Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study

Purpose

To compare single-level circumferential spinal fusion using pedicle (n = 27) versus low-profile minimally invasive facet screw (n = 35) posterior instrumentation.

Method

A prospective two-arm cohort study with 5-year outcomes as follow-up was conducted. Assessment included back and leg pain, pain drawing, Oswestry disability index (ODI), pain medication usage, self-assessment of procedure success, and >1-year postoperative lumbar magnetic resonance imaging.

Results

Significantly less operative time, estimated blood loss and costs were incurred for the facet group. Clinical improvement was significant for both groups (p < 0.01 for all outcomes scales). Outcomes were significantly better for back pain and ODI for the facet relative to the pedicle group at follow-up periods >1 year (p < 0.05). Postoperative magnetic resonance imaging found that 20 % had progressive adjacent disc degeneration, and posterior muscle changes tended to be greater for the pedicle screw group.

Conclusion

One-level circumferential spinal fusion using facet screws proved superior to pedicle screw instrumentation.     

Comparative effectiveness of PEEK rods versus titanium alloy rods in lumbar fusion: A preliminary report

Background

Posterior lumbar instruments made of titanium and its alloys could change the physiological distribution of load at the instrumented and adjacent segments, which is a main cause of implant failure, non-fusion and adjacent segment degeneration. Posterior lumbar rods made of polyetheretherketone (PEEK) which is a semirigid alternative to titanium and its alloys have been introduced in lumbar fusion. This prospective study compared the radiological and clinical outcomes of patients undergoing lumbar fusion with PEEK rods versus titanium alloy rods.

Methods

Using transpedicular fixation and lumbar fusion, 21 patients were treated with titanium alloy rods (TI group), and 20 patients with PEEK rods (PEEK group). Radiological and clinical outcomes were evaluated, including the status of the implanted instruments, fusion rate, lumbar lordosis angle (LA), disc space height (DH), visual analog score (VAS) for lower back pain (VAS-BP) and leg pain (VAS-LP), Japanese Orthopedic Association scoring system (JOA score) and complications.

Results

Clinical VAS-BP, VAS-LP and JOA scores were significantly improved at 3 months, 6 months, and 1 year postoperatively as compared with preoperative scores in both groups (p?<?0.05), with similar levels of improvement observed at the same time points postoperatively between the two groups. The overall fusion rate was 100 % at the 1-year follow-up for both groups. No significant differences in lumbar lordosis angle were found preoperatively, 1 week and 1 year postoperatively in both groups (p?>?0.05). The postoperative increase of disc space height and loss of disc space height during the follow-up showed a similar extent of change between both groups (p?>?0.05).

Conclusions

PEEK rods offer a similar radiological and clinical efficacy as titanium alloy rods. PEEK rods, as a semirigid implant with unique characteristics, may be an effective alternative treatment for patients with degenerative lumbar disease in lumbar fusion.     

Hemilaminoplasty for the treatment of lumbar intraspinal synovial cysts (LISCs) and literature review

Purpose

The present report intended to introduce the hemilaminoplasty technique and evaluate the efficacy of our surgical procedure for LISCs.

Methods

This retrospective study was conducted to analyze the results in 24 LISCs who had undergone our hemilaminoplasty between 2000 and 2012 in two hospitals. All were confirmed by pathological histology and mid- to long-term follow-up had been performed in all cases with a mean of 4.9 years. Using the Japanese Orthopedic Association scoring system (JOA score) and visual analog scale (VAS), symptoms resulting from cyst compression were quantified at various stage for statistical analysis.

Results

The JOA score and VAS of back/leg pain following surgery were improved significantly (P < 0.01). At final follow-up, with normal aging there was a little decrease in JOA score and VAS of back/leg pain, but still significantly improved (P < 0.01). Similarly, mean improvement rate of JOA was 83.5 % at 1 year after surgery while 75.6 % at final visit. Successful bone healing was obtained at a mean of 3.8 months after surgery. No cyst reformation and recurrent back/leg pain were observed around the surgical sites.

Conclusions

These lesions could be regarded as a result of facet arthrosis/instability and repetitive facet minor trauma with herniation of synovium through the defective joint capsule. Improvement in lumbago and leg pain may be a consequence of complete cyst resection via hemilaminoplasty plus partial facetectomy with anatomical reconstruction of the posterior spinal elements.

