Although a rare entity, intraspinal extradural cyst can cause severe deficit via neural compression. After reviewing available literature, the authors report a rare case of cord compression by intraspinal extradural cystic mass that developed after an osteoporotic vertebral compression fracture. An 80-year-old female patient had undergone vertebroplasty for osteoporotic vertebral compression fracture of T12, subsequent to a minor fall. However, the patient complained about sustained pain and progressive weakness of lower extremities even after the procedure. Follow-up magnetic resonance imaging revealed an intraspinal extradural cystic lesion compressing the spinal cord, and the patient had to undergo a surgical intervention via the posterior approach. Symptoms were relieved postoperatively, with no recurrence during the 1-year follow-up.

Angioleiomyomas are relatively uncommon benign tumors originating from smooth cells of a blood vessel. Although curative by surgical excision, they are rarely diagnosed definitely before surgery. We report on a case of calcified angioleiomyoma occurring on the sole, which was treated by surgical excision without recurrence and a review of literature is presented.
Angiomyoma* ; Blood Vessels ; Foot ; Recurrence

STUDY DESIGN: A case report. OBJECTIVES: To report a case of simultaneous pulmonary and renal embolisms after balloon kyphoplasty and review relevant literature. SUMMARY OF LITERATURE REVIEW: Pulmonary or renal embolism caused by cement leakage during balloon kyphoplasty is a rare complication but can be fatal. MATERIALS AND METHODS: An 84-year-old female patient was treated with balloon kyphoplasty for an osteoporotic compression fracture. Pulmonary and renal embolisms were detected after the procedure and the patient was treated conservatively. RESULTS: After conservative treatment, embolism-related symptoms were not found during the follow-up period. CONCLUSIONS: We encountered a case of simultaneous pulmonary and renal cement embolisms which occurred during kyphoplasty. This is a very rare but potentially serious complication. However, the patient had no long-term sequelae after conservative treatment.
Aged, 80 and over ; Embolism* ; Female ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty* ; Pulmonary Embolism ; Spine

Pregnancy- and lactation associated osteoporosis is a rare condition. However, it may cause fragility fracture with severe pain. A 29-year-old woman had first delivery without any complications and she was breast-feeding her baby. In a postpartum one month, she had a severe back pain and it has gotten worse. She was diagnosed with multiple recent compression fractures in thoracic spines and treated with brace immobilization and bisphosphonate therapy. We report this rare case of pregnancy- and lactation associated osteoporosis with multiple vertebral compression fractures.
Adult ; Back Pain ; Braces ; Female ; Fractures, Compression ; Humans ; Immobilization ; Lactation ; Osteoporosis ; Postpartum Period ; Pregnancy ; Spine

A short femoral stem (type 1 cementless stem) is being increasingly used to perform total hip arthroplasty; however, various types of intra- or postoperative periprosthetic fractures have been reported in recent times. A 66-year-old woman with a history of bilateral total hip arthroplasties using a type 1B femoral stem was admitted 2 months post-operation for a Vancouver type C periprosthetic fracture. She underwent open reduction and internal fixation; however, we observed recurrent non-union and plate breakage at the same site. In this case report, we discuss the factors associated with treatment failure in patients with a Vancouver type C periprosthetic fracture following type 1 femoral stem im-plantation.

Intramedullary osteosclerosis is an uncommon benign condition characterized by endosteal new bone formation in long tubular bone of lower extremity and treatment as well as etiology is unknown. Due to the rarity of this disease, and because there is no specific clinical finding except leg pain, it is difficult to differentiate this entity from other causes presenting similar symptoms. We report on a case of intramedullary osteosclerosis mistaken for radiculopathy from lumbar disease with a review of the literature.
Leg* ; Lower Extremity ; Osteogenesis ; Osteosclerosis* ; Radiculopathy

Purpose: To evaluate the timing of the improvement in surgical skills of the direct anterior approach for hip arthroplasty through an analysis of the clinical features and learning curve in 58 cases. Materials and Methods: From November 2016 to November 2018, 58 patients, who were divided into an early half and late half, and underwent hip arthroplasty by the direct anterior approach, were enrolled in this retrospective study. The operation time and complications (fracture, lateral femoral cutaneous nerve injury, heterotopic ossification, infection, and dislocation) were assessed using a chi-square test, paired t-test, and cumulative sum (CUSUM) test. Results: The mean operation times in total hip arthroplasty (26 cases) and bipolar hemi-arthroplasty were 132.1 minutes and 79.7 minutes, respectively, demonstrating a significant difference between the two groups. CUSUM analysis based on the results revealed breakthrough points of the operation time, decreasing to less than the mean operation time because of the 16th case in total hip arthroplasty and 14th case in bipolar hemiarthroplasty. Complications were encountered in the early phase and late phase: five cases of fractures in the early phase, no case in the late phase; eight and two cases of lateral femoral cutaneous nerve injury, respectively; three and two cases of heterotopic ossification, respectively; and one case of dislocation, one case of infection and three cases of others in the early phase. The CUSUM chart for the fracture rate during operation in the early phase revealed the following: five cases fracture (17.2%) in the early phase and no case in the late phase (0%). This highlights the learning curve and the need for monitoring the inadequacy of operation based on the complications. Conclusion Hip arthroplasty performed by the direct anterior approach based on an anatomical understanding makes it difficult to observe the surgical field and requires a learning curve of at least 30 cases.

