Normal Functional Local Alignment and Segmental Motion at the Thoracolumbar Junction: A Cross-Sectional Study of Healthy Subjects.

OBJECTIVE: Several studies have investigated the mechanical behavior of the thoracolumbar spine. However, finding an accurate reference for the normal functional local alignment and segmental motion (SM) at the thoracolumbar junction (TLJ) is challenging. Therefore, this study aimed to assess age- and sex-related changes and differences in local alignment and SM at the TLJ. METHODS: The study recruited healthy subjects aged 20 to 79 without complaints of back pain. Healthy subjects (60 males and 60 females) with appropriate imaging results were enrolled in the study. The subjects were divided into age groups (20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years); each group included 10 subjects of each sex. RESULTS: The SM at the TLJ was small but noticeable, and the motion gradually increased toward the lower level of the TLJ, closer to the lumbar region. No significant differences were observed between male and female subjects in any SM measurements at the TLJ. The SM at the TLJ gradually decreased with age, while local kyphosis of TLJ progressed. The results also showed that the thoracolumbar slope value did not change with age and remained at a mean of -12.8 ± 7.2° (P = 0.893). CONCLUSIONS: This study's results provide valuable guidance for appropriate surgical planning and rehabilitation of patients with spinal diseases or trauma. Furthermore, the results can be the basis for categorizing accurate criteria to evaluate the degree of disability after treatment.

Neurenteric cyst of the craniovertebral junction treated to reduce recurrence using different strategies: Two case reports and a literature review.

RATIONALE: Neurenteric cysts are rare benign lesions that are usually located in the lower cervical and upper thoracic spine and extremely rare in the craniovertebral junction. It is generally challenging to completely remove the neurenteric cysts of the craniovertebral junction. We report the cases of 2 patients with neurenteric cyst in the ventral craniovertebral junction managed using different treatment strategies. PATIENT CONCERNS: The first patient was a 64-year-old man. He man was admitted with headache, posterior neck pain, and a tingling sensation in both the forearms. The second patient was a 53-year-old woman. She was admitted with tingling sensations and numbness in both the hands and feet. DIAGNOSES: Cervical spine magnetic resonance imaging showed 2 intradural extramedullary cystic lesions in case 1 and a C2 to C3 intradural extramedullary cystic mass in case 2. INTERVENTIONS AND OUTCOMES: The patient of the case 1 underwent a left C1 to C2 hemi-laminectomy and the cysts were completely removed. Eleven years after the surgery, there was no recurrence. In case 2, we performed a left C2 to C3 hemi-laminectomy and removed only a part of the outer membrane to enable sufficient communication with the surrounding normal subarachnoid space. After removing the cyst wall, the patient underwent C1 to 2 trans articular screw fixation to prevent cervical instability. Ten years after surgery, there was no recurrence of the cyst or new lesions. LESSONS: Clinicians should consider neurenteric cyst in the differential diagnosis of arachnoid cyst or epidermoid cyst. If performing a complete surgical removal is difficult, partial surgical removal, using a cysto-subarachnoid shunt and stabilization, such as screw fixation, could be an alternative treatment option to reduce the risk of mortality and morbidity.

Iatrogenic atlantoaxial rotatory subluxation after thyroidectomy in a pediatric patient: A case report.

