Current Procedures Research Articles

New runs‐based approach to testing value at risk forecasts

AbstractThe reformed Basel framework has left value at risk (VaR) as a basic tool of validating risk models. Within this framework, VaR independence tests have been regarded as critical to ensuring stability during periods of financial turmoil. However, until now, there is no consent among researchers regarding the choice of the appropriate test. The available procedures are either inaccurate in finite samples or need to rely on Monte Carlo simulations. To remedy these problems, we propose a new method for testing VaR models, based on the distribution of the number of runs. It outperforms the existing methods in two main aspects: First, it is exact in finite samples and thus allows for perfect control over the Type 1 error; second, its distribution is available in a closed form, so it does not require simulations before implementation. We show that it is the most adequate current procedure for testing low‐level VaR series, which corresponds to today's regulatory standards.

Operative Time Accuracy in the Era of Electronic Health Records: Addressing the Elephant in the Room.

Accurate prediction of operating room (OR) time is critical for effective utilization of resources, optimal staffing, and reduced costs. Currently, electronic health record (EHR) systems aid OR scheduling by predicting OR time for a specific surgeon and operation. On many occasions, the predicted OR time is subject to manipulation by surgeons during scheduling. We aimed to address the use of the EHR for OR scheduling and the impact of manipulations on OR time accuracy. Between April and August 2022, a pilot study was performed in our tertiary center where surgeons in multiple surgical specialties were encouraged toward nonmanipulation for predicted OR time during scheduling. The OR time accuracy within 5months before trial (Group 1) and within the trial period (Group 2) were compared. Accurate cases were defined as cases with total length (wheels-in to wheels-out) within ±30min or ±20% of the scheduled duration if the scheduled time is ≥ or <150min, respectively. The study included single and multiple Current Procedural Terminology code procedures, while procedures involving multiple surgical specialties (combo cases) were excluded. The study included a total of 8,821 operations, 4,243 (Group 1) and 4,578 (Group 2), (p <.001). The percentage of manipulation dropped from 19.8% (Group 1) to 7.6% (Group 2), (p <.001), while scheduling accuracy rose from 41.7% (Group 1) to 47.9% (Group 2), (p =.0001) with a significant reduction of underscheduling percentage (38.7% vs. 31.7%, p =.0001) and without a significant difference in the percentage of overscheduled cases (15% vs. 17%, p =.22). Inaccurate OR hours were reduced by 18% during the trial period (2,383 hr vs. 1,954hr). The utilization of EHR systems for predicting OR time and reducing manipulation by surgeons helps improve OR scheduling accuracy and utilization of OR resources.

Auto-BCS: A Hybrid System for Real-Time Breast Cancer Screening from Pathological Images.

Breast cancer is recognized as a prominent cause of cancer-related mortality among women globally, emphasizing the critical need for early diagnosis resulting improvement in survival rates. Current breast cancer diagnostic procedures depend on manual assessments of pathological images by medical professionals. However, in remote or underserved regions, the scarcity of expert healthcare resources often compromised the diagnostic accuracy. Machine learning holds great promise for early detection, yet existing breast cancer screening algorithms are frequently characterized by significant computational demands, rendering them unsuitable for deployment on low-processing-power mobile devices. In this paper, a real-time automated system "Auto-BCS" is introduced that significantly enhances the efficiency of early breast cancer screening. The system is structured into three distinct phases. In the initial phase, images undergo a pre-processing stage aimed at noise reduction. Subsequently, feature extraction is carried out using a lightweight and optimized deep learning model followed by extreme gradient boosting classifier, strategically employed to optimize the overall performance and prevent overfitting in the deep learning model. The system's performance is gauged through essential metrics, including accuracy, precision, recall, F1 score, and inference time. Comparative evaluations against state-of-the-art algorithms affirm that Auto-BCS outperforms existing models, excelling in both efficiency and processing speed. Computational efficiency is prioritized by Auto-BCS, making it particularly adaptable to low-processing-power mobile devices. Comparative assessments confirm the superior performance of Auto-BCS, signifying its potential to advance breast cancer screening technology.

