Clinical Outcomes of Severe Rhinosinusitis Complicated with Cavernous Sinus Syndrome.

Background: Various diseases involving the cavernous sinus can cause a condition called cavernous sinus syndrome (CSS), which is characterized by ophthalmoplegia or sensory deficits over the face resulting from the compression effect of internal structure. While tumor compression is the most reported cause of CSS, statistical data on CSS caused by infections are limited. Its risk factors, treatment methods, and clinical outcomes are not well-documented. Methods: In this retrospective study, we reviewed the data of patients admitted to a tertiary medical center from 2015 to 2022 with a diagnosis of acute and chronic sinusitis and at least one diagnostic code for CSS symptoms. We manually reviewed whether patients were involved in two or more of the following cranial nerves (CN): CN III, CN IV, CN V, or CN VI, or at least one of these nerves with a neuroimaging-confirmed lesion in the cavernous sinus. Results: Nine patients were diagnosed with rhinosinusitis-related CSS. The most common comorbidity was type 2 diabetes, and the most common clinical manifestations were diplopia and blurred vision. The sphenoid sinus was the most affected sinus. One patient expired due to a severe brain abscess infection without surgery. The remaining patients underwent functional endoscopic sinus surgery, and 50% of the pathology reports indicated fungal infections. Staphylococcus spp. was the most cultured bacteria, and Amoxycillin/Clavulanate was the most used antibiotic. Only four patients had total recovery during the follow-up one year later. Conclusions: CSS is a rare but serious complication of rhinosinusitis. Patients with diabetes and the elderly may be at a higher risk for this complication. Even after treatment, some patients may still have neurological symptoms.

Preoperative planning of compact zone trajectory is necessary in treating osteoporotic vertebral compression fracture with endplate involvement: A prospective randomized controlled study.

BACKGROUND: This prospective randomized controlled study compares the clinical and radiological outcomes between reduction methods with or without compact trabecular bone during percutaneous kyphoplasty in osteoporotic vertebral fractures. METHODS: The cohort of 100 patients who underwent percutaneous kyphoplasty was randomly divided into group A (guide pin and balloon introduced directly into fracture site) and group B (guide pin and balloon inserted away fracture site). The surgery duration, clinical and radiological outcomes postoperatively and at follow-up, and complications of cement leakage and adjacent fracture were recorded. Patients were followed up for an average of 20.18 months. The clinical outcomes were assessed using the Oswestry Disability Index and visual analog scale. RESULTS: The two groups had similar patient demographics, surgery times, and volume of cement injected. The method using elevation of the collapsed endplate indirectly had no significant influence on radiological outcomes but significantly decreased the occurrence of intradiscal cement leakage and improved 1- and 12-month postoperative functional outcomes. CONCLUSION: Elevating and reinforcing the collapsed endplate rather than just filling the defect during percutaneous kyphoplasty is safe and effective. This technique decreased pain and improved function with lower rates of further collapse of the osteoporotic vertebrae compared to defect-filling alone.

Biomechanical Effects of a Novel Pedicle Screw W-Type Rod Fixation for Lumbar Spondylolysis: A Finite Element Analysis.

Lumbar spondylolysis involves anatomical defects of the pars interarticularis, which causes instability during motion. The instability can be addressed through instrumentation with posterolateral fusion (PLF). We developed a novel pedicle screw W-type rod fixation system and evaluated its biomechanical effects in comparison with PLF and Dynesys stabilization for lumbar spondylolysis via finite element (FE) analysis. A validated lumbar spine model was built using ANSYS 14.5 software. Five FE models were established simulating the intact L1-L5 lumbar spine (INT), bilateral pars defect (Bipars), bilateral pars defect with PLF (Bipars_PLF), Dynesys stabilization (Bipars_Dyn), and W-type rod fixation (Bipars_Wtyp). The range of motion (ROM) of the affected segment, the disc stress (DS), and the facet contact force (FCF) of the cranial segment were compared. In the Bipars model, ROM increased in extension and rotation. Compared with the INT model, Bipars_PLF and Bipars_Dyn exhibited remarkably lower ROMs for the affected segment and imposed greater DS and FCF in the cranial segment. Bipars_Wtyp preserved more ROM and generated lower stress at the cranial segment than Bipars_PLF or Bipars_Dyn. The injury model indicates that this novel pedicle screw W-type rod for spondylolysis fixation could return ROM, DS, and FCF to levels similar to preinjury.

