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Journal Central

Study Design: Retrospective case-control study. Objectives: We analyzed the radiological results of the double-balloon inflation technique in terms of its ability to reduce cement leakage, to increase bone cement bonding, and to promote anterior column height recovery. Summary of Literature Review: Various methods, such as the egg-shell technique, have been proposed to prevent leakage of cement during kyphoplasty in cases of osteoporotic compression fracture. Materials and Methods: This study analyzed 18 patients diagnosed with osteoporotic compression fracture of the lumbar spine who underwent the double-balloon inflation technique after April 2015, and 30 consecutive patients with the same diagnosis who were treated using the conventional method prior to April 2015. We analyzed the radiological results on immediate postoperative simple X-rays in the anteroposterior and lateral views, 6-week postoperative lateral X-rays, and 6-month postoperative lateral X-rays to detect changes in anterior vertebral height and the cement leakage rate. Results: The average anterior vertebral height increased by 7.58 mm in the double-balloon inflation group, and by 5.8 mm in the conventional group on the immediate postoperative radiographs (p=0.044). On average, a decrease of 3.08 mm was observed at 6 weeks postoperatively in the double-balloon inflation group, in contrast to a decrease of 4.68 mm in the conventional group (p=0.149). At the 6-month postoperative follow-up, an average decrease of 1.45 mm was found in the double-balloon inflation technique group, while a decrease of 1.40 mm was found in the conventional group (p=0.9110). The cement leakage rate was 22% in the double-balloon inflation group and 27% in the conventional group (p=0.730). Conclusions: Compared to the conventional method, the double-balloon inflation technique can be done more safely, and also promotes a greater recovery of anterior vertebral height.

Study Design: Retrospective evaluation. Objectives: To determine the relationship between lumbar disc degeneration and back muscle degeneration. Summary of Literature Review: In the degenerative cascade of the spine described by Kirkaldy-Willis, degeneration of the disc and of the facet joint co-occur with aging. However, the muscles of the back are not included in this model. Several studies have reported significant correlations between back muscle degeneration and facet joint arthritis. The purpose of our study was to evaluate relationships between lumbar disc degeneration and fatty degeneration of the back muscles. Materials and Methods: In this study, 65 patients over the age of 50 years who had undergone lumbar spine MRI in our orthopaedic clinic were recruited. Fatty degeneration of the back muscles was qualitatively graded from I to III by the degree of the fat signal in the muscle layer, including both the multifidus and erector spinae. Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. Correlations between the back muscle degeneration grade and radiological parameters were analyzed. Results: The degeneration grade of the multifidus correlated positively with age and the grade of disc degeneration. Correlations with other radiologic parameters were not significant. The degeneration grade of the erector spinae correlated positively with age. Other radiologic parameters were not significant. Conclusions: There was a significant correlation between lumbar disc degeneration and multifidus degeneration. Erector spinae degeneration was correlated with age, but not with lumbar disc degeneration. The degenerative cascade of the spine was accompanied by fatty changes of the multifidus with aging.

Study Design: Retrospective evaluation. Objectives: To analyze the effect of cervical lordosis on cervical disc degeneration in patients with a high T1 slope. Summary of Literature Review: The T1 slope is known to be a parameter that may be very useful in evaluating sagittal balance. We previously reported that a low T1 slope was a potential risk factor for cervical spondylosis, especially in the C6-7 cervical segment. However, no study has analyzed the effect of cervical lordosis in patients with a high T1 slope (>25) on cervical disc degeneration. Materials and Methods: Seventy-seven patients with a high T1 slope who underwent cervical spine MRI in our orthopedic clinic were enrolled. Patients were divided into 2 groups according to cervical compensation. The radiologic parameters obtained from radiography and cervical spine MRI were compared between the uncompensated group (cervical lordosis <25) and the compensated group (cervical lordosis ≥25). Results: In the uncompensated group, the average degeneration grade of each segment was 2.72 (±0.70) in C2-3, 3.00 (±0.76) in C3-4, 3.02 (±0.91) in C4-5, 3.37 (±0.95) in C5-6, and 2.95 (±0.98) in C6-7. The average degeneration grade of each segment in the compensated group was 2.38 (±0.78) in C2-3, 2.38 (±0.60) in C3-4, 2.62 (±0.60) in C4-5, 2.82 (±0.72) in C5-6, and 2.41 (±0.74) in C6-7. The degeneration grade was significantly higher in the uncompensated group than in the compensated group for all cervical segments. The risk of high-grade degeneration of C3-4 was significantly higher in the uncompensated group (odds ratio = 6.268; 95% CI, 2.232-17.601; p<.001). Conclusions: Patients with a high T1 slope without compensation of cervical lordosis had a higher grade of degeneration in all cervical segments.

