Foreign body granuloma after bone cement augmentation of pedicle screws for osteoporotic spinal surgery: A case report

Osteoporosis causes a decrease in bone mineral density. To overcome the decrease in fixation strength, a variety of techniques and devices have been developed, including cement augmentation of pedicle screws. Polymethyl methacrylate (PMMA), is commonly known as bone cement, and is widely used for implant fixation in various orthopaedic and spine surgery. In general, PMMA augmentation of pedicle screws is simple and safe if performed with technical precautions. PMMA is a safe agent, but it may rarely lead to significant foreign body reactions. In this report, we present a patient who developed bone cement-related epidural space foreign body granuloma

The Effect of Zoledronic Acid on the Volume of the Fusion-Mass in Lumbar Spinal Fusion

BACKGROUND: Few studies have explored the effects of bisphosphonates on bony healing in patients undergoing spinal fusion surgery. Most previous studies used animal models and found that bisphosphonate shows negative effects on spinal fusion consolidation. We intended to evaluate the effect of a single-dose of zoledronic acid on the volume of the fusion-mass in lumbar spinal fusion. METHODS: A retrospective review was carried out on 44 patients with symptomatic degenerative lumbar spinal stenosis who underwent one or two-level posterolateral fusion from January 2008 and January 2011. They were divided into 4 groups: group 1, autograft and zoledronic acid; group 2, allograft and zoledronic acid; group 3, autograft alone; and group 4, allograft alone. Functional radiography and three-dimensional computed tomography scans were used to evaluate and quantify the volume of the fusion-mass. The visual analog scale (VAS), the Oswestry disability index (ODI), and the short form 36 (SF-36) were used to evaluate the clinical outcomes. RESULTS: The mean volume of the fusion-mass per level was 8,814 mm3, 8,035 mm3, 8,383 mm3, and 7,550 mm3 in groups 1, 2, 3, and 4, respectively, but there were no significant differences between the groups (p = 0.829). There were no significant decreases in the volume of the fusion-mass (p = 0.533) in the zoledronic acid groups (groups 1 and 2). The VAS, the ODI, and the SF-36 at the 6-month follow-up after surgery were not significantly different (p > 0.05) among the 4 groups. The VAS, the ODI, and the SF-36 were not correlated with the volume of the fusion-mass (p = 0.120, 0.609, 0.642). CONCLUSIONS: A single dose of zoledronic acid does not decrease the volume of the fusion-mass in patients undergoing spinal fusion with osteoporosis. Therefore, we recommend that zoledronic acid may be used after spinal fusion in osteoporotic patients.

Lumbosacral Fixation Using the Diagonal S2 Screw for Long Fusion in Degenerative Lumbar Deformity: Technical Note Involving 13 Cases

Placing instrumentation into the ilium has been shown to increase the biomechanical stability and the fusion rates, but it has some disadvantages. The diagonal S2 screw technique is an attractive surgical procedure for degenerative lumbar deformity. Between 2008 and 2010, we carried out long fusion across the lumbosacral junction in 13 patients with a degenerative lumbar deformity using the diagonal S2 screws. In 12 of these 13 patients, the lumbosacral fusion was graded as solid fusion with obvious bridging bone (92%). One patient had a rod dislodge at one S2 screw and breakage of one S1 screw and underwent revision nine months postoperatively. So, we present alternative method of lumbopelvic fixation for long fusion in degenerative lumbar deformity using diagonal S2 screw instead of iliac screw.

Management of Tibial Bony Defect with Metal Block in Primary Total Knee Replacement Arthroplasty

PURPOSE: To analyze minimum 2-year clinical and radiological follow-up results of primary total knee replacement arthroplasty (TKRA) with metal block augmentation for tibial bony defect. MATERIALS AND METHODS: We analyzed 67 cases (52 patients) of primary TKRA with metal block augmentation for tibial bony defects from March 1999 and March 2008. Clinical results were evaluated using the Knee Society clinical rating system and the Western Ontario and McMaster University (WOMAC) score. Radiologic results were evaluated using the Knee Society roentgenographic evaluation system. RESULTS: The mean knee score and function score improved from 42.0 and 45.6 preoperatively to 94.5 and 85.4 postoperatively. At last follow-up, the mean WOMAC score was 16.8. The incidence of radiolucent lines was 10% (7 cases) during the follow-up period, but there was no case of progression. There were no statistically significant differences between the groups divided according to the block size (below 5 mm and over 8 mm) and between the stem and no-stem groups for all parameters. CONCLUSIONS: Primary TKRA with a metal block produced satisfactory results for the minimum 2-year follow-up and can be considered as a simple and effective method for the treatment of tibial bony defect in primary TKRA.

