Cheng-Yi Wu

Posterior fixation with pedicle screws and rods may be required when treating Chance fractures involving the posterior ligamentous complex. Only a few studies have evaluated the outcomes of older adults with Chance fractures. Given that bone mineral density decreases with increasing age, cement augmentation of pedicle screws may be critical in older patients. This study compared the postoperative outcomes of patients aged ≥ 65 with Chance fractures who underwent fixation with or without cement-augmented pedicle screws. This retrospective single-center comparative study included the data of patients enrolled between August 2014 and September 2022. The patients were divided into 3 groups according to whether cement augmentation was employed for pedicle screws. The Cobb angle was measured before and after surgery and at final follow-up. Refractures, adjacent fractures, implant removals, and screw pullouts were recorded. Twenty-one patients with a follow-up duration of ≥ 6 months were included, with 13 and 8 patients in the uncemented and cement-augmented screw groups, respectively. The mean Cobb angles significantly improved in both groups after surgery and the improvements were not different between groups. At final follow-up, the Cobb angle improvement in the uncemented screw group was significantly inferior to that in the cement-augmented screw group. The incidence of screw pullout was significantly higher in the uncemented screw group (69.2% vs 12.5%) and was especially higher in patients with a T-score greater than − 2.5 (87.5%). No between-group differences were noted in refracture, adjacent fracture, and implant removal rates. In patients aged ≥ 65 with Chance fractures, cement-augmented pedicle screws may help to reduce the risk of screw pullout. This effect was most notable in patients with a T-score greater than − 2.5, although this subgroup finding should be interpreted with caution.

Risk factors and reasons for romosozumab nonadherence remain unclear. This study compared patients who adhered to romosozumab therapy with those who did not to identify possible risk factors and reasons for treatment nonadherence. This case-control study included all eligible patients diagnosed with osteoporosis who received romosozumab therapy at our hospital between February 2022 and March 2024. The patients were divided into adherence and nonadherent groups. Nonadherence was defined as failure to follow the monthly injection schedule for 12 injections over a one-year period, without transitioning to other antiosteoporotic medications. Relevant data were retrospectively collected from the patients’ medical records. Univariate and logistic regression analyses were performed to identify the associations of patient characteristics with romosozumab nonadherence. A subgroup analysis was performed to identify the associations between the reasons for nonadherence and the type of payment for romosozumab therapy. The adherence and nonadherent groups comprised 62 and 69 patients, respectively. Male patients had a 9.03-fold higher risk of nonadherence than did female patients (P = .041). Self-payment for medications was associated with a 2.756-fold higher risk of nonadherence than was receiving a full subsidy (P = .024). The most common reasons for nonadherence were patient-related factors (87.0%, 60 of the 69 patients in the nonadherent group), followed by medicine-related factors (8.7%, 6 patients) and health system–related factors (4.3%, 3 patients). Male sex and self-payment for medications are risk factors for romosozumab nonadherence. Patient-related factors appear to be the most common reasons for nonadherence. These results can aid healthcare providers in implementing appropriate interventions.

Deep gluteal syndrome (DGS) is caused by sciatic nerve entrapment. Because fascial entrapment neuropathies may occur in multiple locations, ultrasound-guided nerve hydrodissection is a key component of DGS treatment. In this study, we examined the clinical outcomes of patients with DGS undergoing ultrasound-guided sciatic nerve hydrodissection. A 10 mL mixture consisting of 5% dextrose, 0.2% lidocaine (Xylocaine), and 4 mg betamethasone (Rinderon) was used for nerve hydrodissection. Clinical outcomes were evaluated using Numeric Rating Scale (NRS) scores of pain, the proportion of patients with favorable outcomes (reduction of ≥50% in pain), the duration for which patients exhibited favorable outcomes (percentage of follow-up duration), and the occurrence of major complications and minor side effects. A total of 53 patients were consecutively included and followed up for 3 to 19 months. After the initial injection, the NRS scores significantly improved at 1 week, 1 month, 3 months, and the final follow-up. Specifically, 73.6%, 71.7%, 64.2%, and 62.3% of the patients exhibited favorable outcomes at 1 week, 1 month, 3 months, and the final follow-up, respectively. The median duration for which the patients exhibited favorable outcomes was 84.7% of the follow-up period. Three patients (5.7%) experienced transient dizziness and vomiting, which resolved without further treatment. No vessel or nerve puncture was observed. Overall, ultrasound-guided sciatic nerve hydrodissection is a safe procedure that mitigates the pain associated with DGS. To achieve favorable outcomes, three consecutive injections 3 weeks apart are required.

Because fascial entrapment neuropathy can occur in multiple locations, ultrasound-guided nerve hydrodissection has become a key component of the treatment of cervical radicular pain. In this paper, we propose a combination of injectates used for nerve hydrodissection of the cervical nerve roots and compare the clinical outcomes of this treatment among patients with different severities of stenosis. This is a retrospective cohort study designed to compare outcomes between patients with mild stenosis and moderate to severe stenosis. Forty-four patients with mild cervical stenosis and 30 patients with moderate to severe cervical stenosis were consecutively enrolled into two groups. A 10-mL mixture in a single level consisting of 5% in Dextrose, 0.2% lidocaine (Xylocaine), and 4 mg betamethasone (Rinderon) was used for nerve roots hydrodissection. The two groups were compared with regard to their numeric rating scales (NRS) of pain, proportion of patients who exhibited a favorable outcome (a reduction of pain ≥ 50%), duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects. The follow-up period ranged from 3 to 20 months. The NRS of both groups improved significantly by 1 week, 1 month, 3 months, and final follow-up after the initial injection. Differences in the groups’ NRS, proportion of patients who exhibited a favorable outcome, duration of patient exhibited a favorable outcome, and occurrence of serious complications and minor side effects were nonsignificant. There were 4 patients (5.4%) experienced dizziness in that resolved without further treatment. Ultrasound-guided nerve hydrodissection of cervical nerve roots is a safe procedure that reduces pain associated with cervical radicular pain, even in patients with moderate to severe stenosis.