (expected lifetime of the system) with a sample time of one hour to validate the master control of the EMS; and (2) A short-term simulation with sudden net power variations to validate the slave control of the EMS

  2. An optimized Fuzzy Logic Controller by Water Cycle Algorithm for power management of Stand-alone Hybrid Green Power generation

    International Nuclear Information System (INIS)

    Sarvi, Mohammad; Avanaki, Isa Nasiri

    2015-01-01

    Highlights: • A new method to improve the performance of renewable power management is proposed. • The proposed method is based on Fuzzy Logic optimized by the Water Cycle Algorithm. • The proposed method characteristics are compared with two other methods. • The comparisons confirm that the proposed method is robust and effectiveness one. - Abstract: This paper aims to improve the power management system of a Stand-alone Hybrid Green Power generation based on the Fuzzy Logic Controller optimized by the Water Cycle Algorithm. The proposed Stand-alone Hybrid Green Power consists of wind energy conversion and photovoltaic systems as primary power sources and a battery, fuel cell, and Electrolyzer as energy storage systems. Hydrogen is produced from surplus power generated by the wind energy conversion and photovoltaic systems of Stand-alone Hybrid Green Power and stored in the hydrogen storage tank for fuel cell later using when the power generated by primary sources is lower than load demand. The proposed optimized Fuzzy Logic Controller based power management system determines the power that is generated by fuel cell or use by Electrolyzer. In a hybrid system, operation and maintenance cost and reliability of the system are the important issues that should be considered in studies. In this regard, Water Cycle Algorithm is used to optimize membership functions in order to simultaneously minimize the Loss of Power Supply Probability and operation and maintenance. The results are compared with the particle swarm optimization and the un-optimized Fuzzy Logic Controller power management system to prove that the proposed method is robust and effective. Reduction in Loss of Power Supply Probability and operation and maintenance, are the most advantages of the proposed method. Moreover the level of the State of Charge of the battery in the proposed method is higher than other mentioned methods which leads to increase battery lifetime.

  3. Optimization of a stand-alone Solar PV-Wind-DG Hybrid System for Distributed Power Generation at Sagar Island

    Science.gov (United States)

    Roy, P. C.; Majumder, A.; Chakraborty, N.

    2010-10-01

    An estimation of a stand-alone solar PV and wind hybrid system for distributed power generation has been made based on the resources available at Sagar island, a remote area distant to grid operation. Optimization and sensitivity analysis has been made to evaluate the feasibility and size of the power generation unit. A comparison of the different modes of hybrid system has been studied. It has been estimated that Solar PV-Wind-DG hybrid system provides lesser per unit electricity cost. Capital investment is observed to be lesser when the system run with Wind-DG compared to Solar PV-DG.

  4. Losses Evaluation for a Two-Level Three-Phase Stand-Alone Voltage Source Converter Using Model Predictive Control

    DEFF Research Database (Denmark)

    Al hasheem, Mohamed; Dragicevic, Tomislav; Rivera, Marco

    2017-01-01

    conventional and improved controller is conducted in terms of losses. The switching and conduction losses for the VSC are calculated using MATLAB/SIMULINK and PLECS software. A power level up to 1 kW is considered for the conventional and the improved schemes. All simulation and experimental results......This paper discusses a Model Predictive Control (MPC) scheme for a Voltage Source Converter (VSC) where the aim is to minimize losses and Total Harmonics distortion (THD) compared to the conventional MPC scheme. Different Cost Functions (CFs) are applied to the stand-alone VSC. A comparison between...

  5. Dynamic behavior of PEM FCPPs under various load conditions and voltage stability analysis for stand-alone residential applications

    Science.gov (United States)

    Uzunoglu, M.; Onar, O. C.; Alam, M. S.

    In this paper, dynamic behavior and performance of a fuel cell power plant (FCPP) which operates in parallel with a battery bank is tested under classified load conditions, such as mostly resistive, mostly inductive, resistive-inductive and non-linear loads. Thereafter, voltage stability analysis is performed using the dynamic response of the FCPP for stand-alone residential applications. Simulation results are obtained using the MATLAB ® and Simulink ® software packages, based on the mathematical and dynamic electrical models of the system. Using the experimental results, a validated model has been realized and voltage stability analysis is performed through this model.

  6. Degenerative Cervical Disc Disease: Long-term Changes in Sagittal Alignment and Their Clinical Implications After Cervical Interbody Fusion Cage Subsidence: A Prospective Study With Standalone Lordotic Tantalum Cages.

    Science.gov (United States)

    Tomé-Bermejo, Félix; Morales-Valencia, Julián A; Moreno-Pérez, Javier; Marfil-Pérez, Juan; Díaz-Dominguez, Elena; Piñera, Angel R; Alvarez, Luis

    2017-06-01

    A retrospective, observational study of prospectively collected outcomes. To investigate the long-term clinical course of anterior cervical discectomy and fusion with interbody fusion cages (ACDF-IFC) with lordotic tantalum implants and to correlate the radiologic findings with the clinical outcomes, with special emphasis on the significance and the influence of implant subsidence. Cage subsidence is the most frequently reported complication after ACDF-IFC. However, most reports fail to correlate cage subsidence with lower fusion rates or with unsatisfactory clinical results. Forty-one consecutive patients with symptomatic degenerative cervical disk disease with failure of conservative treatment were included. All patients underwent 1-/2-level ACDF-IFC with lordotic tantalum implants. The mean follow-up was 4.91 years. The final follow-up fusion rate was 96.96% (32/33). The interspace height (IH) at the affected levels was significantly incremented after implant insertion, and despite a gradual loss in the height over time, the final follow-up IH was significantly higher than that measured preoperatively (Psubsidence (>3 mm) occurred in 11 disk spaces (26.82%). Preoperative and postoperative IH were significantly higher in subsidence patients; however, there was no difference in the final follow-up IH (P>0.05). Patients with ≥3 years of follow-up (n=29) did not demonstrate further significant subsidence beyond the second year. Regarding C1-C7 lordosis, the segmental Cobb angle, the cervical Visual Analogue Scale, and Neck Disability Index questionnaires, no difference between patients with or without final follow-up endplate subsidence was encountered. Until fusion occurs, tantalum cage settlement into the vertebral body is to be expected. Further subsidence could be the result of segmental adaptative changes. Graft subsidence did not affect the clinical outcome in any of our patients during long-term follow-up. The occurrence of dynamical implant subsidence had

  7. Economic and Environmental Assessment of a Renewable Stand-Alone Energy Supply System Using Multi-objective Optimization

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dohyun; Han, Seulki; Kim, Jiyong Kim [Incheon National University, Incheon (Korea, Republic of)

    2017-06-15

    This study aims to propose a new optimization-based approach for design and analysis of the stand-alone hybrid energy supply system using renewable energy sources (RES). In the energy supply system, we include multiple energy production technologies such as Photovoltaics (PV), Wind turbine, and fossil-fuel-based AC generator along with different types of energy storage and conversion technologies such as battery and inverter. We then select six different regions of Korea to represent various characteristics of different RES potentials and demand profiles. We finally designed and analyzed the optimal RES stand-alone energy supply system in the selected regions using multiobjective optimization (MOOP) technique, which includes two objective functions: the minimum cost and the minimum CO{sub 2} emission. In addition, we discussed the feasibility and expecting benefits of the systems by comparing to conventional systems of Korea. As a result, the region of the highest RES potential showed the possibility to remarkably reduce CO{sub 2} emissions compared to the conventional system. Besides, the levelized cost of electricity (LCOE) of the RES-based energy system is identified to be slightly higher than conventional energy system: 0.35 and 0.46 $/kWh, respectively. However, the total life-cycle emission of CO{sub 2} (LCECO{sub 2}) can be reduced up to 470 gCO{sub 2}/kWh from 490 gCO{sub 2}/kWh of the conventional systems.

  8. Comparison of pulp-mill-integrated hydrogen production from gasified black liquor with stand-alone production from gasified biomass

    International Nuclear Information System (INIS)

    Andersson, E.; Harvey, S.

    2007-01-01

    When gasified black liquor is used for hydrogen production, significant amounts of biomass must be imported. This paper compares two alternative options for producing hydrogen from biomass: (A) pulp-mill-integrated hydrogen production from gasified back liquor; and (B) stand-alone production of hydrogen from gasified biomass. The comparison assumes that the same amount of biomass that is imported in Alternative A is supplied to a stand-alone hydrogen production plant and that the gasified black liquor in Alternative B is used in a black liquor gasification combined cycle (BLGCC) CHP unit. The comparison is based upon equal amounts of black liquor fed to the gasifier, and identical steam and power requirements for the pulp mill. The two systems are compared on the basis of total CO 2 emission consequences, based upon different assumptions for the reference energy system that reflect different societal CO 2 emissions reduction target levels. Ambitions targets are expected to lead to a more CO 2 -lean reference energy system, in which case hydrogen production from gasified black liquor (Alternative A) is best from a CO 2 emissions' perspective, whereas with high CO 2 emissions associated with electricity production, hydrogen from gasified biomass and electricity from gasified black liquor (Alternative B) is preferable. (author)

  9. Multi-objective optimal planning of the stand-alone microgrid system based on different benefit subjects

    International Nuclear Information System (INIS)

    Guo, Li; Wang, Nan; Lu, Hai; Li, Xialin; Wang, Chengshan

    2016-01-01

    As an important means to realize the energetic complementarity and improve the efficiency of renewable resources, the stand-alone microgrid (SAMG) system gains attention increasingly, especially in islands and remote areas. In this paper, considering the interest conflict of the distribution company and the distributed generation owner, a new multi-objective optimal planning model is formulated for medium voltage SAMG. Besides, to avoid the power constraint of distributed generation (DG) once the over-limit voltage occurs, a novel two-step power dispatch control method including the voltage regulation strategy is proposed, in which the absorption of distributed power by energy storage system (ESS) and the reactive power adjustment though its power control system are used to regulate voltage. The goal of this paper is to search the Pareto-optimal front of the site and capacity of DG as well as the contract price between both parties, and thus can provide effective references for practical planning of SAMG. Considering the high cost of ESS, the investment analysis of ESS is also discussed in the paper. - Highlights: • A multi-objective planning model based on different benefit subjects is proposed. • A two-step power dispatch method including the voltage regulation is proposed. • The economical efficiency of the proposed model is analyzed. • The effective reference for the stand-alone microgrid planning is provided.

