[Show abstract][Hide abstract] ABSTRACT: The optimal treatment option for osteochondritis dissecans of the knee is still controversial. We report the case of a boy who developed osteochondritis dissecans in the lateral femoral condyles of his bilateral knees requiring repeat surgical procedures. There has been no literature reporting juvenile osteochondritis dissecans of bilateral knees requiring repeat surgical procedures.
A 6-year-old Japanese boy presented with pain in his bilateral knees. Although conservative treatment with prohibition of sports activities was continued for 6 months, healing could not be attained. Conservative treatment consisting of prohibition of sports activities that included running and jumping and use of a brace with a locking mechanism at full extension was applied. He was instructed to walk with the brace. Since his lateral femoral osteochondritis dissecans lesion was located at the contact area during flexion, weight bearing with the use of the brace could effectively unload the lesion. Surgery was subsequently conducted on his left knee which had a more advanced stage lesion. Transchondral drilling was performed because the articular surface maintained its smooth continuity. At 9 months after the surgery, no appreciable healing was observed in the follow-up radiographs. Moreover, during the postoperative time course, lesions suggestive of osteochondritis dissecans in his contralateral right knee had become more evident. Based on the diagnosis of delayed union of bilateral osteochondritis dissecans lesions, a second surgery was attempted. The preceding arthroscopic observation of his left knee showed preserved surface continuity with softening and suspected partial detachment. Considering the delayed healing process observed in this patient, autogenous cylindrical osteochondral graft transplantation (8 mm in diameter) was performed as a revision procedure, while transchondral drilling was performed for the stable osteochondritis dissecans lesion in his right knee. Postoperatively, healing was achieved at 6 months.
Following failed conservative treatment, he underwent arthroscopic drilling; however, the osteochondritis dissecans lesion did not heal requiring revision surgery using a cylindrical autogenous osteochondral graft. Finally, clinical and radiological healing was attained 6 months after the second surgery. Initial presentation at a young age with bilateral lesions may be clinical factors related to poor healing response and susceptibility to stress-related subchondral lesions.
Full-text · Article · Dec 2016 · Journal of Medical Case Reports
[Show abstract][Hide abstract] ABSTRACT: A 47-year-old man underwent ceramic cup arthroplasty when he was 22 years old. Revision total hip arthroplasty was performed 25 years later because of limited range of motion without implant loosening. Histologic examination revealed that the femoral head and ceramic implant were well fixed through a thin fibrous membrane. The energy-dispersive X-ray analysis indicated that calcium and phosphorus were detected in the same peak pattern as cancellous bone in the bone-ceramic interface.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Recent clinical trials and animal models demonstrated that immune checkpoint blockade enhanced effector cell responses and tumor rejection, however, further development and improvement of cancer immunotherapy is necessary for more favorable objective responses. In this study, we examined the effect of IL-18 on the anti-tumor effect of immune checkpoint inhibitors.
We examined the effect of IL-18 on the peritoneal dissemination of CT-26 cells or tail vein injection metastasis of B16/F10 cells using anti-programmed death-1 ligand-1 (αPD-L1) and/or anti-cytotoxic T lymphocyte-associated antigen-4 (αCTLA-4) monoclonal antibodies.
Massive ascites developed after i.p. inoculation of CT-26, resulting in animal death within 30 days. Treatment of mice with αPD-L1 and/or αCTLA-4 significantly prolonged their survival, and a combination of the antibodies and IL-18 provided a much greater therapeutic benefit. The combination modality led to the accumulation of precursor of mature natural killer (pre-mNK) cells in the peritoneal cavity together with increased CD8+ T and decreased CD4+CD25+Foxp3+ T cells. Depletion of the pre-mNK cells abrogated the therapeutic effects and increased the number of CD4+CD25+Foxp3+ T cells. The combination treatment also suppressed tail vein injection metastasis of B16/F10 cells.
The results demonstrated that IL-18 enhanced therapeutic effects of immune checkpoint blockade against peritoneal dissemination of carcinoma or tail vein injection metastasis of melanoma through accumulation of pre-mNK cells, memory-type CD8+ T cells, and suppression of CD4+CD25+Foxp3+ T cells. A combination of immune checkpoint inhibitors with IL-18 may give a suggestion to the development of next-generation cancer immunotherapy.
