Project description:BackgroundAnterior column realignment (ACR) is a novel surgical method for correcting spinal sagittal balance. meanwhile, oblique lumbar interbody fusion (OLIF) and anterior lumbar interbody fusion (ALIF) are considered minimally invasive surgical methods through natural anatomical space. This study aimed to explore the corrective effects and clinical outcomes of OLIF or ALIF combined with ACR technology in patients with adult spinal deformity (ASD).MethodsWe retrospectively analyzed patients with sagittal imbalance who received OLIF and/or ALIF and ACR treatment from 2018 to 2021. Surgical time and intraoperative bleeding volume are recorded, the corrective effect is determined by the intervertebral space angle (IVA), lumbar lordosis (LL), the sagittal vertical axis (SVA), clinical outcome is evaluated by preoperative and final follow-up visual analog pain score (VAS), Japanese orthopedic association scores (JOA) and complications.ResultsSixty-four patients were enrolled in the study, average age of 65.1(range, 47-82) years. All patients completed 173 fusion segments, for 150 segments of ACR surgery. The operation time of ALIF-ACR was 50.4 ± 22.1 min; The intraoperative bleeding volume was 50.2 ± 23.6 ml. The operation time and intraoperative bleeding volume of single-segment OLIF-ACR was 66.2 ± 19.4 min and 70.2 ± 31.6 ml. At the follow-up of 6 months after surgery, the intervertebral space angle correction for OLIF-ACR and ALIF-ACR is 9.2° and 12.2°, the preoperative and postoperative lumbar lordosis were 16.7° ± 6.4°and 47.1° ± 3.6° (p < 0.001), VAS and JOA scores were improved from 6.8 to 1.8 and 7.8 to 22.1 respectively, statistically significant differences were observed in these parameters. The incidence of surgical related complications is 29.69%, but without serious complications.ConclusionACR via a minimally invasive hybrid approach for ASD has significant advantages in restoring local intervertebral space angulation and correcting the overall sagittal balance. Simultaneously, it can achieve good clinical outcomes and fewer surgical complications.

Project description:BackgroundSagittal malalignment is associated with poor quality of life. Correction of lumbar lordosis through anterior column release (ACR) has been shown to improve overall sagittal alignment, however typically in combination with long posterior constructs and associated morbidity. The technical feasibility and radiographic outcomes of short-segment anterior or lateral minimally invasive surgery (MIS) ACR techniques in moderate to severe lumbar sagittal deformity were evaluated.MethodsConsecutive patients treated with short-segment MIS ACR techniques for moderate to severe lumbar sagittal deformity correction were retrospectively analyzed from a prospectively collected database. Clinical outcomes included perioperative measures of invasiveness, including operative time, blood loss, complications, and average length of stay. Radiographic outcomes included measurement of preoperative, immediate postoperative, and long-term follow-up radiographic parameters including coronal Cobb angle, lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch, pelvic tilt (PT), T1 pelvic angle (TPA), T1 spino-pelvic inclination (T1SPI), proximal junctional angle (PJA), and sagittal vertical axis (SVA).ResultsThe cohort included 34 patients (mean age 63) who were treated at an average 2.5 interbody levels (range 1-4) through a lateral or anterior approach (LLIF or ALIF). Of 89 total interbody levels treated, 63 (71%) were ACR levels. Posterior fixation was across an average of 3.2 levels (range 1-5). Mean total operative time and blood loss were 362 minutes and 621 mL. Surgical complications occurred in 2 (5.9%). Average hospital stay was 5.5 days (including staging). At last follow-up (average 25.4 months; range 0.5-7 years), all patients (100%) demonstrated successful achievement of one or more alignment goal, with significant improvements in coronal Cobb, LL, PI-LL mismatch, PT, and TPA. No patient was revised for PJK.ConclusionsThese data show that short-segment MIS ACR correction of moderate to severe lumbar sagittal deformity is feasible and effective at achieving overall alignment goals with low procedural morbidity and risk of proximal junctional issues.

