Arthroscopic Treatment of the Intratendinous Ganglion of the Long Head of Biceps Brachii: A Case Report

A ganglion is a benign cystic mass, commonly found around a joint or tendon sheath. It frequently occurs at the wrist, foot, ankle, and knee. Intratendinous ganglion has been rarely reported, and intratendinous ganglion of the long head of biceps brachii is extremely rare. According to our literature review, this is the third case of intratendinous ganglion of the long head of biceps brachii, and the first case of arthroscopic treatment. Therefore we report a case of an arthroscopic treatement for an intratendinous ganglion of the long head of biceps brachii.

Arthroscopic Treatment of the Intratendinous Ganglion of the Long Head of Biceps Brachii: A Case Report

A ganglion is a benign cystic mass, commonly found around a joint or tendon sheath. It frequently occurs at the wrist, foot, ankle, and knee. Intratendinous ganglion has been rarely reported, and intratendinous ganglion of the long head of biceps brachii is extremely rare. According to our literature review, this is the third case of intratendinous ganglion of the long head of biceps brachii, and the first case of arthroscopic treatment. Therefore we report a case of an arthroscopic treatement for an intratendinous ganglion of the long head of biceps brachii.

Anterior Interbody Fusion and Posterior Instrumentation / 대한척추외과학회지

No abstract available.

Anterior Interbody Fusion and Posterior Instrumentation / 대한척추외과학회지

No abstract available.

The Effect of Nerve-Root Injection on Pain Relief in the Management of Osteoporotic Vertebral Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the efficacy of a nerve-root injection for the alleviation of pain in osteoporotic vertebral fracture. MATERIALS AND METHODS: Eighteen patients with pain from osteoporotic vertebral fracture, without improvement after conservative treatment, were included in this study. The group consisted of sixteen women and two men, and had with a mean age of 71 years. Patients underwent a nerve-root injection with lidocane, bupivacane and depomedrol, and were allowed as many as three injections. The mean follow-up period was 13.5 months. RESULTS: The average pain scores at pre-injection, 1 month and 6 months after the injection and final follow-up were 85, 24.9, 14.1 and 17.4, respectively. According to the criteria used to assess clinical results, there was one excellent, thirteen good and four fair results. A newly developed compression fracture was noted in one patient. No complication was related to the injection. CONCLUSION: Our data show that nerve-root injections are effective at improving pain. This suggests that patients with pain from osteoporotic vertebral fractures should be considered for treatment with nerve-root injections prior to being considered for percutaneous vertebroplasty or operative intervention.

Schmid Type of Metaphyseal Chondrodysplasia: 17 years Follow-up Case / 대한정형외과학회잡지

Metaphyseal chondrodysplasia (MCD) is a relatively rare hereditary disease of the skeletal system, in which disproportionate dwarfism sparing the trunk is noted. Among the four subtypes of MCD, the Schmid type is relatively common and shows minimal clinical abnormalities. We report a boy, diagnosed to have MCD, Schmid type, and who was followed-up for 17 years until skeletal maturity, during this period he underwent proximal femoral valgus osteotomies as well as tibial deformity correction with lengthening and femoral lengthening procedures.

Clinical and Radiologic Factors Predicting the Low Back Pain after Discectomy / 대한척추외과학회지

STUDY DESIGN: Retrospective analysis to evaluate predictive factors of low back pain after discectomy in lumbar disc herniation. OBJECTIVE: We analysed clinical and radiological predictive factors which possibly contribute to postoperative low back pain in herniated lumbar disc disease. SUMMARY OF LITERATURE REVIEW: There was no statistically significant factors which contribute to postoperative low back pain. MATERIALS AND METHODS: Ninety two patients with herniated lumbar disc who were treated by one level simple discectomy from June 1995 to June 2000 were included in this study. They were divided into two groups by severity of postoperative low back pain, back pain group and no back pain group. We analyzed clinical and radiological factors retrospectively in each group by medical records, preoperative radiographs and telephone interview. Then statistical analysis was performed with Chi-square test and logistic regression analysis. Confidence interval was 95%. RESULTS: Eighteen patients (19.6%) were in back pain group and seventy four patients (80.4%) were in no back pain group. Among patients over 50 years old and below 50 years old, the ratio of low back pain after discectomy was 33% and 13.8% respectively (Odds ratio=3.1, confidence interval 1.07~9.03). It was proved statistically that except age factor, such factors as follows did not affect postoperative lower back pain. Sex, smoking, preceeding low back pain before discectomy, level of discectomy, disc space narrowing, bony spur, grade of disc degeneration, presence of high intensity zone of disc. CONCLUSIONS: There was no other significant predictive factors of post-discectomy low back pain than the age over 50 years old.

