The incidence of spinal fusion surgery has increased due to an increase in the incidence of degenerative spinal disease or trauma. Moreover, the development of various kinds of implants and bone graft substitutes has also increased. The animal models of spinal fusion are useful methods in evaluating the effectiveness of the newly developed spinal implants or bone graft substitutes. The most widely used animal models of spinal fusion are posterolateral fusion model, posterior fusion model, and anterior interbody fusion model. Mice, rats, rabbits, dogs, pigs, goats, sheep, and primates are frequently used in animal models of spinal fusion. Small animals are implanted with a bone graft substitute without internal fixation; however middle- or large-sized animals are implanted with a bone graft substitute using pedicle screws or cages. Small animals are easy to handle due to their size, but have different anatomical or biomechanical reactions with the human body. Middle- or large-sized animals have characteristics like the human body, but they are difficult to handle or there is an ethical problem. The fusion status is evaluated by manual palpation, mechanical testing using Instron, and radiologic techniques such as computed tomography, micro-computed tomography or undecalcified histology. The fusion rate and duration required for successful fusion differ according to the species and anatomical site. We have identified and reviewed several typical animal models of spinal fusion.
Animals* ; Dogs ; Goats ; Human Body ; Incidence ; Mice ; Models, Animal* ; Orthopedics* ; Palpation ; Pedicle Screws ; Primates ; Rabbits ; Rats ; Sheep ; Spinal Diseases ; Spinal Fusion* ; Swine ; Transplants

Objectives: This study was conducted to demonstrate the reliability of mini-open anterior lumbar interbody fusion (ALIF) combined with lateral lumbar interbody fusion (LLIF) followed by 2-stage posterior fixation in patients with adult spinal deformity (ASD).Summary of Literature Review: Although the correction of ASD using LLIF has become more widespread, the amount of sagittal plane correction has been reported to be suboptimal.Materials and Method: Thirty ASD patients who underwent ALIF with LLIF followed by 2-stage posterior fixation (AP group) were compared to 60 patients who underwent posterior-only surgery (PO group) and were matched according to age, sex, diagnosis, fusion level, pelvic incidence, and follow-up duration. Spinopelvic parameters, hospitalization data, clinical outcomes, and complications were compared between the 2 groups. Results: Postoperative lumbar lordosis was greater in the AP group than in the PO group (p<0.001). The reduction in the sagittal vertical axis was also greater in the AP group than in the PO group (p=0.005). Postoperatively, 90.0% of the AP group had a pelvic incidence– lumbar lordosis value within 9°, whereas only 50.0% of the PO group met that criterion (p<0.001). The operation time of the AP group was longer than that of the PO group, while estimated blood loss and red cell transfusion were lower in the AP group. Postoperative medical complications and delayed surgical complications developed more frequently in the PO group. Conclusions Mini-open ALIF with LLIF followed by 2-stage posterior fixation can restore sagittal balance more appropriately, with a lower rate of complications, than posterior-only surgery for the correction of ASD.

Background: To evaluate the clinical impact of intraoperative tranexamic acid administration in minimizing intraoperative blood loss and transfusion requirements during minimally invasive scoliosis surgery (MISS). Methods: Consecutive data were collected from 97 patients with adolescent idiopathic scoliosis who underwent MISS between 2021 and 2023. Tranexamic acid was first introduced in June 2022. Surgical outcomes, complications, and blood parameters were compared between group A (no tranexamic acid) and group B (tranexamic acid). Results: Forty-three patients underwent surgery without intraoperative tranexamic acid (group A), and 54 underwent surgery with tranexamic acid (group B). Variables including age, height, weight, body mass index, hospital stay duration, Cobb angle, correction rate, curve type, fusion extent, and pre- and postoperative hemoglobin levels were not significantly different between the 2 groups (all p > 0.50). On average, 2.03 red blood cell (RBC) transfusions were administered. Group A required 2.6 units, whereas group B required 1.7 units, representing a significant reduction (p = 0.005). Postoperatively, an average of 0.5 RBC units were administered.Group A required 0.9 units, and group B required 0.3 units, with a significant difference (p = 0.001). No significant difference was found in the hemoglobin level between the day before surgery and postoperative days 1 and 4 (all p > 0.05). Significant differences were observed between the 2 groups in the estimated blood loss change (1,358 vs. 1,118 mL, p = 0.035) and Hemovac volume (1,063.26 vs. 910.65 mL, p = 0.002). Eleven patients in group A required thoracentesis or chest tube insertion after MISS, whereas those in Group B did not require invasive procedures. Conclusions In MISS, tranexamic acid reduced blood transfusion needs, Hemovac volume, incidence and severity of hemothorax, and pleural effusion were associated with thoracoplasty.

