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Purpose@#The use of absorbable skin staplers (ASS) for skin closure has been increasing due to their convenience and timesaving effect. In this study, we evaluated the effectiveness of ASS in reducing skin closure time and its safety regarding surgical site infection (SSI), comparing it to conventional hand sewing (HS) in patients who underwent mastectomy. @*Methods@#A single-center, retrospective study was conducted. The electronic medical records of patients who underwent mastectomy between July 2015 and June 2020 in Samsung Medical Center were reviewed. The data included previously known risk factors for SSI. We compared the time expended on skin closure and the occurrence rate of SSI between the ASS group and the HS group. @*Results@#We included 4,311 patients in the analysis. Among them, 520 patients were treated with ASS and 3,791 patients with HS. The average time for skin closure was 16.2 ± 10.1 minutes in the ASS group and 36.5 ± 29.0 minutes in the HS group (P 0.999). @*Conclusion@#The use of ASS in mastectomy reduced the time for skin closure significantly but did not increase the SSI. Therefore, it can be an effective and safe choice to use ASS instead of HS for skin closure in mastectomy.
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Purpose@#This study aimed to investigate the differences in sleep disturbance changes between patients receiving two hormone therapies (“tamoxifen plus ovarian function suppression group [T+OFS group]” versus “tamoxifen group [T group]”) and the chronological changes in sleep disturbances in each group. @*Methods@#Premenopausal women with unilateral breast cancer who underwent surgery and were scheduled to receive hormone therapy (HT) with tamoxifen alone or with tamoxifen plus gonadotropin-releasing hormone (GnRH) agonist for ovarian function suppression were included. The enrolled patients wore an actigraphy watch for two weeks and completed questionnaires (insomnia, sleep quality, physical activity [PA], and quality of life [QOL]) at five time points: immediately before HT and 2, 5, 8, and 11 months after HT. @*Results@#Among the 39 enrolled patients (21 and 18 patients in the T+OFS group and T group, respectively), 25 (17 and 8 patients in the T+OFS group and T group, respectively) were finally analyzed. There were no differences between the two groups in time-dependent changes in insomnia, sleep quality, total sleep time, rapid eye movement sleep rate, QOL, and PA;however, the severity of hot flashes was significantly higher in the T+OFS group than in the T group. Although the interaction between group and time was not significant, insomnia and sleep quality significantly worsened at 2–5 months of HT when changes over time were analyzed within the T+OFS group. In both the groups, PA and QOL were maintained without significant changes. @*Conclusion@#Unlike tamoxifen alone, tamoxifen plus GnRH agonist initially worsened insomnia and sleep quality, but gradually improved with long-term follow-up. Patients who initially experience insomnia during tamoxifen plus GnRH agonist administration can be reassured based on the results of this study, and active supportive care may be used during this period.
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Purpose@#Cancer antigen 15-3 (CA15-3) is a serum tumor marker for breast cancer (BC) extensively used in clinical practice. CA15-3 is non-invasive, easily available, and a costeffective tumor marker for immediate diagnosis, monitoring and prediction of BC recurrence. We hypothesized that an elevation of CA15-3 may have prognostic impact in patients with early BC with normal serum CA15-3 level. @*Methods@#This was a retrospective cohort study, which included patients with BC who received curative surgery at a comprehensive single institution between 2000 and 2016.CA15-3 levels from 0 to 30 U/mL were considered normal, and patients who had CA15-3 > 30 U/mL, were excluded from the study. @*Results@#The mean age of study participants (n = 11,452) was 49.3 years. The proportion of participants with elevated CA15-3 ≥ 1 standard deviation (SD) compared with the previous examination during follow-up was 23.3% (n = 2,666). During the follow-up (median followup 5.8 years), 790 patients experienced recurrence. The fully-adjusted hazard ratio (HR) for recurrence comparing participants with stable CA15-3 level to subjects with elevated CA15-3 level was 1.76 (95% confidence interval [CI], 1.52–2.03). In addition, if the CA15-3was elevated ≥ 1 SD, the risk was much higher (HR, 6.87; 95% CI, 5.81–8.11) than in patients without elevated CA15-3 ≥ 1 SD. In sensitivity analysis, the recurrence risk was consistently higher in participants with elevated CA15-3 levels than in participants without elevated CA15-3 levels. The association between elevated CA15-3 levels and incidence of recurrence was observed in all subtypes and the association was stronger in patients with N+ than in patients with N0 stage (p-value for interaction < 0.01). @*Conclusion@#The results of the present study demonstrated that elevation of CA15-3 in patients with early BC and initial normal serum CA15-3 levels has a prognostic impact.
