Synovial sarcoma in patients under 20 years of age: a multicenter study with a minimum follow-up of 10 years

Purpose  

Synovial sarcoma (SS) is an aggressive soft-tissue tumor noted for late local recurrence and metastasis. This study investigates the long-term outcome of SS in patients of pediatric age and evaluates potential prognostic factors for SS.     

Long-term results of anterior cruciate ligament reconstruction: a comparison with non-operative treatment with a follow-up of 17–20 years

Purpose

The aim of our study was to review the clinical and radiological outcome of patients who had undergone anterior cruciate ligament (ACL) reconstruction in comparison to a group of non-operatively treated patients.

Methods

In a retrospective study we compared ACL reconstruction using a bone-patellar tendon-bone graft with a non-operatively treated group of patients 17–20 years later. Fifty-four patients that met the inclusion criteria, with arthroscopically proven ACL rupture, were treated between 1989 and 1991. Thirty-three patients underwent ACL reconstruction, forming group one. Eighteen non-reconstructed patients continued with rehabilitation and modification of activities (group two). The International Knee Documentation Committee (IKDC) subjective and objective evaluation forms and the Lysholm and Tegner scale were used to assess the knees at follow-up. Radiographic assessment was performed using the IKDC grading scale.

Results

Follow-up results showed that 83% of reconstructed patients had stable knees and normal or nearly normal IKDC grade. Patients in the non-reconstructed group had unstable knees with 84% having abnormal or severe laxity. The subjective IKDC score was significantly in favour of group one: 83.15 compared to 64.6 in group two. The Lysholm and Tegner score was also significantly better in group one. Conservatively treated patients all had unstable knees and worse scores. The rate of osteoarthritis showed more severe changes in non-reconstructed patients with additional meniscus injury.

Conclusions

We can conclude that 94% of patients who underwent ACL reconstruction had stable knees after 15–20 years and there was a significantly lower percentage of osteoarthritis in comparison to conservatively treated patients.     

Pinealectomy in the chicken: a good model of scoliosis?

The phenomenon of spinal deformity in the pinealectomized chicken has led researchers to postulate a disturbance of melatonin activity as a potential cause of adolescent idiopathic scoliosis (AIS). More recently, structural differences between curves seen in this model and those seen in scoliosis have been highlighted suggesting the deformities observed are not as similar as first thought. We examined melatonin levels, and the radiological and histological characteristics of scoliosis after pinealectomy in chickens. They underwent pinealectomy (P) at 2 days of age, sham surgery (S) or served as controls (C). Mean melatonin levels were 32.9 pmol/L (P), 175 pmol/L (S) and 227.3 pmol/L (C). Scoliosis developed in 75% of chickens after pinealectomy and 38% after a sham procedure. Nineteen percent of unoperated controls also developed scoliosis. A lower melatonin level was associated with the development of scoliosis (p ≤ 0.001), but exceptions were seen with levels up to 265 pmol/L observed in one case. Most of the curves occurring spontaneously and after sham surgery and almost half after pinealectomy were short angular curves: distinct from those resembling idiopathic scoliosis. These occur over one or two segments and are characterized by marked apical wedging, frequently associated with subluxation or dislocation. The intervertebral joint in the chicken is more like a synovial joint histologically than an intervertebral disc. This study highlights important differences between the chicken and the human, and between their respective spinal deformities. Caution is advised when drawing conclusions regarding the pathogenesis of AIS from this model.     

Natural history of renal cell carcinoma: a case with 18 years follow-up

A 53-year-old woman presented to our hospital with a non-metastatic 4 cm renal mass in the right kidney. The patient rejected treatment, but consented to follow-up observation of her condition. The patient underwent a series of computed tomography scans to monitor the progression of the disease. We were able to observe not only an increase in renal mass size, but also involvement of para-aortic lymph nodes, inferior vena cava, and metastasis to the lung. Eighteen years after diagnosis, the subject was hospitalized and died as a result of complications of the disease. Autopsy showed the pathologic diagnosis of the renal mass to be a grade 2 clear cell carcinoma. The literature contains several papers that describe the natural history of renal masses and carcinomas over short periods; however, prior to our case, no reports existed that detailed long-term progression of renal cell carcinoma (RCC) from initial diagnosis to death. It is necessary to clarify the course that RCC takes due to its unpredictable, indolent nature. This will provide clinicians with better insight into how to manage the disease, decide on treatment options, and improve overall survival.     

