Decarbonizing the Transport of Microalgae-based Products - The Role of E-mobility.

BACKGROUND: The decarbonization of road transport is a precondition for achieving carbon neutrality. Battery-electric vehicle technology can make this a reality. In this bias, the objective of the article is to shed light on the ongoing debate about the potentially important role of the adoption of electric vehicles in the transport of microalgae- based products to help them advance to a cleaner life cycle. METHODS: Five routes, including unimodal and multimodal conditions, were defined to assess the carbon emissions of the transport system and, more specifically, of road transport. The headquarters of market-leading microalgae manufacturers were selected as the origin of the routes and, as the destination, regions that sustain them. RESULTS: The results reveal the supremacy of road transport of microalgae-based products using electric vehicles powered by nuclear, hydroelectric, and wind, followed by biomass and photovoltaic energy. They also show that the positive impact of wind, water, and photovoltaic energy on the climate, added to the lower battery charging costs and the greater opportunity to generate revenue from the sale of carbon credits, make their tradeoffs. CONCLUSION: The exquisite results of this study convey key messages to decision-makers and stakeholders about the role of electromobility in building a zero-carbon delivery route.

Acclimatization and Foraging of Native Brazilian Stingless Bees in Arenas with Covering Materials of Different Spectral Properties.

The use of Meliponini for crop pollination in protected environments is practically non-existent. One of the reasons is the difficulty of acclimatizing Meliponini to the temperature and light conditions inside greenhouses. We investigated how covering materials used in greenhouses, which filter different intensities of ultraviolet (UV) light, affect the foraging behaviors, flight orientation, attraction to walls and ceilings, and mortality of Scaptotrigona cf. postica (Letreille), Frieseomelitta varia (Lepeletier), and Melipona quadrifasciata (Lepeletier). The experiments were conducted in 5.3 m3 arenas covered with four types of plastic films that do not polarize sunlight, with UV transmittance levels ranging from 0.1 to 54%, compared to a transparent glass control. The temperature inside the arenas varied between treatments, from 27 ± 3°C to 31 ± 2°C. All three species collected resources and returned to the colony, regardless of the covering material. However, the proportion of this behavior, the number of bees attracted to the ceiling and wall, and mortality varied among treatments and/or throughout the confinement days for each species. Melipona quadrifasciata and F. varia acclimatized better to the confined environments than S. cf. postica and showed consistent resource collection behavior throughout the confinement days in all tested materials, except for the one that filtered around 90% of UV. In all three species, the mortality gradually decreased throughout the confinement days. The results indicate that the choice of covering material, considering its optical characteristics, can be crucial to ensure greater effectiveness of the pollination services provided by stingless bees in protected systems.

The inheritance of alternative nest architectural traditions in stingless bees.

The transmission of complex behavior and culture in humans has long been attributed to advanced forms of social learning,1,2 which play a crucial role in our technological advancement.3 While similar phenomena of behavioral traditions and cultural inheritance have been observed in animals,1,2,4,5,6 including in primates,7 whales,8 birds,9 and even insects,10 the underlying mechanisms enabling the persistence of such animal traditions, particularly in insects, are less well understood. This study introduces pioneering evidence of enduring architectural traditions in the stingless bee Scaptotrigona depilis, which are maintained without any evidence for social learning. We demonstrate that S. depilis exhibits two distinct nest architectures, comprising either helicoidal or flat, stacked horizontal combs, which are transmitted across generations through stigmergy11,12,13,14,15,16,17-an environmental feedback mechanism whereby the presence of the existing comb structures guides subsequent construction behaviors-thereby leading to a form of environmental inheritance.18,19,20 Cross-fostering experiments further show that genetic factors or prior experience does not drive the observed variation in nest architecture. Moreover, the experimental introduction of corkscrew dislocations within the combs prompted helicoidal building, confirming the use of stigmergic building rules. At a theoretical level, we establish that the long-term equilibrium of building in the helicoidal pattern fits with the expectations of a two-state Markov chain model. Overall, our findings provide compelling evidence for the persistence of behavioral traditions in an insect, based on a simple mechanism of environmental inheritance and stigmergic interactions, without requiring any sophisticated learning mechanism, thereby expanding our understanding of how traditions can be maintained in non-human species.

Intra-abdominal Content Movement in Prone Versus Lateral Decubitus Position Lateral Lumbar Interbody Fusion (LLIF).