BACKGROUND: Atlantoaxial rotatory subluxation (AARS) is an uncommon disease with a greater prevalence among children than adults, and it is mostly associated with trauma. Iatrogenic spinal injury accounts for a low percentage of injuries. However, in AARS, 20%-40% of cases are associated with surgery, and 48% are caused by infection. Here, we describe our experience with a case of iatrogenic AARS after general anesthesia. CASE SUMMARY: A 12-year-old girl presented with right-sided torticollis and cervical motion limit. The patient had undergone thyroidectomy 2 mo ago. Computed tomography revealed AARS with bilateral locked facets. Following the failure of repeated external reduction under general anesthesia, the patient underwent an open surgical reduction. The patient gained atlantoaxial alignment without any complications. Follow-up radiographs showed a normal appearance without instability. The cervical spine of children is more predisposed to injury due to anatomical and biomechanical differences. AARS secondary to infection and surgery is known as Grisel's syndrome, which involves non-traumatic AARS. Several cases of AARS after surgery and other procedures with no evidence of inflammation have been reported. Our experience shows that surgery requiring hyperextension of the neck after general anesthesia should also be included as a risk factor. CONCLUSION: Surgeons and anesthesiologists should be careful not to excessively extend the neck during pediatric surgery. Moreover, clinicians caring for pediatric patients with recent head and neck procedures must be aware of common AARS presentations.

Folate deficiency is associated with increased radiographic severity of osteoarthritis in knee joints but not in hand joints.

OBJECTIVES: No previous studies have explored the effect of folate deficiency on the severity of osteoarthritis (OA). Therefore, we investigated the relationship between folate level and features on knee and hand radiographs in a large, population-based OA cohort. METHODS: Among 9,260 subjects enrolled in the Dong-gu study, 2,489 who had knee and hand joint radiographs were included. Of these, subjects with a history of amputation or total knee replacement were excluded. Serum folate levels were measured using blood samples collected at the time of enrolment and stored. A semi-quantitative system was used to grade the severity of hand and knee x-ray changes. Linear regression was performed to assess relationships between serum folate levels and knee and hand radiographic scores after adjusting for age, sex, body mass index, smoking, alcohol consumption, education, physical activity, occupation, vitamin D, and ferritin. RESULTS: A total of 2,322 subjects were recruited. After adjusting for confounders, participants with folate deficiency (<4 ng/mL) had higher total (p<0.001), osteophyte (p<0.001), joint space narrowing (p=0.002), tibial attrition (p<0.001), and sclerosis (p=0.005) scores for knee joint radiographs compared to participants with a normal folate level. After adjusting for confounders, the radiographic scores for hand joints did not differ between the groups. CONCLUSIONS: Folate deficiency is associated with increased radiographic severity of OA in knee joints, but not in hand joints. Further studies are needed to explore the differential effects of folate on the severity of knee and hand OA.

Erratum: Validation of the European Quality of Life-5 Dimensions, 3-Level Version (EQ-5D-3L) in Patients With Osteoporotic Vertebral Fracture and Comparing Their Health-Related Quality of Life with That of the General Population in Korea.

[This corrects the article on p. 64 in vol. 18, PMID: 35557648.].

Influence of subsidence after stand-alone anterior cervical discectomy and fusion in patients with degenerative cervical disease: A long-term follow-up study.

This study aimed to evaluate the influence of subsidence in patients who performed stand-alone anterior cervical discectomy and fusion (ACDF) by analyzing the long-term clinical and radiological outcomes. This retrospective study enrolled 53 patients with 79 segments with degenerative cervical disease treated with stand-alone ACDF with ≥5 years of follow-up. Segmental angle (SA), cervical sagittal alignment (CSA), subsidence, and fusion were analyzed. Visual analog scale (VAS) scores and neck disability index (NDI) were also evaluated. Subsidence occurred in 24 (45.2%) patients and 38 segments (48.1%) at the last follow-up. The mean VAS score and NDI had improved in both the subsidence and non- subsidence groups. The mean SA at the last follow-up had increased to 1.3°â€…±â€…8.5° in the subsidence group and to 1.5°â€…±â€…5.2° in the non-subsidence group compared with the post-operative SA (P < .001). The overall mean CSA at the last follow-up increased over time in both the groups compared with the post-operative CSA (P = .003). The fusion rate at 1 year after surgery was 86.8% and 82.9% in the subsidence and non-subsidence groups, respectively. However, the differences in the SA, CSA, and fusion rates between the groups were not statistically significant (P = .117, .98, and .682, respectively). Subsidence after stand-alone ACDF occurs to a certain capacity; however, it does not appear to significantly influence the radiological and clinical outcomes if foramen decompression is adequately and sufficiently provided in a long-term follow-up study. In contrast, subsidence appears to positively affect the fusion rate in the short-term follow-up.

