Comparison of clinical outcomes between cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of single-level cervical spondylosis: a 10-year follow-up study

BACKGROUND CONTEXTThe theoretical advantage of cervical disc arthroplasty includes preserved motion at the cervical level, which may reduce degeneration of the adjacent segments. The long-term follow-up results are still controversial.PURPOSEThe present study aimed to retrospectively study the long-term efficacy and complications of cervical disc arthroplasty using a single commercially-available device in a single center.STUDY DESIGNThis was a propensity-score matched cohort study.PATIENT SAMPLEThis study enrolled 148 single-level cervical degenerative disease patients from January 2009 to March 2012. After 1:1 propensity score matching, 39 patients remained in the ACDF or ACDR groups.OUTCOME MEASURESThe outcome measures were neurological functions (Neck Disability Index (NDI) and Japan Orthopedic Association (JOA) scores), radiographic evaluations (cervical curvature, operative segment range of motion, degenerative condition of adjacent segments, heterotopic ossification (HO) of the surgical segment), and complications.METHODSNDI and JOA scores were used to evaluate patient neurological functions. Cervical curvature (C2-C7 Cobb angle) and operative segment range of motion (ROM) were compared between the two groups. Grading criteria for osteophyte formation were used to evaluate the degenerative condition of adjacent segments. HO after ACDR was graded according to the McAfee grading method.RESULTSThe average follow-up time was 119.3 ±17.2 months. Satisfactory improvements in neurological function were obtained for both the ACDR and ACDF groups. There were no significant differences in VAS or NDI scores between the two groups. In the ACDR group, the ROM of the operative segment increased from 6.7 ±4.3° before the operation to 8.9 ±3.5° on the second day after the operation (p<.001). The ROM of the operative segment was 8.1 ±4.0° at the 1-year follow-up, 7.2 ±3.6° at the 2-year follow-up, 5.7 ±4.5° at the 5-year follow-up and 4.3 ±3.9° at the last follow-up. ASD was more likely to develop in the caudal adjacent segments and progressed with the follow-up time. At the last follow-up, HO was present in 27 patients (69.23%), while high-grade HO (McAfee scores III and IV) was detected in 6 patients (15.38%).CONCLUSIONSThrough nearly 10 years of follow-up, ACDR was as effective as ACDF for treating single-level degenerative cervical disc disease. However, HO and the role of ACDR in the protection of ASD remains to be further observed and followed up.     

The incidence and severity of the cold intolerance after reverse homodigital dorsoradial flap for coverage of thumb tissue defect

BackgroundThe reverse homodigital dorsoradial flap (RHDF) has been an optional treatment for thumb soft tissue defects. The current study aims to investigate the incidence and severity of cold intolerance after the use of the RHDF for thumb soft tissue reconstruction.Methods49 patients with thumb soft-tissue defects treated with RHDF from 2010 to 2018 were included with the mean follow-up time of 36 (range, 14–61) months. The assessment of sensory recovery in the flap, the Cold Intolerance Symptom Severity (CISS) questionnaire, symptoms triggering temperature grade, and natural history of the symptoms were included in the final follow-up.Results35 out of 49 patients (71.4%) reported cold intolerance. The mean CISS score of 35 cases was 28 (range 3–72) points. The mean age of the intolerance group was significantly older than that of the non-cold intolerance group. The incidence of cold intolerance in the dorsum was significantly lower than in the pulp and tip. Significantly positive correlations were presented between CISS scores and temperature grades of symptoms triggered. Seven patients were with partial recovery while 6 patients were with complete recovery from negative symptoms. 22 patients reported no change in terms of the symptoms.ConclusionsCold intolerance is a common complication after the RHDF for thumb tissue reconstruction, especially in the elderly population. Cold intolerance following RHDF warrants more attention for surgeons to describe the patient expect after the procedure.     

Comparison of symptomatic unstable ankle with and without os subfibulare

BackgroundThis study aimed to compare the patients background, clinical scores, condition of the lateral ligament, mechanical instabilities, and chondral lesions in ankles with symptomatic os subfibulare compared to those in ankles with chronic lateral instability without os subfibulare.MethodsOf the 212 ankles with a chronic lateral instability that were surgically treated, 72 ankles had an os subfibulare. All ankles were examined by arthroscopy during surgery. Age, sex, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot Scale scores, remnant condition of the lateral ligaments, and chondral lesions were compared between ankles with symptomatic os subfibulare and ankles with chronic lateral instability without os subfibulare.ResultsThere were no statistically significant differences between the groups in terms of the sex ratio (males: females, 35:37 vs. 53:87, n.s.) and the AOFAS Ankle–Hindfoot Scale scores (median; 75 vs. 77, n.s.). There were statistically significant differences in patient age (median: 20 vs. 24.5 years, p < 0.01), talar tilt angle (median: 9.0° vs 12.0°, p < 0.01), anterior drawer distance (6.2 vs. 7.0 mm, p < 0.01), chondral lesions (G0:G1:G2:G3, 35:21:66:5 vs. 40:44:27:29, p < 0.01), condition of the anterior talofibular ligament (intact: repairable remnant: poor remnant, 0:70:2 vs. 1:112:27, p < 0.01), and condition of the calcaneofibular ligament (intact: repairable remnant: poor remnant, 44:26:2 vs. 77:35:28, p < 0.01) between the groups.ConclusionThis study suggests that the condition of the lateral ligaments including mechanical instability and cartilage of the ankle were less severe in the ankles with symptomatic os subfibulare than in those with chronic lateral instability without os subfibulare. The patients’ age was lower in the ankles with symptomatic os subfibulare than in those with chronic lateral instability without os subfibulare. The clinical scores and gender ratio were not statistically different between the group.     

