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Journals
Year of Publication
1.  Three Different Methods in Deformity Correction of Degenerative Flat Back: A Single Surgeon's Experience with 64 Consecutive Cases 
Asian Spine Journal  2015;9(3):361-369.
Study Design
Retrospective study.
Purpose
To evaluate the radiological and clinical results of three different methods in the deformity correction of a degenerative flat back.
Overview of Literature
There are no comparative studies about different procedures in the treatment of degenerative flat back.
Methods
Sixty-four patients who consecutively underwent corrective surgery for degenerative flat back were reviewed. The operations were performed by three different methods: posterior-only (group P, n=20), one-stage anterior-posterior (group AP, n=12), and two-stage anterior-posterior with iliac screw fixation (group AP-I, n=32). Medical and surgical complications were examined and radiological and clinical results were compared.
Results
The majority of medical and surgical complications were found in group AP (5/12) and group P (7/20). The sagittal vertical axes were within normal range immediately postoperatively in all groups, but only group AP-I showed normal sagittal alignment at the final follow-up. Postoperative lumbar lordosis was also significantly higher in group AP-I than in group P or group AP and the finding did not change through the last follow-up. The Oswestry disability index was significantly lower in groups AP and AP-I than in group P at the final follow-up. Meanwhile, the operating time was the longest in group AP-I, and total amount of blood loss was larger in group AP-I and group AP than in group P.
Conclusions
Anterior-posterior correction showed better clinical results than posterior-only correction. Two-staged anterior-posterior correction with iliac screw fixation showed better radiological results than posterior-only or one-staged anterior-posterior correction. Two-staged anterior-posterior correction with iliac screw fixation also showed a lower complication rate than one-staged anterior-posterior correction.
doi:10.4184/asj.2015.9.3.361
PMCID: PMC4472584  PMID: 26097651
Lumbar vertebrae; Kyphosis; Surgical procedures; Treatment outcome
2.  Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography? 
Annals of Rehabilitation Medicine  2016;40(2):362-367.
Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA.
doi:10.5535/arm.2016.40.2.362
PMCID: PMC4855133  PMID: 27152289
Cervical radiculopathy; Magnetic resonance imaging
3.  Radiological Stability after Revision of Infected Total Knee Arthroplasty Using Modular Metal Augments 
Purpose
To evaluate the radiological stability according to the number of modular augments after revision of infected total knee arthroplasty (TKA).
Materials and Methods
Between February 2006 and September 2013, 37 patients (39 knees) followed ≥2 years after revision of infected TKA using modular metal augments for bone defects were reviewed retrospectively. We divided the patients into 3 groups according to the number of augments into group A (≤2 augments, 14 knees), group B (3–4 augments, 18 knees), and group C (5≥ augments, 7 knees) and evaluated the width of radiolucent zones around the implant at the last follow-up.
Results
There were 3 Anderson Orthopedic Research Institute type I, 33 type II, and 3 type III bone defects. The mean number of radiolucent zones of group A was 3 and the sum of width averaged 4.4 mm. In group B, the values were 4.8 and 6.2 mm, respectively. In group C, the values were 8.1 and 12.9 mm, respectively. The differences between the three groups were statistically significant.
Conclusions
In revision TKA with modular metal augmentation caused by infected TKA, increased modularity can result in radiological instability.
doi:10.5792/ksrr.2016.28.1.55
PMCID: PMC4779806  PMID: 26955613
Knee; Revision arthroplasty; Modular metal augmentation; Radiologic stability
4.  Ultrasound-Guided Percutaneous Removal of Wooden Foreign Bodies in the Extremities with Hydro-Dissection Technique 
Korean Journal of Radiology  2015;16(6):1326-1331.
Objective
We described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases.
Materials and Methods
Four patients referred to the radiology department for US evaluation and US-guided percutaneous removal of the FBs in the upper and lower extremities between November, 2006 and November, 2013 were included in this study. The procedures started with US evaluation for the exact location and shape of the FB. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. We adopted a hydrodissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution. Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. After the tip of the mosquito forceps reached the FB, the wooden FBs were removed.
Results
The mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance.
