Biomechanical Comparisons of Different Reconstructive Techniques for Scapholunate Dissociation: A Cadaveric Study.

There are many techniques for the treatment of chronic scapholunate dissociation. The three-ligament tenodesis (3LT) is used most widely, but reconstruction of the dorsal ligament alone may not provide sufficient stability. The Mark-Henry technique (MHT) compensates for the insufficient stability of 3LT by additional reconstruction of the volar ligament, but the procedure is complex. The SwiveLock technique (SWT), a recently introduced method, provides stability by using autologous tendons with synthetic tapes, but lacks long-term clinical results. To perform biomechanical comparisons of different reconstructive techniques for scapholunate dissociation using a controlled laboratory cadaveric model. Eleven fresh-frozen upper-extremity cadaveric specimens were prepared. The scapholunate distance, scaphoid rotation, and lunate rotation of the specimens were measured during continuous flexion-extension and ulnar-radial deviation movements. The data were collected using a wrist simulator with a linear guide rail system (tendon load/motion-controlled system) and a motion capture system. Results were compared in five conditions: (1) intact, (2) scapholunate dissociation, (3) SWT, (4) 3LT, and (5) MHT. Paired t-test was employed to compare the biomechanical characteristics of intact wrists to those of scapholunate dissociated wrists, and to those of wrists after each of the three reconstruction methods. SWT and MHT were effective solutions for reducing the widening in scapholunate distance. According to the radioscaphoid angle, all three reconstruction techniques were effective in addressing the flexion deformity of the scaphoid. According to the radiolunate angle, only SWT was effective in addressing the extension deformity of the lunate. In terms of scapholunate angle, only the results after SWT did not differ from those of the intact wrist. The SWT technique most effectively improved distraction intensity and rotational strength for the treatment of scapholunate dissociation. Taking into account the technical complexity of 3LT and MHT, SWT may be a more efficient technique to reduce operating time and minimize complications due to multiple incisions, transosseous tunnels, and complicated shuttling.

Impact of the COVID-19 Pandemic on Adolescent Self-Harm: Based on a National Emergency Department Information System.

Republic of Korea's suicide rate is the highest among Organization for Economic Co-operation and Development countries. In Republic of Korea, suicide is the leading cause of death among young people aged 10-19 years. This study aimed to identify changes in patients aged 10-19 years who visited the emergency department in Republic of Korea after inflicting self-harm over the past five years and to compare the situations before and after the outbreak of the COVID-19 pandemic. Analysis of government data revealed that the average daily visits per 100,000 were 6.25, 8.18, 13.26, 15.31, and 15.71 from 2016 to 2020, respectively. The study formed four groups for further analysis, with the population divided by sex and age (10-14 and 15-19 years old). The late-teenage female group showed the sharpest increase and was the only group that continued to increase. A comparison of the figures 10 months before and after the outbreak of the pandemic revealed a statistically significant increase in self-harm attempts by only the late-teenage female group. Meanwhile, visits (per day) in the male group did not increase, but the rates of death and ICU admission increased. Additional studies and preparations that account for age and sex are warranted.

Biomechanical Analysis of Three Different Reconstruction Techniques for Scapholunate Instability: A Cadaveric Study.

Background: This study aimed to compare the biomechanical strength of 360° scapholunate interosseous ligament (SLIL) reconstruction only using an artificial material (AM), double dorsal limb (DDL) SLIL reconstruction only using AM, and the modified Brunelli technique (MBT) with ligament. Methods: Eight cadaver wrists were used for this study. The SL interval, SL angle, and radiolunate (RL) angle were recorded with MicroScribe. The SL distance was measured after dividing the volar and dorsal aspects. We utilized four different wrist postures (neutral, flexion, extension, and clenched fist) to compare five conditions: intact wrist, SLIL resection, 360° SLIL reconstruction using AM, DDL SLIL reconstruction using AM, and MBT SLIL reconstruction with ligament. Results: The dorsal SL distance in the SLIL resection was widened in all wrist positions. The dorsal SL distance was restored with all three techniques and in all wrist positions. The volar SL distance in the wrist extension position was widened in the SLIL resection condition. The volar SL distance was restored in the extension position after 360° SLIL reconstruction using AM condition. There were no statistically significant differences in SL and RL angles among the conditions. Conclusions: All three reconstruction techniques could restore the dorsal SL distance. However, only the 360° SLIL reconstruction using AM restored the volar SL distance in the wrist extension position. DDL SLIL reconstruction using AM tended to overcorrect, whereas 360° SLIL reconstruction using AM effectively stopped volar SL interval widening.

