Assessing the Usefulness of Motor-Evoked Potential Changes in Disc Height Determination in Patients with Degenerative Disc Diseases Treated with Interbody Fusion.

AIM: To evaluate the effectiveness of improved motor-evoked potentials (MEPs) in treatment of degenerative disc diseases using the transforaminal lumbar interbody fusion (TLIF) technique. MATERIAL AND METHODS: Data of one hundred and eleven patients who underwent TLIF were retrospectively reviewed. The inclusion criteria were preoperative radiculopathy and presence of neurological deterioration without previous surgery. Improved MEP amplitudes reaching the baseline MEP amplitudes of the contralateral side at the same level were used as the thresholds for determining the final disc height and cage size during surgery. Cage size, disc heights of the three areas, foraminal area, and global spinal and local balance were measured. RESULTS: Twenty-two patients (3 male and 19 female) with a mean age of 61.9 ± 8.9 years were included into the study. The mean height of cages was 10.3 ± 1.4 mm (range, 8-14 mm). The mean improvement in MEP amplitude was 27 ± 11% (range, 15-50%). The anterior, middle, and posterior disc heights improved to 2 ± 1.6, 2.7 ± 1.7, and 1.7 ± 1.3 mm, respectively. The improvement in the middle disc height was significantly greater (p < 0.05). Segmental lordosis improved from 16.2° ± 10.7° to 19.4° ± 9.2°. Additionally, lumbar lordosis improved from 46.7° ± 14.6° to 51.2° ± 11.2° (p < 0.05). Cage height or improvements in disc height was not correlated with MEP changes. However, there was a positive correlation between ipsilateral foraminal area restoration and MEP changes (r=0.501; p < 0.01). CONCLUSION: Improved MEP amplitudes reaching the baseline MEP amplitudes of the contralateral side of the same spinal level might be a useful threshold for determining the final minimum disc height during TLIF surgery with satisfactory postoperative radiological results, including sagittal and segmental radiological parameters.

Nail disorders associated with cast immobilization of the forearm and wrist: report of two cases and review of the literature

Abstract Cast immobilization is used in the management of various injuries of joints and/or limbs. A variety of nail disorders have been reported in association with cast immobilization of the forearm and wrist among a limited number of patients so far. The mechanism was not clearly identified in some of these cases. Here, the authors report two patients with nail disorders appeared after the removal of immobilization cast of forearm and wrist and review the literature.

Nail disorders associated with cast immobilization of the forearm and wrist: report of two cases and review of the literature.

Cast immobilization is used in the management of various injuries of joints and/or limbs. A variety of nail disorders have been reported in association with cast immobilization of the forearm and wrist among a limited number of patients so far. The mechanism was not clearly identified in some of these cases. Here, the authors report two patients with nail disorders appeared after the removal of immobilization cast of forearm and wrist and review the literature.

The Survival of Well-Fixed Cementless Femoral Component After Isolated Acetabular Component Revision.

BACKGROUND: It remains controversial whether isolated acetabular component revision or both component revision surgeries should be performed in patients with stable femoral component. The present study aimed to evaluate the survival of patients with unrevised stable uncemented femoral stem who underwent isolated acetabular component revision. MATERIAL AND METHODS: A retrospective analysis was conducted in patients who underwent isolated acetabular component revision and had stable uncemented femoral component during revision hip arthroplasty between February 1998 and December 2009. Demographic data of the patients included age, previous surgery, complications, duration between primary and revision surgery, and duration between revision and latest follow-up. Functional results were analyzed using Harris Hip Score (HHS). RESULTS: Fifteen hips of thirteen patients were included in the study with a mean age of 62.08 ± 12.9 years. Average time from THA to the isolated acetabular revision was 9.2 ± 3.48 years. Average follow-up time from revision to the latest follow-up was 12.39 ± 2.68 years, and femoral components had been followed for an average of 21.6 ± 4.06 years since the time of implantation. Average HHS of the patients were 53 before revision surgery and 81.9 at the last follow-up (p < 0.001). The 10-year survival rate of patients who underwent revision in the femoral component was 100%, whereas their 15-year survival rate was 93.3%. None of the acetabular components required revision. CONCLUSION: Isolated revision of acetabular component may be considered if there is stable uncemented femoral component in revision THA. Acetabular reconstruction quality, acetabular and unrevised femoral component survival are not affected by retaining well-fixed femoral component. LEVEL OF EVIDENCE: 4, retrospective cohort study.