Postoperative hematoma in cervical spondylosis patient complicated with Huntington's disease: Case report and literature review.

Hematoma is a life-threatening complication of anterior surgery in cervical spondylosis patients. Herein, we report a cervical spondylosis patient complicated with Huntington's disease, who developed unexpected neck hematoma after anterior cervical discectomy and fusion (ACDF) surgical treatment. During the debridement, we found no noticeable vessel lesions and concluded that the occurrence of postoperative hematoma might be due to the drainage displacement caused by excessive uncontrolled movements of the neck after the operation. The patient recovered well, and further literature review suggests that chorea secondary to Huntington's disease likely increases mechanical stress on the cervical spine, indicating an internal relationship between degenerative cervical spondylosis and Huntington's disease. Cervical spondylotic patients complicated with Huntington's disease can be treated with surgical intervention but need to be immobilized and under close observation.

Application of a new integrated low-profile anterior plate and cage system in single-level cervical spondylosis: a preliminary retrospective study.

BACKGROUND: Although ACDF has been widely used in treating cervical spondylosis and related diseases, the complications along with this anterior surgical technique have hindered its application and affected the postoperative outcome of the patients. Here, we investigated the clinical and radiological outcomes of a new integrated low-profile anterior plate and cage system for anterior cervical discectomy and fusion (ACDF) in treating cervical spondylosis. METHODS: A total of 96 cervical spondylosis patients who underwent single-level ACDF between 2018 to 2020 in our institute were enrolled. There were 28 patients using the new implants and 68 patients using the zero-profile (Zero-P) implants. The Japanese Orthopedic Association (JOA) score and the visual analog scale (VAS) were used to evaluate the clinical outcomes. The cervical and segmental Cobb angle and range of motion (ROM) were used to assessed the radiological outcomes. Incidence of complications were also recorded. All data were recorded at pre-operation, 6-month and 12-month post-operation. RESULTS: All patients were followed-up for at least 1-year, the mean follow-up time was over one year. The fusion rate was similar in the two groups. There was no significant difference in the postoperative JOA score recovery rate, postoperative VAS score of neck and arm pain, postoperative ROM, and incidence of complications between two groups (P > 0.05). However, postoperative cervical and segmental Cobb angle were better maintained in the new low-profile implant group compared to Zero-P group. CONCLUSIONS: The clinical outcomes of the new low-profile implant were satisfactory and comparable to that of zero-profile system. It may have advantages in improving and maintaining the cervical lordosis, and can be an alternative device for single-level cervical spondylosis treated with ACDF.

The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients.

BACKGROUND CONTEXT: Laminoplasty is a common surgical method used to treat patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although laminoplasty is preferred over traditional laminectomy, the factors affecting the complications and outcomes are unclear. Recently, sagittal balance indexes have been revealed to be predictors of clinical outcomes in patients with cervical degenerative diseases, but their relationships with laminoplasty-treated OPLL outcomes remains unknown. PURPOSE: The purpose of this study is to evaluate the relationship of preoperative cervical sagittal balance indexes and clinical outcome in laminoplasty treated OPLL patients. STUDY DESIGN: This is a retrospective case study. PATIENT POPULATION: Between January 2015 and January 2017, 181 consecutively included patients who underwent cervical laminoplasty for OPLL were enrolled (male:female ratio=126:75; mean age=60.2 years). Cervical spine lateral radiographs in neutral, flexion, and extension positions were taken before and 2 years after the surgery. OUTCOME MEASURES: The C2-C7 Cobb angle, T1 slope, C1-C7 sagittal vertical axis (SVA), C2-C7 SVA, CGH (center of gravity of the head)-C7 SVA, cervical JOA (Japanese Orthopedic Association) score, and neck VAS (visual analogue scale) score were measured preoperatively and postoperatively at the 2-year follow-up. METHODS: The patients were divided into two groups according to changes in the lordotic angle or the recovery rate of the JOA score. The relationships between the postoperative lordosis loss or the clinical outcome and the preoperative variables, including the patient's age, JOA score, C2-C7 Cobb angle, T1 slope, C1-C7 SVA, C2-C7 SVA, and CGH-C7 SVA, were investigated. RESULTS: The patients were divided into two groups according to the postoperative change in the C2-C7 Cobb angle. There were no differences in the age, preoperative C2-C7 Cobb angle, C1-C7 SVA, or C2-C7 SVA; there was only a difference in the preoperative CGH-C7 SVA and T1 slope level (p=.038, p=.042). The postoperative JOA and JOA recovery rate were related to the postoperative lordosis loss in cervical alignment (p=.048, p=.031). We again divided the patients into two groups according to the JOA recovery rate and found that only the preoperative CGH-C7 SVA and C1-C7 SVA were related to the neurological outcome (p=.011, p=.047). According to the multivariate logistic regression analysis, higher preoperative CGH-C7 SVA levels were significantly associated with decreases in the lordosis angle postoperatively and the clinical outcome (p=.018, OR=1.225; p=.034, OR=1.654). The ROC (receiver operating characteristic) analysis revealed that the proper cutoff value of preoperative CGH-C7 SVA for predicting the postoperative loss of lordosis and clinical outcomes is 3.8 cm. CONCLUSION: Preoperative cervical sagittal balance indexes are related to the outcomes of OPLL patients after laminoplasty. Patients with high preoperative CGH-C7 SVA levels have a high probability of developing sagittal imbalances and neurological symptoms of the cervical spine, and this measurement can be used as a predictor of outcomes in laminoplasty-treated cervical OPLL patients.