Clinical application of bone turnover markers in treating osteoporotic vertebral compression fractures and their role in predicting fracture progression.

This study aimed to investigate whether changes in the bone turnover markers (BTMs) during teriparatide therapy for osteoporotic vertebral compression fractures could reflect therapeutic effects by analyzing the relationship between clinical and radiological features and BTMs. A total of 33 patients with 51 osteoporotic vertebral compression fracture segments were included. Plain radiographs and BTM levels were evaluated at the pretreatment and at 3 months after teriparatide treatment. Based on serial vertebral compression ratio analysis, the progression of fracture was defined as a vertebral compression ratio decrease of ≥10%, relative to the pretreatment values. All segments were divided into 2 groups: the "maintain" group with 32 (62.7%) segments and the "progression" group with 19 (37.3%) segments. After the teriparatide treatment, serum osteocalcin and serum C-terminal telopeptide of type I collagen levels (P = .028 and .008, respectively), and change amounts of them were significantly larger, increasing (P = .001) in the progression group. The vitamin D (25OH-D) levels were significantly lower (P = .038) in the progression group; however, the relative changes in the 25OH-D levels between the 2 groups, before and after the treatment, were not significantly different (P = .077). The parathyroid hormone (PTH) levels were reduced by the teriparatide treatment in both groups, while the decrease in PTH concentration after the treatment was significantly more pronounced in the progression group (P = .006). Significant increase in the osteocalcin and serum C-terminal telopeptide of type I collagen levels and a simultaneous decrease in the PTH levels during the teriparatide treatment suggest that clinicians should assume the progression of fracture.

Validation of the European Quality of Life-5 Dimensions, 3-Level Version (EQ-5D-3L) in Patients With Osteoporotic Vertebral Fracture and Comparing Their Health-Related Quality of Life With That of the General Population in Korea.

Objective: This study examined the validity of the European Quality of Life-5 dimensions, 3-Level version (EQ-5D-3L) in patients with osteoporotic vertebral compression fractures (OVCF) and compared the health-related quality of life (HRQOL) of these patients with that of the general population in Korea. Methods: Study participants completed several questionnaires, such as the EQ-5D-3L, 12-item short-form health survey version 2.0 (SF-12v2), Roland-Morris disability questionnaire (RMQ), and Pain Numeric Rating Scale (Pain NRS). Spearman's correlation analyses of the questionnaire results were conducted to examine the discriminant and convergent validity of the EQ-5D-3L. Finally, EQ-5D-3L results from study participants were compared with those from the comparison group of the general population that were match-sampled according to age and sex from the 2013 Korean National Health and Nutritional Examination Survey. Results: Spearman's correlation coefficients between EQ-5D-3L and pain NRS, SF-12v2, and RMQ were statistically significant. The coefficients between the relevant dimensions, such as mobility in the EQ-5D-3L and physical functioning in the SF-12v2, were higher than those between irrelevant ones. Problems reported by study participants in each dimension of EQ-5D-3L showed statistically significant lower scores in pain NRS, PCS, and MCS from the SF-12v2 and RMQ scores. In comparison with the general population, the problems reported in the patient group were statistically higher than those reported by the general population. Conclusion: This study showed that EQ-5D-3L will be useful for patients with OVCF in Korea because it could be valid. The HRQOL of patients with OVCF was very low in all dimensions of the EQ-5D-3L.

Vertical split fracture of the vertebral body following oblique lumbar interbody fusion: A case report.

