Efficacy of Antibiotic-Loaded Cement Augmentation for Correcting Low Grade Pedicle Screw Loosening / 대한신경손상학회지

Objective@#Altered biomechanics and bone fragility can contribute to pedicle screw loosening. This study aimed to evaluate the efficacy of antibiotic-loaded cement augmentation for correcting symptomatic screw loosening as a minimally invasive alternative to open revision surgery. @*Methods@#Ten consecutive patients who underwent percutaneous cement augmentation for pedicle screw loosening were included in this study. Low grade pedicle screw loosening was deemed clinically relevant in cases of continuous back pain with significant radiolucent halo zones at a vertebral level without screw backing out or stripping. We analyzed the screw loosening at the main location of halo formation. All patients were treated by fluoroscopyguided antibiotic-loaded cement augmentation of the loosened pedicle screws. Patient demographics and pre- and postoperative data were also assembled and analyzed. @*Results@#Most (80%) halo formation locations were the inferior type. Augmentation was technically feasible in all but one patient, in whom the procedure was unsuccessful due to access difficulty. This patient ultimately underwent percutaneous screw re-implantation via a different trajectory. The other nine patients in whom cement filling was satisfactory reported significant pain relief at the final follow-up. Moreover, no severe complications such as wound infection or repeated screw loosening occurred during the follow-up period. @*Conclusion@#The most common halo formation location was the inferior type. In cases without access difficulty, antibiotic-loaded cement augmentation for the treatment of low grade pedicle screw loosening can relieve pain and avoid extensive open surgery.

Anterior Approach Following Intraoperative Reduction for Cervical Facet Fracture and Dislocation

Objective@#: The purpose of this study was to evaluate the efficacy of the anterior approach following intraoperative reduction under general anesthesia in patients with cervical facet fracture and dislocation. @*Methods@#: Twenty-three patients with single level cervical facet fracture and dislocation who were subjected to the anterior approach alone following immediate intraoperative reduction under general anesthesia from March 2013 to December 2017 were enrolled in this study. Neurological status, clinical outcome, and radiological studies were evaluated preoperatively, postoperatively, and during the follow-up period. @*Results@#: The cohort comprised 15 men and eight women with a mean age of 57 years (from 24 to 81). All patients were operated on within the first 8 hours following the injury. After gentle manual reduction or closed reduction with Gardner-Wells traction, under general anesthesia monitored by somatosensory-evoked potentials, all operations were successfully completed using the anterior approach alone except in two patients, who had a risk of over-distraction. In them, a satisfactory gentle manual reduction or closed reduction was not possible, and required open posterior reduction of the locked facets followed by anterior cervical discectomy and fusion. In one patient, screw retropulsion was observed in 1 month after surgery. There were no reduction-related complications or neurological aggravations after surgery. All patients showed evidence of stability at the instrumented level at the final follow-up (mean follow-up, 12 months). @*Conclusion@#: Anterior approach following intraoperative reduction monitored by somatosensory-evoked potentials under general anesthesia for cervical dislocation and locked facets is a relatively safe and effective alternative when cervical alignment is achieved by intraoperative reduction.

Complete Fusion of Three Lumbar Vertebral Bodies in Ankylosing Spondylitis / 대한신경손상학회지

Ankylosing spondylitis is a seronegative arthropathy of unknown etiology affecting mainly young adults. Acute or chronic changes of the spine such as sacroiliitis, spondylodiscitis, osteitis, ossification, and arthropathic lesions characterize the disease. Spinal involvement may accompany ossification of the ligaments, disc, end-plates and apophyseal structures, and seems to be bamboo spine. Here, we report a rare case describing the complete fusion of three lumbar vertebral bodies in ankylosing spondylitis. This rare case is presented alongside a literature review.

