Radiographic Outcomes Research Articles

Intramedullary nailing for concomitant extra-articular ulnar head fractures in distal radial fractures

Four adult female patients were treated with an intramedullary Steinmann pin for an unstable extra-articular distal ulnar fracture associated with a distal radial fracture treated with plate osteosynthesis. All showed good radiographic and functional outcomes. One patient required removal of the Steinmann pin.

Efficacy and safety of upadacitinib in patients with active ankylosing spondylitis refractory to biologic therapy: 2-year clinical and radiographic results from the open-label extension of the SELECT-AXIS 2 study

Abstract Background The efficacy and safety of upadacitinib in patients with ankylosing spondylitis (AS) and inadequate response/intolerance to biologic disease-modifying antirheumatic drugs (bDMARD-IR) were evaluated through 1 year in the SELECT-AXIS 2 study. Here, we assess 2-year efficacy, safety, and imaging outcomes in SELECT-AXIS 2. Methods Patients who received continuous upadacitinib, and those who switched from placebo to upadacitinib at week 14, could enter the open-label extension (OLE). Efficacy endpoints included Assessment of SpondyloArthritis international Society (ASAS) and Axial Spondyloarthritis Disease Activity Score (ASDAS) responses, and changes from baseline in measures of disease activity, back pain, function, and quality of life. Radiographic progression was evaluated using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). As observed (AO) and AO with non-responder imputation (AO-NRI) analyses were used for binary endpoints; AO with mixed-effects model for repeated measures (AO-MMRM) for continuous endpoints; and AO-analysis of covariance for mSASSS. Treatment-emergent adverse events (TEAEs) in patients receiving ≥ 1 upadacitinib dose through week 104 are presented as events (E)/100 patient-years (PY). Subgroup analyses were performed by prior tumor necrosis factor/interleukin-17 inhibitor exposure and bDMARD lack of efficacy/intolerance. Results Of 420 patients who entered the bDMARD-IR AS study, 409 entered the OLE, and 331 (continuous upadacitinib, n = 163; placebo to upadacitinib, n = 168) completed week 104. Improvements in efficacy measures were sustained through the OLE, with similar response rates between the continuous upadacitinib and placebo to upadacitinib groups at week 104. At week 104, 64.9% and 61.7% of patients, respectively, had achieved ASAS 40% response (AO-NRI). Mean changes from baseline were similar between the two groups at week 104 across measures (ASDAS: -2.1 and -2.0; total back pain: -4.9 and -4.6, respectively; AO-MMRM). Over 93.0% of patients showed no radiographic progression (mSASSS mean change from baseline < 2) at week 104. The overall TEAE rate was 165.2 E/100 PY, with low rates of major adverse cardiovascular and venous thromboembolic events (0.3 E/100 PY each). Conclusions Upadacitinib efficacy, including very low rates of radiographic progression, was demonstrated through 104 weeks in treatment-refractory patients with active AS. Treatment was well tolerated, with no newly identified safety signals. Trial registration NCT04169373.

Clinical and Radiographic Results in Thoracic Hyperkyphosis Surgical Treatment Considering the Optimal Distal Fusion Area

Introduction: The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of patients who underwent posterior correction and fusion for thoracic hyperkyphosis, with a focus on determining the optimal distal fusion level. Methods: From 2006 to 2012, 26 patients with a median age of 16.8 years (range 14–25), diagnosed with either idiopathic hyperkyphosis or Scheuermann’s kyphosis, underwent posterior fusion and Ponte osteotomies at two medical centers. Radiographic evaluations were performed preoperatively, immediately postoperatively, and at the final follow-up and included assessments of fusion extension, Cobb angle, sagittal balance, and the presence of junctional kyphosis or discopathy. Results: The median follow-up period was 12.3 years (range 11–17). Good clinical outcomes were observed in 24 patients, with no cases of hardware failure. The distal fusion area included the first lordotic vertebra in 17 patients, the sagittal stable vertebra in four patients, and both in five patients. Cobb angle correction was maintained at 50% at the final follow-up (p > 0.05). Significant sagittal balance correction was achieved in 87% of patients immediately postoperatively and was maintained at the final follow-up (p > 0.05). Junctional kyphosis occurred in two patients whose fusion area included only the first lordotic vertebra. Conclusions: Including at least the first lordotic vertebra in the fusion area is crucial for preventing junctional kyphosis. Extending the fusion to the stable vertebra can reduce the incidence of distal junctional kyphosis, especially in symptomatic young adult patients, potentially avoiding the need for revision surgery.

Does the clinical and radiologic outcomes following total knee arthroplasty using a new design cobalt-chrome tibial plate or predecessor different?

