Radiographic and Clinical Outcomes of Surgical Treatment of Kümmell’s Disease With Thoracolumbar Kyphosis: A Minimal Two-Year Follow-Up

2021 ◽  
Author(s):  
Hao Cheng ◽  
Guo-dong Wang ◽  
Tao Li ◽  
Xiao-yang Liu ◽  
Jian-min Sun
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Sagittal Balance ◽  
Rating Scale ◽  
Clinical Results ◽  
Spinal Alignment ◽  
Thoracolumbar Kyphosis ◽  
Kummell’S Disease ◽  
Kümmell’S Disease

Abstract Background: To evaluate the short to mid-term radiographic and clinical outcomes of the restoration of normal spinal alignment and sagittal balance in the treatment of Kümmell’s disease with thoracolumbar kyphosis. Methods: Between February 2016 and May 2018,30 cases of Kümmell’s disease with thoracolumbar kyphosis were divided into two groups (A and B) according to whether the kyphosis was combined with neurological deficits.All of the cases underwent surgical treatment to regain the normal spinal alignment and sagittal balance.And the radiographic outcomes and clinical results of these 30 patients were retrospectively evaluated.The sagittal imaging parameters including sagittal vertebral axis (SVA),thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL),pelvic incidence (PI),pelvic tilt (PT),and sacral slope (SS)of the whole spine before operation,immediately after operation,and the last follow-up of each group were measured and evaluated.The clinical results included the Oswestry Disability Index (ODI) and the Numerical Rating Scale (NRS) of the two groups .Results: The average follow-up period of group A and B were 34.2 and 38.7 months respectively.The parameters of both groups such as SVA,TLK,and thoracolumbar Cobb angle after surgery and at the last follow-up were significantly improved compared with those before surgery.The ODI and the NRS of the two groups at the last follow-up were also significantly improved. Conclusion: In the treatment of Kümmell’s disease with thoracolumbar kyphosis,to restore the normal alignment and sagittal balance can obtain a satisfactory radiographic and clinical short and medium-term effects.

scholarly journals Radiographic and clinical outcomes of surgical treatment of Kümmell’s disease with thoracolumbar kyphosis: a minimal two-year follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hao Cheng ◽  
Guo-dong Wang ◽  
Tao Li ◽  
Xiao-yang Liu ◽  
Jian-min Sun
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Sagittal Balance ◽  
Rating Scale ◽  
Thoracolumbar Kyphosis ◽  
Postoperative Evaluation ◽  
Kummell’S Disease ◽  
Group A ◽  
Kümmell’S Disease

Abstract Background Up to now in the surgical treatment of Kümmell’s disease combined with thoracolumbar kyphosis, little research has focused on the evaluation of the imaging and clinical outcomes of restoring the normal alignment and sagittal balance of the spine. This study aimed to evaluate the short to mid-term radiographic and clinical outcomes in the treatment of Kümmell’s disease with thoracolumbar kyphosis. Methods From February 2016 to May 2018, 30 cases of Kümmell’s disease with thoracolumbar kyphosis were divided into group A and B according to whether the kyphosis was combined with neurological deficits. All of the cases underwent surgical treatment to regain the normal spinal alignment and sagittal balance. The radiographic outcomes and clinical outcomes of the cases were retrospectively evaluated. The sagittal imaging parameters including sagittal vertebral axis (SVA),thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL),pelvic incidence (PI),pelvic tilt (PT),and sacral slope (SS) before operation,immediately after operation,and the last follow-up of each case were measured and evaluated. The clinical results included the Oswestry Disability Index (ODI) and the Numerical Rating Scale (NRS) of the two groups. Statistical software SPSS21.0 was used to analyze the data. Results In group A: Mean SVA before operation was 75 mm and 26.7 mm at the final postoperative evaluation (P = 0.000); Mean TLK before operation was 39°, and 7.1° at the final postoperative evaluation (P = 0.000); Mean NRS before operation was 4.7, compared with 0.9 at the final postoperative evaluation (P = 0.000). In group B: Mean preoperative SVA was 62.5 mm and decreases to 30.7 mm at the final postoperative evaluation (P = 0.000); Mean TLK before operation was 33°, and 9.7° 2 years post-operation (P = 0.000); Mean NRS prior to surgery was 4.0, and 0.8 at the last follow-up evaluation (P = 0.000). The improvement of the NRS scores of groups A and B was related to the improvement of the cobb angle (P = 0.020); (P = 0.009) respectively. Conclusion In the treatment of Kümmell’s disease with thoracolumbar kyphosis,to restore the normal alignment and sagittal balance can obtain a satisfactory radiographic and clinical short and medium-term effects.