Posterior Lumbar Interbody Fusion Using an Unilateral Cage: A Prospective Study of Clinical Outcome and Stability

OBJECTIVE: The purpose of this study was to evaluate the clinical and radiological results of instrumented posterior lumbar interbody fusion (PLIF) using an unilateral cage. METHODS: Seventeen patients with unilateral radiculopathy who underwent bilateral percutaneous screw fixation with a single fusion cage inserted on the symptomatic side for treatment of focal degenerative lumbar spine disease were prospectively enrolled in this study. Their clinical results, radiological parameters, and related complications were assessed 10 days, 3 months, and 12 months postoperatively. RESULTS: There was no pseudarthrosis, instrumented fusion failure, significant cage subsidence, or retropulsion in any patient. The surgery restored the disc space height and maintained it as of 12 months postoperatively and did not exacerbate the lumbar lordotic and scoliotic angles. All patients had excellent or good outcomes according to the modified MacNab's criteria. The mean pain score according to the visual analogue scale was 7.5 preoperatively but had improved to 2.5 when reassessed 3 months postoperatively. The improvement was maintained as of 12 months postoperatively. CONCLUSION: In cases of uncomplicated unilateral radiculopathy, PLIF using a single cage can be an effective and safe procedure with the advantage of preserving the posterior elements of the contralateral side. A shorter operative time and greater cost-effectiveness than for PLIF using bilateral cages can be expected.

Implant Removal after Percutaneous Short Segment Fixation for Thoracolumbar Burst Fracture : Does It Preserve Motion?

OBJECTIVE: The purpose of this study was to evaluate the efficacy of implant removal of percutaneous short segment fixation after vertebral fracture consolidation in terms of motion preservation. METHODS: Between May 2007 and January 2011, 44 patients underwent percutaneous short segment screw fixation due to a thoracolumbar burst fracture. Sixteen of these patients, who underwent implant removal 12 months after screw fixation, were enrolled in this study. Motor power was intact in all patients, despite significant vertebral height loss and canal compromise. The patients were divided into two groups by degree of osteoporosis : Group A (n=8), the non-osteoporotic group, and Group B (n=8), the osteoporotic group. Imaging and clinical findings including vertebral height loss, kyphotic angle, range of motion (ROM), and complications were analyzed. RESULTS: Significant pain relief was achieved in both groups at final follow-up versus preoperative values. In terms of vertebral height loss, both groups showed significant improvement at 12 months after screw fixation and restored vertebral height was maintained to final follow-up in spite of some correction loss. ROM (measured using Cobb's method) in flexion and extension in Group A was 10.5degrees (19.5/9.0degrees) at last follow-up, and in Group B was 10.2degrees (18.8/8.6degrees) at last follow-up. Both groups showed marked improvement in ROM as compared with the screw fixation state, which was considered motionless. CONCLUSION: Removal of percutaneous implants after vertebral fracture consolidation can be an effective treatment to preserve motion regardless of osteoporosis for thoracolumbar burst fractures.

Short Segment Screw Fixation without Fusion for Low Lumbar Burst Fracture: Severe Canal Compromise but Neurologically Intact Cases / 대한신경손상학회지

OBJECTIVE: The purpose of this study was to determine whether screw fixation without bone fusion in patients with a low lumbar burst fracture has satisfactory outcomes. METHODS: Twelve patients that underwent screw fixation without bone fusion for a low lumbar burst fracture (L3-5) between 2006 and 2009, were included in this study. Motor power was intact despite severe canal compromise in all. Surgical procedures included postural reduction for 2 days and screw fixation without bone fusion. Imaging and clinical findings, including level of the involved vertebra, vertebral height, canal compromise, clinical outcomes, and related complications were analyzed. RESULTS: Mean follow-up was 23.1+/-11.0 months. Mean pain score (visual analogue scale) prior to surgery was 7.8+/-2.0 and this decreased to 1.8+/-1.0 at final follow-up. In 5 patients, open screw fixation by midline skin incision was performed and 7 patients underwent percutaneous screw fixation at one level above, one level below the fractured vertebra and fractured level itself. The proportion of canal compromise at the fractured level improved significantly from 60% to 30% at final follow-up (p<0.001). Mean preoperative vertebral height loss was 31.0%, and improved to 20.5% at final follow-up, though this improvement was not statistically significant (p<0.001). No neurological aggravation related to neural injury was observed. CONCLUSION: Short segment pedicle screw fixation without bone fusion can be an effective and safe operative technique for the management of selected low lumbar burst fractures.