  10. SedInConnect: a stand-alone, free and open source tool for the assessment of sediment connectivity

    Science.gov (United States)

    Crema, Stefano; Cavalli, Marco

    2018-02-01

    There is a growing call, within the scientific community, for solid theoretic frameworks and usable indices/models to assess sediment connectivity. Connectivity plays a significant role in characterizing structural properties of the landscape and, when considered in combination with forcing processes (e.g., rainfall-runoff modelling), can represent a valuable analysis for an improved landscape management. In this work, the authors present the development and application of SedInConnect: a free, open source and stand-alone application for the computation of the Index of Connectivity (IC), as expressed in Cavalli et al. (2013) with the addition of specific innovative features. The tool is intended to have a wide variety of users, both from the scientific community and from the authorities involved in the environmental planning. Thanks to its open source nature, the tool can be adapted and/or integrated according to the users' requirements. Furthermore, presenting an easy-to-use interface and being a stand-alone application, the tool can help management experts in the quantitative assessment of sediment connectivity in the context of hazard and risk assessment. An application to a sample dataset and an overview on up-to-date applications of the approach and of the tool shows the development potential of such analyses. The modelled connectivity, in fact, appears suitable not only to characterize sediment dynamics at the catchment scale but also to integrate prediction models and as a tool for helping geomorphological interpretation.

  11. A Control Approach and Supplementary Controllers for a Stand-Alone System with Predominance of Wind Generation

    Directory of Open Access Journals (Sweden)

    Tiago Lukasievicz

    2018-02-01

    Full Text Available This paper proposes a control approach and supplementary controllers for the operation of a hybrid stand-alone system composed of a wind generation unit and a conventional generation unit based on synchronous generator (CGU. The proposed controllers allow the islanded or isolated operation of small power systems with predominance of wind generation. As an advantage and a paradigm shift, the DC-link voltage of the wind unit is controlled by means of a conventional synchronous generator connected to the AC grid of the system. Two supplementary controllers, added to a diesel generator (DIG and to a DC dump load (DL, are proposed to control the DC-link voltage. The wind generation unit operates in V-f control mode and the DIG operates in PQ control mode, which allows the stand-alone system to operate either in wind-diesel (WD mode or in wind-only (WO mode. The strong influence of the wind turbine speed variations in the DC-link voltage is mitigated by a low-pass filter added to the speed control loop of the wind turbine. The proposed control approach does not require the use battery bank and ultra-capacitor to control the DC-link voltage in wind generation units based on fully rated converter.

  12. Study on Soft Phase Locked Method to Solving the Synchronization Problem of Active Power Filter in Stand-alone Power Grid

    DEFF Research Database (Denmark)

    Zhuo, Fang; Wu, Longhui; Chen, Zhe

    2009-01-01

    on zero-cross detection can't work effectively in small rating stand-alone power grid. Then a soft phase locked loop with additional filter is proposed. It can lock the phase angle on to the positive sequence of fundamental voltage accurately and rapidly. It ensures the performance of APF applied...... in the small rating stand-alone power grid. Moreover, the soft phase locked loop is easy to be implemented in a Digital Signal Processor (DSP). Simulation and experimental results validate that the soft phase locked loop has satisfactory performance.......Traditional LC filters can't work stably in small rating stand-alone power grid. So active power filter (APF) is becoming an important tool to solve the power quality problem in small rating stand-alone power grid. In most current detection algorithm of APF, it needs a synchronizing signal. Firstly...

  13. Comparison of a Stand-Alone Anchored Spacer Versus Plate-Cage Construct in the Treatment of Two Noncontiguous Levels of Cervical Spondylosis: A Preliminary Investigation.

    Science.gov (United States)

    Shi, Sheng; Zheng, Shuang; Li, Xin-Feng; Yang, Li-Li; Liu, Zu-De; Yuan, Wen

    2016-05-01

    The application of stand-alone anchored spacer (SAAS) in anterior cervical discectomy and fusion (ACDF) has been proven to be safe and effective to treat cervical spondylosis. Skip-level ACDF with SAAS, fusing only the involved levels without anterior plates, may be the optimal treatment. The aim of the study was to compare the clinical outcomes, radiologic results of SAAS, and plate-cage construct in the treatment of 2 noncontiguous levels of cervical spondylosis. A total of 65 patients with 2 noncontiguous levels of cervical spondylosis were included in the retrospective review of prospective collected data. The clinical and radiologic outcomes were assessed with the Japanese Orthopaedic Association score, Neck Disability Index, cervical alignment, and range of motion and disc height of intermediate segment, respectively. All the aforementioned parameters were compared before and after surgery in the respective group, which also were compared between the 2 groups. Complications also were recorded, and correlations between the surgical outcome and various factors were analyzed. No significant differences existed in clinical results between the 2 groups (P > 0.05). In addition, no statistical significance was observed in fusion rate, cervical alignment, and range of motion and disc height of intermediate segment, dysphagia, and hoarseness (P > 0.05). Preoperative Japanese Orthopaedic Association score and high-intensity signal in T2-weighted images were important predictors for surgical outcome. Skip-level ACDF with SAAS is a safe and effective treatment of 2 noncontiguous levels of cervical spondylosis without obvious contraindications, which can keep the IS intact, and have a low impact on the IS. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Time-sequential changes of differentially expressed miRNAs during the process of anterior lumbar interbody fusion using equine bone protein extract, rhBMP-2 and autograft

    Science.gov (United States)

    Chen, Da-Fu; Zhou, Zhi-Yu; Dai, Xue-Jun; Gao, Man-Man; Huang, Bao-Ding; Liang, Tang-Zhao; Shi, Rui; Zou, Li-Jin; Li, Hai-Sheng; Bünger, Cody; Tian, Wei; Zou, Xue-Nong

    2014-03-01

    The precise mechanism of bone regeneration in different bone graft substitutes has been well studied in recent researches. However, miRNAs regulation of the bone formation has been always mysterious. We developed the anterior lumbar interbody fusion (ALIF) model in pigs using equine bone protein extract (BPE), recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge (ACS), and autograft as bone graft substitute, respectively. The miRNA and gene expression profiles of different bone graft materials were examined using microarray technology and data analysis, including self-organizing maps, KEGG pathway and Biological process GO analyses. We then jointly analyzed miRNA and mRNA profiles of the bone fusion tissue at different time points respectively. Results showed that miRNAs, including let-7, miR-129, miR-21, miR-133, miR-140, miR-146, miR-184, and miR-224, were involved in the regulation of the immune and inflammation response, which provided suitable inflammatory microenvironment for bone formation. At late stage, several miRNAs directly regulate SMAD4, Estrogen receptor 1 and 5-hydroxytryptamine (serotonin) receptor 2C for bone formation. It can be concluded that miRNAs play important roles in balancing the inflammation and bone formation.

  15. Online retrieval of patient information by asynchronous communication between general purpose computer and stand-alone personal computer

    International Nuclear Information System (INIS)

    Tsutsumi, Reiko; Takahashi, Kazuei; Sato, Toshiko; Komatani, Akio; Yamaguchi, Koichi

    1988-01-01

    Asynchronous communication was made between host (FACOM M-340) and personal computer (OLIBETTIE S-2250) to get patient's information required for RIA test registration. The retrieval system consists of a keyboad input of six numeric codes, patient's ID, and a real time reply containing six parameters for the patient. Their identified parameters are patient's name, sex, date of birth (include area), department, and out- or inpatient. Linking this program to RIA registration program for individual patient, then, operator can input name of RIA test requested. Our simple retrieval program made a useful data network between different types of host and stand-alone personal computers, and enabled us accurate and labor-saving registration for RIA test. (author)

  16. Life cycle assessment study of a 4.2 kW{sub p} stand-alone photovoltaic system

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Valverde, R.; Miguel, C.; Urbina, A. [Universidad Politecnica de Cartagena, Departamento de Electronica, Tecnologia de Computadoras y Proyectos, Campus Muralla del Mar, 30203, Cartagena, Murcia (Spain); Martinez-Bejar, R. [Universidad de Murcia, Departamento de Ingenieria de la Informacion y las Comunicaciones, Facultad de Informatica, Campus de Espinardo, 30071, Murcia (Spain)

    2009-09-15

    The energetic and environmental life cycle assessment of a 4.2 kW{sub p} stand-alone photovoltaic system (SAPV) at the University of Murcia (south-east of Spain) is presented. PV modules and batteries are the energetically and environmentally most expensive elements. The energy pay-back time was found to be 9.08 years and the specific CO{sub 2} emissions was calculated as 131 g/kWh. The SAPV system has been environmentally compared with other supply options (diesel generator and Spanish grid) showing lower impacts in both cases. The results show the CO{sub 2}-emission reduction potential of SAPV systems in southern European countries and point out the critical environmental issues in these systems. (author)

  17. Integration of hydrogen energy technologies in stand-alone power systems analysis of the current potential for applications

    International Nuclear Information System (INIS)

    Zoulias, E.I.; Lymberopoulos, N.; Tsoutsos, T.; Glockner, R.; Mydske, H.J.; Vosseler, I.; Gavalda, O.; Taylor, P.

