Posterior Cord Syndrome After Spinal Cord Stimulation Electrode Lead Insertion: A Case Report / 대한신경손상학회지

Chronic neuropathic pain after spinal cord injury is often refractory to conventional treatments. Spinal cord stimulation (SCS) is used to manage intractable chronic neuropathic pain. A 42-year-old man presented with chronic neuropathic pain in his right lower extremity for 5 years. He had undergone posterior fusion from T11 to L3 for a burst fracture of L1 vertebra and conus medullaris syndrome. Conservative treatment with medications, pain blocks, and physical therapy did not relieve the neuropathic pain in the right lower limb. A paddle-type SCS electrode lead was inserted at the level of T9–11 vertebrae for test stimulation. Postoperatively, the patient immediately complained of decreased proprioception, while the motor and sensory neurologic states did not change. Since his neurological deficit did not recover spontaneously, we had to remove the epidural SCS electrode to resolve the neurological symptoms.

Cerebral Microangiopathy Mimicking a High-Grade Glioma in Old Age: A Case Report

Cerebral microangiopathy (CM) has become a common disease related to improved neuroimaging modalities and an increased life expectancy. Intracerebral tumor-like mass lesions have rarely been reported in cases of cerebral amyloid angiopathy (CAA) in elderly patients. However, tumor-like mass lesions from CM without amyloid deposits have rarely been reported. These two angiopathies may have different pathogeneses and neuroimaging characteristics. Herein, we present the case of an 83-year-old man with CM mimicking a high-grade glioma. We described the possible pathogenesis and different neuroimaging features of CM compared to CAA.

Are “Unstable” Burst Fractures Really Unstable?

Objective@#: The stability is an important factor to decide the treatment plan in thoracolumbar burst fracture patients. Patients with an unstable burst fracture generally need operative management. Decrease in vertebral body height, local kyphosis, involvement of posterior column, and/or canal compromise are considered important factors to determine the treatment plan. On the other hand, in thoracolumbar injury classification system (TLICS), surgery is recommended in patients with TLICS of more than 5 points. The purpose of this study was to apply the TLICS score in patients with thoracolumbar burst fractures and to distinguish the differences of treatment plan on burst fracture. @*Methods@#: All patients, diagnosed as a thoracolumbar burst fracture between January 2006 and February 2019 were included in this study. Unstable thoracolumbar burst fracture was defined as burst fracture with neurologic deficit, three-column injury, kyphosis over 30 degrees, decrease of anterior body height over 40 percent and canal comprise more than 50%. TLICS score was measured with morphology, neurological involvement and posterior ligamentous complex integrity. The existence of instability was compared with TLICS score. @*Results@#: Total 233 patients (131 men, 102 women) were included in this study. In Denis classification, 51 patients (21.9%) diagnosed as stable burst fracture while 182 patients (78.1%) had unstable burst fracture. According to TLICS, 72 patients (30.9%) scored less than 4, while 161 patients (69.1%) scored 4 or more. All the patients with stable burst fracture scored 2 in TLICS. Twenty-one patients (9.0) scored 2 in TLICS but diagnosed as unstable burst fracture. Thirteen patients had over 40% of vertebra body compression, four patients had more than 50% of canal compromise, three patients had both body compression over 40% and kyphosis over 30 degrees, one patients had both body compression and canal compromise. Fifteen patients presented kyphosis over 30 degrees, and three (20%) of them scored 2 in TLICS. Seventy-three patients presented vertebral body compression over 40% and 17 (23.3%) of them scored 2 in TLICS. Fifty-three patients presented spinal canal compromise more than 50%, and five (9.4%) of them scored 2 in TLICS. @*Conclusion@#: Although the instability of thoracolumbar burst fracture was regarded as a critical factor for operability, therapeutic strategies by TLICS do not exactly match with the concept of instability. According to the concept of TLICS, it should be reconsidered whether the unstable burst fracture truly unstable to do operation.

