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PURPOSE: To introduce easy and useful methods using 3D navigation system with skin-fixed dynamic reference frame (DRF) in anterior cervical surgery and to validate its accuracy. METHODS: From September 2012 to May 2013, 31 patients underwent anterior cervical surgery and a total of 48 caspar distraction pins were inserted into each cervical vertebra. Every operation was performed using O-arm® navigation system with skin-fixed DRF. To validate the accuracy of these methods, a custom-made metal sleeve was used. In surgical field, through the metal sleeve, the tip of a navigation probe promptly contacts to the tip of caspar pin. We measured the vertical and horizontal distances and the angular deviation in sagittal plane between the caspar pin and the navigation probe on the virtual images and evaluated accuracy of navigation system with skin fixed DRF. RESULTS: Total 31 (males 20, females 11) patients and 48 caspar pins were included in this study. The mean horizontal distance between the caspar pin and the navigation probe displayed in navigation monitor was 0.49 ± 0.71 mm. The mean vertical distance between the caspar pin and the navigation probe displayed in navigation monitor was 0.88 ± 0.93 mm. And the mean angular deviation in sagittal plane between the caspar pin and the navigation probe displayed in navigation monitor was 0.59 ± 0.55°. CONCLUSIONS: 3D navigation system with skin-fixed DRF in anterior cervical surgery is a simple and reliable method and it can be a helpful supplement to a spine surgeon's judgement.

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The stability of screw constructs is of considerable importance in determining the outcome, especially in spinal osteoporosis. Polymethylmethacrylate (PMMA) has been proven as an effective material for increasing the pullout strength of pedicle screws inserted into the osteoporotic bones. However, PMMA has several disadvantages, such as its exothermic properties, the risk of neural injury in the event of extravasation, and difficulties in performing revision surgery. In the current study, we used hydroxyapatite (HA) cement for screw augmentation in spinal osteoporosis. We conclude that HA cement is a useful tool for screw augmentation and recommend it as a promising option for spinal instrumentation in osteoporotic patients.

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Here, we show that the pathways, products, and efficiencies of reactions occurring on a metal surface can be spatially modulated by varying the type and energy of hot carriers produced by injecting tunneling electrons or holes from a scanning tunneling microscope tip into the metal surface. Control over the metal surface reactions was demonstrated for the large-scale dissociation reaction of O2 molecules on a Ag(110) surface. Hot electrons (or holes) transported through the metal surface to chemisorbed O2 selectively dissociated the molecule into two oxygen atoms separated along the [110] (or [001]) lattice direction. The reaction selectivity was enhanced compared to the selectivity of a direct reaction involving tunneling carriers.

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A 55-year-old female was diagnosed with L5-S1 degenerative disc disease (DDD). Initial scores by the visual analogue scale (VAS) were 5 (back) and 9 (leg) and the Oswestry disability index (ODI) was 32. Arthroplasty was performed. Clinical and radiographic monitoring took place thereafter at one month, three months, six months and annually. At one month, VAS scores were 2 (back) and 3 (leg), ODI was 12 and ROM was 2.1° by radiographs. At two years, VAS scores were 1 (back) and 2 (leg), ODI was 6 and ROM was approaching 0. Five years after surgery, the entire operated segment (L5-S1) was solidly fused. A malpositioned disc implant may impair normal spinal movement, culminating in heterotopic ossification or complete fusion of the operated segment.

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INTRODUCTION: Symptomatic thoracic disc herniations (TDHs) are uncommon and can be surgically treated. Although transthoracic decompression is considered the gold standard, it is associated with significant comorbidities. In particular, approach via a posterior laminectomy has been associated with poor results. Several strategies have been developed for the resection of TDHs without manipulating the spinal cord. We describe a minimally invasive technique by using 3-D navigation and tubular retractors with the aid of a robotic holder via an oblique paraspinal approach. MATERIALS AND METHODS: The 20-mm working tube via an oblique trajectory through the fascia provides a good surgical field for thoracic discectomy through a microscope. We present our first five patients with TDHs operated using this minimally invasive approach. RESULTS: Neurological symptoms were improved postoperatively, and there were no surgical complications. There was no instability or recurrence during the follow-up period. CONCLUSION: The oblique paraspinal approach may offer an alternative surgical option for treating TDHs.

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OBJECTIVE: The use of segmental instrumentation technique using pedicle screw has been increasingly popular in recent years owing to its biomechanical stability. Recently, intralaminar screws have been used as a potentially safer alternative to traditional fusion constructs involving fixation of C2 and the cervicothoracic junction including C7. However, to date, there have been few clinical series of C7 laminar screw fixation in the literature. Thus, the purpose of this study is to report our clinical experiences using C7 laminar screw and the early clinical outcome of this rather new fixation technique. METHODS: Thirteen patients underwent C7 intralaminar fixation to treat lesions from trauma or degenerative disease. Seventeen intralaminar screws were placed at C7. The patients were assessed both clinically and radiographically with postoperative computed tomographic scans. RESULTS: There was no violation of the screw into the spinal canal during the procedure and no neurological worsening or vascular injury from screw placement. The mean clinical and radiographic follow up was about 19 months, at which time there were no cases of screw pull-out, screw fracture or non-union. Complications included two cases of dorsal breech of intralaminar screw and one case of postoperative infection. CONCLUSION: Intralaminar screws can be potentially safe alternative technique for C7 fixation. Even though this technique cannot be used in the cases of C7 laminar fracture, large margin of safety and the ease of screw placement create a niche for this technique in the armamentarium of spine surgeons.

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We present a scanning tunneling microscopy and first-principles calculations study of the adsorption structures of aniline on a Si(5 5 12)-2x1 surface. Dissociation from the aniline molecules of one or two H atom(s) bonded to N is favored, and then adsorption onto adatom, tetramer, and dimer rows of Si(5 5 12)-2x1 occurs in several distinct configurations. On the adatom row, aniline binds to an adatom in a tilted configuration, which is formed via a sigma bond between the adatom and N, with one dissociated H atom adsorbed on a nearby adatom. No further hydrogen dissociation occurs. On the tetramer and dimer rows, the structures with two dissociated hydrogens and upright configurations are the most stable. Aniline does not adsorb onto the honeycomb chains; this adsorption configuration has a low adsorption energy. In all the adsorption configurations of aniline on this surface, the molecule's aromaticity is preserved. Thus Si-N bonding of aromatic amine molecules provides a strategy for the homogeneous aromatic functionalization of high index Si surfaces.

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