Bumin Hospital Group

Evogliptin, a dipeptidyl peptidase-4 inhibitor with a glucose-dependent mechanism of action, is widely used as a monotherapy or in combination with other agents. However, observational studies in routine clinical settings remain limited. This study aimed to evaluate the effectiveness and safety of evogliptin in combination with other antidiabetic agents frequently used in clinical practice. This study was conducted in 51 hospitals in South Korea. We evaluated evogliptin in three groups: the evogliptin add-on, evogliptin-switching, and initial combination groups. The primary endpoint was the change in haemoglobin A1c (HbA1c) levels (%) from baseline to 12 weeks. The change in HbA1c (%) levels from baseline to 24 weeks was a secondary endpoint in the extended study. Proportions of patients achieving the HbA1c target, changes in fasting and postprandial glucose levels, and safety endpoints were also evaluated. Between-group comparisons were performed between the add-on and initial combination groups. In the 1596 patients of the effectiveness set, the mean changes in HbA1c levels at 12 weeks were -0.8% ± 1.2%, -0.3% ± 0.8% and -1.9% ± 1.4% for the evogliptin add-on, evogliptin-switching and initial combination groups, respectively. Among the 1920 patients in the safety set, 23 experienced adverse drug reactions, and there was no significant difference among the three groups. Evogliptin reduces blood glucose levels and is well-tolerated when used as an add-on, as a switch from other dipeptidyl peptidase 4 inhibitors, or as part of an initial combination therapy in patients with type 2 diabetes mellitus.

BackgroundThe purpose of this study was to assess the clinical results and complicatiosn of arthroscopic labral repair repair using all-suture type soft anchors for patients with labral tears.MethodsFrom January 2015 to December 2019, 89 hips with labral tears underwent arthroscopic labral repair using all-suture type soft anchors, followed by CTA one year later. Outcomes and intraoperative parameters were prospectively measured with the UCLA score, the modified Harris Hip Score (MHHS), the Hip disability and Osteoarthritis Outcome Score (HOOS), and the Hip Outcome Score (HOS). The incidence of malposition of anchor sutures was assessed on follow-up CTA.ResultsNine patients were lost to follow-up. A total of 80 hips were finally analyzed. Survival rate, using reoperation or progression of osteoarthritis as the primary end points, was 100 %. 83 % of cases had excellent and good MHHS scores after 2 years of follow-up. Fifteen anchors were placed in cartilage–bone transitional zone. There was no progression of arthritic change at the latest follow-up.ConclusionsLabral repair using all-suture type soft anchors resulted in significant postoperative improvements and cartilage penetration or broken tip were not influence of clinical outcomes after 2 years of follow-up.

This study aimed to evaluate the learning curve for biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) and assess 90-day postoperative complications during the learning phase. We retrospectively analyzed 188 consecutive patients who underwent single-level BE-TLIF performed by three surgeons at three institutions. Learning curve-cumulative summation (LC-CUSUM) analysis was used to determine the number of cases required to achieve proficiency, defined as an operative time of less than 160min. Patients were divided into the early and late groups based on the learning curve. Clinical outcomes, including Oswestry Disability Index and Visual Analog Scale scores for back and leg pain, were assessed preoperatively and at 1 and 3 months postoperatively. Complications within 90 days were recorded and analyzed. LC-CUSUM analysis showed that surgeons required an average of 39 cases (range: 29-51) to achieve proficiency. Operative time and estimated blood loss significantly decreased in the late group (p < 0.001 and p = 0.002, respectively). Clinical outcomes improved significantly in both groups over time, with no statistically significant differences between the groups. The overall complication rate was 6.9%, with a trend toward lower rates in the late group than in the early group, although this was not statistically significant. The 90-day reoperation rate decreased from 5.1% in the early group to 1.4% in the late group. BE-TLIF demonstrated a learning curve comparable to other minimally invasive spine surgeries, with proficiency achieved after approximately 39 cases. Clinical outcomes were favorable and consistent across learning phases, indicating that BE-TLIF can provide significant benefits to patients even during the initial learning period. The trend toward lower complication rates in the late phase than those in the early phase underscores the importance of proper training and experience in maximizing the benefits of this technique.