Abstract Background This study aimed to compare clinical and radiographic outcomes for a new tibial component (Attune S +) and the previous design (Attune S) in total knee arthroplasty (TKA) patients using ATTUNE® posterior stabilized (PS) prosthesis and also assessed related factors for the development of tibial radiolucent line(RLL). Methods This retrospective study included 362 knees (179 Attune S, 183 Attune S +) with an average 4 years (range, 2–8) follow-up. Clinical outcomes, radiologic parameters and the incidence of RLL around the tibial component were compared through the serial assessment. For the subgroup analysis, radiologic parameters were compared between patients with and without RLL. Results There was no significant difference in terms of clinical outcomes and radiologic parameters between two designs. The incidence of RLL was not different through the serial follow-up (P > 0.05). In the subgroup analysis, the preoperative medial proximal tibial angle (83.7° versus 85.0°, P = 0.01) was smaller and preoperative hip-knee-ankle angle (169.1° versus 171.8°, P = 0.01) has more varus in the group with RLL than those without. Conclusions The clinical and radiologic outcomes including the incidence of tibial RLL between new design and predecessor were not significantly different at average 4 years follow-up. The development of tibial RLL was associated with preoperative varus deformity of tibia and lower limb alignment.

Maxillary Sinus Mucosa Preservation Versus Mucosal Sacrifice: Radiographic Outcomes After Inferior Maxillectomy and Soft‐Tissue Free Flap Reconstruction

ABSTRACTBackgroundThis study evaluates the impact of maxillary sinus mucosa preservation on radiographic outcomes after an inferior maxillectomy and soft‐tissue free flap reconstruction.MethodsA total of 90 patients in two cohorts (mucosal sacrifice versus mucosa preservation) were evaluated from an institutional dataset. Imaging was reviewed at set time points and sinus scores were allotted based on a modification of the Lund—MacKay system. Patients were evaluated for changes in sinus scores. A univariate (UVA) and multivariate (MVA) analysis was performed.ResultsIn gp1 (mucosal sacrifice), mean postoperative sinus score was 1.21 ± 1.30 (p = < 0.001) at 24 months. On UVA, advanced T‐stage at 12 months (OR 7.143, 95% CI 1.484–34.384, p = 0.014) and 24 months (OR 5.500, 95% CI 1.219–24.813, p = 0.027), and on MVA, advanced T‐stage were associated with increased odds for higher sinus score (OR 4.993, 95% CI 1.084–22.995, p = 0.039). In Gp2 (Mucosa preserved), the mean postoperative sinus score was 0.31 ± 0.47 (p = 0.021) at 24 months. On UVA and MVA, no predictors were identified for a higher sinus score.ConclusionFollowing an inferior maxillectomy and soft‐tissue free flap reconstruction, notably reduced sinus scores were seen in patients with preservation of the remaining maxillary sinus mucosa.

Transfibular Total Ankle Arthroplasty: Clinical, Functional, and Radiographic Outcomes and Complications at a Minimum of 5-Year Follow-up

Background: The Trabecular Metal Total Ankle Implant differs from other newer-generation implants in the transfibular approach, multiplanar external frame for alignment, tantalum trabecular metal interfaces, curved geometry, and shallow resection depths. The primary aim of this study was to report midterm clinical and radiographic results, as well as survivorship and adverse events at a minimum of 5-year follow-up. Methods: A total of 83 ankles (81 patients, average age 60.6 years old, 50.6% females) with average 6.3 years’ (range, 5.0-10.1) follow-up were included. Postoperative patient-reported outcome measures (PROMs) included SF-12 physical (PCS) and mental component summary (MCS) scores, Ankle Osteoarthritis Scale (AOS), pain visual analog scale (VAS). Radiographic outcomes included postoperative range of motion (ROM) and coronal/sagittal alignment. Adverse events were reported using the Canadian Orthopaedic Foot and Ankle Society Reoperation Coding System (CROCS). Results: Preoperative tibiotalar coronal deformity included 27 valgus (10 degrees, range 2-20 degrees) and 25 varus ankles (−9 degrees, range −2 to −25 degrees), corrected to neutral postoperatively. Postoperative tibiopedal ROM was 17.8 degrees dorsiflexion and 21.8 degrees plantarflexion. Adverse events occurred at average 28.7 months, most commonly gutter debridement (n = 17, 16.7%) and subsequent operative treatment unrelated to metal components (n = 10, 12.0%). There were 2 cases (2.4%) of acute deep infection treated with irrigation and debridement, polyethylene exchange, and retention of metal components without recurrence of infection. There were no cases of fibular nonunion, septic or aseptic loosening, or implant subsidence. Postoperative PROMS included SF-12 PCS: 40.4; SF-12 MCS: 56.0; VAS: 2.3; AOS Pain: 17.0; and AOS Disability: 24.9. Overall implant survival, defined by retention of the metal components, was 100% at final follow-up. Conclusion: At a minimum of 5 years, patients who underwent TM TAA reported minimal ankle pain and regained neutral ankle alignment and mobility, without septic or aseptic implant loosening. Although having certain limitations, this study suggests that TM TAA is a viable option for the treatment of end-stage ankle arthritis.