Assessing media mergers and acquisitions: The power pyramids of regulatory cooperation

Due to the media goods’ dual economic and cultural role, merger and acquisition (M&amp;A) assessments are complex and differ from M&amp;As in other sectors. An additional layer of complexity is added to the assessment when various authorities are involved. An even more complicated matter is when the authorities have different remits. These authorities mostly comprise National Competition Authorities that enforce competition law, focused on economic considerations, and National Regulatory Authorities that enforce and oversee the application of media law, focused not only on setting rules and limitations on the media market but also on considering non-economic elements such as plurality. In certain countries, ministries and government authorities can intervene in these assessments. There have been discussions on the need for cooperation between authorities, however, mostly at the international level. Thus, little is known about the current cooperation procedures at the national level. The article proposes a typology of cooperation at the EU member states level and the United Kingdom and introduces the concept of the ‘power pyramid’ to represent the hierarchical relationships between authorities. Cooperation proves that competition policy and media-specific regulation are intertwined and are complementary. Furthermore, the article shows that having more than one authority assessing media M&amp;As leads to media pluralism being more often explicitly one of the criteria used in the assessments, and thus providing a more holistic approach.

The Effect of a Six-Week Course of Surya Namaskar Practice on Back Flexibility and Lumbar Flexion in Male College Students

Study purpose. The strenuous Surya Namaskar exercise programme has gained considerable popularity among contemporary yoga practitioners. Its special combination of yogic breathing techniques, asanas (postures) and dharana (focused mind concentration) helps to improve flexibility. The aim of this study was to investigate the effectiveness of an original six-week course of Surya Namaskar on back flexibility and lumbar flexion in male college students. Materials and methods. Thirty male college students aged between eighteen and twenty years were randomly assigned to treatment group (Surya Namaskar practice) (n=15) and control group (n=15). The treatment group performed Surya Namaskar practice for six weeks, while the control group did not participate in any treatment other than their regular activities for six weeks. Back flexibility and lumbar flexion of the subjects were assessed at the baseline and after six weeks. Results. Back flexibility and lumbar flexion increased in the treatment group after six weeks of Surya Namaskar practice. Conclusions. The current Surya Namaskar procedure contributes to the kinanthropometric well-being of male college students in terms of back flexibility and lumbar flexion. Surya Namaskar should be included in school and college curriculum because of its numerous physical and physiological benefits.

Ultra-thin CdTe film properties enhancement via eco-friendly MgCl2-assisted thermal treatment

AbstractThe thermal treatment of the CdTe thin film in the presence of CdCl2 is a crucial step in the creation of high-efficiency CdTe-based solar cells. The process influences the grain growth, grain boundary passivation, and doping, including CdTe recrystallization, and promotes to building of the photovoltaic junction. However, toxic Cd2+ ions released by the CdCl2, which is highly soluble in water is a major environmental concern of this process. Also, the price of CdCl2 (about 30 cents/gram) that drives up manufacturing costs is another limitation of the current processs. Finding a non-toxic Cl molecule is therefore currently in high demand and key factor for the thermal treatment of CdTe. In this study, MgCl2 was thoroughly explored as an alternative, non-toxic, and somewhat less expensive chlorine-containing chemical for CdTe thermal treatment. CdTe thin films, approximately 1.0 µm thick, were deposited on a glass substrate at 350 ºC using RF magnetron sputtering, and after deposition, different concentrations of MgCl2 (0.2 M, 0.3 M, 0.4 M, and 0.5 M) mixed with 10% methanol were applied to the films for around 10 s, forming a thin MgCl2 coating, followed by the optimized heat treatment at 400 ºC in a nitrogen–oxygen environment. We found that the thermal treatment of CdTe films using MgCl2 showed improved crystallinity, surface morphology, impurity profiles, and carrier density similar to the conventional CdCl2 process. The sample treated with 0.4 M MgCl2 exhibited the best output as obtained the band gap of nearly 1.46 eV, a refractive index of 2.84, a carrier concentration of 9.81E+15 cm−3, and mobility 35.08 cm2/V-S with a moderate resistivity. Our findings show that MgCl2 could be utilized instead of traditional CdCl2 in the current fabrication procedure, which substantially lowers the environmental hazard with a cost-effective production process of CdTe-assembled solar cells.

Detecting Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder Using Multimodal Time-Frequency Analysis with Machine Learning Using the Electroretinogram from Two Flash Strengths.