Scapholunate and lunotriquetral interosseous ligament augmentation with internal bracing in perilunate dislocation: Case reports.

RATIONALE: The goals of surgical treatment of the perilunate dislocation (PLD) are confirmation of reduction, ligament repair, and supplemental fixation of the bony architecture. Open reduction and direct repair of the torn ligament are recommended for acute PLD. However, repair of the scapholunate interosseous ligament (SLIL) and lunotriquetral interosseous ligament (LTIL) is often unreliable, and secure repair is challenging. Internal bracing (IB) is an augmentation method that uses high-strength non-absorbable tape and enhances strength and support during the critical period of ligamentous healing. However, there is a paucity of data on the application of IB for PLD in the wrist. We report 3 cases of PLD that were augmented with IB after SLIL and LTIL repair. PATIENT CONCERNS: All 3 cases were men who visited our emergency department with wrist after falling off a ladder. DIAGNOSES: Initial radiographs revealed a dorsal PLD. INTERVENTIONS: Surgically, complete rupture of the SLIL and LTIL were confirmed. K-wires were placed into the scaphoid and lunate and used as joysticks to correct the intercalated segment instability pattern. This usually requires correcting scaphoid flexion and lunate extension and closing the scapholunate interval. Prior to SLIL and LTIL repair, temporary intercarpal fixation was performed with K-wires to maintain the carpal relationship. The dorsal SLIL and LTIL were carefully repaired using suture anchors. However, ligament repair was unreliable, and insecure. In view of the likelihood of insufficient repair, we performed IB augmentation using synthetic tape. OUTCOMES: At the last follow-up, all cases were pain-free and had returned to all activities. The last follow-up radiographs showed good alignment of the carpal bones and no arthritic changes. LESSONS: IB augmentation can reduce the period of K-wire fixation and cast immobilization and can enable early joint motion. We believe that interosseous ligament augmentation using IB is a reasonable treatment option for PLD.

Kinematic analysis of two scapholunate ligament reconstruction techniques.

PURPOSE: This study compares the kinematic changes after the procedures for scapholunate interosseous ligament (SLIL) reconstruction-the modified Brunelli technique (MBT) and Mark Henry's technique (MHT). METHODS: Ten cadaveric wrists were used. The scapholunate (SL) interval and angle and radiolunate (RL) angle were recorded using the MicroScribe system. The SL interval was measured by dividing the volar and dorsal portions. Four motions of the wrist were performed-neutral, flexion, extension, and clenched fist (CF) positions-and compared among five conditions: (1) intact wrist, (2) volar SLIL resection, (3) whole SLIL resection, (4) MBT reconstruction, and (5) MHT reconstruction. RESULTS: Under the whole SLIL resection condition, the dorsal SL intervals were widened in all positions. In all positions, the dorsal SL intervals were restored after MBT and MHT. The volar SL interval widened in the extension position after volar SLIL resection. The volar SL interval was not restored in the extension position after MBT and MHT. The SL angle increased in the neutral and CF positions under the whole SLIL resection condition. The SL angle was not restored in the neutral and CF positions after MBT and MHT. The RL angle increased in the neutral and CF positions under the whole SLIL resection condition. The RL angle was not restored in the neutral and CF positions after MBT and MHT. CONCLUSION: The MBT and MHT may restore the dorsal SL interval. No significant differences in restoration of the SL interval between MBT and MHT were found in the cadaveric models. CLINICAL RELEVANCE: No significant differences between MBT and MHT were found in the cadaveric models for SLIL reconstruction. When considering the complications due to volar incision and additional procedures in MHT, MBT may be a more efficient technique in terms of operative time and injury of the anterior structures during surgery, but further research is needed.

Biceps Box Configuration for Superior Capsule Reconstruction of the Glenohumeral Joint Decreases Superior Translation but Not to Native Levels in a Biomechanical Study.