Long‐Term Clinical and Radiographic Outcomes of Hydrophilic Implants: A 10‐Year Study in a Specialist Private Practice

ABSTRACTAimTo report the 10‐year clinical and radiographic outcomes of implants placed in grafted (GBR) and non‐grafted (no‐GBR) sites in a Swiss specialist private practice using hydrophilic implants with a low surface roughness flange.MethodsFifty consecutively enrolled patients received 159 hydrophilic implants with a low surface roughness flange. A first re‐evaluation was performed 1 year after delivery of restoration (T1). An additional examination was performed at the 10‐year follow‐up (T2) including the assessment of clinical (i.e., periodontal/peri‐implant pockets probing depths (PPD) (mm), full‐mouth bleeding score (%), implant survival rate, mid‐buccal keratinized mucosa (KM) width in mm, and peri‐implant phenotype), and radiographic (i.e., marginal bone level change [ΔMBL]) outcomes. Biological, mechanical and technical complications were also recorded.ResultsOut of the initial cohort, 22 patients (9/40.9% male and 13/59% female) and 63 implants (47 with GBR, 16 without GBR), could be re‐examined at T2. Overall, ΔMBL (T2‐T1) was −0.56 ± 0.96 mm. In the GBR group, ΔMBL were significantly higher at the distal sites compared to the no‐GBR group (−0.75 ± 1.17 mm vs. −0.12 ± 1.29 mm, p = 0.045), however, in the GBR group MBL started at a higher level at T1 but were similar with the no‐GBR group at T2. Implant survival was 100% with only very few technical complications (6.3%). Mean PPD amounted to 3.84 ± 1.00 mm with significantly higher values in the GBR group (3.98 ± 1.08 mm vs. 3.45 ± 0.60 mm; p = 0.016). Nineteen implants (30.1%) were diagnosed with peri‐implant health while 44 (69.9%) presented with peri‐implant mucositis.ConclusionWithin the limitations of this study, favorable clinical and radiographic conditions were recorded around hydrophilic implants with a low surface roughness flange placed in pristine and augmented bone after 10 years in function.

Clinical Comparison of Endoscopic Posterior Lumbar Interbody Fusion and Open Posterior Lumbar Interbody Fusion for Treating Lumbar Spondylolisthesis

Study Design: A retrospective case-control study. Objective: To compare the clinical efficacy of endoscopic (Endo) and open posterior lumbar interbody fusion (PLIF) in treating lumbar spondylolisthesis. Background: Endo-PLIF has emerged as a new technique for treating lumbar spondylolisthesis. We propose Endo-PLIF as an alternative method. Materials and Methods: Sixty-four patients with single-segment lumbar spondylolisthesis underwent Endo-PLIF (n = 39) or open PLIF (n = 25) treatment. Demographic data, perioperative parameters, and radiographic parameters were recorded. Clinical results were evaluated by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. The fusion rate was evaluated by computed tomography at 12 months postoperatively. In addition, a case-control process was included to ensure unbiased comparisons. Results: The average operation time was longer in the Endo-PLIF group. Endo-PLIF showed advantages in reducing blood loss, shortening hospital stay, and early ambulation, but with a longer x-ray exposure time. Both VAS and ODI scores significantly improved in both groups, but the VAS for back pain was lower in the Endo-PLIF group. The radiographic results were similar in both groups. Three patients in the Endo-PLIF group had minor complications. Two patients in the open PLIF group experienced cerebrospinal fluid leakage. Both VAS and ODI scores significantly improved in both groups compared with preoperative scores, but the Endo-PLIF group showed more significant improvement at early follow-up (P < 0.05). There was no significant difference in interbody fusion rate between the two groups. Conclusion: Both Endo-PLIF and open PLIF are effective for treating single-segment lumbar spondylolisthesis. Endo-PLIF shows advantages in reducing blood loss, shortening hospital stays, and promoting early ambulation, with comparable fusion rates and patient satisfaction to open PLIF. Despite minor complications in the Endo-PLIF group and cerebrospinal fluid leakage in the open PLIF group, both procedures lead to significant improvements in pain and disability scores, with Endo-PLIF demonstrating more significant early improvements.

