Level Fusion Research Articles

Risk Factors and Characteristics of In-Hospital Falls After Spine Surgery: A Retrospective, Single-Center Cohort Study in the Republic of Korea.

Falls after orthopaedic surgery can cause serious injuries, which lengthen hospital stays and increase medical expenses. This has prompted hospitals to implement various fall-prevention protocols. The aims of this study were to determine the incidence of in-hospital falls after spine surgery, to analyze the overall risk factors, to discern factors that have a major influence on falls, and to evaluate the effectiveness of the fall-prevention protocol that we implemented. This was a retrospective, single-center study including patients who underwent spine surgery from January 2011 to November 2021 at the National Health Insurance Service Ilsan Hospital (NHISIH) in Goyang, Republic of Korea. Reported falls among these patients were examined. Patient demographics; surgery type, date, and diagnosis; and fall date and time were evaluated. Overall, 5,317 spine surgeries were performed, and 128 in-hospital falls were reported (overall incidence: 2.31%). From the multivariable analyses, older age and American Society of Anesthesiologists (ASA) score were identified as independent risk factors for in-hospital patient falls (multivariable adjusted hazard ratio [aHR] for age 70 to 79 years, 1.021 [95% confidence interval (CI), 1.01 to 1.031]; for age ≥80 years, 1.035 [1.01 to 1.06]; and for ASA score of 3, 1.02 [1.01 to 1.031]). Similar results were seen in the subgroup who underwent primary surgery. Within 2 weeks following surgery, the highest frequency of falls occurred at 3 to 7 days postoperatively. The lowest fall rate was observed in the evening (6 to 10 p.m.). Morbidities, including rib, spine, and extremity fractures, were recorded for 14 patients, but none of these patients underwent operative treatment related to the fall. The NHISIH implemented a comprehensive nursing care service in May 2015 and a fall protocol in May 2017, but the annual incidence rate did not improve. The fall rate was higher after thoracolumbar surgeries (2.47%) than after cervical surgeries (1.20%). Moreover, a higher fall rate was observed in thoracolumbar cases with a greater number of fusion levels and revision spine surgeries. Patients with advanced age, more comorbidities, a greater number of fusion levels, and revision surgeries and who are female are more vulnerable to in-hospital falls after spine surgery. Novel strategies that target these risk factors are warranted. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Radiographic Fusion Outcomes for Trinity Cellular Based Allograft versus Local Bone in Posterolateral Lumbar Fusion.

Cellular-based autograft (CBA) is being used in posterolateral lumbar arthrodesis as a fusion supplementation alternative. To assess radiographic fusion in patients undergoing posterolateral lumbar fusion with unilateral Trinity CBA compared with contralateral local bone autograft as an internal control. A single surgeon's practice database was interrogated for consecutive patients undergoing primary posterolateral lumbar fusion with Trinity from 2018 to 2021. Patients had Trinity applied unilaterally, with local bone autograft applied contralaterally. Fusion was assessed postoperatively by using CT after 9 months. Demographics and patient-reported outcome measures were collected preoperatively and up to 12 months postoperatively. Thirty-nine patients were included. There were 81 attempted fusion levels. Overall fusion rate, defined as bony bridging on at least one side of a given level for all levels fused, was 85.2% of patients. No statistically significant difference was observed in fusion rates between CBA versus local bone (79.0% versus 76.54% of levels attempted, respectively, P = 0.3527). Oswestry Disability Index improved by 3 months (P = 0.0152) and was maintained. Two patients required revision for symptomatic nonunion. Similar radiographic fusion rates were achieved with Trinity and local bone. Trinity is a viable alternative to local bone in posterolateral lumbar fusion.

Could the different surgical goals of fusion and non-fusion also be achieved in combination within the same patient? Clinical and radiological outcome of hybrid cervical spine surgery.