PURPOSE: To quantitatively biomechanically assess superior stability, subacromial contact pressures, and glenohumeral kinematics of an in situ biceps tenodesis and a box-shaped long head of the biceps tendon (LHBT) superior capsule reconstruction (SCR) in a superior massive rotator cuff tear (MCT) model. METHODS: Eight cadaveric shoulders (mean age, 62 years; range, 46-70 years) were tested with a custom testing system used to evaluate range of motion, superior translation, and subacromial contact pressure at 0°, 20°, and 40° of abduction. Conditions tested included native state, MCT (complete supraspinatus and one-half of the infraspinatus), a box-shaped LHBT SCR, and an in situ biceps tenodesis. The box-shaped SCR was performed by maintaining the biceps origin, securing 2 corners to the greater tuberosity, and one corner to the posterior glenoid. The in situ tenodesis was performed anatomically at the top of the articular margin in the same shoulder after take-down of the box SCR. RESULTS: Range of motion was not impaired with either repair construct (P > .05). The box SCR decreased superior translation by approximately 2 mm compared with the MCT at 0°, but translation remained greater compared with the intact state in nearly every testing position. The in situ tenodesis had no effect on superior translation. Peak subacromial contact pressure was increased in the MCT at 0° and 20° abduction compared with the native state but not different between the native and box SCR at the same positions. CONCLUSIONS: A box-shaped SCR using the native biceps tendon partially restores increased superior translation and peak subacromial contact pressure due to MCT. The technique may have a role in augmentation of an irreparable MCT. CLINICAL RELEVANCE: The box-shaped LHBT SCR technique may have a role in augmentation of an irreparable MCT.

Comparison of Three Different Internal Brace Augmentation Techniques for Scapholunate Dissociation: A Cadaveric Biomechanical Study.

Internal bracing (IB) is an augmentation method using high-strength nonabsorbable tape. However, there is no detailed information about the direction, location, or number of IBs required for scapholunate interosseous ligament (SLIL) injury repair. Thus, this study compared the biomechanical characteristics of short-transverse IB, long-oblique IB, and the combination of short-transverse and long-oblique (Combo) IB for SLIL injury in a biomechanical cadaveric model. We prepared nine fresh-frozen full upper extremity cadaveric specimens for this study. The scapholunate distance, scapholunate angle, and radioscaphoid angle were measured using the MicroScribe digitizing system with the SLIL intact, after scapholunate dissociation and the three different reconstructions. Three-dimensional digital records were obtained in six wrist positions in each experimental condition. Short-transverse IB had a similar effect compared with long-oblique IB in addressing the widening of the scapholunate distance. However, both were less effective than Combo IB. For scaphoid flexion deformity, short-transverse IB had minimal effect, while long-oblique IB had a similar effect compared to Combo IB. Combo IB was the most effective for improving distraction intensity and rotational strength. This study provides important information about the biomechanical characteristics of three different IB methods for SLIL injury and may be useful to clinicians in treating scapholunate dissociation.

Biomechanics of tensor fascia lata allograft for superior capsular reconstruction.

BACKGROUND: We hypothesized that in a cadaveric massive rotator cuff tear (MCT) model, a fascia lata (FL) allograft superior capsular reconstruction (SCR) would restore subacromial contact pressure and humeral head superior translation without limiting range of motion (ROM). Therefore, the objective of this study was to compare these parameters between an intact rotator cuff, MCT, and allograft FL SCR. METHODS: Eight fresh cadavers were studied using a custom shoulder testing system. ROM, superior translation, and subacromial contact pressure were measured in each of 3 states: (1) intact rotator cuff, (2) MCT, and (3) MCT with SCR. RESULTS: Total ROM was increased in the MCT state at 60° of abduction (P = .037). FL SCR did not restrict internal or external rotational ROM. Increased superior translation was observed in the MCT state at 0° and 30° of humeral abduction, with no significant difference between the intact cuff and FL SCR states. The MCT state significantly increased mean subacromial contact pressure at 0° of abduction with 30° and 60° of external rotation, and FL SCR restored this to intact levels. Peak subacromial contact pressure was increased for the MCT state at 0° of abduction with 30° and 60° of external rotation, as well as 30° of abduction with 30° of external rotation. CONCLUSION: This study demonstrates a tensor FL allograft preparation technique for use in SCR. After MCT, FL SCR restores ROM, superior translation, and subacromial contact pressure to the intact state.

Direction and Severity of Root Compression Affects the Clinical Outcome After Decompression?: Correlation Between Radiologic Grading and Postoperative Prognosis in Lumbar Foraminal Stenosis.