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Purpose@#Based on the results of previous trials, de-escalation of axillary surgery after neoadjuvant chemotherapy (NAC) has increased in patients with axillary lymph node (ALN) metastasis at presentation. This study aimed to review the trends of axillary surgery by time period and molecular subtype in patients with ALN metastasis. @*Methods@#We analyzed the rates of sentinel lymph node biopsy (SLNB) and ALN dissection (ALND) based on time period and subtype. The time period was divided into 3 subperiods to determine the rate of axillary surgery type over time (period 1, from 2009 to 2012; period 2, from 2013 to 2016; and period 3, from 2017 to July 2019). @*Results@#From 2009 to July 2019, 2,525 breast cancer patients underwent surgery. Based on subtype, the ALND rate of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2–) disease decreased by 13.0% from period 1 to period 3 (period 1, 99.4%; period 2, 97.5%; and period 3, 86.4%; P < 0.001). Conversely, the ALND rate in HR+/HER2+, HR–/HER2+, and triple-negative breast cancer (TNBC) significantly decreased by 43.7%, 48.8%, and 35.2% in period 1, period 2, and period 3, respectively (P < 0.001). In the patient group receiving NAC, HR+/HER2– had a significantly higher ALND rate (84.1%) than HR+/HER2+, HR–/HER2+, and TNBC (60.8%, 62.3%, and 70.7%, respectively; P < 0.001). @*Conclusion@#The SLNB rate in patients with ALN metastasis has increased over time. However, the ALND rate in HR+/ HER2– was significantly higher than in other subtypes.
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Purpose@#The GenesWell™ breast cancer test (BCT) is a recently developed multigene assay that predicts the risk of distant recurrence in patients with hormone receptor-positive (HR+) and human epidermal growth factor-2 negative (HER2−) early breast cancer (BC). The ability of this assay to predict the response to neoadjuvant chemotherapy (NACT) has not been established to date. @*Methods@#Biopsy specimens from HR+/HER2− BC patients with axillary lymph node (LN) metastasis who underwent NACT were analyzed using the BCT score. The modified BCT score was developed and patients classified into high-and low-response groups. A total of 88 patients were available for the BCT score among the 108 eligible patients. The median followup duration was 35.9 (7.8–128.5) months. @*Results@#Among them, 61 (65.1%) had cN1 and 53 (60.2%) had cT1 or cT2 disease. The BCT score was low in 25 (28.4%) patients and high in 63 (71.6%). Among the 50 patients with pathologic complete response or partial response, 41 (82.0%) were in the high BCT score group and 9 (18.0%) were in the low BCT score group. Among the 38 patients with stable or progressive disease, 22 (57.9%) were in the high BCT score group and 16 (42.1%) were in the low BCT score group (p = 0.025). Ki-67 before NACT was a significant factor for predicting tumor response (p = 0.006; 3.81 [1.50–10.16]). The BCT score showed a significant response to NACT (p = 0.016; 4.18 [1.34–14.28]). Distant metastasis-free survival was significantly different between the high- and low-response groups (p = 0.004). @*Conclusion@#We demonstrated that the BCT score predicts NACT responsiveness in HR+/ HER2− BC with LN metastasis and might help determine whether NACT should be performed. Further studies are required to validate these results.