Shorter screw lengths in dynamic Dynesys fixation have less screw loosening: From clinical investigation to finite-element analysis.

BACKGROUND: The dynamic Dynesys Stabilization System preserves lumbar mobility at instrumented levels. This study investigated the effect of screw length on screw loosening (SL) after dynamic Dynesys fixation and screw displacement during lumbar motion, using clinical investigation and finite-element (FE) analysis. METHODS: Clinical data of 50 patients with degenerative spondylolisthesis treated with decompression and Dynesys fixation in 2011 were analyzed retrospectively. Horizontal sliding displacement and vertical displacement of screw tips at L4 were analyzed postoperatively using displacement-controlled FE analysis at the L4-L5 level with screw lengths 45 (long screw), 36 (median screw), and 27 (short screw), and 6.4 mm in diameter, under flexion, extension, lateral bending, and rotation. RESULTS: In 13 patients (13/50, 26%), 40 screws (40/266, 15%) were loose at mean follow-up of 101.3 ± 4.4 months. Radiographic SL at 35, 40, 45, and 50 mm were 7.7%, 10.7%, 12.1%, and 37.5%, respectively, regardless of the fixation level ( p = 0.009). FE analysis revealed that the long screw model with corresponding longer lever arm had maximal horizontal sliding displacement under all directions and maximal vertical displacement, except for lateral bending. CONCLUSION: Shorter screws in Dynesys fixation may help avoid dynamic SL. Clinically, 50 mm screws showed the greatest SL and median screw screws demonstrated the least displacement biomechanically.

Posterior instrumentation for osteoporotic fractures in the thoracic or lumbar spine: Cement-augmented pedicle screws vs hybrid constructs.

BACKGROUND: Cement-augmented pedicle screws (CPS) and hybrid construct (HC), consisting of pedicle screws and additional hooks, are common fixation methods for osteoporotic spine fracture. No study has compared surgical results of CPS and HC for treating osteoporotic spine fracture. The aim of the study was to compare surgical results using CPS or HC for osteoporotic fractures of the thoracic or lumbar spine. METHODS: This retrospective cohort study included 84 patients who received surgical treatment with CPS (n = 43) or HC (n = 41) for osteoporotic spine fractures from January 2011 to December 2015, with a mean follow-up of 67 months. Sixty-five patients with neurological deficits received long posterior instrumentation, short posterior decompression, and posterolateral fusion. The 19 patients without neurologic deficits received long posterior instrumentation without posterior decompression and fusion. Radiographic, clinical, and neurologic outcomes were evaluated. RESULTS: The HC group had significantly shorter operative times (231 vs 258 minutes), greater blood loss (497 vs 427 mL), better immediate postoperative kyphosis reduction (10.6° vs 9.1°), and greater final reduction loss (9.8° vs 7.1°) than the CPS group. In both groups, significant loss of the kyphotic angle was apparent during follow-up. Improved ambulation after surgery occurred in 51.2% and 58.5% of patients in the CPS and HC groups, respectively. Neurologic function after surgery improved 0.5 and 0.7 grades in the CPS and HC groups, respectively. Implants failed in 2.3% and 2.4% of patients in the CPS and HC groups, respectively. The incidence of cement leakage from screw augmentation was 38.9%. CONCLUSION: The CPS and HC techniques for treating osteoporotic fractures of the thoracic or lumbar spine did not differ statistically in terms of improved radiologic and clinical outcomes, final neurologic and ambulatory function, or implant failure rates, making them equally comparable alternatives.

CT Hounsfield unit is a reliable parameter for screws loosening or cages subsidence in minimally invasive transforaminal lumbar interbody fusion.

