Rapid progression of spinal epidural lipomatosis after percutaneous endoscopic spine surgery mimicking disc herniation.

INTRODUCTION: Spinal epidural lipomatosis (SEL) is well known but uncommon complication of endoscopic spine surgery. Here, we present a case of SEL that progressed focally and rapidly after endoscopic spinal surgery. PRESENTATION OF CASE: A 67-year-old man presented with back and Lt. leg radiating pain. MRI of the lumbar spine demonstrated severe foraminal stenosis at Lt. L4/5/S1. He underwent endoscopic posterior foraminotomy at Lt. L4/5/S1. After surgery, his leg pain disappeared. A month after surgery, the patient developed Lt. leg pain again. MR images showed focally progressed epidural fat posterior to the L5 body. After removal of lipomatosis via endoscopic posterior decompression at L3/4/5, his symptoms improved. DISCUSSION: Mostly, the epidural fat accumulates insidiously, and distributes widely across several levels. And the increased accumulation of fat is predominantly posterior and posterolateral within the spinal canal. As in this case, focally progressed SEL anterior to the dural sac is rare. And focally progressed SEL can be misdiagnosed for disc herniation. CONCLUSION: SEL should be recognized as a rare complication of endoscopic spine surgery.

Early detected femoral neck insufficiency fracture in a patient treated with long-term bisphosphonate therapy for osteoporosis: A need for MRI.

INTRODUCTION: Atypical femoral fracture is an uncommon complication of prolonged use of bisphosphonates, mainly occurring in the femoral shaft. We report a case of an atraumatic insufficiency fracture of femoral neck after four years of treatment with a bisphosphonate. PRESENTATION OF CASE: A 71-year-old female presented with history of pain on Lt. hip and difficulty in walking. Although there was no fracture on the radiographs, diagnosis could be made early using magnetic resonance imaging (MRI) scans. She was treated by internal fixation using cannulated screws. DISCUSSION: Because bisphosphonate prevents bone healing and remodeling, it is difficult to accomplish the bony union despite of proper treatment in patients who have fractured after long-term use of bisphosphonate. CONCLUSION: A high suspicion index and early diagnosis through the use of MRI are essential for the successful treatment of these fractures.

Is Mobile-Bearing Medial Unicompartmental Knee Arthroplasty Appropriate for Asian Patients With the Risk of Bearing Dislocation?

BACKGROUND: Mobile-bearing unicompartmental knee arthroplasty (UKA) is an attractive operation for medial unicompartmental knee arthritis, but unexpected bearing dislocation is a drawback. Bearing dislocation occurs more frequently in Asians, whose lifestyle involves deeper knee flexion than Westerners. This study investigated whether mobile-bearing medial UKA is appropriate for Asians by analyzing (1) the rate of bearing dislocation and (2) the results of patients with bearing dislocation. METHODS: We retrospectively reviewed 531 consecutive mobile-bearing medial UKA in the previous 15 years, including 22 patients with bearing dislocation who had at least 2 years of follow-up. The entire patient cohort was divided into 2 groups: the symmetrical bearing (187 knees) and the anatomic bearing (344 knees) groups. In the anatomic bearing group, patients who underwent surgery using the conventional phase III (283 knees) vs the Microplasty (61 knees) instrumentation systems were compared. RESULTS: The overall incidence of bearing dislocation was 4.1% (22/531). Patients with the symmetrical bearing displayed a relatively high dislocation rate of 9.6% (18/187), which significantly decreased to 1.1% (4/344) after changing to the anatomic bearing (P < .001). In the anatomic bearing group, the dislocation rate with the conventional phase III system was 1.4% (4/283). There were no bearing dislocations in the Microplasty system group (0%, 0/61) after at least 2 years of follow-up. CONCLUSION: Although mobile-bearing medial UKA was reported to have a high incidence of bearing dislocation in Asians, this frequency of dislocation is drastically decreased by bearing design and implantation system improvements. We consider mobile-bearing medial UKA appropriate for Asians.

Predictors of Clinical Outcome After Endoscopic Partial Facetectomy for Degenerative Lumbar Foraminal Stenosis.

