Search

Objective : ABM/P-15 (anorganic bone matrix/15-amino acid peptide fragment) is a commercially available synthetically manufactured P-15 collagen peptide fragment, that is adsorbed on ABM. This study was done to investigate the efficacy of ABM/ P-15 in achieving fusion in the lumbar spine and comparing it with that of recombinant bone morphogenic protein-2 (rhBMP-2) and demineralized bone matrix (DBM).Methods : A retrospective observational study of prospectively collected data of 140 patients who underwent lumbar spinal fusion surgeries in a single specialty spine hospital between 2016 and 2020, with a minimum 6-month follow-up was conducted. Based on the material used for the augmentation of the bone graft at the fusion site, the patients were divided into three categories namely ABM/P-15, rhBMP-2, and DBM group.Results : ABM/P-15, rhBMP-2, and DBM were used in 46, 44, and 50 patients, respectively. Patient characteristics like age, gender, bone mineral density, smoking history, and presence of diabetes mellitus were comparable amongst the three groups. Average follow-up was 16.0±5.2, 17.9±9.8, and 26.2±14.9 months, respectively in ABM/P-15, rhBMP-2, and DBM groups. The fusion was achieved in 97.9%, 93.2%, and 98% patients while the average time-to-union was 4.05±2.01, 10±4.28, and 9.44±3.49 months (pp=0.900) for ABM/P-15, rhBMP-2 and DBM groups, respectively, which reduced to 1.02±0.80, 1.21±0.96, and 0.54±0.70 (p=0.112), respectively at the last follow up. Pre-operative Oswestry disability index scores were 52.7±18.02, 55.4±16.8, and 53.56±19.6 (p=0.751) in ABM/P-15, rhBMP-2, and DBM groups, which post-operatively reduced to 33.77±15.52, 39.42±16.47, and 38.3±15.89 (p=0.412) and further to 15.74±8.3, 17.41±10.45, and 16.76±9.81 (p=0.603), respectively at the last follow-up.Conclusion : ABM/P-15 appears to achieve union significantly earlier than rhBMP-2 and DBM in lumbar spinal fusion cases while maintaining a comparable clinical and complication profile.

Author(s): Bae, Junseok; Sathe, Ashwin; Lee, Shih-Min; Theologis, Alexander A; Deviren, Vedat; Lee, Sang-Ho | Abstract: ObjectiveThe purpose of this study was to investigate the changes in spinopelvic parameters before and after the setting of muscle fatigue along with its correlation with pre-existing paraspinal and psoas muscle mass.MethodsSingle-center retrospective review of prospectively collected data was conducted on 145-adults with symptomatic loss of lumbar lordosis (LL). Radiographs were taken before and after walking for 10 minutes. Magnetic resonance imaging was used to calculate paraspinal muscle (PSM) cross-sectional area (CSA), mean signal intensity, fatty infiltration (FI), and lean muscle mass at thoracolumbar junction (T12) and lower lumbar level (L4). Psoas CSA was calculated at L3. Patients were divided into 2 groups namely compensated sagittal deformity (CSD) (SVA ≤ 4 cm, PT g 20°) and decompensated sagittal deformity (DSD) (SVA g 4 cm, PT g 20°) based on prewalk measurements.ResultsInitial mean SVA was 1.8 cm and 11 cm for CSD and DSD respectively (p l 0.01). After walking, significant deteriorations in SVA, PT-LL (p l 0.01) were observed in CSD without significant change in thoracic kyphosis (TK). All sagittal parameters in DSD deteriorated significantly. DSD group had significantly poorer PSM quality at T12 and L4 compared to CSD group. In CSD group, sagittal decompensation correlated with muscle quality, i.e. , decreases in LL (ΔLL) correlated with CSA of PSM/vertebral body (VB) at L4 (r = -0.412, p = 0.046) while increases in TK (ΔTK) correlated with CSA of PSM/VB at T12 (r = 0.477, p = 0.018). ΔSVA and ΔPT correlated with FI at L4 (r = 0.577, p = 0.003 and r = -0.407, p = 0.048, respectively). DSD group, had weak correlations (-0.3 l r l -0.1) between changes in sagittal and PSM parameters.ConclusionPSM quality in adults with spinal deformity correlates with patients' ability to maintain an upright posture and sagittal decompensation after walking for 10 minutes.