    2006-01-01

    The European study entitled: 'Market Potential Analysis for Introduction of Hydrogen Energy Technology in Stand-Alone Power Systems (H-SAPS)' aimed to establish a broad understanding of the market potential for H-SAPS and provide a basis for promoting in wide scale new technological applications. The scope of the study was limited to small and medium installations, up to a few hundred kW power rating and based on RE as the primary energy source. The potential for hydrogen technology in SAPS was investigated through an assessment of the technical potential for hydrogen, the market analysis and the evaluation of external factors. The results are mostly directed towards action by governments and the research community but also industry involvement is identified. The results include targeted market research, establishment of individual cost targets, regulatory changes to facilitate alternative grid solutions, information and capacity building, focused technology research and bridging the technology gaps. (author)

  18. Extra-peritoneal pressure packing without external pelvic fixation: A life-saving stand-alone surgical treatment

    Directory of Open Access Journals (Sweden)

    Guy Ron

    2015-01-01

    Full Text Available Purpose: Traditional maneuvers aim to decrease retroperitoneal bleeding in hemodynamically unstable multi-trauma patients with unstable pelvic fractures, are reportedly successful in approximately only 50%. The life-saving effect of extra-peritoneal pressure packing (EPPP is based on direct compression and control of both venous and arterial retroperitoneal bleeders. This study describes the safety and efficacy of emergent EPPP employment, as a stand-alone surgical treatment, that is, carried out without external pelvic fixation or emergent angiography. Materials and Methods: A retrospective chart review of all hemodynamic unstable, multi-trauma patients with mechanically unstable pelvic fractures treated by the EPPP technique at our medical center between the years 2005 and 2011. Survival rates, clinical, and physiological outcomes were followed prospectively. Results: Twenty-five of the 181 pelvic fracture patients had biomechanically unstable fractures that required surgical fixation. Fourteen of those 25 patients had deteriorating hemodynamic instability from massive pelvic bleeding which was resistant to resuscitation, and they underwent EPPP, as a stand-alone treatment. The procedure successfully achieved hemodynamic stability in all 14 patients and obviated the early mortality associated with massive pelvic bleeding. Three of these patients eventually succumbed to their multiple injuries. Conclusion: Implementation of EPPP improved all measured physiological outcome parameters and survival rates of hemodynamically unstable multi-trauma patients with unstable pelvic fractures in our trauma center. It provided the unique advantage of directly compressing the life-threatening retroperitoneal bleeders by applying direct pressure and causing a tamponade effect to stanch venous and arterial pelvic blood flow and obviate the early mortality associated with massive pelvic bleeding.

  19. Application of Gelatin Sponge Impregnated with a Mixture of 3 Drugs to Intraoperative Nerve Root Block Combined with Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery in the Treatment of Adult Degenerative Scoliosis: A Clinical Observation Including 96 Patients.

    Science.gov (United States)

    Du, Jin Peng; Fan, Yong; Liu, Ji Jun; Zhang, Jia Nan; Chang Liu, Shi; Hao, Dingjun

    2017-12-01

    Application of nerve root block is mainly for diagnosis with less application in intraoperative treatment. The aim of this study was to observe clinical and imaging outcomes of application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery in to treat adult degenerative lumbar scoliosis. From January 2012 to November 2014, 108 patients with adult degenerative lumbar scoliosis were treated with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery combined with intraoperative gelatin sponge impregnated with a mixture of 3 drugs. Visual analog scale and Oswestry Disability Index scores were used to evaluate postoperative improvement of back and leg pain, and clinical effects were assessed according to the 36-Item Short-Form Health Survey. Imaging was obtained preoperatively, 1 week and 3 months postoperatively, and at the last follow-up. Fusion status, complications, and other outcomes were assessed. Follow-up was complete for 96 patients. Visual analog scale scores of leg and back pain on postoperative days 1-7 were decreased compared with preoperatively. At 1 week postoperatively, 3 months postoperatively, and last follow-up, visual analog scale score, Oswestry Disability Index score, coronal Cobb angle, and coronal and sagittal deviated distance decreased significantly (P = 0.000) and lumbar lordosis angle increased (P = 0.000) compared with preoperatively. Improvement rate of Oswestry Disability Index was 81.8% ± 7.4. Fusion rate between vertebral bodies was 92.7%. Application of gelatin sponge impregnated with 3 drugs combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion for treatment of adult degenerative lumbar scoliosis is safe and feasible with advantages of good short-term analgesia effect, minimal invasiveness, short length of stay, and good long-term clinical

  20. Leadership in Dental Hygiene Degree Completion Programs: A Pilot Study Comparing Stand-Alone Leadership Courses and Leadership-Infused Curricula.

    Science.gov (United States)

    Smith, Michelle L; Gurenlian, JoAnn R; Freudenthal, Jacqueline J; Farnsworth, Tracy J

    2016-05-01

    The aim of this study was to define the extent to which leadership and leadership skills are taught in dental hygiene degree completion programs by comparing stand-alone leadership courses/hybrid programs with programs that infuse leadership skills throughout the curricula. The study involved a mixed-methods approach using qualitative and quantitative data. Semi-structured interviews were conducted with program directors and faculty members who teach a stand-alone leadership course, a hybrid program, or leadership-infused courses in these programs. A quantitative comparison of course syllabi determined differences in the extent of leadership content and experiences between stand-alone leadership courses and leadership-infused curricula. Of the 53 U.S. dental hygiene programs that offer degree completion programs, 49 met the inclusion criteria, and 19 programs provided course syllabi. Of the program directors and faculty members who teach a stand-alone leadership course or leadership-infused curriculum, 16 participated in the interview portion of the study. The results suggested that competencies related to leadership were not clearly defined or measurable in current teaching. Reported barriers to incorporating a stand-alone leadership course included overcrowded curricula, limited qualified faculty, and lack of resources. The findings of this study provide a synopsis of leadership content and gaps in leadership education for degree completion programs. Suggested changes included defining a need for leadership competencies and providing additional resources to educators such as courses provided by the American Dental Education Association and the American Dental Hygienists' Association.

  1. Biomechanics of Nested Transforaminal Lumbar Interbody Cages.

    Science.gov (United States)

    Soriano-Baron, Hector; Newcomb, Anna G U S; Malhotra, Devika; de Tranaltes, Kaylee; Martinez-Del-Campo, Eduardo; Reyes, Phillip M; Crawford, Neil R; Theodore, Nicholas; Tumialán, Luis M

    2016-02-01

    Arthrodesis is optimized when the structural graft occupies most of the surface area within a disc space. The transforaminal corridor inherently limits interbody size. To evaluate the biomechanical implications of nested interbody spacers (ie, a second curved cage placed behind a first) to increase disc space coverage in transforaminal approaches. Seven lumbar human cadaveric specimens (L3-S1) underwent nondestructive flexibility and axial compression testing intact and after transforaminal instrumentation at L4-L5. Specimens were tested in 5 conditions: (1) intact, (2) interbody, (3) interbody plus bilateral pedicle screws and rods (PSR), (4) 2 nested interbodies, and (5) 2 nested interbodies plus PSR. Mean range of motion (ROM) with 1 interbody vs 2 nested interbodies, respectively, was: flexion, 101% vs 85%; extension, 97% vs 92%; lateral bending, 127% vs 132%; and axial rotation, 145% vs 154%. One interbody and 2 nested interbodies did not differ significantly by loading mode (P > .10). With PSR, ROM decreased significantly compared with intact, but not between interbody and interbody plus PSR or 2 interbodies plus PSR (P > .80). Mean vertical height during compressive loading (ie, axial compressive stiffness) was significantly different with 2 nested interbodies vs 1 interbody alone (P < .001) (compressive stiffness, 89% of intact vs 67% of intact, respectively). Inserting a second interbody using a transforaminal approach is anatomically feasible and nearly doubles the disc space covered without affecting ROM. Compressive stiffness significantly increased with 2 nested interbodies, and foraminal height increased. Evaluation of the clinical safety and efficacy of nested interbodies is underway.

  2. Evaluation of Coflex interspinous stabilization following decompression compared with decompression and posterior lumbar interbody fusion for the treatment of lumbar degenerative disease: A minimum 5-year follow-up study.

    Science.gov (United States)

    Yuan, Wei; Su, Qing-Jun; Liu, Tie; Yang, Jin-Cai; Kang, Nan; Guan, Li; Hai, Yong

    2017-01-01

    Few studies have compared the clinical and radiological outcomes between Coflex interspinous stabilization and posterior lumbar interbody fusion (PLIF) for degenerative lumbar disease. We compared the at least 5-year clinical and radiological outcomes of Coflex stabilization and PLIF for lumbar degenerative disease. Eighty-seven consecutive patients with lumbar degenerative disease were retrospectively reviewed. Forty-two patients underwent decompression and Coflex interspinous stabilization (Coflex group), 45 patients underwent decompression and PLIF (PLIF group). Clinical and radiological outcomes were evaluated. Coflex subjects experienced less blood loss, shorter hospital stays and shorter operative time than PLIF (all pdisease was higher in the PLIF group, but this did not achieve statistical significance (11.1% vs. 4.8%, p=0.277). Both groups provided sustainable improved clinical outcomes for lumbar degenerative disease through at least 5-year follow-up. The Coflex group had significantly better early efficacy than the PLIF group. Coflex interspinous implantation after decompression is safe and effective for lumbar degenerative disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. 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

    Science.gov (United States)

    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

  4. A cross-sectional study of stand-alone percutaneous coronary intervention in a Nigerian cardiac catheterization laboratory.

    Science.gov (United States)

    Johnson, Adeyemi; Falase, Bode; Ajose, Ifeoluwa; Onabowale, Yemi

    2014-01-16

    There is a paucity of diagnostic and therapeutic facilities in Nigeria to confirm coronary artery disease and offer appropriate interventional therapy. There is now a private cardiac catheterization laboratory in Lagos but as there are no sustained Open Heart Surgery programmes, percutaneous coronary interventions are currently being performed without surgical backup. This study was designed to assess results of stand-alone percutaneous coronary intervention (PCI) as currently practiced in Lagos, Nigeria. This cross-sectional study was conducted between July 2009 and July 2012. The study included all patients that underwent PCI in Lagos. Data was extracted from a prospectively maintained database. Coronary artery disease was confirmed in 80 (52.6%) of 152 Nigerians referred with a diagnosis of Ischaemic Heart Disease. There were 53 males (66.2%) and 27 females (33.8%). The average age was 60.3 +/-9.6 years and average euroscore was 4.5 +/-3.1. Of the 80 patients, 77 (96.3%) had significant stenoses and were candidates for revascularization. Distribution of significant stenoses was one in 32 patients (41.5%), two in 11 patients (14.3%), three in 19 patients (24.7%), four in 13 patients (16.9%) and five in 2 patients (2.6%). PCI was performed in 48 (62.3%) of the patients eligible for revascularization as the coronary anatomy in the remaining patients was not suitable for PCI. The indication for PCI was for myocardial infarction or unstable angina in 39 patients (81.2%). PCI was performed with PTCA plus stenting in 41 patients (85.4%) and with PTCA alone in 7 patients (14.6%) with good angiographic results. Overall 29 of the 48 patients (60.4%) had complete revascularization of significant stenoses. Complications of PCI were bleeding that required blood transfusion in 1 patient (2.1%), minor femoral haematomas in 2 patients (4.2%), and a major adverse clinical event in 1 patient (2.1%). A stand-alone PCI programme has been developed in Lagos, Nigeria. Both elective