Repeated Migration of a Fusion Cage after Posterior Lumbar Interbody Fusion

Although posterior lumbar interbody fusion (PLIF) is a widely accepted procedure, perioperative and postoperative complications are still encountered. In particular, cage migration can result in severe sequelae, and revision surgery is technically demanded. Here, we report a rare case of repeated migration of a fusion cage after PLIF. To the best of our knowledge, no report has been previously issued on repeated migration of a fusion cage after PLIF. The authors discuss the radiological and clinical findings of this unusual complication with a review of the literature.

Short Segment Fixation for Thoracolumbar Burst Fracture Accompanying Osteopenia : A Comparative Study

OBJECTIVE: The purpose of this study was to compare the results of three types of short segment screw fixation for thoracolumbar burst fracture accompanying osteopenia. METHODS: The records of 70 patients who underwent short segment screw fixation for a thoracolumbar burst fracture accompanying osteopenia (-2.5< mean T score by bone mineral densitometry <-1.0) from January 2005 to January 2008 were reviewed. Patients were divided into three groups based on whether or not bone fusion and bone cement augmentation procedure 1) Group I (n=26) : short segment fixation with posterolateral bone fusion; 2) Group II (n=23) : bone cement augmented short segment fixation with posterolateral bone fusion; 3) Group III (n=21) : bone cement augmented, short segment percutaneous screw fixation without bone fusion. Clinical outcomes were assessed using a visual analogue scale and modified MacNab's criteria. Radiological findings, including kyphotic angle and vertebral height, and procedure-related complications, such as screw loosening or pull-out, were analyzed. RESULTS: No significant difference in radiographic or clinical outcomes was noted between patients managed using the three different techniques at last follow up. However, Group I showed more correction loss of kyphotic deformities and vertebral height loss at final follow-up, and Group I had higher screw loosening and implant failure rates than Group II or III. CONCLUSION: Bone cement augmented procedure can be an efficient and safe surgical techniques in terms of achieving better outcomes with minimal complications for thoracolumbar burst fracture accompanying osteopenia.

Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients

OBJECTIVE: The purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture. METHODS: Nine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed. RESULTS: Prior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal. CONCLUSION: Short segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.

Short Segment Screw Fixation without Fusion for Unstable Thoracolumbar and Lumbar Burst Fracture : A Prospective Study on Selective Consecutive Patients

OBJECTIVE: The purpose of this prospective study was to evaluate the efficacy and safety of screw fixation without bone fusion for unstable thoracolumbar and lumbar burst fracture. METHODS: Nine patients younger than 40 years underwent screw fixation without bone fusion, following postural reduction using a soft roll at the involved vertebra, in cases of burst fracture. Their motor power was intact in spite of severe canal compromise. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants 12 months after the initial operation, due to possibility of implant failure. Imaging and clinical findings, including canal encroachment, vertebral height, clinical outcome, and complications were analyzed. RESULTS: Prior to surgery, the mean pain score (visual analogue scale) was 8.2, which decreased to 2.2 at 12 months after screw fixation. None of the patients complained of worsening of pain during 6 months after implant removal. All patients were graded as having excellent or good outcomes at 6 months after implant removal. The proportion of canal compromise at the fractured level improved from 55% to 35% at 12 months after surgery. The mean preoperative vertebral height loss was 45.3%, which improved to 20.6% at 6 months after implant removal. There were no neurological deficits related to neural injury. The improved vertebral height and canal compromise were maintained at 6 months after implant removal. CONCLUSION: Short segment pedicle screw fixation, including fractured level itself, without bone fusion following postural reduction can be an effective and safe operative technique in the management of selected young patients suffering from unstable burst fracture.

Paraspinal Muscle Sparing Versus Percutaneous Screw Fixation: A Comparative Enzyme Study of Tissue Injury during the Treatment of L4-L5 Spondylolisthesis