Comparative long-term outcomes of Petit-Morel versus overhead traction methods versus immediate closed reduction for late-detected developmental dysplasia of the hip: A systematic review

Purpose: This study aimed to compare the clinical and radiographic outcomes of traction to assist reduction in patients with late-detected developmental dislocation of the hip using the Petit-Morel technique versus the Bryant overhead traction technique, and to compare the clinical and radiographic outcomes of these two traction techniques with immediate closed reduction. Methods: A comprehensive systematic search of the MEDLINE/PubMed, EMBASE, and Web of Science databases was performed to identify relevant studies. Studies on Petit-Morel and overhead traction techniques and immediate closed reduction were then screened, selected, and data collected; included studies were assessed using the Methodological Index for Non-Randomized Studies criteria. Results: In total, 22 studies met the inclusion criteria. The Petit-Morel group had a successful reduction rate of 87% while the overhead traction group had a successful reduction rate of 67.1%, and the immediate closed reduction group had a successful reduction rate of 78.4% (Petit-Morel versus overhead traction, p < 0.001; overhead traction versus immediate closed reduction, p < 0.001, Petit-Morel versus immediate closed reduction, p = 0.021). The Petit-Morel group had an overall avascular necrosis rate of 2.7%, compared to 10.6% for overhead traction and 21.5% for immediate closed reduction (Petit-Morel versus overhead traction, p = 0.001; Petit-Morel versus immediate closed reduction, p < 0.001; overhead traction versus immediate closed reduction, p < 0.001). The Petit-Morel group achieved a satisfaction rate of 86.4% according to the Severin classification, as compared to 71.2% in the overhead traction group and 76.4% in the immediate closed reduction group (Petit-Morel versus overhead traction, p < 0.001; Petit-Morel versus immediate closed reduction, p = 0.018; overhead traction versus immediate closed reduction, p = 0.195). Conclusion: Petit-Morel and overhead traction techniques did not outperform immediate closed reduction in terms of redislocation rates, and radiological satisfaction, the Petit-Morel technique, has lower clinically significant avascular necrosis rates than overhead traction and immediate closed reduction. Level of evidence: Level III.

Triple Pelvic Osteotomy for Hip Dysplasia: The Akbulut-Coskun Technique Using a Modified Stoppa Approach.

Many successful osteotomies have been reported for the treatment of acetabular dysplasia. However, triple pelvic osteotomy remains a technically challenging procedure with potential for significant complications. This study examined a series of Tönnis periacetabular osteotomy (TPAO) procedures performed using the modified Stoppa approach to treat acetabular dysplasia in adolescents. To describe the radiographic outcomes, complications, and early functional results of TPAO using the modified Stoppa approach for acetabular dysplasia in adolescents. This study included 16 patients (20 hips) who underwent TPAO using the modified Stoppa approach for symptomatic acetabular dysplasia. The characteristics of the patients and the surgical procedure were discussed. The radiologic outcome was evaluated using the lateral center-edge (CE) and Tönnis roof angles. Perioperative data including surgery duration, blood loss, and complications were recorded. Complications were also discussed. The mean age of the patients was 11.5±1.1 (10 to 13) years. The mean preoperative anteroposterior CE angle was 14.7±3 degrees (7 to 19 degrees), and the mean postoperative angle was 35.7±3.1 degrees (30 to 42 degrees; P<0.001). The mean preoperative Sharp's angle was 55.9±5.4 degrees (48 to 65 degrees), and the postoperative mean was 33±5 degrees (24 to 40 degrees; P<0.001). The mean Tönnis angle before and after osteotomy was 23.3±7.1 degrees (17 to 36 degrees) and 7.1±2 degrees (4 to 10 degrees), respectively (P<0.001). The mean operative time was 42.2±10.3 minutes with a mean blood loss of 167.7±50.3mL. One patient sustained a bladder injury as a major complication. The use of TPAO with the intrapelvic modified Stoppa approach in the treatment of hip dysplasia provides the benefits of a single incision, access to 2 hips in the same session, positional advantage, and abductor function preservation. Early results are satisfactory and safe. Level IV.

Radiographic Outcome Following Treatment of Residual Hip Dysplasia with Pemberton Versus Salter Osteotomy: Comparison of Results in Patients Followed to Skeletal Maturity.

