Farmers' Perspectives of the Benefits and Risks in Precision Livestock Farming in the EU Pig and Poultry Sectors

More efficient livestock production systems are necessary, considering that only 41% of global meat demand will be met by 2050. Moreover, the COVID-19 pandemic crisis has clearly illustrated the necessity of building sustainable and stable agri-food systems. Precision Livestock Farming (PLF) offers the continuous capacity of agriculture to contribute to overall human and animal welfare by providing sufficient goods and services through the application of technical innovations like digitalization. However, adopting new technologies is a challenging issue for farmers, extension services, agri-business and policymakers. We present a review of operational concepts and technological solutions in the pig and poultry sectors, as reflected in 41 and 16 European projects from the last decade, respectively. The European trend of increasing broiler-meat production, which is soon to outpace pork, stresses the need for more outstanding research efforts in the poultry industry. We further present a review of farmers' attitudes and obstacles to the acceptance of technological solutions in the pig and poultry sectors using examples and lessons learned from recent European projects. Despite the low resonance at the research level, the investigation of farmers' attitudes and concerns regarding the acceptance of technological solutions in the livestock sector should be incorporated into any technological development.

Lateral versus posterior approaches to treat degenerative lumbar pathologies-systematic review and meta-analysis of recent literature

INTRODUCTION

The lateral lumbar interbody fusion arose as a revolutionary approach to treating several spinal pathologies because the techniques were able to promote indirect decompression and lordosis restoration through a minimally invasive approach allowing for reduced blood loss and early recovery for patients. However, it is still not clear how the technique compares to other established approaches for treating spinal degenerative diseases, such as TLIF, PLIF, and PLF.

MATERIAL AND METHODS

This is a systematic review and meta-analysis of articles published in the last 10 years comparing lateral approaches to posterior techniques. The authors included articles that compared the LLIF technique to one or more posterior approaches, treating only degenerative pathologies, and containing at least one of the key outcomes of the study. Exclusion articles that were not original and the ones that the authors could not obtain the full text; also articles without the possibility to calculate the standard deviation or mean were excluded. For count variables, the odds ratio was used, and for continuous variables, the standard means difference (SMD) was used, and the choice between random or fixed-effects model was made depending on the presence or not of significant (p < 0.05) heterogeneity in the sample.

RESULTS

Twenty-four articles were included in the quantitative review. As for the intra-/perioperative variables, the lateral approaches showed a significant reduction in blood loss (SMD-1.56, p < 0.001) and similar operative time (SMD =  - 0.33, p = 0.24). Moreover, the use of the lateral approaches showed a tendency to lead to reduced hospitalization days (SMD =  - 0.15, p = 0.09), with significantly reduced odds ratios of complications (0.53, p = 0.01). As for the clinical outcomes, both approaches showed similar improvement both at improvement as for the last follow-up value, either in ODI or in VAS-BP. Finally, when analyzing the changes in segmental lordosis and lumbar lordosis, the lateral technique promoted significantly higher correction in both outcomes (p < 0.05).

CONCLUSION

Lateral approaches can promote significant radiological correction and similar clinical improvement while reducing surgical blood loss and postoperative complications.

Environmental Risk Factors Influence the Frequency of Coughing and Sneezing Episodes in Finisher Pigs on a Farm Free of Respiratory Disease

This study aimed to assess baseline levels of coughing on a farm free of respiratory disease, and to identify relationships between environmental conditions and coughing frequency in finisher pigs. Six replicates were conducted (690 pigs in total). A cross-correlation analysis was performed and lags of the predictor variables were carried forward for multivariable regression analysis when significant and showing r > 0.25. Results show that coughing frequency was overall low. In the first replicate, coughing was best predicted by exposure to higher ammonia concentrations that occurred with a lag of 1, 7, and 15 days (p = 0.003, p = 0.001, and p < 0.001, respectively), while in the sixth replicate coughing frequency was best predicted by the exposure to lower relative humidity and higher ventilation rates with a lag of 7 and 15 days (p < 0.001 and p = 0.003, respectively). Ammonia concentrations varied according to ventilation rates recorded on the same day (r > −0.70). In conclusion, guidelines on coughing levels in healthy pigs and calibration of the alarm systems of tools that measure coughing frequency can be extrapolated from this study. Environmental risk factors are associated with the respiratory health of finisher pigs.