  5. Surgeon, staff, and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion: impact of 3D fluoroscopy-based navigation partially replacing conventional fluoroscopy: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Hubbe, Ulrich; Sircar, Ronen; Scheiwe, Christian; Scholz, Christoph; Kogias, Evangelos; Krüger, Marie Therese; Volz, Florian; Klingler, Jan-Helge

    2015-04-09

    Some symptomatic degenerative conditions of the lumbar spine may be treated with spinal fusion if conservative treatment has failed. The minimally invasive technique of transforaminal lumbar interbody fusion (MIS TLIF) is increasingly used but has been found to generate increased radiation exposure to the patient and staff. Modern three-dimensional (3D) C-arm devices are capable of providing conventional two-dimensional fluoroscopic images (x-rays) as well as 3D image sets for intraoperative navigation. This study was designed to compare the radiation exposure between these two intraoperative imaging techniques in MIS TLIF procedures. This study is a randomized controlled trial. Forty participants scheduled to undergo monosegmental MIS TLIF will be recruited and randomly allocated to one of two groups with respect to the applied intraoperative imaging technique: conventional fluoroscopy (FLUORO group) and 3D fluoroscopy-based navigation combined with conventional fluoroscopy (NAV group). Furthermore, patients scheduled to undergo bisegmental MIS TLIF during the recruitment period for monosegmental MIS TLIF will be assessed for eligibility and will be randomly assigned separately. The primary endpoint is the radiation exposure to the surgeon and is measured by dosimeter readings. Secondary endpoints are the radiation exposure to the assistant surgeon, scrub nurse, anesthetist, patient, and C-arm as well as radiation exposure in relation to the body mass index of the patient. Results of this randomized study will help to compare the radiation exposure to the operating staff and patient during MIS TLIF procedures using conventional fluoroscopy versus 3D fluoroscopy-based navigation combined with conventional fluoroscopy. Furthermore, recommendations regarding the appropriate use of the investigated intraoperative imaging techniques will be made to improve radiation protection and to reduce radiation exposure. Registration number of the German Clinical Trials Register

  6. Adaptive Artificial intelligence based fuzzy logic MPPTcontrol for stande-alone photovoltaic system under different atmospheric conditions

    Directory of Open Access Journals (Sweden)

    Zaghba Layachi

    2015-08-01

    Full Text Available there is an increased need for analysing the effect of atmospheric variables on photovoltaic (PV production and performance. The outputs from the different PV cells in different atmospheric conditions, such as irradiation and temperature , differ from each other evidencing knowledge deficiency in PV systems [14]. Maximum power point tracking (MPPT methods are used to maximize the PV array output power by tracking continuously the maximum power point (MPP. Among all MPPT methods existing in the literature, perturb and observe (P&O is the most commonly used for its simplicity and ease of implementation; however, it presents drawbacks such as slow response speed, oscillation around the MPP in steady state, and even tracking in wrong way under rapidly changing atmospheric conditions. In order to allow a functioning around the optimal point Mopt, we have inserted a DC-DC converter (Buck–Boost for a better matching between the PV and the load. This paper, we study the Maximum power point tracking using adaptive Intelligent fuzzy logic and conventional (P&O control for stande-alone photovoltaic Array system .In particular, the performances of the controllers are analyzed under variation weather conditions with are constant temperature and variable irradiation. The proposed system is simulated by using MATLAB-SIMULINK. According to the results, fuzzy logic controller has shown better performance during the optimization.

  7. Modeling and Experimental Test of Grid-Tied Photovoltaic Cell Emulating System in the Stand-alone Mode

    Directory of Open Access Journals (Sweden)

    Vu Minh Phap

    2017-06-01

    Full Text Available In recent decades, generation of electricity from solar arrays has been increased to meet the world's growing energy demand. However, the utilization rate of the power conditioner in the grid-tied solar power system is low because the operation of solar panels is dependent on sunlight. Thus, we studied the method that the small scale wind power generating system in size from a few hundred watts to two or three kilowatts can be connected to the grid-tied power conditioner of the solar power system for residential applications with low power ratings (single phase, size is limited to 10kW by emulating characteristic of the solar panel. In this paper, we introduce the application of the grid-tied PV cell emulating system in the stand-alone mode to improve the utilization rate of the power conditioner. The simulation and experimental test results verify that the PV cell emulating system can operate the power conditioner of the gridtied solar power system.

  8. Automation infrastructure and operation control strategy in a stand-alone power system based on renewable energy sources

    Science.gov (United States)

    Ziogou, Chrysovalantou; Ipsakis, Dimitris; Elmasides, Costas; Stergiopoulos, Fotis; Papadopoulou, Simira; Seferlis, Panos; Voutetakis, Spyros

    The design of the automation system and the implemented operation control strategy in a stand-alone power system in Greece are fully analyzed in the present study. A photovoltaic array and three wind generators serve as the system main power sources and meet a predefined load demand. A lead-acid accumulator is used to compensate the inherent power fluctuations (excess or shortage) and to regulate the overall system operation, based on a developed power management strategy. Hydrogen is produced by using system excess power in a proton exchange membrane (PEM) electrolyzer and is further stored in pressurized cylinders for subsequent use in a PEM fuel cell in cases of power shortage. A diesel generator complements the integrated system and is employed only in emergency cases, such as subsystems failure. The performance of the automatic control system is evaluated through the real-time operation of the power system where data from the various subsystems are recorded and analyzed using a supervised data acquisition unit. Various network protocols were used to integrate the system devices into one central control system managing in this way to compensate for the differences between chemical and electrical subunits. One of the main advantages is the ability of process monitoring from distance where users can perform changes to system principal variables. Furthermore, the performance of the implemented power management strategy is evaluated through simulated scenarios by including a case study analysis on system abilities to meet higher than expected electrical load demands.

  9. Stand-alone power systems for the future: Optimal design, operation and control of solar-hydrogen energy systems

    Energy Technology Data Exchange (ETDEWEB)

    Ulleberg, Oeystein

    1998-12-31

    This thesis gives a systematic review of the fundamentals of energy systems, the governing physical and chemical laws related to energy, inherent characteristics of energy system, and the availability of the earth`s energy. It shows clearly why solar-hydrogen systems are one of the most viable options for the future. The main subject discussed is the modelling of SAPS (Stand-Alone Power Systems), with focus on photovoltaic-hydrogen energy systems. Simulation models for a transient simulation program are developed for PV-H{sub 2} components, including models for photovoltaics, water electrolysis, hydrogen storage, fuel cells, and secondary batteries. A PV-H{sub 2} demonstration plant in Juelich, Germany, is studied as a reference plant and the models validated against data from this plant. Most of the models developed were found to be sufficiently accurate to perform short-term system simulations, while all were more than accurate enough to perform long-term simulations. Finally, the verified simulation models are used to find the optimal operation and control strategies of an existing PV-H{sub 2} system. The main conclusion is that the simulation methods can be successfully used to find optimal operation and control strategies for a system with fixed design, and similar methods could be used to find alternative system designs. 148 refs., 78 figs., 31 tabs.

  10. Multi-Objective Optimal Design of Stand-Alone Hybrid Energy System Using Entropy Weight Method Based on HOMER

    Directory of Open Access Journals (Sweden)

    Jiaxin Lu

    2017-10-01

    Full Text Available Implementation of hybrid energy system (HES is generally considered as a promising way to satisfy the electrification requirements for remote areas. In the present study, a novel decision making methodology is proposed to identify the best compromise configuration of HES from a set of feasible combinations obtained from HOMER. For this purpose, a multi-objective function, which comprises four crucial and representative indices, is formulated by applying the weighted sum method. The entropy weight method is employed as a quantitative methodology for weighting factors calculation to enhance the objectivity of decision-making. Moreover, the optimal design of a stand-alone PV/wind/battery/diesel HES in Yongxing Island, China, is conducted as a case study to validate the effectiveness of the proposed method. Both the simulation and optimization results indicate that, the optimization method is able to identify the best trade-off configuration among system reliability, economy, practicability and environmental sustainability. Several useful conclusions are given by analyzing the operation of the best configuration.

  11. Development of a Laser-Powered Dielectric Structure-Based Accelerator as a Stand-Alone Particle Source

    International Nuclear Information System (INIS)

    Yoder, R. B.; Travish, G.; Arab, E. R.; Fong, D.; Hoyer, Z.; Lacroix, U. H.; Vartanian, N.; Rosenzweig, J. B.

    2010-01-01

    An experimental program to develop and build a dielectric-based slab-symmetric structure (the micro-accelerator platform, or MAP) for generating and accelerating low-energy electrons is underway at UCLA and Manhattanville College. This optical acceleration structure is effectively a resonant cavity powered by a side-coupled laser, and has applications as a radiation source for medicine or industry. We present recent experimental and computational results on the accelerator, and progress toward its incorporation into a self-contained particle source. Such a particle source would incorporate a micron-scale electron emitter and a non-relativistic capture region to enable self-injection into the synchronous field within the accelerator. A prototype of the accelerator itself has been constructed from candidate dielectric materials using micromanufacturing techniques; the current status of the testing program is described. A novel electron emitter incorporating pyroelectric crystals with field-enhancing tips has been demonstrated to produce steady currents; the results are dependent on tip geometry, and appear suitable for injection into a microstructure. Extension of the MAP concept to non-relativistic velocities, as in the stand-alone source, requires a tapered structure that gives rise to numerous complications including beam defocusing and manufacturing challenges; approaches for addressing these complications are mentioned.

  12. Life cycle assessment of stand-alone photovoltaic (SAPV) system under on-field conditions of New Delhi, India

    International Nuclear Information System (INIS)

    Sharma, Rakhi; Tiwari, G.N.

