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INTRODUCTION: Routine orthopedic implant removal surgery (OIRS) in patients with no implant-related symptoms after union is controversial. Various factors, such as various fracture sites, fracture types, and accompanying fractures at other sites, act as error variables in the evaluation of routine OIRS. The purpose of this study is to evaluate the benefits of orthopedic implant removal surgery (OIRS) in patients with no implant-related symptoms such as infection and soft tissue irritation after union of isolated lower extremity shaft fractures from a patient-centered evaluation MATERIALS AND METHODS: Eighty-four patients who achieved fracture union after internal fixation of femoral shaft or tibial shaft fractures (March 2004 to December 2018) and who showed no implant-related symptoms were evaluated retrospectively. Minimum post-OIRS follow-up period was 1 year. Thirty-eight patients were treated with intramedullary nail and 13 were treated with plate and screws for femoral shaft fracture. Twenty patients were treated with intramedullary nail and 13 were treated with plate and screws for tibial shaft fracture. All patients subsequently underwent OIRS. Quality of life (QoL) and lower extremity pain using visual analogue scale (VAS) were evaluated 1 day before OIRS. Patient satisfaction with the OIRS, VAS, and QoL were assessed at least 1 year after OIRS using the SF-36 questionnaire. RESULTS: The physical component score, mental component score, and scores of all eight domains showed significant improvement after OIRS (p < 0.01). Patients with femoral shaft fractures tended to have lower pre- and post-OIRS SF-36 scores than those with tibial shaft fracture. Among patients with femoral shaft fracture, SF-36 scores were comparable in the nail and plate groups. Among patients with tibial shaft fracture, nail group showed relatively better QoL than the plate group, before and after OIRS in spite of several complications such as formation of scar tissue, nerve damage, and refracture. CONCLUSIONS: Patients with no implant-related symptoms showed significant improvement in QoL and satisfaction after OIRS. This suggests that OIRS is beneficial from the patients' evaluation. LEVEL OF EVIDENCE: Therapeutic Level II.
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Fracturas del Fémur , Fijación Intramedular de Fracturas , Fracturas de la Tibia , Humanos , Calidad de Vida , Estudios Retrospectivos , Fijación Intramedular de Fracturas/efectos adversos , Clavos Ortopédicos , Fracturas del Fémur/cirugía , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/cirugía , Extremidad Inferior/cirugía , Atención Dirigida al Paciente , Curación de Fractura , Resultado del TratamientoRESUMEN
BACKGROUND: Cervical spondylotic myelopathy (CSM) is a critical condition that results in significant neurologic deterioration. An accurate diagnosis is essential for determining its outcome and prognosis. The pathology is strongly associated with dynamic factors; therefore, dynamic magnetic resonance (MR) image could be crucial to accurately detect CSM. However, very few studies have evaluated the reliability and accuracy of dynamic MR in CSM. In this study, we aimed to compare intra- and interobserver reliabilities and accuracy of dynamic MR in detecting CSM using sagittal MR scans of the neck in the flexed, neutral, and extended position. METHODS: Out of 131 patients who underwent surgical treatments for CSM, 107 were enrolled in this study. The patient underwent three-types of sagittal MR scans that were obtained separately in different neck positions (neutral, flexion, and extension postures). The MR scans of the cervical spine were evaluated independently by three spine professionals, on the basis of tabled questionnaires. For accuracy, we performed a receiver operator characteristic analysis, and the overall discriminating ability of each method was measured by calculating the area under the ROC curve. The Cohen's kappa coefficient and the Fleiss-generalized kappa coefficient was used to the inter- and intra-observer reliabilities. RESULTS: The intraobserver reliability (using the Cohen's kappa coefficient) and interobserver reliability (using the Fless kappa coefficient) were respectively 0.64 and 0.52 for the neutral sagittal MR. The accuracy of neutral sagittal MR in detecting CSM was 0.735 (95% CI, 0.720 to 0.741) while that of extension sagittal MRI was 0.932 (96% CI, 0.921 to 0.948). CONCLUSIONS: Dynamic MR significantly showed better diagnostic reliability and accuracy in detecting CSM compared to conventional MR. In particular, extension MR scans could provide a more accurate diagnosis than other images.
