STUDY DESIGN: Retrospective study. PURPOSE: To investigate the relationship between preoperative total spinal sagittal alignment and the early onset of adjacent segment degeneration (ASD) after single-level posterior lumbar interbody fusion (PLIF) in patients with normal sagittal spinal alignment. OVERVIEW OF LITERATURE: Postoperative early-onset ASD is one of the complications after L4–L5 PLIF, a common surgical procedure for lumbar degenerative disease in patents without severe sagittal imbalance. A better understanding of the preoperative characteristics of total spinal sagittal alignment associated with early-onset ASD could help prevent the condition. METHODS: The study included 70 consecutive patients diagnosed with lumbar degenerative disease who underwent single-level L4–L5 PLIF between 2011 and 2015. They were divided into two groups based on the radiographic progression of L3–L4 degeneration after 1-year follow-up: the ASD and the non-ASD (NASD) group. The following radiographic parameters were preoperatively and postoperatively measured: sagittal vertebral axis (SVA), thoracic kyphosis (TK), lumbar lordosis, pelvic tilt, and pelvic incidence (PI). RESULTS: Eight of the 70 patients (11%) experienced ASD after PLIF (three males and five females; age, 64.4±7.7 years). The NASD group comprised 20 males and 42 females (age, 67.7±9.3 years). Six patients of the ASD group showed decreased L3–L4 disc height, one had L3–L4 local kyphosis, and one showed both changes. Preoperative SVA, PI, and TK were significantly smaller in the ASD group than in the NASD group (p <0.05). CONCLUSIONS: A preoperative small SVA and TK with small PI were the characteristic alignments for the risk of early-onset ASD in patients without preoperative severe sagittal spinal imbalance undergoing L4–L5 single-level PLIF.
Animals ; Female ; Follow-Up Studies ; Humans ; Incidence ; Kyphosis ; Lordosis ; Male ; Retrospective Studies

The use of pharmaceuticals requires establishing a safe environment and securing a system to reduce risk. In our isotope inspections, the operational system for using radiopharmaceuticals was insufficient, which became a problem. For this reason, through cooperation between a radiological technologist responsible for radiation safety management and a pharmacist responsible for medicine safety management, we considered the operational system for the preparation and management of radiopharmaceuticals at our hospital. In accordance with the guidelines for handling radiopharmaceuticals, we established a system to reduce risks by reviewing pharmaceuticals, creating checklists, and improving the work environment. By reviewing and improving the system of safety management and safe use in cooperation with other disciplines, it became possible to reduce risk through double checks and to improve the work environment for routine operations. This report describes the efforts made in our hospital.

We report a case of ureteral endometriosis thought to have developed following relapse of pelvic peritoneal endometriosis after laparoscopic surgery. The patient was a woman in her late 40s who had undergone laparoscopic right adnexectomy for an endometrial cyst 5 years earlier. Electrocoagulation was performed for residual endometriosis of adherent cyst wall on the right sacrouterine ligament. The normal left ovary was preserved and she received no postoperative hormonal therapy. She developed right back pain during menstruation 5 years after the surgery. Pyeloureterography revealed stenosis of the ureter to the right of the uterus. Urinary cytology revealed endometrial cells with no atypia. Conservative management was opted for because malignant transformation of endometriosis was considered unlikely and she was expected to reach menopause within a few years. She is now doing well 24 months after initiation of progestin treatment with placement of a ureteral stent. Postoperative hormonal therapy is recommended for patients who are considered to have possible lesions of residual endometriosis and for whom ovarian function is preserved.