Mild Anemia and Risk for All-Cause, Cardiovascular and Cancer Deaths in Apparently Healthy Elderly Koreans / 가정의학회지

BACKGROUND: Being common, mild anemia is sometimes considered a mere consequence of aging; however, aging alone is unlikely to lead to anemia. Therefore, this study aimed to investigate the association between mild anemia and total mortality and cause-specific mortality in apparently healthy elderly subjects. METHODS: A retrospective cohort study was conducted on 10,114 apparently healthy elderly individuals who underwent cancer screening and routine medical check-ups at one Health Promotion Center between May 1995 and December 2007. We defined mild anemia as a hemoglobin concentration between 10.0 g/dL and 11.9 g/dL in women and between 10.0 g/dL and 12.9 g/dL in men. We assessed the relationship between the overall, cardiovascular (CV), and cancer mortality and mild anemia using Cox proportional hazard models. RESULTS: Mild anemia was present in 143 men (3.1%) and 246 women (6.1%). During an average follow-up of 7.6 years, 495 deaths occurred, including 121 CV and 225 cancer deaths. After adjustments, mild anemia was associated with a 128% increase in the risk of all-cause mortality (hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.54–3.37) in men and cancer-related mortality (HR, 2.25; 95% CI, 1.22–4.13), particularly lung cancer (HR, 2.70; 95% CI, 1.03–7.08) in men, but not in women. In the subgroup analyses based on smoking status, obesity, and age, the associations were more prominent in never or former smoker groups and the older group. CONCLUSION: The present study shows that overall and cancer-related mortality was associated with mild anemia in elderly men. Future prospective studies are needed to consolidate our findings.

Spontaneous Anterior Thoracic Spinal Cord Herniation through Dura Defect: A Case Report

Thoracic spinal cord herniation is a rare disease cause of progressive myelopathy. Magnetic resonance image is a useful tool to diagnose preoperatively. Operation is a treatment of option. Sixty-six-year-old female visited Dong-A University Medical Center for progressive gait disturbance with falling tendency to right side. She had radiating pain and tingling sense on both leg. Sense of touch and temperature was decreased below T6 level. Both hip and knee motor power were grade IV. Magnetic resonance imaging scan showed anterior displacement of the spinal cord at T4-T5 vertebral level. Under the diagnosis of thoracic spinal cord herniation with dura defect, operation was performed for the patient with intraoperative neuromonitoring. Laminectomy at T4 and T5 level was done, and intradural exploration of the spinal cord revealed dura defect about 25mm×8mm in size. Spinal cord was released under microscope and dura defect was repaired with Lyoplant. The patient's symptom improved after the surgical procedure, but touch and temperature sense under T6 level had unchanged.

In vivo Kinematics of the Knee after a Posterior Cruciate-Substituting Total Knee Arthroplasty: A Comparison between Caucasian and South Korean Patients

PURPOSE: This study compared in vivo kinematic differences between Caucasian and South Korean patients after a posterior-substituting total knee arthroplasty (PS-TKA). MATERIALS AND METHODS: In vivo motions of 9 Caucasian and 13 South Korean knees with a PS-TKA during weight bearing single leg lunge were determined using a dual fluoroscopic imaging technique. Normalized tibiofemoral condylar motions and articular contact locations were analyzed. RESULTS: Femoral condylar motions of the two groups showed a similar trend in anteroposterior translation, but the South Korean patients were more anteriorly positioned than the Caucasian patients at low flexion and maximal flexion angles in both medial and lateral compartments (p<0.05). Mediolateral femoral condyle translations were similar between the two groups. For tibiofemoral articular contact kinematics, the South Korean patients had significantly more anterior contact locations at the medial compartment at low flexion angles, and more lateral contact locations at the lateral compartment at 0° and 90° flexion compared to the Caucasian patients (p<0.05). The South Korean patients had significantly larger distances between the medial and lateral contact locations at 60° and 90° flexion compared to the Caucasian patients (p<0.05). CONCLUSIONS: The study revealed that while the Caucasian and South Korean knees had similar femoral condylar motions, after PS-TKA the South Korean patients showed different articular contact point kinematics compared to the Caucasian patients.

