A Comparison of Clinical and Radiological Outcome Between Two-Level Discectomy and One-Level Corpectomy for Cervical Degenerative Disc Disease

OBJECTIVE: The clinical and radiographic success of a two-level discectomy and autologous iliac bone fusion with anterior cervical plate fixation (ACDFP) was compared with that of a one-level corpectomy and fusion using a titanium mesh cage (corpectomy) for the treatment of degenerative cervical disc disease. METHODS: From January 2004 to December 2007, there were 45 consecutive cases of two disc level degenerative cervical disc disease treated with either ACDFP or corpectomy. The medical records and radiological studies were reviewed, retrospectively. The clinical outcomes were measured using Odom's criteria. The radiologic assessment was performed using images showing the lordosis and bony fusion. RESULTS: Twenty-seven patients were treated with ACDFP. Eighteen patients were treated with corpectomy. The clinical outcome was excellent or good in 25 cases (93%) and 17 cases (94%) treated with ACDFP and corpectomy, respectively. The fusion rate was 96% and 94% for ACDFP and corpectomy, respectively. There was a slight increase in the cervical lordosis in both groups, but there was no significant difference between the 2 groups. There were no irriversible complications in both groups. Reversible complications were encountered in 1 case of corpectomy, and 7 cases of ACDFP, which were mainly associated with donor site. CONCLUSION: Either a ACDFP or a corpectomy provides good clinical outcome and similar bone fusion rates for degenerative disc diseases. However, absence of donor site complications makes a corpectomy better than ACDFP.

A Study on Accuracy and Safety of Thoracic Pedicle Screw Fixation

OBJECTIVE: The purpose of this study is to evaluate the accuracy and safety of pedicle screws in the treatment of thoracic spine disease. METHODS: Thirty-eight patients who had undergone thoracic pedicle screw fixation between January 2003 and December 2007 were retrospectively studied. Postoperative computed tomography scans were obtained using 3-mm axial cuts to evaluate the pedicle screw placement. The screws were further evaluated by the location and degree of the perforation. RESULTS: Of the 214 thoracic pedicle screws placed, 174 (81.3%) were fully contained within the pedicle or anterior cortices of the vertebral body. Of the remaining 40 (18.7%) screws, 25 (62.5%) were lateral perforations, 12 (30.0%) were medial perforations, and 3 (7.5%) were anterior perforations of the vertebral body. The screws inserted at T1-T4 (28.5%) and T5-T8 (34.8%) revealed a higher perforation rate than the screws inserted at T9-12 (11.4%). No neurologic or vascular complications were encountered, but one screw 6 mm above a medial perforation required reinsertion. CONCLUSION: Although clinical outcomes were not affected by mild displacement of thoracic pedicle screws, accurate measurements and considerable experience were required in the placement of screws, especially screws placed in the upper and midthoracic spine.

Spontaneous Cervical Spondylodiscitis and Epidural Abscess Caused by Klebsiella Pneumonia-single Stage Operation with Decompressive Corpectomy and Autologous Bone Fusion

We present a very rare case of spontaneous cervical spondylodiscitis and epidural abscess caused by Klebsiella pneumonia. A 45-year-old man presented with severe posterior neck pain radiating down both arms with decreased range of motion of the neck. He also complained of paresthesia of the upper extremities and a subjective weakness of his right arm. Magnetic resonance imaging (MRI) revealed spondylodiscitis and epidural abscess on the C5 and C6. In order to obtain adequate drainage of the abscess and complete removal of granulation tissues we performed a total decompressive corpectomy of C5 and C6. After drainage of the abscess, single stage autologous iliac bone graft was performed. The patient was followed by three months with antibiotic treatment confirmed to be sensitive to the organism. Klebsiella pneumonia was cultured postoperatively from the surgical biopsy samples. The patient recovered with no complications and the postoperative MRI showed improvement of the lesions.

Brucellar Spondylodiscitis in an Endemic Bovine Brucellosis Region of Korea: A Case Report

Human brucellosis is an endemic zoonotic disease that is rare in Korea. However, there have been regional increases in its prevalence. Spondylodiscitis is a common osteoarticular complication of brucellar infection and is difficult to diag nose- because the clinical presentation is often variable and nonspecific. We report the case of a 56-year-old male with brucellar spondylodiscitis who was from Gyeongsangbuk-do, an endemic region of bovine brucellosis in Korea.