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Lumbar interbody fusion (LIF) is an excellent treatment option for a number of lumbar diseases. LIF can be performed through posterior, transforaminal, anterior, and lateral or oblique approaches. Each technique has its own pearls and pitfalls. Through LIF, segmental stabilization, neural decompression, and deformity correction can be achieved. Minimally invasive surgery has recently gained popularity and each LIF procedure can be performed using minimally invasive techniques to reduce surgery-related complications and improve early postoperative recovery. Despite advances in surgical technology, surgery-related complications after LIF, such as pseudoarthrosis, have not yet been overcome. Although autogenous iliac crest bone graft is the gold standard for spinal fusion, other bone substitutes are available to enhance fusion rate and reduce complications associated with bone harvest. This article reviews the surgical procedures and characteristics of each LIF and the osteobiologics utilized in LIF based on the available evidence.

STUDY DESIGN Retrospective multicenter case series. OBJECTIVE We sought to evaluate the safety and efficacy of anterior cervical plating in anterior cervical debridement and fusion (ACDF) for patients with cervical pyogenic spondylodiscitis (CPS). SUMMARY OF BACKGROUND DATA Due to concerns about bacterial seeding on the foreign material after instrumentations in pyogenic infections, the safety and efficacy of anterior cervical plating for CPS are still undetermined and controversial. Little information is available about the safety and efficacy of anterior cervical plating to manage CPS. METHODS Twenty-three patients who underwent ACDF with (n = 12) or without (n = 11) plating for CPS were included. The mean age was 62.6 years. Medical records were reviewed and radiological parameters including segmental height, segmental angle, C2-C7 angle, and fusion status were analyzed. The mean follow-up period after surgery was 21.3 months. RESULTS After ACDF with plating, segmental height, segmental angle, and C2-C7 angle were significantly improved compared with preoperative conditions and remained well-maintained at the last follow-up. After ACDF without plating, three radiological parameters were also initially improved compared with preoperative condition, but significantly deteriorated to preoperative levels at the time of the last follow-up. The fusion rate was higher in the ACDF with plating group compared with the ACDF without plating group (90.9% vs. 63.6%; P

Objectives To elaborate on the relationship between degeneration grade and autophagy expression in human nucleus pulposus obtained from surgical procedures. Methods For the 16 patients included in the present study, we determined the Pfirrmann classifications of degenerative lesions by MRI. Western blot analysis, LC3, LAMP2, and p62 protein expressions were quantified in different degeneration grades of disc nucleus pulposus. Double immunofluorescence staining was used to show co‐localization of LC3 and LAMP2, and immunohistochemistry to show LC3 and p62 in the nucleus pulposus. Results In the western blot analysis, LC3‐II was highly expressed in grade III and decreased progressively from grade IV to V. In addition, LC3‐II expression in grade III was significantly higher than in grade II, IV, and V (P

Study design Retrospective case analyses. Purpose To investigate the causes, diagnosis, and management of esophageal perforation, depending on the time of diagnosis. Overview of literature To date, few studies have addressed these issues. Methods A total of seven patients were included in this study. The patients were classified into three groups based on esophageal perforation diagnosis time: intraoperative (diagnosed during surgery), perioperative (diagnosed within 30 days postoperatively), and delayed (diagnosed >30 days postoperatively) groups. Results In the intraoperative group (N=2), infectious spondylitis was the main cause of esophageal perforation. Anterior plate and screw removal, followed by posterior instrumentation, was performed. The injured esophagus was managed by omentum flap repair in one patient and primary repair in one patient. In the perioperative group (N=2), revision surgery for infection and metal failure were the main causes of esophageal perforation. In both cases, food residue was drained on the third postoperative day. The injured esophagus was managed conservatively. In the delayed group (N=3), chronic irritation caused by metal failure was the main cause of esophageal perforation. In all patients, there was no associated infection. The anterior instrumentation was removed, and the two patients were treated by primary repair, and one patient was treated using sternocleidomastoid muscle flap. One patient in intraoperative group died of sepsis. Conclusions The main cause of intraoperative esophageal perforation was esophageal adhesions because of infectious spondylitis. However, perioperative and delayed esophageal perforations were caused by chronic irritation because of metal failure. Anterior plate and screw removal was necessary, and posterior instrumentation and fusion may be considered, depending on the fusion status.

BACKGROUND Opioids are recently recommended for those who do not gain adequate pain relief from the use of acetaminophen or nonsteroidal anti-inflammatory drugs. Medical opioids are administered in various routes, and transdermal opioid products that can make up for the weaknesses of the oral or intravenous products have been developed. This study is to evaluate the clinical usefulness of fentanyl matrix in terms of the long-term improvement in pain and physical and mental functions. METHODS This was a multicenter, open, prospective, observational study that was conducted in 54 institutions in Korea. Patients with non-cancerous chronic pain completed questionnaires, and investigators also completed questionnaires. A total of 1,355 subjects participated in this study, and 639 subjects completed the study. Subjects received transdermal fentanyl matrix (12 µg/hr, 25 µg/hr, or 50 µg/hr depending on the patient's response and demand). Subjects visited at 29 ± 7 days, 85 ± 14 days, and 169 ± 14 days after administration, respectively, to receive drug titration and fill out the questionnaires. The results were analyzed using the intention-to-treat (ITT) analysis, full analysis set (FAS), and per-protocol (PP) analysis. The FAS analysis included only 451 participants; the PP analysis, 160 participants; and the ITT analysis, 1,355 participants. RESULTS The intensity of pain measured by the Numeric Rating Scale decreased from 7.07 ± 1.78 to 4.93 ± 2.42. The physical assessment score and mental assessment score of the Short-Form Health Survey 12 improved from 28.94 ± 7.23 to 35.90 ± 10.25 and from 35.80 ± 11.76 to 42.52 ± 10.58, respectively. These differences were significant, and all the other indicators also showed improvement. Adverse events with an incidence of ≥ 1% were nausea, dizziness, vomiting, and pruritus. CONCLUSIONS The long-term administration of fentanyl matrix in patients with non-cancerous pain can reduce the intensity of pain and significantly improves activities of daily living and physical and mental capabilities.