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are conditions that similarly alter cognitive functioning ability and challenge the social interaction, attention, and communication skills of affected individuals. Yet these are distinct neurological conditions that can exhibit diverse characteristics which require different management strategies. It is desirable to develop tools to assist with early distinction so that appropriate early interventions and support may be tailored to an individual's specific requirements. The current diagnostic procedures for ASD and ADHD require a multidisciplinary approach and can be lengthy. This study investigated the potential of electroretinogram (ERG), an eye test measuring retinal responses to light, for rapid screening of ASD and ADHD. Previous studies identified differences in ERG amplitude between ASD and ADHD, but this study explored time-frequency analysis (TFS) to capture dynamic changes in the signal. ERG data from 286 subjects (146 control, 94 ASD, 46 ADHD) was analyzed using two TFS techniques. Key features were selected, and machine learning models were trained to classify individuals based on their ERG response. The best model achieved 70% overall accuracy in distinguishing control, ASD, and ADHD groups. The ERG to the stronger flash strength provided better separation and the high frequency dynamics (80-300Hz) were more informative features than lower frequency components. To further improve classification a greater number of different flash strengths may be required along with a discrimination comparison to participants who meet both ASD and ADHD classifications and carry both diagnoses.

Importance to establish and deploy technical management processes to support organizations: A case study

Due to today’s intense competition and rapid changes in the market, organizations must concentrate on their process management to improve their effectiveness to be able to respond quickly. Studies have shown that organizations are not necessarily even aware of the current primary function of technical management (TM) because their internal procedures are not currently modeled. This results in a lack of efficiency in terms of how businesses operate in organizations. This study aims to create internal procedure manuals for the technical support function of a case company and considers how to pinpoint areas for process improvement. Since TM is a part of the case company internally, it has not been able to update its internal procedure charts to reflect this, so cannot show its current roles in the surrounding organization. The methodology of this study is separated into two stages: modeling swim lane diagrams describing the existing state (as-is) of TM processes and then conducting semi-structured interviews with key stakeholders to ascertain their expectations and suggestions for change. Thematic analysis of the interview data and performing a comparison with the current procedure charts are used to determine whether or not TM’s procedures can be strengthened to better assist the surrounding organization. The study concludes that further actions are needed to clarify the role of TM in ways other than in the sub-process task level in the procedure charts of the case company. In addition, TM could conduct further analysis to optimize the case company’s business processes to achieve maximum benefit in the future.

Application of the patient-reported outcome-based postoperative symptom management model in lung cancer: a multicenter randomized controlled trial protocol

IntroductionLung cancer is the most common cancer in China, with the highest mortality rate. Surgery is the primary treatment for early lung cancer. However, patients with lung cancer have a heavy burden of symptoms within 3 months after surgery, which seriously affects their quality of life (QOL). The symptom management model based on the patient-reported outcome (PRO) is considered the best caregiving model. The clinical evidence about the symptom management of lung cancer within 3 months after the operation is very limited. Herein, we propose a randomized controlled trial to evaluate the PRO score-based monitoring and alert system for follow-up on psychological and physiological symptoms of lung cancer patients within 3 months after surgery and further investigate the effect of intervention measures based on this PRO score-based system.Methods and analysisThis multicenter, open-label, randomized, parallel superiority trial will be conducted at four hospitals in China. A total of 440 lung cancer patients will be recruited in this study, who will be randomly assigned to the intervention group or the control group in a ratio of 1:1. Any of the target symptoms reaches the preset threshold (score ≥ 4), the patients will accept the symptom management advices based on the PRO. The patients in the control group will follow the current standard procedure of symptom management. The symptom management system is an electronic management system based on WeChat mini programs. All patients will be evaluated for symptoms through the lung cancer module of the MDASI lung cancer-specific scale on the day before surgery, days 1, 3, 5, and 7 after surgery, and once a week during the 12-week post-discharge period. Simultaneously, the EORTC QLQ-C30 scale will be used to evaluate patients’ quality of life at baseline and the fourth and twelfth week after the surgery. The mean number of symptom threshold events of the intervention and the control groups were compared by t-test, and the changes of PRO were compared by a mixed effect model. The primary endpoint has been set as the 12-week post-discharge period.DiscussionThis study will test the feasibility of the symptom management system based on the mobile social media applet in postoperative caregiving and the efficacy of psychiatrist-assisted treatment and provide evidence in managing the symptoms of patients in the medium and long term.Trials registrationTrials registration number: ChiCTR 2200058876, Registered 18 April 2022

Leave it Alone: Ulnar Nerve Management in Distal Humerus Fracture Fixation – A Large Database Study

