Effect of Transverse Sinus Stenting on Diffuse Leukoencephalopathy with Idiopathic Intracranial Hypertension

A diagnosis of idiopathic intracranial hypertension (IIH) can be made after excluding secondary causes. As stenosis of transverse sinuses is often revealed with IIH patients, transverse sinus stenting is used to release intracranial hypertension. It is rare to find a case of leukoencephalopathy secondary to IIH. Herein, we describe a case of diffuse leukoencephalopathy with IIH, which improved after stent insertion in the transverse sinus.

Cerebral Infarction Caused by Direct Cardiac Tumor Emboli Mixed with Thrombus

Cerebral infarction in cancer patients is often caused by thrombosis due to hypercoagulability, and in some cases, caused by direct tumor embolism. We report the case of cerebral infarction due to direct tumor embolism mixed with thrombus. Biopsy of blood clots obtained during thrombectomy is important for diagnosis. If there is a high risk of thrombosis among cancer patients with cerebral infarction, the use of appropriate antithrombotic agents along with maintaining a certain level of platelets should be considered.

Analysis of Risk Factors Affecting Degeneration of the Acetabular Cartilage after Bipolar Hemiarthroplasty

PURPOSE: This study attempted to investigate the rate of acetabular cartilage wear, as well as the risk factors that are related to degeneration, for patients who were diagnosed with femur neck or intertrochanteric fracture and who underwent bipolar hemiarthroplasty. MATERIALS AND METHODS: 34 patients who were diagnosed with femur neck or intertrochanteric fracture and who underwent bipolar hemiarthroplasty were selected as the study subjects, and they were followed up for more than 2years. We examined potential relationships between the degeneration of acetabular cartilage and the various risk factors by comparing radiographs taken before and after operations. RESULTS: After bipolar hemiarthroplasty, the average degenerative change in the acetabular cartilage was 0.20 mm/yr. Specifically, the average appeared significantly different according to gender (p=0.039, Male: 0.26 mm/yr, Female: 0.19 mm/yr), age (p=0.02, the under 70-year olds: 0.29 mm/yr, the upper 70-year olds: 0.13 mm/yr), the life style, (p=0.037, the stand-up life style: 0.18 mm/yr, the sit-down life style: 0.24 mm/yr), (ED note: stand up and sit down made no sense.) and using femoral stem cementing (p=0.237, cement: 0.22 mm/yr, non-cement: 0.21 mm/yr). The bone mineral density score (p=0.254), activity score (p=0.041), HHS (p=0.027) and femoral stem alignment (p=0.438) were shown to be -3.7, 3.2, 87 and varus 1 degree for people with less than average degeneration of the acetabular cartilage and -3.9, 4.3, 75 and varus 2 degrees for people with more than average degeneration of the acetabular cartilage, respectively. CONCLUSION: The results showed no significant relationship between degeneration of the acetabular cartilage and patient gender, the presence of osteoporosis and using femoral stem cement. The degeneration of acetabular cartilage was faster for young patients, for patients with a sit-down life style, for a higher activity score or for a lower HHS. It is strongly recommended for surgeons to consider the patients' various conditions such as age, activity and a sit-down lifestyle when deciding between hemiarthroplasty and total hip arthroplasty.

Operative Treatment of Delayed Collapse of Osteoporotic Vertebral Fracture with Claudication: Transpedicular Bone Graft and Pedicle Screw Fixation / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the efficacy of transpedicular bone graft and pedicle screw fixation in delayed collapse of osteoporotic vertebral fracture with claudication. SUMMARY OF LITERTURE REVIEW: Delayed collapse of osteoporotic vertebral fracture may result in seemingly unrelenting back pain and neurologic deficits. Though there are many surgical options for such cases, comprehensive improvement of symptoms is uncertain. MATERIALS AND METHODS: Nineteen patients who underwent operation and were followed-up for more than 2 years were studied. The regional sagittal angle, restoration ratio of the vertebral body, standing sagittal balance, and additional fracture were assessed. Improvement of back and leg pain was assessed using 10 point Visual Analog Scales (VAS). The causes of sustained clinical symptoms were analyzed. RESULTS: The regional sagittal angle was corrected from 25.2+/-13.9degrees to 12.4+/-10.4degrees (p=0.000). The vertebral body ratio was restored from 36+/-14.1% to 72+/-16.7% (p=0.000). Six cases were found to be neutral and 13 cases showed a positive sagittal balance. Additional fractures were found in 11 cases. The VAS value for leg pain was improved from 6.6+/-1.0 to 1.0+/-1.1 (p=0.000), while that for back pain was not improved (6.4+/-1.7 to 7.1+/-2.3, p=0.474). Positive sagittal balance was a significant risk factor (p=0.037, odds ratio=58.084) for sustained back pain. CONCLUSION: For the treatment of delayed collapse of osteoporotic vertebral fracture with claudication, transpedicular bone graft and pedicle screw fixation was effective in improving claudication and restoring the vertebral body and regional sagittal angle. However, it was not capable of alleviating back pain. Positive sagittal balance was considered to be a cause of sustained back pain.