STUDY DESIGN: A case report. OBJECTIVES: To report a case of cauda equine syndrome due to a lumbar intradural disc herniation. SUMMARY OF LITERATURE REVIEW: IDH is rare but there is a higher incidence of neurologic deficit in IDH. Therefore, it should be treated immediately. MATERIALS AND METHODS: A 34-year-old male patient was presented with cauda equina syndrome due to a lumbar intradural mass and underwent surgical excision. RESULTS: Operative findings and the histologic study revealed an intradural disc herniation. CONCLUSIONS: IDH is very rare lesion but should be considered in a differential diagnosis if preoperative MRI demonstrates an intradural lesion.
Adult ; Diagnosis, Differential ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Polyradiculopathy

PURPOSE: The purpose of this study is to analyze the affecting factors of adjacent level ossification development (ALOD) after anterior cervical discectomy and fusion. MATERIALS AND METHODS: This study enrolled 75 patients who underwent anterior cervical discectomy and fusion and were followed-up for more than two years. Twenty-five patients were related with trauma and 47 patients were diagnosed as degenerative cervical disorder. We assessed the incidence, location and timing of ALOD, and compared the incidence of ossification between trauma and degenerative disease groups to know the effect of soft tissue damage. We also reviewed the correlation between the development of ossification at adjacent level and the factors, such as fusion level, age, operation time, duration of follow-up, and the presence of ossification of posterior longitudinal ligament (OPLL), as well as ossification of yellow ligament (OYL). RESULTS: Ossification developed in 33 patients (44%). Five cases (15%) were detected during the first year after surgery, 10 (30%) cases detected during the second year after surgery, 13 (40%) between second and third year, and 5 (15%) cases of more than three years after surgery. Only the fusion level was related with the development of ossification statistically (p<0.001). Age, operation time, duration of follow-up, sex ratio, presence of OPLL, and OYL were not related with the incidence of ossification significantly. There was no significant difference in the incidence of ALOD between the trauma group and degenerative disease group (p=0.3625). CONCLUSION: To detect ALOD, it needs a long time for follow-up after surgery. We thought that ALOD is affected by excessive loading at the adjacent level after fusion rather than severity of the soft tissue damage.
Cervical Vertebrae ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Incidence ; Ligaments ; Ossification of Posterior Longitudinal Ligament ; Sex Ratio

Purpose: The clinical outcomes were investigated to determine if arthroscopic management is a useful method for 19 hips with iliopsoas tendon impingement (IPI) after total hip arthroplasty (THA). Materials and Methods: Eighteen patients (19 hips), who complained of groin pain and flexion pain that persisted after THA from September 2013 to December 2019, were the subjects of this investigation. The mean time to manifestation after THA was four months (range, 1–9 months) in patients of an average age of 60 years (range, 50–69 years). Thirteen out of 18 patients underwent THA using the direct anterior approach and five by the lateral approach. IPI was diagnosed by the medical history, physical examination, blood test, radiographic examination using X-ray and computed tomography, and topical injection therapy. All patients underwent arthroscopic treatment and a dynamic arthroscopic physical examination after exposure to the iliopsoas tendon revealed impingement. Tenotomy was then performed on the muscle portion through the total tendon portion. Symptoms and pain levels of preoperative, postoperative and follow-up period were investigated and compared. Results: The Western Ontario and McMaster Universities Osteoarthritis Index score decreased from an average of 58.4 (range, 40–88) before surgery to an average of 35.0 (range, 15–76) after surgery. Similarly, the visual analogue scale decreased from an average of 4.0 (range, 2–6) before surgery to an average of 1.4 (range, 0–4) after surgery. Sixteen patients (88.9%) showed pain relief and improvement in the straight leg raise test, and two patients showed postoperative muscle weakness and sustained pain. In the follow-up period, muscle weakness improved. One patient underwent arthroscopic iliopsoas tenotomy at the lesser trochanteric level but the symptoms persisted.The clinical symptoms were improved after one more tenotomy at the joint level. Conclusion Arthroscopic iliopsoas tenotomy performed in patients with IPI after THA showed good clinical results.