Repair Using Conventional Implant for Ruptured Annulus Fibrosus after Lumbar Discectomy: Surgical Technique and Case Series

Study DesignA retrospective review of annulus fibrosus repair (AR) using a novel technique with a conventional implant.PurposeThe purpose of this study was to present the feasibility and clinico-radiological outcomes of a novel AR technique using a conventional implant to minimize recurrence following a lumbar discectomy (LD).Overview of LiteratureConventional repair techniques to prevent recurrence following LD have several drawbacks. The AR surgical technique has received little attention as an adjunct to LD.MethodsA total of 19 patients who underwent novel AR following LD, and who were available for follow-up for at least three years, were enrolled in this study. Several variables, including the type and size of disc herniation, and the degree of disc degeneration, were evaluated preoperatively. Postoperatively, the presence of clinical and radiological recurrence of disc herniation was evaluated from pain intensity and functional statuses, as well as an enhanced L-spine magnetic resonance imaging at the final follow-up. The presence of a peripheral hollow rim and inserted anchor mobilization were also evaluated during the follow-up.ResultsDuring follow-ups, there were no recurrences of disc herniation or complications, including neurovascular complications. Pain and functional disability improved significantly after surgery, and the improvement was maintained throughout the three-year follow-up period. No mobilization or implant peripheral hollow rim was observed during the follow-up.ConclusionsThis study examined the feasibility of a novel and easily available annulus implant technique following LD. These results suggest performing AR with this technique may be a valuable alternative for optimizing outcomes, if the procedure is performed in proper candidates

Feasibility Study of Free-Hand Technique for Pedicle Screw Insertion at C7 without Fluoroscopy-Guidance

Study DesignRetrospective interventional study.PurposeTo introduce a free-hand pedicle screw (PS) insertion technique without fluoroscopic guidance in the C7 vertebra and evaluate the procedure's feasibility and radiologic outcomes.Overview of LiteratureAlthough PS insertion at C7 has been recognized as a critical procedure in posterior cervical fusion surgery, conventional techniques for C7 PS have several limitations.MethodsThirty two patients (64 screws) who underwent PS insertion in C7 with the novel technique were included in this study. Postoperative clinical and radiological outcomes were evaluated. Special attention was paid to the presence of any problems in the screw position including cortical breaches of the PS and encroachment of the PS into the spinal canal or the vertebral foramen. This novel technique for PS insertion in C7 without fluoroscopy guidance had three key elements. First, the ideal PS entry point was chosen near the C6–7 facet joint using preoperative images. Second, the convergent angle distance was measured at axial computed tomography (CT) imaging, which defined the distance between the tip of C7 spinous process and the extended line passing through the pedicle axis from the ideal entry point. Third, the cranial-caudal angle distance was measured in sagittal CT images, which defined the distance between the tip of the C7 spinous process and the extended line passing through the pedicle axis.ResultsCortical breach on postoperative CT images was observed in three screws. All violated only the lateral wall of the affected pedicle. The breached screws occurred in the initial five cases. Postoperative neurologic deterioration was not observed in any patient, regardless of cortical breaching.ConclusionsThe novel technique successfully allows for C7 PS to be placed and is associated with a low rate of cortical breach

The Influence of Pain Sensitivity on the Symptom Severity in Patients with Lumbar Spinal Stenosis

Background: The symptom severity of back pain/leg pain is not correlated with the severity of degenerative changes and canal stenosis in lumbar stenosis. Considering the individual pain sensitivity might play an important role in pain perception, this discordance between the radiologic findings and clinical symptoms in degenerative lumbar stenosis might originate from the individual difference of pain sensitivity for back pain and/or leg pain.Objective: To determine the relationship among the clinical symptoms, radiologic findings, and the individual pain sensitivity in the patients with degenerative lumbar spinal stenosis.Study Design: Retrospective analysis of prospectively collected data.Setting: A spine center in the department of orthopedic surgery.Methods: In 94 patients who had chronic back pain and/or leg pain caused by degenerative lumbar spinal stenosis, a medical history, a physical examination, and completion of a series of questionnaires, including pain sensitivity questionnaire (PSQ) [total PSQ and PSQ-minor], Oswestry Disability Index (ODI), Visual Analog Pain Scale (VAS) for back pain, and Short Form-36 (SF-36) were recorded on the first visit. Radiologic analysis was performed using the MRI findings. The grading of canal stenosis was based on the method by Schizas, and the degree of disc degeneration was graded from T2-weighted images with the Pfirrmann classification. The correlations among variables were statistically analyzed.Results: Total PSQ and PSQ-minor were not dependent on the grade of canal stenosis after gender adjustment. VAS for leg pain and back pain was highly associated with the total PSQ and the PSQ-minor. Total PSQ and PSQ-minor were also significantly associated with ODI. Among SF-36 scales, the PSQ minor had significant correlations with SF-36 such as bodily pain (BP), Role-emotional (RE), and Mental Component Summary (MCS) after control of confounding variables such as body mass index (BMI), age, and the grade of canal stenosis/disc degeneration. Total PSQ was significantly associated with the SF-36 RP, BP, and RE. Furthermore, after adjustment for gender and pain sensitivity, there was no significant association between the grade of canal stenosis and VAS for back pain/leg pain and ODI, and no correlation was found between the grade of disc degeneration and VAS for back pain/leg pain and ODI, either.Limitations: The multiple lesions of canal stenosis and/or disc degeneration and the grade of facet degeneration were not considered as a variable.Conclusion: The current study suggests that the pain sensitivity could be a determining factor for symptom severity in the degenerative spinal disease.OAIID:oai:osos.snu.ac.kr:snu2013-01/102/0000004226/3SEQ:3PERF_CD:SNU2013-01EVAL_ITEM_CD:102USER_ID:0000004226ADJUST_YN:YEMP_ID:A076317DEPT_CD:801CITE_RATE:10.722FILENAME:E046T_PainPhysician_Kim_The Influence of Pain Sensitivity on the Symptom Severity.pdfDEPT_NM:의학과EMAIL:[email protected]_YN:YCONFIRM:

