Efficacy of a Topical Gelatin-Thrombin Matrix Sealant in Reducing Postoperative Drainage Following Anterior Cervical Discectomy and Fusion

STUDY DESIGN: Retrospective fusion level(s)-, age-, and gender-matched analysis. PURPOSE: To determine whether the application of a topical gelatin-thrombin matrix sealant (Floseal) at the end of anterior cervical discectomy and fusion (ACDF) can reduce the amount of postoperative hemorrhage. OVERVIEW OF LITERATURE: The effect of the matrix sealant in decreasing postoperative hemorrhage following ACDF has not been reported. METHODS: Matrix sealant was (n=116, study group) or was not applied (n=58, control group) at the end of ACDF. Patients were selected by 1:2 matching criteria of fusion level(s), age, and gender. Seven parameters described below were compared between the two groups. RESULTS: The total drain amount for the first 24 hours (8+/-9 versus 27+/-22 mL), total drain amount until the 8-hour drainage decreased to < or =10 mL (8+/-10 versus 33+/-26 mL), and the total drain amount until 6 AM on the first postoperative day (7+/-8 versus 24+/-20 mL) were significantly lower in the study group than the control group (all p<0.001). The time for the 8-hour drainage to decrease to < or =10 mL was significantly lower in the study group (10+/-5 versus 26+/-14 hours, p<0.001). The 8-hour drainage decreased to < or =10 mL on the operation day in most patients (88%) in the study group versus mostly on the first (48%) or second (33%) postoperative day in the control group (p<0.001). The total drain amount until 6 AM on the first postoperative day was 0 mL in 43% of patients in the study group and in 7% in the control group (p<0.001). No patient in either group required hematoma evacuation. CONCLUSIONS: Application of the topical matrix sealant at the end of ACDF can significantly reduce the amount of postoperative hemorrhage.

Total Uncinatectomy Revisited: Revision Surgery for Persistent Radiculopathy Following Anterior Cervical Discectomy and Fusion (ACDF) / 대한정형외과학회잡지

We report on a case involving total en bloc uncinatectomy of C7 without removal of the previously inserted cage, performed on a patient with a history of previous anterior cervical discectomy and fusion without uncoforaminotomy at C5-6-7 who had persistent pain radiating to the upper extremity along with progressive weakness. Satisfactory results were achieved. This procedure should be regarded as an effective option for surgical treatment of persistent or recurrent radiculopathy caused by remaining foraminal stenosis following anterior cervical fusion, and we suggest it as a new indication for this procedure.

Correction in Rotational Deformity with Thoracolumbosacral Orthosis in Idiopathic Scoliosis / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: This study examined the effect of a TLSO brace treatment for the correction of axial rotational deformities in idiopathic scoliosis. SUMMARY OF THE LITERATURE REVIEW: A TLSO brace treatment is effective in correcting 2-dimensional deformities of idiopathic scoliosis but is questionable in axial rotational deformities. MATERIALS AND METHODS: Fifty three cases treated by bracing in March, 1999~February, 2005 at our department were reviewed. The posteroanterior and lateral radiographs were checked in the standing position throughout the study. The change in axial rotational deformity were analyzed using Nash & Moe method and Perdriolle's method. RESULTS: The rotational deformity had improved in 2 curves, was aggravated in 8 curves, and showed no change in 43 curves with the TLSO brace. CONCLUSIONS: The TLSO brace treatment in axial rotational deformity of idiopathic scoliosis is not effective in correcting the rotational deformity but is effective in preventing the progress of a rotational deformity.

Comparison of Bone Mineral Density in Elderly Patients according to Presence of Intertrochanteric Fracture

PURPOSE: To analyze difference in bone mineral density (BMD) between intertrochanteric fracture and control group and to explore the predictive value of BMD for intertrochanteric fracture. MATERIALS AND METHODS: 57 patients who were over 60-year-old with intertrochanteric fracture were examined. For control group, 110 patients who did not have any fracture were selected. Dual energy X-ray absorptiometry was studied at 1, 2, 3, 4 lumbar vertebrae, femoral neck, trochanter and Ward's triangle. BMD was compared at each site between two groups statistically. RESULTS: Fracture group consisted of 16 male, 41 female and was average 70.8 year old. Control group consisted of 21 male, 89 female and was average 68.1 year old. There was no differences in sex and age between two groups (p>0.05). BMD of L1, L2 and mean lumbar area were significantly less in fracture group than control group (p0.05). CONCLUSION: BMD of L1, L2 and mean lumbar area in fracture group had lower value significantly, but had no differences between two groups at another sites. BMD of L1, L2 and mean lumbar area might be used as the most sensitive predictive indicator for risk of osteoporotic fractures including intertrochanteric fracture in elderly patient.