Background: To evaluate the clinical impact of intraoperative tranexamic acid administration in minimizing intraoperative blood loss and transfusion requirements during minimally invasive scoliosis surgery (MISS). Methods: Consecutive data were collected from 97 patients with adolescent idiopathic scoliosis who underwent MISS between 2021 and 2023. Tranexamic acid was first introduced in June 2022. Surgical outcomes, complications, and blood parameters were compared between group A (no tranexamic acid) and group B (tranexamic acid). Results: Forty-three patients underwent surgery without intraoperative tranexamic acid (group A), and 54 underwent surgery with tranexamic acid (group B). Variables including age, height, weight, body mass index, hospital stay duration, Cobb angle, correction rate, curve type, fusion extent, and pre- and postoperative hemoglobin levels were not significantly different between the 2 groups (all p > 0.50). On average, 2.03 red blood cell (RBC) transfusions were administered. Group A required 2.6 units, whereas group B required 1.7 units, representing a significant reduction (p = 0.005). Postoperatively, an average of 0.5 RBC units were administered.Group A required 0.9 units, and group B required 0.3 units, with a significant difference (p = 0.001). No significant difference was found in the hemoglobin level between the day before surgery and postoperative days 1 and 4 (all p > 0.05). Significant differences were observed between the 2 groups in the estimated blood loss change (1,358 vs. 1,118 mL, p = 0.035) and Hemovac volume (1,063.26 vs. 910.65 mL, p = 0.002). Eleven patients in group A required thoracentesis or chest tube insertion after MISS, whereas those in Group B did not require invasive procedures. Conclusions In MISS, tranexamic acid reduced blood transfusion needs, Hemovac volume, incidence and severity of hemothorax, and pleural effusion were associated with thoracoplasty.

Background: To evaluate the clinical impact of intraoperative tranexamic acid administration in minimizing intraoperative blood loss and transfusion requirements during minimally invasive scoliosis surgery (MISS). Methods: Consecutive data were collected from 97 patients with adolescent idiopathic scoliosis who underwent MISS between 2021 and 2023. Tranexamic acid was first introduced in June 2022. Surgical outcomes, complications, and blood parameters were compared between group A (no tranexamic acid) and group B (tranexamic acid). Results: Forty-three patients underwent surgery without intraoperative tranexamic acid (group A), and 54 underwent surgery with tranexamic acid (group B). Variables including age, height, weight, body mass index, hospital stay duration, Cobb angle, correction rate, curve type, fusion extent, and pre- and postoperative hemoglobin levels were not significantly different between the 2 groups (all p > 0.50). On average, 2.03 red blood cell (RBC) transfusions were administered. Group A required 2.6 units, whereas group B required 1.7 units, representing a significant reduction (p = 0.005). Postoperatively, an average of 0.5 RBC units were administered.Group A required 0.9 units, and group B required 0.3 units, with a significant difference (p = 0.001). No significant difference was found in the hemoglobin level between the day before surgery and postoperative days 1 and 4 (all p > 0.05). Significant differences were observed between the 2 groups in the estimated blood loss change (1,358 vs. 1,118 mL, p = 0.035) and Hemovac volume (1,063.26 vs. 910.65 mL, p = 0.002). Eleven patients in group A required thoracentesis or chest tube insertion after MISS, whereas those in Group B did not require invasive procedures. Conclusions In MISS, tranexamic acid reduced blood transfusion needs, Hemovac volume, incidence and severity of hemothorax, and pleural effusion were associated with thoracoplasty.

Background: To evaluate the clinical impact of intraoperative tranexamic acid administration in minimizing intraoperative blood loss and transfusion requirements during minimally invasive scoliosis surgery (MISS). Methods: Consecutive data were collected from 97 patients with adolescent idiopathic scoliosis who underwent MISS between 2021 and 2023. Tranexamic acid was first introduced in June 2022. Surgical outcomes, complications, and blood parameters were compared between group A (no tranexamic acid) and group B (tranexamic acid). Results: Forty-three patients underwent surgery without intraoperative tranexamic acid (group A), and 54 underwent surgery with tranexamic acid (group B). Variables including age, height, weight, body mass index, hospital stay duration, Cobb angle, correction rate, curve type, fusion extent, and pre- and postoperative hemoglobin levels were not significantly different between the 2 groups (all p > 0.50). On average, 2.03 red blood cell (RBC) transfusions were administered. Group A required 2.6 units, whereas group B required 1.7 units, representing a significant reduction (p = 0.005). Postoperatively, an average of 0.5 RBC units were administered.Group A required 0.9 units, and group B required 0.3 units, with a significant difference (p = 0.001). No significant difference was found in the hemoglobin level between the day before surgery and postoperative days 1 and 4 (all p > 0.05). Significant differences were observed between the 2 groups in the estimated blood loss change (1,358 vs. 1,118 mL, p = 0.035) and Hemovac volume (1,063.26 vs. 910.65 mL, p = 0.002). Eleven patients in group A required thoracentesis or chest tube insertion after MISS, whereas those in Group B did not require invasive procedures. Conclusions In MISS, tranexamic acid reduced blood transfusion needs, Hemovac volume, incidence and severity of hemothorax, and pleural effusion were associated with thoracoplasty.