Hybrid cervical spine surgery (HS) is a novel surgical strategy wherein an artificial disc replacement is done with a cervical fusion nearby with a stand-alone titanium cage to combine the advantages in both procedures. The aim of this study was to evaluate interactions of these devices within the same patient, and to analyze, if the different goal of each implant is accomplished. Thirty-six patients were treated surgically within a non-randomized retrospective study framework with HS. Patients were examined preoperatively followed by clinical and radiological examination at least one year postoperative. Clinical outcome was detected with NDI, VAS arm/neck, pain self-assessment questionnaires and subjective patient satisfaction. Radiological assessments included RoM, segmental lordosis, cervical lordosis of C2-C7, subsidence, ap-migration and heterotopic ossifications (HO) at the cTDR levels. Statistically significant improvement of all clinical scores was observed (NDI 37.5 to 5.76; VASarm 6.41 to 0.69; VASneck 6.78 to 1.48). Adequate RoM was achieved at cTDR levels. RoM in the ACDF levels was reduced statistically significant (p < 0.001), and solid fusion (> 2°) was achieved in all evaluated fusion level. Global lordosis (C2-C7) increased statistically significant (2.4° to 8.1°). Subsidence and HO at the cTDR levels did not occur. HS results in preservation of the segmental motion in the cTDR and fast and solid fusion in the cage cohort simultaneously. Patient safety was proven. In carefully selected cases, HS is a safe and viable treatment option by choosing the right "philosophy" level per level.

Gender Classification through Fusion of Holistic and Region-based Facial Patterns

In this study, a robust gender prediction system is proposed to fuse global and regional facial representations through score and feature level fusion. In order to extract facial features for gender classification, Binarized Statistical Image Features (BSIF) approach is applied on holistic and regional features of face images. The extracted features are then concatenated to combine the region-based information at feature level fusion. Then the optimized sub-set of features is selected using Particle Swarm Optimization (PSO) method. Finally, the holistic and regional features are combined at score level fusion to produce the final set of scores for gender classification. This study applies Weighted Sum (WS) rule strategy for score level fusion. The experimental results are performed on Multiple Biometric Grand Challenge (MBGC) and CASIA-Iris-Distance databases with consideration of subject-disjoint training and testing evaluation to testify the validity of the proposed gender classification system. The experimental results of the study demonstrate the success of the proposed scheme for gender prediction.

Preoperative Robotics Planning Facilitates Complex Construct Design in Robot-Assisted Minimally Invasive Adult Spinal Deformity Surgery-A Preliminary Experience.

(1) Background: The correction of adult spinal deformity (ASD) can require long, complex constructs with multiple rods which traverse important biomechanical levels to achieve multi-pelvic fixation. Minimally invasive (MIS) placement of these constructs has historically been difficult. Advanced technologies such as spinal robotics platforms can facilitate the design and placement of these constructs and further enable these surgical approaches in MIS deformity surgery. (2) Methods: A retrospective study was performed on a series of ASD patients undergoing MIS deformity correction with ≥eight fusion levels to the lower thoracic spine with preoperative robotic construct planning and robot-assisted pedicle screw placement. (3) Results: There were 12 patients (10 female, mean age 68.6 years) with a diagnosis of either degenerative scoliosis (8 patients) or sagittal imbalance (4 patients). All underwent preoperative robotic planning to assist in MIS robot-assisted percutaneous or transfascial placement of pedicle and iliac screws with multiple-rod constructs. Mean operative values per patient were 9.9 levels instrumented (range 8-11), 3.9 interbody cages (range 2-6), 3.3 iliac fixation points (range 2-4), 3.3 rods (range 2-4), 18.7 screws (range 13-24), estimated blood loss 254 cc (range 150-350 cc), and operative time 347 min (range 242-442 min). All patients showed improvement in radiographic sagittal, and, if applicable, coronal parameters. Mean length of stay was 5.8 days with no ICU admissions. Ten patients ambulated on POD 1 or 2. Of 224 screws placed minimally invasively, four breaches were identified on intraoperative CT and repositioned (three lateral, one medial) for a robot-assisted screw accuracy of 98.2%. (4) Conclusions: Minimally invasive long-segment fixation for adult spinal deformity surgery has historically been considered laborious and technically intensive. Preoperative robotics planning facilitates the design and placement of even complex multi-rod multi-pelvic fixation for MIS deformity surgery.

