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Background@#Spinopelvic fixation (SPF) has been a challenge for surgeons despite the advancements in instruments and surgical techniques. C-arm fluoroscopy-guided SPF is a widely used safe technique that utilizes the tear drop view. The tear drop view is an image of the corridor from the posterior superior iliac spine to the anterior inferior iliac spine (AIIS) of the pelvis. This study aimed to define the safe optimal tear drop view using three-dimensional reconstruction of computed tomography images. @*Methods@#Three-dimensional reconstructions of the pelvises of 20 individuals were carried out. By rotating the reconstructed model, we simulated SPF with a cylinder representing imaginary screw. The safe optimal tear drop view was defined as the one embracing a corridor with the largest diameter with the inferior tear drop line not below the acetabular line and the lateral tear drop line medial to the AIIS. The distance between the lateral border of the tear drop and AIIS was defined as tear drop index (TDI) to estimate the degree of rotation on the plane image. Tear drop ratio (TDR), the ratio of the distance between the tear drop center and the AIIS to TDI, was also devised for more intuitive application of our simulation in a real operation. @*Results@#All the maximum diameters and lengths were greater than 9 mm and 80 mm, respectively, which are the values of generally used screws for SPF at a TDI of 5 mm and 10 mm in both sexes. The TDRs were 3.40 ± 0.41 and 3.35 ± 0.26 in men and women, respectively, at a TDI of 5 mm. The TDRs were 2.26 ± 0.17 and 2.14 ± 0.12 in men and women, respectively, at a TDI of 10 mm. @*Conclusions@#The safe optimal tear drop view can be obtained with a TDR of 2.5 to 3 by rounding off the measured values for intuitive application in the actual surgical field.
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Background@#The commercially available design of a three-dimensional (3D)–printed titanium (3D-Ti) cage can be divided into two types according to the presence of a window: a cage with a window that allows filling of bone graft materials and a non-window cage for stand-alone use. This prospective observational case series study aimed to explore the clinical feasibility of using a nonwindow type 3D-Ti cage in cases of combined window and non-window cage implantation. Furthermore, we evaluated the bone in growth patterns of non-window cages and their correlation with published fusion grading systems. @*Methods@#A total of 31 consecutive patients who underwent single-level posterior lumbar interbody fusion surgery were included. Two 3D-Ti cages with different designs were inserted: a non-window cage on the left side and a window cage on the right side.Radiographic fusion was defined by the segmental angle between flexion and extension radiographs (F-E angle) and cage bridging bone (CBB) scores on computed tomography. The association between the F-E angle and osteointegration scoring system including the surface osteointegration ratio (SOR) score was analyzed. @*Results@#Radiographic fusion was achieved in 27 of 31 patients (87%) at 12 months postoperatively. Among the non-window cages, 23 of 31 (74.2%) had fair SOR scores, while 19 of 31 (61.3%) window cages had fair intra-cage CBB scores. The higher the SOR score was, the smaller the flexion-extension angle (SOR 0 vs. SOR 1: 6.30° ± 2.43° vs. 1.95° ± 0.99°, p < 0.001; SOR 0 vs. SOR 2: 6.03° ± 2.43° vs. 0.99°± 0.74°, p < 0.001). @*Conclusions@#The clinical feasibility of using a non-window 3D-Ti cage during lumbar interbody fusion might be acceptable. Furthermore, a newly suggested fusion criterion for the use of the non-window cage, the SOR score, showed a significant association with the published fusion grading systems, demonstrating its feasibility in determining interbody fusion in lumbar spinal surgery.
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Methods@#In retrospectively collected data, 149 patients who underwent single-level ACDF for degenerative disease were enrolled and divided into non-plating (n=66) and plating (n=83). Interspinous motion (ISM) at the arthrodesis segment, Numeric Rating Scale (NRS) for neck pain, and Neck Disability Index (NDI) were serially evaluated at 3, 6, and 12 months postoperatively. Predictable factors for fusion, including age, sex, plating, diabetes, smoking, and type of grafts, were investigated, and fusion was defined as ISM <1 mm. @*Results@#In both groups, ISM was the highest at 3 months and gradually decreased thereafter, and the plating group showed significantly lower serial ISM than the non-plating group at 12 months. The plating group had lower NRS and NDI scores than the nonplating group at 12 months, and the difference in the NRS scores was statistically significant, particularly at 3 and 6 months, although that of the NDI scores was not. In a multivariate analysis, plating was the most powerful predictor for fusion. @*Conclusions@#Plating significantly decreases the serial ISM compared with non-plating in single-level ACDF, and such decreased motion is correlated with decreased neck pain until 12 months postoperatively, particularly at 3 and 6 months. Given that plating was the most predictive factor for fusion, we recommend plating even in single-level ACDF for better early clinical outcomes.
