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Background Cortical bone trajectory (CBT) has been well-known in spine surgery for obtaining improved fixation while minimizing soft tissue dissection. This study was designed to compare the bone mineral density (BMD) between the CBT and traditional trajectory (TT) by using Hounsfield unit (HU) values and identify the ideal decades of patients and the suitable lumbar segments using this CBT technology from a radiological standpoint. Methods Patients were selected randomly from an institutional database based on age (evenly distributed by a decade of life) and gender. A total of 240 healthy patients had a computed tomography (CT) scan of the chest, abdomen, and pelvis. For each patient, axial slices of every vertebra were cut in two planes: one horizontal to the pedicle representing the plane wherein pedicle screws were inserted using the TT and the other in a caudocranial plane representing the plane wherein pedicle screws were inserted using the CBT. For each trajectory, a region of interest (ROI) was selected within the area wherein the screws were inserted. A CT number (HU values) was then calculated within each ROI to represent bone density. Results HU values measured at the ROI of CBT were significantly greater than those of the traditional pedicle screw in all age groups, and the specific value (ratio of the HU values of CBT/the HU values of TT) between CBT and TT was 1.92. A significant difference was observed between male and female. The HU values of CBT and TT of males were generally higher than those of females (males: CBT/TT 1.89 ± 0.45; Females: CBT/TT 1.95 ± 0.47). The specific value in HU values significantly increased with increasing age (p = 0.000) and cauda lumbar level (p = 0.000) in males and females. Conclusion BMD, as measured by HU values for the ROI of the CBT screw, was significantly greater than that of the traditional pedicle screw, especially in old patients and cauda lumbar segments.

STUDY DESIGN A retrospective study. OBJECTIVE To compare the accuracy of pedicle screw placement and proximal facet joint violation (FJV) in single-level degenerative lumbar diseases using cortical bone trajectory (CBT) and traditional trajectory (TT) techniques, and analyze their possible risk factors. SUMMARY OF BACKGROUND DATA CBT screws have been utilized increasingly to improve cortical bone contact to prevent screw pullout and reduce approach-related morbidity. However, the studies on intra-pedicular accuracy and proximal FJV between the two methods are rare. METHODS A total of 40 patients who required single-level instruments were included in the retrospective study treated with the CBT-TLIF and the TT-TLIF at a 1:1 ratio from March 2019 to August 2020. The radiographic outcomes were the intra-pedicular accuracy and proximal FJV. Moreover, the possible risk factors were assessed using bivariate and multivariate analyses. RESULTS As for the intra-pedicular accuracy, 73 screws (91.3%) were classified as grade A, 7 screws (8.7%) classified as grade B in the CBT group. A total of 71 screws (88.8%) were graded A with remaining 8 screws (10.0%) graded B and 1 screw (1.2%) graded C in the TT group. The proportion of optimal and clinically acceptable screw positions in the two groups were not significantly different (P > 0.05). In addition, the rate of proximal FJV in CBT approach (8.3%) was significantly lower than that in the TT approach (35.0%) (P

Objective To determine the rates and risk factors of pedicle screw placement accuracy and the proximal facet joint violation (FJV) using TINAVI robot-assisted technique. Methods Patients with thoracolumbar fractures or degenerative diseases were retrospectively recruited from June 2018 and June 2020. The pedicle penetration and proximal FJV were compared in different instrumental levels to identify the safe and risk segments during insertion. Moreover, the factors were also assessed using univariate and multivariate analyses. Results A total of 72 patients with 332 pedicle screws were included in the current study. The optimal and clinically acceptable screw positions were 85.8% and 93.4%. Of the 332 screws concerning the intra-pedicular accuracy, 285 screws (85.8%) were evaluated as Grade A according to the Gertzbein and Robbins scale, with the remaining 25 (7.6%), 10 (3.0%), 6 (1.8%), and 6 screws (1.8%) as Grades B, C, D, and E. Moreover, in terms of the proximal FJV, 255 screws (76.8%) screws were assessed as Grade 0 according to the Babu scale, with the remaining 34 (10.3%), 22 (6.6%), and 21 screws (6.3%) as Grades 1, 2, and 3. Furthermore, the univariate analysis showed significantly higher rate of penetration for patients with age p = 0.007), facet angle ≥ 45° (adjusted OR 0.266, 95% CI 0.090–0.786; p = 0.017), distance from skin to insertion point ≥ 4.5 cm (adjusted OR 0.342, 95% CI 0.134–0.868; p = 0.024), and lumbosacral instrumentation (adjusted OR 0.227, 95% CI 0.091–0.566; p = 0.001) were independently associated with intra-pedicular accuracy; the L5 insertion (adjusted OR 2.020, 95% CI 1.084–3.766; p = 0.027) and facet angle ≥ 45° (adjusted OR 1.839, 95% CI 1.026–3.298; p = 0.041) were independently associated with the proximal FJV. Conclusion TINAVI robot-assisted technique was associated with a high rate of pedicle screw placement and a low rate of proximal FJV. This new technique showed a safe and precise performance for pedicle screw placement in spinal surgery. Facet angle ≥ 45° is independently associated with both the intra-pedicular accuracy and proximal FJV.

