Formosan Journal of Musculoskeletal Disorders/中華骨科醫學雜誌
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中華民國骨科醫學會,正常發行
選擇卷期
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Background: Few studies have been published concerning about the osteoporotic symptomatic vertebral compression fractures (VCFs) following instrumented spinal fusion for degenerative spinal disease. Purpose: The purpose of this study was to evaluate the incidence of symptomatic VCFs and the differences in the timing of occurrence and bone mineral density (BMD) between patients with adjacent and remote VCFs after instrumented spinal fusion. Methods: We performed a retrospective analysis of 1,936 patients who received posterior instrumentation for degenerative spinal disease at our institution and were followed-up for at least 3 years. Dual-energy X-ray absorptiometry surveys were arranged, and symptomatic subsequent VCFs were identified during regular follow-up. Eligible patients were divided into two groups (adjacent or remote to instrumented spinal fusion, based on the location of their VCFs. The Wilcoxon signed-rank test or chi-square test was used to assess between-group differences. Linear regression analysis was used to examine the relationship between the timing of the occurrence of VCFs and BMD (T-score). Results: The incidence of symptomatic VCFs following instrumented lumbar spine fusion was 2.37% (46/1,936), which accounted for 20.53% (46/224) of patients with VCFs. Linear regression analysis revealed a positive trend between the timing of the occurrence of symptomatic VCFs and values of BMD (T-score). The mean time to develop adjacent VCFs was 6.8 months, while that to develop remote VCFs was 13.7 months (p ＜ 0.05). Conclusion: Symptomatic adjacent VCFs occurred much earlier than remote VCFs. Device-related osteoporosis may be one of risks in subsequent VCFs, which highlight the importance of osteoporosis medication.
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Background: Patients who were diagnosed with failed back surgery syndrome (FBSS) underwent posterior lumbar interbody fusion (PLIF) with instrumentation at our hospital. Purpose: The aim of this study was to analyze the clinical and radiologic outcomes of PLIF for post-laminectomy pain syndrome and determine whether any single operation can be used to overcome most of these complications. Methods: The surgical technique consisted of wide decompression with further laminectomy over the ongoing fusion level, nearly total discectomy, end-plate preparation, bone graft packing, insertion of a dual intervertebral spacer, and rigid pedicle screw instrumentation. Results: The mean visual analog scale (VAS) pain score improved from 8.5 preoperatively to 1.9 at the final follow-up. The mean Japanese Orthopaedic Association (JOA) score improved from 9.3 preoperatively to 23.1 at the final follow-up (p ＜ 0.001). The mean recovery rate at the final follow-up was 70.1% (range, 21.0-94.1%). Complications were seen because of perioperative dural tears in six cases, but there were no cases of nerve root injury. A satisfactory result was achieved in 79.7% of our patients, while the overall fusion rate was 88.7%. Conclusion: According to the results of our series, we believe that PLIF can be a reasonable and effective procedure for post-laminectomy pain syndrome with different surgically correctable structural causes.
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Background: A full-length standing scanogram (FLSS) can be difficult to measure a quadriceps angle (Q-angle). The trochlear groove (TG) and tibial tubercle (TT) normally cannot be inspected. Purpose: The purpose of this retrospective study was to use magnetic resonance imaging (MRI) of knees to aid in accurately defining the TG and TT on FLSS radiographs. Methods: Sixty consecutive adult patients (29 men and 31 women; average, 46 years) took knee MRI for ligament or meniscus injury. A standardized patellar center was defined as the deepest point of the TG on a transverse MRI film along the femur trans-epicondylar line (TEL). The distance from this point to the lateral femoral cortex and the TEL were measured. The TT was chosen at the insertion of patellar tendon (the lowest margin) revealed on a transverse MRI film. Then, the distance from the TT to the lateral tibial cortex and the tibial diameter at this level were measured. Results: The standardized patellar center was at a point 42% from the lateral end of the femur TEL. The TT was 2 cm distal to the articular surface, and 37% from the lateral end of the tibial diameter. There was no statistical significance between men and women for the location of the TG and TT (p ＞ 0.05). However, men had more distal insertion of the TT (22.2 mm vs. 19.6 mm, p ＜ 0.001). Conclusion: A Q-angle may be more accurately defined on a FLSS by using MRI to aid localizing the TG and TT.