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Background@#The efficacy and safety of denosumab have been established in a phase 3, randomized, placebo-controlled trial in Korean postmenopausal women with osteoporosis. This postmarketing surveillance study was aimed to investigate the safety and effectiveness of denosumab in Korean real-world clinical practice. @*Methods@#Patients with osteoporosis who had received denosumab per the Korean approved indications in the postmarketing setting between September 2014 and September 2019 were enrolled. The primary endpoint was the incidence of adverse events (AEs) and adverse drug reactions (ADRs). The secondary endpoint was the percent change from baseline in bone mineral density (BMD) of the lumbar spine, total hip, and femoral neck. @*Results@#Of the 3,221 patients enrolled, 3,185 were included in the safety analysis set; 2,973 (93.3%) were female, and the mean± standard deviation (SD) age was 68.9±9.9 years. The mean±SD study period was 350.0±71.4 days. AEs, fatal AEs, and ADRs occurred in 19.3%, 0.8%, and 1.6%, respectively. The most frequent AEs, occurring in >0.5% of patients, were dizziness (0.7%), arthralgia (0.7%), back pain (0.6%), and myalgia (0.6%). Hypocalcemia occurred in 0.3% of patients. There were no cases of osteonecrosis of the jaw and atypical femoral fracture. Mean±SD percent change from baseline in BMD of the lumbar spine, total hip, and femoral neck was 7.3%±23.6%, 3.6%±31.4%, and 3.2%±10.7%, respectively. @*Conclusion@#The safety and effectiveness of denosumab in Korean patients with osteoporosis in this study were comparable with those in the Korean randomized controlled trial, with no new safety findings.
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Proximal junctional problems are among the potential complications of surgery for adult spinal deformity (ASD) and are associated with higher morbidity and increased rates of revision surgery. The diverse manifestations of proximal junctional problems range from proximal junctional kyphosis (PJK) to proximal junctional failure (PJF). Although there is no universally accepted definition for PJK, the most common is a proximal junctional angle greater than 10° that is at least 10° greater than the preoperative measurement. PJF represents a progression from PJK and is characterized by pain, gait disturbances, and neurological deficits. The risk factors for PJK can be classified according to patient-related, radiological, and surgical factors. Based on an understanding of the modifiable factors that contribute to reducing the risk of PJK, prevention strategies are critical for patients with ASD.
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Adolescent idiopathic scoliosis (AIS) has a diagnosis rate of 3% to 5% per year, but the number of cases requiring surgical treatments is very small, accounting for only 0.17% to 1.75% of all AIS patients. Most patients with AIS are diagnosed, treated, and managed in outpatient clinics.Current Concepts: AIS is a disease that occurs more frequently, and progresses faster, in females than in males. Scoliosis deformity can occur due to various causes. To differentially diagnose AIS, it is necessary to perform careful physical examinations, investigate family history, and check for neurological, growth, and developmental abnormalities. Definitive diagnosis of AIS can be performed through radiographic imaging. In the case of atypical curvature and symptoms, examinations such as magnetic resonance imaging could be required in addition to radiographic imaging. Treatment of AIS patients in outpatient clinics can be performed through observation, exercise, and orthosis. The selection and application of treatment methods and the termination period of the treatments are complexly affected by the age at the time of diagnosis; pattern, location and size of the curve; and growth potential.Discussion and Conclusion: AIS is a disease in which good results can be obtained with conservative treatments such as exercise and orthosis, which is generally applied in an outpatient setting. To properly treat AIS, it is necessary to have an in-depth understanding of the characteristics of AIS, timing of treatment, and factors influencing treatment.