RATIONALE: Oblique lumbar interbody fusion (OLIF) is an effective and safe surgical technique widely used for treating spondylolisthesis; however, its use is controversial because of several associated complications, including endplate injury. We report a rare vertebral body fracture following OLIF in a patient with poor bone quality. PATIENT CONCERNS: A 72-year-old male patient visited our clinic for 2 years with lower back pain, leg radiating pain, and intermittent neurogenic claudication. DIAGNOSES: Lumbar magnetic resonance imaging revealed L4-5 stenosis. INTERVENTION: We performed OLIF with percutaneous pedicle screw fixation and L4 subtotal decompressive laminectomy. We resected the anterior longitudinal ligament partially for anterior column release and inserted a huge cage to maximize segmental lordosis. No complications during and after the operation were observed. Further, the radiating pain and back pain improved, and the patient was discharged. Two weeks after the operation, the patient visited the outpatient department complaining of sudden recurred pain, which occurred while going to the bathroom. Radiography and computed tomography revealed a split fracture of the L5 body and an anterior cage displacement. In revision of OLIF, we removed the dislocated cage and filled the bone cement between the anterior longitudinal ligament and empty disc space. Further, we performed posterior lumbar interbody fusion L4-5, and the screw was extended to S1. OUTCOMES: After the second surgery, back pain and radiating pain in the left leg improved, and he was discharged without complications. LESSON: In this case, owing to insufficient intervertebral space during L4-5 OLIF, a huge cage was used to achieve sufficient segmental lordosis after anterior column release, but a vertebral body coronal fracture occurred. In patients with poor bone quality and less flexibility, a huge cage and over-distraction could cause a vertebral fracture; hence, selecting an appropriate cage or considering a posterior approach is recommended.

What Clinicians Should Consider When Performing Oblique Lumbar Interbody Fusion in a Patient with Long Vertebral Body Osteophytes.

OBJECTIVE: Oblique lumbar interbody fusion (OLIF) is known as a minimally invasive technique for disc space augmentation. Motor weakness after OLIF has been known to occur in some cases. This study aimed to report the incidence and potential risk factors for motor weakness following OLIF. METHODS: We enrolled 36 patients and 57 segments who underwent OLIF. Computed tomography was performed before and after OLIF. Clinical data, including age, sex, presenting symptoms, bone mineral density, visual analog scale score, operating segments, and postoperative complications, were collected. We divided the patients into groups with and without neurologic deficit. The disc height was measured and compared between the 2 groups. We also divided the segments into groups with and without neurologic deficit. Foramen height and osteophyte length were measured and compared between the 2 groups. RESULTS: The neurologic deficit group included 3 patients (8%), whereas non-neurologic deficit group included 33 patients (92%). The neurologic deficit group included 5 segments (4%), whereas the non-neurologic deficit group included 109 segments (96%). The disc and foramen heights did not differ significantly between the groups with and without neurologic deficit; however, the osteophyte lengths were longer in the neurologic deficit group. CONCLUSIONS: In our study, vertebral osteophyte length was found to be a potential risk factor for motor weakness after OLIF. For patients with long osteophytes, additional laminectomy following OLIF or another surgical approach for direct decompression should be considered.

Non-adherence to methotrexate was associated with high disease activity and poor health-related outcomes during a 4-year follow-up of rheumatoid arthritis patients.

OBJECTIVES: Although methotrexate (MTX) is the first-line drug for management of rheumatoid arthritis (RA), non-adherence to MTX is highly prevalent and under-recognised. Here, we investigated adherence to MTX and its impact on clinical outcomes during follow-up in patients with RA. METHODS: In total, 367 RA patients were included in this study, with patient visits conducted annually for 4 consecutive years. Adherence was defined by the medication possession ratio during the follow-up period. We divided the patients into two groups; patients who took ≥80% of their prescribed MTX doses and those who did not. In a prospective cohort, the generalised estimating equations were used to identify longitudinal associations between drug adherence and clinical outcomes including disease activity, physical function, and quality of life. RESULTS: Of the 367 RA patients, 8.7% were found to have taken MTX <80% during the period of follow up. After adjustment for confounders, non-adherence to MTX was significantly associated with higher DAS28-ESR during the follow-up period (coefficient ß=0.989, 95%; CI: 0.603-1.375; p<0.001). In addition, non-adherence to MTX was a significant predictor of RAPID3 (coefficient ß=1.847; 95% CI: 0.221-3.472; p=0.026) and EQ-5D (coefficient ß= -0.051; 95% CI: -0.090-0.012; p=0.010) after adjustment for confounding factors. CONCLUSIONS: Non-adherence to MTX was significantly associated with worse clinical outcomes, as evidenced by higher disease activity, poorer physical function, and lower health-related quality of life during a 4-year follow-up of RA patients.

