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Objectives@#This case report presents a surgical technique used to perform vertebral anterior column stabilization in an elderly male patient who had recently been diagnosed with an uppermost instrumented vertebral fracture (IVF) at the site of previous posterior lumbar instrumented fusion (PIF).Summary of Literature Review: Although conservative treatment is also used for IVF, the proximal junction of PIF is an area where the compression load is concentrated biomechanically, so the uppermost IVF often requires surgical treatment. This may require fixation of extended segments and more surgical morbidity. @*Materials and Methods@#A 73-year-old male patient who had undergone PIF from L2 to L5 more than 20 years previously was recently diagnosed with uppermost IVF without a traumatic event. He complained of persistent back pain even after 2 months of conservative treatment. He ultimately underwent percutaneous vertebroplasty through the parapedicular approach.Result: The patients showed a favorable outcome at a 1-year follow-up. @*Conclusions@#Percutaneous vertebroplasty through the parapedicular approach for uppermost IVF at the site of a previous PIF might be a feasible and less invasive alternative.
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Objectives@#This case report presents a surgical technique used to perform vertebral anterior column stabilization in an elderly male patient who had recently been diagnosed with an uppermost instrumented vertebral fracture (IVF) at the site of previous posterior lumbar instrumented fusion (PIF).Summary of Literature Review: Although conservative treatment is also used for IVF, the proximal junction of PIF is an area where the compression load is concentrated biomechanically, so the uppermost IVF often requires surgical treatment. This may require fixation of extended segments and more surgical morbidity. @*Materials and Methods@#A 73-year-old male patient who had undergone PIF from L2 to L5 more than 20 years previously was recently diagnosed with uppermost IVF without a traumatic event. He complained of persistent back pain even after 2 months of conservative treatment. He ultimately underwent percutaneous vertebroplasty through the parapedicular approach.Result: The patients showed a favorable outcome at a 1-year follow-up. @*Conclusions@#Percutaneous vertebroplasty through the parapedicular approach for uppermost IVF at the site of a previous PIF might be a feasible and less invasive alternative.
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STUDY DESIGN: Case report. OBJECTIVES: To document unilateral biportal endoscopy (UBE) as a treatment for acute radiculopathy after osteoporotic vertebral fracture. SUMMARY OF LITERATURE REVIEW: Acute radiculopathy after osteoporotic vertebral fracture leads to claudication. Treatment of osteoporotic vertebral fractures with accompanying radiating pain is challenging. MATERIALS AND METHODS: A 74-year-old woman was diagnosed with an osteoporotic vertebral fracture at L3 after slipping and falling. Vertebroplasty was performed for the osteoporotic vertebral fracture at L3. She still complained of right lower extremity radiating pain. UBE was performed to treat acute radiculopathy. RESULTS: Foraminal decompression using UBE was performed at the L3–4 right foraminal area. Her symptoms resolved after surgery. CONCLUSIONS: UBE is a useful treatment method for acute radiculopathy after osteoporotic vertebral fracture.
Subject(s)
Aged , Female , Humans , Accidental Falls , Decompression , Endoscopy , Fractures, Compression , Lower Extremity , Methods , Radiculopathy , VertebroplastyABSTRACT
OBJECTIVES@#To document unilateral biportal endoscopy (UBE) as a treatment for acute radiculopathy after osteoporotic vertebral fracture.SUMMARY OF LITERATURE REVIEW: Acute radiculopathy after osteoporotic vertebral fracture leads to claudication. Treatment of osteoporotic vertebral fractures with accompanying radiating pain is challenging.@*MATERIALS AND METHODS@#A 74-year-old woman was diagnosed with an osteoporotic vertebral fracture at L3 after slipping and falling. Vertebroplasty was performed for the osteoporotic vertebral fracture at L3. She still complained of right lower extremity radiating pain. UBE was performed to treat acute radiculopathy.@*RESULTS@#Foraminal decompression using UBE was performed at the L3–4 right foraminal area. Her symptoms resolved after surgery.@*CONCLUSIONS@#UBE is a useful treatment method for acute radiculopathy after osteoporotic vertebral fracture.
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STUDY DESIGN: Case report. OBJECTIVES: We report 3 cases of loss of disc height after spontaneous regression of a herniated lumbar disc. SUMMARY OF LITERATURE REVIEW: Reports of spontaneous regression of a herniated lumbar disc were identified. MATERIALS AND METHODS: We conservatively treated 3 patients who were diagnosed with a herniated lumbar disc. During outpatient follow-up, radiating pain improved in all patients, but they complained of chronic lower back pain. Magnetic resonance imaging (MRI) was performed for diagnostic purposes. RESULTS: On MRI, spontaneous regression of the herniated lumbar discs was observed, but loss of disc height was also found. CONCLUSIONS: A herniated lumbar disc may be a risk factor for loss of disc height. It is important to recognize that a patient with a herniated lumbar disc can struggle with chronic lower back pain even if spontaneous regression of the herniated lumbar disc occurs.
Subject(s)
Humans , Follow-Up Studies , Low Back Pain , Magnetic Resonance Imaging , Outpatients , Risk FactorsABSTRACT
STUDY DESIGN: Case report OBJECTIVES: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). SUMMARY OF LITERATURE REVIEW: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. MATERIALS AND METHODS: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. RESULTS: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. CONCLUSIONS: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.
