Spontaneous Reduction Finding: Magnetic Resonance Imaging Evaluation of Segmental Instability in Spondylolisthesis

STUDY DESIGN: Retrospective chart review. PURPOSE: To assess whether spontaneous reduction of spondylolisthesis, as seen on magnetic resonance imaging (MRI), is related to the degree of segmental instability and low back pain. OVERVIEW OF LITERATURE: The flexion-extension radiographs obtained in the sagittal plane are frequently used when segmental instability of spondylolisthesis is evaluated. METHODS: We retrospectively reviewed 137 patients and measured the differences of the percentage of sagittal translation and sagittal angulation to determine the segmental instability between the flexion and extension radiographs, and the spontaneous reduction on MRI. We then compared the degrees of segmental instability and the degrees of spontaneous reduction. To assess the effect of low back pain on segmental motion in regards to the flexion-extension radiographs, we compared the preoperative visual analogue scales (VAS) score for low back pain between the more and the less spontaneous reduction groups. RESULTS: The mean degree of spontaneous reduction was 5.2%. A statistically significant correlation was found between the sagittal translation on the flexion-extension radiographs and the degree of spontaneous reduction (r = 0.557, p < 0.001) and between the sagittal angulation on the flexion-extension radiographs and the degree of spontaneous reduction (r = 0.215, p = 0.012). The preoperative VAS scores for low back pain of the more spontaneous reduction group and the less spontaneous reduction group were 4.6 and 3.6 points, respectively, and this difference was statistically significant (p = 0.002). CONCLUSIONS: Spontaneous reduction of spondylolisthesis on MRI was found to be closely related to segmental instability, and the degree of spontaneous reduction seen on MRI could be useful for the evaluation of segmental instability in patients with spondylolisthesis, especially with severe low back pain.

The Alignment and Deformity of the Upper Extremity in Hereditary Multiple Exostoses / 대한골관절종양학회지

PURPOSE: This study was aimed to analyze the incidence and the anatomical distributions of HME (Hereditary Multiple Exostoses) on upper limbs and its related change in alignment of the upper limbs in HME patients. MATERIALS AND METHODS: Thirty eight patients who had been diagnosed HME between 2001 and 2009, were categorized into two groups; (1) group A (1-2 involvements); (2) group B (> or =3 involvements). We checked the carrying angle, VAS (Visual Analogue Scale), limitations in daily activities, cosmetic satisfaction according to the number of exostoses invasion. RESULTS: Among the 38 patients, 23 patients (43 cases) had exostoses in the upper limbs. The locations of exostoses in the upper limbs were proximal humerus in 33 cases (30%), distal ulna in 31 cases (28.2%), and distal radius in 24 cases (21.8%). The carrying angle of group A and B was 10.7degrees, 13.8degrees, VAS was 1.3, 3.5, and the limitations in daily activities was 7.3, 6.6 of 8 points. The cosmetic satisfactory cases were 13 and 10 cases, respectively. CONCLUSION: The deformity in upper limbs was observed in 65% of the HME patients. As the number of invasion increases, carrying angle and VAS were increased but limitations in daily activities and cosmetic satisfaction were decreased.

Cervical Facet Cyst Causing Progressive Paraplegia: A Case Report and Review of Literature

STUDY DESIGN: A case report and literature review. OBJECTIVES: To report a patient with a cervical facet cyst causing progressive paraplegia, and to review the clinical features, treatment and outcomes of a cervical facetal cyst. SUMMARY OF LITERATURE REVIEW: Extradural intraspinal synovial cysts of the cervical spine are quite rare. They typically occur in the cervical region at the C1-C2 junction or in the space adjacent to the facet joints in the lower cervical spine, and show similar clinical features to the intervertebral disc protrusion. MATERIALS AND METHODS: This article reports a case of a male patient, 64 years old, who presented with a 2 day history of numbness below the nipple and progressive paraplegia. A physical examination at admission revealed a wheelchair ambulatory state due to a motor deficit (motor grade good) below both hip flexors. Magnetic resonance imaging of the cervical spine showed an extradural lesion with a left lateral extension between C7 and T1, causing spinal cord compression. The patient underwent a hemi-laminectomy of C7 and complete cyst excision through the posterior approach. His motor power improved to almost normal. RESULTS: The patient showed good recovery of myelopathy, and he was able to walk with a cane 3 months after surgery. A 1 year follow-up did not reveal any recurrence or new neurological conditions. CONCLUSION: Cervical facet cysts are rare lesions that are occasionally signaled by progressive paraplegia but can be treated successfully by a surgical excision.

