Presence Of Instability Research Articles

Can magnetic resonance imaging findings effectively diagnose the instability observed on radiographs in patients with degenerative lumbar spinal stenosis?

BackgroundDegenerative lumbar spinal stenosis (LSS) is a common condition that involves the narrowing of the spinal canal. Diagnosing instability traditionally requires standing lateral radiographs to detect dynamic translation, but there is debate about relying solely on radiographs due to challenges like patient discomfort and radiation exposure. This study aimed to evaluate if Magnetic Resonance Imaging (MRI) findings could effectively diagnose instability observed on radiographs.MethodsWe reviewed 478 consecutive patients with degenerative LSS who had surgery at our institution. Instability was defined as a sagittal translation exceeding 3 mm on standing lateral radiographs in both extension and flexion. Patients were divided into stable (those with < 3 mm translation) and unstable groups (those with > 3 mm translation). The study assessed potential variables for instability, including MRI findings like facet joint effusion, facet joint angle, disk height index, intradiscal vacuum presence, endplate sclerosis, ligamentum flavum hypertrophy, and multifidus muscle fatty degeneration, comparing these factors between the two groups.ResultsA total of 478 consecutive patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS) were included. The average age of the patients was 66.32 years, with 43.3% being male. Approximately 27.6% of the cases exhibited signs of instability on the standing lateral radiograph during extension and flexion. The multivariate analysis using binary logistic regression revealed that facet joint effusion (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.27–3.94; P = 0.002), disk height index (OR 2.22; 95% CI 1.68–3.35; P = 0.009), and the presence of the Vacuum sign (OR 1.77; 95% CI 1.32–2.84; P = 0.021) were identified as factors associated with instability.ConclusionsOur findings showed thata higher facet joint effusion, the presence of Vacuum sign, and a greater Disk Height Index were associated with the presence of instability on the standing lateral radiograph in extension and flexion in patients with degenerative LSS.

Fault root cause analysis using degree of change and mean variable threshold limit in non-linear dynamic distillation column

The chemical industrial processes are both dynamic and complex. The presence of instability and danger in the production process poses significant challenges to safety management. Early and accurate fault diagnosis is essential to ensure a sustainable and stable chemical process performance. Most studies in literature do not provide detailed information about diagnosing the root cause of faults in distillation columns using contribution plots. Using principal component analysis (PCA) in conventional contribution plots leads to a large number of contributing variables, making it difficult to identify the root cause of a specific fault. In this study, the authors suggest employing the Degree of Change of Contribution Values (DCC) and Mean Variable Threshold Limit (LMVT) techniques alongside the Wavelet Transform-Principal Component Analysis (WT-PCA) method to decrease the quantity of fault identification variables in a non-linear system (distillation column). The Aspen Plus software is utilized to perform a dynamic simulation of a distillation column, generating data for both normal and faulty operations. Two distinct types of faults are considered, which include loss of feed flow and feed temperature changes. This study aims to analyze the results obtained from the Hotelling T2 and SPE contribution plots by calculating the average difference between the normal and faulty conditions using the Degree of Change in Contribution Values. This procedure is performed to determine the extent of deviation from the standard state. Subsequently, the variables that have surpassed the threshold limit for means variables (LMVT) are designated as the variables that serve as the primary underlying cause of the fault. The technique was employed in a case study involving a nonlinear distillation column, and the results indicate that only one "dominant" variable intersects the LMVT by Hotelling T2, which represents the true underlying cause of the corresponding fault.

A biomimetic spore nanoplatform for boosting chemodynamic therapy and bacteria-mediated antitumor immunity for synergistic cancer treatment

