RESUMEN
BACKGROUND CONTEXT: In cranio-vertebral junction, retro-odontoid pseudotumor without evidence of rheumatoid arthritis is a rare condition. PURPOSE: To discuss the mechanism of enlarging retro-odontoid pseudotumor after expanding cervical laminoplasty as a predictable complication. STUDY DESIGN: We report a rare case of an elderly man with non-inflammatory retro-odontoid pseudotumor after cervical expanding laminoplasty. PATIENT SAMPLE: A 76-year-old man presented with progressive quadriparesis of two week's duration caused by enlarging retro-odontoid soft tissue mass after cervical laminoplasty. OUTCOME MEASURES: Pre- and postoperative image, including X-ray and MRI, and the Japanese Orthopaedic Association scores for cervical myelopathy were assessed. METHODS: The patient subsequently underwent resection of the posterior arch of the atlas and posterior fusion from the occiput to C6 using Olerud system without removal of the retro-odontoid soft tissue mass. RESULTS: One year after surgery, the Japanese Orthopaedic Association scores for cervical myelopathy improved from 1 to 10 points, and postoperative MRI showed a mild reduction in the size of the retro-odontoid soft tissue mass. CONCLUSIONS: The kyphotic stability from C3 to C7 after laminoplasty, leading to a compensatory hyperlordosis at the occipitocervical junction, may cause the development of a degenerative osteoarthritic change, resulting in the production of an enlarging mass. Not only posterior compression of spinal cord due to posterior arch of the hyperextended atlas but also anterior compression of spinal cord due to retro-odontoid pseudotumor probably triggered the severe myelopathy. Laminoplasty may be inappropriate in cervical myelopathy with kyphosis.
Asunto(s)
Vértebras Cervicales/patología , Cifosis/etiología , Laminectomía/efectos adversos , Apófisis Odontoides/patología , Complicaciones Posoperatorias/patología , Enfermedades de la Columna Vertebral/etiología , Anciano , Vértebras Cervicales/cirugía , Humanos , Cifosis/cirugía , Imagen por Resonancia Magnética , Masculino , Complicaciones Posoperatorias/cirugía , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/cirugíaRESUMEN
We treated a 64-year-old female with bilateral painful snapping elbows due to synovial folds. Resection of the bilateral synovial folds resulted in relief from pain and snapping, and resulted in patient satisfaction. Daily dumbbell exercises of the bilateral elbows starting at an elderly age may have led to the bilateral snapping. Painful snapping elbow is a relatively rare condition, which usually occurs in a unilateral elbow of a younger patient. To our knowledge, bilateral painful snapping elbows triggered by daily dumbbell exercises in older patients have not been previously reported.
Asunto(s)
Artralgia/etiología , Articulación del Codo , Levantamiento de Peso , Artralgia/cirugía , Traumatismos en Atletas/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Sinovectomía , Membrana Sinovial/patologíaRESUMEN
The influence of hip position on knee flexion angle before total knee arthroplasty (TKA) and that after TKA were investigated and compared. Sixty-six patients (70 knees) with osteoarthritis who were undergoing TKA were examined using lateral radiographs of maximum knee flexion angle with the hip joint at 0 degrees extension and 90 degrees flexion. The postoperative rate of decrease in knee flexion angle caused by hip extension was significantly larger compared with the value before surgery. The preoperative rate of decrease in knee flexion angle caused by hip extension showed strong inverse correlation with the preoperative and postoperative knee flexion angle ratio. In conclusion, tightness of the extensor mechanism is present in all knees undergoing TKA and especially has a strong influence on the postoperative flexion angle of the knee.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Articulación de la Cadera/fisiopatología , Articulación de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/cirugía , Rango del Movimiento Articular , Articulación de la Cadera/diagnóstico por imagen , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/fisiopatología , Postura , RadiografíaRESUMEN
We implanted 60 posterior stabilized total knee prostheses (P.F.C. Sigma, DePuy, Warsaw, USA). In 30 cases, we used a CT-free navigation system (Vector Vision, Brain LAB, Heimstetten, Germany), and in 30 matched-paired controls, we used a conventional manual implantation. We compared postoperative long-leg radiographs in the two groups. The results revealed a significant difference in favor of navigation. In addition, we compared the preoperative anteroposterior dimension of the femoral condyle with the postoperative value. While there were no significant differences in the preoperative anteroposterior dimension of the femoral condyle between the two groups, the postoperative value in the navigation group was significantly larger than that of the preoperative value. Therefore, surgeons using navigation systems should guard against the possibility of oversizing when determining the size of the femoral component.