Long-term follow-up after vertebroplasty - A mean 10-years follow-up control study.

Objectives: To evaluate the clinical 10 year outcome of patients treated with percutaneous vertebroplasty for vertebral compression fractures and to determine the incidence of new fractures in this time interval, as well as the mortality of the patients who underwent this procedure. Methods: All patients undergoing vertebroplasty for vertebral compression fractures between May 2007 until July 2008 were prospectively followed up at 10 years postoperatively. Patients were assessed for radiologic outcome and self-reported outcome parameters (PROs). Gathered parameters remained unmodified to the initial ones analyzing QoL improvement (EQ5D 3L and NASS score) and pain alleviation (VAS, NRS). Mortality was defined as an additional endpoint. Exclusion criteria include additional instrumentation, use of additional devices such as kyphoplasty balloons/stentoplasty, cognitive impairment, insufficient radiological documentation or absent re-consent. Results: Of 280 patients who underwent vertebroplasty, 49 (17.5%) were available for re-assessment with a mean follow-up of 10.5 years (9.9-11.1). Thirty patients (10.7%) were assessed clinically and radiologically, 16 (5.7%) in written form and three (1.1%) by phone only. A total of 186 (66.4%) died during the follow up period. Out of the remaining 45 patients, 27 patients declined participation, eight couldn't participate due to cognitive impairment, four had insufficient radiologic documentation. Six patients were lost to follow-up. At 10 years, patients reported a consistently improved quality of life (EQ-5D; p < 0.01) and global satisfaction. Vertebroplasty demonstrated a substantial and enduring effect on alleviating back pain over 10 years (p < 0.001). 26 (53%) patients experienced a new fracture since the initial procedure. Conclusion: A decade following vertebroplasty, patients continue to demonstrate a quality of life and pain level comparable to short and medium-term assessments, with a significant difference from baseline measurements. More than half (53%) of the patients participating at last follow-up experienced new fractures during this interim period. The cohort as a whole has been impacted by an elevated mortality rate over the time period.

Case report: C1/2 rotational instability progressing to extreme subaxial hyperkyphosis in an adolescent with severe catatonia.

Introduction: Autism spectrum disorder (ASD) is characterized by deficits in social communication, repetitive behaviors, and can be accompanied by a spectrum of psychiatric symptoms, such as schizophrenia and catatonia. Rarely, these symptoms, if left untreated, can result in spinal deformities. Research question and case description: This case report details the treatment of a 16-year-old male ASD patient with catatonic schizophrenia and mutism, presenting with neck pain, left-rotated torticollis, and fever. MRI revealed atlantoaxial rotational instability and spinal cord compression from a dislocated dens axis. After inconclusive biopsies, empirical antibiotics, hard collar and halo fixation treatment, persistent instability necessitated C1/2 fusion. The ongoing catatonia was addressed with electroconvulsive therapy. Concurrently, he developed severe subaxial hyperkyphosis. The report examines the decision-making between conservative and surgical management for an adolescent with significant psychiatric comorbidity and progressive spinal symptoms against a backdrop of uncertain etiology. Materials and methods: A case report and review of the literature. Results: Posterior C1-C7 stabilization was successfully executed, effectively restoring cervical sagittal alignment, which was maintained throughout a two-year follow-up. Concurrently, the catatonia resolved. Discussion and conclusion: To our knowledge, this is the third reported case of severe cervical deformity associated with fixed posture in a psychiatric patient. This case report emphasizes the critical importance of multidisciplinary collaboration in managing the interplay between neuropsychiatric disorders and severe spinal deformities. It showcases the practicality and efficacy of surgical intervention for persistent cervical deformity in pediatric schizophrenia patients, highlighting the necessity for a comprehensive risk-benefit analysis.

Return to sports/activity level after 360° thoracolumbar fusion after burst fractures in young patients.

Introduction: Traumatic thoracolumbar burst fractures are the most common spinal injuries and the proper treatment is controversial. In central Europe in particular, these fractures are often treated with minimally invasive anterior-posterior reduction and fusion, whereas a conservative approach is preferred in the USA. Independent of the treatment strategy, no data exists regarding the outcome related to return to activity level/sport. Research question: The aim of this study was to evaluate the return to sports and activity levels after 360° fusion in patients with thoracolumbar burst fractures without neurological deficits. Methods: Between January 2013 and December 2022, 46 patients aged 18 to 40 years underwent partial or complete vertebral body replacement in the thoracolumbar region due to traumatic burst fractures without neurologic deficit as an isolated injury. Patients were contacted retrospectively by phone calls to assess their activities using a modified version of the Tegner activity scale at different time points: Before trauma, 3, 6, and 12 months post-surgery. Results: After applying exclusion criteria, data collection was complete for 28 patients. The median modified Tegner activity scale was 5.4 before sustaining the fracture, declined to 2.9 at three months post-trauma, improved to 4.2 at six months, and reached 5.0 at 12 months. The majority (83%) of patients achieved their pre-accident activity level within 12 months. No significant differences were observed between patients with partial or complete corpectomy. Conclusion: This is the first study assessing return to sports/physical activity based on the modified Tegner scale in young patients undergoing 360° fusion for spinal burst fractures. The majority of patients (83%) return to the pre-injury activity level within 12 months after surgery.

