The American journal of orthopedics
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The majority of patients with symptomatic herniated discs can be successfully and conservatively managed and can achieve clinical improvement without surgical intervention. Resorption of the herniated nucleus pulposus (HNP) is 1 conservative mechanism for clinical improvement. We present the case of a 76-year-old healthy man with acute cervical radicular right arm pain and positive Spurling test. ⋯ The patient returned to his normal activities and has not had recurrence of symptoms for 2 years. This report provides an interesting example of complete resorption of a large, extruded cervical herniated disc in a symptomatic patient and a review of the literature on resorption of herniated discs. The review suggests that larger herniations with an epidural location (penetration of the posterior longitudinal ligament) have a greater chance of resorption.
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Because the spine and pelvis are integrated, changes in spine sagittal balance affect relative acetabulum position. A 1° change of the anterior pelvic plane changes acetabulum anteversion by 0.8°. Three-column spine osteotomies correct fixed sagittal plane deformity. ⋯ This correction of the sagittal balance is associated with a concomitant increase in sacral slope, pelvic tilt, and the anterior pelvic plane angles. These changes will increase acetabulum anteversion by a predicted 6.54°. This increase will change acetabular cup position and must be considered in patients with spine and pelvic osteoarthritis that requires hip surgery.
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We tried to reduce our rate of conversion from index knee arthroscopy to total knee arthroplasty (TKA) for degenerative pathology (primarily meniscal) in the setting of coexisting arthritis in patients 50 years or older. We hypothesized that, by using a 2-surgeon independent evaluation method, we could reduce the rate to less than 10% by 3-year follow-up. Forty-two consecutive patients were initially evaluated by the knee replacement surgeon to determine if they were TKA candidates. ⋯ The overall rate of conversion to TKA was 26%. The 2 main groups (arthroscopy only, arthroscopy-plus-TKA) did not differ in all measured characteristics. Failure of our method to achieve better outcomes demonstrates that conventional criteria are poor in predicting which patients with meniscal pathology, which is believed to be relatively more symptomatic than coexisting arthritis, should avoid arthroscopy and go straight to TKA.