Neurologic deficit due to vertebral body osteophytes after oblique lumbar interbody fusion: A case report.

RATIONALE: In recent years, oblique lumbar interbody fusion (OLIF), which uses a window between the peritoneum and the iliopsoas muscle to split the muscle to access the lumbar spine, is known as an effective and safe treatment for spinal diseases, such as degenerative disc disease, spondylolisthesis, recurrent disc herniation, and spinal deformity. Despite this fast and useful surgical method, there were often cases of new neurological symptoms or worsening of symptoms after surgery. We analyzed the preoperative risk factors in a patient with neurologic symptoms, such as motor weakness and exacerbation of radiating pain, after OLIF. PATIENT CONCERNS: A 78-year-old man presented with complaints of numbness in the soles of both feet. L4-5 stenosis was diagnosed on MRI. We performed bilateral L4 laminotomy and L4-5 percutaneous posterior screw fixation after L4-5 OLIF. Postoperatively, his radiating pain improved, and there were no other neurologic symptoms. In the 6th week after surgery, he complained of pain in both ankles, while in the 10th week, the pain progressively worsened, and there was a decrease in motor performance of the right ankle. DIAGNOSIS: Magnetic resonance imaging findings indicated that L4-5 stenosis was resolved. On the basis of the computed tomography findings, the cage was well inserted, the disc height and foramen height increased, and the alignment was good. However, a nerve root injury due to the protruding osteophyte from the inferior endplate of the L4 body was suspected, necessitating exploration of both L4 nerve roots by focusing on the right side. INTERVENTIONS: We performed right facetectomy and right foraminotomy. During surgery, it was confirmed that the right L4 nerve root was entrapped by the osteophyte. OUTCOMES: Postoperatively, his radiating pain improved, and motor performance of his right ankle was restored. LESSONS: A prominently protruding osteophyte is assessed as a possible risk factor for the development of new neurologic deficits after OLIF. In patients with confirmed osteophytes, surgery should be planned taking into consideration the shape of the osteophytes and their relationship to the nerve root.

Elevated resting heart rate is associated with increased radiographic severity of knee but not hand joints.

Although the resting heart rate (RHR) predicts the clinical outcomes of cardiovascular disease, chronic obstructive lung disease, diabetes mellitus, and the risk of cancer, its role in patients with musculoskeletal diseases, such as osteoarthritis (OA), remains unclear. We explored the association of the RHR with the extents of radiographic changes in the knees and hands of 2369 subjects from the Dong-gu Study. The radiographic hand and knee joint findings were graded semi-quantitatively; we calculated total hand and knee joint scores. Multiple linear regression was performed to examine the associations between the RHR and the radiographic characteristics of these joints. For the knee joints, the RHR was associated positively with the total (p < 0.01), osteophyte (p < 0.01), joint space narrowing (JSN; p < 0.01), and tibial attrition (p = 0.02) scores after adjustment for age, sex, body mass index, smoking status, alcohol consumption, educational and physical activity levels, and comorbidities. For the hand joints, the RHR was associated positively with the JSN (p = 0.01) and subchondral cyst (p < 0.01) scores after such adjustment. The RHR was not associated with the total, osteophyte, sclerosis, erosion, or malalignment score for the hand joints. This study is the first to reveal an association between the RHR and the radiographic severity of knee, but not hand, OA.

