The Effect of Anxiety, Depression, and Optimism on Postoperative Satisfaction and Clinical Outcomes in Lumbar Spinal Stenosis and Degenerative Spondylolisthesis Patients: Cohort Study

BACKGROUND: The aim of this study is to evaluate the effect of depression, anxiety, and optimism on postoperative satisfaction and clinical outcomes in patients who underwent less than two-level posterior instrumented fusions for lumbar spinal stenosis and degenerative spondylolisthesis. METHODS: Preoperative psychological status of subjects, such as depression, anxiety, and optimism, was evaluated using the Hospital Anxiety and Depression Scale (HADS) and the Revised Life Orientation Test (LOT-R). Clinical evaluation was determined by measuring changes in a visual analogue scale (VAS) and the Oswestry Disability Index (ODI) before and after surgery. Postoperative satisfaction of subjects assessed using the North American Spine Society lumbar spine questionnaire was comparatively analyzed against the preoperative psychological status. The correlation between patient's preoperative psychological status (depression, anxiety, and optimism) and clinical outcomes (VAS and ODI) was evaluated. RESULTS: VAS and ODI scores significantly decreased after surgery (p < 0.001), suggesting clinically favorable outcomes. Preoperative psychological status of patients (anxiety, depression, and optimism) was not related to the degree of improvement in clinical outcomes (VAS and ODI) after surgery. However, postoperative satisfaction was moderately correlated with optimism. CONCLUSIONS: Anxiety and optimism were more correlated with patient satisfaction than clinical outcomes. Accordingly, the surgeon can predict postoperative satisfaction of patients based on careful evaluation of psychological status before surgery.

Single System Langerhans' Cell Histiocytosis with Multifocal Bone Lesions and Pathologic Fracture: A Case Report / 대한골관절종양학회지

Langerhans cell histiocytosis is known as one of the diseases related to excessive proliferation of normal monocytes and has the variety of clinical courses and treatment. Especially, in cases with the spine, it shows a feature of single or multiple osteolysis. According to the location, disease progression and concomitant symptom, variety of treatments (observation, radiotherapy, chemotherapy, surgery, etc.) have been attempted, however, appropriate treatment has not been established yet. The authors introduce the case of single system Langerhans cell histiocytosis which involves cervical and lumbar vertebrae simultaneously with bone marrow destruction and pathologic fracture.

Spontaneous Compression Fracture on the Instrumented End Vertebra: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: This case report presents an elderly male who sustained compression fractures twice on the instrumented end vertebra following a spinal fusion with pedicle screws. SUMMARY OF LITERATURE REVIEW: Because of its low incidence, there is considerable debate regarding an optimal treatment of adjacent segment fracture after long lumbar fusion. Almost all of the reports about adjacent segment fracture are about adjacent vertebral fractures rather than the instrumented vertebral fractures. MATERIALS AND METHODS: A 69 year-old male who was admitted with low back pains of no apparent physical injury underwent pedicle subtraction osteotomy and posterolateral fusion for L3 vertebral fracture and post-traumatic kyphosis. Extension of the fusion segment was performed two months after the initial operation to correct his compression fracture of the instrumented end vertebra, followed by conservative treatments due to a second compression fracture of the instrumented end vertebra two months after the second surgery. RESULTS: Conservative treatment was performed with TLSO brace, after which the fracture was gradually stabilized. CONCLUSIONS: Further research via additional case studies is required to better understand its cause and to develop effective treatment options.

Lumbosacral Fixation Using the Diagonal S2 Screw for Long Fusion in Degenerative Lumbar Deformity: Technical Note Involving 13 Cases

Placing instrumentation into the ilium has been shown to increase the biomechanical stability and the fusion rates, but it has some disadvantages. The diagonal S2 screw technique is an attractive surgical procedure for degenerative lumbar deformity. Between 2008 and 2010, we carried out long fusion across the lumbosacral junction in 13 patients with a degenerative lumbar deformity using the diagonal S2 screws. In 12 of these 13 patients, the lumbosacral fusion was graded as solid fusion with obvious bridging bone (92%). One patient had a rod dislodge at one S2 screw and breakage of one S1 screw and underwent revision nine months postoperatively. So, we present alternative method of lumbopelvic fixation for long fusion in degenerative lumbar deformity using diagonal S2 screw instead of iliac screw.

