Non-traumatic Atlanto-axial Rotatory Subluxation: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a case of diagnostic, clinical and radiologic follow-up of a non-traumatic atlanto-axial rotatory subluxation. SUMMARY OF LITERATURE REVIEW: Atlanto-axial rotatory subluxation, caused by a non-traumatic inflammation or infectious diseases, has been branded as "Grisel's syndrome". However, the pathophysiology of the syndrome has not been clearly understood, and its diagnostic criteria and appropriate treatment plans are not established. MATERIALS AND METHODS: The patient suffering from antlanto-axial subluxation without any neurological symptoms was treated with halter traction and Miami J brace. RESULTS: The patient maintained a normal reduction state, and a normal cervical movement was observed after undergoing 4 weeks of non-surgical treatment. CONCLUSION: Early detection and treatment are essential and critical in avoiding catastrophic outcomes. It requires a combination of clinical assessment and appropriate radiographic imaging.

Efficiency of Implant Removal for Treatment of the Thoraco-lumbar Unstable Fractures: Multi Segments Fixation, Single Segment Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the safety and usefulness of implant removal based on fusion by radiological change analyses and non-fused segment motion angle after open reduction, multi-segment fixation, and single segment fusion. SUMMARY OF LITERATURE REVIEW: There have been reports that discuss possible fracture of fixator, loss of reduction, or failure of fixation in certain cases of single segment fixation consistent with thoracolumbar fracture. MATERIALS AND METHODS: We analyzed 83 patients who had undergone treatment by fixation of the top 2 segments and the bottom segment. The posterolateral fusions were performed for the top segment for thoracolumbar fractures. The mean follow-up was 21.3 months. Wedge and local kyphotic angles, anterior, and posterior heights of the vertebral body were measured on plain radiograph. The range of motion of each segment was recorded by flexion-extension lateral radiographs at 6 month after the removal of implants. RESULTS: Radiologic assessments performed on 83 patients demonstrated preoperative mean wedge angle, kyphotic angle, mean anterior body height of 20.1degrees, 18.5degrees and 62.0%, respectively, and, postoperatively, these were corrected by 9.0degrees, 9.3degrees and 24.6%, respectively. In the 44 cases that had the implants removed, the correction losses were 0.4degrees(P=0.258) and 3.7degrees(P=0.000), 0.5%(P=0.756), and at the last follow-up, compared to measurements prior to the removal. There was no statistical significance in wedge angle or anterior body height. The range of motion measured on the non-fused segment was 3.9degrees on average at 6-months after the hardware removal. CONCLUSIONS: The multi-segments fixation and single-segment fusion for the thoracolumbar fracture can preserve correction and the motion of non-fusion segment. Although the implant removal after union can sustain motion, further studies regarding degenerative change of the non-fused segment are necessary.

Efficiency of Anterior Interbody Fusion using Cage Packed with DBM in the Distractive Flexion Injury of Cervical Spine: Demineralized Bone Matrix vs Autoiliac Cancellous Bone

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to evaluate the effectiveness and safety of a PEEK cage filled with DBM in patients with a distractive flexion injury of the cervical spine. SUMMARY OF LITERATURE REVIEW: AIF of the cervical spine using an autoiliac bone graft and plate fixation is known to be an effective treatment for traumatic injuries. However, the complications arising from the donor site are troublesome, and so fusion with cage is an alternative treatment. MATERIALS AND METHODS: We analyzed 32 cases (22 males and 10 females) with distractive flexion injury of the cervical spine. They underwent anterior decompression and interbody fusion with a PEEK cage and anterior plate fixation. In 18 patients, the cage was filled with autogenous iliac bone (Group I), and for the other 10 the cages were filled with DBM (Group II). RESULTS: All the cases in Group I and Group II achieved fusion except for one case of nonunion in group II. The anterior and posterior vertebral heights of the fused segments of group II were decreased more than those of group I, resulting a statistical difference (p=0.003). The changes of segmental lordosis (p=0.69) and the neurologic status (p=0.22) showed no statistical difference between the two groups. CONCLUSIONS: AIF using a PEEK cage filled with DBM and plate fixation showed no significant clinical differences compared to the case of iliac bone autografting. However, from a radiologic perspective, the time to achieve union was extensive and a case of nonunion was also observed. Therefore, many considerations are necessary when using DBM as a replacement for iliac bone autografting and further research should be done on this subject.