This study aims to introduce an innovative adjustable prone positioning frame (APPF) and explore its feasibility and safety for treatment of severe kyphosis secondary to ankylosing spondylitis (AS) with two-level osteotomy.A retrospective, non-controlled study was conducted to illustrate the process where 13 patients diagnosed with severe kyphosis secondary to AS received operations on the APPF. Parameters of chin brow vertical angle (CBVA), global kyphosis (GK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL) and sagittal vertical axis (SVA) were measured. Positioning time, operation time, intraoperative blood loss aḥd complications were also determined. The Scoliosis Research Society outcomes instrument (SRS-22) was applied for clinical assessment.All patients were placed on the APPF successfully with the positioning time of 2.92 ± 0.76 min, received operation with 457.00 ± 88.04 min and had blood loss of 2330.77 ± 1423.25 ml. Four cases experienced pain due to tensional skin of the abdomen and one case suffered cerebrospinal fluid leakage postoperatively, but these patients were all cured conservatively. No neurological complications were observed, although sagittal translation occurred in four patients. Significant improvements were detected in CBVA, GK, TLK, LL and SVA postoperatively (P 0.05), but no significant difference was observed between postoperation and the final follow-up (P 0.05). The SRS-22 scores at 2 years after operation were significantly higher than those before operation (P 0.05).The innovative APPF provided great convenience to place patients with severe kyphosis secondary to AS in a prone position. Performing two-level osteotomy with the aid of APPF is safe, feasible and effective.

A new terahertz (THz) polarization beam splitter (PBS) based on cyclic olefin copolymer (COC) photonic crystal fiber (PCF) with a simple structure is proposed. The dual cores are achieved by introducing six circular air holes in two rows of upper and lower symmetry into the fiber core. The mode coupling characteristics between the even and odd modes for the proposed dual-core PBS are investigated using the time-domain finite-difference (FDTD) method and coupled-mode theory. The influence of geometrical structure parameters on the PBS performance is analyzed. The numerical simulation results reveal that when the incident light frequency is 0.6 THz and the PBS length is 53.88 mm, the bandwidths of 0.0217 THz (from 0.5895 THz to 0.6112 THz) and 0.0225 THz (from 0.5908 THz to 0.6133 THz) are obtained for the x and y-polarization modes, respectively. The highest polarization extinction ratios (ERs) are 114.5 dB and 72.3 dB for the x and y-polarization modes, respectively. The simple structure and wide bandwidth make the proposed PBS will find extensive applications in THz communication, imaging, sensing, metrology, and microscopy.

Background Context Surgical treatment for unstable atlas fractures has evolved in recent decades from C1-C2 or C0-C2 fusion to motion-preservation techniques of open reduction and internal fixation (ORIF). However, regardless of a transoral or a posterior approach, the reduction is still not satisfactory. Purpose The article describes and evaluates a new technique for treating unstable atlas fractures by using a monoaxial screw-rod system. Study Design This is a retrospective study. Patient Sample The sample includes adult patients with unstable C1 fractures treated with a posterior monoaxial screw-rod system. Outcome Measures The outcome measures included a visual analog pain scale, radiographic reduction (lateral mass displacement [LMD]), maintenance of reduction, C1-C2 instability (anterior atlantodens interval), and complications. Materials and Methods From August 2013 to May 2016, nine consecutive patients with unstable atlas fractures were retrospectively reviewed. All patients were treated with posterior ORIF by using a monoaxial screw-rod system. The medical records and the preoperative and postoperative radiographs were reviewed. Preoperative and postoperative computed tomography scans were used to specify the fracture types and to assess the reduction. Results All nine patients with a mean age of 50.3 years successfully underwent surgery with this technique, and a follow-up of 17.4±9.3 months was performed. Transverse atlantal ligament (TAL) injury was found in eight of the nine patients: one of type I and seven of type II. The preoperative LMD averaged 7.0±2.2 mm and was restored completely after surgery; all the fractures achieved bony healing without loss of reduction or implant failure. None of the patients had complications of neurologic deficit, vertebral artery injury, or wound infection associated with the surgical procedure. Two patients complained of greater occipital nerve neuralgia after the operation, which gradually disappeared in 1 month. All patients had a well-preserved range of motion of the upper cervical spine at the final follow-up. Conclusions Posterior osteosynthesis with a monoaxial screw-rod system is capable of an almost anatomical reduction for the unstable atlas fractures. The TAL incompetence may not be a contraindication to ORIF for C1 fractures, but the long-term effect of C1-C2 instability remains to be further investigated.

