Chorpart's Dislocation: A Case Report / 대한족부족관절학회지

The midtarsal joint which consists of the talonavicular and calcaneocuboid joints lies transversely across the medial and lateral arches of the foot. Complete dislocation of this joint unassociated with fracture is extremely rare. A 36 year-old male who was injured by motor vehicle accident came to help for his left midfoot pain and deformity. We misdiagnosed as subtalar dislocation. Closed reduction was performed. We reviewed initial and post-reduction X-rays, and then we diagnosed as Chopart's dislocation. CT scan was taken; it showed fracture of the anterior process of the calcaneous.

Surgical Treatment of Isthmic Spondylolisthesis: Pedicle Screw Fixation, Posterolateral Fusion, and Posterior Lumbar Interbody Fusion with Cage after Wide Decompression / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To verify the advantages of adding gentle reduction and posterior lumbar interbody fusion (PLIF), using a cage to the usual posterolateral fusion (PLF), with pedicle screw instrumentation, in the surgical treatment of spinal stenosis with isthmic spondylolisthesis. SUMMARY OF LITERATURE REVIEW: The stabilization of isthmic spondylolisthesis, following decompression, is difficult. The PLIF, with a cage, offers anterior column support, reduction and a broad fusion base. MATERIALS AND METHODS: 31 patients were treated with wide decompression, pedicle screws fixation, PLF and PLIF, and followed up for more than 1 year. The degrees of slippage were grades I and II in 20 and 11 patients, respectively. The grade I patients were treated with gentle reduction of the slippage in the disc space, using a leverage maneuver with a Cobb's spinal elevator. The grade II patients were treated with the insertion of a pedicle screws, fixation of rods, reduction and distraction, and then insertion of a cage. After the procedure all the patients were evaluated for the reduction of spondylolisthesis, restoration of the disc space, radiological bony union and clinical results. RESULTS: Ninety percent of the patients were rated as excellent or good. Fusion of the PLIF occurred in all patients. The average reduction in the spondylolisthesis was 42.6 and 47.8% in the grade I and II patients, respectively. The average restorations of the disc spaces were 46.9 and 100.2% in the grade I and II patients, respectively. The maintenance of the reduction and disc height were excellent in the final follow-up radiographs. CONCLUSIONS: Adding gentle reduction and PLIF, using a cage, to the usual posterolateral fusion, with pedicle screw instrumentation, in the surgical treatment of spinal stenosis, with isthmic spondylolisthesis, showed satisfactory results in the reduction of the spondylolisthesis, the restoration of the disc height, the bony union and clinically.

Comparison of Outcome between Percutaneous Vertebroplasty and Kyphoplasty for Osteoporotic Painful Vertebral Compression Fracture: A Preliminary Report / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To compare the outcome of percutaneous vertebroplasty (VP), with kyphoplasty, in the treatment of osteoporotic painful vertebral compression fractures (VCF). SUMMARY OF LITERATURE REVIEW: There is much controversy relating to the treatment of painful osteoporotic VCF. Recent analytical data exists on VP and kyphoplasty. MATERIALS AND METHODS: A consecutive group of patients, undergoing VP and kyphoplasty at our institution, between July 2000 and November 2002, were retrospectively reviewed. A total of 23 patients underwent 25 VP procedures under local anesthesia, and 8 underwent 8 kyphoplasty procedures, 3 under general and 5 under local anesthesia. A radiological assessment was achieved by the percentage of height restored, using both the preoperative and postoperative radiographs. The Visual analog scale (VAS) scores, obtained pre and postoperatively were used for the clinical assessment. The activity levels were assessed preoperatively, after discharge and at the last follow up period, by the ambulatory stati. RESULTS: The VP restored 27.62% (anterior*) and 30.26% (middle**) of the lost height. The kyphoplasty restored 35.52% (anterior*) and 53.43% (middle**) of the lost height (P=0.3334*, P=0.0264**). The postoperative pain was improved in all patients after both procedures. The postoperative VAS score was 3.826 after the VP and 2.875 after the kyphoplasty (P=0.5647). The activity levels were improved in all patients after both procedures. CONCLUSIONS: The kyphoplasty was more efficient in restoring the middle vertebral body height than the VP in the treatment of osteoporotic painful VCF. However, both procedures showed similar clinical improvements in the pain and restoration of the anterior vertebral body height in the treatment of painful osteoporotic VCF. Both kyphoplasty and VP safely increased the vertebral body height, decreased the acute back pain and quickly returned geriatric patients to higher activity levels, resulting in an increased independence and quality of life.