Psoas abscess caused by spontaneous rupture of colon cancer.

Spontaneous rupture of colon cancer, combined with psoas abscess formation, is rare. A 44-year-old male visited for back pain and left buttock mass. Abdominal computed tomography and magnetic resonance image revealed a large abscess in the left psoas muscle and in the left lower quadrant area. Ten days after incision and drainage, a skin defect around the left anterior superior iliac spine remained. A local flap was performed using a superficial skin graft. Ten days after the stitches had been removed, fecal discharge was observed around the anterior superior iliac spine at the flap site. An operation was performed by a general surgeon who had diagnosed this as a case of enterocutaneous fistula. Operative findings included a ruptured tumor mass in the descending colon, which was connected to a retroperitoneal abscess. Pathologic report findings determined adenocarcinoma of the resected colon. Herein, we report a case of psoas abscess resulting from perforating colon cancer.

Comparative study of clinical outcomes of anterior cervical discectomy and fusion using autobone graft or cage with bone substitute.

STUDY DESIGN: A retrospective study. PURPOSE: To compare the clinical and radiological outcomes of autogenous bone graft and cage with bone substitute for anterior cervical discectomy and fusion. OVERVIEW OF LITERATURE: The clinical outcomes of cage with bone substitute for anterior cervical discectomy and fusion is satisfactory. METHODS: Eighty four patients who underwent cervical spine surgery between February 2004 and April 2009 were included. Fifty-nine patients were approached anteriorly and underwent anterior cervical discectomy and fusion by the Smith-Robinson method (Group A), and 25 patients underwent fusion by decompression of the cervical spine and cage with bone substitute (Group B). We measured and evaluated the postoperative period until patients were able to ambulate, for pre- and postoperative symptomatic improvement, postoperative complications, pre- and postoperative change of lordosis, degree of endplate collapse or subsidence, and fusion rate and period of union. RESULTS: By Robinson's criteria, respectively 45, 10 and 4 patients in Group A experienced excellent, good and fair symptomatic improvement, and respectively 19, 5 and 1 patients in Group B experienced excellent, good and fair symptomatic improvement. The postoperative period in which patients became ambulant and the period of hospital stay was significantly shorter in Group B. Increase of lordosis at final follow up after surgery was significantly larger in Group A, as was the fusion period. Significantly more endplate collapse occurred in Group B. CONCLUSIONS: Of patients who had anterior cervical discectomy and fusion, results of both groups were both satisfactory.

Prognostic factors that affect the surgical outcome of the laminoplasty in cervical spondylotic myelopathy.

BACKGROUND: This study examined the prognostic factors that affect the surgical outcome of laminoplasty in cervical spondylotic myelopathy patients by comparative analysis. METHODS: Thirty nine patients, 26 males and 13 females, who were treated with laminoplasty for cervical myelopathy from September 2004 to March 2008 and followed up for 12 months or longer, were enrolled in this study. The mean age of the subjects was 62.4 years (range, 37 to 77 years). The patients' age, number of surgical segments, spinal cord compression ratio, segment number, level, localized marginal pattern of high signal intensity within the spinal cord in the T2 image, preoperative Japanese Orthopaedic Association Scoring System (JOA) score with the recovery ratio were compared respectively. The JOA score was used for an objective assessment of the patients' preoperative and postoperative clinical status. The recovery ratios of surgery were graded using the Hirabayashi equation. Statistical analysis was carried out using Pearson correlation analysis. RESULTS: The patients' JOA score increased from a preoperative score of 11.1 (range, 5 to 16) to a postoperative score of 14.9 (range, 7 to 17). The average recovery ratio was 65.8% (range, 0 to 100%). The number of segments with high signal changes in the T2 image, a localized marginal pattern with high signal change, signal intensity changes in the upper cervical spinal cord were inversely associated with the recovery ratio, whereas the spinal cord compression ratio showed a significant positive correlation. However, the currently known prognostic factors, such as number of surgical segment, age, and preoperative JOA score, showed no statistically significant correlation. CONCLUSIONS: The number of segments, localized marginal pattern, rostral location of signal intensity changes with a high signal change in the T2 image and a low spinal cord compression ratio in cervical spondylotic myelopathy patients treated by laminoplasty can indicate a poor prognosis.