    2013-01-01

    In this paper, life cycle analysis has been carried out to evaluate overall performance of given rated stand-alone solar photovoltaic (SAPV) in terms of basic energy matrices, life cycle cost analysis, and earned carbon credit. Further, the experimentally calculated actual on-field life cycle performance results of existing outdoor SAPV system (i.e. almost 20 years old) have been represented with respect to the potential (max.) performance of same SAPV system estimated under same environmental conditions of solar intensity, ambient temperature, PV operating temperature as obtained during actual on-field performance evaluation. This new approach of overall performance evaluation by considering the on-field SAPV system installation as new (i.e. with potential/max. performance) and old (i.e. with actual performance) under same environmental conditions provides an inclusive comparative life cycle assessment of on-field PV system. - Highlights: • We present comparative life cycle assessment methodology for outdoor PV system. • We evaluate on-field PV system life performance by considering it as new and old. • We examine fall in actual on-field PV performance compared to potential performance. • PV system techno-economic performance reduces with the long term exposure or aging. • We observe fall in earned carbon credit and rise in cost/kWh as PV system ages

  13. Comparison of Turkey’s Geographical Regions in terms of Stand-Alone PV System Design and Cost Parameters

    Directory of Open Access Journals (Sweden)

    Nevzat Onat

    2017-01-01

    Full Text Available Stand-alone photovoltaic (SAPV systems are widely used in rural areas where there is no national grid or as a precaution against power outages. In this study, technical and economic analysis of a SAPV system was carried out using meteorological data for 75 province centers in seven geographical regions of Turkey. Obtained results for each province center were separated by geographical area. The averages of the centers for each region are taken as output. A calculation algorithm based on MsExcel has been established for these operations. The analyses made with the developed algorithm are repeated for five different scenarios that they cover periods of time when a constant strong load is active for all seasons (winter, spring, summer, and autumn and all year round. The developed algorithm calculates the life-cycle cost, the unit energy cost, the electrical capacity utilization rate, the amount of generated/excess energy per month, the initial investment/replacement, and operating and maintenance (O&M costs of each element. As a result, geographical regions of Turkey are compared in terms of these outputs graphically. Further investigations may include the sale of excess energy generated, small-scale PV system cost factors parallel to the grid, and the effects of government incentives.

  14. Adult Degenerative Scoliosis with Spinal Stenosis Treated with Stand-Alone Cage via an Extreme Lateral Transpsoas Approach; a Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Arvind von Keudell

    2015-04-01

    Full Text Available We report the case of a 73-year-old female with severe degenerative scoliosis and back and leg pain that wassuccessfully treated with stand- alone cages via an extreme lateral transpsoas approach. This patient had declinedopen surgery and instrumentation due to her advanced age concerns about potential side effects.

  15. Stand-alone Inverter: Reviews, Models and Tests the exist system in Term of the Power Quality, and Suggestions to Design it

    Directory of Open Access Journals (Sweden)

    Ali Algaddafi

    2016-10-01

    Full Text Available Developments in power electronics have enabled the widespread application of Pulse Width Modulation (PWM inverters, notably for obtaining electricity from renewable systems. This paper critical review the previous studies in designing stand-alone inverter and modelling the inverter with two control loops to improve and provide a high-quality power of a stand-alone inverter. Multi-loop control techniques for a stand-alone inverter are utilised as the first loop is a capacitor current control to provide active damping and improve transient and steady state inverter performance. The capacitor current control is cheaper than inductor current control, where a small current sensing resistor is used. The second loop is the output voltage control that is used to improve the system performance and also control the output voltage. The power quality of the off-grid system is measured experimentally and compared with the grid power, showing power quality of off-grid system to be better than that of the grid. The suggestions and key findings to design the stand-alone inverter are given based in the reviewing of previous publications and from the literature’s point of view.

  16. Energetic and financial investigation of a stand-alone solar-thermal Organic Rankine Cycle power plant

    International Nuclear Information System (INIS)

    Tzivanidis, Christos; Bellos, Evangelos; Antonopoulos, Kimon A.

    2016-01-01

    Highlights: • A stand-alone solar driven Organic Rankine Cycle is optimized parametrically. • The system is optimized energetically and financially. • Nine working fluids are tested with cyclohexane to be the most suitable. • A collecting area of 25,000 m 2 parabolic trough collectors is the optimum solution. • The maximum IRR is 13.46% and the payback period is about 9 years. - Abstract: The use of solar thermal energy for electricity production is a clean and sustainable way to cover the increasing energy needs of our society. The most mature technology for capturing solar energy in high temperature levels is the parabolic trough collectors (PTC). In this study, an Organic Rankine Cycle (ORC) coupled with PTC is analyzed parametrically in order to be optimized financially and energetically. The first step is the thermodynamic investigation of the ORC by using various working fluids. The second step is the energetic and financial investigation of the total system which includes the solar field, the storage tank and the ORC module. By testing many combinations of collecting areas and storage tank volumes, finally cyclohexane proved to be the most suitable working fluid for producing 1 MW el with PTC. Specifically, in the optimum situation a solar field of 25,000 m 2 with storage tank of about 300 m 3 leads to a payback period of 9 years and to an internal rate of return (IRR) equal to 13.46%. Moreover, an economic comparison for different commercial collectors is presented, with Eurotrough ET-150 being the financially optimum solution for this case study.

  17. An adaptive artificial neural network model for sizing stand-alone photovoltaic systems: Application for isolated sites in Algeria

    International Nuclear Information System (INIS)

    Mellit, A.; Benghanem, M.; Hadj Arab, A.; Guessoum, G.

    2004-07-01

    In this paper we investigate, by using an adaptive Artificial Neural Network (ANN), in order to find a suitable model for sizing Stand-Alone Photovoltaic (SAPV) systems, based on a minimum of input data. This model combines Radial Basis Function (RBF) network and Infinite Impulse Response (IIR) filter in order to accelerate the convergence of the network. For the sizing of a photovoltaic (PV) system, we need to determine the optimal sizing coefficients (K PV , K B . These coefficients allow us to determine the number of solar panels and storage batteries necessary to satisfy a given consumption, especially in isolated sites where the global solar radiation data is not always available and which are considered the most important parameters for sizing a PV system. Obtained results by classical models (analytical, numerical, analytical- numerical, B-spline function) and new models like feed-forward (MLP), radial basis function (RBF), MLP-IIR and RBF-IIR have been compared with experimental sizing coefficients in order to illustrate the accuracy of the results of the new developed model. This model has been trained by using 200 known optimal sizing coefficients corresponding to 200 locations in Algeria. In this way, the adaptive model was trained to accept and even handle a number of unusual cases, the unknown validation sizing coefficients set produced very set accurate estimation and a correlation coefficient of 98% was obtained between the calculated and that estimated by the RBF-IIR model. This result indicates that the proposed method can be successfully used for the estimation of optimal sizing coefficients of SAPV systems for any locations in Algeria, but the methodology can be generalized using different locations over the world. (author)

  18. System dynamic model and charging control of lead-acid battery for stand-alone solar PV system

    KAUST Repository

    Huang, B.J.

    2010-05-01

    The lead-acid battery which is widely used in stand-alone solar system is easily damaged by a poor charging control which causes overcharging. The battery charging control is thus usually designed to stop charging after the overcharge point. This will reduce the storage energy capacity and reduce the service time in electricity supply. The design of charging control system however requires a good understanding of the system dynamic behaviour of the battery first. In the present study, a first-order system dynamics model of lead-acid battery at different operating points near the overcharge voltage was derived experimentally, from which a charging control system based on PI algorithm was developed using PWM charging technique. The feedback control system for battery charging after the overcharge point (14 V) was designed to compromise between the set-point response and the disturbance rejection. The experimental results show that the control system can suppress the battery voltage overshoot within 0.1 V when the solar irradiation is suddenly changed from 337 to 843 W/m2. A long-term outdoor test for a solar LED lighting system shows that the battery voltage never exceeded 14.1 V for the set point 14 V and the control system can prevent the battery from overcharging. The test result also indicates that the control system is able to increase the charged energy by 78%, as compared to the case that the charging stops after the overcharge point (14 V). © 2010 Elsevier Ltd. All rights reserved.

  19. Techno-economic analysis of stand-alone photovoltaic/wind/battery/hydrogen systems for very small-scale applications

    Directory of Open Access Journals (Sweden)

    Stojković Saša M.

    2016-01-01

    Full Text Available The paper presents the results of a technical and economic analysis of three stand-alone hybrid power systems based on renewable energy sources which supply a specific group of low-power consumers. This particular case includes measuring sensors and obstacle lights on a meteorological mast for wind measurements requiring an uninterrupted power supply in cold climate conditions. Although these low-power (100 W measuring sensors and obstacle lights use little energy, their energy consumption is not the same as the available solar energy obtained on a daily or seasonal basis. In the paper, complementarity of renewable energy sources was analysed, as well as one of short-term lead-acid battery-based storage and seasonal, hydrogen-based (electrolyser, H2 tank, and fuel cells storage. These relatively complex power systems were proposed earlier for high-power consumers only, while this study specifically highlights the role of the hydrogen system for supplying low-power consumers. The analysis employed a numerical simulation method using the HOMER software tool. The results of the analysis suggest that solar and wind-solar systems, which involve meteorological conditions as referred to in this paper, include a relatively large number of lead-acid batteries. Additionally, the analysis suggests that the use of hydrogen power systems for supplying low power-consumers is entirely justifiable, as it significantly reduces the number of batteries (two at minimum in this particular case. It was shown that the increase in costs induced by the hydrogen system is acceptable.

  20. 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.

    Science.gov (United States)

    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.

  1. Post-processing in cardiovascular computed tomography. Performance of a client server solution versus a stand-alone solution

    International Nuclear Information System (INIS)

    Luecke, C.; Foldyna, B.; Andres, C.; Grothoff, M.; Nitzsche, S.; Gutberlet, M.; Lehmkuhl, L.; Boehmer-Lasthaus, S.