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Background: Reverse total shoulder arthroplasty (RSA) has also become popular in Taiwan, however, no related article regarding RSA has been reported in the orthopaedic literature in Taiwan. Purpose: To examine functional outcomes and complications after RSA. Methods: Patients undergoing RSA between March 2015 and March 2017 were reviewed for inclusion in this retrospective study. All patients had rotator cuff arthropathy, fracture malunion with cuff arthropathy, and locked shoulder. Clinical outcomes were evaluated using Constant scores and active range of motion (ROM) of the shoulder joint. Active ROM was evaluated in terms of anterior elevation, abduction, external rotation at 90 degree of abduction, and internal rotation. Constant scores and ROMs were analyzed postoperatively at 6 months and 1 year. Results: Fourteen patients (eight women, six men; average age, 75 years (range, 64 to 89 years) were evaluated with an average follow-up of 13.8 months. The average absolute Constant score at 6 months follow-up was 61.6 ± 10.6 points. Average degree of anterior elevation, abduction, external rotation, and internal rotation improved from 66.4, 27.8, 40, and sacrum, respectively, before surgery to 147.1, 33.9, 84.6, and L4, respectively, postoperatively. However, average external rotation did not improve significantly after surgery (p = 0.0055). Similar results were noted at 1 year follow-up. Two complications (14.3%) were recorded including RSA shoulder dislocation and postoperative acromion fracture. Conclusion: RSA provides reliable pain relief and return of shoulder function in patients with rotator cuff arthropathy.
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Spondylodiscitis is usually caused by hematogenous spread, and recently there have been only a few published reports citing the soft tissue as the hematogenous source. We present an unusual case of pyogenic spondylodiscitis following elbow cellulitis. In addition to white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values, we checked the procalcitonin (PCT) level to confirm if the infection was in acute phase. Although the patient’s fever subsided after administration of antibiotics, the neurologic claudication worsened, and we performed an anterior debridement and interbody fusion combined with posterior instrumentation. The direct lateral retroperitoneal approach, which we adapted, has the advantage of excellent exposure for irrigation, debridement, and reconstruction without requiring blood vessel mobilization or manipulation of the peritoneal contents. After surgery, intravenous antibiotics were administered for 6 weeks, followed by oral antibiotics until the CRP normalized and the ESR was decreasing. The patient made an uneventful recovery, with no significant neurologic sequelae reported at outpatient follow-up evaluations. The purpose of this case report is to inform clinicians of the potentially severe complication of spondylodiscitis following cellulitis and describe a modified approach to surgical treatment.
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Gouty arthritis is a form of inflammatory arthritis, most prevalent among middle-aged to elderly men and postmenopausal women as well. The radiograph of extra-articular gouty tophi presented with calcification at medial collateral ligament (MCL) of knee is uncommon. We describe a case of the 68-year-old woman with intermittent left knee pain for one year who had extra-articular calcification. After the failure of conservative treatment, she received excision under the impression of Pellegrini-Stieda disease according to the calcification location and size near the MCL of left knee. However, the postoperative pathological examination showed tophaceous gout, which was not compatible with our preoperative diagnosis. Back to preoperative survey, ultrasonography or dual-energy computed tomography may help us to make correct diagnosis. Thus, the patient may need not excision, but medical treatment. In addition, we also discuss the differential diagnosis of extra-articular calcification in this article.
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The incidence of complications of subtalar arthroereisis has been reported to be wide ranging. We describe a rare case of stress fracture of the lesser metatarsus after subtalar arthroereisis. Conservative treatment with short leg casting and non-weight bearing was performed for four weeks. The fracture united uneventfully. Post-operative gait training, including avoiding persistent hindfoot inversion, should be mentioned to the patient before surgery.
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Uncemented modular acetabulum components demonstrate a lower rate of radiographic loosening. However, most of late failure was caused by the osteolysis, inducing bone destruction and loss of fixation. Loosening of the well-fixed cup caused by late shedding of the ingrowth surface of uncemented cup is a rare complication. We report of three cases, and through retrieval analysis of the cup we postulate the possible mechanism of late shedding of well-fixed cup. We found that improper position of the cup and eccentric polyethylene (PE) wear may cause impingement of the cup by neck and increase tensile and shear forces which may cause late shedding of good bone-ingrowth cup. Early revision of the eccentric wear PE is indicated for prevention of this complication.