Clinical Characteristics of Elderly People with Osteoporotic Vertebral Compression Fracture Based on a 12-Year Single-Center Experience in Korea.

In an aging human population, osteoporotic vertebral compression fracture (OVCF) frequently occurs. We conducted this retrospective study to analyze the clinical characteristics of elderly people with OVCF who underwent percutaneous vertebroplasty or kyphoplasty over a 12-year period at a single medical center in Korea. Between 2007 and 2019, A total of 868 patients (n = 868) were treated at our institution. We assessed 600 of these patients as eligible for study purposes and divided them into three groups: Group A (spine and hip T-scores ≤-2.5; n = 332); Group B (spine T-scores ≤-2.5; n = 189); and Group C (hip T-scores ≤-2.5; n = 79). The baseline characteristics of the patients included age, sex, body mass index (BMI), past history of steroid use, alcohol consumption, use of osteoporosis therapy, smoking, and treatment for OVCF. We compared these characteristics between the three groups. We found that the mean patient age was significantly higher in Group A, compared with Group B, and significantly lower in Group B, compared with Group C. We also found significant differences in the male-to-female ratio and mean body mass index between the three groups. In conclusion, we suggest that special attention should be paid to factors closely associated with spine and hip T-scores when evaluating elderly people with OVCF and determining appropriate treatment.

Epidemiology of Achilles Tendon Rupture in South Korea: Claims Data of the National Health Insurance Service from 2009 to 2017.

BACKGROUND: The incidence of Achilles tendon rupture and its trend has not been studied in Asia. The purpose of this nationwide study was to analyze the trend of incidence and surgical treatment of tendon ruptures in South Korea based on sex, age, and income level of patients, as well as seasonal variation. METHODS: A descriptive epidemiologic study was performed based on the data collected retrospectively from the Korea National Health Insurance Service. Data of all outpatients and inpatients were collected from approximately 52 million residents of South Korea, primarily diagnosed with Achilles tendon rupture from 2009 to 2017. RESULTS: A total of 112,350 patients had Achilles tendon rupture, of which 44,248 patients underwent surgical treatment during the study period. The overall, age-specific, and sex-specific incidence of Achilles tendon rupture and surgical treatment showed an increasing trend. Patients in the age group of 41 to 50 years showed the highest increase in incidence. Regarding season, higher incidence was reported during spring and summer, whereas the lowest incidence was found in winter. Higher income level was associated with increased incidence of the condition. CONCLUSIONS: The incidence of Achilles tendon rupture and surgical treatments increased rapidly in patients between 41 and 50 years of age. Patients in the higher income quintile groups experienced more Achilles tendon injury than those in lower income groups, and fewer ruptures were observed during winter.

Relationship of Bone Mineral Density and Knee Osteoarthritis (Kellgren-Lawrence Grade): Fifth Korea National Health and Nutrition Examination Survey.

BACKGROUND: Osteoarthritis (OA) and osteoporosis (OP) are the 2 most common bone disorders associated with aging. We can simply assume that older patients have a higher incidence of OA and OP with more severity. Although several papers have conducted studies on the relationship between OA and OP, none of them has demonstrated a conclusive link. In this study, we used radiological knee OA and bone mineral density (BMD; T-score of the total hip and lumbar spine) to analyze the incidence of OA and OP in a large population. We aimed to determine the relationship between OA and OP and investigate the associated risk factors. METHODS: This cross-sectional study used data extracted from the 2010-2012 Korea National Health and Nutrition Examination Survey. We evaluated a total of 4,250 participants aged ≥ 50 years who underwent knee radiography and dual-energy X-ray absorptiometry and their laboratory results. The relationship between radiological knee OA and BMD was assessed. The generalized linear model was used to evaluate the relationship between BMD and Kellgren-Lawrence (KL) grade. RESULTS: The higher KL grade was associated with older age, higher body mass index (BMI), female sex, and lower hemoglobin level (p < 0.001). No significant association was found between OA and the following variables: white blood cell, platelet, total cholesterol, vitamin D, alkaline phosphatase, parathyroid hormone, hypertension, diabetes, asthma, dyslipidemia, smoking status, alcohol consumption, and regular exercise (p > 0.05). After adjusting for confounding factors (age, BMI, diabetes, hypertension, smoking, and alcohol consumption), the average T-scores of total hip and lumbar spine were the highest in the mild OA group with KL grade 2 (-0.22 ± 1.08 and -0.89 ± 1.46, respectively, p < 0.001). The average T-scores of the total hip and lumbar spine significantly decreased as OA progressed from moderate (KL grade 3; -0.49 ± 1.05 and -1.33 ± 1.38, respectively, p < 0.001) to severe (KL grade 4; -0.73 ± 1.13 and -1.74 ± 1.75, respectively, p < 0.001). T-scores of the moderate-to-severe OA group were significantly lower than those of the non-OA group (KL grades 0 and 1, p < 0.001). CONCLUSIONS: Compared with the non-OA group, BMD (T-scores of the total hip and lumbar spine) was higher in the mild OA group and lower in the moderate-to-severe OA group.

