When is the Optimal Time Point for Predicting the 1-Year Follow-up Outcome of Selective Nerve Root Block for Cervical Radiculopathy?

OBJECTIVES@#In the current study, we aimed to (1) evaluate the early and late therapeutic effects of selective nerve root block (SNRB) for cervical radiculopathy, and (2) to determine the optimal time point for predicting the long-term effectiveness of cervical SNRB.SUMMARY OF LITERATURE REVIEW: Although SNRB is an important option for cervical radiculopathy, various studies of cervical SNRB have failed to specify its efficacy, especially long-term effectiveness.@*MATERIALS AND METHODS@#We retrospectively enrolled 35 patients with cervical radiculopathy who were regularly followed-up for at least 1 year after SNRB. Clinical outcomes were evaluated using a visual analogue scale (VAS) for pain intensity and the modified Kim's method for patient satisfaction at regular follow-up intervals. In the correlation analysis, stepwise multiple linear regression was used to identify selected and unselected factors.@*RESULTS@#The average VAS score decreased over time (p<0.05); the values just before the injection and at 1 week, 3 weeks, and 1 year of follow-up were 6.11, 3.29, 2.89, and 1.37, respectively. In the stepwise multiple regression analysis, the 1-week VAS score was related to the initial VAS score, the 3-week VAS score was related to the 1-week VAS score, and the last VAS score was related to the 3-week VAS score and symptom duration before the injection. The degree of satisfaction at the 1-year follow-up point was significantly associated with the 3-week VAS score (p=0.011).@*CONCLUSIONS@#The current study showed that pain intensity at the 3-week time point after cervical SNRB might be the optimal time point for predicting long-term effectiveness.

When is the Optimal Time Point for Predicting the 1-Year Follow-up Outcome of Selective Nerve Root Block for Cervical Radiculopathy?

STUDY DESIGN: Retrospective study. OBJECTIVES: In the current study, we aimed to (1) evaluate the early and late therapeutic effects of selective nerve root block (SNRB) for cervical radiculopathy, and (2) to determine the optimal time point for predicting the long-term effectiveness of cervical SNRB. SUMMARY OF LITERATURE REVIEW: Although SNRB is an important option for cervical radiculopathy, various studies of cervical SNRB have failed to specify its efficacy, especially long-term effectiveness. MATERIALS AND METHODS: We retrospectively enrolled 35 patients with cervical radiculopathy who were regularly followed-up for at least 1 year after SNRB. Clinical outcomes were evaluated using a visual analogue scale (VAS) for pain intensity and the modified Kim's method for patient satisfaction at regular follow-up intervals. In the correlation analysis, stepwise multiple linear regression was used to identify selected and unselected factors. RESULTS: The average VAS score decreased over time (p<0.05); the values just before the injection and at 1 week, 3 weeks, and 1 year of follow-up were 6.11, 3.29, 2.89, and 1.37, respectively. In the stepwise multiple regression analysis, the 1-week VAS score was related to the initial VAS score, the 3-week VAS score was related to the 1-week VAS score, and the last VAS score was related to the 3-week VAS score and symptom duration before the injection. The degree of satisfaction at the 1-year follow-up point was significantly associated with the 3-week VAS score (p=0.011). CONCLUSIONS: The current study showed that pain intensity at the 3-week time point after cervical SNRB might be the optimal time point for predicting long-term effectiveness.

Efficacy of Open Debridement and Polyethylene Exchange in Strictly Selected Patients with Infection after Total Knee Arthroplasty

PURPOSE: To assess the efficacy of open debridement and polyethylene exchange (ODPE) combined with proper antibiotic therapy in strictly selected patients with infection after total knee arthroplasty (TKA) and analyze factors associated with treatment failure. MATERIALS AND METHODS: From January 2010 to January 2014, 25 cases that underwent ODPE under the diagnosis of infection within four weeks after TKA or acute hematogenous infection within five days of symptom onset were reviewed in this study. RESULTS: Treatment was successful in 22 out of 25 cases (88.0%). Factors associated with failure were accompanying infection (periprosthetic infection in the ipsilateral foot, cervical parotid abscess, and masticator space abscess) and diagnosis of rheumatoid arthritis (RA) before TKA. Resistant bacteria did not entail a risk. On clinical results, the mean postoperative Lysholm score and Korean Knee score were 81.4 and 79.4, respectively, the knee range of motion was 115.4°±12.9°, and duration of hospitalization was 32.3±8.4 days. On radiographic results, 3.47±1.56 mm joint line elevation and a valgus change of 0.61°±2.35° in knee alignment were observed. CONCLUSIONS: ODPE combined with appropriate antibiotics therapy could be a useful treatment method for infection after TKA if the procedure is performed within a symptom duration of five days or less in the absence of accompanying infection in patients whose indication for TKA was not RA.