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Enfermedades de la Médula Espinal , Espondilosis , Humanos , Reproducibilidad de los Resultados , Espondilosis/cirugía , Enfermedades de la Médula Espinal/cirugía , Imagen por Resonancia Magnética/métodos , Vértebras Cervicales/cirugíaRESUMEN
BACKGROUND: Selective nerve root block (SNRB) was shown to effectively control radiating pain and reduce the need for surgical intervention. However, repetitive injections may trigger corticosteroid-induced side effects (hypercorticism, hyperglycemia, or fluid retention). This study aims to compare the potency of hyaluronic acid-carboxymethylcellulose (HA-CMC) solution versus that of corticosteroids regarding lower leg radiating pain (LLRP) improvement and functional outcome. METHODS: Among 128 patients, 44 patients who complain about having LLRP due to lumbar spinal stenosis and do not have neurological symptoms requiring surgery were enrolled for this study. Group A with 22 patients injected with cocktail A (local anesthetics and corticosteroid) and group B with 22 patients injected with cocktail B (local anesthetics and HA-CMC). Outcome measures were the visual analog scale (VAS), Oswestry Disability Index (ODI), and short form-36 (SF-36). All patients were asked to fill in the questionnaires during the follow-up assessment period at 3 days, 7 days, 2 weeks, 6 weeks, and 12 weeks. RESULTS: In all time periods, there were no statistical differences between the two groups for VAS scores and VAS improvement over time, ODI scores and ODI improvement over time, and SF-36 PCS scores and SF-36 mental component score scores. Additionally, the 95% confidence interval of the difference in VAS score improvement between the 2 groups in all time periods was within VAS 5.0, which is the minimum clinically relevant difference. CONCLUSIONS: Considering the adverse effects of corticosteroids, and the similar LLRP improvements, functional outcome, and quality of life, the HA-CMC solution may be an alternative option to corticosteroid in SNRB.
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Carboximetilcelulosa de Sodio , Radiculopatía , Corticoesteroides , Humanos , Ácido Hialurónico , Vértebras Lumbares/cirugía , Estudios Prospectivos , Calidad de Vida , Radiculopatía/tratamiento farmacológico , Resultado del TratamientoRESUMEN
PURPOSE: In this study, we addressed the correlation between the cross-sectional area (CSA) of the dural sac and the nerve root sedimentation sign (SedSign) and the correlation between the distance of claudication and the CSA of the dural sac or SedSign in patients with lumbar spinal stenosis. We also evaluated the reliability of clinical symptom prediction. METHODS: We checked claudication distance using a questionnaire, and we gauged low back pain when standing, referred pain, and radiating pain using visual analog scale scores. Three observers measured the CSA of the dural sac and SedSign, and normal nerve root sedimentation was classified as negative (N) and the absence of nerve root sedimentation was positive (P). P was sub-classified as positive with room [P(+); empty space apparent in the dura] or positive without room [P(-); no empty space in the dura]. SedSign reflected ongoing sedimentation inside the spinal canal of the nerve roots. We demonstrated negative sedimentation for the nerve root except for exiting nerve roots that settled into more than half of the dorsal region of the spinal canal and positive sedimentation as compressed nerve roots or as distribution of nerve roots that conglomerated from the ventral to the dorsal part of the equator as nerve roots. We evaluated functional outcomes using the Oswestry Disability Index and Roland-Morris Disability Questionnaire. One-way ANOVAs, Chi square tests, and correlation analyses evaluated the correlation CSAs and SedSigns. RESULTS: The total CSAs for the 716 sites were 98.63 ± 34.38 for N, 76.78 ± 28.78 for P(+), and 55.43 ± 27.77 for P(-), which were all statistically significant (p = 0.01). The correlations between pain and SedSign were not statistically significant (p > 0.05). There was no statistical significance in the correlations between the distance of the claudication and the CSA of the dura sac and the SedSign and between the functional score and the SedSign (both p > 0.05). CONCLUSIONS: Increasing severity of SedSign indicates progressively smaller dural sac CSA, but there is an inconsistent association with clinical symptoms. Therefore, it is reasonable to suggest that spinal stenosis is severe in patients with severe symptoms.
