Melorheostosis is a rare type of sclerosing bone dysplasia with an incidence of approximately 0.9 per million individuals. This disease predominantly affects the appendicular skeleton, with rare involvement of the axial skeleton. Patients with spinal melorheostosis may present with symptoms such as scoliosis, stiffness, back pain, progressive myelopathy, radiculopathy, and vertebrobasilar insufficiency. Surgical management for spinal melorheostosis has been reported, but it remains exceedingly rare. Here, we present the case of a 67-year-old woman with incidental findings on thoracic vertebral imaging from a preoperative chest computed tomography scan performed for shoulder surgery. The patient had experienced gait disturbances and mild, motion-related back pain for approximately 2 to 3 years, along with a recent symptom of mild tingling sensations in both feet. A diagnosis of spinal melorheostosis was considered based on the characteristic imaging findings. In this case, rather than prioritizing the severity of the current symptoms, we focused on the location and extent of osteosclerotic lesions, which are directly associated with the potential development of neurological complications. Therefore, we opted for surgical treatment involving decompression and screw fixation. The patient’s symptoms were relieved without significant surgical complications over a 1-year follow-up period.

Melorheostosis is a rare type of sclerosing bone dysplasia with an incidence of approximately 0.9 per million individuals. This disease predominantly affects the appendicular skeleton, with rare involvement of the axial skeleton. Patients with spinal melorheostosis may present with symptoms such as scoliosis, stiffness, back pain, progressive myelopathy, radiculopathy, and vertebrobasilar insufficiency. Surgical management for spinal melorheostosis has been reported, but it remains exceedingly rare. Here, we present the case of a 67-year-old woman with incidental findings on thoracic vertebral imaging from a preoperative chest computed tomography scan performed for shoulder surgery. The patient had experienced gait disturbances and mild, motion-related back pain for approximately 2 to 3 years, along with a recent symptom of mild tingling sensations in both feet. A diagnosis of spinal melorheostosis was considered based on the characteristic imaging findings. In this case, rather than prioritizing the severity of the current symptoms, we focused on the location and extent of osteosclerotic lesions, which are directly associated with the potential development of neurological complications. Therefore, we opted for surgical treatment involving decompression and screw fixation. The patient’s symptoms were relieved without significant surgical complications over a 1-year follow-up period.

Melorheostosis is a rare type of sclerosing bone dysplasia with an incidence of approximately 0.9 per million individuals. This disease predominantly affects the appendicular skeleton, with rare involvement of the axial skeleton. Patients with spinal melorheostosis may present with symptoms such as scoliosis, stiffness, back pain, progressive myelopathy, radiculopathy, and vertebrobasilar insufficiency. Surgical management for spinal melorheostosis has been reported, but it remains exceedingly rare. Here, we present the case of a 67-year-old woman with incidental findings on thoracic vertebral imaging from a preoperative chest computed tomography scan performed for shoulder surgery. The patient had experienced gait disturbances and mild, motion-related back pain for approximately 2 to 3 years, along with a recent symptom of mild tingling sensations in both feet. A diagnosis of spinal melorheostosis was considered based on the characteristic imaging findings. In this case, rather than prioritizing the severity of the current symptoms, we focused on the location and extent of osteosclerotic lesions, which are directly associated with the potential development of neurological complications. Therefore, we opted for surgical treatment involving decompression and screw fixation. The patient’s symptoms were relieved without significant surgical complications over a 1-year follow-up period.

Objective: : To investigate the clinical efficacy and safety of the controlled distraction-compression technique using an expandable titanium cage (ETC) in posttraumatic kyphosis (PTK). Methods: : We retrospectively studied and collected data on 20 patients with PTK. From January 2014 to December 2017, the controlled distraction-compression technique using ETC was consecutively performed in 20 patients with PTK of the thoracolumbar zone (range, 36–82 years). Among them, nine were males and 11 were females and the mean age was 61.5 years. The patients were followed regularly at 1, 3, 6, and 12 months, and the last follow-up was more than 2 years after surgery. Results: : The mean follow-up period was 27.3±7.3 months (range, 14–48). The average operation time was 286.8±33.1 minutes (range, 225–365). The preoperative regional kyphotic angle (RKA) ranged from 35.6° to 70.6° with an average of 47.5°±8.1°. The immediate postoperative mean RKA was 5.9°±3.8° (86.2% correction rate, p=0.000), and at the last follow-up more than 2 years later, the mean RKA was 9.2°±4.9° (80.2% correction rate, p=0.000). The preoperative mean thoracolumbar kyphosis was 49.1°±9.2° and was corrected to an average of 8.8°±5.3° immediately after surgery (p=0.000). At the last follow-up, a correction of 11.9°±6.3° was obtained (p=0.000). The preoperative mean back visual analog scale (VAS) score was 7.9±0.8 and at the last follow-up, the VAS score was improved to a mean of 2.3±1.0 with a 70.9% correction rate (p=0.000). The preoperative mean Oswestry disability index (ODI) score was 32.3±6.9 (64.6%) and the last follow-up ODI score was improved to a mean of 6.85±2.9 (3.7%) with a 78.8% correction rate (p=0.000). The overall complication was 15%, with two of distal junctional fractures and one of proximal junctional kyphosis and screw loosening. However, there were no complications directly related to the operation. Conclusion : PVCR through the controlled distraction-compression technique using ETC showed safe and good results in terms of complications, and clinical and radiologic outcomes in PTK. However, to further evaluate the efficacy of this surgical procedure, more patients need long-term follow-up and there is a need to apply it to other diseases.

