Preoperative Radiological Parameters Research Articles

The Role of Spinopelvic Parameters in Clinical Outcomes of Spinal Osteotomies in Patients with Sagittal Imbalance.

Sagittal imbalance is known as the main radiographic driver of disability in adult spinal deformity (ASD). In this study, the association of radiological spinopelvic parameters and clinical outcomes was evaluated following the corrective surgery of sagittal imbalance, in order to explore the predictive ability of each parameter. A total of 23 patients, who underwent corrective osteotomy for restoration of sagittal balance, were included in this study. The mean follow-up period of the patients was 15.5±2.1, ranging from 12 to 18 months. Pre- and postoperative radiological parameters including pelvic tilt (PT), sagittal vertical axis (SVA) and pelvic incidence minus lumbar lordosis (PI-LL) were assessed for each patient. Clinical outcomes were evaluated using Oswestry disability Index (ODI). The mean ODI improved 32% following the corrective osteotomy of sagittal imbalance. Postoperative ODI was significantly correlated with all preoperative radiological parameters (r=0.608, P=0.002 for PI-LL; r=0.483, P=0.01 for PT; and r=0.464, P=0.02 for SVA). ODI improvement was significantly correlated with PI-LL and SVA change (r=536, P=0.008 and r=416, P=0.04, respectively), but not with PT change (r=247, P=0.25). The outcome was better in pedicle subtraction osteotomy (PSO) compared to Smith-Petersen Osteotomy (SPO). Surgical correction of sagittal imbalance could limit the amount of disability caused by this misalignment. According to our results, while all the spinopelvic parameters could be used in the prediction of the outcomes of corrective surgery of sagittal imbalance, PI-LL was the most informative parameter and more attention should be devoted to this parameter.

Can K-Line Predict the Clinical Outcome of Anterior Controllable Antedisplacement and Fusion Surgery for Cervical Myelopathy Caused by Multisegmental Ossification of the Posterior Longitudinal Ligament?

To analyze the correlation between the K-line-based classification of patients with ossification of the posterior longitudinal ligament (OPLL) and their outcome after anterior controllable antedisplacement and fusion (ACAF) surgery. A series of 24 patients with multisegmental OPLL were enrolled. All patients underwent ACAF surgery. First, the patients were classified into 2 groups according to their K-line classification. Then, we separated the patients into subgroups according to their OPLL thickness. The Japanese Orthopaedic Association scores before and 6 months after surgery were studied, and the recovery rate (RR) was calculated. The preoperative and postoperative radiologic parameters were also investigated. Clinical and radiographic assessments showed no significant correlation between the K-line-based classification of patients with OPLL and their outcome of ACAF surgery (P > 0.05). When the OPLL was ≤6 mm thick, K-line-based classification groups had a similar change of occupation ratio and RR (P > 0.05). However, when the OPLL was >6 mm thick, the mean RR was 61.8% ± 14.0% in the K-line (+) group and 78.3% ± 9.7% in the K-line (-) group (P < 0.05), and the mean was 16.0% ± 4.2% in the K-line (+) group and 28.0% ± 7.1% in the K-line (-) group (P < 0.05). This study shows that K-line can predict the clinical outcome of ACAF surgery for multisegmental OPLL in a different way from posterior decompression surgery. When the OPLL was thin, the outcome was satisfactory and there was no correlation with K-line-based classification of patients with OPLL. When the OPLL was >6 mm thick, the K-line (-) group patients had a better outcome than did K-line (+) group patients.

Minimally Invasive Lumbar Spinal Decompression in Elderly Patients with Magnetic Resonance Imaging Morphological Analysis.

