Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Lumbar Spine: A Minimum 5 Years Follow up / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of a selective nerve root block (SNRB) in patients with sciatica before surgery through a more than 5 year follow up. MATERIALS AND METHODS: Between January 2000 and December 2000, patients with sciatica, who were recommended to undergo surgery to diagnose and treat sciatica by other clinics or at our hospital, were selected to undergo SNRB before surgery. Among them, 69 patients were followed up for 5 years. The analysis was based on the patients' medical records and telephone interviews, and the treatment results in the SNRB group and operation group were analyzed using Kim's criteria and the Visual Analog Scale score. RESULTS: Among the 69 patients, there was no improvement in symptoms in 37 patients after SNRB. Therefore, they underwent surgery. The symptoms of the remaining 32 patients were improved by SNRB. Overall, younger patients and those with a longer symptom duration required surgery. CONCLUSION: SNRB was performed on patients with sciatica who were scheduled to undergo surgery. Some patients showed improvement in their symptoms in the long term. Therefore, SNRB should be considered as a treatment option prior to surgery.

Analysis and Measurement of the Lumbar Spinal Canal Dimension using Magnetic Resonance Imaging / 대한정형외과학회잡지

PURPOSE: It is very difficult to measure the spinal canal dimension in elderly patients because of disc degeneration and facet joint hypertrophy. The purpose of this study is to determine reference values of the spinal canal dimension in a population of normal Korea subjects and to evaluate other measurement methods of the spinal canal dimension that correlate to normal spinal canal dimensions determined using Magnetic Resonance Imaging (MRI). MATERIALS AND METHODS: We studied 100 patients who had mild symptoms and had normal MRI findings from 2475 outpatients that had undergone lumbar MRI from November 2002 to May 2004. The dimension of the spinal canal and dural sac was measured at the center of intervertebral discs L3/4, L4/5 and L5/S1. The dimension of the spinal canal and vertebral body was measured and was compared at the transverse plane perpendicular to the spinal canal that transected L4, L5 and the S1 pedicle. RESULTS: For the sequence of L3/4, L4/5 and L5/S1, the mean spinal canal dimensions were 249.38+/-38.30 mm2, 253.04+/-48.62 mm2 and 288.46+/-57.62 mm2, respectively. For the sequence of L4, L5 and S1, the mean spinal canal dimensions were 279.78+/-42.36 mm2, 301.50+/-54.26 mm2 and 355.10+/-60.65 mm2, respectively. The correlation coefficient was high at 0.913 for the L3/4 and L4 interpedicular transverse plane. The correlation coefficient for L4/5 and L5 was 0.905, and the correlation coefficient for L5/S1 and S1 was 0.845. CONCLUSION: The lumbar spinal canal dimension measured at the intervertebral disc level in a population of normal Korean subjects is expected to be useful as reference data. The transpedicular plane perpendicular to the spinal canal can give information for estimating the spinal canal dimension at the disc level.

Operative Treatment of the Tuberculous Arthritis on the Sternoclavicular Joint: A Report of Two Cases

Tuberculous arthritis on the sternoclavicular joint is an uncommon disease and a delayed diagnosis can be due to the obscure clinical symptoms. We should suspect tuberculous arthritis in patients with slowly progressive pain, swelling, mild fever and a previous history of tuberculosis. Early diagnosis is important through conducting a thorough physical examination and performing laboratory tests and radiologic study. Tuberculous arthritis on the sternoclavicular joint should be treated with a combination of systemic antituberculous agents and thorough surgical debridement in marked damaged joints. When performing this operation, it is important not only to minimized the injury of the costoclavicular ligament, but also to avoid injury to the surrounding the vital structures such as the mediastinum and pleura after aggressive resection or radical debridement. We describe here 2 cases of the tuberculous arthritis on the sternoclavicular joint: one case had a good result after surgical debridement with using an anti-tuberculous agent, and the other had fatal complications such as mediastinal abscess and pleural effusion after the operation.

Radiographic and Magnetic Resonance Imaging of Segond Fracture in the Knee Joint

PURPOSE: Patients with Segond fracture have a high probability of anterior cruciate ligament and meniscal injury. The purpose of this study is to evaluate the site and shape of fragment of Segond fracture on plain radiograph and to analyze associated intraarticular injuries of knee joint on Magnetic Resonance(MR) imaging. MATERIALS AND METHODS: From July. 1994 to June 2002, 10 Segond fractures were reviewed retrospectively on plain radiograph and MR imaging. We confirmed by arthroscopic findings that ligamentous injuries and meniscal injuries were associated in all of the 10 cases. RESULTS: The radiographic findings of Segond fractures were as follows: the elliplical shape was 8 case, the average size 7.2 mm x 2.5 mm (length x width), the location average 4.3mm below tibial articular surface and the displacement average 2.0 mm from original site. Of the 10 patients, 9 (90%) had anterior cruciate ligament (ACL), 2 posterior cruciate ligament, 2 lateral collateral ligament and 4 medial collateral ligament injury. Meniscal injury was also diagnosed in 6. CONCLUSION: In plain radiograph of patients with acute traumatic knee injury, the caution is needed to examine Segond fracture. MR imaging is an useful study because anterior cruciating ligament disruption is often associated with Segond fracure.