Burst Fracture with Distraction Injury in the Posterior Column of the Thoracolumbar Spine / 대한정형외과학회잡지

PURPOSE: To evaluate the characteristics of burst fracture with distraction injury of the posterior column and provide diagnostic information categorizing thoracolumbar fractures causing instability. MATERIALS AND METHODS: Twenty-one patients with a thoracolumbar burst fracture and posterior column injury, as confirmed by radiogram or MRI were included in this study. To evaluate clinical features, the characteristics of the injury mechanism and the physical findings were reviewed. The degree of kyphotic deformity, compression ratio and canal encroachment were measured. RESULTS: The group consisted of ten men and eleven women with a mean age of 39.3 years. The most common cause of injury was a fall from height in 14 cases. A superficial tenderness was noted in all cases. Of twenty-one patients, eleven had an associated spinal fracture. Kyphotic deformity, compression ratio and canal encroachment were 19.9o, 23% and 14% in an average, respectively. CONCLUSION: Our data demonstrated that burst fracture with distraction injury of the posterior column has no remarkable radiographic parameter despite the associated significant instability. This finding suggests that the index of suspicion for this type of injury is important, and physicians should be aware of the integrity of the posterior column.

Deep Vein Thrombosis After Major Spinal Surgery: Incidence in a Korean Population / 대한정형외과학회잡지

PURPOSE: To determine the incidence of deep vein thrombosis (DVT) after major spinal surgery in a Korean population without antithrombic prophylaxis. MATERIALS AND METHODS: Three hundred and thirteen patients who underwent major spinal surgery were evaluated prospectively. All patients were examined with duplex ultrasonography assessments of both lower extremities. No specific antithrombotic prophylaxes were used in any patient before or after surgery. RESULTS: There were 4 patients with positive findings of DVT on duplex ultrasonography and only 1 patient with clinically symptomatic DVT. The overall incidence of thrombotic complications was 1.3% and incidence of symptomatic DVT was 0.3%. CONCLUSION: Considering the low rate of DVT, routine screening and prophylaxis for DVT appears unwarranted in Koreans before or after major spinal surgery.

Evaluation of the Patterns of Tibial Plateau Fractures using MRI / 대한정형외과학회잡지

PURPOSE: To analyse the efficacy of MRI in assessing fracture configuration of tibial plateau. MATERIALS AND METHODS: The subjects were consisted of the MR images and the plain radiographs of the thirty one patients with tibial plateau fracture. With the plain radiographs, the fractures were classified according to the Schatzker's system and the amount of depression and displacement, location of the major fragment were measured. Then the same parameters were measured with MR images. Additionally new fracture lines and resulting fragments which can be fixed with a screw or transfixing wire were described. The two groups were compared with the each parameters. RESULTS: Fracture classifications were changed in 4 cases. The locations of main fragment were changed in 10 cases. Significant difference was noted in the amount of articular depression (p<0.05) but no significant difference was found in displacement (p=0.332) . Especially in Schatzker-VI cases, articular step offs over 2mm and articular fragments over 2x2cm were revealed in detail by MRI (p<0.05) . CONCLUSION: Fracture type, amount of depression, location, and fracture configuration can be better visualized by MRI, especially in highly comminuted plateau fractures (Schatzker-VI) . The MR imaging seems to be recommended as a primary mode for evaluation of plateau fractures, especially in Schatzker-VI fractures.