     

A study of the incidence of implantation cyst at anastomotic sites after low anterior resection of the rectum with the double stapling technique

Background

The incidence of implantation cyst occurring at sites of anastomosis after low anterior resection of the rectum were studied in two different periods depending on the type of surgical devices used to close the rectal stump.

Subjects

The study included 361 patients undergoing the surgery during the first 8-year period between 1996 and 2003 and 87 patients undergoing the surgery during the second 3-year period between 2004 and 2006.

Results

Implantation cysts were found in nine (2.5%) of the patients undergoing the surgery during the first period and one of them also had local recurrence. Implantation cysts occurred 9 to 31 months postoperatively (mean, 17.1?±?6.9 months). Clinical symptoms were noted in one patient and treatment of the cysts, including local recurrence, was given to two patients. Anastomosis of the distal rectum was performed with the Roticulator or the Access 55 in all patients. Although implantation cysts were found in any patient undergoing surgery during the second period, no statistically significant difference was recognized (p?=?0.217). Anastomosis of the distal rectum was performed with the TX30 in all patients.

Conclusion

The pathogenesis of implantation cysts may be explained by the production of mucus when the mucosal epithelium of the colon is caught under the submucosa, forming a cyst after closure of the rectal stump, and the difference in the incidence rates of implantation cyst was presumably due to the characteristics of the device used and progress of the operative procedure.     

Diagnosis and surgical strategy for sacral meningeal cysts with check-valve mechanism: technical note

Objective

There is agreement that symptomatic sacral meningeal cysts with a check-valve mechanism and/or large cysts representing space-occupying lesions should be treated surgically. This study investigated factors indicating a need for surgical intervention and surgical techniques for sacral meningeal cysts with a check-valve mechanism.

Methods

In ten patients presenting with sciatica and neurological deficits, myelography, computed tomography (CT) myelography, and magnetic resonance imaging (MR imaging) detected sacral meningeal cysts with a check-valve mechanism. One patient had two primary cysts. Ten cysts were type 2 and one cyst was type 1. Nine of the ten patients had not undergone previous surgery, while the remaining case involved recurrent cyst. For the seven patients with normal (i.e., not huge or recurrent) type 2 cysts and no previous surgery (eight cysts), suture after collapse of the cyst wall was performed. For the recurrent type 2 cyst, duraplasty and suture with collapse of the cyst wall were performed to eliminate the check-valve mechanism. For the remaining type 2 cyst, a primary root was sacrificed because of the huge size of the cyst. For the type 1 cyst, the neck of the cyst was ligated.

Results

In all cases, chief complaints disappeared immediately postoperatively and no deterioration of clinical symptoms has been seen after a mean follow-up of 27 months.

Conclusions

The presence or absence of a check-valve mechanism is very important in determining the need for surgical intervention for sacral meningeal cysts.     

Parameters influencing the outcome after total disc replacement at the lumbosacral junction. Part 2: distraction and posterior translation lead to clinical failure after a mean follow-up of 5 years

Purpose

The aim of the second part of the study was to investigate the influence of parameters that lead to increased facet joint contact or capsule tensile forces (disc height, lordosis, and sagittal misalignment) on the clinical outcome after total disc replacement (TDR) at the lumbosacral junction.

Methods

A total of 40 patients of a prospective cohort study who received TDR because of degenerative disc disease or osteochondrosis L5/S1 were invited to an additional follow-up for clinical (ODI and VAS for overall, back, and leg pain) and radiographic analysis (a change in disc height, lordosis, or sagittal vertebral misalignment compared with the preoperative state). Based on the final ODI, patients were retrospectively distributed into groups N (normal: <25 %) or F (failure ≥25 %) for radiographic parameter comparison. A correlation analysis was performed between the clinical and radiological results.

Results

A total of 34 patients were available at a mean follow-up of 59.5 months. Both groups (N = 24; F = 10 patients) presented a significant improvement in overall pain, back pain, and ODI over time. At the final follow-up, higher clinical scores correlated with a larger disc height, increased lordosis, and posterior translation of the superior vertebra, which was also reflected by significant differences in these parameters in the group comparison.

Conclusions

Parameters associated with increased facet joint capsule tensile forces lead to an inferior clinical outcome at mid-term follow-up. When performing TDR, we therefore suggest avoiding iatrogenic posterior translation and overdistraction (and consecutive lordosis).     

