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This study investigated the characteristics of physical activity according to sit-to-stand, standing, and stand-to-sit abilities in subacute stroke with walking difficulty. In this study, 29 participants with subacute stroke and walking difficulty were enrolled and classified into two groups: participants who successfully completed three items (i.e., sit-to-stand, standing, and stand-to-sit) of the Functional Balance Scale (independent group, n = 13) and those who showed incomplete scores on any of the three items (dependent group, n = 16). Light-intensity physical activity (LIPA) and moderate-to-vigorous physical activity (MVPA) were measured using an accelerometer at three periods (i.e. daytime, therapy time, and non-therapy time) for a week. Two-way analysis of variance (groups × physical activity intensity) demonstrated a significant interaction in each period. Post-hoc tests showed significantly more LIPAs and MVPAs in the independent group in all periods, except for MVPA in the non-therapy time. Particularly, LIPA showed significant between-group differences in each period. Among individuals with subacute stroke and walking difficulty, those who could completely perform sit-to-stand, standing, and stand-to-sit could perform more LIPAs. Increasing sit-to-stand, standing, and stand-to-sit abilities could be an important factor in increasing the opportunity to perform LIPAs. [ABSTRACT FROM AUTHOR]

The present study measured changes in plasma pentosidine and bone turnover markers in elderly patients with osteoporosis treated using bisphosphonate. The relationship between pentosidine and bone turnover markers and bone mineral density (BMD) was investigated. This study consisted of post-menopausal osteoporotic women who could be treated using bisphosphonate for 3 years were included in the present analysis. The study population consisted of 58 cases, all women, ranging in age from 53 to 86 years (mean, 67.1 years). Bisphosphonate treatment significantly increased BMD of the lumbar spine to 0.914 ± 0.141 g/cm2 and BMD of the femoral neck to 0.708 ± 0.086 g/cm2 after 3 years ( p < 0.001 versus baseline). The mean BAP level was 27.3 ± 8.3 U/L in patients at baseline. After bisphosphonate treatment, BAP significantly decreased to 18.1 ± 7.2 U/L at 3 years ( p < 0.001). Urinary NTX also decreased after bisphosphonate treatment. After 3 years of treatment, urinary NTX significantly decreased from 50.0 ± 19.0 nmol BCE/mmol Cr to 24.6 ± 10.2 nmol BCE/mmol Cr at 3 years ( p < 0.001). Serum pentosidine levels were 0.0413 ± 0.0094 μg/mL at baseline and 0.0413 ± 0.0122 μg/mL after 3 years. They were not significantly changed by bisphosphonate treatment. Serum pentosidine levels were not changed by treatment with bisphosphonates. Thus, serum pentosidine may not be suitable as a marker of bone quality after 3 years of bisphosphonate treatment. [ABSTRACT FROM AUTHOR]

A 76-year-old woman presented history of left hip joint pain on walking, which occurred after she bent to move a planter. Plain radiographs showed no fracture. Bone scintigraphy revealed accumulation, and magnetic resonance imaging showed a low signal area on T1-weighted images. We diagnosed an insufficiency fracture and pain decreased naturally on conservative treatment. Insufficiency fracture of the acetabulum should be considered when elderly patients have hip joint pain. Magnetic resonance imaging and bone scintigraphy is most useful for the diagnosis. [ABSTRACT FROM AUTHOR]

