Delayed-Onset Leg Weakness Caused by Posterior Migration of a Herniated Disc to the Thecal Sac Mimicking Epidural Hematoma in a Flexion-Distraction Injury of the Lumbar Spine: A Case Report

OBJECTIVES@#To document the first known case of posterior migration of a herniated disc in a lumbar flexion-distraction injury.SUMMARY OF LITERATURE REVIEW: Lumbar disc herniation is sometimes confused with epidural hematoma, especially when the disc migrates posterior to the thecal sac. There has been no report of posterior migration of a herniated disc after a lumbar flexion-distraction injury.@*MATERIALS AND METHODS@#A 47-year-old woman with no pertinent medical history was diagnosed with a flexion-distraction injury of the L2–L3 vertebrae after a motor vehicle accident. The patient had no neurological deficit initially. Magnetic resonance imaging (MRI) showed a space-occupying lesion with T2 hyperintensity and T1 isointensity on the dorsal side of the thecal sac at L2–L3. After posterior lumbar fixation and fusion, progressive leg weakness occurred 1 week postoperatively.@*RESULTS@#A second operation revealed no evidence of epidural hematoma, but a sequestrated disc. Decompression and sequestrectomy were performed, and the patient's neurological status had recovered fully at 4 months postoperatively.@*CONCLUSIONS@#This case highlights the potential for posterior migration of a herniated disc with flexion-distraction injuries of the thoracolumbar spine. Discontinuity of the posterior annulus fibrosus on MRI may aid the distinction of posterior migration of a herniated disc from epidural hematoma. Because posterior migration of a herniated disc is associated with progressive neurological deficits, surgeons must consider decompression surgery when such herniation is suspected, even in the absence of neurological symptoms.

Delayed-Onset Leg Weakness Caused by Posterior Migration of a Herniated Disc to the Thecal Sac Mimicking Epidural Hematoma in a Flexion-Distraction Injury of the Lumbar Spine: A Case Report / 대한척추외과학회지

STUDY DESIGN: Case report. OBJECTIVES: To document the first known case of posterior migration of a herniated disc in a lumbar flexion-distraction injury. SUMMARY OF LITERATURE REVIEW: Lumbar disc herniation is sometimes confused with epidural hematoma, especially when the disc migrates posterior to the thecal sac. There has been no report of posterior migration of a herniated disc after a lumbar flexion-distraction injury. MATERIALS AND METHODS: A 47-year-old woman with no pertinent medical history was diagnosed with a flexion-distraction injury of the L2–L3 vertebrae after a motor vehicle accident. The patient had no neurological deficit initially. Magnetic resonance imaging (MRI) showed a space-occupying lesion with T2 hyperintensity and T1 isointensity on the dorsal side of the thecal sac at L2–L3. After posterior lumbar fixation and fusion, progressive leg weakness occurred 1 week postoperatively. RESULTS: A second operation revealed no evidence of epidural hematoma, but a sequestrated disc. Decompression and sequestrectomy were performed, and the patient's neurological status had recovered fully at 4 months postoperatively. CONCLUSIONS: This case highlights the potential for posterior migration of a herniated disc with flexion-distraction injuries of the thoracolumbar spine. Discontinuity of the posterior annulus fibrosus on MRI may aid the distinction of posterior migration of a herniated disc from epidural hematoma. Because posterior migration of a herniated disc is associated with progressive neurological deficits, surgeons must consider decompression surgery when such herniation is suspected, even in the absence of neurological symptoms.

Clinical Usefulness of Fentanyl Matrix Patch for the Patients with Chronic Low Back Pain

STUDY DESIGN: Prospective observational study. OBJECTIVES: The aim of this study was to examine the usefulness of a fentanyl matrix patch in the management of chronic low back pain. SUMMARY OF LITERATURE REVIEW: Chronic low back pain is a significant disabling disease with high medical costs and socioeconomical effects. Oral medication is a fundamental tool for conservative treatment. The fentanyl matrix patch is currently regarded as an alternative method for oral medication, however, the usefulness of the fentanyl matrix patch has not been fully evaluated. MATERIALS AND METHODS: From September 2008 to May 2009, a multicenter, open, prospective observational study was conducted. The inclusion criteria included chronic pain patients that did not respond to conservative pain management. The clinical usefulness was evaluated with pain intensity, and the KEQ-5D (Korean version of Euro QoL-5 dimension). RESULTS: Overall, 538 patients were included in this study. The pain intensity decreased about 1.84 +/- 1.91 at the second visit and further decreased by about 2.52 +/- 2.34 at the third visit (p<0.0001). The KEQ-5D score decreased about 0.12 +/- 0.18 at the second visit, and decreased further to 0.18 +/- 0.24 at the third visit (p<0.0001). The number of patients with adverse effects was 121 (22.49%). CONCLUSIONS: The fentanyl matrix patch improves the pain and disability in patients with chronic low back pain. It is a useful alternative method for the management of chronic low back pain.