Melorheostosis is a rare type of sclerosing bone dysplasia with an incidence of approximately 0.9 per million individuals. This disease predominantly affects the appendicular skeleton, with rare involvement of the axial skeleton. Patients with spinal melorheostosis may present with symptoms such as scoliosis, stiffness, back pain, progressive myelopathy, radiculopathy, and vertebrobasilar insufficiency. Surgical management for spinal melorheostosis has been reported, but it remains exceedingly rare. Here, we present the case of a 67-year-old woman with incidental findings on thoracic vertebral imaging from a preoperative chest computed tomography scan performed for shoulder surgery. The patient had experienced gait disturbances and mild, motion-related back pain for approximately 2 to 3 years, along with a recent symptom of mild tingling sensations in both feet. A diagnosis of spinal melorheostosis was considered based on the characteristic imaging findings. In this case, rather than prioritizing the severity of the current symptoms, we focused on the location and extent of osteosclerotic lesions, which are directly associated with the potential development of neurological complications. Therefore, we opted for surgical treatment involving decompression and screw fixation. The patient’s symptoms were relieved without significant surgical complications over a 1-year follow-up period.

A 73-year-old man presented with progressive gait impairment. He exhibited slow, shuffling, and unstable gait. A formal neuropsychological evaluation revealed memory deficits with frontal dysfunction. Brain MRI revealed communicating hydrocephalus with an Evans' index of 0.27. After cerebrospinal fluid (CSF) removal by lumbar puncture, the patient exhibited a marked improvement in gait. A CSF tap test after careful clinical examination may need to be considered in the diagnosis of idiopathic hydrocephalus with an Evans' index of <0.3.
Aged ; Brain ; Cerebrospinal Fluid* ; Diagnosis ; Gait ; Humans ; Hydrocephalus* ; Magnetic Resonance Imaging ; Memory Disorders ; Spinal Puncture

Purpose: Little is known about the soft tissue destruction by holmium laser clinically used for holmium laser enucleation of the prostate (HoLEP), subject to the distance between the laser fiber tip and the tissue surface. We aimed to investigate the impact of the distance between the laser fiber tip and the phantom surface (DLP) on a soft tissue phantom (STP) in relation to the surgical modes of HoLEP. Methods: STP responses to the laser pulses produced by a commercial holmium:yttrium aluminum garnet (Holmium:YAG) laser at an output setting 2 J were observed at different values of the DLP (0, 1, 2, 3, and 4 mm) to look at (1) the single laser pulse-induced cavitation bubble and its penetration into the STP, (2) the STP destruction by a single pulse, (3) the STP destruction by 60 pulses repeated at 12 Hz, and (4) the thermal effect by the multiple pulses visualized on a thermosensitive bovine serum albumin (BSA) STP. Results: We observed that the laser pulse produced a heated gas bubble in water centered at the laser fiber tip. The bubble shape depended on the DLP. The bubble completely penetrated into the STP at the DLP of 0 mm and the penetration decreased with the DLP. The size of the destruction of the STP by the laser pulses was shown to decrease as the DLP increased. Test with the BSA STP showed that, at the DLP of 3 mm, the destruction became insignificant while the thermal effects were still effective. Conclusions We illustrated that soft tissue destruction by the Holmium:YAG laser is associated with cavitation effects. We provide for the first time experimental evidence for various surgical modes in HoLEP such as incision and hemostasis in relation to the DLP.