Bacterial-based antitumor immunity has become a promising strategy to activate the immune system for fighting cancer. However, the potential application of bacterial therapy is hindered by the presence of instability and susceptibility to infections within bacterial populations. Furthermore, monotherapy is ineffective in completely eliminating complex cancer with multiple contributing factors. In this study, based on our discovery that spore shell (SS) of Bacillus coagulans exhibits excellent tumor-targeting ability and adjuvant activity, we develop a biomimetic spore nanoplatform to boost bacteria-mediated antitumor therapy, chemodynamic therapy and antitumor immunity for synergistic cancer treatment. In detail, SS is separated from probiotic spores and then attached to the surface of liposome (Lipo) that was loaded with hemoglobin (Hb), glucose oxidase (GOx) and JQ1 to construct SS@Lipo/Hb/GOx/JQ1. In tumor tissue, highly toxic hydroxyl radicals (•OH) are generated via sequential catalytic reactions: GOx catalyzing glucose into H2O2 and Fe2+ in Hb decomposing H2O2 into •OH. The combination of •OH and SS adjuvant can improve tumor immunogenicity and activate immune system. Meanwhile, JQ1-mediated down-regulation of PD-L1 and Hb-induced hypoxia alleviation synergistically reshape immunosuppressive tumor microenvironment and potentiate immune response. In this manner, SS@Lipo/Hb/GOx/JQ1 significantly suppresses tumor growth and metastasis. To summarize, the nanoplatform represents an optimum strategy to potentiate bacteria-based cancer immunotherapy.

Natural disasters, deforestation, and emissions affect economic growth in Somalia

This study ascertains the effect of natural disasters, deforestation, and emissions on economic growth in Somalia using annual time series spanning 1990–2018. Contrary to previous attempts, this study utilized the kernel regularized least squares (KRLS) technique, robust Granger causality in the presence of instabilities, and novel supremum right-tail Augment Dickey-Fuller unit root to test explosive behaviors in data series. While two date-stamped explosive behaviors are detected in economic growth (2003–2012, 2014–2016) and FDI (2004, 2016–2018), one explosive behavior is observed in capital formation (2010–2018) and population density (2010–2018). Moreover, time-varying granger causalities among sampled variables are observed. The empirical results show natural disasters and deforestation significantly undermine economic growth, whereas GHG emissions stimulate economic growth. Besides, while GHG emissions have increasing marginal effects, natural disasters and deforestation have decreasing marginal effects. The marginal effect of the interaction between natural disasters and temperature change is close to zero, implying that temperature changes do not mediate the disaster-growth nexus. Nevertheless, the study underscores the need for the implementation of environmental and economic policy reforms related to natural disaster preparedness, eliminating deforestation for charcoal exports while implementing a paradigm shift from domestic charcoal and firewood energy consumption to clean and renewable energy.

Assessing the Forecasting Performance of GARCH Models in the Presence of Instabilities

Assessing the Forecasting Performance of GARCH Models in the Presence of Instabilities

The relationship between cryptocurrencies and convention financial market: Dynamic causality test and time-varying influence

This paper examines the dynamic causal effect of financial markets on cryptocurrencies from a return perspective by applying the dynamic asymmetric causality tests. Applying daily data from February 1, 2018, to August 31, 2023, this paper also investigates whether the major events, such as COVID-19 or the categories of cryptocurrency, will alter or intensify the existing relationship. The empirical result shows that the causal relationship for both symmetric and asymmetric, between traditional financial markets and cryptocurrency is cyclical and only significant in the short term; such a result is robust with the examination of the VAR-based Granger causality test in the presence of instabilities. The pandemic does not influence the causal relationship, and the gold price had the most significant causal impact on cryptocurrency portfolio returns, while the fluctuations in the stock market had a negligible influence and the two indices did not have different causal impacts on the different types of cryptocurrencies. Adding cryptocurrencies to portfolios with only traditional financial assets can significantly reduce risk.

IS THERE A CLINICAL AND FUNCTIONAL DIFFERENCE BETWEEN USING A QUADRICEPS TENDON OR QUADRUPLED HAMSTRING GRAFT IN ACL RECONSTRUCTION?

IntroductionAnterior cruciate ligament (ACL) injuries represent a significant burden of disease to the orthopaedic surgeon and often necessitate surgical reconstruction in the presence of instability. The hamstring graft has traditionally been used to reconstruct the ACL but the quadriceps tendon (QT) graft has gained popularity due to its relatively low donor site morbidity.MethodsThis is a single centre comparative retrospective analysis of prospectively collected data of patients who had an ACL reconstruction (either with single tendon quadrupled hamstring graft or soft tissue quadriceps tendon graft). All surgeries were performed by a single surgeon using the All-inside technique. For this study, there were 20 patients in each group. All patients received the same post-operative rehabilitation protocol and were added to the National Ligament Registry to monitor their patient related outcome scores (PROM).ResultsThe average age of patients in the QT group was 29 years (16 males, 4 females) and in the hamstring group was 28 years (18 males, 2 females). The most common mechanism of injury in both groups was a contact twisting injury. There were no statistical differences between the two patient groups in regards to PROMS and need for further revision surgery as analysed on the National Ligament Registry.ConclusionsThe all soft tissue QT graft seems to be equivocal to quadrupled hamstring graft in terms of patient function and recovery graft characteristics. Further research may be needed to elucidate the long-term results of the all soft tissue QT graft given its recent increase in use.