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Purpose@#We evaluated the relationship between breast pathologic complete response (BpCR) and axillary pathologic complete response (ApCR) after neoadjuvant chemotherapy (NACT) according to nodal burden at presentation. As the indications for NACT have expanded, clinicians have started clinical trials for the omission of surgery from the treatment plan in patients with excellent responses to NACT. However, the appropriate indications for axillary surgery omission after excellent NACT response remain unclear. @*Methods@#Data were collected from patients in the Korean Breast Cancer Society Registry who underwent NACT followed by surgery between 2010 and 2020. We analyzed pathologic axillary nodal positivity after NACT according to BpCR stratified by tumor subtype in patients with cT1-3/N0-2 disease at diagnosis. @*Results@#A total of 6,597 patients were identified. Regarding cT stage, 528 (9.5%), 3,778 (67.8%), and 1,268 (22.7%) patients had cT1, cT2, and cT3 disease, respectively. Regarding cN stage, 1,539 (27.7%), 2,976 (53.6%), and 1,036 (18.7%) patients had cN0, cN1, and cN2 disease, respectively. BpCR occurred in 21.6% (n = 1,427) of patients, while ApCR and pathologic complete response (ypCR) occurred in 59.7% (n = 3,929) and ypCR 19.4% (n = 1,285) of patients, respectively. The distribution of biologic subtypes included 2,329 (39.3%) patients with hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative disease, 1,122 (18.9%) with HR-positive/HER2-positive disease, 405 (6.8%) with HR-negative/HER2-positive disease, and 2,072 (35.0%) with triple-negative breast cancer . Among the patients with BpCR, 89.6% (1,122/1,252) had ApCR. Of those with cN0 disease, most (99.0%, 301/304) showed ApCR. Among patients with cN1-2 disease, 86.6% (821/948) had ApCR. @*Conclusion@#BpCR was highly correlated with ApCR after NACT. In patients with cN0 and BpCR, the risk of missing axillary nodal metastasis was low after NACT. Further research on axillary surgery omission in patients with cN0 disease is needed.
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Objective@#This study aimed to investigate the impact of baseline values and temporal changes in body composition parameters, including skeletal muscle index (SMI) and visceral adipose tissue area (VAT), measured using serial computed tomography (CT) imaging on the prognosis of operable breast cancers in Asian patients. @*Materials and Methods@#This study retrospectively included 627 Asian female (mean age ± standard deviation [SD], 53.6 ± 8.3 years) who underwent surgery for stage I–III breast cancer between January 2011 and September 2012. Body composition parameters, including SMI and VAT, were semi-automatically calculated on baseline abdominal CT at the time of diagnosis and follow-up CT for post-treatment surveillance. Serial changes in SMI and VAT were calculated as the delta values. Multivariable Cox regression analysis was used to evaluate the association of baseline and delta SMI and VAT values with disease-free survival. @*Results@#Among 627 patients, 56 patients (9.2%) had breast cancer recurrence after a median of 40.5 months. The mean value ± SD of the baseline SMI and baseline VAT were 43.7 ± 5.8 cm2 /m2 and 72.0 ± 46.0 cm2 , respectively. The mean value of the delta SMI was -0.9 cm2 /m2 and the delta VAT was 0.5 cm2 . The baseline SMI and VAT were not significantly associated with disease-free survival (adjusted hazard ratio [HR], 0.983; 95% confidence interval [CI], 0.937–1.031; p = 0.475 and adjusted HR, 1.001; 95% CI, 0.995–1.006; p = 0.751, respectively). The delta SMI and VAT were also not significantly associated with disease-free survival (adjusted HR, 0.894; 95% CI, 0.766–1.043; p = 0.155 and adjusted HR, 1.001; 95% CI, 0.989–1.014; p = 0.848, respectively). @*Conclusion@#Our study revealed that baseline and early temporal changes in SMI and VAT were not independent prognostic factors regarding disease-free survival in Asian patients undergoing surgery for breast cancer.
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Despite its benign nature, chronic subdural hematoma (SDH) can be fatal if surgical intervention is delayed. Here, we report on bilateral chronic SDH in an 84-year-old man who died of duret hemorrhage in the brain stem and ischemia in the occipital and temporal lobes. We discuss the necessity for urgent surgical intervention to treat bilateral chronic SDH, and provide a review of the relevant literature.
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Although the exact etiology of the Andersson lesion (AL) remains unclear, it is known to occur mostly in patients with long-standing ankylosing spondylitis (AS). Among the various theories for the etiology of AL, repetitive trauma and inflammatory causes are the most common. The histopathological appearance of the AL in this report was consistent with that of chronic inflammation without any infection. Pyogenic ALs in the context of AS are extremely rare; to the best of our knowledge, positive cultures of this lesion in bone biopsies have never been reported. Herein, we report a rare case of a pyogenic AL with a positive culture and discuss a relevant review of the literature.
