Multilevel instrumented posterolateral lumbar spine fusion with an allogeneic cellular bone graft

Background

Low back pain (LBP) is the leading cause of absence from work, disability, and impaired quality of life. Fusion surgery may be indicated when non-operative treatments have failed to provide relief. Surgery may include the use of fusion-enhancing implants, such as cellular bone allografts (CBAs). The purpose of this retrospective study was to evaluate efficacy and safety of one CBA (V-CBA) in patients who underwent instrumented posterolateral fusion (IPLF).

Methods

Retrospective data were collected from 150 consecutive patients who had undergone IPLF surgery between January 1, 2015, and March 31, 2018, in which V-CBA was used. All surgeries were performed by one surgeon. V-CBA was mixed with local autograft bone. Patient diagnoses included degenerative disc disease, spondylosis, spondylolisthesis, or spondylolysis with or without stenosis. Standing anteroposterior (AP) and lateral images were collected prior to surgery and again at the terminal visit, which took place between 6 and 33 months post-operatively. De-identified images were assessed radiologically. Adverse events were documented. The primary composite endpoint of fusion status was dependent upon two main criteria: bridging bone per the Lenke scale (classified as “A” definitely solid or “B” possibly solid) and posterior hardware status (intact). Lenke scale C or D were categorized as pseudarthrosis.

Results

Eighty-seven male and 63 female patients (613 levels total) underwent IPLF in which V-CBA was implanted. An average of 4.1 levels was treated, with 59.3% of patients having undergone treatment for more than 3 levels. Twenty-nine percent of patients had diabetes. Fifty-two percent of patients had previously used nicotine products, and 12% were current smokers. Sixteen serious adverse events were recorded and included lumbar seroma, cerebrospinal fluid leak, wound dehiscence, pneumonia, urinary tract infection, and myocardial infarction. Successful fusion (Lenke scale “A” or “B”) was recorded in 148 out of 150 patients (98.7%), or 608 out of 613 levels. The total pseudarthrosis rate was 0.8%.

Conclusions

The use of V-CBA combined with local autograft in multilevel IPLF resulted in successful fusions in 98.7% of patients. These results are particularly robust given the complex nature of many of these cases: 89 patients had 4 or more surgical levels, and many patients had multiple comorbidities.

Level of evidence

IV

Variability in the edible fraction content of 60Co, 99Tc, 110mAg, 137Cs and 241Am between individual crabs and lobsters from Sellafield (north eastern Irish Sea)

We investigated the variability of anthropogenic radionuclide content of the edible fractions of individual edible crabs (Cancer pagurus L.) and European lobsters (Homarus gammarus L.) caught commercially in the Sellafield offshore area. Sixteen female and 18 male crabs and 20 female and 17 male lobsters were selected from commercial catches made between 25 May and 5 June 1997. Each gender group was selected to be within the known weight range for commercially caught crustacea from the area. Four artificial radionuclides (60Co, 110mAg, 137Cs or 241Am) were detected by gamma-spectrometry. The edible fraction content of these radionuclides between males and females for either species were not statistically significantly different. 99Tc was analysed by chemical separation and beta-counting. 99Tc concentrations in female crabs tended to be higher (172 +/- 205 (16) Bq kg-1(wet); mean +/- standard deviation (n samples)) than those in males (85 +/- 58 (18) Bq kg-1 (wet)), although this was not a statistically significant difference. For both male and female crabs, 99Tc concentrations tended to decrease with increasing whole live weights. For 99Tc in lobsters the picture is less clear. Female lobsters contained more activity (14800 +/- 7400 (20) Bq kg-1 (wet)) than males (7100 +/- 3900 (17) Bq kg-1 (wet)). The results were used to discuss the implications for sampling and monitoring.

The QUASIMEME laboratory performance study of polycyclic aromatic hydrocarbons (PAHs): assessment for the period 1996-1999. Quality Assurance of Information in Marine Environmental Monitoring in Europe

The results of the laboratory performance studies held during the period 1996-99 and involving the determination of PAHs in sediments and biota have been assessed. Overall 67% of the data submitted met the QUASIMEME criterion for satisfactory performance, although differences in performance were apparent between the two main analytical techniques employed: gas chromatography and high-performance liquid chromatography. Further development of PAH methodology utilising coupled gas chromatography mass spectrometry is encouraged as the most appropriate means of meeting the future requirements for the determination of a wider range of PAH analytes. More reference materials are also urgently required for use in marine monitoring programmes, and they need to be certified for a wider range of PAHs than hitherto, including both parent PAHs and their alkylated derivatives.