Relationships among Disability, Quality of Life, and Physical Fitness in Lumbar Spinal Stenosis: An Investigation of Elderly Korean Women

STUDY DESIGN: A cross-sectional, case-control study. PURPOSE: To investigate associations between physical fitness measures and disabilities related to back pain and quality of life (QOL) by the presence of symptomatic lumbar spinal stenosis (LSS) in elderly Korean women. OVERVIEW OF LITERATURE: LSS leads to decreased functioning and reduced QOL. However, correlations among physical fitness, disability, and QOL have not been investigated in elderly women with LSS. METHODS: Participants included women aged 65 years and older (n=192), divided into a study group (n=38) and a control group (n=154) based on the presence/absence of LSS. All participants underwent physical function and fitness tests. Oswestry disability index (ODI) scores and EuroQol five-dimensional questionnaire (EQ-5D-5L) scores were used to assess disability and health-related QOL. RESULTS: The results for the handgrip strength, sit-and-reach, functional reach, and timed up and go (TUG) tests were significantly higher in the control group than the LSS group. ODI scores were significantly higher and EQ-5D-5L scores significantly lower in the LSS group. TUG and functional reach test scores were significantly correlated with ODI scores, and handgrip strength was strongly interrelated with ODI and EQ-5D-5L scores in the LSS group. No other physical fitness measures showed statistically significant relationships with ODI or EQ-5D-5L scores. CONCLUSIONS: In elderly Korean women with LSS, back pain-related disability and QOL are significantly associated with some physical fitness parameters such as handgrip strength. Handgrip strength reflects general muscle strength, which is significantly interrelated with the level of disability and QOL. Our results suggest that enhancing generalized muscle strength helps to reduce disability due to back pain and improve QOL in patients with LSS.

Glomangiopericytoma of the Spinal Cord

Glomangiopericytoma, also referred to as a hemangiopericytoma-like tumor or sinonasal type hemangiopericytoma, is a rare tumor of the nasal cavity and paranasal sinus that has never been reported in the spinal cord. Here, we report a case of a 47-year-old man who developed glomangiopericytoma in the thoracic spine. This lesion showed a heterogeneous high signal intensity compared to the spinal cord on a T2-weighted image and an easily enhanced isointense signal on a T1-weighted image.

Laminoplasty and Recapping Procedure of C7 for Intradural Tumor Excision: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report laminoplasty and recapping procedure of C7 for intradural tumor excision SUMMARY OF LITERATURE REVIEW: Various surgical techniques have been attempted to decrease postoperative axial neck pain. MATERIALS AND METHODS: Kurokawa laminoplasty of C7 was performed. Autogenous bone graft material was harvested from partial T1 laminectomy. Intradural tumor was removed without any complications. Four mini plates were applied at hinge sites of laminoplasty and one lag screw was fixed at the longitudinally splitted lamina of C7. RESULTS: Early range of motion without braces was possible following laminoplasty and recapping procedure. Solid union was achieved at the hinge sites of laminoplasty at the 3-month postoperative follow-up. No instability was observed at the 2-year postoperative followup. The visual analog scale of axial neck pain at the 2-year postoperative follow-up was 2. CONCLUSIONS: Laminoplasty and recapping procedure might be a good option for intradural tumor excision to facilitate early range of motion and decrease postoperative axial neck pain.

Efficacy of a Topical Gelatin-Thrombin Matrix Sealant in Reducing Postoperative Drainage Following Anterior Cervical Discectomy and Fusion

STUDY DESIGN: Retrospective fusion level(s)-, age-, and gender-matched analysis. PURPOSE: To determine whether the application of a topical gelatin-thrombin matrix sealant (Floseal) at the end of anterior cervical discectomy and fusion (ACDF) can reduce the amount of postoperative hemorrhage. OVERVIEW OF LITERATURE: The effect of the matrix sealant in decreasing postoperative hemorrhage following ACDF has not been reported. METHODS: Matrix sealant was (n=116, study group) or was not applied (n=58, control group) at the end of ACDF. Patients were selected by 1:2 matching criteria of fusion level(s), age, and gender. Seven parameters described below were compared between the two groups. RESULTS: The total drain amount for the first 24 hours (8+/-9 versus 27+/-22 mL), total drain amount until the 8-hour drainage decreased to < or =10 mL (8+/-10 versus 33+/-26 mL), and the total drain amount until 6 AM on the first postoperative day (7+/-8 versus 24+/-20 mL) were significantly lower in the study group than the control group (all p<0.001). The time for the 8-hour drainage to decrease to < or =10 mL was significantly lower in the study group (10+/-5 versus 26+/-14 hours, p<0.001). The 8-hour drainage decreased to < or =10 mL on the operation day in most patients (88%) in the study group versus mostly on the first (48%) or second (33%) postoperative day in the control group (p<0.001). The total drain amount until 6 AM on the first postoperative day was 0 mL in 43% of patients in the study group and in 7% in the control group (p<0.001). No patient in either group required hematoma evacuation. CONCLUSIONS: Application of the topical matrix sealant at the end of ACDF can significantly reduce the amount of postoperative hemorrhage.