Clinical outcomes and complications after pedicle subtraction osteotomy for correction of thoracolumbar kyphosis

2007 ◽  
Vol 6 (4) ◽  
pp. 330-336 ◽  
Author(s):  
Minoru Ikenaga ◽  
Jitsuhiko Shikata ◽  
Mitsuru Takemoto ◽  
Chiaki Tanaka
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcomes ◽  
Late Onset ◽  
Intraoperative Complications ◽  
Clinical Results ◽  
Pedicle Subtraction Osteotomy ◽  
Plumb Line ◽  
Adjacent Segment ◽  
Thoracolumbar Kyphosis

Object Many patient complications have been reported after the use of the pedicle subtraction osteotomy (PSO) technique. To the authors' knowledge, no previous reseachers have reported on the causes of complications after using the single-stage PSO technique with a posterior approach. The purpose of this study was to investigate complications after the procedure, to clarify the factors influencing the complications, and to identify ways to minimize complications. Methods Records for 67 patients treated with the PSO technique were examined retrospectively. All complications were recorded and analyzed in relation to the radiological and clinical outcomes. No patient died or became paraplegic as a result of surgery. There were 48 surgery-related complications in 27 patients (40%): six intraoperative, four perioperative, and 38 late-onset postoperative complications. As the study progressed and more patients were treated, the rate of intraoperative complications decreased significantly. The incidence of late-onset complications associated with an adjacent-segment progression of kyphosis was lower in patients with a long fusion from a midthoracic vertebra to the sacrum or pelvis than in patients treated with a shorter fusion. The C-7 plumb line values and postoperative complications were closely correlated with clinical results. Conclusions Intraoperative complications can be prevented or the risks minimized with adequate surgical training. Most of the late-onset complications in these patients were related to the progression of kyphosis. The frequency of complications was closely correlated with patient satisfaction at follow up. Correcting the C-7 plumb line value with minimal complications appeared to lead to better clinical results.

scholarly journals Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0020
Author(s):  
Michael Ryan ◽  
Benton Emblom ◽  
E. Lyle Cain ◽  
Jeffrey Dugas ◽  
Marcus Rothermich
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Failure Rate ◽  
Osteochondritis Dissecans ◽  
Surgical Techniques ◽  
The Other ◽  
Return To Play ◽  
Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

scholarly journals Kümmell's Disease Treated with Percutaneous Vertebroplasty: Minimum 1 Year Follow-Up

2017 ◽  
Vol 13 (2) ◽  
pp. 119 ◽  
Author(s):  
Jae Won Park ◽  
Jong-Hwa Park ◽  
Hong Jun Jeon ◽  
Jong Young Lee ◽  
Byung Moon Cho ◽  
...  
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Kummell’S Disease ◽  
Kümmell’S Disease

A Retrospective Study in the Treatment of a 2-Part Greater Tuberosity Fracture Using the F3 Biomet Plate

2016 ◽  
Vol 101 (9-10) ◽  
pp. 465-472
Author(s):  
Jun Ma ◽  
Liangyu Zhao ◽  
Tao Liu ◽  
Qiang Fu ◽  
Aimin Chen
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Constant Score ◽  
Shoulder Function ◽  
Open Reduction Internal Fixation ◽  
Dash Score ◽  
X Rays ◽  
Level Of Evidence ◽  
Greater Tuberosity

