STUDY DESIGN: This is a retrospective study. OBJECTIVES: The purpose of this study is to decrease the frequency of the postoperative complications and to improve the postoperative clinical outcomes for the elderly patients with lumbar spinal stenosis. Summery of Literature REVIEW: Many controversies exist about postoperative complication and its influencing factors in the elderly patients suffering with lumbar spinal stenosis. MATERIALS AND METHODS: We reviewed the hospital records of 213 patients who underwent decompression and posterolateral fusion between February 1, 1998 and December 31, 2003 to treat their degenerative lumbar spinal stenosis. This study was performed, to assess and compare the postoperative complications and clinical outcomes of surgical management for the patients over 65 years (Group A) and the patients between 50-64 years (Group B). All the patients had at least a 1-year follow-up evaluation. The factors that could have influenced the complications that resulted within 12 weeks after the operation were evaluated and statistically analyzed. RESULTS: Postoperative complications occurred in 62 patients of Group A and in 40 patients of Group B, of which the major complications occurred in 10 patients of Group A and in 1 patient of Group B and minor complications occurred in 52 patients of Group A and in 39 patients of Group B. A statistical relationship between diabetes and major complications was observed in Group A (p=0.005). While any relationship between age and the frequency of complication in each group was not found, Group A had a higher frequency of major complication than did Group B (p=0.004). CONCLUSIONS: Surgeon should be vigilant about postoperative complications in elderly patients suffering with diabetic mellitus.Elderly patients with diabetic mellitus should be made aware that they are at an increased risk for postoperative complications because of their fragility.
Aged ; Decompression ; Follow-Up Studies ; Hospital Records ; Humans ; Postoperative Complications* ; Retrospective Studies ; Spinal Stenosis*

STUDY DESIGN: This is a retrospective study. OBJECTIVES: This study examined the MRI findings, injury mechanism, clinical findings, and prognosis of a spinal cord injury without radiographic abnormality (SCIWORA) in adults with a normal spinal canal. SUMMARY OF LITERTURE: Most reports on SCIWORA deal with the pediatric age group. However, there are few reports on the MRI findings, clinical features and outcomes in adult patients with cervical SCIWORA. MATERIALS AND METHODS: The hospital records of 753 patients, who were treated for cervical spine injury between February 1, 1994 and July 31, 2004, were reviewed. This study included the 10 subjects with no fractures or dislocation on the plain roentgenograms or cord compression caused by degenerative change or disc herniation on MRI corresponding to the location of the cord lesion. All the patients had at least a 2-year follow-up evaluation. The relationships between the MRI findings, neurological findings and outcomes were evaluated. RESULTS: The MRI findings revealed 7 cases with cord contusion, 3 cases with cord edema, 3 cases with gliosis and 3 cases with syrinx formation at the follow-up. The injury mechanism was hyperextension and hyperflexion in 7 and 3 cases, respectively. The initial motor function scores of ASIA in the edema and contusion groups was 60.7 and 43.9, respectively. At the last follow-up, the motor function scores of ASIA in the edema and contusion groups were 90 and 70.3, respectively. The Frankel grade improved by 1.3 and 1.1 in the edema and contusion groups, respectively. CONCLUSIONS: In patients with SCIWORA, the MRI findings correlated well with the clinical picture and were of prognostic significance. The cord edema group showed better clinical features than the contusion group, and prognosis was relatively good in both groups. A further careful evaluation, such as MRI, is still needed to determine the appropriate treatment for spinal cord injuries without radiographic abnormalities.
Adult* ; Asia ; Contusions ; Dislocations ; Edema ; Follow-Up Studies ; Gliosis ; Hospital Records ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Retrospective Studies ; Spinal Canal ; Spinal Cord Injuries* ; Spinal Cord* ; Spine

BACKGROUND: We evaluated the role and effects of prolotherapy in patients presenting with lower back pain and detected sacral asymlocation, by retrospectively analyzing the results of prolotherapy performed at our institute. METHODS: Twenty-three patients with referred pain in the lower back rather than distinct radiculopathy, were detected to have sacral asymlocation by simple X-ray from May 2004 through July 2005. The patients were treated with prolotherapy and manipulation by the Ongley's method around the lumbosacral junction, iliolumbar ligament, and sacroiliac joint. They were treated for approximately one to two week intervals, and during this period were rechecked by X-ray and evaluated using the visual analogue scale (VAS). RESULTS: A total of 23 patients were included in the study (10 male and 13 female), and the average age was 41 years. The average VAS at the time of visit was 8.5, the average treatment time was 4.7 days, and the average VAS after treatment was 2.1. CONCLUSIONS: Back pain, and associated leg and buttock pain, originate from several causes. In these case analyses, instability around the lumbosacral area and sacral asymlocation might have been important causes of patient back pain and associated buttock and leg pain. We therefore applied prolotherapy as well as manipulation techniques devised by Ongley to these patients, and obtained good results.
Back Pain* ; Buttocks ; Diagnosis* ; Humans ; Leg ; Ligaments ; Low Back Pain ; Male ; Pain, Referred ; Radiculopathy ; Retrospective Studies ; Sacroiliac Joint