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.

The effectiveness of vitamin D supplementation in functional outcome and quality of life (QoL) of lumbar spinal stenosis (LSS) requiring surgery.

STUDY DESIGN: This is a retrospective cohort comparative study. BACKGROUND: Vitamin D supplementation is considered to be associated with good functional outcome. Thus, a few studies have proposed vitamin D supplementation is benefit to the functional outcome in LSS requiring surgery. The purpose of this study is to identify the prevalence of vitamin D deficiency in patients with LSS requiring surgery, and to compare the differences between the cases whether vitamin D is supplemented and vitamin D is not supplemented in terms of a QoL during postoperative 2 year. METHODS: All patients with LSS who underwent surgery from March 1, 2015 to August 31, 2016 were enrolled. Among them, 61 patients with vitamin D deficiency were divided into two groups (supplemented group (A) and non-supplemented group (B)). Functional outcomes using Oswestry Disability Index (ODI) and Rolland Morris Disability Index (RMDQ) and QoL using SF-36 were evaluated at 12-month and 24-month follow-up periods. Differences in functional score and SF-36 between the vitamin D supplemented and non-supplemented group were compared. RESULTS: Among the total 102 patients, 78 patients (76.5%) had vitamin D deficiency. Of the 78 patients, 61 patients were included, 27 patients were group A and 27 patients were group B. There was no difference in age and 25-OHD level between the two groups (all 0 > 0.05). Group A were better functional outcomes at 2 years after surgery (p < 0.05). On the QoL, group A were higher score than group B from 12 month later after surgery (p < 0.05). CONCLUSIONS: Vitamin D deficiency was highly prevalent in LSS patients (76.5%). Assessment of serum 25-hydroxyvitamin D (25(OH)D) is recommended in LSS needing surgical intervention and active treatment vitamin D supplementation and maintenance of normal range should be considered for better postoperative functional outcome and QoL.

The Prevalence of Facet Tropism and Its Correlation with Low Back Pain in Selected Community-Based Populations.

BACKGROUND: The incidence of facet tropism (FT) and its correlation with low back pain (LBP) have, to our knowledge, not yet been investigated among selected community-based populations who visited departments unrelated to LBP with their chief complaints unrelated to LBP. In this study, we aimed to evaluate the prevalence of FT among selected patients in whom LBP was not the chief complaint and the correlation between FT and LBP among these patients. METHODS: Among patients who underwent computed tomography during 2014 for reasons unrelated to LBP, we enrolled 462 patients who satisfied the inclusion and exclusion criteria. The degree of tropism was defined as grade 0, 1, and 2 for FT, FT+, and FT++, respectively. LBP was evaluated using a modified version of the Nordic low back pain questionnaire. For additional evaluation of dynamic LBP, the question, "Did your pain go away when lying down still or standing up straight, and did it also intensify when you bend or stretch your back?," was included in the questionnaire. RESULTS: The L4-5 intervertebral area was most frequently and severely affected by FT with an incidence rate of 46.3%, and severe FT was observed in 24.7% of the patients. FT increased with age at L2-3 and L5-S1 levels. FT at L2-3 level was correlated with LBP (p = 0.035) and dynamic LBP (p = 0.033). The FT grade at L2-3 level was correlated with dynamic LBP (p = 0.022) but not with LBP (p = 0.077). The relative risk of FT at L2-3 level was 1.614 for LBP and 1.724 for dynamic LBP. CONCLUSIONS: The prevalence of FT among community-based populations was 46.3% and its severe form was more frequently observed at L4-5 level (24.7%). LBP was correlated with FT at L2-3 level. The relative FT-associated risk of LBP was 1.6 at L2-3 level, and the relative L2-3 FT-associated risk of dynamic LBP was 1.724.

Comparison of Pain-reducing Effect After Selective Nerve Root Block According to the Type of Lumbar Foraminal Stenosis.