New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years

Purpose

Pyogenic spondylodiscitis (PS) is still burdened by a high rate of orthopedic and neurological complications. Despite the rising incidence, the choice of a proper orthopedic treatment is often delayed by the lack of clinical data. The aim of this study was to propose a clinical-radiological classification of pyogenic spondylodiscitis to define a standard treatment algorithm.

Methods

Based on data from 250 patients treated from 2008 to 2015, a clinical-radiological classification of pyogenic spondylodiscitis was developed. According to primary classification criteria (bone destruction or segmental instability, epidural abscesses and neurological impairment), three main classes were identified. Subclasses were defined according to secondary criteria. PS without segmental instability or neurological impairment was treated conservatively. When significant bone loss or neurological impairment occurred, surgical stabilization and/or decompression were performed. All patients underwent clinical and radiological 2-year follow-up.

Results

Type A PS occurred in 84 patients, while 46 cases were classified as type B and 120 as type C. Average time of hospitalization was 51.94 days and overall healing rate was 92.80%. 140 patients (56.00%) were treated conservatively with average time of immobilization of 218.17 ± 9.89 days. Both VAS and SF-12 scores improved across time points in all classes. Residual chronic back pain occurred in 27 patients (10.80%). Overall observed mortality was 4.80%.

Conclusions

Standardized treatment of PS is highly recommended to ensure patients a good quality of life. The proposed scheme includes all available orthopedic treatments and helps spine surgeons to significantly reduce complications and costs and to avoid overtreatment.

     

Posterior hemivertebra resection with bisegmental fusion for congenital scoliosis: more than 3 year outcomes and analysis of unanticipated surgeries

Purpose

Until now there have been many reports on hemivertebra resection. But there were no large series on the posterior hemivertebra resection with bisegmental fusion. This is a retrospective study to evaluate the surgical outcomes of posterior hemivertebra resection only with bisegmental fusion for congenital scoliosis caused by fully segmented non-incarcerated hemivertebra.

Methods

In our study, 36 consecutive cases (19 males, 17 females) diagnosed with congenital scoliosis, resulting from fully segmented non-incarcerated hemivertebra, treated by posterior hemivertebra resection with bisegmental fusion were investigated retrospectively, with at least a 3 year follow-up period (36–106 months).

Results

The total number of resected hemivertebra was 36. Mean operation time was 188.6 min with average blood loss of 364.2 ml. The segmental scoliosis was corrected from 36.6° to 5.1° with a correction rate of 86.1 %, and segmental kyphosis(difference to normal segmental alignment) from 21.2° to 5.8° at the latest follow-up. The correction rate of the compensatory cranial and caudal curve is 76.4 and 75.1 %. Unanticipated surgeries were performed on eight patients, including one delayed wound healing, two pedicle fractures, one progressive deformity and four implants removals.

Conclusions

Posterior hemivertebra resection with bisegmental fusion allows for early intervention in very young children. Excellent correction can be obtained while the growth potential of the unaffected spine could be preserved well. However, it is not indicated for the hemivertebra between L5 and S1. The most common complication of this procedure is implant failure. Furthermore, in the very young children we noted that although solid fusion could be observed in the fusion level, implants migration may still happen during the time of adolescence, when the height of the body developed rapidly. So a close follow-up is necessary.     

Histological analysis of cobalt-chromium stents with and without Camouflage® polymer coating: experimental porcine carotid artery model

This study evaluated the arterial response to cobalt-chromium stents with and without polymer coating (Camouflage?, Hemoteq AG, Wuerselen, Germany) implanted in pigs. Cobalt-chromium balloon-expandable stents (4 × 16 mm) were implanted in the common carotid arteries of nine pigs. Histological analysis of endothelialization, inflammation and injury was performed one month later. All stents were successfully deployed, and all but one animal survived the 30 study days. All arteries were patent. Endothelialization was nearly complete in most sections of all carotid stents in both groups. There were mild inflammatory infiltrate and mild-to-moderate injury, which were associated with the stent shafts and not significantly different between groups. Our findings suggest that, in porcine carotid arteries, the histological response to balloon-expandable cobalt-chromium stents coated with polymer (Camouflage?, Hemoteq AG) is similar to the response to non-coated cobalt-chromium stents.     

Posterior corrective surgery for moderate to severe focal kyphosis in the thoracolumbar spine: 57 cases with minimum 3 years follow-up

Purpose

To evaluate the radiological and clinical outcomes of the corrective surgery for patients with moderate to severe focal kyphosis in thoracolumbar spine.