Salter osteotomy (SO) and Pemberton acetabuloplasty (PA) are procedures to treat skeletally immature patients with developmental dysplasia of the hip (DDH). The purpose of this study was to compare the radiographic results and rate of residual dysplasia (RD) after treatment with SO and with PA. This was a retrospective analysis of pediatric patients treated with either SO or PA for DDH between 1980 and 2013 who were skeletally mature at the time of follow-up. The preoperative and postoperative acetabular index (AI) and postoperative lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) were collected. RD was defined as an LCEA or ACEA of <20° or an acetabular inclination (AIn) of >15° at skeletal maturity. Continuous variables were compared between treatment groups with 2-sample t tests, and categorical variables were compared using chi-square tests. Multivariable analysis was used to identify risk factors for RD with p < 0.05. The study included 113 hips in 102 patients with a mean follow-up of 10.5 years. The SO group had 73 hips treated at a mean patient age of 5.4 years, and the PA group had 40 hips treated at a mean age of 5.3 years. The preoperative AI did not differ between the treatment groups (32.2° versus 31.3°, p = 0.658), nor did the immediate postoperative AI (20.0° versus 20.2°, p = 0.459). At the time of final follow-up, the SO group had a significantly smaller AIn (8.6° versus 13.2°, p = 0.001), a trend toward a greater LCEA (26.2° versus 21.6°, p = 0.056), and a similar ACEA (24.1° versus 26.1°, p = 0.808). By the abovementioned definition, 36 hips (31.9%) had evidence of RD, with a lower rate in the SO group (26.0% versus 42.5%, p = 0.07). Patients who had a positive family history of hip dysplasia were more likely to have RD (odds ratio = 4.311, 95% confidence interval = 1.125 to 16.528). Patients with RD could be effectively treated with either SO or PA, with overall good radiographic outcomes. However, SO achieved a better AI and may thus yield better long-term health of the affected hip. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Multicenter Randomized Clinical Trial of Highly Cross-Linked Polyethylene Versus Conventional Polyethylene in 518 Primary TKAs at 10 Years

Background: Second-generation highly cross-linked polyethylene (HXLPE) has revolutionized total hip arthroplasty. However, the long-term risks and benefits of HXLPE in primary total knee arthroplasty (TKA) remain unknown. This randomized clinical trial evaluated implant survivorship, complications, radiographic results, and clinical outcomes of HXLPE and conventional ultra-high molecular weight polyethylene (UHMWPE) inserts in primary TKAs. Methods: We enrolled 518 patients (518 knees) who underwent primary TKA in 3 centers within 1 tertiary referral network. The mean age was 67 years, the mean body mass index was 32 kg/m2, and 58% of the patients were women. All of the patients underwent primary TKA with a cemented posterior-stabilized tibial insert and patellar resurfacing. Randomization proceeded via stratified dynamic allocation. The patients were blinded to their study group allocation: those in the control group (254 knees) underwent TKA with an UHMWPE insert (N2Vac; Stryker); those in the treatment group (264 knees) received an HXLPE insert (X3; Stryker). Kaplan-Meier survivorship, radiographic results, and clinical outcomes were assessed. This trial was registered with ClinicalTrials.gov. The mean follow-up was 11 years. Results: The 10-year overall survivorship free from any revision and from any reoperation was 96% and 94%, respectively. There were no differences in the risk of revision or reoperation between the groups (p &gt; 0.05). There were a total of 19 revisions. Revision indications included periprosthetic joint infection (14 knees), instability (4 knees), and open reduction and internal fixation (ORIF) for a patellar fracture due to osteolysis around a UHMWPE insert (1 knee). There were no revisions due to polyethylene wear, osteolysis, or fracture of the post in the HXLPE group. The radiographic results and clinical outcomes were otherwise similar. Conclusions: Notably, no wear-related failures were identified in the HXLPE group, but there was 1 case of osteolysis in the UHMWPE group. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Clinical Efficacy of CBCT and 3D-Printed Replicas in Molar Autotransplantation: A Controlled Clinical Trial.

To evaluate the efficacy of the combined cone-beam (CBCT)/3D-replicas protocol on the clinical and radiographic outcomes of autotransplanted molars. Controlled clinical trial registered ISRCTN13563091 from August 2019 to September 2022. Patients aged 13-22 years requiring permanent premolar extraction and having at least one non-erupted third molar were enrolled at the Institute of Stomatology, Stradins University, Riga, Latvia. Patients in the 3D-replicas (n = 30) underwent maxillary CBCT scans and had 3D-printed replicas of the third molar fabricated, while the control group (n = 28) did not. The clinical outcomes included tooth mobility, bleeding on probing, and periodontal pocket depth assessed at 3, 6, and 12 months. The radiographic outcomes included root development, obliteration, periapical status, and crown changes at 12 months. Of the 55 patients assigned to interventions, 46 completed the study. No significant differences in survival and radiographic outcomes were found between the control (n = 22) and 3D-replica group (n = 24): root development (p = 0.3), root resorption (p = 0.057), periapical status (p = 0.7), and crown/root ratio change (p = 0.4). Logistic regression showed no significant associations between radiologic predictors (root resorption: p = 0.4; periapical status: p > 0.9; root development: p = 0.8). Significant clinical outcome predictors included total operative time (β = 0.0043, p = 0.049), Moorrees' stage (stage 4: β = -0.31, p < 0.001; stage 5: β = -0.39, p < 0.001), and four donor placement times (β = 0.93, p < 0.001), but group assignment was not a significant predictor. The CBCT/3D-replica protocol showed no significant differences in the clinical or radiological outcomes. The high success rates in both groups suggest that the protocol is valuable primarily for optimizing surgical efficiency and as a training tool for clinicians.