STUDY DESIGN: A prospective, anatomical imaging study of healthy volunteer subjects in accurate surgical positions. OBJECTIVE: To establish if there is a change in the position of the abdominal contents in the lateral decubitus (LD) versus prone position. SUMMARY OF BACKGROUND DATA: Lateral transpsoas lumbar interbody fusion (LLIF) in the LD position has been validated anatomically and for procedural safety, specifically in relation to visceral risks. Recently, LLIF with the patient in the prone position has been suggested as an alternative to LLIF in the LD position. MATERIALS AND METHODS: Subjects underwent magnetic resonance imaging of the lumbosacral region in the right LD position with the hips flexed and the prone position with the legs extended. Anatomical measurements were performed on axial magnetic resonance images at the L4-5 disc space. RESULTS: Thirty-four subjects were included. The distance from the skin to the lateral disc surface was 134.9 mm in prone compared with 118.7 mm in LD ( P <0.0001). The distance between the posterior aspect of the disc and the colon was 20.3 mm in the prone compared with 41.1 mm in LD ( P <0.0001). The colon migrated more posteriorly in relation to the anterior margin of the psoas in the prone compared with LD (21.7  vs . 5.5 mm, respectively; P <0.0001). 100% of subjects had posterior migration of the colon in the prone compared with the LD position, as measured by the distance from the quadratum lumborum to the colon (44.4  vs . 20.5 mm, respectively; P <0.001). CONCLUSION: There were profound changes in the position of visceral structures between the prone and LD patient positions in relation to the LLIF approach corridor. Compared with LD LLIF, the prone position results in a longer surgical corridor with a substantially smaller working window free of the colon, as evidenced by the significant and uniform posterior migration of the colon. Surgeons should be aware of the potential for increased visceral risks when performing LLIF in the prone position. LEVEL OF EVIDENCE: Level II-prospective anatomical cohort study.

Lateral lumbar interbody fusion at L4-L5 has a low rate of complications in appropriately selected patients when using a standardized surgical technique.

Aims: The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique. Methods: This was a multicentre retrospective study involving consecutively enrolled patients who underwent L4-L5 LLIF by seven surgeons at seven institutions in three countries over a five-year period. The demographic details of the patients and the details of the surgery, reoperations and complications, including femoral and non-femoral neuropraxia, thigh pain, weakness of hip flexion, and abdominal complications, were analyzed. Neurological and psoas-related complications attributed to LLIF or posterior instrumentation and persistent symptoms were recorded at one year postoperatively. Results: A total of 517 patients were included in the study. Their mean age was 65.0 years (SD 10.3) and their mean BMI was 29.2 kg/m2 (SD 5.5). A mean of 1.2 levels (SD 0.6) were fused with LLIF, and a mean of 1.6 (SD 0.9) posterior levels were fused. Femoral neuropraxia occurred in six patients (1.2%), of which four (0.8%) were LLIF-related and two (0.4%) had persistent symptoms one year postoperatively. Non-femoral neuropraxia occurred in nine patients (1.8%), one (0.2%) was LLIF-related and five (1.0%) were persistent at one year. All LLIF-related neuropraxias resolved by one year. A total of 32 patients (6.2%) had thigh pain, 31 (6.0%) were LLIF-related and three (0.6%) were persistent at one year. Weakness of hip flexion occurred in 14 patients (2.7%), of which eight (1.6%) were LLIF-related and three (0.6%) were persistent at one year. No patients had bowel injury, three (0.6%) had an intraoperative vascular injury (not LLIF-related), and five (1.0%) had ileus. Reoperations occurred in five patients (1.0%) within 30 days, 37 (7.2%) within 90 days, and 41 (7.9%) within one year postoperatively. Conclusion: LLIF involving the L4-L5 disc level has a low rate of persistent neurological, psoas-related, and abdominal complications in patients with the appropriate indications and using a standardized surgical technique.

Green technologies applied to low-NaCl fresh sausages production: Impact on oxidative stability, color formation, microbiological properties, volatile compounds, and sensory profile.

The influence of different concentrations of NaCl (2.5% and 1.75%), basic electrolyzed water (BEW), and ultrasound (US, 25 kHz, 159 W) on the quality of fresh sausages was studied. During storage at 5 °C, TBARS, pH, Eh, aw, nitrous pigments, and bacterial evolution were evaluated at three specific time intervals: 1d, 15d, and 30d. At the same time, the volatile compounds and sensory profile were specifically assessed on both the 1d and 30d. Notably, sausages with 1.75% NaCl and BEW displayed higher pH values (up to 6.30) and nitrous pigment formation, alongside reduced Eh (as low as 40.55 mV) and TBARS values (ranging from 0.016 to 0.134 mg MDA/kg sample), compared to the 2.5% NaCl variants. Protein content ranged between 13.01% and 13.75%, while lipid content was between 18.23% and 18.86%, consistent across all treatments. Psychrotrophic lactic bacteria showed a significant increase in low-NaCl sausages, ranging from 5.77 to 7.59 log CFU/g, indicative of potential preservative benefits. The sensory analysis favored the TUSBEW70 treatment for its salty flavor on the 30th day, reflecting a positive sensory acceptance. The study highlights that employing US and BEW in sausage preparation with reduced NaCl content (1.75%) maintains quality comparable to higher salt (2.5%) counterparts. These findings are crucial for meat processing, presenting a viable approach to producing healthier sausages with reduced sodium content without compromising quality, aligning with consumer health preferences and industry standards.

SPINE20 recommendations 2023: One Earth, one family, one future WITHOUT spine DISABILITY.

