CT-Guided Percutaneous Vertebroplasty in the Treatment of an Upper Thoracic Compression Fracture

Percutaneous vertebroplasty (PVP) has been used to relieve pain and to prevent further collapse of the vertebral body in patients with an osteoporotic compression fracture. The most commonly affected site for the use of PVP is the thoracolumbar junction. There are few reports that have described on the usefulness of PVP in the treatment of a high thoracic compression fracture. We report a case of an upper thoracic compression fracture that was treated with computed tomography (CT)-guided PVP. It was possible to obtain easy access to the narrow thoracic pedicle and it was also possible to monitor continuously the proper volume of polymethylmethacrylate employed, under CT guidance.

En Plaque Meningioma in Thoracic Spine: Case Report

Spinal en plaque meningioma is rarely found in the spinal canal, although lateral sphenoid wing meningioma displays a propensity for growth en plaque. We encountered a case of completely circumferential spinal en plaque meningioma, which is an even rarer condition. Herein, we report the CT & MRI findings along with a review of the related literature.

Laparoscopic Interbody Fusion in Degenerative Disc Disease of the Lumbosacral Spine

OBJECTIVE: The surgical treatment of symptomatic degenerative disc disease remains one of the most controversial topics among spine surgeons. Recently, advances in many endoscopic surgical techniques have resulted in lowered morbidity, expense, and suffering associated with their open surgery counterparts. The purpose of this study is to evaluate the efficacy of laparoscopic anterior lumbosacral interbody fusion in our patients with symptomatic degenerative disc disease. PATIENTS AND METHODS: We performed laparoscopic anterior interbody fusion for degenerative disc disease at L5-S1 in 26 patients who were unresponsive to conservative treatments for 1 year, from Oct. 1996 to Dec. 1997. This technique consists of a four-puncture laparoscopic approach with a 10mm trocar at the umbilicus for laparoscope, two 5mm trocars at left and right flanks for dissection, and a 15mm trocar at suprapubic area for working port. We performed complete discectomy and stabilized the spine with carbon interbody fusion cages filled with allograft bone. RESULTS: Laparoscopic fusion at L5-S1 was successful in 22 of 26 patients and the remaining four patients were successfully converted to minilaparotomy. The operation time averaged 150 minutes, hospitalization 4.1 days and average blood loss was 90cc. The mean follow-up period was 16.8 months. Radiographic fusion was achieved in 23 of 26 patients(88.5%) and clinical results showed excellent in 11/26, good in 11/26, fair in 3/26, poor in 1/26 according to Macnab's criteria. There were four complications; retroplacement of cages(1), transient dry ejaculation (1), transient urinary bladder dysfunction(1) and malposition of cages(1). CONCLUSION: Laparoscopic fusion at L5-S1 in degenerative disc disease seems to be safe, with satisfactory clinical results. Main advantage are early recovery and short hospitalization time compared with conventional technique.

Balloon Dilatation of Tuberculous Bronchial Stenosis :Immediate and Long Term Effect

PURPOSE: To evaluate the long-term immediate effects of balloon dilatation of the tuberculous bronchial stenosis. MATERIALS AND METHODS: Twenty-three women with tuberculous bronchial stenosis (19, left main bronchus ; 4, right main bronchus) underwent balloon dilatation (13 bronchoscopically guided ; 10 fluoroscopically guided). Immediate (n=23) and long-term follow-up (mean, 17.2 months; range, 1 month-6years 3 months; n=20) assessments focused on changes in the results of the pulmonary function test (PFT). An increase in FVC or FEVI of more than 10% after the procedure was considered effective. in all patients, any complications were evaluated. RESULTS: Balloon dilatation was effective at immediate follow-up in 69.5% of patients(16/23) and in 75.0%(15/20) atlong-term follow-up. Bronchoscopically and fluoroscopically-guided balloon dilatation proved effective in 61/5%(8/13) and 80.0% of patients (8/10) on immediate follow-up respectively, but in 90.0%(9/10) and 60/0%(6/10)on long term folow-up respectively. Balloon dilatation was effective in the active(n=10) and inactive(n=13) stage of tuberculous bronchitis in 80.0%(8/10) and 61.5% of cases(8/13) on immediate follow-up respectively, but in 66.6%(6/9) and 81.8%(9/11) on long term follow-up study, respectively. CONCLUSION: On immediate follow-up, balloon dilatation of tubular bronchial stenosis was more effective in the active than in the inactive stage, buton long-term foolow-up was less effective; long-term improvement in the inactive stage was, however, well-maintained.

Measurement of Lung Volumes: Usefulness of Spiral CT

PURPOSE: To evaluate the usefulness of spiral CT in the measurement of lung volumes. MATERIALS AND METHODS: Fifteen healthy volunteers were studied by both spirometer and spiral CT at full inspiration and expiration inorder to correlate their results, including total lung capacity (TLC), vital capacity (VC) and residual volume(RV). 3-D images were reconstructed from spiral CT, and we measured lung volumes at a corresponding CT window range ; their volumes were compared with the pulmonary function test (paired t-test). RESULTS: The window range corresponding to TLC was from -1000HU to -150HU (p=0.279, r=0.986), and for VC from -910HU to -800HU (p=0.366,r=0.954) in full-inspiratory CT. The optimal window range for RV in full-expiratory CT was from -1000HU to -450HU (p=0.757, r=0.777), and TLC-VC in full-inspiratory CT was also calculated (p=0.843, r=0.847). CONCLUSION: Spiral CT at full inspiration can used to lung volumes such as TLC, VC and RV.

Differentiation of Exudative and Transudative Pleural Effusion: MR Appearances

PURPOSE: The purpose of this study is to determine whether MR images after intravenous administration of Gd-DTPA can differentiate exudative and transudative pleural effusion. MATERIALS AND METHODS: We studied 18 patients with ten exudative and eignt transudative pleural effusions diagnosed clinically and by thoracentesis. We analysed the relationship between T1 value(normalized to fat) and the ratio of effusion/serum protein of pleuraleffusion. We also assessed the contrast enhancement of exudative and transudative pleural effusion on T1 weighted SE images taken at 15 and 30 minutes after administration of Gd-DTPA. RESULTS: The relationship between the effusion/serum protein ratio and T1 value(normalized to fat) was statistically not significant(r=0.27, P=0.381).On precontrast spin-echo T1W1, mean signal intensity of the transudate was 0.18 (+/-0.04) and that of the exudatewas 0.24(+/-0.07), values which were not significant differences(P>0.05). Postcontrast mean signal intensities of transudates at 15 and 30 were 0.20+/- 0.06 and 0.26+/-0.08, respectively, values which were not significantly higherthan that of precontrast mean signal intensity(P<0.05). Postcontrast mean signal intensity values of exudative pleural effusions at 15 and 30 mimutes(0.32+/-0.06 and 0.39+/-0.06, respectively) were, on the other hand, significantly higher than that of precontrast mean signal intensity(P<0.05). CONCLUSION: Postcontrast T1-weighted SE images at 15 and 30 minutes can be helpful in the differentiation of transudative and exudative pleural effusion.