Herniated Discs at the Cervicothoracic Junction.

BACKGROUND: Disc herniations at the cervicothoracic junction (C7-T1 level) are unusual, and there have only been a few studies of patients with herniated C7-T1 discs. In addition, previous studies did not focus on the mechanism and causes of solitary cervicothoracic junction disc herniation. The authors investigated the characteristics, symptom duration, clinical course, and biomechanics of cervicothoracic junction disc herniation by comparing patients with C7-T1 disc herniation (C7-T1 group) with control groups. METHODS: Thirty-six patients who underwent solitary C7-T1 single-level disc surgery between 2006 and 2015 were included. For radiographic comparison, patients in a herniated C5-C6 disc group and the healthy control group were cohort matched. RESULTS: In the C7-T1 group, the disc herniation mainly occurred in the foraminal space (P < 0.0001). The C7-T1 group was significantly associated with a history of trauma (P < 0.0001). In addition, the cervical vertebral body was more readily observed on plain lateral radiographs in the C7-T1 group (7.36 ± 0.068). Patients in the C5-C6 group tended to have the sternal notch more frequently located above the T2-T3 disc space than other groups (P = 0.014). CONCLUSIONS: C7-T1 disc herniation demonstrates unique characteristics. Understanding the features of disc herniation at the cervicothoracic junction would be helpful for optimal care.

WITHDRAWN: Characteristics of patients with herniated discs at the cervicothoracic junction.

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Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion.

BACKGROUND CONTEXT: Adjacent segment degeneration (ASD) is one of the major complications after lumbar fusion. Several studies have evaluated the risk factors of ASD. Although the paraspinal muscles play an important role in spine stability, no study has assessed the relationship between paraspinal muscle atrophy and the incidence of ASD after lumbar fusion. PURPOSE: In the present study, we aimed to verify the known risk factors of ASD, such as body mass index (BMI), preoperative adjacent facet joint degeneration, and disc degeneration, and to assess the relationship between paraspinal muscle atrophy and ASD. STUDY DESIGN: This is a retrospective 1:1 pair analysis matched by age, sex, fusion level, and follow-up period. PATIENT SAMPLE: To calculate the appropriate sample size for the study, we performed a pre-study analysis of the paraspinal muscle cross-sectional area (CSA), and estimated that at least 35 cases would be needed for each group. Among the 510 patients who underwent posterior lumbar fusion for degenerative lumbar disease between January 2009 and October 2009, a total of 50 patients with ASD after surgery were selected. Another group of 50 matched patients with degenerative lumbar disease without ASD after spinal fusion were selected as the control group. Each patient in the ASD group was matched with a control patient according to age, sex, fusion level, and follow-up period. OUTCOME MEASURES: Radiographic measurements and demographic data were reviewed. METHODS: The risk factors considered were higher BMI, preoperative adjacent segment disc and facet degeneration, and preoperative paraspinal muscle atrophy and fatty degeneration. The radiographic data were compared between the ASD and control groups to determine the predictive factors of ASD after posterior lumbar fusion by using logistic regression analysis. The study was not externally funded. The authors have no conflict of interest to declare. RESULTS: Multivariate logistic regression analysis indicated that higher BMI (odds ratio [OR]: 1.353, p=.008), preoperative facet degeneration on computed tomography examination (OR: 3.075, p=.011), disc degeneration on magnetic resonance imaging (MRI) (OR: 2.783, p=.003), fatty degeneration (OR: 1.080, p=.044), and a smaller relative CSA of the paraspinal muscle preoperatively (OR: 0.083, p=.003) were significant factors for predicting the development of ASD. CONCLUSIONS: The occurrence of radiological ASD is most likely multifactorial, and is associated with a higher BMI, preexisting facet and disc degeneration on preoperative examination, and a smaller preoperative relative CSA of the paraspinal muscle on MRI.

The Fate of Adjacent Segments After Anterior Cervical Discectomy and Fusion: The Influence of an Anterior Plate System.