Introduction: The purpose is to report on the fourth set of recommendations developed by SPINE20 to advocate for evidence-based spine care globally under the theme of "One Earth, One Family, One Future WITHOUT Spine DISABILITY". Research question: Not applicable. Material and methods: Recommendations were developed and refined through two modified Delphi processes with international, multi-professional panels. Results: Seven recommendations were delivered to the G20 countries calling them to:-establish, prioritize and implement accessible National Spine Care Programs to improve spine care and health outcomes.-eliminate structural barriers to accessing timely rehabilitation for spinal disorders to reduce poverty.-implement cost-effective, evidence-based practice for digital transformation in spine care, to deliver self-management and prevention, evaluate practice and measure outcomes.-monitor and reduce safety lapses in primary care including missed diagnoses of serious spine pathologies and risk factors for spinal disability and chronicity.-develop, implement and evaluate standardization processes for spine care delivery systems tailored to individual and population health needs.-ensure accessible and affordable quality care to persons with spine disorders, injuries and related disabilities throughout the lifespan.-promote and facilitate healthy lifestyle choices (including physical activity, nutrition, smoking cessation) to improve spine wellness and health. Discussion and conclusion: SPINE20 proposes that focusing on the recommendations would facilitate equitable access to health systems, affordable spine care delivered by a competent healthcare workforce, and education of persons with spine disorders, which will contribute to reducing spine disability, associated poverty, and increase productivity of the G20 nations.

Non-Digestible Carbohydrates: Green Extraction from Food By-Products and Assessment of Their Effect on Microbiota Modulation.

The nature and composition of the waste produced by food industrial processing make its abundance and accumulation an environmental problem. Since these by-products may present a high potential for revalorization and may be used to obtain added-value compounds, the main goals of the technological advancements have been targeted at reducing the environmental impact and benefiting from the retrieval of active compounds with technological and health properties. Among the added-value substances, nondigestible carbohydrates have demonstrated promise. In addition to their well-known technological properties, they have been discovered to modify the gut microbiota and enhance immune function, including the stimulation of immune cells and the control of inflammatory reactions. Furthermore, the combination of these compounds with other substances such us phenols could improve their biological effect on different noncommunicable diseases through microbiota modulation. In order to gain insight into the implementation of this combined strategy, a broader focus concerning different aspects is needed. This review is focused on the optimized green and advanced extraction system applied to obtain added-value nondigestible carbohydrates, the combined administration with phenols and their beneficial effects on microbiota modulation intended for health and/or illness prevention, with particular emphasis on noncommunicable diseases. The isolation of nondigestible carbohydrates from by-products as well as in combination with other bioactive substances could provide an affordable and sustainable source of immunomodulatory chemicals.

Further evidences of an emerging stingless bee-yeast symbiosis.

Symbiotic interactions between microorganisms and social insects have been described as crucial for the maintenance of these multitrophic systems, as observed for the stingless bee Scaptotrigona depilis and the yeast Zygosaccharomyces sp. SDBC30G1. The larvae of S. depilis ingest fungal filaments of Zygosaccharomyces sp. SDBC30G1 to obtain ergosterol, which is the precursor for the biosynthesis of ecdysteroids that modulate insect metamorphosis. In this work, we find a similar insect-microbe interaction in other species of stingless bees. We analyzed brood cell samples from 19 species of stingless bees collected in Brazil. The osmophilic yeast Zygosaccharomyces spp. was isolated from eight bee species, namely Scaptotrigona bipunctata, S. postica, S. tubiba, Tetragona clavipes, Melipona quadrifasciata, M. fasciculata, M. bicolor, and Partamona helleri. These yeasts form pseudohyphae and also accumulate ergosterol in lipid droplets, similar to the pattern observed for S. depilis. The phylogenetic analyses including various Zygosaccharomyces revealed that strains isolated from the brood cells formed a branch separated from the previously described Zygosaccharomyces species, suggesting that they are new species of this genus and reinforcing the symbiotic interaction with the host insects.

Do ultrasound form spontaneously nitrous pigments in nitrite-free pork meat batter?

The effects of ultrasound (US) on myoglobin modification, nitrous pigment formation, color, and total and free sulfhydryl content in nitrite-free pork meat batter were assessed. Five treatments were elaborated: Control (without US); TUS10'12 and TUS20'12 (sonication at 25 kHz, at 12 °C for 10 and 20 min, respectively); TUS10'18 and TUS20'18 (sonication at 25 kHz, at 18 °C for 10 and 20 min, respectively). Sonication for 20 min at 12 °C increased OxyMb and DeoxyMb pigments while reducing MetMb levels. This US condition also yielded higher red color indices and lower yellow color indices. Moreover, TUS20'12 exhibited enhanced nitrous pigment formation and decreased FerrylMb and free sulfhydryl (SH) values, indicating reduced oxidation in OxyMb and DeoxyMb pigments. In conclusion, the findings demonstrate that US can impart a cured color to nitrite-free meat products.

Personalized Interventional Surgery of the Lumbar Spine: A Perspective on Minimally Invasive and Neuroendoscopic Decompression for Spinal Stenosis.

