Postoperative Clinical Outcomes of Balloon Kyphoplasty Treatment: Would Adherence to Indications and Contraindications Prevent Complications?

STUDY DESIGN: We retrospectively assessed the postoperative clinical outcomes of balloon kyphoplasty (BKP). PURPOSE: To evaluate the risk factors for complications and to reconfirm the indications and contraindications for BKP. OVERVIEW OF LITERATURE: In Japan, BKP is indicated for cases of osteoporotic vertebral fractures when pain is not improved even after an adequate period of conservative treatment. Contraindications to BKP include pedicle fracture, fracture of a flat vertebra, or fracture of the posterior wall of the vertebral body diagnosed on computed tomography. METHODS: Seventy-five patients who underwent BKP in our institution participated in this study; 49 provided follow-up data. Those with complications and persistent pain were assigned to the "eventful" group; the others, to the "uneventful" group. We evaluated risk factors for complications and persistent pain, including the presence or absence of severe posterior wall injury/pedicle fracture, the shape of the vertebral body, and the time period from onset of pain to BKP. RESULTS: The incidences of severe posterior wall injury, pedicle fracture, and flattened vertebral body did not differ significantly between the uneventful and eventful groups. However, there was a significant difference in disease duration between those with and those without adjacent vertebral fractures (AVFs): The incidence of AVF was lower among patients with disease of less than 8 weeks' duration. CONCLUSIONS: Disease duration is a possible risk factor for developing AVF, whereas other characteristics were not risk factors for complications after BKP. Although it has been suggested that BKP treatment in the early phase after injury results in a good outcome, the indications should be determined according to prognosis that is based on findings obtained with tools such as imaging examinations.

Index extensor digitorum communis tendon entrapment in a growth plate injury of distal radius.

BACKGROUND: We report a rare case in which an epiphyseal injury of the distal radius caused entrapment and rupture of the index extensor digitorum communis tendon during conservative treatment. CASE PRESENTATION: A 16-year-old girl suffered epiphyseal injury of the right distal radius with palmar displacement during playing judo. Closed reduction and application of a short arm cast were performed. 4 weeks after injury, movement of her index finger was limited. Extensor tendons adhesion at the fracture site was suspected. It was found that the index extensor digitorum communis tendon had become trapped and ruptured at the site of epiphyseal injury, then reconstruction was done by tendon transfer. At 12 months after surgery, the patient had resumed judo at the same level as before the injury. CONCLUSIONS: The present case suggested that there is a risk of extensor tendon entrapment associated with closed reduction.

Traumatic dislocation of the hip in a child caused by trivial force for age.

Traumatic hip dislocation in children has a relatively rare occurrence. There are some residual complications, such as avascular necrosis of the femoral head, growth disturbance caused by premature fusion, neurological injury, recurrent dislocation, and posttraumatic arthritis. There is no consensus in the literature about the period of non-weight bearing after reduction. A rare case of a 13-year-old boy of hip dislocation caused by trivial force for age is reported followed by review of the pediatric literatures with treatment recommendation.

Acute posterior neck pain in adult: a case series.

Calcification around the cervical spine is thought to be relatively rare case, among these conditions the calcification at the longus colli muscle is called retropharyngeal tendinitis and only several cases were reported in the literature. In this disease, the three characteristic clinical features are acute severe posterior neck pain without any trigger, severely restricted range of motion, and odynophagia. The radiographic findings include swelling of the retropharyngeal space and amorphous calcification anterior to C1-C2 in lateral view of the cervical spine. Diagnosis is established by sound history taking coupled with computed tomography (CT) scan of the affected area, treatment is the administration of oral non-steroidal anti-inflammatory drugs (NSAID), for a few weeks and/or oral steroid. We present a new 3 cases (27, 35, and 24 years old, male) and review of literature.

The biologic response to particles from a potential disc prosthesis material.

STUDY DESIGN: An in vivo study of material from a potential disc prosthesis. OBJECTIVE: To examine the histopathologic effect of particulate debris on the dura and neural tissue in sheep. SUMMARY OF BACKGROUND DATA: Disc prostheses are emerging as alternatives to spinal fusion for the treatment of symptomatic degenerative lumbar disc disease. Preclinical biocompatibility trials must be conducted before any device is considered for general use. METHODS: Artificially generated wear particles of a material known as Sinux (DePuy Spine, Raynham, MA) were implanted directly onto the lumbosacral dura and nerve roots of 18 sheep that were randomly allocated to 3 groups to survive between 1 and 6 months. Tissue sections from T12 to the sacrum were examined for histopathological evidence of inflammation and wound healing in response to the particles and for the effects on the neural elements. RESULTS: There was no significant evidence of inflammation, macrophage accumulation, or other tissue response. Other observations included some minor tissue pigmentation due to microhemorrhage, occasional but minimal lymphocyte infiltration, and crystalline Sinux in the fibroadipose connective tissue external to the dura. CONCLUSION: Artificially generated particles of Sinux placed directly onto the dura and nerve roots did not induce any significant biologic response in a sheep model.