A Systematic Review on Validated Precision Livestock Farming Technologies for Pig Production and Its Potential to Assess Animal Welfare

Several precision livestock farming (PLF) technologies, conceived for optimizing farming processes, are developed to detect the physical and behavioral changes of animals continuously and in real-time. The aim of this review was to explore the capacity of existing PLF technologies to contribute to the assessment of pig welfare. In a web search for commercially available PLF for pigs, 83 technologies were identified. A literature search was conducted, following systematic review guidelines (PRISMA), to identify studies on the validation of sensor technologies for assessing animal-based welfare indicators. Two validation levels were defined: internal (evaluation during system building within the same population that were used for system building) and external (evaluation on a different population than during system building). From 2,463 articles found, 111 were selected, which validated some PLF that could be applied to the assessment of animal-based welfare indicators of pigs (7% classified as external, and 93% as internal validation). From our list of commercially available PLF technologies, only 5% had been externally validated. The more often validated technologies were vision-based solutions (n = 45), followed by load-cells (n = 28; feeders and drinkers, force plates and scales), accelerometers (n = 14) and microphones (n = 14), thermal cameras (n = 10), photoelectric sensors (n = 5), radio-frequency identification (RFID) for tracking (n = 2), infrared thermometers (n = 1), and pyrometer (n = 1). Externally validated technologies were photoelectric sensors (n = 2), thermal cameras (n = 2), microphone (n = 1), load-cells (n = 1), RFID (n = 1), and pyrometer (n = 1). Measured traits included activity and posture-related behavior, feeding and drinking, other behavior, physical condition, and health. In conclusion, existing PLF technologies are potential tools for on-farm animal welfare assessment in pig production. However, validation studies are lacking for an important percentage of market available tools, and in particular research and development need to focus on identifying the feature candidates of the measures (e.g., deviations from diurnal pattern, threshold levels) that are valid signals of either negative or positive animal welfare. An important gap identified are the lack of technologies to assess affective states (both positive and negative states).

Pneumolabyrinth: a systematic review

PURPOSE

The aim of this study is to provide a systematic review of the literature about the etiology, clinical and radiological presentation, surgical management, and outcomes of pneumolabyrinth (PNL).

METHODS

A systematic review of the literature was performed including studies published up to September 2020 in electronic databases (PubMed/MEDLINE, EMBASE, Cochrane Library, and Scopus). The PRISMA standard was applied to identify English, Italian, or French-language studies mentioning PNL. Full texts lacking information on the etiology were excluded. Data concerning the cause, site of air bubbles/fistula, clinical presentation, treatment, and outcome were collected. A qualitative synthesis of the results was performed.

RESULTS

Seventy-eight articles were eventually included; 132 patients were involved in the qualitative synthesis. The most common causes were: stapes surgery (24/132, 18.2%), temporal bone fracture (42/132, 31.8%), head trauma without temporal bone fracture (19/132, 14.4%), penetrating trauma (21/132, 15.9%), and barotrauma (15/132, 11.4%). The site most commonly involved was the vestibule (102/107, 95.3%), followed by cochlea (43/107, 40.2%) and semicircular canals (25/107, 23.4%).

CONCLUSION

The etiopathogenesis of PNL can be summarized in traumatic, iatrogenic, or inflammatory/infective. Its management consists in exploratory tympanotomy and sealing the fistula, but also conservative treatments can be attempted. Vestibular symptoms disappear in the majority of cases. Instead, the prognosis of hearing function is widely variable, and complete recovery is less probable. The certainty of evidence is still too low to make it useful for clinical decision-making.