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Improved medical care and increased life expectancy have led to a focus on the impact of adult spinal deformity (ASD) on health-related quality of life (HRQoL) in the field of the spine. Recently, there has been a paradigm shift in the evaluation and management of ASD regarding the important correlation between sagittal imbalance and clinical outcomes.Current Concepts: Loss of lumbar lordosis is recognized as a key driver of ASD followed by forward-leaning of the trunk, reducing thoracic kyphosis, pelvic retroversion, and knee flexion. Radiological assessment has been critical for evaluating ASD from the anteroposterior and lateral view of the whole spine radiograph. Important parameters include coronal, regional, global, and sagittal spinopelvic parameters. Especially, sagittal spinopelvic parameters significantly correlate with disability and HRQoL in patients with ASD, which can influence the process of decision-making with respect to the choice between conservative treatment and surgery.Discussion and Conclusion: Sagittal imbalance has been recently emphasized in patients with ASD. Therefore, the decision-making of ASD treatment should be focused on restoring harmonious alignment to prevent catastrophic complications and improvement of HRQoL.
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Methods@#In total, 55 patients with SIFs were retrospectively investigated in this study. The study population was divided into lumbosacral fusion (n=20) and non-fusion (n=35) groups. Subsequently, the patients’ demographic characteristics, comorbidities, medication history, results of diagnostic imaging studies, and bone mineral density were assessed. The fracture patterns were classified either according to the five typical types (H-pattern bilateral vertical plus horizontal component, unilateral vertical only, bilateral vertical only, unilateral vertical plus horizontal component, and horizontal only fracture) or atypical types. @*Results@#In total, 44 of 55 patients (80%) suffered from more than one senile disease and received corresponding medications that caused secondary osteoporosis. A total of 12 patients had S1 lumbosacral fixation. Moreover, three of these 12 patients who developed a SIF immediately after a lumbosacral fracture had an unstable sacral U fracture. The remaining nine patients showed fracture patterns similar to the non-fusion patients. Single-photon emission computed tomography (SPECT)/computed tomography (CT) can identify fracture recurrence in previously healed fractures. In total, 24 patients (43.6%) had fractures of the pelvis, femur, and thoracolumbar spine. @*Conclusions@#SIF develops in elderly patients with multiple adult diseases that can induce secondary osteoporosis. Such fractures may occur in the patients with instrumented lumbosacral fusion. Importantly, some patients showed stress fractures after multilevel instrumented lumbosacral fusion, whereas others showed insufficiency fractures. The different fracture patterns correspond to different grades of SIF, and SPECT/CT can easily identify the fracture status.
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Adult spinal deformity (ASD) is characterized by three-dimensional abnormalities of the thoracic or thoracolumbar spine that exerts significant impacts on the health-related quality of life (HRQoL). With the important effects that deformity of the sagittal plane exerts on the HRQoL, there have been paradigm shifts in ASD evaluation and management. Loss of lumbar lordosis is recognized as a key driver of ASD followed by reducing kyphosis, pelvic retroversion, and knee flexion. The Scoliosis Research Society (SRS)– Schwab classification reflects the sagittal spinopelvic parameters that correlate pain and disability in ASD patients. Although the SRS–Schwab classification provides a realignment target framework for surgeons, a structured patient-specific systemic approach is crucial for the process of decision-making. ASD management should be focused on restoring age-specific harmonious alignment and should consider the comorbidities and risk factors of each patient to prevent catastrophic complications and enhance the HRQoL.
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Adult spinal deformity (ASD) is characterized by three-dimensional abnormalities of the thoracic or thoracolumbar spine that exerts significant impacts on the health-related quality of life (HRQoL). With the important effects that deformity of the sagittal plane exerts on the HRQoL, there have been paradigm shifts in ASD evaluation and management. Loss of lumbar lordosis is recognized as a key driver of ASD followed by reducing kyphosis, pelvic retroversion, and knee flexion. The Scoliosis Research Society (SRS)– Schwab classification reflects the sagittal spinopelvic parameters that correlate pain and disability in ASD patients. Although the SRS–Schwab classification provides a realignment target framework for surgeons, a structured patient-specific systemic approach is crucial for the process of decision-making. ASD management should be focused on restoring age-specific harmonious alignment and should consider the comorbidities and risk factors of each patient to prevent catastrophic complications and enhance the HRQoL.
