Prevalent morphometric vertebral fractures as a risk factor for subsequent clinical vertebral fractures after shortfusion surgery in older Japanese women with degenerative spondylolisthesis.

STUDY DESIGN: A retrospective cohort study using the Kaplan-Meier method with propensity-score matching. PURPOSE: To evaluate whether the presence of prevalent morphometric vertebral fractures (VFs) poses a risk for subsequent clinical VFs after short-fusion surgery in women aged ≥60 years with degenerative spondylolisthesis. OVERVIEW OF LITERATURE: VFs are common osteoporotic fractures and are associated with a low quality of life. Subsequent VFs are a complication of instrumented fusion in patients with degenerative lumbar disorders. Thus, risk factors for subsequent VFs after fusion surgery must be analyzed. Population-based studies have suggested that prevalent morphometric VFs led to a higher incidence of subsequent VFs in postmenopausal women; however, no studies have investigated whether prevalent morphometric VFs are a risk factor for subsequent VFs after fusion surgery in patients with degenerative spondylolisthesis. METHODS: The study enrolled a total of 237 older female patients: 50 and 187 patients had prevalent morphometric VFs (VF [+] group) and nonprevalent morphometric VFs (VF [-] group), respectively. The time to subsequent clinical VFs after fusion surgery was compared between the two groups using the Kaplan-Meier method. Moreover, 40 and 80 patients in the VF (+) and VF (-) groups, respectively, were analyzed and matched by propensity scores for age, follow-up duration, surgical procedure, number of fused segments, body mass index, and number of patients treated for osteoporosis. RESULTS: Kaplan-Meier analysis indicated that the VF (+) group had a higher incidence of subsequent clinical VFs than the VF (-) group, and Cox regression analysis showed that the presence of prevalent morphometric VFs was an independent risk factor for subsequent clinical VFs before matching. Kaplan-Meier analysis demonstrated comparable results after matching. CONCLUSIONS: The presence of prevalent morphometric VFs may be a risk factor for subsequent clinical VFs in older women with degenerative spondylolisthesis who underwent short-fusion surgery.

Association between ligamentous stenosis at spondylolisthetic segments before fusion surgery and symptomatic adjacent canal stenosis at follow-up in patients with degenerative spondylolisthesis.

STUDY DESIGN: A retrospective case-control propensity score-matching study. PURPOSE: This study aimed to longitudinally evaluate whether preoperative ligamentous stenosis at the spondylolisthetic segments could affect the incidence of symptomatic adjacent canal stenosis following one-segment fusion surgery. OVERVIEW OF LITERATURE: Several risk factors for symptomatic adjacent canal stenosis following fusion surgery have been assessed. Patients with lumbar canal stenosis mainly due to ligamentum flavum (LF) hypertrophy (ligamentous stenosis) also have LF hypertrophy in other segments. METHODS: In total, 76 patients participated in this case-control study (neurologically symptomatic adjacent canal stenosis, n=33; neurologically asymptomatic cases at follow-up, n=43). Their risk factors during surgery and magnetic resonance (MR) images before the surgery and at follow-up were evaluated. Data from the two groups (n=25 each) were matched using propensity scores for age, sex, time to MR imaging at follow-up, surgical procedure, and LF hypertrophy in adjacent segments before the surgery and analyzed. RESULTS: Compared with the asymptomatic group, the symptomatic adjacent canal stenosis group had a significantly larger LF area/spinal canal area in the spondylolisthetic segments before the surgery. During the follow-up periods (in months), they had a larger LF area/ spinal canal area in the adjacent segments: the two values were significantly correlated. The sensitivity, specificity, and positive and negative predictive values for determining symptomatic adjacent canal stenosis were high compared with on the cutoff value for the LF area/spinal canal area at the spondylolisthetic segments before the surgery. These results were the same after matching. CONCLUSIONS: Symptomatic adjacent canal stenosis is mainly caused by LF hypertrophy. Ligamentous stenosis at the spondylolisthetic segments before fusion surgery might be strongly associated with symptomatic adjacent canal stenosis at follow-up.

Cognitive Impairment as the Principal Factor Correlated with the Activities of Daily Living Following Hip Fracture in Elderly People.

