Introduction: There is no unified view about the indication of local corrective fusion surgeries for osteoporotic posttraumatic kyphosis in thoracolumbar junction.
Methods: The relationship between preoperative values of each X-ray parameter and postoperative PI-UIV.LL (the angle between the upper instrumented vertebra and the sacrum) at the final observation were examined for only the cases in whom the lowest instrumented vertebra was above L4.
Results: Preoperative PI-UIV.LL and PT correlated with the final PI-UIV.LL. The cutoff values of the postoperative PI-UIV.LL were ≤10, as calculated by the ROC curve, and those of the preoperative PI-UIV.LL and PT were ≤33 and ≤29, respectively.
Conclusions: Postoperative sagittal balance could be predicted by the value of preoperative PT and PI-UIV.LL. Local corrective fusion surgeries should not be applied if these values exceed above the thresholds.
Introduction: We investigated the clinical results of percutaneous pedicle screw (PPS) fixation involving infected vertebral body for pyogenic spondylitis.
Methods: The study included six patients (one man, five women) with pyogenic spondylitis that could not be healed. The average age of the patients was 79 years, and the average observation period was 410 days.
Results: Pyogenic spondylitis was healed in all the patients, and white blood cell count and C-reactive protein levels gradually normalized after the operation. The Denis pain scale score of all the patients improved.
Conclusions: In this study, we found that PPS fixation involving the infected vertebral body for pyogenic spondylitis provided good results.
Introduction: Cervical disorders in patients with athetoid cerebral palsy (CP) are known to be difficult surgical treatments. Of these, cranio-cervical lesions lead to various postoperative problems. This study aimed to elucidate failures and complications of upper cervical surgeries for athetoid CP patients and possible solutions for the same.
Methods: A total of 35 athetoid CP patients (19 males and 16 females) who underwent surgical treatments on the cranio-cervical junction in past 23 years (1995-2017) were included. The mean age at surgery was 60.9 years old and the mean follow-up period was 13.1 years. We examined the preoperative athetosis exercise intensity, surgical methods, reoperation rates, incidence and timing of instrument failure.
Results: Adopted surgical methods were occipital-cervical (O-C) fusion in 27 patients, C1-C2 fusion in 3 patients, and C1 posterior decompression in 5 patients. Reoperation was performed in 2 patients of O-C fusion (7%), 1 patient of C1-C2 fusion (33%), 2 patients of C1 posterior decompression (40%). Instrument failure occurred in 6 cases, and the incidence was 22.2% in all cases of O-C fusion. Failure occurred most often after >6 postoperative months with an average of 8.5 months. However, in each case, there is no worsening of the neurological symptoms, and none of them required revision procedures.
Conclusions: Our current surgical strategy for upper cervical spine lesions in athetoid CP patients is as follows: ① fixation is performed in principle, and ② atlantoaxial fusion is performed for patients in whom the spinal stenosis lesions are limited to the atlantoaxial vertebrae, and the instrumental intervention is possible in the atlantoaxial vertebrae. ③ Occipital cervical intervertebral fusion is performed for patients in whom the spinal stenosis lesion is multi-vertebral or the instrumental intervention in the atlantoaxial vertebral is difficult, and ④ the intervertebral space without the spinal stenosis lesion is preserved as much as possible.
Introduction: Optical tracking-based motion capture is a non-invasive, convenient, and versatile technology for assessment of body movements. In the present study, attempts were made to establish a novel measurement method for cervical range of motion that is clinically reliable and physician friendly in the actual clinical setting using the optical tracking system.
Methods: Eight healthy volunteers were recruited. Under direct instruction from an examiner, the participants in the upright sitting position performed maximum flexion/extension, left/right rotation, and left/right lateral bending; these were captured on a 100-Hz infrared camera as the motion of five surface markers placed on the head in relation to three markers placed on the bilateral acromia and sternoclavicular joint as the trunk segment. A three-dimensional model was created to analyze their motions along three orthogonal axes. One examiner tested a participant twice at an interval of minimum 1 day.
Results: Five males and three females aged 29-40 years were included in the study. With the initial status defined as neutral position, the average flexion was 65°, extension was 47°, right/left rotation was 74°/76°, and right/left lateral bending was 42°/44°. Intra-class correlation (ICC; 1,1) was 0.42-0.89, showing that intra-rater reliability could be moderate for some parameters. On the other hand, the range of motion for flexion/extension, rotation, and side bending averaged 112°, 150°, and 86°, respectively, and the results showed high reproducibility with ICC (1,1) ranging from 0.73 to 0.86.
Conclusions: Three-dimensional optical tracking-based motion capture was performed to assess cervical range of motion in eight healthy volunteers.