OBJECTIVE: Endoscopic partial facetectomy (EPF) is an effective option for decompressing the lumbar exiting root without causing spinal instabilities in the treatment of patients with degenerative lumbar foraminal stenosis. The aim of the present study was to identify the preoperative risk factors of poor clinical outcomes after EPF in patients with degenerative lumbar foraminal stenosis. METHODS: A total of 51 consecutive patients who had undergone EPF from 2012 to 2015 were included in the present study. The clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry disability index (ODI), and Short-Form 36-item (SF-36) outcome questionnaires. The preoperative radiological risk factors were measured using the lumbar Cobb's angle, disc wedging angle, lumbar lordosis (LL), segmental lordosis, disc height index, presence of spondylolisthesis, and morphological changes (no change, horizontal collapse, vertical collapse) of the exiting root within the most stenotic level on preoperative magnetic resonance imaging. RESULTS: The VAS, ODI, and SF-36 scores had significantly improved at the 1-month follow-up visit compared with the baseline mean values and were maintained within the 2-year follow-up period. A correlation analysis revealed significant relationships between various preoperative factors and clinical outcomes. On multiple regression analysis, the morphological change of vertical collapse significantly predicted the VAS, ODI, and SF-36 scores, and LL significantly predicted the ODI and SF-36 scores. CONCLUSIONS: A morphological change in vertical collapse found on preoperative magnetic resonance imaging and decreased LL were significant predictors of poor clinical outcomes after EPF in the treatment of lumbar foraminal stenosis.

Radiologic parameters of ankylosing spondylitis patients treated with anti-TNF-α versus nonsteroidal anti-inflammatory drugs and sulfasalazine.

PURPOSE: Limited data are available on the relationship between treatment agents and sagittal balance in ankylosing spondylitis (AS). We investigated radiological features related to treatment agents and compared sagittal balance between patients treated with anti-tumor necrosis factor-α (anti-TNF-α) and those treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and sulfasalazine (SSZ). METHODS: We prospectively enrolled 133 consecutive AS patients. Patients were eligible for the trial if they were under medical treatment with the same treatment agents for at least 1 year. All patients were treated initially with NSAIDs and SSZ. Sixty-nine patients achieved an excellent pain control outcome with these agents (group A). Sixty-four patients who reported of intractable low back pain were switched to anti-TNF-α treatment (group B). Twelve radiographic parameters were measured. Clinical outcome was assessed with the Bath AS Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). All parameters were measured at enrolment, upon changing treatment agents, and every 6 months during follow-up. RESULTS: The mean ESR, CRP, BASDAI, and thoracic kyphosis at baseline were significantly higher in group B. After treatment, group B had significantly higher lumbar lordosis (LL) and significantly better clinical outcomes. Correlation analysis revealed significant relationships between radiologic parameters and BASDAI. On multiple regression analysis, LL was a significant predictor of BASDAI. CONCLUSIONS: This study demonstrated a clear association between treatment agents and radiologic parameters in AS. Anti-TNF-α treatment improved LL with improvement in clinical outcomes. Lumbar lordosis was a significant predictor of clinical outcome in AS patients treated with anti-TNF-α. These slides can be retrieved under Electronic Supplementary Material.

Endoscopic posterior decompression under local anesthesia for degenerative lumbar spinal stenosis.

OBJECTIVEVarious minimally invasive techniques have been described for the decompression of lumbar spinal stenosis (LSS). However, few reports have described the results of endoscopic posterior decompression (EPD) with laminectomy performed under local anesthesia. This study aimed to evaluate the clinical and radiological outcomes of EPD performed under local anesthesia in patients with LSS and to compare the procedural outcomes in patients with and without preoperative spondylolisthesis.METHODSFifty patients (28 female and 22 male) who underwent EPD under local anesthesia were included in this study. Patients were assessed before surgery and were followed up with regular outpatient visits (at 1, 3, 6, 12, and 24 months postoperatively). Clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and the 36-Item Short Form Survey (SF-36) outcome questionnaire. Radiological outcomes were assessed by measuring lumbar lordosis, disc-wedging angle, percentage of vertebral slippage, and disc height index on plain standing radiographs.RESULTSThe VAS, ODI, and SF-36 scores were significantly improved at 1 month after surgery compared to the baseline mean values, and the improved scores were maintained over the 2-year follow-up period. Radiological progression was found in 2 patients during the follow-up period. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical and radiological outcomes.CONCLUSIONSEPD performed under local anesthesia is effective for LSS treatment. Similar favorable outcomes can be obtained in patients with and without preoperative spondylolisthesis using this approach.