Surgery for Spinal Deformities in Patients with Osteoporosis — A Secondary Publication

Objective: This review aims to present relevant considerations for the surgical treatment of spinal deformities accompanied by osteoporosis, how surgeons are trying to overcome the challenges posed by osteoporosis in patients with spinal deformities, and directions for further development. Summary of literature review: Various trials have been carried out to overcome the short- and long-term complications associated with osteoporosis in order to achieve successful clinical results in the surgical treatment of spinal deformities. Methods: A comprehensive review of relevant articles was conducted. Results: The surgical goal of treating spinal deformities is to reverse neurological compromise and restore balanced spine alignment. To achieve these goals, several surgical considerations should be kept in mind. Osteoporosis is an important issue related to early and long-term complications following surgery. Methods of overcoming the challenges posed by osteoporosis such as rigid fixation techniques, proper selection of the fusion levels, perioperative medical treatment, and effective bone grafting materials are described herein; however, further development in these areas is also necessary. Conclusions: Osteoporosis may be a major obstacle in spinal deformity surgery. Although several effective attempts have been made to overcome these limitations, further research and trials are necessary to obtain better results.

Exploring the personality and relationship factors that mediate the connection between differentiation of self and phubbing

One of the family patterns crucial for mental and physical well-being is differentiation of self. In this study, our aim was to investigate its impact on the phenomenon of phubbing—where individuals prioritize smartphones over in-person interactions. The prevalence of phubbing behavior has risen substantially in tandem with the increased adoption of smartphones. The study investigated familial, interpersonal, and personal factors that could potentially contribute to the escalation of phubbing behaviors. It was hypothesized that differentiation of self would be associated with phubbing through the mediation of fear of missing out, romantic relationship satisfaction, and loneliness in intimate relationships. We also expected gender differences in the study variables. A sample of 431 young adults, with an average age of 29 (M = 29.05, SD = 9.14), completed the DSI-R, Phubbing, FoMO, ENRICH, and LIRS questionnaires online. Results indicated that fear of missing out mediated the relationship between three dimensions of differentiation of self—emotional reactivity, emotional cutoff, and fusion with others—and phubbing behavior. However, the expected mediation by romantic relationship satisfaction and loneliness in intimate relationships did not reach significance, although these variables were found to be associated with differentiation of self. Women reported higher levels of phubbing behavior, emotional reactivity, and fusion with others, whereas men reported higher levels of I-position. We conclude that fear of missing out may serve as a catalyst, triggering anxiety in individuals, which in turn drives them to adopt phubbing as a coping mechanism. Moreover, individuals with lower levels of differentiation of self appear to be at increased risk of engaging in phubbing behaviors through the mediation of fear of missing out.

Return to Activities of Daily Living After Fusion to the Pelvis for Adult Spinal Deformity

