Restoration of Segmental Lordosis and Related Factors in Interbody Fusion for Degenerative Lumbar Disease

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze restoration of segmental lordosis and factors related to interbody fusion and the fusion rate with degenerative lumbar disease. SUMMARY OF LITERATURE REVIEW: Few studies have addressed the restoration of segmental lordosis and factors related to interbody fusion for degenerative lumbar disease. MATERIALS AND METHODS: Records of 43 patients treated by anterior lumbar interbody fusion (ALIF) or posterior lumbar interbody fusion (PLIF) surgery from 2011 to 2013 were reviewed. ALIF used a metal cage with a 10degrees lordotic angle and PLIF used a metal cage with an 8degrees lordotic angle. Preoperative, postoperative, and at least 1 year outcomes were analyzed from radiographs. As a related factor, segmental flexibility, disc height, osteophytes, vaccuum disc, hypertrophic facet, spondylolisthesis, and endplate violation were analyzed. We also analyzed the bony union rate. RESULTS: The segmental lordotic angle was 4.67degrees before surgery, improved to 10.43degrees after surgery, and was 9.32degrees at the final follow-up. Comparing between the ALIF and PLIF at the L3-4 level in a similar number of patients revealed 7.24degrees and 4.61degrees restoration after ALIF and PLIF surgery, postoperatively. The difference was statistically significant (p=0.011). Segmental flexibility had a statistically significant positive correlation (p=0.013). Lower disc height and osteophytes limited restoration of segmental lordosis, but vaccuum disc was restored well after interbody fusion. Bony union was achieved in 92.8% of the cases. CONCLUSIONS: Intebody fusion, especially ALIF surgery, results in acceptable restoration of segmental lordosis. Even with narrowed disc space or osteophytes, remained segmental flexibility is an important factor of segmental lordosis restoration.

Pulmonary Embolism Complication after Surgical Treatment of Patella Fracture: A Case Report

Deep vein thrombosis and pulmonary embolism are serious and fatal complications in orthopedic surgery. Most cases of symptomatic pulmonary embolism in knee surgery have been reported after total knee arthroplasty, but rarely after patella fracture. We report on a case of symptomatic pulmonary embolism after surgical treatment of a patella fracture in a 42-year-old female patient.

Conus Medullaris Syndrome Caused by Delayed Recollapse after Surgery of Burst Fracture: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: Lumbar burst fracture was treated with operation, which delayed recollapse of L1 and led to conus medullaris syndrome. SUMMARY OF LITERATURE REVIEW: After operation, conus medullaris syndrome causing by delayed recollapse is not frequently reported. MATERIALS AND METHODS: A 56-year-old male was admitted with lower back pain caused by a fall. Radiologic findings showed L1 burst fracture with about 42% of height loss. There was no neurologic deficit. Posterior fusion was performed using instrumentation. Five weeks after the operation, the patient was admitted for urination and defecation difficulty. Radiologic findings showed that the L1 had recollapsed with about 38% of height loss. To resolve the problem, anterior surgery was performed. RESULTS: Two years after surgery, bladder and anal sphincter dysfunction wasn't recovered. CONCLUSIONS: Lumbar burst fracture should be follow up carefully until union of the fracture because burst fracture leads to delayed recollapse.