OBJECTIVE: The purpose of this study was to compare anterior cervical discectomy and fusion with cage alone (ACDF-CA) and anterior cervical discectomy and fusion with cage and plate (ACDF-CP) with regard to adjacent segment degeneration (ASD) diagnosed by the use of CT and MRI with retrospective matched cohort design. METHODS: This study enrolled 68 patients who underwent single-level ACDF who were diagnosed with cervical degenerative disc disease and were followed up for at least 2 years with plain radiographs, computed tomography, and magnetic resonance imaging. The patients were divided into 2 groups according to the operation method: ACDF-CA (33 patients) and ACDF-CP (35 patients). RESULTS: ASD occurred in 4 of 33 patients who underwent ACDF-CA and 9 of 35 patients who underwent ACDF-CP as determined by computed tomography and magnetic resonance imaging. The upper segment range of motion and lower segment range of motion increased in both groups postoperatively. The increase was greater in the ACDF-CP group without statistical significance. The upper segment disc height and lower segment disc height gradually decreased in both groups over time. The decrease was significantly greater in the ACDF-CP group at each follow-up visit. Pseudarthrosis and cage subsidence was observed more in the ACDF-CA group. The pain intensity for the neck in the ACDF-CA group was increased 12 and 24 months postoperatively. CONCLUSIONS: The anterior plate system in ACDF tends to increase adjacent segmental motion and decrease adjacent segmental disc height. In addition, irrespective of clinical symptoms, ACDF-CP has a greater tendency to result in ASD than ACDF-CA after 24 months after surgery.

Effects of carotid artery stenosis treatment on blood pressure.

OBJECT: The purpose of this study was to evaluate and compare the long-term effects of carotid endarterectomy (CEA) and carotid artery stenting (CAS) on blood pressure (BP). METHODS: Between January 2003 and December 2009, 134 patients underwent 145 procedures for treatment of carotid artery stenosis. Patients with at least 1 year of clinical and radiographic follow-up after treatment were included in this study. A total of 102 patients met this criterion and were placed in the CEA group (n = 59) or the CAS group (n = 43) according to their treatment. The percentage change in BP decrement and the number of patients with a normotensive BP were evaluated and compared between the groups. RESULTS: There were no significant differences between the groups with regard to baseline characteristics. Compared with the pretreatment BP, the follow-up BPs were significantly decreased in both groups. At the 1-year followup, the percentage change in the BP decrement was greater in the CAS group (percentage change: systolic BP 9.6% and diastolic BP 12.8%) than in the CEA group (percentage change: systolic BP 5.9% [p = 0.035] and diastolic BP = 8.1% [p = 0.049]), and there were more patients with a normotensive BP in the CAS group (46.5%) than in the CEA group (22.0%, p = 0.012). CONCLUSIONS: Both CEA and CAS have BP-lowering effects. Carotid artery stenting seems to have a better effect than CEA on BP at the 1-year follow-up.

Influence of history of brain disease or brain trauma on psychopathological abnormality in young male in Korea : analysis of multiphasic personal inventory test.

OBJECTIVE: The purpose of this study is to confirm whether brain disease or brain trauma actually affect psychopathology in young male group in Korea. METHODS: The authors manually reviewed the result of Korean military multiphasic personal inventory (KMPI) in the examination of conscription in Korea from January 2008 to May 2010. There were total 237 young males in this review. Normal volunteers group (n=150) was composed of those who do not have history of brain disease or brain trauma. Brain disease group (n=33) was consisted of those with history of brain disease. Brain trauma group (n=54) was consisted of those with history of brain trauma. The results of KMPI in each group were compared. RESULTS: Abnormal results of KMPI were found in both brain disease and trauma groups. In the brain disease group, higher tendencies of faking bad response, anxiety, depression, somatization, personality disorder, schizophrenic and paranoid psychopathy was observed and compared to the normal volunteers group. In the brain trauma group, higher tendencies of faking-good, depression, somatization and personality disorder was observed and compared to the normal volunteers group. CONCLUSION: Young male with history of brain disease or brain trauma may have higher tendencies to have abnormal results of multiphasic personal inventory test compared to young male without history of brain disease or brain trauma, suggesting that damaged brain may cause psychopathology in young male group in Korea.