Efficacy of Prophylactic Antibiotics in Spinal Surgery

STUDY DESIGN: Retrospective comparative study. OBJECTIVES: The aim of this study was to compare the efficacy of prophylactic antibiotics in spinal surgery for the occurrence of postoperative surgical site infection (SSI) and host immune reactions depending on various administration regimens and protocols. SUMMARY OF LITERATURE REVIEW: The superiority of one regimen or protocol of prophylactic antibiotics over others for SSI in spinal surgery has not been clearly demonstrated. We designed a controlled clinical trial to compare the occurrence of SSI with the changes of hematologic results depending on prophylaxis regimens and protocols. MATERIALS AND METHODS: Between January 2007 and February 2011, two hundred consecutive patients who had undergone thoracolumbar/lumbar surgery for degenerative or traumatic disease were included. Postoperative protocol was altered for each group of fifty consecutive patients; 1st generation cephalosporins for 5-days (group A), 2nd generation cephalosporins for 5-days (group B), 1st generation cephalosporins for 3-days (group C), and 2nd generation cephalosporins for 3-days (group D). Preoperative antibiotic prophylaxis was administrated within 1 hour prior to surgical incision with the same trial antibiotics. Intraoperative bacterial culture was performed from the surgical site. The occurrences of SSI were evaluated as either incisional or organ/space SSI. Serial changes in hematologic inflammatory markers (WBC, ESR, CRP) and DIC markers (fibrinogen, FDP, D-dimer) were compared until postoperative 2 weeks. RESULTS: The study groups were homogeneous regarding age, sex, body mass index, estimated blood loss, diabetes mellitus, smoking, diagnosis, baseline laboratory values, and type of surgery including instrumentation. Overall, 13 cases of incisional SSI (6.5%) and 3 cases (1.5%) of organ/space SSI occurred. There was no difference in the occurrence of incisional and organ/space SSI among the 4 groups (P=0.690, 0.799). Laboratory results revealed that postoperative changes in hematologic inflammatory markers and DIC markers were not influenced by prophylaxis regimens and protocols (all P>0.05). CONCLUSIONS: The occurrences of SSI and host immune responses were not influenced by postoperative antibiotics regimens and protocols. Hematologic investigation revealed that host immune responses did not depend on the type of prophylactic antibiotics.

Measurement of Canal Encroachment Using Axial and Sagittal-Reconstructed Computed Tomographic Images in Thoracolumbar Burst Fractures

STUDY DESIGN: A retrospective study. OBJECTIVES: The aim of this study was to examine the usefulness of axial and sagittal-reconstructed CT images in the evaluation of spinal canal encroachment by thoracolumbar burst fractures. SUMMARY OF LITERATURE REVIEW: The dimensions of spinal canal encroachment by burst fractures have been described using axial CT images in the thoracolumbar region and sagittal-reconstructed images in the lower cervical region. However, the validity and reliability, depending on the measuring method, have not been fully evaluated. MATERIALS AND METHODS: A hundred and ninety-nine patients, who had diagnosed as a thoracolumbar burst fracture, were included in this study. Three orthopedic surgeons independently measured the canal encroachment of the burst fragment in the axial CT images and the sagittal-reconstructed images using the ratio of spinal length (method 1) and the ratio of area (method 2). The validity for the evaluation of the deformity and fracture stability was evaluated. In addition, the reliability of each method was assessed. RESULTS: Sixty-seven stable burst fractures and 132 unstable burst fractures were assessed. The mean kyphotic angle of stable and unstable burst fracture were 11.89 +/- 8.49degreesand 15.90 +/- 9.63degrees(P=0.005). The mean canal encroachment ratios of stable fracture were 17.21 +/- 15.82 % (axial-method 1), 16.71 +/-16.49 % (axial-method 2), 19.54 +/- 17.03 % (sagittal reconstructed-method 1), and 11.75 +/- 12.33 % (sagittal reconstructed-method 2). The mean canal encroachment ratios of unstable fracture were 31.54 +/- 17.10 % (axial-method 1), 29.67 +/- 18.47 % (axial-method 2), 28.53 +/- 18.60 % (sagittal reconstructed-method 1), and 21.20 +/- 15.11 % (sagittal reconstructed-method 2). There was no relationship between the fracture deformity and the canal encroachment ratio in all 4 methods. All ratios in the 4 method showed significant differences in the evaluation of fracture stability. All methods except method 1 in the sagittal-reconstructed images showed significant differences in the assessment of neurologic compromise. CONCLUSIONS: The measurement of a canal encroachment area using axial and sagittal-reconstructed images was valid in the description of fracture stability.