Effect of the screw type (S2-alar-iliac and iliac), screw length, and screw head angle on the risk of screw and adjacent bone failures after a spinopelvic fixation technique: A finite element analysis.

PURPOSE: Spinopelvic fixations involving the S2-alar-iliac (S2AI) and iliac screws are commonly used in various spinal fusion surgeries. This study aimed to compare the biomechanical characteristics, specifically the risk of screw and adjacent bone failures of S2AI screw fixation with those of iliac screw fixation using a finite element analysis (FEA). METHODS: A three-dimensional finite element (FE) model of a healthy spinopelvis was generated. The pedicle screws were placed on the L3-S1 with three different lengths of the S2AI and iliac screws (60 mm, 75 mm, and 90 mm). In particular, two types of the S2AI screw, 15°- and 30°-angled polyaxial screw, were adopted. Physiological loads, such as a combination of compression, torsion, and flexion/extension loads, were applied to the spinopelvic FE model, and the stress distribution as well as the maximum von Mises equivalent stress values were calculated. RESULTS: For the iliac screw, the highest stress on the screw was observed with the 75-mm screw, rather than the 60-mm screw. The bones around the iliac screw indicated that the maximum equivalent stress decreased as the screw length increased. For the S2AI screw, the lowest stress was observed in the 90-mm screw length with a 30° head angle. The bones around the S2AI screw indicated that the lowest stress was observed in the 90-mm screw length and a 15° head angle. CONCLUSIONS: It was found that the S2AI screw, rather than the iliac screw, reduced the risk of implant failure for the spinopelvic fixation technique, and the 90-mm screw length with a 15° head angle for the S2AI screw could be biomechanically advantageous.

Validation of the Korean version of the Brace Questionnaire.

OBJECTIVE: To evaluate the reliability and validity of an adapted Korean version of the Brace Questionnaire (K-BrQ). METHODS: The Greek version of the BrQ was translated/retranslated, and all steps of the cross-cultural adaptation process were performed. The K-BrQ and the previously validated Korean version of the Scoliosis Research Society-22 Outcomes questionnaire (K-SRS-22) were mailed to 120 patients with adolescent idiopathic scoliosis (AIS). Reliability assessments were conducted using kappa statistics to assess item agreements, and intraclass correlation coefficients (ICC) and Cronbach's α values were calculated. Convergent validity was evaluated by comparing the K-BrQ and K-SRS-22 scores and discriminant validity by analyzing relationships between the K-BrQ scores and patient characteristics. RESULTS: 103 patients filled in questionnaires twice. All items of the K-BrQ had kappa values of agreement of >0.6. The K-BrQ showed an excellent test/re-test reliability with an ICC of 0.913. The internal consistency of the K-BrQ was found to be very good (α = 0.872). The convergent validity testing demonstrated a strong correlation between the K-BrQ and K-SRS-22 (r = 712). The correlation between the K-BrQ and major curve magnitude was significant (r = -0.302). CONCLUSION: The adapted K-BrQ showed satisfactory reliability and validity and is thus considered suitable for monitoring the quality of life of Korean-speaking patients with AIS during brace treatment.

Correlation between body image perception and spinopelvic parameters in ankylosing spondylitis.