BACKGROUND CONTEXT If lateral mass displacement (LMD) exceeds 6.9 mm, burst fracture of the C1 atlas is considered an unstable fracture due to transverse atlantal ligament (TAL) injury. Recently, unilateral sagittal split fracture (USSF) of C1 lateral mass (LM) was recognized as a rare variant of C1 atlas fracture. Conservatively-treated USSF of C1 LM is reported to cause late deformity of occipitocervical junction requiring major reconstructive surgery. Therefore, it is necessary to verify whether such LMD criteria can be applied to determine TAL injury in USSF of C1 LM. PURPOSE We performed the current study to investigate radiologic criteria to predict the presence of injury of TAL in USSF of C1 LM. STUDY DESIGN/SETTING Retrospective case analyses. PATIENT SAMPLE Twenty-six consecutive cases of USSF of C1 LM were included in this study. The fractures associated with other cervical spines, such as C2 and occiput, were excluded from the study. The mean age was 52 years-old; 16 were male and 10 were female. OUTCOME MEASURES Two radiologists determined presence of TAL injury in MRI using Dickman's classification and divided the cases into two groups: TAL injury and TAL intact. If the results of two judgements were not identical, the third radiologist re-evaluated. The radiologic results were measured and compared between TAL intact and TAL injury. METHODS Three spine surgeons measured radiologic parameters and the averages were used as final results: total LMD of both sides, unilateral LMD of the fracture side, atlanto-dental interval (ADI), and fracture gap. Radiologic parameters were measured and compared between TAL injury and TAL intact. RESULTS Sixteen were TAL injury group (9 type I and 7 type II) and 10 were TAL intact group. Total LMD (5.9 mm vs 1.2 mm, p CONCLUSIONS Compared to the rule of Spence (LMD > 6.9 mm) in C1 burst fracture, total LMD > 5.9 mm (or unilateral LMD > 4.3 mm) are the radiological criteria to predict the presence of TAL injury in USSF of C1 LM, which is considered as an unstable fracture. In addition, if fracture gap more than 7 mm is considered together, the possibility of diagnostic error for TAL injury can be further reduced in USSF of C1 LM. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Purpose The purpose of this study was to report clinical results of open excision of extra-articular ganglion cysts around the knee joint combined with arthroscopic management of intra-articular pathologies if present. Materials and Methods Of the total 107 cases of cystic lesions around the knee, 23 cases of extra-articular ganglion cysts were reviewed between January 2006 and July 2011. There were 13 males and 10 females with a mean age of 48 years (range, 30 to 73 years). The mean follow-up duration was 40 months (range, 30 to 60 months). Preoperative magnetic resonance imaging (MRI) scan was done in all cases. Open surgical excision of the cyst was performed after arthroscopic management of intra-articular pathologies in all but 1 case. At the last follow-up, Lysholm and International Knee Documentation Committee (IKDC) scores were evaluated and MRI was conducted to detect recurrence. Results The mean Lysholm and IKDC scores showed significant improvement (p=0.005 and 0.013, respectively).The location of the cysts was anterior in 9, lateral in 7, medial in 6, and posterosuperior in 1. Intra-articular pathologies were found in 16/23 cases (69.6%). In 10/23 cases (43%), the cyst was connected to the knee joint. Three months postoperative MRI did not show any recurrence of ganglion cysts except for 1 case. Conclusions In the treatment of extra-articular ganglion cysts, MRI can be useful for detecting intra-articular lesions and connecting orifices, and arthroscopic management of intra-articular pathologies with open excision of the cyst should be considered as a viable treatment option.

Background:Intratendinous tears of the rotator cuff are rare, and little has been written about them.Purpose:To investigate the prevalence and clinical and radiological outcomes of arthroscopically confirmed intratendinous tears treated with transtendon suture bridge repair.Study Design:Case series; Level of evidence, 4.Methods:Included in the study were 33 patients (16 male, 17 female; mean age, 53.4 years) with arthroscopically confirmed intratendinous tears treated with transtendon suture bridge repair from March 2006 to July 2012. A history of trauma was found in 10 cases (30.3%). The dominant arm was involved in 26 cases (78.8%). The mean follow-up duration was 56 months. Preoperatively, a thorough physical examination was performed; at final follow-up, shoulder range of motion (ROM) in forward flexion, abduction, external rotation (ER) at the side, and internal rotation (IR) at the back was noted, and clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score; University of California, Los Angeles [UCLA] score; visual analog scale [VAS] for pain; and Simple Shoulder Test [SST]) were recorded and compared with the preoperative data. Postoperative magnetic resonance imaging (MRI) was performed at 6 months to investigate rotator cuff healing status and repair integrity.Results:The prevalence of arthroscopically confirmed intratendinous tears was 4.7% among all arthroscopically treated partial-thickness rotator cuff tears. Impingement signs were positive in most of the patients (positive Hawkins-Kennedy test result in 78.8%, positive Neer sign in 66.7%, and either positive Hawkins-Kennedy test result or Neer sign in 84.8%). At final follow-up, mean ASES, UCLA, VAS, and SST scores improved significantly from a preoperative mean of 51.4, 18.9, 6.0, and 5.4, respectively, to a postoperative mean of 90.6, 32.9, 1.4, and 10.8, respectively ( P < .001). According to the UCLA rating scale, outcomes were excellent in 17, good in 13, and fair in 3 cases. Shoulder ROM in forward flexion, abduction, ER at the side, and IR at the back improved from a preoperative mean of 135°, 129°, 25°, and L2, respectively, to a postoperative mean of 161°, 160°, 29°, and T10, respectively ( P < .001 for all except ER). As per the Sugaya classification, on postoperative MRI, type I healing status was found in 10 (30.3%), type II in 18 (54.5%), and type III in 2 (6.1%) cases. None of the patients showed any evidence of retears.Conclusion:Transtendon suture bridge repair yielded satisfactory clinical and radiological outcomes in patients with intratendinous rotator cuff tears.

Steroid applications are able to repress inflammatory activity in various conditions, including herniation of the nucleus pulposus (HNP), by inhibiting tumour necrosis factor (TNF)-α, but the effects of long-term use are unknown. Here, we investigated the effect of dexamethasone (DEXA) on TNF-α-stimulated intervertebral disc cells by monitoring the expression and localization of NF-κB in the cytoplasm and nucleus. Cultured human intervertebral disc cells were left untreated or treated with only TNF-α, only DEXA, or with TNF-α and DEXA simultaneously. Cytoplasmic and nuclear proteins were extracted and Western blotted after 10 min, 1 or 2 h, to evaluate the expression of p50, p65, p52, and p100 (components of NF-κB). Immunofluorescence analysis was used to determine the subcellular localization of the proteins at 1 h. DEXA had limited effects on NF-κB expression in TNF-α-stimulated disc cells within the first 10 min. At 1 h, DEXA prevented the TNF-α-stimulated translocation of p50, p52, and p65. After 2 h, DEXA reduced the nuclear expression of p50, p65, and p52. Thus, DEXA resulted in delayed expression of NF-κB components and inhibited the translocation of p50, p52, and p65 to the nucleus, which would prevent expression of the corresponding genes. Therefore, following stimulation with TNF-α, transcriptional regulation of NF-κB in disc cells is mainly mediated via the classical pathway, but also to some extent via the alternative pathway. Hence, blockade of sub-acute inflammatory changes in HNP can be achieved by early injection of steroids, whereas long-term injection of a steroid may initiate NF-κB autophosphorylation.