Retrospective cohort study. To validate computed tomography (CT) radiodensity in Hounsfield units (HU) as a prognostic marker for pedicle screw loosening or cage subsidence in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). The retrospective study involved 198 patients treated with MI-TLIF. Screw loosening (SL), cage subsidence (CS), and fusion status were assessed by plain radiographs. The risk factors of SL and CS were identified using logistic regression. A total of 258 levels and 930 screws were analyzed. During a 2-year follow-up, 16.2% and 24.7% of patients had CS and SL respectively. The cut-off value of L1 HU for predicting SL or CS was 117. The L1 HU < 117 and BMI ≥ 25 were two independent risk factors. The risk of SL or CS was 4.1 fold in patients L1 HU < 117 and 2.6 fold in patients with BMI ≥ 25. For patients concurrently having BMI ≥ 25 and pre-op L1 HU < 117, the risk was 4.3 fold. Fusion rate and clinical outcome were comparable in patients with SL or CS. L1 HU < 117 and BMI > 25 were two independent risk factors that can be screened preoperatively for preventing SL or CS and lead to better management of patients undergoing MI-TLIF.

Does local vancomycin powder impregnated with autogenous bone graft and bone substitute decrease the risk of deep surgical site infection in degenerative lumbar spine fusion surgery?-An ambispective study.

BACKGROUND: Deep surgical site infection (DSSI) is one of the most challenging complications in lumbar fusion surgery. Few investigations examined the effect of vancomycin powder mixed with autogenic bone graft (ABG) and bone substitutes on preventing DSSI in degenerative lumbar fusion surgeries as well as any interference with bony fusion. The aim of the study was to investigate the effects of ABG along with bone substitutes as a local vancomycin delivery system on preventing DSSI in lumbar instrumented fusion and compared with those who did not use vancomycin powder. METHODS: From January, 2015 through December, 2015, a one-year prospective study using vancomycin powder mixed with ABG and bone substitute for degenerative lumbar fusion surgeries as vancomycin (V) group, 1 gm vancomycin for 2 and 3-level, and 2 gm for more than 3-level instrumentation. From December, 2013 through December 2014, patients received degenerative lumbar fusion surgeries without using vancomycin before the vancomycin protocol were retrospectively enrolled as non-vancomycin (NV) group. Vancomycin concentration was checked at post-operative days 1 and 3 for both the serum and drainage. Patients' demographic data, microbiology reports, fusion status and functional outcomes were evaluated. RESULTS: One hundred and ten patients were enrolled prospectively in the V group, and 86 for the NV group. After an average 41 months follow-up (range, 36-54), 3 patients (3.48%) developed postoperative DSSIs in the NV group, thereby requiring revision surgeries and parenteral antibiotics treatment versus no DSSIs (0%, 0/100) in the V group. (p = 0.048). The postoperative serum vancomycin levels were undetectable and no vancomycin related side effects was encountered. The mean vancomycin concentration of drainage at postoperative days 1 and 3 were 517.96 ± 174.4 and 220.14 ± 102.3 µg/mL, respectively. At final follow-up, there was no statistical difference observed in terms of clinical and radiologic outcomes. CONCLUSIONS: Our vancomycin protocol may reduce the incidence of DSSI in degenerative lumbar fusion surgery without affecting bony fusion. LEVEL OF EVIDENCE: Level III ambispective comparative study.

Multilevel calcium pyrophosphate dihydrate deposition in cervical ligamentum flavum: clinical characteristics and imaging features.

