Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

BACKGROUND: To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondylolisthesis on lumbar lordosis after an intraoperative prone position. METHODS: Sixty-seven patients, who underwent spinal fusion at the Department of Orthopaedic Surgery of Gwangmyeong Sungae Hospital between May 2007 and February 2012, were included in this study. The study compared lumbar lordosis on preoperative upright, intraoperative prone and postoperative upright lateral X-rays between the simple stenosis (SS) group and spondylolisthesis group. The average age of patients was 67.86 years old. The average preoperative lordosis was 43.5degrees (+/- 14.9degrees), average intraoperative lordosis was 48.8degrees (+/- 13.2degrees), average postoperative lordosis was 46.5degrees (+/- 16.1degrees) and the average change on the frame was 5.3degrees (+/- 10.6degrees). RESULTS: Among all patients, 24 patients were diagnosed with simple spinal stenosis, 43 patients with spondylolisthesis (29 degenerative spondylolisthesis and 14 isthmic spondylolisthesis). Between the SS group and spondylolisthesis group, preoperative lordosis, intraoperative lordosis and postoperative lordosis were significantly larger in the spondylolisthesis group. The ratio of patients with increased lordosis on the OSI frame compared to preoperative lordosis was significantly higher in the spondylolisthesis group. The risk of increased lordosis on frame was significantly higher in the spondylolisthesis group (odds ratio, 3.325; 95% confidence interval, 1.101 to 10.039; p = 0.033). CONCLUSIONS: Intraoperative lumbar lordosis on the OSI frame with a prone position was larger in the SS patients than the spondylolisthesis patients, which also produced a larger postoperative lordosis angle after posterior spinal fusion surgery. An increase in lumbar lordosis on the OSI frame should be considered during posterior spinal fusion surgery, especially in spondylolisthesis patients.

Development of Preliminary Quality Assurance Software for GafChromic(R) EBT2 Film Dosimetry / 의학물리

Software for GafChromic EBT2 film dosimetry was developed in this study. The software provides film calibration functions based on color channels, which are categorized depending on the colors red, green, blue, and gray. Evaluations of the correction effects for light scattering of a flat-bed scanner and thickness differences of the active layer are available. Dosimetric results from EBT2 films can be compared with those from the treatment planning system ECLIPSE or the two-dimensional ionization chamber array MatriXX. Dose verification using EBT2 films is implemented by carrying out the following procedures: file import, noise filtering, background correction and active layer correction, dose calculation, and evaluation. The relative and absolute background corrections are selectively applied. The calibration results and fitting equation for the sensitometric curve are exported to files. After two different types of dose matrixes are aligned through the interpolation of spatial pixel spacing, interactive translation, and rotation, profiles and isodose curves are compared. In addition, the gamma index and gamma histogram are analyzed according to the determined criteria of distance-to-agreement and dose difference. The performance evaluations were achieved by dose verification in the 60o-enhanced dynamic wedged field and intensity-modulated (IM) beams for prostate cancer. All pass ratios for the two types of tests showed more than 99% in the evaluation, and a gamma histogram with 3 mm and 3% criteria was used. The software was developed for use in routine periodic quality assurance and complex IM beam verification. It can also be used as a dedicated radiochromic film software tool for analyzing dose distribution.

Dosimetric Characteristics of Edge Detector(TM) in Small Beam Dosimetry / 의학물리

In this study, we evaluated an edge detector for small-beam dosimetry. We measured the dose linearity, dose rate dependence, output factor, beam profiles, and percentage depth dose using an edge detector (Model 1118 Edge) for 6-MV photon beams at different field sizes and depths. The obtained values were compared with those obtained using a standard volume ionization chamber (CC13) and photon diode detector (PFD). The dose linearity results for the three detectors showed good agreement within 1%. The edge detector had the best linearity of +/-0.08%. The edge detector and PFD showed little dose rate dependency throughout the range of 100~600 MU/min, while CC13 showed a significant discrepancy of approximately -5% at 100 MU/min. The output factors of the three detectors showed good agreement within 1% for the tested field sizes. However, the output factor of CC13 compared to the other two detectors had a maximum difference of 21% for small field sizes (~4x4 cm2). When analyzing the 20~80% penumbra, the penumbra measured using CC13 was approximately two times wider than that using the edge detector for all field sizes. The width measured using PFD was approximately 30% wider for all field sizes. Compared to the edge detector, the 10~90% penumbras measured using the CC13 and PFD were approximately 55% and 19% wider, respectively. The full width at half maximum (FWHM) of the edge detector was close to the real field size, while the other two detectors measured values that were 8~10% greater for all field sizes. Percentage depth doses measured by the three detectors corresponded to each other for small beams. Based on the results, we consider the edge detector as an appropriate small-beam detector, while CC13 and PFD can lead to some errors when used for small beam fields under 4x4 cm2.

A Case of Primary Hyperparathyroidism / 대한내분비외과학회지

A 65 years old male, who had complained of severe lower back pain with generalized muscular weakness, nausea and constipation since last 18 months, showed typical loboratory and radilogical findings of primary hyperparathyroidism. It had extensive skeletal involvement and some urological complication. The mass, which was palpated in the right upper corner of the thyroid, was surgically completely removed. It was measured 8×4×3 cm, and was weighed 38 gm. Microscopic examination revealed adenoma of the parathyroid gland consisting of small dark chiefe ells. Postoperative course has been satisfactory. (

Genetic Transmission of Fibrodysplasia Ossificans Progressiva: Report of Two Cases in a Family

Fibrodysplasia ossificans progressiva (FOP) is a rare connective tissue disorder characterized by congenital malformation of the great toes and by progressive heterotopic ossification of the tendons, ligaments, fasciae and skeletal muscles. We document the radiologic manifestation of FOP passed from a sporadically affected father to each of his two children (a son and a daughter). Previous consideration of a genetic etiology was based on the fact that the disease has been reported in several sets of monozygotic twins and that increased paternal age has been associated with sporadic occurrence of the disorder. Although autosomal-dominant transmission has long been suspected, the findings in this family provide confirmation for such inheritance and a basis for the diagnosis and counseling of patients with FOP.

