Efficacy of automated percutaneous lumbar discectomy for lumbar disc herniation in young male soldiers.

Lumbar disc herniation (LDH) often results in back pain and radicular pain and is frequently treated with minimally invasive non-surgical methods in Korean Armed Forces Hospitals. Automated percutaneous lumbar discectomy (APLD) has been reported to have good clinical outcomes with low complication rates; however, the clinical efficacy of APLD performed in young male soldiers is uncertain. In order to clarify the efficacy of APLD for the treatment of LDH in young male soldiers, we designed a retrospective case-control study to compare patients who received APLD with patients treated with epidural steroid injection (ESI) alone.A total of 181 patients were enrolled and divided into the APLD (n = 92) and ESI (n = 89) groups according to the treatment modality. A simple logistic regression analysis was conducted to clarify the difference between the two. To optimize patient selection, APLD group was additionally divided for subgroup analysis into favorable (n = 59) and unfavorable (n = 33) groups based on satisfaction scales. A simple logistic analysis was also performed.The differences between pre- and postoperative numerical rating scale of pain (P = .0027) and hospital-own satisfaction scale (P = .0045) of the APLD group were significantly better compared to those of the ESI group. In terms of subgroup analysis, single-level pathology (P = 0.244) and protruded disc (P = .0443) were associated with favorable outcomes, whereas dual pathology and extruded disc were related with unfavorable outcomes.APLD using Dekompressor, performed in young male soldiers with back and radicular pain owing to LDH, showed better clinical outcomes compared to the ESI only therapy. Additionally, a single-level pathology with protruded disc was associated with favorable outcomes and may be indicated for treatment.

Does Proximally Coated Single-Wedge Cementless Stem Work Well in Dorr Type C Femurs? Minimum 10-year Followup.

BACKGROUND: Total hip arthroplasty (THA) with a proximally coated single-wedge (PSW) cementless stem had been generally considered not to be suitable for Dorr Type C femurs. This study compares the long term outcomes of PSW stem according to the type of proximal femoral geometry. MATERIALS AND METHODS: 307 primary THAs in 247 patients were performed with PSW cementless stem and followed up for over 10 years in this retrospective study. According to Dorr's criteria, 89 femurs were classified as Type A, 156 as Type B, and 62 as Type C. They were followed up for an average of 13.2 years (range 10.0-17.3 years). All the hips were evaluated clinically and radiologically. RESULTS: There was no significant difference in stem survivorship and clinical outcomes including the incidence of thigh pain and the mean postoperative Harris hip score (HHS) in all three groups. No significant differences were observed in osteolysis, pedestal formation, or cortical hypertrophy among the groups. Radiolucent lines <2 mm in thickness in Gruen zone 4 and 7 (P = 0.003 and P = 0.044, respectively), spot-weld (P < 0.001), and stress shielding (P = 0.010) of proximal femur were more pronounced in Dorr C type femora than in Type A or B. Fifty-six intraoperative fractures were identified among 307 hips with PSW stems. The incidence of intraoperative or postoperative femoral fractures was not significantly different among the groups. CONCLUSIONS: From over a 10-year followup, the PSW stem provided a recommendable option with satisfactory outcomes and excellent stem survivorship regardless of the Dorr type.

Adhesive capsulitis of the hip.

PURPOSE: Adhesive capsulitis of the hip (ACH) is not a well-defined disease entity. We evaluated the change in the clinical features of patients whose chief complaint was inability to sit cross-legged on the floor. All patients had painful limitation in hip joint motion. Based on the diagnosis of ACH, active stretching exercise (ASE) was recommended. METHODS: In February 2013 and June 2014, a total of 44 patients (50 hips), who visited outpatient clinic in 2011, were evaluated by telephone interviews. Recovery of hip motion was analyzed according to compliance with ASE and abnormalities found on plane radiographs and magnetic resonance (MR) images. RESULTS: There were 27 women and 17 men with mean age of 51.7 years. In the first telephone interview, 40 patients (45 hips) reported improvement in hip motion but 4 patients (5 hips) reported absolutely no improvement. Compliance with ASE did not affect recovery of motion ( p = 0.225). On plain radiographs, 10 patients (22.7%) had abnormal finding in both hips. Those abnormal findings were not correlated with symptom and did not show adverse effect on motion recovery. Sixteen patients took MR images outside, and abnormal findings such as round ligament or labral tear were observed in nine patients. Those abnormal findings neither correlated with the symptom nor affected motion recovery adversely. In the second telephone interview, nine hips of further improvement and two hips of recurrence were identified. CONCLUSIONS: Most cases showed improvement in the range of motion with or without ASE. Surgical treatments including arthroscopy seemed to be unnecessary for these patients.