A Systematic Review on Commercially Available and Validated Sensor Technologies for Welfare Assessment of Dairy Cattle

In order to base welfare assessment of dairy cattle on real-time measurement, integration of valid and reliable precision livestock farming (PLF) technologies is needed. The aim of this study was to provide a systematic overview of externally validated and commercially available PLF technologies, which could be used for sensor-based welfare assessment in dairy cattle. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was conducted to identify externally validated sensor technologies. Out of 1,111 publications initially extracted from databases, only 42 studies describing 30 tools (including prototypes) met requirements for external validation. Moreover, through market search, 129 different retailed technologies with application for animal-based welfare assessment were identified. In total, only 18 currently retailed sensors have been externally validated (14%). The highest validation rate was found for systems based on accelerometers (30% of tools available on the market have validation records), while the lower rates were obtained for cameras (10%), load cells (8%), miscellaneous milk sensors (8%), and boluses (7%). Validated traits concerned animal activity, feeding and drinking behavior, physical condition, and health of animals. The majority of tools were validated on adult cows. Non-active behavior (lying and standing) and rumination were the most often validated for the high performance. Regarding active behavior (e.g., walking), lower performance of tools was reported. Also, tools used for physical condition (e.g., body condition scoring) and health evaluation (e.g., mastitis detection) were classified in lower performance group. The precision and accuracy of feeding and drinking assessment varied depending on measured trait and used sensor. Regarding relevance for animal-based welfare assessment, several validated technologies had application for good health (e.g., milk quality sensors) and good feeding (e.g., load cells, accelerometers). Accelerometers-based systems have also practical relevance to assess good housing. However, currently available PLF technologies have low potential to assess appropriate behavior of dairy cows. To increase actors' trust toward the PLF technology and prompt sensor-based welfare assessment, validation studies, especially in commercial herds, are needed. Future research should concentrate on developing and validating PLF technologies dedicated to the assessment of appropriate behavior and tools dedicated to monitoring the health and welfare in calves and heifers.

Individual dairy cow management: achievements, obstacles and prospects

This review deals with the prospects and achievements of individual dairy cow management (IDCM) and the obstacles and difficulties encountered in attempts to successfully apply IDCM into routine dairy management. All aspects of dairy farm management, health, reproduction, nutrition and welfare are discussed in relation to IDCM. In addition, new IDCM R&D goals in these management fields are suggested, with practical steps to achieve them. The development of management technologies is spurred by the availability of off-the-shelf sensors and expanded recording capacity, data storage, and computing capabilities, as well as by demands for sustainable dairy production and improved animal wellbeing at a time of increasing herd size and milk production per cow. Management technologies are sought that would enable the full expression of genetic and physiological potential of each cow in the herd, to achieve the dairy operation's economic goals whilst optimizing the animal's wellbeing. Results and conclusions from the literature, as well as practical experience supported by published and unpublished data are analyzed and discussed. The object of these efforts is to identify knowledge and management routine gaps in the practical dairy operation, in order to point out directions and improvements for successful implementation of IDCM in the dairy cows' health, reproduction, nutrition and wellbeing.

Rheumatoid Arthritis Increases Risk of Medical Complications Following Posterior Lumbar Fusion

BACKGROUND

Rheumatoid arthritis (RA) is a systemic disease with prominent musculoskeletal manifestations that is associated with increased morbidity and mortality in patients undergoing cervical spine surgery; however, few studies have specifically examined postoperative outcomes in patients with RA following lumbar surgery. The aim of this study was to evaluate whether patients with RA who underwent posterior lumbar fusion experienced increased postoperative complications and economic burden compared with patients without RA.

METHODS

Patients <85 years old who underwent elective 1- or 2-level instrumented posterior lumbar fusion for degenerative lumbar pathology between 2006 and 2012 were identified in the Medicare insurance claims database. Same-day revisions and cases for spinal infection, malignancy, and trauma were excluded. The resulting cohort was divided into patients with RA before fusion and patients without RA (controls). All outcomes of interest were compared using multivariate regression. Reoperation-free survival at 1- and 2-year follow-up was analyzed used log-rank test. Significance was defined as P < 0.05.