Double Dome Laminoplasty: A Novel Technique for C2 Decompression.

OBJECTIVE: To introduce a new surgical technique - double dome laminoplasty for decompression of the entire C2 lamina and preservation of an extensor muscle insertion. METHODS: Eleven consecutive cervical myelopathy patients due to ossification of the posterior longitudinal ligament involving the Axis (C2) area were contained at this study. Direct decompression was evaluated as an increasing rate in space available cord (%) and posterior cord shift (mm) at C2 level. The Japanese Orthopaedic Association (JOA) score, visual analogue scale, and C2-7 Cobb angle in a neutral lateral x-ray were analyzed. RESULTS: The mean increase in space available for spinal cord at the C2 level, average posterior cord shift, and JOA recovery rate were 69.7%, 5.3 ± 0.15 mm, and 58.0%, respectively. Cervical lordotic angle was maintained in all patients. One patient reported neck pain (visual analogue scale 6) postoperatively. No specific complications such as C2 laminar fracture or insufficient decompression were observed. CONCLUSION: We recommend double dome laminoplasty for treating patients with cervical myelopathy involving the C2 area to avoid C2 laminectomy, reduce postoperative neck pain, and maintain lordotic cervical spine alignment.

Development of a heat labile antibiotic eluting 3D printed scaffold for the treatment of osteomyelitis.

In general, osteomyelitis is treated with antibiotics, and in severe cases, the inflammatory bone tissue is removed and substituted with poly (methyl methacrylate) (PMMA) beads containing antibiotics. However, this treatment necessitates re-surgery to remove the inserted PMMA beads. Moreover, rifampicin, a primary heat-sensitive antibiotic used for osteomyelitis, is deemed unsuitable in this strategy. Three-dimensional (3D) printing technology has gained popularity, as it facilitates the production of a patient-customized implantable structure using various biodegradable biomaterials as well as controlling printing temperature. Therefore, in this study, we developed a rifampicin-loaded 3D scaffold for the treatment of osteomyelitis using 3D printing and polycaprolactone (PCL), a biodegradable polymer that can be printed at low temperatures. We successfully fabricated rifampicin-loaded PCL 3D scaffolds connected with all pores using computer-aided design and manufacturing (CAD/CAM) and printed them at a temperature of 60 °C to prevent the loss of the antibacterial activity of rifampicin. The growth inhibitory activity against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), the representative causative organisms of osteomyelitis, was confirmed. In addition, we optimized the rifampicin-loading capacity that causes no damage to the normal bone tissues in 3D scaffold with toxicity evaluation using human osteoblasts. The rifampicin-releasing 3D scaffold developed herein opens new possibilities of the patient-customized treatment of osteomyelitis.

Preoperative Halo Traction for Severe Scoliosis.

STUDY DESIGN: Retrospective case control study. OBJECTIVE: The aim of this study was to analyze the appropriate traction period and preoperative halo traction (HT)-related factors in severe scoliosis SUMMARY OF BACKGROUND DATA.: HT can reduce risks involved in severe scoliosis treatment, and its safety and efficacy are well known. However, a lack of evidence exists in guiding the appropriate traction period and other factors involved in HT. METHODS: We retrospectively reviewed 59 patients who underwent preoperative HT, analyzed correction rate changes over time using HT, and assessed other factors by dividing the patients into two groups according to differences between the post-bending correction angle (PBC) and post-halo traction correction angle (PTC): group A (PBC ≒ PTC) and group B (PBC < PTC). The grouping was determined by whether the difference between PBC and PTC was >8°, the maximum measurement error when measuring the Cobb angle. RESULTS: The mean Cobb angle improved from 96.9° preoperatively to 72.9° post-bending to 63.3° post-traction and 32.5° postoperatively. The coronal correction of the major curve (change in curve from the start to each week/total change in curve after traction) was 28.2% at 1 week (n = 59), 34.0% at 2 weeks (n = 58), 33.8% at 3 weeks (n = 41), and 32.2% at 4 weeks (n = 13); a difference was noted between the first and second weeks (P < 0.001, <0.001, 0.244, and 0.082, respectively). Compared with group A, group B had a lower height (154.9 vs. 144.4 cm, P = 0.029), lower body weight (49.1 vs. 39.4 kg, P = 0.017), higher traction/body weight ratio (0.41 vs. 0.47, P = 0.025), and more halo-femoral traction (0 vs. 6, P = 0.018). CONCLUSION: Traction for ≥3 weeks was unnecessary for optimal traction. In patients with low height and weight, halo-femoral traction with a heavy traction weight was effective. LEVEL OF EVIDENCE: 4.