BACKGROUND: The purpose of this study was to determine whether in patients with rotator cuff tears a correlation exists between molecular changes and clinical parameters such as age, duration of symptom, range of motion, and tear size. Molecular changes of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) were assessed by measuring messenger RNA (mRNA) levels of the two proteins.METHODS: The rotator cuff tissue from was obtained from the edge of a torn tendon revealed after debridement by a motorized shaver. Using the sample of rotator cuff tissue, the reverse transcription polymerase chain reaction was performed to quantify MMP-2 and TIMP-2 mRNA expression. To determine whether mRNA levels and the clinical variables, such as age, defect size, range of motion (ROM) of shoulder, and duration of symptoms, show any correlation, Spearman's correlation coefficients were used to test for significant differences.RESULTS: There was an inverse correlation between the mRNA levels of MMP-2 and TIMP-2 from the torn rotator cuff tendons regardless of the clinical variables. However, comparison of mRNA levels versus clinical parameters such as age, defect size, range of motion and duration of symptoms revealed a number of findings. We found a significant correlation between age and mRNA levels of MMP-2 from torn cuffs (r = 0.513, p = 0.021). Further, we found a significant correlation between defect size in the full thickness tears and mRNA levels of MMP-2 (r = 0.454, p = 0.045). Conversely, no significant association between mRNA levels of MMP-2 and ROM or duration of symptom was found.CONCLUSIONS: Our results suggest that both MMP-2 and TIMP-2 may be involved in the disease process of rotator cuff tears. Although the level of mRNA expression of MMP-2 and TMP-2 remain constant in torn rotator cuffs irrespective of the clinical variables, their levels may be influenced by age and defect size, which could account to change in tendon degradation and the healing process.

BACKGROUND CONTEXT A unilateral sagittal split fracture (USSF) of the C1 lateral mass (LM) is a rare variant of C1 atlas fracture. To date, definite treatment guideline of USSF of C1 LM has not been established. The integrity of transverse atlantal ligament (TAL) is a key factor to determine the stability in C1 atlas fracture. However, the effect of TAL injury on treatment outcomes is controversial in USSF of C1 LM. Previous study of small case series reported that despite the TAL competency, conservatively-treated USSF of C1 LM causes late deformity of occipitocervical junction requiring major reconstructive surgery. PURPOSE Therefore, we performed the current study to investigate these two issues in USSF of C1 LM and suggest appropriate treatment guideline. STUDY DESIGN/SETTING Retrospective case analyses. PATIENT SAMPLE Twenty-six consecutive cases of USSF of C1 LM were included from 5 trauma centers of tertiary university hospitals. The fractures associated with other cervical spines, such as C2 and occiput, were excluded from the study. The mean age was 52 years old; 16 were male and 10 were female. OUTCOME MEASURES The radiologic outcomes were evaluated by comparing initial presentation and last follow-up in two groups. Clinical outcomes were evaluated by visual analog scale (VAS) and Odom's criteria. METHODS Of the total cases,16 were TAL injury group (9 type I and 7 type II according to Dickman's classification) and 10 were TAL intact group. All cases were treated by conservative measures including rigid brace or halovest for 12 weeks. The mean follow-up was 16 months (range, 12-47 months). Three spine surgeons measured radiologic parameters on lateral radiograph and open mouth view of cervical spine, 2-dimensional reconstructed CT scans and MRI of initial and last follow-up: total LM displacement (LMD), unilateral LMD of fracture side, atlanto-dental interval (ADI), clivus canal angle (CCA), atlanto-occipital joint axis angle (AOJAA), and basion-dens interval (BDI). The averages of three measurements were used as final results. RESULTS At the last follow-up, for TAL intact group, total LM displacement (LMD), unilateral LMD of fracture side, atlanto-dental interval, basion-dental interval, clivus canal angle, and atlanto-occipital joint axis angle were maintained compared to initial presentation. However, for TAL injury group, all radiological parameters were worsened. The worsening of radiological parameters was more severe in type I injury than type II injury except for total LMD and unilateral LMD. Neck VAS significantly decreased and patient's satisfaction was higher in TAL intact group compared to TAL injury group. CONCLUSIONS Conservative treatment for USSF of C1 LM with TAL injury failed to achieve healing of fracture site, which caused deterioration of lateral displacement of C1 LM. This caused coronal and sagittal malalignment of occipitocervical junction, resulting in unsatisfactory clinical outcomes. Our results suggest that early surgical treatment should be considered as the first choice treatment for USSF of the C1 LM, especially type I TAL injury. However, conservative treatment may be sufficient for USSF of the C1 LM with TAL intact. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

To report the clinical and radiological outcomes of arthroscopic suture bridge repair for the GT fractures of the shoulder joint.From March 2008 to July 2013, we performed arthroscopic suture bridge repair of the GT fractures displaced more than 5 mm superiorly or posteriorly, but less than 2 cm in 40 cases [20 men, 20 women; mean age, 56 (27-80) years] with the average 32 (24-48) months follow-up. At the final follow-up, clinical (ASES, UCLA, SST, KSS score and range of motions) and radiological outcomes using post-operative MRI or CT scan were evaluated. Associated injuries occurred in 21 cases (52.5%): 8 rotator cuff tears; 7 SLAP lesions; 3 glenoid rim fractures; 3 Bankart lesions; 5 biceps tendon tears; 1 partial subscapularis tear; 1 combined subscapularis and biceps tendon tear, and 1 brachial plexus injury.At the final follow-up, the mean VAS score improved from 7 to 1; ASES, to 92; UCLA, to 32; KSS, to 90; and SST, to 10. Mean forward flexion, abduction, external rotation at the side, and internal rotation at the back were improved to 157°, 157°, 37° and T11, respectively. Mean residual superior and posterior displacement of the fracture was 0 (range -5 to 3.3) mm and 0.1 (-5.5 to 3.2) mm, respectively, compared to pre-operative displacement of 4.9 (0-14) mm and 4.5 (0-20) mm, respectively (p 0.001). Complications included anchor protrusion in five cases.Arthroscopic suture bridge repair was useful for the treatment of displaced GT fractures with or without comminution and the management of the combined lesions. At the final follow-up, meaningful remodeling of the GT fracture and satisfactory clinical outcomes could be achieved.

Pseudoaneurysms in the foot are more often reported in the lateral plantar artery than the medial plantar artery, most likely because of its more superficial location. There are no reports of pseudoaneurysm of the medial plantar artery after trauma. We present two cases of pseudoaneurysm of the medial plantar artery after blunt foot trauma and foot laceration. This pseudoaneurysm compressed a posterior tibial nerve, resulting in tarsal tunnel syndrome. The patients were treated successfully using transcatheter embolization without the need for surgical intervention. The tarsal tunnel syndrome also subsided. Here, the authors report these cases and provide a review of literature.

Extensor tendon triggering is a rare disease entity. Even less common is a case of extensor digiti minimi (EDM) double triggering caused by impingement on the extensor retinaculum. Herein, we describe one patient with EDM double triggering developed at the extensor retinaculum and over the metacarpal head caused by its impingement on the extensor retinaculum.