RESULTS

RA patients had significantly higher risk of 90-day readmission (odds ratio [OR] = 1.27, P < 0.001), thromboembolic events (OR = 1.39, P = 0.010), sepsis (OR = 2.32, P < 0.001), pneumonia (OR = 1.57, P = 0.001), and wound complications (OR = 1.41, P < 0.001). Reoperation-free survival was significantly lower in RA patients at 2-year follow-up (90.4% vs. 92.4%, P < 0.001). Following adjusted regression, RA independently contributed to a $1491 increase in additional 90-day costs (P < 0.001).

CONCLUSIONS

Preexisting RA may increase risk for short-term postoperative medical complications following posterior lumbar fusion, specifically infectious events. In addition, patients with RA have higher rates of subsequent reoperation following index surgery. Patients with RA be should counseled regarding these risks.

Managing respiratory disease in finisher pigs: Combining quantitative assessments of clinical signs and the prevalence of lung lesions at slaughter

This study aimed to assess the relationship between quantitative assessments of clinical signs of respiratory disease (recorded manually and automatically) and the prevalence of lung lesions at slaughter to validate the use of both in the management of respiratory disease on farm. This was an observational study where pigs (n = 1573) were monitored from 25 ± 5.3 kg (week 12) to slaughter at 114 ± 15.4 kg (week 24). Pigs were housed in eight rooms divided into six pens on a wean-to-finish farm. A manual pen-based coughing (CF) and sneezing (SF) frequency was recorded weekly, for ten consecutive weeks, and a SOMO box (SoundTalks®) was installed in each room, issuing a daily respiratory distress index (RDI) for 13 weeks. Lungs were individually scored for pneumonia, scarring and dorsocaudal (DC) and cranial (CP) pleurisy lesions at slaughter. Relationship between prevalence of lung lesions and weekly RDI and CF and SF was assessed using Spearman's rank correlations and multivariable linear and logit-normal models. Both coughing and lung lesions were largely pen-specific, which fit the disease presentation of Mycoplasma hyopneumoniae. Results showed agreement between RDI and CF (rs = 0.5, P < 0.001), measuring higher levels of coughing at the beginning (weeks 13-14) and end (weeks 21-24, and weeks 21-22, respectively) of the finisher period. Positive associations were found between the prevalence of pneumonia and CF on week 21 and 22 (P < 0.001 and P = 0.011, respectively) and RDI on week 21-24 (r_s > 0.70; P < 0.050); the prevalence of DC and CP, and CF on week 22 (P < 0.001); and prevalence of scar lesions and CF on week 17 and 21 (P = 0.013 and P = 0.004, respectively), and RDI on week 21-24 (r_s > 0.70; P < 0.050). In the earlier weeks of the finisher stage, coughing was recorded but was not reflected in a higher prevalence of lung lesions at slaughter. These findings highlight the benefit of including measurements of coughing frequency to complement post mortem findings, to improve the management of respiratory disease on farm.

Congenital Membranous Stapes Footplate Producing Episodic Pressure-Induced Perilymphatic Fistula Symptoms

Introduction: Recent third window syndrome studies have revealed that the intact bony labyrinth and differences in the stiffness of the oval and round windows are essential for proper cochlear and vestibular function. Herein we report a patient with a congenital dehiscence of the right stapes footplate. This dehiscence caused long-standing episodic pressure-induced vertigo (Hennebert sign). At the time of presentation, her increased thoracic pressure changes induced the rupture of the membranous stapes footplate. Perilymph leakage was confirmed by imaging and a biochemical test [perilymph-specific protein Cochlin-tomoprotein (CTP) detection test].

Case Report: A 32-year-old woman presented with a sudden onset of right-sided hearing loss and severe true rotational vertigo, which occurred immediately after nose-blowing. CT scan showed a vestibule pneumolabyrinth. Perilymphatic fistula (PLF) repair surgery was performed. During the operation, a bony defect of 0.5 mm at the center of the right stapes footplate, which was covered by a membranous tissue, and a tear was found in this anomalous membrane. A perilymph-specific protein CTP detection test was positive. The fistula in the footplate was sealed. Postoperatively, the vestibular symptoms resolved, and her hearing improved. A more detailed history revealed that, for 15 years, she experienced true rotational vertigo when she would blow her nose. After she stopped blowing her nose, she would again feel normal.

