INTRODUCTION: Computer aided navigation is an important tool which has the capability to enhance surgical accuracy, while reducing negative outcomes. However, it is a relatively new technology and has not yet been accepted as the standard of care in all settings. OBJECTIVES: The objective of the present study is to present the development and current state of technologies in computer aided navigation in Orthopedic Spine Surgery, specifically in navigated placement of pedicle screws, to examine the clinical need for navigation, it's effect on surgical accuracy and clinical outcome and to determine whether the benefits justify the costs, and make recommendations for future use and enhancements. CONCLUSION: Computer aided navigation in pedicle screw placement enhances accuracy, reduces the probability of negative outcomes, reduces the exposure of the patient and staff to radiation, reduces operative time, and provides cost-savings. Future investigations may potentially enhance this effect further with the use of innovative augmented reality type displays.

Background: Temporomandibular disorder (TMD) is a common and costly problem often leading to chronic pain. There exists moderate evidence for physical therapy (PT) interventions in the management of TMD. A known relationship between TMD and the cervical spine exists with some evidence to support cervical intervention treatments. Cervical spine thrust joint manipulation (TJM) is an effective PT intervention explored in a limited fashion for this population. Objectives: To determine the immediate and short term (1 and 4 week) effects of cervical TJM on pain, dysfunction, and perception of change in individuals with a primary complaint of TMD. Methods: In this single blind randomized clinical trial, individuals with TMD (n=50) were randomly assigned to receive cervical TJM or sham manipulation in 4 PT visits over 4-weeks. All participants also received behavioral education, a home exercise program, and soft tissue mobilization. Primary outcomes included jaw range of motion (ROM), Numeric Pain Rating Scale (NPRS), TMD Disability Index, Jaw Functional Limitation Scale (JFLS), Tampa Scale of Kinesiophobia (TSK-TMD), and Global Rating of Change (GROC). Self-report and objective measurements (with blinded assessor) were taken at baseline, immediately after baseline treatment, 1-week, and 4-weeks. A 2 x 4 mixed model ANOVA was used with treatment group as the between-subjects factor and time as the within-subjects factor. Separate ANOVAs were performed for dependent variables and the hypothesis of interest was the group by time interaction. Results: Statistically significant 2-way interactions were noted in JFLS (p = .026) and TSK-TMD (p = .008), favoring the thrust manipulation group. Both groups showed statistically significant main effects in all measures over time. GROC and PASS favored the thrust manipulation group with statistically significant differences in successful outcomes noted immediately after baseline treatment (NNT = 5) and at 4-weeks (NNT = 4). Conclusion: Both groups received identical multi-modal treatments with the addition of the randomized intervention: cervical TJM or sham manipulation. Differences between groups were small, however, improvements favored the TJM on all measures. Cervical TJM may be beneficial in the treatment of TMD.

The theme of the master’s thesis is detailed design bridge structure. The thesis is devoted to limit states assessment of the structure. The thesis includes a time analysis structure and a detailed solution influence of construction on its proposal.

SAMMANFATTNING Den prehospitala vården börjar när samtalet inkommer till SOS och avslutas när patienten avlämnas på mottagande enhet. Den prehospitala vården innefattar undersökning, övervakning och behandling av skadade och sjuka. Kompetensen det senaste årtiondet har förändrats från att ha varit enbart en transportorganisation till att utföra avancerade medicinska bedömningar och åtgärder. I Sverige drabbas ca 4000 personer varje år av skador i hals-, bröst- och ländrygg. Dessa frakturer orsakas ofta av hög energi och uppkommer samtidigt med andra svåra skador. Ryggradsskador innebär stort lidande för patienten och även höga kostnader för samhället. När den prehospitala personalen kommer fram till en patient med misstänkt skada på kotpelaren så är spinal immobilisering den åtgärd som utförs. Spinal immobilisering innebär att patienten påförs en hård nackkrage och sedan läggs och spänns fast på en spineboard. Detta i syftet att minimera rörelse i kotpelaren under transport in till mottaganade enhet. Syftet med studien var att belysa påverkan av att vara spinalt immobiliserad. Den metod som användes var litteraturstudie. Tjugo vetenskapliga artiklar valdes ut och sammanställdes efter sökning i olika databaser. Artiklarnas kvalitet har bedömts utifrån ett protokoll för att värdera dess kvalitet. Resultatet presenteras under fyra kategorier. Det främsta resultatet som framkom var att spinal immobilisering är obekväm och framkallar smärta. Detta på grund av att metoden framkallar kraftigt ökat tryck på vissa utsatta områden av kroppen så som bakhuvudet, skuldror och rumpa. Spinal immobilisering ger även en negativ påverkan på andningen och minskar cirkulationen till hjärnan och den hud och vävnad som utsätts för tryck. Slutsatsen var att många negativa effekter finns av att spinalt immobilisera patienterna på spineboard. Få studier eller inga studier visar att det faktiskt är en åtgärd som har någon positiv effekt eller ens den effekt som eftersträvas med spinal immobilisering.