Thoracolumbar Slope Is Useful Parameter for Evaluating HealthRelated Quality of Life and Sagittal Imbalance Aggravation in Adult Spinal Deformity: A Prospective Observational Cohort Study.

OBJECTIVE: The purpose of the present study was to evaluate the natural course of primary degenerative sagittal imbalance (PDSI), its aggravating factors, and health-related quality of life (HRQoL) associated with various spinal alignment parameters (SAPs) in patients with PDSI who have not undergone surgery. METHODS: One hundred three participants volunteered to participate. The SAPs, including T1 pelvic angle (T1PA), thoracolumbar tilt, and thoracolumbar slope (TLS), were measured on whole-spine standing radiographs. The back and lumbar muscle volumes were measured. To determine HRQoL at baseline and at 2-year follow-up, face-to-face questionnaires were administered, which included visual analogue scale of the back and leg, physical component summary/mental component summary of 36-item Short Form Health Survey, Oswestry Disability Index (ODI), and Mini-Mental State Examination. RESULTS: Overall HRQoL measures had improved after 2 years of follow-up compared to baseline. PDSI aggravation was observed in 18 participants (26.1%). TLS, sagittal vertical axis (SVA), and T1PA were strongly correlated with each other. TLS, SVA, and T1PA were correlated with ODI score. Among them, TLS was most highly correlated with ODI score. TLS greater than -3.5° was a predicting factor for PDSI aggravation (p = 0.034; 95% confidence interval, 1.173-63.61; odds ratio, 8.636). CONCLUSION: The present study implied that PDSI does not necessarily worsen with aging. TLS is an appropriate parameter for assessing the clinical situation in patients with PDSI. Furthermore, a TLS greater than -3.5° predicts PDSI aggravation; thus, TLS may be a useful parameter for predicting prognosis in PDSI.

Clinical, Radiographic, and Genetic Analyses in a Population-Based Cohort of Adult Spinal Deformity in the Older Population.

OBJECTIVE: This study aimed to identify the sagittal parameters associated with health-related quality of life and genetic variations that increase the risk of adult spinal deformity (ASD) onset in the older population. METHODS: We recruited 120 participants who had a sagittal vertical axis > 50 mm in a sagittal imbalance study. Sagittal radiographic parameters, cross-sectional area, and intramuscular fatty infiltration using the Goutallier classification in the paraspinal lumbar muscles were evaluated. Functional scales included the self-reported Oswestry Disability Index (ODI), 36-item Short Form Health Survey (SF-36), and visual analogue scales (VAS) for back and leg pain. We performed whole-exome sequencing and an exome-wide association study using the 100 control subjects and 63 individuals with severe phenotypes of sagittal imbalance. RESULTS: Pelvic incidence minus lumbar lordosis (PI-LL) mismatch was negatively associated with the SF-36 and positively correlated with ODI and VAS for back and leg pain. PI-LL was related to the quality and size of the paraspinal muscles, especially the multifidus muscle. We identified common individual variants that reached exome-wide significance using single-variant analysis. The most significant single-nucleotide polymorphism was rs78773460, situated in an exon of the SVIL gene (odds ratio, 9.61; p = 1.15 × 10-9). CONCLUSION: Older age, higher body mass index, and a more significant PI-LL mismatch were associated with unfavorable results on functional scales. We found a genetic variation in the SVIL gene, which has been associated with the integrity of the cytoskeleton and the development of skeletal muscles, in severe ASD phenotypes. Our results help to elucidate the pathogenesis of ASD.

Risks and benefits of timely screw removal after thoracolumbar spine fractures treated with non-fusion technique.