Radiolucent zone of the patella following total knee arthroplasty without patellar resurfacing

Background

The radiolucent zones in the patella are sometimes observed in patients who have undergone total knee arthroplasty (TKA) without patellar resurfacing. On the basis of radiological findings from our clinical experience, we hypothesize that the pathogenesis of this lesion may be similar to that of the lesions of spontaneous osteonecrosis, and this lesion may be due to both osteoporosis and stress concentration. The present study aimed to determine the incidence of the radiolucent zone after TKA without patellar resurfacing. Moreover, the roles of osteoporosis and patellar morphology, which are related to the stress distribution in the patella, were also investigated.

Methods

We studied 48 knees of 38 patients who underwent primary TKA using the Genesis II prosthesis. Axial radiographs taken 1 year postoperatively were used to assess the incidence of the radiolucent zone. The World Health Organization fracture risk assessment tool (FRAX) score and the preoperative patellar facet angle were compared between patients with and without the radiolucent zones.

Results

Five patellae (10.4 %) showed the radiolucent zones postoperatively (the radiolucent group), whereas no such lesions were found in the remaining 43 patellae (the normal group). The major osteoporotic fracture risk of the radiolucent group calculated using the FRAX was 24.8 % and significantly higher than that in the normal group (14.7 %; p = 0.01). The average patellar facet angle in the radiolucent group was 123.6°, which was significantly smaller than that in the normal group (133.6°; p = 0.003).

Discussion and conclusions

The results of the present study suggest that both underlying osteoporosis and a steep patellar facet angle may play an important role in the pathogenesis of the radiolucent zones in patellae after TKA without patellar resurfacing. Patellar resurfacing may be considered, particularly in osteoporotic patients who have a steep patellar facet angle, to avoid the appearance of the postoperative radiolucent zone in the patella.     

Tally counter test as a simple and objective assessment of cervical myelopathy

Purpose

To test the usefulness of a novel performance test, the tally counter test (counter test), which uses a hand tally counter to objectively assess the severity of cervical myelopathy.

Methods

Eighty-three patients with compressive cervical myelopathy (mean age 64 ± 13 years) who were undergoing cervical laminoplasty and 280 healthy control subjects (aged 20–89 years) were tested. The subjects were instructed to push the button of a tally counter as many times as possible in 10 s. The average of the right- and left-sided values in each patient was used for analysis. In the patient group, counter test values were compared with Japanese Orthopaedic Association (JOA) and Japanese version of the 36-Item Short Form Health Survey scores preoperatively and 12 months postoperatively.

Results

The average counter test value was significantly lower in patients with myelopathy than age- and gender-matched controls (32.9 ± 10.9 vs. 46.9 ± 8.5, P < 0.0001). The counter test value was significantly higher at 2 weeks postoperatively than preoperatively (P = 0.0014). Counter test values showed a moderate correlation with JOA scores and a weak to moderate correlation with SF-36 physical functioning, role functioning, and role-emotional scores both pre- and postoperatively. The intraclass correlation coefficient of counter test values was high both pre- and postoperatively.

Conclusion

The tally counter test is objective and quantitative assessment method for patients with cervical myelopathy. The test is simple, reliable, and capable of detecting small functional changes.     

Maze learning in patients with intracranial arachnoid cysts

Background

The temporal lobe is of importance for visuospatial orientation. Intracranial arachnoid cysts have a predilection for the temporal fossa, and might therefore affect visuospatial orientation. The aim was to find out whether temporal cysts affect maze learning and if surgical cyst decompression improves maze performance.

Methods

Forty-five patients with a temporal arachnoid cyst and 17 control patients with cervical disc disease were tested in a labyrinth route in the hospital corridors the day before surgery and at least 3 months postoperatively.

Results

Thirty-five cyst patients (78 %) experienced postoperative improvement of their preoperative complaints. The cyst patients spent significantly longer time than the controls navigating through the maze in the preoperative test, 161 s and 127 s, respectively, but there was no difference in number of errors between the two groups. However, the cyst patients improved significantly in the postoperative test, both with regards to number of errors they made and time spent, contrary to the control patients, whose postoperative performance equalled that of the preoperative test. For the cyst patients, postoperative improvement in the labyrinth test correlated with the clinical outcome—but not the neuroradiological outcome—after the operation.

Conclusions

Thus, temporal arachnoid cysts may affect visuospatial orientation and learning in a reversible manner.     

