The Impact of Lumbosacral Transitional Vertebrae on Therapeutic Outcomes of Transforaminal Epidural Injection in Patients with Lumbar Disc Herniation.

BACKGROUND: Although some studies have evaluated the clinical impact of lumbosacral transitional vertebrae (LSTV), few have attempted to determine an effective conservative treatment method for lumbar disc herniation (LDH) presenting concurrently with LSTV. METHODS: We prospectively enrolled 291 consecutive patients who were followed-up for at least one year after transforaminal epidural injection (TFEI) for LDH. We confirmed the presence of LSTV with Paik et al.'s method, the Castellvi classification, and the Southworth and Bersack method. Clinical outcomes were evaluated with a visual analogue scale (VAS) for pain intensity and the Oswestry Disability Index (ODI) for functional status. RESULTS: Of the 291 patients, 47 (16.2%) had LSTV, including 33 with sacralization and 14 with lumbarization, while 244 (83.8%) did not have LSTV. Patients in both groups improved significantly after TFEI in terms of the VAS (P < 0.001) and ODI (P < 0.001) scores. However, LDH patients with LSTV had a worse clinical outcome after six months of TFEI than did those without LSTV, with a significant difference between groups for both the VAS (P < 0.01) and ODI (P = 0.01) scores. LDH patients with sacralization had worse post-treatment clinical outcomes than LDH patients with lumbarization (P < 0.001) or LDH patients without LSTV (P < 0.001). CONCLUSIONS: Sacralization can reduce the improvement after TFEI among LDH patients, while lumbarization appears to have no direct effect on TFEI outcomes. The presence of sacralization should be identified before TFEI, and if present, patients should be informed that the outcomes of TFEI may not be as good as they would be if sacralization was not present.

Accessory anterolateral portal in arthroscopic PCL reconstruction.

PURPOSE: To evaluate the clinical and radiological results of arthroscopic PCL reconstruction using an accessory anterolateral portal for femoral tunneling and to compare these results with those of the conventional technique. METHODS: We retrospectively reviewed the clinical and radiological results for 57 patients who underwent PCL reconstruction, including 31 patients who underwent arthroscopic PCL reconstruction with an accessory anterolateral portal (group A) and 26 patients who underwent conventional arthroscopic PCL reconstruction (group B). Lysholm score, IKDC score, simple radiographs (AP and lateral), and posterior drawer test results were evaluated preoperatively and at 3 years postoperatively. RESULTS: No major complication was observed in group A. However, posterior cortical disruption due to improper placement of the femoral tunnel was observed in one patient in group B. The mean Lysholm knee scores increased from 41.5 ± 4.8 preoperatively to 92.5 ± 6.2 at final follow-up in group A (P < 0.001), and from 43.5 ± 3.4 preoperatively to 88.5 points ± 3.7 in group B (P = 0.002). Posterior stress radiographs with a KT-1000 showed that the mean side-to-side differences improved from 13.79 ± 5.1 mm preoperatively to 3.1 ± 0.7 mm postoperatively in group A and from 12.68 ± 6.3 mm preoperatively to 3.5 ± 0.5 mm postoperatively in group B. The sensitivity and specificity of the placement and direction of the femoral tunnel were significantly higher in group A than group B (P = 0.002). CONCLUSION: Arthroscopic PCL reconstruction with an accessory anterolateral portal can provide a better surgical view than the conventional technique, and this can minimize the problems associated with femoral tunneling, such as inappropriate and inconsistent placement of the tunnel, abnormal angulation, and sliding of the guide tip. Moreover, this approach may have a shorter operative time and a better functional recovery than the conventional technique. LEVEL OF EVIDENCE: Retrospective comparative study, Level IV.

The efficacy of patellar decompression for improving anterior knee pain following total knee arthroplasty without patellar resurfacing.

BACKGROUND: Anterior knee pain remains common following total knee arthroplasty (TKA). In this study, we evaluated the efficacy of patellar decompression via drilling for the treatment of anterior knee pain following TKA without patellar resurfacing. METHODS: A prospective cohort study was performed in 271 consecutive patients who underwent primary total knee replacement with patellar decompression (study group, n = 131) or without decompression (control group, n = 140). The patients were assessed according to the Knee Society rating, clinical anterior knee pain score, and British Orthopaedic Association patient-satisfaction score in each group. Each assessment was performed without the examiner knowing whether the patella had been decompressed. Radiographic evaluations were also performed according to the Knee Society scoring system for functional activity and our own severity grade system for patellofemoral articular change. RESULTS: There were no adverse events following patellar decompression. The overall prevalence of anterior knee pain was not significantly different between groups (p = 0.71). However, patients presenting pain over grade II after the operation in the study group were statistically low (p = 0.01). The overall postoperative knee scores were higher in the study group, but there were no significant differences between groups (p = 0.0731). Analyses of the radiographs revealed similar postoperative outcomes in both groups of knees. CONCLUSIONS: As we observed significantly lower rates of anterior knee pain and no patellar complications following patellar decompression via drilling in TKA without patellar resurfacing, we recommend performing patellar decompression in cases of total knee replacement without patellar resurfacing.

