Comparison of Clinical Outcomes and Complications of Primary and Revision Surgery Using a Combined Anterior and Posterior Approach in Patients with Adult Spinal Deformity and Sagittal Imbalance

Background@#The purpose of this study was to compare clinical outcomes and complications of primary and revision surgery in patients with adult spinal deformity (ASD) accompanied by sagittal imbalance. Revision surgery has been associated with poor clinical outcomes and increased risk of complications. Previous studies comparing primary versus revision surgery included data for a wide variety of diseases and ages, but few investigated patients with ASD with sagittal imbalance undergoing anterior and posterior combined surgery. @*Methods@#Retrospective cohort analysis of prospectively collected data. We identified 60 consecutive patients with ASD combined with sagittal imbalance who underwent primary or revision surgery; of these, 6 patients were excluded for lack of a minimal 2-year follow-up. Patients’ surgical and radiological data, clinical outcomes, and complications were reviewed. @*Results@#There were 30 patients in the primary group and 24 patients in the revision group. Patient characteristics, including the prevalence of sarcopenia, were similar between the two groups. Pedicle subtraction osteotomy was performed more frequently in the revision group although there was no statistically significant difference between groups. The primary group had more proximal junctional problems, whereas the revision group had more rod breakage (p < 0.05). There were significant improvements in clinical outcomes in both groups when the preoperative and 2-year postoperative values were compared. The Oswestry disability index and visual analog scale score were similar in both groups 2 years postoperatively. @*Conclusions@#Considering the greater pain and disability at the time of the revision procedure, revision patients benefited more from surgery at the 2-year follow-up than the primary surgery patients. Complication rates were similar between the groups except for proximal junctional problems and rod breakage. Therefore, revision surgery should not be avoided in the treatment of ASD patients with sagittal imbalance.

Comparison of Clinical Outcomes and Complications of Primary and Revision Surgery Using a Combined Anterior and Posterior Approach in Patients with Adult Spinal Deformity and Sagittal Imbalance

Background@#The purpose of this study was to compare clinical outcomes and complications of primary and revision surgery in patients with adult spinal deformity (ASD) accompanied by sagittal imbalance. Revision surgery has been associated with poor clinical outcomes and increased risk of complications. Previous studies comparing primary versus revision surgery included data for a wide variety of diseases and ages, but few investigated patients with ASD with sagittal imbalance undergoing anterior and posterior combined surgery. @*Methods@#Retrospective cohort analysis of prospectively collected data. We identified 60 consecutive patients with ASD combined with sagittal imbalance who underwent primary or revision surgery; of these, 6 patients were excluded for lack of a minimal 2-year follow-up. Patients’ surgical and radiological data, clinical outcomes, and complications were reviewed. @*Results@#There were 30 patients in the primary group and 24 patients in the revision group. Patient characteristics, including the prevalence of sarcopenia, were similar between the two groups. Pedicle subtraction osteotomy was performed more frequently in the revision group although there was no statistically significant difference between groups. The primary group had more proximal junctional problems, whereas the revision group had more rod breakage (p < 0.05). There were significant improvements in clinical outcomes in both groups when the preoperative and 2-year postoperative values were compared. The Oswestry disability index and visual analog scale score were similar in both groups 2 years postoperatively. @*Conclusions@#Considering the greater pain and disability at the time of the revision procedure, revision patients benefited more from surgery at the 2-year follow-up than the primary surgery patients. Complication rates were similar between the groups except for proximal junctional problems and rod breakage. Therefore, revision surgery should not be avoided in the treatment of ASD patients with sagittal imbalance.

Clinical and Radiological Outcomes after Various Treatments of Midshaft Clavicle Fractures in Adolescents

Background@#Controversy exists about the optimal treatment of midshaft clavicle fractures in the presence of significant displacement, comminution, or shortening of the fracture in adolescents. The purpose of this study was to compare the clinical and radiological outcomes of 4 different treatments for midshaft clavicle fractures in adolescents: conservative treatment with a figure-of-8 (FO8) brace, open reduction and internal fixation with a plate (OPL), minimally invasive plate osteosynthesis (MIPO), and intramedullary nail fixation with a threaded Steinmann pin (TSP). @*Methods@#A total of 94 teenagers with midshaft clavicle fractures were divided into the FO8, OPL, MIPO, and TSP groups (n = 24, 33, 16, and 21, respectively). We analyzed clinical and radiological outcomes and complications in each group and compared the results among the groups. @*Results@#All groups showed satisfactory clinical and radiological outcomes, but each group showed different results for the assessment items. The Constant-Murley scores were higher in the operated groups than in the FO8 group. Recovery of joint motion was faster in the operated groups. The TSP group had the highest cosmetic satisfaction with respect to the satisfaction score and measured scar length. Fracture union was achieved in all patients. At the final follow-up, the bone length was closer to normal in the OPL and TSP groups than in the FO8 and MIPO groups, and angulation was less in the OPL and TSP groups than in the MIPO and FO8 groups. The TSP and MIPO groups obtained faster bone healing than the OPL and FO8 groups. In the operated groups, 9 patients had metal-induced irritating symptoms; 1, supraclavicular nerve injury symptoms; and 4, refractures after plate removal. @*Conclusions@#The nonoperatively treated group had no iatrogenic complications. The operated groups complained of various disadvantages induced by surgery; however, these groups achieved faster functional recovery and slightly better radiological and functional results than the nonoperative group.