OBJECTIVE: Screw fixation via the paraspinal muscle sparing approach and by percutaneous screw fixation are known to diminish the risk of complications, such as, iatrogenic muscle injury as compared with the conventional midline approach. The purpose of this study was to evaluate tissue injury markers after these less traumatic screw fixation techniques for the treatment of L4-L5 spondylolisthesis. METHODS: Twenty-two patients scheduled for posterior lumbar interbody fusion (PLIF) at the L4-L5 segment for spondylolisthesis were prospectively studied. Patients were divided into two groups by screw fixation technique (Group I: paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Levels of serum enzymes representing muscle injury (CK-MM and Troponin C type 2 fast), pro-inflammatory cytokine (IL-8), and anti-inflammatory cytokine (IL-1ra) were analyzed using ELISA techniques on the day of the surgery and 1, 3, and 7 days after the surgery. RESULTS: Serum CK-MM, Troponic C type 2 fast (TNNC2), and IL-1ra levels were significantly elevated in Group I on postoperative day 1 and 3, and returned to preoperative levels on postoperative day 7. No significant intergroup difference was found between IL-8 levels despite higher concentrations in Group I on postoperative day 1 and 3. CONCLUSION: This study shows that percutaneous screw fixation procedure is the preferable minimally invasive technique in terms of minimizing muscle injury associated with L4-L5 spondylolisthesis.

Screw Fixation without Fusion for Low Lumbar Burst Fracture : A Severe Canal Compromise But Neurologically Intact Case

The low lumbar spine is deeply located in flexible segments, and has a physiologic lordosis. Therefore, burst fractures of the low lumbar spine are uncommon injuries. The treatment for such injuries may either be conservative or surgical management according to canal compromise and the neurological status. However, there are no general guidelines or consensus for the treatment of low lumbar burst fractures especially in neurologically intact cases with severe canal compromise. We report a patient with a burst fracture of the fourth lumbar vertebra, who was treated surgically but without fusion because of the neurologically intact status in spite of severe canal compromise of more than 85%. It was possible to preserve motion segments by removal of screws at one year later. We also discuss why bone fusion was not necessary with review of the relevant literature.

Bone Cement Augmented Screw Fixation for Severe Osteoporotic Spine: Large Series of Clinical Application

OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of bone cement augmented screw fixation for the patients accompanying severe osteoporosis. METHODS: Between February 2004 and August 2007, 157 patients with various spinal diseases including fractures accompanying severe osteoporosis underwent a bone cement augmented screw fixation (947 levels). About 4.8cc of polymethylmethacrylate was injected into the each vertebral body through transpedicular route. We divided the patients into two groups (Group I: Posterior fusion for compression/burst fractures or idiopathic scoliosis, Group II: Interbody fusion for various spinal diseases). Imaging and clinical features were analyzed, including bone cement augmented levels, fusion rate, clinical outcome and complications. The visual analog scale (VAS), Oswestry disability questionnaire and modified MacNab's criteria were used for the assessment of pain and functional capacity. RESULTS: In both groups, a significant improvement in VAS and Oswestry disability questionnaire was achieved. 146 out of 157 patients (93%) were graded as excellent or good result according to the modified MacNab's criteria. None of the patients experienced operative death, screw pullout or cut-up. However, there were two cases of neurologic deterioration as a result of bone cement extravasation. CONCLUSION: Bone cement augmented transpedicular screwing can reduce the possibility of screw loosening and pullout in patients with severe osteoporosis.

Paraspinal Muscle Sparing versus Percutaneous Screw Fixation : A Prospective and Comparative Study for the Treatment of L5-S1 Spondylolisthesis

OBJECTIVE: Both the paraspinal muscle sparing approach and percutaneous screw fixation are less traumatic procedures in comparison with the conventional midline approach. These techniques have been used with the goal of reducing muscle injury. The purpose of this study was to evaluate and to compare the safety and efficacy of the paraspinal muscle sparing technique and percutaneous screw fixation for the treatment of L5-S1 spondylolisthesis. METHODS: Twenty patients who had undergone posterior lumbar interbody fusion (PLIF) at the L5-S1 segment for spondylolisthesis were prospectively studied. They were divided into two groups by screw fixation technique (Group I : paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Clinical outcomes were assessed by Low Back Outcome Score (LBOS) and Visual Analogue Scale (VAS) for back and leg pain at different times after surgery. In addition, modified MacNab's grading criteria were used to assess subjective patients' outcomes 6 months after surgery. Postoperative midline surgical scarring, intraoperative blood loss, mean operation time, and procedure-related complications were analyzed. RESULTS: Excellent or good results were observed in all patients in both groups 6 months after surgery. Patients in both groups showed marked improvement in terms of LBOSs all over time intervals. Postoperative midline surgical scarring and intraoperative blood loss were lower in Group II compared to Group I although these differences were not statistically significant. Low back pain (LBP) and leg pain in both groups also showed significant improvement when compared to preoperative scores. However, at 7 days and 1 month after surgery, patients in Group II had significantly better LBP scores compared to Group I. CONCLUSION: In terms of LBP during the early postoperative period, patients who underwent percutaneous screw fixation showed better results compared to ones who underwent screw fixation via the paraspinal muscle sparing approach. Our results indicate that the percutaneous screw fixation procedure is the preferable minimally invasive technique for reducing LBP associated with L5-S1 spondylolisthesis.