Measurement of Vertebral Compression and Kyphosis in the Thoracolumbar and Lumbar Fractures

STUDY DESIGN: A retrospective radiologic study. OBJECTIVES: We wanted to compare the compression ratio and kyphosis of thoracolumbar and lumbar fractures according to the radiologic measuring methods and we wanted to analyze their relationship with the stability of fracture. SUMMARY OF THE LITERATURE REVIEW: There are several methods for measuring the compression ratio and kyphotic angle in thoracolumbar fractures, but no definitive measurements and no different values according to the stability have been established. MATERIALS AND METHODS: From July 2002 to August 2008, the plain films, CT, MRI and medical records of thoracolumbar and lumbar fracture were reviewed. The compression ratio and kyphotic angle were calculated by several different formulas with using the lateral view of the plain X-ray film, the sagittal reconstruction image of CT and the sagittal image of MRI and the results were compared. Each subject was classified according to both McAfee's classification and the TLISS classification. RESULTS: Two hundred forty eight vertebral bodies of 205 thoracolumbar fracture patients were analyzed. The compression ratio according to formula 1, which was calculated as 1-anterior vertebral height/posterior vertebral height, was significantly correlated with Cobb's angle and the local kyphotic angle. There was no significant difference between the Cobb's angle calculated using the lateral X-ray and that using the sagittal view of CT; however, it was significantly less using the sagittal MRI view. The unstable fractures according to McAfee's classification showed a significantly higher compression ratio and kyphotic angle compared to those of the stable fractures. CONCLUSIONS: The compression ratio formula 1 was most significantly correlated with the kyphotic deformity. The unstable fractures showed a mean compression ratio higher than 30%, a mean Cobb's angle of 15degrees and local kyphotic angle of 18degrees. The sagittally reconstructed CT was a useful measuring method for the evaluation of kyphotic deformity, and it was more accurate than that of the plain film.

Surgical Treatment of Degenerative and Isthmic Spondylolisthesis / 대한척추외과학회지

The etiology of spondylolisthesis, which determines the pathoanatomy and natural course, includes the abnormal development of lumbosacrum and various acquired conditions. Many patients with symptomatic degenerative and isthmic spondylolisthesis respond to non-surgical treatments, such as modification of their daily activity, medication, physical therapy and nerve block.

MRI Patterns in the Acute or Subacute Stage of Osteoporotic Vertebral Fractures / 대한척추외과학회지

