Doctors Medical Center (originally Brookside Hospital) was an eight-story, 120-bed public hospital in San Pablo, California which served 250,000 residents in western Contra Costa County from 1954 to 2015.
To perform a narrative review of the biomechanics of lumbar pedicle subtraction osteotomies (L-PSO) and associated surgical constructs. A non-systematic literature search was performed. PubMed was queried for investigations published between 2010 and 2025 with the following search terms: “lumbar”, “PSO”, “biomechanics, “finite element analysis”, “cadaver”. Studies evaluating biomechanical properties of L-PSO (L1-L5) constructs were included. Clinical studies and non-lumbar level (cervical/thoracic) PSOs were excluded. L-PSOs create a highly destabilized environment, particularly in axial rotation. Two-rod constructs significantly reduce range of motion (ROM) relative to the uninstrumented spine but are associated with high rod stresses. Multi-rod constructs (satellite and accessory rods) consistently reduce ROM and primary rod stresses, although the magnitude of benefit varies across studies and configurations. Rod material (cobalt chrome) and increased rod diameter further enhance construct rigidity but may increase stress shielding. Cross-links may increase rod stress when placed near a L-PSO site, while monoaxial screws increase construct stiffness compared to polyaxial screws. Interbody cages placed adjacent to L-PSOs improve load sharing and reduce posterior rod strains, particularly when used in a “sandwich” configuration. Biomechanical improvements, such as reduced rod strain and ROM, have not been directly linked to clinical outcomes, including fusion rates or rod fractures. While biomechanical studies demonstrate multi-rod constructs and adjunct techniques improve construct stability, the relationship between these biomechanical advantages and clinical outcomes, including osseous healing and rod fractures, remains unclear. In L-PSOs, increasing construct rigidity alone is not the primary goal; instead, optimal load sharing across the osteotomy site is a critical biomechanical consideration. As such, future work should focus on elucidating the optimal balance between protecting posterior instrumentation through construct rigidity and preserving adequate compressive forces across L-PSOs, integrating biomechanical findings with clinical data, and developing patient-specific biomechanical modeling to further refine L-PSO instrumentation techniques.
Small studies show that 0° head positioning of patients with large vessel occlusion (LVO) stroke improves penumbral blood flow and clinical stability. Understanding whether 0° head position maintains clinical stability would allow for optimal patient positioning before thrombectomy. To determine superiority of 0° over 30° head positioning at maintaining clinical stability in patients with LVO before thrombectomy. This was a prospective randomized clinical trial with blinding to study enrollment/end points conducted from May 2018 to November 2023. There were 3 planned interim analyses, and the study was conducted at certified thrombectomy hospitals in the US. Included in this analysis were consecutive consenting individuals with computed tomography (CT) angiography–positive anterior or posterior LVO who were candidates for thrombectomy (baseline mRS 0-1) and had viable penumbra (CT perfusion or Alberta Stroke Program Early Computed Tomography Score ≥6) within 24 hours of stroke onset. Enrollment of systemic thrombolysis more than 15 minutes from consent was discouraged to prevent confounding of head position effects; in addition, patients with disabilities who lacked a legal representative could not participate due to lack of consent. Randomization to 0° or 30° head positioning with monitoring every 10 minutes using the National Institutes of Health Stroke Scale (NIHSS) until movement to a catheterization table. The primary outcome was worsening of 2 or more NIHSS points before thrombectomy. Safety outcomes included severe neurologic deterioration (worsening ≥4 NIHSS points) before thrombectomy, hospital-acquired pneumonia (HAP) during hospitalization, and all-cause death within 3 months. Planned enrollment included 182 patients. Before data and safety monitoring board study closure, a total of 92 patients (mean [SD] age, 66.6 [14.4] years; 48 male [52.2%]) were randomized: 45 patients to the group with 0° head positioning and 47 patients to the group with 30° head positioning. Patient characteristics were similar between groups; however, patients with head position at 30° experienced worsening on the NIHSS of 2 points or more, whereas patients with head position at 0° showed score stability (hazard ratio [HR], 34.40; 95% CI, 4.65-254.37; P < .001). One patient with 0° head positioning and 20 patients with 30° head positioning experienced worsening on the NIHSS of 4 points or more during positioning (HR, 23.57; 95% CI, 3.16-175.99; P = .002). No patients developed HAP; all-cause death occurred in 2 patients (4.4%) in the 0° group, compared with 10 patients (21.7%; P = .03) in the 30° group. Results suggest that 0° head positioning for patients with acute LVO was a protective maneuver to maintain clinical stability in the prethrombectomy phase while awaiting definitive treatment. ClinicalTrials.gov Identifier: NCT03728738
Encouragement of cost-effectiveness in patient care is necessary due to the rising cost of healthcare and the depletion of financial resources.Case cancellations on the day of surgery results in inefficient use of operating rooms, waste of precious staff, and a reduction in resources available to patients and hospitals.Financial troubles and psychological stress are possible for patients.Hospitals could miss out on chances to do surgery, waste disposable equipment that was opened for cases that were never handled, and spend money on paying wages and benefits to employees who aren't working.In order to prevent needless case cancellations, the medical community must promote cost-effectiveness in all facets of patient care without compromising the standard of care that a doctor provides.
The elbow joint, although non-weight bearing, may be the most complex joint in the human body. The elbow is a synovial hinge joint made up of articulations of mainly the distal humerus and the proximal ulna. However, articulations exist between the proximal radius and the humerus as well as the proximal radius and ulna. The three articulations are referred to as the ulnohumeral, radiohumeral, and proximal radioulnar joints respectively. Many of the muscles of both the upper and lower arm either cross or attach to at least one component of the elbow joint making it no surprise that after the shoulder, the elbow joint is the second most commonly injured joint in sports-related injuries.