OBJECTIVE: To identify relationships between spinopelvic parameters and body image perception in ankylosing spondylitis (AS). METHODS: The study and control groups comprised 107 AS patients (18 women and 89 men) and 40 controls. All underwent anteroposterior and lateral radiography of whole spine, including hip joints, and completed clinical questionnaires. The radiographic parameters examined were sagittal vertical axis, sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, thoracic kyphosis, spinosacral angle (SSA), and spinopelvic angle (SPA). The Trunk appearance scale (TAPS), and the Scoliosis Research Society 22 appearance questionnaire (SRSapp) were administered to evaluate body image perception. RESULTS: The patient and control groups were found to differ significantly in terms of sagittal vertical axis, sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, SSA, and SPA. However, no significant intergroup difference was observed for thoracic kyphosis (p > .05). Correlation analysis revealed significant relationships between radiographic parameters and body image perception. Multiple regression analysis was performed to identify predictors of body image perception scores, and the results obtained revealed age, SSA, and SPA significantly predicted SRSapp scores and that age and SSA predicted TAPS scores. CONCLUSIONS: AS patients and normal controls were found to differ significantly in terms of sagittal spinopelvic parameters. Correlation analysis revealed significant relationships between radiographic parameters and body image perception. In particular, age, SSA, and SPA were found to be significant predictors of body image perception scores in AS patients.

Iatrogenic dural tear in endoscopic lumbar spinal surgery: full endoscopic dural suture repair (Youn's technique).

BACKGROUND: With the advancement of minimally invasive spinal surgery, endoscopic lumbar decompression has been widely used for the treatment of degenerative lumbar spinal diseases. Iatrogenic dural tear is a relatively common complication in endoscopic lumbar spinal surgery. The golden standard of treatment for iatrogenic dural tear is immediate open conversion and direct repair under microscopic visualization. Recently, most of endoscopic spinal surgery is performed under local anesthesia. So, conversion to open surgery is very embarrassing situation because of the need of additional general anesthesia. But, direct endoscopic dural repair is very difficult procedure due to the limitation of manipulation. No report showed direct dural suture under full endoscopic situation. PURPOSE: The purpose of this surgical technique is to provide a method of full endoscopic dural suture repair without conversion to open surgery.

Effects of Psychiatric Factors on Patient-Reported Outcomes after Surgical Correction of Lumbar Degenerative Kyphosis.

STUDY DESIGN: A prospective study. PURPOSE: To identify associations between psychiatric factors and patient-reported outcomes after corrective surgery in patients with lumbar degenerative kyphosis (LDK). OVERVIEW OF LITERATURE: Thus far, to the best of our knowledge, patient factors that may help predict patient-reported outcomes after corrective surgery for LDK have not been studied. METHODS: We prospectively investigated 46 patients with LDK who underwent surgical correction with a minimum follow-up of 2 years. Demographic data were collected. Short form-36, mental component scores (MCS), physical component scores (PCS), Scoliosis Research Society-22 (SRS-22) scores, and Roland-Morris Disability Questionnaire (RMDQ) scores were determined before the surgery and after 2 years of follow-up. Psychiatric conditions were preoperatively evaluated using the Zung depression scale (ZDS) and Zung anxiety scale (ZAS). Patients were divided into two groups (with or without psychiatric issues), according to baseline ZDS and ZAS scores. RESULTS: Patients included 43 women and 3 men. Twelve patients were deemed to have psychiatric problems (P group) and 34 patients had no psychiatric problems (NP group). No significant intergroup differences were found in MCS, PCS, SRS-22, and RMDQ scores preoperatively. However, at the 2-year follow-up, a significant intergroup difference was observed between PCS and RMDQ scores. Multiple regression analysis revealed that only the presence of a preoperative psychiatric problem can predict PCS and RMDQ scores. Other factors, such as, gender, age, body mass index, bone mineral density, osteotomy site, number of fusion segments, and instrumented levels did not affect PCS or RMDQ scores. CONCLUSIONS: The presence of a psychiatric factor may be an important risk factor underlying poor physical and pain scores after corrective surgery in patients with LDK. The findings presented here suggest that psychiatric factors should be evaluated prior to surgery for determining the risk of a poor outcome.

Full endoscopic lumbar interbody fusion (FELIF): technical note.

PURPOSE: Interbody fusion by open discectomy is the usual treatment for degenerative lumbar disease but requires a relatively long recovery period. Prevalent several interbody fusion methods have shown limitations by its own character. Full endoscopic lumbar interbody fusion (FELIF) has advantages in direct decompression of pathology with minimal invasive technique. We report novel technique of endoscopic fusion method through full guided with endoscopic view monitoring system. METHODS: The authors provide an introduction of FELIF technique followed by a description of the technical steps with discussion on its indications and advantages. In particular, tips to shorten operation time, simplify technical steps, and avoid complications are also presented. CONCLUSIONS: FELIF is a safe and effective interbody fusion option to decompress the lumbar exiting nerve root and ventral side of dura directly with minimal invasive situation. These slides can be retrieved under Electronic Supplementary Material.