Intradural Extramedullary Tuberculoma of the Spinal Cord Following Tuberculous Meningitis

Intradural extramedullary tuberculoma of the spinal cord (IETSC) is an uncommon disease which can occurs secondary to tuberculous meningitis. A 31-year-old woman was diagnosed as tuberculous meningitis after mental disorientation. Her mentality was recovered after antituberculous therapy. After 7 months of antituberculous therapy, paraplegia has developed. Magnetic resonance imaging (MRI) revealed a mass lesion between the T1 and T12 spinal levels with arachnoid thickening which results in the development of tuberculoma. She received surgical resection of IETSC followed by antituberculous therapy and neurological function has been improved. The two years after surgical treatment, spinal MRI showed syringomyelia between T1 to L1. But, her neurological outcome was not aggravated.

Clinical Value of Procalcitonin in Patients with Spinal Infection

OBJECTIVE: This study was designed to evaluation the diagnostic value of procalcitonin (PCT) in patients with spinal infection, compare to the classical biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count. METHODS: All patients who were diagnosed as a spinal infection between January, 2013 and July, 2014 were included in this study. Serum PCT, CRP, ESR, and WBC count were checked at initial hospital visit and once a week serially until they were discharged. Patient's medical history, causes and pathogens of spinal infection were reviewed. RESULTS: Total 34 (16 men, 18 women) patients were included in this study. Mean age of the patients was 65.6 year-old. Causes of spinal infection were pain block procedure (14, 41.2%) and post-operation (5, 14.7%). Out of 25 patients who showed elevated initial serum PCT level, 20 patients (80%) had a combined systemic infection. 14 patients (6.7%) had a sepsis, 3 patients (14.2%) had a urinary tract infection and 2 (9.6%) had a pneumonia. 14 patients (41.2%) showed elevation of serum PCT level during treatment. Among them, 9 patients (64.3%) had a combined infection such as sepsis and urinary tract infection. CONCLUSION: Serum CRP showed more sensitivity compared to serum PCT in patients with spinal infection. Patients with spinal infection who showed elevated serum PCT level should be investigated for combined infection and proper antibiotics should be applied.

Neurological Outcome after Surgical Treatment of Intramedullary Spinal Cord Tumors

OBJECTIVE: Recently, surgical outcomes of patients with intramedullary spinal cord tumors (IMSCT) have been improved due to advances of medicine. The purposes of our study were to evaluate the recent neurological outcomes after surgical treatment of IMSCTs. METHODS: We retrospectively reviewed 69 patients who underwent surgical treatment for IMSCT in our hospital between 1998 and 2013. Patient's age, sex, histological origin and grade, tumor location, tumor extension, preoperative neurological state, initial presenting symptom, and extend of tumor resection were analyzed to evaluate predictive factors that affect postoperative functional outcome. RESULTS: The neurological states at last follow-up were improved in 16 patients (23.2%), unchanged in 47 (68.1%), aggravated in 6 (8.7%). In all patients, the functional outcomes were good in 52 patients (75.4%), fair in 10 (14.5%), poor in 7 (10.1%). Preoperative good neurological state was the strongest positive predictor of good functional outcome (p<0.05). In tumor location, functional outcomes of thoracic tumors were poor than those in cervical and conus medullaris region (p=0.011). High-grade tumor shows poor outcome compare to low-grade tumor (p=0.03). CONCLUSION: The most reliable predicting factor of surgical outcome was the preoperative neurological state. In addition, IMSCTs in thoracic region and high-grade tumor showed relatively bad outcome and had a risk of postoperative morbidity.