ABSTRACT Objectives: To determine the impact of intra-operative ulnar nerve manipulation during distal humerus open reduction internal fixation (ORIF) on post-operative ulnar neuritis. Methods: This study was a retrospective cohort analysis using the PearlDiver Mariner Database. Patients undergoing ORIF of distal humerus fractures were identified using Current Procedure Terminology (CPT) codes. Concurrent ulnar nerve transposition, neuroplasty, or neurolysis was defined using CPT-64718, occurring on the same day as the index procedure. Patients with pre-existing ulnar neuropathy within one year prior to the index procedure were excluded. The incidence of delayed ulnar neuropathy, occurring at least 2 weeks post-operatively, was compared at 3, 6, 9, and 12 months. Multivariable logistic regression models were employed to evaluate the association between ulnar nerve transposition, neuroplasty, or neurolysis and the development of delayed ulnar neuropathy, adjusting for the effects of age, sex, insurance type, and Elixhauser comorbidity index. Results: 16,881 patients who underwent distal humerus ORIF were identified, of which 2,016 (11.9%) received concurrent ulnar nerve transposition, neuroplasty, or neurolysis. The cohorts differed by age and insurance type (p&lt;0.001). Ulnar neuropathy between 2 weeks and 1 year occurred in 191/2,016 (9.5%) patients who received ulnar nerve transposition, neuroplasty, or neurolysis and 742/14,865 (5.0%) patients who did not (p &lt; 0.001). Ulnar nerve transposition, neuroplasty, or neurolysis was associated with increased odds of delayed ulnar neuropathy at all time points (p&lt;0.001). Conclusion: Ulnar nerve transposition, neuroplasty, or neurolysis at the time of distal humerus ORIF was associated with an increased incidence of delayed post-operative ulnar neuritis.

Alternative Evacuation Procedures and Smart Devices’ Impact Assessment for Large Passenger Vessels under Severe Weather Conditions

Within the expansive domain of maritime safety, optimizing evacuation procedures stands as a critical endeavour. After all, evacuation is literally the last and fundamental safety level afforded to mariners and passengers. Recent incidents have rekindled interest in assessing the performance of this ultimate safety barrier. However, addressing evacuability requires a holistic approach. The authors present herein the setup, simulation, and ultimately evaluation of a novel approach and its ability to rigorously assess multiple innovative risk-control options in a challenging, realistic setting. Moreover, its benchmarking against conventional regulation-dictated evacuation processes is captured distinctively along with the relative effectiveness of each proposed measure. Such measures include smart technologies and procedural changes that can result in substantial improvements to the current procedures. These will impact the ongoing discourse on maritime safety by providing insights for policymakers, vessel operators, emergency planners, etc., and emphasize the need for further research and development efforts to fortify the industry against evolving safety challenges.

Estimation for vector autoregressive model under multivariate skew-t-normal innovations

Current procedures for estimating the parameters of [Formula: see text]th order vector autoregressive (VAR [Formula: see text]) model are usually based on assuming that the ensuing error distribution is multivariate normal. But there exists large body of evidence that several data encountered in real life are skewed; thereby making estimators derived based on normality assumption not suitable in such scenarios. This prompts for the search of appropriate methods for skewed distributions. Therefore, this article proposes estimators for the mean and covariance matrices of the [Formula: see text] model under multivariate skew- [Formula: see text]-normal (MSTN) distribution. Also, estimators for the shape and skewness parameters are provided. The expectation conditional maximization (ECM) and its extension the expectation conditional maximization either (ECME) algorithms are the tools used to derive the estimators. The performance of the estimators were examined through extensive simulations, and results show that they compete favourably with other numerical methods especially when the underlying distribution is skewed. The usefulness of our estimators was illustrated using a real data set on some US economic indicators. The VAR [Formula: see text] model under MSTN distribution provides a good fit, better than [Formula: see text] model under the assumption of normality.

The Scope of Risk Management Policies and Practices Within Collegiate Recreational Sports: Reinvigorating the Conversation

Risk management is an essential component of effective campus recreational sport programming. However, research on risk management policies, procedures, and practices within recreational sports is both limited and outdated. As such, this study provides an overview of current risk management policies, procedures, and practices across North American collegiate recreational sports departments. Specifically, the results emphasize current training practices for both part-time and full-time staff, practices in establishing and updating emergency action plans, and contents covered in emergency action plans. The results suggest that while the vast majority of recreational sport programs have established risk management procedures and engage in risk management training, they diverge in best practices related to emergency action plans and in terms of contents covered in such plans. Applications of these results for practitioners and institutions are emphasized, including discussions around best practices in risk management.