Discussion: There is a spectrum of anomalies that can occur in the middle ear, including the ossicles. The present case had a dehiscence of the stapes, with a small membranous layer of tissue covering a bony defect in the center of the footplate. Before her acute presentation to the hospital, this abnormal footplate with dehiscence induced pathological pressure-evoked fluid-mechanical waves in the inner ear, which resulted in Hennebert sign. When patients have susceptibility (e.g., weak structure) to rupture, such as that identified in this case, PLF can be caused by seemingly insignificant events such as nose-blowing, coughing, or straining.

Conclusion: This case demonstrates that PLF is a real clinical entity. Appropriate recognition and treatment of PLF can improve a patient's condition and, hence, the quality of life.

Outpatient Versus Inpatient Posterior Lumbar Fusion for Low-Risk Patients: An Analysis of Thirty-Day Outcomes From the National Surgical Quality Improvement Program

BACKGROUND

Outpatient spine surgery has been increasingly used recently owing to its perceived cost benefits and its ability to offset the volume from the inpatient setting. However, the 30-day outcomes of outpatient posterior lumbar fusion (PLF) for low-risk patients have not been extensively studied. In the present study, we assessed the 30-day outcomes of outpatient PLF surgery for low-risk patients using a national surgical quality registry.

METHODS

For the present study, we queried the American College of Surgeons National Surgical Quality Improvement Program for patients who had undergone PLF from 2009 to 2016. Only patients with an American Society of Anesthesiologists grade of 1-2 were included. The 30-day outcomes, including any complications, readmissions, and reoperations, were studied using multivariable logistic regression after adjustment for an array of patient-specific factors.

RESULTS

A total of 29,830 cases were identified. Of these 29,830 cases, 1016 (3.4%) had been performed as outpatient cases and 28,814 (96.6%) as inpatient. After adjusting for an array of patient-specific factors, we did not find any significant association between the procedure setting and complication rate (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.6-1.1; P = 0.15) or 30-day readmission rate (OR, 0.9; 95% CI, 0.6-1.4; P = 0.76). Patients undergoing outpatient PLF were more likely to have required a 30-day reoperation (OR, 1.6; 95% CI, 1.1-2.4; P = 0.02).

CONCLUSION

Our results have demonstrated that the 30-day outcomes of patients who have undergone outpatient PLF might be comparable to those of patients who have undergone PLF in an inpatient setting. However, outpatient surgery might be associated with a greater overall reoperation rate.

Efficacy of platelet-rich plasma in posterior lumbar interbody fusion: systematic review and meta-analysis

INTRODUCTION

We have conducted a systematic review and meta-analysis that aims to compare outcomes (pain VAS, fusion and adverse event) of PRP and placebo after posterolateral lumbar fusion (PLF) surgery.

MATERIALS AND METHODS

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies were identified from Medline and Scopus from inception to September 16, 2019 that reported visual analog scale back pain, postoperative complications and fusions of either group.

RESULTS

In a total of seven studies, two, two, three studies were RCT, prospective and retrospective studies, respectively. Overall, there were 270 patients (150 in the PRP group and 149 in the placebo group). Three, three, four, three, two, seven and four studies were reported for pain VAS back in 3 months, 6 months, 12 months, 24 months, period of fusion, postoperative fusion and adverse events, respectively. The unstandardized mean difference (UMD) VAS back in 3, 6, 6 and 24 months was - 0.41 (95% CI - 0.87, 0.05) score, - 0.97 (95% CI - 1.68, - 0.27) score, - 0.33 (95% CI - 0.61, - 0.59) score, - 0.19 (95% CI - 1.00, 0.62) scores lower than placebo after posterolateral lumbar fusion (PLF) patients. The UMD period of bone union were - 1.62 (95% CI - 1.85, - 1.39) months faster than placebo after PLF patients. A total of seven and four studies were reported fusion and adverse events between PRP and placebo group. No significant differences were noted for fusion and adverse events with the pooled RR of 1.03 (95% CI 0.48, 1.80) and 0.95 (95% CI 0.14, 6.56).

