Video-assisted lateral intertransverse process arthrodesis. Validation of a new minimally invasive lumbar spinal fusion technique in the rabbit and nonhuman primate (rhesus) models

STUDY DESIGN: Cadaveric anatomic and in vivo survival animal studies were performed to develop a new arthrodesis technique for the lumbar spine. OBJECTIVES: To examine the feasibility, efficacy, and safety of a minimally invasive lumbar intertransverse process arthrodesis technique using an osteoinductive growth factor (rhBMP-2) delivered in a collagen sponge carrier. The technique was first developed using a rabbit model and modified for the nonhuman primate (rhesus monkey), a larger animal with the most similar bone biology to humans. SUMMARY OF BACKGROUND DATA: The morbidity of conventional posterolateral lumbar intertransverse process arthrodesis includes graft donor site morbidity; paraspinal muscle devascularization, denervation, and scarring and nonunion in up to 36% of patients. Minimally invasive anterior lumbar interbody arthrodesis techniques have been developed, but these often require a metal implant and carry risks to major vessels and development of retrograde ejaculation. A minimally invasive technique for posterolateral intertransverse process arthrodesis has not been described previously. METHODS: In Part 1, we examined seven New Zealand white rabbits and five rhesus monkeys at necropsy and during nonsurvival surgeries to determine the best access routes and to develop special instruments for video-assisted lateral intertransverse process arthrodesis. In Part 2, 38 New Zealand white rabbits underwent L4-L5 intertransverse process arthrodesis: the "OPEN" group (n = 16) underwent a standard open muscle-splitting approach using rhBMP-2 (bone morphogenetic protein) and collagen as a bone graft substitute; the "video-assisted control" group (n = 6) underwent video-assisted lateral intertransverse process arthrodesis with the collagen implant only (no growth factor); and the "video-assisted-BMP" group (n = 16) underwent video-assisted lateral intertransverse process arthrodesis with rhBMP-2 and collagen as the graft material. In Part 3, rhesus monkeys (n = 4) underwent video-assisted lateral intertransverse process arthrodesis using rhBMP-2 and collagen after laminectomy of L4-L5. RESULTS: In Part 1, we identified expedient, minimally invasive routes to the intertransverse process interval appropriate for each species: an intermuscular approach for the rabbit and a lateral, extramuscular approach for the rhesus monkey. In Part 2, all rabbits in the OPEN and video-assisted-BMP groups achieved solid intertransverse process lumbar fusions when assessed at 10 weeks. There were no neurologic impairments nor any difference between the two groups in the frequency of postoperative infection or other complications. None of the animals in the video-assisted control group showed evidence of fusion. In Part 3, exposure, decortication and grafting with rh-BMP-2 and collagen was accomplished successfully in all four monkeys through the video-assisted minimally invasive approach without complications. CONCLUSION: Video-assisted lateral intertransverse process arthrodesis is a feasible, effective, and safe method of lumbar spinal fusion in the rabbit and rhesus monkey. Use of this arthrodesis procedure will minimize the morbidity of paraspinal muscle denervation and devascularization seen with open intertransverse process fusion techniques, and the use of an osteoinductive growth factor will eliminate the problem of graft donor site morbidity and possibly increase the chances for successful fusion.     

A complexity measure for selective matching of signals by the brain

We have previously derived a theoretical measure of neural complexity (CN) in an attempt to characterize functional connectivity in the brain. CN measures the amount and heterogeneity of statistical correlations within a neural system in terms of the mutual information between subsets of its units. CN was initially used to characterize the functional connectivity of a neural system isolated from the environment. In the present paper, we introduce a related statistical measure, matching complexity (CM), which reflects the change in CN that occurs after a neural system receives signals from the environment. CM measures how well the ensemble of intrinsic correlations within a neural system fits the statistical structure of the sensory input. We show that CM is low when the intrinsic connectivity of a simulated cortical area is randomly organized. Conversely, CM is high when the intrinsic connectivity is modified so as to differentially amplify those intrinsic correlations that happen to be enhanced by sensory input. When the input is represented by an individual stimulus, a positive value of CM indicates that the limited mutual information between sensory sheets sampling the stimulus and the rest of the brain triggers a large increase in the mutual information between many functionally specialized subsets within the brain. In this way, a complex brain can deal with context and go "beyond the information given."     