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Background: Unplanned readmission has gained increasing interest as a quality marker for inpatient care, as it is associated with patient mortality and higher economic costs. Spinal neurosurgery is characterized by a lack of epidemiologic readmission data. The aim of this study was to identify causes and predictors for unplanned readmissions related to index diagnoses and surgical procedures. Methods: In this study, from 2015 to 2017, spinal neurosurgical procedures were recorded for surgical and non-surgical treated patients. The main reasons for an unplanned readmission within 30 days following discharge were identified. Multivariate logarithmic regression revealed predictors of unplanned readmission. Results: A total of 1172 patient records were examined, of which 4.27% disclosed unplanned readmissions. Among the surgical patients, the readmission rate was 4.06%, mainly attributable to surgical site infections, while it was 5.06% for the non-surgical patients, attributable to uncontrolled pain. A night-time surgery presented as the independent predictive factor. Conclusion: In the heterogeneous group of spinal neurosurgical patients, stratification into diagnostic groups is necessary for statistical analysis. Degenerative lumbar spinal stenosis and spinal abscesses are mainly affected by unplanned readmission. The surgical procedure dorsal root ganglion stimulation is an independent predictor of unplanned re-hospitalizations, as is the timing of surgery.

Problem: A lot of attention is given to the safety of the driving and the possibility to register fatigue of the drivers. Driving cars is monotony and static. Vibration loading, which causes changes in the axial system. This causes discomfort and fatigue to drivers after some time of exposure to the loading. Hypothesis: It is possible to prove the changes of mechanical characteristics (indicators) of the axial system using the TVS (transfer vibration through spine) method. By using TVS method before and after different types of loading or before and after relaxation it is possible to detect changes of the viscoelastic properties. This can be done by checking changes in the way of waves transfer through the axial system of the observed participants. Objective: Verify the possibility of use of TVS method to register changes of the viscoelastic characteristics of the axial system. Method: The TVS was chosen as a detection method. The method is based on the use of five-msec semi-bandwidth γ pulse stimuli and consequent application of continuously changing harmonic stimuli which periodically differ between 5Hz and 160Hz to the vertebrae C7 and L5. This wave is carried through the axial system and its acceleration on the spinous processes between C7 and S1 is scanned with the help of accelerometric...

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Biomechanical testing of cadaveric spinal segments forms the basis for our current understanding of healthy, pathological, and surgically treated spinal function. Over the past 40 years there has been a substantial amount of data published based on a spinal biomechanical testing regimen known as the flexibility method. This data has provided valuable clinical insights that have shaped our understanding of low back pain and its treatments. Virtually all previous lumbar spinal flexibility testing has been performed at room temperature, under very low motion rates, without the presence of a compressive follower-load to simulate upper body weight and the action of the musculature. These limitations of previous work hamper the applicability of published spinal biomechanics data, especially as researchers investigate novel ways of treating low back pain that are intended to restore the spine to a healthy biomechanical state. Thus, the purpose of this thesis work was to accurately characterize the rate-dependent flexibility of the lumbar spine at body temperature while in the presence of a compressive follower-load. A custom spine simulator with an integrated environmental chamber was developed and built as part of this thesis work. Cadaveric spinal motion segments were tested at 12 different rates of loading spanning the range of voluntary motion rates. The testing methodology allowed for comparison of spinal flexibility at room and body temperatures in the three primary modes of spinal motion, both with and without a compressive follower-load. Additionally, the work developed a stochastic model for rate-dependent spinal flexibility that allows for accurate prediction of spinal flexibility at any rate within the range of voluntary motion, based on a single flexibility test. In conclusion, the biomechanical response was significantly altered due to testing temperature, loading-rate, and application of a compressive follower-load. The author emphasizes the necessity to simulate the physiological environment during ex vivo biomechanical analysis of the lumbar spine in order to obtain a physiological response. Simplified testing procedures may be implemented only after the particular effect is known.