This document discusses techniques for subaxial cervical fixation, including anterior and posterior approaches. Anterior techniques include interbody struts, screw-plate constructs, and cages. Posterior techniques include wiring, laminar screws, lateral mass screws, and pedicle screws. Lateral mass screws are widely used as they provide stability with fewer risks than other posterior options. Anterior and posterior approaches are sometimes combined for severe cervical instability involving both columns. Rigid constructs are needed to prevent graft extrusion and maintain alignment.
Angulation, trajectory and depth of screw placement in spine is not everyone's cup of tea unless you have a very clear idea of its ergonomics and dynamics.
Angulation, trajectory and depth of screw placement in spine is not everyone's cup of tea unless you have a very clear idea of its ergonomics and dynamics.
Applied surgical anatomy of the craniovertebral spineKshitij Chaudhary
This presentation was made at the Advanced Cervical Spine Course conducted by Dr. Sandeep Sonone and Dr. Kshitij Chaudhary for the Bombay Orthopaedic Society. http://bombayorth.org/academics/instructional-courses/
Applied surgical anatomy of the craniovertebral spineKshitij Chaudhary
This presentation was made at the Advanced Cervical Spine Course conducted by Dr. Sandeep Sonone and Dr. Kshitij Chaudhary for the Bombay Orthopaedic Society. http://bombayorth.org/academics/instructional-courses/
Do you know what is a cerclage cable? During hip replacement and treatment of associated peri-prosthetic fractures, it is often necessary to hold the bone or fragments of bone together to create a stable environment for healing to occur. This is typically done with metal wires or cables using a technique called Cerclage. A cerclage wire or cable is wound around a bone or bony fragments to hold them together to allow them to heal.
conventional plates including different functions of screws, modes of plate application, Compression Mode.
Neutralization Mode.
Buttress plate.
Antiglide plate.
Bridge plating or span plating.
Tension band.
prebending precountouring
working length
lag screw
AO principles
biological fixation
MIPO
Distal humerus fracture fixation dr mohamed ashraf-HOD-govt TD medical colleg...drashraf369
presentation illustrates various aspects of principles and practical tips of fixation of lower humerus fracture fixation .various options are demonstrated by dr mohamed ashraf HOD govt TD medical college ,alleppey,kerala,india
Can read freely here
https://sethiortho.blogspot.com/
Challenges and Solutions in
Management of Distal Humerus Fractures
Epidemiology
Anatomy
Classification
Controversies and Recent studies
Approach
Implants selection
Plate configuration
Ulnar nerve transposition
Role of total elbow arthroplasty in DHF
Role of hemiarthroplasty in DHF
Metaphyseal comminution –
Anatomic complexity of the distal humerus
Positioning of the plates
TBW –
Skin closure
Osteoporotic nature of the bone –
Less BMD/Thin metaphysis
Screw Pullout strength is low
DHF account for 2% of all adult fractures
The common pattern of fracture
Intraarticular and involves both columns
Bimodal distribution
Peak incidence in young male and in older female patients
Young male – High-velocity injury
Older female - Osteoporosis
The distal humerus is flattened and expanded bony structure
It is composed of lateral and medial columns with the trochlea situated between these columns.
The location of the trochlea is central rather than medial
Formed by Medial SCR + M/Epicondyle
The distal end has 450 angulation with humeral shaft
M/ Epicondyle gives attachment for MCL & Common Flexor Origin
The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection
Ulnar nerve
Formed by Lateral SCR and L/Epicondyle and Capitulum
Distal end has 200 with humeral shaft
L/ epicondyle gives attachment for LCL & common extensor origin
Its posterior surface is non articular and can be used as a site for a plate fixation
The lateral column curves anteriorly
Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus.
The medial column including the medial epicondyle is in line with the humeral shaft.
It forms the center of the triangle
It has 30 - 80 – external rotation & 250 anterior divergent with the shaft
It forms a 40 - 80 degree valgus direction
X-ray -
Anterior-posterior view
lateral View
Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture.
NCCT – Elbow
Articular surfaces
Position of the fracture fragments
useful for identifying impacted fracture fragments that make reduction challenging
Olecranon Osteotomy Approach – 52-57%
Triceps sparing VS Olecranon osteotomy approach
The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter
Smaller diameter of the humerus, permitting only one or two short screws for fixation.
