Clinical Outcomes of Lateral Lumbar Interbody Fusion with Percutaneous Pedicle Screw for Dialysis-Related Spondyloarthropathy.

Background: The usefulness and problems with lateral lumbar interbody fusion (LLIF) with a percutaneous pedicle screw (PPS) for dialysis-related spondyloarthropathy are not clear. Therefore, we investigated the usefulness and problems with LLIF with PPS in dialysis-related spondyloarthropathy. Methods: In total, 77 patients who underwent LLIF with PPS were divided into two groups: the dialysis-related spondyloarthropathy group ("Group D") consisted of 15 patients (10 males and 5 females) with a mean age of 70.4 years and a mean duration of hemodialysis of 10.8 years; and the lumbar degenerative disease group ("Group L") included 62 patients (31 males and 31 females) with a mean age of 71.0 years. The mean follow-up period was 4 years in Group D and 3 years 9 months in Group L. We compared surgical invasiveness (operative time, blood loss), perioperative complications, clinical outcomes (Improvement ratio of the JOA score), bone fusion rate, reoperation, sagittal alignment, and coronal imbalance between the two groups. Results: There were no significant differences in operative time, blood loss, or the improvement ratio of the JOA score, but dialysis-related spondyloarthropathy was observed in one patient with superficial infection, three patients with endplate failure, and one patient with restenosis due to cage subsidence. Conclusions: We consider LLIF with PPS for dialysis-related spondyloarthropathy to be an effective treatment option because its surgical invasiveness and clinical outcomes were comparable to those for cases of lumbar degenerative disease. However, as endplate failure due to bone fragility and a reduced bone fusion rate were observed in dialysis spondylolisthesis cases, we advise a careful selection of indications for indirect decompression as well as the application of suitable pre- and postoperative adjuvant therapies.

A correlative electrophysiologic study of nerve fiber involvement in carpal tunnel syndrome using current perception thresholds.

OBJECTIVE: To relate clinical severity of idiopathic carpal tunnel syndrome (CTS) to current perception threshold (CPT). METHODS: Subjects were 51 patients with CTS (involving 51 hands), and 50 healthy control subjects (50 hands). Involved hands were grouped into three clinical grades (mild, moderate, severe). Using a neurometer (Neurotron, Baltimore, MD), we investigated the relationship between clinical grade and CPT abnormalities. RESULTS: In the mild CTS group, most hands showed CPT abnormalities only at 2000 Hz stimulation. The moderate group included a higher percentage of hands showing abnormalities at both 2000 and 250 Hz stimulation increased. The severe group included the highest percentage of hands with abnormal values at all frequencies tested. CONCLUSIONS: CPT showed abnormalities appear progressively from 'higher to lower' frequency stimulations relative to the increasing severity of CTS. SIGNIFICANCE: Sensory nerve fiber dysfunction apparently begins in larger fibers, extending stepwise to smaller fibers as the clinical grade of CTS progresses.

Objective evaluation of sensory function in patients with carpal tunnel syndrome using the current perception threshold.

The purpose of this study was to determine the sensitivity and specificity for the current perception threshold (CPT) test during clinical examination of idiopathic carpal tunnel syndrome (CTS). We studied 71 patients (102 hands) with CTS; 50 healthy individuals (100 hands) served as a control group. Using a neurometer, we investigated standard CPT values to obtain the sensitivity and specificity of the CPT test in the clinical examination of CTS. In the CTS group, cases that had abnormal values in the range analysis, the ratio analysis, or both were called "true-positive CPTs"; in the control group cases that had normal values in the range and ratio analyses were called "true-negative CPTs." We defined the sensitivity as the percentage of true-positive CPTs in the CTS group and the specificity as the percentage of true-negative CPTs in the control group. The sensitivity of the CPT test using both range and ratio analyses was 73%, and its specificity was 74%. Based on these results we concluded that the CPT test is a reliable quantitative sensory function test.

Evaluation of sensory function after median nerve decompression in carpal tunnel syndrome using the current perception threshold test.

The recovery level for sensory function after carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome (CTS) was assessed with the current perception threshold (CPT) test. Seventeen CTS patients (21 hands) were followed, and the CPTs at the index finger of each patient was measured preoperatively and at 1, 3, and 6 months postoperatively. After carpal tunnel release, there was significant recovery of CPT at all stimulation frequencies, indicating improvement of all sensory functions including sensations of temperature, pain, touch, and vibration.