Lumbopelvic Fixation with Iliac Screw in Spinopelvic Dissociation / 대한정형외과학회잡지

PURPOSE: Spinopelvic dissociation which occurs by high energy trauma with associated fractures is rare. Treatment is difficult and only a few studies on treatment of spinopelvic dissociation have been reported. Therefore we evaluated spinopelvic dissociation patients treated with iliac screw. MATERIALS AND METHODS: We analyzed patients who underwent surgery using an iliac screw from 2005 to 2010. Preoperative radiologic classification was performed using the level of the transverse fracture line of the sacrum, shape of the fracture, and Roy-Camille classification. Neurologic evaluation was performed using Gibbons classification. Eleven patients underwent surgery with a pedicle screw in 1 level (L5 to S1) and bilateral iliac screws were added. RESULTS: A total of 11 patients were included in this study. The level of the transverse fracture line of the sacrum was mainly at S2, and there were mostly type 3 or 4 in Roy-Camille classification. Bony union was checked in 11 patients without metal failure. Six of 7 patients were treated by posterior decompression. Among them, 5 patients recovered from neurological deficit and 1 patient still had a sensory disorder on both lower legs. CONCLUSION: The more displacement of fracture, the more neurologic deficit occurred. In addition, we think that aggressive surgical treatment for spinopelvic dissociation should be considered, because a good clinical result was achieved with 1 level (L5 to S1) fixation and bilateral iliac screw fixation.

Risk Factors and Postoperative Prognostic Factors of Spontaneous Spinal Epidural Hematoma

STUDY DESIGN: Retrospective study. OBJECTIVES: To explore the risk factors and the factors associated with the neurological improvement after operation in the spontaneous spinal epidural hematoma. SUMMARY OF LITERATURE REVIEW: The cause of the spontaneous spinal epidural hematoma is unknown. The objective risk and prognostic factors are still controversial. MATERIALS AND METHODS: From January 2006 to December 2014, a total of 12 patients with spontaneous epidural hematoma were evaluated. The risk and prognostic factors analyzed were sex, age, underlying diseases, medications, neurologic status, level and extent of hematoma, cord edema, and interval from onset to surgery. We analyzed the correlation between each factor and neurologic recovery. The neurologic status was analyzed using the American Spinal Injury Association impairment scale (AIS) at the first and the last neurologic examination. RESULTS: The average age of the patients was 68.6 years. Seven patients were treated with anticoagulation therapy, and two were advised to switch to a healthier diet. The initial neurologic status of the patients was AIS A in 2 cases, B in 5 cases, C in 4 cases, D in 1 case, and in two patients, cord edema was revealed on magnetic resonance imaging (MRI). The interval of time from onset to surgery was less than 24 hours in 6 cases, 24-48 hours in 4 cases, and more than 48 hours in 2 cases. CONCLUSIONS: The prognostic factors associated with spontaneous spinal epidural hematoma were found to be initial neurologic status, cord edema on MRI, and interval from onset to surgery. We found no correlation between anticoagulation therapy or healthy diet and spontaneous spinal epidural hematoma, but anticoagulation therapy cannot be excluded as a risk factor.

Surgical Treatment of Spinal Extradural Arachnoid Cyst: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a case of spinal extradural arachnoid cyst. SUMMARY OF LITERATURE REVIEW: Extradural arachonid cysts of the spine are a rare cause of spinal cord and nerve root compression. There are few reports about it, and the etiology remains unclear. MATERIALS AND METHODS: The authors performed a clinical and radiographic case review. RESULTS: A 56-year-old male patient presented with both lower extremity radiating pain and tingling sensation in both feet for four years. His MRI revealed a large, well-demarcated extradural lesion, isointense to cerebrospinal fluid from L1 to L3. We performed dural repair and laminectomy for partial resection of the cyst. The outcome was good in the immediate postoperative period, and the patient made a full recovery without complications. CONCLUSIONS: Surgical treatment should be considered for large spinal extradural arachnoid cysts with neurologic symptoms when conservative treatment does not work.