Assessing Neurological Complications in Thoracic Three-Column Osteotomy: A Clinical Application of a Novel MRI-Based Classification Approach.

STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To investigate the occurrence of neurological complications in patients undergoing thoracic three-column osteotomy (3CO) utilizing an magnetic resonance imaging (MRI)-based classification that assesses spinal cord shape and the presence of cerebrospinal fluid at the curve apex and evaluate its prognostic capacity for postoperative neurological deficits. SUMMARY OF BACKGROUND DATA: Recent advancements in correction techniques have improved outcomes for severe spinal deformity patients undergoing 3CO. A novel MRI-based spinal cord classification system was introduced, but its validation and association with postoperative complications remain unexplored. MATERIALS AND METHODS: Between September 2012 and September 2018, a retrospective analysis was conducted on 158 adult patients with spinal deformities undergoing 3CO. Radiographic parameters were measured. T2-weighted axial MRI was used to describe spinal cord morphology at the apex. Intraoperative neurophysiological monitoring alerts were recorded, and preoperative and postoperative neurological functions were assessed using the Frankel score. Categorical data were compared using the χ 2 or the Fisher exact test. The paired t test was utilized to assess the mean difference between preoperative and postoperative measurements, while the one-way analysis of variance and independent t test were used for comparative analyses among the different spinal cord types. RESULTS: Patients were categorized into three groups: type 1, type 2, and type 3, consisting of 12, 85, and 61 patients. Patients with type 3 morphology exhibited larger Cobb angles of the main curve ( P <0.001). This disparity persisted both postoperatively and during follow-up ( P <0.05). Intraoperative neurophysiological monitoring alerts were triggered in 32 patients (20.3%), with a distribution of one case in type 1, six cases in type 2, and 22 cases in type 3 morphologies ( P <0.001). New neurological deficits were observed in 15 patients (9.5%), with 1, 3, and 11 cases in type 1, 2, and 3 morphologies, respectively. CONCLUSIONS: Patients with type 3 morphology exhibited greater spinal deformity severity, a higher likelihood of preoperative neurological deficits, and an elevated risk of postoperative neurological complications. This underscores the utility of the classification as a tool for predicting postoperative neurological complications in patients undergoing thoracic 3CO. LEVEL OF EVIDENCE: 4.

Complete Intradural Interbody Cage Migration in Lumbar Spine Surgery: A Case Report and Literature Review.

Background: Spinal fusion is a common surgery, in which vertebrae are fused to restore spinal stability and eliminate pain during movement. The use of an interbody cage facilitates spinal fusion. However, complete cage migration into the dura matter rarely occurs and can be challenging to manage. Case Presentation: A 44-year-old man presented at our spine center with a history of incomplete paraplegia and cauda equina syndrome that had lasted for 2 years and 4 months. This condition developed after he underwent six lumbar spine surgeries to address lower back pain and right-sided sciatica. A structural allograft kidney-shaped cage was found completely within the dura at the level of the L3 vertebra. Durotomy, cage retrieval, and pedicle screw fixation from the L2 to L4 vertebrae were performed. Numbness in both lower limbs markedly decreased within several days of the operation. After four months following the progressive physical therapy, the patient could partially control both urination and defecation. Five months postoperatively, he could stand with slight assistance. Conclusions: Complete intradural cage migration is a rare and serious complication. To the best of our knowledge, this is the first reported case with such a condition in the literature. Even if treatment is delayed, surgical intervention may salvage the remaining neurologic function and may even lead to partial recovery.

Computed Tomography-Guided Endoscopic Surgery in Lumbar Disc Herniation With High-grade Migration: A Retrospective, Comparative Study.

