ABSTRACT
STUDY DESIGN: Retrospective analysis of case series. PURPOSE: This study aimed to clarify the effects of full endoscopic posterior cervical foraminotomy (FPCF) on cervical spondylotic amyotrophy (CSA). OVERVIEW OF LITERATURE: The method for decompressing the ventral nerve root and anterior horn (AH) in CSA is controversial. METHODS: Patients without myelopathy who underwent FPCF for proximal CSA between 2017 and 2022 were analyzed. The outcome measure was the results of the manual muscle testing (MMT) of the deltoid and biceps. Preoperative nerve root and AH compression were evaluated by magnetic resonance imaging. The intervertebral foramen morphology and bony decompression extent were evaluated by computed tomography. RESULTS: FPCF was performed at the C4/5 level and at the C4/5 and C5/6 levels in 14 and 11 patients, respectively. The width of the narrowest intervertebral foramen was significantly narrower on the affected side than on the healthy side at the C4/5 (2.5 mm vs. 3.6 mm) and operated C5/6 (1.9 mm vs. 3.1 mm) levels. AH compression occurred at the C4/5 and C5/6 levels in 28% and 21% of the patients, respectively. Bony decompression was performed laterally beyond the narrowest foramen at the C4/5 and C5/6 levels in 96% and 91% of the patients, respectively. Compared with patients without AH compression, in those with AH compression, the lamina was resected medially by an average of >1.7 mm and >3.6 mm at the C4/5 and C5/6 levels, respectively. Furthermore, 76% and 81% of the facet joint surfaces were preserved at the C4/5 and C5/6 levels, respectively. Postoperative MMT grade improvement was excellent, good, and fair in 64%, 20%, and 16% of the patients, respectively. CONCLUSIONS: FPCF was effective for treating proximal CSA.
ABSTRACT
Full-endoscopic lumbar discectomy (FED) is one of the least invasive procedures for lumbar disc herniation. Patients who receive FED for lumbar disc herniation may develop recurrent herniation at a frequency similar to conventional procedures. Reoperation and risk factors of recurrent lumbar disc herniation were investigated among 909 patients who received FED using an interlaminar approach (FED-IL). Sixty-five of the 909 patients received reoperation for recurrent herniation. Disc height, smoking, diabetes mellitus (DM), subligamentous extrusion (SE) type, and Modic change were identified as the risk factors for recurrence. Other indicators such as LL, Cobb angle, disc migration, age, sex, and body mass index (BMI) did not reach significance. Among 65 patients, reoperation was performed within 14 days following FED-IL (very early) in 7 patients, from 15 days to 3 months (early) in 14 patients, from 3 months to 1 year (midterm) in 17 patients, and after more than 1 year (late) in 27 patients. The very early group included a greater number of males, and the mean age was significantly lower in comparison to other groups. All patients in the very early group received FED-IL for reoperation. Reoperation within 2 weeks allows FED-IL to be performed without adhesion. Fusion surgery was performed on three cases in the early and midterm groups and on 10 cases in the late group, which increased over time as degenerative change and adhesion progressed. The procedure selected to treat recurrent herniation mostly depends on the surgeon's preference. Revision FED-IL is the first choice for recurrent herniation in terms of minimizing surgical burden, whereas fusion surgery offers the advantage that discectomy can be performed through unscarred tissues. FED-IL is recommended for recurrent herniation within 2 weeks before adhesion progresses.
ABSTRACT
BACKGROUND: Acquiring a higher peak bone mass during puberty reduces the risk of osteoporosis later in life. Peak bone mass is influenced by a variety of genetic and environmental factors. Age-appropriate nutrition and physical education for school-age children is indispensable. In the present study, bone examinations were performed on 1611 female students in junior and senior high school along with their 1376 mothers, and a 5-year follow-up survey was conducted. METHODS: Quantitative ultrasound assessment of the calcaneus was performed to calculate the osteo-sono assessment index (OSI) using an ultrasound system Acoustic Osteo-Screener. A questionnaire was distributed to all participants to investigate their physical status and lifestyle. In addition, the presence of determinant factors of bone status and genetic factors in mother-daughter pairs and lifestyle, including diet and physical activity, in those with low bone status were examined. RESULTS: The OSI was determined by age, weight, the body mass index (BMI), years after menarche, exercise history, and milk intake in daughters, as well as by age, menopause status, history of bone fracture, and exercise history in mothers. Multiple regression analysis showed significant relations between the daughter's OSI and weight, the mother's OSI, the years after menarche, and physical activity. A correlation in mother-daughter pairs was observed between the OSI and height, weight, BMI, and calcium intake. The OSI and milk intake significantly increased with accumulated follow-up checkups owing to the age-matched nutrition instruction; however, physical activity was not improved in either daughters or mothers. CONCLUSIONS: Because the lifestyle of mothers has been already established, it is difficult to change their diet. Therefore, a well-rounded diet during childhood and adolescence is important for achieving good bone health, which reduces the risk of osteoporosis later in life.