Combination of Superficial Keratectomy, Ethylenediaminetetraacetic (EDTA), and Amniotic Membrane Transplantation as A Treatment of Band keratopathy: A Case Report

Introduction : Band keratopathy is a degeneration of the cornea characterized by the presence of opacity, which isa deposit of calcium hydroxyapatite. These calcium deposits can be removed in several ways, including using ethylenediaminetetraacetic (EDTA), superficial keratectomy, or phototherapy keratectomy.&#x0D; Case Illustration : A 29-year-old male patient came with complaints of blurry vision in the right eye since 2-3 years ago, accompanied by the middle part of both eyes looking white, especially the right eye, since 17 years ago. The examination revealed a band keratopathy in the nasal to temporal region with neovascularization in the right eye, and keratopathy bands in the nasal and temporal parts, as wellas a cloudy lens in the right eye (Figure 1). Patients received treatment that included a combination of superficial keratectomy, administration of EDTA, and amniotic membrane transplantation (Figure 2). After the procedure, the clarity of the cornea improves (Figure 3). The patient was scheduled to undergo cataract surgery on his right eye.&#x0D; Discussion : Band keratopathy is a degenerative condition of the cornea characterized by grayish-white hazy deposits in the superficial layers of the cornea, primarily affecting Bowman's layer. In the treatment of individuals with symptomatic band keratopathy, chelation with EDTA, superficial keratectomy, laser keratectomy for phototherapy, or combining current procedures are the most often utilized therapeutic approaches.&#x0D; Conclusion : The combination of surgical management in cases of band keratopathy is expected to remove deposits on the cornea, improve the ocular surface, and reduce recurrences.

Toward an application of automatic evaluation system for central facial palsy using two simple evaluation indices in emergency medicine

A stroke is a medical emergency and thus requires immediate treatment. Paramedics should accurately assess suspected stroke patients and promptly transport them to a hospital with stroke care facilities; however, current assessment procedures rely on subjective visual assessment. We aim to develop an automatic evaluation system for central facial palsy (CFP) that uses RGB cameras installed in an ambulance. This paper presents two evaluation indices, namely the symmetry of mouth movement and the difference in mouth shape, respectively, extracted from video frames. These evaluation indices allow us to quantitatively evaluate the degree of facial palsy. A classification model based on these indices can discriminate patients with CFP. The results of experiments using our dataset show that the values of the two evaluation indices are significantly different between healthy subjects and CFP patients. Furthermore, our classification model achieved an area under the curve of 0.847. This study demonstrates that the proposed automatic evaluation system has great potential for quantitatively assessing CFP patients based on two evaluation indices.

Survey of evaluation policies and procedures in clinical neuropsychology postdoctoral fellowship programs

Objective The objectives of this study were to examine current procedures that are used to evaluate competency development in clinical neuropsychology at the postdoctoral level and to investigate policies and procedures for the management of performance that is below expectations during the postdoctoral fellowship. Method Clinical neuropsychology fellowship program directors were invited via email with multiple reminders to participate in an online survey between 1/26/2023 and 3/31/2023. Results Most programs administer a competency-based written evaluation of fellow performance (92%) and have a written policy for managing performance that is below expectations (86%). However, greater variability was reported regarding the use of other evaluation tools, including fellow self-assessments (46% of programs), program evaluations (57% of programs), supervisor evaluations (73% of programs), and exit interviews (82% of programs). Moreover, there was variability between programs with regard to the specific competencies that were measured and how performance that is below expectations is managed. Conclusions Competency-based evaluations and clear, written policies and procedures for management of performance that is below expectations are recommended. Such tools and policies provide clear expectations for fellowship outcomes, promote regular communication between fellows and supervisors, foster early identification of gaps in training, facilitate program quality improvement, and increase opportunities to support and intervene during the course of fellowship training.

Topographically and Chemically Enhanced Textile Polycaprolactone Scaffolds for Tendon and Ligament Tissue Engineering.