STUDY DESIGN: This is a retrospective radiologic study OBJECTIVES: The aim of this study is to analyze the signals and configurations of the MRI findings of osteoporotic vertebral fractures and the clinical consequences of each type of the MRI findings. SUMMARY OF THE LITERATURE REVIEW: There have been some reports that have focused on the MR findings for the differentiation of osteoporotic and metastatic fractures, but there are few reports on the characteristics of the early stage of osteoporotic vertebral fractures. MATERIALS AND METHODS: From July 2002 to April 2008, the MRI findings and medical records of 97 patients who were diagnosed with acute or subacute osteoporotic vertebral fractures and who were followed-up for more than 1 year were analyzed. The patients with minor trauma within 3 months before obtaining MRIs and they had decreased bone density were included in this study. Those with fractures due to severe trauma or pathologic causes or normal bone density were excluded. Three spine surgeons evaluated, at three times per each surgeon, the T1-weighted, T2-weighted and fat suppression T1-enhanced sagittal images for the signal of the vertebral body bone marrow and the type of the intravertebral body lesion shape. The relationships between the type of MRI findings and the time from the trauma and the follow up clinical consequences were analyzed. RESULTS: The MRI patterns of 97 patients with 111 fractures of the vertebrae were divided into three types. There were 56 cases of Type I (50.5%), which was defined as diffuse typical signal intensity in the vertebral body, 39 cases (35.1%) of Type II, which was defined as geographic low signal in the center of the vertebral body with typical signal changes, and 16 cases (14.4%). of type III, which was defined as atypical signal intensity or a shape of lesion that did not correspond to type 1 nor type 2. The average time from trauma was 10.8+/-19.0days (0~90) for type I, 19.1+/-24.9days (0~90) for type III and 37.5+/-31.1days (0~90) for type III, which showed differences among each types (p<0.001). CONCLUSIONS: The analysis of the relationship between the time from trauma and the signal intensity and the type of lesion on MRI examination revealed that the low signal intensity in the typical vertebral body signal or an atypical signal or shape were poor prognostic factors of osteoporotic vertebral fracture

Korean Guideline Development for the Evaluation of Permanent Impairment of the Spine: Proposal by the Korean Academy of Medical Sciences Committee

The criteria for the evaluation of spinal impairment are diverse, complex, and have no standardized form. This makes it difficult and somewhat troublesome to accurately evaluate spinal impairment patients. A standardized guideline was studied for the evaluation of spinal impairment, based on the American Medical Association (AMA) Guides and the McBride method. This guideline proposal was developed by specialty medical societies under the Korean Academy of Medical Sciences. In this study, the grades of impairment were assessed by dividing patients into three different categories: spinal cord impairment, spinal injury impairment and spinal disorder impairment. The affected regions of the spine are divided into three: the cervical region, the thoracic region, and the lumbosacral region. The grade of impairment was differentially evaluated according to the affected region. The restricted range of motion was excluded in the evaluation spinal impairment because of low objectivity. Even though the new Korean guideline for the evaluation of spinal impairment has been proposed, it should be continuously supplemented and revised.

Clinical Importance of MRI in Thoracolumbar Spinal Fracture / 대한척추외과학회지

STUDY DESIGN: Retrospective radiologic assessment OBJECTIVES: To assess the clinical importance of MRI for the diagnosis of posterior spinal ligament complex injuries in thoracolumbar fractures. SUMMARY OF LITERATURE REVIEW: Evaluation of spinal instability is important in thoracolumbar fractures. When simple radiography and CT alone are performed, spinal instability may be missed, especially that involving the posterior spinal ligament complex. MATERIALS AND METHODS: Eighty-seven patients who were evaluated using simple radiography, computed tomography (CT), and magnetic resonance imaging (MRI) between March 1994 and March 2003 were included in the study. The local kyphotic angle was measured on lateral radiography, and it was then compared to the fracture pattern on MRI. Statistical analysis was performed using ANOVA. RESULTS: There was no correlation between the local kyphotic angle on radiography and fracture involvement on MRI (p=0.106). In 41 patients who were found to have involvement of the anterior column on CT, 25 had anterior column involvement, 4 had middle column involvement, and 12 had posterior column involvement on MRI. In 36 patients who were found to have involvement of the middle column on CT, 17 had involvement of the middle column and 19 had involvement of the posterior column on MRI. The fractures of the ten patients who were found to have posterior column involvement on CT were all seen on MRI. The coincidence of fracture patterns between CT and MRI, which was evaluated using Cohen's Kappa analysis, was 0.434. The sensitivity of CT compared with MRI was 0.741 in the middle column and 0.243 in the posterior column. CONCLUSIONS: Many thoracolumbar fractures are missed on both simple radiography and CT. MRI is essential for accurate diagnosis of posterior spinal ligament complex injuries, especially when there is involvement above the middle column, or when canal encroachment is seen on CT.