Is platelet-rich plasma able to enhance the results of arthroscopic microfracture in early osteoarthritis and cartilage lesion over 40 years of age?

Most studies suggested that arthroscopic microfracture is effective method at only less than 40 years of age. Thus, the authors thought that "how can this indication regarding age be extended?," and tried to find a way to use this technique effectively over 40 years of age. The aim of this study was the first to report the results regarding the PRP as an adjunct for arthroscopic microfracture in the early osteoarthritic (OA) knee with cartilage lesion over 40 years of age. 49 patients who underwent arthroscopic microfracture for cartilage lesion sized less than 4 cm(2) with early OA, aged 40-50 years, were enrolled and randomly divided into 2 groups: a control group with only arthroscopic microfracture (25 patients) and a study group with arthroscopic microfracture and PRP (24 patients). The patients were prospectively evaluated with VAS, IKDC score at preoperative and postoperative 1, 6, 12, and 24 months. And we perform second arthroscopies in 10 patients of each group to identify the extent of cartilage restoration at 4-6 months postoperatively. There were significant improvements in clinical results between preoperative evaluation and postoperative 2 years in both groups (p = 0.017). In the postoperative 2 years, clinical results showed significantly better in the study group than in the control group (p = 0.012). In post-arthroscopic finding, hardness and elasticity degree was better in the study group. The PRP injection with arthroscopic microfracture would be improved the results in early osteoarthritic knee with cartilage lesion in 40-50 years old, and the indication of this technique could be extended to 50 years.

A case report and literature review on fabella syndrome after high tibial osteotomy.

RATIONALE: The fabella is a normal structure, but is occasionally reported to cause posterior knee pain. The aim of this study was to present fabella syndrome after high tibial osteotomy. PATIENT CONCERNS: A 55-year-old female patient was admitted to the hospital due to about 1 year and 8 months of left knee pain. Sclerosis was observed in the anterior margin of the fabella in the preoperative magnetic resonance (MR) T2 image, and reactive bone marrow was found and was considered to be due to degeneration of the distal femur. Degenerative change (Kellgren and Lawrence-KL grade 2) of the left knee was observed, along with cartilage delamination corresponding to International Cartilage Repair Society (ICRS) grade 4 in the patellofemoral joint. DIAGNOSES: We present the first reported case of fabella syndrome in Korea, after high tibial osteotomy due to degenerative arthritis and varus deformity, rather than artificial joint surgery. INTERVENTIONS: We excised the fabella from the patient's knee. OUTCOMES: There was no evidence of recurrence during 5 months of postoperative follow-up. Posterolateral Corner including the fabella might have sustained increased tensile force causing symptoms due to compression of the fabella by the posterior joint of the posterior femoral condyle. LESSONS: We present the first reported case of fabella syndrome in Korea, after high tibial osteotomy due to degenerative arthritis and varus deformity, rather than artificial joint surgery. Collision syndrome caused by a fabella has previously been attributed to inconsistency of the joint surface due to excessive exercise and degenerative changes due to knee instability. We report this case since it appeared to involve collision syndrome due to mechanical change of an angular deformity.

The comparison of pedicle screw and cortical screw in posterior lumbar interbody fusion: a prospective randomized noninferiority trial.