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Vértebras Lumbares/fisiopatología , Estenosis Espinal , Estudios de Cohortes , Humanos , Estenosis Espinal/epidemiología , Estenosis Espinal/fisiopatologíaRESUMEN
PURPOSE: The aim is to analyze the agreement between different types of physicians in terms of the inter-observer and intra-observer reliability in addition to the agreement between the experienced and non-experienced physicians with respect to three different classification systems for diagnosis of cervical spinal canal stenosis. METHODS: Total nine doctors including experienced group of three doctors and non-experienced group of six doctors classified the patients according to three different classification in an independent, blinded manner using magnetic resonance imaging (MRI) to diagnose cervical canal stenosis. MRI slice included sagittal plane (midline cut) and an image slice from each horizontal plane that penetrated the right center of each disk (C3-4, C4-5, C5-6, and C6-7) was made by PPT format. RESULTS: For the inter-observer reliability, Vaccaro et al.'s classification system showed the excellent reproducibility, followed by Muhle et al. and Kang et al. All three classification systems showed excellent reproducibility and substantial agreement in terms of the intra-observer reliability. CONCLUSIONS: All three classification systems showed excellent reproducibility and also displayed a substantial agreement. The classification system used by Vaccaro et al. was proven to be a method with substantial agreement both in the experienced group and the non-experienced group. It can be a useful classification system for simplifying communication among all physicians.
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Canal Medular/patología , Estenosis Espinal/clasificación , Adulto , Anciano , Anciano de 80 o más Años , Constricción Patológica/clasificación , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Estudios Retrospectivos , Estenosis Espinal/patología , Adulto JovenRESUMEN
The mechanism by which the 8q24 MYC enhancer region, including cancer-associated variant rs6983267, increases cancer risk is unknown due to the lack of protein-coding genes at 8q24.21. Here we report the identification of long noncoding RNAs named cancer-associated region long noncoding RNAs (CARLos) in the 8q24 region. The expression of one of the long noncoding RNAs, CARLo-5, is significantly correlated with the rs6983267 allele associated with increased cancer susceptibility. We also found the MYC enhancer region physically interacts with the active regulatory region of the CARLo-5 promoter, suggesting long-range interaction of MYC enhancer with the CARLo-5 promoter regulates CARLo-5 expression. Finally, we demonstrate that CARLo-5 has a function in cell-cycle regulation and tumor development. Overall, our data provide a key of the mystery of the 8q24 gene desert.