Urethral obstruction in a ram with a periurethral abscess: clinical findings, diagnostic imaging and pathology

BackgroundUrethral obstruction is a common and life-threatening condition in male small ruminants.Case presentationThis case report describes a 3-year old 103 kg Zwartbles breeding ram, presented with the complaint of straining, suspected to have an urethral obstruction. The work-up included clinical examination, laboratory analyses, ultrasound imaging, (contrast) radiography and urine examination. At presentation, blood analysis revealed a respiratory alkalosis, hyperkalaemia and mild azotaemia. On transabdominal ultrasound an enlarged bladder (diameter 11 cm) and free fluid surrounding the right kidney were observed. Treatment of the animal included tube cystostomy, intravenous perfusion, antimicrobial treatment, ammonium chloride and NSAIDs. No indications for urolithiasis were found on ultrasound, radiography, or urine examination. As no improvement was seen despite 16 days of therapy, a contrast radiograph of the urinary tract, as well as reproductive exam were conducted. Positive anterograde urethrogram showed a contrast filled cavitary lesion at the caudal aspect of the pelvic urethra. The reproductive ultrasonography revealed the same large urethral distention or abscess compressing the pelvic urethra, as well as severe testicular degeneration in both testis. The results of the contrast radiograph and the reproductive exam lead to the decision to euthanize the animal, as the animal would not be capable of breeding. Computed tomography was performed post-mortem, which showed close relation between the cavitary lesion and the left bulbourethral gland. Pathology revealed a lymphoplasmacytic to suppurative infection at the level of the urogenital tract, chronic interstitial nephritis and a perirenal to cortical abscess of the right kidney as well as a periurethral abscess. As for the reproductive system, multifocal interstitial inflammatory infiltrates were seen on the entire system. Marked fibrosis and atrophy was seen at the level of the testes and both epididymides.ConclusionsA periurethral abscess should be included in the differential diagnosis for an urethral obstruction in small ruminants. The extensive medical imaging, together with the ante-mortem and post-mortem findings, makes this a good reference case for diagnosticians confronted with urethral problems in a ram.

Long-term Clinical and Radiographic Results of Posteromedial Lateral Release for Neuromuscular Clubfoot Deformity.

Clubfoot occurs in up to 50% of patients with spina bifida (SB) and 90% with arthrogryposis (AR). Many of these patients with neuromuscular clubfoot deformity fail conservative casting and require surgery with posteromedial lateral release (PMLR). Limited data exist for the outcomes of PMLR in patients with SB and AR. Retrospective chart review was performed on PMLR in patients with SB and AR from January 2007 to June 2022, excluding those with follow-up <3 years or incomplete charts. Radiographic measurements were obtained pre-PMLR and post-PMLR when available. In total, 51 patients with 79 cases of clubfeet treated with PMLR at a tertiary children's hospital were identified. Of those, 35 patients with 54 cases of clubfeet treated with PMLR were analyzed, including 22 patients (29 feet) with SB and 13 patients (25 feet) with AR. In the SB cohort, 41% of feet required reoperation at an average of 4.6 years, and 76% of AR feet required reoperation at an average of 4.7 years post-PMLR. In addition, 21% of SB feet and 8% of AR feet required 2 or more reoperations. Talectomy was required post-PMLR in 24% of SB feet and 40% of AR feet at an average of 4.9 and 5.9 years, respectively. Younger age at time of PMLR was associated with significantly increased reoperation rates in AR (P=0.01). Greater change in calcaneus-fifth metatarsal angle after PMLR was associated with a future need for reoperation (P=0.047). Greater talo-first metatarsal angle after PMLR was associated with a future need for reoperations of any kind (P=0.040) in SB. Although PMLR remains a safe and successful treatment in the short term, many neuromuscular clubfeet will require additional procedures. Younger age and greater preoperative versus postoperative changes in calcaneus-fifth metatarsal and postoperative talo-first metatarsal angles were associated with increased reoperation rate. These results help orthopaedic surgeons counsel families about the long-term prognosis of clubfoot treatment in SB and AR. Level IV.

Efficacy of Stand-Alone Anterior Lumbar Interbody Fusion With PEEK Cages, BMP-2, and Allografts for Treating Discogenic Low Back Pain: Assessing Clinical and Radiographic Outcomes.