Background: No studies have reported on osteotomies utilizing a navigation system in congenital scoliosis surgery. This study aimed to evaluate the surgical outcomes of eight patients with congenital scoliosis or kyphoscoliosis due to hemivertebrae treated by computer-assisted hemivertebral resection using only a posterior approach. Methods: Eight consecutive patients (two scoliotics and six kyphoscoliotics) managed by computer-assisted hemivertebral resection using only a posterior approach with transpedicular instrumentation were investigated retrospectively. A CT-based navigation system was used to confirm the positions of the vertebra, spinal cord and aorta in real-time when we inserted a pedicle screw and conducted the osteotomy. The mean patient age at surgery was 18 years (range 11-41 years). The mean follow-up was 46 months (range 18-84 months). Results: Before surgery, the mean kyphotic curve was 55.8° (range 26-83°), and the mean scoliotic curve was 50.0° (range 36-62°). At the final follow-up period, the curves averaged 23.2° (range 15-40°) and 31.6° (range 21-44°), respectively, yielding kyphotic angle corrections of 32.7° (range 11-58°) and Cobb angle correction rates of 36.8% (range 24.1-48.3%). A total of 72 pedicle screws were inserted with the navigation system, and two screws revealed a perforating pedicle. No neurovascular complications occurred. The perforation rate was 2.8%. Conclusions: Hemivertebral resection via a single posterior approach is less invasive than combined anterior and posterior approaches; however, this procedure increases the risk of spinal cord and vascular injuries. Computer-assisted hemivertebral resection enables safe and accurate performance of a hemivertebral resection via a single posterior approach. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the precision of multilevel registration in image-guided and computer-assisted insertion of skip pedicle screw for adolescent idiopathic scoliosis (AIS) treatment. The study evaluated various variables, such as blood loss, from 19 patients who experienced skip pedicle screw insertion through multilevel registration. Results show that multilevel registration can minimize the time of operation without affecting the accuracy of the insertion process.

Abstract: Background: In degenerative lumbar spinal disease with nerve root compression, the L5 and S1 nerve roots are the most often affected and the L3 nerve root is involved infrequently. The purpose of this study was to investigate the characteristics of L3 nerve root radiculopathy. Methods: Seventeen consecutive patients with L3 radiculopathy were treated. The symptomatic nerve roots were determined by the pain distribution, the neurologic findings, and selective nerve root injection. The clinical characteristics and outcomes of these patients were assessed retrospectively. Results: The average age was 76 years. The spinal diseases that were associated with L3 radiculopathy were lumbar canal stenosis in 6 patients, lumbar extraforaminal stenosis and lumbar disk herniation in 5 each, and lumbar canal stenosis with degenerative scoliosis in 1. The patients'' symptoms were thigh pain in 12 patients, and hip or knee pain in 5. Four patients were nonambulatory because of severe pain. Although a sensory disturbance was reported in 9 patients, motor weakness was present in 2. Selective nerve root injection was completely effective in 10 patients. Six had decompressive surgery and/or fusion followed by a favorable outcome. Four patients were misdiagnosed and received conservative treatment for hip and/or knee joint diseases. Conclusions: L3 radiculopathy was characterized by various lower limb pain and neurologic deficit. Selective nerve root injection was effective for most patients. In elderly patients who do not respond to treatment for hip and/or knee joint diseases, L3 nerve root radiculopathy should be considered as the cause of lower limb pain. [Copyright &y& Elsevier]

Background Context: Cervical pedicle screw (CPS) insertion is technically demanding and carries a risk of serious neurovascular complications when screws perforate. To avoid such serious risks, we currently perform CPS insertion using a computed tomography (CT)-guided navigation system. However, there remains a low probability of screw perforation during CPS insertion that is affected by factors such as CPS insertion angle and anatomical pedicle transverse angle (PTA).Purpose: This study aimed to understand the perforation tendencies of CPS insertion angles in relation to anatomical PTA.Study Design: This is a retrospective chart review.Patient Sample: The study enrolled 151 consecutive patients (95 men and 56 women, with a mean age of 64.6 years).Outcome Measures: Anatomical PTA and CPS insertion angles were evaluated by axial CT images.Methods: The medical records of 151 consecutive patients who underwent CPS insertion using a CT-based navigation system were reviewed. We examined the relationships between PTA and CPS insertion angle on axial CT images according to vertebral level.Results: The average preoperative PTA at each vertebral level was 32.1° for C2, 41.5° for C3, 41.0° for C4, 39.4° for C5, 34.4° for C6, and 27.3° for C7. Corresponding CT-determined pedicle screw insertion angles were 24.9°, 31.3°, 28.7°, 27.8°, 28.0°, and 26.0°, respectively. The CPS insertion angles at C2-C6 were significantly smaller than those for PTA (p<.01). In evaluations of angle thresholds from C3 to C5 that predicted a higher risk of perforation, the receiver operating characteristic curve analysis determined CPS insertion angles of <24.5° and >36.5° for the identification of lateral and medial perforations, respectively.Conclusion: For CPS insertion into the C3-C5 pedicles using CT, there is an increased likelihood of lateral or medial perforation for insertion angles of <24.5° or >36.5°, respectively. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective chart review. Purpose: A comparison of mini open foraminotomy (MOF) for cervical radiculopathy using either large tubular (LT) or TrimLine (TL) retractors. Overview of Literature: Posterior foraminotomy relieves compression of the cervical nerve root in radiculopathy patients. However, invasion of the paravertebral muscle may cause major problems in these patients. To address these problems, we performed MOF. Methods: Twenty cervical radiculopathy patients (16 male and 4 female) who underwent MOF between May 2004 and August 2011 were assigned to LT and TL groups. Each group contained 10 subjects. Surgical and clinical outcomes were compared. Results: The average operating time in the TL group was significantly shorter than that in the LT group. The final follow-up mean neck disability indices significantly improved compared to the preoperative values (LT group, 12.0±7.8 vs. 28.0±9.4; TL group, 6.0±5.9 vs. 21.9±10). The final follow-up neck pain visual analog scale (VAS) scores also decreased significantly from the preoperative of 8.0±1.5 and 2.5±2.5 to the final follow-up values of 2.2±2.2 and 1.0±2.5 in the LT and TL groups, respectively. The recovery rate for the neck pain VAS score was 70.0±31.9 in the LT group and 87.0±32.0 in the TL group, thus suggesting no significant difference between the two groups. Conclusions: MOF with the TL retractor is an easy and safe procedure. Furthermore, the use of the TL retractor allows for a minimally invasive and effective surgical treatment of cervical radiculopathy patients. [ABSTRACT FROM AUTHOR]