Pain generator-based lumbar spinal decompression surgery is the backbone of modern spine care. In contrast to traditional image-based medical necessity criteria for spinal surgery, assessing the severity of neural element encroachment, instability, and deformity, staged management of common painful degenerative lumbar spine conditions is likely to be more durable and cost-effective. Targeting validated pain generators can be accomplished with simplified decompression procedures associated with lower perioperative complications and long-term revision rates. In this perspective article, the authors summarize the current concepts of successful management of spinal stenosis patients with modern transforaminal endoscopic and translaminar minimally invasive spinal surgery techniques. They represent the consensus statements of 14 international surgeon societies, who have worked in collaborative teams in an open peer-review model based on a systematic review of the existing literature and grading the strength of its clinical evidence. The authors found that personalized clinical care protocols for lumbar spinal stenosis rooted in validated pain generators can successfully treat most patients with sciatica-type back and leg pain including those who fail to meet traditional image-based medical necessity criteria for surgery since nearly half of the surgically treated pain generators are not shown on the preoperative MRI scan. Common pain generators in the lumbar spine include (a) an inflamed disc, (b) an inflamed nerve, (c) a hypervascular scar, (d) a hypertrophied superior articular process (SAP) and ligamentum flavum, (e) a tender capsule, (f) an impacting facet margin, (g) a superior foraminal facet osteophyte and cyst, (h) a superior foraminal ligament impingement, (i) a hidden shoulder osteophyte. The position of the key opinion authors of the perspective article is that further clinical research will continue to validate pain generator-based treatment protocols for lumbar spinal stenosis. The endoscopic technology platform enables spine surgeons to directly visualize pain generators, forming the basis for more simplified targeted surgical pain management therapies. Limitations of this care model are dictated by appropriate patient selection and mastering the learning curve of modern MIS procedures. Decompensated deformity and instability will likely continue to be treated with open corrective surgery. Vertically integrated outpatient spine care programs are the most suitable setting for executing such pain generator-focused programs.

Co-encapsulation of Lactobacillus plantarum and bioactive compounds extracted from red beet stem (Beta vulgaris L.) by spray dryer.

Probiotic bacteria and bioactive compounds obtained from plant origin stand out as ingredients with the potential to increase the healthiness of functional foods, as there is currently a recurrent search for them. Probiotics and bioactive compounds are sensitive to intrinsic and extrinsic factors in the processing and packaging of the finished product. In this sense, the present study aims to evaluate the co-encapsulation by spray dryer (inlet air temperature 120 °C, air flow 40 L / min, pressure of 0.6 MPa and 1.5 mm nozzle diameter) of probiotic bacteria (L.plantarum) and compounds extracted from red beet stems (betalains) in order to verify the interaction between both and achieve better viability and resistance of the encapsulated material. When studying the co-encapsulation of L.plantarum and betalains extracted from beet stems, an unexpected influence was observed with a decrease in probiotic viability in the highest concentration of extract (100 %), on the other hand, the concentration of 50 % was the best enabled and maintained the survival of L.plantarum in conditions of 25 °C (63.06 %), 8 °C (88.80 %) and -18 °C (89.28 %). The viability of the betalains and the probiotic was better preserved in storage at 8 and -18 °C, where the encapsulated stability for 120 days was successfully achieved. Thus, the polyfunctional formulation developed in this study proved to be promising, as it expands the possibilities of application and development of new foods.

Sagittal Alignment Concepts and Spinopelvic Parameters.

Spinal surgery continues to expand its horizons to care for disabled patients presenting pain and deformities. Over the past decade, our knowledge of spinal alignment, from the skull to the pelvis, has increased considerably. Such knowledge must expand to reach general orthopedists and improve the care required for so many people. Global spinal alignment is a critical concept in understanding the impact of pathological conditions (degenerative diseases, traumas, deformities) and their treatment, including spinal instrumentation and arthrodesis. Therefore, the treatment of any spinal disease must include the knowledge of the complexity of the spinopelvic alignment. At first, all parameters seem like pure mathematics, hardly applicable to the everyday life of the inattentive reader. However, it gradually becomes clear that, like everything else in orthopedics, biomechanics is an essential part of the knowledge of the musculoskeletal system, revealing the logic behind the physiology of movements. The knowledge of the sagittal alignment concepts and spinopelvic parameteres provide a better comprehension of the axial and appendicular skeletons, increasing the understanding of the physiological and adaptive spinal processes in the face of the degenerative process that increases throughout life.

Sagittal Alignment Concepts and Spinopelvic Parameters / Conceitos de alinhamento sagital e parâmetros espinopélvicos

Abstract Spinal surgery continues to expand its horizons to care for disabled patients presenting pain and deformities. Over the past decade, our knowledge of spinal alignment, from the skull to the pelvis, has increased considerably. Such knowledge must expand to reach general orthopedists and improve the care required for so many people. Global spinal alignment is a critical concept in understanding the impact of pathological conditions (degenerative diseases, traumas, deformities) and their treatment, including spinal instrumentation and arthrodesis. Therefore, the treatment of any spinal disease must include the knowledge of the complexity of the spinopelvic alignment. At first, all parameters seem like pure mathematics, hardly applicable to the everyday life of the inattentive reader. However, it gradually becomes clear that, like everything else in orthopedics, biomechanics is an essential part of the knowledge of the musculoskeletal system, revealing the logic behind the physiology of movements. The knowledge of the sagittal alignment concepts and spinopelvic parameteres provide a better comprehension of the axial and appendicular skeletons, increasing the understanding of the physiological and adaptive spinal processes in the face of the degenerative process that increases throughout life.