Advantages of the Plating for Anterior Cervical Discectomy and fusion: Comparison with Wearing Cervical Collar Without Plate

OBJECTIVE: Most patients wear cervical braces regardless of any anterior cervical discectomy and fusion (ACDF) technique for cervical disc herniation, even in the plating. We compared clinical and radiological results in patients with cervical disc herniations. The purpose of this study was to evaluate the efficacy of plate insertion during ACDF and determine if this could eliminate the need for external cervical braces after ACDF. METHODS: In this study, we evaluated 67 patients treated for single level cervical disc herniation with radiculopathy. The patients were divided into two groups: 30 patients treated with ACDF using a Solis(R) cage with plating who did not wear a cervical brace after the operation (Group I: Plated group), and 37 patients treated with ACDF using a Solis(R) cage without plating who wore a cervical brace for 3 months (Group II: Non-plated group). Clinical outcomes were assessed using the neck disability index (NDI), and visual analogue scale (VAS) for neck and arm pain at different times after the surgery. In addition, modified MacNab's grading criteria were used to assess the subjective patients' outcome at the last follow-up. Fusion was assessed at 6, 12, and 18 months after the surgery using upright AP, lateral, and flexion-extension views. RESULTS: Excellent or good results were achieved in the most patients from both groups. Patients in both groups showed marked pain relief in terms of neck and arm pain scores over all time intervals. The NDI scores in both groups significantly improved when compared to preoperative scores; however, at 1 and 2 months after the surgery, patients in Group I (Plated group) had significantly better NDI scores compared to Group II (Non-plated group). Higher rates of fusion were reported in Group I over all time intervals although none of these were statistically significant. There were two patients who required second surgery for cage subsidence in Group II. CONCLUSION: Our study demonstrates that anterior cervical fusion with plating for cervical radiculopathy is a safe and effective treatment which can eliminate unnecessary need for an external cervical brace.

Ligamentum Flavum Hematoma in the Adjacent Segment after a long Level Fusion

Ligamentum flavum hematoma (LFH) is a very rare condition of dural compression; most are observed in the mobile cervical and lumbar spine regions. A 67-year-old man who had a long level interbody fusion at L3-S1 four years ago presented with symptoms suggestive of dural compression. Magnetic resonance imaging showed a posterior semicircular mass located at the adjacent L2-L3 level. After decompression of the spinal canal and removal of the mass lesion, pathological examination of the surgical specimen revealed a hematoma within the ligamentum. The patient fully recovered to normal status after surgery. Here, we report our experience with a LFH in the adjacent segment after a long level fusion procedure and discuss the possible associated mechanisms.

Emergent Endovascular Embolization for Iatrogenic Vertebral Artery Injury during Cervical Discectomy and Fusion

Injury to the vertebral artery during anterior cervical discectomy is rare but potentially fatal. We report a case of cerebellar infarction after endovascular embolization for iatrogenic vertebral artery injury at C5-C6 during an anterior cervical discectomy and fusion. A 61-year-old man had an intraoperative injury of the right vertebral artery that occurred during anterior cervical discectomy and fusion at C5-C6. Hemorrhage was not controlled successfully by packing with surgical hemostatic agents. While the patient was still intubated, an emergency angiogram was performed. The patient underwent endovascular occlusion of the right V2 segment with coils. After the procedure, his course was uneventful and he did not show any neurologic deficits. Brain computed tomographic scans taken 3 days after the operation revealed a right cerebellar infarction. Anti-coagulation medication was administered, and at 3-month follow-up examination, he had no neurologic sequelae in spite of the cerebellar infarction.