Pseudomeningocele After Spine Surgery: 3 cases of different symptoms / 대한척추외과학회지

Pseudomeningocele after spine surgery can cause various symptoms, but it can also be silent. We experienced 3 cases of pseudomeningocele with different symptoms and we analyzed the characteristics of each case. A small pseudomeningocele without connection to the subarachnoidal space can show no symptoms. A pseudomeningocele with a small dural tear and it's abutted on the duramater at a small portion can produce sciatica and limitations of straight leg raising due to adhesion of the cauda equina around the dural tear. In addition, a large pseudomeningocele with a big dural and lamina defect can produce back tenderness furthermore, a patient with such a lesion can have low back pain and leg pain that are aggravated by an increment of abdominal pressure or by impact to the body and even by walking. Pseudomeningocele should be suspected when symptoms recur after spine surgery and especially in the case of dural tear during an operation

Short-Term Results and Early Complications of Minimally Invasive Unicompartmental Knee Arthroplasty

PURPOSE: To evaluate the short-term postoperative results of minimally invasive Unicompartmental Knee Arthroplasty(UKA) and to analysis the early postoperative complications. MATERIALS AND METHODS: 241 cases of UKA have been performed since January 2002 and followed up for average 27.3 months. Most of cases were medial compartment degenerative arthritis. All operative procedures were performed through minimally invasive technique. Clinical assessments were carried out using the Knee Society Score (KSS) rating system. RESULTS: The average knee score and the knee function score were improved from 55.4 and 55.4 points preoperatively to 89.3 and 84.9 points at final follow up. The average range of knee motion was 128.4 degrees preoperatively and recovered to 133.0 degrees at final follow up. Average preoperative tibiofemoral angle was 0.2 degrees of varus, which changed to 5.5 degrees of valgus at final follow up. Early complications after minimally invasive UKA were seen in 14 cases, 13 of which were occured within the first year. There were 4 polyethylene insert dislocation, 3 periprosthetic fracture, 2 femoral component loosening, 3 MCL injury and 1 infection. We also experienced 2 partial capsular rupture, 1 remained cement fragment in the joint and 1 impingement between osteophyte and stem. Two femoral component loosening and 1 MCL injury were combined with bearing dislocation. CONCLUSION: The short-term postoperative results of minimally invasive UKA were clinically satisfactory for improvement of knee score, function score and in the recovery of knee motion. The complication rate of UKA was relative low, but mostly caused by errors in surgical technique. Accurate surgical technique and enough experience were needed to improve clinical results and reduce the complications. When complications have occurred, better results are expected by more appropriate treatment for the cause of the complications.

Operative Treatment of Lumbosacral Spondylitis Through a Posterior-only Approach / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of this operative method, which includes removal of infected materials, insertion of a bone graft and fixation with pedicle screws through a posterior-only approach in spondylitis with advanced bone destruction and radicular pain. MATERIALS AND METHODS: Ten patients with refractory single level spondylitis of the lumbosacral spine, who underwent the above operation and were followed-up for more than 2 years, were analyzed retrospectively. Six cases were tuberculous and 4 cases were pyogenic in etiology. Radiologically, bone union and restoration of sagittal alignment were assessed. Clinically, Visual Analog Scales (VAS) for back pain, leg pain and resolution of neurologic symptom were analyzed. RESULTS: Bone union was achieved in all cases. Sagittal angle was corrected significantly from -3.6+/-12.5 degrees to -11.4+/-9.3 degrees (p=0.007). However, loss of correction was noted from -16.2+/-10.2 degrees at immediate after surgery to -11.4+/-9.3 degrees at last follow-up (p=0.005). Back pain VAS was improved from 8.3+/-0.7 to 2.6+/-1.6 (p=0.005) and leg pain VAS was improved from 6.8+/-2.1 to 0.5+/-0.9 (p=0.005). There was strong positive correlation between age and final back pain (r=0.79, p=0.011) and leg pain VAS (r=0.75, p=0.020). There was no meaningful correlation between the sagittal angle and back pain (r=0.30, p=0.430) and leg pain VAS (r=0.41, p= 0.274). Implant related complications and deep wound infections did not occur. CONCLUSION: In single level spondylitis of the lumbosacral spine, a posterior-only surgical approach is a useful method in which debridement, bone graft placement and pedicle screw fixation can be performed. This procedure did not provide increased risk with respect to infection control, and it allowed correction of the sagittal angle. The younger the age of the patients, the better the back pain and leg pain VAS results.

High Tibial Osteotomy Fixed with Long-winged Modified Steinmann pin

PURPOSE: To report the clinical and radiological results after high tibial osteotomy that was fixed with a long winged modified Steinmann pin. MATERIALS AND METHODS: Forty knees of twenty patients with genu varum, degenerative or physiologic, underwent high tibial osteotomy using a long-winged modified Steinmann pin and four-week cast immobilization. Mean follow up was 36.0 months(5~67 months). Clinical results were assessed using the Knee society score and radiographic measurements, using Bauer 's method and Insall-Savati ratio. Statistical analyses were performed with the paired samples t-test. RESULTS: The corrected angle was varus 3.2+/-2.7 degrees preoperatively, valgus 7.3+/-2.0 degrees postoperatively(p<0.05), and valgus 6.0+/-1.4 degrees at the latest follow up. According to the Knee society clinical rating system, the knee score was 61.8+/-7.2 preoperatively and 92.8+/-2.8 postoperatively (p<0.05). The function score was 77.8+/-5.8 preoperatively and 89.0+/-6.3 postoperatively(p<0.05). The Insall-Salvati ratio was 1.02+/-0.14 preoperatively and 1.00+/-0.15 at the latest follow up(p=0.018). CONCLUSION: High tibial osteotomy with a long-winged modified Steinmann pin could obtain good correction of angles and clinical results with few complications. And this method was also useful in maintaining the correction angles.

Treatment of Soft Tissue Defect after TKA Using Dorsalis Pedis Flap: A Case Report

Skin and soft tissue defect developed after total knee arthroplasty have important influence on prosthesis survival. Thus an adequate treatment have to be performed according to the size and depth of defect. We report a case of dorsalis pedis flap for treatment of skin and soft tissue defect combined with infection after conversion total knee arthroplasty and its good result with a review of the literature.