Study Design: Cross-sectional survey and retrospective review of prospectively-collected data. Objective: To investigate return to activities among adult spinal deformity (ASD) patients following long-segment fusion to the pelvis. Summary of Background Data: No prior studies have assessed the extent and timing of return to employment, driving, and walking among a single cohort of ASD patients. Methods: Patients who underwent thoracolumbar ASD surgery between 2016-2021 with ≥1 year follow-up were included (posterior-only, ≥3 levels of fusion to pelvis). A cross-sectional survey was implemented to evaluate preoperative and postoperative activity tolerance. Patients were categorized into (1)Better/Unchanged or (2)Worse groups based on their postoperative activity tolerance to allow for comparison of demographics and perioperative variables. Results: Ninety-five patients were included (mean age:64.3±10.1 years; body mass index (BMI):27.3±6.1 kg/m2; levels fused:8 [range 3-16]; follow-up:43.5 months). Most patients endorsed improved capacity to walk (improved:64.2%, unchanged:17.9%, worse:17.9%) and navigate stairs (improved:52.6%, unchanged:33.7%, worse:13.7%) postoperatively. Seventy-five (97.4%) patients returned to driving (4.1±10.8 months) and 44 (88.0%) patients returned to work (5.4±8.0 months). Patients with decreased walking tolerance were more likely to have greater lumbar lordosis correction (37.2±10.5° vs. 18.6±16.7°, P=0.02) and worse Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) at long-term follow-up (40.2±11.0 vs. 48.0±9.6, P=0.03). Patients with decreased ability to navigate stairs were more likely to have undergone revision fusion (69.2% vs. 28.0%, P=0.003) and have greater BMI (30.7±5.8 vs. 26.7±6.0 kg/m2, P=0.04). Patients requiring the use of a postoperative assistive walking device were more likely to have undergone revision fusion (66.7% vs. 27.5%, P=0.003), exhibit greater BMI (31.4±7.2 vs. 26.5±5.6 kg/m2, P=0.004), longer operative times (285.1±79.9 vs. 244.5±63.4 minutes, P=0.03), and worse PROMIS-PF at long-term follow-up (39.9±5.1 vs. 47.7±10.5, P=0.04). Conclusion: Despite the reduced range of motion caused by spinopelvic fusion, a majority of patients are able to successfully return to ADLs after deformity surgery.

Novel criteria for silicone rubber insulators condition monitoring based on leakage current analysis: Considering asymmetric aging and pollution

Insulators' flashover due to pollution is the biggest challenge of power systems. This phenomenon will become more intense with the aging of the insulator. Precise and prompt determination of the severity of pollution and the insulator status in terms of aging is essential for preventing pollution flashovers. Therefor monitoring insulator leakage current is essential for preventing the pollution flashover phenomenon. This article proposes innovative criteria based on the insulator's leakage current analysis for the classification of aging and pollution severity. The leakage current signal of the virgin, fully aged, and asymmetric aged insulators have been examined under different pollution conditions. Based on the experimental results analysis, two new criteria have been proposed for assessing the silicon rubber insulator condition which have resulted from the first-order harmonic of leakage current (It1), the third and fifth-order harmonics ratio of leakage current (It3/5), and the cosine of first-order harmonic phase angle (PI). Analyzing the proposed criteria demonstrates that two proposed criteria have a strong correlation to aging and pollution, respectively. These two new criteria can be implemented to identify the early signs of pollution and aging of insulators. The ability of proposed criteria has been established based on random forest, support vector machine, decision tree algorithm, multi-layer perceptron, and decision-making level fusion in Python language. The obtained criteria based on experimental data in different conditions have been employed for classifier training which can be applied in industrial settings without the need for laborious data labeling, ensuring fast and accurate outcomes.

A novel feature-level fusion scheme with multimodal attention CNN for heart sound classification

Background and objectiveMost of the existing machine learning-based heart sound classification methods achieve limited accuracy. Since they primarily depend on single domain feature information and tend to focus equally on each part of the signal rather than employing a selective attention mechanism. In addition, they fail to exploit convolutional neural network (CNN) - based features with an effective fusion strategy. MethodsIn order to overcome these limitations, a novel multimodal attention convolutional neural network (MACNN) with a feature-level fusion strategy, in which Mel-cepstral domain as well as general frequency domain features are incorporated to increase the diversity of the features, is proposed in this paper. In the proposed method, DilationAttenNet is first utilized to construct attention-based CNN feature extractors and then these feature extractors are jointly optimized in MACNN at the feature-level. The attention mechanism aims to suppress irrelevant information and focus on crucial diverse features extracted from the CNN. ResultsExtensive experiments are carried out to study the efficacy of the feature level fusion in comparison to that with early fusion. The results show that the proposed MACNN method significantly outperforms the state-of-the-art approaches in terms of accuracy and score for the two publicly available Github and Physionet datasets. ConclusionThe findings of our experiments demonstrated the high performance for heart sound classification based on the proposed MACNN, and hence have potential clinical usefulness in the identification of heart diseases. This technique can assist cardiologists and researchers in the design and development of heart sound classification methods.