Significance of Coronal Proset Magnetic Resonance Imaging to Detect Hidden Zone of the Mid-Zone Stenosis in the Lumbar Spine and Morphometric Analysis of the Mid-Zone Stenosis

STUDY DESIGN: Retrospective exploratory imaging study. PURPOSE: To investigate the significance of the coronal magnetic resonance imaging (MRI) using Proset technique to detect the hidden zone in patients with mid-zone stenosis by comparing with conventional axial and sagittal MRI and to explore the morphologic characteristic patterns of the mid-zone stenosis. OVERVIEW OF LITERATURE: Despite advancements in diagnostic modalities such as computed tomography and MRI, stenotic lesions under the pedicle and pars interarticularis, also called the mid-zone, are still difficult to definitely detect with the conventional axial and sagittal MRI due to its inherited anatomical peculiarity. METHODS: Of 180 patients scheduled to undergo selective nerve root block, 20 patients with mid-zone stenosis were analyzed using MRI. Characteristic group patterns were also explored morphologically by comparing MRI views of each group after verifying statistical differences between them. Hierarchical cluster analysis was performed to classify morphological characteristic groups based on three-dimensional radiologic grade for stenosis at all three zones. RESULTS: At the mid-zone, the stenosis of grade 2 or more was found in 14 cases in the coronal image,13 cases in the sagittal image, and 9 cases in the axial image (p<0.05). Especially, mid-zone stenosis was not detected in six of 20 cases at the axial images. At the entrance and exit-zone, coronal image was also associated with more accurate detection of hidden zone compared to other views such as axial and sagittal images. After repeated statistical verification, the morphological patterns of hidden zone were classified into 5 groups: 6 cases in group I; 1 case in group II; 4 cases in group III; 7 cases in group IV; and 2 cases in group V. CONCLUSIONS: Coronal MRI using the Proset technique more accurately detected hidden zone of the mid-zone stenosis compared to conventional axial and sagittal images.

Treatment of Fused Knee Flexion and Valgus Deformity Using Gradual Correction with Ilizarov Frame / 대한정형외과학회잡지

Various surgical methods including soft tissue procedures and bone procedures are commonly used to treat knee flexion and contracture deformity. However, several complications such as, neurovascular injury and skin necrosis were reported because of rapid correction. We aim to report good results from gradual correction using Ilizarov following supracondylar osteotomy in a 24-year-old man suffering from fused knee flexion and valgus deformity, a complication developed by septic arthritis.

A Two-Stage Approach to Primary Total Knee Arthroplasty in Recurrent Septic Arthritis / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the usefulness of a two-stage approach to primary knee arthroplasty with recurrent septic arthritis. MATERIALS AND METHODS: We studied 22 patients with recurrent septic arthritis, and we observed them for more than one year of follow-up survey from January 2005 to April 2012 at Yeungnam University Medical Center. The clinical assessment was performed following Knee Society knee score, Knee Society function score, and International Knee Documentation Committee Score (IKDC) subjective assessment. In addition, we analyzed the causative organisms, significant medical comorbidities (diabetes mellitus), period up to primary knee arthroplasty, and radiologic assessment with reference to disease prognosis. RESULTS: The average range of postoperative knee motion showed a good result, with an average of 115degrees. Knee Society knee score improved from 23.5 to 81.0, and Knee Society function score also increased from 22.5 to 73.2. Subjective assessment by IKDC was divided into 15 normal patients and 7 nearly normal patients. No significant difference was observed between patients with causative organisms and those with diabetes mellitus. In the final follow-up survey, recurrence of infection was not reported. CONCLUSION: A two-stage approach to primary knee arthroplasty with recurrent septic arthritis is a useful method, because it showed good clinical and radiologic results and favorable subjective assessment.