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Background: There is a paucity of data examining anterior lumbar interbody fusion (ALIF) with pedicle-screw fixation (ALIF-PSF) or without (standalone, sa-ALIF) for the treatment of low-grade isthmic spondylolisthesis (IS). Treating pathology with sa-ALIF reduces costs, operative times, and posterior access morbidity. This study aimed to investigate the clinical and radiographic outcomes of sa-ALIF for the management of low-grade IS compared with an ALIF-PSF cohort. Methods: Retrospective analysis of prospectively collected data. Consecutive patients from 1 senior spine surgeon performing sa-ALIF or ALIF-PSF for management of low-grade IS. Patient-reported outcome measures (PROMs) were collected at baseline, then postoperatively at 6 weeks, 6 months, 12 months, and a final follow-up timepoint. Computed tomography was conducted at 6 months, 12 months, or until interbody fusion was confirmed. Results: Two cohorts comprised 51 patients (sa-ALIF 22 and ALIF-PSF 29). Both cohorts' PROMs improved from baseline to 12 months postoperatively. There were no significant differences (P = 0.05) in PROMs between the 2 cohorts at 6 months postoperatively, 12 months postoperatively, or at a final follow-up timepoint. There were no significant differences in mean fusion rates 12 months postoperatively (sa-ALIF 82% and ALIF-PSF 88%). Compared with preoperative measurements in sa-ALIF and ALIF-PSF cohorts, listhesis and segmental lordosis showed no significant changes, while disc height significantly increased (P = 0.0001). There were no significant differences in disc L5/S1 radiographic measurements between the cohorts at 12 months. There were 12 complications (sa-ALIF 2 and ALIF-PSF 10). Only 1 patient in the ALIF-PSF cohort required revision surgery. Conclusions: In appropriately selected patients with normal bone density, sacral slope <40°, and a body mass index <35, sa-ALIF is a safe and effective treatment option for grade I IS. The additional morbidity and cost of PSF may not be justified given the satisfactory clinical and radiographic outcomes of sa-ALIF for grade I IS. Clinical Relevance: Clinically, this research continues to suggest that sa-ALIF is a safe and effective method of treatment for low grade IS. [ABSTRACT FROM AUTHOR]

Background: Various strategies have been used to reduce pedicle screw loosening following lumbar instrumented fusion, but all strategies have limitations. In this prospective multicenter cohort study, outcomes of elderly patients with reduced bone density who underwent primary or revision fusion surgery using a novel technique of pedicle screw augmentation with demineralized bone fiber (DBF) anchors were evaluated. Methods: This study included elderly patients (aged >65 years) with dual-energy x-ray absorptiometry-confirmed reduced bone density who required lumbar pedicle screw fixation and were treated with supplemental DBF allograft anchors during primary or revision surgery. The need for DBF anchors was determined by evaluating preoperative computed tomography (CT) scans (for revision surgery) and by the surgeons’ tactile feedback intraoperatively during pedicle screw insertion and removal. After determining the pedicle screw void diameter with a sizing instrument, DBF anchors and pedicle screws of the same diameter were placed into the void. CT scans were obtained on postoperative day 2 to assess pedicle breach, pedicle fracture, or anchor material extrusion and at 6 and 12 months postoperatively to assess screw loosening. Thereafter, to minimize radiation exposure, CT scans were only performed for recurrence of pain. Results: Twenty-three patients (79% women; mean age, 74 years) received 50 lumbosacral pedicle screws augmented with DBF anchors. Most surgeries (n = 18, 78%) were revisions, and most anchors were inserted into revision pedicle screw trajectories (n = 33, 66%). Day-2 CT scans revealed no pedicle breach/fracture or extrusion of anchor material. During a mean follow-up of 15 months (12–20 months), no screw loosening was detected, and no patient required pedicle screw revision surgery. There were no adverse events attributable to DBF allografts. Conclusions: DBF allograft anchors appear to be safe and effective for augmenting pedicle screws during revision surgeries in female elderly patients with reduced bone density. Clinical Relevance: Clinically, DBF reduced the rate of pedicle screw loosening in patients with reduced bone density. A significant reduction in screw loosening can decrease the need for revision surgeries, which are costly and carry additional risks. Enhanced bone integration from the DBF may promote better healing and long-term stability. [ABSTRACT FROM AUTHOR]