A Sternum-Disk Distance Method to Identify the Skin Level for Approaching a Surgical Segment without Fluoroscopy Guidance during Anterior Cervical Discectomy And Fusion

Study DesignA retrospective review of prospectively collected data.PurposeTo introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability.Overview of LiteratureAlthough spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has rarely been reported.MethodsIn total, 103 patients who underwent single-level ACDF surgery with the SDD method were enrolled. The primary outcome measure was the accuracy of the SDD method. The secondary outcome measures were the mean SDD value at each cervical level from the cranial margin of the sternum in the neutral and extension positions of the cervical spine and the inter- and intra-observer reliability of the SDD outcome determined using repeated measurements by three orthopedic spine surgeons.ResultsThe SDD accuracy (primary outcome measure) was indicated in 99% of the patients (102/103). The mean SDD values in the neutral-position magnetic resonance imaging (MRI) were 108.8 mm at C3–C4, 85.3 mm at C4–C5, 64.4 mm at C5–C6, 44.3 mm at C6–C7, and 24.1 mm at C7–T1; and those in the extension-position MRI were 112.9 mm at C3–C4, 88.7 mm at C4–C5, 67.3 mm at C5–C6, 46.5 mm at C6–C7, and 24.3 mm at C7–T1. The Cohen kappa coefficient value for intra-observer reliability was 0.88 (excellent reliability), and the Fleiss kappa coefficient value for inter-observer reliability as reported by three surgeons was 0.89 (excellent reliability).ConclusionsBased on the results of the present study, we recommend performing ACDF surgery using the SDD method to determine the skin level for approaching the surgical cervical segment without fluoroscopic guidance

Reduction of atlantoaxial subluxation RESPONSE

OAIID:oai:osos.snu.ac.kr:snu2014-01/102/0000004226/13SEQ:13PERF_CD:SNU2014-01EVAL_ITEM_CD:102USER_ID:0000004226ADJUST_YN:YEMP_ID:A079510DEPT_CD:801CITE_RATE:2.355FILENAME:e054tr_jns-spine-2013_suh_reduction of atlantoaxial subluxation.pdfDEPT_NM:의학과SCOPUS_YN:NCONFIRM:

BT-11 improves stress-induced memory impairments through increment of glucose utilization and total neural cell adhesion molecule levels in rat brains

In Oriental medicine, roots of Polygala tenuifolia Willdenow have been known to be an important herb that exhibits sedative effects in insomnia, palpitation with anxiety, restlessness, and disorientation in humans. We previously reported that BT-11, extracted from those roots, improved scopolamine-induced amnesia in rats and inhibited acetylcholinesterase activities in vitro. Therefore, we proposed that BT-11 could remedy stress-induced memory deficits in rats. In this study, the stress-induced memory impairments in rats were significantly reversed almost to the control level by BT-11 treatment. To seek an active component of BT-11 that plays an important role in antipsychotic effects, we compared BT-11 with 3,4,5-trimethoxycinnamic acid (TMCA), which is a constituent of those root extracts. However, the effects of TMCA were less or were not consistent with those of BT-11 in some of tests. In particular, BT-11 reversed the stress-induced reduction of glucose utilization by [(18)fluorodeoxyglucose]FDG-PET and the levels of neural cell adhesion molecule (NCAM) in rat brains to the control levels, whereas TMCA did not. Therefore, BT-11 improved stress-induced memory impairments through increment of glucose utilization and total NCAM levels in rat brains. In conclusion, BT-11 may be strongly effective against stress-induced amnesia in rats, through the combined effects of TMCA and other active components of BT-11