Invasiveness of decompression surgery affects modeled lumbar spine kinetics in patients with degenerative spondylolisthesis.

Introduction: The surgical treatment of degenerative spondylolisthesis with accompanying spinal stenosis focuses mainly on decompression of the spinal canal with or without additional fusion by means of a dorsal spondylodesis. Currently, one main decision criterion for additional fusion is the presence of instability in flexion and extension X-rays. In cases of mild and stable spondylolisthesis, the optimal treatment remains a subject of ongoing debate. There exist different opinions on whether performing a fusion directly together with decompression has a potential benefit for patients or constitutes overtreatment. As X-ray images do not provide any information about internal biomechanical forces, computer simulation of individual patients might be a tool to gain a set of new decision criteria for those cases. Methods: To evaluate the biomechanical effects resulting from different decompression techniques, we developed a lumbar spine model using forward dynamic-based multibody simulation (FD_MBS). Preoperative CT data of 15 patients with degenerative spondylolisthesis at the level L4/L5 who underwent spinal decompression were identified retrospectively. Based on the segmented vertebrae, 15 individualized models were built. To establish a reference for comparison, we simulated a standardized flexion movement (intact) for each model. Subsequently, we performed virtual unilateral and bilateral interlaminar fenestration (uILF, bILF) and laminectomy (LAM) by removing the respective ligaments in each model. Afterward, the standardized flexion movement was simulated again for each case and decompression method, allowing us to compare the outcomes with the reference. This comprehensive approach enables us to assess the biomechanical implications of different surgical approaches and gain valuable insights into their effects on lumbar spine functionality. Results: Our findings reveal significant changes in the biomechanics of vertebrae and intervertebral discs (IVDs) as a result of different decompression techniques. As the invasiveness of decompression increases, the moment transmitted on the vertebrae significantly rises, following the sequence intact ➝ uILF ➝ bILF ➝ LAM. Conversely, we observed a reduction in anterior-posterior shear forces within the IVDs at the levels L3/L4 and L4/L5 following LAM. Conclusion: Our findings showed that it was feasible to forecast lumbar spine kinematics after three distinct decompression methods, which might be helpful in future clinical applications.

Finite Element Analysis of Bilateral Double Rod Constructs in Thoracolumbar Fractures.

To evaluate bilateral double rod contructs in thoracolumbar fractures in a Finite Element model MATERIAL and METHODS: A computed tomography of a 35-year old male have been chosen to create a vertebra model and 1/3 of the T12 was removed to create the burst fracture model. In model A, transpedicular polyaxial screws were inserted two levels above and two levels below the burst fracture. On each side the screws were connected with a single rod. In model B, the screws were connected with two rods on each side attached to two lateral connectors. A uniform 150 N axial load and 10 N/m torque was applied on the superior T10. ROM and von Mises stress nephrograms revealed that the bilateral double-rod construct is being the most rigid and that the force on the pedicle screws were significantly lower compared to model A. We believe that bilateral double-rod constructs for the stabilization of thoracolumbar fractures have a decreased load on pedicle screws and rods compared to the classic bilateral single rod stabilization system and can lower the risk of implant failure and the risk for secondary complications and revision surgery.

The future of extreme meteorological fire danger under climate change scenarios for Iberia

