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Retrospective cohort study OBJECTIVE: To investigate the long-term effects of bone cement-augmented instrumentation in multilevel lumbar fusions SUMMARY OF BACKGROUND DATA: Cement-augmented screw is one of the techniques used to reduce early mechanical failure in multilevel lumbar fusion, especially in the elderly. However, there is little information regarding the long-term effects.Fifty one patients who underwent three or more levels of lumbar fusion were divided into two groups according to bone cement-augmented screw fixation involving the upper instrumented vertebra (UIV): 22 patients (cemented group, group I) and 29 patients (non-cemented group, group II). The analysis of radiographic adjacent segment degeneration (ASD) involved patients with lumbosacral fusion showing a similar degree of osteoporosis. Radiologic ASD was defined as more than two UCLA grades of progression at 2 years postoperatively. Other sagittal parameters were analyzed and preoperative MR Pfirrmann grades for adjacent level, probably related to ASD.Even when no significant differences existed in preoperative demographic and radiographic parameters between the two groups, the postoperative kyphotic changes at 3 months were higher in the non-cemented group. In terms of long-term effects, radiologic ASD (20 patients (95.2%) in group I; 15 (53.6%) in group II) was significantly higher in the cemented group. Logistic regression analysis of radiologic ASD including other clinical and radiological parameters, postoperative PI-LL mismatch (OR 5.201, 95% CI 1.123-24.090, p = 0.035) and cement augmentation (OR 20.193, 95% CI 2.195-185.729, p = 0.008) showed a significant correlation with the development of radiologic ASD at postoperative 2 years.Although bone cement-augmented screw implantation can prevent kyphotic deformation at the proximal junction of UIV in early postoperative stages of multi-level lumbar fusion, a discreet selection of patients is required due to possible accelerated degeneration of adjacent segments.

STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to investigate proximal junctional kyphosis (PJK) after lumbosacral long fusion according to preoperative Roussouly and lumbar degenerative kyphosis (LDK) types. SUMMARY OF BACKGROUND DATA Although previous studies have suggested some risk factors for PJK, the effects of preoperative grade of sagittal imbalance and paraspinal muscles degeneration on PJK remain unclear. METHODS Eighty-seven patients who had undergone lumbosacral fusion more than five levels with available clinical and radiological data were enrolled. The presence of PJK defined as sagittal Cobb angle ≥20° between the uppermost instrumented vertebra (UIV) and two supra-adjacent vertebrae at postoperative 2-year radiographs was recorded. Its occurrence was compared according to preoperative Roussouly and LDK types (Takemistu type) and the degree of paraspinal muscle degeneration at the upper level of UIV. Other sagittal radiographic parameters were also measured. RESULTS In this series, 28 patients (group I, 32.2%) showed radiological PJK, whereas 59 patients did not show radiological PJK (non-PJK patients, group II, 67.8%) at postoperative 2 years. PJK presented more prevalence in type III and type IV of LDK types (26/27, 96.3%). However, Roussouly types did not show any significant difference in PJK prevalence. In radiological parameters, a larger preoperative SVA (P = 0.018) and PI-LL (P = 0.015) were associated with PJK. Also, smaller quantity and lower quality of paraspinal muscles at T12-L1 level showed significant (P

Study Design: Retrospective case-control study. Objectives: The aim of this study was to develop a simple and reliable imaging parameter to predict postoperative ambulatory status in patients with metastatic epidural spinal cord compression (MESCC). Methods: Sixty-three patients with MESCC underwent spine surgery because of neurologic deficits were included. On preoperative axial MRI, the cord compression ratio was analyzed for postoperative ambulatory status. The relationship between other imaging features, such as fracture of the affected vertebra and increased T2 signal intensity of the spinal cord at the compression level, and the postoperative ambulatory status were also analyzed. Results: Cord compression ratio and increased T2 signal change of the spinal cord were significantly different between the postoperative ambulatory group and the non-ambulatory group. Receiver operating characteristic analysis showed that the optimal cut-off value was 0.84. In the multivariate regression analysis, only a cord compression ratio of more than 0.84 was significantly associated with postoperative ambulatory status (odds ratio = 10.80; 95% confidence interval = 2.79-41.86; P = .001). Interobserver/intraobserver agreements were strong for the cord compression ratio, however those agreements were weak for increased T2 signal intensity. Conclusions: On preoperative MRI, the cord compression ratio may predict postoperative ambulatory status in patients with MESCC. The measurement of this imaging parameter was simple and reliable. This imaging predictor may be helpful for both clinicians and patients.