Conclusion
Ultrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.
doi:10.3348/kjr.2015.16.6.1326
PMCID: PMC4644755  PMID: 26576123
Ultrasound; Intervention; Foreign bodies; Surgery
5.  Surgical Correction in Patients with Lumbar Degenerative Kyphosis Who Had Low Bone Mineral Density: An Analysis of 40 Patients with a Minimum Follow-Up of Two Years 
Asian Spine Journal  2015;9(1):65-74.
Study Design
Retrospective study.
Purpose
To investigate influence of bone mineral density (BMD) on the surgical correction of lumbar degenerative kyphosis (LDK).
Overview of Literature
No studies so far have reported the influence of BMD on the surgical correction of LDK.
Methods
Forty LDK patients with more than 2 years follow-up were studied. Pelvic incidence (PI), pelvic tilt, sacral slope, sagittal vertical axis (SVA), lumbar lordosis (LL), and thoracic kyphosis were measured preoperatively, immediate postoperatively and at final follow-up. Adverse outcomes: proximal adjacent fractures, sagittal decompensation, pseudoarthrosis, and cage subsidence were documented.
Results
There were 37 females and 3 males. Average age was 65.1±4.5 years and mean follow-up was 34.2±16.7 months. 42.5% were Takemitsu type 3 curves, 27.5% type 2, 20.0% type 4 and 10.0% type 1. 37.5% had osteopenia, 40.0% osteoporosis and 22.5% had severe osteoporosis. SVA improved from 237.0±96.7 mm preoperatively to 45.3±41.8 mm postoperatively (p=0.000). LL improved from 10.5°±14.7° to -40.6°±10.9° postoperatively (p=0.000). At final follow-up SVA deteriorated to 89.8±72.2 mm and LL to 34.7°±15.8° (p=0.000). The association between late sagittal decompensation, pseudoarthrosis, or proximal adjacent fractures and osteoporosis was insignificant. The difference between immediate postoperative LL and PI (PIDiff) had a significant association with sagittal decompensation and pseudoarthrosis.
Conclusions
Osteoporosis did not influence the degree of correction, late sagittal decompensation, proximal adjacent fractures, and pseudoarthrosis in LDK. PIDiff had a significant association with sagittal decompensation and pseudoarthrosis.
doi:10.4184/asj.2015.9.1.65
PMCID: PMC4330221  PMID: 25705337
Lumbar degenerative kyphosis; Bone mineral density; Surgery; Outcome; Osteoporosis
6.  Efficacy of Intra-Articular Injection of Thrombin-Based Hemostatic Agent in the Control of Bleeding after Primary Total Knee Arthroplasty 
Knee Surgery & Related Research  2014;26(4):236-240.
Purpose
To evaluate the hemostatic effect of intraarticular injection of a thrombin-based hemostatic agent in total knee arthroplasty (TKA).
Materials and Methods
We performed a prospective randomized controlled trial on the use of a thrombin-based hemostatic agent in patients undergoing unilateral TKA. A total of 100 TKA patients were enrolled, with 50 patients randomized into the study group and the other 50 patients into the controlled group. Drain output, hemoglobin level, total red blood cell loss for 24 hours after surgery, transfusion rates, and complications were assessed.
Results
Postoperative drain output was 525 mL in the study group and 667 mL in the control group (p=0.01). Nine patients in the study group and eighteen in the control group received blood transfusion (p=0.043). But, there was no significant difference between two groups in terms of hemoglobin level change and total red blood cell loss (p>0.05).
Conclusions
The thrombin-based hemostatic agent demonstrated efficacy in reducing drain output and blood transfusion rates. Thus, we believe the use of a thrombin-based hemostatic agent should be considered as an option in orthopedic surgery that involves massive bleeding.
doi:10.5792/ksrr.2014.26.4.236
PMCID: PMC4258491  PMID: 25505706
Knee; Osteoarthritis; Arthroplasty; Bleeding; Hemostatic agent
7.  Surgical Treatment of T1-2 Disc Herniation with T1 Radiculopathy: A Case Report with Review of the Literature 
Asian Spine Journal  2012;6(3):199-202.