Introduction: Generally, the resection of lumbar facet cysts (ganglion or synovial cysts) yields good results. Recently, considering recurrence, some reports recommend resection of the cyst with spinal fusion. Since we have been performed en bloc cyst resection through fenestration (medial facetectomy) as the initial operation, this study aimed to evaluate the surgical results of our procedure for this lesion.
Methods: The study involved 96 cysts excised from 89 patients (male: 52, female: 37), who underwent surgery for a lumbar facet cyst. The mean age at surgery was 66 years (43-82 years). There were 6 cysts located at L2/L3, 26 cysts at L3/L4, 52 cysts at L4/L5, and 12 cysts at L5/S1. Thirty-two cases had degenerative spondylolisthesis at the affected level. The mean follow-up period was 2.5 years (1-10 years). In each case, cyst localization was evaluated based on preoperative MRI and CT facet arthrography.
The duration of symptoms and the clinical features were investigated retrospectively. The presence of cyst-dura adhesion was investigated by classifying the cases into no adhesions (grade 0), mild adhesions that could be bluntly separated (grade 1), severe adhesions that were difficult to separate (grade 2), and those that caused dural tear at the time of separation (grade 3). Surgical outcomes were evaluated using the pre- and postoperative Japanese Orthopaedic Association (JOA) score (the highest score is 29), and the recovery rate. Also, cyst recurrence after surgery was investigated using MRI at the time of follow-up.
Results: The mean duration of symptoms was 14 months (1 month-7 years). The preoperative neurological condition was radiculopathy in 49 cases and cauda equina syndrome in 40 cases. As for the adhesion between the cyst and dura mater, 25 cysts were grade 0, 31 cysts were grade 1, 37 cysts were grade 2, and 3 cysts were grade 3. The mean pre- and postoperative JOA scores were 13 and 26, respectively, and the mean recovery rate was 86%. There were no additional surgery nor reoperation. Facet cyst recurrence was confirmed in two cases by MRI. But there were no complaints, and the cysts regressed spontaneously.
Conclusions: En bloc resection of lumbar facet cyst through fenestration provided good results, with a mean recovery rate of 86%, without additional surgery or reoperation. The recurrence rate of the cyst after surgery was 2.1%. This recurrence rate is not high enough to use concomitant fusion surgery. However, cysts and dura were adherent in 74% of cysts. To avoid intraoperative complications, cyst localization should be investigated in detail preoperatively by MRI and CT facet arthrography.
Introduction: Several authors have reported that patients with osteoporosis have an impaired health-related quality of life (HRQoL). We hypothesized that secondary osteoporosis, prevalent vertebral fractures, and spinal sagittal imbalance might affect HRQoL in elderly patients with osteoporosis. In the current study, we evaluated HRQoL in elderly patients with osteoporosis and also examined factors affecting HRQoL.
Methods: In this study, 181 (35 males and 146 females) elderly patients with osteoporosis aged 60-79 years were included. In all cases, we measured the eight subscales of the Short Form 36 (SF-36) score as an indication of HRQoL as well as young adult mean (YAM) of bone mineral density (BMD) at the lumbar spine and femoral neck; prevalent vertebral fractures; and spinal sagittal alignment using the sagittal vertical axis (SVA). First, we compared all eight subscales of the SF-36 score between elderly patients with osteoporosis and the Japanese national average for age-matched subjects. Second, we divided the patients into two groups: patients with primary (n = 126) or secondary osteoporosis (n = 55) and compared all eight subscales of the SF-36 score between the two groups. Third, in female patients with primary osteoporosis, we compared the SF-36 score between YAM ≥ 70% group and YAM < 70% group. We also compared the SF-36 score between the group that had one or less prevalent vertebral fractures and the group with multiple prevalent vertebral fractures and between the group with SVA < 40 mm and the group with SVA ≥ 40 mm.
Results: The SF-36 scores of patients with secondary osteoporosis were significantly lower than those of patients with primary osteoporosis (p < 0.05) except for the physical functioning (PF) subscales. The Vitality and Mental Health scores of YAM at femoral neck of the < 70% group were significantly lower than those of the ≥ 70% group. All eight subscales of the SF-36 scores of the group with multiple prevalent vertebral fractures were significantly lower than those of the group that had one or less prevalent vertebral fractures. In addition, all eight subscales of the SF-36 scores of the SVA ≥ 40 mm group were significantly lower than those of the SVA < 40 mm group (p < 0.05).
Conclusions: The SF-36 scores in patients with secondary osteoporosis or lower BMD at the femoral neck or multiple prevalent vertebral fractures or spinal sagittal malalignment were low in elderly patients with osteoporosis.