Osteoporotic Spinal Compression Fracture and Degree of Vitamin D Deficiency

PURPOSE: The aim of the present study was to evaluate the degree of serum vitamin D deficiency in patients with osteoporotic spinal compression fracture and correlation of serum vitamin D level with several variables. MATERIALS AND METHODS: The medical records of 134 patients with osteoporotic spinal compression fracture, diagnosed at our hospital between October 2008 and June 2011, were reviewed. Serum 25(OH)vitamin D3 was used to evaluate the status of vitamin D level. Serum 25(OH)vitamin D3 level was compared and analyzed according to sex, the number of fractured vertebral body, living environment, and the season of injury. The correlation between vitamin D level and age, bone mineral density, and bone turnover marker were evaluated. RESULTS: In the serum 25(OH)vitamin D3, 87 patients (65%) associated with osteoporotic spinal compression fracture had an insufficient level. Vitamin D level was the lowest in winter, the highest in summer, and significantly higher in the living home than nursing home. Vitamin D level was negatively correlated with age (r=-0.201, p=0.02) and positively correlated with bone mineral density (r=0.217, p=0.012). CONCLUSION: Evaluation of vitamin D level in osteoporotic vertebral compression fracture patients may be helpful in planning the treatment of the patients. For insufficient vitamin D level, the adequate sun exposure and supplement of vitamin D may be used.

Treatment of Unstable Sacral Fractures Related to Spino-Pelvic Dissociations

PURPOSE: To evaluate the outcomes of surgical treatment modality in unstable sacral fractures combined with spinal and pelvic ring injury depending on the presence of spino-pelvic dissociations. MATERIALS AND METHODS: The subjects were 16 patients, with unstable sacral fractures combined with spinal and pelvic ring injuries, were operated from July 2004 to January 2011. The patients were divided into 2 groups depending on the presence of spino-pelvic dissociations: those with dissociations were group 1, and those without dissociations were group 2. Group 1 was treated with spino-pelvic fixations using iliac screw, while group 2 was treated with percutaneous iliosacral screw fixations. The availability of the radiological bony union with its application periods, and clinical results using visual analogue scale (VAS) and oswestry disability index (ODI) were evaluated, retrospectively. RESULTS: Out of 16 patients, 8 patients in group 1 were treated with spino-pelvic fixation using iliac screw, and 8 patients in group 2 were treated with percutaneous iliosacral screw fixation. The mean bony union period was 17.4 weeks in group 1, and 19.6 weeks in group 2. The Mean VAS and ODI scores on the last follow-up were 2.5 points and 15.6 points in group 1, 2 points and 18.8 points in group 2, respectively. Both groups had favorable clinical results at the last follow-up. CONCLUSION: For surgical treatments of unstable sacral fractures, spino-pelvic fixation using iliac screws is advised for cases with combined spino-pelvic dissociation, while percutaneous iliosacral screw fixation is advised for cases without combined dissociation.

The Effect of Zoledronic Acid on the Volume of the Fusion-Mass in Lumbar Spinal Fusion