Study DesignCase-control study.PurposeIn this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with lumbar spinal stenosis (LSS) who were treated by minimally invasive surgery (MIS) unilateral laminectomy for bilateral decompression (ULBD) using a tubular retractor.Overview of LiteratureNumerous methods using imaging have been attempted to describe the severity of spinal stenosis. But the relationship between clinical symptoms and radiological features remains debatable.ObjectiveIn this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with LSS who were treated by MIS-ULBD.MethodsWe methodically assessed 85 consecutive patients aged >65 years who were treated for LSS. The patients were retrospectively analyzed in two age groups: 66–75 years (group 1) and >75 years (group 2). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria. Outcome parameters were compared between the groups at the 1-year follow-up. Core radiologic parameters for central and lateral stenosis were analyzed and clinical findings of the groups were compared.ResultsAt the 1-year follow-up, patients in both groups 1 and 2 demonstrated significant improvement in their VAS and ODI scores. All clinical outcomes, except postoperative ODI, were not significantly difference between the groups. In addition, no significant difference was noted in the preoperative radiological parameters between the groups. There was no statistically significant correlation between radiological parameters and clinical symptoms or their outcomes. Moreover, no differences were noted in perioperative adverse events and in the need for repeat surgery at follow-ups between the groups.ConclusionsMIS-ULBD by tubular approach is a safe and effective treatment option for elderly patients with LSS. Clinical outcomes in patients with LSS and aged >75 years were comparable with those in patients with LSS and aged 66–75 years. Moreover, we did not find any correlation between radiological parameters and clinical outcomes in either of the two patient groups.

102 lumbar pedicle subtraction osteotomies: one surgeon's learning curve.

Pedicle Subtraction Osteotomy (PSO) is an effective surgical technique for the correction of fixed sagittal malalignment of the spine. It is a demanding technique that requires a long learning curve. The aim of this study is to analyze a surgeon's learning curve for lumbar PSO in relation to the preoperative, perioperative, and postoperative management, with assessment of the global outcome. 102 patients operated over an 8-year period were included, distributed in 3 groups over the time, and retrospectively analyzed. The following data were collected: demographic characteristics, preoperative and postoperative radiological parameters, operative technical details, and complications. Multiple regression analysis was performed, and while the number of cases was the predictor, other variables such as demographic, radiographical, and surgical variables were considered as a covariate in the final model. When comparing the first group and the last group of patients, the mean surgical time had decreased by 50min, the estimated blood loss was decreased by 655ml, and a significant decrease in dural tear occurrence was noticed. In addition, we found a significant decrease in the hospital stay length. Multivariate linear regression analysis showed that when the surgeon's experience doubles, the operative time decreases by 29min, the blood loss by 281ml, and the odds of hospital stay≥21days decrease by 0.66 times. PSO technique has a relatively long learning curve. This study showed that accumulating the experience over the years, while performing cases on a regular basis, is definitely the key in mastering this complex and risky technique, with significant improvements in the perioperative parameters that directly impact the recovery and global outcome. These slides can be retrieved under Electronic Supplementary Material.

Salvage Anterior Lumbar Interbody Fusion for Pseudoarthrosis After Posterior or Transforaminal Lumbar Interbody Fusion: A Review of 10 Patients

After interbody cage implantation for posterior or transforaminal lumbar interbody fusion (PLIF or TLIF) spinal fusion surgery, pseudoarthrosis can develop. However, there are several shortcomings of the posterior approach if the interbody cage requires removal. Therefore, an anterior approach may be useful. We reviewed salvage anterior lumbar interbody fusion (ALIF) for pseudoarthrosis after PLIF or TLIF performed from December 2006 to December 2016. A total of 10 patients met inclusion criteria for the study. All preoperative and postoperative clinical and radiologic parameters were recorded. Salvage ALIF resulted in improvements in clinical and radiologic outcomes in all cases. In 9 cases, the previously inserted cage was successfully removed. In 1 case, only 1 of the 2 previously inserted cages could be removed, as the previously inserted cage exhibited a high subsidence and remained in a diagonal position in the vertebral body. No serious complications occurred in all cases. Bone fusion was successful in all cases. ALIF is useful for salvage surgery to treat failed PLIF or TLIF. The advantages of salvage ALIF include improvements in clinical and radiologic outcomes and a low complication rate after surgery. To successfully remove a previously inserted cage, the vascular window of the anterior index level and the degree of subsidence of the cage should be well characterized through preoperative radiologic imaging.

