Abstract: Kyphoplasty is advantageous over vertebroplasty in terms of better kyphosis correction and diminished risk of cement extravasations. Literature described cement leakage causing neurological injury mainly after vertebroplasty procedure; only a few case reports show cement leakage with kyphoplasty without neurological injury or proper cause of leakage. We present a report two cases of osteoporotic vertebral compression fracture treated with kyphoplasty and developed cement leakage causing... Show More
Full-text available · Article · Aug 2010 · Journal of Orthopaedic Surgery and Research
Abstract: Radiologic study of scoliosis in pectus excavatum patients.
To determine the relation between pectus excavatum deformity and adolescent idiopathic scoliosis (AIS).
AIS may be related to other whole body deformities, but few reports have addressed the relation between chest deformity and scoliosis.
A total of 248 patients with a diagnosis of pectus excavatum were enrolled in this study. All study patients underwent whole spine anteroposterior radiographs and chest computed tomography.... Show More
Article · Dec 2011 · Journal of pediatric orthopedics
Abstract: The thickness of the human spine dural sac can show differences between individuals and levels, and these differences can alter clinical outcomes.
To analyze spinal cord dural sac thicknesses.
Anatomical study of human cadavers.
The subjects of this study were 19 human cadavers with no prior history of spinal surgery or deformity. Seventeen specimens from T1/T2 to L5/S1 were obtained from each of 19 cadavers, a total of 323 specimens. Multiple sections were prepared from these specimens.... Show More
Article · Dec 2011 · The spine journal: official journal of the North American Spine Society
Abstract: BACKGROUND CONTEXT: Although the Cobb method is considered the gold standard, the centroid method may offer a reasonable alternative in adult scoliosis because it has better inter- and intraobserver reliabilities in adolescent scoliosis. PURPOSE: To compare the reliabilities of the Cobb and the centroid methods for measuring coronal curvature in degenerative scoliosis in older patients. STUDY DESIGN: Observational study involving three examiners. PATIENT SAMPLE: Sixty whole spine... Show More
Full-text available · Article · Jan 2013 · The spine journal: official journal of the North American Spine Society
Abstract: PURPOSE: To identify factors that can affect postoperative shoulder balance in AIS. METHOD: 89 adolescent idiopathic scoliosis patients with six types of curvatures who underwent surgery were included in this study. Whole spine antero-posterior and lateral radiographs were obtained pre- and postoperatively. In radiograms, shape and changes in curvatures were analyzed. In addition, four shoulder parameters and coronal balance were analyzed in an effort to identify factors significantly... Show More
Abstract: Study Design. Observational study with three examinersObjectives. To compare the reliability of shoulder balance measurement methodsSummary of Background Data. There are several measurement methods for shoulder balance. No reliability analysis has been performed, despite the clinical importance of this measurement.Methods. Whole spine postero-anterior radiographs (n = 270) were collected to compare the reliability of the four shoulder balance measures in adolescent idiopathic scoliosis... Show More
Abstract: Radiographic analysis with scoliosis patients.
To analyze correlations between sagittal spinal alignment and coronal scoliotic curvature.
Sagittal spinal alignment and scoliosis may have a significant relationship, and schematic analysis is needed.
The study group was comprised of 163 patients with adolescent idiopathic scoliosis. Subjects underwent antero-posterior and lateral radiographs of the whole spine including hip joints. The radiographic parameters used were magnitude, location and... Show More
Article · Mar 2015 · Journal of spinal disorders & techniques
Of the 262 patients who received epidural steroid injections, 204 did not have operations for up to one year. However, 58 patients experienced inadequate relief of pain or wanted operations and therefore underwent surgery. At baseline, the 2 groups had similar mean disability indices and pain scores, as well as gender ratios, ages, and durations of symptoms (P > 0.05). In the patients who underwent surgery, the mean disability and pain scores were not significantly decreased after... Show More
Abstract: Osteoarthritis is prominent among the elderly, with symptoms originating from multiple parts of the body. A cross-sectional study of a nationwide survey was performed to describe the prevalence of and identify factors related to symptomatic hip, knee, and spine osteoarthritis.