OBJECTIVE: The purpose of this study was to determine the efficacy of short segment fixation following postural reduction for the re-expansion and stabilization of unstable burst fractures in patients with osteoporosis. METHODS: Twenty patients underwent short segment fixation following postural reduction using a soft roll at the involved vertebra in cases of severely collapsed vertebrae of more than half their original height. All patients had unstable burst fracture with canal compromise, but their motor power was intact. The surgical procedure included postural reduction for 2 days and bone cement-augmented pedicle screw fixations at one level above, one level below and the fractured level itself. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. RESULTS: The mean follow-up period was 15 months. The mean pain score (visual analogue scale) prior to surgery was 8.1, which decreased to 2.8 at 7 days after surgery. The kyphotic angle improved significantly from 21.6+/-5.8degrees before surgery to 5.2+/-3.7degrees after surgery. The fraction of the height of the vertebra increased from 35% and 40% to 70% in the anterior and middle portion. There were no signs of hardware pull-out, cement leakage into the spinal canal or aggravation of kyphotic deformities. CONCLUSION: In the management of unstable burst fracture in patients with severe osteoporosis, short segment pedicle screw fixation with bone cement augmentation following postural reduction can be used to reduce the total levels of pedicle screw fixation and to correct kyphotic deformities.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Osteoporosis ; Spinal Canal ; Spine

PURPOSE: The aim of this study was to correlate patients 'satisfaction with the objective measurement of the knee stability after a ACL reconstruction using a patellar tendon autograft. MATERIALS AND METHODS: Contact was made with 120 patients who a ACL reconstruction using a patellar tendon autograft on unilateral ACL rupture between January 1995 and April 2002 by single surgeon. Assessment was made by the KOOS score, Tegner score, Lysholm score, patients 'satisfaction, IKDC score, manual physical examination, one leg hop test and radiologic AP translation. Paired t-test, Pearson product moment correlation(PPMC) and Spearman 's rank correlation test were used to test the correlation between the parameters. RESULTS: Radiologic AP translation showed a statistically significant correlation with manual lachman and pivot shift tests. The Lysholm score had a high correlation with the patients 'satisfaction and one leg hop test. The final IKDC evaluation system showed the highest correlations with the Lysholm score, the patients 'satisfaction, the Tegner score, the manual lachman test, one leg hop test. Resumption of sports and work according to the Tegner score correlated with the patients 'satisfaction but had a very low correlation with manual lachman test. The knee laxity measurement using manual lachman test correlated with neither one leg hop test nor the patients 'satisfaction. The one leg hop test correlated with the Lysholm score, the patients 'satisfaction, the final IKDC evaluation system. CONCLUSION: We conclude that the final IKDC evaluation system is a very reliable tool and the patients 'satisfaction is important for evaluating the results after ACL reconstructiuon. And the one leg hop test also appear to be a reliable way of evaluating the functional outcome of the ACL reconstruction.
Anterior Cruciate Ligament ; Autografts ; Humans ; Humulus ; Knee ; Leg ; Patellar Ligament ; Patient Satisfaction ; Physical Examination ; Rupture ; Sports

PURPOSE: To evaluate the Three years clinical results of a total knee arthroplasty using the NexGen LPS-Flex fixed bearing system. MATERIALS AND METHODS: One hundred knees(65 patients) which used the LPS-Flex system for primary TKA and were followed up for a minimum Three years were evaluated. Evaluations included preoperative and postoperative range of motion(ROM), factors affecting the postoperative ROM that included age of the patient, the body mass index, the flexion contracture, degree of varus deformity, and Hospital for Special Surgery score. RESULTS: Knee ROM increased from preoperative 122.8 degrees to postoperative 130.5 degrees. The mean HSS score improved from preoperative 58.4 to postoperative 91.3. The femoral-tibial angle was changed from preoperative 6.4 degrees varus to a pos- toperative 5.5 degrees valgus. The most important factor that influenced the range of motion after an arthroplasty was the preoperative range of motion. One deep infection developed, but was cured with synovectomy and administration of antibiotics. CONCLUSION: Primary TKR with NexGen LPS-Flex system showed satisfactory early results including excellent ROM. We found that preoperative ROM had a significant effect on postoperative ROM.
Anti-Bacterial Agents ; Arthroplasty* ; Body Mass Index ; Congenital Abnormalities ; Contracture ; Follow-Up Studies* ; Humans ; Knee* ; Range of Motion, Articular