BACKGROUND: Involvement in cervical ligamentum flavum is a rare manifestation of the calcium pyrophosphate dihydrate deposition disease. Only few cases of this condition have been reported. We revealed eighteen cases of CPPD in cervical ligamentum flavum that diagnosed at a single medical center. In our case series, clinical characteristics and magnetic resonance imaging findings of patients are described. METHODS: We retrospectively reviewed the medical charts and imaging studies of the eighteen patients with pseudogout attack of the cervical ligamentum flavum. In addition, we discussed the differences between this disease and ossification of ligamentum flavum in image manifestations. RESULTS: There were fourteen men and four women aged between 59 and 87 years. Diabetes mellitus and hypertension were the most common comorbidities. Myelopathy and neck pain were presented in most patients. C4-5 and C5-6 were attacked most frequently, and multiple- rather than single-level involvement could be observed in our series. "Acute on chronic phenomenon" was a specific magnetic resonance image finding in patients whose symptom durations were between 2 to 5 months. Compared to ossification of ligamentum flavum, calcium pyrophosphate dihydrate crystal deposition had different image signs, including morphology, side of the involved ligament, no continuity with the lamina, acute on chronic phenomenon, and presence of retro-odontoid mass. CONCLUSIONS: Nodular calcifications in cervical ligamentum flavum raise highly suspicion for calcium pyrophosphate dihydrate deposition and must be diagnosed by histological examination and polarized light microscopy. This disease is different from ossification of ligamentum flavum, and it could be recognized by specific image features.

Preoperative facet joint arthropathy does not impact long-term clinical outcomes after lumbar-stability-preserving decompression and dynesys fixation.

To evaluate the impact of the preoperative severity of facet joint arthropathy on long-term functional outcomes and spinopelvic parameters in patients undergoing lumbar-stability-preserving decompression and Dynesys fixation. In this retrospective study, 88 patients undergoing combined surgery at our hospital from 2008 to 2015 were included. The patients were divided into two groups, the less and more than mean degeneration groups, based on preoperative facet joint arthropathy of the index level(s). The clinical outcomes were the Visual Analogue Scale (VAS) score, the Oswestry Disability Index (ODI) score and spinopelvic parameters. The mean follow-up durations for the less and more than mean degeneration groups were 84.83 ± 27.58 and 92.83 ± 20.45 months, respectively. The combined surgery significantly improved VAS and ODI scores, and increased sacral slope (SS) regardless of preoperative arthropathy severity. In addition, facet joint arthropathy at adjacent levels continued to worsen after surgery in both arthropathy severity groups. Preoperative facet joint arthropathy did not influence most long-term clinical outcomes in patients undergoing lumbar-stability-preserving decompression and Dynesys fixation. This combined surgery may be suitable for patients with facet joint arthropathy regardless of disease severity.

Risk Factors of Cage Subsidence in Patients Received Minimally Invasive Transforaminal Lumbar Interbody Fusion.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To determine the risk factors of cage subsidence in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and its correlation with patient-reported outcomes. SUMMARY OF BACKGROUND DATA: Cage subsidence is among the cage-related complications after TLIF and may lead to poor outcomes. Few studies have addressed the incidence of cage subsidence in MI-TLIF. METHODS: This retrospective study of a prospectively collected database was conducted from October 2015 to October 2017. All patients received MI-TLIF with a minimum of 2-year follow-up. All levels were separated into the cage subsidence (CS group) and no cage subsidence (non-CS group) groups. Cage subsidence was evaluated using lateral radiographs and defined as more than 2 mm migration of the cage into the endplate of adjacent vertebral body. Patient demographics, perioperative details, and radiographic parameters were recorded. Cage-related parameters were cage height, cage insertion level, and cage position. Cage position was recorded using central point ration (CPR). Patient-reported outcome was analyzed using the Oswestry Disability Index (ODI) questionnaire and Visual Analog Scale (VAS) preoperatively and at 2 years postoperatively. RESULTS: Ninety-three patients (126 levels) were included. Mean age was 66.5 years with an average follow-up of 36.9 months. Overall incidence of cage subsidence was 34.1%. The CS group had significantly higher body mass index, less bone mineral density (BMD), shorter disc height, and higher CPR than the non-CS group. BMD, disc height, and CPR were significantly negatively correlated with depth of cage subsidence. ODI improvement was significantly lesser in the CS group than in the non-CS group. Fusion rate and complications were unrelated to cage subsidence. CONCLUSION: The BMD, disc height, and cage position were the most significant risk factors that were negatively correlated with depth of cage subsidence. Placing a TLIF cage anteriorly if possible may reduce the risk of cage subsidence. LEVEL OF EVIDENCE: 3.