Surgical treatment of giant liver hydatid cysts: comparison of cystojejunostomy and partial cystectomy

Purpose

The aim of this study was to compare partial cystectomy and internal drainage of the cyst cavity with cystojejunostomy for the surgical treatment of giant hepatic hydatid cysts.

Methods

Patients who underwent any type of surgical treatment between March 2009 and May 2013 for giant hepatic hydatid cysts were retrospectively evaluated. The data collected included demographic variables, diagnostic methods, surgical procedures, morbidity and mortality rates.

Results

Twenty-eight patients who underwent surgery for giant hepatic hydatid cysts were included. There were 16 (57 %) female patients, with a mean age of 32.8 years. The diagnostic methods primarily included abdominal ultrasonography and computed tomography, which were performed in 62 % of the patients. The patients were divided into two groups with respect to the treatment modality: Group A (n = 13) treated with cystojejunostomy and Group B (n = 15) treated with partial cystectomy. The overall rate of cavity-related complications was 25 % in Group B, whereas none of the patients in Group A had a cavity-related complication during the follow-up period (p < 0.05).

Conclusion

Cystojejunostomy is an effective and safe surgical approach for the treatment of giant hepatic hydatid cysts, with a lower rate of morbidity than partial cystectomy, and thus may be the surgical treatment of choice for giant hepatic hydatid cysts.     

Arthroscopic anatomic study of posteromedial joint capsule in knee joint associated with popliteal cyst

Purpose

The purpose of this study was to examine the arthroscopic anatomy of posteromedial capsule and magnetic resonance imaging (MRI) findings in internal derangement of the knee joint and to analyze the relationship between popliteal cysts and the posteromedial capsule.

Methods

From 2011 to 2012, a prospective study included 194 knees of consecutive arthroscopic surgeries for assorted knee problems. The anatomy of the posteromedial joint capsule was evaluated arthroscopically and divided into three types by the presence of capsular fold and opening: no capsular fold and no opening (type I), capsular fold without opening (type II), capsular fold with opening (type III). The presence and size of popliteal cyst were documented by MRI.

Results

Type I was observed in 160 knees (82.5 %), type II in 10 (5.1 %) and type III in 24 (12.4 %). Popliteal cysts were found in 25 knees (12.9 %) by MRI. Of these cases, symptomatic popliteal cysts were identified in 12 knees (6.9 %). On 160 knees demonstrated to be type I, only 3 knees (1.9 %) had popliteal cysts in MRI, 6 knees (60 %) in 10 knees of type II and 16 knees (66.7 %) in 24 knees of type III. Therefore, there was a statistically significant relationship between the type of anatomy in the posteromedial capsule and the popliteal cyst (p < 0.001).

Conclusion

An association between popliteal cyst and arthroscopic anatomy of posteromedial capsule was demonstrated. Comprehensive understanding and knowledge of the arthroscopic anatomy of posteromedial capsule would contribute to the arthroscopic approach in understanding the pathogenesis of popliteal cyst.

Study design

Development of diagnostic criteria on basis of consecutive patients.

Level of evidence

2.     

Longitudinal morphological change of acetabular subchondral bone cyst after total hip arthroplasty in developmental dysplasia of the hip

Purpose

The purpose of this study is to clarify morphological changes of acetabular subchondral bone cyst after total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip.

Methods

Two hundred and sixty-one primary cementless total hip arthroplasties of 208 patients, 18 males, 190 females, were retrospectively reviewed. Morphological changes of subchondral bone cyst were evaluated by computed tomography (CT). The mean cross-sectional area of the cyst from CT scans at 3 months postoperatively and after 7–10 years (average 8.4 years) were compared.

Results

Acetabular subchondral bone cysts were found in 49.0% of all cases in preoperative CT scans. There was no cyst which was newly recognized in CT scan performed after postoperative 7–10 years. All the cross-sectional areas of the cysts evaluated in this study were reduced postoperatively.

Conclusions

This study revealed that acetabular subchondral bone cysts do not increase or expand after total hip arthroplasty and indicated that the longitudinal morphological change of acetabular bone cysts in patients of developmental dysplasia of the hip do not influence long-term implant fixation in total hip arthroplasty.

     

Can decompression surgery relieve low back pain in patients with lumbar spinal stenosis combined with degenerative lumbar scoliosis?