This cross-sectional study collected data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V-5; 2010?2012). After excluding ineligible subjects, there were 8976 subjects in this study... Show More
Other authors have found similar correlations between these measures when evaluating Lenke 1 and 2 curves . This low correlation cannot be attributed to the reliability of the parameters evaluated if we consider that in all works published the reliability of the photographic measurements is excellent [6,11] and the same occurs with radiological measurements . It is possible that the photographic measurements differ from radiological measurements because of the effect of the soft tissues in the shoulder area.
[Show abstract] [Hide abstract] ABSTRACT: To determine the validity of digital photography as an evaluation method for shoulder balance (ShB) in patients with idiopathic scoliosis.
A total of 80 patients were included (mean age 20.3 years; 85% women). We obtained a full x-ray of the vertebral column and front and back clinical photography for all patients. For antero-posterior x-rays we measured the proximal thoracic curve angles (CPT). To evaluate radiological shoulder balance we calculated the clavicle-rib intersection angle (CRIA) and T1-tilt. For clinical photography we measured shoulder height angle (SHA), axilla height angle (AHA) and the left right trapezium angle (LRTA). We analyzed the reliability of the different photographic measurements and the correlation between these and the radiological parameters.
The mean magnitude of PTC, CRIA and T1-tilt were 19°, -0.6° and 1.4° respectively. Mean SHA from the front was -1.7°. All photographic measurements revealed an excellent-near perfect intra and inter-observer reliability in both photographic projections. No correlation was found between the ShB and the magnitude of the PTC. A statistically significant correlation was found between clinical balance of the shoulders and radiological balance (r between 0.37 and 0.51).
Digital clinical photography appears to be a reliable method for objective clinical measurement of ShB. The correlation between clinical and radiological balance is statistically significant although moderate/weak.
As a natural consequence a lot of literature emerged on selecting Upper Instrumented Vertebra (UIV) to achieve balanced shoulders8910. Simultaneously several authors started looking at the radiographic criteria to define shoulder balance . Since it was soon established that the T1 vertebral tilt traditionally used to bench mark shoulder level was not a reliable indicator of clinical shoulder level, multiple other measures like Clavicle angle, Coracoid process height difference, Trapezius length, First Rib –Clavicle height, Clavicle rib cage intersection difference, First Rib angle, Clavicle tilt angle, Clavicle chest cage angle difference , First Rib Index etc. emerged [25, 26].
[Show abstract] [Hide abstract] ABSTRACT: Study design: Retrospective observational study. Objective: To assess what features determine post-operative shoulder asymmetry in Adolescent Idiopathic Scoliosis (AIS). Summary of background data: Shoulder balance is one of the major determinants of the cosmetic outcomes of AIS surgery. Yet, other than level of the shoulders we are not clear what parameters are to be measured to assess torso symmetry. This study looks at the various features that might affect the appearance of the shoulder region. Methods: The records of 157 operated cases of AIS were retrospectively reviewed. Eight patients with documented post-operative shoulder asymmetry and were dissatisfied with their cosmetic outcomes were selected for the study. Their clinical photographs alone were studied. Three regions- the base of the neck, the shoulder and upper arm region- were analysed separately. Four measures each for the neck and shoulder and two for the arms were documented. No statistical tools were employed since the numbers were quite small but consensus was obtained between two Consultant Orthopaedic surgeons regarding the cosmetic impact of each parameter. Results: The neck and the shoulder appeared independent determinants of cosmesis of the proximal trunk. The base of neck symmetry seemed to be dependent on four features viz. centralization of the neck, neck tilt, trapezius angle and base of neck angle. The appearance of the shoulder itself depended on its level, axillary fold level, scapular level and the scapular prominence. The upper arm parameters appeared less critical in determining the cosmetic impact. Conclusions: Proximal trunk symmetry in AIS depends on the symmetry of the base of the neck and shoulder regions. The level of the shoulders, axillary folds along with the base of neck angle, Trapezius angle appear to be key determinants of symmetry.