Risk factors for residual neurologic deficits after surgical treatment for epidural abscess in the thoracic or lumbar spine.

BACKGROUND CONTEXT: Spinal epidural abscess (SEA) can cause neurologic deficits and needs urgent surgical intervention. Many clinical factors had been proposed to predict surgical outcomes in patients with SEA, but the predictive radiographic risk factors for residual neurologic deficits were not addressed sufficiently. PURPOSE: To analyze the clinical and radiographic risk factors for residual neurologic deficit in patients with SEA after surgical intervention of the thoracic or lumbar spine. STUDY DESIGN/SETTING: A retrospective consecutive case series. PATIENT SAMPLE: From January 2005 through December 2014, 53 patients with primary SEA, confirmed by culture or histopathology, in the thoracic or lumbar spine who underwent posterior-only approach surgery at our hospital. OUTCOME MEASURES: Neurologic status was assessed using the Frankel grading system preoperatively, postoperatively, and at final follow-up. METHODS: The patients were allocated into two groups based on the presence of postoperative residual neurologic deficits. Patients' demographic, clinical, and factors based on magnetic resonance imaging (MRI) were analyzed for their influence on residual neurologic deficits. Clinical factors included age, sex, diabetes, comorbidities, pathogens, affected spinal levels, the interval between onset of symptoms to surgery, preoperative neurologic status, presence of cauda equina syndrome, and surgical procedures. MRI factors included the distribution of abscesses within the spinal canal, presence of ring enhancement, presence of paravertebral abscess or psoas abscess, canal compromise anteroposterior (AP) ratio and cross-sectional area ratio, abscess length, and abscess thickness. RESULTS: Thirty-five of the 53 patients (66%) had preoperative neurologic deficits, and 21 of 53 patients (40%) had postoperative residual neurologic deficits. Patients' neurologic status improved significantly after the surgery (p<.001). Risk factors including age, diabetes, cauda equina syndrome, presence of anterior with posterior (A+P) dural abscess, canal compromise AP ratio, cross-sectional area ratio, abscess length, and abscess thickness were significantly correlated with postoperative residual neurologic deficits. In multivariate logistic regression analysis, age ≥70 years, preoperative cauda equina syndrome, abscess length ≥5.5 cm and abscess thickness ≥0.8 cm were the four most significant factors related to residual neurologic deficits. CONCLUSIONS: In patients with SEA of the thoracic and lumbar spine, age ≥70 years, preoperative cauda equina syndrome, abscess length ≥5.5 cm and abscess thickness ≥0.8 cm were the most significant preoperative risk factors for residual neurologic deficits after surgery.

Functional outcomes and survival after surgical stabilization for inoperable non-small-cell lung cancer with spinal metastasis of the thoracic and lumbar spines: a retrospective comparison between epidermal growth factor receptor-tyrosine kinase inhibitor and platinum-based chemotherapy groups.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To compare the surgical results between targeted therapy and post-operative chemotherapy for patients with spinal metastasis of inoperable non-small-cell lung cancer (NSCLC). SETTING: Single-center study at an academic orthopedic department in Taiwan. METHODS: Sixty-five patients were treated surgically for spinal metastasis of inoperable NSCLC with long posterior instrumentation with or without posterior decompression according to the patient's neurologic status. Post-operative radiotherapy of the spinal lesion and targeted therapy or chemotherapy were done following surgery after the surgical wound healed. Post-operative clinical outcomes and survival were evaluated and compared between these two groups. The overall survival represented survival from the date of diagnosis to death. RESULTS: Thirty-five patients were grouped as the targeted therapy group and 30 patients as the chemotherapy group. The overall median survival times were 12.0 and 10.0 months in the targeted therapy and chemotherapy groups, respectively. Sixty-two patients were able to walk with or without an aid postoperatively. There was no significant difference observed between these two groups in terms of pain relief, neurologic improvement, ambulatory improvement, and survival. CONCLUSIONS: Surgical stabilization with or without laminectomy improved functional outcomes in patients with inoperable non-small-cell lung cancer, and post-operative functional outcomes were similar between chemotherapy and targeted therapy groups. A longer survival was observed with targeted therapy for the patients whose NSCLC was diagnosed before spinal metastasis, however, the longer survival was not statistically significant.

