One-Stage Posterior Debridement, Interbody Fusion and Instrumentation in the Treatment of Pyogenic Lumbar Spondylodiscitis

STUDY DESIGN: A retrospective study on the outcomes of surgical treatment for pyogenic lumbar spondylodiscitis. OBJECTIVES: To report the clinical outcomes of the surgical treatment of pyogenic lumbar spondylodiscitis using a one stage posterior approach. SUMMARY OF LITERATURE REVIEW: There are few reports on the treatment of pyogenic lumbar spondylodiscitis through a one stage posterior approach. MATERIALS AND METHODS: Between June 1999 and June 2005, this study examined the history of 12 patients with pyogenic lumbar spondylodiscitis treated by simultaneous posterior debridement, autogenous iliac bone graft and pedicle screw fixation. The clinical outcomes were evaluated in terms of the pain level, neurological status, hematological parameters and radiology findings. RESULTS: The clinical symptoms improved in all cases after surgery. There was no case of the infection recurring. The mean time for postoperative antibiotics and hospitalization was 6 weeks and 41.6 days, respectively. Radiological bony fusion was observed at 5.5 months on average. The mean preoperative, immediate postoperative and final follow-up sagittal angles were 4.6, 8.6 and 6.9degrees. CONCLUSION: One stage posterior interbody fusion and instrumentation for the treatment of pyogenic lumbar spondylodiscitis can provide radical debridement, bone graft and immediate stability without prohibiting the control of infection. Therefore, it can be used in selected cases.

Meniscal Ossicle in the Knee: 2 Case Reports

A meniscal ossicle is an ossified structure embedded in the meniscus of the knee, and it very rarely occurs in human. We present here two cases of meniscal ossicle. The two patients were men in their thirties. They had intrameniscal ossicles from the torn posterior horn of the medial meniscus without having any history of trauma. Both cases were treated by arthroscopic excision.

Ulna Nerve Compression Caused by a Tortuous Ulnar Artery

PURPOSE: This case report presents ulnar nerve compression which associated with variant distribution of ulnar artery at the proximal site of the wrist. MATERIALS AND METHODS: Based on the patient's symptoms, we could assume a neuropathy resulting from the compression of the ulnar nerve. The magnetic resonance imaging (MRI) was used to evaluate the anatomical abnormality of the ulnar artery at the site of compression, and the elecromyogram (EMG) and Nerve conduction velocity (NCV) were also performed to confirm the overall abnormality of the ulnar nerve. RESULTS: The tortuous ulnar artery of the lesion which was in the same course as that of ulnar nerve surrounded by sheath seemed to be compressed. Such finding was resolved 5 minutes after taking off tourniquet during adhesiolysis. Along with the improvement in the symptoms of paresthesia and the numbness of the patient a day after the surgery, the atrophy of the muscle and the weakness of the affected lesion were also slightly improved 6 months after the adhesiolysis. The decrease in abnormal spontaneous activity of the ulnar nerve was observed in both EMG and NCV, performed after the 6 month of the surgery. CONCLUSION: Among the patients manifesting significant symptoms of neuropathy arising from ulnar nerve compression, the tortuous ulnar artery as the source of entrapment of ulnar nerve was observed. Six months after the adhesiolysis of the sheath, the overall improvement of clinical symptoms was remarkable.