Objectives: Hip fracture is a common injury occurring in elderly people and often impairs their activities of daily living (ADL). This study aimed to identify and analyze factors associated with ADL following hip fracture treatment. Methods: A total of 371 consecutive patients with hip fractures who were surgically treated in our hospital were enrolled. Among these, 103 patients who underwent acute- to recovery-phase postoperative rehabilitation at our hospital and whose motor scale of the functional independence measure (mFIM) score was ≥70 before the fracture were finally included in this study. Single and multiple regression analyses were performed to identify the factors correlated with ADL. The mFIM at hospital discharge was set as the outcome variable, and various clinical factors, such as fracture type, surgical technique, serum and biological data, mini-mental state examination (MMSE) score, and serial mFIM scores, were used as explanatory variables. Results: Only MMSE and preinjury mFIM scores were significantly correlated with mFIM at discharge, and MMSE had the larger effect on the outcome. Receiver operating characteristic curve analysis revealed an MMSE cutoff value of 20/21. Patients with an MMSE score of ≤20 showed a relatively poor recovery of mFIM from 2-3 weeks postoperatively compared with those with an MMSE score of ≥21. Conclusion: Cognitive impairment and the preinjury ADL level were correlated with short-term ADL outcomes following hip fracture. Cognitive impairment was the most important factor affecting ADL; treatment and postoperative rehabilitation should be carefully considered for cognitively disturbed patients from the acute phase after hip fracture.

Presence or absence of adjacent vertebral fractures has no effect on long-term global alignment and quality of life in patients with osteoporotic vertebral fractures treated with balloon kyphoplasty.

BACKGROUND: Global sagittal malalignment after osteoporotic vertebral fracture is correlated with decreased quality of life. Balloon kyphoplasty promotes short-term global alignment, but long-term correction is difficult in patients with such fractures. Adjacent vertebral fracture is one of the major complications of balloon kyphoplasty. We investigated the correlation of the incidence of adjacent vertebral fracture with the loss of global alignment correction after balloon kyphoplasty. METHODS: Forty patients were enrolled in this retrospective study. Adjacent vertebral fracture occurred in 17 patients. Sagittal vertical axis, the angle between the two vertebrae above and below the balloon kyphoplasty site (local alignment angle), and the vertebral kyphotic angle at the kyphoplasty site were measured pre- and post-operatively. Clinical results were assessed. RESULTS: There were no significant differences between the sagittal vertical axis before and after balloon kyphoplasty in groups with (+) or without (-) adjacent vertebral fracture. Local alignment angles decreased soon after balloon kyphoplasty, but increased during follow-up in both groups. Vertebral kyphotic angles decreased significantly soon after balloon kyphoplasty in both groups; although this increased significantly in the adjacent vertebral fracture (-) group, but not in the adjacent vertebral fracture (+) group, during follow-up. Correction loss of alignment was found in both adjacent vertebral fracture (+) and (-) groups, attributed to adjacent vertebral fracture in the former and re-collapse of the balloon kyphoplasty site in the latter. No significant differences in clinical results were observed between the groups, although these were strongly correlated with sagittal vertical axis before balloon kyphoplasty. CONCLUSIONS: The adjacent vertebral fracture (+) and (-) groups exhibited similar correction loss of alignment and improved quality of life. The presence or absence of adjacent vertebral fractures had no effect on long-term global alignment and patient quality of life.

Lower lumbar osteoporotic vertebral fractures with neurological symptoms might have two different pathogeneses according to early magnetic resonance images.

BACKGROUND: Most osteoporotic vertebral fractures (OVFs) occur in the thoracolumbar area without neurological symptoms. The pathogenesis and clinical results of symptomatic lower lumbar OVFs have not been analysed. We aimed to retrospectively investigate the risk factors for the occurrence of neurological symptoms in patients with lower lumbar OVFs and to assess the clinical results of these symptoms using magnetic resonance (MR) images. METHODS: Of the 104 patients enrolled, 21% reported neurological symptoms. We divided OVFs with neurological symptoms into various types using early MR images and investigated the risk factors for each type. Clinical results of symptomatic patients were also evaluated. RESULTS: Symptomatic patients with lower lumbar OVFs mainly had one of two fracture types, indicated by total low and superior/inferior low-intensity signals on T1-weighted images. A multivariate logistic regression analysis showed that a smaller canal area and longer disease duration were risk factors for all patients. For patients with OVFs indicated by total low intensity, symptomatic patients had a significantly smaller canal area than non-symptomatic patients. For patients with OVFs indicated by superior/inferior low intensity, symptomatic patients had a significantly higher frequency of L4 and L5 vertebral fractures, longer disease duration, smaller canal area, smaller angle between the facets, and higher frequency of coexisting degenerative spondylolisthesis than non-symptomatic patients. Symptomatic patients with OVFs indicated by total low intensity had poorer clinical results regarding walking ability than symptomatic patients with OVFs indicated by superior/inferior low intensity. CONCLUSIONS: Lower lumbar OVFs with neurological symptoms might have two different pathogeneses according to early MR images. Compared with symptomatic patients with OVFs indicated by superior/inferior low intensity, symptomatic patients with OVFs indicated by total low intensity may require different treatment strategies to avoid symptoms.