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Most spine surgeons and anesthesiologists believe that the risk of spinal cord injury (SCI) during intubation is mainly due to mechanical compression of the spinal cord due to cervical spine movement in cases of undiagnosed but severe cervical lesions. With this reasoning, difficult intubation, which is more frequently encountered in patients with preexisting cervical diseases, is likely to result in SCI. Several reports have described SCI after non-cervical surgery in patients previously diagnosed with cervical myelopathy and a chronically compressed cervical cord; however, to date, there is less acknowledgement of SCI in patients with undiagnosed cervical myelopathy. Here, we report a painful experience of neurological deterioration that developed immediately after elective lumbar decompressive surgery in a 76-year-old man. The possible mechanism behind these unexpected complications is discussed in a review of the literature.
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Background@#Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). @*Methods@#We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into “uninsured” and “insured” groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. @*Results@#Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38–48] vs. 45 [40–50] years; P < 0.001).Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. @*Conclusion@#IBR rate in patients undergoing TM increased after NHI reimbursement.
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Purpose@#Tumor size and lymph node metastasis are important factors that contribute to the progression of breast cancer. We aimed to analyze the relationship between tumor size and lymph node metastasis molecular subtype and examine the effects of nodal metastasis on overall survival (OS). @*Methods@#We retrospectively reviewed the data of 16,552 patients who underwent breast surgery in Samsung Medical Center between 2000 and 2015. Information on tumor size (largest diameter of the invasive component), number of positive lymph nodes, and molecular subtype were obtained. We constructed a linear regression model to evaluate the relationship between tumor size and lymph node metastasis. To determine the effect of nodal metastasis on OS, we performed a Cox proportional regression analysis with Np/T (number of metastatic lymph nodes [n]/tumor size [cm]). @*Results@#This study included 12,007 patients with a median follow-up of 62 months. The linear regression coefficients were 1.043 for luminal A, 1.024 for luminal B, 0.656 for HER2, and 0.435 for triple-negative breast cancer (TNBC) subtypes. No significant difference was observed in the coefficients between the luminal A and B subtypes (p = 0.797), while all other coefficients showed significant difference. After adjusting for other risk factors, the hazard ratio (HR) of Np/T for each subtype was significant for OS: luminal A (HR, 1.134; 95% confidence interval [CI], 1.097–1.171; p < 0.001), luminal B (HR, 1.049; 95% CI, 1.013–1.086;p = 0.007), HER2 (HR, 1.069; 95% CI, 1.014–1.126; p = 0.013), and TNBC (HR, 1.038; 95% CI, 1.01–1.067; p = 0.008). @*Conclusion@#The incidence of lymph node metastasis differed according to molecular subtype. Luminal types have higher incidence of nodal metastasis than HER2 and TNBC. The HR of Np/T was highest in luminal A subtypes and lowest in TNBC subtypes.
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Purpose@#Restricted shoulder motion is a major morbidity associated with a lower quality of life and disability after axillary lymph node dissection (ALND) in patients with breast cancer.This study sought to evaluate the antiadhesive effect of a poloxamer-based thermosensitive sol-gel (PTAS) agent after ALND. @*Methods@#We designed a double-blind, multicenter randomized controlled study to evaluate the clinical efficacy and safety of PTAS in reducing upper-limb dysfunction after ALND. The primary outcome was the change in the range of motion (ROM) of the shoulder before surgery and 4 weeks after ALND (early postoperative period). Secondary outcomes were shoulder ROM at six months, axillary web syndrome, and lymphedema (late postoperative period). @*Results@#A total of 170 patients with planned ALND were randomly assigned to one of 2 groups (poloxamer and control) and 15 patients were excluded. In the poloxamer group (n = 76), PTAS was applied to the surface of the operative field after ALND. ALND was performed without the use of poloxamer in the control group (n = 79). Relative to the control group, the poloxamer group had significantly lower early postoperative restrictions in total shoulder ROM at four weeks (−30.04 ± 27.76 vs. −42.59 ± 36.79; p = 0.0236). In particular, the poloxamer group showed greater reductions in horizontal abduction at four weeks (−3.92 ± 9.80 vs. −10.25 ± 15.42; p = 0.0050). The ROM of the shoulder at 24 weeks, axillary web syndrome, and lymphedema were not significantly different between the two groups. No adverse effects were observed in either group. @*Conclusion@#We suggest that poloxamer might improve the early postoperative shoulder ROM in patients with breast cancer who have undergone ALND.