Project description:Multi-word expressions (MWEs) are fixed, conventional phrases often used by native speakers of a given language (L1). The type of MWEs investigated in this study were collocations. For bilinguals who have intensive contact with the second language (L2), collocational patterns can be transferred from the L2 to the L1 as a result of cross-linguistic influence (CLI). For example, bilingual migrants can accept collocations from their L2 translated to their L1 as correct. In this study, we asked whether such CLI is possible in native speakers living in the L1 environment and whether it depends on their L2 English proficiency. To this end, we created three lists of expressions in Polish: (1) well-formed Polish verb-noun collocations (e.g., ma sens - ∗has sense), (2) collocational calques from English (loan translations), where the English verb was replaced by a Polish translation equivalent (e.g., ∗ robi sens - makes sense), and, as a reference (3) absurd verb-noun expression, where the verb did not collocate with the noun (e.g., ∗ zjada sens - ∗eats sense). We embedded the three types of collocations in sentences and presented them to L1 Polish participants of varying L2 English proficiency in two experiments. We investigated whether L2 calques would (1) be explicitly judged as non-native in the L1; (2) whether they would evoke differential brain response than native L1 Polish equivalents in the event-related potentials (ERPs). We also explored whether the sensitivity to CLI in calques depended on participants' level of proficiency in L2 English. The results indicated that native speakers of Polish assessed the calques from English as less acceptable than the correct Polish collocations. Still, there was no difference in online processing of correct and calques collocations as measured by the ERPs. This suggests a dissociation between explicit offline judgments and indices of online language processing. Interestingly, English L2 proficiency did not modulate these effects. The results indicate that the influence of English on Polish is so pervasive that collocational calques from this language are likely to become accepted and used by Poles.

Project description:Recent systematic reviews have shown anterior cruciate ligament reconstruction using quadriceps tendon (QT) grafts to have superior clinical outcomes compared with traditional bone–patella tendon–bone and hamstring tendons grafts. Using minimally invasive techniques to harvest the QT graft can reduce postoperative pain and intraoperative surgical time. This technique is usually performed with a distal-to-proximal approach but often has issues of inadvertently harvesting a graft short of the desired length or causing a hematoma. As an alternative, we introduce a minimally invasive approach with a proximal-to-distal harvest technique that results in better visualization of tissue planes, more consistent graft sizes, lower risk of inadvertent arthrotomy, and reduced risk of hematoma. The minimally invasive QT graft harvest with a proximal-to-distal approach can offer unique advantages over the current standard distal-to-proximal approach. Technique Video Video 1 In this video, we demonstrate a novel technique for harvesting the quadriceps tendon (QT) for anterior cruciate ligament reconstruction. The patient is supine on the operating table with the leg flexed over the side of the bed for dissection and harvest. The harvest can be adequately done with a 2-cm horizontal incision approximately 8 to 9 cm proximal to the patella. Before the incision the vastus medialis obliquus, rectus femoris (RF), and patella are outlined. The Arthrex QuadPro can be used as a ruler as seen here. Through a 2-cm horizontal incision, subcutaneous fat is dissected to reveal the facial envelope of the RF and QT. A split is made in the fascia, which usually reveals a small amount of fat overlying the tendon. Pretendinous fat and adhesions are removed to expose the RF tendon. The next step is to feather off the musculotendinous junction. At this proximal level, the muscle of the quadriceps begins to envelope the tendon making the tendon width appear smaller than it actually is. This can be done with a scalpel, key elevator, knife, Cobb, or any other sharp instrument. Adequate feathering of the muscle bellies will show a wide tendon adequate for harvest. A rectangular-shaped tenotomy consistent with the harvester diameter or slightly larger is performed in the RF tendon. Below, the VI will come into view. This is a proximal to distal view of the plane between the RF and VI. The RF is then quickly whip stitched. Blunt dissection is performed above and below the RF tendon to allow easier passage of the harvester. The graft is loaded into the harvester. We know from anatomical studies that the tendon 2-cm distal to our tenotomy should begin to splay out and widen. Furthermore, the central aspect of the RF tendon is not in the center of the patella but about 10% lateral due to the Q angle of the tendon. Therefore, direct visualization of the harvest path 2-cm distal and aiming at the proximal pole of the patella just off center laterally should minimize the risk of poor trajectory leading to short graft harvest. The desired length is seen on the harvester and the graft is amputated. A 9-mm harvester was used in this example, which yields a graft that will easily pass through the corresponding tunnel or will be a snug fit slightly smaller as seen. There are various graft fixation methods. A reliable and reproducible fixation method is the Arthrex FiberTag.

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Surgical technique of combined minimally invasive anterior column realignment at L1–L2 with open extension of prior fusion

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