BACKGROUND: Percutaneous-short segment screw fixation (SSSF) without bone fusion has proven to be a safe and effective modality for thoracolumbar spine fractures (TLSFs). When fracture consolidation is confirmed, pedicle screws are no longer essential, but clear indications for screw removal following fracture consolidation have not been established. METHODS: In total, we enrolled 31 patients with TLSFs who underwent screw removal following treatment using percutaneous-SSSF without fusion. Plain radiographs, taken at different intervals, measured local kyphosis using Cobb' angle (CA), vertebra body height (VBH), and the segmental motion angle (SMA). A visual analogue scale (VAS) and the Oswestry disability index (ODI) were applied pre-screw removal and at the last follow-up. RESULTS: The overall mean CA deteriorated by 1.58° (p < 0.05) and the overall mean VBH decreased by 0.52 mm (p = 0.001). SMA preservation was achieved in 18 patients (58.1%) and kyphotic recurrence occurred in 4 patients (12.9%). SMA preservation was statistically significant in patients who underwent screw removal within 12 months following the primary operation (p = 0.002). Kyphotic recurrence occurred in patients with a CA ≥ 20° at injury (p < 0.001) with a median interval of 16.5 months after screw removal. No patients reported worsening pain or an increased ODI score after screw removal. CONCLUSION: Screw removal within 12 months can be recommended for restoration of SMA with improvement in clinical outcomes. Although, TLSFs with CA ≥ 20° at the time of injury can help to predict kyphotic recurrence after screw removal, the clinical outcomes are less relevant.

Comparison of the AAPT Fibromyalgia Diagnostic Criteria and Modified FAS Criteria with Existing ACR Criteria for Fibromyalgia in Korean Patients.

INTRODUCTION: Recently, new sets of diagnostic criteria were proposed, including criteria by the ACTTION-American Pain Society Pain Taxonomy (AAPT) group and Fibromyalgia Assessment Status (FAS) 2019 modified criteria for fibromyalgia (FM). Here, we explored the performances of the AAPT criteria and modified FAS criteria for diagnosing FM compared to existing American College of Rheumatology (ACR) criteria. METHODS: We enrolled 95 patients with FM and 108 patients who had other rheumatologic disorders, including rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, and myofascial pain syndrome. All patients were classified using proposed criteria including the 1990, 2010, 2011, and 2016 versions of the ACR criteria. RESULTS: In patients with existing FM diagnoses, FM was diagnosed in 56.8% using the AAPT criteria and in 60.0% using the modified FAS criteria. However, FM was diagnosed in 37.9%, 97.9%, 90.5%, and 94.7% of those patients using the 1990, 2010, 2011, and 2016 ACR criteria, respectively. For the AAPT criteria, the sensitivity was 56.8% and the specificity was 94.4%. For the modified FAS criteria, the sensitivity was 60.0% and the specificity was 92.6%. The areas under the receiver-operating characteristic curve were 0.852 (95% confidence interval [CI] 0.801-0.903) for the AAPT criteria and 0.903 (95% CI 0.861-0.944) for the modified FAS criteria, which were lower than the existing ACR criteria. CONCLUSIONS: Although the AAPT criteria and modified FAS criteria have simplified the diagnostic criteria to facilitate patient identification, their poor diagnostic accuracy will limit the adoption and spread of these criteria in routine clinical practice.

Increased adiponectin levels are associated with higher radiographic scores in the knee joint, but not in the hand joint.