BACKGROUND CONTEXT: Pedicle screws (PS) offer great benefits in posterior lumbar interbody fusion (PLIF), but several drawbacks of PS, including the risk of superior facet joint violation and muscle injury, have also pointed out. Recently, cortical screws (CS) were invented, which can be placed without the drawbacks associated with PS. However, whether CS in PLIF can provide similar or greater clinical and radiologic outcomes compared to those of PS has not been fully evaluated in clinical research studies. PURPOSE: To evaluate whether the CS provides similar results to the PS in PLIF, in terms of fusion rate, clinical and surgical outcomes, and complications. STUDY DESIGN: This is a prospective, randomized, noninferiority trial. PATIENT SAMPLE: Seventy-nine eligible patients were randomly assigned to either Group A (39 patients), for which PS was used, or Group B (40 patients), for which CS was used. OUTCOME MEASURES: The primary study end point was to measure fusion rate using dynamic radiographs and computed tomography scans. Secondary end points included intensity of low back pain and pain radiating to the leg using visual analog scales, and also, functional status using the Oswestry Disability Index, surgical morbidity, and additional outcomes such as pedicle fracture and mechanical failure. METHODS: We compared baseline data in both groups. To evaluate the efficacy of CS in PLIF compared to PS, we compared fusion rates, clinical outcomes, and complications after surgery in both groups. RESULTS: At the 6- and 12-month follow-up points, similar fusion rates were observed in both groups (p=.81 and 0.61, respectively). According to the clinical outcome, CS provided similar improvements in pain amelioration and functional status compared to PS, with no significant differences. Additionally, CS resulted in significantly less surgical morbidity, including shorter incision length, quicker operative time, and less blood loss, compared to PS. CONCLUSIONS: CS in PLIF provides similar clinical and radiologic outcomes compared to PS in PLIF. On the basis of the present study, we suggest CS to be a reasonable alternative to PS in PLIF.

Clinical efficacy and safety of Lyprinol, a patented extract from New Zealand green-lipped mussel (Perna Canaliculus) in patients with osteoarthritis of the hip and knee: a multicenter 2-month clinical trial.

OBJECTIVE: To validate the clinical efficacy and safety of Lyprinol (a patented extract from Perna Canaliculus), a 5-LOX inhibitor in patients with osteoarthritis. METHODS: In this multicenter trial, 60 patients with symptomatic osteoarthritis of the knee and hip were included to receive Lyprinol at a dose of 2 capsules twice a day. After a 4- and 8-week treatment period, the following parameters were analyzed: visual analogue scale; Lequesne functional index; global assessment by patients; global assessment by physician; and adverse effects. RESULTS: Lyprinol treatment led to significant improvement of the signs and symptoms of osteoarthritis as determined by all efficacy measures. After a 4- and 8-week treatment period, 53% and 80% (respectively) of patients experienced significant pain relief, and improvement of joint function. There was no reported adverse effect during this clinical trial. CONCLUSION: Lyprinol was very effective and is a promising anti-inflammatory product that relieves the signs and symptoms of osteoarthritis, without adverse effect.

Flexible crossbar-structured resistive memory arrays on plastic substrates via inorganic-based laser lift-off.

Crossbar-structured memory comprising 32 × 32 arrays with one selector-one resistor (1S-1R) components are initially fabricated on a rigid substrate. They are transferred without mechanical damage via an inorganic-based laser lift-off (ILLO) process as a result of laser-material interaction. Addressing tests of the transferred memory arrays are successfully performed to verify mitigation of cross-talk on a plastic substrate.

Highly-efficient, flexible piezoelectric PZT thin film nanogenerator on plastic substrates.

A highly-efficient, flexible piezoelectric PZT thin film nanogenerator is demonstrated using a laser lift-off (LLO) process. The PZT thin film nanogenerator harvests the highest output performance of ∼200 V and ∼150 µA·cm(-2) from regular bending motions. Furthermore, power sources generated from a PZT thin film nanogenerator, driven by slight human finger bending motions, successfully operate over 100 LEDs.

The efficacy of percutaneous long-segmental posterior fixation of unstable thoracolumbar fracture with partial neurologic deficit.

STUDY DESIGN: Retrospective analysis. PURPOSE: The aim of this study was to evaluate the clinical and radiological outcomes of patients with unstable thoracolumbar fracture (UTLF) who were treated by percutaneous long-segmental posterior fixation (PLSPF) by two vertebrae cranial to the fracture with two vertebrae caudal. OVERVIEW OF LITERATURE: To the best of our knowledge, PLSPF for stabilization of UTLF has not been reported. METHODS: The study involved retrospective analysis and investigation from the results of 27 patients who had undergone PLSPF for stabilization of a UTLF with partial neurologic deficit, over a follow-up period of two years. Kyphotic angle (KA), anterior vertebral height percentage (AVHP) and cross-sectional ratio of the displaced fragment within the spinal canal were evaluated with simple radiographs and axial computed tomography scans preoperatively and two years postoperatively. The clinical outcome for pain was assessed by a visual analogue scale (VAS) and Denis' scale, and the degree of neurologic deficit was measured by modified Frankel classification. RESULTS: Five patients had minor complications. The KA, AVHP, and cross-sectional ratio of the displaced fragment improved significantly after surgery (p<0.001, p<0.001, p<0.003, respectively). Neurologic recovery of one or more for the Frankel grade was seen in 19 patients with an average improvement of 1.7. The VAS and Denis' score improved significantly at a two year follow-up (p=0.02, p=0.012, respectively). CONCLUSIONS: The technique of PLSPF is useful for the treatment of UTLF with partial neurologic deficit, and produces decreased morbidity and fewer complications.