Study design: A cross-sectional study of the data retrospectively collected by chart review. Objectives: This study aimed to clarify screw perforation features in 129 consecutive patients treated with computer-assisted cervical pedicle screw (CPS) insertion and to determine important considerations for computer-assisted CPS insertion. Summary of background data: CPS fixation has been criticized for the potential risk of serious injury to neurovascular structures. To avoid such serious risks, computed tomography (CT)-based navigation has been used during CPS insertion, but screw perforation can occur even with the use of a navigation system. Methods: The records of 129 consecutive patients who underwent cervical (C2-C7) pedicle screw insertion using a CT-based navigation system from September 1997 to August 2013 were reviewed. Postoperative CT images were used to evaluate the accuracy of screw placement. The screw insertion status was classified as grade 1 (no perforation), indicating that the screw was accurately inserted in pedicle; grade 2 (minor perforation), indicating perforation of less than 50 % of the screw diameter; and grade 3 (major perforation), indicating perforation of 50 % or more of the screw diameter. We analyzed the direction and rate of screw perforation according to the vertebral level. Results: The rate of grade 3 pedicle screw perforations was 6.7 % (39/579), whereas the combined rate of grades 2 and 3 perforations was 20.0 % (116/579). No clinically significant complications, such as vertebral artery injury, spinal cord injury, or nerve root injury, were caused by the screw perforations. Of the screws showing grade 3 perforation, 30.8 % screws were medially perforated and 69.2 % screws were laterally perforated. Of the screws showing grades 2 and 3 perforation, 21.6 % screws were medially perforated and 78.4 % screws were laterally perforated. Furthermore, we evaluated screw perforation rates according to the vertebral level. Grade 3 pedicle screw perforation occurred in 6.1 % of C2 screws; 7.5 % of C3 screws; 13.0 % of C4 screws; 6.5 % of C5 screws; 3.2 % of C6 screws; and 4.0 % of C7 screws. Grades 2 and 3 pedicle screw perforations occurred in 12.1 % of C2 screws, 22.6 % of C3 screws, 31.5 % of C4 screws, 22.2 % of C5 screws, 14.4 % of C6 screws, and 12.1 % of C7 screws. C3-5 screw perforation rate was significantly higher than C6-7 ( p = 0.0024). Conclusions: Careful insertion of pedicle screws is necessary, especially at C3 to C5, even when using a CT-based navigation system. Pedicle screws tend to be laterally perforated. [ABSTRACT FROM AUTHOR]