Methods

Fifty-seven patients with moderate to severe focal kyphosis of the thoracolumbar spine underwent apical segmental resection osteotomy with dual axial rotation correction at our hospital. There were 30 male and 27 female patients. The mean age was 34.3 years. The kyphosis level radiographs were obtained from each patient before surgery, immediately after surgery and at follow-up. Local kyphosis and scoliosis Cobb angles were measured. Full-spine standing radiographs were obtained before surgery and at follow-up, and the spine sagittal and coronal balance were evaluated. The height of patients, the Frankel grading system for neurological functions, the Oswestry disability index for life quality, the visual analogue score for back pain and the patient satisfactory index for satisfaction to surgery were applied before surgery and at follow-up. The radiological and clinical outcomes were further analyzed in different sub-groups of patients according to etiology, severity of kyphosis, age, level of kyphosis apex, Frankel grade before surgery, and complications.

Results

The average follow-up time of patients was 46.1 months. The average kyphosis angle reduced from 94.6° before surgery to 31.0° immediately after surgery, and remained at 34.4° at follow-up. The sagittal balance of the spine, height of patients, Frankel grading, Oswestry disability index and visual analogue score were improved. The patient satisfactory index (PSI) showed a satisfied rate of 91.2%. The correction rate was significantly higher in patients with kyphosis angle less than 95° and age less than 35 years. The clinical improvement rate was significantly higher in patient with kyphosis apex at lower thoracic spine or thoracolumbar segment, Frankel grade E before surgery and no complication group. The incidence of intra-operative and early stage complications was 38.6%, and the incidence of instrumentation failure was 10.5%. The most severe complication was transient spinal cord injury, and the incidence was 7.0%. All complications got good relief after appropriate intervention.

Conclusions

Apical segmental resection osteotomy with dual axial rotation correction is an effective procedure to treat moderate to severe focal kyphosis, the prevention of serious neurological complications is fundamental to achieve the ideal clinical results.

     

The impact of lifestyle factors on serum 25-hydroxyvitamin D levels: a cross-sectional study in Japanese women aged 19–25 years

Insufficient levels of serum 25-hydroxyvitamin D [25(OH)D] lead to low bone mineral density (BMD) by increasing serum levels of intact parathyroid hormone (PTH), and are associated with a high mortality rate. Therefore, the 25(OH)D level is used as an indicator of frailty in older persons. To obtain higher serum 25(OH)D levels, management of lifestyle habits and nutrient intake is important beginning in a person's younger years. This study evaluated the degree of association between serum 25(OH)D concentrations and lifestyle factors in young Japanese women. A cohort study was conducted from December 2003, and the survey was finished by February 2004. The subjects were 274 Japanese women aged 19–25 years old. The parameters evaluated in these subjects included: (1) serum concentrations of 25(OH)D, intact PTH, calcium, and phosphorus; (2) BMD in the lumbar spine and hip; and (3) lifestyle factors (nutrient intake, physical activity, and duration of sunlight exposure). The serum 25(OH)D level was negatively associated with the intact PTH level (Spearman; r = –0.17, P = 0.006). The BMD was significantly higher in the high 25(OH)D and low intact PTH group than the other group (P < 0.05). The serum 25(OH)D level was significantly correlated with daily intake of dietary vitamin D (r = 0.20, P = 0.001), the mean number of steps taken per day (r = 0.16, P = 0.010) and the mean time spent in sedentary activity (r = –0.14, P = 0.018) among the lifestyle factors evaluated. Multiple regression analysis showed the degree of association between lifestyle factors and serum 25(OH)D to be small (R ² = 0.084). Daily intake of dietary vitamin D and daily walking may be useful for increasing the serum 25(OH)D level in young Japanese women.     

Delayed ORIF of proximal humerus fractures at a minimum of 3 weeks from injury: a functional outcome study

Purpose

To evaluate the clinical results of open reduction and internal fixation (ORIF) in proximal humerus fractures with delayed presentation.

Design

Retrospective comparative study.

Setting

Level III.