The Prophylaxis of Venous Thromboembolism in Korean Patients with Total Knee Replacement Arthroplasty / 대한정형외과학회잡지

PURPOSE: To evaluate the effects and problems of venous thromboembolism (VTE) prophylaxis with a reduced dosage and administration period in Korean total knee arthroplasty (TKA) patients. MATERIALS AND METHODS: We analyzed 135 consecutive TKA patients with three different VTE prophylaxis regimens. Group dalteparin-aspirin (DA) injected dalteparin for the first 2 days, followed by taking aspirin for the next 5 days, Group aspirin (A) was on aspirin and Group dalteparin (D) on dalteparin 7 days postoperatively. We evaluated the incidence of VTE and safety among the 3 groups. RESULTS: Symptomatic deep vein thrombosis was detected in 4 cases (Group DA: 2, Group A: 1, Group D: 1). Pulmonary embolism (PE) was found in 1 case in each group with no fatal PE. Although no major bleeding complications were seen, minor bleeding incidents were detected in 14 cases (Group DA: 2, Group A: 1, Group D: 11), which was significant in Group D. No significant differences were observed in perioperative blood loss, effusion in the knee joint, thigh swelling or oozing on the wound area among the groups except thigh bruising, which developed more frequently in group D. CONCLUSION: The reduced dosage and administration period of VTE prophylactic medicine combined with mechanical prophylaxis for Korean TKA patients showed no fatal PE, but some minor bleeding incidents frequently developed with 7 days of dalteparin injections. We need to adjust the dosage and duration of prophylactic medication deliberately for Korean TKA patients, considering prophylaxis effectiveness and bleeding complication risks.

Subdural Abscess in a Patient with Epidural Abscess Combined with Dural Tear / 대한정형외과학회잡지

Abscesses of the epidural and subdural spine are relatively rare, but can rapidly progress and cause paraplegia; the mortality rate is high despite improvements in treatment method. In particular, the reoccurrence of subdural abscesses after treatment of an epidural abscess is extremely rare. We experienced a case in which the subdural abscess reoccurred after spinal decompression and drainage of an epidural abscess combined with a dural tear. We report this rare case with a review of the relevant literatures.

The Impact on Clinical Results by Sagittal Imbalance in Posterior Fixation for Thoraco-lumbar Burst Fractures

PURPOSE: Evaluate the effects of sagittal imbalance on the clinical outcomes in thoracolumbar burst fractures. MATERIALS AND METHODS: We evaluated 11 patients who had received posterior fixation for unstable burst fractures. Radiologic assessment including the compression ratio, focal kyphotic angle and sagittal balance were obtained. The clinical outcomes were assessed by ODI, VAS and SF-36. We subdivided the patients into sagittal balance and imbalance group, and compared with clinical outcomes. The relationship between radiologic and clinical outcomes was examined using correlation analysis. RESULTS: The radiologic assessment were changed on preoperative and postoperative as follows: mean compression ratio: 15.2%, 4.9%, mean focal kyphotic angle: 43.2degrees, 20.9degrees. The mean sagittal balance was 11.5 cm. The mean score of VAS, ODI, Physical and Mental Component Summary of SF-36 were 3.7, 45.8, 43.3 and 39.8, respectively. The ODI was significantly higher in sagittal imbalance group, and SF-36 was significantly higher in sagittal balance group (p<0.05). The VAS was correlated with compression ratio and focal kyphotic angle. The ODI and Mental Component Summary of SF-36 were correlated with sagittal imbalance. CONCLUSION: Sagittal balance effects on the functions of spine, surgical treatment should be carefully considered with unstable burst fractures.

Vertebroplasty in the Multiple Osteoporotic Compression Fracture / 대한골다공증학회지

Recently, vertebroplasy has been widely used to treat osteoporotic vertebral compression fractures in the elderly. Outstanding results such as immediate pain relief and functional improvement have been achieved using vertebroplasty. However, some elderly patients suffer from multiple osteoporotic compression fractures due to severe osteoporosis. Although treating single- or 2-level osteoporotic spinal compression fractures using vertebroplasty has shown some significant curative effects and results, few reports are available in the management of multiple-level compression fractures. The purpose of this study is to report the cases that brought good clinical results using vertebroplasty to multiple osteoporotic compression fractures, including a review of the relevant literatures.