The purpose of this study was to evaluate the clinical efficacy of the F3 Biomet plate in the treatment of 2-part displaced humeral greater tuberosity fractures. We compared the clinical outcomes of patients with displaced greater tuberosity fractures who underwent surgical treatment using an F3 plate with those of patients who were treated nonsurgically. Eleven patients with 2-part displaced humeral greater tuberosity fractures were surgically treated with use of an F3 Biomet plate, whereas 12 patients with equal injuries were treated nonsurgically. Each patient underwent follow-up for at least 1 year. We retrospectively collected data and analyzed the clinical outcomes. The Constant score and DASH score were used to assess the shoulder function, and X-rays were taken to evaluate the fracture healing. X-rays of the patients in both groups showed that the fractures achieved union after the 1-year follow-up. Patients treated surgically with an F3 plate and open reduction internal fixation had better Constant score and DASH score results for shoulder function than those treated nonsurgically. In the present study, surgical treatment of displaced humeral greater tuberosity fractures with the use of an F3 plate led to a 100% union rate and good clinical outcomes. The F3 Biomet plate can be considered an effective implant for the treatment of displaced humeral greater tuberosity fractures. The level of evidence is therapeutic III.

scholarly journals Treatment of Catastrophic Failures of Achilles Tendon Repairs Due to Deep Wound Complications

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Jamal Ahmad
Keyword(s):  
Surgical Treatment ◽  
Achilles Tendon ◽  
Wound Infection ◽  
Clinical Outcomes ◽  
Single Stage ◽  
Wound Complications ◽  
Deep Wound Infection ◽  
Deep Wound ◽  
Catastrophic Failures

Category: Sports Introduction/Purpose: The Achilles tendon is the most commonly injured tendon in the lower extremity. Whether these ruptures are acute or chronic, a surgical Achilles repair or reconstruction is often needed to restore tendon integrity and function. Risks from such surgeries include superficial or deep wound infections and/or dehiscence. To date, there is scant literature regarding the treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound infection and dehiscence. The purpose of this study is to retrospectively examine clinical outcomes from uniform single-stage surgical treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications. Methods: Between 2007 and 2016, 10 patients developed a deep wound infection and dehiscence after surgical treatment of an acute or chronic Achilles rupture. Medical co-morbidities included obesity in 4, diabetes in 3, and nicotine use in 2 patients. Six and 4 patients had a mid-substance and insertional Achilles rupture respectively. Three patients had an acute injury that received an end-to-end suture repair. Seven patients had a chronic injury with Achilles retraction, which necessitated proximal Achilles or gastrocnemius lengthening. These patients required surgery for their wound problem due to depth and involvement of their Achilles repair/reconstruction site. Surgery involved a single-stage wound irrigation and debridement, Achilles excisional debridement at the repair/reconstruction site, flexor hallucis longus transfer to the calcaneus to replace the compromised or failed Achilles repair/reconstruction, and primary or vacuum assisted wound closure. Patients were followed for 6 months after this surgery and invited for recent follow-up to collect data. Results: With uniform surgical treatment, full resolution of deep wound infection and dehiscence after Achilles repair/reconstruction was achieved in all 10 patients. No patients developed a recurrence of wound complications and/or infection to necessitate any further surgical debridements. All 10 patients presented for recent follow-up at a mean of 57.3 months. Mean Foot and Ankle Ability Measures increased from 36.3% at initial presentation before Achilles repair/reconstructive surgery to 84.2% at latest follow-up (P<0.05). Mean Visual Analog Scores of pain decreased from 6.6 of 10 before the Achilles repair/reconstruction to 1.5 of 10 at latest follow-up (P<0.05). All patients were able to return to normal gait and full activities at home, with 3 reporting difficulties with prolonged ankle activities at work. Conclusion: This study demonstrates that our method of single-stage surgical treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications can achieve a high rate of improved patient function and pain relief. Clinical outcomes of treating patients with this particular complication of Achilles repair/reconstruction in this manner have not been previously reported in the orthopaedic literature. As catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications are studied further, our method of surgical care should be strongly considered as treatment.