Methods

From June 2005 to June 2010, thirty-nine (39) proximal humerus fractures were treated with ORIF after a delay of 21–120 days from the initial injury. Patients were divided into three groups: (1) isolated 2-part greater tuberosity fractures; (2) part surgical neck fractures; and (3) 3- and 4-part complex fractures. The range of motion (ROM), visual analogue scale (VAS), Constant–Murley score, University of California Los Angeles (UCLA) scoring system score and Simple Shoulder Test (SST) score were all recorded. The results were analyzed with the use of the Mann–Whitney U test and stratified by age, gender, side of injury, interval from injury to surgery, and postoperative functional results. Additionally, the results of different fracture types and complications were compared across the three groups.

Results

The mean forward flexion was 143.8° ± 28.9°, external rotation was 33.2° ± 19.6°, and internal rotation was up to the T10 level. The mean VAS was 0.8 ± 1.2; the mean Constant score was 82.0 ± 15.0; the UCLA score was 27.2 ± 7.1; and the mean SST was 9.5 ± 2.0 at the last follow-up. There were no significant differences among the three groups except in internal rotation. Compared to those without any complications, patients with complications demonstrated worse ROM and a lower functional score (p < 0.05).

Conclusions

Delayed treatment of proximal humerus fractures is a challenging problem. With appropriate surgical technique, satisfactory results can be expected with respect to different fracture types, and complications may be avoided regardless of delay.

Level of evidence

Therapeutic Level IV.     

The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years

The concept of a dual articulation acetabular cup was developed by Prof. Bousquet in 1974. This concept has been shown to provide high stability after revision and primary total hip arthroplasty. The aim of our study was to evaluate the incidence of prosthetic instability in a consecutive homogeneous series of 384 primary dual mobility cups. Incidence of instability and implant survival were evaluated. Mean follow-up was 15.3 years (range, 12–20). There was no early or late instability. On the acetabular side there were 13 aseptic loosenings, 14 intraprosthetic dislocations, and seven polyethylene wear cases that required replacement of the liner. The cumulative survival rate of the dual-articulation acetabular cup using surgical revision for aseptic loosening as the endpoint was 95.9% ± 4.1% at 18 years postoperatively. Our series proves the good long term behaviour of dual-articulation acetabular components in primary arthroplasty. Their excellent survivorship rate and the absence of episodes of prosthetic instability increase our confidence in this concept.

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Résumé  Le concept de cupule à double mobilité a été inventé par le Professeur Gilles BOUSQUET en 1974. Ce concept a permis de mettre en évidence une importante stabilité des hanches, notamment après révision mais également dans les prothèses totales de hanches de première intention. Le but de cette étude est d’évaluer l’incidence et l’instabilité sur une série homogène consécutive de 384 hanches traitées avec cupule à double mobilité. Le taux d’instabilité des implants sur les patients survivants a été évalué. Le suivi moyen a été de 15,3 ans (de 12 à 20 ans) au plus long recul, il n’y a aucune instabilité ni primaire, ni tardive. Par contre, il existe 13 descellements aseptiques acétabulaires, 14 luxations intra prothétiques, 7 usures du polyéthylène qui ont nécessité un remplacement du PE. Le taux de survie cumulé de cette cupule à double mobilité est de 95,9% ± à 18 ans si l’on prend comme critère la révision pour descellement aseptique. Cette série prouve le bon devenir à long terme de cette articulation dans les prothèses totales primaires, avec un excellent taux de survie et l’absence de phénomènes de luxation inhérentes à ce concept.

     

Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hip arthroplasty: impact of cross-linked polyethylene on implant longevity

Purpose

The purpose of this study was to report results at a minimum of 10 years for hydroxyapatite (HA) coating on the titanium arc-sprayed cementless total hip arthroplasty (THA) and to evaluate the impact of cross-linked polyethylene (XLPE) on implant longevity.

Methods

A total of 131 consecutive primary THAs in 123 patients using an AMS acetabular cup and a PerFix HA stem were retrospectively reviewed. Conventional PE was used for 62 hips (CPE group) and cross-linked PE for 69 hips (XLPE group), with mean follow-up periods of 13 and 11.5 years, respectively. These patients were reviewed using the Japanese Orthopaedic Association (JOA) Hip Score and evaluated in terms of PE wear, osteolysis, and implant survival.