MRI Assessments of Adjacent Disc Degeneration Following Lumbar Fusion / 대한척추외과학회지

STUDY DESIGN: Retrospective case-control study OBJECTIVE: To use MRI to assess intervertebral disc degeneration at adjacent levels after spinal fusion and after discectomy. SUMMARY OF LITERATURE REVIEW: Degeneration of adjacent intervertebral discs following lumbar spinal fusion is one of the principal reasons for considering motion preservation techniques, such as placement of an artificial disc. Much attention has recently been directed toward disc morphometric studies using MRI. MATERIALS AND METHODS: Fifty-six patients who underwent spinal surgery for lumbar degenerative disease and who underwent a minimum of 2 years of follow-up MRIs were included in this study. Thirty-four patients were included in the lumbar fusion study group, and 22 patients were included in the discectomy control group. The MRI Thompson classification was used to grade both upper and lower adjacent disc degeneration preoperatively and at the time of last follow-up. RESULTS: There were significant changes in Thompson degenerative grade in the upper adjacent levels for both the fusion group patients and in the discectomy group patients. However, there was no statistically significant difference between the two groups with regard to either the upper or lower adjacent levels (p=0.146 and 0.350, respectively). CONCLUSIONS: In this short-term study comparing MRI outcomes in spinal fusion and discectomy patients, no significant difference in adjacent disc degeneration was observed between the two group.

The Recurrent Psoas Abscess Caused by Two Different Pathogens: A Case Report / 대한정형외과학회잡지

We report a case of a recurrent psoas abscess caused by two different pathogens. The abdominal CT scans revealed a multiseptated cystic mass along the right psoas-iliacus muscle. The patient was treated with antibiotics treatment in combination with CT-guided percutaneous aspiration and drainage using a catheter. The microbiological examination revealed Klebsiella pneumoniae. Six months later, the patient presented with anorexia, malaise, epigastric pain, lower back pain and fever of 37.8 degrees C for a one-week duration. The abdominal CT scans revealed an abscess cavity on the inferior side of the right psoaos-iliacus muscle. This was accompanied by retrocecal appendicitis and a periappendiceal abscess. Magnetic resonance imaging of the pelvis showed that the psoas abscess was located on the right psoas-iliacus muscle. We performed an appendectomy and laparotomy. Subsequently, the culture yielded Escherichia coli in the psoas abscess. To our knowledge, this is the first case of a recurrent psoas abscess caused by two different pathogens.

Coincidental Congenital Absence of the Posterior Arch of the Atlas and the Unilateral Lumbosacral Articular Process: A Case Report / 대한정형외과학회잡지

We encountered a case of coincidental congenital complete absence of the posterior arch of the atlas and the unilateral lumbosacral articular process. A 21-year-old man presented with pain in the lower back and right buttock. The patient was a swimming coach. On plain radiography, computerized tomography and magnetic resonance imaging, the congenital absence of the unilateral lumbosacral articular process was noted. Six months later, the patient developed severe neck pain and suboccipital headaches without neurological signs. On plain radiography and computerized tomography, the congenital complete absence of the posterior arch of the atlas was noted. Magnetic resonance imaging showed no abnormal signs originating from the posterior spinal cord. There was no segmental instability. For this case, the lower back pain and neck pain were managed by conservative treatment. To the best of our knowledge, this is the first case of a coincidental congenital complete absence of the posterior arch of the atlas and the unilateral lumbosacral articular process.

The Comparison of Changes in the Dimensions of the Intervertebral Disc and Neural Foramen between Anterior Lumbar Interbody Fusion and Posterolateral Fusion in the Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: A prospective radiologic assessment. OBJECTIVES: To compare the changes of dimensions of the intervertebral disc and neural foramen between the anterior lumbar interbody fusion and the posterolateral fusion in the lumbar spine. SUMMARY OF LITERATURE REVIEW: There are few reports comparing an anterior lumbar interbody fusion with pedicle screw fixation and a posterolateral fusion with pedicle screw fixation. MATERIALS AND METHODS: We studied 62 patients with degenerative lumbar diseases who underwent minimal anterior lumbar interbody fusion with pedicle screw fixation (group I, 40 patients) or who underwent posterolateral fusion with pedicle screw fixation (group II, 22 patients). We measured the height of disc and the height, width, and area of the neural foramen measured in 1-mm reconstructive sagittal images of computed tomography before and 6 months after the operation. The factors were independently measured by three different observers. RESULTS: Disc height was increased by a mean of 39.1+/-3.28% in group I and 3.1+/-2.99% in group II. The height of the neural foramen was increased by a mean of 18.7+/-4.21% in I and 1.0+/-2.34% in II. The area of neural foramen was increased by a mean of 21.5+/-3.50% in I and -2.1+/-4.39% in II, with significant differences between groups in all parameters. CONCLUSION: The minimal anterior lumbar interbody fusion with pedicle screw fixation was superior to posterolateral fusion with pedicle screw fixation for increasing disc height and the height and area of neural foramen.