Study design: A retrospective single-center study. Summary and background: We routinely have used C1–C2 transarticular and cervical pedicle screw fixations to reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions. However, there is little data on mid-term results of surgical reconstruction for rheumatoid cervical disorders, particularly, cervical pedicle screw fixation. Objectives: The purpose of this study was to evaluate the mid-term surgical results of computer-assisted cervical reconstruction for such lesions. Methods: Seventeen subjects (4 men, 13 women; mean age, 61 ± 9 years) with RA cervical lesions who underwent C1–C2 transarticular screw fixation or occipitocervical fixation, with at least 5 years follow-up were studied. A frameless, stereotactic, optoelectronic, CT-based image-guidance system, was used for correct screw placement. Variables including the Japanese Orthopaedic Association (JOA) score, Ranawat class, EuroQol (EQ-5D), atlantodental interval, and Ranawat values before, and at 2 and 5 years after surgery, were evaluated. Furthermore, screw perforation rates were evaluated. Results: The lesions included atlantoaxial subluxation (AAS, n = 6), AAS + vertical subluxation (VS, n = 7), and AAS + VS + subaxial subluxation ( n = 4). There was significant neurological improvement at 2 years after surgery, as evidenced by the JOA scores, Ranawat class, and the EQ-5D utility weight. However, at 5 years after surgery, there was a deterioration of this improvement. The Ranawat values before, and at 2 and 5 years after surgery, were not significantly different. Major screw perforation rate was 2.1 %. No neural and vascular complications associated with screw insertion were observed. Conclusions: Subjects with rheumatoid cervical lesions who underwent C1–C2 transarticular screw fixation or occipitocervical fixation using a pedicle screw had significantly improved clinical parameters at 2 years after surgery. However, there was a deterioration of this improvement at 5 years post surgery. [ABSTRACT FROM AUTHOR]

Abstract: Background context: The EuroQol (EQ-5D) is a widely used comprehensive measure of health-related quality of life. There has been no study that has evaluated the health-related quality of life before and after the surgical reconstruction of rheumatoid arthritis (RA) cervical spine lesions using EQ-5D. Purpose: The present study aimed to evaluate the improvement of quality of life before and after surgical reconstruction of rheumatoid cervical spine using EQ-5D, and the surgical outcomes of cervical spine affected by RA. Study design: A retrospective study of the patients who underwent surgical reconstruction of cervical disorders in RA. Patient sample: Twenty-five patients (seven men, 18 women, mean age 62.2 years) who underwent surgical reconstruction of cervical disorders in RA were enrolled. Outcome measures: Japanese Orthopaedic Association (JOA) score and EQ-5D. Methods: Clinical symptoms were evaluated before surgery and at 2 years after surgery by measuring the JOA score. We also investigated health-related quality of life before surgery and outcome at 2 years after surgery using the EQ-5D questionnaire. Results: Mean observation period was 46.3 months. Mean JOA score significantly improved from 9.1±4.5 points before surgery to 12.4±2.8 at the 2 years after surgery (p=.0001). All the EQ-5D data were improved at the 2 years after surgery, compared with the data before surgery; especially, pain (p=.005), usual activity (p=.005), mobility (p=.008), and anxiety/depression (p=.02) were significantly improved. Utility weight was 0.37±0.27 before surgery and 0.56±0.26 at the 2 years after surgery, showing significant improvement at the 2 years after surgery compared to before surgery (p=.002). Conclusions: The surgical reconstruction of rheumatoid cervical spine has been demonstrated to improve patients'' health-related quality of life. [Copyright &y& Elsevier]

Study Design: A retrospective study. Purpose: To evaluate the surgical results of computer-assisted C1-C2 transarticular screw fixation for atlantoaxial instability and the usefulness of the navigation system. Overview of Literature: We used a computed tomography (CT)-based computer navigation system in planning and screw insertion in Magerl's procedure, which provides the most rigid atlantoaxial fusion, to avoid risk of vertebral artery (VA) tear by avoiding high-riding VA during screw insertion. Methods: Twenty patients who underwent atlantoaxial fusion under the CT-based navigation system were studied. The mean observation period was 33.5 months. The evaluated items included the existence of VA stenosis by preoperative magnetic resonance angiography, surgical time, blood loss volume, Japanese Orthopaedic Association (JOA) score and Ranawat's pain criteria before surgery and at final follow-up, postoperative screw position evaluated by CT, and bony fusion. Results: The mean operation time was 205 minutes, with the mean blood loss volume of 242 ml. The mean JOA score was 11.6 points before surgery and 13.7 at final follow-up. Occipital and/or cervical pain presented before operation was remitted or resolved in all patients. Evaluation of screw insertion by CT revealed correct penetration to atlantoaxial joints, with a perforation rate of 2.6%. There was no complication, including VA tear, and all patients who were followed-up during one year or more after surgery achieved bony fusion. Some subjects who appeared inappropriate for surgery from CT images were assessed as eligible for surgery based on the evaluation results obtained using the navigation system. Conclusions: It was demonstrated that the CT-based navigation system is an effective support device for Magerl's procedure. [ABSTRACT FROM AUTHOR]

