Myung-Jin Sung

Surgical treatment is required in infectious spondylitis when conservative management fails or vertebral destruction causes instability. Autologous bone graft is considered the gold standard but is limited by donor-site morbidity and availability. Femoral ring allografts are widely used in degenerative conditions, but their role in infectious spondylitis is unclear. This study evaluated the clinical, radiologic, and laboratory outcomes of anterior reconstruction using femoral ring allografts. In this single-center retrospective cohort study, reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement, we reviewed 25 patients who underwent anterior corpectomy and reconstruction using femoral ring allografts followed by posterior instrumentation between December 2011 and September 2023. Clinical outcomes (VAS, Oswestry Disability Index, Frankel grade), laboratory parameters (erythrocyte sedimentation rate, C-reactive protein), and radiologic outcomes (Cobb angle, fusion) were compared preoperatively and at final follow-up. Paired comparisons used the Wilcoxon signed-rank test, with Hodges–Lehmann estimates, distribution-free 95% confidence intervals (CIs), and effect sizes ( r ). Infection control and complications were analyzed. The mean follow-up was 29.2 ± 23.9 months (range, 12.0–87.2 months). VAS improved from 7.3 ± 1.1 to 1.9 ± 1.0 (Hodges–Lehmann estimate −5.50; 95% CI, −6.00 to −5.00; r = 0.87) and Oswestry Disability Index from 37.7 ± 5.9 to 10.7 ± 3.5 (−26.50; 95% CI, −29.50 to −23.50; r = 0.87; both P < .001). Neurological function improved significantly ( r = 0.76, P < .001). Erythrocyte sedimentation rate and C-reactive protein decreased significantly (both P < .001). Sagittal alignment was corrected with partial loss over time but remained improved at final follow-up (5.55°; 95% CI, 3.40°–8.95°; r = 0.69; P < .001). Fusion was achieved in 92% and infection control in 96%. Complications occurred in 16%. In patients with large anterior column defects not amenable to tricortical iliac autograft, femoral ring allograft reconstruction achieved reliable infection control, a high fusion rate, and satisfactory clinical and radiologic outcomes over a mean follow-up of 29.2 months. Within this period, it appears a reasonable alternative to structural autograft when donor-site morbidity or graft availability is a concern. Longer-term comparative studies are needed to confirm the durability of graft incorporation and to define its role relative to contemporary titanium-based reconstruction.

Background/Objectives: Postoperative delirium is a clinically important complication after lumbar fusion surgery, yet whether the choice of fusion technique influences its occurrence remains unclear. We compared the incidence of postoperative delirium between oblique lateral interbody fusion with percutaneous pedicle screw fixation (OLIF-PPSF) and transforaminal lumbar interbody fusion (TLIF). Methods: The medical records of 850 patients (335 OLIF-PPSF, 515 TLIF) treated between 2008 and 2023 were retrospectively reviewed; 487 patients were eligible, and propensity score matching yielded 141 matched pairs. Delirium was identified through symptom-triggered psychiatric consultation rather than routine screening. Analyses were stratified by treatment era and repeated within the period in which both procedures were performed. Results: Delirium occurred in no OLIF-PPSF patient and in 9 TLIF patients (6.4%; risk difference 6.4%, 95% CI 2.4–11.7%; McNemar exact p = 0.004; adjusted odds ratio 19.82, 95% CI 1.20–326.53). However, OLIF-PPSF was performed only from 2017 onward, whereas 118 of the 141 matched TLIF operations (83.7%) preceded 2017, and all events occurred during 2008–2014. Within 2017–2023 no delirium occurred after either procedure (0/168 versus 0/34). Conclusions: Although delirium was less frequent after OLIF-PPSF, every event preceded its introduction, and none occurred after either procedure once both were performed contemporaneously. The difference cannot be attributed to the surgical approach and more likely reflects changes in perioperative care over time. These findings are exploratory.

