Lumbar HIVD Associated with Spondylolysis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study determining the surgical result of lumbar HIVD associated with spondylolysis. OBJECTIVES: To analyze the incidence of lumbar HIVD associated with spondylolysis and to compare the results of open discectomy for lumbar HIVD associated with spondylolysis to simple lumbar HIVD. SUMMARY OF LITERATURE REVIEW: Lumbar HIVD associated with spondylolysis need be treated by spinal fusion. MATERIALS AND METHODS: Nine patients(5 males and 4 females) who had lumbar HIVD with spondylolysis, no instability, fol-low-up period of 1yr were identified out of 273 patients with lumbar HIVD, treated by open discectomy from March 1989 to Feb. 1999. The type of HIVD and level of spondylolysis were evaluated, the clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR and severity of radiating pain were periodically followed up on the predesigned protocol. RESULTS: The incidence of lumbar HIVD associated with spondylolysis is 3.7%. The recovery of back pain was 2.1 to 2.1 by visu-al analogue scale, radiating pain was 7.6 to 0.8. The recovery rate of SLR was 100%, motor deficit; 100%, sensory deficit; 85%, change of DTR; 40%. The clinical evaluation was excellent(2), good(6), fair(1). CONCLUSIONS: According to the recovery rate of the clinical symptoms, the results of open discectomy for lumbar HIVD associ-ated with spondylolysis without spinal instability and simple HIVD was not different. Therefore, we conclude that lumbar HIVD associated with spondylolysis need not be treated by spinal fusion.

Intraspinal Gas with Lumberjack Injury: A Case Report / 대한척추외과학회지

STUDY DESIGN: A case report and review of the literature. OBJECTIVE: To discuss the intraspinal gas associated with lumberjack injury and review the literature. MATERIAL AND METHOD: A 60-year-old man developed chest pain & paraplegia by fall down from 4m height, having hypoes-thesia on T7-8 dermatome and complete motor-sensory loss below T9. RESULTS: Multiple rib fractures and hemopneumothorax were observed on chest radiograph and only mild offset was noted on plain spine lateral radiograph. CT scan reveals multiple air bubbles around epidural space at T7-8 and fracture of T7 pedicle. MRI shows rupture of both anterior and posterior longitudinal ligaments and extruded intervertebral disc of T7-8. Posterior decompression and stabilization with posterolateral fusion was performed on T5-9, but pain was persisted and paralysis was not improved after surgery. SUMMARY: The intraspinal gas of this case is supposed to be made by air migration from pleural cavity to intraspinal canal because of severe soft tissue injuries and fistula formation. Immediate and precise diagnosis with operative treatment was con-sidered to be important.

Chondroblastoma of the First Lumbar Vertebra: A Case Report / 대한척추외과학회지

STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To discuss the chondroblastoma of the lumbar spine and review the literatures. MATERIALS AND METHODS: A 36-year-old woman had back pain and pain radiating to the left lateral abdomen. Straight leg rais-ing was not limited. Plain roentgenograms show a small round radiolucent area in left L1 vertebral pedicle and expansile sclerotic margin in L1 vertebral body. T1-weighted MR images show the lesion displaying low signal intensity, T2-weighted images show high signal intensity, Gadolinium enhanced images show a necrotic area with low signal intensity in the lesion. RESULTS: The mass of left L1 transverse process and pedicle was excised through posterior approach and pedicle screws were inserted T12 and L2 pedicle. L1 vertebral body was excised through anterior approach and a titanium mesh was inserted. It was a ovoid mass, measured 2.3 x 2 x 1.5 cmcm in size and histologically diagnosed as chondroblastoma consisting of chondroid matrix and chondroblast. Soft tissue nodule shows chicken-wire calcification. All the symptoms were relieved at 14 months follow-up and no evidence of recurrence on follow-up roentgenogram and bone scan. However, the patient had persistent lower back pain. CONCLUSIONS: A case of chondroblastoma in L1 vertebral body was successfully excised by combined anterior and posterior approach and stabilized with a titanium meh.

Intradural Epidermoid Cyst: A Case Report / 대한척추외과학회지

STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To discuss the iatrogenic intradural-extramedullary epidermoid cyst and review the literatures. SUMMARY OF LITERATURE REVIEW: Intradural epidermoid cyst has two types of lesions, congenital and iatrogenic. The former is fre-quently associated with bone or skin malformations(spina bifida. etc) and the latter resulting from lumbar puncture, due to direct implantation of epithelial cell by puncture needle. MATERIALS AND METHODS: A 13-year-old boy had pain radiating down to the right lower extremity and hypoesthesia on the anterolateral aspect of right thigh. Straight leg raising was markedly limited. T1 weighted image reveals round intradural mass on L3-4, which was not enhanced by gadolinium. He had the history of spinal tapping two and a half years ago for the work-up of headache. RESULTS: The mass was excised through posterior approach and midline durotomy. It was whitish ovoid mass, measuring 2x1.5x1.5cm in size and histologically diagnosed as epidermoid cyst consisting of keratinous material and cholesterol. All the symptoms were completely relieved at 16 months follow-up. CONCLUSIONS: A case of iatrogenic epidermoid cyst was successfully treated by excision. Epidermoid cyst must be ruled out if space occupying lesion exists in lumbar spine and patients complaining of lower back pain.