Can preoperative clinicoradiological parameters predict the difficulty during laparoscopic retroperitoneal simple nephrectomy? - A prospective study.

Introduction:Urologists tend to prefer retroperitoneal approach for open nephrectomy and transperitoneal route for laparoscopic nephrectomy. Urologists consider retroperitoneal laparoscopic approach difficult to learn and perform. There is a need to objectively define predictors of difficulty during laparoscopic retroperitoneal simple nephrectomy (LRSN) for the proper preoperative selection. To the best of our knowledge, this is the first study to prospectively assess the factors associated with difficulty during LRSN.Materials and Methods:All adult patients of nonfunctioning kidneys (due to benign causes) planned for simple nephrectomies from November 2014 to January 2017 were included in the study. Various clinical and radiological parameters were noted along with intraoperative difficulty parameters (difficulty score, total operative time, and estimated blood loss). Renal and perirenal parameters were assessed and noted on computed tomography scan. Difficulty scale was calculated based on the three difficulty parameters and was used to objectively categorize the patients in easy and difficult group.Results:A total of 44 patients were included in the study. There were 23 patients in Group I (Easy) and 21 patients in Group II (Difficult). Various preoperative clinical and radiological parameters were analyzed and compared between these two groups. History of pyonephrosis and presence of nephrostomy tube were the only two statistically significant factors associated with difficult cases (Group II). None of the factors were statistically significant in multivariate analysis.Conclusion:Based on the findings of our study, history of pyonephrosis and presence of nephrostomy are the most significant factors predicting difficulty during LRSN.

FACTORS PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

&#x0D; Background &#x0D; Laparoscopic cholecystectomy has become the standard operative procedure for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy, mainly because of technical difficulty. &#x0D; Objectives &#x0D; To identify the prediction of difficult laparoscopic cholecystectomy.&#x0D; Materials and Methods&#x0D; Preoperative clinical, laboratory, and radiologic parameters of 249 patients, who underwent laparoscopic cholecystectomy, were analyzed for their technical difficulty. Parameters (male sex, abdominal tenderness, previous upper abdominal operation, sonographically thickened gallbladder wall, age over 65 years, preoperative diagnosis of acute cholecystitis, history of ERCP) were found to have significant effect in multivariate analysis.&#x0D; Results&#x0D; Overall 54 operations (21.7%) were difficult; 36 operations (14.5%) took long time and 18 patients (7.2%) required conversion to open cholecystectomy. &#x0D; Conclusions&#x0D; Conversion risk can be predicted to some extent. Patients having high risk may be informed and scheduled appropriately. An experienced surgeon has to operate on these patients, and he or she has to make an early decision to convert in case of difficulty.&#x0D;

The Predictable Factors of the Postoperative Kyphotic Change of Sagittal Alignment of the Cervical Spine after the Laminoplasty.

ObjectiveLaminoplasty is an effective surgical method for treating cervical degenerative disease. However, postoperative complications such as kyphosis, restriction of neck motion, and instability are often reported. Despite sufficient preoperative lordosis, this procedure often aggravates the lordotic curve of the cervical spine and straightens cervical alignment. Hence, it is important to examine preoperative risk factors associated with postoperative kyphotic alignment changes. Our study aimed to investigate preoperative radiologic parameters associated with kyphotic deformity post laminoplasty.MethodsWe retrospectively reviewed the medical records of 49 patients who underwent open door laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) at Pusan National University Yangsan Hospital between January 2011 and December 2015. Inclusion criteria were as follows: 1) preoperative diagnosis of OPLL or CSM, 2) no previous history of cervical spinal surgery, cervical trauma, tumor, or infection, 3) minimum of one-year follow-up post laminoplasty with proper radiologic examinations performed in outpatient clinics, and 4) cases showing C7 and T1 vertebral body in the preoperative cervical sagittal plane. The radiologic parameters examined included C2–C7 Cobb angles, T1 slope, C2–C7 sagittal vertical axis (SVA), range of motion (ROM) from C2–C7, segmental instability, and T2 signal change observed on magnetic resonance imaging (MRI). Clinical factors examined included preoperative modified Japanese Orthopedic Association scores, disease classification, duration of symptoms, and the range of operation levels.ResultsMean preoperative sagittal alignment was 13.01° lordotic; 6.94° lordotic postoperatively. Percentage of postoperative kyphosis was 80%. Patients were subdivided into two groups according to postoperative Cobb angle change; a control group (n=22) and kyphotic group (n=27). The kyphotic group consisted of patients with more than 5° kyphotic angle change postoperatively. There were no differences in age, sex, C2–C7 Cobb angle, T1 slope, C2–C7 SVA, ROM from C2–C7, segmental instability, or T2 signal change. Multiple regression analysis revealed T1 slope had a strong relationship with postoperative cervical kyphosis. Likewise, correlation analysis revealed there was a statistical significance between T1 slope and postoperative Cobb angle change (p=0.035), and that there was a statistically significant relationship between T1 slope and C2–C7 SVA (p=0.001). Patients with higher preoperative T1 slope demonstrated loss of lordotic curvature postoperatively.ConclusionLaminoplasty has a high probability of aggravating sagittal balance of the cervical spine. T1 slope is a good predictor of postoperative kyphotic changes of the cervical spine. Similarly, T1 slope is strongly correlated with C2–C7 SVA.