Subject(s)
Humans , Adhesives , Diagnosis , Diskectomy , Electromyography , Fistula , Lower Extremity , Magnetic Resonance Imaging , Nylons , Pain, Intractable , TearsABSTRACT
OBJECTIVES@#We report 3 cases of loss of disc height after spontaneous regression of a herniated lumbar disc.SUMMARY OF LITERATURE REVIEW: Reports of spontaneous regression of a herniated lumbar disc were identified.@*MATERIALS AND METHODS@#We conservatively treated 3 patients who were diagnosed with a herniated lumbar disc. During outpatient follow-up, radiating pain improved in all patients, but they complained of chronic lower back pain. Magnetic resonance imaging (MRI) was performed for diagnostic purposes.@*RESULTS@#On MRI, spontaneous regression of the herniated lumbar discs was observed, but loss of disc height was also found.@*CONCLUSIONS@#A herniated lumbar disc may be a risk factor for loss of disc height. It is important to recognize that a patient with a herniated lumbar disc can struggle with chronic lower back pain even if spontaneous regression of the herniated lumbar disc occurs.
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OBJECTIVES@#To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD).SUMMARY OF LITERATURE REVIEW: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified.@*MATERIALS AND METHODS@#A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures.@*RESULTS@#In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably.@*CONCLUSIONS@#Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.
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PURPOSE: In our previous study, the authors developed high heat-treated mineralized porcine cancellous bone(TS-GBB, TaeSan Green Bone Block) as bone-substitute. So we projected that this experiments about TSGBB would prove its safety about problems after transplants, and its stability in mechanical strength as the human bone-substitute. MATERIALS AND METHODS: Highly heat-treated mineralized porcine cancellous bone was made. The chemical, mechanical, and morphological properties were evaluated through various tests. Animal study Total 31 New Zealand White rabbits were randomly selected. Bony defect on medial side of the proximal tibia was made. TS-GBB was implanted into the defect area in experimental group, while it was not inserted in control group. For stable fixation self-designed plate of stainless steel was used in both groups. At 2, 8, and 24 weeks, radiological evaluation was performed to measure new bone formation. At 4 and 16 weeks, clinical laboratory tests were performed. Mechanical shear tests were performed for control and experimental groups at 2, 8, and 16 weeks after operation. Also, histological observations were performed by H & E staining at 2 and 16 weeks after operation. Clinical experiments With the approval of IRB in Pusan Paik Hospital of Inje University and Hwasoon Hospital of Chunnam National University, the clinical trials were processed. After harvesting iliac bone for auto grafts from the 40 patients, 20 for each hospital, the TS-GBB were inserted to the donor site. ESR, CRP, WBC count were performed at postoperative time immediately, 1 week, 4 weeks, and 12 weeks to examine possible infection. At 12 weeks after operation, additional X-ray and CT observation were performed. RESULTS: Animal study At all laboratory finding, two group did not indicate a significant difference. At radiologic evaluation, we could comfirm that bone defect size was small gradually by new bone formation in the control group but new bone formation degree was more smaller and slower compared to the TS-GBB group. And at result of biological dynamic stiffness experiments, at postoperative 16 weeks, maximum load at breakage of control group showed to approximately 70% in normal tibia's that. But, maximum load at breakage or yield of TS-GBB group showed to more than 95% in normal tibia's that. In histologic examination, at postoperative 16 weeks, we comfirmed that in control group atypical bony tissue existed in defect site. On the other side, in TS-GBB group new bone formation formed in uniform. Clinical experiments In 20 cases of Inje University, absorption rate was slow a little at 1 case, but the others absorbed normally. In 17 cases of Hwasun Hospital of Chunnam National University, we comfirmed in grade 3 about TS-GBB's absorption and new bone formation at 16 case. At only 1 case, degree of TS-GBB's absorption and new bone formation was poor. In clinical chemistry tests to evaluate the safety, 19 of 20 patients who participated in the experiment in Pusan Paik hospital showed no specific abnormality and showed similar result to preoperative laboratory. In 1 case at postoperative 12 weeks, CRP was elevated, at 16 weeks this patient showed in normal value in ESR, CRP, and WBC count. In 20 patients of Hwasun Hospital all showed similar results to preoperative laboratory in clinical chemistry tests. CONCLUSION: We think that TS-GBB is the suitable material for regeneration of bone defect site as xenograft of clinical bone substitute.
Subject(s)
Animals , Humans , Rabbits , Absorption , Bone Substitutes , Chemistry, Clinical , Clinical Chemistry Tests , Ethics Committees, Research , Osteogenesis , Reference Values , Regeneration , Stainless Steel , Tibia , Tissue Donors , Transplantation, Heterologous , TransplantsABSTRACT
PURPOSE: To emphasize the importance of considering tuberculosis in atypical cases of foot and ankle by reporting clinical results of those cases. MATERIALS AND METHODS: Seven cases which were diagnosed as tuberculosis around foot and ankle from March 1996 to June 2007 were included. We reviewed initial impressions, the time to be diagnosed, clinical symptoms, laboratory findings, radiological findings and the clinical results and complications. RESULTS: We followed up at least 6 months (6~24 months) after surgery in all cases. Initially 2 cases had been diagnosed as cellulitis, 4 cases as chronic osteomyelitis, and 1 case as an ankle instability. Tuberculosis was diagnosed after biopsy in all cases. Mean duration of symptom was 15 months (6~36 months) except in infants. There were various radiologic manifestations such as osteopenia, bony erosion or destruction and cystic changes. Symptoms were relieved in all cases within 4 months with chemotherapy followed by surgical biopsy, except one ankle which had been misdiagnosed as ankle instability and joint destruction was developed after modified Brostrom surgery. CONCLUSION: It is important to perform a surgical biopsy for diagnosis and proper management even with a faint suspicion on tuberculosis in foot and ankle. And in case of need, when surgical biopsy is performed, curettage procedure may help to improve clinical result.