Is bony attachment necessary for dynamic reference frame in navigation-assisted minimally invasive lumbar spine fusion surgery?

This study aimed to compare the accuracy of navigation-assisted percutaneous pedicle screw insertions between traditional posterior superior iliac spine (PSIS) fixed and cutaneously fixed dynamic reference frame (DRF) in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF). This is a prospective randomized clinical study. Between May 2016 and Nov 2017, 100 patients who underwent MIS TLIF were randomly divided into bone fixed group (with PSIS fixed DRF) and skin fixed group (with cutaneously fixed DRF). The pedicel screws were inserted under navigational guidance using computed tomography (CT) data acquired intraoperatively with a Ziehm 3-dimensional fluoroscopy-based navigation system. Screw positions were immediately checked by a final intraoperative scan. The accuracy of screw placement was evaluated by a sophisticated computed tomography protocol. Both groups had similar patient demographics. Totally Five-hundred Twelve pedicle screws were placed in the lumbar spine. There were 2 moderate (2-4 mm) pedicle perforations in each group. The accuracy showed no significant difference between bone fixed and skin fixed DRF. There were no significant procedure-related complications. The skin fixed DRF provides similar accuracy in pedicle screw insertions with bone fixed DRF using intraoperative 3D image guided navigation in MIS TLIF. Skin fixed DRF not only serves as an alternative method but also saves a separate incision wound for bony attachment.

Intra-articular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study.

PURPOSE: To evaluate the effect of intra-articular injection of tranexamic acid (TXA) in patients receiving arthroscopic anterior cruciate ligament reconstruction (ACLR). METHODS: A total of 304 patients were included in this study, which was performed between August 2017 and April 2018. Single-bundle reconstructions using autologous hamstring tendon grafts were performed in all patients. Patients were randomized into 2 groups: Group 1 patients (TXA group) received the index procedure with a 10-mL intra-articular injection of TXA (100 mg/mL). Group 2 patients (control group) received the index procedure without TXA injections. An intra-articular suction drain was placed in the joint and clamped for 2 hours after the procedure. The volume of drainage was recorded 24 hours after surgery. Clinical evaluations using the International Knee Documentation Committee functional score, range of motion, and a visual analog scale pain score were performed on day 3 and at week 4 postoperatively. RESULTS: Twenty-four hours after surgery, a significant decrease in the amount of drainage was observed in patients receiving intra-articular injections (TXA group, 56.1 ± 34.1 mL; control group, 80.1 ± 48 mL; P < .05). On day 3 and at week 4, significantly reduced pain scores were reported in the TXA group. However, at week 4, clinical function scores did not show significant differences between the 2 groups. CONCLUSIONS: Intra-articular injection of TXA could significantly reduce postoperative intra-articular bleeding in the first 24 hours in patients receiving arthroscopic ACLR. TXA injection may also decrease pain and the grade of hemarthrosis in the early postoperative period. No systemic side effects or need for aspiration was noted during the follow-up period. Therefore, intra-articular injection of TXA could be considered an effective and relatively safe solution to reduce postoperative bleeding and pain in ACLR patients. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Use of Allogeneic Hypoxic Mesenchymal Stem Cells For Treating Disc Degeneration in Rabbits.

