Spondylolysis repair using a pedicle screw hook or claw-hook system. -a comparison of bone fusion rates.

INTRODUCTION: To assess the bone fusion rates and clinical results of two surgical methods (pedicle screw claw-hook fixation and pedicle screw hook fixation) of lumbar spondylolysis repair. METHODS: A multicenter database of surgical patients with lumbar spondylolysis was reviewed. All patients < 20 years old with a minimum of 6 months of follow-up and computed tomography images were included. Operation time and blood loss amount were investigated. Visual analogue scale (VAS; 0-10) scores for lower back pain were evaluated to assess clinical results. RESULTS: A total of 17 patients met the inclusion criteria. Pedicle screw hook fixation was performed in five patients (the hook group), and pedicle screw claw-hook fixation was performed in 13 patients (the claw-hook group). One patient was included in both groups because each method was performed at different lumbar levels (L4 and L5). The bone fusion rates at 3, 6, and 9 months after surgery were significantly higher in the claw-hook group than those in the hook group. Operation time and blood loss amount were not significantly different between the groups. VAS scores improved in the claw-hook group but not in the hook group because of a small number of patients. CONCLUSIONS: Pedicle screw claw-hook fixation was more effective than pedicle screw hook fixation in terms of bone fusion rates.

Retraction Note: Relationship between bone density and bone metabolism in adolescent idiopathic scoliosis.

[This retracts the article DOI: 10.1186/s13013-015-0043-x.].

Relationship between bone density and bone metabolism in adolescent idiopathic scoliosis.

Several authors have confirmed that 27 to 38 % of AIS patients had osteopenia. But few studies have assessed bone metabolism in AIS. This study assessed bone mineral density and bone metabolism in AIS patients using the bone metabolism markers, BAP and TRAP5b. The subjects were 49 consecutive adolescent AIS patients seen at our institutes between March 2012 and September 2013. Sixty-five percent of AIS patients had osteopenia or osteoporosis and 59 % of AIS patients had high values for TRAP5b. The AIS patients with high values of TRAP5b had lower Z scores than those with normal values of TRAP5b. Higher rates of bone resorption are associated with low bone density in AIS patients.

Relationship between bone density and bone metabolism in adolescent idiopathic scoliosis.

Several authors have confirmed that 27 to 38% of AIS patients had osteopenia. But few studies have assessed bone metabolism in AIS. This study assessed bone mineral density and bone metabolism in AIS patients using the bone metabolism markers, BAP and TRAP5b. The subjects were 49 consecutive adolescent AIS patients seen at our institutes between March 2012 and September 2013. Sixty-five percent of AIS patients had osteopenia or osteoporosis and 59% of AIS patients had high values for TRAP5b. The AIS patients with high values of TRAP5b had lower Z scores than those with normal values of TRAP5b. Higher rates of bone resorption are associated with low bone density in AIS patients.

Accuracies in Measuring Spinopelvic Parameters in Full-Spine Lateral Standing Radiograph.