Chronic low back pain secondary to degenerative disc disease is a significant public health issue worldwide, contributing to substantial health care burdens and patient disability. Anterior lumbar interbody fusion (ALIF) has emerged as a promising surgical solution, offering benefits such as disc height restoration, reduced neural compression, and improved spinal alignment. This study evaluates the efficacy of stand-alone ALIF using polyetheretherketone (PEEK) cages, structural femoral head allografts, and recombinant human bone morphogenetic protein-2 (rhBMP-2) in treating discogenic low back pain caused by degenerative disc disease. This prospective case series study included 1335 patients who underwent stand-alone ALIF by a single surgeon. The surgical construct involved PEEK cages with structural femoral allograft dowels and rhBMP-2, supplemented by anterior fixation. Patient-reported outcome measures, including the visual analog scale for back and leg pain, the Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and patient satisfaction, were monitored over 12 months. The overall fusion rate was 99.6%, with pseudoarthrosis occurring in 0.2% of patients. Lower fusion rates were observed in patients older than 65 years and those using the Brantigan cage. Significant improvements were seen in visual analog scale for back and leg pain, Oswestry Disability Index, and Roland-Morris Disability Questionnaire scores from baseline, with most scores exceeding the substantial clinical benefit thresholds. More than 85% of patients reported "Excellent" or "Good" outcomes. Stand-alone ALIF, augmented with rhBMP-2 and structural femoral head allografts, can enhance mechanical stability, fusion rates, and radiographic assessment. This integrated approach achieves successful spinal fusion and positive clinical outcomes for patients with refractory discogenic low back pain. Stand-alone ALIF with PEEK cages, structural femoral head allografts, and rhBMP-2 demonstrates high fusion rates and significant clinical improvements in patients with discogenic low back pain. This approach enhances spinal stability and promotes biological healing, making it a reliable and effective surgical option.

Influence of the deviated center of rotation on facet joint degeneration after cervical disc replacement – an in vivo study with a minimum of 10-year follow-up

BackgroundShort term results of the change of center of rotation (COR) after Bryan cervical disc replacement (CDR) have been reported. However, there is a lack of long-term studies focusing on the COR and its influences on facet joint degeneration.ObjectiveTo evaluate the long-term clinical and radiographic results of Bryan CDR, and to explore the influence of deviated COR on facet joint degeneration at index level.MethodsIt is a retrospective follow up study conducted in China. Eighty-three consecutive patients who received single-level Bryan CDR were retrospectively reviewed. Clinical evaluation included Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Odom’s scale. Radiographic evaluation underwent before surgery, at early follow-up (3 months) and last follow-up (10 years). The radiographic parameters included range of motion (ROM), location of COR presented by the coordinates (COR-x, COR-y), and facet joint degeneration score. Correlation analysis was conducted between changes of COR and facet joint degeneration score.ResultsFifty-nine patients were included, with an average age of 44.6 ± 7.4 years. The mean follow-up time was 135.7 ± 12.4 (120–155) months. JOA score, NDI and Odom’s scale showed significant improvements at last follow-up. The ROM was well preserved through follow-up. 33 patients (55.9%) showed deterioration of facet joint degeneration at index level. The increment of facet joint degeneration score at index level was strongly correlated with the change of COR-x (r = 0.758, P < 0.001), and weakly correlated with the change of COR-y (r=-0.473, P < 0.001). The deviation of COR was significantly greater in Group Degeneration than that in Group Non-degeneration (14.8 ± 10.5% vs. -2.6 ± 8.1% for COR-x, and − 6.4 ± 7.5% vs. 0.8 ± 8.3% for COR-y).ConclusionsBryan CDR with minimum of 10-year follow-up achieved favorable clinical outcome and good maintenance of ROM. Deviated COR could be an important risk factor for facet joint degeneration.

A Comparison of Clinical and Radiographic Outcomes Between Isolated Total Talus Replacement and Combined Total Talus Replacement with Total Ankle Arthroplasty or Hindfoot Arthrodesis

