Early Rehabilitation after Total Mastectomy and Immediate Reconstruction with Tissue Expander Insertion in Breast Cancer Patients: A Retrospective Case-control Study / 한국유방암학회지

PURPOSE: To prevent surgical site complications, many plastic surgeons use the so-called “conventional protocol,” which immobilizes the shoulder and upper arm for 1 month after reconstruction. In an effort to improve the shoulder mobility of patients who received immediate breast reconstruction with tissue expander insertion (TEI), we introduced an early rehabilitation protocol with a short-term immobilization period of 2 weeks. This study aims to compare this early rehabilitation exercise program with the conventional protocol and to determine factors affecting shoulder mobility and quality of life of patients after immediate breast reconstruction. METHODS: A total of 115 patients with breast cancer who underwent reconstructive surgery were retrospectively reviewed. For patients who underwent reconstruction before January 2017, the conventional protocol was followed with immobilization of their shoulder for over 4 weeks. Patients who underwent reconstruction after January 2017 were educated to undergo a self-exercise program after a short-term immobilization period of 2 weeks. We compared shoulder mobility, pain, quality of life, and complications at postoperative 1 and 2 months between the groups. RESULTS: Patients who received early rehabilitation showed greater shoulder flexion and abduction range at postoperative 1 month than those who received the conventional protocol. This increased shoulder abduction range continued until postoperative 2 months. There were no significant surgical site problems in both groups during the 2 months of follow-up. CONCLUSION: To enhance the recovery of shoulder mobility, early rehabilitation with a shorter immobilization period should be recommended to patients with breast cancer undergoing reconstruction surgery with TEI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03541161

Surgical Treatment of Osteoporotic Vertebral Fracture with Neurologic Deficits in Thoracolumbar Junction: Comparative Analysis of the Results According to the Surgical Methods / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the clinical and radiological results of different surgical methods in osteoporotic vertebral fracture patients, with neurologic deficits in the thoracolumbar junction. SUMMARY OF LITERATURE REVIEW: Various surgical methods have been reported for osteoporotic vertebral fractures, with neurologic deficits, in the thoracolumbar junction. These are: anterior decompression, anterior decompression and anterior or posterior reconstruction, and Egg shell procedure. However, it is controversial as to which method is better. MATERIALS AND METHODS: 13 patients that had undergone surgical treatment for osteoporotic vertebral fractures, with neurologic deficits, With a mean age of 68+/-8.4, ranging from 51 to 79 years. Six of the cases were male and seven were female. The mean follow up period was 18 months. The patients were divided into two groups. Group A (n=8): Anterior decompression, anterior interbody fusion, with cage or autologous strut iliac bone block, and instrumentation (anterior or posterior). Group B (n=5): Posterior decompression and posterior reconstruction (egg shell procedure). The kyphotic angles, neurologic improvements and complications in each group were analyzed preoperatively, postoperatively and at final follow up. RESULTS: In group A, the mean kyphotic angles were 29+/-5.9 degrees, 18+/-6.7 degrees and 23+/-7.7 degrees preoperatively, postoperatively and at the final follow up, respectively. In group B, the mean kyphotic angles were 31+/-1.1 degrees, 12+/-6.3 degrees and 18+/-5.5 degrees preoperatively, postoperatively and at the final follow up, respectively. In group A, 3 and 5 patients were graded as Frankel grades C and D, respectively. In group B, 1, 1 and 3 patients were graded as Frankel grades B, C and D, respectively. The neurological status improved in all the patients, by mean 1.1 grades in group A and 1.2 grades in group B. In group A, postoperative transient dyspnea and screw loosening occurred in one and two patients, respectively. In group B, postoperative paralytic ileus and screw loosening occurred in one two patients, respectively. CONCLUSIONS: Posterior decompression and posterior reconstruction (egg shell procedure) was an effective surgical method, equivalent to an anterior or anterior and posterior procedure, for osteoporotic vertebral fracture patients, with neurologic deficits.