Percutaneous reduction during intramedullary nailing in comminuted tibial shaft fractures.

Percutaneous reduction with a reduction clamp during intramedullary nailing without reaming is a simple, easily reproducible, and minimally invasive method.

The impact of adjacent segment degeneration on the clinical outcome after lumbar spinal fusion.

STUDY DESIGN: A retrospective study. OBJECTIVE: To determine the impact of the adjacent segment degeneration (ASD) on the clinical outcome after lumbar fusion. SUMMARY OF BACKGROUND DATA: Few studies have analyzed correlation between clinical outcomes and ASD. METHODS: From January 2000 to December 2004, 217 patients who underwent lumbar fusion and have more than 2 years of follow-up were evaluated. The patients were divided into 3 groups: fusion was carried out on 1 (A), 2 (B), and more than 3 segments (C). UCLA grading scale was used to evaluate the ASD on radiograph preoperative, postoperative, and last follow-up. The clinical outcome was evaluated and the association between clinical outcome and ASD was evaluated by the Spearman correlation. RESULTS: ASD occurred 11.6% (13/112 cases) in group A, 14.5% (9/62 cases) in group B, and 16.3% (7/43 cases) in group C. Among them, the cases which had progressed more than 2 level of degenerative grade were 0 in group A, 7 cases (77.8%) in group B, and 6 cases (85.7%) in group C. In group A, 5 cases with ASD had down graded 1 level in clinical outcome. In group B, all 9 cases with ASD had down graded more than 1 level in clinical outcome; 1 level aggravation in 1, 2 level in 5, and 3 level in 1 case. In group C, all 7 cases with ASD also had down graded more than 1 level in clinical outcome; 1 level aggravation in 2, 2 level in 5 cases. Finally, the more the change of the degenerative grade is severe, the more the clinical outcome is worse (P < 0.05). CONCLUSION: The impact of ASD on clinical outcome after fusion showed a significant correlation, especially with the ASD after multiple-segments fusion. Careful attention is needed in multiple-segments fusion such as degenerative lumbar deformity.

Tibial unreamed intramedullary nailing using schanz screws in displaced diaphyseal segmental fractures.

Reduction and manipulation using percutaneously fixated Schanz screws and unreamed intramedullary nailing facilitates fracture reduction, promotes early weight bearing, and decreases complications such as nonunion, malalignment, in failure.

Distal hybrid interlocking in the femoral shaft fracture.

This technique may be beneficial for stabilizing fractures less invasively and may decrease complications, such as nonunion and postoperative infection, by avoiding iatrogenic devascularization of the fracture site.

Partially ruptured posterior cruciate ligament causing medial tibiofemoral joint impingement.

Impingement syndrome resulting from a partially torn posterior cruciate ligament (PCL) stump has not been reported in the English-language literature. We present 2 cases of impingement caused by the torn stump of a partially ruptured PCL. Both patients suffered from severe knee joint pain during knee flexion over 70 degrees to 90 degrees and medial joint-line tenderness after the injury. Magnetic resonance imaging (MRI) showed the partial rupture of the PCL, mainly in the posteromedial (PM) bundle. In both cases, arthroscopic examination revealed that the rupture of the PCL involved the femoral side of the PM bundle, and the torn stump of the PCL was entrapped in the medial tibiofemoral joint (TFJ). The torn stump was removed completely, and the symptoms improved significantly. Partial ruptures of the PCL occur frequently, and it is anticipated that many patients may suffer from pain arising from impingement of a partially torn PCL entrapped in the medial TFJ. Therefore, studies on this subject should continue.

Diagnosis and treatment of tuberclous spondylitis and pyogenic spondylitis in atypical cases.

