Analysis of pain markers and epidural fibrosis caused by repeated spinal surgery in Sprague-Dawley rats.

BACKGROUND: Epidural fibrosis is one of the aetiologies of pain following a spinal revision surgery. It is reported that the specific members of the mitogen - activated protein kinases (MAPK) family might mediate neuropathic pain. However, roles of epidural fibrosis caused by repeated spinal surgeries and pain-related proteins in causing the post spinal surgery syndrome remain unknown. Using a rat spinal surgery epidural fibrosis and adhesion model, in this study, we evaluated and investigated the relationship between pain markers and epidural fibrosis. METHODS: Sprague-Dawley rats that underwent the spinal surgery were divided into three groups: group A (single laminectomy), group B (two repeated surgeries) and group C (three repeated surgeries). Dural thickness was measured in each experimental group, and immunohistochemical analysis and western blotting of mitogen-activated protein kinases were performed (ERK, p38 and JNK) using the spine cord. RESULTS: Dural thickness was 6.363 ± 1.911 µm in group A, 13.238 ± 2.123 µm in group B and 19.4 ± 2.115 µm in group C, respectively. In the western blotting, phosphorylated ERK expression gradually increased with the number of repeated surgeries, and expression in groups B (1.77-fold) and C (2.42-fold) increased as compared to expression in group A. Phosphorylated p38 showed an increasing trend with the number of repeated surgeries, and groups B (1.17-fold) and C (1.33-fold) expression increased compared with group A. However, phosphorylated JNK expression did not gradually increase with the number of repeated surgeries, and groups B (1.62-fold) and C (1.43-fold) expression increased compared with group A. Excluding phosphorylated JNK, immunohistochemical analysis revealed that phosphorylated ERK and p38 expression gradually increased with the number of repeated surgeries in the spine dorsal horn, as evidenced by western blotting. CONCLUSIONS: Repeated spinal surgeries may increase dural thickness and expression of phosphorylated ERK and p38 in the spinal dorsal horn, and it suggests that the neuropathic pain is likely induced by epidural fibrosis and that the pain increases with the number of repeated surgeries.

Alternative treatment for varus instability of the hallux interphalangeal joint: A case report.

Forefoot injuries are commonly caused by sport-related activities and are often around the metatarsophalangeal joints. The hallux interphalangeal (IP) joint is anatomically stable; therefore, injuries to this joint are considered to be rare compared with those to the metatarsophalangeal joint. Instability of the hallux IP joint has rarely been reported in barefoot contact sports, and its treatment has not been sufficiently explored.This study investigated chronic varus instability of the hallux IP joint. We performed a surgical reconstruction owing to conservative treatment failure. A good surgical outcome was achieved by reconstruction of the collateral ligament using the 4th extensor tendon-a promising alternative treatment option for this type of injury. This method indicated no morbidity outside the site of surgery and was more cost-effective than reconstruction using an allograft.

Medialization of medial row anchor via the Nevasier portal yield enhanced footprint and outcomes in medium-to-large rotator cuff tears.

PURPOSE: To evaluate clinical and radiological outcomes of medial row anchor insertion between 90° or 45° (deadman) angle in the suture-bridge rotator cuff repair of medium-to-large rotator cuff tears. METHODS: This retrospective analysis included 113 consecutive patients undergoing arthroscopic suture-bridge repair for medium-to-large rotator cuff tears (mean tear size: 2.8 × 2.3 cm) between 2010 and 2013. The patients were divided into two groups: group I (53 patients) and group II (60 patients) involving 90° and 45° medial row anchors, respectively. The conventional lateral row anchors were inserted in the suture-bridge repair. The clinical outcomes at 2 years and radiological outcomes including re-tear or footprint coverage (anteroposterior length and mediolateral width) of the repaired tendon using postoperative MRI were evaluated. RESULTS: Clinical outcome scores were significantly improved in both groups. However, Group I (90° anchor insertion group) showed better clinical scores without the difference of range of motion. The postoperative MRI revealed enlarged footprint coverage with 90° medial row anchor. The repaired footprint cuff size (mediolateral width) in the coronal plane MRI showed a statistically significant difference (45°: 19 mm vs. 90°: 24 mm) (p < 0.05). CONCLUSIONS: Enhanced clinical outcomes and additional anatomical footprint coverage (coronal width of repaired tendon) in the suture-bridge repair are obtained with the 90° medial row anchors compared with the 45° medial row anchors. These findings would guide clinical application of 90° medial row anchor insertion for further medialization in the medium-to-large rotator cuff tears. LEVEL OF EVIDENCE: Level III (retrospective comparative trial).

A rare case of multiple and huge simple bone cysts in Wilson's disease.

A simple bone cyst is a tumor-like lesion that is not a true neoplasm. It usually presents as a solitary lesion within the proximal humerus and proximal femur. The etiology of simple bone cysts is still to be elucidated. We describe our experience in the successful surgical management of a rare case of two, large-sized, simple bone cysts involving the entire left humerus and right femoral head, respectively, in a 34-year-old male patient with Wilson's disease and concomitant hepatic cirrhosis. We theorized that Wilson's disease could be the cause of the delay or blockage of the natural healing process of the simple long-bone cysts, leading to their abnormal growth and development. To our knowledge, such a combined occurrence of multiple, simple long-bone cysts and Wilson's disease has not been reported in the literature to date.