Laser spine surgery has made numerous advances over the past few decades. This has helped many patients to be free from pain. Through laser surgery in spinal disease treatment, surgeries have been carried out with advantages at lumbar radiculopathy, lumbar discogenic back pain, recurrent herniation of lumbar disc, cervical foraminotomy, removal of ossification of the posterior longitudinal ligament (OPLL), and lumbar discal cyst. This has advantages such as reduction of intraoperative bleeding, reduction of edema after surgery, clean incision window, and reduction of postoperative inflammation.

Kummell disease was first described by Hermann Kummell in 1891 as affecting the elderly population with delayed posttraumatic spinal collapse. It presents several challenges to spine surgeons, and treatment options are still controversial. Treatment methods range from conservative treatment to extensive vertebral body resection and fixation. Various surgical treatments have been described, and the choice of surgery depends on the severity of the disease, the experience of the surgeon, and the patient’s preference. In this chapter, we describe spinal stabilization and percutaneous intrabody cage insertion for the treatment of patients with Kummell disease.

CSF leakage after incidental durotomy usually occurs after thoracic ossification of posterior longitudinal ligament (OPLL) surgery. This complication is always associated with low intracranial pressure symptoms, high risk of perioperative infection, prolonged hospital stay, and pseudomeningocele in these situations will be a more problematic complication. It is a multifactor-related complication, and pathological factors play a decisive role. The importance of CSF leakage is in its impact on the increased risk of other complications during the postoperative period. Methods to prevent these complications are in need. In this chapter, we describe our experience of managing CSF leakage after thoracic OPLL removal.

Introduction: Transforaminal percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive spinal procedure for soft disc herniation of the lumbar spine. It is considered relatively safe and is commonly used. However, hemorrhagic complications can occur. Herein, we report two cases of severe retroperitoneal bleeding after transforaminal PELD. Case reports: Two patients underwent PELD at the L4-5 level, and the preoperative symptoms improved. However, a few hours after the surgery, the patients complained of severe abdominal pain. Radiologic evaluation showed a large retroperitoneal hematoma compressing the abdominal organs. Results: The patients did not undergo an open hematoma evacuation but received intensive care. After 9–14 days of intensive care, they recovered and were discharged. Conclusion: Retroperitoneal hematoma may occur after PELD due to segmental artery perforation. The spinal needle should be manipulated carefully. Even for large hematomas, conservative treatment is possible in select patients. Keywords: Retroperitoneal hematoma, PELD, Percutaneous endoscopic lumbar discectomy, Complication

Objective Chronic low back pain (CLBP) often causes disabling pain that impairs a patient's quality of life. Surgical treatment is recommended for patients who do not respond to conservative treatments lasting more than 6 months. The purpose of this study is to present results after the use of an interlaminar dynamic spacer for CLBP. Methods We enrolled consecutive patients with CLBP irresponsive to more than 6 months of conservative treatment into the present study. Included patients underwent an interlaminar dynamic spacer insertion without direct decompression. We assessed radiographic parameters and health-related quality of life (HRQoL) data included visual analog scale back/leg pain and Oswestry Disability Index scores. Substantial clinical benefit achievement was assessed. Results Thirty-five patients (average age, 47.8 years; 21 female) were included. The mean preoperative symptom duration was 29.6 months. Surgeries involved 1-level (n = 18) and 2-levels (n = 17) procedures. Operative levels included L4-5 (n = 8), L5-S1 (n = 10), L3-4-5 (n-2), and L4-5-S1 (n = 15). The average follow-up period was 16.6 months. After the procedure, all radiographic parameters (including disc height, segmental extension angle, and foraminal area) improved significantly. All preoperative HRQoL parameters improved significantly at the final follow-up. Substantial clinical benefit achievement was observed in 75.8% of the cases on the Oswestry Disability Index, and in 72.7% and 84.8% of the cases on the visual analog scale back and leg pain, respectively. Conclusions An interlaminar dynamic spacer significantly improves HRQoL scores in patients with CLBP who do not respond to conservative treatment. Although encouraging, these results should be confirmed with studies assessing a larger cohort and a longer follow-up.

