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OBJECTIVEAs life expectancy continues to increase, primary degenerative sagittal imbalance (PDSI) is diagnosed in an increasing number of elderly people. Although corrective surgery for this sagittal deformity is becoming more popular, the effectiveness of the procedure remains unclear. The authors aimed to collate the available evidence on the effectiveness and complications of deformity-correction surgery in patients with PDSI.METHODSThe authors carried out a meta-analysis of clinical studies regarding deformity correction in patients with PDSI. The studies were identified through searches of the PubMed, Embase, Web of Science, and Cochrane databases. Surgery outcomes were evaluated and overall treatment effectiveness was assessed in terms of the minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) values and pain levels according to visual analog scale (VAS) scores and in terms of restoration of spinopelvic parameters to within a normal range. Data are expressed as mean differences with 95% CIs.RESULTSTen studies comprising 327 patients were included. The VAS and ODI values improved after deformity-correction surgery. The smallest treatment effect exceeded the MCID for VAS values (4.15 [95% CI 3.48–4.82]) but not for ODI values (18.11 [95% CI 10.99–25.23]). At the final follow-up visit, the mean lumbar lordosis angle (−38.60° [95% CI −44.19° to −33.01°]), thoracic kyphosis angle (31.10° [95% CI 24.67°–37.53°]), C-7 sagittal vertical axis (65.00 mm [95% CI 35.27–94.72 mm]), and pelvic tilt angle (30.82° [95% CI 24.41°–37.23°]) remained outside their normal ranges. Meta-regression analyses revealed a significant effect of ODI change in relation to lumbar lordosis change (p = 0.004). After a mean of 2 years after deformity correction, the mean lumbar lordosis angle and C-7 sagittal vertical axis decreased by 5.82° and 38.91 mm, respectively, and the mean thoracic kyphosis angle increased by 4.7°. The incidences of proximal junctional kyphosis and pseudarthrosis were 23.7% and 12.8%, respectively.CONCLUSIONSDeformity correction substantially relieves back pain for about 2 years in adult patients with PDSI. Sufficient surgical restoration of lumbar lordosis can lead to substantial improvement in patient disability and reduced decompensation. Deformity correction represents a viable therapeutic option for patients with PDSI, but further technical advancements are necessary to achieve sufficient lumbar lordosis and reduce complication rates.

ObjectiveC5 palsy is a severe complication after cervical spine surgery, the pathophysiology of which remains unclear. This multicenter study investigated the incidence of C5 palsy following cervical spine surgery in Korea. MethodsWe conducted a retrospective multicenter study involving 21 centers from the Korean Cervical Spine Study Group. The inclusion criteria were cervical spine surgery patients between 2012 and 2016, excluding cases of neck surgery. In patients with C5 palsy, the operative methods, disease category, onset time of C5 palsy, recovery time, C5 manual muscle testing (MMT) grade, and post-C5 palsy management were analyzed. ResultsWe collected 15,097 cervical spine surgery cases from 21 centers. C5 palsy occurred in 88 cases (0.58%). C5 palsy was more common in male patients (p=0.019) and after posterior approach procedures (p<0.001). C5 palsy usually occurred within 3 days after surgery (77 of 88, 87.5%) and most C5 palsy patients recovered within 6 months (51 of 88, 57.95%). Thirty C5 palsy patients (34.09%) had motor weakness, with an MMT grade≤2. Only four C5 palsy patients (4.5%) did not recover during follow-up. Posterior cervical foraminotomy was performed in 7 cases (7.95%), and steroids were used in 56 cases (63.63%). Twenty-six cases (29.55%) underwent close observation only. ConclusionThe overall incidence of C5 palsy was relatively low (0.58%). C5 palsy was more common after posterior cervical surgery and in male patients. C5 palsy usually developed within 3 days after surgery, and more than half of patients with C5 palsy recovered within 6 months.