The prevalence of intervertebral disc herniation (IDH) of the thoracic spine is rare compared to the cervical or lumbar spine. In particular, IDH of the upper thoracic spine is extremely rare. We report the case of T1-2 IDH and its treatment, with a literature review. A 37-year-old male patient visited our hospital due to radiating pain at the left upper extremity and weakness of grip power. In cervical spine magnetic resonance images, T1-2 disc space showed herniated disc material and compressed T1 root was identified. Laminoforaminotomy was performed with a posterior approach. The radiating pain and weakness of grip power improved immediately after the surgery. Of patients who show radiating pain or numbness at the medial aspect of forearm, or weakness of intrinsic muscle of hand, can be suspected to have T1 radiculopathy. A detailed physical examination and a radiologic evaluation including this area should be required for the T1 radiculopathy.
doi:10.4184/asj.2012.6.3.199
PMCID: PMC3429611  PMID: 22977700
Thoracic Vertebrae; Intervertebral Disc; Radiculopathy; Laminotomy
8.  Ipsilateral femoral neck and shaft fracture in children: a report of two cases and a literature review 
Concomitant ipsilateral fractures of the neck and shaft of the femur in children are rare. The most recent report in this context found a total of only nine reported cases (<12 years of age) following a search of the indexed English literature. These injuries occur in children due to high-velocity trauma, and there is no generally accepted method of treatment. We report three additional cases from the literature and two cases of our own. In our cases, one had a residual 10° varus deformity at the subtrochanteric level in the femur, but this did not affect hip function. Another patient exhibited a limp at final follow-up due to leg length discrepancy, and peroneal nerve palsy at the time of injury. We advocate operative stabilization of the femoral shaft fracture first to reduce the risk of further displacement and simplify the subsequent reduction of the femoral neck. The series shows that these rare injuries have a poor prognosis, with high rates of incidence of avascular necrosis, coxa vara, and leg length discrepancy.
doi:10.1007/s10195-012-0188-9
PMCID: PMC3667384  PMID: 22562084
Femoral neck fracture; Ipsilateral femoral shaft fracture; Children
9.  Ipsilateral femoral neck and shaft fracture in children: a report of two cases and a literature review 
Concomitant ipsilateral fractures of the neck and shaft of the femur in children are rare. The most recent report in this context found a total of only nine reported cases (<12 years of age) following a search of the indexed English literature. These injuries occur in children due to high-velocity trauma, and there is no generally accepted method of treatment. We report three additional cases from the literature and two cases of our own. In our cases, one had a residual 10° varus deformity at the subtrochanteric level in the femur, but this did not affect hip function. Another patient exhibited a limp at final follow-up due to leg length discrepancy, and peroneal nerve palsy at the time of injury. We advocate operative stabilization of the femoral shaft fracture first to reduce the risk of further displacement and simplify the subsequent reduction of the femoral neck. The series shows that these rare injuries have a poor prognosis, with high rates of incidence of avascular necrosis, coxa vara, and leg length discrepancy.
doi:10.1007/s10195-012-0188-9
PMCID: PMC3667384  PMID: 22562084
Femoral neck fracture; Ipsilateral femoral shaft fracture; Children
10.  Late diagnosis of medial condyle fracture of the humerus with rotational displacement in a child 
For displaced medial condyle fractures in children, open reduction with internal fixation seems to be most popular treatment method. The major complication of this method is failure to make the proper early diagnosis. Corrective supracondylar humeral osteotomy has been preferred to open reduction and internal fixation for managing malunited fragments. We report a case of a child with nonunion of the medial condyle of the humerus who was subsequently treated successfully with open reduction and internal fixation.
doi:10.1007/s10195-011-0155-x
PMCID: PMC3225620  PMID: 21879318
Late diagnosis; Open reduction; Medial condyle; Humerus; Child
11.  Late diagnosis of medial condyle fracture of the humerus with rotational displacement in a child 
For displaced medial condyle fractures in children, open reduction with internal fixation seems to be most popular treatment method. The major complication of this method is failure to make the proper early diagnosis. Corrective supracondylar humeral osteotomy has been preferred to open reduction and internal fixation for managing malunited fragments. We report a case of a child with nonunion of the medial condyle of the humerus who was subsequently treated successfully with open reduction and internal fixation.
doi:10.1007/s10195-011-0155-x
PMCID: PMC3225620  PMID: 21879318
Late diagnosis; Open reduction; Medial condyle; Humerus; Child

Results 1-11 (11)