Effect of Auditory and Visual Cues on Gait in Patients with Idiopathic Parkinson's Disease

OBJECTIVE: To examine the effects of auditory and visual cues on gait in patients with idiopathic Parkinson's disease (IPD). METHOD: Patients were 16 persons with IPD, and controls were 14 age-matched healthy persons. Controls were allowed to walk at self-selected gait speed and patients walked at no, auditory and visual cues. Gait parameters were gained, and stride variability were measured at each gait trial. RESULTS: In patients, cadence at visual cues was decreased compared with that of controls, no and auditory cues in the statistics. Walking velocity was decreased in all patients than controls, but there was no difference in each cues. Stri-de length at visual cues was increased compared with that of no and auditory cues, and increased to that of controls. Stride variability was decreased at visual cues compared with that of no and auditory cues, and decreased to that of controls. CONCLUSION: With the use of visual cues in patients with IPD, the cadence was decreased but stride length was increased and stride variability was decreased to the level of controls. Thus, visual cues could be one of the useful method for gait training in patients with IPD.

Gait Analysis in Patients with Idiopathic Parkinson's Disease during Obstacle Crossing

OBJECTIVE: To compare gait parameters of patients with idiopathic Parkinson's disease (IPD) during obstacle crossing with those of healthy control subjects. METHOD: Conventional physical examinations and three- dimensional gait analysis were performed on 16 patients of IPD with stage 2~3 of the Hoehn and Yahr disease rating scale, and 11 healthy control subjects during stepping over the obstacle. Temporospatial, kinematic and kinetic parameters of patients were compared with those of the control group. RESULTS: In patients with IPD, walking velocity was slower and stride length were shorter than control group. Decreased post-obstacle distance of the lead limb and increased pre-swing time of the lead and trail limbs were noted in IPD patients compared to control group. Many significant modifications of kinematic and kinetic parameters were detected in IPD patients compared to control group during obstacle crossing. CONCLUSION: Using three-dimensional gait analysis, we could identify specific modifications of gait parameters in IPD patients during obstacle crossing. These modifications may reduce or increase the risk of a falling in IPD patients.

Bone Mineral Density in Men with Type 2 Diabetes Mellitus

OBJECTIVE: To investigate the association between type 2 diabetes mellitus and bone mineral density (BMD), the relationship between the duration of type 2 diabetes and BMD, and the effect of diabetic microangiopathies on BMD. METHOD: 52 men, aged 55~65 years, with type 2 diabetes and 52 men without diabetes were studied and matched by age and body mass index (BMI). The slit-lamp examinations and the nerve conduction studies were used for diagnosing diabetic retinopathies and diabetic peripheral polyneuropathies, respectively. The densitometric studies were carried out in the L1, L2, L3, L4 and total lumbar vertebra, the femoral necks, the trochanters, and total hips using a DEXA densitometer. RESULTS: Diabetic men had BMDs similar to those of the control group. There is no relationship between the duration of diabetes and BMD. BMDs at the trochanters in subjects with diabetic microangiopathies were reduced in comparison with those without diabetic microangiopathies (p<0.05). CONCLUSION: The densitometric studies may be helpful to diabetic men with microangiopathies, especially with other osteoporotic risks.

Correlations of the Clinical Factors and Gait Parameters in Failed Back Surgery Syndrome

OBJECTIVE: To analyze the relationship of clinical factors and gait parameters of patients with failed back surgery syndrome. METHOD: We investigated 25 male patients with back and /or lower limb pain who underwent lumbar spine operation. The following data were evaluated: clinical symptoms, physical examination, duration from operation to the gait analysis, number and level of operation, Visual Analogue Scales (VAS), modified Dallas pain questionnaire, psychological evaluations (Beck Depression Inventory, BDI) and gait parameters through 3 dimensional gait analysis. RESULTS: Walking velocity was inversely correlated with scores of modified Dallas pain questionnaire and BDI. Stride length was inversely correlated with scores of return to work, neurogenic claudication, VAS, modified Dallas pain questionnaire and BDI. Range of pelvic obliquity was inversely correlated with scores of modified Dallas pain questionnaire and BDI. There was no significant differences between findings of physical exam and gait parameters. CONCLUSION: Results of the gait analysis of patients with failed back surgery syndrome showed significant relationship with clinical factors reflecting psychosocial background of patients.