CONCLUSIONS

PRP with autologous bone graft had lower back pain and faster bone union time than bone graft alone. While, there have no difference in fusion rate and adverse events in both groups. Larger, prospective randomized controlled studies are needed to confirm these findings as the current literature is still insufficient. Further research including cost of operation, postoperative function and satisfaction, quality of life and cost-efficacy analysis is required to determine whether the PRP with autologous bone graft is superior to bone graft alone or not.

LEVEL OF EVIDENCE

Level II.

Fusion technique does not affect short-term patient-reported outcomes for lumbar degenerative disease

BACKGROUND/CONTEXT

Degenerative lumbar disease can be addressed via an anterior or posterior approach, and with or without the use of an interbody cage. Although several studies have compared the type of approach and technique, there is a lack of literature assessing patient-reported outcome measures (PROMs) and radiographic parameters between different fusion techniques.

PURPOSE

To determine whether the surgical approach and fusion technique for lumbar degenerative disease had an effect on short-term PROMs and radiographic parameters.

STUDY DESIGN/SETTING

Retrospective Cohort Study.

PATIENT SAMPLE

Three hundred and ninety-one patients who underwent a 1-3 level lumbar spine fusion procedure at a high-volume academic center were retrospectively identified. Patients were divided into three groups based on the type of fusion they underwent: posterolateral fusion (PLF), anterior lumbar interbody fusion (ALIF), or transforaminal lumbar interbody fusion (TLIF).

OUTCOME MEASURES

PROMs: Short Form-12 (SF-12) Physical Component Score (PCS) and Mental Component Score (MCS), Oswestry Disability Index (ODI), Visual Analog Score (VAS) Back, VAS Leg. Spinopelvic measurements: Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), Segmental Lordosis (SL), PI-LL mismatch.

METHODS

Patients with less than 1-year follow-up were excluded from the cohort. Pre- and postoperative spinopelvic measurements were obtained for all patients. Univariate analysis (Chi-squared/Fisher's exact test or ANOVA test with post-hoc Bonferroni test) was used to compare among the three groups in the PROMs and radiographic spinopelvic parameters. Multiple linear regression was used to determine if fusion technique was an independent predictor of change in each patient outcome.

RESULTS

Two hundred and sixteen patients were included in the PLF group, 33 patients in the ALIF group, and 142 patients in the TLIF group. The PLF group was significantly older at baseline (p<.001) and had lower preoperative diagnosis rates of degenerative scoliosis and disc herniations (p<.001), whereas the ALIF group underwent a higher proportion of three-level fusions (p<.001). There was no significant difference in spinopelvic parameters preoperatively, however the ALIF group showed significantly more improvement in SL postoperatively (p=.004) than the PLF and TLIF groups. Within each group, SL improved for the PLF and ALIF groups (p=.002 for both), but not for the TLIF group (p=.238). Comparing patient outcomes, the ALIF group reported lower preoperative VAS Leg scores (p=.031), however, this difference resolved postoperatively. Stratifying for preoperative diagnosis, there were no significant differences in outcomes, except for a greater improvement in VAS Leg scores for degenerative scoliosis patients undergoing ALIF. Using multivariate analysis, fusion technique was not found to be a significant predictor of change in any patient outcome or in odds of revision.

CONCLUSIONS

Lumbar degenerative disease can be treated with several different fusion techniques, however, the relationship between type of fusion and PROMs is not established. Based on the findings in this study, the ALIF group showed greater improvement in SL compared with the PLF and TLIF groups, however, there was no difference noted in overall LL, PI-LL mismatch or other spinopelvic parameters. Despite these radiographic findings, patient outcome measures remained similar between all three fusion types.

Outcomes Following Posterior Lumbar Fusion in Patients with Polycythemia Vera

BACKGROUND

Polycythemia vera (PV) is a chronic myeloproliferative neoplasm that is associated with increased risk for venous and arterial thromboembolism. The aim of this study was to evaluate outcomes following elective posterior lumbar fusion (PLF) and/or posterior interbody fusion (PLIF) among patients with PV.