STUDY DESIGN: This was a nonrandomized controlled cohort study (level 3). OBJECTIVE: This study was designed to compare the differences in clinical features among patients with various degrees of lumbar foraminal stenosis (LFS), and the therapeutic effect of selective nerve root block (SNRB). SUMMARY OF BACKGROUND DATA: Symptomatic improvement rate was lower in grade IV (0.377) than in other grades (1T: 0.612, 2:0.527, 3:0.551), with statistical significance (P=0.03). PATIENTS AND METHODS: A total of 233 patients with radiating pain, concurrent with neurological and radiologic findings, were assigned to receive SNRB for at least 1 level, and screened for ≥6 months. The degree of foraminal stenosis was classified by perineural fat obliteration, and the degree of radiating pain was assessed by visual analog scale. After SNRBs were performed, symptomatic improvement was assessed after 2, 12, and 24 weeks after injection. RESULTS: There were no significant differences in visual analog scale with regard to the degree of stenosis. Improvements were significantly higher after 2 weeks (P=0.030), and there were no significant differences in symptomatic improvement rates over time except LFS grade 1V. At 2 weeks after injection, there was no significant difference in the extent of symptomatic improvement between the grades. At 12 and 24 weeks after injection, patients with LFS grade 1T, 2, 3 showed significantly higher symptomatic improvement rates than patients with LFS grade 1V. CONCLUSIONS: Among the patients with LFS, SNRB reduced pain by 51% after 2 weeks. At after 12 weeks, SNRBs were more effective in patients with LFS grade 1T, 2, 3, compared with patients with grade 1V. All patients showed persistent symptomatic relief, whereas those with grade 1T showed a reduced degree of symptomatic relief after 2 weeks.

Prolonged pain reducing effect of sodium hyaluronate-carboxymethyl cellulose solution in the selective nerve root block (SNRB) of lumbar radiculopathy: a prospective, double-blind, randomized controlled clinical trial.

BACKGROUND: The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block (SNRB) is called rebound pain. PURPOSE: The purpose of this study was to determine if sodium hyaluronate and carboxymethyl cellulose solution (HA-CMC sol) injection could reduce the occurrence of rebound pain at 3 days to 2 weeks after SNRB in patients with radiculopathy compared with injection with corticosteroids and local anesthetics alone. STUDY DESIGN/SETTING: Double blinded randomized controlled clinical trial. PATIENT SAMPLE: A total of 44 patients (23 of 24 patients in the Guardix group and 21 of 24 patients in the control group) who finished the follow-up session were subjects of this study. OUTCOME MEASUREMENT: Patients were asked to write down their average VAS pain scores daily for 12 weeks. Functional outcomes were assessed by Oswestry Disability Index, Roland Morris Disability Questionnaire , and Short Form-36. METHOD: A cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of normal saline was used for the control group whereas a cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of HA-CMC solution was used for the G group. Study participants were randomized into one of two treatment regimens. They were followed up for 3 months. RESULTS: VAS score at 2 weeks after the procedure was 4.19±1.32 in the control group, which was significantly (p<.05) higher than that (2.43±1.24) in the G group. VAS score at 6 weeks after the procedure was 4.00±1.23 in the control group and 3.22±1.45 in the G group, showing no significant (p=.077) difference between the two groups. There were no significant differences in functional outcomes at 6 or 12 weeks after the procedure. CONCLUSIONS: Compared with conventional cocktail used for SNRB, addition of HA-CMC sol showed effective control of rebound pain at 3 days to 2 weeks after the procedure.

Carpal tunnel syndrome caused by synovial osteochondromatosis of the finger flexor tendon: A case report.

RATIONALE: Carpal tunnel syndrome (CTS) is the most common peripheral nerve neuropathy resulting from compression of the median nerve as it traverses the carpal tunnel. The pathophysiology of this condition is multifactorial, and majority of cases of CTS are idiopathic. We report cases of CTS caused by synovial osteochondromatosis (SOC), which has rarely been reported. PATIENT CONCERNS: A 45-year-old female was admitted to the clinic due to right hand tingling sensation for 4 months. On physical examination, the patient's symptoms and signs corresponded to the median nerve entrapment at wrist. However, there is mild swelling and tenderness around the second metacarpal bone. Pain was aggravated during wrist and finger flexion. DIAGNOSES: An electrodiagnostic study revealed CTS. She was advised to begin splinting the hand using a wrist brace and to undergo physiotherapy. After 2 weeks, the tingling sensation decreased slightly. However mild swelling and tenderness around the second metacarpal bone did not improve. Ultrasonography showed multiple echogenic foci. Magnetic resonance imaging (MRI) revealed a nodule at the proximal metacarpal level with synovial thickening, enhancement, and a calcified shadow close to the flexor tendon. After confirming the presence of an osseous nodule with synovial thickening, the patient underwent surgery INTERVENTIONS:: Carpal tunnel release and mass excision with synovectomy of the adjacent structures were performed. Histologically, the lesion was compatible with a diagnosis of SOC. OUTCOME: The symptoms have improved. LESSONS: CTS due to SOC on finger flexor tendon is rare but should be considered for possible etiology. Appropriate clinical examination, plain radiography, ultrasonography, and MRI will help physicians to diagnose this condition. In this paper, we report the successful diagnosis and treatment of CTS caused by SOC within the finger flexor tendon.