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Cromosomas Humanos Par 8/genética , Regulación Neoplásica de la Expresión Génica/genética , Predisposición Genética a la Enfermedad/genética , Neoplasias/genética , ARN Largo no Codificante/genética , Secuencia de Bases , Línea Celular Tumoral , Elementos de Facilitación Genéticos/genética , Citometría de Flujo , Humanos , Datos de Secuencia Molecular , Polimorfismo de Nucleótido Simple/genética , Regiones Promotoras Genéticas/genética , ARN Interferente Pequeño/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Análisis de Secuencia de ADNAsunto(s)
Vértebras Cervicales/cirugía , Quilotórax/etiología , Discectomía , Complicaciones Posoperatorias/etiología , Fusión Vertebral , Profilaxis Antibiótica , Tubos Torácicos , Quilotórax/terapia , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Octreótido/uso terapéutico , Nutrición Parenteral Total , Complicaciones Posoperatorias/terapiaRESUMEN
STUDY DESIGN: Retrospective study. OBJECTIVE: This study was conducted to assess the usefulness of posterior instrumentation without fusion in the surgical treatment of thoracolumbar and lumbar unstable burst fracture. MATERIALS AND METHODS: We enrolled 60 patients who received only posterior instrumentation without fusion for thoracolumbar and lumbar unstable burst fracture between September 1, 2003 and December 31, 2009 at our hospital and who were available for longer than 12-month follow-up observation after the implant removal. For clinical evaluation, 12 months after the implant removal, we used the Oswestry Disability Index, the Visual Analog Scale of back pain, and the Smiley-Webster Scale. RESULTS: In comparison with preoperative conditions, the postoperative kyphotic angle and the ratio of anterior vertebra height were significantly increased (P=0.005, 0.007) and they were maintained even after implant removal. The average range of joint motion was 9.47±1.85 degrees, 1.77±0.99 Visual Analog Scale, and 0.78±3.46 Oswestry Disability Index, and scores greater than "good" on the Smiley-Webster Scale were observed in 50 of the 60 patients. CONCLUSIONS: In thoracolumbar and lumbar unstable burst fracture, performing posterior instrumentation without fusion and removing the instrument after bone union is achieved is considered a useful procedure for selected patients.
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Vértebras Lumbares/cirugía , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/instrumentación , Vértebras Torácicas/cirugía , Adulto , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Radiografía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/epidemiología , Fusión Vertebral/efectos adversos , Vértebras Torácicas/diagnóstico por imagen , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Although vitamin D is one of the essential nutrients associated with musculoskeletal system function, there is no standard treatment method for vitamin D deficiency. This study aimed to investigate the effects of vitamin D supplementation on the improvement in symptoms, functional recovery of the spine, and changes in the quality of life in patients with spinal stenosis. METHODS: In this prospective study, patients with spinal stenosis and serum 25-hydroxy vitamin D levelsâ <â 10 ng/mL were randomly assigned to a supplementation group (Group S) and a non-supplementation group (Group NS): 26 participants in Group S (16 females and 10 males) and 25 in Group NS (15 females and 10 males). The degree of lower back pain in both groups was assessed using the visual analog scale; spine function was assessed using the Oswestry disability index and Roland-Morris disability questionnaire; and patient quality of life was assessed using the 36-item short form health survey. We compared and analyzed the values that were measured at baseline, between 4 and 6 weeks (V1), 10 and 12 weeks (V2), and 22 and 26 weeks (V3). RESULTS: No statistically significant difference was observed in lower back pain, spine function, or quality of life between both groups at baseline. In terms of lower back pain in V1, Group S scored 4.15â ±â 3.12, while Group NS scored 5.64â ±â 1.85 (Pâ =â .045). In V2, Group S scored 3.15â ±â 2.38, while Group NS scored 4.52â ±â 1.87 (Pâ =â .027). Moreover, in V3, Group S scored 3.58â ±â 1.65, while Group NS scored 4.60â ±â 1.68 (Pâ =â .033), indicating a statistically significant improvement in each period. CONCLUSION: If a vitamin D deficiency that does not require surgical treatment exists in patients with lumbar spinal stenosis, high-dose vitamin D injections can improve lower back pain, which is the main symptom of lumbar spinal stenosis, as well as the functional outcomes of the spine and quality of life.
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Dolor de la Región Lumbar , Estenosis Espinal , Deficiencia de Vitamina D , Masculino , Femenino , Humanos , Estenosis Espinal/complicaciones , Estenosis Espinal/tratamiento farmacológico , Dolor de la Región Lumbar/cirugía , Proyectos Piloto , Calidad de Vida , Estudios Prospectivos , Colecalciferol/uso terapéutico , Vértebras Lumbares/cirugía , Deficiencia de Vitamina D/complicaciones , Suplementos Dietéticos , Resultado del TratamientoRESUMEN
Osteoporosis and osteoporotic fractures cause socioeconomic concerns, and medical system and policies appear insufficient to prepare for these issues in Korea, where the older adult population is rapidly increasing. Many countries around the world are already responding to osteoporosis and osteoporotic fractures by adopting fracture liaison service (FLS), and such an attempt has only begun in Korea. In this article, we introduce the operation methods for institutions implementing FLS and characteristics of services, and activities of the FLS Committee for FLS implementation in the Korean Society for Bone and Mineral Research. In addition, we hope that the current position statement will contribute to the implementation of FLS in Korea and impel policy changes to enable a multidisciplinary and integrated FLS operated under the medical system.