METHODS

Using PearlDiver retrospective national database, Medicare patients <85 years old who underwent elective primary PLF (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 81.07) and/or PLIF (ICD-9-CM code 81.08) for degenerative lumbar spine pathologies during 2006-2013 were identified. Patients included in the PLF and/or PLIF cohort were separated into patients with a prior diagnosis of PV (ICD-9-CM code 238.4) and a control cohort of patients without PV. Comparisons of postoperative outcomes were made between the PV patient group and matched control group. Significance was set at 0.05.

RESULTS

Selected study participants included 1491 patients with PV and 29,056 patients in the matched control group. Patients with PV had a significantly increased rate of 90-day acute pulmonary embolism (1.9% vs. 1.2%, odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10-2.38, P = 0.010), 90-day lower extremity deep vein thrombosis (3.4% vs. 1.9%, OR 1.81, 95% CI 1.33-2.40, P < 0.001), and 1-year diagnosis of surgical site infection (5.4% vs. 4.2%, OR 1.30, 95% CI 1.02-1.63, P = 0.027) compared with patients without PV. Nonetheless, PV was not associated with other major medical complications, including stroke, myocardial infarction, and mortality, following PLF and/or PLIF.

CONCLUSIONS

Patients with PV undergoing elective PLF and/or PLIF have a significantly increased risk for pulmonary embolism, lower extremity deep vein thrombosis, and surgical site infection.

Smart Animal Agriculture: Application of Real-Time Sensors to Improve Animal Well-Being and Production

Consumption of animal products such as meat, milk, and eggs in first-world countries has leveled off, but it is rising precipitously in developing countries. Agriculture will have to increase its output to meet demand, opening the door to increased automation and technological innovation; intensified, sustainable farming; and precision livestock farming (PLF) applications. Early indicators of medical problems, which use sensors to alert cattle farmers early concerning individual animals that need special care, are proliferating. Wearable technologies dominate the market. In less-value-per-animal systems like sheep, goat, pig, poultry, and fish, one sensor, like a camera or robot per herd/flock/school, rather than one sensor per animal, will become common. PLF sensors generate huge amounts of data, and many actors benefit from PLF data. No standards currently exist for sharing sensor-generated data, limiting the use of commercial sensors. Technologies providing accurate data can enhance a well-managed farm. Development of methods to turn the data into actionable solutions is critical.

Does approach matter? A comparative radiographic analysis of spinopelvic parameters in single-level lumbar fusion

BACKGROUND CONTEXT

Lumbar fusion is a popular and effective surgical option to provide stability and restore anatomy. Particular attention has recently been focused on sagittal alignment and radiographic spinopelvic parameters that apply to lumbar fusion as well as spinal deformity cases. Current literature has demonstrated the effectiveness of various techniques of lumbar fusion; however, comparative data of these techniques are limited.

PURPOSE

This study aimed to directly compare the impact of various lumbar fusion techniques (anterior lumbar interbody fusion [ALIF], lateral lumbar interbody fusion [LLIF], transforaminal lumbar interbody fusion [TLIF], and posterolateral fusion [PLF]) based on radiographic parameters.

STUDY DESIGN/SETTING

A single-center retrospective study examining preoperative and postoperative radiographs was carried out.

PATIENT SAMPLE

A consecutive list of lumbar fusion surgeries performed by multiple spine surgeons at a single institution from 2013 to 2016 was identified.

OUTCOME MEASURES

Radiographic measurements used included segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence (PI), pelvic incidence-lumbar lordosis (PI-LL) mismatch, anterior and posterior disc height (DH-A, DH-P, respectively), and foraminal height (FH).

METHODS

Radiographic measurements were performed on preoperative and postoperative lateral lumbar radiographs on all single-level lumbar fusion cases. Demographic data were collected including age, gender, approach, diagnosis, surgical level, and implant lordosis. Paired sample t test, one-way analysis of variance (ANOVA), McNemar test, and independent sample t test were used to establish significant differences in the outcome measures. Multiple linear regression was performed to determine a predictive model for lordosis from implant lordosis, fusion technique, and surgical level.