    2014-01-01

    Purpose: To compare the performance of server-based (CSS) versus stand-alone post-processing software (ES) for the evaluation of cardiovascular CT examinations (cvCT) and to determine the crucial steps. Data of 40 patients (20 patients for coronary artery evaluation and 20 patients prior to transcatheter aortic valve implantation [TAVI]) were evaluated by 5 radiologists with CSS and ES. Data acquisition was performed using a dual-source 128-row CT unit (SOMATOM Definition Flash, Siemens, Erlangen, Germany) and a 64-row CT unit (Brilliance 64, Philips, Hamburg, Germany). The following workflow was evaluated: Data loading, aorta and coronary segmentation, curved multiplanar reconstruction (cMPR) and 3 D volume rendering technique (3D-VRT), measuring of coronary artery stenosis and planimetry of the aortic annulus. The time requirement and subjective quality for the workflow were evaluated. The coronary arteries as well as the TAVI data could be evaluated significantly faster with CSS (5.5 ± 2.9 min and 8.2 ± 4.0 min, respectively) than with ES (13.9 ± 5.2 min and 15.2 ± 10.9 min, respectively, p = 0.01). Segmentation of the aorta (CSS: 1.9 ± 2.0 min, ES: 3.7 ± 3.3 min), generating cMPR of coronaries (CSS: 0.5 ± 0.2 min, ES: 5.1 ± 2.6 min), aorta and iliac vessels (CSS: 0.5 ± 0.4 min and 0.4 ± 0.4 min, respectively, ES: 1.6 ± 0.7 min and 2.8 ± 3 min, respectively) could be performed significantly faster with CSS than with ES with higher quality of cMPR, measuring of coronary stenosis and 3D-VRT (p < 0.05). Evaluation of cvCT can be accomplished significantly faster and better with CSS than with ES. The segmentation remains the most time-consuming workflow step, so optimization of segmentation algorithms could improve performance even further.

  2. An efficient sizing method for a stand-alone PV system in terms of the observed block extremes

    International Nuclear Information System (INIS)

    Chen, Shin-Guang

    2012-01-01

    Highlights: ► A fast optimal sizing method under climate change. ► It provides the method of creating climate cycles for PV system applications. ► It proposes a new reliability indicator to denote the upper bound probability of a PV application. ► It presents a premiere economic optimization for such approach. ► It gives examples to illustrate the proposed approach. -- Abstract: This paper proposes a novel and fast sizing method under the constant daily load profile for sizing a stand-alone PV system. The term “efficient sizing” means that the approach did not use simulation but could get the result as good as those employing simulation. So, the sizing method is more efficient than the others. Traditionally, a typical day or a typical year’s solar irradiation profile is employed for the sizing task. However, facing the global warming crisis as well as the fact that no 2 years would have the same weather condition for a single site, this approach statistically models the trend of climate change year by year and put it into the sizing formula, so that the results are optimal for the current weather condition and for the future as well. Hence, the suitable size for the PV array and the number of batteries are obtained by purely computation. This is different from the traditional sizing curve method. Although the traditional sizing curve method were satisfactory in the normal cases, they might fail in the extreme climate condition. This paper concludes the behavior of the extreme climate for at least 20 years. So, the derived system may have statistical confidence for at least 20 years of operation. A new reliability index (Loss of Power Probability) in terms of Extreme Value Theory is introduced. LPP provides upper bound reliability for application and rich information for many extreme events. A technological and economical comparison among the traditional daily energy balance method, sizing curve method and this approach is conducted and shows the

  3. Post-processing in cardiovascular computed tomography: performance of a client server solution versus a stand-alone solution.

    Science.gov (United States)

    Lücke, C; Foldyna, B; Andres, C; Boehmer-Lasthaus, S; Grothoff, M; Nitzsche, S; Gutberlet, M; Lehmkuhl, L

    2014-12-01

    To compare the performance of server-based (CSS) versus stand-alone post-processing software (ES) for the evaluation of cardiovascular CT examinations (cvCT) and to determine the crucial steps. Data of 40 patients (20 patients for coronary artery evaluation and 20 patients prior to transcatheter aortic valve implantation [TAVI]) were evaluated by 5 radiologists with CSS and ES. Data acquisition was performed using a dual-source 128-row CT unit (SOMATOM Definition Flash, Siemens, Erlangen, Germany) and a 64-row CT unit (Brilliance 64, Philips, Hamburg, Germany). The following workflow was evaluated: Data loading, aorta and coronary segmentation, curved multiplanar reconstruction (cMPR) and 3 D volume rendering technique (3D-VRT), measuring of coronary artery stenosis and planimetry of the aortic annulus. The time requirement and subjective quality for the workflow were evaluated. The coronary arteries as well as the TAVI data could be evaluated significantly faster with CSS (5.5  ±  2.9  min and 8.2  ±  4.0  min, respectively) than with ES (13.9  ±  5.2  min and 15.2  ±  10.9  min, respectively, p ≤  0.01). Segmentation of the aorta (CSS: 1.9 ±  2.0  min, ES: 3.7  ±  3.3  min), generating cMPR of coronaries (CSS: 0.5  ±  0.2  min, ES: 5.1  ±  2.6  min), aorta and iliac vessels (CSS: 0.5  ±  0.4  min and 0.4  ±  0.4  min, respectively, ES: 1.6  ±  0.7  min and 2.8  ±  3  min, respectively) could be performed significantly faster with CSS than with ES with higher quality of cMPR, measuring of coronary stenosis and 3D-VRT (p < 0.05). Evaluation of cvCT can be accomplished significantly faster and better with CSS than with ES.  The segmentation remains the most time-consuming workflow step, so optimization of segmentation algorithms could improve performance even further. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Removal of fixation construct could mitigate adjacent segment stress after lumbosacral fusion: A finite element analysis.

    Science.gov (United States)

    Hsieh, Yueh-Ying; Chen, Chia-Hsien; Tsuang, Fon-Yih; Wu, Lien-Chen; Lin, Shang-Chih; Chiang, Chang-Jung

    2017-03-01

    Combined usage of posterior lumbar interbody fusion and transpedicular fixation has been extensively used to treat the various lumbar degenerative disc diseases. The transpedicular fixator aims to increase stability and enhance the fusion rate. However, how the fused disc and bridged vertebrae respectively affect adjacent-segment diseases progression is not yet clear. Using a validated lumbosacral finite-element model, three variations at the L4-L5 segment were analyzed: 1) moderate disc degeneration, 2) instrumented with a stand-alone cage and pedicle screw fixators, and 3) with the cage only after fusion. The intersegmental angles, disc stresses, and facet loads were examined. Four motion tests, flexion, extension, bending, and twisting, were also simulated. The adjacent-segment disease was more severe at the cephalic segment than the caudal segment. After solid fusion and fixation, the increase in intersegmental angles, disc stresses and facet loads of the adjacent segments were about 57.6%, 47.3%, and 59.6%, respectively. However, these changes were reduced to 30.1%, 22.7%, and 27.0% after removal of the fixators. This was attributed to the differences between the biomechanical characteristics of the fusion and fixation mechanisms. Fixation superimposes a stiffer constraint on the mobility of the bridged segment than fusion. The current study suggested that the removal of spinal fixators after complete fusion could decrease the stress at adjacent segments. Through a minimally invasive procedure, we could reduce secondary damage to the paraspinal structures while removing the fixators, which is of utmost concern to surgeons. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. 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.

    Science.gov (United States)

    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). Preoperative and postoperative clinical outcomes were similar in both groups (p>.05) except

  6. A compact seven switches topology and reduced DC-link capacitor size for single-phase stand-alone PV system with hybrid energy storages

    DEFF Research Database (Denmark)

    Liu, Xiong; Wang, Peng; Loh, Poh Chiang

    2011-01-01

    Single-phase stand-alone PV system is suitable for household applications in remote area. Hybrid battery/ultra-capacitor energy storage can reduce charge and discharge cycles and avoid deep discharges of battery. This paper proposes a compact seven switches structure for stand-alone PV system......-order harmonic current caused by single-phase inverter. In the proposed compact topology, a small size DC-link capacitor can achieve the same function through charging/discharging control of ultra-capacitor to mitigate second-order ripple current. Simulation results are provided to validate the effectiveness......, which otherwise needs nine switches configuration, inclusive of one switch for boost converter, four switches for single-phase inverter and four switches for two DC/DC converters of battery and ultra-capacitor. It is well-known that a bulky DC-link capacitor is always required to absorb second...

  7. Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial

    Directory of Open Access Journals (Sweden)

    Joan Leung

    2014-12-01

    Full Text Available Question: Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury? Design: A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures. Intervention: All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone. Outcome measures: The primary outcome was passive ankle dorsiflexion with a 12 Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9 Nm; spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. Outcome measures were taken at baseline (Week 0, end of intervention (Week 6, and follow-up (Week 10. Results: The mean between-group differences (95% CI for passive ankle dorsiflexion at Week 6 and Week 10 were –3 degrees (–8 to 2 and –1 degrees (–6 to 4, respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at Week 6 (95% CI 0.1 to 1.8 in favour of the experimental group, but this effect disappeared at Week 10. There were no differences for other secondary outcome measures except the physiotherapists’ perceived treatment credibility. Conclusion: Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury. Trial registration: ACTRN12608000637347. [Leung J, Harvey LA, Moseley AM, Whiteside B, Simpson M, Stroud K (2014 Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion

  8. A comparative sizing analysis of a renewable energy supplied stand-alone house considering both demand side and source side dynamics

    International Nuclear Information System (INIS)

    Elma, Onur; Selamogullari, Ugur Savas

    2012-01-01

    Highlights: ► Backup sizing analyses for PV–Wind energy supplied stand-alone house are completed. ► Source and demand side dynamics are considered for the first time in backup sizing. ► Backup size is reduced by 10% compared to backup size found with hourly values. ► The importance of data resolution on sizing study in such systems is shown. -- Abstract: Solar and wind energy use to supply the electrical demand of a stand-alone residential house is investigated. Combining solar and wind energy sources provide more reliable power source for stand-alone applications since they complement each other. Backup units (battery/supercapacitor) are also needed for uninterrupted energy. For a proper backup sizing in such systems, high resolution load data, wind speed and solar radiation data must be used as compared to the use of hourly averaged data found in literature. In this study, high resolution data on both load side and source side are collected experimentally. Then, collected data used as input to system simulations in Matlab/Simulink for sizing the backup in the considered hybrid power system. Backup state of the charge (SOC) is used as decision criteria. It is shown that, when load and source dynamics are considered, approximately 10% less backup size is required compared to backup size found with hourly averaged values. The study shows the importance of data resolution on backup sizing in such systems and could be a guide for renewable energy system designers.

