Among closely related species, larger mammals tend to have a longer face and proportionally smaller braincase. This putative ‘rule’ in mammalian macroevolution has been proposed for the first time in 2013 based on 3D geometric morphometrics of antelopes, fruit bats, tree squirrels and mongooses. To firmly demonstrate that this trend holds as a ‘rule’ requires expanding the analysis in more lineages and other mammalian orders: if supported in most groups, it may indeed become a new evolutionary ‘rule’ besides famous ones such as Bergmann’s and Allen’s. In this study, using statistical shape analysis and both standard and comparative methods on a sample of kangaroos, wallabies and other macropodine marsupials, we show that the ‘big size-long face’ pattern is indeed found also outside the placentals. This provides support to the hypothesis of an important role of size-related shape changes (i.e., allometry) in the origin of the exceptional disparity of mammals, that, only in terms of size, span more orders of magnitude than any other animal: from 3 to 4 g of a tiny bat to more than 100 tons in blue whales
Introduction: The sacroiliac joint (SIJ) may be a source of chronic low back pain in 15 -22% of patients. Over
the past four years MIS is an emerging standard of care for SI joint fusion. The International Society for the Advancement
of Spine Surgery (ISASS) and Society for Minimally Invasive Spine Surgery (SMISS) conducted a survey of their
members to examine current preferences in surgeon practice of MIS SI fusion.Methods: To qualify for survey participation, the surgeon had to perform at least one open or MIS SIJ fusion procedure
between 2009 and 2012. All surgeons were instructed to review their records. This included the number of surgical
procedures performed annually from 2009-2012, site of service where each procedure was commonly performed, and
average length of stay for each approach.Results: Twenty four percent (121/500) of the eligible members participated in this survey. This survey revealed that the
percentage of MIS procedures increased from 39% in 2009 to over 87% in 2012. The survey showed a significant increase
in average number of MIS surgeries and a significant difference between open and MIS surgeries in 2012 (p<0.0001). In
addition, 80% of the survey respondents indicated a lack of preference toward open approach if that was the only
available option.Conclusions: According to performed survey, MIS SIJ fusion is preferred over open technique. Incorporation of the MIS
technique into the spine surgeon's specter of skills would allow an increased number of surgical options as well as
possible increase in outcome quality.
Objectives:The sacroiliac joint (SIJ) is an important and significant cause of low back pain. We sought to quantify the burden of disease attributable to the SIJ.
Methods:The authors compared EuroQol 5D (EQ-5D) and Short Form (SF)-36-based health state utility values derived from the preoperative evaluation of patients with chronic SIJ pain participating in two prospective clinical trials of minimally invasive SIJ fusion versus patients participating in a nationally representative USA cross-sectional survey (National Health Measurement Study [NHMS]). Comparative analyses controlled for age, sex, and oversampling in NHMS. A utility percentile for each SIJ subject was calculated using NHMS as a reference cohort. Finally, SIJ health state utilities were compared with utilities for common medical conditions that were published in a national utility registry. Results: SIJ patients (number [n]=198) had mean SF-6D and EQ-5D utility scores of 0.51 and 0.44, respectively. Values were significantly depressed (0.28 points for the SF-6D utility score and 0.43 points for EQ-5D; both P,0.0001) compared to NHMS controls. SIJ patients were in the lowest deciles for utility compared to the NHMS controls. The SIJ utility values were worse than those of many common, major medical conditions, and similar to those of other common preoperative orthopedic conditions. Conclusion: Patients with SIJ pain presenting for minimally invasive surgical care have marked impairment in quality of life that is worse than in many chronic health conditions, and this is similar to other orthopedic conditions that are commonly treated surgically. SIJ utility values are in the lowest two deciles when compared to control populations.
ObjectCurrently, few studies regarding morbidity and mortality associated with operative treatment of spinal disorders in children are available to guide the surgeon. This study provides more detailed morbidity and mortality data with an analysis of 23,918 pediatric cases reported in the multicenter, multisurgeon Scoliosis Research Society morbidity and mortality database.MethodsThe Scoliosis Research Society morbidity and mortality database was queried for the years from 2004 to 2007. The inclusion criterion was age 18 years or younger. Cases were categorized by operation type and diagnosis. Details on the surgical approach, use of neurophysiological monitoring, and type of instrumentation were recorded. Major perioperative complications and deaths were evaluated. Statistical analysis was performed with chi-square testing, with a p value < 0.05 considered significant.ResultsA total of 23,918 patients were included. The mean age was 13 ± 3.6 years (± SD). Spinal pathology included the following: scoliosis (in 19,642 patients), kyphosis (in 1455), spondylolisthesis (in 748), trauma (in 478), and other (in 1595 patients). The overall complication rate was 8.5%. Major complications included wound infections (2.7%), new neurological deficits (1.4%), implant-related complications (1.6%), and hematomas (0.4%). The most common medical complications were respiratory related (0.9%). Morbidity rates differed based on pathology, with patients undergoing treatment for kyphosis and spondylolisthesis having higher overall rates of morbidity (14.7% and 9.6%, respectively). Patients undergoing revision procedures (2034) or corrective osteotomies (2787) were more likely to suffer a complication or new neurological deficit. The majority of these deficits improved at least partially. Thirty-one deaths were reported for an overall rate of 1.3 per 1000. Respiratory complications were the most common cause of mortality (13 cases). Twenty-six of the deaths occurred in children undergoing scoliosis correction.ConclusionsSpinal surgery in children is associated with a range of complications depending on the type of operation. Mortality rates for all indications and operations were low. Patients undergoing more aggressive corrective procedures for deformity are more likely to suffer complications and new neurological deficits.
Hemimetameric shift is a common finding in congenital scoliosis. Hemivertebrae are most commonly found in the thoracic spine; however, surgical intervention is most commonly observed when the caudal hemivertebrae is located from the thoracolumbar to lumbosacral junction. The incidence of abnormal magnetic resonance imaging findings is low (6%).
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