BT-11 Improves Stress-Induced Memory Impairments Through Increment of Glucose Utilization and Total Neural Cell Adhesion Molecule Levels in Rat Brains

In Oriental medicine, roots of Polygala tenuifolia Willde-now have been known to be an important herb that exhibits sedative effects in insomnia, palpitation with anxiety, restlessness, and disorientation in humans. We previously reported that BT-11, extracted from those roots, improved scopolamine-induced amnesia in rats and inhibited acetylcholinesterase activities in vitro. Therefore, we proposed that BT-11 could remedy stress-induced memory deficits in rats. In this study, the stress-induced memory impairments in rats were significantly reversed almost to the control level by BT-11 treatment. To seek an active component of BT-11 that plays an important role in antipsychotic effects, we compared BT-11 with 3,4,5-trimethoxycinnamic acid (TMCA), which is a constituent of those root extracts. However, the effects of TMCA were less or were not consistent with those of BT-11 in some of tests. In perticular, BT-11 reversed the stress-induced reduction of glucose utilization by [(18)fluorodeoxyglucose] FDG-PET and the levels of neural cell adhesion molecule (NCAM) in rat brains to the control levels, whereas TMCA did not. Therefore, BT-11 improved stress-induced memory impairments through increment of glucose utilization and total NCAM levels in rat brains. In conclusion, BT-11 may be strongly effective against stress-induced amnesia in rats, through the combined effects of TMCA and other active components of BT-11. (C) 2008 Wiley-Liss, Inc.Tsoory M, 2008, NEUROPSYCHOPHARMACOL, V33, P378, DOI 10.1038/sj.npp.1301397Garcia-Bueno B, 2007, NEUROPSYCHOPHARMACOL, V32, P1251, DOI 10.1038/sj.npp.1301252Wilson RS, 2007, PSYCHOSOM MED, V69, P47, DOI 10.1097/01.psy.0000250264.25017.21Wesolowska A, 2006, EUR J PHARMACOL, V553, P185, DOI 10.1016/j.ejphar.2006.09.064Frassetto SS, 2006, CAN J PHYSIOL PHARM, V84, P1239, DOI 10.1139/Y06-082Kleen JK, 2006, BEHAV NEUROSCI, V120, P842, DOI 10.1037/0735-7044.120.4.842Wright RL, 2006, EUR J NEUROSCI, V24, P595, DOI 10.1111/j.1460-9568.2006.04948.xTeipel SJ, 2006, PSYCHOPHARMACOLOGY, V187, P86, DOI 10.1007/s00213-006-0408-1Fueger BJ, 2006, J NUCL MED, V47, P999Freo U, 2005, AM J PSYCHIAT, V162, P2061Pereira P, 2005, PHARMACOL RES, V52, P199, DOI 10.1016/j.phrs.2005.03.003Sandi C, 2005, BIOL PSYCHIAT, V57, P856, DOI 10.1016/j.biopsych.2004.12.034Sandi C, 2004, NAT REV NEUROSCI, V5, P917, DOI 10.1038/nrn1555Jia HX, 2004, NEUROSCI LETT, V367, P123, DOI 10.1016/j.neulet.2004.05.093Kawashima K, 2004, BIOL PHARM BULL, V27, P1317, DOI 10.1248/bpb.27.1317Ikeya Y, 2004, BIOL PHARM BULL, V27, P1081, DOI 10.1248/bpb.27.1081Dong H, 2004, NEUROSCIENCE, V127, P601, DOI 10.1016/j.neuroscience.2004.05.040Shah ZA, 2003, EUR NEUROPSYCHOPHARM, V13, P321, DOI 10.1016/S0924-977X(03)00005-1Koo JW, 2003, FASEB J, V17, P1556, DOI 10.1096/fj.02-1032fjeMizoguchi K, 2003, PHARMACOL BIOCHEM BE, V75, P419, DOI 10.1016/S0091-3057(03)00131-XRoozendaal B, 2002, NEUROBIOL LEARN MEM, V78, P578, DOI 10.1006/nlme.2002.4080Park CH, 2002, J NEUROSCI RES, V70, P484, DOI 10.1002/jnr.10429Chung IW, 2002, PHARMACOL BIOCHEM BE, V71, P191Kiss JZ, 2001, BRAIN RES REV, V36, P175Kornblum HI, 2000, NAT BIOTECHNOL, V18, P655Park CH, 2000, J NEUROCHEM, V74, P244Newcomer JW, 1999, ARCH GEN PSYCHIAT, V56, P527Newcomer JW, 1998, PSYCHONEUROENDOCRINO, V23, P65Muller RA, 1998, J CHILD NEUROL, V13, P16Schachner M, 1997, CURR OPIN CELL BIOL, V9, P627Bergsneider M, 1997, J NEUROSURG, V86, P241Cremer H, 1997, MOL CELL NEUROSCI, V8, P323Iglesias S, 1996, STROKE, V27, P1192MAHER F, 1995, J NEUROSCI RES, V42, P459BRUEHL C, 1995, ANN NEUROL, V38, P414HATZINGER M, 1995, NEUROBIOL AGING, V16, P205MAZURE CM, 1995, PROGR PSYCHIAT, P270CHUGANI HT, 1994, ANN NEUROL, V36, P794HUANG KC, 1993, PHARM CHINESE HERBSCHUGANI HT, 1991, J CEREBR BLOOD F MET, V11, P35SARTER M, 1988, PSYCHOPHARMACOLOGY, V94, P491REUS VI, 1984, DRUG DEVELOP RES, V4, P489COHEN RM, 1982, ARCH GEN PSYCHIAT, V39, P593GREER CA, 1981, BRAIN RES, V217, P279SCHWARTZ WJ, 1979, SCIENCE, V205, P7231