STUDY DESIGN: Prospective comparative study of measuring pelvic incidence (PI) among standing radiographs of whole spine and pelvis and computed tomographic (CT) scans in a cohort of patients. OBJECTIVE: To analyze accuracies in measuring PI and other spinopelvic parameters. SUMMARY OF BACKGROUND DATA: Previous reports indicated relatively low agreement in measuring PI even among experienced spinal surgeons; intra- and inter-rater reliability in manually measuring PI were 0.69 (0.62-0.74) and 0.41 (0.36-0.45), respectively; the mean interclass correlation coefficient value of manually measuring PI was 0.881. No study compared PI on standing radiographs with that measured on CT scans. METHODS: A total of 120 consecutive patients with spinal disease (38 patients had history of hip arthroplasty) who admitted to our hospital from April 2012 for 6 months were enrolled. Subjects had obtained full-spine lateral standing radiograph, standing radiograph of pelvis, and CT scans. Pelvic incidence on full-spine lateral standing radiograph and that on pelvis lateral standing radiograph were measured manually by 2 experienced spinal surgeons. Intra- and interobserver reliability of the measurements were analyzed by using interclass correlation coefficient. On CT scans, PI was measured using 3-dimensional CT scan software (CT-PI). PI among 3 different imaging modalities was evaluated using correlation coefficients. RESULTS: In whole-spine radiographs, the intra- and interobserver agreement rates with measurements in PI (0.84 and 0.79, respectively) and sacral slope (0.87 and 0.83, respectively) were lower than those in pelvic tilt (0.98 and 0.96, respectively) and PI-lumbar lordosis (0.97 and 0.97, respectively). The correlation coefficient between P-PI and CT-PI was higher (0.95) than that between FS-PI and CT-PI (0.81) and between FS-PI and P-PI (0.85). CONCLUSION: The reliability of measuring PI is comparatively lower than that of other spinopelvic parameters, and the variability of PI measurement is mainly due to difficulty of precisely identifying sacral endplate. LEVEL OF EVIDENCE: 2.

Roentgenographic and computed tomographic findings in symptomatic lumbar foraminal stenosis.

PURPOSE: To determine the static and dynamic radiological findings characteristic of symptomatic foraminal stenosis. METHODS: Between 2006 and 2011, a total of 114 patients with unilateral leg pain due to L5 nerve root compression were screened to investigate the characteristic radiological findings of symptomatic foraminal stenosis. Static findings on sagittal CT images and dynamic findings on X-rays were compared between 39 surgically treated L5-S1 foraminal stenosis patients (FS group) and 75 surgically treated L4-5 intra-spinal canal stenosis patients (CS group). RESULTS: There was no significant difference between the FS and CS groups in all demographic data and radiologic findings, except for the segmental range of motion in sagittal plane on functional X-rays and posterior translation on extension. The segmental range of motion in sagittal plane at L5-S1 was significantly larger in the FS group (13.4 ± 3.1 vs. 4.2 ± 2.0; p = 0.03) compared to the CS group. The prevalence of 3 mm or more posterior translation at L5 was significantly higher in the FS group (38 vs. 3%; p = 0.04) compared to the CS group, and the average posterior translation of L5 was significantly greater in the FS group (3.1 ± 1.6 mm) than that in the CS group (0.3 ± 0.6 mm) (p = 0.02). CONCLUSIONS: A large segmental range of motion in sagittal plane of L5-S1 and posterior instability of L5 are risk factors for symptomatic L5-S1 foraminal stenosis. These dynamic radiological findings support the diagnosis of symptomatic foraminal stenosis.

Lumbar foraminal stenosis causes leg pain at rest.

PURPOSE: Lumbar intra-spinal canal stenosis is characterized by leg pain that intensifies during walking and intermittent claudication, while leg pain at rest is a characteristic neurological symptom of lumbar disc herniation. Until now, a correlation between leg pain at rest and symptomatic foraminal stenosis has not been reported. This is a prospective and comparative study of unilateral leg pain from L5 nerve root compression due to spinal canal stenosis to determine clinical characteristics of lumbar foraminal stenosis. METHODS: Clinical and neurological findings were compared among 38 patients receiving L5-S1 transforaminal lumbar interbody fusion for L5-S1 foraminal stenosis (FS group) and 60 patients receiving L4-5 decompression or/and fusion for L4-5 intra-spinal canal stenosis (CS group). RESULTS: The only significant difference between the FS and CS groups in demographic clinical data was leg pain at rest. The prevalence of leg pain was significantly higher in the FS group compared to the CS group (76 vs. 35%). The visual analogue scale for leg pain at rest was also significantly higher in the FS group than in the CS group (6.6 ± 3.1 vs. 1.3 ± 1.9). CONCLUSIONS: Leg pain at rest is characteristic of L5-S1 foraminal stenosis.