Aims: The aim of this study was to analyze the natural history of solitary osteochondroma and determine how skeletal maturity influences tumour behaviour and treatment outcomes. Methods: A retrospective analysis of 236 patients with solitary osteochondroma (151 skeletally immature, 85 skeletally mature) was undertaken. Skeletal maturity was defined as bone age ≥ 18 years in males and ≥ 17 years in females. Tumour characteristics, disease progression, indications for surgery and recurrence rates were evaluated. Interobserver reliability for bone age assessment was excellent (intraclass correlation coefficient (ICC) 0.92 (95% CI 0.88 to 0.95)). Results: Spontaneous regression occurred exclusively in skeletally immature patients (17.2% (n = 26) vs 0%; p < 0.001). Skeletally immature patients predominantly presented with sessile lesions (76.2%; n = 115), had lower surgical needs (31.8%; n = 48), but higher progression rates (9.9% (n = 15) vs 1.2% (n = 1); p = 0.013). Skeletally mature patients showed more stable disease but required surgery more often (54.1%; n = 46). Among skeletally immature patients with regression, independent predictors were younger age at diagnosis (odds ratio (OR) 0.82 (95% CI 0.73 to 0.92); p < 0.001), proximal humeral location (OR 10.59 (95% CI 2.01 to 55.85); p = 0.005), and humeral shaft location (OR 38.93 (95% CI 4.81 to 315.10); p = 0.001). The optimal cutoff age for regression prediction was 14.8 years. No local recurrence occurred in the 94 operated patients. Conclusion: Skeletal maturity fundamentally determines the natural history of osteochondroma. Conservative management with serial radiological follow-up is recommended for young patients, particularly those with humeral lesions, given their substantial potential for spontaneous regression. Earlier surgical intervention should be considered for skeletally mature patients with persistent symptoms. Cite this article: Bone Joint J 2026;108-B(8):1060–1067.

Background: Primary cervical spine infection is a rare but rapidly progressive disease that can cause early neurological damage, leading to increased morbidity and mortality. Despite its rising incidence, optimal treatment remains controversial. This study compared clinical, hematological, microbiological, and radiological outcomes among such patients treated with different methods. Methods: This retrospective comparative study is a secondary analysis of a previously reported cohort of 59 patients with primary cervical spine infection between 1992 and 2018 at a single institution. Patients were stratified into conservative (Group C, n = 14), surgery with instrumentation (Group S + I, n = 32), and surgery without instrumentation (Group S, n = 13) groups. Outcome measures included neurological status, antibiotic duration, hematological markers, radiological parameters (segmental angle, C2–C7 angle, segmental height, fusion rate), and complications. Results: The mean age and follow-up period were 61.4 years and 19.4 months, respectively. Group S + I demonstrated significantly better neurological outcomes at the last follow-up (p = 0.047) and shorter antibiotic treatment duration (p < 0.001). Radiological outcomes were superior in Group S + I, with greater improvements in segmental angle (p < 0.001), C2-C7 angle (p < 0.001), mean segmental height (p < 0.001), and fusion rate (84.4% vs. 14.3% and 46.2% in Group C and Group S, respectively; p < 0.001). Group S had significantly higher complication (46.2%, p = 0.011) and mortality (30.8%, p = 0.001). Hematological and microbiological results were not significantly different among groups. Conclusions: Surgical debridement with anterior instrumentation provided superior outcomes compared with conservative treatment or surgery without instrumentation. Early surgery with appropriate stabilization should be considered to optimize prognosis and minimize complications.

Background: Gartland type III pediatric supracondylar humerus fractures can be unstable and prone to loss of reduction. The Internal Rotational Stress Test (IRST) aims to assess and address rotational instability during surgery. Method: This retrospective study analyzed treatments for Gartland type III pediatric supracondylar humerus fractures at our institution from January 2020 to December 2022. Only patients who underwent IRST were included. IRST was performed after inserting either two or three lateral pins. Patients were divided into Group 1 (IRST +) or 2 (IRST −) based on IRST results. Radiographic and clinical outcomes were compared between the two groups. Result: A total of 46 patients were included in the study. The mean age at the time of diagnosis was 5.7 years (range, 4 to 11 years), and the mean duration of follow-up was 2.8 years (range, 1.0 to 4.8 years). Group 1 consisted of 24 patients, and Group 2 comprised 22 patients. We did not find any differences in radiographic parameters and clinical scores between the two groups. Additionally, in both groups, there were no instances of major loss of reduction, defined as greater than 12 degrees or 12%. In five patients, we identified two types of fracture patterns that were stable with only two lateral pins. Conclusions: In patients with Gartland type III supracondylar humerus fractures, if reduction is adequately achieved and sufficient fixation force is maintained, the IRST results do not significantly impact radiologic and clinical outcomes. The pattern of the fracture can influence instability, necessitating further research on this matter.