Radiology Reports Do Not Accurately Portray the Severity of Cervical Neural Foraminal Stenosis.

Retrospective study. (1) To compare cervical magnetic resonance imaging (MRI) radiology reports to a validated grading system for cervical foraminal stenosis (FS) and (2) to evaluate whether the severity of cervical neural FS on MRI correlates to motor weakness or patient-reported outcomes. Radiology reports of cervical spine MRI are often reviewed to assess the degree of neural FS. However, research looking at the association between these reports and objective MRI findings, as well as clinical symptoms, is lacking. We retrospectively identified all adult patients undergoing primary 1 or 2-level anterior cervical discectomy and fusion at a single academic center for an indication of cervical radiculopathy. Preoperative MRI was assessed for neural FS severity using the grading system described by Kim and colleagues for each level of fusion, as well as adjacent levels. Neural FS severity was recorded from diagnostic radiologist MRI reports. Motor weakness was defined as an examination grade <4/5 on the final preoperative encounter. Regression analysis was conducted to evaluate whether the degree of FS by either classification was related to patient-reported outcome measure severity. A total of 283 patients were included in the study, and 998 total levels were assessed. There were significant differences between the MRI grading system and the assessment by radio-logists ( P < 0.001). In levels with moderate stenosis, 28.9% were classified as having no stenosis by radiology. In levels with severe stenosis, 29.7% were classified as having mild-moderate stenosis or less. Motor weakness was found similarly often in levels of moderate or severe stenosis (6.9% and 9.2%, respectively). On regression analysis, no associations were found between baseline patient-reported outcome measures and stenosis severity assessed by radiologists or MRI grading systems. Radiology reports on the severity of cervical neural FS are not consistent with a validated MRI grading system. These radiology reports underestimated the severity of neural foraminal compression and may be inappropriate when used for clinical decision-making. Level III.

Integration of ultrasound and mammogram for multimodal classification of breast cancer using hybrid residual neural network and machine learning

Breast cancer (BC) is one of the topmost causes of mortality in women all over the world. Early detection and classification of the tumor allow proper treatment of patients and chances of survival. In this article, we propose a hybrid residual neural network (ResNet) and machine learning framework and integrate the features of both mammography (MG) and ultrasound (US) images to perform the multimodal classification of BC images as benign or malignant. The features are extracted automatically from the input images of each modality using the residual neural network from the average pooling layer. Next, the feature level fusion is carried out to obtain a feature vector by combining features of MG & US. Finally, the multimodal classification is performed using the support vector machine (SVM) as a classifier. Experiments are performed on a real-time dataset collected from patients who have undergone both MG and US examinations. The classification accuracy obtained for the multimodal approach with SVM is 99.22%, which is higher than unimodal systems. Results show that the proposed multimodal approach performs better in classifying breast tumors than unimodal mammogram and ultrasound systems.

Functional Characteristics and Coping Strategies among Rugby Athletes: A Cluster Analysis Approach.

The developing domain of mental health in sports has gained much interest, acknowledging its pivotal role in athlete performance and well-being. The aim of this research is to provide a quantitative description concerning the levels of mental health, physical activity, cognitive fusion, cognitive flexibility, and coping strategies that characterize rugby athletes by using a data-driven approach. A total of 92 rugby athletes took part in this study and filled out a set of self-administered questionnaires. A correlational analysis showed that general well-being was positively associated with years spent playing rugby (r = 0.23) and coping mechanisms (r = 0.29). Athletes' well-being was also negatively correlated with cognitive inflexibility (r = -0.41) and cognitive fusion (r = -0.39). A k-means cluster analysis identified two unique groups: group 1, characterized by higher levels of psychological well-being, lower levels of physical activity, greater cognitive flexibility, improved coping techniques, and reduced cognitive fusion, and group 2, which exhibits opposite characteristics. The discrepancies observed in psychological characteristics such as coping strategies, cognitive fusion, and cognitive inflexibility highlight their potential impact on the general health of rugby players. To comprehend the complex interplay between psychological and physical elements in rugby athletes, long-term studies with larger samples are crucial.