The use of tissue engineering to address the shortcomings of current procedures for tendons and ligaments is promising, but it requires a suitable scaffold that meets various mechanical, degradation-related, scalability-related, and biological requirements. Macroporous textile scaffolds made from appropriate fiber material have the potential to fulfill the first three requirements. This study aimed to investigate the biocompatibility, sterilizability, and functionalizability of a multilayer braided scaffold. These macroporous scaffolds with dimensions similar to those of the human anterior cruciate ligament consist of fibers with appropriate tensile strength and degradation behavior melt-spun from Polycaprolactone (PCL). Two different cross-sectional geometries resulting in significantly different specific surface areas and morphologies were used at the fiber level, and a Chitosan-graft-PCL (CS-g-PCL) surface modification was applied to the melt-spun substrates for the first time. All scaffolds elicited a positive cell response, and the CS-g-PCL modification provided a platform for incorporating functionalization agents such as drug delivery systems for growth factors, which were successfully released in therapeutically effective quantities. The fiber geometry was found to be a variable that could be manipulated to control the amount released. Therefore, scaled, surface-modified textile scaffolds are a versatile technology that can successfully address the complex requirements of tissue engineering for ligaments and tendons, as well as other structures.

An Exact Approach to the Multi-Compartment Vehicle Routing Problem: The Case of a Fuel Distribution Company

Over the years, the vehicle routing problem has been studied by several authors, creating several extensions, such as the multi-compartment vehicle routing problem. Several studies in the literature have addressed this problem, but few have solved it through exact approaches owing to model convolution. In this way, a mathematical model is proposed for the multi-compartment vehicle routing problem with time windows, in which three types of fuel products are distributed to a set of customers using a limited homogeneous fleet. The model explicitly considers time windows, as well as regulatory rest times for the drivers and time limits for each trip and for working schedules, addressing a real company’s decision support requirements, which is scarce in the literature. The optimal solution determines, for each vehicle, the distribution route and time to carry out the deliveries with the corresponding loading of products to compartments, complemented by the calculation of carbon emissions. The main objective is to minimize the total distance traveled, which corresponds to the sum of the distances traveled by each one of the allocated vehicles. The results allow the assessment of the solution optimization applied to a set of instances for a Portuguese company to evaluate the performance and compare decision support improvements with current baseline company procedures.

A timely efficient and emissions-aware multiobjective truck-sharing integrated scheduling model in container terminals

In line with the development of green port terminals and the necessity of environmentally friendly efficient use of handling and transportation equipment, criteria such as emission reduction, energy minimization, and efficiency in a container terminal are prominent issues, which in recent years, have been the main concern of container terminal managers in developing terminal operating systems. Therefore, in this study, a bi-objective mixed integer mathematical programing model of integrated scheduling for ships’ loading and unloading operation sequencing in container terminals is proposed, which considers the minimization of containers’ flow time, trucks’ emission, and energy consumption as well as sharing trucks among quay cranes and decreasing their empty trips. In this model trucks’ technical specifications and polluting levels are input parameters for estimating emission and energy consumption of operation, which consequently leads to two uniform parallel machine scheduling models. To derive the exact solution of the model, the epsilon-constraint method is applied. Nevertheless, due to the problem’s NP-hardness attribute, two variants of non-dominated sorting genetic algorithm and multiobjective particle swarm optimization metaheuristic algorithms are proposed to identify the approximate Pareto front of solutions. In large-size problems, these algorithms outperform the epsilon-constraint method by finding acceptable results in a reasonable time. This model, which could be embedded in terminal operating software, not only yields a practical optimum operational sequence but also measures the amount of energy and emission from trucks during loading and unloading operations. The results, which utilized the data collected from Shahid Rajaee port in southern Iran, indicate that this practical model as compared to the current procedure in the terminal, results in a significant improvement in energy and emission reduction and terminal flow time.

How I do it: dual operation channels percutaneous endoscopic far-lateral transforaminal lumbar interbody fusion

BackgroundThe current surgical procedure of interbody fusion in the lumbar spine has several limitations including low efficiency, potential endplate damage, overdose radiation exposure, and failure of fusion.MethodsThrough the endoscopic operating channel, we efficiently removed the superior and inferior articular processes and decompressed the ligamentum flavum. Another operating channel was established under endoscopic monitoring to excise the annulus fibrosus, remove the cartilaginous endplate using open instruments, perform interbody bone grafting, and place a non-expandable polyetheretherketone open surgical fusion cage.ConclusionLumbar interbody fusion was performed successfully using a far-lateral transforaminal approach combined with dual operation channels of percutaneous endoscopic-assisted technique.