Correlation between Short-Form 36 Scores and Neck Disability Index in Patients Undergoing Anterior Cervical Discectomy and Fusion.

STUDY DESIGN: Case control study. PURPOSE: To determine how the Neck Disability Index (NDI), a cervical spine-specific outcome, reflects health-related quality-of-life, and if NDI is correlated to the 36-item Short-Form Health Survey (SF-36) scores. OVERVIEW OF LITERATURE: NDI is a useful tool for assessing health-related quality of life in patients with neck pain. METHODS: We used the Pearson product-moment correlation coefficient to assess the validity of all items under NDI and SF-36, and the Pearson's correlation coefficient to assess the correlation between NDI and total SF-36 scores. The primary outcome measures were spine-specific health status- and general health status-measures after spine surgery, and these were evaluated every year for 2 years, using both NDI and SF-36 scores. RESULTS: NDI had a strong linear correlation with SF-36 and its two scales, the Physical Component Score (PCS) and the Mental Component Score (MCS), attesting to the validity of these two instruments. Among the eight subscales of SF-36, there was a strong linear correlation between NDI and PCS-physical functioning, PCS-bodily pain, and MCS-role emotional. Further, a moderate linear correlation was observed between NDI and subscales of PCS-role physical, PCS-general health, and MCS-social functioning, and between NDI and MCS-vitality and MCS-mental health. CONCLUSIONS: Our findings suggest that the NDI adequately reflects the patient's physical and mental quality of life, implying that the use of NDI to assess functional outcomes can also be ultimately used to evaluate the patient's quality of life.

Prevalence and Risk Factors of Neuropathic Pain in Patients with a Rotator Cuff Tear.

BACKGROUND: Until now, few studies had investigated the neuropathic pain component in patients with a rotator cuff tear (RCT). OBJECTIVES: The aim of the study was to identify the neuropathic pain component in patients with RCT and to determine the factors correlated with neuropathic pain in patients with RCT. STUDY DESIGN: Prospective, cohort, prognostic study. SETTING: Study patients who required arthroscopic rotator cuff repair were analyzed in a hospital setting. METHODS: We prospectively studied 101 patients who were less than 60 years old with full-thickness tears requiring arthroscopic rotator cuff repair and met the inclusion and exclusion criteria. Multiple regression analysis was performed to identify variables that independently affected neuropathic pain in patients with a RCT. We use Douleur neuropathique 4 questionnaire (DN4) to assess neuropathic pain, which was >/= 4 points of the DN4 questionaire. The visual analog scale (VAS) for the most severe pain within 4 weeks before admission and mean pain level during the last 4 weeks were checked. The atrophy grades of the rotator cuff muscles were classified on magnetic resonance images according to the Goutallier classification. The size and medial retraction of the RCT were measured during arthroscopic repair for RCT. RESULTS: Sixteen (15.8%) of the 101 patients had neuropathic pain according to the cut-off values on the DN4 questionnaire for diagnosing neuropathic pain. The neuropathic pain group had significantly higher prevalence of smoking (P = 0.042), more mean VAS during last 4 weeks (P = 0.008), larger cuff tear (P = 0.003), more medial retraction of cuff (P = 0.016), and severe fatty degeneration of rotator cuff muscles (supraspinatus, P < 0.001; subscapularis, P < 0.001; and infraspinatus, P = 0.003) than the nonneuropathic pain group. The multiple logistic regression analyses showed that more mean VAS during the last 4 weeks and tear size of a rotator cuff were independent of other factors for the neuropathic pain of the patients with a full-thickness RCT. LIMITATIONS: Small sample size is the first limitation of this study. CONCLUSIONS: The prevalence of neuropathic pain in patients with a full-thickness RCT requiring arthroscopic rotator cuff repair was 15.8 % according to the DN4 questionnaire. The neuropathic pain component was more relevant to the severity of pain and tear size in the patients with a full-thickness RCT. It is important to be aware of the existence of neuropathic pain when treating a patient presenting with pain due to a RCT because accompanying neuropathy with a RCT could have a worse effect on repair of a RCT. IRB approval and clinical trial registration number: CR-15-045. KEY WORDS: Shoulder, rotator cuff tear, arthroscopic rotator cuff repair, neuropathic pain.