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OBJECTIVES@#To provide reference data for the study and treatment of thoracic scoliosis.SUMMARY OF LITERATURE REVIEW: There have been no reports on the prevalence of thoracic scoliosis in Korea.@*MATERIALS AND METHODS@#From August 2011 to October 2012, radiographs of patients under 80 years of age who underwent routine chest radiographs were retrospectively reviewed. Based on their age when the chest radiographs were obtained, the patients were divided into 8 groups. The prevalence and angle of the curve of thoracic scoliosis were investigated in each age group, and the prevalence of thoracic scoliosis according to sex, the direction of the curve, number of vertebrae in the major curve, the location and rotation of the apical vertebrae, and osteophyte location were examined.@*RESULTS@#The prevalence of thoracic scoliosis was 2.4% (621 patients), and female patients (3.0%, 375 of 12471) showed a higher prevalence than male patients (1.8%, 246 of 13654) (p<0.001). Right curvature was present in 445 patients and left curvature in 176 patients. In each age group, the prevalence and degree of thoracic scoliosis were 1.1% (14.2°±3.2°), 2.3% (17.4°±7.7°), 2.5% (17.0°±8.9°), 1.9% (15.8°±5.9°), 1.3% (15.5°±6.6°), 2.1% (18.0°±13.6°), 2.9% (14.3°±3.6°), and 6.1% (16.2°±4.8°), respectively. The mean curvature in all scoliosis patients was 16.0°±7.0°. The angle of the curve was significantly different by sex (15.4°±7.1° for males, 16.8°±7.6° for females). The average curve angle of patients with thoracic scoliosis was 16.0°±7.0°, among whom it was 10°–20° in 533 patients, 20°–30° in 64, 30°–40° in 11, and over 40° in 13.@*CONCLUSIONS@#This study could be used as a reference point for the study and treatment of thoracic scoliosis.
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OBJECTIVE: The efficacy of preoperative embolization for hypervascular metastatic spine disease (MSD) such as renal cell and thyroid cancers has been reported. However, the debate on the efficacy of preoperative embolization for non-hypervascular MSD still remains unsettled. The purpose of this study is to determine whether preoperative embolization for non-hypervascular MSD decreases perioperative blood loss.METHODS: A total of 79 patients (36 cases of preoperative embolization and 43 cases of non-embolization) who underwent surgery for metastatic spine lesions were included. Representative hypervascular tumors such as renal cell and thyroid cancers were excluded. Intraoperative and perioperative estimated blood losses (EBL), total number of transfusion and calibrated EBL were recorded in the embolization and non-embolization groups. The differences in EBL were also compared along with the type of surgery. In addition, the incidence of Adamkiewicz artery and complications of embolization were assessed.RESULTS: The average age of 50 males and 29 females was 57.6±13.5 years. Lung (30), hepatocellular (14), gastrointestinal (nine) and others (26) were the primary cancers. The demographic data was not significantly different between the embolization and the non-embolization groups. There were no significant differences in intraoperative EBL, perioperative EBL, total transfusion and calibrated EBL between two groups. However, intraoperative EBL and total transfusion in patients with preoperative embolization were significantly lower than in non-embolization in the corpectomy group (1645.5 vs. 892.6 mL, p=0.017 for intraoperative EBL and 6.1 vs. 3.9, p=0.018 for number of transfusion). In addition, the presence of Adamkiewicz artery at the index level was noted in two patients. Disruption of this major feeder artery resulted in significant changes in intraoperative neuromonitoring.CONCLUSION: Preoperative embolization for non-hypervascular MSD did not reduce perioperative blood loss. However, the embolization significantly reduced intraoperative bleeding and total transfusion in corpectomy group. Moreover, the procedure provided insights into the anatomy of tumor and spinal cord vasculature.
