Predictable factors for aggravation of cervical alignment after posterior cervical foraminotomy.

OBJECTIVE: This study aimed to investigate the risk factors for aggravation of cervical alignment after posterior cervical foraminotomy (PCF) and to identify their relationships with kyphotic changes in cervical curvature. METHODS: Ninety-eight patients who underwent PCF for unilateral radiculopathy and received follow-up for more than 2 years were retrospectively reviewed. Segmental Cobb angle (SA), cervical Cobb angle (CA), Pfirrmann grade, foraminal stenosis, and clinical outcomes including neck pain, arm pain, and Neck Disability Index scores were assessed. Radiological and clinical outcomes were compared between groups C (control group with kyphotic change in CA < 5°) and K (kyphotic group with kyphotic change in CA ≥ 5°). Multivariate regression analysis was performed to determine the risk factors for kyphotic change ≥ 5° after PCF. RESULTS: Group K was significantly older than group C (p = 0.002) and had a higher Pfirrmann grade (p = 0.025). In group K, neck pain had significantly increased at last follow-up (p < 0.001). Multivariate linear regression analysis revealed that kyphotic changes in CA were related to older age (p = 0.016, B = 0.420) and Pfirrmann grade of the operative levels (p = 0.032, B = 4.560). Preoperative hypolordosis was not an independent risk factor for kyphotic changes in CA. Receiver operating characteristic curve analysis showed that the cutoff value for kyphotic changes in patients with CA ≥ 5° was Pfirrmann grade 3.417 (p = 0.008). CONCLUSIONS: Contrary to previous studies, preoperative hypolordosis was not a risk factor for kyphotic changes in CA after PCF. Older patients with disc degeneration of Pfirrmann grade IV or greater for should be carefully considered.

Vertebral Body Sliding Osteotomy for Cervical Myelopathy With Rigid Kyphosis.

Cervical spondylotic myelopathy is surgically demanding when associated with rigid kyphosis. Posterior surgery cannot restore cervical lordosis, and adequate decompression is not possible with rigid kyphosis. Vertebral body sliding osteotomy (VBSO) is a safe and novel technique for anterior decompression in patients with multilevel cervical spondylotic myelopathy. It is safe in terms of dural tear, pseudarthrosis, and graft dislodgement, which are demonstrated at high rates in anterior cervical corpectomy and fusion. In addition, VBSO is a powerful method for restoring cervical lordosis through multilevel anterior cervical discectomy and fusion above and below the osteotomy level. It may be a feasible treatment option for patients with cervical spondylotic myelopathy and kyphotic deformity. This is a technical note and literature review that describes the procedures involved in VBSO.

Full Cementation in Revision Total Knee Arthroplasty Using a Constrained Condylar Knee Prosthesis with an Average 7-Year Follow-up.

Purpose: To evaluate clinical and radiological outcome of the full cementation technique in revision total knee arthroplasty (TKA) using a constrained condylar knee (CCK) prosthesis. Materials and Methods: Between January 2008 and March 2012, 18 cases (16 patients) of fully cemented revision TKA were performed using a CCK prosthesis. Fifteen cases of aseptic loosening (13 patients) and 3 cases of infection were included. There were 2 males and 14 females with a mean age of 76.7 years at the time of surgery, and the average follow-up was 81 months. Clinically, the pain score, function score and Hospital for Special Surgery (HSS) score were evaluated. Radiologically, loosening, radiolucent lines and migration of implant were evaluated. Results: Preoperatively, the pain score, function score and HSS score were 50.3, 24.4 and 61.8 points, respectively. At the latest follow-up, the scores were improved to 84.8, 63.6 and 85.6 points, respectively (p<0.05). Loosening or migration of implant was not observed in any cases. Radiolucent lines were observed in 5 cases underneath the tibial component without progression during the follow-up. Conclusions: The full cementation technique in revision TKA using a CCK showed excellent clinical results. Although radiolucent lines were observed in 27.8% underneath the tibial component, there was no progression to loosening or instability.