Minimally invasive percutaneous endoscopic treatment for acute pyogenic spondylodiscitis following vertebroplasty.

INTRODUCTION: Acute pyogenic spondylodiscitis caused by percutaneous vertebroplasty is a rare complication. We present the first report of minimally invasive endoscopic treatment for acute spondylodiscitis caused by vertebroplasty. CASE PRESENTATION: A 60-year-old female was transferred with the symptom of right hip flexion weakness for 1 day. The patient underwent a vertebroplasty procedure because of L3 osteoporotic compression fracture at other hospital 6 weeks ago. Physical examination, laboratory finding and magnetic resonance imaging revealed an acute pyogenic spondylodiscitis with right L2 nerve root palsy caused by compression of bone and cement after L3 body collapse. Percutaneous endoscopic procedures including needle biopsy, debridement, root decompression and drainage were performed. One week after endoscopic treatment, her symptoms of back pain and nerve palsy improved significantly. After endoscopic treatment, the patient underwent conservative treatment with appropriate antibiotics according to the bacterial culture test results. Six weeks postoperatively, she was pain free with no neurological deficits or signs of infection. Five months later, spontaneous fusion between L2 and L3 body was observed. CONCLUSION: We report a case treated with endoscopic procedure without open surgery for acute pyogenic spondylodiscitis following vertebroplasty.

Interleukin 6 gene polymorphism in patients with degenerative lumbar scoliosis: a cohort study.

PURPOSE: Low bone mass and a female gender increase susceptibility to the development of degenerative lumbar scoliosis (DLS), which suggests the potential involvement of an osteoporosis-related gene in the pathogenesis of DLS. In the present study, the authors studied the relations between polymorphisms of interleukin 6 (IL-6) gene and DLS in a patient cohort. METHODS: In 184 patients with a diagnosis of DLS, the authors determined the presence of the -597 G/A, -572 G/C, and -174 G/C polymorphisms, measured bone mineral densities at the lumbar spine (LSBMD) and femoral neck (FNBMD), assessed radiological findings including lumbar scoliosis and lateral listhesis, investigated biochemical markers of bone turnover, and compared these results obtained with those of 220 healthy normal controls. RESULTS: Genotype frequencies in the DLS patients and controls revealed a significant difference for the IL6-572 G/C polymorphism (P = 0.0168). Mean LSBMD was lower in DLS patients than in controls, but no significant difference was found between these two groups with respect to FNBMD, biochemical markers, or radiological findings. A significant association was found between the IL6-572 G/C polymorphism and LSBMD. LSBMD in DLS with the CC genotype was found to be significantly higher than in DLS with the GC (P < 0.05) or GG (P < 0.05) genotypes. CONCLUSION: The results of this study suggest that the IL6-572 G/C polymorphism influences LSBMD in Korean DLS patients and the prevalence of the disease.

Three-dimensional versus two-dimensional shear-wave elastography: Associations of mean elasticity values with prognostic factors and tumor subtypes of breast cancer.

PURPOSE: To explore associations between prognostic factors and subtypes of invasive breast cancer (IBC) and elasticity values using three-dimensional (3D) and two-dimensional (2D) shear-wave elastography (SWE). MATERIALS AND METHODS: Mean elasticity values (kPa) of 121 IBCs were measured using both 3D and 2D SWE. Associations between these values and prognostic factors and subtypes were analyzed using linear regression model. RESULTS: In both 3D and 2D SWE, larger size and presence of lymphovascular invasion were independent factors influencing higher mean elasticity on multivariate analyses (all p values<0.05). CONCLUSIONS: Using either 3D or 2D SWE, higher mean elasticity values are associated with poor prognostic factors of IBC.

Predictive Findings of the Presence of Stooping in Patients With Lumbar Degenerative Kyphosis by Upright Whole Spine Lateral Radiography.

