The Role of Calcium Pyrophosphate Dihydrate Deposition in the Postoperative Outcome of Lumbar Spinal Stenosis Patients

STUDY DESIGN: Retrospective study.PURPOSE: This study aimed to investigate the association of surgical intervention with clinical and quality of life (QoL) outcomes in patients who underwent posterior spinal surgery for lumbar spinal stenosis (LSS) with spinal calcium pyrophosphate dihydrate deposition (SCPPD) versus that in those who underwent the surgery for LSS without SCPPD.OVERVIEW OF LITERATURE: Calcium pyrophosphate (CPP)-associated arthritis is one of the most common types of arthritis. The clinical outcomes are well studied in CPP-associated arthritis of the appendicular joints. However, few studies have investigated SCPPD.METHODS: A single-institution database was reviewed. LSS patients were categorized as those who did and did not have SCPPD, based on histologic identification. Clinical presentations and postoperative results were analyzed. Disability and QoL were assessed using the Oswestry Disability Index (ODI) and the 36-item Short-Form Health Survey.RESULTS: Thirty-four patients were enrolled, with 18 patients being allocated to the SCPPD group and 16 being allocated to the non- SCPPD group. Preoperative and postoperative pain scores were not significantly different between the groups (p=0.33 and p=0.48, respectively). The average preoperative ODI score in the SCPPD group was slightly higher than that in the non-SCPPD group (57 vs. 51, p=0.33); however, the postoperative ODI score was significantly lower (15 vs. 43, p=0.01). The postoperative physical function, vitality, and mental health of the SCPPD patients were also significantly improved (p=0.03, p=0.022, and p=0.022, respectively).CONCLUSIONS: Surgical intervention resulted in good clinical outcomes in SCPPD patients. As per our findings, total removal of CPPinvolved tissue is unnecessary. As such, surgery should be performed as indicated according to clinical presentation without considering the presence of CPPD.

Vocational and avocational activities after traumatic spinal cord injury.

Vocational and avocational activities of the thoracic and lumbar level of the spinal cord injury patients admitted at the Orthopaedic Department, Siriraj Hospital, were studied. Fifty-five patients from the total of 78 answered the questionnaire. The vocational ability was found in 29.1 percent (16/55 patients) : 8 persons worked for the whole day, 5 persons did half-day work and 3 persons did less than a half-day work. The reasons for not working were disability, the condition of the working place and lack of transportation ; 32, 18 and 15 percent respectively. There were significant differences in the income and severity of diseases between the two groups (people who can work and can’t work) with p value of 0.0006 and 0.007. Sixty-nine percent of patients had avocational activities and the most favorite activity was reading. Modification of the working place or the job and improvement of public transportation system should be performed in order to increase the number of working peoples.

The efficacy of simple aspiration and manipulation for carpal ganglion.

One hundred and three cases of carpal ganglion were treated by simple aspiration and manipulation with one year of follow up. The success rate was 72 percent. Therefore, these procedures may provide an alternative choice of initial treatment rather than immediately starting with a complicated procedure.