Arthroscopic reconstruction for unstable scaphoid non-union

ObjectiveTo evaluate the results of arthroscopic reconstruction for the treatment of unstable scaphoid non-union with cancellous bone autograft. Methods13 patients were treated with a mean age of 26 (18–45) years. The average time from injury until surgery was 14 (6–48) months. Preoperative and postoperative clinical and radiological parameters were evaluated. Mean follow-up was 16.8 (12–36) months. ResultsConsolidation was achieved in all cases at 7 (4–10 weeks), no patient had complications or reoperations. Range of motion, pain, functional assessment (DASH questionnaire) and radiological measurements improved compared to preoperative measurements. The average range of flexion improved: flexion 71.9° (55°–80°) to 81.7° (55°–90°), extension 66.3° (30°–80°) to 84.4° (70°–90°), ulnar deviation 21.5 (10°–25°) to 25.5° (20°–45°) and radial deviation 11.9° (5°–25°) to 13.3° (10th–20th). Pain (VAS 0–10) improved from 6.8 (4–10) to 0.7 (0–3). DASH functional scale improved from 36 (12–78) to 8 (0–10).The Scapho-Lunate Angle improved from 67.7° (62°–88°) to 47° (32°–55°), and the Radio-Lunate Angle improved from 30.8° (10°–45°) to 4(0°–10°). ConclusionTreatment of unstable scaphoid non-union with cancellous bone graft assisted by arthroscopy presents good clinical results with a short period of consolidation and recovery.

Reconstrucción artroscópica de la seudoartrosis inestable del escafoides carpiano

ObjectiveTo evaluate the results of arthroscopic reconstruction for the treatment of unstable scaphoid non-union with cancellous bone autograft. Methods13 patients were treated with a mean age of 26 (18-45) years. The average time from injury until surgery was 14 (6-48) months. Preoperative and postoperative clinical and radiological parameters were evaluated. Mean follow-up was 16.8 (12-36) months. ResultsConsolidation was achieved in all cases at 7 (4-10 weeks), no patient had complications or reoperations. Range of motion, pain, functional assessment (DASH questionnaire) and radiological measurements improved compared to preoperative measurements. The average range of flexion improved: flexion 71.9° (55°-80°) to 81.7° (55°-90°), extension 66.3° (30°-80°) to 84.4° (70° -90°), ulnar deviation 21.5 (10°-25°) to 25.5° (20°-45°) and radial deviation 11.9° (5°-25°) to 13.3° (10th-20th). Pain (VAS 0-10) improved from 6.8 (4-10) to 0.7 (0-3). DASH functional scale improved from 36 (12-78) to 8 (0-10).The Scapho-Lunate Angle improved from 67.7° (62°-88°) to 47° (32°-55°), and the Radio-Lunate Angle improved from 30.8° (10° -45°) to 4(0°-10°). ConclusionTreatment of unstable scaphoid non-union with cancellous bone graft assisted by arthroscopy presents good clinical results with a short period of consolidation and recovery.