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ABSTRACT: Most postoperative patients with herniated lumbar disc complained of lower leg radiating pain (LRP), referred buttock pain (RBP), and low back pain (LBP). When discectomy is performed, improvement in LRP is observed due to spinal nerve irritation. However, long-term LBP due to degenerative changes in the disc may occur postoperatively. In addition, limited research has been reported on the short-term (within 1âyear) improvement in LBP after discectomy. This study aimed to evaluate the effectiveness of discectomy in reducing LBP within 1âyear postoperatively.Among the 183 patients who underwent discectomy performed by a single surgeon from January 2010 to December 2016, 106 who met the inclusion and exclusion criteria were enrolled. In the 106 patients who underwent lumbar discectomy, 3 types of spine-related pain were pre-operatively assessed and 3, 6, and 12âmonths postoperatively. Functional outcomes were evaluated, and quality of life was assessed 12âmonths postoperatively by using the Short-Form 36 questionnaire, which was subdivided into mental and physical components.LBP showed both statistical and clinical improvement within the first 3âmonths postoperatively, but the improvement was not observed until 12âmonths postoperatively. RBP and LRP showed both statistical and clinical improvement within the first 3âmonths and further consistently showed statistical improvement. LBP improved clinically only until 3âmonths postoperatively regardless of the type of herniation.LBP showed improvement within the first 3âmonths postoperatively and plateaued afterward, and RBP and radiculopathy showed consistent improvement until 12âmonths postoperatively. This may explain why patients from 12-month follow-up showed improvement in RBP and radiculopathy but not LBP.
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Discectomía/efectos adversos , Discectomía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Disco Intervertebral/cirugía , Dolor de la Región Lumbar , Radiculopatía , Adulto , Femenino , Humanos , Disco Intervertebral/fisiopatología , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/psicología , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/cirugía , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Dolor Postoperatorio , Calidad de Vida , Radiculopatía/etiología , Radiculopatía/cirugía , Resultado del TratamientoRESUMEN
Physical factors such as frequency of low back pain, sensory abnormalities in the lower extremities, smoking history before surgery, and preoperative mental health status as predictors of operative outcomes have been growing as areas of interest in the field of degenerative lumbar spinal stenosis (DLSS). This study aimed to investigate the correlation between the preoperative Short Form-36 Mental Component Score (SF-36 MCS) and long-term prognosis after decompression surgery for DLSS. In total, 198 patients were enrolled in this study. The Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ) were used to evaluate spinal functional outcomes. The SF-36 questionnaire was used and analyzed by classifying it into physical component score (PCS) and mental component score (MCS). The SF-36 MCS was divided into role limitations caused by emotional problems, social functioning, vitality, and emotional well-being. In the correlation between preoperative MCS and ODI improvement, the r value was -0.595 (P < .05) at 12 months postoperatively. ODI improvement at 12 months after decompression surgery showed a statistically significant and strong negative correlation with preoperative MCS. In the correlation between preoperative MCS and RMDQ improvement, the r value was -0.544 (P < .05) at 12 months postoperatively. Therefore, RMDQ improvement 12 months after decompression surgery showed a strong negative correlation with preoperative MCS. Regarding the correlation between preoperative MCS and SF-36 PCS improvement, the r values were 0.321 (P < .05) at 6 months postoperatively and 0.343 (P < .05) at 12 months postoperatively. Therefore, SF-36 PCS improvement at 6 and 12 months after decompression surgery showed a strong positive correlation with preoperative SF-36 MCS scores. Preoperative SF-36 MCS is a factor that can predict the prognosis of patients who underwent decompression surgery for lumbar spinal stenosis for at least 1 year postoperatively.