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Background@#Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). @*Methods@#We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into “uninsured” and “insured” groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. @*Results@#Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38–48] vs. 45 [40–50] years; P < 0.001).Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. @*Conclusion@#IBR rate in patients undergoing TM increased after NHI reimbursement.
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Purpose@#Tumor size and lymph node metastasis are important factors that contribute to the progression of breast cancer. We aimed to analyze the relationship between tumor size and lymph node metastasis molecular subtype and examine the effects of nodal metastasis on overall survival (OS). @*Methods@#We retrospectively reviewed the data of 16,552 patients who underwent breast surgery in Samsung Medical Center between 2000 and 2015. Information on tumor size (largest diameter of the invasive component), number of positive lymph nodes, and molecular subtype were obtained. We constructed a linear regression model to evaluate the relationship between tumor size and lymph node metastasis. To determine the effect of nodal metastasis on OS, we performed a Cox proportional regression analysis with Np/T (number of metastatic lymph nodes [n]/tumor size [cm]). @*Results@#This study included 12,007 patients with a median follow-up of 62 months. The linear regression coefficients were 1.043 for luminal A, 1.024 for luminal B, 0.656 for HER2, and 0.435 for triple-negative breast cancer (TNBC) subtypes. No significant difference was observed in the coefficients between the luminal A and B subtypes (p = 0.797), while all other coefficients showed significant difference. After adjusting for other risk factors, the hazard ratio (HR) of Np/T for each subtype was significant for OS: luminal A (HR, 1.134; 95% confidence interval [CI], 1.097–1.171; p < 0.001), luminal B (HR, 1.049; 95% CI, 1.013–1.086;p = 0.007), HER2 (HR, 1.069; 95% CI, 1.014–1.126; p = 0.013), and TNBC (HR, 1.038; 95% CI, 1.01–1.067; p = 0.008). @*Conclusion@#The incidence of lymph node metastasis differed according to molecular subtype. Luminal types have higher incidence of nodal metastasis than HER2 and TNBC. The HR of Np/T was highest in luminal A subtypes and lowest in TNBC subtypes.
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Purpose@#Restricted shoulder motion is a major morbidity associated with a lower quality of life and disability after axillary lymph node dissection (ALND) in patients with breast cancer.This study sought to evaluate the antiadhesive effect of a poloxamer-based thermosensitive sol-gel (PTAS) agent after ALND. @*Methods@#We designed a double-blind, multicenter randomized controlled study to evaluate the clinical efficacy and safety of PTAS in reducing upper-limb dysfunction after ALND. The primary outcome was the change in the range of motion (ROM) of the shoulder before surgery and 4 weeks after ALND (early postoperative period). Secondary outcomes were shoulder ROM at six months, axillary web syndrome, and lymphedema (late postoperative period). @*Results@#A total of 170 patients with planned ALND were randomly assigned to one of 2 groups (poloxamer and control) and 15 patients were excluded. In the poloxamer group (n = 76), PTAS was applied to the surface of the operative field after ALND. ALND was performed without the use of poloxamer in the control group (n = 79). Relative to the control group, the poloxamer group had significantly lower early postoperative restrictions in total shoulder ROM at four weeks (−30.04 ± 27.76 vs. −42.59 ± 36.79; p = 0.0236). In particular, the poloxamer group showed greater reductions in horizontal abduction at four weeks (−3.92 ± 9.80 vs. −10.25 ± 15.42; p = 0.0050). The ROM of the shoulder at 24 weeks, axillary web syndrome, and lymphedema were not significantly different between the two groups. No adverse effects were observed in either group. @*Conclusion@#We suggest that poloxamer might improve the early postoperative shoulder ROM in patients with breast cancer who have undergone ALND.