Diagnosis and Prognosis of Adult Post-traumatic Cervical Cord Injury Without Radiographic Evidence of Trauma Using Magnetic Resonance Imaging / 대한척추외과학회지

STUDY DESIGN: This is a retrospective review of 10 consecutive patients with spinal cord injury without radiographic evidence of abnormalities (SCIWORA) and 17 spinal cord injury patients without radiographic evidence of trauma (SCIWORET). OBJECTIVES: We wanted to assess the MRI and clinical findings, the prognosis and effect of anterior decompression of the spinal cord in SCIWORET patients. SUMMARY OF THE LITERATURE REVIEW: SCIWORET is not uncommon among middle-age and elderly people. It is less reported in adults as compared with children. There are no studies on the method for the treatment or the effectiveness of anterior decompression of the spinal cord. MATERIALS AND METHODS: From February 1994 to December 2005, this study included 27 patients who had cervical spinal cord injury without radiographic evidence of trauma on the plain roentgenography and MRI. Ten patients had no spinal cord compression (SCIWORA patients, group 1) and 17 had their spinal cord compressed from the anterior (SCIWORET patients, group 2), We conservatively treated the group 1 patients and 10 of the group 2 patients, and anterior decompression and fusion were done for 7 of the group 2 patients. Neurological evaluation was performed initial and at last follow up using an ASIA motor score and the Frankel grade. RESULTS: The patients who had spinal cord edema on MRI had a better prognosis than those who had contusion (p=0.06). There is no statistical difference between the two groups for the neurologic changes at the initial period and the last follow up period (p=0.06, 0.61). Decompression of the spinal cord anteriorly was not effective for the neurologic recovery (p=0.25) and the involved segments were not related to the neurologic changes (p=0.34, 0.25). CONCLUSIONS: It was presumed that patients with edema of the spinal cord had a better prognosis than those with contusion of the spinal cord. There was no difference between the SCIWORA and SCIWORET groups for the neurologic changes and anterior decompression was not effective for the recovery of neurologic symptoms. This study was limited by its retrospective nature and the small number of patients, so a multi-center study is needed.

Cervical Spondylolysis with Dysplasia: A Case Report / 대한척추외과학회지

Cervical spondylolysis is defined as a corticated cleft between the superior and inferior articular facets of the articular pillar, which is the cervical equivalent of pars interarticularis in the lumbar spine. It is very important to avoid confusion with more clinically significant abnormalities, such as fracture or dislocation. This case report describes bilateral spondylolysis and associated dysplasia of C6. We describe the radiographic presentation of this anomaly, stressing the importance of computed tomography and magnetic resonance imaging for a correct diagnosis. A review of the literature on this interesting abnormality and a complete differential diagnosis are presented.

Cementless Bipolar Hemiarthroplasty for Hip Fracture in Patients More than Seventy Years Old with Osteoporosis

Purpose: This study evaluated the effectiveness of bipolar hemiarthroplasty with a cementless femoral stem for hip fractures in patients older than 70 years with osteoporosis. Materials and Methods: This study examined 84 hips with osteoporosis that are available to follow up of more than 2 years, between July 1997 and May 2006. The clinical evaluation was carried out using the Koval classification before the fracture and at the last follow-up, and the Harris hip score at the last follow up. The radiological evaluation was carried out using the plain radiographs. Results: The average follow up period was 31.4 months. The Koval classification was as follows: recovery to the condition before the fracture in 25 cases (30.1%), degradation by 1 class in 56 cases (67.5%) and degradation by 2 classes in 2 cases (2.4%). The Harris hip score was 82.7 points at the last follow-up. One case (1.2%) showed cortical hypertrophy and all cases showed stable insertion of the femoral stem. Conclusion: Bipolar hemiarthroplasty with a cementless femoral stem is effective and satisfactory, both clinically and radiologically, for the treatment of elderly patients with fractures around the hip.