The Changes in the Dimensions of Neural Foramen After Anterior Interbody Fusion in the Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: A prospective radiological assessment was performed using computerized tomography measurements. OBJECTIVES: The aim of this study was to assess the changes in the dimensions of the neural foramen after anterior interbody fusion with posterior fixation in spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Anterior lumbar interbody fusion distracts the height and width of the neural foramen. MATERIALS AND METHODS: Anterior interboody fusion with posterior fixation was performed in twenty-five patients. The sagittal parameters were the height and area of the neural foramen. The fused lumbar segments was imaged in the direct sagittal projections in a CT (SOMATOM Senstaion; SIMENS, Germany) and 1-mm slice thickness before surgery and after solid fusion. Computer digitation was used for the measurements independently by three different observers. Statistical analysis was performed using a Wilcoxon signed test and a paired T-test to determine the correlation between the measurements, and Pearson correlation to determine the level of interobserver and intraobserver agreement. RESULTS: After anterior interbody fusion and posterior fixation, the height and the area of the neural foramen had increased significantly by 15.5+/-14.0%(p.0.001) and 23.2+/-17.7%(p.0.001). There was a significant confidence in interobserver (0.9466~0.9996) and intraobserver(0.8896~0.9991) agreement. CONCLUSIONS: Anterior interbody fusion significantly increased the changes in the dimensions of the neural foramen. Anterior distraction and decompression with anterior interbody fusion increased the area of the neural foramen This study shows that anterior interbody fusion can be used to decompress the neural foramen in the spondylolisthesis.

Validation in the Cross-Cultural Adaptation of the Korean Version of the Oswestry Disability Index

Disability questionnaires are used for clinical assessment, outcome measurement, and research methodology. Any disability measurement must be adapted culturally for comparability of data, when the patients, who are measured, use different languages. This study aimed to conduct cross-cultural adaptation in translating the original (English) version of the Oswestry Disability Index (ODI) into Korean, and then to assess the reliability of the Korean versions of the Oswestry Disability Index (KODI). We used methodology to obtain semantic, idiomatic, experimental, and conceptual equivalences for the process of cross-cultural adaptation. The KODI were tested in 116 patients with chronic low back pain. The internal consistency and reliability for the KODI reached 0.9168 (Cronbach's alpha). The test-retest reliability was assessed with 32 patients (who were not included in the assessment of Cronbach's alpha) over a time interval of 4 days. Test-retest correlation reliability was 0.9332. The entire process and the results of this study were reported to the developer (Dr. Fairbank JC), who appraised the KODI. There is little evidence of differential item functioning in KODI. The results suggest that the KODI is internally consistent and reliable. Therefore, the KODI can be recommended as a low back pain assessment tool in Korea.

Evaluation of Disability for Degenerative Disc Disease / 대한척추외과학회지

No abstract available.

Usefulness of Fluorine-18 FDG-PET In the Diagnosis of Vertebral Pathologic Fracture / 대한척추외과학회지

STUDY DESIGN: A prospective study of the reproducibility of F-18 FDG-PET. OBJECTIVES: The purpose of this study was to determine whether F-18 FDG-PET had value in distinguishing between vertebral pathologic fractures and osteoporotic compression fractures. SUMMARY OF LITERATURE REVIEW: There were many reports in the literature about vertebral pathologic disease studied with F-18 FDG-PET, but few about the distinction between pathologic and benign causes in fractured vertebrae. MATERIALS AND METHODS: Twenty-nine patients with vertebral fractures that did not result from major trauma, who were admitted to our hospital from December 2002 to May 2004, were included in this study; and all of them were evaluated with MRI and F-18 FDG-PET. Their final diagnoses were confirmed by biopsy (n=12) or clinical follow-up (n=17). There were 18 cases of vertebral compression fractures, 11 cases of pathologic fractures (4 cases of tumor lesions and 7 cases of pyogenic spondylitis). F-18 FDG-PET images of those patients were interpreted as vertebral compression fractures or pathologic fractures by one nuclear medicine specialist and one radiology specialist without any clinical or radiologic information. The sensitivity and specificity of MRI and F-18 FDG-PET for the diagnosis of vertebral pathologic fractures were calculated and compared. RESULTS: Twenty-four (82.8 %) of 29 cases demonstrated a coincidence between MRI and F-18 FDG-PET interpretations. The sensitivity of F-18 FDG-PET for the diagnosis of vertebral pathologic fractures was 90.9 % and the specificity was 88.9 %. The sensitivity of MRI was 81.8% and the specificity was 83.3%. F-18 FDG-PET demonstrated a higher sensitivity and specificity, and these were statistically insignificant differences. CONCLUSIONS: F-18 FDG-PET is a useful method for determining the differential diagnosis of vertebral pathologic fractures, with high sensitivity and specificity.