Prediction of height increment using preoperative radiological parameters following selective thoracic fusion with alternate-level pedicle screw construct in Lenke 1 and 2 adolescent idiopathic scoliosis patients.

This study aims to derive a formula to predict post-operative height increment in Lenke 1 and Lenke 2 adolescent idiopathic scoliosis (AIS) patients using preoperative radiological parameters. This study involved 70 consecutive Lenke 1 and 2 AIS patients who underwent scoliosis correction with alternate-level pedicle screw instrumentation. Preoperative parameters that were measured included main thoracic (MT) Cobb angle, proximal thoracic (PT) Cobb angle, lumbar Cobb angle as well as thoracic kyphosis. Side-bending flexibility (SBF) and fulcrum-bending flexibility (FBF) were derived from the measurements. Preoperative height and post-operative height increment was measured by an independent observer using a standardized method. MT Cobb angle and FB Cobb angle were significant predictors ( p < 0.001) of height increment from multiple linear regression analysis ( R = 0.784, R2 = 0.615). PT Cobb angle, lumbar, SB Cobb angle, preoperative height and number of fused segment were not significant predictors for the height increment based on the multivariable analysis. Increase in post-operative height could be calculated by the formula: Increase in height (cm) = (0.09 × preoperative MT Cobb angle) - (0.04 x FB Cobb angle) - 0.5. The proposed formula of increase in height (cm) = (0.09 × preoperative MT Cobb angle) - (0.04 × FB Cobb angle) - 0.5 could predict post-operative height gain to within 5 mm accuracy in 51% of patients, within 10 mm in 70% and within 15 mm in 86% of patients.

Digging Deeper into the Patello - Femoral Joint: Patello - Femoral Composite - A New Dimension for Overstuffing of Patello - Femoral Joint.

Patello-femoral complications are the most common complications in postoperative Total Knee Arthroplasty (TKA) patients especially overstuffing of Patello - Femoral Joint (PFJ). So, to study the effects of overstuffing of PFJ in postoperative TKA patients we put forth a new dimension - "PATELLO - FEMORAL COMPOSITE (PFC)". This is the maximum distance between anterior cortical line of femur shaft and the anterior cortex of patella with knee in full extension. To calculate chances of overstuffing of PFJ in postoperative TKA patients and document the effect of overstuffing of PFJ on the passive knee Range of Motion (ROM) in post- op TKA patients. This was a prospective observational study which included 51 consecutive primary TKAs. Preoperative and postoperative (24 weeks) passive knee ROM was measured. Preoperative and postoperative radiological parameters {PFC, Anterior Femur Offset (AFO), Patellar thickness (PT)} was recorded using Computed Tomography (CT) Scanogram image of patient in lateral view with knee in full extension and perfect overlap of both femur condyles, using DICOM format of the CT Scanogram image on the DICOM viewer. The postoperative PFC was more than its preoperative-value in 80.39% TKAs. Patients who had increased postoperative PFC had significantly less preoperative AFO. Female patients in our study had significantly less preoperative AFO compared to males. Thus, we deduced that female patients with lesser preoperative AFO undergoing TKA had increased postoperative PFC than male patients. PFC not only accounted for the overstuffing of the PFJ because of the patellar component, but also because of the femoral component; thus was a better measure of PFJ overstuffing compared to isolated PT. Passive knee ROM in the postoperative TKA patients approximately decreased by 2 degrees for every 1 mm increase in PFC compared to its preoperative-value in the patients with PFJ overstuffing. We conclude that overstuffing of the PFJ in postoperative TKA is present in 80.39% patients. Higher chances of postoperative PFJ over stuffing are present in female patients and those with thinner anterior cortex of distal femur. Postoperative passive knee ROM decreases significantly in patients with postoperative PFJ overstuffing (Every 1 mm increase in the postoperative PFC, passive knee ROM decreased by approximately 2 degrees).