Purpose: Little is known about the soft tissue destruction by holmium laser clinically used for holmium laser enucleation of the prostate (HoLEP), subject to the distance between the laser fiber tip and the tissue surface. We aimed to investigate the impact of the distance between the laser fiber tip and the phantom surface (DLP) on a soft tissue phantom (STP) in relation to the surgical modes of HoLEP. Methods: STP responses to the laser pulses produced by a commercial holmium:yttrium aluminum garnet (Holmium:YAG) laser at an output setting 2 J were observed at different values of the DLP (0, 1, 2, 3, and 4 mm) to look at (1) the single laser pulse-induced cavitation bubble and its penetration into the STP, (2) the STP destruction by a single pulse, (3) the STP destruction by 60 pulses repeated at 12 Hz, and (4) the thermal effect by the multiple pulses visualized on a thermosensitive bovine serum albumin (BSA) STP. Results: We observed that the laser pulse produced a heated gas bubble in water centered at the laser fiber tip. The bubble shape depended on the DLP. The bubble completely penetrated into the STP at the DLP of 0 mm and the penetration decreased with the DLP. The size of the destruction of the STP by the laser pulses was shown to decrease as the DLP increased. Test with the BSA STP showed that, at the DLP of 3 mm, the destruction became insignificant while the thermal effects were still effective. Conclusions We illustrated that soft tissue destruction by the Holmium:YAG laser is associated with cavitation effects. We provide for the first time experimental evidence for various surgical modes in HoLEP such as incision and hemostasis in relation to the DLP.

Purpose: Little is known about the soft tissue destruction by holmium laser clinically used for holmium laser enucleation of the prostate (HoLEP), subject to the distance between the laser fiber tip and the tissue surface. We aimed to investigate the impact of the distance between the laser fiber tip and the phantom surface (DLP) on a soft tissue phantom (STP) in relation to the surgical modes of HoLEP. Methods: STP responses to the laser pulses produced by a commercial holmium:yttrium aluminum garnet (Holmium:YAG) laser at an output setting 2 J were observed at different values of the DLP (0, 1, 2, 3, and 4 mm) to look at (1) the single laser pulse-induced cavitation bubble and its penetration into the STP, (2) the STP destruction by a single pulse, (3) the STP destruction by 60 pulses repeated at 12 Hz, and (4) the thermal effect by the multiple pulses visualized on a thermosensitive bovine serum albumin (BSA) STP. Results: We observed that the laser pulse produced a heated gas bubble in water centered at the laser fiber tip. The bubble shape depended on the DLP. The bubble completely penetrated into the STP at the DLP of 0 mm and the penetration decreased with the DLP. The size of the destruction of the STP by the laser pulses was shown to decrease as the DLP increased. Test with the BSA STP showed that, at the DLP of 3 mm, the destruction became insignificant while the thermal effects were still effective. Conclusions We illustrated that soft tissue destruction by the Holmium:YAG laser is associated with cavitation effects. We provide for the first time experimental evidence for various surgical modes in HoLEP such as incision and hemostasis in relation to the DLP.

Purpose: Little is known about the soft tissue destruction by holmium laser clinically used for holmium laser enucleation of the prostate (HoLEP), subject to the distance between the laser fiber tip and the tissue surface. We aimed to investigate the impact of the distance between the laser fiber tip and the phantom surface (DLP) on a soft tissue phantom (STP) in relation to the surgical modes of HoLEP. Methods: STP responses to the laser pulses produced by a commercial holmium:yttrium aluminum garnet (Holmium:YAG) laser at an output setting 2 J were observed at different values of the DLP (0, 1, 2, 3, and 4 mm) to look at (1) the single laser pulse-induced cavitation bubble and its penetration into the STP, (2) the STP destruction by a single pulse, (3) the STP destruction by 60 pulses repeated at 12 Hz, and (4) the thermal effect by the multiple pulses visualized on a thermosensitive bovine serum albumin (BSA) STP. Results: We observed that the laser pulse produced a heated gas bubble in water centered at the laser fiber tip. The bubble shape depended on the DLP. The bubble completely penetrated into the STP at the DLP of 0 mm and the penetration decreased with the DLP. The size of the destruction of the STP by the laser pulses was shown to decrease as the DLP increased. Test with the BSA STP showed that, at the DLP of 3 mm, the destruction became insignificant while the thermal effects were still effective. Conclusions We illustrated that soft tissue destruction by the Holmium:YAG laser is associated with cavitation effects. We provide for the first time experimental evidence for various surgical modes in HoLEP such as incision and hemostasis in relation to the DLP.