Transoral unilateral lag screw osteosynthesis for coronal split fracture of the lateral mass of the atlas - case report, operative technique and review of the literature.

Introduction: Atlas ring fractures, which account for 1.3% of all spinal fractures, are predominantly managed conservatively. However, in certain cases, surgical treatment may be necessary depending on the type of fracture, degree of comminution, fracture location, and associated ligamentous injuries. Surgical stabilization frequently results in a posterior C1-2 or C0-2 fusion, which restricts movement, particularly craniocervical rotation. Coronal split fractures of the lateral mass need to be reduced and fixed due to dislocation, instability and secondary osteoarthritis. The preferred treatment approach involves internal fixation of the reduced fracture fragments, while avoiding restriction of the upper cervical spine's range of motion (ROM). Research question: Is unilateral anterior transoral lag screw for treatment of unstable coronal split fracture of lateral mass of the atlas feasible and a safe treatment option? Case Report Material and Methods: We report on a 55-year-old female suffering from polytrauma with multiple spinal and extremity injuries. Results: A coronal split fracture of the lateral mass of the atlas was treated minimally invasive with a transoral lag screw technique to reduce and fix the fracture that has a tendency for fracture gap widening. Stable fixation and fracture union and thus restoration of function was achieved. Discussion and conclusion: Transoral lag screw osteosynthesis for coronal split fracture of the lateral mass of the atlas is a potential treatment option in selected cases to preserve mobility in the upper cervical spine after spinal trauma.

Is increased trapezial slope a cause of early trapeziometacarpal osteoarthritis?

OBJECTIVES: Thumb carpometacarpal joint osteoarthritis is one of the most common forms of osteoarthritis in the hand. The underlying causes are multifactorial. We investigated whether increased trapezial slope could be a causal factor. MATERIAL AND METHODS: We measured trapezial slope and 1st metacarpal slope in 37 patients with early thumb carpometacarpal joint osteoarthritis and compared results with 41 patients without osteoarthritis, using computer-supported 3D-analysis based on CT scans. RESULTS: There was a significant intergroup difference in trapezial slope (111° in patients with osteoarthritis, and 107° in patients without) and in 1st metacarpal slope (17° versus 14°). CONCLUSION: Steeper trapezial slope seemed to be a risk factor for thumb carpometacarpal joint osteoarthritis. Therefore, correction of trapezial slope by trapezium osteotomy could be a valuable surgical approach in early thumb carpometacarpal joint osteoarthritis.

Subtrochanteric osteotomy in the management of femoral maltorsion results in anteroposterior malcorrection of the greater trochanter: computed simulations of 3D surface models of 100 cadavers.

AIM: The purpose of this study was to investigate the greater trochanter's (GT) behaviour in simulated subtrochanteric osteotomy. MATERIALS AND METHODS: Measurement of functional and anatomical femoral torsion, and position of the GT and lesser trochanter was performed using 3-dimensional (3D) surface models of 100 cadaveric femora. Femoral torsion between 2° and 22° was defined as normal, femora with <2° and >22° of femoral torsion were assigned to the low- and high-torsion group. Subtrochanteric osteotomy was simulated to normalise torsional deformities to 12°. RESULTS: With subtrochanteric osteotomy, functional torsion was simultaneously corrected while adjusting anatomical torsion (R2 = 0.866, p < 0.001). Compared to the normal-torsion group, an anteroposterior (AP) overcorrection of ±0.5 centimetres (range 0.02-1.1 cm) of the GT resulted in the high- and low-torsion group, respectively (p < 0.001): Mean AP GT distance to a standardised coronal plane was 2.1 ± 0.3 cm (range 12-30 cm) in the normal-torsion group compared to 1.61 ± 0.1 cm (range 1.4-1.71 cm) and 2.6 ± 0.6 cm (range 1.8-3.6 cm) for the corrected high and low-torsion groups, respectively. The extent of the GT shift in AP direction correlated strongly with the extent to which anatomical femoral torsion was corrected (R2 = 0.946; p < 0.001). CONCLUSIONS: Subtrochanteric osteotomy for femoral maltorsion reliably adjusts anatomical and functional torsion, but also results in a ±1 cm AP shift of the GT per 10° of torsional correction. However, this effect of the procedure is most likely not clinically relevant in relation to hip abductor performance.

Flexor hallucis longus hypertrophy secondary to Achilles tendon tendinopathy: an MRI-based case-control study.