Intra-articular injection versus interscalene brachial plexus block for acute-phase postoperative pain management after arthroscopic shoulder surgery

BackgroundThe minimally invasive approach of arthroscopic shoulder surgery is beneficial; however, for optimal outcomes, perioperative pain management is essential. This cross-sectional study aimed to examine the analgesic effectiveness of intra-articular injection (IA) versus interscalene brachial plexus block (ISPB) among patients treated with arthroscopic shoulder surgeries.MethodsWe reviewed 100 consecutive patients who underwent shoulder arthroscopic surgery, of whom 50 each underwent IA (February 2019─January 2020; IA group) and ISPB (October 2018─July 2019; ISPB group). The primary outcome was the postoperative pain score measured using a Wong–Baker FACES Pain Rating Scale preoperatively and at 2, 6, 12, 24, and 48 h postoperatively. We performed multiple regression analysis to examine whether IA/ISPB selection is associated with acute-phase postoperative pain and adjusted for intra-articular injection, interscalene brachial plexus block, postoperative pain management, arthroscopic shoulder surgery, IA with 10 mg of morphine previously reported prognostic factors for postoperative pain (e.g., surgical procedures, operative time, older age, and preoperative pain). Furthermore, we examined induction time, total pentazocine dosage, and total postoperative nausea and vomiting (PONV) events.ResultsThere were no significant differences between the IA and ISPB groups in perioperative pain control during the acute-phase periods (p = 0.12, repeated analysis of variance). The difference in anesthesia method was not a prognostic factor for acute-phase postoperative pain (p = 0.11). The IA group (15.06 ± 4.00 min) had a significantly shorter mean anesthesia induction time than the ISPB group (29.23 ± 9.22 min) (p = 0.0001). There was no significant between-group difference in the total pentazocine dosage during the first 7 days (p = 0.3934) postoperatively. PONV was observed in eight (17.0%) and two (4.2%) patients in the IA and ISPB groups, respectively. There was no significant between-group difference in the PONV incidence (p = 0.1582).ConclusionsThere was no significant difference in acute-phase postoperative pain management between the IA and ISPB groups. The induction time was significantly shorter in IA.IRBApproval number: UOEHCRB20-078, IRB approval date: September 9th, 2020; study duration: October 2018 to January 2020.     

Factors affecting the quality of life in the chronic phase of thoracolumbar osteoporotic vertebral fracture managed conservatively with a brace

BACKGROUND CONTEXTAlthough osteoporotic vertebral fractures (OVFs) are the most common type of osteoporotic fracture, few reports have closely investigated the factors contributing to the quality of life (QOL) in the chronic phase after thoracolumbar OVFs using detailed radiographic evaluation.PURPOSEThis study aimed to identify factors associated with the QOL in the chronic phase after thoracolumbar OVF.DESIGNPost hoc analysis of a prospective randomized study.PATIENT SAMPLEParticipants included 195 patients with fresh thoracolumbar OVF managed conservatively with a brace who were available for radiographic analysis 48 weeks after injury.OUTCOME MEASURESThe degree of QOL impairment at 48 weeks after thoracolumbar OVF was assessed using the Japanese three-level version of the EuroQol five-dimensional questionnaire (EQ-5D) score.METHODSUnivariate and multivariate regression analyses were used to evaluate the relationships between the QOL and radiographic factors.RESULTSThe univariate analysis showed that age, analgesic use, T10/L5 Cobb angle on magnetic resonance imaging (MRI), subsequent vertebral fracture, and nonunion were significantly associated with the EQ-5D score at 48 weeks after thoracolumbar OVF. The multiple regression analysis showed that nonunion, analgesic use, subsequent vertebral fracture, and sacral slope on MRI were independently associated with the EQ-5D score at 48 weeks after thoracolumbar OVF. Receiver operating characteristic analysis for the deterioration of QOL showed that the cutoff value for sacral slope on MRI was 35 degrees.CONCLUSIONSThis study demonstrated that nonunion, subsequent vertebral fracture, and lower sacral slope were independently associated with poorer QOL in the chronic phase of thoracolumbar OVF managed conservatively with a brace. Therefore, improving or preventing these factors in patients with thoracolumbar OVF in the chronic phase may improve the QOL of the affected patients.     

弥漫性特发性骨质增生症伴腰椎管狭窄症的影像学特征

目的：探讨弥漫性特发性骨质增生症（diffuse idiopathic skeletal hyperostosis,DISH）伴腰椎管狭窄症的影像学特征。方法：回顾性分析2017年6月～2021年10月在我院手术治疗的96例DISH合并L4/5椎管狭窄症患者的术前影像学资料，男58例，女38例；年龄51～77岁（65.9±6.1岁）；将骨化仅限于胸椎节段的患者纳入T-DISH组（n=49），骨化累及胸椎和腰椎节段的患者纳入L-DISH组（n=47）；选取同期在我院手术治疗的性别、年龄及狭窄节段相匹配的无DISH的腰椎管狭窄症患者作为对照组（N-DISH组，n=125）。测量各组术前胸椎后凸角（thoracic kyphosis,TK）、腰椎前凸角（lumbar lordosis,LL）、骶骨倾斜角（sacral slope,SS）、骨盆入射角（pelvic incidence,PI）、骨盆倾斜角（pelvic tilt,PT）和矢状位平衡距离（sagittal vertical axis,SVA），计数骨化韧带节段数目，按照Pfirrmann分级和Weishaupt分级分别评估椎间盘与...