Sung-Hyun Yoon

Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty.

Study Design Retrospective study. Purpose To evaluate risk factors related to the development of new fractures in adjacent vertebrae after percutaneous vertebroplasty. Overview of Literature Recent reports indicate that undue numbers of new fractures in adjacent vertebral bodies occur after percutaneous vertebroplasty. Methods One hundred four of 369 patients who underwent percutaneous vertebroplasty were followed for over 1 year. Fifty-four patients (51.9%) subsequently suffered from adjacent vertebral fractures. Age, lumbar lordotic angle, sacral slope, pelvic tilt, pelvic incidence, bone mineral density, amounts of cement injected, the restoration of vertebral height, kyphotic angle differences preexisting fracture, and intradiscal cement leakage were noted. Results Average bone mineral density was -3.52 in the fracture group and -2.91 in the fracture-free group; the risk of adjacent vertebral fracture increased as bone mineral density decreased (p < 0.05). Intradiscal cement leakage occurred in 18 patients (33.3%) in the fracture group, indicating that the risk of adjacent vertebral fracture increased with intradiscal cement leakage. In addition, 36 patients (66.7%) in the fracture group had a pre-existing fracture; thus, the presence of a preexisting fracture was found to be significantly associated with an increased risk of an adjacent vertebral fracture (p < 0.05). Higher restoration rates are associated with a greater likelihood of developing adjacent vertebral fractures (p < 0.05). Conclusions The factors found to contribute significantly to new fractures in adjacent vertebral bodies after percutaneous vertebroplasty were a lower bone mineral density, a greater restoration rate of vertebral height, a pre-existing fracture, and intradiscal cement leakage.

What Is the Most Effective Eccentric Stretching Position in Lateral Elbow Tendinopathy

Background A variety of treatment options suggest that the optimal treatment strategy for lateral elbow tendinopathy (LET) is not known, and further research is needed to discover the most effective treatment for LET. The purpose of the present study was to verify the most effective position of eccentric stretching for the extensor carpi radialis brevis (ECRB) in vivo using ultrasonic shear wave elastography. Methods A total of 20 healthy males participated in this study. Resting position was defined as 90° elbow flexion and neutral position of the forearm and wrist. Elongation of the ECRB was measured for four stretching maneuvers (forearm supination/pronation and wrist extension/flexion) at two elbow angles (90° flexion and full extension). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the eight aforementioned stretching maneuverangle combinations. Results The shear elastic modulus was the highest in elbow extension, forearm pronation, and wrist flexion. The shear elastic moduli of wrist flexion with any forearm and elbow position were significantly higher than the resting position. There was no significant difference associated with elbow and forearm positions except for elbow extension, forearm pronation, and wrist flexion positions. Conclusions This study determined that elbow extension, forearm pronation, and wrist flexion was the most effective eccentric stretching for the ECRB in vivo.

Comments on the Article “What Is the Most Effective Eccentric Stretching Position in Lateral Elbow Tendinopathy?”: In Reply

Joong-Bae Seo, Sung-Hyun Yoon, Joon-Yeul Lee, Jun-Kyom Kim, Jae-Sung Yoo, Reply: We thank Dr. Stasinopoulos for your interest in our recent paper published in March 2018 issue of Clinics in Orthopedic Surgery. We would like to answer to the specific points raised by Dr. Stasinopoulos in the letter as follows. First, we agree with you that the proper term should be passive stretching. We feel sorry if the term caused confusion among readers; however, we had the paper reviewed by native English speakers in an attempt to minimize Englishrelated errors. Second, measurement of the optimal time of stretching was not performed according to Umehara et al. Any suggestion on the optimal time of stretching would be helpful. Third, the stretching maneuver was performed by an orthopedic fellow. Although he was not an expert in passive stretching, the maneuver of extensor carpi radialis brevis (ECRB) stretching was relatively simple. Fourth, we agree with you on the need for evaluation of lateral elbow tendinopathy (LET) patients. We already addressed the issue in the limitation section of the paper. However, the purpose of this study was to figure out the most effective stretching position, not the therapeutic effect of LET patients. Lastly, we are also aware that the stretching protocol was not newly developed. However, this study is the first objective in vivo study to figure out the most effective stretching position of ECRB with elastography. Again, we thank Dr. Stasinopoulos for the letter to the editor, we will take consideration into your valuable suggestion in our further study.