Intervertebral discs (IVDs) are important biomechanical components of the spine. Once degenerated, mesenchymal stem cell (MSC)-based therapies may aid in the repair of these discs. Although hypoxic preconditioning enhances the chondrogenic potential of MSCs, it is unknown whether bone marrow MSCs expanded under hypoxic conditions (1% O2 , here referred to as hypoxic MSCs) are better than bone marrow MSCs expanded under normoxic conditions (air, here referred to as normoxic MSCs) with regards to disc regeneration capacity. The purpose of this study was to compare the therapeutic effects of hypoxic and normoxic MSCs in a rabbit needle puncture degenerated disc model after intra-disc injection. Six weeks after needle puncture, MSCs were injected into the IVD. A vehicle-treated group and an un-punctured sham-control group were included as controls. The tissues were analyzed by histological and immunohistochemical methods 6 and 12 weeks post-injection. At 6 and 12 weeks, less disc space narrowing was evident in the hypoxic MSC-treated group compared to the normoxic MSC-treated group. Significantly better histological scores were observed in the hypoxic MSC group. Discs treated with hypoxic MSCs also demonstrated significantly better extracellular matrix deposition in type II and XI collagen. Increased CD105 and BMP-7 expression were also observed upon injection of hypoxic MSCs. In conclusion, hypoxic MSC injection was more effective than normoxic MSC injection for reducing IVD degeneration progression in vivo. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1440-1450, 2019.

Comparison of Tunnel Enlargement and Clinical Outcome Between Bioabsorbable Interference Screws and Cortical Button-Post Fixation in Arthroscopic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Study With a Minimum Follow-Up of 2 Years.

PURPOSE: To investigate the tunnel enlargement rate and clinical function by comparing double-bundle anterior cruciate ligament reconstruction (ACLR) using different fixation devices. METHODS: Patients receiving primary arthroscopic double-bundle ACLR were screened and divided into 2 groups on the basis of the method of graft fixation: bioabsorbable interference screw (BS) group and cortical button (CB) group. Bone tunnel size was assessed digitally using magnetic resonance imaging, which was performed a minimum of 2 years postoperatively. Clinical evaluations were performed using the Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee score, and KT-1000 arthrometer 2 years postoperatively. RESULTS: Sixty patients receiving primary arthroscopic double-bundle ACLR were included. Overall, the BS group showed greater tunnel enlargement than the CB group, as well as a significantly increased rate of tunnel communication (P = .029). The average anteromedial tunnel enlargement rates for the BS and CB groups were 50% and 28%, respectively. The enlargement rate of the posterolateral (PL) femoral tunnel was similar in both groups. In the PL tibial tunnel, the CB group showed a significant increase in enlargement compared with the BS group (64% vs 45%, P = .0001). Both groups showed functional improvement in the Knee Injury and Osteoarthritis Outcome Score and International Knee Documentation Committee score. No significant difference in postoperative functional outcomes was found between the 2 groups. CONCLUSIONS: The BS group showed significantly greater tunnel enlargement in anteromedial tunnels and an increased tunnel communication rate compared with the CB group. On the other hand, the CB group showed greater tunnel enlargement in tibial PL tunnels. Tunnel communication was observed mostly on the tibial side in the BS patients. Equivalent clinical function outcomes were noted at 2 years after surgery in both groups of patients. LEVEL OF EVIDENCE: Level II, randomized controlled clinical trial.

The fates of pedicle screws and functional outcomes in a geriatric population following polymethylmethacrylate augmentation fixation for the osteoporotic thoracolumbar and lumbar burst fractures with mean ninety five month follow-up.

