2nd and 3rd generation full endoscopic lumbar spine surgery: clinical safety and learning curve.

AIM: 2nd and 3rd generation endoscopic spine surgery techniques offer visualisation of familiar inter-laminar anatomy to spinal surgeons. We have prospectively evaluated the clinical outcome, complications and learning curve associated with these techniques in patients with lumbar spine radiculopathy. METHODS: This is a prospective study of 50 consecutive patients with radicular pain from disc herniation and/or lateral recess stenosis. In 6 patients, endoscopy couldn't be done. Operating times, PROM's (VAS, ODI and EQ-5D scores) and complication rates of 44 patients were evaluated after mean FU of 52 months (range 39-65). MRI was used to divide these into protrusions (n = 19), extrusions (n = 17) and lateral recess stenosis (n = 8). Evidence about the learning curve was gathered by curvilinear regression analyses. RESULTS: Using a composite clinical success criterion, 95% patients had a successful outcome, with no major complications. ODI, VAS and EQ-5D scores had a statistically significant improvement and achieved MCID. Revision discectomy rate was only 4.5% (n = 2). MRI based grouping, case sequence and degree of difficulty influenced the duration of surgery and a learning curve was found for protrusions and lateral recess decompressions, but not for extrusions. A learning curve effect was also observed with respect to the ODI. CONCLUSIONS: Although anatomy visualised in 2nd and 3rd generation endoscopy is familiar to spinal surgeons, our learning curve experience suggests a careful and MRI pathology based take up of this technique in clinical practice, despite its clinical safety in our series. LEVEL OF EVIDENCE: Level 3, prospective cohort study.

Intrathecal morphine in combination with bupivacaine as pre-emptive analgesia in posterior lumbar fusion surgery: a retrospective cohort study.

BACKGROUND: The purpose of this study was to evaluate the efficacy of intrathecal morphine (ITM) in combination with bupivacaine as pre-emptive analgesia in patients undergoing posterior lumbar fusion surgery. This is in comparison with traditional opioid analgesics such as intravenous (IV) morphine. METHODS: Two groups were identified retrospectively. The first (ITM group) included patients who had general anaesthesia (GA) with low-dose spinal anaesthesia prior to induction using 1-4 mls of 0.25% bupivacaine and 0.2 mg ITM. 1 ml of 0.25% bupivacaine was administered per hour of predicted surgery time, up to a maximum of 4 ml. The insertion level for the spinal anaesthetic corresponded to the spinal level of the iliac crest line and the level at which the spinal cord terminated. The control group had GA without any spinal anaesthesia. Patients were instead administered opioid analgesia in the form of IV morphine or diamorphine. The primary outcome was the consumption of opioids administered intraoperatively and in recovery, and over the first 48 h following discharge from the post-anaesthesia care unit (PACU). Total opioid dose was measured, and a morphine equivalent dose was calculated. Secondary outcomes included visual analogue scale (VAS) pain scores in recovery and at day two postoperatively, and the length of stay in hospital. RESULTS: For the ITM group, the median total amount of IV morphine equivalent administered intraoperatively and in recovery, was 0 mg versus 17 mg. The median total amount morphine equivalent, administered over the first 48 h following discharge from PACU was 20 mg versus 80 mg. Both are in comparison with the control group. The median length of stay was over 1 day less and the median VAS for pain in recovery was 6 points lower. No evidence was found for a difference in the worst VAS for pain at day two postoperatively. CONCLUSION: ITM in combination with bupivacaine results in a significantly decreased use of perioperative opioids. In addition, length of hospital stay is reduced and so too is patient perceived pain intensity. Trial registration The study was approved by the ethics committee at The Robert Jones and Agnes Hunt Orthopaedic Hospital as a service improvement project (Approval no. 1617_004).

Betatron coupling measurement and optimization in Indus-2 storage ring.

Brightness is an important parameter for any synchrotron radiation source. Correcting the emittance coupling is one of the ways to increase photon beam brightness in the operational storage ring. The main source of this effect is betatron coupling, resulting from the skew quadrupolar errors. Tune split and Linear Optics from Closed Orbit (LOCO) techniques are used to measure the betatron coupling. We discuss the measurement result of betatron coupling and its correction in the Indus-2 storage ring using available four power supplies, as the knobs, driving the skew quadrupole windings located on sextupoles. The measured coupling ratio of ∼0.8% closely matches with the coupling ratio obtained from the LOCO fit model. Based on LOCO correction, the coupling ratio can be reduced to ∼0.4%, which is limited by the degrees of freedom and not by the field strengths. To achieve a smaller and controlled value of coupling, simulation studies based on the LOCO fit model and using the multi-objective differential evolution algorithm with more skew quadrupole power supplies are performed in Indus-2. With sixteen independent power supplies, the emittance ratio can be reduced to <0.04% and the brightness enhances by an order of magnitude. Besides, the optimization method used provides quantitative trade-offs between coupling related parameters such as beam tilt angle, emittance ratio, vertical emittance, and vertical beam size, and desired values can be chosen from the Pareto optimal front.

Population genetic structure of cotton pink bollworm, Pectinophora gossypiella (Saunders) (Lepidoptera: Gelechiidae) using mitochondrial cytochrome oxidase I (COI) gene sequences from India.

