Ten-Year Clinical Outcomes of Endoscope-Assisted Minimally Invasive Surgical Decompression for Lumbar Spinal Stenosis with Degenerative Spondylolisthesis and Comparison with Conservative Treatment.

Introduction: This study aimed to evaluate the 10-year clinical outcomes of endoscope-assisted, minimally invasive surgical (MIS) decompression for lumbar spinal canal stenosis (LSS) with lumbar degenerative spondylolisthesis (DS) and to compare the radiographic changes in patients who underwent this procedure with those who underwent conservative therapy at 10-year follow-up. Methods: Between April 2007 and April 2010, 347 consecutive patients with DS and evidence of LSS underwent conservative treatment first from 2 to 4 weeks. The 114 patients who failed conservative treatment were then treated surgically by endoscope-assisted MIS decompression. Of them, 91 patients were followed for more than 10 years (group S), and 146 of the 233 patients treated conservatively were followed for more than 10 years (group C). Clinical outcomes of endoscope-assisted MIS decompression were assessed using the Short Form Health Survey-36 score (SF-36), the Roland Morris Disability Questionnaire (RDQ), and the neurological leg symptoms of the Japanese Orthopaedic Association Score (JOA score). Radiographic changes of the two groups were assessed by %slip, dynamic %slip, range of motion (ROM), and the height of the disc (DH) on plain radiographs. Results: Significant improvements in clinical outcomes on the SF-36, RDQ, and neurological leg symptoms of the JOA were observed. Radiographic assessment did not show significant differences in the assessed items between the two groups at baseline and after last treatment. Both groups had significantly decreased ROM and DH. Conclusions: The 10-year clinical outcomes of endoscope-assisted MIS decompression for DS were generally good. Furthermore, on radiographic comparison, the progress of spondylolisthesis after this procedure was virtually the same as in the natural course of the disease at 10-year follow-up.

Simultaneous-onset infectious spondylitis with vertebral fracture mimicking an acute osteoporotic vertebral fracture erroneously treated with balloon kyphoplasty: illustrative case.

BACKGROUND: Early balloon kyphoplasty (BKP) intervention for acute osteoporotic vertebral fracture (OVF) has been reported to be more effective than the conservative treatment. However, complications of early BKP intervention are still unknown. OBSERVATIONS: A 71-year-old patient with OVF of L2 underwent BKP 2 weeks after symptom onset. Preoperative magnetic resonance imaging (MRI) and radiograph were compatible with new L2 OVF. Although computed tomography (CT) images revealed the atypical destruction of lower endplate of L2 as OVF, L2 BKP was planned. After BKP, his back pain improved dramatically. Two weeks after BKP, his lower back pain recurred. MRI and CT confirmed the diagnosis of infectious spondylitis with paravertebral abscess formation. With adequate antibiotic treatment and rehabilitation, he was symptom-free and completely ambulatory without signs of infection. LESSONS: Signal changes on the fractured vertebral bodies during initial MRI and fractured vertebral instability on radiograph can mislead the surgeon to interpret the infection as a benign compression fracture. If the patients exhibit unusual destruction of the endplate on CT imaging, "simultaneous-onset" spondylitis with vertebral fracture should be included in the differential diagnosis. To determine the strategy for OVF, preoperative biopsy is recommended if simultaneous-onset spondylitis with vertebral fracture is suspected.

Spontaneous Incidence of Vertebral Body Infection Following Osteoporotic Vertebral Fracture: A Case Series Study and Review of Literature.