The Production of Phospholipase A2 in Different Types of Cultured Human Intervertebral Disc Cells / 대한척추외과학회지

STUDY DESIGN: Evaluation of phospholipase A2 production according to cell type of human intervertebral disc. SUMMARY OF LITERATURE REVIEW: It was reported that the phospholipase A2 activity in human lumbar disc herniation was more active than that in other tissues. OBJECTIVES: The purpose of this study was to evaluate the differences between the cells of anulus fibrosus and nucleus pulposus when lactate was added to the culture medium. MATERIALS AND METHODS: Cells from the anulus fibrosus and nucleus pulposus of a human intervertebral disc were prepared enzymatically. After the monolayer was set up, the cells were divided to three groups and lactate doses of a 0mM, 2mM or 5mM were added respectively. At two week after lactate addition the production of phospholipase A2 was measured by Northern blotting. RESULTS: Cells of nucleus pulposus produced a small amount of phospholipase A2. Those of anulus fibrosus showed a high activity of phospholipase A2 production. The concentration of lactate did not influenced on the production of phospholipase A2. CONCLUSION: The anulus fibrosus has an important role in the production of phospholipase A2 and is thought to be related with generation of discogenic pain.

Anatomical Versus Mechanism of Injury Classification Systems in Children's Ankle Fracture / 대한정형외과학회잡지

We evaluated the two classification systems of children's ankle fractures, the anatomical (Salter-Harris) and the mechanism of injury (Dias-Tachdjian) classifications, in terms of their usefulness and inter-observer variations. An ideal or useful classification system should comprise any possible types of injury, be easily remembered, and have little inter-observer variations. Five observers were asked to classify 57 physeal fractures of the ankle according to each classification systems. Fifty-four (94%) fractures were classifiable with Salter-Harris anatomical classification system. If we adopt the recently developed Peterson's anatomical classification system, the other three fractures could also be classified. In contrast, the mechanism of injury classification system of Dias and Tachdjian could be applied to 44 (77%) fractures. Though the mechanism of injury classification system was more cumbersome to understand, each observer successfully memorized both classification systems. For observer variations, calculated by kappa statistics, there was an acceptable level of agreement for overall classification by both systems. The results indicate that both classification systems of children's ankle fracture have reproducibility within an acceptable range of inter-observer variation. The Dias-Tachdjian's system needed to be upgraded to a more comprehensive one to include some variant types of ankle injuries.

The Posterior Instrumentation Using Compressive Laminar Hooks Combined with Anterior Interbody Fusion for the Treatment of Tuberculous Spondylitis in the Lower Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: The authors employed a new mode of treatment for the tuberculosis of the lower lumbar spine that has difficulty in using pedicle screws. SUMMARY OF LITERATURE REVIEW: It has been reported that patients ended up with a kyphosis had a higher incidence of back pain. OBJECTIVES: The purpose of this study is to evaluate the efficacy of the method consisting of posterior instrumentation with compressive laminar hooks and anterior lumbar interbody fusion. MATERIALS AND METHODS: Twenty-one patients with tuberculosis of lower lumbar spine underwent posterior instrumentation with laminar hooks and anterior interbody fusion by a single surgeon. The clinical outcomes were evaluated and the radiographs were analyzed with respect to fusion status and sagittal angle. RESULTS: A solid bony fusion was obtained in all patients. The preoperative, immediate postoperative, and follow-up sagittal angles were -4.8 degree(range; from 2 degreeto -10 degree, SD = +/-4.1 degree), -14 degree(range; from -10 degreeto -18 degree, SD = +/-3.3 degree), and -11.3 degree(range; from -6 degree to -15 degree, SD = +/-4.1 degree), respectively. There is no complication related to the instrument, but one patient suffered a tear of inferior vena cava during the operation. CONCLUSIONS: This method appears to be effective in stabilizing the vertebrae without sacrificing additional motion segment. We would recommend this method for tuberculosis of lower lumbar spine.

Significance of the High-intensity Zone(HIZ) on Magnetic Resonance Imaging for Diagnosis of the Internal Disc Disruption / 대한척추외과학회지

STUDY DESIGN: Analysis of correlation of high-intensity zone in magnetic resonance image and pain provocation in discography. OBJECTIVES: The purpose of this investigation was to evaluate the relationship of the high-intensity zone to the results of discography in identifying the painful intervertebral disc. SUMMARY OF LITERATURE REVIEW: There is some disagreement in validity of high-intensity zone on MRI for diagnosis of discogenic pain. MATERIALS AND METHODS: Magnetic resonance images were obtained in 52 patients who were considered for surgical intervention after failing to respond to conservative treatment. The presence of a high-intensity zone was specially looked for within anulus fibrosus. Each patient subsequently underwent discography; and types of provocative pain and image were recorded. Statistical analysis was used to evaluate the correlation of high-intensity zone and concordant pain response and disc disruption. RESULTS: The interobserver reliability for detecting a high-intensity zone in a given disc was substantial(kappa=0.646). The sensitivity of high-intensity zone for concordant pain was 47% but its specificity was relatively high(81%). Posttest odds was not so high(68%). CONCLUSION: These results suggest that the usefulness of high-intensity zone is limited by low sensitivity and a high-intensity zone is not indicative of exactly painful disc disruption.

