Comparison of Clinical Outcomes and Complications of Primary and Revision Surgery Using a Combined Anterior and Posterior Approach in Patients with Adult Spinal Deformity and Sagittal Imbalance.

BACKGROUD: The purpose of this study was to compare clinical outcomes and complications of primary and revision surgery in patients with adult spinal deformity (ASD) accompanied by sagittal imbalance. Revision surgery has been associated with poor clinical outcomes and increased risk of complications. Previous studies comparing primary versus revision surgery included data for a wide variety of diseases and ages, but few investigated patients with ASD with sagittal imbalance undergoing anterior and posterior combined surgery. METHODS: Retrospective cohort analysis of prospectively collected data. We identified 60 consecutive patients with ASD combined with sagittal imbalance who underwent primary or revision surgery; of these, 6 patients were excluded for lack of a minimal 2-year follow-up. Patients' surgical and radiological data, clinical outcomes, and complications were reviewed. RESULTS: There were 30 patients in the primary group and 24 patients in the revision group. Patient characteristics, including the prevalence of sarcopenia, were similar between the two groups. Pedicle subtraction osteotomy was performed more frequently in the revision group although there was no statistically significant difference between groups. The primary group had more proximal junctional problems, whereas the revision group had more rod breakage (p < 0.05). There were significant improvements in clinical outcomes in both groups when the preoperative and 2-year postoperative values were compared. The Oswestry disability index and visual analog scale score were similar in both groups 2 years postoperatively. CONCLUSIONS: Considering the greater pain and disability at the time of the revision procedure, revision patients benefited more from surgery at the 2-year follow-up than the primary surgery patients. Complication rates were similar between the groups except for proximal junctional problems and rod breakage. Therefore, revision surgery should not be avoided in the treatment of ASD patients with sagittal imbalance.

Double-tiered subchondral support fixation with optimal distal dorsal cortical distance using a variable-angle volar locking-plate system for distal radius fracture in the elderly.

BACKGROUND: Double-tiered subchondral support (DSS) procedures with optimal distal dorsal cortical distance (DDD) have been reported to be effective in treating distal radius fractures, but there have been no studies of osteoporotic distal radius fractures in elderly patients. In this study, we demonstrated the efficacy of the DSS procedure with optimal DDD using a variable-angle volar locking-plate system for the treatment of osteoporotic distal radius fractures in elderly patients. METHODS: One hundred and twenty-two patients (mean age, 73.3 years; age range, 65-88 years) with distal radius fracture were treated using a variable-angle volar locking-plate system with DSS. Patients were divided into DSS and non-DSS groups based on postoperative and 12-month follow-up radiographs, and radiological and clinical assessment was performed. Finally, we divided all 122 patients into two groups based on volar tilt of 6° on 12-month follow-up radiographs, and postoperative DDD values were compared. RESULTS: Volar tilt decreased (p=0.02), and ulnar variance increased (p=0.01) more in the non-DSS group. The non-DSS group showed a significant correlation between postoperative DDD value and change in DDD value (p=0.00). The mean postoperative DDDs in the group with final volar tilt<6° and in the group with final volar tilt≥6° were 6.4mm (SD±1.7mm) and 4.6mm (SD±1.4mm) respectively (p=0.02). At 4-month follow-up, pronation (p=0.05) and supination (p=0.04) were improved, and at 12-month follow-up, supination (p=0.05) was improved in the DSS group. CONCLUSION: The use of the DSS procedure and reduction of DDD to 4.6mm or less using a variable-angle volar locking-plate system was effective in maintaining anatomical reduction for the treatment of osteoporotic distal radius fractures in elderly patients. LEVEL OF EVIDENCE: III Therapeutic study.

Orbital volume augmentation after injection of human orbital adipose-derived stem cells in rabbits.

PURPOSE: This randomized, controlled animal study investigated the morphologic and histologic properties of rabbit orbital fat following injection of human orbital adipose-derived stem cells (hoADSCs). METHODS: The efficacy of hoADSCs was compared to that of hyaluronic acid gel (HAG) and human orbital stromal vascular fraction (hoSVF). A total of 30 orbits from 15 New Zealand white rabbits (25 weeks postnatal, 2500-3000 g) underwent injection with HAG (molecular weight [MW] 1,000,000, 0.5 mL, n = 10, HAG only), hoSVF (0.25 mL) mixed with HAG (0.25 mL, n = 10, HAG + hoSVF), or hoADSCs (0.25 mL) mixed with HAG (0.25 mL, n = 10, HAG + hoADSCs). The degree of proptosis, and the time course of changes were determined and compared among groups. RESULTS: The difference between the initial exophthalmometric value and that at 4 weeks after injection was 1.77 mm for HAG only and 2.01 mm for HAG + hoSVF. The difference between the initial value and that at 12 weeks decreased to 0.05 mm for HAG only and 0.24 mm for HAG + hoSVF. In contrast, injection of HAG + hoADSCs increased the exophthalmometric value by 2.43 mm at 4 weeks after injection, and this difference was maintained at 2.56 mm at 12 weeks. Histopathologic examination revealed specific inflammation around the injection materials at 4 weeks after injection, and inflammation subsided 8 weeks after injection in all three groups. CONCLUSIONS: Thus, transplantation of hoADSCs with HAG is a safe and effective technique for orbital fat volume expansion. This is a new and promising method for orbital reconstruction and aesthetic orbital volume augmentation.