Adjuvant Teriparatide Therapy for Surgical Treatment of Femoral Fractures; Does It Work?

PURPOSE: Atypical femoral fracture (AFF), periprosthetic femoral fracture (PPFF) and femoral nonunion (FNU) are recalcitrant challenges for orthopedic surgeons. Teriparatide (TPTD) had been demonstrated to have anabolic effects on bone in various studies. We postulated that adjuvant TPTD after operation would enhance biologic stimulation for bone formation. We investigated (1) whether the adjuvant TPTD could achieve satisfactory union rate of surgically challenging cases such as displaced AFF, PPFF and FNU; (2) whether the adjuvant TPTD could promote development of abundant callus after surgical fixation; (3) whether the adjuvant TPTD had medically serious adverse effects. MATERIALS AND METHODS: Thirteen patients who agreed to off label use of TPTD in combination of operation were included in this retrospective case series. Median patients' age was 68.7 years, and there were three male and ten female patients. Their diagnoses were nonunion in six patients and acute fracture in seven. Medical records and radiographic images were reviewed. RESULTS: Twelve of thirteen fractures were united both clinically and radiologically within a year after adjuvant TPTD. Union completed radiologically median 5.4 months and clinically 5.7 months after the medication, respectively. Callus appeared abundantly showing median 1.4 of fracture healing response postoperatively. There was no serious adverse reaction of medication other than itching, muscle cramp, or nausea. CONCLUSION: Even appropriate surgical treatment is a mainstay of treatment for AFF, PPFF, and FNU, the current report suggested that adjuvant TPTD combined with stable fixation results in satisfactory outcome for the challenging fractures of femur.

Changes of functional outcomes according to the degree of completeness of spinal cord injury.

OBJECTIVE: To evaluate whether an initial complete impairment of spinal cord injury (SCI) contributes to the functional outcome prediction, we analyzed the relationship between the degree of complete impairment according to the American Spinal Injury Association impairment scale (AIS), the posterior tibial nerve somatosensory evoked potential (PTSEP) and the changes of functional indices. METHODS: Sixty subjects with SCI were studied who received rehabilitative management for over 2 months. The degree of completeness on basis of the initial AIS and PTSEP were evaluated at the beginning of rehabilitation. Following treatment, several functional indices, such as walking index for spinal cord injury version II (WISCI II), spinal cord independence measure version III (SCIM III), Berg Balance Scale (BBS), and Modified Barthel Index (MBI), were evaluated until the index score reached a plateau value. RESULTS: The recovery efficiency of WISCI and BBS revealed a statistically significant difference between complete and incomplete impairments of initial AIS and PTSEP. The SCIM and MBI based analysis did not reveal any significant differences in terms of the degree of AIS and PTSEP completeness. CONCLUSION: AIS and PTSEP were highly effective to evaluate the prognosis in post-acute phase SCI patients. BBS and WISCI might be better parameters than other functional indices for activities of daily living to predict the recovery of the walking ability in post-acute SCI.

Gold nanoparticle-hybridized "nano-sponge" polymer coatings to enhance the reliability and sensitivity of biosensors.

We have created a new functional biosensor coating composed of polyelectrolyte multilayers containing gold nanoparticles. This gold-hybridized polyelectrolyte multilayer film possesses a stable nanoporous structure under physiological conditions. Antibody molecules were successfully conjugated onto the gold nanoparticles within the film. This functional coating successfully extinguished false signals from non-specific binding of proteins and cells and also provided highly enhanced detection sensitivity. Furthermore, the drastic differences in protein and cellular adhesion properties between a chip coated with the nanoporous PEM film and a bare chip demonstrate that morphological control of biological interactions on chip surfaces is possible.