Sarcopenia as a Novel Preoperative Prognostic Predictor for Survival in Patients with Bladder Cancer Undergoing Radical Cystectomy.

To investigate the prognostic significance of sarcopenia on long-term outcomes in patients with bladder cancer after radical cystectomy (RC). We retrospectively reviewed 136 patients undergoing RC for urothelial carcinoma at our institution. Prognostic impact of the preoperative clinical, laboratory, and radiologic parameters were evaluated by Cox proportional hazard model analyses, and a nomogram was developed to predict cancer-specific survival (CSS) after RC. The mean follow-up was 46.7months. Patients with sarcopenia had a significantly shorter CSS than those without sarcopenia. On univariate Cox analysis, clinical T stage, histology of transurethral resection of bladder tumor (TURBT) specimen, pretreatment hemoglobin, pretreatment neutrophil-to-lymphocyte ratio (NLR), pretreatment serum C-reactive protein level, pretreatment serum albumin level, presence of hydronephrosis, and presence of sarcopenia were associated with significantly worse CSS. On multivariate Cox stepwise analysis, sarcopenia (hazard rate [HR]=2.3, p=0.015), clinical T stage (cT4: HR=5.3; p=0.0096), presence of hydronephrosis (HR=2.0; p=0.033), histology of TURBT specimen (HR=2.2, p=0.044), and NLR (HR=1.3; p=0.0048) were significant independent predictors of an unfavorable prognosis Based on the results of the multivariate analysis, we developed a nomogram to predict 1-, 3-, and 5-year CSS after RC. Sarcopenia, clinical T stage, presence of hydronephrosis, histology of TURBT specimen, and NLR are novel preoperative prognostic factors even after adjustment for other known preoperative predictors in patients undergoing RC for bladder cancer.

Use of a Zero-Profile Device for Contiguous 2-Level Anterior Cervical Diskectomy and Fusion: Comparison with Cage with Plate Construct

A new zero-profile, standalone device (Zero P) was recently developed and has shown a lower incidence rate of complications and competitive clinical outcomes compared with anterior cervical cage with plate construct (CP) in single and multilevel anterior cervical diskectomy and fusion (ACDF). However, there is still concern whether Zero P is appropriate for multilevel ACDF. In addition, there have been few reports of contiguous 2-level ACDF used in conjunction with Zero P. We reviewed contiguous 2-level ACDF performed from December 2006 to February 2015. A total of 63 patients met inclusion criteria for the study (CP group= 32 cases; Zero P group= 31 cases). All preoperative and postoperative clinical and radiologic parameters were recorded. These parameters were compared between both groups. The postoperative change of Cobb S over time in the Zero P group was significantly different from that in the CP group. The maintenance of Cobb S in the Zero Pgroup was better than that in the CP group (P < 0.05). The maintenance of anterior intervertebral disk height (IDH) at postoperative assessment for the Zero P group was significantly better than that in the CP group (P < 0.05). Within-group comparison of the postoperative change of anterior and posterior IDH over time revealed that the anterior IDH was significantly lower than the posterior IDH in the Zero P group (P < 0.05). For 2-level contiguous ACDF, the use of a zero-profile device has the capacity to show compatible outcomes in correction and maintenance of segmental angle if the anterior titanium alloy plate is properly positioned at the anterior vertebral line.

Changes in hindfoot alignment after total knee arthroplasty in knee osteoarthritic patients with varus deformity.