Total Uncinatectomy Revisited: Revision Surgery for Persistent Radiculopathy Following Anterior Cervical Discectomy and Fusion (ACDF) / 대한정형외과학회잡지

We report on a case involving total en bloc uncinatectomy of C7 without removal of the previously inserted cage, performed on a patient with a history of previous anterior cervical discectomy and fusion without uncoforaminotomy at C5-6-7 who had persistent pain radiating to the upper extremity along with progressive weakness. Satisfactory results were achieved. This procedure should be regarded as an effective option for surgical treatment of persistent or recurrent radiculopathy caused by remaining foraminal stenosis following anterior cervical fusion, and we suggest it as a new indication for this procedure.

Computer-Assisted Spine Surgery (CASS) / 대한정형외과학회잡지

Computer-assisted spine surgery (CASS) is a new discipline involving application of computer engineering and mechanical engineering to spine surgery. The tools used most commonly include preoperative surgical simulation, intraoperative navigation, and robot-assisted surgery. Surgical simulation has been utilized for both clinical and basic research. Navigation in spine surgery has focused on guidance of screw placement, however, due to limited accuracy and high cost, its use is somewhat sparse. CASS may be combined with minimal invasive spine surgery in the near future. Further validation of clinical accuracy issues and surgical outcomes as well as cost-benefit analysis is required.

C2 En Bloc Hemilaminectomy and Recapping Using Laminar Screws: A New Approach to Preserve the C2 Extensor Muscles during Intradural Tumor Resection at the C2 Level: A Technical Report / 대한정형외과학회잡지

Conventional posterior approach for resection of an intradural tumor at C2 involves C2 lamincectomy and detachment of extensor muscles from C2 spinous process. Being major extensors of the cervical spine, the destruction of C2-attached muscles may lead to detrimental consequences, namely, neck pain, limited neck motion, progressive kyphosis, and instability. We report a new technique on exposing and reconstructing the C2 level while preserving C2 extensors for resection of an intradural tumor at C2 level. We performed an en bloc hemilaminectomy of C2 while carefully preserving C2 extensor muscles to adequately expose the dura mater at the C2 level. After removal of the tumor, we proceeded with the reconstruction by recapping the C2 hemilamina using 2 laminar screws.

Myositis Ossificans of the Elbow after a Trigger Point Injection

Trigger point injection is a simple procedure that is widely performed for relieving pain. Even though there are several complications of trigger point injection, myositis ossificans has not been documented as one of its complications. We treated a patient who suffered from painful limitation of elbow motion and this was caused by myositis ossificans between the insertions of brachialis and supinator muscles after a trigger point injection containing lidocaine mixed with saline, and we also review the relevant medical literature.

Heterotopic Ossification Combined with Infection in the Hand: A Case Report

Heterotopic ossification was defined as the formation of mature lamellar bone in soft tissues. Heterotopic ossification of the hand has been rarely reported. Plain radiograghs of a 71-years-old female patient who had denied a definite trauma history showed a diffuse mass with calcified density between the ulnar styloid process and the 5th metacarpal bone of his right hand. Histopathologic assessment revealed heterotopic ossification with acute cellulitis. There was no evidence of recurrence for 3-year follow-up after wide excision.

Minimally Invasive Plate Osteosynthesis of Proximal, Middle and Distal Humerus Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the clinical and radiological outcomes of proximal, middle and distal third humeral fractures treated with the minimally invasive plate osteosynthesis (MIPO). MATERIALS AND METHODS: Thirty-one patients with the proximal, middle or distal third humeral fractures underwent MIPO. There were 12 men and 19 women with an average age of 46.7 years. The radiological outcomes of bony union and anatomical reduction were evaluated. The clinical outcomes were assessed by measuring the range of shoulder and elbow motion, UCLA scores, KSS sores and the postoperative complications. RESULTS: Fracture union was obtained in all patients at an average of 18.4 weeks. According to the UCLA scores, 9 were excellent and 3 were good for the proximal humeral fractures. For the middle and distal third fractures, UCLA scoring system showed excellent results in 15 cases and good results in 4 cases. The average KSS scores of proximal and shaft fracture were 92.5 and 98.6, respectively. Complications developed in 3 patients: one had radial nerve palsy, one had a fracture adjacent to the plate distally, and one had a rotational deformity. CONCLUSION: MIPO for proximal, middle and distal third humeral fractures provided satisfactory clinical and radiological outcomes considering high union rate and minor complications.