Effect of the Pedicle Screw Fixation on the Anterior Lumbar Interbody Fusion Using the Freeze - Dried Structural Allograft / 대한정형외과학회잡지

The authors performed a study of 32 patients who had undergone anterior lumbar interbody fusion using allograft with posterior pedicular instrumentation. The clinical outcomes were evaluated and the radiographs were analyzed with respect to graft subsidence, interspace collapse, graft collapse, sagittal angle and fusion status. In 71% of the levels there was a loss of disc space height during the follow-up, with 18% of the levels being narrower than their preoperative height at late follow-up. Significant(more than 3mm) subsidence and collapse were noted in three and four levels respectively. Approximately 84% of the 32 patients had satisfactory results and a radiological fusion was obtained in 88.2% of the 34 levels. We consider the pedicle screw fixation improves the retention of interspace distraction and the fusion rate of allograft in anterior lumbar interbody fusion.

Immediate Nailing of Open Tibial Shaft Fractures after Removal of External Fixation / 대한정형외과학회잡지

Many authors have recommended delayed conversion to nailing of open tibial shaft fractures which had been treated initially with external fixation. Most authors have agreed that it was safe to first remove the external fixator, temporarily immobilize the limb in a cast or traction to allow for pin tract healing(generally 1 to 3 weeks), and then proceed to nailing. But, as far as we know, there was few data that had proven the time interval for pin tract healing was necessary to decrease the risk of deep infection. The purpose of this study was to evaluate the results of secondary nailing that was done immediately after removal of external fixator in the patients of open tibial shaft fractures. There were 12 males and 1 female with an average age of the 37.2 years(range, 18-64 years). The mean follow up period was 16.7 months(range, 12-23 months). The external fixation had been mainteined for an average of 47.5 days(range, 21-90 days). Indication of conversion to nailing without time interval was abscence of any serous discharge, reddness or local heating around pin-sites and normal range of laboratory data. All 13 fractures had united without additional surgical procedures or major complications such as deep infection. There were three superficial infections controlled with curettage and short period of oral antibiotics. On the basis of the favorable results of this study, we concluded that the time interval for pin tract healing is not an absolute prerequisite for preventing deep infection as far as no pin tract infection is present.

Diagnostic Landmarks of Ankle Syndesmosis Separation Measured on Standard Ankle Anterior - posterior Radiographs of Normal Korean Adults / 대한정형외과학회잡지

We performed standardized anterior-posterior radiographs of the normal ankle on 50 males and 50 females to determine the validity of current radiographic landmarks of the ankle syndesmosis separation. The average tibiofibular overlap was 6.9+/-2.1mm. The tibiofibular clear space was measured 4.1+/-0.9mm overall. The ratio of the tibiofibular overlap to the fibular width averaged 48+/-14%. Our data show that for 95% confidence intervals, the values for the syndesmosis separation are : (1) tibiofibular overlap less than 2.7mm, (2) tibiofibular clear space greater than 5.9mm, (3) tibiofibular overlap: fibular width ratio less than 24%. According to current diagnositc criterion of tibiofibular overlap under 10mm, 87% of this cohort was defined as syndesmosis separation. Other current criteria of tibiofibular clear space over 5 mm and tibiofibular overlap: fibular width ratio less than 24%, the false positivity was only 7% and 2%, respectively. Therefore the tibiofibular clear space and the tibiofibular overlap: fibular width ratio are more reliable diagnositc criteria for syndesmosis separation than the tibiofibular overlap.

