Comparison between Cases of Total Hip Arthroplasty Followed by Colonna Capsular Arthroplasty and Lorenz Cast Reduction in Patients with Developmental Dysplasia of the Hip.

Most patients with developmental dysplasia of the hip (DDH) now receive closed-reduction treatment within 6 months after birth. The long-term outcomes of patients with late-detection DDH have remained unclear. We reviewed the clinical records of 18 patients who underwent Colonna capsular arthroplasty (n=8) or closed reduction (n=10) for developmental dysplasia of the hip as infants or young children and underwent total hip arthroplasty approximately in midlife. Both the Colonna capsular arthroplasty and closed reduction groups achieved good clinical results after total hip arthroplasty. However, the operating time was longer and the improvements of hip range of motion and clinical score were significantly worse in the Colonna capsular arthroplasty group than in the closed reduction group.

Investigation of long lateral mass screw insertion torque.

Background: Here, we assessed a new trajectory and insertion torque for the placement of a long lateral mass screw (LLMS) that offers stronger posterior fixation versus a shorter lateral mass screw (LMS) in the posterior cervical spine. We report a short technical note of the insertion torque of LLMS. Methods: The insertion trajectory/torque was evaluated in 30 patients (10 males and 20 females) undergoing posterior cervical LLMS fusions (2021-2023). Patients averaged 65 years of age. Pathology included eight cervical spine injuries, ten cord injuries, four dislocations/fractures, and eight other entities. Variables studied included the length of the LLMS inserted from C3-7, screw deviation rates, insertion torque, and adverse events. Results: A total of 146 screws were inserted: 11 pedicle screws (PSs) and 135 LLMS. The average insertion torque was 105.9 cNm for PS and 64.9 cNm for LLMS. As the screw lengthened by 1 mm, the insertion torque increased by approximately 4.4 cNm. Conclusion: Here, we documented that the insertion torque of LLMS was 66.1 cNm, greater than the 51.0 cNm for LMS, which should provide stronger posterior cervical fixation.

Debridement, Antibiotics, and Implant Retention for a Rare Serratia marcescens Infection after Total Knee Arthroplasty: A Case Report.

Introduction: Recently, Serratia marcescens was reported to cause nosocomial infections. Case Report: In this study, we report a case of S. marcescens infection occurring after total knee arthroplasty (TKA) in a 72-year-old woman. The patient had undergone TKA for knee osteoarthritis. She had a past medical history of diabetes mellitus, for which she was receiving cefazolin sodium. Six days after surgery, redness and effusion were observed in the wound, and post-operative infection was suspected. Thus, the patient was treated with linezolid, clindamycin, and tazobactam/piperacillin hydrate post-operatively. Twelve days after TKA, reinfection was suspected; hence, washing and debridement were repeated. Conclusion: In this case, remission of S. marcescens infection was achieved without the need to remove the implant by cleaning, debridement, and the use of sensitive antimicrobial agents.

Minimally Invasive Trans-sacral Canal Plasty for Lumbar Canal Stenosis.

Objective The elderly population is increasing in Japan. Along with the increase in the elderly population, the number of patients with lumbar degenerative diseases is also on the rise. In general, elderly patients tend to have more complications and are at higher risk for surgery. Many elderly people suffer from lumbar degenerative disease. We reviewed our initial experience with trans-sacral canal plasty (TSCP) for patients with lumbar spinal canal stenosis and examined the pertinent literature for this report. Methods An analytical observational study was performed on 120 patients with lumbar spinal canal stenosis who underwent TSCP at our single institution from March 2019 to October 2021. These patients had leg pain and/or lower back pain due to degenerative lumbar disease. Patients who had coagulation abnormality, pregnancy, contrast allergy, pyogenic spondylitis, or spinal metastasis were excluded. Results Immediately after TSCP, the average Visual Analog Scale (VAS) score for back pain improved from 58.2 to 29.3, and for leg pain from 72.0 to 31.3. Two years after TSCP, the average VAS score for back pain increased slightly and the average score for leg pain remained almost the same. Additional surgery was performed in 37 of 120 (31%) patients who underwent TSCP. The additional surgery group had significantly worse back pain at one and three months postoperatively than the conservative treatment group. The additional surgery group had significantly worse leg pain immediately after TSCP and at one and three months postoperatively than the conservative treatment group. Logistic regression analysis demonstrated that a decreased spinal canal area (OR 0.986, p = 0.039) was associated with additional surgery. Conclusions We reviewed the outcomes of TSCP at our hospital. The average VAS score for back pain and leg pain improved. However, 31% of patients who underwent TSCP required additional surgery. It was found that the spinal canal area was a major factor in the need for additional surgery.

Efficiency of Long Lateral Mass Screw in Posterior Cervical Fusion.

INTRODUCTION: Long lateral mass screw (LLMS) technique for posterior cervical fusion has been performed in our hospital since 2019. In this study, the LLMS insertion technique, deviation rate, and insertion torque have been described. Moreover, several major concerns associated with LLMS have been adequately addressed. METHODS: This study included 58 patients (43 men and 15 women) who had undergone LLMS surgery at our hospital during the four-year period from December 2019 to December 2023, and were evaluated using postoperative CT. The evaluation parameters included the screw length at each vertebral segment, screw angle in the sagittal section, distance between the screw heads, and complications. RESULTS: The median screw length at C3 was 23.0 mm (22.0-24.0 mm), the screw angle was 36.1° (31.6-41.8°), and the distance between screw heads was 13.8 mm (11.6-17.2 mm). The median screw length at C4 was 22.0 mm (21.0-24.0 mm), the screw angle was 36.2° (28.7-40.7°), and the distance between screw heads was 15.9 mm (13.0-19.0 mm). The median screw length at C5 was 21.0 mm (20.0-22.0 mm), the screw angle was 35.6° (28.0-39.7°), and the distance between screw heads was 17.6 mm (15.1-20.4 mm). The median screw length for C6 was 20.0 mm (19.0-22.0 mm), the screw angle was 29.2° (25.2-36.8°), and the distance between screw heads was 20.4 mm (16.1-24.4 mm). CONCLUSION: The major limitations of the LLMS technique were inadequate screw angle, difficulty inserting long screws, inadequate decompression, and the inability to perform cervical laminoplasty. However, these limitations did not substantially affect the efficiency of LLMS. LLMS has fewer complications and can insert longer screws than LMS.