  9. Supervisory control applied to stand-alone photovoltaic systems based on multi string topology; Controle supervisorio aplicado a sistemas fotovoltaicos autonomos com topologia multi string

    Energy Technology Data Exchange (ETDEWEB)

    Candido, Diogo Brum

    2010-07-01

    This master thesis analyses and implements a stand-alone photovoltaic system based on decentralized 'Multi String' topology. The proposed system is composed of a set of DC-DC converters linked to the PV arrays of panels, a bidirectional converter to perform the control of the charge/discharge process of the battery bank and ensure the specifications of DC link and a full-bridge inverter that feed the AC loads. Therefore, all operation modes that the stand-alone PV system can work are presented and analyzed. As the chief aim is to ensure the energy balance of the stand-alone PV system, are presented independents control loops for each converter of the PV system and a propose of a supervisory control that, based on information about the conditions of the DC link and the bank of batteries, defines each operation mode should be active, in order to maximize the power extracted from the PV arrays, the life cycle of the battery bank and ensuring the uninterrupted feeding of energy to the loads. Finally, simulation and experimental results validate the operation of the proposed system under different load and solar radiation conditions. (author)

  10. Performance of a small stand alone photovoltaic-wind system at El Oyameyo D.F., Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez Juarez, A.; Campos, J. [Centro de Investigacion en Energia, UNAM, Mexico, D. F. (Mexico); Tiburcio Silver, A. [Instituto Tecnologico de Toluca-Division de Posgrado, Toluca (Mexico)

    1997-12-31

    El Oyameyo, is an ecological site located to the South-West of the Topilejo town, D.F., 19 degree 25` North latitude, 99 degree 5` West longitude and at an altitude of 3100 m. At present, there are 10 families living at this place. They have energy generators to produce their own electricity by means of solar or wind energy using photovoltaic (PV) technology and eolic systems, respectively. There are three different configurations of energy generators: DC regulated PV systems, AC regulated PV systems and one PV-Wind hybrid system. The electrical power installed for the stand alone PV systems are from 48 W-p up to 768 W-p range. Among these, there are 4 PV systems that are configurated in DC regulated systems, and other 6 are AC regulated systems. All these systems use lead-acid battery (scaled or vented) banks to store the energy produced daily by the systems. The PV-Wind hybrid system in formed, at present, by a 5.0 kW wind generator, a PV array of 768 W-p, a 37.8 kW-h storage battery bank and a 5.0 kW DC/AC inverter. In this work, we report the electricity generated, load pattern and overall system performance of the photovoltaic-wind hybrid system. The technical characteristics, energy test on the hybrid system and the experience obtained from energy handling and system maintenance for all the systems are presented. We found that all the systems had shown good performance and users` satisfaction. [Espanol] El Oyameyo es un lugar ecologico localizado al Sur-Oeste del pueblo de Topilejo, D. F., 19 grados 25` de latitud Norte 99 grados 5` de longitud Oeste y a una altitud de 3100m. Actualmente hay 10 familias viviendo en este lugar. Tienen generadores de energia para producir su propia electricidad mediante la energia solar y la del viento usando sistemas fotovoltaicos (FV) y sistemas eolicos, respectivamente. Hay tres diferentes configuraciones de generadores de energia: sistemas fotovoltaicos de CD regulados, sistemas fotovoltaicos de CA regulados y un sistema

  11. Clinician's perspectives of the relocation of a regional child and adolescent mental health service from co-located to stand alone premises.

    Science.gov (United States)

    Francis, K J; Boyd, C P; Sewell, J; Nurse, S

    2008-01-01

    Australia's National Mental Health Strategy's statement of rights and responsibilities states that children and adolescents admitted to a mental health facility or community program have the right to be separated from adult patients and provided with programs suited to their developmental needs. However, in rural Australia, where a lack of healthcare services, financial constraints, greater service delivery areas and fewer mental healthcare specialists represent the norm, Child and Adolescent Mental Health Services (CAMHS) are sometimes co-located with adult mental health services. The aim of the present study was to evaluate the impact of a recent relocation of a regional CAMHS in Victoria from co-located to stand alone premises. Six CAMHS clinicians who had experienced service delivery at a co-located setting and the current stand-alone CAMHS setting were interviewed about their perceptions of the impact of the relocation on service delivery. An exploratory interviewing methodology was utilized due to the lack of previous research in this area. Interview data were transcribed and analysed according to interpretative phenomenological analysis techniques. Findings indicated a perception that the relocation was positive for clients due to the family-friendly environment at the new setting and separation of CAMHS from adult psychiatric services. However, the impact of the relocation on clinicians was marked by a perceived loss of social capital from adult psychiatric service clinicians. These results provide increased understanding of the effects of service relocation and the influence of co-located versus stand-alone settings on mental health service delivery - an area where little prior research exists.

  12. Techno-economic assessment of FT unit for synthetic diesel production in existing stand-alone biomass gasification plant using process simulation tool

    DEFF Research Database (Denmark)

    Hunpinyo, Piyapong; Narataruksa, Phavanee; Tungkamani, Sabaithip

    2014-01-01

    such as Fischer-Tropsch (FT) diesel. The embedding of the FT plant into the stand-alone based on power mode plants for production of a synthetic fuel is a promising practice, which requires an extensive adaptation of conventional techniques to the special chemical needs found in a gasified biomass. Because...... there are currently no plans to engage the FT process in Thailand, the authors have targeted that this work focus on improving the FT configurations in existing biomass gasification facilities (10 MWth). A process simulation model for calculating extended unit operations in a demonstrative context is designed...

  13. Effect of State Feedback Coupling and System Delays on the Transient Performance of Stand-Alone VSI with LC Output Filter

    DEFF Research Database (Denmark)

    Federico, de Bosio; de Sousa Ribeiro, Luiz Antonio; Freijedo Fernandez, Francisco Daniel

    2016-01-01

    The influence of state feedback coupling in the dynamics performance of power converters for stand-alone microgrids is investigated. Computation and PWM delays are the main factors that limit the achievable bandwidth of current regulators in digital implementations. In particular, the performance...... provided. A proportional resonant voltage controller is designed according to Nyquist criterion taking into account application requirements. For this purpose, a mathematical expression based on root locus analysis is proposed to find the minimum value of the fundamental resonant gain. Experimental tests...

  14. Posterior lumbar interbody fusion using non resorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D,L-lactide fusion devices. Clinical outcome at a minimum of 2-year follow-up

    NARCIS (Netherlands)

    Jiya, T.U.; Smit, T.H.; van Royen, B.J.; Mullender, M.G.

    2011-01-01

    Previous papers on resorbable poly-L-lactideco-D,L-lactide (PLDLLA) cages in spinal fusion have failed to report adequately on patient-centred clinical outcome measures. Also comparison of PLDLLA cage with a traditionally applicable counterpart has not been previously reported. This is the first

  15. DCE-MRI of the breast in a stand-alone setting outside a complementary strategy - results of the TK-study

    Energy Technology Data Exchange (ETDEWEB)

    Kaiser, Clemens G.; Krammer, J.; Wasser, K.; Schoenberg, S.O. [University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Reich, C.; Kaiser, W.A. [Friedrich-Schiller-University Hospital Jena, Institute of Diagnostic and Interventional Radiology I, Jena (Germany); Dietzel, M. [Friedrich-Alexander-University Hospital Erlangen-Nuernberg, Department of Neuroradiology, Erlangen (Germany); Baltzer, P.A.T. [Medical University Vienna, Institute of Radiology and Nuclear Medicine, Vienna (Austria)

    2015-06-01

    To evaluate the accuracy of MRI of the breast (DCE-MRI) in a stand-alone setting with extended indications. According to the inclusion criteria, breast specialists were invited to refer patients to our institution for DCE-MRI. Depending on the MR findings, patients received either a follow-up or biopsy. Between 04/2006 and 12/2011 a consecutive total of 1,488 women were prospectively examined. Of 1,488 included patients, 393 patients were lost to follow-up, 1,095 patients were evaluated. 124 patients were diagnosed with malignancy by DCE-MRI (76 TP, 48 FP, 971 TN, 0 FN cases). Positive cases were confirmed by histology, negative cases by MR follow-ups or patient questionnaires over the next 5 years in 1,737 cases (sensitivity 100 %; specificity 95.2 %; PPV 61.3 %; NPV 100 %; accuracy 95.5 %). For invasive cancers only (DCIS excluded), the results were 63 TP; 27 FP; 971 TP and 0 FN (sensitivity 100 %; specificity 97.2 %; PPV 70 %; NPV 100 %; accuracy 97.5 %). The DCE-MRI indications tested imply that negative results in DCE-MRI reliably exclude cancer. The results were achieved in a stand-alone setting (single modality diagnosis). However, these results are strongly dependent on reader experience and adequate technical standards as prerequisites for optimal diagnoses. (orig.)

  16. Hollow modular anchorage (HMA) screws for anterior transvertebral fixation in high-grade spondylolisthesis cases requiring 360 degrees in-situ fusion.

    Science.gov (United States)

    König, Matthias A; Boszczyk, Bronek M

    2018-03-22

    360 degrees in-situ fusion for high-grade spondylolisthesis showed satisfying clinical long-term results. Combining anterior with posterior surgery increases fusion rates. Anteriorly inserted transvertebral HMA screws could be an alternative to strut graft constructs or cages, avoiding donor site complications. In addition, complete posterior muscle detachment is avoided and the injury risk of neural structures is minimized. This study investigates the use of HMA screws in this context. Five consecutive patients requiring L4-S1 in-situ fusion for isthmic spondylolisthesis (four Grade 3 and one Grade 4) were included. The L5/S1 level was fused with an HMA screw filled with local bone and bone morphogenic protein (BMP2), inserted via the L4/5 disc space level. An L4/5 stand-alone interbody fusion with additional minimal invasive posterior screw fixation was added. Transvertebral insertion of the HMA device was accomplished via a retroperitoneal approach to L4/L5 in all cases without exposure of L5/S1. Blood loss ranged from 150 ml-350 ml. No intraoperative complication occurred. One patient developed posterior wound infection requiring debridement. Solid fusion was confirmed with a CT scan after 6 months in all patients. All patients improved to unrestricted activities of daily living with two being limited by occasional back pain. HMA screws allow for effective lumbosacral fusion via a limited anterior exposure. This is technically easier than posterior exposure of the lumbosacral junction in high-grade spondylolisthesis requiring 360 degrees fusion.