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Fusión Vertebral , Estenosis Espinal , Descompresión , Evaluación de la Discapacidad , Humanos , Vértebras Lumbares/cirugía , Pronóstico , Estenosis Espinal/complicaciones , Estenosis Espinal/cirugía , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
STUDY DESIGN: Retrospective study with prospectively collected data. OBJECTIVE: The purpose of this study is to investigate the difference in fusion rate and clinical outcome of patients with local bone as filler for the graft and demineralized bone matrix (DBM) plus only the cancellous bone from local bone as a filler for cage in 1-level posterior lumbar interbody fusion (PLIF) with cage. SUMMARY OF BACKGROUND DATA: Cancellous bone is more advantageous than cortical bone in the local bone for improving bone formation in spine fusion surgery. There are little studies on the difference in fusion rate and reduction of fusion time using only these cancellous bones. METHODS: Of the 40 patients who underwent 1-level PLIF using cage, 20 patients in group A used local bone and 20 patients in group B used mixture of cancellous bone extracted separately from local bone and commercially available DBM as filler for cage. Changes in fusion rate and intervertebral spacing were measured using lateral radiography, and fusion was determined as nonunion using the Brantigan-Steffee classification. The clinical outcome was evaluated. RESULTS: There was no difference in height change over time between the two groups. Regarding union grade, group B showed better union grade than group A. However, no difference in union grade change over time was observed between the 2 groups. In group B, Oswestry Disability Index (ODI), Rolland-Morris Disability Questionnaire (RMDQ), and SF-36 mental component score (MCS) significantly decreased, but there was no difference in change over time. CONCLUSIONS: In 1-level PLIF for degenerative lumbar disease, better fusion rate was observed in the group that used only cancellous bone from local bone plus DBM than that in the group that used local bone; however, there was no difference in fusion grade change over time in the 2 groups.
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Fusión Vertebral , Matriz Ósea , Trasplante Óseo , Hueso Esponjoso , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
ABSTRACT: It is hypothesized that if it is confirmed that the pain caused by the injection needle coincides with the lower leg radiating pain(LLRP) that the patient mainly complains of, then the contrast agents may be used less. This study aims to understand if the identification of lancinating identical pain in the procedure could replace the use of contrast agents that causes additional pain provocation using control arm of randomized clinical trial.This retrospective study included 165 patients who met exclusion criteria from among patients who underwent Selective nerve root block for the treatment of LLRP. With the identical and lancinating pain confirmed in the same site of the patient, consistent with that of the original symptom, the subjects were divided into 2 groups: 1 without contrast injection (Non-Dye [ND] group; 57 patients) and the other with contrast injection (Dye [D] group; 108 patients). The degree of LLRP in the 2 groups was evaluated using visual analog scale (VAS) before injection, 2, 6, and 12âweeks after injection. Functional outcomes were measured using Owestry Disability Index and Rolland-Morris Disability Questionnair, whereas quality of life was measured using Physical component score and Mental component score of Short Form 36 (SF-36) before injection and 3âmonths after injection.There was no statistically significant difference in the LLRP severity in both groups at all times and no statistical difference in the degree of VAS improvement relative to the before-injection VAS value between the 2 groups at 2 and 6âweeks after injection (all Pâ>â.05). At 12âweeks after injection, there was a statistically significant difference, but they were below Minimum Clinical Important Difference, bearing little clinical implications. There was no statistically significant difference between the 2 groups in Owestry Disability Index, Rolland-Morris Disability Questionnair, SF-36 Physical component score, and SF-36 Mental component score at every interval (all Pâ>â.05).Instead of contrast agent injections that have been used for accurate nerve root identification during Selective Nerve Root Block, the method of merely checking if the needle-induced pain under fluoroscopic imaging is consistent with the LLRP that the patient predominantly experiences shows the same effect in the patient's pain control and functional outcome.