Nutrition Label Use and Its Relation to Dietary Intake among Chronic Disease Patients in Korea: Results from the 2008-2009 Fourth Korean National Health and Nutrition Examination Survey (KNHANES-IV)

BACKGROUND: Nutrition label reading is helpful in attaining a healthy diet. Nutrition label use and its related factors have been studied in many Korean articles, but their research samples were the general population and not chronic disease patients. This study aimed to explore the use of nutrition labels and its relation to dietary intake among chronic disease patients in Korea. METHODS: A total of 3160 respondents aged> or =20 years from the 2008-2009 Fourth Korean National Health and Nutrition Examination Survey (KNHANES-IV) participated in the study. Their chronic medical conditions included hypertension, hyperlipidemia, coronary artery disease, diabetes and/or stroke and they were interviewed regarding their use of nutrition labels. Nutrition intake was also estimated by 24-hour dietary recalls. RESULTS: Overall, 10.4% of the chronic disease patients reported to using nutrition labels. The nutrients they looked at first were total calories, fat and cholesterol. Factors related to reading nutrition labels were relatively higher education, high body mass index and lower frequency of alcohol intake in males and relatively younger age and higher education in females. Nutrition label users consumed lower total calories, protein and fat in the male CAD group, lower total calories and carbohydrate in both diabetes and total groups and lower total calories and fiber in the female stroke group. CONCLUSIONS: Our study found that, in Korea, a significantly lower rate of patients with chronic disease read nutrition labels. Strategies need to be developed to improve clinical application of nutrition labels in this population.

Association between Physical Activity and Health-Related Quality of Life in Korean: The Korea National Health and Nutrition Examination Survey IV / 가정의학회지

BACKGROUND: Numerous studies have identified that physical activity (PA) has positive influences on quality of life. However, there has been little domestic research about the relation of PA to health-related quality of life (HRQoL) among the general population. The purpose of this study was to evaluate the effect of PA on HRQoL in Korean adults aged 40 years or over. METHODS: This cross-sectional study was based on data acquired from the Korean National Health and Nutrition Examination Survey IV. Final study subjects were 10,392 adults aged 40 years or over. According to the severity and frequency of PA, the subjects were divided into three PA groups as follows: high-activity, mid-activity, and low-activity group. We compared the HRQoL estimated by the EuroQoL 5-dimension (EQ-5D), the EQ visual analogue scale (EQ-VAS), and EQ-5D index between three PA groups. RESULTS: The odds ratios for mid-activity group and high activity group compared with low activity group were significantly decreased in the dimension of mobility of EQ-5D (mid-activity group, 0.81 [0.69-0.94]; high activity group, 0.81 [0.67-0.99]). EQ-VAS was decreased as PA level was lowered from high activity group and mid-activity to low activity group. EQ-5D index was the highest in mid-activity group and the lowest in low activity group. CONCLUSION: PA above mid-activity group showed better HRQoL compared than low activity group.

Heterotopic Ossification after Cervical Arthroplasty with ProDisc-C: Time Course Radiographic Follow-up over 3 years

OBJECTIVE: Heterotopic ossification (HO) is a well-known complication after total hip replacement. But the occurrence rate by the time-course, clinical effect and risk factors of HO after total cervical disc replacement (TCDR) are not well described. The purpose of this study is to evaluate the occurrence rate by the time-course and risk factors for HO after TCDR with a ProDisc-C. METHODS: Thirty-two patients whom followed up more than one year after the TCDR are enrolled. Radiographic study was done at 12, 24 and 36 months after the TCDR and classified HO with McAfee classification. Segmental range of motion, preoperative existence of spondylosis, type of operation, disc space occupying ratio by artificial disc, surgical level are analyzed to identify the risk factors of HO. The visual analog scale and the neck disability index were evaluated preoperatively and at last follow-up time for clinical parameters. RESULTS: Eighteen patients (56%) showed HO at 12 months, 18 patients (86%) showed HO at 24 months and 6 patients (89%) showed HO at 36 months after the TCDR. Clinical significant HO(Grade 3 and 4) was shown in one patient (3%) at 12 months, 3 patients (14%) at 24 months and 5 patients (56%) at 36 months. Only post-operative follow-up period increases the risk of development clinical significant HO. All patients showed improvement of clinical parameters (p<0.005). CONCLUSION: Incidence of HO is getting higher as time course progress. However, there are no relation between clinical outcome and radiologic change of ROM and the grade of HO.

