Comparison between O-arm Navigation and Conventional Fluoroscopic Guidance in Corrective Posterior Fixation for Cervical Spinal Injury.

Purpose : To compare the effectiveness of O-arm navigation with that of conventional fluoroscopic guidance in corrective posterior fixation for cervical spinal injury. Methods : This retrospective comparative study involved 11 consecutive patients who underwent corrective posterior fixation using O-arm navigation or conventional fluoroscopy for cervical spinal injury between February 2016 and May 2021. Patient-specific characteristics (age and sex), number of screws, number of pedicle screws, accuracy of pedicle screw insertion, number of vertebral bodies fixed, operating time, and length of hospital stay were analyzed using the t-test. A P-value < 0.05 was considered statistically significant. Results : Corrective posterior fixation was performed under O-arm navigation in 5 patients and under conventional fluoroscopic guidance in 6. A significantly greater number of pedicle screws was used in the O-arm group (6.4 vs 2.7, P = 0.046). According to the Neo classification for pedicle screw placement, there were no grade 2 or 3 breaches. No other items showed a significant difference between the groups (P > 0.05). Conclusion : O-arm navigation can improve the accuracy of cervical pedicle screw insertion. Its introduction could expand the indications for use of pedicle screws in posterior fixation of cervical spinal injury beyond those that are possible using conventional fluoroscopy. J. Med. Invest. 69 : 273-277, August, 2022.

Magnetic Resonance Imaging Findings and Clinical Outcomes in the Early Postoperative Period after Full Endoscopic Diskectomy for Lumbar Disk Herniation.

INTRODUCTION: This prospective case-control study aimed to establish the normal spectrum of early magnetic resonance imaging (MRI) findings in patients whose symptoms resolve after full endoscopic diskectomy (FED). We examined the changes in postoperative MRI findings and their relation to early clinical symptoms. METHODS: In total, 33 patients underwent FED under local anesthesia. Clinical assessments and MRI examinations were performed preoperatively and immediately (within 1 week) and late (at 3 and 12 months) postoperatively. Residual disk bulging after surgery was classified into four grades compared with preoperative MRI findings: none (grade A), <25% (grade B), 25-75% (grade C), and >75% (grade D). RESULTS: MRI at postoperative week 1 showed grade B residual disk bulging in 9 patients, grade C residual disk bulging in 8 patients, and grade D residual disk bulging in 16 patients. Improvement was seen at postoperative month 3 (grade A in 18 patients, grade B in 10 patients, and grade C in 5 patients) and at postoperative month 12 (grade A in 29 patients, grade B in 3 patients, and grade C in 1 patient). Visual analog scale scores and the Japanese Orthopaedic Association scores showed significant differences at 1 week, 3 months, and 12 months after surgery. CONCLUSION: Postoperative MRI findings within 1 week of FED showed grade C or D residual disk material in 24 of 33 patients (73%). Clinical symptoms improved in the early postoperative period, even though residual disk bulging was present. Persisting residual bulging in the early stage following surgery may not correlate with clinical symptoms.

An Elite Triathlete with High-grade Isthmic Spondylolisthesis Treated by Lumbar Decompression Surgery without Fusion.

The patient was a 48-year-old female recreational triathlete who had been experiencing mild low back pain since high school. She had recently developed right leg pain and had gradually worsening difficulty in running. She preferred to undergo spinal surgery without fusion so that she could return to triathlons as soon as possible, and she was referred to our hospital. Plain radiographs showed Meyerding grade 3 isthmic spondylolisthesis at L5 and a slipped L5 vertebral body. Selective nerve root block at L5 relieved the right leg pain temporarily. The final diagnosis was right L5 radiculopathy due to compression by the ragged edge of the L5 pars defect from the posterior side and by the upside-down foraminal stenosis at L5-S1. An L4-L5 partial laminectomy was performed with resection of the ragged edge and one-third of the caudal pedicle at L5. Adequate decompression was achieved by exposing the L5 spinal nerve root from the branch portion to the outside of the L5 pedicle. The right leg pain disappeared postoperatively and she returned to participating in triathlons. One year after surgery, there was slight radiographic progression of the slip in 5 mm; however, there had been no recurrence of the right leg pain. Several studies have reported excellent outcomes after decompression surgery in patients with isthmic spondylolisthesis. To our knowledge, this is the first report of successful lumbar decompression surgery without fusion for high-grade isthmic spondylolisthesis in a triathlete, although in short-term results.

Consecutive double-level lumbar spondylolysis successfully treated with the double "smiley face" rod method.