Pink bollworm (PBW), Pectinophora gossypiella is one of the most destructive pest's globally inflicting huge economic losses in cotton even during later stages of crop growth. In the present investigation, the population genetic structure, distribution, and genetic diversity of P. gossypiella in cotton growing zones of India using partial mitochondrial DNA cytochrome oxidase-I (COI) gene was addressed. The overall haplotype (Hd), number of nucleotide differences (K), and nucleotide diversity (π) were 0.3028, 0.327, and 0.00047, respectively which suggest that entire population exhibited low level of genetic diversity. Zone-wise clustering of population revealed that central zone recorded low level of Hd (0.2730) as compared to north (0.3619) and south (0.3028) zones. The most common haplotype (H1) reported in all 19 locations could be proposed as ancestral/original haplotype. This haplotype with one mutational step formed star-like phylogeny connected with 11 other haplotypes. The phylogenetic relationship studies revealed that most haplotypes of populations are closely related to each other. Haplotype 5 was exclusively present in Dharwad (South zone) shared with populations of Hanumangarh and Bathinda (North zone). The result indicated that there is no isolation by distance effect among the Indian populations of PBW. The present study reports a low genetic diversity among PBW populations of India and H1, as ancestral haplotype from which other haplotypes have evolved suggests that the migration and dispersal over long distance and invasiveness are major factors.

Beam emittance reduction during operation of Indus-2.

Indus-2 storage ring is a 2.5 GeV third generation synchrotron radiation source. This source was commissioned using a moderate optics. Beam injection was accomplished using an off momentum electron beam to avoid difficulties faced in storage of beam at 550 MeV. The injection procedure and relevant beam dynamical studies are discussed. The switch over from the moderate optics to low emittance optics is done at 2.5 GeV after storing the electron beam. The procedure evolved to reduce the beam emittance and its implementation during the operation is discussed.

Beam based alignment and its relevance in Indus-2.

Initially in the Indus-2 storage ring, the closed orbit distortion (COD) could be best corrected to 1.3 mm rms in the horizontal and 0.43 mm rms in the vertical plane. The strength of the corrector magnets required high values for COD correction. This revealed that offsets in COD readout by the beam position monitors (BPMs) played a role in not achieving a rms COD lower than the above value. Thus, the offset between the electrical center of BPMs and the magnetic center of the nearest quadrupole magnet could be estimated using the beam based alignment (BBA) method. It prefers that the quadrupole magnet is able to be controlled individually and active shunt power supply (ASPS) system was designed for this purpose that works efficiently. This paper describes the methodology of BBA, topology of ASPS and its performance, and COD minimization using the measured BPM offsets. After BBA, the COD could be reduced to 0.45 mm rms and 0.2 mm rms in horizontal and vertical planes, respectively.

An analytical study of double bend achromat lattice.

In a double bend achromat, Chasman-Green (CG) lattice represents the basic structure for low emittance synchrotron radiation sources. In the basic structure of CG lattice single focussing quadrupole (QF) magnet is used to form an achromat. In this paper, this CG lattice is discussed and an analytical relation is presented, showing the limitation of basic CG lattice to provide the theoretical minimum beam emittance in achromatic condition. To satisfy theoretical minimum beam emittance parameters, achromat having two, three, and four quadrupole structures is presented. In this structure, different arrangements of QF and defocusing quadruple (QD) are used. An analytical approach assuming quadrupoles as thin lenses has been followed for studying these structures. A study of Indus-2 lattice in which QF-QD-QF configuration in the achromat part has been adopted is also presented.

Studies of beam injection with a compensated bump and uncompensated bump in a synchrotron.

Synchrotron radiation sources Indus-1 and Indus-2 have a synchrotron as the common injector. A three kicker compensated bump injection scheme was employed for beam injection into this synchrotron. The stored beam current in the synchrotron is higher, when all the three kickers are operated at the same current than when kickers are operated at currents required to generate compensated bump. Beam dynamics studies have been done to understand why this happens. Theoretical studies indicate that higher stored current in the later case is attributed to smaller residual oscillations of injected beam. These studies also reveal that if the angle of the injected beam during beam injection is kept varying, the performance could be further improved. This is experimentally confirmed by injecting the beam on rising part of the injection septum magnet current pulse.

Measurements of aperture and beam lifetime using movable beam scrapers in Indus-2 electron storage ring.

In this paper, the measurements of vertical and horizontal aperture which are available for stable beam motion in Indus-2 at beam energy 2.5 GeV using movable beam scrapers are presented. These beam scrapers are installed in one of the long straight sections in the ring. With the movement of beam scrapers towards the beam centre, the beam lifetime is measured. The beam lifetime data obtained from the movement of vertical and horizontal beam scrapers are analyzed. The contribution of beam loss due to beam-gas scattering (vacuum lifetime) and electron-electron scattering within a beam bunch (Touschek lifetime) is separated from the measured beam lifetime at different positions of the beam scrapers. Vertical and horizontal beam sizes at scrapers location are estimated from the scraper movement towards the beam centre in quantum lifetime limit and their values closely agree with measured value obtained using X-ray diagnostic beamline.

Measurement of parameters in Indus-2 synchrotron radiation source.

The paper presents the measurement of optics parameters in Indus-2 synchrotron radiation source, which include betatron tune, beta function, dispersion function, natural chromaticity, corrected chromaticity, central RF frequency, momentum compaction factor, and linear betatron coupling. Two methods were used for beta function measurement; a conventional quadrupole scan method and a method using the fitting of the orbit response matrix. A robust Levenberg-Marquardt algorithm was used for nonlinear least square fitting of the orbit response matrix. In this paper, detailed methods for the parameter measurements are described. The measured results are discussed and compared with the theoretical values obtained using accelerator simulation code Accelerator Toolbox in MATLAB.