Asymptomatic Cervical or Thoracic Lesions in Elderly Patients who Have Undergone Decompressive Lumbar Surgery for Stenosis

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the prevalence and risk factors of asymptomatic cervical or thoracic lesions in elderly patients who have undergone surgery for lumbar spinal stenosis. OVERVIEW OF LITERATURE: Concurrent multiple spinal lesions have been reported in many studies with a varied prevalence, and described the characteristics of the disease and its treatment options. However, the cervical or thoracic lesions without apparent symptoms in patients with symptomatic lumbar stenosis had not been evaluated. METHODS: A total of 101 elderly patients (aged 65 or more), who had undergone surgery for lumbar spinal stenosis from January 2005 to December 2005, were enrolled in this study. All patients underwent lumbar magnetic resonance imaging (MRI) along with T2-weighted cervical and thoracic sagittal MRI prior to surgery. The concurrent cervical or thoracic lesions were classified according to the disease entity, and the severity of the lesions was graded from grade 0 (no lesion) to grade 4 (any lesion compressing the cord with a signal change). The prevalence of concurrent cervical and thoracic lesions was then analyzed. In addition, the risk factors for the development of concurrent lesions were evaluated, and the risk factors affecting the severity of the concurrent lesion were analyzed individually. RESULTS: Seventy-seven (76.2%) and 30 (29.7%) patients had a concurrent cervical and thoracic lesion, respectively. Twenty-six patients (25.7%) had both a cervical and thoracic lesion. There was a positive correlation between the symptom duration of lumbar stenosis and the prevalence of both cervical (p = 0.044) and thoracic (p = 0.022) lesions. CONCLUSIONS: The incidence of asymptomatic cervical or thoracic lesions is apparently high in elderly patients who have undergone surgery for lumbar spinal stenosis, particularly in those with longer symptom duration. This highlights the need for a preoperative evaluation of the cervical and thoracic spine in these patients.

Chondrosarcoma of the Pelvis following Internal Pelvectomy:Functional and Oncological Results / 대한정형외과학회잡지

PURPOSE: We analyzed the nature of primary chondrosarcoma of the pelvis, along with long-term survival, complications, and functional outcomes. MATERIALS AND METHODS: Twenty-five cases of pelvic chondrosarcoma were enrolled. The average age was 40 (range: 17-69) years. The stage was IB in 5, IIB in 20. All of the 25 cases had underwent internal pelvectomy. Twelve cases had resections involving the acetabulum, while 7 involved the iliac wing and 6 involved the pubic bone. Study points were the reconstructive methods according to the extent of resection and the functional results, complications, local recurrence and the metastasis pattern following the clinical factors affecting long-term survival. RESULTS: The 16-year CDF survival of 25 cases following operation was 78.7%. Three (12%) local recurrences and 3 metastases occurred. The MSTS score of the iliac and pubic resection group was 25.3. Of 12 cases with acetabular resection, 6 had prosthetic arthroplasty, 4 had psuedoarthrosis, 1 had arthrodesis, and 1 had excision. Their overall MSTS score was 19.4. There were 2 infections, 1 flap necrosis, 1 screw failure and 2 hip dislocations. Of 11 cases of a high grade (G3), there were 3 metastases and 1 local recurrence. CONCLUSION: The long-term survival rate was good and the pathologic grade had some correlation with prognosis. Because acetabular reconstructions of any kind may involve serious complications, primary pseudoarthrosis can be regarded as an alternative option.

The Primary Malignant Bone Tumors of Distal Tibia: Comparison between Limb Salvage and Amputation / 대한정형외과학회잡지

PURPOSE: The long term survival and indications of limb salvage surgery for primary malignant bone tumors of the distal tibia were evaluated, and the results of the reconstruction method using a pasteurized autograft alone or a pasteurized autograft and living fibular bone graft composite were examined. MATERIALS AND METHODS: From March 1985 to June 2004, 13 cases were considered eligible. The diagnosis included 9 osteosarcomas, 2 chondrosarcomas, 1 parosteal osteosarcoma, and 1 malignant fibrous histiocytoma of the bone. There was 1 case of stage IB, 1 IIA, and 11 IIB according to the Enneking classification. Each case underwent surgery and 10 cases underwent additional chemotherapy. Six cases underwent a below-knee amputation and 7 cases had limb salvage surgery. The reconstruction methods were pasteurized bone alone (5), an additional living fibula bone graft (1) or a living fibula bone graft alone (1). RESULTS: There was no recurrence or metastasis at the final follow up. The MSTS functional score of the limb salvage group and amputation group were 85% and 82% respectively. Two out of 5 cases of reconstruction with pasteurized bone alone achieved bony union at 6 and 9 months after surgery. The remaining 3 cases showed nonunion and fractures of the pasteurized bone that was followed by an additional living fibula graft (2 cases) and cancellous iliac bone graft (1 case). Two cases of primary living fibula grafts are in the course of healing. CONCLUSION: The prognosis was good. Neurovascular invasion by the tumor and the necessity of a radical soft tissue excision indicated an amputation. There was no difference in the functional outcome between the limb salvage group and amputation group. A reconstruction method using pasteurized bone has bio-mechanical and economical benefits. However, primary additional living fibular bone graft is a promising method.

Hemiarthroplasty performed with Ultrahigh Molecular Weight Polyethylene Liner Composite in a 10 Years Old Child having Osteosarcoma of the Proximal Tibia: A Case Report / 대한정형외과학회잡지

The proximal tibia is the second most common site for primary malignant bone tumors. With the progression of chemotherapy and surgical technique, limb salvage is being accepted as a generalized procedure, even in growing child. But for those children, especially around 10 years, who still have a considerable growth potential, it is difficult to selecting the appropriate prosthesis, except for cases with arthrodesis, and arthroplasty is an unreasonable procedure in many cases. We tried to maintain the mobile joint along with minimal complications, and we designed the hemiarthroplastic technique using the ultrahigh molecular weight polyethylene (UHMWPE) liner, intramedullary nail, bone cement and low heat treated autograft composite. This article present the results of 52 months follow up on this surgical procedure.