Resumo A cirurgia da coluna continua a expandir seus horizontes para cuidar dos pacientes incapacitados com dor e deformidades. Desde a última década, nosso conhecimento sobre o alinhamento espinal, do crânio à pelve, aumentou consideravelmente. Portanto, faz-se necessária a expansão de tal conhecimento para o ortopedista geral, para que possamos proporcionar melhores cuidados para essa população. O alinhamento espinal global é um conceito crítico no entendimento do impacto ocasionado pela condição patológica (doença degenerativa, trauma, deformidade) e mesmo do seu tratamento, como na instrumentação e artrodese da coluna. O tratamento de qualquer doença na coluna deve incluir o entendimento da complexidade do alinhamento espinopélvico. A princípio, todos os parâmetros parecem puramente matemáticos e pouco aplicáveis à realidade do leitor mais desatento. Mas, aos poucos, fica claro que, como tudo em ortopedia, a biomecânica faz parte essencial do conhecimento do sistema musculoesquelético, tornando mais claras as lógicas da fisiologia do movimento. O conhecimento dos conceitos de alinhamento sagital e dos parâmetros espinopélvicos proporcionam uma melhor compreensão dos esqueletos axial e apendicular, além de um melhor entendimento dos processos fisiológicos e adaptativos da coluna frente ao processo degenerativo crescente que ocorre ao longo da vida.

Single-Position Transpsoas Corpectomy and Posterior Instrumentation in the Thoracolumbar Spine for Different Clinical Scenarios.

BACKGROUND: The concept of single-position spine surgery has been gaining momentum because it has proven to reduce operative time, blood loss, and hospital length of stay with similar or better outcomes than traditional dual-position surgery. The latest development in single-position spine surgery techniques combines either open or posterior pedicle screw fixation with transpsoas corpectomy while in the lateral or prone positioning. OBJECTIVE: To provide, through a multicenter study, the results of our first patients treated by single-position corpectomy. METHODS: This is a multicenter retrospective study of patients who underwent corpectomy and instrumentation in the lateral or prone position without repositioning between the anterior and posterior techniques. Data regarding demographics, diagnosis, neurological status, surgical details, complications, and radiographic parameters were collected. The minimum follow-up for inclusion was 6 months. RESULTS: Thirty-four patients were finally included in our study (24 male patients and 10 female patients), with a mean age of 51.2 (SD ± 17.5) years. Three-quarter of cases (n = 27) presented with thoracolumbar fracture as main diagnosis, followed by spinal metastases and primary spinal infection. Lateral positioning was used in 27 cases, and prone positioning was used in 7 cases. The overall rate of complications was 14.7%. CONCLUSION: This is the first multicenter series of patients who underwent single-position corpectomy and fusion. This technique has shown to be safe and effective to treat a variety of spinal conditions with a relatively low rate of complications. More series are required to validate this technique as a possible standard approach when thoracolumbar corpectomies are indicated.

Anatomy of the great vessels by magnetic resonance in anterior lumbar interbody fusion / Anatomia dos grandes vasos por ressonância magnética na fusão intersomática lombar anterior / Anatomía de los grandes vasos por resonancia magnética en fusión intersomática lumbar anterior

ABSTRACT: Objective: To perform an analysis of the anatomy of the great vessels relevant to the access for anterior lumbar interbody fusion (ALIF), determining the level of their bifurcation, the distance between the iliac vessels at L5-S1, the morphological configuration of the left iliac vein and the presence of fatty tissue between the vessel and the disc. Methods: Two hundred magnetic resonance imaging (MRI) scans of the lumbar spine of patients (18-80 years old) were evaluated using axial, coronal, and sagittal cuts at levels L1-S1 in T2 weighting. The interiliac distance was defined as the measurement between the left iliac vein and the right iliac artery. The presence of fatty tissue was defined as the identification of space between the vessel and the disc. Vessel morphology was divided into oval and flat. Results: The population's average age was 49.6 years, with 52% being female. The average interiliac distance at L5-S1 was 27.48mm. The bifurcation of the aorta artery was identified at the level of L4 in 56.3%, as well as the confluence of the iliac veins (37.2%). The left iliac vein was identified as oval in 69% of patients and flat in 31% of patients. Fat tissue was evidenced in 60.5% of the exams. Conclusion: As a routine preoperative examination and surgical planning, lumbar MRI is fundamental in investigating the anatomy regarding anterior approach surgeries, allowing an effective assessment of the relationships between the great vessels and the lumbar spine. Level of Evidence IV; Retrospective Investigation.