Hindfoot alignment can affect the weight-bearing kinematics of the knee joint in patients undergoing total knee arthroplasty (TKA). This study evaluated the change in hindfoot alignment after TKA by prospectively analysing the correlation between the knee joint and the hindfoot deformity, the post-operative improvement in the hindfoot deformity, and the long-term post-operative changes in hindfoot alignment. This study included 195 knees from 117 patients with osteoarthritis who underwent TKA between 2012 and 2013. The mechanical alignment angle of the knee joint and the hindfoot alignment angle were measured preoperatively and 6weeks, 1, and 2years post-operatively. The patients were divided into two groups according to the severity of the preoperative knee joint deformity: <10° varus (group 1, N=81) and ≥10° varus (group 2, N=114). The preoperative and post-operative radiologic parameters of the axis of the knee joint and hindfoot were evaluated, and the results were compared. A Spearman correlation analysis was used to assess the differences in both the mechanical alignment and the hindfoot alignment pre- and post-operatively. After TKA, the hindfoot valgus deformity improved from 5.2° (±3.8) valgus to 2.1° (±3.9) valgus. At 6weeks post-operatively, the hindfoot alignment angle was 1.4° (±3.5) valgus and 2.5° (±4.1) valgus in group 1 and group 2, respectively; the difference between the two groups was not statistically significant. Hindfoot alignment showed greater valgus with increasing varus of the mechanical alignment of the knee joint preoperatively (-0.484, p<0.001) and post-operatively (-0.147, p=0.040). The post-operative 1- and 2-year hindfoot alignment angles were 2.2° (±4.2) valgus and 2.2° (±4.1) valgus, respectively. None of the differences between the post-operative hindfoot alignment angles were statistically significant. The stable improvement in the hindfoot deformity after TKA demonstrates that a valgus deformity of the hindfoot in a patient with a varus knee joint deformity does not require preoperative correction. In patients with a residual hindfoot deformity and pain 6weeks after TKA, active treatment should be considered because no further improvement can be expected. Prospective cohort study, Level II.

Preoperative and post-operative sleep quality evaluation in rotator cuff tear patients

The aim of this study was to examine the potential relationship between subjective sleep quality and degree of pain in patients with rotator cuff repair. Thirty-one patients who underwent rotator cuff repair prospectively completed the Pittsburgh Sleep Quality Index, the Western Ontario Rotator Cuff Index, and the Constant and Murley shoulder scores before surgery and at 6months after surgery. Preoperative demographic, clinical, and radiologic parameters were also evaluated. The study analysed 31 patients with a median age of 61years. There was a significant difference preoperatively versus post-operatively in terms of all PSQI global scores and subdivisions (p<0.001). A statistically significant improvement was determined by the Western Ontario Rotator Cuff Scale and the Constant and Murley shoulder scores (p˂0.001). Sleep disorders are commonly seen in patients with rotator cuff tear, and after repair, there is an increase in the quality of sleep with a parallel improvement in shoulder functions. However, no statistically significant correlation was determined between arthroscopic procedures and the size of the tear and sleep quality. It is suggested that rotator cuff tear repair improves the quality of sleep and the quality of life. IV.

Acute appendicitis in overweight patients: the role of preoperative imaging

BackgroundThe diagnosis of acute appendicitis in overweight patients is challenging due to the limited value of the clinical examination. The benefits of ultrasonography and abdominal CT have been studied in the general population, but there is limited data regarding their use in overweight and obese patients with suspected appendicitis. This study analyzes the role of preoperative radiological modalities in overweight patients with suspected appendicitis.MethodsRetrospective analysis of a prospectively acquired database including 705 patients operated for suspected acute appendicitis. Patients were divided into two groups according to their BMI (BMI ≥25 kg/m2 (n = 242) and BMI <25 kg/m2 (n = 463)). The use of preoperative radiological modalities, laboratory findings and outcome parameters were analyzed.ResultsUltrasonography was the preferred radiological assessment in our cohort (68 % in BMI <25 kg/m and 52.4 % in BMI ≥25 kg/m2). However, it was non-conclusive in 42 % of overweight as compared to 6 % in patients with a BMI < 25 (p < 0.0001). This difference was particularly obvious between female patients (8 % of non-conclusive US for BMI <25 kg/m2 vs 52 % for BMI ≥25 kg/m2, p < 0.0001). Significantly more CT scans were performed in overweight patients (37 % vs. 20 %; p <0.0001). The accuracy of CT did not differ according to BMI (85 % vs. 88 %; p = 0.76). Preoperative radiological imaging did not significantly delay surgery. Laparoscopy was the preferred approach for both groups (98.2 % vs 98.7 %, P = 0.86) with an overall conversion rate of 4 %. The overall rate of negative appendectomy was 10 %.ConclusionsThe role of ultrasonography in patients with BMI ≥25 kg/m2 with suspected acute appendicitis is questionable due to its high rate of non-conclusive findings. Therefore, abdominal CT scans should be preferred to investigate suspected appendicitis in overweight patient if clinical findings are not conclusive.