We report a case of double-level lumbar spondylolysis at L4 and L5 that was successfully treated with the double "smiley face" rod method. A healthy 29-year-old man who presented with a 6-year history of chronic low back pain was referred to us for surgical treatment. Plain radiographs and computed tomography of the lumbar spine revealed bilateral pars defects at L4 and L5 without slip or scoliosis. The patient underwent direct repair of the pars defects using the double smiley face rod method at L4 and L5. There were no intraoperative or postoperative complications, and the patient had improved clinically by 1 year after surgery. The low back pain was completely disappeared and visual analog scale was 0. He restarted tennis again as the recreational level. While several techniques for direct repair of lumbar spondylolysis have been described, this is the first report of the double smiley face rod method being used to repair the consecutive double-level lumbar spondylolysis. J. Med. Invest. 67 : 202-206, February, 2020.

Morphometric Changes of the Lumbar Intervertebral Foramen after Percutaneous Endoscopic Foraminoplasty under Local Anesthesia.

BACKGROUND: Percutaneous endoscopic diskectomy (PED) for the lumbar spine is a relatively new technique that is becoming more common due to its relatively less invasive nature. However, one possible serious complication is an exiting nerve injury when the cannula of the endoscope is inserted into the neural canal through the intervertebral foramen. A technique to enlarge the intervertebral foramen, called foraminoplasty, was recently established to insert the cannula safely into an appropriate position in the neural canal. METHODS: In this study we performed foraminoplasty during PED under local anesthesia on 15 patients. Using computed tomography scans before and after surgery, the morphometric changes of the intervertebral foramen were evaluated. Surgery-related complications were reviewed. RESULTS: There were 13 men and 2 women, 21 to 86 years of age (mean: 47.1 years). Disk levels were 13 cases at L4-L5, one case at L3-L4, and one case at L5-S1. In 50% of the cases, the mean foraminal area significantly increased from 58.6 mm2 before surgery to 88.4 mm2 after surgery (p < 0.05 by paired t test). The diameter of the foramen was increased at all three points: the lower end plate of the superior vertebrae, the disk, and the upper end plate of the inferior vertebrae. The area increased ∼ 1.5 times, especially at the upper end plate of the inferior vertebrae. In all cases, no exiting nerve injury was encountered during PED. CONCLUSION: Foraminoplasty was an effective method for avoiding exiting nerve root injury during transforaminal PED.

Percutaneous endoscopic lumbar discectomy utilizing ventral epiduroscopic observation technique and foraminoplasty for transligamentous extruded nucleus pulposus: technical note.

Percutaneous endoscopic discectomy (PED) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an 8-mm skin incision. For transligamentous extruded nucleus pulposus with foraminal stenosis, it is very hard to remove the migrated mass with a simple transforaminal approach. For such difficult cases, foraminoplasty and an epiduroscopic technique is useful. A 29-year-old man visited the authors' hospital, complaining of low-back and right leg pain. MRI revealed a massive herniated nucleus pulposus with foraminal stenosis. A transforaminal PED was planned to remove the herniated mass. Through the inside-out technique, the base of the herniated mass was removed. Following the foraminoplasty, the cannula was moved into the epidural space. With epidural observation just beneath the nerve root, the extruded transligamentous fragment was confirmed and removed en bloc. Immediately after the surgery, the patient's symptoms resolved. The combination of foraminoplasty and epiduroscopic observation during the transforaminal approach for PED is a useful and reliable technique to remove extruded transligamentous disc fragments.

Open dislocation of the proximal interphalangeal joint of the little finger subsequent to chronic radial collateral ligament injury: a case report of primary ligament reconstruction with a half-slip of the flexor digitorum superficialis: Case Report.

Open dislocation of the proximal interphalangeal (PIP) joint is relatively rare. We report a case of a 32-year-old man who had open dislocation of the PIP joint of the little finger while playing American football. He had a history of chronic radial collateral ligament injury. We reconstructed the radial collateral ligament with a half-slip of the flexor digitorum superficialis tendon.

Salmonella osteomyelitis of the distal radius in a healthy young adult patient: report of a rare case and literature review.

Salmonella osteomyelitis of the radius in a healthy individual is very rare. We present such a case involving the distal radius of a healthy 23-year-old man without underlying disease or possible episode. He had right wrist pain for approximately 3 years, and osteolytic lesion was seen in the right distal radius. He underwent surgical treatment, and salmonella was isolated from pus in the lesion. Postoperative antibiotics successfully treated his infection. He had no sign of recurrence, but the point of entry for infection remains unknown.

Osteomyelitis Caused by Candida glabrata in the Distal Phalanx.

Osteomyelitis caused by Candida glabrata is rare and its optimal treatment is unknown. Here we report a case of osteomyelitis caused by C. glabrata in the distal phalanx in a 54-year-old woman. Despite partial resection of the nail and administering a 1-month course of antibiotics for paronychia, the local swelling remained and an osteolytic lesion was found. C. glabrata osteomyelitis of the distal phalanx was later diagnosed after curettage. Thereafter, the patient was treated with antifungal agents for 3 months. The infection eventually resolved, and radiological healing of the osteolytic lesion was achieved. Antifungal susceptibility testing should be performed in the case of osteomyelitis caused by nonalbicans Candida species, due to their resistance to fluconazole.