Congenital Anomalies of the Hand: A Clinical Study / 대한정형외과학회잡지

Congenital hand anomalies encompass a very broad spectrum of deformity, and precise classification of these deformities has always posed a major problem. We reviewed 50 cases of congenital hand deformities in 47 patients, managed at Department of,Orthopedic Surgery, Severance Hospital from Jan. 1980. to Jun. 1984 and the following results were obtained. 1. There were 26 males and 21 females in 47 patients and the ratio between male and female was 1.2: 1. Right hands were involved in 16 patients and both hands were in 14 patients. 2. The most commomn type of anomalies were polydactylysm(48%), next were syndactylysm (24%) and the follwing anomalies were found: camptodactyly, congenital constriction band syndrome, congenital ulnar deficiency, congenital clasped thumb, clinodactyly, congenital finger deficiency, symphalangism. 3. 9 associated congenital anomalias were found in 5 patients, in which, anomalies of the foot were most common. 4. Prenatal history such as drug ingestion, preeclampsia, breech delivery, prematurity, low birth weight were found and 2 cases of family history were found. 5. Treatment was stressed upon the function of hand and the improvement of the deformity.

A Clinical Study on the Supracondylar Fractures of the Femur / 대한정형외과학회잡지

The management of supracondylar fractures of the femur remains controversial. Most studies over the past twenty years have attempted to compare the results of non-surgical with those of surgical methods. Until a few years ago, conservative treatment was considered superior to internal fixation of supracondylar fractures of the femur. However, the development of new fixation devices and techniques have, according to several investigations, improved the results of the treatment of these fractures. The following clinical results were shown by analysis of 96 cases of supracondylar fractures of the femur treated in the Department of Orthopedic Surgery, Yonsei University, College of Medicine during the past 10 years from Jan. 1971 to Dec. 1980. 1. The prevalent age distribution was between 21 and 50 years of age (79.1%), and the ratio between males and females was 3.4:1. The most common cause of injury was car accidents (51.0%). 2. A classification of supracondylar fractures was unicondylar, simple supracondylar and intercondylar. Intercondylar which was subdivided into Type I, II-A, II-B, III according to Neer's classification. 3. Fifty nine patients (61.4%) were associated with injuries of other parts and the most frequent associated fracture was tibial fracture and the most common associated soft tissue injury was cerebral concussion or contusion. 4. The methods of treatment: conservative management by using skeletal traction for 34 cases, surgical treatment by open reduction and internal fixation for 58 cases and A-K amputation for 4 cases due to populiteral artery injury. 5. Fifty nine cases were suitable for result analysis. The satisfactory result of surgical treatment was 63.4% and conservative treatment was 50.0% respectively. The factors affecting the final results were Type of fracture, severity of injury, and rigid internal fixation. 6. The main complications of the supracondylar fractures of the femur were delayed union (10.2%), infection (10.2%), and traumatic arthritis (13.3%). 7. Finally, the results of treatment depend largely on anatomical reduction, rigid fixation, early joint motion.

Clinical Study on the Femoral Shaft Fracture / 대한정형외과학회잡지

The femur is the largest long bone in the body which is related to weight bearing. As a result of rapid increase in traffic accidents and industrial injuries, the incidence of femoral shaft fractures has risen also. The methods of treatment in children and adults are different, therefore inadequate treatment can cause permanent disability. The authors have reviewed 211 cases of femoral shaft fractures in 204 persons (children and adults) from September 1967 to September 1976 whe were admitted and treated in Orthopedic Department, Severance Hospital. The results were as follows: 1. The fractures occured commonly in the 6–10 yr. age group (41.2%) in children and in the 21–40 yr. group (54.2%) in adults. Males comprised 138 cases (67.6%). 2. Closed fractures were 185 cases (87.7%) and comminuted fractures were the most common type, 94 cases (44.5%) in all. The fracture site was middle third in 116 cases (55%). 3. Causes were mainly car accidents, 146 cases (71.5%) and industrial injuries. Pedestrian injuries are particularly common in Korea. Many industrial accidents occur due to inadequate working facilities in factories. 4. Associated injuries were common in young adults and in order of frequency these were fractures of the tibia and fibula; skulls; pubic bone. 5. In the early and delayed operation groups, primary bony union rate was better (92%) in the early than the late operation group (78.3%). 6 The period of bony union was 13 weeks with compression plate and screw fixation: 16 weeks with Kuntscher nailing; 17. 5 weeks with plate and screw fixation; and 20 weeks with skeletal traction in adults. 7. Knee joint motion was most limited with skeletal traction (33.5%), less with plate and screw fixation (14.7%) and Kuntscher nailing (1.7%), but none with compression plate and screw fixation. 8. Good results were obtained with conservative treatment in children and operative treatment in adults. 9. Complications were much less frequent in children than in adults and were treated well. 10. Post-operative infection rate was 4.4% and infection was treated well with conservative measures. 11. The 90° – 90° skeletal traction in children and compression plate and screw fixation along with cast brace in adults were recommended.