Interruption of blood supply to the lateral column
blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Evaluation of Lumbar Spine Disease starts with understanding the clinical back grounds. It starts with good history and physical examination. This is a teaching lecture given twice by Prof. Dr. Mohamed Mohi Eldin, professor of neurosurgery, in the Basic Spine Course, Egyptian Medical Syndicate, Cairo, March 2009 and in 2010.
Basic spine anatomy is the first step in understanding the spine profession. Being familiar with spine anatomy makes you spine-minded, understand pathological spine diseases, correlate symptoms and signs, and facilitate your surgical skills.
This is a teaching lecture given twice by Prof. Dr. Mohamed Mohi Eldin, professor of neurosurgery, in the Basic Spine Course, Egyptian Medical Syndicate, Cairo, March 2009 and in 2010.
Schmorl’s nodes (SN) or Intervertebral Disc Herniations are Commonly observed on routine radiographs at autopsy.
This is a teaching lecture given by Prof. Dr. Mohamed Mohi Eldin, professor of neurosurgery, in the weekly conference of kasr El Aini Neurosurgery Department, Cairo University, November 2010.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Before placement of any implant, a
some questions should be answered
1. Is implant indicated?
2. Is a rigid or dynamic implant optimal?
3. Is deformity reduction, correction, or
prevention required?
4. Which system is ideal for
– obtaining fusion and
– preventing subsidence?
8. Anterior Compression (Tension Band)
Fixation
• +/- interbody struts
• Allows the application of
compression using a
screw-rod construct,
thereby
• enabling preloading of
bone graft, increasing
bone healing.
10. First-Generation Plates
• Bohler (1967) first use
• Orozco and Houet (1970s):
– One-third tubular plate
– ‘H’ and ‘HH’ plates
• Herrmann (1975)
• Caspar‘trapezoidal’ plate
(1980)
• First anterior cervical plates
were unlocked and required
bicortical purchase.
11. First-Generation Plates
(abandoned nonrigid)
• Motion at screw-plate interface.
• Compressive forces (higher chance of fusion)
• Both unicortical and bicortical screws
• High rate of screw backout and breakage.
H-Plates
12. Second-Generation Plates
(Constrained-rigid plates)
• Screw convergence
• Ventral distraction fixation in
neutral position.
• Usually with interbody graft
• In extension, resist distraction
(tension-band)
Orion
Plate
14. Screw Toggling
(permission of axial subsidence)
• Rounded screw head/cup configuration
allows the screw to rotate in the
sagittal plane with respect to the plate
as subsidence occurs.
15.
16. Allowance of axial settling
• The screws allowed to
slide along the long axis
of the plate for a limited
distance
• Allow subsidence while
minimizing the risk of
screw cutout.
17. Subsidence (settling)
• Loss of disc height following surgery
• Due to
1. Bone Graft remodeling and resorption (normal, complex
biological process) before being replaced by new living bone
2. Graft collapse, and
3. Pistoning of the graft.
18. Stress shielding
• Bone heals best under
compression (Wolfe’s
law).
• Stress shielding is
defined as ‘an implant
induced reduction of
bone healing, enhancing
stresses leading to
osteoporosis, or
nonunion’
19. Multilevel Fixation
• The caudal end of the construct is
the most likely to fail (longer
moment arm and increased forces)
– screw loosening or
– hardware failure
• This can be decreased by
1. maximizing screw purchase at
caudal end
2. dynamic fixation
3. good bone-grafting techniques
4. Postoperative immobilization (rigid
collar in the first few months)
20. Advantages of Anterior Cervical Plates
• Enhancing solid fusion
• Resisting kyphosis
• Reduce external bracing
• Mobilization of adjacent
segments
• Reduce risk of graft
extrusion
• Reduce rate of nonunion.
21. Disadvantages of
Anterior Cervical Plates
• Increased cost
• Special instruments and
training
• Plate-specific complications:
– screw loosening or fracture,
– infection,
– neural injury
23. Interspinous Wiring
• Intact posterior
elements
• Restore posterior
tension band
• After soft tissue injury
• Augment other
anterior or posterior
fixation techniques
24. Rogers’ interspinous wiring
• Burr hole at the base of the upper and lower
spinous processes.