Previous studies of women with dysmenorrhea have focused on menstrual attitudes, the characteristics of menstrual pain, and self-care behavior. Traditional Chinese Medicine (TCM) studies on dysmenorrhea, on the other hand, have focused on the efficacy and safety of TCM treatments. Few studies have investigated how women perceive their own TCM-treatment experience of dysmenorrhea.The objective of this study was to explore the experience of dysmenorrhea and life adjustments of women undergoing TCM treatment.A semi-structured interviewing guide was used to collect data. A total of 40 dysmenorrheal women participated in the study. Individual, in-depth interviews were conducted for about 60-90 minutes with each participant. Their speech tone, facial expressions, and gestures during the interview process were also observed and recorded. The findings were analyzed using content analysis via ATLAS. ti 5.2 software.The process that the participants used to adjust to dysmenorrhea were distinguished into four progressive stages: "tip of the iceberg", "ice-breaking", "tug-of-war", and "blending-in". Initially, the participants perceived the symptoms of dysmenorrhea as the "tip of the iceberg". They attempted to hide / ignore the initial pain until the problem gradually worsened to the point that the symptoms began to significantly affect various aspects of life. It was only then that the participants began to pay attention to the problem and to seek help from TCM practitioners, which we defined as the "ice-breaking" stage. If they encountered unexpected situations with regard to the treatment regimen, the participants entered the "tug-of-war" stage, during which they struggled over whether to continue with TCM treatments. Afterward, the participants gradually achieved a "blending-in" of new ideas, which allowed them to identify the strategies that best facilitated adjustment and rebalancing. Eventually, the participants achieved a new life balance.The outcomes of the present study may be referenced for nurse-patient communications that relate to dysmenorrhea and TCM treatment.探索接受中醫治療痛經婦女經期不適的生活經驗.過去研究著重於婦女痛經的態度、痛經的特性和自我照顧行為，或探討傳統中醫治療痛經的療效及安全性，對於連結婦女自身的痛經經驗與傳統中醫治療的研究相對較少。.探索接受中醫治療痛經婦女的經期不適之生活經驗。.本研究以半結構的訪談指引，採一對一深入訪談的方式蒐集資料。參與研究者每人接受一次訪談，費時約60–90分鐘。研究者於訪談過程同時觀察婦女的語氣、表情與行為舉止並予記錄，共有40位因痛經接受中醫治療的婦女參與研究。使用內容分析法分析所得的文本資料，並以ATLAS. ti 5.2版軟體輔助進行。.本研究個案經歷痛經並接受中醫治療的過程及相關生活經驗資料，分為四個主題來探索，即「冰山一角」、「破冰之舉」、「心力拔河」和「最終融合」。起先，她們痛經的症狀常被視為像冰山一角的小問題，直到問題逐漸惡化影響到生活才進入破冰階段，想要去改變它，故而尋求傳統中醫的協助。當婦女無法依中醫師提供的治療方式或改變生活習慣的建議時，則會陷入心力拔河，不知是否繼續中醫治療。至最後逐漸接受中西醫作法的交融，致使她們能夠找出最適合自己減除痛經的策略，達到最終的適應與平衡。.本研究結果可提供護理人員作為與病患在進行溝通其痛經及中醫治療時的參考。.

We report 13 consecutive cases of complex intracranial aneurysms treated by the waffle-cone technique and the midterm angiographic results and discuss the effectiveness and safety of this technique. We performed a retrospective review to evaluating the angiographic results and clinical effectiveness of 15 cases in which waffle-cone stenting for treating broad-necked complex intracranial aneurysms at our institution up to July 2008. Among these 15 patients, we enrolled 13 patients who had undergone at least one follow-up angiography. We collected patient data including age, sex, ruptured state, aneurysm size, neck size, complications, initial Hunt and Hess (HH) grade, modified Rankin Score (mRS) at the last angiographic follow-up, and initial and follow- up angiographic results. The mean size of the aneurysm was 10.6 mm (range, 4.0 to 20.4 mm) and the mean size of the aneurysm neck was 5.7 mm (range, 2.7 to 9.2 mm). The mean angiographic follow-up time was 13.6 months (range, six to 30 months). There were no procedure-related complications. However, there were two delayed complications. One complication was delayed focal embolic infarct and the other complication was delayed rebleeding. Angiographic improvement was achieved in two cases (15.4%), stable occlusion was achieved in seven cases (53.8%), and recanalization or compaction that needed retreatment occurred in four cases (30.8%). We think that the waffle-cone technique is an effective alternative in selected aneurysms unable to be “Y” stented or surgically clipped.