Wildfires are disturbances that occur in ecosystems, both naturally and derived from anthropogenic factors, often caused by extreme meteorological conditions, and have recurrently destructive impacts on forests throughout the world. The complex nature of the interactions between wildfires, their dynamics, and human interference from a climate change perspective has motivated a growing number of researchers to address this topic. The fire weather index (FWI) has been extensively used to analyze the link between meteorological fire danger and its local to regional characteristics contributing to the severity of these events, as well as real-time operational monitoring at national and international levels. Recently, a new improved fire danger index that includes the effect of atmospheric instability has been developed, the so-called FWIe. The presence of instability in the atmosphere may be a boost to more energetic wildfires, such as the June 2017 extreme event in central Portugal, making it an important asset in risk monitoring and management. Here, a comprehensive examination of future fire risk on the Iberian Peninsula was performed. Additionally, a comparative analysis between FWI and FWIe was pursued in the context of climate change. We computed both FWI and FWIe using a multi-model ensemble composed of 13 Euro-CORDEX Regional Climate Model (RCM) simulations forced by different global climate models. The historical period (1971–2000) and three projected periods of 30 years (2011–2040, 2041–2070, and 2071–2 100), under three emission scenarios (RCP2.6, RCP4.5, and RCP8.5) were considered. When assessing modelled FWI and FWIe, results show that summer values tend to substantially increase in the future when assuming the historical period as the benchmark, with an expected extension of the danger period to June and, in a lower magnitude, to September. The north-western region of Iberia, including the north of Portugal and the north-western-to-central Spain are the regions with larger increases in danger in the future, which may be critical since these are the regions with more fire-prone vegetation. This work also points to large differences in fire danger projections among scenarios, calling for a distinct set of adaptation needs that should be timely prepared by stakeholders and authorities.

Helicopter radio system for low altitudes and flight speed measuring with pulsed ultra-wideband stochastic sounding signals and artificial intelligence elements

The subject matter of this study is algorithms for measuring the components of an aircraft speed vector and altitude. The goal of this study is to improve algorithms for processing wideband stochastic pulse signals in helicopter low-altitude and flight-speed radio systems by introducing secondary signal processing based on artificial intelligence elements. The tasks to be solved are as follows: to develop an optimal algorithm for determining the speed and altitude of flight for a helicopter radio complex; to supplement the signal processing algorithm with an artificial intelligence-based processor to determine the "safety" of the current trajectory; provide the pilot with relevant information about possible options for further actions based on an analysis of the current position of the helicopter and flight parameters; and to analyse the efficiency of the proposed complex when using various artificial intelligence-based algorithms. The methods used are as follows: methods of mathematical statistics and optimal solutions for solving problems of statistical synthesis of active radio complex structure; methods of machine learning; and methods of computer simulation. The following results were obtained. The algorithms for signal processing in a helicopter radio complex are obtained by the method of maximum likelihood, and the use of three radio channels to calculate the full vector of speed and altitude is argued. The structure of a secondary information processing system, using algorithms based on artificial intelligence is proposed. The effectiveness of determining the safety of the current landing trajectory using various algorithms based on artificial intelligence (LinearSVC, GaussianNB, DecisionTreeClassifier, RandomForestClassifier, KNeighborsClassifier, MLPClassifier and RidgeClassifier) was analysed. Conclusions. The simulation results show that in the presence of accurate (noise-free) information on the current location of the helicopter, its axial velocities, and a map of the terrain with defined areas dangerous for landing, the DecisionTreeClassifier and RandomForestClassifier algorithms can provide a high probability of correctly determining the safety of the current landing trajectory. At the same time, in the presence of instability in the measurements of helicopter movement parameters, only the RandomForestClassifier algorithm maintains high accuracy.

Forecasting Exchange Rates Comparison In The Presence Of Instabilities

Exchange rate forecasting is an inherent approach in financial risk management, yet previous forecasting models were criticized for their poor predictive ability, mainly during periods of exceptional macroeconomic weaknesses. This is attributed to their failure to identify the importance and strength of key transmission and amplification channels, especially those linked to financial markets and uncertainty. Though there is no model that can be precise, especially during periods of crises, it is important to find a model that can yield near-accurate results. The present study therefore evaluates the different forecasting models, considering how each handles instabilities. The Rossi Sekhposyan forecast rationality test results reveal that the EGARCH model under general error distribution and APARCH under normal error distribution show the strongest evidence against rationality around the year 2009, identifying the concentration of instabilities during that time. This vindicates the need to control for instabilities in forecasting. This implies that, in the presence of instabilities, the fluctuation tests are more powerful than traditional tests.