• Stainless steel or titanium wire or cable through
the burr holes in a figure eight pattern.
• Wire is tightened using a Tensioner.
25. Abdu’s triple-wiring
• As the Rogers’ technique.
• 2nd wire through upper burr hole and looped around upper spinous
process.
• 3rd wire through lower burr hole and looped around the lower
spinous process.
• These two wires are passed through two autologous bone graft
struts, lateral to spinous processes.
• Wires are tightened under tension
27. SUBLAMINAR WIRING
• Pros:
– Simple
– Safe
– Large surface area for fusion
• Cons:
– Wire breakage or cutout
– Not suitable if posterior elements deficient
– Poor fixation in axial load & rotation
28. SUBLAMINAR WIRING
Almost never used in the subaxial spine
because the spinal canal is smaller compared to
the spinal canal at the C1/C2 levels.
Specially in patients with degenerative or
congenital cervical stenosis.
31. Posterior cervical wiring
Complications (rare)
• Wire pullout
• Injury (cord or spinal nerves)
• Over-tightening (avulsion
fractures).
• Loss of fixation (poor bone
quality)
• Inadequate postoperative
immobilization.
• Nonunion, malunion
• Hardware failure
• Infection
32. Posterior cervical screw fixation
1. Laminar screw,
2. Lateral Mass
Screw:
– Plate
– Rod
3. Pedicle Screws
33. LAMINAR SCREWS
(Translaminar screw fixation)
• Uncommon in subaxial spine
• C7 has larger laminar size
– high unilateral screw placement success
rate:
• 100% for 3.5 mm screw,
• 92% for 4.0 mm screw
– moderate bilateral screw placement
success rate
• 90% for 3.5 mm,
• 68.8% for 4.0 mm.
• At C3-C6, success rates much lower.
34. Utilized in only selected cases
• Deficient lateral masses
• Failure to place a lateral mass screw
• Requires intact posterior elements, specifically
intact laminae
35. Complications of laminar screw
• laminar cortical breach:
– medial cortex (thecal and cord injury)
• Violation of the facet joint
• Screw loosening
• hardware failure
36. Lateral mass screw fixation
widely considered the mainstay technique for
posterior fixation of the subaxial spine
With high fusion rates, (85-100%)
37. LATERAL MASS SCREW FIXATION
• Restore posterior column tension band
• Rotational & axial stability
• Greater stability in lateral bending
• Applicable C3 to C7 levels
• No need for intact lamina
39. The relation between the lateral mass
and the VA
• At the C7 level, the VA is
more laterally located.
Thus, at C7 the direction
should be calculated
carefully.
43. Cervical Pedicle Screws
• To correct deformity esp.
Kyphosis
• More risky
• Needs very lateral
dissection to allow for 45
degrees angulation
• Higher resistance to pullout
than lateral mass screws.
44. CERVICAL PEDICLE SCREWS
• Pedicular width 3.5–6.5 mm,
• Pedicular height is 5–8 mm
• Pedicular angulation decreases
from 50 degrees medially at
the C5 to 11 degrees medially
at the T5 in the transverse
plane.
• The pedicle angulation in the
sagittal plane is 3–5 degrees
downward with reference to
the lower endplate of C7.
45. C7 Pedicle Screw
• C7 lateral mass is often inadequate (average
thickness is about 9 mm)
• A pedicle screw at C7 is preferable.
46. C7 Pedicle Screw
• A small laminotomy
(paplate pedicle)
• Entry point at junction of two
lines:
– Vertical line (middle of C6–7 facet joint)
– Horizontal line 1 mm under middle of
C7 transverse process.
• Direction
– 30–35 degrees medially
– 5 degrees downward (reference to C7
lower endplate)
• Screw:
– length 20- to 22-mm
– diameter 3.5-mm
54. Posterior column + Anterior column
Disruption
• An anterior standalone bone graft will not be
sufficient for fixation…. WHY ?
– Graft extrusion,
– Kyphotic deformity
– Significant risk of neural injury.
• To avoid dislocation and graft extrusion :
1. Anterior plating
2. Supplemental posterior fixation,
3. Rigid external orthosis (halo vest)
55. As a rule
Any stand-alone posterior
fixation technique, is
insufficient to restore
stability in cases involving
the anterior and/or middle
columns.