Background/Objectives: Previous studies have reported satisfactory outcomes and low rates of instrumentation-related complications (IRCs) following nonfusion posterior fixation in patients with metastatic spinal tumors (MSTs). However, to adequately assess the longevity and durability of nonfusion instrumentation in patients with longer life expectancy, an extended follow-up period is essential. This study aims to evaluate the incidence of and risk factors for IRCs in patients with MSTs who underwent nonfusion posterior fixation and had radiographic follow-up data available for at least one year postoperatively. Methods: Consecutive data were collected from patients who underwent pedicle screw-based posterior fixation without fusion for MSTs in the thoracic and/or lumbar region from 2005 to 2018. The IRCs included screw loosening, screw pull-out, and metal breakage. The IRC-free survival and related factors were analyzed by Kaplan–Meier survivorship analysis with the log-rank test within a minimum follow-up period of one year. A multivariate analysis was performed using a Cox proportional-hazards regression model. Results: In total, 61 patients were included. The mean follow-up period was 28.3 months (range: 12.0–102.6 months). There were 27 cases (44.2%) of IRCs, including 22 cases of screw loosening, four cases of screw pull-out, and one case of rod breakage, at an average of 9.6 months (range: 1.0–38.1 months). The median IRC-free survival was 38.1 months (range: 1.0–102.6 months). Only three patients experienced pain aggravation with IRCs. No revision surgery was performed. A multivariate analysis identified that fixation length was a risk factor for IRCs (odds ratio: 0.358, 95% confidence interval: 0.114–0.888; p = 0.027). Conclusions: IRCs are frequent but mostly asymptomatic after nonfusion posterior fixation in patients with MSTs followed up for at least one year. Overall, the IRC-free survival was long enough considering the patient survival. Fixation length was a significant risk factor for IRCs regardless of MST location.

Background/Objectives: Accurate postural assessment is essential for managing musculoskeletal disorders; however, routine screening is often limited by radiation exposure, cost, and accessibility constraints of radiography. Recent advances in artificial intelligence (AI) have enabled automated, marker-free analysis using two-dimensional photographs. This study evaluated the validity and reliability of MORA Vu, an AI-based posture estimation software, against radiographic parameters. Methods: A prospective pilot study was conducted with 72 participants, divided equally into the cervical and lower-limb alignment groups. Forward head posture (FHP) and digital hip-knee-ankle (DHKA) angles were measured using MORA Vu and compared with corresponding radiographic parameters. Three healthcare professionals independently conducted the AI-based assessments. Correlations were analyzed, and interrater reliability was assessed using the intraclass correlation coefficient (ICC). Results: FHP showed the strongest correlation with the craniovertebral angle (r = -0.712) and C2-7 sagittal vertical axis (r = 0.704). The DHKA angle strongly correlated with the radiographic hip-knee-ankle angle (r = 0.754). Interrater reliability demonstrated high agreement (ICC: 0.84 FHP, 0.90 DHKA). Conclusions: MORA Vu demonstrated strong validity and high reliability, supporting its potential as a noninvasive screening tool for postural assessment. Given its accessibility and radiation-free nature, it may serve as a viable alternative for routine postural evaluation.

Cement augmentation and hook fixation are popular prophylactic techniques against proximal junctional kyphosis (PJK) development. However, the efficacy of cement and hook has been inconsistent and conflicting. This study investigated the prophylactic effects of cement and hook augmentation in preventing PJK after adult spinal deformity surgery. We included patients undergoing ≥7-level fusion including sacrum for adult spinal deformity. The patients were divided into 3 groups: no-augmentation, cement, and hook groups. PJK was evaluated as mild (proximal junctional angle [PJA] 10°-27°) or severe (PJA ≥28°) PJK according to the PJA. In addition, patients undergoing revision surgery were assigned to severe PJK. Multivariate regression analyses were performed, including confounding variables, which showed significant differences between the no-augmentation and cement groups and between the no-augmentation and hook groups on comparison of baseline and perioperative radiographic data. Altogether, 227 patients were included in the study (female, 90.1%; mean age, 69.7 years; total levels fused, 8.6). There were 105, 79, and 68 patients in the no-augmentation, cement, and hook groups, respectively. Multivariate analysis revealed that no use of cement augmentation did not increase the risk of PJK (odds ratio [OR] = 0.818, P = .706 for mild PJK; OR = 3.483, P = .087 for severe PJK). Multivariate analysis for hook fixation showed that no use of hook fixation did not affect the development of mild PJK (OR = 1.057, P = .891), but significantly increased the risk of severe PJK (OR = 8.287, P = .004). Cement augmentation did not prevent PJK development in the bivariate and multivariate analyses. The preventive effect of hook fixation on PJK development was not significant in unadjusted bivariate analysis. However, hook fixation significantly mitigated the risk of severe PJK in the confounder-adjusted multivariate analysis.