Ulnar nerve palsy caused by synovial protrusion in synovial chondromatosis of the elbow: a case report and literature review.

We describe an unusual case of ulnar nerve compression (cubital tunnel syndrome) caused by synovial protrusion in primary synovial chondromatosis of the elbow in a 59-year-old man. Magnetic resonance imaging is a useful tool for diagnosing this rare condition. Surgical excision of the intra-articular multiple loose bodies and ulnar nerve decompression were performed. The clinician should be aware of primary synovial chondromatosis as one of the causative factors of cubital tunnel syndrome.

Isolated Salter-Harris Type III Physeal Fracture of the Distal Ulna.

We describe a case of isolated physeal fracture of ulna distal end in a 13-year-old boy. This fracture type is uncommon, especially Salter-Harris type III of this injury has not been reported. Plain radiographs showed a small vertical fracture line at the ulnar distal end and an enlargement of epiphyseal plate at the base of ulnar styloid process. The present case was successfully managed with conservative treatment because of its minimal displacement.

Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study.

AIM: To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging (MRI). METHODS: A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years (range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI. RESULTS: Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially (AM type), six posteromedially (PM type), and five posteriorly (P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI. CONCLUSION: We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.

Cystic lesion around the hip joint.

This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.

Spontaneous resorption of calcification at the long head of the biceps tendon.

Calcific tendinitis of the long head of the biceps tendon is a rare cause of shoulder pain. Calcium deposits are often spontaneously resorbed or reduced in size in the rotator cuff tendons, which represent the most common sites of calcific tendinitis around the shoulder. To our knowledge, no case of spontaneous resorption of calcification in the long head of the biceps tendon has been reported in the literature. Here, we report one such case and describe its successful treatment using a conservative approach.

Smaller facet effusion in association with restabilization at the time of operation in Japanese patients with lumbar degenerative spondylolisthesis.

OBJECT: The objective of this study was to assess, in patients with degenerative lumbar spondylolisthesis, which factors determine whether the involved disc levels were restabilized or remained unstable at the time of operation using multifactorial analysis. METHODS: A total of 195 consecutive patients who had received laminectomy with or without fusion at our hospital between 2003 and 2007 for progressed degenerative spondylolisthesis (slip percentage > 10% at lateral flexion position) with spinal canal stenosis participated in this study. Sagittal plane unstable motion was defined according to the criteria that translatory displacement was > 4 mm (translatory hypermobility) or rotatory displacement was > 10 degrees (rotatory hypermobility). There were 52 unstable cases (including 23 translatory and 43 rotatory hypermobility cases) and 143 stable cases. Nine parameters were investigated retrospectively as candidate factors: age, sex, body mass index, disc level, grade of disc degeneration, grade of disc spur formation, facet effusion size, length of facet spur formation, and angle between facets. The differences in the candidate factors between the unstable and stable group, together with the association between translatory or rotatory displacements and factors other than sex and disc level, were investigated. Multivariate logistic regression analysis was also used to determine independent factors for the presence of unstable motion at the time of operation. RESULTS: The unstable group had significantly greater facet effusion size (p < 0.001) than the stable group. There were no significant differences between the 2 groups in age, sex, body mass index, disc level, grade of disc degeneration, grade of disc spur formation, length of facet spur formation, or angle between facets. Multiple regression analysis for all candidate factors (except for sex and disc level) indicated that translatory displacement significantly correlated with facet effusion size positively (p < 0.001), and that rotatory displacement significantly correlated with facet effusion size positively (p < 0.001) and with age (p = -0.042) and grade of disc degeneration (p = -0.033) negatively. Logistic regression analysis for all candidate factors demonstrated that increased facet effusion size (OR 1.656, 95% CI 1.182-2.321) was the only independent factor for the presence of unstable motion at the time of operation. Facet effusion size had high negative but low positive predictive value in determining unstable motion at the time of operation. One of the reasons for the low positive predictive value was the association between facet spur formation and restabilization of the segments in the patients with greater facet effusion. CONCLUSIONS: Facet effusion size was associated with the determination of whether the affected disc was stabilized or remained unstable at the time of operation. In particular, a smaller facet effusion size strongly suggested that the affected disc had been restabilized in the patients with lumbar degenerative spondylolisthesis.