RESULTS

There were 164 patients (78 men, 86 women) with a mean age of 60.1 years and average radiographic follow-up time of 9.3 months. These included 34 ALIF, 23 LLIF, 63 TLIF, and 44 PLF surgeries. ALIF and LLIF significantly improved SL (7.9° and 4.4°), LL (5.5° and 7.7°), DH-A (8.8 mm and 5.8 mm), DH-P (3.4 mm and 2.3 mm), and FH (2.8 mm and 2.5 mm), respectively (p≤.003). TLIF significantly improved these parameters, albeit to a lesser extent: SL (1.7°), LL (2.7°), DH-A (1.1 mm), DH-P (0.8 mm), and FH (1.1 mm) (p≤.02). PLF did not significantly alter any of these parameters while significantly reducing FH (-1.3 mm, p=.01). One-way ANOVA showed no significant differences between ALIF and LLIF other than ALIF with greater ΔDH-A (3.0 mm, p=.02). Both ALIF and LLIF significantly outperformed PLF in preoperative to postoperative changes in all parameters p≤.001. Additionally, ALIF significantly outperformed TLIF in the change in SL (6.2°, p<.001), and LLIF significantly outperformed TLIF in the change in LL (5.0°, p=.02). Both outperformed TLIF in ΔDH-A (7.7 mm and 4.7 mm) and ΔDH-P (2.6 mm and 1.5 mm), respectively (p≤.02). ALIF was the only fusion technique that significantly improved the proportion of patients with a PI-LL<10° (0.410.66, p=.02). Lordotic cages had superior improvement of all parameters compared with non-lordotic cages (p<.001). Implant lordosis (m=1.1), fusion technique (m=6.8), and surgical level (m=6.9) significantly predicted postoperative SL (p<.001, R²=0.56).

CONCLUSIONS

This study demonstrated that these four lumbar fusion techniques yield divergent radiographic results. ALIF and LLIF produced greater improvements in radiographic measurements postoperatively compared with TLIF and PLF. ALIF was the most successful in improving PI-LL mismatch, an important parameter relating to sagittal alignment. Lordotic implants provided better sagittal correction and surgeons should be cognizant of the impact that these differing implants and techniques produce after surgery. Surgical technique is an important determinant of postoperative alignment and has ramifications upon sagittal alignment in lumbar fusion surgery.

Does Transforaminal Lumbar Interbody Fusion Have Advantages over Posterolateral Lumbar Fusion for Degenerative Spondylolisthesis?

Study Design Retrospective cohort study. Objective To compare the clinical and radiographic outcomes of transforaminal lumbar interbody fusion (TLIF) and posterolateral lumbar fusion (PLF) in the treatment of degenerative spondylolisthesis. Methods This study compared 24 patients undergoing TLIF and 32 patients undergoing PLF with instrumentation. The clinical outcomes were assessed by visual analog scale (VAS) for low back pain and leg pain, physical component summary (PCS) of the 12-item Short-Form Health Survey, and the Oswestry Disability Index (ODI). Radiographic parameters included slippage of the vertebra, local disk lordosis, the anterior and posterior disk height, lumbar lordosis, and pelvic parameters. Results The improvement of VAS of leg pain was significantly greater in TLIF than in PLF unilaterally (3.4 versus 1.0; p = 0.02). The improvement of VAS of low back pain was significantly greater in TLIF than in PLF (3.8 versus 2.2; p = 0.02). However, there was no significant difference in improvement of ODI or PCS between TLIF and PLF. Reduction of slippage and the postoperative disk height was significantly greater in TLIF than in PLF. There was no significant difference in local disk lordosis, lumbar lordosis, or pelvic parameters. The fusion rate was 96% in TLIF and 84% in PLF (p = 0.3). There was no significant difference in fusion rate, estimated blood loss, adjacent segmental degeneration, or complication rate. Conclusions TLIF was superior to PLF in reduction of slippage and restoring disk height and might provide better improvement of leg pain. However, the health-related outcomes were not significantly different between the two procedures.