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to identify the relationships between radiological findings and the presence of stooping in lumbar degenerative kyphosis (LDK). SUMMARY OF BACKGROUND DATA: Many studies have addressed fixed sagittal imbalances and surgical treatments. However, information regarding the relationship between radiological findings and stooping in LDK is sparse. METHODS: The study included 73 patients with LDK and 44 with normal lumbar lordosis. Of those with LDK, 63 patients exhibited stooping (group 1) and 10 did not (group 2). Of those with 44 normal lumbar lordosis, 13 patients exhibited stooping (group 3) and 31 patients did not (group 4). Radiographic parameters such as sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), horizontal distance between C7 plumb line and the posterosuperior corner of the sacrum (C7PL), sacrofemoral distance (SFD), C7PL/SFD ratio (C7/SFD), spinosacral angle (SSA), spinopelvic angle (SPA), C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (C2-C7 SVA), T1 slope, and T1 slope minus C2-C7 lordosis (TS-CL) were analyzed. RESULTS: Significant differences were observed in TK, LL, C7PL, SFD, C7/SFD, PT, SS, SSA, SPA, C2-C7 SVA, and TS-CL between LDK and normal lumbar lordosis, but no significant intergroup difference was observed in PI, CL, or T1 slope. These results showed that groups 1 and 3 had higher C7PL, C7/SFD, PT, and CL values than groups 2 and 4. Logistic regression analysis revealed that C7/SFD and CL could significantly predict stooping in LDK. CONCLUSION: C7/SFD and CL predict the presence of stooping in LDK. Furthermore, patients with LDK with compensatory mechanisms to maintain sagittal balance have low C7PL values, that is, C7/SFD < 0.5 and high PT and CL on upright whole spine lateral radiography. LEVEL OF EVIDENCE: 3.

Biologic Profiles of Invasive Breast Cancers Detected Only With Digital Breast Tomosynthesis.

OBJECTIVE: The purpose of this study was to analyze the clinicopathologic and immunohistochemical features of invasive breast cancers detected only with digital breast tomosynthesis (DBT), compared with those of cancers detected with both DBT and full-field digital mammography (FFDM). MATERIALS AND METHODS: The medical records of 261 women (108 without and 153 with symptoms) with invasive breast cancers who underwent FFDM and DBT between April 2015 and June 2016 were retrospectively reviewed. To assess detectability, all DBT and FFDM images were reviewed independently by three radiologists blinded to clinicopathologic information. The reference standard was established by an unblinded consensus review of all images. Clinicopathologic and immunohistochemical features were analyzed according to the detectability status. RESULTS: Of the 261 cancers, 223 (85.4%) were detected with both DBT and FFDM (both-detected group). Twenty-four cancers (9.2%) not detected with FFDM (DBT-only group) were classified by DBT as a mass (58.3%), architectural distortion (33.3%), or asymmetry (8.3%). The remaining 14 cancers (5.4%) were not detected with either DBT or FFDM (both-occult group). On multivariate analysis, a dense breast parenchyma (p = 0.007), small tumor size (≤ 2 cm; p = 0.027), and luminal A-like subtype (estrogen receptor positive or progesterone receptor positive or both, human epidermal growth factor receptor 2 negative, and Ki-67 expression < 14%; p = 0.008) were significantly associated with the DBT-only group. For 108 screening-detected cancers, a dense breast parenchyma (p = 0.007) and luminal A-like subtype (p = 0.008) also maintained significance. CONCLUSION: The addition of DBT to FFDM in screening would aid in the detection of less-aggressive subtypes of invasive breast cancers in women with dense breasts.

Validation of the Korean version of the Spinal Appearance Questionnaire.