Improving the efficiency of variational methods for solving strongly nonsymmetric linear algebraic equation system received in convection-diffusion problems

An efficient algorithm for implementing the mathematical model of convection-diffusion transport with a dominant convection is proposed. Preconditioned Krylov subspace methods are used to solve strongly nonsymmetric systems of linear algebraic equations. Theoretical convergence analysis of product triangular skew-symmetric preconditioners is carried out. A series of numerical experiments have confirmed the technique’s efficiency.     

Iterative global and local methods of image restoration

Most of the reconstruction algorithms smooth out the edges of the reconstructed images but iterative total variation regularization and local adaptive methods preserve the edge information without any prior knowledge about the image geometric details. The restoration performance of the proposed algorithms for image deblurring is compared in terms of the mean squared error. Computer simulation results are provided and discussed.     

LiveROMS: A virtual environment for ocean numerical simulations

LiveROMS is a bootable DVD that contains an Linux-based computer operating system which has a complete, functioning version of the ROMS ocean circulation model and an Octave version of ROMSTOOLS. It allows students and scientists to experiment with this ocean numerical model, with just a basic knowledge of Linux.     

An efficient spectral code for incompressible flows in cylindrical geometries

An efficient and accurate numerical scheme is proposed to solve the incompressible Navier-Stokes equations in a bounded cylinder. The scheme is based on a projection method formulated in primitive variables to maintain the incompressibility constraint, with a second-order semi-implicit scheme for the time integration, and a pseudospectral approximation for the space variables. The Chebyshev-collocation method applied in the radial and axial directions, and the Fourier-Galerkin approximation used in the azimuthal direction lead to a sequence of two-dimensional Helmholtz and Poisson equations for every azimuthal coefficient that are solved by a diagonalization technique. Radial expansions are considered in the diameter of the cell in order to avoid clustering about the axis, and the number of points are selected to ensure that r=0 is not a collocation point. A minimal number of regularity conditions are imposed implicitly at the origin by forcing the proper parity of the Fourier expansions in the radial direction. The method has been tested on analytical solutions and compared with other reliable three-dimensional results. The improvements introduced in the treatment of the spatial discretization reduce significantly the difficulty of implementation of the code, and facilitate the use of high resolutions. Different boundary conditions can also be easily implemented.     

Schauder bases and approximation property in fuzzy normed spaces

Our aim in this article is to introduce and study the notion of weak and strong Schauder bases in fuzzy normed spaces. Further, we introduce strong and weak fuzzy approximation properties and set a relationship between these two new notions which may provide an acceleration to the structural analysis of fuzzy normed spaces.     

Interactive surgery simulation for the nose augmentation using CT data

Surgery to reshape the nose with an implant has been a regular procedure for enhancing a patient’s appearance and self-confidence. The purpose of this study was to establish a computed tomography (CT) based three-dimensional assistant plastic surgery systems, which can provide the patients with realistic prediction of their own postoperative appearance in computer and specifically produce a nose implant for an individual patient. Preoperative CT data and 3D reconstruction techniques were employed to generate 3D model of the patient’s skull. 3D collision detection and finite elements model deformation were then applied to simulate nose augmentation surgery and predict postoperative appearance. According to the patient’s expectation, digital models of the nose implants were constantly modified. When the patient is satisfied with the simulated results, custom made silicone implants were produced by a computer controlled device. Accurately regeneration of 3D images and realistic operative simulations could be achieved with this system. The implants produced exactly conformed to the results of simulation. No curving and reshaping were needed during operating. The clinical results extremely matched with the simulations. The system enhances surgeon patient communication and facilitates preoperative planning. It is especially desirable for implant surgery with less guesswork of size, contour, and orientation of the implant. The best chance of optimal results could be achieved.