Preview · Article · Jan 2016 · Clinical Cancer Research
[Show abstract][Hide abstract] ABSTRACT: Anterior cruciate ligament (ACL) injury causes knee joint instability, and effects on sports performance. Therefore, ACL reconstruction is essential to keep their high performance. It is well known that the outcome of ACL reconstruction is strongly related to the placement and orientation of the bone tunnel. Therefore, optimization of tunnel drilling technique is an important factor to obtain satisfactory surgical results. Current procedure relies on arthroscopic evaluation and there is a risk of damaging arteries and ligaments during surgery. The damages may reduce the accuracy and reproducibility of ACL reconstruction. As a postoperative evaluation method, a quadrant method has been used to evaluate the placement and orientation of the bone tunnel in X-ray radiography. This study proposes a computer-aided surgical planning system for evaluating ACL insertion site and orientation using magnetic resonance (MR) images. We first introduce MR image based the quadrant method to determine the ACL insertion site for preoperative patients. It also evaluates the 3-D spatial relationship between the planning femoral drilling hole and arteries around the femoral condyle. This system has been applied to ACL injured patients, it may increase the accuracy and reproducibility of ACL bone tunnel, and it can evaluate a risk of damaging the surrounding arteries and ligaments.
Full-text · Article · Dec 2015 · Procedia Computer Science
[Show abstract][Hide abstract] ABSTRACT: Conventionally, posterior C1-C2 fusion has been performed using a sublaminar wiring technique with a structural bone graft. Subsequent advent of newer fixation devices, such as the C1 lateral mass screw and C1 hook, has achieved more solid fixation with improved surgical outcome; however, in these fixation systems, the protruding end of the metal implant above the level of the atlas may result in a complication due to contact with the surrounding structures.
Two men and two women whose ages at the time of surgery ranged from 14 to 72 years. A supralaminar hook was used as a fixation device for C1 in two cases, whereas a lateral mass screw (Tan's method) and an atlas claw hook were employed for one each of the remaining 2 cases. We retrospectively reviewed the clinical features and postoperative course of these patients using the clinical records. Moreover, we measured the protruding height of the instrument above the atlas as well as the Redlund-Johnell (R-J) value on postoperative radiographs. All patients complained of crepitus and/or pain on neck extension. Erosion in the occipital bone was detected on multiplanar reconstruction computed tomography (MPR-CT), whereas plain radiographs failed to reveal the bony change. In those cases, protruding instruments used for C1 fixation contacted the occipital bone resulting in an erosive change at the impingement point. We removed the implant in all four cases after confirmation of solid bony union.
Two of the four patients complained of occipital crepitus alone without pain. The management options for this condition may be controversial; however, progression of bony erosion may result in perforation of the occipital bone. This may possibly be associated with the serious complication of cerebrospinal fluid leakage. Considering this potential sequela, we removed the implants from all our reported cases after confirmation of solid bony union.
We treated four cases that developed erosion in the occipital bone after posterior spinal instrumentation was performed for upper cervical lesions including C1. MPR-CT was useful in detecting the erosive changes in the occipital bone.
[Show abstract][Hide abstract] ABSTRACT: Minimally invasive surgery (MIS) for transforaminal lumbar interbody fusion (MIS-TLIF) is widely used for lumbar degenerative diseases. In the paper the authors report a unique case of a hemothorax caused by the trocar tip of the rod inserter after MIS-TLIF. A 61-year-old woman presented with thigh pain and gait disturbance due to weakness in her lower right extremity. She was diagnosed with a lumbar disc herniation at L1-2 and the MIS-TLIF procedure was performed. Immediately after surgery, the patient's thigh pain resolved and she remained stable with normal vital signs. The next day after surgery, she developed severe anemia and her hemoglobin level decreased to 7.6 g/dl, which required blood transfusions. A chest radiograph revealed a hemothorax. A CT scan confirmed a hematoma of the left paravertebral muscle. A chest tube was placed to treat the hemothorax. After 3 days of drainage, there was no active bleeding. The patient was discharged 14 days after surgery without leg pain or any respiratory problems. This complication may have occurred due to injury of the intercostal artery by the trocar tip of the rod inserter. A hemothorax after spine surgery is a rare complication, especially in the posterior approach. The rod should be caudally inserted in the setting of the thoracolumbar spine.
No preview · Article · Nov 2015 · Journal of Neurosurgery Spine
[Show abstract][Hide abstract] ABSTRACT: Study design:
A retrospective case review.
To assess the clinical and radiographic outcomes and identify the predictive factors associated with poor clinical outcomes after lumbar spinous process-splitting laminectomy (LSPSL) for lumbar spinal stenosis (LSS).
