The complication rate after posterior fusion and instrumentation for degenerative lumbar scoliosis was 68%. Abundant blood loss was a significant risk factor for early perioperative complications. The improvement of Oswestry disability index was less in patients with late complications.

There is a debate regarding the distal fusion level for degenerative lumbar scoliosis. Whether a healthy L5-S1 motion segment should be included or not in the fusion remains controversial. The purpose of this study was to determine the optimal indication for the fusion to the sacrum, and to compare the results of distal fusion to L5 versus the sacrum in the long instrumented fusion for degenerative lumbar scoliosis. A total of 45 patients who had undergone long instrumentation and fusion for degenerative lumbar scoliosis were evaluated with a minimum 2 year follow-up. Twenty-four patients (mean age 63.6) underwent fusion to L5 and 21 patients (mean age 65.6) underwent fusion to the sacrum. Supplemental interbody fusion was performed in 12 patients in the L5 group and eleven patients in the sacrum group. The number of levels fused was 6.08 segments (range 4-8) in the L5 group and 6.09 (range 4-9) in the sacrum group. Intraoperative blood loss (2,754 ml versus 2,938 ml) and operative time (220 min versus 229 min) were similar in both groups. The Cobb angle changed from 24.7°before surgery to 6.8°after surgery in the L5 group, and from 22.8°to 7.7°in the sacrum group without statistical difference. Correction of lumbar lordosis was statistically better in the sacrum group (P = 0.03). Less correction of lumbar lordosis in the L5 group seemed to be associated with subsequent advanced L5-S1 disc degeneration. The change of coronal and sagittal imbalance was not different in both groups. Subsequent advanced L5-S1 disc degeneration occurred in 58% of the patients in the L5 group. Symptomatic adjacent segment disease at L5-S1 developed in five patients. Interestingly, the development of adjacent segment disease was not related to the preoperative grade of disc degeneration, which proved minimal degeneration in the five patients. In the L5 group, there were nine patients of complications at L5-S1 segment, including adjacent segment disease at L5-S1 and loosening of L5 screws. Seven of the nine patients showed preoperative sagittal imbalance and/or lumbar hypolordosis, which might be risk factors of complications at L5-S1. For the patients with sagittal imbalance and lumbar hypolordosis, L5-S1 should be included in the fusion even if L5-S1 disc was minimal degeneration.

The increased penetration of distributed generation (DG), renewable energy utilization, and the introduction of the microgrid concept have changed the shape of conventional electric power networks. Most of the new power system networks are transforming into the DG model integrated with renewable and non-renewable energy resources by forming a microgrid. Islanding detection in DG systems is a challenging issue that causes several protection and safety problems. A microgrid operates in the grid-connected or stand-alone mode. In the grid-connected mode, the main utility network is responsible for a smooth operation in coordination with the protection and control units, while in the stand-alone mode, the microgrid operates as an independent power island that is electrically separated from the main utility network. Fast islanding detection is, therefore, necessary for efficient and reliable microgrid operations. Many islanding detection methods (IdMs) are proposed in the literature, and each of them claims better reliability and high accuracy. This study describes a comprehensive review of various IdMs in terms of their merits, viability, effectiveness, and feasibility. The IdMs are extensively analysed by providing a fair comparison from different aspects. Moreover, a fair analysis of a feasible and economical solution in view of the recent research trend is presented.

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