Introduction

Decompression with fusion is usually recommended in patients with lumbar spinal stenosis (LSS) combined with degenerative lumbar scoliosis (DLS). However, elderly patients with LSS and DLS often have other comorbidities, and surgical treatment must be both safe and effective. The aim of this study was to investigate whether decompression surgery alone alleviates low back pain (LBP) in patients with LSS and DLS, and to identify the predictors of postoperative residual LBP.

Materials and methods

A total of 75 patients (33 males and 42 females) with a mean age of 71.8 years (range 53–86 years) who underwent decompression surgery for LSS with DLS (Cobb angle ≥ 10°) and had a minimum follow-up period of 1 year, were retrospectively reviewed using the Japanese Orthopaedic Association scoring system for the assessment of lumbar spinal diseases (JOA score). Radiographic measurements included coronal and sagittal Cobb angles, apical vertebral rotation (Nash-Moe method), and anteroposterior and lateral spondylolisthesis. Logistic regression analysis was performed to investigate the predictors of residual LBP after surgery.

Results

Forty-nine patients had preoperative LBP, of which 29 (59.1 %) experienced postoperative relief of LBP. Logistic regression analysis demonstrated that the degree of apical vertebral rotation on preoperative radiography was significantly associated with postoperative residual LBP (odds ratio, 8.16, 95 % confidence interval, 1.55–83.81, p = 0.011).

Conclusion

A higher degree of apical vertebral rotation may therefore be an indicator of mechanical LBP in patients with LSS and DLS. Decompression with fusion should be recommended in these patients.     

Clinical and radiological results of total disc replacement in the cervical spine with preoperative reducible kyphosis

Purpose

To investigate the clinical and radiological results of total disc replacement (TDR) in the cervical spine with preoperative reducible kyphosis, and discuss when TDR is indicated for the patients with preoperative kyphosis.

Methods

Fifty-two patients who underwent single-level cervical TDR from June 2008 to May 2010 were included in this study. TDR was indicated for patients with preoperative lordosis or reducible kyphosis, and the patients were divided into a lordotic group (preoperative global angle of ≥0°) and kyphotic group (preoperative global angle of <0°). Clinical results were evaluated using the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score and Neck Disablity Index (NDI). For radiological evaluation, the global and functional spinal unit (FSU) angles and the global and FSU range of motion were measured preoperatively and postoperatively.

Results

The mean NDI in the kyphotic group was significantly higher than that in the lordotic group preoperatively and at six months postoperatively, but the groups showed no significant differences in JOA score, VAS score and NDI at the two year follow-up. The mean global and FSU angles in the kyphotic group were significantly lower than those in the lordotic group preoperatively and at six months postoperatively, but they gradually improved postoperatively. The differences lost significance at the two year follow-up.

Conclusions

Postoperative cervical kyphosis had adverse effects on the NDI after TDR. Artificial discs, symptom relief, and neck functional exercises may contribute to correction of preoperative reducible kyphosis at different stages after cervical TDR. Preoperative reducible kyphosis should not be an independent contraindication for cervical TDR.     

Association of facet tropism and progressive facet arthrosis after lumbar total disc replacement using ProDisc-L®

Purpose

The purpose of this retrospective study was to examine the association of facet tropism and progressive facet arthrosis (PFA) after lumbar total disc replacement (TDR) surgery using ProDisc-L^®.

Methods

A total of 51 segments of 42 patients who had undergone lumbar TDR using ProDisc-L^® between October 2003 and July 2007 and completed minimum 36-month follow-up period were retrospectively reviewed. The changes of facet arthrosis were categorized as non-PFA and PFA group. Comparison between non-PFA and PFA group was made according to age, sex, mean follow-up duration, grade of preoperative facet arthrosis, coronal and sagittal prosthetic position and degree of facet tropism. Multiple logistic regression analysis was also performed to analyze the effect of facet tropism on the progression of facet arthrosis.

Results

The mean age at the surgery was 44.43 ± 11.09 years and there were 16 males and 26 females. The mean follow-up period was 53.18 ± 15.79 months. Non-PFA group was composed of 19 levels and PFA group was composed of 32 levels. Age at surgery, sex proportion, mean follow-up period, level of implant, grade of preoperative facet arthrosis and coronal and sagittal prosthetic position were not significantly different between two groups (p = 0.264, 0.433, 0.527, 0.232, 0.926, 0.849 and 0.369, respectively). However, PFA group showed significantly higher degree of facet tropism (7.37 ± 6.46°) than that of non-PFA group (3.51 ± 3.53°) and p value was 0.008. After adjustment for age, sex and coronal and sagittal prosthetic position, multiple logistic regression analysis revealed that facet tropism of more than 5° was the only significant independent predictor of progression of facet arthrosis (odds ratio 5.39, 95 % confidence interval 1.251–19.343, p = 0.023).