The pedicle screw fixation system has been used for various spinal disorders. Many studies have been conducted on the fixation ability of the pedicle screw, but variable results have been reported based on bone qualities, pedicle screw properties, insertion techniques, and experimental methods.An experimental and biomechanical study.To evaluate the geometric factors of screws affecting fixation ability after assessing pullout strength based on various pedicle screw designs and different bone densities.Nine types of pedicle screws were prepared according to the outer diameter shape (cylindrical or conical), the inner diameter shape (cylindrical or conical), and thread shape (V shape, buttress shape, and square shape). The pedicle screws were inserted into standardized polyurethane foams of Grades 5, 15, and 20. The pullout strength of each pedicle screw was determined using an MTS 858 machine (Material Testing System Corp., Minneapolis, MN, USA), and the results were analyzed statistically.Pullout strength based on the shape of thread was the highest in the V shape and lowest in the square shape for all foam grades (p.05). The outer cylindrical and inner conical shape of pedicle screw showed the highest pullout strength in Grades 5 and 15 foam (p.05). An outer cylindrical and inner conical shape with a V-shaped thread showed the highest pullout strength in all foam grades (p.05).Pedicle screw with an outer cylindrical and inner conical configuration with a V-shaped thread may have maximum pullout strength, regardless of bone density.

Almost all traumatic injuries can be classified using established criteria, but foot trauma can result in various combinations of injuries. Leibner et al. first described concomitant Lisfranc fracture-dislocation and complex dislocation of the metatarsophalangeal (MTP) joint, and coined the term ‘floating metatarsal.’ Since then several variants of floating metatarsal have been reported.2,4–7,9,10 Isolated floating metatarsal involving dislocation alone without fracture of the metatarsal is even more uncommon. We describe a case of an isolated locked floating metatarsal without fracture caused by minor trauma. In this case, the metatarsal head was button-holed and locked. The patient was treated by open reduction without fixation.

We present two patients with open pilon fractures with large bone defects treated successfully with fibular strut allografts. The patients were initially treated by massive irrigation, wound debridement, and temporary external fixation. After complete wound healing, the bone defects were managed. Because autologous iliac crest or fibular bone grafts were impossible to be harvested due to multiple fractures, the bone defects were reconstructed with fibular strut allografts. Fixation was performed with a periarticular distal tibia locking plate. At 2 months postoperatively, the patients ambulated with partial weight-bearing; at 6 months, they had full range of motion of the ankle joint and full weight-bearing.

절에서발생한화농성관절염과결핵성관절염에대한수술 술기와치료결과를보고하고자한다. 증례1 (결핵성관절염). 61세가정주부가약3개월전부터발생한우측흉쇄관절부위의압통과종창을주소로내원하였다. 흉쇄관절의종창으로개인병원에서2차례절제술을시행한후, 조직검사소견에서만성육아성염증인결핵성관절염으로확진되어전원되었다. 내원시흉쇄관절의절개창이개방되어있는소견과함께장액성의분비물이관찰되었다(Fig. 1). 발열등의전신증상은 없었다.이학적검사상발적, 압통과종창소견을보였고있었으며, 견관절운동범위는전방거상140도, 외전130도외회전및내전은각각30도및제2요추수준으로감소되어있었다. 검사소견상적혈구침강속도74mm/hr, C-반응성단백질0.29 mg/dl로관찰되었다. 내원시시행한단순방사선검사상우측흉쇄관절의내측연에피질골의파괴소견이보이고(Fig. 2A)MRI 소견상흉쇄관절의흉골쇄골관절양골단에피질골파괴소견과함께조직액이증가되어있었으며(Fig. 2B), 전후방및상하부위로관절밖으로파급되는양상으로관찰되었다. 조영증강영상에서이병변들은다수의조영되지않는부분을갖는테두리조영증강(rim enhanced lesion with multifocal non-enhanced foci) 병변을보이는농양 (abscess)의소견이여러군데에서관찰되었다 (Fig. 2C). 수술전폐사진소견에서폐결핵소견도같이발견되어호흡기내과에서항결핵제투여요법으로치료하기로하였다.수술소견전신마취하에해변의자자세로환자를위치시킨후우측쇄골과흉쇄관절에걸쳐비스듬하게약5 cm 의절개를가하였다. 피하지방층과근막을절개하여박리한후, 흉골쇄골관절의뼈부위까지깊게절개창을넣어골막과관절부위를노출시켰다. 피하지방층으로부터광범위하게감염된노란색의육아성염증조직이관찰되었다. 흉골의전연을큐렛으로소파술을시행하자흉쇄관절과제1늑골의후연을따라노란색의치즈같은조직파편(debris)이 관찰되어이를절제하였다. 심한골파괴양상이흉골근위부, 제1 늑골과근위부쇄골말단부에서관찰되었다(Fig. 3). 각각의골 조직에서색깔변화와함께괴사되어있는골을론저 (rongeur)를이용하여변연절제술및소파술을시행하였다(Fig. 4). 6개월이상추시상배액관 (sinus tract)이나장액성분비물없이잘봉합되어치유된상처의소견을보여주었다. 항결핵제로 INH (Isoniazid) 300mg. RMP (Rifampin) 600 mg, MBT (Ethambu-tol) 1200 mg, PZ (Pyrazinamide) 1500 mg 을2개월간투약하였으며이후에는INH 300 mg, RMP600 mg, MBT 800 mg 으로1년간 투약하였으며1년4개월이추시상재발소견은관찰되지않고있다. 증례2 (화농성관절염). 43세여자환자가3일전부터발생한좌측흉쇄관절부위의통증및부종그리고견관절운동시악화되는통증을주소로내원하였다. 외상병력은없었고과거력

We reviewed 19 patients over 50 years of age who had rotator cuff tears com-bined with shoulder dislocation between October 2004 and October 2008. There were 7 males and 12females with a mean age 64.7 years (range, 50 to 78 years). The average follow-up duration was 22months (range, 8 to 56 months). We investigated the number of dislocations, the size of the cuff tear, thepresence of Bankart lesions and the time interval from dislocation to surgery. We also investigated theASES score, UCLA score, SST score, and shoulder range of motion before and after surgery. We ana-lyzed clinical outcomes and contributing factors.

Background: There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears. Materials and Methods: 22 patients of arthroscopic single row repair (group I) and 25 patients who underwent double row repair (group II) from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA) rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES). Results: In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method. Conclusions: Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.

Greater tuberosity of the humerus malunion is relatively uncommon, and open techniques are the treatment of choice in most cases. Recent advances in arthroscopic techniques for treatment of greater tuberosity fractures have produced promising results. The use of arthroscopic techniques for the treatment of proximal humerus malunion, however, has been reported only rarely in the literature. This case report describes the malunited greater tuberosity fracture treated arthroscopically using the suture-bridge technique.