Quantitative evaluation of motion compensation in post-stroke rehabilitation training based on muscle synergy.

Introduction: Stroke is the second leading cause of death globally and a primary factor contributing to disability. Unilateral limb motor impairment caused by stroke is the most common scenario. The bilateral movement pattern plays a crucial role in assisting stroke survivors on the affected side to relearn lost skills. However, motion compensation often lead to decreased coordination between the limbs on both sides. Furthermore, muscle fatigue resulting from imbalanced force exertion on both sides of the limbs can also impact the rehabilitation outcomes. Method: In this study, an assessment method based on muscle synergy indicators was proposed to objectively quantify the impact of motion compensation issues on rehabilitation outcomes. Muscle synergy describes the body's neuromuscular control mechanism, representing the coordinated activation of multiple muscles during movement. 8 post-stroke hemiplegia patients and 8 healthy subjects participated in this study. During hand-cycling tasks with different resistance levels, surface electromyography signals were synchronously collected from these participants before and after fatigue. Additionally, a simulated compensation experiment was set up for healthy participants to mimic various hemiparetic states observed in patients. Results and discussion: Synergy symmetry and synergy fusion were chosen as potential indicators for assessing motion compensation. The experimental results indicate significant differences in synergy symmetry and fusion levels between the healthy control group and the patient group (p ≤ 0.05), as well as between the healthy control group and the compensation group. Moreover, the analysis across different resistance levels showed no significant variations in the assessed indicators (p > 0.05), suggesting the utility of synergy symmetry and fusion indicators for the quantitative evaluation of compensation behaviors. Although muscle fatigue did not significantly alter the symmetry and fusion levels of bilateral synergies (p > 0.05), it did reduce the synergy repeatability across adjacent movement cycles, compromising movement stability and hindering patient recovery. Based on synergy symmetry and fusion indicators, the degree of bilateral motion compensation in patients can be quantitatively assessed, providing personalized recommendations for rehabilitation training and enhancing its effectiveness.

DIA-Based Proteomic Analysis Reveals MYOZ2 as a Key Protein Affecting Muscle Growth and Development in Hybrid Sheep.

Hybridization of livestock can be used to improve varieties, and different hybrid combinations produce unique breeding effects. In this study, male Southdown and Suffolk sheep were selected to hybridize with female Hu sheep to explore the effects of male parentage on muscle growth and the development of offspring. Using data-independent acquisition technology, we identified 119, 187, and 26 differentially abundant proteins (DAPs) between Hu × Hu (HH) versus Southdown × Hu (NH), HH versus Suffolk × Hu (SH), and NH versus SH crosses. Two DAPs, MYOZ2 and MYOM3, were common to the three hybrid groups and were mainly enriched in muscle growth and development-related pathways. At the myoblast proliferation stage, MYOZ2 expression decreased cell viability and inhibited proliferation. At the myoblast differentiation stage, MYOZ2 expression promoted myoblast fusion and enhanced the level of cell fusion. These findings provide new insights into the key proteins and metabolic pathways involved in the effect of male parentage on muscle growth and the development of hybrid offspring in sheep.

Clinical and Radiographic Outcomes of Anterior Lumbar Interbody Fusion With Anterior Plate Fixation.