RESUMO: Objetivo: Realizar uma análise da anatomia dos grandes vasos relevantes ao acesso para fusão intersomática lombar anterior (ALIF), determinando o nível de sua bifurcação, a distância entre os vasos ilíacos em L5-S1, a configuração morfológica da veia ilíaca esquerda e a presença de tecido gorduroso entre o vaso e o disco. Métodos: duzentos exames de ressonância magnética (RM) da coluna lombar de pacientes (18-80 anos) foram avaliados, utilizando cortes axiais, coronais e sagitais nos níveis L1-S1, na ponderação T2. A distância interilíaca foi definida como a medida entre a veia ilíaca esquerda e artéria ilíaca direita. A presença de tecido gorduroso foi definida como identificação de espaço entre o vaso e o disco. A morfologia do vaso foi dividida em oval e plana. Resultados: A idade média da população foi de 49,6 anos, sendo 52% mulheres. A distância média interilíacas em L5-S1 foi 27,48 mm. A bifurcação da artéria aorta foi identificada ao nível de L4 em 56,3%. A confluência das veias ilíacas também foi mais frequente ao nível de L4, representando 37,2%. A veia ilíaca esquerda foi identificada com o formato oval em 69% e plana em 31% dos pacientes. Tecido gorduroso foi evidenciado em 60,5% dos exames. Conclusão: Como rotina no exame pré-operatório e no planejamento cirúrgico, a RM lombar tem fundamental importância na investigação da anatomia visando cirurgias de abordagem anterior, pois permite uma avaliação eficaz das relações entre os grandes vasos e a coluna lombar. Nível de Evidência IV; Investigação Retrospectiva.

RESUMEN: Objetivo: Realizar un análisis de la anatomía de los grandes vasos relevantes para el acceso en artrodesis intersomática lumbar anterior (ALIF), determinando el nivel de su bifurcación, la distancia entre los vasos ilíacos en L5-S1, la configuración morfológica de la vena ilíaca izquierda y la presencia de tejido graso entre el vaso y el disco. Métodos: Se evaluaron 200 imágenes de resonancia magnética (RM) de la columna lumbar de pacientes (18-80 años) mediante cortes axiales, coronales y sagitales en los niveles L1-S1, en ponderación T2. La distancia interilíaca se definió como la medida entre la vena ilíaca izquierda y la arteria ilíaca derecha. La presencia de tejido graso se definió como la identificación de espacio entre el vaso y el disco. La morfología de los vasos se dividió en ovalados y planos. Resultados: La edad media de la población fue de 49,6 años, de los cuales 52% eran mujeres. La distancia interilíaca media en L5-S1 fue de 27,48 mm. La bifurcación de la arteria aorta se identificó a nivel de L4 en 56,3%, así como la confluencia de las venas ilíacas (37,2%). La vena ilíaca izquierda se identificó como ovalada en 69% y plana en 31%. Se evidenció tejido graso en 60,5% de los exámenes. Conclusión: Como rutina en examen preoperatorio, la RM lumbar es fundamental en la investigación de anatomía de cirugías de abordaje anterior, permitiendo una evaluación eficaz de las relaciones entre los grandes vasos y la columna lumbar. Nivel de Evidencia IV; Investigación Retrospectiva.

Lumbar arthrodesis in lateral single position: concepts, rational and clinical-functional results of 100 consecutive cases / Artrodese lombar em decúbito lateral único: conceitos, justificativas e resultados clínico-funcionais de 100 casos consecutivos / Artrodesis lumbar en posición lateral única: conceptos, justificaciones y resultados clínico-funcionales de 100 casos consecutivos

ABSTRACT Objective: Arthrodesis techniques such as anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) aim to reestablish physiological lordosis and minimize tissue damage to the paravertebral musculature. Supplementation with percutaneous pedicle screws is indicated in most cases, therefore, intraoperative changes in decubitus are necessary, generating costs and risks for the patient. This study aims to present concepts and results of a series of 100 cases of patients undergoing 360° fusion in lateral single position surgery (LSPS). Methods: retrospective analysis of databases collected between 2016 and 2021. Patients who underwent 360° fusion of the lumbar spine in single lateral decubitus to treat degenerative and infectious diseases were included. Cases with arthrodesis greater than 3 levels were excluded. Data collected include demographics, body mass index (BMI) and scores such as visual analog scale (VAS), EuroQOL 5D (EQ5D) and Oswestry disability index (ODI). Results: 100 patients were included in the study, submitted to LLIF and/or ALIF associated with percutaneous pedicle fixation. The lumbar VAS improved from 6.75 to 2.1 after 12 months, while the sciatica VAS started from 4.55 and reached 0.81 after one year. The EQ5D improved from 66.1 to 81.6 after the first year, while the ODI ranged from 28.54 to 14.18 in the same period. Conclusions: the clinical-functional results of the LSPS procedures are favorable and place the LSPS as an option to be studied, developed and practiced by spine surgery teams. Level of evidence: IV. Case series.