Purpose: The aim of this study is to analyze the clinical results of using the technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff. Material and Methods: Form January 2005 to January 2007, we performed the arthroscopic biceps repair with incorporating suture to the rotator cuff for 21 patients with large or massive rotator cuff tear. The mean follow up period was 23 months (range: 6-48months). The number of males and females was 9 and 13, respectively. The age distribution ranged from 47 to 73 years with a mean age of 60.3 years. We compared the preoperative score with the postoperative scores using the University of California Los Angeles (UCLA) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES) and a simple shoulder test (SST). Results: The improvement in the VAS, ASES and the UCLA and SST scores was statistically significant at the final follow up (average follow-up 23 months) (p>0.05). Two of nine cases were found to have partial tear with continuity but seven cases were found to have complete tear according to the ultrasonography and MRI. Conclusion: The technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff is considered to be recommendable.

Os acromiale is the rare shoulder disease and its treatment is controversial. Despite conservative treat-ments for 6 months include medication, exercise, physical therapy and subacromial steroid injections,operative treatment for uncontrolled symptomatic Os acromiale is considered the treatment of choice.Operative treatment includes excision, arthroscopic or open reduction and internal fixation with a bonegraft. Open reduction with tension band wiring and a bone graft is now the preferred treatment.We experienced 8 patients with symptomatic Os acromiale from March, 2001 to March, 2006. The aver-age patient’s age was 45 years and the man and women ratio were 2: 6. All 8 cases of symptomatic Osacromiale of the mesoacromion were treated with open reduction and internal fixation using tension-bandwiring. The preoperative ASES(47.3 ±24.4) and UCLA (16.65.8)scores were improved to 88.87.3 and 31.5±1.9,respectively, at the 2 year follow up. The overall UCLA score showed 1 excellent result and 7 good results. Wethink that symptomatic Os acromiale is a specific disease entity, and open reduction and internal fixation usingtension-band wiring with K-wire is a good treatment modality.

1. To investigate the incidence of closed-type PSIS in the Korean population. 2. To categorize the morphological features of Korean sacrum. 3. To measure the safe marginal length and angle for screw fixation considering the PSIS and course of the external iliac vein, using a Korean sacrum model.We performed our study in 160 sacra including the pelvic ring obtained from 80 Korean cadavers. The bony measurements were obtained by performing 1-mm computed tomography cuts from the L5 lumbar vertebra to the pelvic ring and excluding other structures. We evaluated the incidence of anatomic variation of the PSIS and measured the safe marginal length and angle for screw fixation considering the PSIS and course of the external iliac vein, using a Korean sacrum model.Our study showed that the closed type of PSIS is more frequent in males than in females. The optimal angle for screw fixation is 16.91 ± 6.85 (°), while the left side S1 pedicle insertion angle is 16.00 ± 6.20 (°). The average Korean optimal screw length is 58.35 ± 14.90 (cm) for the right side and 55.89 ± 16.16 (cm) for the left side.With reference to these parameters, the optimal screw length and angle can be chosen and bicortical anteromedial screw fixation can be easily and safely performed.

Chronic proximal interphalangeal joint (PIPJ) instability of the finger is rare, and when it occurs usually requires surgical reconstruction. Complications arising from failed ligament reconstruction may result in a situation more difficult to address than the initial reconstruction. This situation is more likely for the finger than other orthopaedic reconstructions because the phalangeal bones are so small. We present a case of chronic radial PIPJ instability of the finger and severe bony defect caused by multiple failed ligament reconstructions that was treated successfully using a modification of the bone-ligament-bone graft technique.

— Surgical Treatment of Neglected Adult Monteggia Fracture - 2 Cases Report - Hyun-Chul Shon, M.D. � , Weon-Yoo Kim, M.D., Sang-Eun Park, M.D., Young-Yul Kim, M.D., Jong-Seoung Yoon, M.D., Jong-Hun Ji, M.D.* Department of Orthopedic Surgery, Chungbuk National University College of Medicine � ,Daejon St. Mary ’ s Hospital, The Catholic University of Korea College of Medicine, Korea Neglected adult Monteggia fracture could induce the pain, instability and malformation of elbow. Especially, com-pared with the chronic Monteggia fracture of child, that of adult is difficult to treat and could concur with valgusinstability and deformity, limitation of range of motion and tardy ulnar nerve palsy. But recently, the chronic Mon-teggia fracture of adult could be treated by the 3.5 mm compression plate (DCP) or 3.5 mm pelvic reconstructionplate, so that the result improved more and more. The treatment of choice of the chronic Monteggia fracture of adultis the corrective osteotomy and reduction of radial head or resection of radial head. We experienced two patients whohad neglected Monteggia fracture over 1 year 6 months and 25 years respectively and we want to report the result ofsurgical treatment of chronic Monteggia fracture of adult.

We report here an unusual case of medial meniscal hematoma of the knee joint. A review of the literature has revealed only one case that was previously reported. The authors present the successful decompression of the posterior horn of a medial meniscal hematoma through the direct posterior-posterior triangulation arthroscopic visualization method. We present here the case report.

The patellar component of a total knee replacement (TKR) is the most frequent source of non-septic complications after total knee arthroplasty. Fracture of patellar pegs in all polyethylene patellar components is a very rare occurrence. We report such a case of a patellar polyethylene fracture in a 72-year-old female patient 10 years after TKR. Due to patellar malalignment and high level of activity, the patellar components failed in this patient. This was treated arthroscopically by removing the components that failed and leaving the patella unresurfaced. We followed up the patient postoperatively and her symptoms were substantially resolved.

To analyze the clinical and radiologic outcomes of arthroscopic cyst decompression and labral repair in patients with inferior paralabral cysts with chronic shoulder pain.Between March 2006 and September 2012, 16 patients who were identified as having inferior paralabral cysts presented with chronic shoulder pain. All patients underwent a thorough physical examination and preoperative magnetic resonance arthrographic evaluation. The mean age was 30 years (range, 17 to 50 years). The mean follow-up period was 38 months (range, 16 to 60 months). Clinical outcome scores (American Shoulder and Elbow Surgeons; University of California, Los Angeles; and Simple Shoulder Test) and passive shoulder range of motion were evaluated at last follow-up. Follow-up magnetic resonance imaging was performed at a mean of 8 months to determine the labral healing status and assess for cyst recurrence.The incidence of isolated inferior paralabral cysts was 0.6% (16 of 2,656 cases). Of the patients, 8 had multiple cysts and 8 had a single cyst. The mean length and width of the cysts were 1.0 cm and 0.4 cm, respectively. Eight cases had a history of trauma, and 13 patients were involved in sports activities. Seventy-five percent of cases showed a positive relocation test. The mean American Shoulder and Elbow Surgeons; University of California, Los Angeles; and Simple Shoulder Test scores improved from 64, 22, and 8.7, respectively, preoperatively to 83, 31, and 10, respectively (P.001), at final follow-up. Shoulder range of motion did not show any significant improvement. The location of the labral tear was as follows: anteroinferior tear in 5 cases, posteroinferior tear in 8 cases, and combined anteroinferior and posteroinferior tear in 3 cases. All cysts were found to be in association with a labral tear. A mean of 2.7 anchors were used for inferior labral repair. These cysts were found only in male patients. None of the patients showed any evidence of cyst recurrence on follow-up magnetic resonance imaging.Inferior labral tears treated with cyst decompression and labral repair showed satisfactory clinical results without any recurrence. Inferior paralabral cysts should be considered in the differential diagnosis in patients presenting with chronic shoulder pain, particularly active male patients.Level IV, therapeutic case series.