Prophylactic cephazolin to prevent discitis in an ovine model.

STUDY DESIGN: An ovine model of discitis was used to determine the efficacy of the antibiotic cephazolin for prophylactic use in spinal surgery. OBJECTIVES: To determine in juvenile and adult sheep spines if 2-g cephazolin given at intervals over a 4-hour period would prevent iatrogenic discitis, and determine the concentration of cephazolin in nucleus and anulus tissue after administration of a bolus dose. SUMMARY OF BACKGROUND DATA: It is standard practice at our institutions to give patients undergoing spinal surgery a single prophylactic (1-2 g) dose of cephazolin with a second dose for prolonged (>4 hours) procedures. Although this regimen provides therapeutic serum levels, the levels of antibiotic in the intervertebral disc are significantly lower. Because cephazolin is a negatively charged molecule, it is thought to diffuse poorly into the disc, raising questions about its efficacy as a prophylactic antibiotic for spinal procedures. METHODS: There were 18 animals, including 9 lambs and 9 sheep, that received a single 2-g dose of cephazolin intravenously at 30-minute intervals over a 4-hour period. Two control animals (1 sheep and 1 lamb) did not receive antibiotic. All animals had diskograms at 2 previously incised lumbar levels and 2 nonincised levels using contrast that was deliberately contaminated with bacteria. Lateral spine radiographs were taken at postoperative intervals. After 12 weeks, all animals received another 2-g dose of cephazolin intravenously at intervals before the spines were removed for pathologic and biochemical analysis. RESULTS: Discitis was detected in all control animals. Of those animals given cephazolin, discitis developed in 1 sheep and 4 lambs. Discitis did not develop in any of the sheep that received cephazolin 30 minutes before inoculation. Cephazolin was detected throughout the disc but was more concentrated in the anulus fibrosus. Disc levels of cephazolin peaked at 15 minutes, at which time serum levels were up to 50 times higher. Cephazolin levels in nonoperated and incised discs were not significantly different. CONCLUSIONS: A single prophylactic 2-g dose of cephazolin administered anytime over a 4-hour period prevented discitis in almost all animals but was not as effective in lambs. Although lambs have a higher vascular supply to deliver antibiotics to the disc, it is likely that some other physiologic factor may be responsible for the increased infection rate. This study supports that timing of antibiotic prophylaxis is critical to prevent iatrogenic disc infection.

The initial safe range of motion of the ankle joint after three methods of internal fixation of simulated fractures of the medial malleolus.

BACKGROUND: Previous studies have demonstrated the safe passive range of ankle motion for inter-bone stiffness after internal fixation under load but there is a lack of information about the safe range of ankle motion for early rehabilitation in the absence of loading. The present study was designed to assess the effect of ankle movement on inter-bone displacement characteristics of medial malleolus fractures following three types of internal fixation to determine the safe range of motion. METHODS: Five lower legs obtained during autopsy were used to assess three types of internal fixation (two with Kirschner-wires alone; two with Kirschner-wires plus tension band wiring; and, one with an AO/ASIF malleolar screw alone). Following a simulated fracture by sawing through the medial malleolus the displacement between the fractured bone ends was measured during a passive range of movement with continuous monitoring using omega (Omega) shaped transducers and a biaxial flexible goniometer. Statistical analysis was performed with repeated measures analysis of variance. FINDINGS: Inter-bone displacement was not proportional to the magnitude of movement throughout the range of ankle motion as, when separation exceeded 25 microm, there was increasingly wide separation as plantar-flexion or dorsal-flexion was increased. There was no statistical significant difference between the small amount of inter-bone displacement observed with three types of fixation within the safe range of dorsal-flexion and plantar-flexion for early rehabilitation. However the inter-bone separation when fixation utilized two Kirschner-wires alone tended to be greater than when using the other two types of fixation during dorsal-flexion and eversion. INTERPRETATION: The present study revealed a reproducible range of ankle motion for early rehabilitation which was estimated to be within the range of 20 degrees of dorsal-flexion and 10 degrees of plantar-flexion without eversion. Also, internal fixation with two Kirschner-wires alone does not seem to provide stability achieved by the other two forms of fixation.