STUDY DESIGN: A retrospective study. PURPOSE: This is a study of the diagnosis and treatment of tuberculous spondylitis and pyogenic spondylitis in atypical cases. OVERVIEW OF LITERATURE: There have been several reports about clinical, hematological, pathological and radiological findings to differentiate pyogenic & tuberculous spondylitis. METHODS: We screened 55 patients diagnosed with tuberculous spondylitis and pyogenic spondylitis from January 1999 to June 2003. There were seven cases where it was difficult to make an accurate diagnosis. We reviewed the clinical manifestation, laboratory tests, radiological findings and confirmed the diagnoses by the use of biopsies and/or clinical response to treatment. RESULTS: Four cases, which were initially diagnosed as pyogenic spondylitis, had a clinical presentation of fever (37.4~38.5) on the day of hospitalization. These cases later turned out to be tuberculous spondylitis, as confirmed by an open biopsy and pathologic study. Three cases initially diagnosed as pyogenic spondylitis were treated with broad-spectrum antibiotics. Symptoms were aggravated in these cases, but improved after the use of an anti-tubercular drug. Bony union was observed in all cases in an averageof 4 months (range, 3~6 months). CONCLUSIONS: In infectious spondylitis, it is important to establish an accurate diagnosis. An accurate diagnosis can be made by laboratory findings and by estimation of the response to treatment during follow-up. If there is no response or aggravation of symptoms despite treatment based on an initial diagnosis, the etiologic organism must be re-evaluated. A biopsy and observation of clinical response are needed to confirm the diagnosis.

Removal of a broken locking screw from the intramedullary canal using a sliding knot.

A locking screw lost in the intramedullary canal during extraction of an intramedullary nail is not an uncommon problem. This report describes a simple procedure using sliding wire knot and an Ender nail for removing a broken locking screw from the intramedullary canal. This method allows the easy removal of a broken locking screw from the intramedullary canal without a special instrument.

Arthroscopy-assisted minimally invasive removal of a plate in the distal femur.

We developed an arthroscopy-assisted minimally invasive procedure for removal of a plate in the distal femur. Under arthroscopic assistance, we made an arthrotomy in the middle of the screws attached to the plate in the knee joint; all screws were removed, except for those placed proximally that were too difficult to remove. An approximately 5-cm skin incision (the distal one half to one third of it was near the proximal end of the knee cavity) was made through the old incision scar under arthroscopic assistance, and visible screws were removed. Proximal screws that were not visible through this incision were removed percutaneously through new small stab incisions placed midway between every 2 screws under the control of an image intensifier. Then, a small arthrotomy was made through the distal portion of the approximately 5-cm incision, at the place where the plate entered the knee joint. Through this arthrotomy, any screws still attached to the plate within the knee joint were removed. Then, the plate was stripped from the distal femur, was pulled proximally, and was removed without difficulty. With the use of this procedure, we can concomitantly assess the condition of the intra-articular region.

Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn.

We developed an effective arthroscopic pullout technique for repairing complete radial tears of the tibial attachment site of the medial meniscus posterior horn (MMPH). In our technique, the torn meniscus is reattached to the tibial plateau immediately medial or anteromedial to the posterior cruciate ligament (PCL) using two No. 2 Ethibond sutures (Ethicon, Somerville, NJ). After a complete radial tear of the tibial attachment site of the MMPH and its reparability were confirmed, using a Caspari suture loaded with a suture shuttle, one No. 2 Ethibond suture is placed through the meniscus, through the red-red zone, 3 to 5 mm medial to the torn edge of the MMPH, and the other is passed through the meniscocapsular junction 3 to 5 mm medial to the torn edge of the meniscus. Then, a tibial tunnel, 5-mm in diameter, is made from the anteromedial aspect of the proximal tibia to the previously prepared tibial plateau, immediately medial or anteromedial to the PCL, and the two No. 2 Ethibond sutures are pulled out through the tibial tunnel and then fixed to the proximal tibia using a 3.5-mm cortical screw and washer. Firm reattachment of the torn meniscus was confirmed arthroscopically.