Overview of literature:
LSPSL is an effective surgical treatment for LSS. Special care should be taken in patients with degenerative lumbar scoliosis (DLS).
A consecutive retrospective case review of patients undergoing LSPSL for LSS with a minimum 2-year follow-up was performed. Mild DLS and mild degenerative spondylolisthesis (DS) were included in the study. The Japanese Orthopedic Association (JOA) score and recovery rate were reviewed. Poor clinical outcome was defined as a recovery rate <50% using Hirabayashi's method.
A total of 52 patients (mean age, 72 years) met the inclusion criteria and had a mean follow-up of 2.6 years (range, 2-4.5 years). The preoperative diagnosis was LSS in 19, DS in 19, and DLS in 14 cases. The mean JOA score significantly increased from 14.6 to 23.2 at the final follow-up. The overall mean recovery rate was 60.1%. Thirteen patients (25%) were assigned to the poor outcome group. A higher rate of pre-existing DLS was observed in the poor outcome (poor) group (good, 15%; poor, 62%; p=0.003) than in the good outcome (good) group. None of the patient factors examined were associated with a poor outcome. A progression of slippage ≥5 mm was found in 8 of 24 patients (33%) in the DS group. A progression of curvature ≥5° was found in 5 of 14 patients (36%) in the DLS group. The progression of scoliosis and slippage did not influence the clinical outcome.
The clinical and radiographic outcomes of LSPSL for LSS were favorable. Pre-existing DLS was significantly associated with poor clinical outcome.
Preview · Article · Oct 2015 · Asian spine journal
[Show abstract][Hide abstract] ABSTRACT: Synovial osteochondromatosis of the hip is a rare condition, and the surgical treatment approach for this condition requires complete removal of loose bodies combined with synovectomy. While these, procedures are generally accepted as the optimal treatment method, this is still controversial topic. Recent studies have reported that open surgical procedures remain acceptable for synovial osteochondromatosis of the hip. These procedures include the dislocation of the femoral head, and complications such as femoral head necrosis and bursitis or great trochanter non-union due to trochanteric osteotomy have been reported. The present study reports a modified technique for surgical dislocation through a Z-shaped capsular incision without trochanteric flip osteotomy for the treatment of synovial osteochondromatosis of the hip.
[Show abstract][Hide abstract] ABSTRACT: Background:
Although both local infiltration analgesia (LIA) and continuous femoral nerve block (FNB) are common analgesic modalities for pain relief after total knee arthroplasty (TKA), we are aware of no parallel-group, randomized controlled trial that has solely compared the efficacy of LIA and continuous FNB.
We conducted a prospective, 2-arm, parallel-group, randomized controlled trial involving patients scheduled for TKA. A total of 45 patients were randomly assigned to either the LIA or the continuous FNB group. Except for the analgesic modality, perioperative managements were identical in both groups. The primary outcome was postoperative pain score at rest 1 day after surgery, measured using a 100-mm visual analog scale.
Patients in the LIA group had a significantly lower visual analog scale score at rest 1 day after surgery than those in the continuous FNB group (34 ± 10 vs 42 ± 13 mm; P = .028). The opioid consumption during the initial 24 hours was significantly lower in the LIA group (12 ± 4 vs 16 ± 7 mg; P = .031). There were no differences in the rate of complications between the groups.
LIA was associated with better pain relief with a comparable complications rate for patients undergoing TKA than FNB. We recommend LIA for pain relief after TKA.
No preview · Article · Oct 2015 · The Journal of arthroplasty
[Show abstract][Hide abstract] ABSTRACT: Among the surgical options for large full-thickness chondral injuries, cell-based therapy has been practiced and its satisfactory outcomes have been reported. One area that appears promising is cell-based therapies utilizing stem cells. Various tissues within the human body contain mesenchymal stem cells (MSCs) from where these can be harvested. These include bone marrow, adipose, synovium, peripheral blood, and umbilical cord. In this article, both preclinical animal studies and clinical studies dealing with the use of MSCs for cartilage repair of the knee are reviewed. Majority of the clinical papers have shown promising results; however, there are a limited number of studies of high evidence level. Clinical significance of the stem cell therapy as compared to other surgical options as well as optimization of the procedure in terms of cell type and delivery method is still to be determined.
No preview · Article · Sep 2015 · Current Reviews in Musculoskeletal Medicine
[Show abstract][Hide abstract] ABSTRACT: Descriptive case report.