BACKGROUND: Few studies have explored the effects of bisphosphonates on bony healing in patients undergoing spinal fusion surgery. Most previous studies used animal models and found that bisphosphonate shows negative effects on spinal fusion consolidation. We intended to evaluate the effect of a single-dose of zoledronic acid on the volume of the fusion-mass in lumbar spinal fusion. METHODS: A retrospective review was carried out on 44 patients with symptomatic degenerative lumbar spinal stenosis who underwent one or two-level posterolateral fusion from January 2008 and January 2011. They were divided into 4 groups: group 1, autograft and zoledronic acid; group 2, allograft and zoledronic acid; group 3, autograft alone; and group 4, allograft alone. Functional radiography and three-dimensional computed tomography scans were used to evaluate and quantify the volume of the fusion-mass. The visual analog scale (VAS), the Oswestry disability index (ODI), and the short form 36 (SF-36) were used to evaluate the clinical outcomes. RESULTS: The mean volume of the fusion-mass per level was 8,814 mm3, 8,035 mm3, 8,383 mm3, and 7,550 mm3 in groups 1, 2, 3, and 4, respectively, but there were no significant differences between the groups (p = 0.829). There were no significant decreases in the volume of the fusion-mass (p = 0.533) in the zoledronic acid groups (groups 1 and 2). The VAS, the ODI, and the SF-36 at the 6-month follow-up after surgery were not significantly different (p > 0.05) among the 4 groups. The VAS, the ODI, and the SF-36 were not correlated with the volume of the fusion-mass (p = 0.120, 0.609, 0.642). CONCLUSIONS: A single dose of zoledronic acid does not decrease the volume of the fusion-mass in patients undergoing spinal fusion with osteoporosis. Therefore, we recommend that zoledronic acid may be used after spinal fusion in osteoporotic patients.

Delayed Soft Tissue Coverage after Negative Pressure Wound Therapy in Open Fractures of Lower Extremities / 대한정형외과학회잡지

PURPOSE: To evaluate the delayed soft tissue coverage after previous negative wound therapy in treating wounds associated with open lower extremity fracture. MATERIALS AND METHODS: Between June 2007 and February 2011, delayed soft tissue coverage of open lower extremity fractures after previous use of a negative pressure vacuum device, were performed in 15 consecutive patients. Patients included 13 male and 2 female, and their mean age was 39.0 (7-65) years old. Information on the time from injury to definitive wound coverage, type of coverage, functional result, bone union, and complications such as infection were collected. RESULTS: The vacuum-assisted closure devices was applied for an average of 29.3 (9-50) days, and the mean time from injury to definitive wound was 36.1 (21-60) days. Skin graft coverage was performed in 5 cases, free flap in 8 cases, and local flap in 3 cases. The mean time to radiographic union was 5.2 (3-8) months and delayed union occurred in 2 cases. CONCLUSION: Delayed soft tissue coverage after previous negative wound therapy was considered an alternative treatment method in open lower extremity fractures associated with severe concomitant injury.

Treatment for Bilateral Congenital Dislocation of the Patella Using Stanisavljevic Procedure / 대한정형외과학회잡지

Congenital dislocation of the patella is a rare clinical entity and is considered to result from a failure in internal rotation when the myotome develops, which forms the femur, the quadriceps muscle, and the extensor mechanism. Several authors have suggested various treatment methods, but there has been no consensus on treatment. A 12-year-old boy complained of knee pain and presented with a deformity due to bilateral congenital dislocation of the patella. The patient was treated with surgical management using the Stanisavljevic procedure. We report this case of congenital dislocation of the patella treated with this procedure that achieved a stable patellofemoral joint and satisfactory clinical results over 6.5 years of follow-up. In addition, we have included a review of the relevant medical literature.

Periprosthetic Fracture after Locked Plating in the Osteoporotic Long Bone Fracture / 대한정형외과학회잡지

The locking plate is used for osteoporotic long bone fracture because of the ability to affect a lock between the plate and locking screws that prevents reduction loss, angular deformity and axial deformity. However, it has been reported that locked plating can increase the periprosthetic fracture risk in osteoporotic bone compared with conventional plating. We report 3 cases of periprosthetic fracture after the use of locked plating in osteoporotic long bone fracture and a review of the relevant literatures.

Subdural Abscess in a Patient with Epidural Abscess Combined with Dural Tear / 대한정형외과학회잡지

Abscesses of the epidural and subdural spine are relatively rare, but can rapidly progress and cause paraplegia; the mortality rate is high despite improvements in treatment method. In particular, the reoccurrence of subdural abscesses after treatment of an epidural abscess is extremely rare. We experienced a case in which the subdural abscess reoccurred after spinal decompression and drainage of an epidural abscess combined with a dural tear. We report this rare case with a review of the relevant literatures.