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Objective This study explored the effects of obesity on clinical manifestations, disease activity and organ damage in Korean patients with systemic lupus erythematosus (SLE). Methods We assessed 393 SLE patients annually for three consecutive years based on demographic information, clinical manifestations, laboratory findings and Physician Global Assessment, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2000 and Systemic Lupus International Collaborating Clinics (SLICC) damage index (SDI) scores. Patients were grouped by body mass index (BMI): normal weight, BMI <23 kg/m2; overweight, 23 kg/m2 ≤BMI <25 kg/m2; obese, BMI ≥25 kg/m2. The impact of obesity on clinical outcomes was assessed using univariate and multivariate analyses. Results Of the 393 patients, 59 (15.0%) were obese at enrollment. They had more comorbidities compared with non-obese patients, including diabetes, hypertension, hyperlipidemia and pulmonary hypertension. Nephritis at enrollment and newly developed nephritis during follow-up were more common ( p = 0.002 and p = 0.002, respectively) and Physician Global Assessment and SDI scores were higher in these patients for three consecutive years ( p = 0.017 and p = 0.039, respectively). Multivariate analysis revealed that obesity was significantly associated with development of nephritis during follow-up (odds ratio = 26.636; 95% confidence interval, 11.370–62.399; p < 0.001) and cumulative organ damage (odds ratio = 4.096; 95% confidence interval, 2.125–7.894, p < 0.001). Conclusions The incidences of newly developed nephritis and cumulative organ damage were higher in obese SLE patients than in non-obese SLE patients.

INTRODUCTIONBleeding into the brain parenchyma occurs in the cases of up to 40% of ruptured aneurysms and the presence of ICH caused by ruptured aneurysms are associated with much higher mortality rates (1). On the other hand, simultaneous occurrence of aneurysmal SAH and hypertensive ICH is very rare with only two cases having been previously reported in the literatures (2, 3). To our knowledge, the case presented here would be the third report of aneurysmal SAH accompanied by hypertensive ICH in the remote area from the site of the ruptured aneurysm. CASE REPORT HistoryA 68-yr-old man with a history of untreated chronic hypertension experienced a sudden onset of headache followed closely by loss of consciousness on January 24, 1998. He recovered over time but suffered from right hemiparesis. Computed tomographic (CT) scan checked at a local hospital showed both SAH in the basal cistern, intraventricular hemorrhage at both lateral ventricles, and ICH at the left putamen ( Fig. 1). After several days of conservative management, aggravated headache and seizure attack followed by neurological deterioration led him to be transferred to our hospital on January 29. ExaminationOn admission, the patient was drowsy with right hemiparesis and his pupils were equal in size and reactive to light. The blood pressure was 250/150 mmHg and other laboratory data were unremarkable. Cerebral angiography demonstrated a 7 mm sized saccular aneurysm at the anterior communicating artery (Fig. 2). There were no other vascular lesions, especially at left putaminal area. OperationNine days after the ictal attack of SAH, the aneurysmal neck was successfully clipped via the left frontotemporal craniotomy without removing the left putaminal hematoma. On postoperative neurological examination, he was stuporous Simultaneous occurrence of aneurysmal subarachnoid hemorrhage (SAH) and hypertensive intracerebral hemorrhage (ICH) is very rare and only two cases have been previously reported in the literatures. We present a case of 68-yr-old man with a history of untreated hypertension, who suffered from sudden onset of headache followed by right hemiparesis. Computed tomographic (CT) scan revealed SAH in the basal cistern and remote ICH at the left putamen. Cerebral angiography showed a saccular aneurysm at the anterior communicating artery.No other vascular anomaly could be found at left putaminal area. Nine days after the ictal attack of SAH, the neck of aneurysm was clipped via the left frontotemporal craniotomy. Because of the ICH at the left frontal lobe and intraventricular hematoma on postoperative CT, we performed hematoma removal and external ventricular drainage 3 hours after the first operation. Postoperative neurological status had been improved to be drowsy and he was discharged in a severely disabled state 4 weeks after surgery. We suggest that the rupture of aneurysm possibly caused a rapid increase in blood pressure and subsequently resulted in hypertensive ICH.