Clinical Efficacy of Hypofractionated Proton Beam Therapy for Intrahepatic Cholangiocarcinoma

Forty-seven patients with intrahepatic cholangiocarcinoma (IHCC) who received proton beam therapy (PBT) were analyzed to evaluate the clinical efficacy and safety of hypofractionated PBT in patients with inoperable or recurrent IHCC. The median prescribed dose of PBT was 63.3 GyE (range: 45–80 GyE) in 10 fractions, and the median duration of follow-up in all the patients was 18.3 months (range: 2.4–89.9 months). Disease progression occurred in 35 of the 47 (74.5%) patients; local, intrahepatic, and extrahepatic progression occurred in 5 (10.6%), 20 (42.6%), and 29 (61.7%) patients, respectively. The 2-year freedom from local progression (FFLP), progression-free survival (PFS), overall survival (OS) rates, and median time of OS were 86.9% (95% confidence interval [CI], 74.4–99.4%), 16.8% (95% CI, 4.3–29.3%), 42.7% (95% CI, 28.0–57.4%), and 21.9 months (95% CI, 16.2–28.3 months), respectively; grade ≥ 3 adverse events were observed in four (8.5%) patients. In selected patients with localized disease (no viable tumors outside of the PBT sites), the median time of OS was 33.8 months (95% CI, 5.4–62.3). These findings suggest that hypofractionated PBT is safe and could offer a high rate of FFLP and promising OS in patients with inoperable or recurrent IHCC

Sex differences in in-hospital management in patients with sepsis and septic shock: a prospective multicenter observational study

Abstract Sex differences in the in-hospital management of sepsis exist. Previous studies either included patients with sepsis that was defined using previous definitions of sepsis or evaluated the 3-h bundle therapy. Therefore, this study sought to assess sex differences in 1-h bundle therapy and in-hospital management among patients with sepsis and septic shock, defined according to the Sepsis-3 definitions. This observational study used data from Korean Shock Society (KoSS) registry, a prospective multicenter sepsis registry. Adult patients with sepsis between June 2018 and December 2021 were included in this study. The primary outcome was adherence to 1-h bundle therapy. Propensity score matching (PSM) and multivariable logistic regression analyses were performed. Among 3264 patients with sepsis, 3129 were analyzed. PSM yielded 2380 matched patients (1190 men and 1190 women). After PSM, 1-h bundle therapy was performed less frequently in women than in men (13.0% vs. 19.2%; p < 0.001). Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently in women than in men (25.4% vs. 31.6%, p < 0.001), whereas adequate fluid resuscitation was performed more frequently in women than in men (96.8% vs. 95.0%, p = 0.029). In multivariable logistic regression analysis, 1-h bundle therapy was performed less frequently in women than in men [adjusted odds ratio (aOR) 1.559; 95% confidence interval (CI) 1.245–1.951; p < 0.001] after adjustment. Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently to women than men (aOR 1.339, 95% CI 1.118–1.605; p = 0.002), whereas adequate fluid resuscitation was performed more frequently for women than for men (aOR 0.629, 95% CI 0.413–0.959; p = 0.031). Invasive arterial blood pressure monitoring was performed less frequently in women than in men. Resuscitation fluid, vasopressor, steroid, central-line insertion, ICU admission, length of stay in the emergency department, mechanical ventilator use, and renal replacement therapy use were comparable for both the sexes. Among patients with sepsis and septic shock, 1-h bundle therapy was performed less frequently in women than in men. Continuous efforts are required to increase adherence to the 1-h bundle therapy and to decrease sex differences in the in-hospital management of patients with sepsis and septic shock