Subject(s)
Female , Humans , Male , Arteries , Hemorrhage , Incidence , Lung , Neoplasm Metastasis , Postoperative Hemorrhage , Spinal Cord , Spine , Thyroid NeoplasmsABSTRACT
OBJECTIVE: The efficacy of preoperative embolization for hypervascular metastatic spine disease (MSD) such as renal cell and thyroid cancers has been reported. However, the debate on the efficacy of preoperative embolization for non-hypervascular MSD still remains unsettled. The purpose of this study is to determine whether preoperative embolization for non-hypervascular MSD decreases perioperative blood loss. METHODS: A total of 79 patients (36 cases of preoperative embolization and 43 cases of non-embolization) who underwent surgery for metastatic spine lesions were included. Representative hypervascular tumors such as renal cell and thyroid cancers were excluded. Intraoperative and perioperative estimated blood losses (EBL), total number of transfusion and calibrated EBL were recorded in the embolization and non-embolization groups. The differences in EBL were also compared along with the type of surgery. In addition, the incidence of Adamkiewicz artery and complications of embolization were assessed. RESULTS: The average age of 50 males and 29 females was 57.6±13.5 years. Lung (30), hepatocellular (14), gastrointestinal (nine) and others (26) were the primary cancers. The demographic data was not significantly different between the embolization and the non-embolization groups. There were no significant differences in intraoperative EBL, perioperative EBL, total transfusion and calibrated EBL between two groups. However, intraoperative EBL and total transfusion in patients with preoperative embolization were significantly lower than in non-embolization in the corpectomy group (1645.5 vs. 892.6 mL, p=0.017 for intraoperative EBL and 6.1 vs. 3.9, p=0.018 for number of transfusion). In addition, the presence of Adamkiewicz artery at the index level was noted in two patients. Disruption of this major feeder artery resulted in significant changes in intraoperative neuromonitoring. CONCLUSION: Preoperative embolization for non-hypervascular MSD did not reduce perioperative blood loss. However, the embolization significantly reduced intraoperative bleeding and total transfusion in corpectomy group. Moreover, the procedure provided insights into the anatomy of tumor and spinal cord vasculature.
Subject(s)
Female , Humans , Male , Arteries , Hemorrhage , Incidence , Lung , Neoplasm Metastasis , Postoperative Hemorrhage , Spinal Cord , Spine , Thyroid NeoplasmsABSTRACT
STUDY DESIGN: A cross-sectional study. OBJECTIVES: To provide reference data for the study and treatment of thoracic scoliosis. SUMMARY OF LITERATURE REVIEW: There have been no reports on the prevalence of thoracic scoliosis in Korea. MATERIALS AND METHODS: From August 2011 to October 2012, radiographs of patients under 80 years of age who underwent routine chest radiographs were retrospectively reviewed. Based on their age when the chest radiographs were obtained, the patients were divided into 8 groups. The prevalence and angle of the curve of thoracic scoliosis were investigated in each age group, and the prevalence of thoracic scoliosis according to sex, the direction of the curve, number of vertebrae in the major curve, the location and rotation of the apical vertebrae, and osteophyte location were examined. RESULTS: The prevalence of thoracic scoliosis was 2.4% (621 patients), and female patients (3.0%, 375 of 12471) showed a higher prevalence than male patients (1.8%, 246 of 13654) (p<0.001). Right curvature was present in 445 patients and left curvature in 176 patients. In each age group, the prevalence and degree of thoracic scoliosis were 1.1% (14.2°±3.2°), 2.3% (17.4°±7.7°), 2.5% (17.0°±8.9°), 1.9% (15.8°±5.9°), 1.3% (15.5°±6.6°), 2.1% (18.0°±13.6°), 2.9% (14.3°±3.6°), and 6.1% (16.2°±4.8°), respectively. The mean curvature in all scoliosis patients was 16.0°±7.0°. The angle of the curve was significantly different by sex (15.4°±7.1° for males, 16.8°±7.6° for females). The average curve angle of patients with thoracic scoliosis was 16.0°±7.0°, among whom it was 10°–20° in 533 patients, 20°–30° in 64, 30°–40° in 11, and over 40° in 13. CONCLUSIONS: This study could be used as a reference point for the study and treatment of thoracic scoliosis.