BACKGROUND: Symptomatic herniated intervertebral discs are debilitating. However, surgical management poses a significant challenge for endoscopic spine surgeons, especially in high-grade migrated lesions. OBJECTIVES: This study aimed to  assess the surgical and clinical outcomes after applying a computed tomography navigated percutaneous endoscopic lumbar discectomy. STUDY DESIGN: The data of patients with high-grade lumbar disc migration who underwent percutaneous endoscopic lumbar discectomy at our spine center were retrospectively collected and analyzed from November 2017 to May 2019. The patients were divided into 2 groups based on different workflows, with group O who underwent percutaneous endoscopic lumbar discectomy with computed-tomography navigation (O-arm), and group C who underwent conventional fluoroscopic guidance (C-arm). SETTING: Twenty-one (n = 21) patients were enrolled with data fully documented. There were 9 patients in group O (n = 9) and 12 patients in group C (n = 12). METHODS: An intraoperative 3-dimensional image was obtained using the O-arm device (O-arm®, Medtronic, Inc., Louisville, CO, United States) after patient positioning in group O, and enable multiplanar visualization during exploring the entry point, trajectory, orientation, and finally discectomy. In group C, conventional imaging scanner intensifier (C-arm) was used during the procedure. RESULTS: The operative time (99.4 ± 40.7 vs 86.9 ± 47.9 minutes, P = .129), blood loss (11.1 ± 15.7 vs 6.7 ± 8.2 mL, P = .602), and hospital stay (2.9 ± 0.3 vs 2.8 ± 0.6 days, P = .552) were similar between the 2 groups. However, group O showed more reduction in the pain and faster functional recovery immediately after the surgery (Visual Analog Score [VAS]: -9 vs -6.7, P =.277; Oswestry Disability Index [ODI]: -53.2% vs -29.1%, P = 0.006) and during the one-year follow-up (VAS: -8.1 vs -7.3, P =.604; ODI: -56.7% vs -40.1%, P = .053) compared with group C. LIMITATIONS: The retrospective nature of the study design, the small population size, and the shorter period of follow-up required further study. CONCLUSIONS: Computed tomography-navigated percutaneous endoscopic surgery is safe and effective for lumbar disc herniation with high-grade migration, and enhance early functional recovery even compared with conventional fluoroscopic guidance.

Cephalometric analysis following combined Sub-SMAS hyaluronic acid injection and subdermal and supraperiosteal poly-L-lactic acid injections in Asian women.

BACKGROUND: The aging face is characterized by skin laxity and volume loss. Attenuation of facial retaining ligaments significantly contributes to skin sagginess and soft tissue volume loss. AIMS: We designed a prospective cohort study to quantitatively assess the efficacy of hyaluronic acid (HA) with adjunct poly-L-lactic acid (PLLA) injections in strengthening the retaining ligaments. PATIENTS/METHODS: A total of 12 Asian women were treated with HA injections to the orbital, zygomatic, buccal-maxillary, and mandibular retaining ligaments with adjunct supraperiosteal and subdermal PLLA injections to the temporal region, midface, and lower face. Cephalometric measurements were done before treatment and 2, 4, 12, and 24 weeks post-procedurally. RESULTS: Eyebrow peak and tail angles increased 20.0° ± 3.8° to 21.0° ± 3.8° (p < 0.05) and -2.9° ± 4.2° to -1.3° ± 3.3° (p < 0.001) at week 12. Eyebrow-to-orbital-rim distance increased 1.9 ± 2.0 mm to 3.9 ± 1.5 mm (p < 0.001) at week 12. Eyebrow-to-upper-eyelid distance increased 11.6 ± 3.0 mm to 12.7 ± 3.2 mm (p < 0.001) at week 24. Eyebrow-peak-to-lateral-limbus distance decreased 6.1 ± 3.1 mm to 5.3 ± 2.4 mm (p < 0.05) at week 4. Tragus-oral-commissure length and lower-facial-contouring length decreased 281 ± 11 mm to 275 ± 10 mm (p < 0.01) and 297 ± 14 to 292 ± 11 mm (p < 0.05) at week 12, respectively. CONCLUSION: Hyaluronic acid injection for strengthening of facial retaining ligaments with adjunct PLLA is viable, safe, and effective in facial rejuvenation as supported by quantitative data.

Makoplasty medial unicondylar knee replacement: Correction or postoperative angle matters?

INTRODUCTION: Various considerations prevail around optimal postoperative varus deformity, correction angle and physiological constitutional varus deformity. The goal of our present study was to understand correlation between these parameters and their influence over Western Ontario McMaster University Osteoarthritis Index scale (WOMAC). MATERIALS AND METHODS: Consecutive robotic-arm-assisted medial onlay fixed bearing unicompartmental knee arthroplasty (UKA) in 143 knees studied. WOMAC score was recorded preoperatively and at specific intervals after surgery for consecutive 2 years. RESULTS: Mean preoperative and postoperative varus deformities were 10.2° and 4.8°, respectively, and mean correction angle was 5.4°. The preoperative varus and correction angles were found well correlated (r = 0.815). The amount of improvement in the WOMAC total score was not influenced by the postoperative varus angle. CONCLUSION: The correction angle has a stronger correlation with preoperative varus deformity, and postoperative varus deformity does not imply favourable clinical outcomes.