Resumo: Objetivo: Técnicas de artrodese como anterior lumbar interbody fusion (ALIF) e lateral lumbar interbody fusion (LLIF) tem como objetivos o reestabelecimento da lordose fisiológica e a mínima lesão tecidual da musculatura paravertebral. A suplementação com parafusos pediculares por via percutânea é indicada na maioria dos casos, sendo, portanto, necessárias mudanças de decúbito intraoperatórias, gerando custos e riscos para o paciente. Este estudo tem como objetivo apresentar conceitos e resultados de uma série de 100 casos de pacientes submetidos a fusão 360° em lateral single position surgery (LSPS). Métodos: análise retrospectiva de banco de dados coletados entre 2016 e 2021. Foram incluídos pacientes submetidos a fusão 360° da coluna lombar em decúbito lateral único para tratamento doenças degenerativas e infecciosas. Foram excluídos casos com artrodeses maiores que 3 níveis. Os dados coletados incluem demografia, índice de massa corpórea (IMC) e scores como visual analog scale (VAS), EuroQOL 5D (EQ5D) e Oswestry disability index (ODI). Resultados: 100 pacientes foram incluídos no estudo, submetidos a LLIF e/ ou ALIF associados a fixação pedicular percutânea. O VAS lombar apresentou melhora de 6,75 para 2,1 após 12 meses, já o VAS ciatalgia partiu de 4,55 e atingiu 0,81 após um ano. O EQ5D apresentou melhora de 66,1 para 81,6 após o primeiro ano, enquanto o ODI variou de 28,54 para 14,18 no mesmo período. Conclusões: os resultados clínico-funcionais dos procedimentos em LSPS se mostram favoráveis e a colocam o LSPS como uma opção a ser estudada, desenvolvida e praticada pelas equipes de cirurgia de coluna. Nível de evidência: IV. Série de casos.

Resumen: Objetivo: Las técnicas de artrodesis como la fusión intersomática lumbar anterior (ALIF) y la fusión intersomática lumbar lateral (LLIF) tienen como objetivo restablecer la lordosis fisiológica. La suplementación con tornillos pediculares percutáneos está indicada en la mayoría de los casos, por lo que son necesarios cambios en decúbito intraoperatorios, generando costos y riesgos para el paciente. Este estudio tiene como objetivo presentar conceptos y resultados de una serie de 100 casos de pacientes sometidos a fusión de 360° en cirugía de posición única lateral (LSPS). Métodos: análisis retrospectivo de bases de datos recolectadas entre 2016 y 2021. Se incluyeron pacientes que se sometieron a fusión de columna lumbar 360° en decúbito lateral y se excluyeron los casos con artrodesis mayores de 3 niveles. Los datos recopilados incluyen datos demográficos, índice de masa corporal (IMC) y puntajes como la escala analógica visual (VAS), EuroQOL 5D (EQ5D) y el índice de discapacidad de Oswestry (ODI). Resultados: 100 pacientes fueron incluidos en el estudio, sometidos a LLIF y/o ALIF asociados a fijación pedicular percutánea. La EVA lumbar mejoró de 6,75 a 2,1 a los 12 meses, mientras que la EVA de ciática partió de 4,55 y llegó a 0,81 al año. El EQ5D mejoró 66,1 a 81,6 después del primer año, mientras que el ODI varió 28,54 a 14,18 en el mismo período. Conclusiones: los resultados clínico-funcionales de los procedimientos de LSPS son favorables y a sitúan como una opción a ser estudiada, desarrollada y practicada por los equipos de cirugía de columna. Nivel de evidencia: IV. Series de casos.

Morphometric analysis of the surgical corridor in the pre-psoas approach: an mri study in the brazilian population / Análise morfométrica do corredor cirúrgico no acesso pré-psoas: um estudo por ressonância magnética da coluna lombar na população brasileira / Análisis morfométrica del corredor quirúrgico en el acceso prepsoas: un estudio de resonancia magnética de la columna lumbar en la población brasileña

ABSTRACT Objective: This study aims to perform a morphometric analysis and explore the characteristics of the surgical corridor of the anterior to psoas approach in the Brazilian population through magnetic resonance imaging (MRI). Methods: Two hundred spinal MRI scans of patients aged between 18 and 80 years were evaluated using axial cuts at L2-L5 levels and a sagittal cut, T2 weighted. The relationship between the left psoas muscle and the abdominal aorta or the left common iliac artery was analyzed. The anterior to psoas corridor was defined as the shortest distance between the posterolateral aspect of the aorta or inferior vena cava or the nearest iliac vessel and the anteromedial aspect of the ipsilateral psoas muscle. Results: 104 females and 96 males with a mean age of 49,68±2.04 (range 18-80) years. The mean anterior to psoas distance at the L2-L3 level was 14,17±0.75mm; at the L3-L4 level was 12,08±0.77m,m and at the L4-L5 level was 9,12±0.77mm. The surgical corridors at all levels were larger in the older population. Conclusion: In most Brazilian patients, the anterior to psoas approach can be a good alternative for lumbar intervertebral fusions. As a routine in preoperative examination and surgical planning, lumbar MRI is fundamental in preoperative evaluation for anterior to psoas approach surgery. Level of Evidence IV; Descriptive study.

