ABSTRACT
Purpose@#With the increasing incidence of recompression fractures after vertebroplasty or kyphoplasty, this study analyzed the risk factors that affect the occurrence of recompression vertebral fractures, such as cement distribution, existence of avascular necrosis (Kummell’s disease), type of procedures, bone mineral density, sex, and age. @*Materials and Methods@#Two hundred and thirty-eight patients who underwent vertebroplasty or kyphoplasty at the author’s clinic from 2005 to 2015 were enrolled in this study. The patients were divided into four groups according to the distribution of injected cement. The patients were classified as type 1 and type 2 when injected cement was contacted only to the upper or lower endplate of the body respectively. They were classified as type 3 when both the upper and lower endplates were contacted by injected cement. When neither the upper nor the lower endplate was contacted, the patients were called type 4. This study statistically evaluated the effects of the risk factors, including the cement distribution on the incidence of recompression vertebral fracture after vertebroplasty or kyphoplasty. @*Results@#There were 59 cases (24.8%) of recompression fracture after vertebroplasty or kyphoplasty, among the 238 cases. According to the analysis, the recompression of the vertebral body after vertebroplasty or kyphoplasty occurred more often when the compression fracture was accompanied by osteonecrosis at the body (p<0.05). The patients who had injected cement distributed at both upper and lower plate simultaneously (type 3) had a lower incidence of recompression fracture of the vertebral body after vertebroplasty or kyphoplasty (p=0.008). In addition, the kyphoplasty group had a lower incidence of recompression after the procedure than vertebroplasty group (p=0.02). @*Conclusion@#Careful attention should be given to these patients with osteonecrosis at the compression fracture level through a preoperative evaluation. In addition, if the injected cement does not contact both the upper and lower endplates, careful observation is required during the follow-up period based on the high incidence of vertebral recompression fractures proven through this study. Further technical and biomechanical research and efforts will be needed to make the cement contact both endplates.
ABSTRACT
A hemiarthroplasty with biologic resurfacing of the glenoid is one procedure that can be performed in young patients where total shoulder arthroplasty may be difficult. The authors introduced two cases in which this procedure was performed. This approach is one treatment option for young glenoid humeral arthritis patients that addresses some of the shortcomings of an isolated hemiarthroplasty.
ABSTRACT
A hemiarthroplasty with biologic resurfacing of the glenoid is one procedure that can be performed in young patients where total shoulder arthroplasty may be difficult. The authors introduced two cases in which this procedure was performed. This approach is one treatment option for young glenoid humeral arthritis patients that addresses some of the shortcomings of an isolated hemiarthroplasty.
ABSTRACT
PURPOSE: To evaluate the effectiveness of posterior lumbar interbody fusion (PLIF) using a single cage and unilateral posterolateral fusion (PLF) with local bone, and to compare the clinical and radiological results with those of posterolateral lumbar fusion (PLF) with autologous iliac bone. MATERIALS AND METHODS: Fifty patients with single segment degenerative lumbar disease were treated with spinal fusion. Twenty six patients, who underwent PLIF with single cage and local bone without autologous iliac bone, were classfied as the "cage group". The other 24 patients, who underwent PLF using autologous iliac bone, were classified as the "PLF group". The fusion rate, lumbar lordortic angle, segmental angle, and intervertebral disc height were compared in the radiograph between the two groups. The clinical outcomes were evaluated by the Oswestry Disability Index. Statistical analysis was performed using a T-test and Chi-Square test. RESULTS: The bony fusion rate was 80.8% in the cage group and 83.3% in the PLF group. The intervertebral disc height was restored better in the cage group, but there was no statistical difference between the two groups (p=0.10). Average intraoperative blood loss was similar in the two groups (565 ml in the cage group vs 567 ml in the PLF group). The average operation time was longer in the cage group but the difference was not significant (146.7 min vs 134 min). In the PLF group, 22 patients experienced pain at the iliac graft donor site in the early postoperative period that persisted for more than 6 months in 5 patients. CONCLUSION: PLIF using a single cage and local bone for single segment degenerative lumbar disease produced satisfactory bony fusion with none of the donor site morbidity at the iliac bone.
Subject(s)
Humans , Intervertebral Disc , Postoperative Period , Spinal Fusion , Tissue Donors , TransplantsABSTRACT
PURPOSE: The usefulness of fast spin-echo MR imaging for the diagnosis of meniscal tear of the knee is amatter of debate. The purpose of this study was to evaluate the accuracy of diagnosis of meniscal tears by fastspin-echo MR imaging and the role of gadolinium enhancement. MATERIALS AND METHODS: Between October 1994 andDecember 1996, 68 consecutive patients with arthroscopically proven meniscal tears participated in this study. AllMR examinations performed on a 1.5-T MR imager with an extremity knee coil. All patients underwent sagittal andcoronal MR imaging, using a fast spin-echo sequence with echo train length(ETL) 8. Sagittal and coronal fatsuppressed T1-weighted MR images were obtained after gadolinium infusion. RESULTS: In 68 cases ofarthroscopically-proven meniscal tears, MR sensitivity to tear was 93% (63/68) for fast spin-echo alone and 96%(65/68) for combined fast spin-echo and fat-suppressed gadolinium enhanced T1-weighted MR images. MR sensitivityto medial meniscus tear was 98% (40/41) for fast spin-echo alone and 98% (40/41) for combined fast spin-echo andfat-suppressed gadolinum-enhanced T1-weighted MR images. MR sensitivity to lateral meniscus tear was 85% (23/27)for fast spin-echo alone and 93% (25/27) for combined fast spin-echo and fat-suppressed gadolinium-enhancedT1-weighted MR images. CONCLUSION: Fast spin-echo MR imaging with adequate imaging parameters is suitable for thediagnosis of meniscal tears, and additional fat-suppressed gadolinium-enhanced T1-weighted MR imaging may increasediagnostic sensitivity to such tears.