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BackgroundComplications and failure of vertebroplasty, such as cement dislodgement, cement leakage, or spinal infection, usually result in spinal instability and neural element compression. Combined anterior and posterior approaches are the most common salvage procedure for symptomatic failed vertebroplasty. The purpose of this study is to evaluate the feasibility and efficacy of a single posterior approach technique for the treatment of patients with symptomatic failed vertebroplasty.MethodsTen patients with symptomatic failed vertebroplasty underwent circumferential debridement and anterior reconstruction surgery through a single-stage posterior transpedicular approach (PTA) from January 2009 to December 2011 at our institution. The differences of visual analog scale (VAS), neurologic status, and vertebral body reconstruction before and after surgery were recorded. The clinical outcomes of patients were categorized as excellent, good, fair, or poor based on modified Brodsky’s criteria.ResultsThe symptomatic failed vertebroplasty occurred between the T11 and L3 vertebrae with one- or two-level involvement. The average VAS score was 8.3 (range, 7 to 9) before surgery, significantly decreased to 3.2 (range, 2 to 4) after surgery (p < 0.01), and continued to decrease to 2.4 (range, 2 to 3) 1 year later (p < 0.01). The average correction of Cobb’s angle after surgery was 17.3° (range, 4° to 35°) (p < 0.01). The mean loss of Cobb’s angle correction after 1 year of follow-up was 2.7° (range, 0° to 5°). The average allograft subsidence at 1 year after surgery was 1 mm (range, 0 to 2). The neurologic status of Frankel’s scale significantly improved after surgery (p = 0.014) and at 1 year after surgery (p = 0.046). No one experienced severe complications such as deep wound infection or neurologic deterioration. All patients achieved good or excellent outcomes after surgery based on modified Brodsky’s criteria (p < 0.01).ConclusionsSingle-stage PTA surgery with circumferential debridement and anterior reconstruction technique provides good clinical outcomes and low complication rate, which can be considered as an alternative method to combined anterior and posterior approaches for patients with symptomatic failed vertebroplasty.

Although the current study involved only a small number of patients and the intervention comprised three stages, we believe that such a protocol may be a valuable alternative for the treatment of recalcitrant distal femoral nonunion.

Graphene's impact on future applications is intimately linked to advances in the synthesis of high quality materials. Chemical vapor deposition (CVD) shows great potential in this area but insufficient connectivity between single-crystalline domains deteriorates the achievable electrical and mechanical performance. We here demonstrate that the inter-grain connectivity can be significantly improved by adding a second material in the vicinity of the growth substrate. This promoter decreases the amount of structural defects that remain at the grain boundaries of conventionally grown graphene even after 6 hour growth. A two-step growth process was employed to selectively enhance the grain connectivity while maintaining an identical graphene grain morphology with and without a promoter. Graphite was found to yield the largest enhancement in the connectivity of graphene grains due to its high catalytic activity compared to other promoter materials. A novel cap-design ensured a large scale and uniform improvement of the inter-grain connectivity results which led to an enhancement of large scale carrier mobilities from 2700 cm(2) V(-1) s(-1) to 4000 cm(2) V(-1) s(-1) and highlights the potential of our approach to improving the connectivity of CVD-grown graphene.

Purpose This study aimed to develop a quantitative dry cupping system that can monitor negative pressure attenuation and soft tissue pull-up during cupping to quantify soft tissue compliance. Methods Baseball players with myofascial pain syndrome were recruited to validate the benefits of cupping therapy. Nine of 40 baseball players on the same team were diagnosed with trapezius myofascial pain syndrome; another nine players from the same team were recruited as controls. All participants received cupping with a negative pressure of 400 mmHg for 15 minutes each time, twice a week, for 4 weeks. Subjective perception was investigated using upper extremity function questionnaires, and soft tissue compliance was quantified objectively by the system. Results During the 15-minute cupping procedure, pressure attenuation in the normal group was significantly greater than that in the myofascial group (p = 0.017). The soft tissue compliance in the normal group was significantly higher than that in the myofascial group (p = 0.050). Moreover, a 4-week cupping intervention resulted in an obvious increase in soft tissue lift in the myofascial pain group (p = 0.027), although there was no statistical difference in the improvement of soft tissue compliance. Shoulder (p = 0.023) and upper extremity function (p = 0.008) were significantly improved in both groups, but there was no significant difference between the two groups. Conclusion This quantitative cupping monitoring system could immediately assess tissue compliance and facilitate the improvement of soft tissues after cupping therapy. Hence, it can be used in athletes to improve their functional recovery and maintain soft tissues health during the off-season period.

Aims This study reports the outcomes of a technique of soft-tissue coverage and Chopart amputation for severe crush injuries of the forefoot. Patients and Methods Between January 2012 to December 2016, 12 patients (nine male; three female, mean age 38.58 years; 26 to 55) with severe foot crush injury underwent treatment in our institute. All patients were followed-up for at least one year. Their medical records, imaging, visual analogue scale score, walking ability, complications, and functional outcomes one year postoperatively based on the American Orthopedic Foot and Ankle Society (AOFAS) and 36-Item Short-Form Health Survey (SF-36) scores were reviewed. Results The mean length of follow-up was 18.6 months (13 to 28). Two patients had a local infection, flap necrosis was seen in one patient, and one patient experienced a skin graft wound healing delay. Of the 12 patients, one had persistent infection and eventually required below-knee amputation, but pain-free walking was achieved in all the other patients. The mean one-year postoperative AOFAS and SF-36 scores were 75.6 (68 to 80) and 82 (74 to 88), respectively. Conclusion Although our sample size was small, we believe that this treatment method may be a valuable alternative for treating severe foot crush injuries. Cite this article: Bone Joint J 2018;100-B:1359–63.

Instrumented spinal fusion has become one of the most common surgeries for patients with various spinal disorders. Only few studies have reported subsequent vertebral compression fractures (VCFs) after instrumented spinal fusion. The purpose of this study was to evaluate the risk of new VCFs in patients undergoing instrumented spinal fusion.We obtained claims data from the National Health Insurance Research Database of Taiwan and retrospectively reviewed 6949 patients with instrumented spinal fusion as the spinal fusion cohort. Control subjects were individually matched at a ratio of 10:1 with those of the spinal fusion cohort according to age, sex, and the index day. Comorbidities were classified as those existing before the index day, and these included diabetes mellitus, hypertension, osteoporosis, and cerebrovascular accident. The end of the follow-up period for the analyses was marked on the day new VCFs developed, enrolment in the National Health Insurance was terminated, on the day of death, or until the end of 2012. We used the Cox proportion hazards model to analyze the hazard ratio (HR) for developing new VCFs.Patients with instrumented spinal fusion were significantly more likely to develop new VCFs (1.87% vs .25%, HR: 8.56; P < 0.001). Female, elderly, and osteoporotic patients had a high incidence of new VCFs after spinal fusion. The HR for developing new VCFs after instrumented spinal fusion was higher in patients younger than 65 years than in those 65 years or older (HR: 10.61 vs 8.09). Male patients with instrumented spinal fusion also had a higher HR of developing new VCFs than female patients (men, HR: 26.42; women, HR: 7.53).In our retrospective cohort study, patients who had undergone instrumented spinal fusion surgery exhibited an increased risk of developing new VCFs. Particularly, the HR increased in young (age <65 years) and male patients.

The results of this research demonstrate that repeat PV may be an effective method for relieving recurrent or persistent pain in patients with symptomatic cemented vertebrae, allowing them to regain functional activity.