Study Design: Retrospective cohort study. Objectives: To investigate the potential clinical use of the spinal instability neoplastic score (SINS) for determining the surgical strategy, especially regarding the need for anterior support. Summary of Literature Review: The SINS seems to enable an improved qualitative and quantitative assessment of spinal instability in patients with spinal metastasis. Materials and Methods: We retrospectively reviewed 69 consecutive patients who underwent surgical treatment for spinal metastasis. We assessed the patients’ preoperative status with respect to each component of the SINS. Multiple logistic regression was performed to calculate odds ratios (ORs) representing the associations among SINS, age, Eastern Cooperative Oncology Group performance status, modified Tokuhashi score, as well as the preoperative Nurick grade variables and reconstruction of the anterior spinal column. Results: Among the 6 items in the SINS, those indicating the degree of collapse and alignment had significantly higher scores in those who underwent corpectomy and anterior support (p<0.001). Multiple logistic regression revealed that the total SINS was the only factor significantly associated with predicting whether anterior support should be performed (adjusted OR=1.595). Receiver operating characteristic (ROC) curve analysis suggested that a cut-off value of 10 points on the SINS scale could be used to decide whether anterior support following corpectomy should be performed (AUC=0.706). Conclusions: The SINS, insofar as it assesses the degree of collapse and alignment, is a potentially useful tool for determining the surgical strategy in patients with spinal metastasis, especially for deciding upon the necessity of additional anterior support procedures.

Study Design: Case report. Objectives: We report a case of hydrocephalus as a complication of durotomy during cervical laminoplasty. Summary of Literature Review: Hydrocephalus is a very rare complication of cervical laminoplasty. Materials and Methods: A 72-year-old man had an incidental durotomy during cervical laminoplasty. The dural leak was repaired by secondary surgery. However, the patient continued to complain of headaches and developed confusion and drowsiness. A computed tomographic scan of the brain showed hydrocephalus. After insertion of a lumbar drain, the patient experienced a temporary improvement in the neurologic symptoms. After 6 months, the neurologic symptoms recurred and a ventriculoperitoneal (VP) shunt was placed. Results: After placement of the VP shunt, the neurologic symptoms improved significantly. Conclusions: If a patient shows deterioration of neurologic symptoms after an incidental durotomy, surgeons should consider the possibility of hydrocephalus.

Study Design: Literature review. Objective: The aim of this article is to introduce the EOS imaging device, with a focus on spinal and pelvic alignment. Summary of Literature Review: The EOS imaging device can obtain images of spinal and pelvic alignment with almost no distortion, using a low radiation dose. Materials and Methods: We searched for studies related to the use of EOS imaging device for spinal and pelvic alignment. Results: The EOS is not only capable of simultaneously obtaining paired anteroposterior and lateral X-ray images with a low radiation dose, but also can reconstruct the image as if it was acquired in the patient’s reference plane, limiting the distortion to the patient’s thickness instead of the whole distance between the source and detector. The EOS device also has the advantage of accurately measuring the sagittal alignment of the spine and pelvis and the torsional deformity of the lower limbs, as the subject can be imaged while standing upright in a weight-bearing posture. Conclusions: EOS is a new diagnostic technique that can detect spinal and pelvic alignment and deformities of the lower limbs under weight-bearing conditions with a low radiation dose.

Study Design: Literature review. Objectives: To summarize the most up-to-date information on the initial management and neurological examination of patients with spinal cord injury (SCI). Summary of Literature Review: Secondary injuries result from acute pathophysiological processes such as bleeding, hypoperfusion, inflammation, necrosis, and apoptosis around neural elements that initially survive a mechanical injury. Materials and Methods: Orthopedic surgeons must be familiar with the anatomy of the spinal cord and the initial management of a patient with SCI. A detailed neurological examination in accordance with the International Standards for the Neurological Classification of Spinal Cord Injury is a prerequisite. It is important to distinguish between spinal shock and neurogenic shock, which are characteristic phenomena in patients with SCI. Results: Rapid realignment of the spine and proper medical management to avoid hypoperfusion are important in the overall care of a patient with SCI. Conclusions: Patients with SCI should be managed and treated properly to enable them to return home and to their work as soon as possible.