Their linkage analysis demonstrated a novel locus for adolescent idiopathic scoliosis and pectus excavatum on chromosome 18q , and the prevalence of scoliosis among pectus excavatum patients is higher than within the general population. Hong et al. reported the prevalence of AIS as 22.58 % of 248 pectus excavatum patients, and the incidence was significantly higher in female patients (38.46 %) . Furthermore, Wang et al. demonstrated that 25 out of 142 patients (17.6 %) with pectus excavatum had scoliosis with a Cobb angle [10° .
[Show abstract] [Hide abstract] ABSTRACT: PurposePectus excavatum can negatively impact cardiac function during scoliosis surgery. Several authors reported severe hypotension associated with the prone position during scoliosis surgery in children that had both scoliosis and pectus excavatum. However, we could find no studies that evaluated the change in the thoracic factors, such as sternal tilt angle and Haller index after scoliosis surgery in patients with both scoliosis and pectus excavatum. The purpose of this study is to evaluate the change in thoracic factors after surgical treatment for scoliosis associated with pectus excavatum. Methods
We performed a retrospective review on 20 patients (10 males and 10 females) who underwent surgical treatment for scoliosis associated with pectus excavatum from August 2004 to April 2014 in our hospital. We investigated the scoliosis diagnosis, preoperative and postoperative Cobb and thoracic kyphosis (TK) angles, the change in TK after surgery and thoracic factors, including the AP and transverse diameters of the chest, the sternal tilt angle, and Haller index. ResultsPatient mean age was 13.2 years old (4–27 years old) at surgery. Types of scoliosis were idiopathic in 8 patients, syndromic in 10, and neuromuscular in 2. The mean Cobb angles were 72.1° preoperatively and 19.0° postoperatively. Curve locations were thoracic in 13 patients, thoracolumbar in 4, and lumbar in 3. Surgical treatment of pectus excavatum was performed in 9 patients (45 %) before scoliosis treatment. Mean sternal tilt angles were 11.5° preoperatively and 11.1° postoperatively. Mean Haller indices were 4.8 preoperatively and 5.3 postoperatively. This was especially true for syndromic or neuromuscular scoliosis and thoracolumbar/lumbar curve type patients in which scoliosis surgery tended to worsen the Haller index. Conclusion
The Haller index increased postoperatively in 11 of 20 patients, which means sternal depression deteriorated after scoliosis surgery in about 50 % of patients. We suggest that surgeons fully assess the thoracic factors in patients with scoliosis and pectus excavatum prior to performing scoliosis surgery and carefully monitor their patient’s general condition during surgery.
Kyphoplasty demonstrates a lower complication rate, as compared to vertebroblasty, including decreased risk of cement extravasation, pulmonary embolism, infection, epidural hematoma, and systemic toxicity [5, 6] . Paralysis following BKP is rare and has been reported to be secondary to cement extravasation . Herein we report two unique cases of patients that were treated with BKP and developed instability with resultant neurological decline.
[Show abstract] [Hide abstract] ABSTRACT: Purpose
To describe two unique cases of osteoporotic vertebral compression fracture (OVCF) treated with balloon kyphoplasty (BKP) that were complicated by spinal instability and resultant lower extremity paraparesis.
Kyphoplasty was performed in two patients with OVCF that had persistent back pain despite a course of conservative care. Immediately following BKP, both patients had a marked improvement in back pain. However, they developed progressive bilateral lower extremity weakness. Lateral spine flexion–extension radiographs demonstrated instability, and polymethyl methacrylate did not adhere to the endplate of the treated vertebrae.
Both the patients underwent a hybrid fixation without a decompression. Postoperatively, both of them demonstrated gradual improvement in their neurological exam.
To the best of our knowledge, this is the first report describing the development of spinal instability with resultant delayed paraplegia following BKP. This case report demonstrates another cause of neurological decline following BKP, in the absence of cement leakage.
Therefore, it makes difficult to feel the needle resistance changes when a patient lacks the ligamentum flavum. Another possible reason is the thickness of the dura matter, as it is thinner at around the second to third lumbar vertebrae and may be easily damaged by usual manipulation during the puncture . Our results show the importance of performing an epidural puncture carefully, especially at lower thoracic and lumbar intervertebral spaces.