To report a rare case of post-traumatic torticollis by odontoid fracture in a patient with diffuse idiopathic skeletal hyperostosis (DISH).
Cervical fractures in DISH can result from minor trauma, and a delay in presentation often prevents their timely diagnosis. Cervical fractures in patients with spinal DISH usually occur in extension injuries, and almost always occur in the lower cervical spine. Reports of odontoid fractures with torticollis in patients with spinal DISH are rare.
A 73-year-old man with DISH presented with severe neck pain and a cervical deformity presenting as torticollis without neurological deficits. He gave a history of a fall while riding a bicycle at a low speed 3 months ago. X-ray showed torticollis in the right side, and computed tomography (CT) showed a type-II odontoid fracture and subluxation at the C1-2 level.
We performed a staged treatment because this patient had severe neck pain associated with a chronic course. Initially, the fracture dislocation was reduced under general anesthesia and was stabilized with a halo vest. We then performed posterior occipitocervical in situ fusion after confirming the correction of the cervical deformity by CT. The patient showed significant amelioration of neck symptoms postoperatively, and bony fusion was achieved 1 year after surgery.
For post-traumatic torticollis due to an odontoid fracture, plain CT is useful for diagnosis and posterior occipitocervical in situ fusion following correction and immobilization with a halo vest is a safe and an effective treatment.
[Show abstract][Hide abstract] ABSTRACT: Descriptive case report.
To report a case of a diffuse idiopathic skeletal hyperostosis (DISH) patient with both massive ossification of the anterior longitudinal ligament (OALL) leading to severe dysphagia as well as ossification of the posterior longitudinal ligament (OPLL) causing mild cervical myelopathy, warranting not only an anterior approach but also a posterior one.
Although DISH can cause massive OALL in the cervical spine, severe dysphagia resulting from DISH is a rare occurrence. OALLs are frequently associated with OPLL. Treatment for a DISH patient with OPLL in setting of OALL-caused dysphagia is largely unknown.
A 70-year-old man presented with severe dysphagia with mild cervical myelopathy. Neurological examination showed mild spastic paralysis and hyper reflex in his lower extremities. Plane radiographs and computed tomography of the cervical spine revealed a discontinuous massive OALL at C4-5 and continuous type OPLL at C2-6. Magnetic resonance imaging revealed pronounced spinal cord compression due to OPLL at C4-5. Esophagram demonstrated extrinsic compression secondary to OALL at C4-5.
We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. We performed posterior decompressive laminectomy with posterior lateral mass screw fixation, as well as both resection of OALL and interbody fusion at C4-5 by the anterior approach. Severe dysphagia markedly improved without any complications.
We considered that this patient not only required osteophytectomy and fusion by the anterior approach but also required decompression and spinal fusion by the posterior approach to prevent both deterioration of cervical myelopathy and recurrence of OALL after surgery.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the preoperative radiographs with cases of developmental dysplasia of the hip (DDH) leading to rotational acetabular osteotomy (RAO) or curved peri-ace-tabular osteotomy (CPO), and examine the frequency of femoroacetabular impingement (FAI) related bone morphology in the acetabulum and femoral head-neck junction. Twenty-four hips with hip dyaplasia who underwent CPO or RAO were included in this study. Six hips had grade 0 and eighteen hips had grade 1 OA according to the Tönnis classification. We excluded patients with moderate and severe hip osteoarthritis and major femoral head deformities. Preoperative radio-graph was evaluated on sharp angle, center-edge angle, alpha angle, crossover sign and posterior wall sign. Crossover signs were revealed in 7 hips (29.2%); posterior wall signs were revealed in 16 hips (66.7%); and cam-type deformities with an alpha angle of ≥50. 5˚ere observed in 19 hips (79.2%) in preoperative evaluation. As determined using the Tönnis scale, no progression of os-teoarthritis was found in 16 of the 24 hips; there was a one-grade progression in 8 hips. Among the 8 hips, either positive cross-over sign or posterior sign in acetabulum, and an alpha angle of ≥50. 5˚n femur were observed in six hips with progression of osteoarthritis. The presence of cam-type deformity and acetabular retroversion in patients who underwent RAO or CPO was relatively high in preoperative radiographs, and caution should be employed during surgery in patients with DDH. There is a possibility of secondary FAI due to excessive forward coverage of the bone fragments after RAO and CPO.
Full-text · Article · May 2015 · Open Journal of Orthopedics