Postoperative complications were examined in 10 cases (6 males, 4 females, average age 65.4±13.2 years) who underwent epidural spinal cord stimulation therapy for spinal surgical pain. One electrode position movement, one generator position movement, one lead skin protruding skin disorder, one generator discomfort caused by protrusion was acknowledged, requiring reoperation in 4 cases. It should be noted that Twiddler syndrome can be caused by generator movement.
Purpose: To compare the gap filling rate and clinical outcome of osteophyte grafting and non-grafting in medial open-wedge high tibial osteotomy using beta-tricalcium phosphate spacer. Methods: A prospective comparative cohort study was conducted with 40 consecutive patients (50 knees) who underwent open-wedge high tibial osteotomy between 2015 and 2016. In Group N (25 knees), only the beta-tricalcium phosphate spacer was implanted in the opening space. In Group O (25 knees), osteophytes harvested by arthroscopy and beta-tricalcium phosphate spacer were implanted. All patients underwent clinical and radiological examinations at 2 years after surgery. Results: Postoperatively, the mean functional knee score significantly improved in each group (p<0.0001). The weight-bearing line percentage shifted to pass through a point 62% and 64% lateral from the medial edge of tibial plateau in Groups O and N, respectively. The gap filling rate of the Group O was significantly faster than that of the Group N (p=0.0008). Discussions: Osteophyte grafting was significantly faster in the gap filling rate than non-grafting in open-wedge high tibial osteotomy. These results suggested that autologous osteophyte grafting can be a useful method for accelerating bone union and therefore enabling weight bearing from an early stage after surgery.
Background: This study aimed to evaluate the survival impact of surgical resection among patients with pulmonary metastases from bone and soft tissue sarcomas.
Patients and Methods: We retrospectively reviewed 29 consecutive patients with ≤5 pulmonary metastases from bone and soft tissue sarcomas. The patients included 17 men and 12 women, with a median age of 66.0 years and a median follow-up of 19 months. We analysed the oncological outcome between patients who underwent surgical or non-surgical treatment.
Results: Eighteen patients underwent surgery and 11 patients did not undergo surgery. The surgery group had a 3 and 5-year overall survival rate of 64% and 58%, respectively. None of the patients in the non-surgery group survived to 3 years. Relative to the non-surgery group, surgery provided significantly better 3-year and 5-year overall survival rates.
Conclusion: Pulmonary metastasectomy may improve the prognosis of patients with pulmonary metastases from bone and soft tissue sarcomas.
We have developed a paste-like complex of β-tricalcium phosphate (β-TCP) granules, hyaluronate, and recombinant human fibroblast growth factor-2 (rhFGF-2) on repair of unstable intertrochanteric fractures. For the preparation of an injectable bone substitute, 2 g of β-TCP granules with 60% porosity, 2 mL of 1% hyaluronate, and 1 mg of rhFGF-2 were mixed aseptically. Patients having 31.A2 intertrochanteric fractures according to the AO classification were treated with injection of the complex followed by intramedullary nails. Fracture union occurred in all cases and union of the displaced lesser trochanter to the shaft was obtained in 4 out of 5 cases by 12 weeks. β-TCP is a calcium phosphate ceramic used in bone grafting as an alternative bone substitute to autograft. FGF-2 is a growth factor having various physiological activities such as bone formation and angiogenesis. The use of the complex promoted the repair of the cortical bone defect in the posterolateral part and the fusion of the lesser trochanter to the shaft. In conclusion, the complex of β-TCP granules, hyaluronate, and FGF-2 can facilitate bone formation and may be useful for the treatment of other cortical bone defects such as long-bone fractures with displaced fragments with minimal surgical invasion.
In this retrospective cohort study the preoperative and postoperative X-ray parameters of patients with adult spinal deformity were measured, dividing the lumbar region into two sections to enable differentiation of the upper lumbar vertebrae angles (L1-4) from the lower lumbar vertebrae angles (L4-S) and to investigate correlations between pelvic parameters, deformity and deformity location. Preoperatively, of ASD patients with reduced total lumbar lordosis (PI-LL>20°) 87% were kyphotic in the upper lumbar vertebrae while maintaining relatively lordotic lower lumbar vertebrae. Our investigation of correlations between pelvic parameters and deformity location in ASD patients with overall lumbar lordosis (preoperative PI-LL>20°) found that 87% were kyphoscoliotic in the upper lumbar region.
Tension band wiring for patella fracture is the gold standard technique. However, implant failure (breakage or loosening, skin irritation, loss of reduction resulting in displacement of fragments) is sometimes occurred. We retrospectively researched 38 cases who underwent surgery for patella fracture (AO classification type C) in our institution. Implant failures were seen in 12 cases. Both short interval before internal fixation, and low rates of using AI Wiring System® were the risk factors of implant failure. In some cases, surgeons might be arranged high strength implants in preparation for delayed internal fixation avoiding fixation on the day of injury even in the open fracture.
For the spinal tumor at fifth lumbar vertebra, the difficulty of approach was more encountered than other thoracic and lumbar vertebra. The narrow window of the fifth lumbar vertebra was made by the surrounding common iliac vessels and iliac crest. The current paper shows the useful method for lateral access of L5 vertebra using the posterior approach by iliac crest cut and transposition with erector spinae muscles.