Two and Three-Dimensional CT Mapping of Hoffa Fractures.

BACKGROUND: Hoffa fractures, coronal-plane fractures involving the distal femoral condyles, are unstable, intra-articular fractures. The aim of this study was to define the location and frequency of fracture lines and comminution zones in Hoffa fractures using computed tomography (CT) mapping in both 2-dimensional and 3-dimensional contexts. METHODS: Seventy-five Hoffa fractures (OTA/AO types 33B3.2 and 33B3.3) were retrospectively reviewed. The directions of fracture lines were characterized in the axial and sagittal CT planes. CT images for all fractures were superimposed on one another and oriented to fit a standard template. Mapping of fracture lines and comminution zones in both the axial and sagittal planes was performed. A 3-dimensional map was created by reducing reconstructed fracture fragments to fit to a model of the distal aspect of the femur. RESULTS: This study included 1 bicondylar and 74 unicondylar (26 medial and 48 lateral) Hoffa fractures. Comminuted fractures accounted for 35.5% of all fractures and 44.9% of lateral fractures. Axial fracture mapping demonstrated that fracture lines were concentrated in the middle-third area of the lateral condyle but were less concentrated and with greater variation in the medial condyle. The mean angle of fracture lines with respect to the posterior condylar axis was 34.4° and 29.0° in the lateral and medial femoral condyles, respectively. Sagittal fracture mapping also demonstrated that fracture lines were concentrated in the middle third of the lateral condyle but were less concentrated in the medial condyle. The mean angle of fracture lines with respect to the posterior cortex of the distal femoral shaft was 23.1° and 19.3° in the lateral and medial condyles, respectively. Three-dimensional mapping demonstrated comminution zones commonly occurring in the weight-bearing zone of the lateral condylar articular surface. CONCLUSIONS: Hoffa fractures occurred more frequently in the lateral femoral condyle. In the axial plane, fractures commonly extended from anterolateral to posteromedial in the lateral condyle and from anteromedial to posterolateral in the medial femoral condyle. In the sagittal plane, fractures traversed from anteroinferior to posterosuperior. Articular comminution was more commonly seen in lateral condylar fractures and concentrated in the weight-bearing zone of the articular surface. CLINICAL RELEVANCE: Research in this area is imperative for optimal preoperative planning, such as for the selection of surgical approach and fixation constructs. Our findings lend insight into fracture morphology, which can assist with fracture classification and the design of biomechanical studies, ultimately aiding in treatment.

Interferometric broadband Fourier spectroscopy with a partially coherent gas-discharge extreme ultraviolet light source.

Extreme ultraviolet (EUV) spectroscopy is a powerful tool for studying fundamental processes in plasmas as well as for spectral characterization of EUV light sources and EUV optics. However, a simultaneous measurement covering a broadband spectral range is difficult to realize. Here, we propose a method for interferometric broadband Fourier spectroscopy connecting soft x ray and visible spectral ranges with moderate spectral resolution. We present an analytical model to recover the spectrum from a double-slit interferogram. We apply our model for spectral characterization of a partially coherent gas-discharge EUV light source operated with different gases in the spectral range between 10 and 110 nm wavelengths. Our approach allows a simple and fast broadband spectroscopy with fully or partially spatially coherent light sources, for instance, to characterize out-of-band radiation in EUV lithography applications.