The Role of Bone Cement Augmentation in the Treatment of Chronic Symptomatic Osteoporotic Compression Fracture

OBJECTIVE: Bone cement augmentation procedures such as percutaneous vertebroplasty and balloon kyphoplasty have been shown to be effective treatment for acute or subacute osteoporotic vertebral compression fractures. The purpose of this study was to determine the efficacy of bone cement augmentation procedures for long standing osteoporotic vertebral compression fracture with late vertebral collapse and persistent back pain. METHODS: Among 278 single level osteoporotic vertebral compression fractures that were treated by vertebral augmentation procedures at our institute, 18 consecutive patients were included in this study. Study inclusion was limited to initially, minimal compression fractures, but showing a poor prognosis due to late vertebral collapse, intravertebral vacuum clefts and continuous back pain despite conservative treatment for more than one year. The subjects included three men and 15 women. The mean age was 70.7 with a range from 64 to 85 years of age. After postural reduction for two days, bone cement augmentation procedures following intraoperative pressure reduction were performed. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. RESULTS: The mean follow-up period after bone cement augmentation procedures was 14.3 months (range 12-27 months). The mean injected cement volume was 4.1 mL (range 2.4-5.9 mL). The unipedicular approach was possible in 15 patients. The mean pain score (visual analogue scale) prior to surgery was 7.1, which decreased to 3.1 at 7 days after the procedure. The pain relief was maintained at the final follow up. The kyphotic angle improved significantly from 21.2 +/- 4.9degrees before surgery to 10.4 +/- 3.8degrees after surgery. The fraction of vertebral height increased from 30% to 60% after bone cement augmentation, and the restored vertebral height was maintained at the final follow up. There were no serious complications related to cement leakage. CONCLUSION: In the management of even long-standing osteoporotic vertebral compression fracture for over one year, bone cement augmentation procedures following postural reduction were considered safe and effective treatment in cases of non-healing evidence.

Brown-Sequard Syndrome Caused by Spinal Cord Infarction: A Case Report and Literature Review

Brown-Sequard syndrome is usually observed in patients with compressive myelopathy due to trauma, cord tumors, and degenerative spinal diseases. Brown-Sequard syndrome resulting from spinal cord infarction is rare. We report the case of a 46-year-old man who presented abruptly with left hemiparesis and diminished pain and temperature sensations on his right side below the C6 dermatome. Cervical spine magnetic resonance imaging revealed abnormally high signal intensity in the left lateral parenchyma of the spinal cord at the level of C4 and C6 on T2 weighted images. After excluding other possible causes, a clinical diagnosis of Brown-Sequard syndrome of probable vascular onset was made, associated with spinal cord infarction. The patient was managed conservatively with intravenous fluids and corticosteroids. However, his condition remained mostly unchanged after six months. Here, we present a rare case of spinal cord infarction causing acute Brown-Sequard syndrome, with a review of the literature.

Modified Decompressive Craniotomy for Control of Intracranial Pressure

OBJECTIVE: Various surgical techniques were developed for control of intracranial pressure such as extraventricular drainage, temporal lobectomy or decompressive craniectomy. We now describe our clinical experience by using the modified decompressive craniotomy. METHODS: Modified decompressive craniotomy was performed in 8 patients with severe cerebral edema from July 2000 to April 2001. The indication of this operation was severe intracranial hypertension and edema in operative field. We analyzed the result(Glasgow coma scale, GCS score, Glasgow outcome scale, GOS score) with the variables(age, sex, mid line shift on brain computed tomography scan) RESULTS: The overall rate of good recovery(GOS score 4 or 5) was 75%(6 of 8 patients), poor recovery(GOS score 2 or 3) was 12.5%(1 of 8 patients), and mortality rate was 12.5%(1 of 8 patients). All of survived patients had improved GCS score(mean: 10.02) compared to preoperative GCS score(mean: 7.82). CONCLUSION: The authors would like to recommend modified decompressive craniotomy for the patient of traumatic brain swelling in appropriate indication. This new operative technique has advantages such as decompressive effect and no need of delayed cranioplasty.