Total talus replacement (TTR) is a viable surgical option in the setting of talar avascular necrosis and collapse, as well as a revision option for failed total ankle arthroplasty with talar implant subsidence. The purpose of the present study was to compare the clinical and radiographic outcomes following isolated TTR and TTR combined with total ankle arthroplasty or hindfoot arthrodesis.Patients who underwent TTR were retrospectively reviewed, as a multicenter consecutive case series. Basic demographic data, comorbidities and surgical date were collected. Medical records were reviewed to obtain postoperative and preoperative visual analog scale (VAS) scores, American Orthopedic Foot and Ankle society (AOFAS) outcome scores, postoperative complications and radiographic measurements. Statistical analysis was conducted to compare radiographic and patient-reported outcomes pre- and postoperatively. Thirty-six patients underwent TTR with mean follow-up of 25.39 months.VAS pain scores improved postoperatively from 8.43 to 2.67 (P <0.001). AOFAS improved postoperatively from 36.33 to 81.78 (P < 0.001). There was an overall improvement in talar arc length (P = 0.035), talar width (P = 0.0037), talar height (P < 0.001), Bohler's (P < 0.001) and Gissane's angle (P = 0.004). The overall complication and subsequent surgery rate were each 16.7%. The TTR implant survivorship rate was found to be 94.5%. When comparing outcome scores between Isolated TTR and Combined TTR, no significant differences were detected in the degree of improvement.Both isolated and combined TTR provide a suitable and safe option for the treatment of advanced talar AVN or associated tibiotalar and hindfoot arthritis.

Effect of Facet Joint Resection on Postoperative Radiographic and Clinical Outcomes After Microendoscopic Laminectomy for Single-Level Lumbar Spinal Stenosis

Facet joint destruction causes postoperative spinal instability, resulting in poor clinical outcomes after lumbar decompression surgery. However, the effect of facet joint destruction on radiographic and clinical outcomes after microendoscopic laminectomy (MEL) is unknown. Therefore, the current study aimed to examine the effect of facet joint resection on radiographic and clinical outcomes after single-level MEL surgery. This study included 116 patients with lumbar spinal canal stenosis (LSCS) who underwent single-level (L4/5) MEL surgery. Eligible patients were divided into the following groups: group P (facet joint preservation rate = 100%) (n = 70); group PR (50% ≤ the facet joint preservation rate < 100%) (n = 27); and group R (the facet joint preservation rate < 50%) (n = 19). The demographic characteristics of the patients, surgical data, pre- and 1-year postoperative radiographic measurements, and clinical outcomes were compared among the three groups. Moreover, pre- and postoperative radiographic and clinical outcomes were compared after adjusting the demographic characteristics of the patients and surgical data by the inverse probability weighting method with propensity scores. The three unweighted groups did not significantly differ in terms of demographic characteristics, surgical data, and pre- and postoperative radiographic and clinical outcomes. Even after adjusting for the demographic characteristics and surgical data, the pre- and postoperative radiographic and clinical outcomes were comparable among the three weighted groups. The extent of facet joint resection might have a minimal impact on radiographic and clinical outcomes at 1 year after single-level MEL surgery.

Improved clinical and radiographic outcomes with expandable cages in transforaminal lumbar interbody fusion: a propensity-matched cohort analysis.

The restoration of sufficient overall lumbar lordosis (LL) and segmental LL (SL) is associated with achieving optimal sagittal balance, decreasing back pain, and enhancing functional outcomes for patients. Expandable cages were developed in hopes of improving radiographic parameters and clinical outcomes, although current clinical evidence is inconclusive. Here, the authors aimed to evaluate the clinical and radiographic outcomes in patients undergoing one- or two-level open transforaminal lumbar interbody fusion (TLIF) with expandable versus static cage placement, using propensity-matched cohorts. An institutional retrospective cohort of patients who underwent one- or two-level open TLIF with either expandable cage or static cage placement was identified. Using relevant preoperative covariates, including age, primary versus revision operation, number of cages implanted, and surgical level implanted, the authors built propensity-matched cohorts. They identified clinical outcomes in both cohorts, including operative characteristics and complication rates, along with pain, weakness, and sensory deficits over follow-up. Furthermore, they extracted and examined preoperative, postoperative, and last follow-up radiographic parameters. A total of 148 patients were included, and they were followed for a mean of 1.7 years (range 0.5-4.3 years). Propensity matching was used to create cohorts of patients who were similar with respect to age, surgical indication, revision status, number of cages implanted, surgical level implanted, and length of follow-up. Patients in both groups had similar preoperative radiographic parameters. Patients with expandable cages saw larger increases in SL, both postoperatively (5.3° ± 7.5° vs 1.6° ± 5.6°, p = 0.006) and at last follow-up (5.7° ± 7.4° vs 1.0° ± 6.1°, p = 0.003). They also saw significant improvements in pelvic incidence minus LL mismatch at last follow-up (-4.4° ± 13.2° vs 5.8° ± 13.8°, p = 0.009). No differences in intraoperative or perioperative complications were found, but patients with expandable cages were less likely to require readmission, develop adjacent-segment disease, or require revision surgery. They were also more likely to be symptom free at 1 month after surgery and at last follow-up. Expandable cages lead to better restoration of radiographic features, including SL and improvements in clinical outcomes, compared with static cages in propensity-matched cohorts in patients undergoing one- or two-level open TLIFs.