4.

While bracing is the standard conservative treatment for acute osteoporotic compression fracture, the efficacy of different brace treatments has not been extensively studied. We aimed to clarify and compare the preventive effect of the different brace treatments on the deformity of the vertebral body and other clinical results in this patient cohort. This multicenter nationwide prospective randomized study included female patients aged 65–85 years with acute one-level osteoporotic compression fractures. We assigned patients within four weeks of injury to either a rigid-brace treatment or a soft-brace treatment. The main outcome measure was the anterior vertebral body compression percentage at 48 weeks. Secondary outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), visual analog scale (VAS) for lower back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A total of 141 patients were assigned to the rigid-brace group, whereas 143 patients were assigned to the soft-brace group. There were no statistically significant differences in the primary outcome and secondary outcome measures between groups. In conclusion, among patients with fresh vertebral compression fractures, the 12-week rigid-brace treatment did not result in a statistically greater prevention of spinal deformity, better quality of life, or lesser back pain than soft-brace.

No abstract

No abstract

No abstract

Study Design. Retrospective clinical review and prospective report of postoperative delirium after cervical spine surgeries.Objective. To investigate factors contributing to the development of delirium after cervical surgery and see whether amended therapeutic protocols could improve or alter postoperative outcomes.Summary of Background Data. Important consequences of postoperative delirium for the orthopedic patients include impaired recovery and increased morbidity and mortality. Although its risk factors have been reported in orthopedic surgery, there are a very few reports regarding postoperative delirium in spine surgery.Methods. Eighty-one cervical myelopathy patients were retrospectively examined about the incidence of postoperative delirium and the risk factors. Similarly, 41 patients who received postoperative care under modified protocols were prospectively examined.Results. Postoperative delirium occurred more commonly in patients over 70 years and those with hearing impairment. Patients who received high-dose methylprednisolone (Ͼ1000 mg) demonstrated an increased incidence of postoperative delirium. Under modified protocol, we reduced the usage of methylprednisolone and encouraged free body movement with cervical orthosis immediately after surgery. The incidence of postoperative delirium was significantly lower under the modified protocol.Conclusion. Early commencement of mobilization after cervical spine surgery would be crucial to the prevention of postoperative delirium in the elderly.Key words: postoperative delirium, cervical spine surgery, hearing impairments, methylprednisolone. Spine 2009;34: 2500-2504Delirium is an acute and relatively sudden decline in attention-focus, perception, and cognition and known to occur usually in the elderly people.1 Its incidence is known to increase during the perioperative period and it can cause major medical management problems. Several previous reviews indicate that delirium may affect a large proportion of orthopedic patients and report prevalence rates of 28% to 61%. 2,3 Although the incidence in hip and knee joint surgery has been widely reported, there are few studies regarding postoperative delirium in spine surgery. 4,5 Increasing age, blood urea levels, cardiothoracic index, hypertension, smoking habits, blood replacement during bypass, atrial fibrillation (AF), pneumonia, and blood fluid balance in the postoperative period were found to be significant risk factors for delirium by logistic regression analysis.6 Previous reports also suggest that prior cognitive impairment and reduced hemoglobin and hematocrit levels are significant risk factors for postoperative delirium. With the development of modern medicine, the percentage of elderly people in the population is increasing and thus the incidence of postoperative delirium would increase. Spinal surgery in general and cervical spinal surgery in particular entail specific management problems and risk factors. During the postoperative phase of cervical spine surgery, it is essential to maintain spina...

These findings should be kept in mind when choosing the highly porous ceramics.

Local bone denervation by magnetic resonance-guided focused ultrasound (MRgFUS) is a promising tool for alleviation of pain in patients with painful bone metastasis (BM). Considering the underlying mechanism of pain alleviation, MRgFUS might be effective for various bone and joint diseases associated with local tenderness. This study was conducted to clarify the therapeutic effect of focused ultrasound in patients with various painful bone and joint diseases that are associated with local tenderness. Ten patients with BM, 11 patients with lumbar facet joint osteoarthritis (L-OA), and 19 patients with knee osteoarthritis (K-OA) were included. MRgFUS treatment was applied to the bone surface with real-time temperature monitoring at the target sites. Pain intensity was assessed using a 100 mm numerical rating scale (NRS) at various time points. Pressure pain threshold (PPT) was evaluated on the sonication area and control sites. Compared to baseline, the pain NRS scores significantly decreased in all groups 1 month after treatment, and PPT at the treated sites significantly increased in all groups 3 months after treatment. The percentage of patients who showed a ≥ 50% decrease in pain NRS scores at 1 month after treatment was 80% in BM, 64% in L-OA, and 78% in K-OA groups. PPTs were significantly higher after treatment at all evaluation time points. This study indicated that MRgFUS is effective in reducing pressure pain at the site of most severe tenderness in patients with painful bone and joint diseases. Treatment response was comparable between patients with BM, L-OA, and K-OA.