Pelvic tilt (PT) is an important sagittal parameter to be restored to the normal range in corrective surgery for spinopelvic malalignment. However, the normal value of PT varies among patients. With the introduction of the pelvic inclination angle (PIA), which is the angle subtended by the vertical axis and the line connecting the anterior pubic tubercle and the anterior superior iliac spine, we aimed to determine whether the PIA could reflect the symptom severity and whether normal PIA values exist. The study cohort consisted of patients with spinopelvic malalignment (patient group) and normal healthy adults (normal group). In the patient group, correlation analyses were performed to investigate the relationship between the PIA and other sagittal parameters and between the sagittal parameters and patient-reported outcome measures. In the normal group, correlation analysis was performed to assess the relationship between pelvic incidence (PI) and other sagittal parameters. The radiographic parameters were compared according to PI categories. There were 162 patients in the patient group, with a mean age of 71.1 years, and 108 in the normal group, with a mean age of 32.1 years. In the patient group, the PIA strongly correlated with the conventional parameters such as PT, PI-lumbar lordosis mismatch, and T1-pelvic angle. The PIA had weak to moderate correlations with all patient-reported outcome measures, of which the correlation coefficients were similar to or greater than those of other sagittal parameters with patient-reported outcome measures. In the normal group, PI showed moderate to strong correlations with all conventional sagittal parameters except for the PIA, which correlated very weakly with PI. Unlike the other sagittal parameters, the PIA did not significantly differ among the PI categories. The PIA reflected the symptom severity and had a normal value independent of PI. As an alternative to PT, the PIA can be a clinically useful parameter in evaluating and managing patients with spinopelvic malalignment. As the PIA is independent of PI, it will be more useful in differentiating between patients with normal spinopelvic alignment and those with spinopelvic malalignment and in reflecting the clinical symptoms of patients with spinopelvic malalignment. In addition, by providing a cutoff value of 13.6°, the PIA can be used as a surgical target or to predict postoperative outcomes.

Adult spinal deformity (ASD) surgery aims to correct abnormal spinal alignment in both the sagittal and coronal planes to alleviate pain and improve functional activities of daily living. Despite the advancements in surgical techniques that have led to better clinical outcomes, postoperative mechanical complications remain. These complications include instrumentation failure, with proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and rod fractures (RFs) being the most common. Such complications deteriorate clinical outcomes and often require revision surgery, which can be more burdensome for surgeons and patients, than index surgery. Thus, the risk factors for mechanical complications must be identified, and effective preventive strategies established. Therefore, this study aimed to review the risk factors for mechanical complications, focusing on PJK, PJF, and RF, and explore prevention strategies for these complications in ASD surgery, drawing upon recent literature.

Conventional decompression surgery for beak-type ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine, whether approached anteriorly or posteriorly, poses several challenges, including technical complexity, cerebrospinal fluid leakage, incomplete decompression, and potential neurological deterioration. Therefore, the authors introduce a novel technique, anterior sliding decompression osteotomy (ASDO), for thoracic myelopathy caused by OPLL and evaluate the efficacy and safety of this technique. Six patients (4 men and 2 women) who underwent ASDO surgery for beak-type OPLL in the thoracic spine with a follow-up period of at least 2 years were included in the cohort. Clinical and surgical outcomes, including modified Japanese Orthopaedic Association (mJOA) score, neurological recovery rate, canal occupying ratio, operation time, and blood loss, were evaluated. The mean ± SD follow-up period was 26.5 ± 2.0 months. The mean mJOA score improved from 6.0 to 9.7, with the mean recovery rate reaching 63.6% at 6 weeks postoperatively to 73.9% at 2 years after surgery. Neural decompression was effective in all patients, reducing the mean canal occupying ratio from 70.8% to 29.1% without complications. ASDO surgery achieves sufficient spinal cord decompression for beak-type OPLL in the thoracic spine. It represents an effective, feasible technique, offering surgeons a familiar view from the conventional posterior approach.

Extensive spinal fusion inevitably results in loss of mobility, which may induce stiffness-related disability (SRD) during activities of daily living. Few studies have examined SRD after surgical correction for adolescent idiopathic scoliosis (AIS). This study aimed to investigate SRD following surgical treatment in AIS patients particularly with respect to the lowest instrumented vertebra (LIV). Patients who underwent surgical correction for AIS between 2014 and 2021 and were followed up for 2 years were included. The degree of SRD was evaluated using the Stiffness-Related Disability Index (SRDI), which consists of 4 categories, each containing 3 questions, giving a total of 12 components of the questionnaire. The SRDI scores were compared according to the LIV level. Correlation analysis was performed to examine the relationship between the SRDI and legacy health-related quality of life (HRQOL) measurements. This study included 174 patients (47 men and 127 women) with a mean age of 13.8 years. Among the 12 items of the SRDI, the scores of 9 items showed a significant increase after surgery. The total sum of the SRDI scores also significantly increased after surgery. Pearson correlation analysis showed that the SRDI scores were significantly correlated with Oswestry disability index, nearly all domains, and the total sum of Scoliosis Research Society-22 questionnaire, and 36-Item Short Form Survey. No differences in the SRDI score were found among cases with the LIV between T12 and L3. However, the SRDI scores of patients with LIV at L4 were significantly higher than those of patients with other LIV levels. Various degrees of SRD occurred after spinal fusion for AIS. The SRDI was significantly correlated with the HRQOL measurements. The SRDI score was highest in patients with the LIV at L4 when compared to those with other LIV levels. Fusion can be safely extended to L3 without significantly increasing SRD.