Background: Menarche has a significant impact on the progression of adolescent idiopathic scoliosis (AIS); however, studies in this area are insufficient. This study used large-scale school screening data to investigate the relationship between menarcheal age and AIS, especially the severity of scoliosis. Methods: Of 2,326,577 students who participated in school screening for scoliosis (SSS) in South Korea from 2001 to 2021, 38,879 girls with AIS, who experienced menarche, were included. Data including the patient’s demographics, such as menarcheal age, Cobb angle, Risser stage, and the interval between menarche and the time of screening were retrieved from the SSS database.Pearson correlation coefficient was used to identify the changes in menarcheal age according to the birth year and to investigate the relationship between menarcheal age and each variable of interest. Results: Based on the birth year, the mean menarcheal ages in girls with AIS from 1988 to 2008 demonstrated a steadily decreasing trend over time (r = –0.857, p < 0.001). Girls with AIS and late menarche demonstrated a higher Cobb angle at the time of screening (r = 0.095, p < 0.001). Other variables did not significantly correlate with menarcheal age. Conclusions Based on the SSS, a large-scale school screening dataset, menarcheal age in girls with AIS demonstrated an ongoing downward trend in the recent 20 years in South Korea. Notably, girls with AIS and late menarche had a higher Cobb angle at screening. Our findings indicate the need for earlier screening of AIS in girls who have not undergone menarche.

BACKGROUND/AIMS: Immune thrombocytopenic purpura (ITP) is an autoimmune disease that is mediated by anti-platelet antibodies. Based on the pathogenesis of ITP we evaluated the efficacy of intravenous anti-D immunoglobulin for adult chronic ITP. METHODS: Fourteen patients (4 without splenectomy and 10 with splenectomy) with refractory chronic ITP were treated with 50-70 microgram/kg of intravenous anti-D immunoglobulin only once. Treatment effects were evaluated by measuring the platelet counts and hemoglobin levels. RESULTS: Five patients (36%) showed a response; improvement in the platelet count lasted for on average 7 days (range: 2~24 days). There were no serious adverse effects. CONCLUSION: Anti-D immunoglobulin, which is associated with an Fc receptor blockade, appeared to be safe and effective for the treatment of adults with chronic ITP. Further studies are needed to confirm these findings and define further potentially effective treatment protocols with intravenous anti-D immunoglobulin.
Adult ; Antibodies ; Autoimmune Diseases ; Clinical Protocols ; Hemoglobins ; Humans ; Immunoglobulins ; Isoantibodies ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; Receptors, Fc ; Rho(D) Immune Globulin ; Splenectomy

PURPOSE: The aim of this study is to evaluate the prevalence and risk factors of seizure aggravation of adjunctive levetiracetam therapy in children with epilepsy. METHODS: We retrospectively identified 125 children (0.3–18 years) with epilepsy who were newly treated with adjunctive levetiracetam therapy from November 2008 to July 2014 in Pusan National University Hospital, and 44 patients were excluded according to the exclusion criteria. Aggravation was diagnosed if the seizure frequency increased by more than 50% of baseline or there were new types of seizures after 1 month of adjunctive levetiracetam therapy. RESULTS: Eighty-one patients (male:female, 44:37) were enrolled, including 27 (33.5%) with generalized seizures and 54 (66.7%) with focal seizures. Twelve patients (14.8%) exhibited seizure aggravation and 69 patients (85.2%) had improvement or no change after 1 month of levetiracetam therapy. Eleven patients (91.7%) in seizure aggravation group and 16 patients (23.2%) in non-seizure aggravation group had generalized seizures, with aggravation significantly more frequent in patients with generalized seizures (P < 0.001). Other factors such as age at diagnosis, age at adding levetiracetam, sex, baseline seizure frequency, etiology, electroencephalography and magnetic resonance imaging abnormalities, and concomitant drug use were not identified as risk factors. CONCLUSION: Although levetiracetam is an effective antiepileptic drug in children with epilepsy, adjunctive levetiracetam therapy was associated with worsening of seizures in 14.8 % of included patients, especially those with generalized seizures. Careful monitoring for increased seizure frequency or the onset of a new type of seizures is advised for patients prescribed levetiracetam add-on treatment.
Anticonvulsants ; Busan ; Child* ; Diagnosis ; Electroencephalography ; Epilepsy* ; Epilepsy, Generalized ; Humans ; Magnetic Resonance Imaging ; Prevalence ; Retrospective Studies ; Risk Factors ; Seizures*

Isolated double chambers of the right ventricle (DCRV) are a rare variant of congenital heart disease. We report here on a case of right-sided infective endocarditis with isolated DCRV that presented in adulthood.
Endocarditis* ; Heart Defects, Congenital ; Heart Ventricles*