Preoperative low Hounsfield units in the lumbar spine are associated with postoperative mechanical complications in adult spinal deformity.

PURPOSE: To determine the most valid bone health parameter to predict mechanical complications (MCs) following surgery for adult spinal deformity (ASD). METHODS: This multicenter study retrospectively examined the records of patients who had undergone fusion of three or more motion segments, including the pelvis, with a minimum two-year follow-up period. Patients with moderate and severe global alignment and proportion scores were included in the study and divided into two groups: those who developed MCs and those who did not. Bone mineral density (BMD) of the lumbar spine and femoral neck was measured using dual-energy X-ray absorptiometry, and Hounsfield units (HUs) were measured in the lumbar spine on computed tomography. Radiographic parameters were evaluated preoperatively, immediately after surgery, and at final follow-up. RESULTS: Of 108 patients, 30 (27.8%) developed MCs, including 26 cases of proximal junctional kyphosis/failure, 2 of distal junctional failure, 6 of rod fracture, and 11 reoperations. HUs were significantly lower in patients who experienced MCs (113.7 ± 41.1) than in those who did not (137.0 ± 46.8; P = 0.02). BMD did not differ significantly between the two groups. The preoperative and two-year postoperative global tilt, as well as the immediately postoperative sagittal vertical axis, were significantly greater in patients who developed MCs than in those who did not (P = 0.02, P < 0.01, and P = 0.01, respectively). CONCLUSION: Patients who experienced MCs following surgery for ASD had lower HUs than those who did not. HUs may therefore be more useful than BMD for predicting MCs following surgery for ASD.

A rare case of right-sided infective endocarditis caused by group B Streptococcus complicated with septic knee arthritis and subcutaneous abscess in the lower extremity.

BACKGROUND: Several reports have assessed group B Streptococcus (GBS) infections in non-pregnant cohorts, especially in immunocompromised hosts and patients with severe disease, including diabetes mellitus. CASE PRESENTATION: We report a rare case of large GBS -associated tricuspid valve infective endocarditis (IE) complicated with septic knee arthritis and s.c. abscess formation in the lower extremity of a non-i.v. drug user. After confirming the absence of vegetation on transthoracic echocardiography (TTE) at admission, the lower extremity was irrigated, and antibiotic therapy was initiated. One week later, the causes of persistent fever were reinvestigated. The TTE detected a large mass around the tricuspid valve. The cultured GBS was penicillin sensitive. The vegetation completely disappeared without surgery within 4 weeks. CONCLUSION: When patients with untreated diabetes mellitus have persistent fever and s.c. abscess or septic arthritis, IE is a possible differential diagnosis. Repetitive evaluation by TTE is warranted to avoid this fatal complication.

Treatment of Multiple Digit Amputation in an Infant Using an Abdominal Pocket Combined with Composite Grafts of the Amputated Distal Phalanxes and Nails.

Retention of the distal phalanxes is important in the treatment of multiple digit amputations in infants to preserve the digit length and nail for functional and cosmetic reasons. We report the case of a 22-month-old boy with multiple digit amputations of his left index, middle, and ring fingers, which were severely mangled and not suitable for replantation. We propose the usefulness of the abdominal pocket method combined with composite grafts of the amputated phalanxes and nails and report the outcome of our case, with 2-year follow-up.