Methods: A total of 209 patients with osteoporosis and 54 with adult spinal deformities were included. Patients were divided into two groups based on pelvic incidence–lumbar lordosis (PI–LL): <20° and ≥20° groups. The sagittal vertical axis (SVA), thoracic kyphosis, PI, pelvic tilt (PT), LL, sacral slope, and pelvic femoral angle (PFA) were measured. Health-related quality of life (HRQOL) was assessed in 86 patients using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A new index, PFA–(PI–LL), was defined as spinopelvic–hip mismatch. Correlation coefficients were calculated for each radiographic parameter, and the coefficient of determination (R2) for the relationship of each parameter with SVA was evaluated in both groups. The correlations between SVA, PT, PI–LL, PFA–(PI–LL), and JOABPEQ domain scores were also analyzed. Results: PI–LL correlated with PFA in the PI–LL <20° group (r=0.56, p<0.001) but not in the PI–LL ≥20° group. Among all parameters, PFA–(PI–LL) demonstrated the strongest association with SVA, indicating its superior ability to explain variations in sagittal alignment in both groups and across all patients (all patients, R2=0.77). Significant correlations were observed between the radiographic parameters and JOABPEQ scores across all domains. Conclusions PFA–(PI–LL), which represented spinopelvic–hip mismatch, was a reliable indicator of hip compensatory function in terms of anterior trunk inclination and HRQOL.

The patient was an 81-year-old woman who had undergone TAVI (Evolut PRO® 26 mm) for severe aortic stenosis at our hospital approximately 6 months previously. She was discharged from the hospital without any postoperative complications, but at 6 months after the surgery, fever, back pain, and high inflammatory findings were observed. Based on lumbar spine MRI findings, the patient was diagnosed with pyogenic spondylitis and epidural abscess, and drainage surgery was performed. Enterococcus faecalis was identified from a blood culture. MRI of the head showed scattered subacute infarcts in the right frontal lobe, and transthoracic echocardiography revealed hyperintense deposits at the aortic valve leaflet, suggesting vegetation. The diagnosis of PVE was made and medical therapy was initiated. However, the vegetation gradually increased in size and mobility, and a surgical approach was indicated. A surgical procedure was performed through a median sternotomy to remove the prosthetic valve and replace the aortic valve. The postoperative course was good, with no recurrence of infection, and the patient was transferred to another hospital for rehabilitation on the 26th postoperative day. In general, TAVI patients are older and have more comorbidities, and surgery is associated with a higher degree of risk. However, radical surgery should be considered if medical therapy is not effective in PVE after TAVI. We reported a case of surgical aortic valve replacement for PVE after TAVI.

No abstract available.
Carcinosarcoma*