Results

The JOA score improved from 42.6 to 83.9 points at the final follow-up. The mean wear rate of 0.12 mm/year in the CPE group was significantly greater than that of XLPE at 0.007 mm/year. In the CPE group, ten (16.1 %) and two (3.2 %) hips, respectively, underwent PE exchange due to severe wear and acetabular revision due to loosening associated with osteolysis. Three patients had revision in the XLPE group: one cup for aseptic loosening, one PE for recurrent dislocation, and one stem for neck fracture. No evident osteolysis was seen in the XLPE group. Kaplan–Meier survivorship with any revision as the end point shows that the 12-year survival rate was 97.7 % for cups, 93.8 % for PE liners, and 99.2 % for stems. Multivariate analysis revealed that the use of XLPE significantly reduced the risk of revision, with the odds ratio (OR) of 4.3.

Conclusions

AMS and PerFix HA components in this series show excellent implant fixation; however, high rates of PE wear and subsequent osteolysis were limiting factors in long-term success. Low wear rates with XLPE suggest improved implant longevity.     

Reoperation for pelvic organ prolapse: a Danish cohort study with 15–20 years’ follow-up

Introduction and hypothesis

The objectives were to determine the reoperation rate of primary pelvic organ prolapse (POP) surgery, to describe the age distribution of the women at primary surgery for those undergoing a reoperation, and to describe the incidence of second and third reoperations.

Methods

We carried out a population-based registry study of Danish women above the age of 18 years when undergoing primary surgery for POP during the period 1996–2000. Data were retrieved from the Danish National Patient Register. All women were followed until one of the following events occurred: reoperation for POP, death, emigration, or end of follow-up period. Reoperation was defined as “repeated surgery in same compartment”. The cumulative incidence rate of reoperation was divided into three compartments (anterior, apical, and posterior) and was calculated using Kaplan–Meier plots.

Results

A total of 18,382 procedures were performed on 11,805 women. After 20 years’ follow-up, the cumulated incidence rate of reoperation for POP in the anterior, apical, and posterior compartments was 12.4%, 7.9%, and 12.1% respectively. The overall rate of reoperation was 11.5%. Of women aged between 18 and 49 years of age at primary surgery, 26.9% had a reoperation, whereas in women between 50 and 90+ years of age at primary surgery, only 10.1% had a reoperation.

Conclusions

This large study with up to 20 years’ follow-up has found that reoperation for POP is modest, that the reoperation rate is lowest for the apical compartment, but highest in all three compartments during the first year after primary surgery. The reoperation rate peaks in the group of women who had their primary surgery before the menopause in all three compartments.

     

Future of 34 meniscectomies after bucket-handle meniscus tear: a retrospective study with a follow-up over 22 years

After a bucket-handle meniscus tear, a partial meniscectomy by arthroscopy is recommended, when a meniscal suture is impossible. Short-term results of meniscectomy after bucket-handle meniscus tear, without cartilage or ligament additional injury, are mostly excellent: pain and blocking disappear, return to sports activities is possible. The aim of this retrospective study is to follow a partial meniscectomy evolution with a long follow-up between March 1990 and April 1994, and a senior surgeon operated 34 meniscectomies for bucket-handle meniscus tear by 34 patients (29 male and 5 female) with a mean age of 31.7 years (16–52 years) at time of surgery. The bucket-handle meniscus tear had a traumatic etiology on a knee with no cartilage lesion. The functional results were assessed by IKDC subjective score (International Knee Documentation Committee) and ARPEGE score (Association pour la Recherche et la Promotion de l’Etude du Genou). These scores were obtained by phone call questionnaire in March 2014 with a mean follow-up of 22.7 years (20–24 years). In this study, patients were reviewed and got a clinical examination to determine the Lequesne score, a radiological knee assessment according to Ahlbäck classification and a weight-bearing teleradiography. With an IKDC mean score of 85.8 after surgery, we observed that 29 patients go back to sports activities with the same level as before injury. The level of sports activity, with a regular practice after a mean follow-up of 22.7 years, was the same as immediately after surgery or just the level under for 85.3 % of patients. With ARPEGE score, 48.5 % of patients had a global excellent result and 38.2 % had a global good result after a long follow-up. With a mean Lequesne score of 2.38, osteoarthritis of knee is still clinical minimal after meniscectomy at long term. The score was worse after external meniscectomy (EM) than after an internal meniscectomy (IM). 57.7 % of patients have osteoarthritis on X-rays. In our study, functional results after partial meniscectomy for bucket-handle meniscus tear are similar than in the literature. More than half of our patients, reviewed after a long follow-up, had radiological osteoarthritis of knee with a variable clinical result, but often minimal to moderate, intensity modulated by the lower limb axis.     