Several studies have evaluated the association between serum adiponectin levels and knee and hand osteoarthritis (OA); mixed results have been reported. We investigated the relationship between OA and serum adiponectin levels according to the radiographic features of knee and hand OA. A total of 2402 subjects was recruited from the Dong-gu Study. Baseline characteristics were collected via a questionnaire, and X-rays of knee and hand joints were scored using a semi-quantitative grading system. The relationship between serum adiponectin levels and radiographic severity was evaluated by linear and logistic regression analysis. Subjects in the higher serum adiponectin levels tertiles were older and had a lower body mass index (BMI) than those in the lower tertiles. Regarding knee joint scores, serum adiponectin levels was positively associated with the total (P < 0.001), osteophyte (P = 0.003), and joint space narrowing (JSN) scores (P < 0.001) after adjustment for age, sex, BMI, smoking, alcohol consumption, education, and physical activity. In terms of hand joint scores, no association was found between serum adiponectin levels and the total, osteophyte, JSN, subchondral cyst, sclerosis, erosion, or malalignment score after the above-mentioned adjustments. Similarly, subjects with serum adiponectin levels above the median had higher total radiographic scores in the knee joints, but not in the hand joints, after adjustment. An increased serum adiponectin levels was associated with a higher radiographic score in the knee joint, but not in the hand joint, suggesting the involvement of different pathophysiologic mechanisms in the development of OA between those joints.

Outcomes of Patients Undergoing Anterior Screw Fixation for Odontoid Fracture and Analysis of the Predictive Factors for Surgical Failure.

OBJECTIVE: Anterior odontoid screw fixation (AOSF) is a safe and effective treatment for type II and rostral type III odontoid fracture. This study aimed to report the outcomes of the AOSF surgery and evaluate the potential risk factors of surgical failure. METHODS: We enrolled 63 patients who underwent AOSF. Follow-up computed tomography was performed 6 months after the surgery and once a year thereafter to evaluate the union. Clinical data including the age, sex, presenting symptoms, cause of injury, fracture gaps, dislocation position, degree of displacement, screw direction angle, and time interval from injury to operation were collected. RESULTS: Successful fusion was achieved in 55 patients (87.3%) and surgical failure occurred in 8 patients (12.7%). Variables such as age, sex, dislocation position, degree of displacement, screw direction angle, and time interval from injury to operation were not significantly associated with the surgical failure. However, surgical failure was statistically significantly associated with the fracture gap. The overall mean fracture gap at the time of injury was 1.29 mm (range, 0-3.11 mm), and the incidence of surgical failure was 8.3 times higher when the fracture gap at the time of injury was > 2 mm (p = 0.019). CONCLUSION: When performing AOSF in patients with type II or rostral shallow type III odontoid fractures, the displacement of the odontoid fracture fragment should be appropriately reduced to the aligning position before screw insertion and downward reduction should be achieved by perforation of the apical cortex of the odontoid during screw fixation, even if the surgery is delayed.

Single-Stage Posterior Circumferential Stabilization Using Double Small Cages for the Treatment of Thoracic and Lumbar Spine Fractures.

OBJECTIVE: Controversy remains regarding the optimal methods for resection of the vertebral body, reconstruction of the anterior column, and decompression of the spinal cord in patients who have severe vertebral body destruction of the thoracic or lumbar spine with associated neurologic impairment. We report an alternative technique for primary treatment and salvage involving single-stage corpectomy followed by reconstruction of the anterior column using double small mesh cages via the posterior-only approach. METHODS: Plain radiographs and computed tomography scans, taken at different intervals, were used to measure local kyphosis, segmental height, and fusion grade. Pain was evaluated using the visual analog scale (VAS), and neurologic symptoms were classified according to Frankel grade. RESULTS: The mean kyphotic deformity improved by 14.47 ± 9.06 degrees (P < 0.001), and the mean segmental height improved by 7.17 mm ± 6.11 mm (P < 0.001) after surgery. Fusion was achieved at 84% of patients, within a median interval of 12 months. Kyphotic recurrence was observed in 2 patients (11%), segmental height loss occurred in 1 patient (5%), and both kyphotic recurrence and segmental height loss occurred in 1 patient (5%). None of the patients reported worsening pain or neurologic symptoms after surgery, and there were no surgery-related complications such as neural injury, cerebrospinal fluid leakage, cage dislocation, surgical site infection, or cardiopulmonary complications. CONCLUSIONS: Single-stage corpectomy followed by reconstruction of the anterior column using double small mesh cages via the posterior-only approach is a reliable and less invasive single-stage treatment and salvage option in selected cases.