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Medios de Contraste , Bloqueo Nervioso , Dolor/etiología , Medios de Contraste/efectos adversos , Humanos , Inyecciones/efectos adversos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
STUDY DESIGN: Retrospective study of data collected prospectively. OBJECTIVE: To investigate changes in the degree of lower leg radiating pain (LLRP) after selective nerve root block (SNRB) and to evaluate associations of this change with postoperative improvements in symptom severity, functional outcomes, and quality of life. SUMMARY OF BACKGROUND DATA: SNRB is routinely performed as an initial treatment for lumbar foraminal or lateral recess stenosis with LLRP. The degree of improvement after SNRB has been suggested to predict the improvement in postoperative pain and functional outcomes. However, there have been no studies on the predictive value of this parameter. METHODS: We enrolled 60 patients who underwent SNRB followed by decompressive surgery. They were divided into three groups. The degree of improvement was evaluated as a percentage of the pre-injection values. Functional outcomes of the spine were assessed using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ). Quality of life was assessed using the 36-item Short Form Survey (SF-36) physical component score (PCS) and mental component score (MCS). The degree of LLRP was measured preoperatively and at 6, 12, and 24âmonths after surgery. These functional outcomes were evaluated preoperatively and at 12 and 24âmonths after surgery. RESULTS: The improvement in LLRP in the short term (6âhours after SNRB) was found to be statistically significantly associated with the improvement in LLRP at 12âmonths after SNRB (P = 0.044, correlation coefficient = 0.261). No relationship between pain improvement after SNRB and functional outcome was identified. CONCLUSION: The degree of improvement in symptoms 6âhours after SNRB can predict the degree of improvement in LLRP at 12âmonths after surgery. However, symptomatic improvement after SNRB does not predict postoperative functional outcome or quality of life.Level of Evidence: 4.
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Estenosis Espinal , Evaluación de la Discapacidad , Humanos , Vértebras Lumbares/cirugía , Dolor Postoperatorio , Calidad de Vida , Estudios Retrospectivos , Estenosis Espinal/complicaciones , Estenosis Espinal/cirugía , Resultado del TratamientoRESUMEN
The authors studied the short-term outcomes of total hip arthroplasty (THA) performed using large diameter femoral heads or bipolar arthroplasty (BA) in physiologically active elderly patients with displaced intracapsular femoral neck fractures. The THA group included 14 males and 66 females with a mean age of 75.5 years, and the BA group included 16 males and 73 females with a mean age of 77.6 years. Surgical procedures were performed by one surgeon using a modified Hardinge approach. Mean operation times were significantly longer in the THA groups. Pain, mobility, and walking ability scores were significantly better in the THA group than in the BA group. Despite no range of motion limitation during the early postoperative period, no dislocation was encountered in either group. The present study suggests that for displaced femoral neck fractures, THA with a large diameter femoral head results in less pain and better function than BA.