Traumatic Intradural Lumbar Disc Herniation without Bone Injury

Intradural lumbar disc herniation is a rare disease. According to the reports of intradural lumbar disc herniations, most cases have developed as a chronic degenerative disc diseases. Traumatic intradural lumbar disc herniations are even rarer. A 52-year-old man visited our emergency center with numbness in his left calf and ankle after falling accident. Initial impression by radiologic findings was a spinal subdural hematoma at the L1 level. A follow up image two weeks later, however, did not demonstrate any interval change. The patient was decided to have an operation. In operative findings, a ruptured disc particle penetrating the ventral and dorsal dura was indentified after laminectomy. It was assumed to be a traumatic outcome not a degenerative change.

Clinical Outcome and Influencing Factor for Repeat Lumbar Discectomy for Ipsilateral Recurrent Lumbar Disc Herniation

OBJECTIVE: Recurrent herniation following disc excision has been reported in 5-15% of patients. There have been numerous studies of recurrent disc herniation, but these have analyzed mixed patient populations. We designed this study to analyze the factors that influencing the clinical results, and efficiency of repeat discectomy for recurrent lumbar disc herniation occurring at the same level and on the same side after primary discectomy. METHODS: Between 1990 and 2011, a total of 52 patients who underwent repeat discectomy for recurrent lumbar disc herniation were retrospectively analyzed. Clinical outcomes were measured with Macnab criteria and visual analog scale (VAS score). Clinical parameters were also analyzed for influencing factors for outcome. RESULTS: Based on Macnab criteria, an excellent surgical outcome was achieved in 28 cases (54%), a good outcome in 22 cases (42%), a fair outcome in 1 case (2%), and a poor outcome in 1 case (2%). Based on VAS score, 47 of 52 patients (90%) showed more than 4 score improvement. Age, sex, diabetes mellitus, smoking, time interval between repeat and primary discectomy, duration of recurrent symptoms, and extent of disc herniation did not significantly affect Macnab criteria and VAS score. However, a traumatic event showed less VAS score improvement whereas not affecting on Macnab criteria. CONCLUSION: Conventional open lumbar discectomy performed as repeat surgery for recurrent herniation showed satisfactory results. Based on the results of this study, repeat discectomy can be recommended for the management of recurrent lumbar disc herniation. Further study is needed to evaluate factors related to the outcomes of repeat discectomy.

Effect of Amniotic Membrane to Reduce Postlaminectomy Epidural Adhesion on a Rat Model

OBJECTIVE: Epidural fibrosis and adhesion are the main reasons for post-laminectomy sustained pain and functional disability. In this study, the authors investigate the effect of irradiated freeze-dried human amniotic membrane on reducing epidural adhesion after laminectomy on a rat model. METHODS: A total of 20 rats were divided into two groups. The group A did not receive human amniotic membrane implantation after laminectomy and group B underwent human amniotic membrane implantation after laminectomy. Gross and microscopic findings were evaluated and compared at postoperative 1, 3 and 8 weeks. RESULTS: The amount of scar tissue and tenacity were reduced grossly in group of rats with human amniotic membrane implantation (group B). On a microscopic evaluation, there were less inflammatory cell infiltration and fibroblast proliferation in group B. CONCLUSION: This experimental study shows that implantation of irradiated freeze-dried human amniotic membrane reduce epidural fibrosis and adhesion after spinal laminectomy in a rat model.