Introduction: Upper cervical or occipitocervical disorders such as rheumatoid arthritis present as atlantoaxial subluxation, vertical subluxation of the axis, and subaxial subluxation, which produce myelopathy and severe pain. In such cases, occipitocervical reconstruction surgery may be indicated, and several reports have described reduction of subluxation by fixing the halo vest before this surgery. Purpose: The purpose of this study was to evaluate the efficacy of using the halo vest before the surgery for unstable upper cervical spine and for occipitocervical instability. Methods: Twenty-eight patients (9 men and 19 women; mean age, 61.8 years at surgery) who presented with atlantoaxial or occipitocervical fusion were studied. In all cases, the halo vest was fixed in the conscious condition, and subluxation was reduced before the surgery. The mean follow-up period was 45 months. Roentgenologic measurement and clinical evaluation were performed before the surgery and at the final follow-up. Results: Using the halo vest resulted in significant reductions in the atlantodental interval, the space available for the spinal cord, and the Ranawat value ( p < 0.05), and these were maintained until the final follow-up. The mean Japanese Orthopedic Association score significantly improved from 9.5 before surgery to 12.2 at the final follow-up ( p = 0.01). Nineteen cases (68%) improved by more than 1 grade by Ranawat's classification after surgery and 16 cases (57%) maintained the same at the follow-up visit. Conclusion: Conscious preoperative reduction using the halo vest for occipitocervical disorders is a useful and safe technique. [ABSTRACT FROM AUTHOR]

Background: Instability of the occipitocervical junction can present challenging surgical problems because of the unique anatomic and biomechanical characteristics of this region. The purpose of this study was to evaluate the long-term surgical results and usefulness of a computed tomography (CT)-based navigation system for the occipitocervical reconstruction. Methods: Twenty-three patients (10 men, 13 women; mean age at surgery 57.9 years; mean follow-up periods 52.9 months) with occipitocervical junction disorders were treated by occipitocervical reconstruction using pedicle screws, aided by a CT-based navigation system. Roentgenologic measurement and clinical evaluation were performed before surgery and at final follow-up. Postoperative CT and plane radiographs were used to determine the accuracy of screw placement. Results: Mean atlantodental interval and Ranawat value were significantly improved (P<.05), and mean clivoaxial angle was increased after surgery and maintained at final follow-up. Mean Japanese Orthopedic Association score before and at final follow-up was 7.1 ± 4.4 and 11.3 ± 3.5 points, showing significant improvement (P = .005). Fourteen patients (61%) improved more than one Ranawat grade. Six of nine patients (67%) in class IIIB were improved. On the other hand, nine patients (39 %) remained at the same class at final follow-up. A total of 88 pedicle screws were inserted into cervical and upper thoracic pedicles using the navigation system, and only one screw (1.1 %) showed major pedicle wall perforation. Solid union was achieved in all 23 patients. Conclusions: Occipitocervical reconstruction using pedicle screws provided a high fusion rate and maintained alignment in the occipitocervical region. The computer-assisted navigation system was a useful tool for accurate and safe pedicle screw insertion. [ABSTRACT FROM AUTHOR]

Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men) with femoral neck fracture and 21 patients (17 women and 4 men) with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX), as well as urine levels of C-terminal telopeptide of type I collagen (CTX) and deoxypyridinoline (DPD), were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX), five weeks (serum NTX and DPD), and 2-3 weeks (CTX) after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures. [ABSTRACT FROM AUTHOR]