Conclusions

The data demonstrate that significant higher degree of facet tropism was seen in PFA group compared with non-PFA group and facet tropism of more than 5° had a significant association with PFA after TDR using ProDisc-L^®.     

Evaluation of a new type of titanium mesh cage versus the traditional titanium mesh cage for single-level, anterior cervical corpectomy and fusion

Study design

A retrospective review of prospectively collected data in an academic institution.

Objective

To evaluate the safety and efficacy of a new type of titanium mesh cage (TMC) in single-level, anterior cervical corpectomy and fusion (ACCF).

Methods

Fifty-eight patients consecutive with cervical spondylotic myelopathy (CSM) from cervical degenerative spondylosis and isolated ossification of the posterior longitudinal ligament were treated with a single-level ACCF using either a new type of TMC (28 patients, group A) or the traditional TMC (30 patients, group B). We evaluated the patients for TMC subsidence, cervical lordosis (C2–C7 Cobb and Cobb of fused segments) and fusion status for a minimum of 30 months postoperatively based on spine radiographs. In addition, neurologic outcomes were evaluated using the Japanese Orthopedic Association (JOA) scores. Neck pain was evaluated using a 10-point visual analog scale (VAS).

Results

The loss of height of the fused segments was less for group A than for group B (0.8 ± 0.3 vs. 2.8 ± 0.4 mm) (p < 0.01); also, there was a lower rate of severe subsidence (≥3 mm) in group A (4 %, 1/28) than in group B (17 %, 5/30) (p < 0.01). There were no differences in the C2–C7 Cobb and Cobb of fused segments between the groups preoperatively or at final follow-up (p > 0.05), but the Cobb of fused segments immediately postoperative were significantly less for group B than for group A (p < 0.01). All patients, however, had successful fusion (100 %, each). Both groups had marked improvement in the JOA score after operation (p < 0.01), with no significant differences in the JOA recovery ratio (p > 0.05). The postoperative VAS neck pain scores for group A were significantly less than that for group B (p < 0.05); severe subsidence was correlated with neck pain.

Conclusions

The new type of TMC provides comparable clinical results and fusion rates with the traditional TMC for patients undergoing single-level corpectomy. The new design TMC decreases postoperative subsidence (compared to the traditional TMC); the unique design of the new type of TMC matches the vertebral endplate morphology which appears to decrease the severity of subsidence-related neck pain in follow-up.     

Hydatid cysts of the lung: lesion size in relation to clinical presentation and therapeutic approach

Purposes

The aim of this study was to assess the relationship between the pulmonary hydatid cyst size and the clinical presentation, surgical approach, and postoperative outcome. We review the problems encountered in treating large pulmonary hydatid cysts and highlight the risks associated with the rupture of the cyst and a delay of the surgical treatment.

Methods

The medical records of 169 patients surgically treated for lung hydatid cysts were reviewed. Patients were divided into two groups based on cyst size: group 1 (n = 128) with small (<10 cm) cysts and group 2 (n = 41) with giant (≥10 cm) cysts. Data related to symptoms, preoperative complications, surgical procedures performed and postoperative morbidity were analyzed and compared.

Results

In both groups, the most common symptom was chest pain, followed by dyspnea and cough, respectively. There were no differences between the two groups with respect to cyst-associated parenchymal or pleural complications before surgery (p = 0.80). In the large majority of cases, the surgical treatment was cystotomy, removal of the cystic membrane and capitonnage. Wedge resection was performed in nine patients in total (seven in group 1, two in group 2) and one patient in group 2 required a lobectomy. Decortication was required significantly more frequently in group 2 than in group 1 (p = 0.001). Sixteen patients in group 1 and 10 patients in group 2 developed postoperative complications (p = 0.19). There was no peri or postoperative mortality. There was no difference between the groups with respect to the duration of hospitalization (p = 0.17). Two patients with complicated hydatid cysts in group 1 had recurrent lesions during follow-up, whereas there was no recurrence in group 2.