Effectiveness of three types of lumbar orthosis for restricting extension motion.

Spinal orthoses are implemented to restrict lumbar motion. Several studies have compared the effectiveness of various types of lumbar orthoses on restricting motion, but none have compared the effect of different back supports on restricting extension. This study sought to evaluate the effectiveness of three types of lumbar orthosis in regard to their ability to restrict motion during extension. Range of motion was quantified using the Spinal Mouse system to measure flexion and extension, and the load distribution of the back support was measured using a pressure sensor. Ten subjects (8 men, 2 women) were assessed under the following five experimental conditions: custom-made stay (CMS), aluminum stay (AS), plastic stay (PS), corset only, and no brace. None of the stays changed the flexion angle, and none of the supports prevented flexion bending. The mean extension angle after immobilization with the CMS, AS, PS, corset only, and no brace was 27.5° ± 8.5°, 33.4° ± 11.0°, 34.3° ± 9.4°, 37.8° ± 10.7°, and 42.6° ± 10.5°, respectively. The load in the CMS was concentrated at the vertical ends of the stay, with a mean load of 11.5 ± 2.4 N at the top and 8.9 ± 2.4 N at the bottom. The loads at the top and bottom of the support were 7.2 ± 4.3 and 5.3 ± 3.1 N with the AS and 5.8 ± 2.3 and 4.4 ± 1.7 N with the PS, respectively. All supports allowed similar flexion motion. Although the CMS, AS, and PS all restricted extension compared with no brace, the CMS was the most effective for restricting trunk extension motion.

Pins and rubber band traction system and osteosynthesis with a hook plate for the treatment of old fracture-dislocation of a toe: application of hand operative techniques in a foot operation.

The treatment of old fracture-dislocation of a toe is usually difficult. The authors used 2 techniques that are commonly used in finger operations: One is the pins and rubber band traction system, and the other is the hook plate osteosynthesis. They treated a 56-year-old woman using these methods, and obtained a good result.

Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results.

The functional and anatomical results of distal end of radius fractures with severe displacement in 22 elderly patients are reviewed in this retrospective study. The mean age of the patients was 69.4 years (range, 60-88 years) and the mean follow-up period was 24 months (range, 12-53 months). According to the sum of demerit points (Saito, 1983), the latest follow-up functional end results were excellent in 64% of fractures and good in 36%. As for the anatomical results at follow-up, the average radial tilt was 20.7 degrees, ulnar variance was 4.0 mm, and palmar tilt was -2.7 degrees respectively. Though most of the patients had satisfactory outcome and the functional results did not correlate with the radiographic evidence of minor deformities, the functional results of the patients with radial shortening of 6 mm or over were poor. Furthermore, the grip power was the most significant factor related to subjective evaluation and did not improve significantly in patients with the non-dominant hand injured.

Clinical evaluation of aged patients who underwent surgery for femoral neck fractures -- comparative study of clinical results according to age.

The objective was to assess mortality and ambulatory ability for elderly patients over 90 years of age with femoral neck fractures treated surgically. From January 1998 to March 1999, 60 patients aged over 80 years were chosen for the study. The patients had a mean age of 87.1 years. The mean follow-up period was 12.9 months. The patients were classified into three groups according to age: group A (80-84 years old), group B (85-89 years old) and group C (over 90 years old). The rates of recovered postoperative walking ability were 72.2% (13/18) of group A, 65.2% (15/23) of group B and 84.2% (16/19) of group C. These patients were followed up until death or for at least one year. The overall mortality rates were 11.1% (2/18) of group A, 17.4% (4/23) of group B and 10.5% (2/19) of group C.

Natural history of extruded lumbar intervertebral disc herniation.

We studied the natural history of extruded lumbar intervertebral discs using MRI. Forty-nine patients with lumbar disc herniation were included in this study. Ages ranged from 19 to 57. On the T2-weighted sagittal MR image, the signal intensity in the herniated mass was measured and the ratio to that in the original nucleus (i.e., nucleus pulposus from which they extruded) was calculated (signal intensity ratio; SIR). The relationship with SIR and duration of illness was evaluated. In ten patients who were re-examined by MRI after conservative treatment, the size of the herniation measured by T1-weighted axial MR image was compared before and after treatment. The signal intensity of HNP became higher than that of the original nucleus immediately following herniation and thereafter decreased with time, suggesting that initial hydration of the HNP occurred shortly after herniation followed by dehydration of the HNP. The size of the HNP with a SIR value of 1.2 and higher on T2-weighted MR images decrease with time, however, the HNP with a SIR below 1.2 did not show any size reduction. The SIR of 1.2 and higher is a good indicator predicting spontaneous reduction of the HNP. Dehydration in the HNP may play an important role in the reduction of the lumbar disc herniation.