Reports on the outcomes following instrumented anterior lumbar interbody fusion (ALIF) with anterior plate fixation are limited. The aim of this study was to assess the clinical and radiographic outcomes of patients undergoing ALIF with anterior plate fixation. Methods: Medical records and radiographic imaging were reviewed for 100 patients who received ALIF with anterior plate fixation between 2008 to 2021 and completed at least one year of follow-up and postoperative imaging. Prospectively collected patient data included indication for surgery, BMI, age, number and location of levels treated, complications, reoperation rates, fusion rate, and measurements of global lordosis, disc space height, and segmental angulation. Results: A total of 100 patients were included in this study. The mean length of follow-up was 81.37 months. Changes in preoperative-to-postoperative Oswestry Disability Index (ODI) and Visual Analog Score (VAS) demonstrated improvements of 30.86% and 18.56%, respectively. Major vascular injuries occurred in 3% of the cases. A hardware failure rate of 5% was observed. The reoperation rate was 10%. The radiographic fusion rate derived from computed tomography (CT) and plain film was 95.45% and 88.87%, respectively. Postoperative global lordosis demonstrated a 6.08% increase. Postoperative segmental angulation measurements increased by 57.74%. No statistically significant differences in clinical or radiographic outcomes were observed based on the spine level of fusion or the number of fusions performed. Conclusions: ALIF with anterior plate fixation achieved an adequate fusion rate with improvements in ODI and VAS scores meeting minimal clinically important difference thresholds. Postoperative disc space heights demonstrated significant improvements compared to preoperative measurements.

Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis.

The objective of this meta-analysis was to determine the incidence of disc degeneration in patients with surgically treated adolescent idiopathic scoliosis (AIS) and identify the associated risk factors. PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched. The outcomes of interest were the incidence of disc degeneration, SRS-22, and radiological risk factors. The lower instrumented vertebra (LIV) was also evaluated. Fixed effects were used if there was no evidence of heterogeneity. Statistical analysis was performed using Review Manager. A meta-analysis was conducted including nine studies with a total of 565 patients. The analysis revealed that the global incidence of intervertebral disc degeneration in patients with surgically treated AIS patients was 24.78% (95% CI 16.59-32.98%) 10years after surgery, which significantly increased to 32.32% (95% CI 21.16-43.47% at an average of 13.8years after surgery. Among patients with significant degenerative disc changes, the SRS-22 functional, self-image, and satisfaction domains showed significantly worse results (MD - 0.25, 95% CI - 0.44 to - 0.05; MD - 0.50, 95% CI - 0.75 to - 0.25; and MD - 0.34, 95% CI - 0.66 to - 0.03, respectively). Furthermore, instrumentation at or above the L3 level was associated with a lower incidence of intervertebral disc degeneration compared to instrumentation below the L3 level (OR 0.25, 95% CI 0.10-0.64). It was also found that the preoperative and final follow-up lumbar curve magnitudes (MD 8.11, 95% CI 3.82-12.41) as well as preoperative and final follow-up lumbar lordosis (MD 0.42, 95% CI - 3.81 to 4.65) were associated with adjacent disc degeneration. This meta-analysis demonstrated that the incidence of intervertebral disc degeneration significantly increased with long-term follow-up using fusion techniques, reaching up to 32% when patients were 28years of age. Incomplete correction of deformity and fusion of levels below L3, were identified as negative prognostic factors. Furthermore, patients with disc degeneration showed worse functional outcomes.

Enhanced multimodal biometric recognition systems based on deep learning and traditional methods in smart environments.

In the field of data security, biometric security is a significant emerging concern. The multimodal biometrics system with enhanced accuracy and detection rate for smart environments is still a significant challenge. The fusion of an electrocardiogram (ECG) signal with a fingerprint is an effective multimodal recognition system. In this work, unimodal and multimodal biometric systems using Convolutional Neural Network (CNN) are conducted and compared with traditional methods using different levels of fusion of fingerprint and ECG signal. This study is concerned with the evaluation of the effectiveness of proposed parallel and sequential multimodal biometric systems with various feature extraction and classification methods. Additionally, the performance of unimodal biometrics of ECG and fingerprint utilizing deep learning and traditional classification technique is examined. The suggested biometric systems were evaluated utilizing ECG (MIT-BIH) and fingerprint (FVC2004) databases. Additional tests are conducted to examine the suggested models with:1) virtual dataset without augmentation (ODB) and 2) virtual dataset with augmentation (VDB). The findings show that the optimum performance of the parallel multimodal achieved 0.96 Area Under the ROC Curve (AUC) and sequential multimodal achieved 0.99 AUC, in comparison to unimodal biometrics which achieved 0.87 and 0.99 AUCs, for the fingerprint and ECG biometrics, respectively. The overall performance of the proposed multimodal biometrics outperformed unimodal biometrics using CNN. Moreover, the performance of the suggested CNN model for ECG signal and sequential multimodal system based on neural network outperformed other systems. Lastly, the performance of the proposed systems is compared with previously existing works.