Conclusion

All pulmonary hydatid cysts should be surgically treated as soon as possible after their diagnosis in order to avoid complications. Most of these lesions, regardless of size, can be surgically managed with procedures that preserve the maximal lung parenchyma and yield excellent outcomes.     

Epidermoid Cyst of the Spleen

Background

The aim of this study is to elucidate the characteristics, clinical presentations, and management of epidermoid cysts located in the spleen and the intrapancreatic accessory spleen.

Methods

Data pooled for analysis were collected from epidermoid cyst cases encountered in the study institution and sporadic case reports obtained from the English literature.

Results

There were 115 cases of epidermoid cyst. Seventy eight (67.8 %) were found in the spleen, whereas 37 (32.2 %) were found in the intrapancreatic accessory spleen. Comparing between the two groups, the splenic group showed female predominance, younger age, and larger cystic size. For symptoms, left upper abdominal mass (57.7 %) and left upper abdominal pain (39.0 %) were more commonly found in the spleen group. Meanwhile, the intrapancreatic accessory spleen group had higher percentage of asymptomatic cysts (59.5 %). As for surgical indication, majority of patients in the spleen group underwent surgery for symptomatic relief (75.4 %), while the intrapancreatic accessory spleen group underwent surgery mainly for suspicious malignancy (90.0 %).

Conclusions

Surgical treatment for epidermoid cysts of the spleen is considered the optimal treatment for either alleviating the symptoms caused by a bulky cyst or for determining the histopathologic nature of a suspicious malignant cystic neoplasm.     

Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion

Purpose

Adjacent segment disease (ASD) is an increasing problematic complication following lumbar fusion surgeries. ASD requires appropriate treatment, although there are only few reports on surgery for ASD. This study aimed to clarify surgical outcomes of posterior lumbar interbody fusion (PLIF) for ASD.

Methods

Medical charts of 18 patients who underwent the second (repeat) PLIF for ASD were retrospectively investigated (average follow-up, 40 [27–66] months). Modified Japanese Orthopaedic Association (JOA) score and Whitecloud classification were used as outcome measures.

Results

Mean modified JOA score improved from 7.7 just before repeat PLIF to 11.4 at maximum recovery and declined to 10.2 at final follow-up. Mean recovery rate of modified JOA score was 52.9 % at maximum recovery and 31.6 % at final follow-up. According to Whitecloud classification, 17 patients (94 %) were excellent or good and only 1 was fair at maximum recovery, whereas 10 (56 %) were excellent or good, 6 were fair, and 2 were poor at final follow-up. Eight patients (44 %) deteriorated again because of recurrent ASD. Two poor patients underwent a third PLIF.

Conclusion

PLIF is effective for ASD after PLIF in the short term, although it tends to lead to a high incidence of recurrent ASD.     

The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion

Purpose

The aim of this study was to evaluate the prevalence of depressive symptoms and disability pre-operatively, at 3 months and at 1 year after lumbar spine fusion surgery.

Methods

Data was extracted from a dedicated lumbar spine fusion register, giving 232 patients (mean age 62 years, 158 females) who had undergone instrumented lumbar spine fusion. The frequency of depressive symptoms and disability was evaluated using the Depression Scale (DEPS) and Oswestry Disability Index (ODI).

Results

Depressive symptoms were found in 34, 13, and 15 % of the patients pre-operatively, at 3 months and at 1 year after surgery, respectively. The mean DEPS score decreased from 16.2 to 8.6 (p < 0.001) in patients who had depressive symptoms pre-operatively, and from 6.1 to 3.8 (p < 0.001) in those patients without pre-operative depressive symptoms. The mean ODI values pre-operatively, at 3 months and at 1 year after surgery were 53, 30, and 23, respectively, in patients with pre-operative depressive symptoms and 41, 23, and 20 in those patients without pre-operative depressive symptoms. The differences between the groups were statistically significant at all time points (p < 0.001).

Conclusions

One-third of our patients with chronic back pain undergoing spinal fusion had depressive symptoms pre-operatively. The prevalence of depressive symptoms decreased after surgery. Although disability remained higher in those patients who had reported depressive symptoms pre-operatively, disability did decrease significantly in both groups post-operatively. Thus, there is no need to exclude depressive patients from operation, but screening measures and appropriate treatment practises throughout both pre-operative and post-operative periods are encouraged.