Surgical Treatment of Osteoporotic Vertebral Fracture with Neurologic Deficits in Thoracolumbar Junction: Comparative Analysis of the Results According to the Surgical Methods / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the clinical and radiological results of different surgical methods in osteoporotic vertebral fracture patients, with neurologic deficits in the thoracolumbar junction. SUMMARY OF LITERATURE REVIEW: Various surgical methods have been reported for osteoporotic vertebral fractures, with neurologic deficits, in the thoracolumbar junction. These are: anterior decompression, anterior decompression and anterior or posterior reconstruction, and Egg shell procedure. However, it is controversial as to which method is better. MATERIALS AND METHODS: 13 patients that had undergone surgical treatment for osteoporotic vertebral fractures, with neurologic deficits, With a mean age of 68+/-8.4, ranging from 51 to 79 years. Six of the cases were male and seven were female. The mean follow up period was 18 months. The patients were divided into two groups. Group A (n=8): Anterior decompression, anterior interbody fusion, with cage or autologous strut iliac bone block, and instrumentation (anterior or posterior). Group B (n=5): Posterior decompression and posterior reconstruction (egg shell procedure). The kyphotic angles, neurologic improvements and complications in each group were analyzed preoperatively, postoperatively and at final follow up. RESULTS: In group A, the mean kyphotic angles were 29+/-5.9 degrees, 18+/-6.7 degrees and 23+/-7.7 degrees preoperatively, postoperatively and at the final follow up, respectively. In group B, the mean kyphotic angles were 31+/-1.1 degrees, 12+/-6.3 degrees and 18+/-5.5 degrees preoperatively, postoperatively and at the final follow up, respectively. In group A, 3 and 5 patients were graded as Frankel grades C and D, respectively. In group B, 1, 1 and 3 patients were graded as Frankel grades B, C and D, respectively. The neurological status improved in all the patients, by mean 1.1 grades in group A and 1.2 grades in group B. In group A, postoperative transient dyspnea and screw loosening occurred in one and two patients, respectively. In group B, postoperative paralytic ileus and screw loosening occurred in one two patients, respectively. CONCLUSIONS: Posterior decompression and posterior reconstruction (egg shell procedure) was an effective surgical method, equivalent to an anterior or anterior and posterior procedure, for osteoporotic vertebral fracture patients, with neurologic deficits.

A Comparative Analysis of Sagittal Spinal Balance in 100 Asymptomatic Young and Older Aged Volunteers / 대한척추외과학회지

STUDY DESIGN: A radiological analysis of the sagittal balance in younger and older aged volunteers. OBJECTIVES: To determine the normal range of the sagittal spinal alignment, and define significant spinopelvic compensations over the hip axis for the sagittal balance with aging. SUMMARY OF LITERATURE REVIEW: Normative data of the sagittal spinal alignment has wide variation and limited clinical usefulness. In addition, the extent to which the "normal"sagittal spinal contour changes with aging remains unknown. MATERIALS AND METHODS: Inclusion criteria were an age between 20 and 29 years (n=50), group A, and between 55 and 65 years (n=50), group B, for the asymptomatic subjects. Measurements made on the standing lateral radiographs included the following: thoracic kyphosis, lumbar lordosis and sagittal vertical axis. In addition, measurements of the sacropelvic translation, spinopelvic balance, pelvic incidence, pelvic tilting and sacral slope were made. RESULTS: The average thoracic kyphosis was 24 degrees, ranging from 3 to 42 degrees, in group A, and 33 degrees, ranging from 9 to 53 degrees, in group B (p0.05). The C7 plumb line, on average, fell 15.4 mm more anteriorly to the posterosuperior corner of S1 in group B than in group A (p<0.05). The anterior positioning of the C7 was also positively correlated with decreasing lordosis (p<0.001). The average sacropelvic translation was -41mm, ranging from -76 to 20 mm, and -48 mm, ranging from -76 to -17 mm, in groups A and B, respectively (p<0.05). The average spinopelvic balance was -57 mm, ranging from -104 to -4 mm, and -49 mm, ranging from -101 to -3 mm, in groups A and B, respectively. The C7 plumb line fell posterior to the hip axis in all cases. The average pelvic incidence was 46 degrees, ranging from 30 to 61 degrees, and 54 degrees, ranging from 28 to 76 degrees, in groups A and B, respectively (p<0.05). The average pelvic tilt was 14 degrees, ranging from 4 to 33 degrees, and 19 degrees, ranging from 3 to 37 degrees, in groups A and B, respectively (p<0.05). The average sacral slope was 32 degrees, ranging from 17 to 47 degrees, and 35 degrees, ranging from 25 to 50 degrees, in groups A and B, respectively (p<0.05). There was significant correlation between pelvic incidence and lumbar lordosis (p<0.001). CONCLUSIONS: The sagittal spinal balance is maintained by spinopelvic compensations over the hip axis with aging, and sacropelvic parameters over the hip axis are important for the evaluation of the sagittal spinal balance.