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Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo/métodos , Fracturas del Cuello Femoral/cirugía , Prótesis de Cadera , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo/instrumentación , Artroplastia de Reemplazo de Cadera/instrumentación , Femenino , Fracturas del Cuello Femoral/diagnóstico por imagen , Cuello Femoral/diagnóstico por imagen , Cuello Femoral/cirugía , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Humanos , Masculino , Radiografía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: In osteoporotic vertebral compression fractures, supplementation using vitamin D preparations and maintenance of blood vitamin D level within the normal range are necessary for proper fracture union, enhancement of muscle strength, and maintenance of body balance. The purpose of this study is to investigate the effects of vitamin D supplementation on blood vitamin D level, pain relief, union time, and functional outcome in patients with osteoporotic vertebral compression fracture and vitamin D deficiency. METHODS: One hundred thirty patients who were deficient in blood vitamin D level and had osteoporotic vertebral compression fracture were divided into supplementation group and non-supplementation group. Initially, 3 months, 6 months, and 12 months after the injury, radiographs were taken to assess fracture union, and questionnaires were evaluated to evaluate the functional outcome and quality of life. RESULTS: The mean age of the 130 patients (36 males and 94 females) was 74.75 ± 7.25 years. There were no statistically significant differences in initial severity of low back pain, functional outcome, and quality of life between the insufficient group and the deficient group (all p values were > 0.05). There was no significant time-by-group interaction between the supplementation group and the non-supplementation group (p = 0.194). In terms of SF-36 physical component score, there was no significant time-by-group interaction between the supplementation group and the non-supplementation group (p = 0.934). CONCLUSIONS: Fracture union was achieved in all patients regardless of serum vitamin D level, and there were significant improvements in severity of low back pain, functional outcome, and quality of life over 12 months in patients with osteoporotic vertebral compression fracture. Short-term vitamin D supplementation of patients with osteoporotic vertebral compression fracture and deficiency of vitamin D did not result in significant differences in fracture union status, functional outcome, and quality of life between the supplementation groups and the non-supplementation groups of patients.
Asunto(s)
Fracturas por Compresión , Dolor de la Región Lumbar , Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Deficiencia de Vitamina D , Vitamina D/uso terapéutico , Anciano , Anciano de 80 o más Años , Suplementos Dietéticos , Fracturas por Compresión/diagnóstico por imagen , Fracturas por Compresión/tratamiento farmacológico , Fracturas por Compresión/etiología , Humanos , Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas Osteoporóticas/tratamiento farmacológico , Calidad de Vida , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/tratamiento farmacológico , Resultado del Tratamiento , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/tratamiento farmacológicoRESUMEN
STUDY DESIGN: This was a retrospective cohort study. OBJECTIVE: To evaluate the correlation between preoperative radiologic degree and the postoperative prognosis in lumbar foraminal stenosis (LFS) patients who required decompression. SUMMARY OF BACKGROUND DATA: There have been only a few studies for postoperative prognosis according to the degree of preoperative stenosis in patients requiring surgery. MATERIALS AND METHODS: The shape and severity of LFS was classified according to Lee et al's classification. Radiating leg pain was assessed preoperatively and at the last follow-up. Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), SF-36 Physical Component Score (PCS), and SF-36 Mental Component Score (MCS) were surveyed at the last follow-up. Mean follow-up was 6.3 years. RESULTS: Among 130 patients, 34 cases were classified as Grade 1T (transverse), 31 cases as Grade 1V (vertical), 32 cases as Grade 2, and 33 cases as Grade 3. The mean age was 65.0 years. Radiating leg pain (Visual Analogue Scale) preoperatively and lastly was 6.8 and 2.3, respectively in Grade 1T; 7.4 and 3.3, respectively in Grade 1V; 7.7 and 3.0, respectively in Grade 2; and 7.4 and 2.9, respectively in Grade 3. ODI and RMDQ at the last follow-up were 13.9 and 6.3, respectively in Grade 1T; 23.1 and 11.2, respectively in Grade 1V; 18.8 and 12.3, respectively in Grade 2; 21.6 and 11.7, respectively in Grade 3. Grade 1T had significantly lower value than Grade 1V, 2 and 3 in ODI and RMDQ, respectively. SF-36 PCS and MCS at the last follow-up were 62.2 and 70.5, respectively in Grade 1T; 33.7 and 40.3, respectively in Grade 1V; 42.1 and 48.2, respectively in Grade 2; 37.0 and 48.5, respectively in Grade 3. Grade 1T had significantly higher value than grade 1V, 2 and 3 in SF-36 PCS and MCS, respectively. CONCLUSIONS: Decompression for LFS was effective for reducing leg radiating pain. Functional outcome and quality of life was better in mild transverse type implying the role of dorsal root ganglion and dynamic stenosis.