OBJECTIVE: To evaluate the reliability and validity of an adapted Korean version of the Spinal Appearance Questionnaire (SAQ). METHODS: Translation/retranslation of the English version of the SAQ was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the SAQ (K-SAQ) and the previously validated appearance domain of the Korean version of the Scoliosis Research Society-22 Outcomes questionnaire (K-SRS-22) were mailed to 160 patients with adolescent idiopathic scoliosis (AIS). Reliability assessments were conducted using kappa statistics to assess item agreements, and intraclass correlation coefficients (ICC) and Cronbach's α values were calculated. Convergent validity was evaluated by comparing K-SAQ and K-SRS-22 appearance domain scores and discriminant validity by analyzing relationships between K-SAQ scores and patient characteristics. RESULTS: All items of the K-SAQ had kappa values of agreement of > 0.6. The K-SAQ showed excellent test/re-test reliability with an intraclass correlation coefficient of 0.922. Internal consistency of the K-SAQ was found to be very good (α= 0.883). Convergent validity testing demonstrated a moderate correlation between the K-SAQ and K-SRS-22 (r=-451). The correlation between the K-SAQ and major curve magnitude was significant (r= 0.812). Discriminant validity was confirmed by significant differences in K-SAQ scores and individual K-SAQ domain scores among patients requiring observation, bracing, or surgery. CONCLUSIONS: The adapted Korean version of the SAQ showed satisfactory reliability and validity, and thus, is considered suitable for the evaluation of spinal deformity appearance in Korean speaking patients with adolescent idiopathic scoliosis.

Correlations Between Sagittal Spinal Balance and Quality of Life in Rheumatoid Arthritis.

STUDY DESIGN: Prospective study. OBJECTIVE: To identify relationships between spinopelvic parameters and health-related quality of life in rheumatoid arthritis (RA). SUMMARY OF BACKGROUND DATA: Little data are available on relationships between sagittal spinopelvic parameters and health-related quality of life in RA. MATERIALS AND METHODS: The study and control groups comprised 120 RA patients and 60 controls. All subjects underwent anteroposterior and lateral radiography of the whole spine, including hip joints, and all completed clinical questionnaires. The radiographic parameters examined were: sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, C7/sacrofemoral distance ratio (C7/SFD), and spinosacral angle (SSA). Quality of life was assessed using a Visual Analog Scale for back pain, the Oswestry disability index questionnaire, and the Scoliosis Research Society (SRS-22) questionnaire. Statistical analysis was performed to identify significant differences between the study and control groups. In addition, correlations between radiologic parameters and clinical questionnaires were sought. RESULTS: The patients and controls were found to be significantly different in terms of sacral slope, pelvic tilt, lumbar lordosis, thoracic kyphosis, C7/SFD, and SSA, but not for pelvic incidence (P>0.05). Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. Multiple regression analysis was performed to identify predictors of clinical outcome, and the results obtained revealed that C7/SFD significantly predicted Visual Analog Scale score and SSA predicted Oswestry disability index and SRS-22 scores. CONCLUSIONS: Sagittal spinopelvic parameters were found to be significantly different in RA patients and normal controls. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. In particular, C7/SFD and SSA were found to be significant predictors of clinical outcomes in RA.

Clinical and radiological outcomes of endoscopic partial facetectomy for degenerative lumbar foraminal stenosis.

BACKGROUND: Several different techniques exist to treat degenerative lumbar foraminal stenosis. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, wide decompression often causes spinal instabilities or may require an additional fusion surgery. The aim of this study was to report the outcomes of endoscopic partial facetectomy (EPF) performed on patients with degenerative lumbar foraminal stenosis. METHODS: Between 2012 and 2014, 25 consecutive patients (12 women and 13 men) who underwent EPF were included in the study. The patients were assessed before surgery and followed-up regularly during outpatient visits (preoperatively and 1, 3, 6, 12, and 24 months postoperatively). The clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) outcome questionnaire. The radiological outcome was measured using the lumbar Cobb angle, disc wedging angle, lumbar lordosis (LL), slip percentage, and disc height index (DHI) in plain standing radiographs. RESULTS: The VAS, ODI, and SF-36 scores significantly improved at 1 month of follow-up compared with the baseline mean values and were maintained within the 2-year follow-up period. There was no radiologic progression in the lumbar Cobb's angle, disc wedging angle, LL, slip percentage, and DHI between preoperatively and 2 years postoperatively. In addition, the EPF with discectomy group and the EPF group were not significantly different in terms of clinical and radiological outcomes. CONCLUSIONS: EPF is an effective option in decompressing the lumbar exiting nerve root without causing spinal instabilities for the treatment of patients with lumbar foraminal stenosis.