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Although acute intracranial bleeding after burr hole drainage for chronic subdural hematoma (SDH) is rare, it could still occur and is associated with a poor clinical outcome. Although rare, most of them occur immediately or within a few days after drainage, especially in patients who are on antiplatelet drugs or anticoagulants. We report an unusual case of delayed-onset acute SDH that developed 14 days after burr hole drainage of chronic SDH in a 54-year-old man with liver cirrhosis and thrombocytopenia. The possible pathophysiological mechanisms of this rare entity are discussed, and the relevant literature is reviewed.
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Spinal epidural abscess (SEA) is an unusual form of spinal infection. Performing multilevel laminectomies is controversial in cases of extensive SEA considering the long surgical time and mechanical instability. Here, we report the case of an older woman with extensive SEA and poor general condition who was successfully treated with a less invasive treatment, namely skipped laminotomy using a pediatric feeding tube. A 79-year-old woman complained of progressive weakness in both legs, fever, and back pain. An extensive epidural abscess from the T3 to L5 vertebrae was observed on thoracic and lumbar magnetic resonance imaging (MRI). We performed skipped laminotomy at the T8 and T12 levels, and a 5-Fr pediatric feeding tube was advanced from the caudal level toward the rostral area and rostral level toward caudal level into the dorsal epidural space. Subsequently, regurgitation was performed with saline through the pediatric feeding tube at each level. Following this, to further irrigate the unexposed epidural abscess through laminotomy, the epidural space was washed by continuous irrigation, and the irrigation system was maintained for 48 hours.Follow-up MRI performed 3 weeks after the procedure confirmed near complete removal of the abscess in the thoracic spine, with a small residual abscess in the lumbar spine.
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Objective@#To compare the clinical and radiogrincaphic results of a hybrid surgery (HS) and cervical artificial disc replacement (ADR) for contiguous two-level cervical spondylosis. @*Methods@#A total of 56 patients with contiguous two-level degenerative cervical spondylosis who underwent cervical HS and ADR via an anterior approach and completed at least 6 years of follow-up were included in this study. Patients were divided into two groups: group I, comprising 22 patients who underwent ADR, and group II, comprising 34 patients who underwent HS combined ADR and anterior cervical discectomy and fusion using a cage.Clinical outcomes were evaluated based on the visual analog scale (VAS) scores for arm pain, neck disability index (NDI), and modified MacNab criteria. Radiological parameters were assessed by measuring the bone fusion status, cervical range of motion (ROM C2-C7), heterotopic ossification (HO), adjacent segment disease (ASD) incidence, and fused segment height (FSH). @*Results@#The VAS scores and NDI significantly improved in both groups, without significant differences between the groups. The incidences of HO, ROM C2–C7, and FSH were similar between groups, without significant differences. New osteophyte formation and osteophyte enlargement at adjacent segments were more frequently found in the HS group; however, the difference was not significant. @*Conclusion@#Clinical results of this study showed that the clinical efficacy and radiological changes in HS were similar to those of ADR. HS can be an alternative procedure for the treatment of two-level cervical spondylosis
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Objective@#Altered biomechanics and bone fragility can contribute to pedicle screw loosening. This study aimed to evaluate the efficacy of antibiotic-loaded cement augmentation for correcting symptomatic screw loosening as a minimally invasive alternative to open revision surgery. @*Methods@#Ten consecutive patients who underwent percutaneous cement augmentation for pedicle screw loosening were included in this study. Low grade pedicle screw loosening was deemed clinically relevant in cases of continuous back pain with significant radiolucent halo zones at a vertebral level without screw backing out or stripping. We analyzed the screw loosening at the main location of halo formation. All patients were treated by fluoroscopyguided antibiotic-loaded cement augmentation of the loosened pedicle screws. Patient demographics and pre- and postoperative data were also assembled and analyzed. @*Results@#Most (80%) halo formation locations were the inferior type. Augmentation was technically feasible in all but one patient, in whom the procedure was unsuccessful due to access difficulty. This patient ultimately underwent percutaneous screw re-implantation via a different trajectory. The other nine patients in whom cement filling was satisfactory reported significant pain relief at the final follow-up. Moreover, no severe complications such as wound infection or repeated screw loosening occurred during the follow-up period. @*Conclusion@#The most common halo formation location was the inferior type. In cases without access difficulty, antibiotic-loaded cement augmentation for the treatment of low grade pedicle screw loosening can relieve pain and avoid extensive open surgery.