Pediatric Traumatic Cervical Distraction Injury: A Case Report.

Spinal cord injury due to trauma is rare in children. We report our experience with the surgical treatment of a cervical spinal cord injury in a one-year-old child with quadriplegia due to traffic trauma. The patient was a girl aged one year and five months. Physical examination findings were quadriplegia and loss of consciousness. Plain computed tomography (CT) of the cervical spine showed a vertical distraction injury of C6/7, and magnetic resonance imaging (MRI) showed spinal cord injuries of C1/2 and C6/7. Based on these findings, a diagnosis of C1/2 and C6/7 spinal cord injury (Frankel A) was made. The patient's state of consciousness did not change during the first week after injury; she was managed systemically with a ventilator. On the 10th day after the injury, her consciousness improved, and she was placed in a pediatric halo vest for weaning. However, as the alignment worsened, we operated. A 5 cm posterior incision was made at the median of C5/6/7. Only the spinous process was deployed, a Nespron tape (Alfresa Pharma Corporation, Osaka, Japan) was wrapped between C5/6 and C6/7, and an autologous iliac bone graft was placed at the C6/7 bilateral facet joint. Six months after surgery, bone fusion was complete. At one year and six months postoperatively, tetraplegia had not improved. Radiographs showed no growth disturbances despite residual alignment abnormalities.

Predicting Skeletal-related Events Using SINS.

STUDY DESIGN: Predictive study utilized retrospectively collected data. OBJECTIVE: The primary objective was to evaluate the predictive association between the Spine Instability Neoplastic Score (SINS) and Skeletal-related events (SREs). Secondary objectives included examining characteristics of cases with SINS < 6 among those who developed SRE, and evaluating the impact of additional predictors on prediction accuracy. SUMMARY OF BACKGROUND DATA: Advances in cancer treatment have prolonged the lives of cancer patients, emphasizing the importance of maintaining quality of life. Skeletal-related events from metastatic spinal tumors significantly impact quality of life. However, currently, there is no scientifically established method to predict the occurrence of SRE. SINS, developed by the Spine Oncology Study Group, assesses spinal instability using six categories. Therefore, the predictive performance of SINS for SRE occurrence is of considerable interest to clinicians. METHODS: This predictive study utilized retrospectively collected data from a single-center registry comprising over 1,000 patients with metastatic spinal tumors. SINS and clinical data were collected. Logistic regression was used to create a prediction equation for SRE using SINS. Additional analyses explored factors associated with SRE in patients with SINS < 6. RESULTS: The study included 1,041 patients with metastatic spinal tumors. SRE occurred in 121 cases (12%). The prediction model for SRE using SINS demonstrated an area under the curve (AUC) of 0.832. Characteristics associated with SRE included lower female prevalence, surgeries to primary sites, bone metastases to non-spinal sites, and metastases to other organs. A post hoc analysis incorporating additional predictors improved the AUC to 0.865. CONCLUSION: The SINS demonstrated reasonable predictive performance for SRE within one month of the initial visit. Incorporating additional factors improved prediction accuracy. The study emphasizes the need for a comprehensive clinical prediction model for SRE in metastatic spinal tumors.

A Continuous Registry of Medical Record, Patient Input, and Epidemiological Data of Patients With Ulcerative Colitis: a Multicentre, Prospective, Observational Clinical Registry Study in Japan.

BACKGROUND: This registry aims to allow for a prospective non-interventional observational study of ulcerative colitis. This will facilitate monitoring of the current state of ulcerative colitis in Japan and improving the long-term disease course and adverse events associated with current treatment options. METHODS: Inclusion of patients from five centres in Japan is planned. The study is expected to take place from July 15, 2020, to November 30, 2024. Background, demographics, and medical history/information will be collected from electronic medical records at enrolment. Medical information including medications, laboratory data, and disease activity will be collected automatically from electronic medical records throughout the study. Patient-reported quality of life data will be collected directly from patients via smartphone. Efficacy endpoints (clinical remission rate, clinical improvement rate, and endoscopic healing rate) and safety endpoints (incidence of adverse events and specific ulcerative colitis-related events) will be collected according to treatment administered. Treatment categories include no treatment, 5-aminosalicylic acids, corticosteroids, immunomodulators, immunosuppressants, anti-tumour necrosis alpha agents, cytapheresis, Janus kinase inhibitors, anti-integrin antibodies, and anti-interleukin-12/23 antibodies. CONCLUSIONS: The dataset will include cross-sectional and longitudinal data and is expected to capture the state of ulcerative colitis in Japan. Patients will be included on a large scale, and the registry will be established automatically from electronic medical records and direct patient input, facilitating the accurate recording of medical information for patients with ulcerative colitis in Japan and minimizing limitations intrinsic to databases that require manual data entry, such as the burden on participating investigators and entry of data with errors/typos.