PURPOSE: The purpose of this study was to outline an indirect sign of advanced Achilles tendinopathy on magnetic resonance imaging (MRI), based on the hypothesis that these patients would present with secondary hypertrophy of the flexor hallucis longus muscle (FHL). METHODS: MRI scans of Achilles tendon were analyzed retrospectively in two cohorts. The study group consisted of consecutive patients presenting with clinical signs of Achilles tendinopathy and no previous surgeries, while the control group were patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4-5 cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the FHL muscle. Ratios (FHL/TS) were calculated for area (Ar) and diameter (Dm) measurements. Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both ratios to assess potential cutoff points to differentiate between the groups. RESULTS: A total of 60 patients for each study group were included. Both ratios Ar(FHL/TS) and Dm(FHL/TS) showed significant higher values in the tendinopathy group (p < 0.001). There were strong to very strong intraclass correlation coefficients (ICC = 0.75-0.93). A diameter ratio Dm (FHL/TS) of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy. CONCLUSION: In our patient cohort, FHL hypertrophy was observed in patients with Achilles tendinopathy as a possible compensatory mechanism. Measuring a diameter ratio Dm(FHL/TS) of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.

Evaluation of transient-evoked otoacoustic emissions in a healthy 1 to 10 year pediatric cohort in Sub-Saharan Africa.

OBJECTIVE: Transient-evoked otoacoustic emissions (TEOAEs) monitor cochlear function. High pass rates have been reported for industrialized countries. Pass rates in low and middle income countries such as Sub-Saharan Africa are rare, essentially lower and available for children up to 4 years of age and frequently based on hospital recruitments. This study aims at providing additional TEOAE pass rates of a healthy Sub-Saharan cohort aged 1-10 years with data from Gabon, Ghana and Kenya. Potentially confounding factors (recruitment site, age) are taken into consideration. METHODS: Healthy children were recruited in hospitals, schools and kindergartens. Inclusion criteria were age 1-10 years and normal otoscopic findings. Exclusion criteria were any sickness or physical ailment potentially impairing the hearing capacity. Five measurements per ear were performed with Capella Cochlear Emission Analyzer (MADSEN, Germany). An overall wave reproducibility of above 60% served as pass-criterion. Pass rates were compared between recruitment sites and age groups (1-5 and 6-10 years). RESULTS: Overall pass rate was 87.5% (n = 264; 231 passes vs. 33 fails). Of these 84.0% of hospital recruited children passed (n = 156; 131 passes vs. 25 fails), compared to 92.6% of community recruitments (n = 108; 100 passes vs. 8 fails), which was significantly different p = 0.039). If analyzed by age groups, this difference was only observed in children younger than 6 years (p = 0.007). CONCLUSION: Hospitals as recruitment sites for healthy controls seem to affect TEOAE pass rates. We advise for a cautious approach when recruiting healthy TEOAE control collectives under the age of 6 in a hospital setting. In children older than 6 years conventional pure-tone audiometry remains the standard method for hearing screening.

Severe malaria in children leads to a significant impairment of transitory otoacoustic emissions--a prospective multicenter cohort study.

BACKGROUND: Severe malaria may influence inner ear function, although this possibility has not been examined prospectively. In a retrospective analysis, hearing impairment was found in 9 of 23 patients with cerebral malaria. An objective method to quickly evaluate the function of the inner ear are the otoacoustic emissions. Negative transient otoacoustic emissions are associated with a threshold shift of 20 dB and above. METHODS: This prospective multicenter study analyses otoacoustic emissions in patients with severe malaria up to the age of 10 years. In three study sites (Ghana, Gabon, Kenya) 144 patients with severe malaria and 108 control children were included. All malaria patients were treated with parental artesunate. RESULTS: In the control group, 92.6 % (n = 108, 95 % confidence interval 86.19-6.2 %) passed otoacoustic emission screening. In malaria patients, 58.5 % (n = 94, malaria vs controls p < 0.001, 95 % confidence interval 48.4-67.9 %) passed otoacoustic emission screening at the baseline measurement. The value increased to 65.2 % (n = 66, p < 0.001, 95 % confidence interval 53.1-75.5 %) at follow up 14-28 days after diagnosis of malaria. The study population was divided into severe non-cerebral malaria and severe malaria with neurological symptoms (cerebral malaria). Whereas otoacoustic emissions in severe malaria improved to a passing percentage of 72.9 % (n = 48, 95 % confidence interval 59-83.4 %) at follow-up, the patients with cerebral malaria showed a drop in the passing percentage to 33 % (n = 18) 3-7 days after diagnosis. This shows a significant impairment in the cerebral malaria group (p = 0.012 at days 3-7, 95 % confidence interval 16.3-56.3 %; p = 0.031 at day 14-28, 95 % confidence interval 24.5-66.3 %). CONCLUSION: The presented data show that 40 % of children have involvement of the inner ear early in severe malaria. In children, audiological screening after severe malaria infection is not currently recommended, but is worth investigating in larger studies.

Release of intracranial pressure leads to improvement of otoacoustic emissions--a case report of a Kenyan child with complicated tuberculous meningitis.

Intracranial pressure usually is measured with invasive techniques. The usability of transient evoked otoacoustic emissions as non-invasive approach has been evaluated only once by Frank et al. This article presents the case of a Kenyan boy with tuberculous meningitis and an active malresorptive hydrocephalus. At this stage, the otoacoustic emissions did show very low correlations. After releasing pressure, the otoacoustic emissions improved significantly. This case report points out the possible usability of otoacoustic emissions in intracranial pressure monitoring.