Anterior Decompression and Fusion in the Treatment of Single-level Cervical Disc Herniation: Plate Fixation vs Cage / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We analyzed the radiological and clinical results to verify the efficacy of anterior interbody fusion with using cages gradually increases in the treatment of cervical radiculopathy. SUMMARY OF LITERATURE REVIEW: Anterior cervical decompression and fusion is well accepted treatments for cervical radiculopathy. Performing anterior interbody fusion using cages has recently gradually increased to minimize the extent of surgery. While there are numerous reports on the primary stabilizing effects of the cervical cages, little is known about the subsidence behavior of such cages in vivo. MATERIALS AND METHODS: We retrospectively analyzed 38 patients with cervical disc herniation who underwent anterior decompression and interbody fusion with autoiliac bone graft and plate fixation (Group I, 21 patients) or who underwent with standalone cage (Group II, 17 patients). We statistically analyzed the changes of the cervical lordosis, the segmental lordosis, the vertebral body height, the fusion rate on the plain x-ray and the clinical results with using a pain visual analogue scale. RESULTS: All the cases were fused by 11.2+/-2.7 weeks after operation. The changes of the cervical lordosis and segmental lordosis show no statistically significant difference between the two groups (p=0.07, 0.66). The anterior and posterior vertebral heights of the fused segments of group II were more decreased than those of group I, but there was no statistically difference between the two groups (p=0.06, 0.30). The clinical results were not statistically difference between the two groups (p=0.64, 0.45). CONCLUSIONS: Implantation of autoiliac cancellous bone impacted stand-alone cages or on a tricortical iliac crest autograft after anterior decompression was safe and reliable options for the treatment of cervical disc herniation that causes single level radiculopathy. Both procedures produced equally satisfying clinical and radiological results, leading to a high fusion rate and they maintained the intervertebral height.

Treatment of Distractive Flexion Injury in Lower Cervical Spine using Anterior Cervical Fusion / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the availability of anterior cervical plating in the treatment of distractive flexion injury of the lower cervical spine and the relationship between the neurologic findings, types of dislocation, and disc herniation. SUMMARY OF LITERATURE REVIEW: Anterior stabilization of unstable cervical spine injuries is increasing. However, the stability of anterior stabilization only is controversial for the treatment of bilateral dislocation of the cervical spine. MATERIAL AND METHODS: We retrospectively analyzed 32 patients treated with anterior decompression, auto-iliac bone graft, and anterior cervical plating, who suffered from distractive flexion injury in the lower cervical spine from Feb. 1999 to Feb. 2006. Unilateral dislocation occurred in 21 cases, bilateral dislocation in 11 cases, with evaluation of disc status at the injured level conducted after closed reduction by MRI. We statistically analyzed changes in vertebral body height, disc angle, fusion rate, neurologic recovery, and complications. RESULTS: All cases were fused by 12.3+/-2.7 weeks after operation, and the loss of anterior and posterior vertebral body height were statistically significant (p=0.00, 0.00), changes in the disc angle were not (p=0.53). Herniation of the disc was more frequent in unilateral dislocation (p=0.02). Clinically 21 (65%) patients had neurologic deficits, but nerve root injuries recovered in all cases, with the original average ASIA motor score of 55.2 improving to 68.3 at last follow up. CONCLUSIONS: Anterior decompression, bone grafting, and metallic osteosynthesis were effective treatment modalities for distractive-flexion injuries of the lower cervical spine, causing slight vertebral body height decreases but no loss of reduction or neurologic compromise.

Cyto-protective Effects of Aqueous Extract from the Gall of Rhus chinensis on Pancreatic Beta-cell / 대한해부학회지

We have previously reported that aqueous extract of gall from Rhus chinensis, known as "Obaeja", inhibited rat intestinal alpha-glucosidase and suppressed postprandial hyperglycemia by delaying digestion and absorption of intestinal carbohydrate (Shim et al., 2003). This led us to speculate that obaeja could be involved in ameliorating beta-cell injury by lowering glucotoxicity. In the present study, we thus examined the protective effect of obaeja on pancreatic beta-cell damage along with its anti-diabetic effect in streptozotocin-induced animal models. Streptozotocin was administered to rat pups (neonate/STZ model), or to adult rats with a lower dose using osmotic pump (osmotic pump/STZ model) for inducing beta cell death and diabetes. Obaeja was given to those rat pups after weaning in neonate/STZ model, or 2 weeks before subcutaneous implantation of osmotic pump to rats of the other latter model. In the diabetic control rats of the neonate/STZ model, which were not fed with obaeja, some pancreatic islets demonstrated a destruction of beta cell mass with insulitis 2 weeks after weaning, while some larger and irregular islets were formed by proliferation of alpha cells. In particular, we found some pancreatic lobules showing a severe inflammation and degeneration of islet and acinar tissues in this model. Islets in these inflammatory lobules were smaller in size with only few cells. In contrast, any inflammatory responses and insulitis were not observed in pancreas of the rats fed obaeja in this model. The islets in those rats maintained their normal profiles and islet cell population. Such anti-cytotoxic effect was also monitored in the diabetic rats of osmotic pump/STZ model. Especially, occurrence of hyperglycemia in the obaeja fed rats was delayed by 25~30 days than that of diabetic control rats in this model. Taken together, these results imply that regulation of postprandial blood glucose level by obaeja feeding may ameliorate a secondary injury caused by glucotoxicity.