Analysis of the Adherence in Once Yearly Intravenous Zoledronic Acid / 대한골다공증학회지

OBJECTIVES: We investigated drug adherence of once yearly intravenous bisphosphonate in patients with osteoporosis or osteoporotic fractures, and factors that influence their adherence. MATERIALS AND METHODS: Patients treated with once yearly intravenous bisphosphonate were asked about drug information and drug adherence using questionnaires. Factors related drug adherence were analyzed between non adherence group and adherence group. RESULTS: 65 patients (49.6%) were adherence group, 66 patients (50.3%) were included in non-adherence group. In group 1, were administered mainly due to 'after physicians suggestion' in 22 cases (36.1%) and 'for ease of administration' in 17 cases (27.9%). In group 2, the patients were not readministered mainly due to economic reasons in 21 cases (42%), unconcerning to osteoporosis in 14 cases (28%). CONCLUSIONS: This study shows 'doctor's suggestion' and 'ease of administration' could enhance drug adherence.

Textiloma Ten Years after a Lumbar Discectomy: A Case Report / 대한정형외과학회잡지

A paraspinal foreign body reaction is a rare condition that can cause severe neurological complications or death. However, the condition is often neglected. The authors report a case of a paraspinal textiloma that was diagnosed and treated with a surgical excision.

Comparison of the Results of Resurfacing Versus Non Resurfacing the Patella after Total Knee Arthroplasties in the Same Patient

PURPOSE: The purpose of this study was to compare the clinical results between patellar resurfacing and patellar retention during total knee arthroplasties (TKA) in both sides of the knee from one patient. MATERIALS AND METHODS: A prospective randomized study was performed for 18 patients, who underwent only unilateral patellar resurfacing without any consideration for the condition of the patella cartilage, among the patients who had osteoarthritis and who underwent bilateral TKA from February 2004 to February 2008. The clinical results were compared using the American Knee Society clinical rating system, Feller's patellar score and the Kujala scoring system. RESULTS: The mean of the knee score and the function score were 94.3 and 73.7 postoperatively in the resurfaced patellar side and these values were 91.4 and 73.6, respectively, in the unresurfaced patella side (p=0.07, p=1.00). The Feller's patella scores were 26.5 and 25.3 for each side (p=0.219). The Kujala scores were 71.7 and 69.9, respectively (p=0.086). There was no statistically significant difference between both sides of the knee for all the parameters. CONCLUSION: There were no statistically significant differences between the resurfaced and non-resurfaced knees with comparing them according to the American Knee Society clinical rating system and the patellar evaluation systems. However, further studies are needed to observe whether these results are maintained in the long-term.

Treatment of Combined Degenerative Lumbar Disease and Adjacent Vertebral Fracture / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVE: To analyze the treatment results of vertebroplasty in patients who suffered osteoporotic compression fractures during conservative treatments for pre-existing degenerative lumbar disease. SUMMARY AND LITERATURE REVIEW: Whilst spinal fusion has shown satisfactory clinical results, solid fusion has been reported to accelerate the degenerative changes at the unfused adjacent levels. Therefore, the level of spinal fusion in patients with compression fractures and pre-existing degenerative lumbar disease is controversial. Few studies have evaluated the outcomes of spinal fusion and adjacent segment vertebroplasty. MATERIALS AND METHODS: A retrospective review was carried out on 28 patients who suffered the osteoporotic compression fractures during conservative treatment for pre-existing degenerative lumbar disease. Posterolateral fusion and vertebroplasty were performed for degenerative disease and compression fractures. The average fusion level was 1.82. The mean compressed vertebral bodies were 1.68. The radiology results were evaluated to determine the progression of the compression rate and fractures in the adjacent segment. The clinical results were evaluated using the Denis pain scale for compression fractures and Katz satisfaction scale for degenerative lumbar disease. RESULTS: The average compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at the final follow-up. There was no fracture in the adjacent segment. Clinically, the preoperative Denis score was P3 and P4 in 8 and 20 patients, respectively. On the other hand, the postoperative Denis score was P1, P2 and P3 in 8, 19 and 1 patients, respectively. In regard to degenerative diseases, the overall satisfaction was 82.1%. CONCLUSION: The stability of fracture sites in vertebroplasty of patients with pre-existing lumbar disease was confirmed. However, further compression of the fractured vertebral body was observed after vertebroplasty in long fusion. Therefore, a followup study of more cases will be necessary to confirm the changes in the vertebroplasty site.