Posterior Correction of Adolescent Idiopathic Scoliosis with High-Density Pedicle Screw-Only Constructs: 5 Years of Follow-Up.

PURPOSE: This study aimed to analyze radiological outcomes in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior correction with high-density pedicle screw-only constructs. We hypothesized that high-density pedicle screw-only constructs in AIS would provide a high correction rate and would facilitate the maintenance of the correction or obviate the loss thereof. MATERIALS AND METHODS: We retrospectively analyzed radiological outcomes over a minimum follow-up period of 5 years in patients with AIS who underwent posterior correction with high-density pedicle screw-only constructs. A total of 124 consecutive patients were included. Demographic data, including age, sex, operated fusion level, numbers of screw, Lenke curve type, Risser stage, and follow-up period were retrospectively collected from electronic medical records and radiological measurements including serial follow-up. RESULTS: The average number of pedicle screws was 1.96/vertebra. The average curve correction was 48.3% for the proximal thoracic (PT) curve, 83.1% for the main thoracic (MT) curve, and 80.2% for the thoracolumbar/lumbar (TL/L) curve at final follow-up. Use of high-density pedicle screw-only constructs helped achieve excellent correction rates, with no significant loss of correction at final follow-up. CONCLUSION: We obtained excellent correction rates of 48.3% for PT, 83.1% for MT, and 80.2% for TL/L curves using high-density pedicle screw-only constructs in AIS, with no significant loss of correction at final follow-up.

A case report: white cord syndrome following anterior cervical discectomy and fusion: importance of prompt diagnosis and treatment.

BACKGROUND: Objective: White cord syndrome is extremely rare and search of the literature has revealed very few cases. Postoperative MR scan revealed hyperintense intrinsic cord signal changes within cord ischemia and edema. It is thought to be caused by reperfusion injury of the spinal cord. This is called white cord syndrome. This report is very rare case of 'White Cord Syndrome' with paraplegia after anterior cervical discectomy and fusion (ACDF). CASE PRESENTATION: A 49-year-old woman presented with neck pain lasting for several months and second and third finger radiating pain. Severe cervical herniated intervertebral disc findings could be identified at C6-7 level on C-spine MRI. ACDF C6-7 surgery was performed. Immediately after the operation, physical examination revealed paraplegia and emergency MRI was performed. On MR images, T2 high signal myelopathy suspected as reperfusion injury at C6-7 level, and emergency surgery was performed under diagnosis of white cord syndrome. After the emergency operation, the paraplegic problem was gradually resolved. Before discharge, motor power and sensory deficit of bilateral lower extremity were fully recovered. CONCLUSION: Surgeons should explain the possibility of white cord syndrome before cervical decompression surgery and should perform a neurological examination immediately after surgery. We recommend that the importance of early recognition and prompt treatment of white cord syndrome.

Does stopping at C7 in long posterior cervical fusion accelerate the symptomatic breakdown of cervicothoracic junction?

OBJECT: To compare the clinical and radiological outcomes between patients with long posterior cervical fusion (PCF) in which fusion stopped at C7 versus patients in which fusion crossed the cervicothoracic junction (CTJ). METHODS: The patients were divided into 2 groups on the basis of the lower-most instrumented vertebra (LIV); C7 group patients (n = 25) and upper thoracic (UT) group (n = 21). We analyzed the visual analogue scale of arm/neck pain, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI). And we also measured the following parameters: (1) pseudomotion of fused segments; (2) C2-C7 sagittal vertical axis; (3) T1 slope; and (4) C2-C7 lordosis. RESULTS: Arm and neck pain were similar in both groups pre- and postoperatively. Interestingly, mean postoperative NDI score in the UT group was significant worse when compared with the C7 group (9.7±4.6 vs. 14.2±3.7, p = 0.006). Although UT patients had longer fusion levels, the fusion rates were not significantly different between the C7 and UT groups (96.0% vs. 90.5%; p = 0.577). The radiographic parameters did not show any significant differences between the groups at final follow-up. CONCLUSIONS: Our study demonstrates that multi-level PCF stopping at C7 does not negatively affect C7-T1 segment failure, fusion rate, neck pain, neurologic outcomes, and global sagittal alignment of the cervical spine. Hence, it is unnecessary to extend the long PCF levels caudally across the healthy CTJ for fear of development of adjacent segmental disease (ASD) at the C7-T1 segment.

