The patient was a 25-year-old primiparous woman complicated with deep vein thrombosis (DVT) of the left iliac vein. Despite conservative therapy for DVT, the thrombus did not disappear completely. A ...temporary inferior vena cava (IVC) filter (Gunther Tulip filterTM) was placed to prevent pulmonary thromboembolism, and she uneventfully delivered a baby. Two weeks after childbirth, computed tomography revealed that the leg of the IVC filter had penetrated the inferior vena cava and the tip of it was located in the pancreas head. The IVC filter was removed under laparotomy, and the patient was discharged on eighth post-operative day without further trouble. In pregnant women, there must be particular concerns in IVC filter insertion such as type of the filter to be used and removal method of the device.
IntroductionThe prevalence of patients with osteoporosis continues to increase in aging societies, including Japan. The first choice for managing osteoporotic vertebral compression fracture (OVF) is ...conservative treatment. Failure in conservative treatment for OVF may lead to non-union or vertebral collapse, resulting in neurological deficit and subsequently requiring surgical intervention. This multicenter nationwide study in Japan was conducted to comprehensively understand the outcomes of surgical treatments for OVF non-union.MethodsThis multicenter, retrospective study included 403 patients (89 males, 314 females, mean age 73.8 ± 7.8 years, mean follow-up 3.9 ± 1.7 years) with neurological deficit due to vertebral collapse or non-union after OVF at T10-L5 who underwent fusion surgery with a minimum 1-year follow-up. Radiological and clinical outcomes at baseline and at the final follow-up (FU) were evaluated.ResultsOVF was present at a thoracolumbar junction such as T12 (124 patients) and L1 (117 patients). A majority of OVF occurred after a minor trauma, such as falling down (55.3%) or lifting objects (8.4%). Short segment fusion, including affected vertebra, was conducted (mean 4.0 ± 2.0 vertebrae) with 256.8 minutes of surgery and 676.1 g of blood loss. A posterior approach was employed in 86.6% of the patients, followed by a combined anterior and posterior (8.7%), and an anterior (4.7%) approach. Perioperative complications and implant failures were observed in 18.1% and 41.2%, respectively. VAS scores of low back pain (74.7 to 30.8 mm) and leg pain (56.8 to 20.7 mm) improved significantly at FU. Preoperatively, 52.6% of the patients were unable to walk and the rate of non-ambulatory patients decreased to 7.5% at FU.ConclusionsThis study demonstrated that substantial improvement in ADL was achieved by fusion surgery. Although there was a considerable rate of complications, fusion surgery is beneficial for elderly OVF patients with non-union.
IntroductionApproximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. ...However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC.MethodsThis study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for ≥2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis.ResultsSixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm² (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228).ConclusionPJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm² may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.
Because of our interesting in the good hitocompatibility of Al2O3 filler, as a new imimplant material, we performed an experiment on rats and rabbits to determine what kind of clinical application ...could be made. These results were presented at the 3rd. Orthopaedic Ceramic Implants Meeting in 1983. In this paper, we will report on 8 clinical cases counducted using results from previous experiments as a base. (Case) Eight clinical cases include 3 cases of bone cyst, 2 cases of giant cell tumor, 2 cases of benign chondroblastoma and a case of osteomyelitis. Follow up period is from 6 months to 2 years 11 months, average 1 year 5 months. (Result) From results of our experiments, we found that a ratio of 1 to 1 mixture of Al2O3 filler and autobone produced the best results when implanted to the site of bone lesion. This was the method used in our clinical cases. Radiographically, implant lesions became homogenous at 2 months to 12 months after surgery, average 4 months. These cases have no recurrence and good clinical course.
PDF