Translated article] Management of vertebral metastases in the cervico-occipital junction

Occipito-cervical metastases correspond to 0.5% of spinal metastases. The management of these lesions is complex and involves multiple radiological studies, such as simple radiology, computed tomography (CT), magnetic resonance imaging (MRI). Is vascular involvement is suspected, tests to assess vascular permeability are also recommended (angioCT). This type of lesion, due to its complex location, may require different types of approaches, commonly it will be the posterior approach, but sometimes anterior or antero-lateral approaches will be needed assisted by maxillofacial surgeons or otorhinolaryngologists for correct excision of the tumour. Pain with head turning can guide us to the diagnosis in an unstable spine. Magnetic resonance is the test of choice to diagnose and study these lesions. The presence of instability or progressive neurological symptoms is an indication for surgery.

Comparative Growth Performance of Okra in Punjab and Haryana

"The primary objective of this study is to analyse the growth pattern and volatility of okra cultivation in Haryana, Punjab, and India. To achieve this, two methods, namely the coefficient of variation and the Cuddy-Della Valle index, were employed to identify the instability in the areas, production, and productivity of okra. The findings indicate that the CDVI index serves as a more precise indicator of instability in all three aspects of okra cultivation. When considering the area, Punjab exhibits the highest level of instability at 35.88%, followed by Haryana at 14.31% and India at 6.43%. In terms of production, Haryana demonstrates the highest CDVI at 17.47%, with India at 9.31% and Punjab at 7.78%. Regarding productivity, Haryana also showcases the highest CDVI of 18.31%, while Punjab records 11.75% and India 3.60%. Despite the presence of instability, the economic growth, production, and productivity of okra in all three regions display positive trends. Furthermore, Punjab outperforms Haryana and India in terms of compound annual growth rate (CAGR) for the area, production, and productivity of ok"

Manejo de las metástasis vertebrales en la charnela cervico-occipital

Occipito-cervical metastases correspond to 0.5% of spinal metastases. The management of these lesions is complex and involves multiple radiological studies, such as simple radiology, computed tomography (CT), magnetic resonance imaging (MRI). Is vascular involvement is suspected, tests to assess vascular permeability are also recommended (angioCT). This type of lesion, due to its complex location, may require different types of approaches, commonly it will be the posterior approach, but sometimes anterior or anterolateral approaches will be needed assisted by maxillofacial surgeons or otorhinolaryngologists for correct excision of the tumor. Pain with head turning can guide us to the diagnosis in an unstable spine. Magnetic resonance is the test of choice to diagnose and study these lesions. The presence of instability or progressive neurological symptoms are an indication for surgery.

Neutrino magnetohydrodynamic instabilities in presence of two-flavor oscillations

The influence of neutrino flavor oscillations on the propagation of magnetohydrodynamic (MHD) waves and instabilities is studied in neutrino-beam driven magnetoplasmas. Using the neutrino MHD model, a general dispersion relation is derived which manifests the resonant interactions of MHD waves, not only with the neutrino beam, but also with the neutrino flavor oscillations. It is found that the latter contribute to the wave dispersion and enhance the magnitude of the instability of oblique magnetosonic waves. However, the shear-Alfvén wave remains unaffected by the neutrino beam and neutrino flavor oscillations. Such an enhancement of the magnitude of the instability of magnetosonic waves can be significant for relatively long-wavelength perturbations in the regimes of high neutrino number density and/or strong magnetic field, giving a convincing mechanism for type-II core-collapse supernova explosion.

Clinical Evolution of Acute Vestibular Syndrome: Longitudinal Retrospective Analysis of Epidemiological Data and Prognostic Factors for Recovery

We evaluated the clinical features of patients admitted to the ED with acute vertigo, verifying symptoms after one month and one year to establish epidemiological factors and predictors of resolution. We reviewed 233 records of patients admitted to ED for acute vertigo (125 F and 85 M, mean age 56.12 years). We analyzed the correlation between time of resolution (at one month and one year) and symptoms duration (subjective and/or objective vertigo, instability, cervical pain, audiological, neurological, and neurovegetative symptoms), comorbidities, and therapies, the result of the clinical and instrumental vestibular examination. Resolution of acute vertigo occurred in 81.1%, while persistence of vertigo one year after ED access was reported in 18.8%. There were 135 patients who recovered in one month. The presence of instability, auditory and neurovegetative symptoms, and neck pain represents a significant factor for recovery within one year. Age over 65 and a history of hypertension are associated with a worst recovery. Patients with spontaneous Nystagmus or positive HIT showed a significant difference in symptoms recovery within one month and one year. Presence of positional Nystagmus represents a positive prognostic factor. Our findings emphasize the importance of clinical evaluation of the acute vertigo, helping the clinicians to define central or peripheral diagnosis and predict the resolution of vertigo.