  17. Solution and crystal structure of BA42, a protein from the Antarctic bacterium Bizionia argentinensis comprised of a stand-alone TPM domain.

    Science.gov (United States)

    Aran, Martin; Smal, Clara; Pellizza, Leonardo; Gallo, Mariana; Otero, Lisandro H; Klinke, Sebastián; Goldbaum, Fernando A; Ithurralde, Esteban R; Bercovich, Andrés; Mac Cormack, Walter P; Turjanski, Adrián G; Cicero, Daniel O

    2014-11-01

    The structure of the BA42 protein belonging to the Antarctic flavobacterium Bizionia argentinensis was determined by nuclear magnetic resonance and X-ray crystallography. This is the first structure of a member of the PF04536 family comprised of a stand-alone TPM domain. The structure reveals a new topological variant of the four β-strands constituting the central β-sheet of the αβα architecture and a double metal binding site stabilizing a pair of crossing loops, not observed in previous structures of proteins belonging to this family. BA42 shows differences in structure and dynamics in the presence or absence of bound metals. The affinity for divalent metal ions is close to that observed in proteins that modulate their activity as a function of metal concentration, anticipating a possible role for BA42. © 2014 Wiley Periodicals, Inc.

  18. Grid parity analysis of stand-alone hybrid microgrids: A comparative study of Germany, Pakistan, South Africa and the United States

    Science.gov (United States)

    Siddiqui, Jawad M.

    Grid parity for alternative energy resources occurs when the cost of electricity generated from the source is lower than or equal to the purchasing price of power from the electricity grid. This thesis aims to quantitatively analyze the evolution of hybrid stand-alone microgrids in the US, Germany, Pakistan and South Africa to determine grid parity for a solar PV/Diesel/Battery hybrid system. The Energy System Model (ESM) and NREL's Hybrid Optimization of Multiple Energy Resources (HOMER) software are used to simulate the microgrid operation and determine a Levelized Cost of Electricity (LCOE) figure for each location. This cost per kWh is then compared with two distinct estimates of future retail electricity prices at each location to determine grid parity points. Analysis results reveal that future estimates of LCOE for such hybrid stand-alone microgrids range within the 35-55 cents/kWh over the 25 year study period. Grid parity occurs earlier in locations with higher power prices or unreliable grids. For Pakistan grid parity is already here, while Germany hits parity between the years 2023-2029. Results for South Africa suggest a parity time range of the years 2040-2045. In the US, places with low grid prices do not hit parity during the study period. Sensitivity analysis results reveal the significant impact of financing and the cost of capital on these grid parity points, particularly in developing markets of Pakistan and South Africa. Overall, the study helps conclude that variations in energy markets may determine the fate of emerging energy technologies like microgrids. However, policy interventions have a significant impact on the final outcome, such as the grid parity in this case. Measures such as eliminating uncertainty in policies and improving financing can help these grids overcome barriers in developing economies, where they may find a greater use much earlier in time.

  19. PR2ALIGN: a stand-alone software program and a web-server for protein sequence alignment using weighted biochemical properties of amino acids.

    Science.gov (United States)

    Kuznetsov, Igor B; McDuffie, Michael

    2015-05-07

    Alignment of amino acid sequences is the main sequence comparison method used in computational molecular biology. The selection of the amino acid substitution matrix best suitable for a given alignment problem is one of the most important decisions the user has to make. In a conventional amino acid substitution matrix all elements are fixed and their values cannot be easily adjusted. Moreover, most existing amino acid substitution matrices account for the average (dis)similarities between amino acid types and do not distinguish the contribution of a specific biochemical property to these (dis)similarities. PR2ALIGN is a stand-alone software program and a web-server that provide the functionality for implementing flexible user-specified alignment scoring functions and aligning pairs of amino acid sequences based on the comparison of the profiles of biochemical properties of these sequences. Unlike the conventional sequence alignment methods that use 20x20 fixed amino acid substitution matrices, PR2ALIGN uses a set of weighted biochemical properties of amino acids to measure the distance between pairs of aligned residues and to find an optimal minimal distance global alignment. The user can provide any number of amino acid properties and specify a weight for each property. The higher the weight for a given property, the more this property affects the final alignment. We show that in many cases the approach implemented in PR2ALIGN produces better quality pair-wise alignments than the conventional matrix-based approach. PR2ALIGN will be helpful for researchers who wish to align amino acid sequences by using flexible user-specified alignment scoring functions based on the biochemical properties of amino acids instead of the amino acid substitution matrix. To the best of the authors' knowledge, there are no existing stand-alone software programs or web-servers analogous to PR2ALIGN. The software is freely available from http://pr2align.rit.albany.edu.

  20. Effects of ozone as a stand-alone and coagulation-aid treatment on the reduction of trihalomethanes precursors from high DOC and hardness water.

    Science.gov (United States)

    Sadrnourmohamadi, Mehrnaz; Gorczyca, Beata

    2015-04-15

    This study investigates the effect of ozone as a stand-alone and coagulation aid on the removal of dissolved organic carbon (DOC) from the water with a high level of DOC (13.8 mgL(-1)) and calcium hardness (270 mgL(-1)) CaCO3. Natural water collected from the Assiniboine River (Manitoba, Canada) was used in this study. Effectiveness of ozone treatment was evaluated by measurement of DOC, DOC fractions, UV254, and trihalomethane formation potential (THMFP). Additionally, zeta potential and dissolved calcium concentration were measured to discern the mechanism of ozone reactions. Results indicated that 0.8 mg O3/mg DOC ozone stand-alone can cause up to 86% UV254 reduction and up to 27% DOC reduction. DOC fractionation results showed that ozone can change the composition of DOC in the water samples, converting the hydrophobic fractions into hydrophilic ones and resulting in the reduction of THMFP. Also, ozone caused a decrease in particle stability and dissolved calcium concentration. These simultaneous ozonation effects caused improved water flocculation and enhanced removal of DOC. This resulted in reduction of the coagulant dosage when ozone doses higher than 0.2 mg O3/mg DOC were applied prior to coagulation with ferric sulfate. Also, pre-ozonation-coagulation process achieved preferential THMFP removal for all of the ozone doses tested (0-0.8 mg O3/mg DOC), leading to a lower specific THMFP in pre-ozonated-coagulated waters than in the corresponding ozonated waters. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Fusion

    International Nuclear Information System (INIS)

    Naraghi, M.

    1976-01-01

    It is proposed that Iran as a world's potential supplier of fossile fuel should participate in fusion research and gain experience in this new field. Fusion, as an ultimate source of energy in future, and the problems concerned with the fusion reactors are reviewed. Furthermore; plasma heating, magnetic and inertial confinement in a fusion reactor are discussed. A brief description of tokamak, theta pinch and magnetic mirror reactors is also included

  2. Analysis of the impact of batteries behaviour on stand-alone photovoltaic systems; Analise do impacto do comportamento de baterias em sistemas fotovoltaicos autonomos

    Energy Technology Data Exchange (ETDEWEB)

    Vera, Luis Horacio

    2009-08-15

    Stand-alone photovoltaic systems are a suitable alternative for rural electrification. However, there are still problems to be solved, mainly related to the system design and the technical quality of the equipment and facilities, which impacts the systems reliability. To determine the factors that affect the reliability of these systems it were studied the most common configurations and associated failures. The Laboratory experimental research, together with an extensive literature review, show the basic technical problems that occur to each of the elements of the installation and the dependence between them. These studies have shown that the storage the system, considering system reliability and economy, is the weakest element due to the decrease of their storage capacity. This led to consider the storage systems as the focus of this study and, through the analysis of their behavior, to develop a procedure to size systems with high reliability, lower cost and appropriate configuration. The impact of batteries on the technical reliability and economic viability of photovoltaic systems is determined. It was achieved through experimental testing and the development and adjustment of mathematical models. These models were implemented to preexisting software called PVSize. The improved software allows the calculation of different configurations of systems and to determine the loss of load probability and the figures of merit associated to the chosen economic-financial project. On this work was installed a photovoltaic system and was developed a battery testing system. The values measured in these systems allow to verify the mathematical models that describe the behavior of each device and characterize the components of the system. Experimental analysis of the behavior of a bank of batteries along a year showed that the connection of batteries in parallel accelerates the batteries degradation process, and this degradation has differentiated impact on the loss of

  3. A practical multi-objective design approach for optimum exhaust heat recovery from hybrid stand-alone PV-diesel power systems

    International Nuclear Information System (INIS)

    Yousefi, Moslem; Kim, Joong Hoon; Hooshyar, Danial; Yousefi, Milad; Sahari, Khairul Salleh Mohamed; Ahmad, Rodina Binti

    2017-01-01

    Highlights: • Heat recovery exchanger is designed based on practical conditions of a hybrid power system. • Off-the-grid electricity system modeling and analysis using micro-grid analysis software HOMER. • NSGA-II is used for the multi-objective design optimization task. • A new local search is proposed to incorporate the engineering knowledge in NSGA-II. • The proposed approach outperforms the existing ones. - Abstract: Integration of solar power and diesel generators (DGs) together with battery storage has proven to be an efficient choice for stand-alone power systems (SAPS). For higher energy efficiency, heat recovery from exhaust gas of the DG can also be employed to supply all or a portion of the thermal energy demand. Although the design of such heat recovery systems (HRSs) has been studied, the effect of solar power integration has not been taken into account. In this paper, a new approach for practical design of these systems based on varying engine loads is presented. Fast and elitist non-dominated sorting genetic algorithm (NSGA-II) equipped with a novel local search was used for the design process, considering conflicting objectives of annual energy recovery and total cost of the system, and six design variables. An integrated power system, designed for a remote SAPS, was used to evaluate the design approach. The optimum power supply system was first designed using the commercial software Hybrid Optimization of Multiple Energy Resources (HOMER), based on power demand and global solar energy in the region. Heat recovery design was based on the outcome of HOMER for DG hourly load, considering different power scenarios. The proposed approach improves the annual heat recovery of the PV/DG/battery system by 4%, PV/battery by 1.7%, and stand-alone DG by 1.8% when compared with a conventional design based on nominal DG