Prospective, parallel-group, controlled, comparative randomized study. To compare cement leakage rate and efficacy for vertebral body restoration of balloon kyphoplasty (BK) versus Kiva novel implant with polymethylmethacrylate (PMMA) for treating osteolytic vertebral body metastasis. Minimally invasively vertebral augmentation techniques with PMMA are mostly performed for treating osteoporotic compression fractures. The Kiva implant with PMMA offers better vertebral body restoration and less PMMA leakage than BK in osteoporotic fractures. No previous study compared leakage rate and efficacy for vertebral body restoration in traditional BK and Kiva with PMMA in osteolytic vertebral body metastases. This study examined 23 patients (71 ± 13 yr) with 41 osteolytic vertebral bodies, who received Kiva with low viscosity PMMA and 24 patients (70 ± 11 yr) with 43 vertebral body osteolyses, who were reinforced with BK and high viscosity PMMA. All osteolyses were graded as Tomita 1 to 3. Anterior vertebral body height ratio (AVBHr), posterior vertebral body height ratio (PVBHr), and middle vertebral body height ratio (MVBHr), Gardner kyphotic deformity, PMMA leakage and were measured and compared between the groups. Visual analogue scale and Oswestry Disability Index were used for functional outcome evaluation. No patient survived after 3 months. Asymptomatic PMMA leakage occurred in 4 (9.3%) vertebrae in the BK group solely (2 to the spinal canal, in Tomita grade 3 osteolysis) Anterior, posterior and middle vertebral body height ratio, Gardner angle improved insignificantly in both groups. Visual anlogue scale and Oswestry Disability Index improved postoperatively similarly in both groups (P < 0.001). BK and Kiva provided equally significant spinal pain relief in patients with cancer with osteolytic metastasis. The absence of cement leakage in the Kiva group and absence of neurological complication in the BK group leakages reflects the safety of both augmentation techniques even in significant osteolysis. The lack of cement leakage in the Kiva cases, although low viscosity PMMA was used, increases this implant safety in augmenting severely destructed thoracolumbar vertebrae and sacrum from osteolytic metastasis. 1.

In this work, an IoT system with edge computing capability is proposed, facilitating the postoperative surveillance of patients who have undergone knee surgery. The main objective is to reliably identify whether a set of orthopedic rehabilitation exercises is executed correctly, which is critical since it is often necessary to supervise patients during the rehabilitation period so as to avoid injuries or long recovery periods. The proposed system leverages the Internet of Things (IoT) paradigm in combination with deep learning and edge computing to classify the extension–flexion movement of one’s knee via embedded machine learning (ML) classification algorithms. The contribution of the proposed work is multilayered, as this paper proposes a system tackling the challenges at the embedded system level, algorithmic level, and user-friendliness level considering a performance evaluation, including the metrics at the power consumption level, delay level, and throughput requirement level, as well as its accuracy and reliability. Furthermore, as an outcome of this work, a dataset of labeled knee movements is freely available to the research community with no limitations. It also provides real-time movement detection with an accuracy reaching 100%, which is achieved with an ML model trained to fit a low-cost off-the-shelf Bluetooth Low Energy platform. The proposed edge computing approach allows predictions to be performed on device rather than solely relying on a Cloud service. This yields critical benefits in terms of wireless bandwidth and power conservation, drastically enhancing device autonomy while delivering reduced event detection latency. In particular, the “on device” implementation is able to yield a drastic 99.9% wireless data transfer reduction, a critical 39% prediction delay reduction, and a valuable 17% increase in the event prediction rate considering a reference period of 60 s. Finally, enhanced privacy comprises another significant benefit from the implemented edge computing ML model, as sensitive data can be processed on site and only events or predictions are shared with medical personnel.

Introduction. Polymethacrylate (PMMA) is commonly used in vertebroplasty and balloon kyphoplasty, but its use has been associated with complications. This study tests three hypotheses: (1) whether strontium hydroxyapatite (Sr-HA) is equivalent to PMMA for restoring thoracolumbar vertebral body fractures, (2) whether the incidence of PMMA leakage is similar to that of Sr-HA leakage, and (3) whether Sr-HAis is resorbed and substituted by new vertebral bone. Materials and Methods. Two age- and sex-matched groups received short percutaneous pedicle screw fixation plus PEEK implant (Kiva, VCF Treatment System, Benvenue Medical, Santa Clara, CA, USA) filled with either Sr-HA (Group A) or PMMA (Group B) after A2- and A3/AO-type thoracolumbar vertebral body fractures. The Visual Analog Scale (VAS) score and imaging parameters, which included segmental kyphosis angle (SKA), vertebral body height ratios (VBHr), spinal canal encroachment (SCE), bone cement leakage, and Sr-HA resorption, were compared between the two groups. Results. The average follow-up was 28 months. No differences in VAS scores between Groups A and B were observed at baseline. Baseline back pain in both groups improved significantly three months postoperatively. Anterior, middle, and posterior VBHr did not differ between the two groups at any time point. SKA was improved insignificantly in both groups. SCE decreased insignificantly in both groups on 12-month follow-up using computed tomography (CT). PMMA leakage was observed in one patient, while no Sr-HA paste leakages occurred. Sr-HA resorption and replacement with vertebral bone were observed, and no new fractures were observed. Conclusions. As all hypotheses were confirmed, the authors recommend the use of Sr-HA instead of PMMA in traumatic spine fractures, although more patients and longer follow-up will be needed to strengthen these results. This trial is registered with NCT03431519.

In the present paper a closed loop fuzzy control scheme for the correction of the drop-foot syndrome is presented. The control scheme is based on EMG signals from the contralateral, unimpaired lower limb and its efficiency is tested by the application of the controller to a simulated bipedal locomotion with one lower limb suffering from the Drop-Foot Syndrome. Two are the major characteristics of the controller: identification of the phase where the stimulation must be provided using EMG signals from the contralateral, unimpaired lower limb and correction of the excitation signal according to the phase using EMG signals from the collateral impaired lower limb.