Quantitative Outcome Assessment of Color Match and the Extent of Repigmentation after Pixel Array Epidermal Grafting for Head and Neck Stable Vitiligo: A Prospective Cohort Study.

BACKGROUND: Epidermal grafting with an automatic harvesting system has been reported as a simple and efficacious procedure for stable vitiligo. However, no prospective cohort study has quantitatively evaluated the color matching and extent of repigmentation in the head and neck area by this method. OBJECTIVE: To evaluate the color matching and extent of repigmentation after pixel array epidermal grafting by image analysis software and physicians' naked eye. METHODS: Ten Asian patients with head and neck vitiligo lesions stable for at least 6 months were treated with pixel array epidermal grafting with an automatic harvesting system and post-grafting phototherapy. The patients were evaluated 1, 3, and 6 months post grafting for the percentage of repigmentation by blinded physicians' assessment and image analysis software. The color matching index of repigmentation was evaluated by measuring the melanin index in the grafted area and the juxta non-vitiliginous area. RESULTS: The average blister harvest time was 46.3 ± 9.7 min. The area percentile of repigmentation by the image analysis software were 32.3 ± 26.8, 64.6 ± 29.4, and 76.5 ± 25.9 at 1, 3, and 6 months post grafting, respectively. There were no significant differences between the physicians' assessments and the results from the image analysis software. The change in the area percentile of repigmentation between 3 and 6 months post grafting was only statistically significant using image analysis software. The grafted area achieved a color match of 83.1 ± 13.4% that of the juxta non-vitiliginous area 6 months after grafting. Three patients had repigmentation of leukotrichia. CONCLUSION: By quantitative measurement, uniform pixel array micrografts provide a very good extent of repigmentation and color match in the head and neck area. Image analysis software revealed a steady increase in repigmentation after POM3 until POM6, which was not detected by subjective assessment.

Functional recovery in human partial thickness skin wounds after application of multicomponent hydrolipidic film (MAS063DP): A prospective, open-label, comparative clinical trial.

Acute and minor skin wounds are common in daily life. However, in clinical practice, after initial management in the acute phase, the wounds are managed mainly through observation, and the patients are usually lost to follow-up. Considering a multicomponent hydrolipidic dressing (MAS063DP) long-known for its safe application in eczema and recently in laser-induced wounds, we aimed to evaluate its ability in functional recovery of impaired skin integrity during wound healing. Sixteen patients (N = 16) were enrolled and completed (n = 8 vs n = 8) this prospective, open-label, vehicle-controlled clinical trial with 12-week follow-up. Transepidermal water, skin viscoelasticity and bioimpedance analysis were measured initially, at the 1st, 4th, 8th, and 12th weeks. Improvements in these parameters were greater in the MAS063DP group (from 31.4 ± 9.0 to 16.4 ± 4.3 g/m2 h, P < .001; from 77 ± 16% to 88 ± 9%, P < .05; from 4182 ± 3823 to 2644 ± 1772 Ω) than in the white petrolatum group. No significant adverse events occurred, and all participants were more satisfied with the intervention. In this study, MAS063DP can restore skin integrity and reinstitute physiologic function as a feasible and safe intervention more markedly than management through observation during the healing process by providing protective hydrolipidic layer on the skin with simultaneous anti-inflammatory and antioxidant activities from its key ingredients such as glycyrrhetinic acid, Vitis vinifera, telmesteine, and vitamins C and E.

Photoaging Reversibility in Asian Patients With Melasma Treated Using Picosecond Lasers With a Diffractive Lens Array: A 1-Year Prospective Observational Cohort Study.