We investigated sequential levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in uncomplicated ACDF (anterior cervical discectomy and fusion) using allograft and DBM (demineralised bone matrix) for primary cervical spondylosis and/or disc herniation. To our knowledge, there has been no study to investigate the diagnostic value of CRP and ESR for postoperative infection in ACDF using allograft and DBM. Blood samples of 85 patients, who underwent one- (n = 51) or two-level (n = 34) ACDF, were obtained and evaluated before surgery and on the first, third, fifth, seventh, 14th, 30th, and 90th postoperative days. No infection was found in any patient for at least one year follow-up period. Mean CRP value increased significantly on the first postoperative day and reached a peak on the third postoperative day. The peak level rapidly decreased but remained elevated on the fifth, seventh, and 14th postoperative days. Mean ESR value increased significantly and reached a peak on the third postoperative day. The peak level gradually decreased but remained elevated on the fifth and seventh postoperative days. One- and two-level ACDF exhibited similar postoperative changes in CRP and ESR values and no significant difference in mean levels of CRP and ESR throughout the follow-up periods. This study demonstrates that uncomplicated ACDF using allograft and DBM showed significant abnormal values of CRP and ESR during the early postoperative period. This result suggests that abnormal values of CRP and ESR in the early postoperative period do not indicate acute postoperative infection after ACDF using allograft and DBM. Straying from the normal course, such as a second rise or a failure to decrease, of CRP and ESR is more important to signpost acute postoperative infection in ACDF using allograft and DBM.

The purpose of this retrospective clinical study was to evaluate the factors that affect recompression of operated vertebrae after percutaneous balloon kyphoplasty (PKP) for osteoporotic vertebral compression fractures (VCFs) and assess their clinical importance. PKP has been used for VCFs with satisfactory results. Several studies about subsequent VCFs adjacent to cemented vertebrae have been reported after PKP. However, the presence and significance of recompression of operated vertebrae have not been adequately described. In total, 80 patients treated with PKP for single thoracolumbar VCFs were reviewed. The follow-up period was at least 1 year. Patients were divided into those without recompression (maintained group, n = 70) and those with recompression (recompressed group, n = 10). Plain roentgenography (preoperative, operative, and last), preoperative BMD, and preoperative MRI were checked. Age, gender, T-score in BMD, duration of symptom, compression rate (CR) of VCF, reduction rate, kyphotic angle (KA), reduction angle, intervertebral cleft (IVC), and non-PMMA-endplate-contact (NPEC) were evaluated. To evaluate the clinical results, we checked the VAS score at each follow-up period. All data were analyzed statistically. The CR for the recompressed group increased significantly after surgery and decreased at the last follow-up (p < 0.05). The last CR was not significantly different from the preoperative CR. The KA showed the same pattern. The preoperative, postoperative, and last VAS scores were significantly different from one another in both groups (p < 0.05). Between the groups, preoperative KA, postoperative KA, last KA, IVC, and NPEC were significantly different (p < 0.05). In particular, last KA, IVC, and NPEC showed highly significant differences (p < 0.001). In a correlation test for the evaluated factors, IVC (r = 0.557) and NPEC (r = 0.496) were the most significant. The presence of IVC and NPEC may play an important role in inducing recompression of treated vertebrae after PKP. Careful observation of patients with these conditions is necessary to prevent deterioration of their clinical course.

Purpose The purpose of this retrospective study was to evaluate the early results of arthroscopic treatment in patients with comminuted, displaced greater tuberosity (GT) fractures using the arthroscopic double-row suture anchor fixation (ADSF) technique. Methods Between August 2004 and December 2007, we used the ADSF technique in 16 cases of isolated comminuted, displaced GT fractures. The early clinical results were evaluated in these patients at a mean of 24 months (range, 16 to 51 months) after surgery. There were 11 male and 5 female patients with a mean age of 56.5 years (range, 27 to 82 years). These 16 cases had at least 5 mm of displacement of the fracture fragments in any plane. For measurement of clinical outcomes, we assessed range of motion and evaluated the visual analog scale score; the University of California, Los Angeles (UCLA) rating scale; and the shoulder index of the American Shoulder and Elbow Surgeons. Results At final follow-up, the visual analog scale score improved from 9.4 (range, 8 to 10 points) to 1.2 (range, 0 to 4 points), the mean UCLA score improved to 31 points (range, 21 to 35 points) postoperatively, and the American Shoulder and Elbow Surgeons score improved to 88.1 points (range, 81.5 to 100 points). According to the UCLA score, there were 3 excellent results, 11 good results, and 2 poor results. Mean forward flexion was 148.7° (range, 120° to 170°), mean abduction was 145° (range, 120° to 170°), mean external rotation in the neutral position was 24° (range, 10° to 40°), and internal rotation improved to the first lumbar vertebral level (from L3 to T7) at last follow-up. Conclusions The early results of the ADSF technique used for displaced, comminuted GT fractures are encouraging, and arthroscopists should attempt to expand the indications for arthroscopic treatment of these fractures. Level of Evidence Level IV, therapeutic case series.