Association between opioid utilization and patient-reported outcome measures following lumbar spine surgery

BACKGROUND CONTEXTThe patient-reported outcomes measurement information system (PROMIS), created by the National institute of Health, is a reliable and valid survey for patients with lumbar spine pathology. Preoperative opioid use has been shown to be an important predictor variable of self-reported health status in legacy patient-reported outcome measures. PURPOSETo investigate the impact of chronic preoperative opiate use on PROMIS survey scores. STUDY DESIGNRetrospective database analysis. PATIENT SAMPLEBetween March 2019 and November 2021, 227 patients underwent lumbar decompression ± ≤ 2 level fusion. Fifty-seven patients (25.11%) had chronic preoperative opioid use. OUTCOME MEASURESOswestry disability index (ODI) and PROMIS survey scores. METHODSA retrospective analysis of a prospectively maintained single center patient-reported outcome database was performed with a minimum of 2 year follow-up. PROMIS Anxiety, Depression, Fatigue, Pain Interference (PI), Physical Function (PF), Sleep disturbance (SD), and Social Roles (SR) surveys were recorded at preoperative intake with subsequent follow-up at 6, 12, and 24 months postoperatively. Patients were grouped into chronic opioid users as defined by >6-month duration of use. Differences in mean survey scores were evaluated using Welch t-tests. RESULTSTwo hundred and twenty-seven patients met our inclusion criteria of completed PROMIS surveys at the designated timepoints. A total of 57 (25.11%) were chronic opioid users (COU) prior to surgery. Analysis of patient-reported health outcomes shows that long term opioid use correlated with worse ODI and PROMIS scores at baseline compared to nonchronic users (NOU). At 1 and 2 year follow-up, the COU cohort continued to have significantly worse ODI, PROMIS Fatigue, PF, PI, SD, and SR scores. There is a statistical difference in the magnitude of change in health status between the 2 cohorts at 1 year follow-up in PROMIS Depression (-5.04±7.88 vs -2.49±8.73, p=.042), PF (6.25±7.11 vs 9.03±9.04, p=.019), and PI (-7.40±7.37 vs -10.58±9.87, p=.011) and 2 year follow-up in PROMIS PF (5.58±6.84 vs 7.99±9.64, p=.041) and PI (-6.71±8.32 vs -9.62±10.06, p=.032). Mean improvement in PROMIS scores for the COU cohort at 2 year follow-up exceeded minimal clinically important difference (MCID) in all domains except PROMIS Depression, SR and SD. CONCLUSIONPatients with chronic opioid use status have worse baseline PROMIS scores compared with patients who had nonchronic use. However, patients in the COU cohort displayed clinically significant postoperative improvement in multiple PROMIS domains. These results show that patients with chronic opioid use can benefit greatly from surgical intervention and will allow physicians to better set expectations with their patients.

Hirayama’s disease associated with cervical deformity and spinal cord compression: a case report from Sweden

BackgroundHirayama’s disease (HD) is most common in young males, and previous studies are predominantly from Asian countries. The cause of HD is unknown but the most common theory about the pathology speculates on forward bending that causes a compression of the dura mater and the anterior horn of the spinal cord against the vertebra during an overstretch flexion that may result in myelopathy. Both anterior and posterior cervical surgical approaches have been shown to be effective in stopping the disease and improving function; however, HD is also reported to be a self-limited disease, and treatment with a cervical collar may be an alternative for these patients.Case reportWe report HD in a 17-year-old male from Sweden who underwent surgical treatment with a 2 level anterior cervical discectomy and fusion (ACDF) due to neurological progression from HD after conservative treatment.ConclusionHD is rare and is easily overlooked. Surgical intervention shows promising results for neurological progression, but HD is also reported to be a self-limited disease.