A Comparative Analysis of Sagittal Spinal Balance in 100 Asymptomatic Young and Older Aged Volunteers / 대한척추외과학회지

STUDY DESIGN: A radiological analysis of the sagittal balance in younger and older aged volunteers. OBJECTIVES: To determine the normal range of the sagittal spinal alignment, and define significant spinopelvic compensations over the hip axis for the sagittal balance with aging. SUMMARY OF LITERATURE REVIEW: Normative data of the sagittal spinal alignment has wide variation and limited clinical usefulness. In addition, the extent to which the "normal"sagittal spinal contour changes with aging remains unknown. MATERIALS AND METHODS: Inclusion criteria were an age between 20 and 29 years (n=50), group A, and between 55 and 65 years (n=50), group B, for the asymptomatic subjects. Measurements made on the standing lateral radiographs included the following: thoracic kyphosis, lumbar lordosis and sagittal vertical axis. In addition, measurements of the sacropelvic translation, spinopelvic balance, pelvic incidence, pelvic tilting and sacral slope were made. RESULTS: The average thoracic kyphosis was 24 degrees, ranging from 3 to 42 degrees, in group A, and 33 degrees, ranging from 9 to 53 degrees, in group B (p0.05). The C7 plumb line, on average, fell 15.4 mm more anteriorly to the posterosuperior corner of S1 in group B than in group A (p<0.05). The anterior positioning of the C7 was also positively correlated with decreasing lordosis (p<0.001). The average sacropelvic translation was -41mm, ranging from -76 to 20 mm, and -48 mm, ranging from -76 to -17 mm, in groups A and B, respectively (p<0.05). The average spinopelvic balance was -57 mm, ranging from -104 to -4 mm, and -49 mm, ranging from -101 to -3 mm, in groups A and B, respectively. The C7 plumb line fell posterior to the hip axis in all cases. The average pelvic incidence was 46 degrees, ranging from 30 to 61 degrees, and 54 degrees, ranging from 28 to 76 degrees, in groups A and B, respectively (p<0.05). The average pelvic tilt was 14 degrees, ranging from 4 to 33 degrees, and 19 degrees, ranging from 3 to 37 degrees, in groups A and B, respectively (p<0.05). The average sacral slope was 32 degrees, ranging from 17 to 47 degrees, and 35 degrees, ranging from 25 to 50 degrees, in groups A and B, respectively (p<0.05). There was significant correlation between pelvic incidence and lumbar lordosis (p<0.001). CONCLUSIONS: The sagittal spinal balance is maintained by spinopelvic compensations over the hip axis with aging, and sacropelvic parameters over the hip axis are important for the evaluation of the sagittal spinal balance.