scholarly journals Curative Glubran 2 Embolization of Cerebral Arteriovenous Malformations Patient Selection and Initial Results

2014 ◽  
Vol 20 (6) ◽  
pp. 722-728 ◽  
Author(s):  
Jie Liu ◽  
Ming Lv ◽  
Xianli Lv ◽  
Hongwei He ◽  
Aihua Liu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Clinical Results ◽  
Hemorrhagic Complication ◽  
Cerebral Arteriovenous Malformations ◽  
Complete Obliteration ◽  
Glubran 2 ◽  
Cerebral Avms

The liquid embolic agents currently used for embolization of cerebral arteriovenous malformations are Onyx and NBCA. Glubran 2, a cyanoacrylate-based synthetic glue, has recently been applied for embolization of cerebral arteriovenous malformations (AVMs). We report the clinical results of selected cerebral AVMs treated with Glubran 2 targeting for curative embolization. Between October 2011 and March 2013, 31 patients with cerebral AVMs were selected for curative embolization with Glubran 2. There were 19 men and 12 women with a mean age of 32 years (range 4–65 years). Initial clinical presentation included hemorrhage in 28 and seizures in three patients. AVM location was frontal in eight patients, parietal in four, occipital in eight temporal in six, cerebellar in two and cerebellar vermis in three patients. Follow-up was performed clinically and with angiography examination at three to six months. Clinical outcomes were evaluated based on the modified Rankin Scale (mRS). A mean of 2.5 (range, 1–12) feeding pedicles were embolized per patient. Complete angiographic obliteration of AVM was achieved in 27 patients. A hemorrhagic complication was observed in one patient, an ischemic complication in one patient and technical complications in four patients. There was no procedure-related disabling neurological deficit or death at discharge. Additional gamma knife radiosurgery was performed in five patients, including one patient with recurrent AVM. All of the patients had favorable clinical outcomes at three to six month follow-up (mRS≤2). The curative embolization technique with Glubran 2 for selected cerebral AVMs achieved a high initial complete obliteration rate with an acceptable complication frequency.

scholarly journals Percutaneous Kyphoplasty for Kummell Disease with Severe Spinal Canal Stenosis

2015 ◽  
Vol 6;18 (6;11) ◽  
pp. E1021-E1028
Author(s):  
Yan Yang
Keyword(s):  
Spinal Canal ◽  
Invasive Procedure ◽  
Cement Leakage ◽  
Spinal Canal Stenosis ◽  
Stage Iii ◽  
Canal Stenosis ◽  
Institutional Review ◽  
Kummell’S Disease ◽  
Kümmell’S Disease

Background: Percutaneous kyphoplasty (PKP) has been proven as an effective, minimally invasive procedure for the treatment of Kummell’s disease in the early stages. However, a risk of cement leakage and further neurological damage remains during and after PKP, especially in chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Objective: To evaluate the feasibility and efficacy of PKP for the treatment of chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Study Design: A retrospective evaluation of postoperative radiographs. Setting: Pain management clinic. Methods: A retrospective study was performed on 9 patients with 11 levels managed with PKP for chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Clinical and radiological outcomes were assessed. Results: Substantial pain relief was attained in all the patients. Both visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores improved significantly from pre- to post-operation (P < 0.05), and remained unchanged at every follow-up. No neurological deterioration was found. Postoperatively, the anterior and midline vertebral body heights were significantly corrected (P < 0.05), and were sustained at the final follow-up. Similar results were seen in the correction of kyphotic angle. Neither cement leakage into the spinal canal nor further dislodging of the posterior vertebral fragments occurred. Two cases experienced subsequent fractures with one having a second PKP and the other being treated conservatively. Limitations: Retrospective study of 9 cases with 11 levels due partly to the rarity of the disorder. Conclusions: PKP is an effective, minimally invasive procedure for the treatment of chronic osteoporotic stage III Kummell’s disease with severe spinal stenosis, leading to a significant relief of symptoms and improvement of functional status. Institutional Review: This study was approved by the Institutional Review Board. Key words: Kummell’s disease, kyphoplasty, spine, osteoporosis, cement leakage, polymethylmethacrylate, neurological deficits, burst fractures

scholarly journals Comparison of Unipedicular and Bipedicular Percutaneous Kyphoplasty for Kummell's Disease