The Evaluation of a Dissolvable Ureteral Catheter in a Rabbit Model / 대한비뇨기과학회지

PROPOSE: Ureteral stents are commonly placed after routine ureteroscopic procedures to prevent acute obstruction. However, stents can cause significant symptoms and they can require a secondary procedure for removal; further, they may possibly be forgotten. In order to overcome these problems, a temporary ureteral drainage stent capable of dissolving spontaneously was developed to evaluate the tissue reaction and toxicity. MATERIALS AND METHODS: We developed a dissolvable ureteral catheter composed of polydioxanone (PDO). We evaluated the toxicity and tissue reaction by hematologic (CBC, aminotransferase/alanine transaminase (AST/ALT), blood urea nitrogen, creatinine (BUN, Cr), alkaline phosphatase) and histologic examination (ureter, kidney and liver tissue). Twelve rabbits were placed into groups of four rabbits each: the uninserted control group, group I that had a dissolvable ureteral catheter inserted with harvest at four weeks, group II that had a dissolvable ureteral catheter inserted with harvest at eight weeks, and group III that had a dissolvable ureteral catheter inserted with harvest at twelve weeks. RESULTS: On histologic examination, the ureter had a normal appearance of transitional cells and it contained the dissolvable ureteral catheter in the ureteral lumen without any inflammatory change. The ureteral surface cells appeared normal after contact with the dissolvable ureteral catheter during the 12 weeks. Liver and kidney tissue showed mild focal inflammatory change, but no definitive difference was noted between the control and groups I, II and III. On the hematologic examination, there was no significant change of the value of CBC, AST/ALT, BUN, Cr and alkaline phosphatase due to the inserted dissolvable ureteral catheter during the 12 weeks. CONCLUSIONS: A dissolvable ureteral catheter appeared to have no toxic effect, as evidenced by histological and hematological examination. However, further study is warranted in order to overcome the catheter's limitations like for its flexibility.

Double-blind, Placebo-controlled, Multi-center Study for Therapeutic Effects of Mountain Panax Ginseng C.A. Meyer Extract in Men with Erectile Dysfunction: a Preliminary Report / 대한남성과학회지

PURPOSE: We investigated the effect of 100-year-old mountain ginseng(Panax ginseng C.A. Meyer, PG-CAM) extract on patients with erectile dysfunction(ED). MATERIALS AND METHODS: A total of 35 patients with ED(23 patients in PG-CAM administration group, 12 in placebo group) were enrolled in this double-blind study. The drug was administered for 12 weeks. Before and after administration, patients took the self-administered IIEF-5 questionnaire and were tested for serum hormone levels(testosterone, LH, FSH, estradiol), complete blood count, liver and renal function test, and urinalysis. RESULTS: The IIEF-5 scores for the placebo group were 19.7+/-2.3 and 19.9+/-3.6 before and after treatment, respectively. For all patients taking PG-CAM, IIEF-5 scores increased 18.1+/-5.6 to 20.2+/-4.5. For those patients with initial scores below 17, IIEF-5 scores increased from 12.4+/-6.2 to 19.7+/-6.7. These results indicate that PG-CAM may increase erectile function in ED patients, particularly those with poor erection. No changes were detected in hormonal levels or blood tests. No toxic side effect were reported. CONCLUSIONS: IIEF-5 score improved significantly in ED patients treated with PG-CAM, suggesting that PG-CAM extract could be a treatment candidates for ED.