BACKGROUND: Picosecond lasers appear to be effective and safe in treating pigmentation and photoaging disorders through laser-induced optical breakdown. OBJECTIVE: To analyze the feasibility of photorejuvenation using picosecond lasers with diffractive lens array (DLA) in patients with melasma. METHODS: Ten Asian (N = 10) women with melasma and Fitzpatrick skin Type IV were enrolled and treated using 755-nm picosecond alexandrite lasers with DLA. All individuals were assessed before treatment, and at 12, 20 weeks, and 1 year by post-hoc test on melasma area and severity index (MASI) and with VISIA Complexion Analysis System using percentile rank for measurement. RESULTS: The median participant age was 46.5 years. The average MASI continually and significantly (p < .05) decreased until the 1-year follow-up, with the photoaging characteristics, such as wrinkles and red areas improving simultaneously (p < .05). Spots, texture, pores, ultraviolet (UV) spots, brown spots, and porphyrins exhibited alleviation, but this improvement relapsed by the 1-year follow-up. No postinflammatory hyperpigmentation or hypopigmentation occurred. CONCLUSION: In patients with melasma, picosecond laser treatment with DLA may alleviate pigmentation disorder and the related photoaging characteristics (e.g., wrinkled skin and increased vascularity), and the effects may be maintained for a long time. Nevertheless, post-treatment clinical visits every 3 to 6 months are recommended.

Application of "parachute" technique for free flap reconstruction in advanced tongue cancer after ablation without lip-jaw splitting: A retrospective case study.

The hemi or subtotal/total glossectomy is usually approached by lip-jaw splitting procedure for advanced tongue cancer ablation. This highly invasive procedure can cause facial disfiguration, bone malunion, and osteoradionecrosis. The aim of this study is to compare the surgical outcome in free flap tongue reconstruction between novel parachute technique in an intact jaw and the conventional lip-jaw splitting procedure after tongue cancer ablation.In this study, parachute technique was adopted for free flap inset in patients without mandibulotomy. We retrospectively reviewed patients who have received primary advanced tongue cancer resection and free flap reconstruction during April, 2008 to January, 2015. Patients were divided into 2 groups. Group A was undergoing parachute technique without lip-jaw splitting. We sutured all the strings through the edges of defect in the first step and through the matching points of flap margin in the second step from outside the oral cavity. Then, the strings were pulled and the flap was parachuted down on the defects after all the matching points were tied together. In group B, the patients received conventional lip-jaw splitting procedure. Student t test was used for results analysis.There were 15 patients (n = 15) in group A and 15 patients (n = 15) in group B. In the patients receiving parachute technique, operation time showed 34 minutes (P = .49) shorter, hospital stay showed 4 days (P = .32) shorter, and the infection rate of surgical site showed 6.6% (P = .64) less than with conventional technique. The survival rates of the flaps were both 100% without revision.The parachute technique is an effective and more accessible method for free flap setting in cases of tongue reconstruction without lip-jaw splitting, and provides patients with better aesthetic appearance.

Efficacy and Safety Evaluation of Picosecond Alexandrite Laser with a Diffractive Lens Array for Treatment of Melasma in Asian Patients by VISIA Imaging System.

Objective: To evaluate the efficacy and safety of picosecond (ps) 755-nm alexandrite laser with a diffractive lens array (DLA) generating laser-induced optical breakdown, which may be beneficial for melasma treatment. Background: Melasma is notorious for difficult to treat with any modality setting. Recently, picosecond alexandrite laser with DLA seems promising for dealing with it without intolerable complications. Methods: Twenty (N = 20) Asian female melasma patients with Fitzpatrick skin type IV were recruited for 3 treatment sessions of picosecond 755-nm alexandrite laser with DLA at a 4- to 6-week interval. The pulse duration was 750 ps. An 8-mm spot size and the fluence of 0.4 J/cm2 was used over the target area with 2 passes per treatment area and around 2000-2500 passes in total. The repetition rate was 10 Hz. Melasma Area and Severity Index (MASI) score and VISIA® imaging system analysis were utilized for evaluation before treatment and 4 weeks after the completion of the third treatment session. The clinical improvement and adverse events were assessed by the physicians and patients, respectively. Results: The median age of the patients was 45 years (from 27 to 55 years). In the physicians' evaluation, 40% (n = 8) of patients showed good improvement and 40% (n = 8) of patients showed moderate improvement. The mean MASI score before and after laser therapy showed significant improvement from 9.0 ± 4.8 to 6.5 ± 3.7 (p < 0.001). VISIA analysis of the forehead presented significant improvement in spots (p = 0.007) and porphyrins (p = 0.032). Some patients experienced erythema (25%), pruritus (20%), and scaling (20%) but subsided within few days of using emollients and sunscreen. Only 5% (n = 1) of patients developed mild postinflammatory hyperpigmentation, which also subsided in 3 weeks. Conclusions: Three sessions of picosecond 755-nm alexandrite laser with a DLA were effective for melasma treatment in Asian patients with minimal side effects.