• Evoked potentials in addition to EMG/tEMG is a more sensitive measure of "pre-pathologic" signal change, which was most often reversible. • Patients that experienced intraoperative signal change in our study rarely correlated with a post-operative deficit. • Our findings indicate that there is less clinical indication for routine neural monitoring at rostral lumbar levels. Minimally Invasive Lateral Lumbar Interbody Fusion (MIS LLIF) is a reliable technique for treatment of degenerative disk disease, foraminal stenosis and spinal deformity. The retroperitoneal transpsoas approach risks lumbar plexus injury that may result in anterior thigh pain, sensory loss and weakness. A prospective study of 64 consecutive patients undergoing MIS LLIF with expandable cages (23 standalone, 41 integrated with lateral plate) using multimodal electrophysiological monitoring was performed. We measured sequential retraction times, complications, patient reported outcome scores and electrophysiologic findings with a minimum 12-month follow-up. Incidence of evoked potential and electromyographic signal change was moderate, and rarely resulted in post-operative neurologic deficit. Evoked potential signal changes were frequently resolved by the un-breaking of the surgical table or repositioning of the retractor. Average retraction times were 24 (15–41) minutes for standalone cages and 30 (15–41) minutes for integrated cages. At follow-up, the vast majority (97%) of patients reported significant clinical improvement post-operatively with only 2 patients reporting postoperative neurologic symptoms and subsequent recovery at 12-months. The present study shows that evoked potentials combined with electromyography is a more sensitive measure of pre-pathologic lumbar plexopathy in LLIF compared to electromyography alone, especially at L3/4 and L4/5 levels. Based on our findings, there is limited clinical indication for routine neural monitoring at rostral lumbar levels. The routine inclusion of multimodal electrophysiological monitoring in lateral transpsoas surgery is recommended to minimise the risk of neural injury by enabling optimal patient and retractor positioning and continued surveillance throughout the procedure. [ABSTRACT FROM AUTHOR]

• Sense of place (SoP) interacts with structural factors stabilizing the CCIR pathway. • SoP legitimizes the dominance of coal and carbon-intensive industries. • SoP hinders alternative visions, fosters path dependency, and shapes imaginaries. • Acknowledging SoP can aid just and effective destabilization-reconfiguration. European coal and carbon-intensive regions (CCIRs) face the intricate challenge of navigating destabilization-reconfiguration pathways, requiring a nuanced understanding of how phase-out intertwines with innovation and lock-in mechanisms. The success of this transformation depends on a multitude of factors, including socio-political, economic, and material conditions, as well as psychosocial and cultural dimensions of place. This study examines how feedback loops between structural factors (i.e., socio-political, socio-economic, and infrastructural) and sense of place can either disrupt or reinforce lock-in mechanisms and path dependency in CCIRs. The study focuses on Sulcis CCIR (Sardinia, Italy), where extractive and metal industries are deeply ingrained in the region's culture and economy. To reconstruct the trajectory of the CCIR and gain in depth understanding of feedback mechanisms of path dependency across time, we triangulate different data sources including policy documents, newspapers, participatory workshops, and interviews with key stakeholders. The findings reveal the profound influence of a sense of place grounded in a shared industrial myth along with associated place meanings, identities, and memories on lock-in mechanisms. Positive feedback loops between sense of place and structural factors of lock-in have legitimated the dominance of coal and carbon-intensive industries across time, impeding the recognition of the need for change and obscuring windows of opportunity for low-carbon transformation. Following the definite destabilization of coal, dominant place meanings are being actively challenged, while the legacy of sense of place is serving as a guiding frame for shaping the legitimacy and imaginaries of place transformation and defining a just transition pathway. The study discusses the importance of recognizing and addressing the role of sense of place and its interaction with structural factors in perpetuating lock-in to ensure effective deliberate destabilization efforts and navigate a just reconfiguration of CCIRs. [ABSTRACT FROM AUTHOR]

Wild edible plants are often considered healthier than crops because they are unaffected by fertilizers, herbicides, and pesticides. However, the occurrence of potentially toxic elements in wild plants is poorly known and needs to be assessed. In this study, 22 elements were determined by inductively coupled plasma mass spectrometry in wild asparagus (Asparagus acutifolius L.). Asparagus shoots were collected in uncontaminated environments (20 sites) and in areas contaminated by past mining (15 sites) in Sardinia, Italy. Beryllium, Bi, Te, Tl, and U were not detected in asparagus (<0.03 μg g-1); Ag, As, Co, Cd, Li, and Sb were detected at very low levels (median, 0.01-0.05 μg g-1); B, Cu, Fe, Mn, Rb, and Zn were relatively abundant (median, 10-58 μg g-1); and Ba, Mo, Ni, Pb, and Sr showed large variations (median, 0.4, 0.3, 3, 0.1, and 0.5 μg g-1, respectively). Median concentrations of detected elements were similar in asparagus collected in uncontaminated environments or previously mined areas. An exception was Cd in asparagus collected in mined areas (median, 1.4 μg g-1), whose levels were much higher than in asparagus from uncontaminated environments (median, 0.01 μg g-1), indicating that high Cd in bedrocks affect contents in asparagus shoots. Also, Sb- and As-rich substrates in mined areas resulted in asparagus with Sb and As concentrations much higher than asparagus samples from areas mined predominantly for Pb and Zn. Results of this study indicate potential health hazards to residents living worldwide in areas affected by past mining. [ABSTRACT FROM AUTHOR]