Double-blind, Placebo-controlled, Multi-center Study for Therapeutic Effects of Mountain Panax Ginseng C.A. Meyer Extract in Men with Erectile Dysfunction: a Preliminary Report / 대한남성과학회지

PURPOSE: We investigated the effect of 100-year-old mountain ginseng(Panax ginseng C.A. Meyer, PG-CAM) extract on patients with erectile dysfunction(ED). MATERIALS AND METHODS: A total of 35 patients with ED(23 patients in PG-CAM administration group, 12 in placebo group) were enrolled in this double-blind study. The drug was administered for 12 weeks. Before and after administration, patients took the self-administered IIEF-5 questionnaire and were tested for serum hormone levels(testosterone, LH, FSH, estradiol), complete blood count, liver and renal function test, and urinalysis. RESULTS: The IIEF-5 scores for the placebo group were 19.7+/-2.3 and 19.9+/-3.6 before and after treatment, respectively. For all patients taking PG-CAM, IIEF-5 scores increased 18.1+/-5.6 to 20.2+/-4.5. For those patients with initial scores below 17, IIEF-5 scores increased from 12.4+/-6.2 to 19.7+/-6.7. These results indicate that PG-CAM may increase erectile function in ED patients, particularly those with poor erection. No changes were detected in hormonal levels or blood tests. No toxic side effect were reported. CONCLUSIONS: IIEF-5 score improved significantly in ED patients treated with PG-CAM, suggesting that PG-CAM extract could be a treatment candidates for ED.

Evaluation of Complementary and Alternative Medicine for Treating Patients with Erectile Dysfunction / 대한비뇨기과학회지

Purpose: The aim of this study was to evaluate complementary and alternative medicines (CAM) employed for treating patients with erectile dysfunction. Materials and Methods: A total of 204 patients with erectile dysfunction who completed a questionnaire between January and June 2005 were evaluated. The questionnaire was composed of 13 questions. This survey employed a broad definition for CAM, including acupuncture, biofeedback, folk remedies, chiropractic, homeopathy, hypnosis, massage, psychotherapy, relaxation, energy healing, imagery, special diet, spiritual healing and herbal medicine. The CAMs used by the patients with erectile dysfunction were divided into processed health foods, natural health foods and other therapies, and these were all analyzed. Results: The mean age was 57.9+/-10.1 years. 78 of the total patients with erectile dysfunction had employed at least one CAM. CAM users were more likely to be high school educated, nonsmokers and exercisers. The CAMs used were processed health foods 62% (48/78), natural health foods 15% (12/78), and other therapies 66% (52/78). The processed health foods were soy 25%, ginseng 23% and mushroom 19%. Of the natural health foods, tomato was 42%, soy was 25% and ginseng was 17%. Of the other therapies, herbal medicine was 45%, acupuncture was 25%, moxibustion and cupping a boil were 17%. 35% (27/78) of the patients with erectile dysfunction had employed more than one of the processed health foods, natural health foods and other therapies. Conclusions: Patients with erectile dysfunction had mainly employed processed health foods more than the natural health foods, herbal medicine and acupuncture. We think that more research is required about the effects and benefits of CAM in association with ED.

Management of Voiding Dysfunction after Surgical Treatment of Female Stress Urinary Incontinence

PURPOSE: We studied the voiding dysfunction after surgical treatment of female stress urinary incontinence and diagnosis and treatment. MATERIALS AND METHODS: Three hundred women with stress urinary incontinence underwent surgical procedure between January 1998 and December 2004. Ninety two patients(30.6%) experienced the postoperative voiding dysfunction. As the primary procedure for the management of postoperative voiding dysfunction alpha-blockers medication and clean intermittent catheterization(CIC) were performed. Then, hegar dilation and urethral pull-down procedure were performed as a secondary measure. For the patients who showed persistent obstructed symptoms, cutting of mesh or sling materials were performed. RESULTS: In 57 patients, symptoms improved by alpha-blockers medication and CIC. The others were received hegar dilation and urethral pull-down procedure, and 29 patients were improved. 6 patients were not controlled by conservative treatment, of which 3 patients underwent cutting of mesh or sling. De novo urgency was developed in 12 patients. Anticholinergics were taken, symptoms were diminished in 10 patients after 5 months of medication. CONCLUSION: Most voiding dysfunction after surgery may be effectively managed by conservative treatment. In cases of failure, hegar dilation and urethral pull-down procedure may be useful within postoperative first weak. Finally, cutting of mesh or sling must be considered in patient whose the secondary measure is failed.