Comparative Study of the In Vivo Stability between a Stable Knee and an Anterior Cruciate Ligament Injured Knee with Using a Navigation System

PURPOSE: We compared the anteroposterior translation and the internal-external rotation of the tibia in stable knees without an anterior cruciate ligament (ACL) injury with those of ACL injured knees by using a navigation system and we report the objective data. MATERIALS AND METHODS: Forty-four patients who were treated for a meniscal tear without ACL injury were allocated to the stable group, and 41 patients were allocated to the ACL injury group. The anteroposterior displacement and the rotation of the knees were measured in 0, 30, 60 and 90 degrees of flexion with using the Orthopilot(R) navigation system. RESULTS: The mean total rotation values were 18.8degrees+/-4.5degrees, 31.4degrees+/-4.2degrees, 30.1degrees+/-5.1degrees and 29.2degrees+/-5.9degrees at 0, 30, 60 and 90 degrees of flexion, respectively, in the stable group and 22.7degrees+/-6.9degrees, 37.6degrees+/-5.8degrees, 34.0degrees+/-9.4degrees and 31.8degrees+/-8.8degrees at 0, 30, 60 and 90 degrees of flexion, respectively, in the ACL injury group. CONCLUSION: The quantitative values for anteroposterior translation and rotations of stable and ACL injured knee were obtained using a navigation system.

The Clinical Results of En Bloc Proximal Fibula Resection for the Treatment of Fibular Head Tumor / 대한정형외과학회잡지

PURPOSE: We retrospectively reviewed cases of en bloc resection of the proximal fibula for the treatment of tumor arising from the fibular head. MATERIALS AND METHODS: Between April 1996 and August 2006, 10 patients who underwent en bloc proximal fibular resection and were followed for at least 12 months were included in this study. The mean age was 27.1 years (range, 5-60 years) and the mean follow-up duration was 64.7 months (range, 12.7-140.6 months). The type of en bloc resection was classified according to the Malaweros resection criteria and the postoperative clinical results were evaluated according to the range of motion, knee joint stability and Musculoskeletal Tumor Society (MSTS) functional scoring system. RESULTS: All patients were able to move the knee joint from 0degrees extension to 145degrees flexion except one patient with flexion contracture of 5degrees. Grade 1 lateral instability of the knee joint was present in two patients. The average MSTS function score was 92.6% (range, 73-100%). There was one patient with lung metastasis who was underwent lobectomy, but there were no patients with local recurrence. CONCLUSION: En bloc resection of the proximal fibula for the treatment of tumors arising from the fibular head is a useful therapeutic method that preserves the knee stability and promotes good functional outcome.

A New Innominate Osteotomy in Legg-Calve-Perthes' Disease / 대한정형외과학회잡지

Purpose: To evaluate the clinical and radiological results of a new innominate osteotomy in Legg-Calve-Perthes' disease (LCPD). Materials and Methods: This study examined 25 hips that were treated with a new innominate osteotomy for LCPD. The treatment involved the anterior half of the ilium being osteomized in a direction of 45degrees to the coronal plane and 30degrees to 45degrees to the sagittal plane, and the posterior half of the ilium being cut using a Gigli saw according to the conventional method. The mean follow-up duration was 5.5 years. Stable interposition of the bone block was achieved using a single biodegradable screw in 8 hips, and without any fixation device in 17 hips. Results: The clinical results according to the criteria of Robinson were good in 20 hips. Twelve hips was graded as good by the Mose method, according to the criteria of Stulberg, 8 hips were included in class I, 6 hips in class II, 8 hips in class III, and 3 hips in class IV. The mean center-edge angle improved from 19.4degrees to 30.2degrees. Conclusion: The new innominate osteotomy is simpler and easier to perform than a routine Salter osteotomy, and satisfactory clinical results can be obtained without fixing the Kirschner wire.

Second-look Arthroscopy after Surgical Treatment for Osteochondral Lesion of Talus: Comparison of Mosaicplasty with Microfracture / 대한족부족관절학회지

PURPOSE: To evaluate the results of mosaicplasty and microfracture after surgical treatments for symptomatic osteochondral lesion of talus (OLT) by second-look arthroscopy. MATERIALS AND METHODS: 7 cases of mosaicplasty and 7 cases of microfracture were reviewed who undertook second-look arthroscopy at 6 months or one year after undertaking mosaicplasty or microfracture for OLT between December 2004 and October 2005. The mean age at first operation was 43.6 years (Range, 20-59) (Mosaicplasty; 43.9 years, Microfracture; 43.4 years). The mean size of cartilage defect was 15.0 x 7.7 mm in mosaicplasty and 7.1 x 6.6 mm in microfracture. Clinical outcomes were evaluated by Freiburg ankle score. Cartilage healing state was evaluated by Insall's classification for chondromalasia during second-look arthroscopy. RESULTS: By the Freiburg ankle score, 9 ankles (6 in mosaicplasty, 3 in microfracture) had excellent and 5 (1 in mosaicplasty, 4 in microfracture) had good results at the times of second-look arthroscopy. By Insall's classification, consistency of the osteochondral grafts and congruity between grafts and native cartilage (Grade I) were shown in 9 (6 ankles in mosaicplasty, 3 ankles in microfracture), a fissuring (Grade II) in one ankle of mosaicplasty, a fasciculation (Grade III) in one ankle of microfracture, and partial exposure of subchondral bone (Grade IV) in 3 ankles of microfractures. CONCLUSION: Mosaicplasty was more excellent in consistency and hardness of cartilage than microfracture. In some cases of microfracture, cartilage healing was incomplete at 6 months postoperatively, so second-look arthroscopy is necessary to identify. If incomplete cartilage healing was shown, additional procedure such as microfracture or mosaicplasty was needed.