There is currently no effective treatment to prevent the progress of Alzheimer’s disease (AD). The traditional Chinese herbs Dengzhan Shengmai (DZSM) capsules and their active component scutellarin possess multiple effects and are clinically used for the treatment of cerebrovascular diseases. Scutellarin has been reported to affect Aβ aggregation. However, the effects of DZSM capsules on AD remain unknown. Through in vivo experiments, our study proved that the alleviating effects of DZSM capsules on cognitive deficits of AD mice were due to the role of scutellarin, which up-regulated low toxic amyloid plaques and down-regulated highly toxic soluble Aβ42 and Aβ40 levels in cortex. In vitro, we confirmed scutellarin’s role in accelerating transforming Aβ42 monomers into high-molecular-mass aggregates by biochemical assays, which supported the results observed in drug-treated APP/PS1 mice. In detail, the 1:10 ratio of scutellarin/Aβ42 mixtures promoted production of large β-sheet-rich fibrils whereas the 1:1 ratio promoted production of protofibrils. In addition, the binding between scutellarin and Aβ monomers was quantified by microscale thermophoresis test and the apparent dissociation constant (Kd) was 1284.4 ± 238.8 μM. What’s more, binding regions between scutellarin and Aβ fibrils were predicted by computational docking models and scutellarin might bind parallel to the long axis of Aβ42 fibrils targeting hydrophobic grooves at residues 35–36 or 39. In conclusion, DZSM capsules protected against cognitive defects of AD through scutellarin-mediated acceleration of Aβ aggregation into fibrils or protofibrils and reduction of soluble Aβ oligomers, thus suggesting potential clinical applications of DZSM capsules and scutellarin in the treatment of AD.

A first principles calculation on the electronic properties of α- and β-UH3 is implemented by using a many-body method merging density functional theory (DFT) with dynamical mean field theory (DMFT). Results show that α- and β-UH3 are both in mixed-valent metallic states with an average occupation of 5f electrons nf about 2.418 and 2.520, respectively, and exhibiting strong valance fluctuation due to the quantum superposition of 5f2 and 5f3 configurations in the ground state. The spectrum function demonstrates that U 5f electrons possess the dual characters, i.e., the localized and itinerant behaviors, and the localized 5f counts are 1.106 and 1.112 for α- and β-UH3, respectively, which is well in accord with the experimental observations. The imaginary part of the impurity Green functions reveals that U 5f j = 5/2 and j = 7/2 states both exhibit the metallic and insulating characteristics, respectively. The quasi-particle weight establishes that U 5f j = 5/2 and j = 7/2 states are in the moderately and weakly correlated regimes, respectively, and jj coupling scheme is more feasible as compared to the intermediate coupling (IC) or the Russel-Saunders (LS) coupling regime.

Study design This is a radiographic and cadaveric study. Objective The aim of this study was to conduct a detailed comparison about the parameters between the ideal cortical bone trajectory (CBT) and practical CBT screw. Summary of background data CBT screws have recently become popular in spinal surgery, mainly because of their improved fixation while minimizing soft tissue dissection. However, to our knowledge, no previous study has provided a detailed comparison on the parameters between the ideal CBT and practical CBT screws. Materials and methods The 3-dimensional computed tomography scans of 126 spinal vertebrae separated from 40 lumbar spines were studied. After determining the CBT, the maximal screw length, maximal screw diameter, lateral angle (LA), and cephalad angle (CA) were calculated. Thereafter, CBT screws were inserted into these cadaveric lumbar spines. Subsequently, the lateral angle of screw (LAs) and cephalad angle of screw (CAs) of the screws were measured using 3-dimensional computed tomography. Results As for the ideal CBT, the maximal screw length gradually increased from L1 (32.0 mm) to L4 (35.3 mm) and then decreased at L5 (34.8 mm). Moreover, the maximal screw diameter increased from L1 (4.5 mm) to L5 (7.5 mm). The LA from L1 to L5 were 9.2, 9.4, 9.9, 11.2, and 12.0 degrees, respectively. The CA from L1 to L5 were 25.8, 25.8, 26.3, 26.8, and 26.0 degrees, respectively. As for the actual CBT screw, the LAs from L1 to L5 were 12.7, 14.1, 13.2, 12.4, and 13.0 degrees, respectively. The CAs from L1 to L5 were 25.4, 27.5, 29.2, 30.1, and 30.5 degrees, respectively. Significant differences were observed between the angles of the ideal trajectory and the actual screw. Conclusions Parameters of the actual CBT screw are slightly larger than the optimal trajectory measurements. The CAs and LAs are ∼25-30 and 10-16 degrees, respectively. L1 and L2 should be given considerable attention when using the CBT technique. And the trajectory measurements can only be used as a guide in clinical practice.