PURPOSE: Polymethylmethacrylate (PMMA) augmentation is a common method to increase pullout strength fixed for osteoporotic spines. However, few papers evaluated whether these pedicle screws migrated with time and functional outcome in these geriatrics following PMMA-augmented pedicle screw fixation. METHODS: From March 2006 to September 2008, consecutive 64 patients were retrospectively enrolled. VAS and ODI were used to evaluate functional outcomes. Kyphotic angle at instrumented levels and horizontal and vertical distances (HD and VD) between screw tip and anterior and upper cortexes were evaluated. To avoid bias, we used horizontal and vertical migration index (HMI and VMI) to re-evaluate screw positions with normalization by the mean of superior and inferior endplates or anterior and posterior vertebral body height, respectively. RESULTS: Forty-six patients with 282 PMMA-augmented screws were analyzed with mean follow-up of 95 months. Nine patients were further excluded due to bed-ridden at latest follow-up. Twenty-six females and 11 males with mean T score of - 2.7 (range, - 2.6 to - 4.1) and mean age for operation of 77.6 ± 4.3 years (range, 65 to 86). The serial HD and kyphotic angle statistically progressed with time. The serial VD did not statistically change with time (p = 0.23), and neither HMI nor VMI (p = 0.772 and 0.631). Pre-operative DEXA results did not correlate with kyphotic angle. Most patients (80.4%) maintained similar functional outcomes at latest follow-up. The incidence of screws loosening was 2.7% of patients and 1.4% of screws, respectively. The overall incidences of systemic post-operative co-morbidities were 24.3% with overall 20.2 days for hospitalization. CONCLUSION: Most patients (80%) remained similar functional outcomes at latest follow-up in spite of kyphosis progression. The incidence of implant failure was not high, but the post-operative systemic co-morbidities were higher, which has to be informed before index surgery.

[Preoperative Disability and Its Influencing Factors in Patients With Lumbar Spondylolisthesis].

BACKGROUND: Patients with lumbar spondylolisthesis typically suffer from symptom discomfort and various degrees of disability for months or years prior to receiving surgical treatments. Knowing the factors that influence the disability status of these patients will help healthcare providers develop effective preventive measures. PURPOSE: To explore preoperative disability and its important predictive factors in patients with lumbar spondylolisthesis. METHODS: A predictive correlational design was used and a convenience sample of eighty-six lumbar spondylolisthesis preoperative patients were recruited from a medical center in northern Taiwan. Data were collected using a study questionnaire, which included the Oswestry disability index, the revised geriatric depression scale-short form, and a pain numeric rating scale. RESULTS: The average disability index of the participants was 48.52 (SD = 16.14). The multiple linear regression analyses identified lower back pain, depression, age, and gender as significant predictors of preoperative disability, collectively explaining 40.9% of the variation in disability severity. Being female, being older, having a higher degree of lower back pain, and having depression were significantly associated with preoperative disability. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of the present study indicate that lumbar spondylolisthesis patients who are older in age, female, currently experiencing lower back pain, and suffering from depression face a higher risk of preoperative disability. Patients in these at-risk categories should be assessed actively and provided with appropriate patient education in order to enhance their quality of life.

Implantation of an empty polyetheretherketone cage in anterior cervical discectomy and fusion: a prospective randomised controlled study with 2 years follow-up.

PURPOSE: To compare the clinical outcomes, radiographic results and fusion rate of ACDF between empty PEEK cages and PEEK cages packed with ß-tricalcium phosphate. METHODS: Forty-five patients were prospectively enrolled with cervical degenerative disc disease who requiring ACDF with a PEEK cage. 23 patients were randomised to the study group (empty cages) and 22 patients were in the control group (cages filled with ß-tricalcium phosphate). Both patient groups were fixed with a cervical locking plate. A CT scan was performed 12 months postoperatively and 24 months if not confirmed fused at 12 months to evaluate the status of fusion. Clinical status was evaluated using the Japanese Orthopaedic Association (JOA) score, the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS). RESULTS: 46 levels (97.88%) in the study group and 44 levels (97.77%) in the control group were confirmed as fused at 24 months. There was no significant difference between the fusion rates observed in the study and control groups (p = 0.82). There was no significant difference in JOA, ODI, or VAS scores at 24 months follow-up. The results showed that the members of the non-fusion group tended to be older than the individuals in the fusion group at 12 months, but was not significant in statistics. CONCLUSIONS: Similar fusion rates and clinical outcomes were achieved when using ACDF with PEEK cages and instrumentation, regardless of whether the cage was filled with bone substitute at 24 months follow-up. Fusion rates improved over time and are comparable between both groups. These slides can be retrieved under Electronic Supplementary material.