Rapid Recurrence of Spinal Idiopathic Hypertrophic Pachymeningitis: A Case Report

Idiopathic hypertrophic pachymeningitis is a rare inflammatory disorder of the dura mater. Spinal involvement is extremely rare and there are few case reports. We present a 36 year-old female of idiopathic hypertrophic spinal pachymeningitis compressing thoracic spinal cord which showed rapid recurrence.

Interspinous Implantation for Degenerative Lumbar Spine: Clinical and Radiological Outcome at 3-yr Follow Up

OBJECTIVE: Interspinous devices for dynamic stabilization of lumbar spine are undergoing development and clinical trials. A few short-term outcomes of interspinous devices have been reported but little has been mentioned about longterm outcomes. We reviewed 19 cases of interspinous implantation (Coflex Paradigm spine, Germany) to evaluate clinical long-term outcome and radiologic features. METHODS: From January 2003 to March 2004, 19 patients (13 female and 6 male) who underwent interspinous implantation were included and follow-up data on clinical and radiologic outcomes were obtained at last clinic visit (mean follow-up: 38 months). Clinical outcomes were assessed by Visual analogue scale (VAS) score and Odom..s criteria. RESULTS: Preoperative VAS score for low back pain and leg pain was improved from 4.9+/-2.4 and 7.5+/-2.4 to 2.6+/-1.2 and 3.0+/-1.8 respectively at postoperative last clinic visit (p<0.01). Using Odom..s criteria, 7 and 9 patients showed excellent (36.8%) and good (47.3%) results for low back pain and 7 and 11 showed excellent (36.8%) and good (57.9%) results for leg pain. Anterior and posterior disc height were decreased significantly on postoperative follow-up radiologic data due to discectomy at the level of instrumentation (p<0.01). There were no complications such as infection or device failure. CONCLUSIONS: In this long-term follow-up study, clinical outcome was good but disc degeneration after discectomy at instumented level resulting in decrease of disc height was observed.

The Clinical Evaluation of Calcium Phosphate Cement Compared with Polymethylmethacrylate for Kyphoplasty

OBJECTIVE: We investigated the clinical outcome of kyphoplasty using calcium phosphate (CaP) for vertebral augmentation compared with polymethylmethacrylate (PMMA). We conducted a retrospective study to determine whether patients with osteoporotic vertebral fracture who underwent CaP kyphoplasty had improved outcome in the correction of vertebral body and relief of pain compared with those who underwent PMMA treatment. METHODS: From January 2005 to December 2006, 117 consecutive patients with osteoporotic compression fracture were treated at our institute. Among them, 23 patients have treated to kyphoplasty using PMMA or CaP. We reviewed the clinical data and imaging studies retrospectively as sources for analysis. RESULTS: The 23 patients included in the study. A mean ages of CaP and PMMA group were 70+/-9.5 and 67+/-9.5 years respectively. Preoperative compression ratios (CR) were 0.71+/-0.12 and 0.74+/-0.15 on both groups. Postoperative CR, however, showed the difference between two groups. The differences of preoperative and postoperative Cobb`s angle were 10.04 and 2.18 on CaP and PMMA group respectively and the mean injected volume of cement were 3.85+/-1.73 and 4.4+/-1.23 ml. CONCLUSION: The amount of injected volume of bone cement in kyphoplasty has no difference on both groups. But, follow-up compression ratio and Cobb`s angle are larger in CaP group than PMMA group. However, pain and functional recovery is not different on both group. As a result, CaP can not sufficiently support the strength of vertebral body, but be used to control the acute pain.

A Clinical Experience of 72 Patients with Aneurysms arising from the Anomalous Cerebral Artery / 대한뇌혈관외과학회지

OBJECTIVE: Aneurysm rupture at the anomalous artery is rare but inadvertent clip occlusion may cause critical complications. The aim of this study was to examine the frequency of the cerebral aneurysms associate with the vascular anomalies and the surgical considerations. METHODS: We analyzed 2802 patients with aneurysms treated from September,1976 to July,2004. A diagnosis of 'anomalous artery'was made on the basis of angiographic or surgical findings in 72 patients. Surgery was carried out in 68 patients and 4 were treated with endovascular methods. RESULTS: Fenestrated anterior communicating artery (A-com.) was the most common anomaly (33cases, 45.8%), 24 cases of 3rd A2 (33.3%), and 9 cases of azygous A2 (12.5%). fenestrated M1 was 1 cases (1.4%) and the one duplicated MCA (1.4%). 3 cases of fenestrated basilar artery (4.2%) and one primitive trigeminal artery aneurysm (1.4%) were treated with GDC. In our series vascular anomalies were found in 6% of the all Acom aneurysm cases. CONCLUSION: It is often difficult to recognize a fenestration or other anomalies of cerebral arteries prior to surgery, even with precise angiographic analysis. The Acom artery complex is one of most frequent sites of vascular anomalies. Preoperative and intraoperative concerns is required to avoid inadvertent occlusion of parent artery or misplacement of clip, which may result in critical complications or poor outcomes.