The population of senescent disc cells has been shown to increase in degenerated or herniated discs. However, the mechanism and signaling pathway involved in the senescence of nucleus pulposus (NP) chondrocytes are unknown.To demonstrate the mechanisms involved in the senescence of NP chondrocytes.Senescence-related markers were assessed in the surgically obtained human NP specimens.NP specimens remaining in the central region of the intervertebral disc were obtained from 25 patients (mean: 49 years, range: 20-75 years) undergoing discectomy. Based on the preoperative magnetic resonance images, there were 3 patients with Grade II degeneration, 17 patients with Grade III degeneration, and 5 patients with Grade IV degeneration.We examined cell senescence markers (senescence-associated beta-galactosidase [SA-beta-gal], telomere length, telomerase activity, p53, p21, pRB, and p16) and the hydrogen peroxide (H(2)O(2)) content as a marker for an oxidative stress in the human NP specimens.SA-beta-gal expression, telomere length, telomerase activity, and H(2)O(2) content as well as their relationships with age and degeneration grades were analyzed. For the mechanism involved in the senescence of NP chondrocytes, expressions of p53, p21, pRB, and p16 in these cells were assessed with immunohistochemistry and Western blotting.The percentages of SA-beta-gal-positive NP chondrocytes increased with age (r=.82, p.001), whereas the telomere length and telomerase activity declined (r=-.41, p=.045; r=-.52, p=.008, respectively) However, there was no significant correlation between age and H(2)O(2) contents (p=.18). The NP specimens with Grade III or Grade IV degeneration showed significantly higher percentages of SA-beta-gal-positive NP chondrocytes than those with Grade II degeneration (p=.01 and p=.025, respectively). Immunohistochemistry showed that the senescent NP chondrocytes in all the specimens expressed p53, p21, and pRB, but a few NP chondrocytes in only two specimens expressed p16. Western blotting showed that the expressions of p53, p21, and pRB displayed a corresponding pattern, that is, a strong p53 expression led to strong p21 and pRB expressions and vice versa.Our in vivo study demonstrated that senescent NP chondrocytes increased or accumulated in the NP with increasing age and advancing disc degeneration. The NP chondrocytes in the aging discs exhibited characteristic senescent features such as an increased SA-beta-gal expression, shortened telomeres, and decreased telomerase activity. We further demonstrated that the telomere-based p53-p21-pRB pathway, rather than the stress-based p16-pRB pathway, plays a more important role in the senescence of NP chondrocytes in an in vivo condition. Our results suggest that prevention or reversal of the senescence of NP chondrocytes can be a novel therapeutic target for human disc degeneration.

Purpose: The purpose of this study was to analyze complications after reverse total shoulder arthroplasty and report the clinical outcomes with review of previously reported studies. Materials and Methods: Complications after reverse total shoulder arthroplasty were analyzed for 98 patients who underwent reverse total shoulder arthroplasty and were followed-up for at least 6 months. Of 98 patients, 22 were men and 76 were women. The mean age was 75.0±6.5 years (range, 59-92 years) with a mean follow-up period of 22±19 months (range, 6-74 months). The types and time of occurrence of complications, methods of treatment, and clinical outcomes at the final follow-up were analyzed. Results: Complications occurred in 18 of 98 patients (18.4%). Seven of them received operative treatment and 11 were treated conservatively. Two cases had postoperative dislocations and were addressed with open reduction. In 2 cases, periprosthetic fractures occurred and were treated with open reduction and plate fixation. Two acromial stress fractures and 8 cases of heterotopic ossification were managed conservatively. Infection and humeral component loosening occurred in one case, respectively, and were treated with revision arthroplasty. Glenoid component loosening occurred in 2 cases, one of which was treated with revision arthroplasty and the other was managed conservatively. At the final follow-up, clinical outcomes showed a statistically significant improvement. Compared to groups with no complications, there were no significant differences in final clinical outcomes. Scapular notching occurred in 43.9% (43/98 cases). No statistically significant differences of clinical outcomes were observed between the scapular notching group and the no notching group (p＞0.05). Conclusion: In our study, 18% of complications occurred after reverse total shoulder arthroplasty and final clinical outcomes of these complications showed significant improvement. Scapular notching developed in 44% and did not provide a significant clinical effect at short term follow-up.

Unicompartmental knee arthroplasty (UKA) with extrusion of cement into the posterior compartment of the knee is uncommon. Various problems after a UKA procedure, such as aseptic loosening, polyethylene wear and progressive arthritis have been reported. This study will report on a patient with extrusion of cement fragments into the posteromedial compartment of the knee after a UKA procedure. This complication was treated successfully with the direct posterior–posterior triangulation arthroscopic visualization method. In cementing the prosthesis, it is of paramount importance to take caution to completely remove extruded cement remnants in order to prevent this complication during UKA.

대퇴골 전자간 골절, 특히 불안정성 분쇄 골절은 점차 그 발생 빈도가 증가하고 있으며, 대퇴골 근위부 골절의 약 50% 정도를 차지하고 있다. 전자간 골절은 대퇴 경부 골절보다 발생 빈도가 4배 정도 많고 노령층에서 주로 발생된다. 따 라서 고령 환자의 불안정성 분쇄 골절에 있어서 골 유합술 대신 인공 고관절 반치환술을 일차적으로 사용하는 것에 대한 관심이 늘고 있으며, 여러 연구에서 골 유합술에 비해 조기 체중 부하 가능으로 인한 여러 전신적인 합병증의 발 생을 감소시키고, 골절부 불유합 및 대퇴 골두 무혈성 괴사 등의 위험성을 제거할 수 있는 장점을 가진다. 전자간 골절 시에 인공 고관절 반치환술을 시행하는 경우 EvansFixation of Greater Trochanter Using an AO Trochanteric Reattachment Device (AO TRD) in Arthroplasty for Intertrochanteric Femur Fracture of Elderly Patients

Purpose: In cases of patients who underwent bipolar hemiarthroplasty (BPHA) for treatment of a pertrochanteric fracture, we compared and analyzed the amount of blood loss and complications between a group using the cemented stem and a group using the cementless stem. Materials and Methods: A total of 104 patients who underwent BPHA for treatment of a pertrochanteric fracture in our hospital for three years and 10 months (From January 2008 to October 2011) were included in this study. Among the 104 patients, 64 patients with a cemented stem were categorized into group 1, and the other 40 patients with an uncemented stem were categorized into group 2. Before surgery, the type of stem was determined by the bone quality of the proximal femur, which had been evaluated with a simple X-ray. Then, after surgery, the amount of blood loss and complications were compared between the two groups. Results: Expected blood loss during the operation was 389.8 cc in group 1, and 395.3 cc in group 2(P=0.88). Postoperatively, average drained blood loss was 219.6 cc in group 1, and 338.1 cc in group 2. Cemented stem was associated with significantly less blood loss (P=0.004). The average operation time in group 1 and in group 2 was 96 minutes and 72 minutes. There was no significant difference in operating time (P=0.85). In addition, there was no difference in INR (International Normalized Ratio) and BMI (Body Mass Index) (P=0.28 and 0.08) regarding total amount of postoperatively drained blood loss. There was no occurrence of hypotensive shock or fatal pulmonary embolism in either group. Three cases of periprosthetic fracture occurred in group 2. Conclusion: Fewer occurrences of postoperative blood loss and fewer complications were observed in the cemented stem group than in the cementless stem group. Preoperative evaluation of bone quality and use of the cement stem for patients with poor bone quality may be a good treatment method that can help to reduce complications.

Pyogenic arthritis of lumber spinal facet joints is an extremely rare condition. There are only 40 reported cases worldwide. Most cases were associated with history of paravertebral injection, which was not found in our patient. At the time of hospital admission, he had no abnormal magnetic resonance image findings. Two weeks later, he developed pyogenic facet joint arthritis associated with paravertebral and epidural abscess. This report is the first to describe delayed presentation of pyogenic arthritis associated with paravertebral abscess and epidural infection.