Comparative Study of the Safety and Effectiveness of Tramadol 37.5 mg/Acetaminophen 325 mg Combined Tablets and Cyclo-Oxygenase-2 (Celecoxib) Inhibitor for the Treatment of Chronic Low Back Pain: A Multicenter, Randomized, Comparative Clinical Study / 대한척추외과학회지

STUDY DESIGN: This is a multicenter, randomized comparative outpatient study on a 8-week administration of Tramadol 37.5 mg/Acetaminophen and 325 mg (Tramadol/APAP) combination tablets and Cyclo-Oxygenase-2 inhibitor (Celecoxib). OBJECTIVES: We wanted to evaluate the efficacy and safety of Tramadol/APAP combination tablets and Celecoxib for the treatment of chronic low back pain. SUMMARY OF THE LITERATURE REVIEW: Tramadol/APAP combination tablets have an analgesic efficacy for the treatment of chronic low back pain. The conditions for which COX-2 inhibitors were be used included a variety of musculoskeletal conditions. However, further analyses are needed to determine the efficacy and safety of Tramadol/APAP combination tablets and Celecoxib for the treatment of chronic low back pain. MATERIALS AND METHODS: One hundred twenty-five patients with chronic low back pain (pain visual analogue scale [VAS] scores >40 mm on 100 mm scale) were randomized to take the Tramadol/APAP combination tablets or Celecoxib for 8 weeks. The primary outcome measure was the pain VAS score, pain relief score and the Korean-version of Oswestry Disability Index (KODI). RESULTS: The study enrolled 125 patients (56 in the Tramadol/APAP tablets group and 69 in the Celecoxib group). There were no significant differences between Tramadol/APAP combination tablets and Celecoxib with regard to the pain VAS scores (VAS; 27.99+/-21.22 vs 24.56+/-16.58, respectively, p>0.05), the pain relief score and the mean decreased disability score on the KODI (0.42+/-0.59 vs 0.46+/-0.05, respectively). The adverse drug reactions showed a statistically significant difference (p<0.05). CONCLUSIONS: The results of this study suggest that Tramadol/APAP combination tablets are just as effective as celecoxib for relieving chronic low back pain.

Cross-cultural Adaptation of the Korean Version Of the Oswestry Disability Index (ODI) / 대한척추외과학회지

STUDY DESIGN: Cross-cultural adaptation of the Korean version of the Oswestry Disability Index (KODI). OBJECTIVES: To conduct the cross-cultural adaptation for translating the original version of Oswestry Disability Index (ODI) (English version) SUMMARY OF LITERATURE REVIEW: Society is multicultural populations income. (This makes no sense?) Since languages and cultures are highly related, any cross-cultural assessment must be addressed in the outcome of the measurements. (I have made this into a proper sentence, but the meaning is still unclear, please confirm?) The Oswestry Disability Index (ODI) has not been translated into Korean, but is the most widely used tool in the world for measuring the intensity of back pain. MATERIAL AND METHOD: We used the guideline for the translation and cultural adaptation process, (Where were these guidelines from?) including forward translation, synthesis of translation, backward translation, committee review, pre-testing, test of the pro-final version, and finally, submission of the documentation to the developers. The Korean version of the Oswestry Disability Index (KODI) was tested on 116 patients with chronic low back pain. RESULTS: The reliability for the KODI, as measured by the Cronbach's alpha value, was 0.9168, and the reliability of the testretest was 0.9331. The process results were reported to the developer (Dr. Jeremy Fairbank), who appraised the KODI. CONCLUSIONS: The KODI was found to have satisfactory reliability. Therefore, the KODI can be recommended as a tool for the measurement of lower back pain in Korea.