Lumbar interbody fusion (LIF) is an effective and popular surgical procedure for the management of various spinal pathologies, especially degenerative diseases. Currently, LIF can be performed with posterior, transforaminal, anterior, and lateral approaches by open surgery or minimally invasive surgery (MIS). Each technique has its own advantages and disadvantages. In general, posterior LIF is a well-established procedure with good fusion rates and low complication rates but is limited by the possibility of iatrogenic injury to the neural structures and paraspinal muscles. Transforaminal LIF is frequently performed using an MIS technique and has an advantage of reducing these iatrogenic injuries. Anterior LIF (ALIF) can restore the disk height and sagittal alignment but has inherent approach-related challenges such as visceral and vascular complications. Lateral LIF and oblique LIF are performed using an MIS technique and have shown postoperative outcomes similar to ALIF; however, these approaches carry a risk of injury to psoas, lumbar plexus, and vascular structures. Herein, we provide a detailed description of the surgical procedures of each LIF technique. We shall then consider the pearls and pitfalls, as well as propose surgical indications and contraindications based on the available evidence in the literatures.

The purpose of this study was to report the characteristics of SIFs after ILSF and discuss its management focusing on pelvic deformation. We retrospectively reviewed all consecutive patients who underwent ILSF for degenerative disc diseases during the period between 2000 and 2017 and were diagnosed as SIF at our institute. The clinical and radiographic data were reviewed on their medical charts. Treatment outcomes for SIF were also investigated. Eight patients (all females) were included in this study. Mean age at SIF diagnosis was 72 years, and the mean follow-up period was 3.8 years (range 1–7 years). SIF developed average 7.5 years (range 1 month−17 years) after the index ILSF. Fracture patterns were unilateral vertical in four, bilateral vertical in three, and horizontal in 1 patient. Unlike patients with unilateral vertical SIF, patients with bilateral vertical or horizontal SIF showed a marked increase of pelvic incidence (PI) by mean 17.0°±5.0° and sagittal vertical axis (SVA) by mean 4.5 ± 2.2 cm, compared to the respective values before the onset of abrupt pain. All patients with unilateral vertical SIF were treated favorably by conservative management, however sacropelvic fixation was inevitable in patients with bilateral vertical or horizontal SIF. Bilateral vertical or horizontal SIF showed marked changes on sagittal radiographic parameters including PI and SVA. Although unilateral vertical SIF has benign courses that responded well to conservative management, bilateral vertical or horizontal SIF is likely to need surgical treatment. Treatment plan should be determined depending on fracture pattern and pelvic deformation.

Purpose: Both column and T-shaped acetabular fractures are frequently presented with difficulty in reduction. Incomplete reduction may cause traumatic arthritis in the hip joint, resulting in inferior clinical outcomes. The purpose of this study is to introduce our wiring technique and to report the clinical and radiological outcomes of such technique. Materials and Methods: Eight patients who underwent our proposed technique for having acetabular fracture with displaced quadrilateral plate between March 2013 and December 2014 were enrolled. All patients were followed-up more than 1 year. The wire passer was set up from an anterolateral aspect of the iliac crest to the greater sciatic notch, between the abductor muscle and the periosteum. The quadrilateral plate of acetabular fracture was reduced with wiring. Internal fixation was added to the pelvic brim. An analysis of the clinical and radiological outcomes was performed. Results: Reduction was performed within the 3 mm intra-articular step-off in all patients. The mean duration of union was 11.8 weeks (9–15 weeks). Five patients (62.5%) showed excellent results, and radiologically, three patients (37.5%) showed good results, and seven patients (87.5%) showed better than good results. Conclusion: The cerclage wiring fixation technique using a large cerclage passer instrument can be a useful and safe reduction method in some cases of acetabular fractures.

Purpose: We evaluated the change of the ulnar variance (UV) as forearm rotation in patients with ulnocarpal impaction syndrome (UIS). Methods: Twenty patients who suffered from ulnar side pain of the wrist and had abnormal lesions at ulno-basal side of the lunate in the radiologic examinations were included in this study. Their UVs in six wrist position (neutral, supination, pronation, neutral and grip, supination and grip, pronation and grip) were measured by the method of perpendiculars. UVs and the maximum change of UV in patients with UIS were compared with those of control group statistically. Results: There were statistically significant differences in UVs of all forearm rotation and grip status. The maximum change of UV was in supination position to pronation and grip status for all cases. The mean maximum change of UV in patients with UIS was 2.03±1.03 mm, and that of control group was 1.86 ±0.86 mm. But there was no significant difference between them. The ulnar shortening osteotomy was performed for thirteen UIS patients, and one patient with osteoarthritis at distal radio-ulnar joint was operated with Darrach procedure. Six patients underwent conservative treatment. Conclusion: There were no significant differences in the maximum change of UV as forearm rotation between UIS patients and control group.