Primary cervical spine infections progress quickly and cause neurological impairment at an early stage. Despite their clinical significance, few studies have investigated primary cervical spine infections, owing to the rarity of the condition. This study analyzed the characteristics of 59 patients treated for primary cervical spine infections between 1992 and 2018 at our hospital. Clinical and radiological analyses were conducted. Moreover, a comparative analysis was performed, incorporating each patient’s underlying disease, mortality and complications, and treatment results. Comparison between groups based on the chronological period (1992–2000, 2001–2009, and 2010–2018) revealed that the mean age of onset has increased significantly in recent years. The rate of neurological impairment, duration of antibiotic use, and frequency of underlying disease increased significantly with time. No significant differences among groups were observed in the hematological and microbiological analyses. The incidence rate of epidural abscess and multisegmental infection increased significantly in recent years. There was no statistically significant difference in the complication and mortality rates, according to the time period. We think that prompt diagnosis and appropriate treatment are necessary, considering the current trends in primary cervical spine infection.

Background: The best treatment for degenerative medial meniscus posterior root tear (MMPRT) remains controversial. This study aimed to compare the clinical and radiological outcomes of arthroscopic meniscectomy and conservative treatment for degenerative MMPRT. Methods: From January 2007 to December 2014, 146 patients (Meniscectomy group, 90; Conservative group, 56) were evaluated. Clinical outcomes were assessed using the Visual Analog Scale, International Knee Documentation Committee subjective scoring scale, Tegner activity scale, and Lysholm knee scoring scale at the final follow-up. Radiologic outcomes evaluated the progression of osteoarthritis (OA) according to the Kellgren-Lawrence (K-L) classification. We compared the hip-knee-ankle angle (HKAA), medial proximal tibial angle, tibial posterior slope angle, and width of medial joint space. After an average follow-up of 6.3 years, the survivorship was analyzed using the Kaplan–Meier method. Results: All clinical outcomes were significantly improved in both groups after treatment, with no significant differences between the two groups at the final follow-up. The progression of OA according to the K-L classification, HKAA and width of medial joint space was significantly advanced in the meniscectomy group (p = 0.03, 0.04, 0.03, respectively). The 10-year survival rates in the meniscectomy and conservative groups were 87 and 88%, respectively. Conclusions: This study demonstrated that both conservative treatment and meniscectomy provided symptomatic relief. However, it was confirmed that OA progression was more severe in the meniscectomy. We conclude that arthroscopic meniscectomy had no advantage over conservative treatment in terms of clinical outcomes and OA progression in middle-aged patients with MMPRT. Level of evidence: Level III; retrospective comparative study.

The purpose of this study was to evaluate the outcomes of patients with Legg–Calvé–Perthes disease (LCPD) with disease onset before 6 years of age who were treated with conservative methods and to identify prognostic factors. Moreover, we evaluated the duration of the Waldenström stage and its correlation with the disease outcome. Disease severity was assessed using the lateral pillar classification, and the final outcome was evaluated using the Stulberg classification. We divided patients with LCPD into two groups according to the age at onset: group 1 (p = 0.162). The duration of the initial stage was 4.1 months in the good outcome group and 6.2 months in the fair or poor outcome group. The duration of the fragmentation stage of the femoral head was 5.9 months in the good outcome group and 11.9 months in the fair or poor outcome group. The durations of initial and fragmentation stages significantly differed between good outcome group and fair or poor outcome group (p = 0.009 and p < 0.001, respectively). The prognosis of patients with disease onset before the age of 6 years was favorable. The disease severity and duration of each Waldenström stage can be predictors of the outcome. Patients with prolonged initial and fragmentation stages showed worse outcomes and often required more active treatment to shorten the durations of the initial and fragmentation stages.