STUDY DESIGN: Retrospective case series. OBJECTIVE: The aim of this study was to examine the spontaneous incidence rate and features of pyogenic vertebral osteomyelitis in osteoporotic vertebral fracture (OVF). SUMMARY OF BACKGROUND DATA: Pyogenic vertebral osteomyelitis is a rare complication of OVF. We experienced some cases of vertebral body infection after OVF. METHODS: In this retrospective, single-center study, clinical data were collected by chart review. We examined the number of cases of pyogenic vertebral osteomyelitis following OVF between April 2014 and August 2018. Further, we examined the mechanism of injury, age, sex, duration from the diagnosis of OVF to the diagnosis of vertebral body infection, C-reactive protein level at the time of diagnosis of OVF, medical history, primary infection site, and serious events. RESULTS: The spontaneous incidence rate of complications was 0.7% (4/554). In all cases (two males and two females), fall history was present and vertebral body infection was not suspected to be present at the point of injury. The average age was 81.8 (range, 75-89, SD, 5.7) years. The average duration from the diagnosis of OVF to the diagnosis of vertebral body infection was 55.0 (range, 16-132, SD, 52.4) days. The average C-reactive protein level at the time of diagnosis of OVF was 11.5 (range, 0.5-29.7, SD, 12.7) mg/L. Medical history included rheumatoid arthritis (n = 1), diabetes mellitus (n = 1), malignant tumor (stage IV) (n = 1), and brain infarction (n = 2). The primary sources of infection were pneumonia (n = 3), and urinary tract infection (n = 1), and all patients experienced bacillemia at/after the diagnosis of fracture. All patients died due to septic shock. CONCLUSION: The spontaneous incidence rate of vertebral body infection among OVF patients was 0.7%; however, the occurrence of this complication led to serious events. Clinicians should pay attention to the possibility of bacillemia in elderly or immunocompromised OVF patients. LEVEL OF EVIDENCE: 4.

A delayed-onset intracranial chronic subdural hematoma following a lumbar spinal subdural hematoma: A case report.

RATIONALE: A spinal subdural hematoma (SDH) is rarely complicated with an intracranial SDH. We found only 7 cases of spontaneous concurrent lumbar spinal and cranial SDHs, in which lumbar symptoms occurred before head symptoms. PATIENT CONCERNS: We describe a 77-year-old man with spontaneous concurrent spinal and cranial SDHs, in whom the spinal SDH was identified 30 days before the intracranial chronic SDH. DIAGNOSIS: Magnetic resonance imaging showed a spinal SDH at L4/L5. There was no paralysis, and the patient was managed conservatively. About 30 days after the onset of back pain, he experienced tinnitus and visual hallucination. Brain computed tomography showed a chronic SDH and midline shift. INTERVENTIONS: Burr-hole evacuation was performed, and the patient's condition improved. OUTCOMES: At 5 months of follow-up, there was no recurrence of the spinal or intracranial SDH. LESSONS: It is important to consider the possibility of intracranial hemorrhage when a spinal SDH is identified.

Activation of the extracellular signal-regulated kinase signal pathway by light emitting diode irradiation.

Irradiation by light emitting diode (LED) promotes fibroblast proliferation and wound healing. However, its mechanism is still unknown. The purpose of this study was to clarify the mechanism of fibroblast proliferation by LED irradiation. Cultured NIH3T3 fibroblasts from normal mice were irradiated by LED with a center wavelength of 627 nm. LED irradiation was performed with an energy density of 4 J/cm(2), at subculture and 24 h later. The expression of several growth factors and their receptors was analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR): platelet-derived growth factor (PDGF)-A, PDGF-B, and PDGF-C, transforming growth factor-beta (TGF-beta), basic fibroblast growth factor (bFGF), PDGF-alpha receptor, and TGF-beta receptor. Then, the activation of the extracellular signal-regulated kinase (ERK) pathway was examined by Western blotting with and without the PDGF receptor inhibitor. LED irradiation induced cell growth of NIH3T3 fibroblasts. The expression of PDGF-C had significantly increased in the irradiated group (P < 0.01). Although strong activation of the ERK pathway was observed in the irradiated group, its activation was completely suppressed by the PDGF receptor inhibitor. We concluded that LED irradiation promotes fibroblast proliferation by increasing autocrine production of PDGF-C and activating the ERK pathway through phosphorylation of the PDGF receptor.