Viscous fingering instabilities in spontaneously formed blisters of MoS2 multilayers.

The viscous fingering in the Hele-Shaw cell can be suppressed by replacing the upper-bounding rigid plate with an elastic membrane. Recently, graphene multilayers while polymer-curing-induced blistering showed the dynamical evolution of viscous fingering patterns on a viscoelastic substrate due to their thickness-dependent elasticity. Under certain conditions, the elastic solid-based instability couples with the viscoelastic substrate-based instability. The mechanisms underlying such a coupling in the blisters of 2D materials and the dynamical evolution of the viscous fingering patterns underneath the blisters are yet to be addressed. Herein, we investigate the viscous fingering instabilities in spontaneously formed blisters of MoS2 multilayers, and provide thorough analytical and experimental insights for the elucidation of the dynamical evolution of the viscous fingering patterns and the coupled instabilities in the blisters. We also estimate the interfacial adhesion energy of the MoS2 flakes over a (poly)vinyl alcohol (PVA) substrate and the confinement pressure inside the MoS2 blisters using a conventional blister-test model. It is observed that the presence of instability gives rise to anomalies in the modeling of the blister test. The adhesion mechanical insights would be beneficial for fundamental research as well as practical applications of 2D material blisters in flexible optoelectronics.

Reliable determination of pulse-shape instability in trains of ultrashort laser pulses using frequency-resolved optical gating

We describe a reliable approach for determining the presence of pulse-shape instability in a train of ultrashort laser pulses. While frequency-resolved optical gating (FROG) has been shown to successfully perform this task by displaying a discrepancy between the measured and retrieved traces for unstable trains, it fails if its pulse-retrieval algorithm stagnates because algorithm stagnation and pulse-shape instability can be indistinguishable. So, a non-stagnating algorithm—even in the presence of instability—is required. The recently introduced Retrieved-Amplitude N-grid Algorithmic (RANA) approach has achieved extremely reliable (100%) pulse-retrieval in FROG for trains of stable pulse shapes, even in the presence of noise, and so is a promising candidate for an algorithm that can definitively distinguish stable and unstable pulse-shape trains. But it has not yet been considered for trains of pulses with pulse-shape instability. So, here, we investigate its performance for unstable trains of pulses with random pulse shapes. We consider trains of complex pulses measured by second-harmonic-generation FROG using the RANA approach and compare its performance to the well-known generalized-projections (GP) algorithm without the RANA enhancements. We show that the standard GP algorithm frequently fails to converge for such unstable pulse trains, yielding highly variable trace discrepancies. As a result, it is an unreliable indicator of instability. Using the RANA approach, on the other hand, we find zero stagnations, even for highly unstable pulse trains, and we conclude that FROG, coupled with the RANA approach, provides a highly reliable indicator of pulse-shape instability. It also provides a typical pulse length, spectral width, and time-bandwidth product, even in cases of instability.

The problems of the operated spine. Treatment of transpedicular fixation failure and the adjacent level pathology: A clinical case

Background: Among the modern methods of surgical treatment of the lumbar spines degenerative stenoses, decompressive-stabilizing surgical interventions using transpedicular screw-rod structures occupy an important place. The use of metal structures is justified not so much by the degenerative process specifics, degree or length of stenosis, but by the presence of instability in the spinal motion segments. In turn, the widespread use of fixing structures has naturally led to an increase in the specific complications, reaching 1020 per cent of the total number of operated patients. One of the threatening complications of decompressive-stabilizing operations is the fracture of structural elements, often with the formation of pathology at the adjacent levels. The reasons for these complications are associated with both an erroneous choice of the construct parameters and a violation of the technique for installing the transpedicular fixation system (TPS). Clinical case description: The article presents an analysis of the clinical symptoms appearing with the formation of the adjacent level syndrome due to a fracture of the TPS system screws used to treat central stenosis of the spinal canal at the LIV -LV level. The correction of the pathology was carried out with a repeated surgical intervention. Conclusion: This clinical example draws attention to the combination of the adjacent level syndrome with a fracture of the metal structure in a patient after a decompressive-stabilizing operation using screw-rod fixation. An early diagnosis and adequate correction of the pathology helps to avoid the aggravation of symptoms and disability of patients.