2020 ◽  
Author(s):  
Dan Pan ◽  
Xiaojie Ouyang ◽  
Qinghua Huang ◽  
Dayong Chen
Keyword(s):  
Bone Cement ◽  
Operative Time ◽  
Cement Leakage ◽  
Vertebral Height ◽  
Kyphotic Angle ◽  
Injection Volume ◽  
Kummell’S Disease ◽  
Kümmell’S Disease ◽  
Better Than

Abstract Background: Percutaneous kyphoplasty (PKP) is effective for the treatment of Kummell's disease. However, controversy remains regarding whether a unipedicular or bipedicular PKP is superior.Methods: A retrospective study was performed to review 40 patients with stage I and II Kummell's disease who underwent PKP in our hospital from January 2015 to June 2018. Based on the transpedicular approach of PKP, those patients were randomly divided into unipedicular group (n = 19) and bipedicular group (n = 21) . Operative time, bone cement injection volume and cement leakage rate were compared in the two groups. Pre- and post-operative visual analogue score (VAS), local kyphotic angle and average vertebral height were also evaluated.Results: All patients underwent surgery successfully. Compared with preoperative condition, VAS was significantly decreased at 1 day after operation and the last follow-up in both groups (P < 0.05) , and local kyphotic angle and average vertebral height were restored markedly (P < 0.05). Operative time of both groups had no significant difference (P > 0.05). Bone cement injection volume was larger in bipedicular group (P < 0.05). At 1 day after operation and the last follow-up , the local kyphotic angle and average vertebral height in bipedicular group were restored better than those in unipedicular group (P < 0.05). There were 4 cases of cement leakage in both groups, with leakage rates of 21.1% and 19.0%, respectively, and the difference was not significant (P > 0.05).Conclusion: Both unipedicular and bipedicular PKP are effective for treating patients with stage I and II Kummell's disease, while postoperative pain relief and imaging results in bipedicular group were better than those in unipedicular group.

scholarly journals Clinical Outcomes of Operative Repair for Patients Who Fail to Conserve the Complete Rupture of the Collateral Ligament in the Proximal Interphalangeal Joint

2021 ◽  
Vol 27 (2) ◽  
pp. 81-84
Author(s):  
Young Hwan Kim
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Stress Test ◽  
Visual Analog Scale Score ◽  
Proximal Interphalangeal Joint ◽  
Joint Stability ◽  
Collateral Ligament ◽  
Complete Rupture ◽  
Pip Joint

Objective: The purpose of this study was to compare the preoperative and postoperative outcomes of surgical treatment for patients who fail to conserve the complete rupture of the collateral ligament in the proximal interphalangeal (PIP) joint.Methods: A complete rupture of the collateral ligament was confirmed by a radiologist using ultrasound or magnetic resonance imaging for patients who had symptoms after 4 weeks of conservative treatment. Eleven patients underwent operative collateral ligament repair using an anchor. All patient was followed up for at least 6 months postoperatively. We evaluated clinical outcomes preoperatively and at 6 months follow-up: (1) range of motion of the PIP, (2) joint stability, (3) Visual Analog Scale score, (4) fusiform index of the PIP joint, and (5) functional & cosmetic satisfaction.Results: There was no instability in the lateral stress test at 6-month follow-up. The ranges of motion of the PIP were not statistically different between preoperative and at 6-month follow-up. Patients had less pain but the cosmetic appearance of the PIP joint did not improve. Functional satisfaction differed statistically, but there was no difference in cosmetic satisfaction.Conclusion: Surgical treatment for patients who fail to conserve the complete rupture of the collateral ligament in the PIP joint can provide good joint stability, functional recovery.

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