Objective To provide radiographic parameters for optimal placement of posterior second sacral alar iliac (S2AI) screw for instrumentation and fusion of scoliosis to the second sacral level in a Chinese population. Methods S2AI screw trajectories were mapped on threedimensional computed tomography (3DCT) reconstructions of 60 normal adult pelvises. 1 mm inferior and 1 mm lateral to the S1 dorsal foramen were chosen as the entry point, and ideal S2AI screw trajectories were explored by rotating and cutting the 3D pelvis, ensuring that the trajectories were of maximum length and width. The directions and depth of these determined trajectories were then measured. Results The ideal S2AI screw trajectories could be found in each pelvis. The left and right screw trajectory parameters for males were shown as follows: angulation was L 29.15 ± 8.60°vs. R 29.96 ± 8.28°(p = 0.286) caudally in the sagittal plane and L 36.49 ± 3.14°vs. R 37.16 ± 3.14°(p = 0.165) laterally in the transverse plane. The maximal and intrasacral lengths of trajectory were L 121.25 ± 8.33 vs. R 120.63 ± 7.54 mm (p = 0.460) and L 26.20 ± 3.31 vs. R 26.92 ± 4.76 mm (p = 0.268). The entry point was L 28.87 ± 3.33 vs. R 29.79 ± 3.55 mm (p = 0.186) lateral to the second sacral midline, and L 44.14 ± 11.87 vs. R 43.89 ± 12.53 mm (p = 0.687) underneath the skin. The trajectories for females were more caudal (L: 34.50 ± 6.56°vs. 29.15 ± 8.60°, p = 0.009; R: 35.72 ± 7.53°vs. 29.96 ± 8.28°, p = 0.007) in the sagittal plane, but the lateral angulation in the transverse plane showed no difference between genders (p [ 0.05). The female iliac medullar cavities were obviously narrower than those of males (L: 14.76 ± 2.46 vs. 16.98 ± 3.52, p = 0.006; R: 14.94 ± 2.60 vs. 17.00 ± 2.81, p = 0.005). Although the average maximal length of trajectories for females were about 5 mm shorter than those of males, intrasacral length were equal to those of males. Furthermore, both the distance from entry point to the S2 midline and skin in the transverse plane showed no difference between genders. Conclusion The feasibility to insert S2AI screws to the sacrum and ilium in an Asian population along with the ideal entry angle and length of trajectory were identified for clinical practice.

This study shows that patients with Type C coronal malalignment may be at greater risk of post-operative coronal imbalance following posterior osteotomy. Cite this article: Bone Joint J 2016;98-B:1227-33.

The emergence of monoclonal antibody (mAb) therapies has created a need for faster and more efficient bioprocess development strategies in order to meet timeline and material demands. In this work, a high-throughput process development (HTPD) strategy implementing several high-throughput chromatography purification techniques is described. Namely, batch incubations are used to scout feasible operating conditions, miniature columns are then used to determine separation of impurities, and, finally, a limited number of lab scale columns are tested to confirm the conditions identified using high-throughput techniques and to provide a path toward large scale processing. This multistep approach builds upon previous HTPD work by combining, in a unique sequential fashion, the flexibility and throughput of batch incubations with the increased separation characteristics for the packed bed format of miniature columns. Additionally, in order to assess the applicability of using miniature columns in this workflow, transport considerations were compared with traditional lab scale columns, and performances were mapped for the two techniques. The high-throughput strategy was utilized to determine optimal operating conditions with two different types of resins for a difficult separation of a mAb monomer from aggregates. Other more detailed prediction models are cited, but the intent of this work was to use high-throughput strategies as a general guide for scaling and assessing operating space rather than as a precise model to exactly predict performance.

No abstract

This study demonstrated that the lower EV disc degeneration strongly correlated with sagittal imbalance in patients with DLS, implying that disc degeneration may be regarded as a potential risk factor for sagittal imbalance. This result strengthened the importance of not selecting the lower EV as the lower instrumented vertebra during the surgical decision making, which may lead to deterioration of sagittal balance. Disc degeneration was also strongly correlated with sagittal malalignment, as demonstrated by a more positive SVA, decreased TK and LL, providing insight into reasons for low quality of life in elderly patients with DLS.