Angiogenesis and Basic Fibroblast Growth Factor Expression of Intervertebral Disc in the Patients with Back Pain / 대한정형외과학회잡지

In the normal disc tissue, the blood vessles have not been observed. It has been suggested that the vascular ingrowth promotes the granulation tissue formation in the herniated disc tissue. The origin of capillaries observed in the herniated disc tissue has remained unclear, but basic fibroblast growth factor(bFGF) may be the important inducer of capillary ingrowth. The purpose of this study is to evaluate the neovascularization in the intervertebral disc without rupture of annulus fibrosus, not being exposed to epidural fat. The disc tissues including nucleus pulposus and annulus fibrosus were obtained at anterior interbody fusion from 30 patients with back pain. All specimens were immediately frozen and stored at -70degrees C. Hematoxylin-eosin stain, polyclonal von Willebrand factor(FVIII) antibody, smooth muscle actin antibody and anti-human endothelial cell antibody(CD31) were used to confirm the blood vessel. Polyclonal bFGF antibody expression was evaluated in the disc tiussues. All of the blood vesseles were observed in the inner portion of annulus fibrosus and the transitional zone. The blood vesseles were observed in 96.7% with hematoxylin-eosin stain, 83.3% with smooth muscle actin antiboy stain, 90% with FVIII, 86.7% with CD31 and the immunopositive blood vesseles were observed in 83.3% with bFGF immunostain. The neovascularization of disc was frequently found in the annulus fibrosus and the transitional zone. The neovasuarlization of intervertebral disc was present in the intervertebral disc without rupture of annulus fibrosus.

Surgical Management of Thoracolumbar Spine Fracture with Pedicle Screws and Inferior Laminar Hooks / 대한척추외과학회지

STUDY DESIGN: Clinical and radiographic results of spine fracutre treated with pedicle screws and hooks were reviewed. OBJECTIVES: Evaluate the efficacy of tile pedicle screw and hook for thoracolumar bursting fracture. SUMMARY OF LITERATURE REVIEW: Despite of the mechanical advantage of the pedicle screw, the metal failure in short segment fusion has been reported. A biomechanical study showed additional laminar hook increased rotational strength. MATERIALS AND METHODS: Between 1994 and 1996, seventeen patients who had a Denis type B bursting fracture of the thoracolumbar spine were treated by posterior instrumentation with pedicle screws and laminar hooks and auterior interbody fusion after partial corpectomy. They have been followed for an average of 13.4 months. RESULTS: At last follow-up, radiographs showed successful fusion of the injured spinal segment in all patient. The subsidence of grafts which were used In anterior interbody fusion was an average of 0.76mm. There was a loss of 2.6 degrees on average in the correction of the kyphosis. No patients had screw breakage or loosening. CONCLUSIONS: We concluded that posterior fixation with screws and hooks, anterior decompression by partial corpectomy, and strut-grafting in patient who had a Denis type B bursting frafture of the thoracolumbar spine yielded good radiographic and functional results.

Direct and Indirect Reduction of the Retropulsed Fragments in Thoracolumbar and Lumbar Burst Fractures / 대한척추외과학회지

STUDY DESIGN: Thirty-eight patients with thoracolumbar and lumbar burst fractures were evaluated according to the treatment methods of the retropulsed fragments. OBJECTIVE: To confirm the pure effect of ligamentotaxis according to the approaching methods to tile involved area. SUMMARY OF BACK GROUND DATA: Retropulsed fragments were effectively treated by indirect posterior reduction. Regardless of size of the retropulsed fragments, remodelling process of the retropulsed fragments was progressed during follow-up period. METHODS: 38 patients with burst fractures of thoracolumbar and lumbar spine were divided into two groups according to tile reduction method of the retropulsed fragments ; the one group consisted of 18 cases which were treated by posterior instrumentation and indirect reduction(Group I: ligamentotaxis) and the other groups consisted of 20 cases which were treated by posterior instrumentation and posterior direct reduction(Group II). Change of neural canal compromise rate, neurologic status, remodelling process of the retropulsed fragments were measured using pre-, post-operative and follow-up radiographs and CT. RESULTS: Comparing the two groups, neural canal compromise rates were decreased at postoperative period but, there were no significant differences in both groups. There were no correlation of neurologic status and neural canal compromise rate. We could confirm the remodelling process of the retropulsed fragments, but there were no significant changes according to the size of the retropulsed fragments between two groups. CONCLUSIONS: Indirect reduction by posterior instrumentation( ligamentotaxis ) could effectively treat the retropulsed fragments in burst fractures of thoracolumbar and lumbar spine without directs posterior reduction.