Simultaneous translation on two rods is an effective method for correction of hypokyphosis in AIS: radiographic results of 24 hypokyphotic thoracic scoliosis with 2 years minimum follow-up

Recent publications confirm that moderate correction of thoracic hypokyphosis can be achieved by posterior instrumentation with hooks or pedicle screws. Twenty-four prospective and consecutive thoracic adolescent scoliosis patients with hypokyphosis (<20°) were operated on by posterior spinal fusion (PSF) with a specific method of reduction: Simultaneous translation on two rods (ST2R), performed by the same surgeon using stable anchorages such as screws or self-stabilizing claws. Radiographic parameters were measured preoperatively, at 1 month, 1 year and at 2 years minimum follow-up. In the coronal plane, the average main curve was significantly reduced from 51° to 17° and maintained at last follow-up, corresponding to an average correction of 67%. In the sagittal plane, the average kyphosis angle was significantly improved from 9° to 30° postoperatively and to 32° at last follow-up, corresponding to a mean gain of 23°. The 24 patients reported normal kyphosis at last follow-up (≥20°). Reduction of scoliosis by ST2R is an effective method that gives coronal correction equivalent to all screw constructs and allows restoration of normal thoracic kyphosis.     

The impact of recombinant parathyroid hormone on malignancies and mortality: 7 years of experience based on nationwide Danish registers

Summary

We used Danish registers to identify patients with osteoporosis, who had been treated with parathyroid hormone and evaluated the probability of developing cancer. We did not find an increased risk of cancer among the patients treated with parathyroid hormone.

Introduction

We evaluated the incidences of malignancies and mortality in osteoporotic patients treated with rPTH.

Methods

Using Danish nationwide registers, we identified patients diagnosed with osteoporosis in the period 1995 through 2010. Each patient treated with rPTH (“case”) was compared with 10 gender- and age-matched patients who did also have osteoporosis but did not receive rPTH (“control”).

Results

A total of 4,104 cases (80.3 % females) were identified. The mean age at the beginning of rPTH treatment was 70.9 (SD 9.7) years. During a follow-up time of 10,118 person-years for the cases and 88,005 person-years for the controls, a total of 255 cases (6.2 %) compared with 2,103 controls (5.1 %) experienced a cancer (Chi square, p?=?0.003). We found an adjusted cancer related HR of 1.1 (95 %CI 0.9–1.4) among the cases. Lung cancer was the only cancer type with a significantly increased rate among patients receiving rPTH (HR 1.7; 95 % CI 1.3–2.3). No cases developed osteosarcomas and nine controls developed osteosarcoma. During follow-up, 627 (15.3 %) cases died and 4,175 (10.2 %) controls died, which yielded an excess mortality risk of 26 % (95 % CI 16–37 %). This could be due to differences in the prevalence of vertebral fractures between the rPTH-treated and non-treated patients.

Conclusion

This study did not support the hypothesis describing a possible link between rPTH treatment and the development of cancer. We also conclude that osteosarcoma has not been diagnosed in any Danish patient receiving rPTH since the year 2003 when it was introduced on the market.     

Depigmentation with Q-switched Nd:YAG laser in universal vitiligo: a long-term follow-up study of 4 years

Q-switched (QS) lasers are used for depigmentation in universal vitiligo, but there is limited data on long-term results after laser treatment. This study was conducted to assess the safety and long-term follow-up results of QS Nd:YAG laser treatment in combination with need-based topical depigmentation therapy for universal vitiligo. A retrospective study was performed on patients with universal vitiligo who had received QS Nd:YAG laser treatment from 2010 to 2013. All patients were contacted and called for follow-up. Patients who reported were assessed clinically and information regarding adverse effects and relapse (repigmentation) in the follow-up period were obtained. Any need for topical depigmenting creams or other interventions and overall satisfaction to treatment were also documented. Records of 34 patients were retrieved, out of whom 28 cases reported for the follow-up visit. Duration of follow-up ranged from 2 to 5 years (mean, 2.78). No long-term adverse effects were reported and the majority of patients were highly satisfied with treatment. Satisfactory results with >90% clearance of pigment was reported by 89.3% (25/28) of patients, out of whom 72% (18/25) had retained the therapeutic effect with the use of sunscreens with/without intermittent topical depigmentation therapies. In seven cases, partial to complete relapse was observed. QS Nd:YAG laser is an effective tool for treating residual pigmentation in universal vitiligo, and the therapeutic effect can be maintained in most cases with regular sunscreen use and need-based topical therapies.