Primary Candida guilliermondii Infection of the Knee in a Patient without Predisposing Factors.

Isolated primary candidal infection of joint is extremely rare, with only a few reported cases. It occurs as a result of accidental implantations of fungus during traumatic procedures, such as surgery, and is usually reported in patients with predisposing factors such as immunosuppression, malignancy, and drug abuse. If left untreated, irreversible deformity and pain with severe osteoarticular destruction occur. Thus, early diagnosis and treatment are important. This paper presents a case of 72-year-old man with primary C. guilliermondii infection of knee joint without predisposing factors and previous traumatic procedures, who was misdiagnosed with advanced degenerative osteoarthritis. Our case is the second case of primary C. guilliermondii arthritis of knee to be reported in the English-language literature and the first to be successfully treated with total knee arthroplasty following IV amphotericin B and oral fluconazole. Primary candidal infection of joint is generally asymptomatic or involves only mild pain and swelling in the affected knee. Thus, although the majority of knee joint infections are of a pyogenic or tuberculous origin, if a patient complains of mild pain and swelling in the knee and has mild signs of infection, the possibility of fungal infection should be considered.

Transphyseal anterior cruciate ligament reconstruction in a skeletally immature knee using anterior tibialis allograft.

Anterior cruciate ligament (ACL) injury in the skeletally immature individual is being recognized with increasing frequency. Nonoperative treatment of ACL injuries in skeletally immature patients have not been favorable. Surgical treatment options for complete ACL tears include primary ligament repair, extraarticular tenodesis, transphyseal reconstruction, partial transphyseal reconstruction, and physeal-sparing reconstruction. The advantage of transphyseal reconstruction is placement of the graft tissue in an isometric position, which provides better results, according to the literature. The potential disadvantage is angular or limb-length discrepancy caused by physeal violation. Controversy exists in allograft selection about whether bone or soft tissue passes into physes. The use of standard tunnels provides reliable results, but carries the risk of iatrogenic growth disturbance from physeal injury.This article presents 4 cases of transphyseal ACL reconstruction using anterior tibialis allograft in skeletally immature patients that had satisfactory functional outcomes with no growth disturbances. This is the first report of transphyseal ACL reconstruction using anterior tibialis allograft in skeletally immature patients in the English-speaking literature. All patients underwent transphyseal ACL reconstruction using anterior tibialis tendon allograft. None of the patients had angular deformities. No early physeal arrest was measured between the preoperative and postoperative radiographs. At last follow-up, the results of the Lachman test were normal for 3 patients and nearly normal for 1 patient. All patients demonstrated full range of knee motion (comparing the reconstructed knee to the contralateral knee). The results of the pivot-shift test were normal for 3 patients and nearly normal for 1 patient. No patients reported giving way.

Anti-TNF-alpha therapy for ankylosing spondylitis.

BACKGROUND: This review evaluated the safety and efficacy of etanercept in patients with ankylosing spondylitis (AS). METHODS: Of 59 patients with AS, this study reviewed 11 patients who were refractory to conventional therapy and treated with etanercept from September 2005 to January 2008. The mean follow-up duration was 13.6 months. The general improvement was evaluated by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and adverse effects, complications and inflammatory markers were also assessed. RESULTS: The mean BASDAI decreased from 7.1 +/- 1.6 before treatment to 4.2 +/- 1.8 at 3 months after the etanercept treatment (p = 0.001). The mean erythrocyte sedimentation rate and C-reactive protein were decreased significantly by the etanercept treatment. The greatest improvement in symptoms was enthesitis, followed by skin involvement and morning stiffness. There was a significant difference in the improvement in BASDAI along with the follow up duration (p = 0.04). A serious infection was observed as a complication in 1 case. CONCLUSIONS: These results suggest that etanercept can induce significant improvement in most patients with less damage. A trial of tumor necrosis factor inhibition is indicated in all AS patients who do not achieve adequate disease control with disease-modifying antirheumatic drugs, such as methotrexate, leflunomide etc. The patients treated with etanercept should be educated about the possibility of infection and monitored closely.