Subject(s)
Female , Humans , Male , Cross-Sectional Studies , Korea , Osteophyte , Prevalence , Radiography , Radiography, Thoracic , Retrospective Studies , Scoliosis , Spine , Thoracic Vertebrae , ThoraxABSTRACT
STUDY DESIGN: In vitro cell culture model. PURPOSE: To investigate the effects of RNA interference (RNAi) on p75 expression and viability of rat notochordal cells treated with serum deprivation. OVERVIEW OF LITERATURE: RNAi enables the inhibition of specific genes by sequence-specific gene silencing using a double-stranded RNA. METHODS: Notochordal cells were isolated, cultured, and placed in 10% (control) or 0% (apoptosis-promoting) fetal bovine serum (FBS) for 48 hours. The expression of p75, apoptosis, and cell proliferation were determined. To suppress p75 expression, a small interfering RNA (siRNA) was synthesized against p75 (p75 siRNA) and transfected into cells. The suppression of p75 mRNA expression was investigated using the reverse transcription-polymerase chain reaction. The degree of p75 suppression was semiquantitatively analyzed using densitometry. The effect of p75 siRNA on apoptosis and proliferation of cells was determined. Solutions of an unrelated siRNA and transfection agent alone served as controls. RESULTS: Serum deprivation significantly increased apoptosis by 40.3%, decreased proliferation of notochordal cells by 45.3% (both, p<0.001), and upregulated p75 expression. The p75 siRNA suppressed p75 expression in cells cultured in 0% FBS. The rate of suppression by p75 siRNA of p75 mRNA was 72.9% (p<0.001). Suppression of p75 expression by p75 siRNA inhibited apoptosis by 7% and increased proliferation by 14% in cells cultured in 0% FBS (both, p<0.05). CONCLUSIONS: siRNA-mediated suppression of p75 inhibited apoptosis and increased proliferation of notochordal cells under conditions of serum deprivation, suggesting that RNAi might serve as a novel therapeutic approach for disc degeneration caused by insufficient viability of disc cells through the suppression of the expression of harmful genes.
Subject(s)
Animals , Rats , Apoptosis , Cell Culture Techniques , Cell Proliferation , Densitometry , Gene Silencing , In Vitro Techniques , Intervertebral Disc Degeneration , Notochord , RNA Interference , RNA , RNA, Double-Stranded , RNA, Messenger , RNA, Small Interfering , TransfectionABSTRACT
PURPOSE: The causes of rotator cuff tendon tear were excessive overuse, aging process and impingement syndrome and a lot of research of these factors have been performed. But molecular study of cuff tear or apoptosis of rotator cuff tenocyte is not done until now. In this study, the apoptosis level and apoptosis-related gene expression were investigated in the specimens from the torn margin of a rotator cuff tear, and compared with those from normal portion. MATERIALS AND METHODS: Among patients who underwent arthroscopic shoulder surgery between April 2008 to August 2008, 15 patients with complete rotator cuff tear was investigated. These were 10 men and 5 women. The age were from 48 years to 76 years old (average 61.5 years). The contol group were 2 patients with intact subscapularis tendon. Patients with impingement syndrome, partial tear or tendinitis were excluded from the design of the study. Tendon specimen in the tear margin of supraspinatus or infraspinatus tendon was evaluated using Hematoxylin-Eosinophilic stain, TUNNEL assay and immunohistochemistry for p53, Bcl-2, Bax and JNK1 were performed. RESULTS: TUNNEL assay was positive in 5 cases of the 15 specimens. In these cases, 5.4% of the cells were positive. The apoptosis-related gene such as p53, Bcl-2, Bax and JNK-1, and tear size were evaluated. These correlations were evaluated using a correlation analysis of Spearman correlation analysis. Spearman correlation coefficient between apoptosis and bcl-2, and between apoptosis and p53 were 0.625 and 0.71, respectively. These p values were 0.01 and 0.003, respectively. Spearman correlation coefficient between p53 and tear size, and Bax and tear size were 0.58 and 0.76, respectively. These p values were 0.02 and <0.001, respectively. The apoptosis of control group in normal subscapular tendon is zero. CONCLUSION: The increased apopotic index was correlated with increased bcl-2 and p53 gene in Rotator cuff tear patients. The larger tear showed increased p53 and Bax gene expression. Further research in this area will need to reduce apoptosis in the development of the rotator cuff tear.