Resumo: Objetivo: O objetivo deste estudo é realizar uma análise morfométrica e explorar as características do corredor cirúrgico da via anterior ao psoas na população brasileira, através de exames de ressonância magnética. Métodos: Duzentos exames de ressonância magnética da coluna lombar de pacientes entre 18 e 80 anos foram avaliados, utilizando cortes axiais nos níveis L2-L5 e um corte sagital na ponderação T2. A relação entre o músculo psoas esquerdo e a aorta abdominal ou a artéria ilíaca comum esquerda foi analisada. O corredor anterior ao psoas foi definido como a menor distância entre a face posterolateral da aorta ou veia cava inferior ou o vaso ilíaco mais próximo e a face anteromedial do músculo psoas ipsilateral. Resultados: A população estudada foi de 104 mulheres e 96 homens com idade média de 49,68±2,04 (18-80) anos. A média da distância anterior ao psoas no nível L2-L3 foi de 14,17 ± 0,75mm; no nível L3-L4 foi de 12,08 ± 0,77mm e no nível L4-L5 foi de 9,12 ± 0,77mm. Os corredores cirúrgicos em todos os níveis foram considerados maiores na população idosa. Conclusão: A abordagem anterior ao psoas pode ser uma boa alternativa para a fusão intervertebral lombar na maioria dos pacientes brasileiros. Como rotina no exame pré-operatório e no planejamento cirúrgico, a ressonância magnética lombar tem fundamental importância na avaliação pré-operatória de cirurgias de abordagem anterior ao psoas. Nível de Evidencia IV; Estudo descritivo.

Resumen: Objetivo: El objetivo de estudio es realizar un análisis morfométrico y explorar las características del corredor quirúrgico de la vía anterior al psoas en la población brasileña, a través de resonancias magnéticas (RM). Métodos: Se evaluaron 200 RM de la columna lumbar de pacientes entre 18 y 80 años, utilizando cortes axiales a niveles L2-L5 y un corte sagital, con ponderación T2. Se analizó la relación entre el músculo psoas izquierdo y la aorta abdominal o la arteria ilíaca común izquierda. El corredor anterior al psoas se definió como la distancia más corta entre la cara posterolateral de la aorta o la vena cava inferior o el vaso ilíaco más cercano y la cara anteromedial del músculo psoas ipsilateral. Resultados: La población estudiada estuvo constituida por 104 mujeres y 96 hombres con una edad media de 49,68±2,04 (18-80) años. La distancia media anterior al psoas en nivel L2-L3 fue de 14,17 ± 0,75 mm; en el nivel L3-L4 fue de 12,08 ± 0,77 mm y en el nivel L4-L5 fue de 9,12 ± 0,77 mm. Los corredores quirúrgicos en todos niveles se consideraron más grandes en la población anciana. Conclusión: El abordaje del psoas anterior puede ser una alternativa para la fusión intervertebral lumbar en la mayoría de los pacientes brasileños. Como rutina en examen preoperatorio, la resonancia magnética lumbar es importante en la evaluación preoperatoria de cirugías con abordaje anterior del psoas. Nivel de Evidencia IV; Estudio descriptivo.

SPINE20 recommendations 2022: spine care-working together to recover stronger.

PURPOSE: Globally, spine disorders are the leading cause of disability, affecting more than half a billion individuals. However, less than 50% of G20 countries specifically identify spine health within their public policy priorities. Therefore, it is crucial to raise awareness among policy makers of the disabling effect of spine disorders and their impact on the economic welfare of G20 nations. In 2019, SPINE20 was established as the leading advocacy group to bring global attention to spine disorders. METHODS: Recommendations were developed through two Delphi methods with international and multi-professional panels. RESULTS: In 2022, seven recommendations were delivered to the leaders of G20 countries, urging them to: Develop action plans to provide universal access to evidence-based spine care that incorporates the needs of minorities and vulnerable populations. Invest in the development of sustainable human resource capacity, through multisectoral and inter-professional competency-based education and training to promote evidence-based approaches to spine care, and to build an appropriate healthcare working environment that optimizes the delivery of safe health services. Develop policies using the best available evidence to properly manage spine disorders and to prolong functional healthy life expectancy in the era of an aging population. Create a competent workforce and improve the healthcare infrastructure/facilities including equipment to provide evidence-based inter-professional rehabilitation services to patients with spinal cord injury throughout their continuum of care. Build collaborative and innovative translational research capacity within national, regional, and global healthcare systems for state-of-the-art and cost-effective spine care across the healthcare continuum ensuring equality, diversity, and inclusion of all stakeholders. Develop international consensus statements on patient outcomes and how they can be used to define and develop pathways for value-based care. Recognize that intervening on determinants of health including physical activity, nutrition, physical and psychosocial workplace environment, and smoking-free lifestyle can reduce the burden of spine disabilities and improve the health status and wellness of the population. At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations. CONCLUSION: SPINE20 advocacy efforts focus on developing public policy recommendations to improve the health, welfare, and wellness of all who suffer from spinal pain and disability. We propose that focusing on facilitating access to systems that prioritize value-based care delivered by a competent healthcare workforce will reduce disability and improve the productivity of the G20 nations.