Psychometric Properties of the Korean Version of the King's Health Questionnaire in Women with Stress Urinary Incontinence

PURPOSE: The purpose of this study is to evaluate the psychometric properties of the Korean version of the King's Health Questionnaire(KHQ) in patients with stress urinary incontinence. MATERIALS AND METHODS: Multicenter prospective study was undertaken in 106 patients with stress urinary incontince. Psychometric properties including discriminant validity, convergent validity were evaluated and the Cronbach's alpha coefficients were calculated. Test-retest analysis was performed and the sensitivity to clinical change before and after treatment was also evaluated. RESULTS: The psychometric properties and clinical validity of the KHQ Korean version were confirmed in 106 study population. The KHQ's good reliability was evidenced by Cronbach's alpha coefficients of>0.60, indicating to change in patients' perception of bladder condition in all domains. CONCLUSION: Our analyses confirm excellent psychometric properties for the Korean version of KHQ, which appears to provide a valid and reliable instrument for clinical usages in Korea.

A Case of Dural Arteriovenous Fistula of Superior Sagittal Sinus presented with ReVersible Dementia

A 58-years-old man came to the hospital because of progressive intellectual deterioration, gait disturbance and postural instability for 6 months. Neuropsychological tests showed severe impairment of memory and executive functions, and dural arteriovenous fistula of the superior sagittal sinus (dAVF of SSS) was found on brain MRI and angiography. The symptoms were markedly improved after selective transvascular embolization treatments. Even though the dAVF of SSS is a rare cause of dementia, we suggest that it can be one of the treatable causes of dementia.

The Reasonability of Nocturnal Penile Tumescense and Rigidity Testing Value with Rigiscan / 대한비뇨기과학회지

PROPOSE: A specific criterion or comprehensive criteria for the condition of nocturnal erection, which can be considered as an abnormal erection mechanism or organic erectile dysfunction(ED), remain to be established. Thus, it was decided to verify the tenability of the currently referred criteria by performing nocturnal erection tests on volunteers with normal sexual cravings and erection capabilities. MATERIALS AND METHODS: This study was performed on 58 volunteers aged 20 years or older, with a normal sexual life and without past perversion. An IIEF questionnaire was used for verification of normalcy. Only the results from the volunteers who had had more than 4 sexual intercourses during the past 4 weeks, and had attained satisfaction, were reflected in the final report. All subjects completed three sessions of 3 nights of recording using the RigiScan device during the 3 day period. The volunteers were excluded if they woke due to the pressure of the ring or when they had less than 6 hours sleep during the test. RESULTS: The average number and period of erections were 3.7+/-1.7 times and 91+/-53.3 minutes and the average hardness of the distal part and base of the penis were 61+/-25.1 and 73.7+/-22.1% respectively. The average number of erections and maintained duration were 3.7 and 91 minutes, respectively. With more than 40% hardness, the distal part and base of the penis stayed erect for 62.3+/-37.0 and 74.1+/-46.5 minutes, while these figures for an erection were 57.7+/-35.7 and 72.8+/-46.3 minutes, respectively, as confirmed by greater than 60% hardness. Therefore, 56 of the 58(96.5%) failed to satisfy more than one of the criteria and 44(75.8%) did not meet the Brandley's nocturnal erection criterion standard. CONCLUSIONS: Our results were below the criteria for the existing erection test, which means there is the likelihood that these standards are overly high for Korean adult males. Apparently not all cases failing to reach the existing standard level of the nocturnal erection test should be considered as ED, with greater discretion required in the diagnosis for patients with ED.

Three Cases of Delayed Onset Post-traumatic Segmental Spinal Myoclonus

Segmental myoclonus can be seen in variable lesions of the brainstem or spinal cord, but the pathophysiology of the segmental myoclonus is not fully defined yet. We describe three patients with delayed developed and chronically persisted involuntary movement restricted to one arm after mild cervical injury. Myoclonus developed 1 month later in 2 patients and the other 5 months later after the injury. They suffered from myoclonus for more than 2 months, 1 year, and 25 years, respectively. Clonazepam and phenytoin were tried, but not satisfactory.