Preoperative LIV Tilt Affects Post Operative Coronal Imbalance in Patients with Lenke 5C Scoliosis

IntroductionLenke 5C curves are increasingly being treated through posterior pedicle screw based correction techniques. We evaluated different preoperative radiological parameters which could affec...

Preoperative Segmental Disc Geometry as a Possible Predictor fo r the Clinical Outcome of Lumbosacral Total Disc Replacement

Total disc replacement has been developed as an alternative to fusion. However, several factors are associated with an inferior clinical mid-term outcome. There is a need for simple but well-defined preoperative factors, which have a predictive value and facilitate patient selection for lumbosacral total disc replacement (TDR). Therefore, in the present study we investigated preoperative radiological parameters to serve as predictors for the clinical outcome after TDR at the lumbosacral junction. A total of 34 patients (16 females, 18 males) with the primary diagnosis of lumbosacral degenerative disc diseases who underwent TDR between 08/2005 and 12/2010 were evaluated in a clinical examination (Oswestry Disability Questionnaire (ODI) and visual analog scale (VAS) for overall, back, and leg pain) after a mean follow-up of 59.5 (24–87) months. A correlation analysis was performed between preoperative radiological parameters (segmental lordosis (SL), mean disc height (meanDH), anterior (aDH), middle (mDH), and posterior disc height (pDH) as well as geometrical relationships of these parameters: nA Index=aDH/meanDH, nP-Index=pDH/meanDH, AP-Index=aDH/ pDH, and nAP Index=aDH/pDH/meanDH) and clinical pain scales (ODI, VAS) at follow-up. Particularly the relationships nA-Index, AP-Index, and nAP-Index were found to be strongly negatively correlated to the clinical outcome. Weaker correlation was found between: ODI and aDH, nA-Index, AP-Index (negative), and nP-Index (positive); VAS overall and SL, nP Index, mDH, and pDH (positive); and VAS back and nP-Index, and pDH (positive). The preoperative normalized anterior-disc-height-index (nA Index) and the normalized anterior-posterior-discheight- index (nAP-Index) can serve as prognostic radiographic parameters before patients undergo lumbosacral TDR.

Preoperative Risk Factors for Recurrent Lumbar Disk Herniation in L5-S1.

Although numerous studies have reported on recurrent lumbar disk herniation (rLDH), few have reported on recurrence of L5-S1 level. We investigated whether the preoperative risk factors, such as disk degeneration, disk height, sagittal range of motion (sROM), width of L5 vertebral transverse process, and iliac crest height, have any effect on rLDH in L5-S1. A retrospective case control study. A total of 467 patients were enrolled in this study. The disk degeneration, disk height, sROM, width of L5 vertebral transverse process, and iliac crest height were calculated using magnetic resonance imaging and simple radiography. We compared the clinical parameters (age, sex, body mass index, symptom duration, diabetes, smoking, preoperative visual analogue scale, herniation type, annular defect size) and preoperative radiologic parameters [disk degeneration, disk height, sROM, relative width of L5 vertebral transverse process (RT), iliac crest height index (IHI)] of recurrent and nonrecurrent groups. Patient with rLDH had its onset 39.4±17.9 months (7-90 mo) after primary surgery. Of the 39 rLDH cases, herniation was ipsilateral to previous LDH in 29 patients and contralateral in 10. Multiple logistic regression analysis showed that moderate disk degeneration with preserved height (group B), a large sROM, a small RT, a low IHI, and being male were significant risk factors for rLDH. Moderate disk degeneration, a large sROM, a small RT, and a low IHI are biomechanical risk factors of rLDH in L5-S1. The results also suggested being male and having a large annular defect increase recurrence after discectomy, especially in cases of ipsilateral rLDH.