Comparison of the Extent of Degeneration among the Normal Disc, Immobilized Disc, and Immobilized Disc with an Endplate Fracture.

BACKGROUND: This study attempts to prove a cause and effect relationship between spine immobilization following posterior fixation for unstable burst fractures and degeneration observed following hardware removal. METHODS: We enrolled 57 patients (259 intervertebral discs [IVDs]) who underwent only posterior instrumentation without fusion for thoracolumbar and lumbar unstable burst fractures. We arbitrarily named the IVD that has an endplate fracture after immobilization using pedicle screws as the fractured endplate and immobilized disc (FEID), the IVD that has no endplate fracture after immobilization using pedicle screws as the nonfractured endplate and immobilized disc (NFEID), and the IVD that has no endplate fracture and no immobilization instrumentation as the normal disc (ND). At 2 years after implant removal, magnetic resonance imaging (MRI) was performed again for comparison. The extent of disc degeneration was classified using the Pfirrmann classification system. RESULTS: FEIDs were present in 67 levels, NFEIDs in 78 levels, and NDs in 114 levels. According to the Pfirrmann classification, 7.9% of the NDs, 32.1% of the NFEIDs, and 43.3% of the FEIDs were more degenerated at 2 years after implant removal. The FEIDs and NFEIDs were more degenerated than the NDs and the FEIDs were more degenerated than the NFEIDs at statistically significant levels (p < 0.001 for both). CONCLUSIONS: Spine immobilization with transpedicular screws has a significant influence on disc degeneration, and an endplate fracture accelerates the degeneration process.

Comparison of inter- and intra-observer reliability among the three classification systems for cervical spinal canal stenosis.

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.

Correlations Between the SF-36, the Oswestry-Disability Index and Rolland-Morris Disability Questionnaire in Patients Undergoing Lumbar Decompression According to Types of Spine Origin Pain.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To determine the correlation between SF-36 (a measure for overall health status in patients) and Oswestry-Disability Index (ODI) or Rolland-Morris Disability Questionnaire (RMDQ) confined to spine according to the type of pain from the spine. SUMMARY OF BACKGROUND DATA: Data showed moderate correlation between ODI and SF-36 Physical Component Score (PCS), Physical Functioning (PF) (r=-0.46), Physical Role Functioning (RP) (r=-0.284), Bodily Pain (BP) (r=-0.327), and Mental Component Score (MCS), Emotional Role Functioning (r=-0.250), Social Role Functioning (r=0.254), Vitality (r=0.296). MATERIALS AND METHODS: Between January 1, 2008 and December 31, 2013, a total of 69 patients were enrolled in this study. They were diagnosed with lumbar spinal stenosis and underwent decompression surgery such as laminotomy in this hospital. The 3 standardized questionnaires (ODI, RMDQ, and SF-36) were given to these patients, at least 1 year after the surgery. RESULTS: ODI and SF-36 had a statistically significant (P=0.001) and moderate correlation. Small correlations were also seen between Physical Functioning (r=-0.46), Physical Role Functioning (r=-0.284), and Bodily Pain (r=-0.327) of SF-36 PCS and ODI, and between Emotional Role Functioning (r=-0.250), Social Role Functioning (r=-0.254), and Vitality (r=-0.296) of SF-36 Mental Component Score and ODI. Items in ODI for the level of pain while standing and traveling were mostly related to axial back pain, while item of lifting was related to referred buttock pain. Sleeping disturbance section in the ODI was mainly caused by radiated leg pain. In addition, RMDQ was also associated to the 3 types of pain. CONCLUSIONS: Moderate correlation was found between ODI or RMDQ as a condition-specific outcome and the SF-36, indicating overall health status. ODI was found to be a more adequate measure to evaluate axial back pain rather than referred pain or radiating pain. RMDQ was adequate to measure the health status and to evaluate the 3 types of spine pain. These 3 instruments could therefore provide the clinician with complementary information about the patient's status.