From February, 2007 to September, 50 patients who underwent minimal invasive unicompartmental knee arthroplasty for treating medial compartment osteoarthritis of the knee were enrolled. The conventional Oxford unicompartmental knee arthroplasty with a 1-peg design was performed in 26 patients, and these patients were 5 males and 21 females with a mean age of 65.1 (±6.9). New 2-peg design unicompartmental knee arthroplasty was performed in 24 patients and these patients were 5 males and 19 females with a mean age of 62.5 (±8.8). The clinical results, the range of motion and the radiologic results were compared between the preoperative period and postoperative 1 year.

Purpose: A closed reduction of the posterior arch and percutaneous fixation with S1 and S2 iliosacral (IS) screw was performed on an unstable pelvis fracture with a disruption of the sacroiliac complex. The radiological and clinical results were analyzed according the number of screws and their position. Materials and Methods: Of 31 cases with an unstable pelvis fracture involving the sacral complex, classified as Tile type C (AO/OTA), 16 and 15 cases were treated with one S1 screw fixation and two screws fixation into S1 and S2, respectively, using a percutaneous fixation technique. The patients were followed up for a minimum of 12 months and the radiological and clinical outcomes were analyzed statistically using the Majeed score and SF-36. Results: Five cases of screw displacement occurred in the one screw fixation group. On the other hand, there was no screw displacement in the two screws fixation group after a mean follow-up of 40.2 months. In the case of a narrow safe zone (iliac cortical density, ICD), it is impossible to fix with two S1 screws. However, in these patients, good clinical results were achieved with S1 and S2 were achieved with S1 and S2 screw without complications. Conclusion: The technique of two screws fixation is an efficient and reliable method for reducing and fixing the unstable pelvic ring disruptions. Additional S2 screw fixation is recommended for patients with a narrow ICD.

‐ Abstract ‐ Study Design: This is a retrospective and preliminary study. Objectives: We wanted to evaluate the characteristics of recompression of vertebral bodies without trauma after balloon kyphoplasty (KP) for treating osteoporotic vertebral compression fractures (VCF). Summary of the Literature Review: KP has been used for fracture reduction, maintenance of vertebral height and relief of pain in VCF. Despite of numerous satisfactory results, several factors have been noted to affect the clinical results of KP. Materials and Methods: Six patients with recompression of vertebral bodies without trauma after KP were reviewed. All the patients were female and their mean age was 75.9±4.1 years old. The follow-up period was 17.2±8.5 months. The compression rates of the operated vertebral bodies (CR) and the kyphotic angles (KA) were checked by using plain roentgenograms at the initial, postoperative and last follow-up periods. The preoperative MRIs were also reviewed. The clinical results were checked using the VAS. Results: The CRs at the initial, postoperative and last follow-up periods were 33.7±14.8%, 13.4±7.6% and, 26.9± 9.9%, respectively. The KAs were 19.2±7.2。 , 14.8±6.2。and 20.5±7.4。for each period, respectively. Statistically, the CR and KA at the initial-postoperative period and at the postoperative-last follow-up period showed significant differences (p�0.05). Intervertebral clefts were found in all the cases on MRI. Normal bones superior or inferior to cement were also seen in all the cases after KP. The VAS scores were 8.5±0.5, 2.3±0.5 and 3.0±0.6, retrospectively, and there were significant differences between each periods (p�0.05). Conclusions: Recompression of a vertebral body without trauma after KP for treating VCF was observed in the cases with a intervertebral cleft seen on MRI and normal bones superior or inferior to the cement were observed after KP. The causes of recompression may be subsequent compression or resorption of the remaining vertebral body.

Study design Senescence-related markers were assessed in surgically obtained human nucleus pulposus (NP) specimens. Purpose To demonstrate the mechanism and signaling pathway involved in the senescence of NP chondrocytes. Overview of literature The population of senescent disc cells has been shown to be increased in degenerated or herniated discs. However, the mechanism and signaling pathway involved in the senescence of NP chondrocytes are unknown. Methods We examined cell senescence markers [senescence-associated beta-galactosidase (SA-beta-gal), telomere length, telomerase activity, p53, p21, pRB and p16] and the hydrogen peroxide (H(2)O(2)) content in human NP specimens. Results The percentage of SA-beta-gal-positive NP chondrocytes increased with age, while the telomere length and telomerase activity declined. However, there was no significant correlation between age and H(2)O(2) content. The NP specimens with grade III or IV degeneration showed significantly higher percentages of SA-beta-gal-positive NP chondrocytes than those with grade II degeneration. Immunohistochemistry showed that senescent NP chondrocytes in all specimens expressed p53, p21, and pRB, while a few NP chondrocytes in only two specimens expressed p16. Conclusions The present study demonstrates that, with increasing age and advancing disc degeneration, senescent NP chondrocytes increase or accumulate in the NP. Furthermore, the telomere-based p53, p21, pRB pathway, rather than the stress-based p16, pRB pathway, plays a more important role in the senescence of NP chondrocytes in in vivo conditions. Our results suggest that prevention or reversal of senescence of NP chondrocytes can be a novel mechanism by which to prevent human disc degeneration.

Degenerative disc disease of the lumbar spine caused leg pain with associated calf weakness and atrophy. However, an unusual case of leg pain and calf atrophy due to neural compression is reported. We reported a rare case of a Baker's cyst causing common peroneal nerve and tibial nerve entrapment neuropathy. Initially, after arthroscopic menisectomy and cyst decompression, Baker's cyst was recurred and then open excision was done. Until 1 year after surgery, the cyst was not recurred, increased muscle bulk was noted and EMG showed improved findings. But she continued to complain of lower leg weakness and sole paresthesia owing to delayed diagnosis and cyst decompression.

Purpose: We reviewed the clinical result of two techniques of anterior fixation method for unstable pelvic ring injuries, which are external and internal fixation. Materials and Methods: A retrospective clinical analysis was performed on 33 cases which had been operated from September 1998 to February 2003. Mean follow-up period is 29 months (range, 12-54 months). Previous to anterior fixation percutaneous iliosacral screw fixation was applied on iliosacral joint in Type C injury. After then plate and screw fixation were done in 17 cases and external fixation in 16 cases as an anterior fixation method. The patient’™s functional outcome was evaluated by Postel score and comparison between two groups was performed. Results: In external fixator group the complaints are long duration of application of external fixator, excessive scar formation due to pin tract infection, pain and discomfort (Postel score 9.9; range, 8-11) due to malunion. In internal fixation group all of them showed more than good result and satisfactory to the postoperative condition and clinically (Postel score 11.6; range, 10-12). Conclusion: An open reduction and internal fixation technique is better than external fixation for the treatment of injured anterior pelvic ring in unstable pelvis fracture.