Different Expression of Extracellular Matrix Genes: Primary vs. Recurrent Disc Herniation

OBJECTIVE: Recurrent lumbar disc herniation has been reported to occur in 5% to 15% of surgically treated primary lumbar disc herniation cases. We investigated the molecular biologic characteristics of primary herniated discs and recurrent discs to see whether the recurrent discs has the similar biological features with primary herniated discs. METHODS: Primary herniated disc and recurrent disc cells were obtained by discectomy of lumbar disc patients and cells were isolated and then taken through monolayer cultures. We compared chondrogenic and osteogenic mRNA gene expression, and western blot between the two groups. RESULTS: The mRNA gene expression of recurrent disc cells were increased 1.47* times for aggrecan, 1.38 times for type I collagen, 2.04 times for type II collagen, 1.22 times for both Sox-9 and osteocalcin, and 1.31 times for alkaline phosphatase, respectively, compared with the primary herniated lumbar disc cells (*indicates p < 0.05). Western blot results for each aggrecan, type I collagen, type II collagen, Sox-9, osteocalcin, and alkaline phosphatase were similar between the primary herniated disc cells and recurrent disc cells. CONCLUSION: These results indicate that the recurrent disc cells have similar chondrogenic and osteogenic gene expression compared to primary herniated disc cells. Therefore, we assumed that the regeneration of remaining discs could fill the previous discectomy space and also it could be one of the factors for disc recurrence especially in the molecular biologic field.

Survival Rate and Neurological Outcome after Operation for Advanced Spinal Metastasis (Tomita's Classification > or = Type 4)

PURPOSE: We investigated whether primary malignancy entities and the extent of tumor resection have an effect on the survival rate and neurological improvement in patients with spinal metastases that extend beyond the vertebral compartment (Tomita's classification > or = type 4). MATERIALS AND METHODS: We retrospectively reviewed 87 patients with advanced spinal metastasis who underwent surgery. They were divided into groups 1 and 2 according to whether they responded to adjuvant therapy or not, respectively. They were subdivided according to the extent of tumor resection: group 1, gross total resection (G1GT); group 1, subtotal resection (G1ST); group 2, gross total resection (G2GT); and group 2, subtotal resection (G2ST). The origin of the tumor, survival rate, extent of resection, and neurological improvement were analyzed. RESULTS: Group 1 had a better survival rate than group 2. The G1GT subgroup showed a better prognosis than the G1ST subgroup. In group 2, the extent of tumor resection (G2GT vs. G2ST) did not affect survival rate. In all subgroups, neurological status improved one month after surgery, however, the G2ST subgroup had worsened at the last follow-up. There was no local recurrence at the last follow-up in the G1GT subgroup. Four out of 13 patients in the G2GT subgroup showed a local recurrence of spinal tumors and progressive worsening of neurological status. CONCLUSION: In patients with spinal metastases (Tomita's classification > or = type 4), individuals who underwent gross total resection of tumors that responded to adjuvant therapy showed a higher survival rate than those who underwent subtotal resection. For tumors not responding to adjuvant therapy, we suggest palliative surgical decompression.

Clinical and Radiological Outcome of an Interspinous Dynamic Stabilization System in Degenerative Lumbar Disease:24 Cases with Over 24 Months of Follow-up

OBJECTIVE: The purpose of this study was to analyze the clinical and radiological outcomes of dynamic stabilization with DIAM implants. METHODS: We evaluated 24 cases in which lumbar decompressive surgery was performed with dynamic stabilization using DIAM and having more than 24 months of follow up. Indications consisted of spinal stenosis with or without a herniated disc and transition level stenosis of the instrumented fusion segment. Operative data, clinical outcome, and plain and flexion/extension radiographs were obtained and compared to preoperative and postoperative data. RESULTS: The mean age at operation was 56.2 years(range 47-68); the mean follow-up duration was 28.4 months(range 24-37 months).The mean pain and function scores improved significantly from baseline to follow-up, as follows: back pain VAS score from 6.2 to 2.5, leg pain VAS score from 7.2 to 2.4, and Prolo's economic and functional rating score from 5.8 to 8.2. Radiological data demonstrated that the heights of the intervertebral foramen and the posterior disc increased significantly after the procedure. There were no implant-associated complications except for two spinous process fractures which occurred during DIAM insertion, and one case of wound infection. Flexion instability and spondylolisthesis occurred in two cases during the follow-up period. CONCLUSION: These mid-term results suggest that DIAM is a safe and effective alternative surgical option in the treatment of degenerative lumbar stenosis without flexion instability. Careful follow-up is needed to watch for the development of flexion instability and spondylolisthesis.