Does Sacral Slanting Affect Distal Adding-on in Lenke Type 1A Adolescent Idiopathic Scoliosis?

STUDY DESIGN: A retrospective clinical study. OBJECTIVE: The purpose of this study was to identify risk factors for postoperative distal adding-on in Lenke 1A adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Distal adding-on is a postoperative complication associated with the Lenke type 1A curve. Although various factors are known to cause postoperative adding-on, no study has reported a correlation between sacral slanting and adding-on. METHODS: A total of 126 consecutive patients who underwent posterior correction and fusion surgery for Lenke type 1A adolescent idiopathic scoliosis were included in this study. Curve type was further categorized into L4-left (L4-L) or L4-right (L4-R), based on the direction of the L4 vertebral tilt. Several clinical and radiological parameters including sacral slanting were investigated to identify risk factors associated with postoperative distal adding-on. RESULTS: A total of 36 patients (28.6%) exhibited sacral slanting. Nineteen out of 20 L4-L type patients had left-sided sacral slanting, whereas 12 out of 16 L4-R type patients had right-sided sacral slanting. The group with adding-on (n = 13) demonstrated a significantly lower age than the group without adding-on (n = 113). Preoperative lumbar Cobb angle (P = 0.022) was determined to be an independent factor for adding-on according to logistic regression analysis. In the L4-R type, the last touching vertebra (LTV) level and the gap difference in levels between lowest instrumented vertebra and LTV (lowest instrumented vertebra-LTV) comprised significant variables. CONCLUSION: Sacral slanting typically occurs to the left in the L4-L type and to the right in the L4-R type. The size of the preoperative lumbar curve was found to be an independent risk factor that caused adding-on in patients with Lenke type 1A scoliosis. In the L4-R type, right-sided sacral slanting tended to lower the LTV. Therefore, the fusion level might be shorter to save the motion segments resulting in distal adding-on. LEVEL OF EVIDENCE: 4.

Referral patterns and patient characteristics at the first visit to a scoliosis center: a 2-year experience in South Korea without a school scoliosis-screening program.

OBJECTIVE The need for scoliosis screening remains controversial. Nationwide school screening for scoliosis has not been performed in South Korea, and there are few studies on the referral patterns of patients suspected of having scoliosis. This study aimed to examine the referral patterns to the largest scoliosis center in South Korea in the absence of a school screening program and to analyze the factors that influence the appropriateness of referral. METHODS The medical records of patients who visited a single scoliosis center for a spinal deformity evaluation were reviewed. Among 1895 new patients who visited this scoliosis center between April 2014 and March 2016, 1211 with presumed adolescent idiopathic scoliosis were included in the study. Patients were classified into 4 groups according to the referral method: non-health care provider, primary physician, hospital specialist, or school screening program. The appropriateness of referral was labeled as inappropriate, late, or appropriate. In total, 213 of 1211 patients were excluded because they had received treatment at another medical facility; 998 patients were evaluated to determine the appropriateness of referral. RESULTS Of the 998 referrals of new patients with presumed adolescent idiopathic scoliosis, 162 (16.2%) were classified as an inappropriate referral, 272 (27.3%) were classified as a late referral, and 564 (56.5%) were classified as an appropriate referral. Age, sex, Cobb angle of the major curve, and skeletal maturity were identified as statistically significant factors that correlated with the appropriateness of referral. The referral method did not correlate with the appropriateness of referral. CONCLUSIONS Under the current health care system in South Korea, a substantial number of patients with presumed adolescent idiopathic scoliosis are referred either late or inappropriately to a tertiary medical center. Although patients referred by school screening programs had a significantly lower late referral rate and higher appropriate referral rate than the other 3 groups, the referral method was not a significant factor in terms of the appropriateness of referral.

Does Additional Uncinate Resection Increase Pseudarthrosis Following Anterior Cervical Discectomy and Fusion?

STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To investigate whether unilateral or bilateral uncinate resection (UR) combined with anterior cervical discectomy and fusion (ACDF) increases the risk of pseudarthrosis at long-term follow-up. SUMMARY OF BACKGROUND DATA: Uncoforaminotomy (or UR), performed along with ACDF, facilitates better and faster improvement of arm pain. As uncovertebral joints are important for maintaining stability, they may affect the fusion process by causing segmental instability if resected during ACDF. METHODS: We retrospectively examined 167 patients (89 men, 78 women; mean age, 58.4 ±â€Š10.5 yr) who consecutively underwent single- or double-level ACDF and were followed for >2 years. UR was not performed in 46 patients (N-UR group). UR of at least one foramen was performed in 121 patients (UR group), including unilateral UR in 89 patients (U-UR group) and bilateral UR in 32 patients (B-UR group). Demographic data, fusion rate, visual analog scale (VAS) scores for neck/arm pain, and neck disability index (NDI) scores were compared between the N-UR and UR groups. Moreover, the fusion rates after the single- and double-level procedures were compared among the groups. RESULTS: There was no difference in sex, age, weight, height, body mass index (BMI), and smoking history between the N-UR and UR groups. The fusion rates after single-level ACDF were not significantly different among the N-UR, U-UR, and B-UR groups (91.4%, 97.8%, and 88.2%; P = 0.290). Solid fusion was achieved in all groups after double-level ACDF (72.7%, 95.5%, and 86.7%), although the rates did not significantly differ among the groups (P = 0.071). The improvement in the VAS score for arm pain was significantly better in the UR group than in the N-UR group at short-term follow-up (P < 0.001). CONCLUSION: Unilateral or bilateral UR does not affect the fusion rate after single- or double-level ACDF. Hence, if necessary, additional UR can be performed during ACDF without concern regarding nonunion. LEVEL OF EVIDENCE: 4.

Comparison of Posterior Lumbar Interbody Fusion and Posterolateral Lumbar Fusion in Monosegmental Vacuum Phenomenon within an Intervertebral Disc.

STUDY DESIGN: Retrospective. PURPOSE: To compare the clinical and radiological outcomes of posterolateral lumbar interbody fusion (PLIF) and posterolateral lumbar fusion (PLF) in monosegmental vacuum phenomenon within an intervertebral disc. OVERVIEW OF LITERATURE: The vacuum phenomenon within an intervertebral disc is a serious form of degenerative disease that destabilizes the intervertebral body. Outcomes of PLIF and PLF in monosegmental vacuum phenomenon are unclear. METHODS: Monosegmental instrumented PLIF and PLF was performed on 84 degenerative lumbar disease patients with monosegmental vacuum phenomenon (PLIF, n=38; PLF, n=46). Minimum follow-up was 24 months. Clinical outcomes of leg and back pain were assessed using visual analogue scales for leg pain (LVAS) and back pain (BVAS), and the Oswestry disability index (ODI). The radiographic outcome was the estimated bony union rate. RESULTS: LVAS, BVAS, and ODI improved in both groups. There was no significant difference in the degree of these improvements between PLIF and PLF patients (p>0.05). Radiological union rate was 91.1% in PLIF group and 89.4% in PLF group at postoperative 24 months (p>0.05). CONCLUSIONS: No significant differences in clinical results and union rates were found between PLIF and PLF patients. Selection of the operation technique will reflect the surgeon's preferences and patient condition.

Induction of bone ingrowth with a micropore bioabsorbable suture anchor in rotator cuff tear: an experimental study in a rabbit model.

BACKGROUND: The bioabsorbable suture anchor is probably one of the most commonly used tools in arthroscopic shoulder operations. However, there is controversy about whether the bioabsorbable anchor is replaced by bone. The object of this study is to evaluate bone ingrowth into the micropore bioabsorbable suture anchor and the differences in the biomechanical properties of a micropore anchor and a nonpore anchor. MATERIALS AND METHODS: A total of 16 microsized holes (diameter, 250 ± 50 µm; depth, 0.2 mm) were made on the bioabsorbable anchors with a microdrill. Twelve adult New Zealand White rabbits were randomly divided into two groups: group A (n = 6), the nonpore bioabsorbable suture anchor group, and group pA (n = 6), the micropore bioabsorbable suture anchor group. Microcomputed tomography was used at 4 and 8 weeks postoperatively to evaluate ingrowth by bone volume fraction (BVF), which was measured by calculating the ratio of the total volume of bone ingrowth to that of the region of interest. For pullout strength testing, 3 additional rabbits (6 limbs) were used for mechanical testing. RESULTS: The mean BVF was higher in group pA (0.288 ± 0.054) than in group A (0.097 ± 0.006). The micropore anchor had a higher pullout strength (0.520 ± 0.294 N) than the nonpore anchor (0.275 ± 0.064 N). CONCLUSION: Micropore bioabsorbable suture anchors induced bone ingrowth and showed higher pullout strength, despite processing.