Objective Selecting optimal strategies for improving fixation in osteoporotic lumbar spine is an important issue in clinical research. Cortical bone trajectory (CBT) screws have been proven to enhance screw pullout strength, but biomechanical efficacy of these screws remains understudied. The aim of this study was to evaluate biomechanical efficacy of CBT screws in osteoporotic lumbar spine. Methods Thirty-one vertebrae from 14 cadaveric lumbar spines were obtained. All specimens were measured by computed tomography; the diameter of pedicles, excluding those of vertebral bodies with very small pedicle developments, was calculated. After measuring bone mineral density, the CBT screw was randomly inserted into 1 side, and the traditional trajectory (TT) screw was inserted into the contralateral side. Maximum insertional torque was recorded after screw insertion. Of vertebrae, 21 were subjected to pullout testing at a rate of 5 mm/minute, and 10 were subjected to cyclic fatigue testing. Each construct was loaded until exceeding 5 mm. Results Average bone mineral density was 0.567 ± 0.101 g/cm2. CBT screws had higher maximum insertional torque (degrees of freedom = 30, t = 5.78, P Conclusions CBT screws had better biomechanical fixation in osteoporotic lumbar spine compared with standard pedicle screws.

A persistent challenge in spine surgery is improving screw fixation in patients with poor bone quality. Augmenting pedicle screw fixation with allograft bone appears to be a promising approach.To evaluate the biomechanical properties of screws augmented or revised with allograft bone particles (ABPs) and the effect of different sizes and amounts of ABP on screw-fixation strength.Biomechanical in vitro study.Sixty vertebrae were separated randomly into six groups. Groups A1 and A2: one pedicle of each vertebra was selected randomly to be the original pedicle and implanted with a screw. Then, biomechanical tests were performed. Subsequently, the failed trajectory was revised with 1 mm ABP, and the contralateral pedicle was augmented with the same size and amount of ABP. Groups B1 and B2: two pedicles of each vertebra were augmented with different amounts of 1 mm ABP. Groups C1 and C2: one pedicle of each vertebra was augmented with 1 mm ABP to the maximum. The contralateral pedicle of each vertebra was augmented with the same amount of 2 mm ABP. After augmentation and screw insertion, groups A1, B1, and C1 were subjected to the pullout test, whereas groups A2, B2, and C2 the cyclic fatigue test.Groups A1 and A2: screw augmentation increased the pullout strength by 47%, cycles to failure by 31%, and failure loads by 21% compared with the screw in the original pedicle (p.05). Screw revision obtained 79% pullout strength, 97% cycles to failure, and 98% failure loads of the screw in the original pedicle (p.05). Groups B1 and B2: full (100%) trajectory augmentation increased the pullout strength by 39%, cycles to failure by 18%, and failure loads by 12% compared with half (50%) trajectory augmentation (p.05). Groups C1 and C2: the values of the pullout strength, cycles to failure, and failure loads of the screw augmented with 1 mm ABP were all greater than those in the 2 mm ABP. However, no significant differences were observed between the two treatments (p.05).Trajectory augmentation with ABP can significantly increase the strength of the augmented screws. Full trajectory augmentation can provide greater strength compared with half trajectory augmentation. In patients with osteoporosis, we recommend using 1 mm ABP in full trajectory augmentation (0.3 g ABP for 5.5 mm×40 mm and 0.5 g ABP for 6.5 mm×45 mm) before trajectory fails.

Retrospective chart audit.This study aims to compare the clinical features and surgical outcomes in patients with cervical spondylotic myelopathy (CSM) among different age groups.The first Affiliated Hospital of Anhui Medical University, China.A total of 460 patients with CSM who were surgically treated over the period of 1995-2009 were investigated. Considering the peak age (40-60 years old) for the onset of symptoms, we divided the patients into three groups by age: young (40), middle-aged (40-60), and old (60). The differences in symptoms, symptom durations, involved levels, surgical approaches and outcomes were evaluated.The number of symptoms and involved levels, symptom duration and posterior approach significantly increased with increasing age, whereas preoperative Japanese Orthopedic Association score decreased among the three groups. Spinal cord function improved after surgery in all groups. The highest degree of recovery occurred during the first 6 months after surgery, especially within the first week, and then reached a plateau. After 6 months, however, recovery continuously improved, stabilized and declined in the young, middle-aged, old groups, respectively. The recovery rate was not significantly different at an immediate period (1 week) after operation among the three groups, but was significantly different at later periods (3 or more months postoperatively). Three groups showed no difference in postoperative complication rates.The severity of CSM increased with increasing age. Age was inversely correlated with recovery, and recovery decreased as age increased. Six months post operation was the prime time for the recovery of spinal cord function.