Long Term Efficacy of Posterior Lumbar Interbody Fusion with Standard Cages alone in Lumbar Disc Diseases Combined with Modic Changes

OBJECTIVE: Posterior lumbar interbody fusion (PLIF) is considered to have the best theoretical potential in promoting bony fusion of unstable vertebral segments by way of a load sharing effect of the anterior column. This study was undertaken to investigate the efficacy of PLIF with cages in chronic degenerative disc disease with Modic degeneration (changes of vertebral end plate). METHODS: A total of 597 patients underwent a PLIF with threaded fusion cages (TFC) from 1993 to 2000. Three-hundred-fifty-one patients, who could be followed for more than 3 years, were enrolled in this study. Patients were grouped into 4 categories according to Modic classification (no degeneration : 259, type 1 : 26, type 2 : 55, type 3 : 11). Clinical and radiographic data were evaluated retrospectively. RESULTS: The clinical success rate according to the Prolo's functional and economic outcome scale was 86% in patients without degeneration and 83% in patients with Modic degeneration. The clinical outcomes in each group were 88% in type 1, 84% in type 2, and 73% in type 3. The bony fusion rate was 97% in patients without degeneration and 83% in patients with Modic degeneration. The bony fusion rate in each group was 81% in type 1, 84% in type 2, and 55% in type 3. The clinical success and fusion rates were significantly lower in patients with type 3 degeneration. CONCLUSION: The PLIF with TFC has been found to be an effective procedure for lumbar spine fusion. But, the clinical outcome and bony fusion rates were significantly low in the patients with Modic type 3. The authors suggest that PLIF combined with pedicle screw fixation would be the better for them.

Endovascular Treatment Using Multiple Stents for Symptomatic Intracranial Vertebral Artery Dissecting Aneurysm / 대한뇌혈관외과학회지

OBJECTIVE: Endovascular treatment with stent placement or stent-assisted coiling was recently introduced as an alternative to parent artery occlusion for treating intracranial vertebral artery dissections. However, complete aneurysm obliteration after single stent placement is often not accomplished. The aim of the study was to evaluate the safety and efficacy of placing multiple stents in intracranial vertebral dissecting aneurysms. METHODS: We retrospectively reviewed 8 patients who underwent stent angioplasty with placing multiple stents for treating intracranial vertebral dissecting aneurysms. There were 5 male patients and 3 female patients with a mean age of 54 years (age range, 37-71 years). Three patients presented with subarachnoid hemorrhage (SAH), 1 presented with ischemic events and 4 presented with headache. Follow-up angiogram was performed in 8 patients within 6~12 months to determine whether or not the affected segment was occluded. RESULTS: Eight patients with intracranial vertebral artery dissections were treated by placing multiple stents, 6 were treated by double stent placement and the others were treated by triple and quadruple stent placement. Although immediate complete occlusion was not shown in any cases, the follow-up angiogram revealed complete occlusion in 5 cases (62.5%) within 6-12 months. There were 2 complications (25%, temporary vasospasm during the procedure and acute thrombosis). On the modified Rankin scale applied during follow-up, 6 patients were ssessed as functionally improved or of a stable clinical status, 1 patient expired due to cardiopulmonary complications, and 1 was lost to follow-up). CONCLUSION: Intracranial vertebral artery dissections can be treated by the endovascular method with placing multiple stents and the morbidity is acceptable. However, further study is needed since the treatment of patients presenting with SAH using multiple stent placement can be controversial.