Dysphagia is the most common complication of anterior cervical discectomy and fusion (ACDF). Several studies have reported dysphagia’s incidence, severity, and prognosis after ACDF; however, few have investigated the objective effects of dysphagia management. We aimed to elucidate the efficacy of laryngeal rehabilitation therapy for dysphagia following ACDF. This prospective randomized control trial included 20 patients who underwent more than two-level ACDF. Laryngeal rehabilitation therapy was performed on 10 patients for 7 days, whereas the remaining 10 comprised the control group. Pharyngeal transit time (PTT) by videofluoroscopic swallowing study (VFSS) was performed to evaluate the objective state of swallowing. We analyzed Bazaz scale and total variance of prevertebral soft tissue swelling (PSTS) from C2 to C7 on lateral cervical radiographs during hospitalization and at 4 and 8 weeks post-surgery. The PTT of the rehabilitation group was shorter than that of the control group at 7 days and 4 weeks post-surgery (p-value; POD 7D = 0.003, POD 4W = 0.042, POD 8W = 0.097). Perioperative laryngeal rehabilitation therapy effectively reduces postoperative dysphagia after ACDF.

Background: Iliopsoas impingement is a complication of total hip arthroplasty that often manifests as groin pain during initial hip flexion. However, there are no reports of mechanical complications after iliopsoas tenotomy following total hip arthroplasty (THA). Case presentation: We present the case of a 64-year-old woman with degenerative lumbar kyphosis who developed anterior hip dislocations after arthroscopic iliopsoas tenotomy for anterior impingement following THA. She ultimately required revision of the acetabular cup. Conclusions: Arthroscopic tenotomy for refractory iliopsoas tendinopathy may be appealing because of its less invasive nature. However, caution should be exercised in the setting of significant cup malpositioning and/or spinopelvic imbalance to avoid iatrogenic anterior instability.

Lumbar facet synovial cysts (LFSCs) are an uncommon degenerative lesion in the lumbar spine, but treatment remains controversial. We report two rare cases of spontaneous regression of large-sized LFSCs. A 68-year-old male visited our outpatient clinic with a complaint of lower back pain and right lower extremity radiculopathy beginning approximately two weeks prior. Computed tomography of the spine showed facet arthrosis, and magnetic resonance imaging (MRI) of the spine revealed a large, oval cystic-mass-like lesion at the L5–S1 level. After conservative treatment for one year, the patient’s symptoms had completely resolved, and a follow-up MRI showed spontaneous regression of the large LFSC. A 69-year-old female with a complaint of radiating pain on left lower extremity and intermittent claudication that had aggravated about 2 months ago also showed a 1.5 × 1.2 × 1.7 cm oval cystic mass involving left L5, S1 nerve roots at L5–S1 level from the MRI. After conservative treatment for three months, a follow-up MRI also showed spontaneous resolution of the large LFSC. The large-sized LFSCs spontaneously regressed without any surgical intervention. If symptoms can be controlled, conservative treatment should be considered for first-line treatment despite a mismatch between radiological and clinical findings. Careful clinical judgments are essential to prevent unnecessary surgery.

Purpose: To report a unique case of incomplete CES following a rebar penetrating injury in perineal region with retro-pulsed fragment, which was treated with anterior approach and discuss suitable surgical approach. Methods: Incomplete cauda equina syndrome caused by non-missile penetrating injury is extremely rare. A 26-year-old male patient presented incomplete cauda equina syndrome due to a penetrating rebar wound from his perineal region to the lumbosacral spine. Computed tomography demonstrated a bony fragment broken from S1 body compressing into the spinal canal. Results: By anterior approach, we performed partial corpectomy of L5, decompression by retrieving the bony fragment and L5-S1 interbody fusion. The patient had a significant recovery, and no clinical complication was found after over 2-year follow-up. Conclusion: It is challenging to determine the optimal strategy of surgical treatment for penetrating spinal injuries with retained foreign bodies, here we suggest an anterior approach situation that has the advantage of being able to effectively perform decompression and prevent iatrogenic damages of thecal sac and nerve rootlets.

Song KJ, et al. J Korean Orthop Assoc. 2016 Feb;51(1):54-60. http://dx.doi.org/10.4055/jkoa.2016.51.1.54

김태호, et al. J Korean Orthop Assoc. 2022 Oct;57(5):409-418. https://doi.org/10.4055/jkoa.2022.57.5.409