Cauda Equina Syndrome by Lumbar Disc Herniation after Caesarian Section Delivery: A Case Report / 대한정형외과학회잡지

Cauda equina syndrome develops as rapidly progressive neurologic deficit of lower extremities and urogenital system often resulting in serious outcome such as complete irreVersible paraparesis. Therefore prompt diagnosis and decompression is mandatory. However, if it occurs after childbirth, it may be overlooked being regarded as symptoms related to pregnancy and delivery. We experienced a cauda equina syndrome by ruptured disc in a 32-year-old woman just after Caesarian section in a local obstetric clinic who was transferred to us 2 days after development of progressive neurologic deficits. We managed her with prompt decompressive surgery and achieved favorable result. Because of the importance of early detect and prompt decompression for cauda equina syndrome and possible occurrence at perinatal period, we report this case reviewing the literature especially concerning about pregnancy and cauda equina syndrome.

Distribution and Patterns of Posterior Column Injury in Flexion-Distraction Injuries of Thoracolumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of the distribution and patterns of posterior column injury in flexion-distraction injuries of the thoracolumbar spine. OBJECTIVES: To recognize the various types of posterior column injury in terms of the path of the distraction force in flexion-dis-traction injuries of the thoracolumbar spine. SUMMARY OF LITERATURE REVIEW: As posterior column injuries are associated with instability of the spine, many authors have described and classified posterior column injuries. However, there are no descriptions or classifications in terms of the path of the distraction force in the literature. MATERIALS AND METHOD: The preoperative plain X-rays, axial CT, MRI (in 5 patients) and operation records of 34 patients were reviewed in relation to the patterns of posterior column injury. RESULTS: Posterior column injuries can be classified into two main types. In Type I(30/34), the distraction failure started from the spinous process one level above the fractured body (Type IA) or the posterior ligament complex between the spinous processes of the fractured and the level above (Type IB). In Type II(4/34), the distraction failure started from the spinous process of the fractured vertebra and from the interspinous ligament between the fractured level and the level below. CONCLUSIONS: Posterior column injuries can be described according to their starting point and the extent of the distraction force. Of these, Type IB was the most common. Using this classification, the injury of the posterior column in injuries of the thora-columbar spine fracture can be predicted.

Bone & Soft Tissue Injuries Diagnosed by Magnetic Resonance Imaging in Thoracolumbar Fractures

PURPOSE: To assess diagnostic efficacy of the MRI in thoracolumbar fractures, especially in changes of bone and soft tissue which cannot be documented by other diagnostic tools. MATERIALS AND METHODS: Among 85 patients managed for thoracolumbar fractures between January 1997 and June 2003, MRI was performed in 30 patients to get more informations. Plain X-ray, CT and MRI of these cases were reviewed retrospectively by two orthopaedic spine surgeons and one radiologist to investigate the informations which only MRI could afford. RESULTS: 14 (46.7%) among 30 patients had occult fractures of vertebrae other than main fracture which had not been diagnosed as fractured. Besides 6 patients who showed distraction of posterior structure on plain X-ray, injury of posterior ligament complex was confirmed by MRI in 12(40%) patients. Additionally, MRI visualized other soft tissue injuries such as intramuscular and subcutaneous hematoma, changes of the spinal cord and intervertebral disc. In 16 among 30 patients, informations achieved from MRI were the most important factors in deciding treatment modality. CONCLUSION: MRI seems to be efficient in visualizing not only soft tissue injury such as ligament but also occult fractures of additional vertebra in thoracolumbar fractures, therefore MRI seems to be an important diagnostic tool in decision of treatment modalities, especially in cases of uncertain stability.